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Introduction: Gabapentin is an antiepileptic drug that alleviates neuropathic pain. Its oral use reduces the intensity of pruritus in patients receiving chronic dialysis therapy. However, it could lead to toxicity because of the patients' renal deficiency. In this study, we assessed the use of gabapentin topical in treating pruritus in dialysis patients. Methods: This randomized, triple‐blinded trial was performed on 80 patients divided into two groups randomly (40 in each group). In intervention group, 92.5% of the patients were on hemodialysis. Patients in intervention and control groups were provided with 5% gabapentin and placebo topical creams every 2 weeks for a month. Both Visual Analog Scale and 12‐item Pruritus Severity Score questionnaire were used to evaluate itching intensity and score before treatment, a month, and 2 months after starting treatment in both groups. In addition, the effect of itching on quality of life was investigated with the same questionnaire. Findings: Eighty patients (40 in each group) participated in our study. No complication was found in our intervention group. Itching score significantly decreased after a month and 2 months of follow‐up in intervention group (p < 0.001). Discussion: Our results showed that 5% gabapentin topical cream can be effective in reducing itching in different areas of the body. None of our patients reported complications. [ABSTRACT FROM AUTHOR]

Phase angle (PhA), measured by bioelectrical impedance analysis, indicates cellular health, integrity, and function. As inflammation can damage cells, phase angle may be useful in detecting inflammatory status early. The relationship between dietary inflammatory index (DII) and PhA has not been studied yet. Therefore, we aimed to examine this association in Iranian adults. This cross-sectional study included 206 university employees. Dietary intakes were assessed by using a validated 86-item food frequency questionnaire (FFQ). Anthropometric indices and blood pressure were measured. A short form of the validated International Physical Activity Questionnaire (IPAQ) was used for evaluating physical activity. The PhA was measured by the Body Composition Analyzer Mc780 MA device. The mean age of participants was 43.50 ± 8.82 years and the range of DII score was − 4.66 to 0 among them. The highest tertile of DII compared to the lowest tertile, showed greater weight, WC, HC, basal metabolic rate (BMR), and diastolic blood pressure. We found no significant association between DII and PhA (crude model: OR: 0.68; 95% CI 0.34, 1.33, fully-adjusted model: OR: 0.65; 95% CI 0.26, 1.64). Also, after BMI stratification this association remained (fully-adjusted: normal weight: OR: 0.61; 95% CI 0.11, 3.27; Overweight and obese: OR: 0.57; 95% CI 0.16, 1.98). Having a higher DII score was not associated with a lower PhA. Further well-controlled prospective studies are warranted. [ABSTRACT FROM AUTHOR]

The imperative for sustainable energy development has become increasingly evident, primarily due to the finite nature of fossil fuel reserves and the associated environmental apprehensions. In light of these concerns, biodiesel emerges as a compelling alternative. Its key attributes include renewability, reduced emissions, and the ability to be produced from a variety of sources, rendering it a promising candidate in addressing these energy and environmental challenges. Biodiesel holds significant promise as an energy source due to its lower environmental impact compared to traditional diesel fuels. This alternative fuel is non-toxic, safe, and biodegradable, primarily derived from renewable biological feedstocks like used cooking oils, making it an affordable and sustainable resource. This paper provides a comprehensive review encompassing biodiesel properties, feedstock options, diverse production techniques, catalyst variations, and the challenges associated with biodiesel production. Furthermore, this study delves into the evolution of biodiesel conversion processes and innovative approaches to enhance scalability. Detailed examinations of pivotal factors influencing transesterification, including catalyst weight percentage, temperature, alcohol-to-oil molar ratio, and reaction duration, are presented. Ultimately, this review concludes with future perspectives and suggestions. It emphasizes the importance of judiciously selecting catalysts, feedstock materials, and production methodologies to develop cost-effective, energy-efficient biodiesel solutions with reduced environmental impact and enhanced operational efficiency. [ABSTRACT FROM AUTHOR]

Background: Apnea testing is mandatory to confirm brain death; however, it is unsafe for patients who have substantial hypoxemia without ventilator support. We used a new modified apnea test without the need to disconnect the patient from the ventilator in the present study and compared the outcomes and complications of the new method to the widely used old method. Materials and Methods: The current study was conducted on people suspected of having brain death. Both the old and new apnea tests were carried out on the same individual. In the new modified method, instead of hyperventilating and then separating the brain death from the ventilator, the induced hypercapnia method was used, and instead of performing repeated arterial blood gas (ABG), the target ETCO2 was obtained, and at the time of the target ETCO2, ABG was also checked followed by comparing ETCO2 with PaCO2. Results: Thirty patients, including 25 (83.3%) males and 5 (16.75%) females, were included in the study. The results showed significant improvement in terms of O2 saturation and heart rate (HR) using the new modified apnea test compared to the common test. Systolic blood pressure, diastolic blood pressure, and the frequency of complications were improved in the new modified test. Conclusion: The modified apnea test produced better results in terms of O2 saturation, HR, and other clinical factors, while it does not require disconnection from the ventilator and repeated ABG assessment. Therefore, it can be used to successfully diagnose brain death in high-risk individuals suffering from severe hypoxia. [ABSTRACT FROM AUTHOR]

Background: Primary cutaneous macular amyloidosis (PCMA) is a chronic pruritic cutaneous disease characterized by heterogeneous extracellular deposition of amyloid protein in the skin. Aims: This study aimed to evaluate the efficacy of topical 6% gabapentin cream for the treatment of patients with PCMA. Materials and Methods: In this triple‐blind clinical trial, a total of 34 patients, who were diagnosed with PCMA, treated using two different strategies of topical gabapentin as the active group and vehicle cream as the control group. Results: Pruritus score reduction in both groups was statistically significant compared with the baseline value (p < 0.001). There was a significant pigmentation score reduction in intervention group compared with control group after 1 month of the study (p < 0.001). The differences of pigmentation score changes between the groups were not significant at month 2 (p = 0.52) and month 3 (p = 0.22). Conclusions: The results of this study suggest that topical gabapentin cream may be effective as a topical agent in the treatment of pruritus associated with PCMA without any significant adverse effects. It is recommended to perform similar studies with a larger sample size and longer duration in both sexes. [ABSTRACT FROM AUTHOR]

This study aimed to systematically review the effect of selenium and inositol combination on thyroid function, autoimmune characteristics in thyroid diseases. To identify eligible studies, a systematic search was conducted in the PubMed/MEDLINE, Science-Direct, CINHAL, EMBASE, SCOPUS, Psychinfo, Cochrane, ProQuest, and Web of Science were searched using the main concepts, and all English-written articles that were published between 2007 and 2022 and had an available full text were examined. The data analysis of this research revealed that after the simultaneous use of selenium and inositol supplements, the level of Triiodothyronine(T3) increased by 0.105 in patients with thyroid disorders although this increase was not significant (P-value: 0.228). The level of Thyroxine (T4) significantly increased by 0.06 (P-value: 0.04). Anti-Thyroid Peroxidase Antibody (TPOAb) titer decreased by 119.36%, which was not significant (P-value: 0.070). Finally, the level of Thyroid-stimulating hormone (TSH) decreased by 1.45%, which was a significant change (P-value: 0.001). It was observed that simultaneous use of selenium and inositol supplements did not change the T3 and TPOAb titer levels; however, it leads to a decrease in TSH and increase in T4 levels. Further studies are required due to the limited number of studies. [ABSTRACT FROM AUTHOR]

