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Abstract Background Multiple sclerosis (MS) is a chronic and progressive neurological autoimmune disease that affects the central nervous system. There are two types of drugs used to treat this disease: injectable and oral drugs. The present study aimed at systematically reviewing the cost effectiveness of oral versus injectable drugs. Methods The researchers searched the PubMed, Scopus, and Web of Science databases to find relevant studies. After removing the duplicates, two authors independently assessed the records. The studies that had conducted full economic evaluations of oral versus injectable drugs in MS patients were included. The Quality of Health Economic Studies (QHES) tool was also used to assess the quality of the studies. Results Thirty studies that had conducted the economic analysis of oral versus injectable therapies in MS patients were included in this review. The QHES scores for all records were generally high (≥ 77) and they were of good quality. The lowest and highest levels of incremental net monetary benefit were respectively obtained through the comparison of Fingolimod and Alemtuzumab (-1,419,333) and the comparison of Teriflunomide and Interferon β-1a (1,792,810). The amount of INMB (incremental net monetary benefit) in the comparisons between oral and injectable drugs showed that the highest and lowest amount of INMB calculated between) Fingolimod and injectable drugs, respectively, compared to (interferon β-1a) 98,253 and (Ocrelizumab) -212,417, the highest amount in dimethyl fumarate is also against (peginterferon β-1a) 191,470 and the lowest against (alemtuzumab) -124,333, Teriflunomide against injectable drugs is the highest against (peginterferon β-1a) 89,956 and the lowest (Ocrelizumab) − 194,169, as well as Cladribine compared to injectable drugs, the highest was compared to (interferon β-1a) 236,430 and the lowest (Ocrelizumab) was 23,965. Conclusion A large number of health economic evaluations of disease-modifying therapies (DMTs) in MS were available at the international level, the comparison of which was difficult and sometimes contradictory. However, despite the difference in the results, Cladribine tablets were cost-effective in all studies compared with injectable drugs. In addition, the present study could be of great importance for policymakers and other beneficiaries regarding the cost-effectiveness of the aforementioned drugs.

Background: This study explored the concept of ‘life balance’ during physical isolation due to COVID-19 in Iran in 2020. Methods: In a cross-sectional design, 403 participants completed the internet-based "Life Balance Inventory (LBI)”, which includes five subscales: health, relationship, identity, challenging/interesting activity, and daily activities. The data were analyzed using SPSS 21, and a significant level of less than 0.05 was considered. Descriptive statistics, t-tests, and one-way ANOVA were utilized in the analysis. Results: The total mean score of LBI was 1.51+_0.38(unbalanced). The scores were distributed among the participants as follows: 52.6% of participants scored between 0.6 and 1.5 (very unbalanced); 37.7% of participants scored between 1 and 1.5 (unbalanced); 8% of participants scored between 2 and 2.5 (moderately balanced); and finally, 1.7% of participants scored between 2.5 and 3 ( very balanced). Significant relationships were found between LBI and gender (P=0.001), chronic comorbidity (P-value =0.029), and Job (P-value=0.044). The health subscale showed no statistical difference according to the demographic factors. Males demonstrated more life balance in their daily activities, including driving and social transportation (p=0/001). Married participants and those older than 40 exhibited more balance in the relationship subscale (p-value=0/001). Teachers and faculty members showed more balance in identity (p=0.014) and relationship (p=0.001). Higher-income participants revealed more life balance in the challenge/interesting subscale (p=0.033). Conclusion: The results suggested that participants experienced an unbalanced lifestyle during the early phase of COVID-19 isolation.

Abstract Background During a COVID-19 pandemic, it is imperative to investigate the outcomes of all non-COVID-19 diseases. This study determines hospital admissions and mortality rates related to non-COVID-19 diseases during the COVID-19 pandemic among 41 million Iranians. Method This nationwide retrospective study used data from the Iran Health Insurance Organization. From September 23, 2019, to Feb 19, 2022, there were four study periods: pre-pandemic (Sept 23-Feb 19, 2020), first peak (Mar 20-Apr 19, 2020), first year (Feb 20, 2020-Feb 18, 2021), and the second year (Feb 19, 2021-Feb 19, 2022) following the pandemic. Cause-specific hospital admission and in-hospital mortality are the main outcomes analyzed based on age and sex. Negative binomial regression was used to estimate the monthly adjusted Incidence Rate Ratio (IRR) to compare hospital admission rates in aggregated data. A logistic regression was used to estimate the monthly adjusted in-hospital mortality Odds Ratio (OR) for different pandemic periods. Results During the study there were 6,522,114 non-COVID-19 hospital admissions and 139,679 deaths. Prior to the COVID-19 outbreak, the standardized hospital admission rate per million person-month was 7115.19, which decreased to 2856.35 during the first peak (IRR 0.40, [0.25–0.64]). In-hospital mortality also increased from 20.20 to 31.99 (OR 2.05, [1.97–2.13]). All age and sex groups had decreased admission rates, except for females at productive ages. Two years after the COVID-19 outbreak, the non-COVID-19 hospital admission rate (IRR 1.25, [1.13–1.40]) and mortality rate (OR 1.05, [1.04–1.07]) increased compared to the rates before the pandemic. The respiratory disease admission rate decreased in the first (IRR 0.23, [0.17–0.31]) and second years (IRR 0.35, [0.26–0.47] compared to the rate before the pandemic. There was a significant reduction in hospitalizations for pneumonia (IRR 0.30, [0.21–0.42]), influenza (IRR 0.04, [0.03–0.06]) and COPD (IRR 0.39, [0.23–0.65]) during the second year. There was a significant and continuous rise in the hematological admission rate during the study, reaching 186.99 per million person-month in the second year, reflecting an IRR of 2.84 [2.42–3.33] compared to the pre-pandemic period. The mortality rates of mental disorders (OR 2.15, [1.65–2.78]) and musculoskeletal (OR 1.48, [1.20–1.82), nervous system (OR 1.42, [1.26–1.60]), metabolic (OR 1.99, [1.80–2.19]) and circulatory diseases (OR 1.35, [1.31–1.39]) increased in the second year compare to pre-pandemic. Myocardial infarction (OR 1.33, [1.19–1.49]), heart failure (OR 1.59, [1.35–1.87]) and stroke (OR 1.35, [1.24–1.47]) showed an increase in mortality rates without changes in hospitalization. Conclusions In the era of COVID-19, the changes seem to have had a long-term effect on non-COVID-19 diseases. Countries should prepare for similar crises in the future to ensure medical services are not suspended.

Background: The hospital autonomy plan, the biggest decentralization plan to reform the administration structure of public hospitals, has been implemented for about three decades in Iran. In this study, we aimed to examine the effects of the plan on the financial indicators of autonomous public hospitals. Materials and Methods: This descriptive cross-sectional study used revenue and cost data associated with all public hospitals affiliated to Bushehr University of Medical Sciences in 2021. The relevant data was extracted from two big databases including health information system (HIS) and accounting system, and after the data quality control, specific financial self-sufficiency balance (the ratio of specific income to the specific cost of the same hospital) and total financial balance (the ratio of specific income to the total cost of the same hospital) were calculated using Excel software. Results: Results demonstrated that the specific financial self-sufficiency balance and the total financial balance were 61% and 27%, respectively. The highest and the lowest values of the specific financial self- sufficiency index pertained to the Heart Hospital (the only single specialty heart hospital in the province) and Imam Hossein Hospital (a hospital with 29 active beds in Tangestan county with a population of 82502) as 74% and 45%, respectively. The gap index between the specific cost and revenue of each ac-tive bed showed that on average, the cost of each bed was nearly 215 million Tomans higher than its own income in 2021. Conclusion: The hospital autonomy plan had different effects on the financial indices of public hospitals studied in this research, denoting it is not possible to cover all hospital-specific expenses through its own earned revenues. Accordingly, government subsidies to autonomous hospitals are necessary.

Background : Dry needling (DN) is recommended as a therapeutic modality for various neuromusculoskeletal disorders. No study has been performed on the impact of DN on arthrogenic muscle inhibition (AMI) after anterior cruciate ligament reconstruction (ACLR). This study protocol is aimed to investigate the impacts of DN on AMI of quadriceps femoris, corticomotor, and spinal reflex excitability in patients with ACLR. Methods : A double-blind, between-subject, randomized, controlled trial will be conducted to measure changes in AMI after DN. Twenty-four subjects with ACLR will be recruited to receive a DN or a sham DN, providing that they met the inclusion criteria. Three sessions of DN on the quadriceps femoris will be applied during a one-week period. The primary outcome measures are the active motor threshold, motor evoked potential, and Hmax - Mmax ratio. The secondary outcomes are the International Knee Documentation Committee subjective knee form questionnaire score and maximum quadriceps isometric torque. Data will be collected at baseline, immediately after the first session, after the third session, and at the one-month follow-up visit. Discussion: The results of this study will provide preliminary evidence regarding the effects of DN on AMI of quadriceps femoris in patients with ACLR.