Background: Regarding the importance of the prevention of non-communicable diseases (NCDs) and higher consumption of salt among the Iranian population than the level recommended by the World Health Organization, the aim of this study was to evaluate the accuracy of the salt mentioned in the traffic light labelling of nuts and seeds. Study Design: A cross-sectional study. Methods: A total of 53 packaged nuts and seeds, including 7, 8, 9, 9, 10, and 10 samples of pumpkin, pistachios, almond, sunflower, peanut, and watermelon nuts and seeds, respectively, with traffic light labelling, were randomly purchased from several local markets in Isfahan, Iran. The amount of sodium was measured by the inductively coupled plasma-optical emission spectroscopy technique and then multiplied by 2.5 to achieve the amount of salt. Results: Varying levels of traffic light labeling value accuracy were observed in most of the samples. In the almond, pistachio, peanut, and watermelon groups, the average amount of laboratory value had a statistically significant difference with the label value (P < 0.05). Conclusion: The results demonstrated that the salt content of 82% of the studied samples had discrepancies with the values stated on the traffic light labelling. The presentation of an accurate amount of salt content is essential for promoting healthy eating habits and enabling individuals to make informed choices about their diet. It is recommended that regulatory authorities should review labelling guidelines and enforce stricter compliance to ensure accurate representation of salt content on packaged foods. [ABSTRACT FROM AUTHOR]

Background: Colistin and carbapenem-resistant Klebsiella pneumoniae (Col-CRKP) represent a significant and constantly growing threat to global public health. We report here an outbreak of Col-CRKP infections during the fifth wave of COVID-19 pandemic. Methods: The outbreak occurred in an intensive care unit with 22 beds at a teaching university hospital, Isfahan, Iran. We collected eight Col-CRKP strains from seven patients and characterized these strains for their antimicrobial susceptibility, determination of hypermucoviscous phenotype, capsular serotyping, molecular detection of virulence and resistance genes. Clonal relatedness of the isolates was performed using MLST. Results: The COVID-19 patients were aged 24–75 years with at least 50% pulmonary involvement and were admitted to the intensive care unit. They all had superinfection caused by Col-CRKP, and poor responses to antibiotic treatment and died. With the exception of one isolate that belonged to the ST11, all seven representative Col-CRKP strains belonged to the ST16. Of these eight isolates, one ST16 isolate carried the iucA and ybtS genes was identified as serotype K20 hypervirulent Col-CRKP. The blaSHV and blaNDM-1 genes were the most prevalent resistance genes, followed by blaOXA-48 and blaCTX-M-15 and blaTEM genes. Mobilized colistin-resistance genes were not detected in the isolates. Conclusions: The continual emergence of ST16 Col-CRKP strains is a major threat to public health worldwide due to multidrug-resistant and highly transmissible characteristics. It seems that the potential dissemination of these clones highlights the importance of appropriate monitoring and strict infection control measures to prevent the spread of resistant bacteria in hospitals. [ABSTRACT FROM AUTHOR]

Background: The stress of surgery itself results in metabolic disturbance. Few studies have mentioned how to manage the metabolic profile of diabetic patients after discharge from the hospital. The present study aimed to determine the effect of home care on metabolic profile and blood pressure in type 2 diabetic patients who underwent general surgeries. Methods: Seventy type 2 diabetic patients who were undergoing surgery were assigned to the intervention and control groups via blocking order. The intervention group received a 3-month home care with an interprofessional team approach. The levels of fasting blood glucose, glycosylated hemoglobin (HbA1c), total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterols, systolic blood pressure, and diastolic blood pressure were measured before and three months after the intervention in both groups. In the control group, only routine care was performed in the postsurgery period. Data were entered in SPSS software version 23 and were analyzed. Results: There were no significant differences between the intervention and control groups for background characteristics. Systolic blood pressure (P < .001), diastolic blood pressure (P = 0.005), lipid profile (P = 0.001) [except for triglycerides level], fasting blood glucose (P = .001), and HbA1c (P = .003) decreased significantly in the intervention group. After controlling baseline data by applying analysis of covariance, a significant increase in HDL-c (P = .032) was seen. Also, the difference between the mean percentage of variations in HbA1c levels between intervention and control groups was significant. Conclusions: Our study showed improvement in HbA1c and HDL-c levels with home care programs in patients with diabetes who underwent general surgeries. More studies with longer follow-ups are necessarily addressing the effects of home care on other metabolic parameters in these patients. [ABSTRACT FROM AUTHOR]

Healthcare systems are burdened by mobility impairments resulting from aging and neurological conditions. One of the recent advances in robotics is lower limb assistive/rehabilitative devices that can make independent living possible. Nonetheless, some limitations need to be addressed before robotics can be used in home‐based applications. This paper describes the current state of the art in intelligent motion planning and control of lower limb assistive devices, which have addressed some of these challenges. Adaptable central pattern generators and the divergent component of motion are introduced as methods for personalized motion planning based on physical human–robot interaction (pHRI). Uncertainty analysis for neural networks is introduced to increase safety in motion planning based on pHRI. For the case that a user cannot apply physical interaction, a reinforcement‐learning‐based approach is introduced to switch between different modes of walking based on the user's input via a push button embedded in a walker. Moreover, a smart walker is introduced as a device that can be synchronized with the lower limb exoskeleton to assist users with their daily activities. Also, a roadmap for future steps that can make lower limb assistive/rehabilitative devices a good fit for home use is introduced. [ABSTRACT FROM AUTHOR]

Background: Disturbed biochemical factors have been observed in viral infections including SARS, Ebola virus, and now COVID-19. This study aimed to evaluate the association between Calcium axis' derangements and hospital duration, ICU admission, mechanical ventilation, and death in patients with COVID-19. Methods: 428 hospitalized patients with COVID-19 were included in this study. On the first day of admission, the patients were extensively evaluated for biochemical and hormonal factors and followed up until discharge/death. The association between hyperphosphatemia, hypoalbuminemia, and hypocalcemia and major outcomes, including hospital duration, ICU admission, mechanical ventilation, and death, was investigated by logistic regression analysis. Results: Hyperphosphatemia and hypoalbuminemia were present in 27 (6.3%) and 59 (13.8%) cases, respectively in the study population. The results of the present study reveal the relation of these factors with worse outcomes in COVID-19 patients; such as hospital duration, ICU admission, mechanical ventilation, and death. On the other hand, high frequency of hypocalcemia (59.1%, 253 subject) has no significant influence on the mentioned outcomes (All P values were greater than 0.05). Conclusions: Poor outcomes were associated with hyperphosphatemia and hypoalbuminemia. It seems that we should evaluate the patients for derangements of phosphate, albumin, and calcium and try to treat them for all COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background. Different epidemiologic aspects of drug-induced Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in children are scarce. Aim. To compare the clinical and epidemiological features of patients with drug-induced SJS and TEN in children and adults. Method. This retrospective study was conducted at two academic referral centers (Isfahan, Iran) over 5 years. SJS and TEN were clinically diagnosed and confirmed by skin biopsy as needed. Results. One hundred one patients (31 children and 70 adults) with a female to male ratio of 1.1 : 1 was identified in the present study. SJS was more commonly diagnosed in both pediatric and adult patients. The most frequent reason for drug administration identified was the infection (45.2%) and seizure (45.2%) in children and infection (34.3%) and psychiatry disorder (27.1%) in adults (P = 0.001). The most common culprit drugs in the pediatric were phenobarbital (9/31), cotrimoxazole (4/31), and amoxicillin (4/31); however, in the adult group, the most common drugs were carbamazepine (11/70) and lamotrigine (9/70). Fever was significantly more common in adults (44.3%) compared to pediatric patients (22.6%) (P = 0.03). Multiple logistic regression models showed that pediatric patients had significantly lower odds of hospitalization (OR [odds ratio]: 0.14; 95% CI 0.02, 0.67). In addition, patients with SCORTEN 1 had significantly higher odds of hospitalization (OR: 6.3; 95% CI: 1.68, 23.79) compared to patients with SCORTEN 0. Conclusions. The present study showed several differences between the pediatric and adult patients with SJS and TEN, including the reason for drug administration, culprit drugs, length of hospital stay, presence of fever, and final diagnosis of disease. [ABSTRACT FROM AUTHOR]