BackgroundDifferent populations and areas of the world experienced diverse COVID-19 hospitalization and mortality rates. Claims data is a systematically recorded source of hospitalized patients' information that could be used to evaluate the disease management course and outcomes. We aimed to investigate the hospitalization and mortality patterns and associated factors in a huge sample of hospitalized patients.MethodsIn this retrospective registry-based study, we utilized claim data from the Iran Health Insurance Organization (IHIO) consisting of approximately one million hospitalized patients across various hospitals in Iran over a 26-month period. All records in the hospitalization dataset with ICD-10 codes U07.1/U07.2 for clinically/laboratory confirmed COVID-19 were included. In this study, a case referred to one instance of a patient being hospitalized. If a patient experienced multiple hospitalizations within 30 days, those were aggregated into a single case. However, if hospitalizations had longer intervals, they were considered independent cases. The primary outcomes of study were general and intensive care unit (ICU) hospitalization periods and case fatality rate (CFR) at the hospital. Besides, various demographic and hospitalization-associated factors were analyzed to derive the associations with study outcomes using accelerated failure time (AFT) and logistic regression models.ResultsA total number of 1 113 678 admissions with COVID-19 diagnosis were recorded by IHIO during the study period, defined as 917 198 cases, including 51.9% females and 48.1% males. The 61-70 age group had the highest number of cases for both sexes. Among defined cases, CFR was 10.36% (95% CI: 10.29-10.42). The >80 age group had the highest CFR (26.01% [95% CI: 25.75-26.27]). The median of overall hospitalization and ICU days were 4 (IQR: 3-7) and 5 (IQR: 2-8), respectively. Male patients had a significantly higher risk for mortality both generally (odds ratio (OR) = 1.36 [1.34-1.37]) and among ICU admitted patients (1.12 [1.09-1.12]). Among various insurance funds, Foreign Citizens had the highest risk of death both generally (adjusted OR = 2.06 [1.91-2.22]) and in ICU (aOR = 1.71 [1.51-1.92]). Increasing age groups was a risk of longer hospitalization, and the >80 age group had the highest risk for overall hospitalization period (median ratio = 1.52 [1.51-1.54]) and at ICU (median ratio = 1.17 [1.16-1.18]). Considering Tehran as the reference province, Sistan and Balcuchestan (aOR = 1.4 [1.32-1.48]), Alborz (aOR = 1.28 [1.22-1.35]), and Khorasan Razavi (aOR = 1.24 [1.20-1.28]) were the provinces with the highest risk of mortality in hospitalized patients.ConclusionHospitalization data unveiled mortality and duration associations with variables, highlighting provincial outcome disparities in Iran. Using enhanced registry systems in conjunction with other studies, empowers policymakers with evidence for optimizing resource allocation and fortifying healthcare system resilience against future health challenges.

Abstract Background Nurses have been at the center of managing the COVID-19 outbreak through direct bedside care in respiratory, emergency and intensive care environments, managing hospital units, providing Covid-19 testing, vaccination and contact tracing. Thus, the present study aimed to analysis the strategies used by Iranian nurses for management of Provided Care for patients with COVID- 19. Methods The present study was conducted based on the conventional content analysis method and Graneheim & Lundman approach. The participants included the nurses working in the COVID-19 wards and were recruited by purposeful sampling and based on inclusion criteria. The data were collected by conducting semi-structured, in-depth, one-to-one interviews until reaching data saturation. Results In-depth interviews with 10 nurses represented four main categories and fifteen subcategories. Four main categories emerged in this study i.e. “justice in human resources management”, “The art and science of comprehensive nursing care”, “managers as agents of change in crisis” and “challenges and its management”. Conclusion The nurses’ experiences of management strategies showed that paying attention to the financial, psychological, educational, equipment needs of nurses and maintaining their safety make the suitable environment for providing high quality care for patients with covid-19.

Introduction: Appropriate information about the ability of patients with Parkinson disease (PD) to perform cognitive instrumental activities of daily living (IADL) is necessary. The present study aimed to assess the psychometric properties of the Persian version of the Penn Parkinson daily activities questionnaire-15 (PDAQ-15). Methods: A total of 165 knowledgeable informants of PD patients completed the PDAQ-15. The clinical dementia rating scale, Hoehn and Yahr staging, hospital anxiety and depression scale (HADS), and Lawton IADL scale were used in the study. Internal consistency and test-retest reliability were evaluated by the Cronbach α coefficient and intraclass correlation coefficient (ICC), respectively. To examine the dimensionality of the questionnaire, exploratory factor analysis was used. The construct validity was assessed using the Spearman rank correlation test. To assess the discriminative validity, PDAQ-15 scores were compared across cognitive stages. Results: The PDAQ-15 showed strong internal consistency (the Cronbach α=0.99) and test-retest reliability (ICC= 0.99). Only one dimension was identified for the PDAQ-15 in the factor analysis. There was a strong correlation between PDAQ-15 with the depression domain of the HADS scale and the Lawton IADL scale (rs=|0.71–0.95|). The correlation of PDAQ-15 with the anxiety domain of the HADS scale was moderate (rs=0.66). Discriminative validity analysis showed that the PDAQ-15 has significant power to discriminate between PD patients across cognitive stages. Conclusion: These results suggest that the PDAQ-15 is a valid and reliable PD-specific instrument and can be useful in clinical and research settings.