Trans-palmar catheterization has been considered to be safe and feasible and choosing a reliable hemostasis method is essential to confirm it. The aim of our study was to compare the efficacy and safety of three hemostasis approaches containing ulnar TR band, manual compression and wrist hyperextension in patients undergoing trans-palmar coronary angiography (CAG). In a non-randomized clinical trial, a total of 106 patients undergoing diagnostic CAG by tarns-palmar access were divided into three groups: ulnar TR band, manual compression and wrist hyperextension. Duration of primary hemostasis, patient satisfaction, puncture site pain severity, hospitalization time and local neuro-vascular complication were evaluated and compared in hospital and 30 days follow-up. The mean age of the patients was 62.9 ± 7.4 years and 72 patients (67.9%) were male. Primary hemostasis time was significantly shorter in hyperextension (11.5 ± 2.10 min) and manual compression groups (12.3 ± 2.20 min) than with TR band group (24.7 ± 10.25 min) (p value < 0.0001). Patient's satisfaction was higher in hyperextension approach (9.4 ± 0.65) than manual compression (8.8 ± 0.79) and TR band group (8.2 ± 0.90) (p value < 0.0001). The most pain was seen in the TR band and the less in hyperextension group until 4 h after the procedure (p value < 0.0001). Hematoma, numbness and ulnar artery occlusion as well as hospitalization time did not have significant statistical differences (p value > 0.05). In conclusion, between three methods of hemostasis in trans-palmar catheterization, hyperextension approach is the preferred method because of effectiveness, safety and less time consuming hemostatic method compared others. [ABSTRACT FROM AUTHOR]

Objective. Evaluation of the pruritus features in children with end-stage renal disease (ESRD) who underwent dialysis at an academic tertiary pediatric dialysis center. Methods. This cross-sectional study was conducted at an academic tertiary pediatric dialysis center, Isfahan, Iran. The reviewed medical records of the children included their characteristics, dialysis properties, and laboratory parameters. The 4-item itch questionnaire was utilized to assess distribution, severity, frequency, and associated sleeping disorders. Results. Thirty ESRD patients with pruritus, including 23 males (76.7%) with a mean age of 11.7 ± 3.64 years, were recruited. The most common cause of CKD was nephronophthisis (23.3%). The median total score of pruritus was 5 (range: 3-15). The distribution score of pruritus was directly correlated with the age (Spearman's rho = 0.42, P = 0.02) and serum level of parathyroid hormone (PTH) (Spearman's rho = 0.42 , P = 0.04). In the reduced multiple logistic regression model, the increasing level of serum calcium was associated with increased odds of having total pruritus score ≥ 5 (OR (odds ratio): 4.5; 95% CI 1.12 to 18.05). In addition, an increase in age for one year was found to be associated with 50% higher odds of having total pruritus score ≥ 5 (OR: 1.5; 95% CI 1.03 to 2.18). Conclusion. Increased level of serum Ca and higher age were associated with increased odds of having more severe pruritus score in children. [ABSTRACT FROM AUTHOR]

Background. Berberis integerrima Bunge fruits have been utilized in traditional medicine to control diabetes mellitus (DM). However, no clinical survey has been done in this regard. This study was conducted to clinically evaluate the effects of fruit extract of this plant in improving glycemic control indices in patients with type 2 DM (T2DM). Methods. In a randomized controlled clinical trial, patients with T2DM who met the inclusion criteria were randomly divided into two groups of drug (Berberis) and control to receive the extract solution 5 ml twice daily (equivalent to 1000 mg of dry extract) with standard treatment (metformin) or only standard treatment, respectively, for 8 weeks. Before and after the intervention, fasting blood sugar (FBS), serum glycosylated hemoglobin (HbA1c), serum insulin, the homeostasis assessment model for insulin resistance (HOMA-IR), body mass index (BMI), and systolic and diastolic blood pressure were determined and compared between the two groups. Results. During the study, 30 and 35 patients in the drug and control groups, respectively, completed the study. Although no significant changes occurred in any parameter within each group, postintervention FBS (117.5 [107–128.8] versus 134 [120–142], P = 0.001) and HbA1c (7 [6.4–7.7] versus 7.5 [6.8–7.9], P = 0.045) were significantly lower in the drug group than in the control one. In terms of other parameters, there were no significant differences between the groups. Conclusion. Consumption of B. integerrima Bunge fruit extract at a dosage of 1000 mg daily decreases FBS and HbA1c but does not affect HOMA-IR in patients with type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]

Background: Supply chain includes all related parts that directly or indirectly meet the customers' demands. During disasters, the supply chain disrupts. It seems that paying attention to innovation and entrepreneurship can solve some of these disruptions. This study was conducted to extract the factors affecting the technology-oriented entrepreneurial rescue supply chain in the Red Crescent Society from experts and specialists in Iran. Materials and Methods: This qualitative content analysis was conducted in 2020. Using the content analysis method, the considered criteria were collected through open-ended questions and interviews. To determine the desired indicators, 30 people were interviewed in-depth in a purposeful manner using snowball sampling. The thematic analysis method was also used to analyze the interviews. Results: A total of 30 experts with a mean age of 46 years were interviewed, of whom 21 cases were male. Also, 16 cases had a PhD degree, and 14 had a Master's degree. After analyzing and extracting the criteria from the interviews, 123 codes were obtained. Finally, the codes were divided into two classes: supply chain management and technology indicators. The supply chain management class included subclasses of customer integration, supplier integration, internal integration, and innovative orientation. The technology indicators class included subclasses of individual characteristics, attitudinal factors, educational factors, technical factors, economic factors, environmental factors, and human and managerial factors. Conclusion: Supply chains are essential for entrepreneurship because of the involvement of different parts of the Red Crescent Organization of Iran in joint activities. Because of the expansion of entrepreneurship issues in the supply chain, presenting a technology-oriented comprehensive model of the entrepreneurial supply chain in the Red Crescent Organization is of great importance. In today's competitive environment, supply chain management is a strategic and robust basis for the Red Crescent Organization to achieve success and competitive advantage. [ABSTRACT FROM AUTHOR]

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease with multifactorial etiology. Several studies show that genetic factors have an important part in the incidence of SLE. The C1QTNF4 gene is involved in the regulation of the inflammatory pathways by pro‐inflammatory function. In the present study, we have evaluated the association between C1QTNF4 gene p.His198Gln mutation and risk of SLE. Methods: Forty SLE patients and 40 control subjects were recruited in this case‐control study. Genotyping of C1QTNF4 p.His198Gln mutation was performed using real‐time polymerase chain reaction high resolution melting method. Results: We found a significant association between this mutation (GG + GC) with the risk of SLE (odds ratio = 6.33, 95% CI = 1.28‐31.11). Furthermore, we observed that in the patient group, this mutation leads to early‐onset SLE (19.7 ± 4.34 years for mutation carriers compared to 27.7 ± 11.4 years for wild type carriers; P =.003). Conclusion: Our results suggest that this mutation (p.His198Gln) potentially has an important role in SLE risk in the Iranian population. [ABSTRACT FROM AUTHOR]

This paper introduces a mathematical model for fixed-charge solid transportation problem for a two-stage supply chain network, considering simultaneously both variable and fixed costs. Existence of the fixed costs and thereupon NP-hardness of the problem, use of meta-heuristics is necessary. Therefore, three approaches as genetic algorithm, electromagnetism-like algorithm and charged system search in accordance with priority-based encoding are developed. Contrary to previous researches which considered conveyances for one stage supply chain, here, conveyances are considered in each stage of the supply chain network for the first time. To determine the parameters' levels and the introduced operators of the algorithms that exhibit best solution, a Taguchi experimental design method is applied. This experimental design decreases the required number of experiments. As final experiment, the performance of the proposed algorithms are compared with each other by running them with different problem sizes. [ABSTRACT FROM AUTHOR]

Background: Currently, it is shown that pregnancy may have an impact on the thyroid that can be leading to pregnancy complications such as abortion, preeclampsia, and preterm delivery. The objective was to compare the thyroid volume, number and characteristics of thyroid nodules, and prevalence of diffuse thyroid diseases in a sample of Iranian pregnant women in the first trimester to nonpregnant women. Materials and Methods: This case-control study was conducted on 298 pregnant and 290 nonpregnant women. Thyroid volume, maximum diameter of thyroid nodules and prevalence of moderate to highly suspicious thyroid nodules, Hashimoto's appearance and goiter were assessed using thyroid ultrasonography. Antithyroperoxidase (TPO) antibodies were measured if the sonographic features were highly suggested for Hashimoto's thyroiditis. Results: The mean of total thyroid volume in pregnant and nonpregnant women was 6 and 6.5 ml, respectively (P = 0.053), and the median (interquartile range) was 6.2 and 5.5, respectively. Nodules were observed in 16.4% of pregnant and 16.6% of nonpregnant women (P = 0.845). Hashimoto's thyroiditis was detected in 6.7% of pregnant and 12.4% of nonpregnant women (P = 0.013). Anti-TPO antibodies were detected in 5% of pregnant and 9.3% of nonpregnant women (P = 0.034). Conclusion: The thyroid volume and nodule characteristics in the first trimester of pregnancy were similar to nonpregnant women. Hashimoto's thyroiditis and anti-TPO antibodies in pregnant women were significantly lower than in nonpregnant women. [ABSTRACT FROM AUTHOR]

Background: The objectives of this study were to compare the interferon induced protein 44 like (IFI44L) promoter methylation level between systemic lupus erythematosus (SLE) patients and healthy controls and to evaluate its diagnostic value in SLE. Materials and Methods: The IFI44L promoter methylation level was measured in 49 patients with SLE and 50 healthy controls. Quantitative analysis of promoter methylation IFI44L gene in genomic DNA samples extracted from peripheral blood mononuclear cells was examined in SLE patients and healthy controls. The level of DNA methylation was compared between SLE patients and healthy controls as well as within SLE patient groups based on the presence of renal involvement. Moreover, diagnostic values of IFI44L were calculated. Results: The IFI44L promoter methylation level in SLE patients was significantly lower than healthy controls (median, 43.8 vs. 57, respectively; P = 0.008). The level of IFI44L promoter methylation was not significantly different between SLE patients with renal involvement and SLE patients without renal involvement (84.6% vs. 92.7%, respectively; P = 0.774). The IFI44L promoter methylation level ≤94.3% was the best cutoff point with a sensitivity of 91.8% and a specificity of 38% to distinguish patients with SLE from healthy individuals. Conclusion: The level of IFI44L promoter methylation from whole peripheral blood in Iranian SLE patients was significantly lower than healthy controls. Furthermore, the DNA methylation level of IFI44L promoter was not associated with renal damage in patients with SLE. [ABSTRACT FROM AUTHOR]

This study aimed to compare the efficacy of rituximab versus Cyclophosphamide on active secondary progressive multiple sclerosis (SPMS). The randomized clinical trial was performed from 2015 to 2017 in multiple sclerosis (MS) clinics affiliated to Isfahan MS society (IMSS). Patients were randomized to two groups, and one of them received Rituximab that was repeated every six months in case of medical indication. The other one received a monthly pulse of methylprednisolone plus cyclophosphamide (Endoxan, Baxter, UK) until two years. Expanded disabilities status scale (EDSS), clinical, and MRI findings were assessed every six months. Statistical analysis was performed using SPSS software. 39 patients in the Rituximab group and 30 in the Cyclophosphamide group with similar age and gender distribution were entered for analysis. At baseline, the mean number of attacks in the Rituximab group was significantly more than the Cyclophosphamide group (P=0.0001). After 6, 12, and 18 months of treatment, the rate of attacks was similar between groups although it increased significantly in the Rituximab group (P=0.030) after 24 months of treatment. EDSS was increased in the Rituximab group more than the other group at the end of the study. Both drugs were well-tolerated by patients. The EDSS was increased in the Rituximab group but the disability score did not worsen in the Cyclophosphamide group. Both therapies were associated with a reduction in disease attacks and improvement in radiologic findings in a two-year period of follow-up. [ABSTRACT FROM AUTHOR]

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Background: The present study is aimed to evaluate the magnetic resonance imaging (MRI) and electroencephalography (EEG) findings based on characteristics variables in patients with epilepsy. Materials and Methods: In this cross-sectional study, all patients with epilepsy who referred between March 2016 and March 2017 to Al-Zahra and Kashani Hospitals in Isfahan, Iran, were enrolled. The completed files of 199 patients were assessed to collect information about characteristic data and MRI and EEG findings. MRI and EEG findings were recorded as normal or abnormal. The characteristic data and risk factors in patients with normal MRI and EEG were compared with those patients with abnormal MRI and EEG. Results: History of seizures and trauma are reported in 84 (42.2%) and 47 (23.6%) of patients, respectively. The most frequent type of seizures was generalized. MRI finding in 51 patients (25.6%) was abnormal, and EEG finding in 124 patients (62.3%) was abnormal. Patients with abnormal MRI were significantly older than those with normal MRI (37.3 vs. 31.4, respectively, P = 0.024). Abnormal MRI in men patients was significantly more frequent than women (31.2% vs. 18.9%, respectively, P = 0.048). In patients with abnormal EEG, seizure was more frequent than patients with normal EEG (50.8% vs. 28%, respectively, P = 0.002). Other characteristics and risk factors were not significant differences between patients with normal or abnormal MRI or EEG findings. Conclusion: In patients with epilepsy, older age and being a male were the risk factors of having abnormal MRI, and seizure was the risk factor of having abnormal EEG. [ABSTRACT FROM AUTHOR]

BACKGROUND: Risk assessment in clinical practice plays an important role in classifying population for appropriate preventive medicine for each category. Several multivariable risk predictor algorithms and inflammatory biomarkers are developed for assessing risk for cardiovascular diseases (CVDs). We aimed to depict a picture of the cardiovascular risk profiles in the Iranian population with diabetes mellitus (DM) through three risk predictors for the first time, as the patients with DM have an increased risk for CVDs. METHODS: In this cross-sectional study, the sample size consisted of 418 patients with DM from Diabetes Clinic of Shariati hospital, Isfahan, Iran, in February to July, 2014. We collected the latest information, and then calculated the 10-year CVD risk using Framingham risk score (FRS) and atherosclerotic cardiovascular disease (ASCVD) risk score, while high-sensitivity C-reactive protein (hs-CRP) was measured for them based on their physicians' prescription. Finally, all data were analyzed using SPSS software. RESULTS: The mean 10-year risk prediction of CVDs in the 30- to 74-year-old Iranian patients with DM was high in all three predictors based on their cut-off points, 16.31%, 12.39%, and 3.46 mg/l for FRS, ASCVD risk score, and hs-CRP level, respectively. Although the mean FRS and ASCVD risk scores were significantly higher among men than women (P < 0.0500), the mean hs-CRP level was slightly lower in men than women (P > 0.0500). CONCLUSION: Mean FRS and ASCVD risk scores and hs-CRP in patients were high, and a considerable proportion of patients with DM in our study were at intermediate and high risk for CVDs in the next 10 years. Future cohort studies would investigate the accuracy of different predictors in upcoming years, and also help to derive a specific model or recalibrate existing predictors with characteristic of Iranian populations and specific target groups. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a major risk factor for premature disability and death and is the leading risk factor for global disease burden. The present study aimed to assess the rates of prevalence, awareness, treatment, and control of hypertension in a sample of teachers, staff, and students at Isfahan University of Medical Sciences (IUMS). Methods: This cross-sectional survey was conducted from January to September 2015 on the staff, teachers, and students at IUMS. A total of 1500 subjects were randomly selected and were invited to participate in the survey. Hypertension was defined as an average of 2 blood pressure measurements of at least 140/90 mmHg. The rate of awareness was determined based on self-reports, treatment was defined as the regular use of blood pressure-lowering medications, and control was defined as the maintenance of blood pressure below 140/90 mmHg. Results: The study population comprised 1317 individuals (45.9% female) at a mean age of 41.4 ± 9.5 years. The prevalence rate of hypertension was 17.5% (231 of 1317 participants), and the rate of awareness was 54.5% (126 of 231 hypertensive patients). Seventy-nine (62.7%) patients were undergoing treatment, and 51.9% (41 of 79) controlled their disease. Institutional position (p value < 0.017), age (p value < 0.001), body mass index (p value < 0.001), education level (p value < 0.001), smoking status (p value < 0.001), and history of diabetes mellitus (p value < 0.001) were the most frequent risk factors associated with hypertension. Conclusion: The percentage of the hypertensive subjects who were aware, treated, and controlled was unacceptably low in our sample at IUMS. Hypertension is, therefore, a major health problem in this state institution. [ABSTRACT FROM AUTHOR]

BACKGROUND: Trans-radial and trans-ulnar accesses have been practiced and recommended as default and alternative techniques for coronary angiography and angioplasty in recent years. In this study, we present new innovative approaches using more distal access points, i.e. transsnuff box and trans-palmar approaches. METHODS: We conducted dorsal hand access (trans-snuff box) for angiography and/or angioplasty on 235 patients, and trans-palmar access (superficial palmar branch of ulnar artery) on 175 patients in 3 hospitals in Isfahan City, Iran. RESULTS: In 221 patients out of 235 ones (94.1%) [men: 76.5%, age: 57.4 ± 10.4 (years); women: 23.5%, age: 62.4 ± 9.5 (years)], our procedure through snuff box (dorsal hand) was successfully performed. In 159 patients out of 175 ones (90.8%) [men: 76.0%, age: 58.1 ± 10.5 (years); women: 24.0%, age: 61.2 ± 9.6 (years)], our procedure through palmar artery was successfully performed. In total, the evaluated patients had mild pain (3.4% for snuff box, and 4.5% for palmar), ecchymosis in distal forearm (5.1% for snuff box, and 2.8% for palmar), with no major complications even one (amputation, infection, thrombosis, need for surgery, hand dysfunction, nerve palsy, and so forth). In addition, percutaneous coronary intervention (PCI) was done in 28.9% and 18.2% of cases via snuff box and palmar approaches, respectively. Meanwhile, hemostasis was very fast and easy with discharge time equivalent to other upper limb accesses. CONCLUSION: Although our procedures are at their early stages with about a follow-up period of 3-15 months, more researches are recommended to be conducted in forthcoming months and years, and this new innovative approaches could be suggested safe, feasible, and reliable with low complications. [ABSTRACT FROM AUTHOR]

Background: Chest tubes are used in every case of coronary artery bypass grafting (CABG) to evacuate shed blood from around the heart and lungs. This study was designed to assess the effective of Jackson-Pratt drain in compare with conventional chest drains after CABG. Materials and Methods: This was a randomized controlled trial that conducted on 218 patients in Chamran hospital from February to December 2016. Eligible patients were randomized in a 1:1 ratio. Jackson-Pratt drain group had 109 patients who received a chest tube insertion in the pleural space of the left lung and a Jackson-Pratt drain in mediastinum, and Chest tube drainage group had 109 patients who received double chest tube insertion in the pleural space of the left lung and the mediastinum. Results: The incidence of pleural effusions in Jackson-Pratt drain group and chest tube group were not statistically different. The pain score at 2-h in Drain group was significantly higher than chest tube group (P = 0.001), but the trend of pain score between groups was not significantly different (P = 0.097). The frequency of tamponade and atrial fibrillation (AF) were significantly lower in Jackson-Pratt drain group (P < 0.05). Conclusion: The Jackson-Pratt drain is equally effective for preventing cardiac tamponade, pleural effusions, and pain intensity in patients after CABG when compared with conventional chest tubes, but was significantly superior regarding efficacy to hospital and Intensive Care Unit length of stay and the incidence of AF. [ABSTRACT FROM AUTHOR]

Background: Tumor-induced osteomalacia is an uncommon paraneoplastic syndrome caused by Fibroblast growth factor-23-secreting tumors. It is characterized by phosphaturia, hypophosphatemia, and a high plasma level of alkaline phosphatase. Case presentation: We report a young patient with psoriasis who had suffered from bone pain and muscle weakness for more than 6.5 years. He was finally diagnosed with tumor-induced osteomalacia. However, mistakenly attributing the patient's signs and symptoms to psoriatic arthritis for a long time had resulted in multiple complications for the patient. Finally, the tumor was localized and surgically resected. This resulted in clinical improvements and the resolution of all biochemical abnormalities. Conclusion: To our knowledge, this is the second case of tumor-induced osteomalacia accompanied by psoriasis. There is growing evidence to suggest that Fibroblast growth factor-23 has a role in regulating immune function while an increased level of it may play a role in the pathogenesis of psoriasis. As a result, tumor-induced osteomalacia may affect the psoriasis clinical course by secreting a high amount of Fibroblast growth factor-23. On the other hand, several studies have showed an increased risk of malignancy among patients with psoriasis. Consequently, long-term psoriasis may predispose patients to Fibroblast growth factor-23-secreting tumors. Finally, as psoriasis is a common disease, this presentation may simply be a coincidence. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancers, including colon, rectum and anus, are relatively prevalent in Iran. Use of opium and its derivatives is also considerably prevalent in some areas in Iran. Objectives: The aim of this study was to assess the association between use of opium and its derivatives, and incidence of lower gastrointestinal (LGI) cancers. Methods: This study was a matched case-control study in Shiraz (south of Iran). Cases were the new colorectal cancers from cancer registry center of Shiraz University of Medical Sciences and controls were selected from healthy volunteers of cases' neighbors matched forage and gender (2 controls per 1 case). Data related to consumption of opium and its derivatives, smoking, alcohol use and diet status were collected through a structured questionnaire. The conditional logistic regression models were used to assess all associations. Results: 160 cases and 320 controls participated in the present study with non-response rate less than 9%. Opium use was associated with increased risk of colorectal cancer (adjusted OR = 4.4; 95% CI: 2.2-8.8). Also, a dose-response association was observed between cumulative consumption of opium and the colorectal cancer incidence (OR = 3.8; 95% CI: 1.5-9.1), and (OR = 4.6; 95% CI: 1.7-12.0) for low and high use, respectively. Also, the significant dose-response association was observed for low (OR = 3.4; 95% CI: 1.2 - 9.2) and high (OR = 7.7; 95% CI: 1.5 - 38.6) opium use with presence of colon cancer. Conclusions: The results of this study showed that opium use can be an important risk factor for colorectal cancer in Iran. [ABSTRACT FROM AUTHOR]

Background: Suicide is an important, preventable, public health problem worldwide, caused by the interaction of numerous environmental, biological and psychosocial factors. Aims: This study aimed to identify the factors associated with suicidal attempts in Isfahan, Iran, in 2015. Methods: In this case–control study, 175 cases who committed suicide and were admitted to emergency services were compared with 175 controls selected among outpatients from the same hospital without any history of suicide attempt. Demographic, psychosocial, personality traits, religiosity, coping skills, stressful life events, socioeconomic status and psychiatric distress were compared between groups. Multivariable logistic regression was used to identify independent risk factors for suicide. Results: Marital status, education, socioeconomic status, psychological distress, perceived social support, stress coping strategies, personality, religious beliefs, stress life events and general health condition were significantly different between groups. The regression analysis revealed that perceived social support (odds ratio (OR) = 0.962, 95% confidence interval (CI): 0.94–0.984), religious beliefs (OR = 0.923, 95% CI: 0.867–0.984) and stressful life event (OR = 1.524, 95% CI: 1.251–1.856) were significantly associated with suicide attempts. Conclusion: Our finding showed that religious beliefs, perceived social support and stressful life events are the main factors associated with suicide attempts. So, positive strategies such as improvements in life skills to control stressful life events, religiosity and perceived social support can be used to control suicide attempts. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate clients' satisfaction regarding health-care services and its determinant factors in South-West of Iran. Methods: Totally, 3400 households were randomly selected for this cross-sectional study, carried out in Shiraz, Iran, from December 2013 to March 2014. Data were collected using a checklist that includes insurance status of the household, enrollment in family physician program, and client's satisfaction level with received health services. The level of statistical significance was set at P < 0.05. Results: The mean age of the interviewees was 51.71 (?14.01) years, including 2427 (71.4%) females. 9.4% were insured while 72.3% had registered in family physician program. With respect to the family physician and governmental clinics, most subjects were ?satisfied? or ?very satisfied? with distance, time for admission, time spent at the clinic, privacy, and cost. As for private clinics, specialist clinics, and private hospitals, the studied subjects were more ?dissatisfied? with cost but were more satisfied with other items. Living in higher socioeconomic regions (P = 0.001), dissatisfaction with family physician (P < 0.001, odds ratio [OR] = 2.3), scarcity of prescribed medication (P = 0.02, OR = 1.6), medication cost (P < 0.001, OR = 1.9), and existing chronic diseases in the household (P = 0.03, OR = 1.4) had determinant role in dissatisfaction with health system. Conclusions: Results of the present study demonstrated a high level of satisfaction with the health-care system and family physician in Shiraz, Iran. Moreover, dissatisfaction with family physicians, socioeconomic status, scarcity and cost of drugs, and existing chronic disease(s) were important predictors for dissatisfaction with the health-care system. [ABSTRACT FROM AUTHOR]

Objective: This study was aimed to evaluate the age at natural menopause and related factors among women in a population based study in 2015 in Isfahan, Islamic Republic of Iran. Methods: In this cross-sectional study 960 menopausal women were selected by cluster sampling. Demographic, socioeconomic, lifestyle behavior and reproductive history aspects were collected using a structured questionnaire. Woman and her husband's educational level and occupation with family income were the variables to construct socioeconomic status using principal component analysis. Results: Mean and median of natural menopause age were 48.66 and 48 years, respectively. Women body mass index (BMI) more than 30 kg/m2 had significantly higher menopausal age than women with lower BMI (P value = 0.022). The mean of menopausal age was not statistically significant in regard to marital status, physical activity, smoking status, menarche age, age at first pregnancy and history of abortion. Menopause age with pregnancy numbers and age at last pregnancy had a significant positive association. Women with better socioeconomic status had significantly higher natural menopause age. Multiple linear regression shows significant relationship between lower age at menopause with higher age at marriage, higher number of pregnancy and lower socioeconomic status. Conclusion: Age at menopause in our studied sample is similar to previous estimates reported for other Iranian populations. Age at marriage, higher number of pregnancy and lower socioeconomic status were the significant factors in relations to age at menopause. [ABSTRACT FROM AUTHOR]

Fasting is one of the recommended worships of several great religions in the world. During the month of Ramadan, circadian rhythm and pattern of eating changes result in physiological, biochemical and hormonal changes in the body. Many Muslims with medical conditions ask their physicians about the feasibility and safety of fasting during Ramadan. In this study, we aim to assess the effect of Ramadan fasting on the quality of life and fatigue in multiple sclerosis (MS) patients. Relapsing-remitting MS (RRMS) patients according to McDonald's criteria who had mild disability (EDSS score ≤3) were included in this study. Fatigue and quality of life were were assessed using the validated Persian versions of modified fatigue impact scale (MFIS) and multiple sclerosis quality of life-54 (MSQOL-54) questionnaires, respectively. 218 patients (150 females and 68 males) were enrolled in our study. There was no statistically significant difference between the mean total score of MSIF before and after fasting (25.50 ± 13.81 versus 26.94 ± 16.65; p = 0.58). The mean physical health and mental health composites of quality of life increased significantly after fasting (p = 0.008 and p = 0.003 respectively). Despite the observed lack of favorable effects on fatigue, our results showed increased quality of life of MS patients once Ramadan has ended. Whether this is specifically related to Ramadan-related fasting deserves further testing in appropriately designed larger prospective clinical studies. [ABSTRACT FROM AUTHOR]

Background and Objectives: Spiritual intelligence has different definitions and one of them is application of spiritual data to solve routine problems. This study was intended to assess the relation between spiritual intelligence and lifestyle with job satisfaction in primary school teachers in Gorgan. Methods: In 2014, from the statistical community of Gorgan's primary school teachers, a number of 297 subjects were selected using the simple random method. After obtaining their informed consent, subjects filled four questionnaires of demographic data, spiritual intelligence self-report inventory (SISRI-24), Lali's lifestyle questionnaire, and Minnesota job satisfaction questionnaire. Data analysis, T-Test, variance analysis, and correlation were all conducted on main data. Level of significance was defined to be P<0.05. Results: From 275 questionnaires, 72 (26.2%) were men and 203 (73.8%) were women. The majority of them were in the 30-40 year old age range. The conceptual model of the research showed that the direct effect of spiritual intelligence on the job satisfaction is not significant, but the indirect effect of them is significant and equal to 0.233. In other words, spiritual intelligence impacts on job satisfaction of Gorgan's primary school teachers through lifestyle effects. Also, spiritual intelligence has a direct significant effect of 0.511 on the life style of Gorgan's primary school teachers. Conclusion: As for the direct effect of spiritual intelligence on the lifestyle and its indirect effect on the job satisfaction, improvement of the teacher's spiritual intelligent aspects should be considered as they are they are the next generation's trainers. [ABSTRACT FROM AUTHOR]

BACKGROUND: Resistant hypertension is a common clinical problem of blood pressure that is not controlled despite the simultaneous application of multiple antihypertensive agents. Ablation of renal afferent nerves has been applied and proved to decrease hypertension and injuries produced by severe sympathetic hyperactivity. The main objective of this study was to investigate the long-term effect of renal artery sympathetic ablation and its complications in patients with treatment-resistant hypertension. METHODS: In this prospective study which done between March 2012 and November 2013, 30 patients with resistant arterial hypertension despite treatment with ≥3 antihypertensive drugs-were randomly enrolled in this self-control clinical study in Isfahan, Iran. The patients were treated with the renal denervation procedure; the femoral artery was accessed with the standard endovascular technique and the Symplicity catheter was advanced into the renal artery and connected to a radiofrequency generator. Before and 12 months after renal denervation procedure waist, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), metabolic syndrome, fasting blood sugar (FBS), high-density lipoprotein (HDL), and triglyceride were measured in all patients. RESULTS: Both mean SBP and DBP were significantly decreased, 12 months after renal denervation (P < 0.001). The frequency of metabolic syndrome was not significantly different after renal denervation in compare to baseline (P = 0.174). Furthermore, a significant decreased in FBS and triglyceride was observed in compare to baseline (P = 0.001). CONCLUSION: This study highlighted the role of renal sympathetic denervation as a modern and secure catheter-based method for sustained reduction hypertension in treatment-resistant cases. [ABSTRACT FROM AUTHOR]

Background. Pentoxifylline is a nonspecific phosphodiesterase inhibitor with anti-inflammatory properties. Human studies have proved its antiproteinuric effect in patients with glomerular diseases, but this study was designed to assess the effects of add-on pentoxifylline to available treatment on reduction of microalbuminuria in diabetic patients without glomerular diseases. Methods. In a double-blind placebo-controlled, randomized study we evaluated the influence of pentoxifylline on microalbuminuria in type 2 diabetic patients. 40 diabetic patients with estimated glomerular filtration rate (eGFR) of more than 60 mL/min/1.73 m2 in eight weeks and microalbuminuria were randomized to two groups which will receive pentoxifylline 1200 mg/day or placebo added to regular medications for 6 months. albuminuria; eGFR was evaluated at three- and six-month follow-up period. Results. Baseline characteristics were similar between the two groups. At six months, the mean estimated GFR and albuminuria were not different between two groups at 3- and 6-month follow-up. Trend of albumin to creatinine ratio, systolic and diastolic blood pressure, and eGFR in both groups were decreased, but no significant differences were noted between two groups (P value > 0.05). Conclusion. Pentoxifylline has not a significant additive antimicroalbuminuric effect compared with placebo in patients with type 2 diabetes with early stage of kidney disease; however, further clinical investigations are necessary to be done. [ABSTRACT FROM AUTHOR]

Objective(s): Helicobacter pylori (H. pylori) is a pathogenic bacterium that colonizes the stomachs of approximately 50% of the world's population. Resistance of H. pylori to antibiotics is considered as the main reason for the failure to eradicate this bacterium. The aim of this study was to determine the rate of resistant H. pylori strains to various antimicrobial agents in different areas of Iran. Materials and Methods: A systematic review of literatures on H. pylori antibiotic resistance in Iran was performed within the time span of 1997 to 2013. Data obtained from various studies were tabulated as following, 1) year of research and number strains tested, 2) number of H. pylori positive patients, 3) study place, 4) resistance of H. pylori to various antibiotics as percentage, and 5) methods used for evaluation of antibiotic resistance. Results: Over the period, a total of 21 studies on H. pylori antibiotic resistance have been conducted in different parts of Iran. In these studies, H. pylori resistance to various antibiotics, including metronidazole, clarithromycin, amoxicillin, tetracycline, ciprofloxacin, levofloxacin and furazolidone were 61.6%, 22.4%, 16.0%, 12.2%, 21.0%, 5.3% and 21.6%, respectively. We found no study on H. pylori resistance to rifabutin in Iran. Conclusion: Compared to the global average, we noted that the prevalence of H. pylori resistance to metronidazole, clarithromycin, amoxicillin, and tetracycline has been rapidly growing in Iran. This study showed that in order to determine an appropriate drug regimen against H. pylori, information on antibiotic susceptibility of the bacterium within different geographical areas of Iran is required. [ABSTRACT FROM AUTHOR]

Background: Considering the effectiveness of craniofacial photographic analysis for diagnosis and management of obstructive sleep apnea-hypopnea syndrome (OSAHS) as well as ethnic differences in indexes measured by this method, this study designed to compare the surface facial dimensions, including nose width, intercanthal width and mandibular width of Iranian patients with mild, moderate and severe OSAHS. Materials and Methods: In this cross sectional study subjects with mild, moderate and severe OSAHS based on apnea-hypopnea index, were studied. To determine cephalometric measurements, face and neck digital photographs were taken from participants following a standardized procedure. Cephalometric measurements including face, intercanthal and mandibular widths were compared between studied groups. Results: In this study, 100 participants enrolled. From which 20 (20.8%), 35 (36.45%) and 41 (42.7%) of them had mild, moderate and severe OSAHS, respectively. Mean of nose, intercanthal and mandibular width were significantly higher in patients with severe OSAHS than those with mild or moderate OSAHS (P < 0.05). In both genders, mandibular width were higher in severe forms of OSAHS. Disease severity was significantly associated with increased age and mandibular width (P < 0.05). Conclusion: Mandibular width was the most important index, which had a significant association with the disease severity. It seems that our results could be used both for diagnosis and follow-up of OSAHS management. They could be used as baseline information as well as a clinical and research tool in the field of OSAHS. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer is one of the most important causes of morbidity and mortality in the world. It has been suggested that tissue inhibitor of metalloproteinase-1 (TIMP-1) plays a particular role in cancer promotion. The objective of the present study was to compare the effect of repeated measurement of carcinoembryonic antigen (CEA) and TIMP-1 plasma levels in a follow-up response to chemotherapy treatment in patients with unresectable metastatic colorectal cancer by surgery. Materials and Methods: All consecutive patients between 18 and 75 years old in both genders with rectal adenocarcinoma who referred to Sayed Al-Shohada Medical Center, during 6 months of study period enrolled in the study. Level of CEA and TIMP-1 were assessed before and after two cycles of chemotherapy. Furthermore, patients underwent computed tomography scan to assess response to chemotherapy. The sensitivity, specificity, and areas under the receiver operating characteristic curves (AUC) calculated for baseline level of CEA and TIMP. Results: The mean age of the studied patients was 52.7 ± 7.5 years, 12 patients (48%) were male. Response to chemotherapy after two cycles was 80%. In patients who responded to chemotherapy level of TIMP after treatment was significantly decreased compared to before treatment (P < 0.0001). Before and after treatment in patients who responded to chemotherapy the level of TIMP was significantly lower than who did not response to chemotherapy (P < 0.05). The critical values for the prediction response to chemotherapy for CEA was >63 (AUC: 0.54) and for TIMP was ≤8823 (AUC: 0.68). Conclusion: The present study has identified a strong significant association between high plasma TIMP-1 levels and short survival in patients with colorectal cancer. In addition, results demonstrated that the TIMP-1 provides stronger prognostic information than CEA. [ABSTRACT FROM AUTHOR]

Background: Rheumatoid arthritis (RA) is a common autoimmune disease that is associated with progressive disability, systemic complications, and early death. The present study was aimed to investigate the level of immunoglobulin G (IgG) and IgA isotypes and anti‑cyclic citrullinated peptide (CCP) antibody and to assess their association with disease severity based on disease activity score (DAS‑28) in patients with IgM rheumatoid factor (IgM‑RF) negative RA. Materials and Methods: In this cross‑sectional study, 62 RA patients with IgM‑RF negative were assessed. Radiographs were obtained for all RA patients. The RF (IgG, and IgA) and anti‑CCP were measured by using the enzyme‑linked immunosorbent assay. Values of cut‑off points over 15 UI/mL for IgA IgA‑RF, 20 UI/mL for IgG‑RF and over 20 units for anti‑CCP were considered positive. DAS‑28 score was compared in regard to the IgA‑RF and IgG‑RF and anti‑CCP positivity using Mann-Whitney test. Results: DAS‑28 score in IgA‑RF positive was significantly higher than IgA‑RF negative (mean score, 6.03 ± 0.33 vs. 5.44 ± 0.76 respectively, P = 0.035). In IgG‑RF positive patients, DAS‑28 score was similar to patients with IgG‑RF negative (5.64 ± 0.59 vs. 5.46 ± 0.78 respectively, P = 0.396). Furthermore, in patients with anti‑CCP positive DAS‑28 score was significantly higher than patients with anti‑CCP negative (5.72 ± 0.61 vs. 5.38 ± 0.79 respectively, P = 0.049). Conclusion: Findings indicated that there was a significant association between the amounts of IgA and anti‑CCP with severity of disease in RF negative RA patients while there was no significant association between the amounts of IgG and severity of RA disease. [ABSTRACT FROM AUTHOR]

Background: Leishmaniasis is a parasitic disease caused by different species of Leishmania parasites with a wide range of clinical manifestations. Antimonial compounds such as meglumine antimoniate (glucantime) are the first line drugs for the treatment of leishmaniasis. However, according to reports of the drug resistance of parasites, the efficacy of antimonial compounds is low. The ATP-binding cassette (ABC) proteins are present in all organisms and mediate the transport of vital elements through biological membranes. One of the important mechanisms of resistance in Leishmania parasites is the overexpression of ABC efflux pumps. P-glycoprotein A (pgpA) is a related gene for ABC transporter in Leishmania species. The aim of this study was to compare the pgpA expression in laboratory-induced resistant L. major (MRHO/IR/75/ER) and sensitive parasites. Methods: RNA extraction of promastigotes of sensitive and resistant clones was performed and total RNA was reverse transcribed. The real-time quantitative polymerase chain reaction (PCR) was used to assess RNA expression profiles and the expression levels were calculated using 2-ΔCt method. Results: The mean expression level of pgpA mRNA was 2.70 ± 0.51 in in sensitive Leishmania clone and 6.08 ± 1.50 in resistant Leishmania clone (P = 0.021). Conclusion: The expression of pgpA gene in resistant strains of L. major was almost fivefold higher than those in susceptible strains. Therefore, this can be used in field isolates, i.e. overexpression of the gene can prove resistance in wild type field isolates. [ABSTRACT FROM AUTHOR]

Staphylococcus epidermidis is one of the most important coagulase-negative staphylococci (CoNS) in the NICU. Various bacterial virulence factors of this opportunistic microorganism such as intercellular protein adhesion, slime layer formation and delta toxin in particular have increased the percentage of true infections. Due to the lack of research on molecular detection of Staphylococcus epidermidis delta toxin and also the unknown percentage of delta toxin in neonate units of the selected university hospitals of Isfahan and Tehran in Iran, we used hld gene as a specific target for detection of mentioned toxin in the present study. Clinical invasive strains of Staphylococcus epidermidis were isolated from different sources of infections including blood culture, blood and urinary catheters, wounds and etc. Using phenotypic method 67.5% of all strains were found to have the ability to produce delta toxin in vitro while 87.5% were found to harbor hld gene in molecular test. Conversely antimicrobial susceptibility test was performed by disc diffusion method on Mueller-Hinton agar. No resistance to vancomycin was observed whereas resistance to cefoxitin (75%), oxacillin (65%) and gentamicin (62.5%) was noticeable. [ABSTRACT FROM AUTHOR]

Background: There is a wide variation in the prevalence of multiple sclerosis (MS) in different geographical regions and the epidemiology of MS in Iran has been a major topic of concern during the last decade. Several population-based studies have shown a sharp increase in the prevalence and incidence of MS in this region. In this study, for the first time, the aim was to provide a comprehensive review regarding the incidence and prevalence of MS across Iran. Methods: A comprehensive literature search was performed using PubMed, Embase, and Web of Science. We also did a manual search of reference lists from primary articles and relevant reviews. Databases of ongoing research and unpublished literature were also searched. Results: A total of 22 relevant studies were reviewed and 11 studies met the inclusion criteria. Incidence data were found in 5 studies and ranged from 0.68 to 9.1/100,000 per year in the Iranian population. Prevalence was reported in all studies and ranged from 5.3 to 74.28/100,000 with the higher prevalence among females (female/male ratio ranged from 1.8 to 3.6). The most prevalent subtype of MS was the relapsing-remitting form (65.8-87.8%). The sensory disturbance was the most initial presentation. Conclusion: The incidence and prevalence of MS in Iran has been increasing rapidly, especially in females. Future research should focus on determining the epidemiological features of MS in the neglected provinces with different ethnicities. Such an effort along with further research towards improvement of data on previously studied areas can enable a field to be opened up to identify the patterns of MS in varied genetic backgrounds and environments of Iran. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Repeated referring of patients from North Baraan region especially from two villages (Timiart and Fesaran) to the Isfahan Research Center of Skin Disease and Leishmaniasis and the Isfahan Province Health Center (Iran) and also repeated writings of level unities to the Disease Control Unit of Health Center No, 1 of this area about the increasing number of rodents in the villages was showing that leismaniasis has an epidemiologic condition in this area. There was no study about the genus and species of reservoir rodents in the region. So, in this study we aimed to study the funa of region rodents and the rate of their involvement by leishmaniasis. Methods: This cross-sectional study was performed on local hunted rodents with Sherman live-traps. Their genus and species were identified using special key references. Samples were taken from animals' ears, beaks, paws, noses and tails by grinding method for both direct smear and culture in Novy-MacNeal-Nicolle (NNN) medium. Then, they were dissected and two direct smears from the liver and spleen of each one were prepared. The slides underwent direct microscopic exam after Giemsa staining to detect amastigote form of parasites. Findings: Among the total of 53 rodents, Rhombomys opimus comprised 38 (71.7%) and the remaining 15 (28.3%) were Meriones libycus. The rate of infection of Rhombomys opimus was (18.4%) and of Meriones libycus was (13.3%). Conclusion: The results suggested that Rhombomys opimus was the principal reservoir of cutaneous leishmaniasis and Meriones libycus was the second host in this area. [ABSTRACT FROM AUTHOR]

Background: Human growth hormone (hGH) is a secretory protein of the blood which is used extensively in biotechnology and medical sciences. Recombinant human growth hormone production is still one of the priorities of the Iranian Ministry of Health. One of the most sensitive and accurate techniques for the measurement of this hormone is the ELISA method. Scientists need to produce antibody against hGH to measure the serum level of hGH in patients. Commercial ELISA kits are commonly imported from other countries to Iran. Therefore, the current study aimed to produce a polyclonal antibody against hGH in order to make a domestic ELISA kit to measure this hormone. Methods: Rabbit polyclonal antibody against hGH was produced following 10 weeks of immunization by the antigen injection. The antibody characteristics were evaluated by immunoblotting. The purified antibody was used to design the ELISA kit. The designed sandwich ELISA method was standardized concerning the amount of antibody coating and antibody conjugate. Ultimately, the sensitivity and specificity of the designed kit was compared with the foreign kits. Findings: The polyclonal antibody against hGH was produced in rabbits and purified successfully. This antibody can be used in the western blot and ELISA methods. The diagnostic value of the designed kit was 98%, compared with the foreign kits. Conclusion: This kit has a diagnostic value in the assessment of hGH; therefore, it can be a good alternative to the commercial kits. Therefore, this antibody and ELISA kit can be produced more cost-effectively and can be a step towards self-sufficiency. [ABSTRACT FROM AUTHOR]

Background: In spite of numerous studies demonstrated efficacy and safety of photorefractive keratectomy (PRK) by cross cylinder and WF-guided methods, only limited studies are done in the field of advanced methods such as advanced personalized technique (APT). This study was performed to compare pre- and post-operation visual acuity and refractive errors in patients with over two diopter astigmatism treated by APT method. Methods: This clinical trial study performed on 16 sequential patients (10 men and 6 women) referred to Sadra clinic of Isfahan, Iran, in the year of 2011. After complete ocular examination, for both eyes of each patient, PRK by APT method was done. Six months after surgery, abrometry was done for patients. Findings: 32 eyes of 16 patients with the mean age of 28.8 ± 6.9 year were involve in this study. Visual acuity of both eyes increased from 2.72 ± 3.13 to 7.06 ± 3.3. Myopia of both eyes changed from -2.18 ± 2.29 to 0.26 ± 0.41 and astigmatism decreased from 3.54 ± 1.03 to 0.75 ± 0.66. All changes were statistically meaningful (P < 0.001 for all). Conclusion: PRK by APT method significantly increases visual acuity, corrected and non-corrected vision and decreases myopia and astigmatism. Despite, further studies with more patients and longtime follow-up is recommended. [ABSTRACT FROM AUTHOR]