Abstract Background Depression disorders are a leading cause of disability in the world which imposes a significant economic burden on patients and societies The present study aimed to determine the economic burden of Major Depressive Disorder (MDD) on the patients referred to the reference psychiatric single-specialty hospitals in southern Iran in 2020. Methods This cross-sectional research is a partial economic evaluation and a cost-of-illness study conducted in southern Iran in 2020. A total of 563 patients were enrolled through the census method, and a researcher-made data collection form was used to gather the required information. The prevalence-based and the bottom-up approaches were also used to collect the cost information and calculate the costs, respectively. The data on direct medical, direct non-medical, and indirect costs were obtained using the information in the patients’ medical records and insurance bills as well as their self-reports or those of their companions. To calculate the indirect costs, the human capital approach was used as well. Results The results showed that the annual cost of MDD was $ 2717.41 Purchasing Power Parity (PPP) (USD 2026.13) per patient in 2020. Direct medical costs accounted for the largest share of the costs (73.68%), of which hoteling and regular beds expenses were the highest (57.70% of the total direct medical costs). The shares of direct non-medical and indirect costs were 7.52 and 18.80%, respectively, and the economic burden of the disease in the country was estimated at $7,120,456,596 PPP (USD 5,309,088,699). Conclusion In general, due to the high prevalence of MDD and the chronicity of the disease, the costs of its treatment can impose a heavy economic burden on the society, healthcare system, insurance system, and the patients themselves. Therefore, it is suggested that health policymakers and managers should take appropriate measures to increase the basic and supplemental insurance coverage of these patients. In addition, in order to reduce the costs, proper and equitable distribution of psychiatrists and psychiatric beds, expansion of home care services, and use of Internet-based technologies and the cyberspace to follow up the treatment of these patients are recommended.

Abstract Background Hearing loss is the second most common chronic disease, the diagnosis and treatment of which can be faster through screening. In addition, early interventions will save significant costs for the education and health systems. Therefore, the present study aimed to evaluate the cost-effectiveness of hearing screening for primary school children in Shiraz. Methods This cross-sectional economic evaluation of cost-effectiveness was conducted from the perspective of the health system. The study population comprised all seven-year-old children participating in the screening program in Shiraz. The present study dealt only with direct costs. The expected costs and outcomes, as well as the ICER index were estimated using the decision tree model. The study outcomes included averted disability-adjusted life years (DALY) and true identification of hearing loss cases. The robustness of the results was evaluated using the one-way sensitivity analysis. The TreeAge 2020 and Excel 2016 software were also used to analyze the collected data. Results The hearing screening data obtained during 6 years (2015–2020) showed that every year, an average of 22,853 children in Shiraz were examined for hearing, of which 260 were true positive (%1.1). The costs of screening and lack of screening were estimated at $30.32 Purchasing Power Parity (PPP) and $13.75 PPP per child, respectively. The averted DALY due to performing hearing screening was estimated at 7 years for each child. The ICER was positive and equal to $ 0.06 PPP for the identified cases and $ 2.37 PPP per averted DALY. The sensitivity analysis confirmed the robustness of the results. Conclusions According to the results, although hearing screening for primary school children had more costs and effectiveness, it was considered cost-effective. Therefore, universal screening with high quality and accuracy is recommended.

Abstract Background Multiple Sclerosis (MS) is a chronic debilitating disease that imposes a heavy socioeconomic burden on societies. This study aimed to determine the economic burden of MS on patients using the first (CinnoVex and ReciGen) and second (Fingolimod and Natalizumab) drug therapy lines. Methods This cost of illness study was an economic evaluation carried out as cross-sectional research in 2019 in southern Iran. A total of 259 patients were enrolled in two lines of drug therapy (178 patients in the first line and 81 ones in the second). The prevalence-based approach and the bottom-up approach were used to collect cost information and to calculate the costs from the societal perspective, respectively. The human capital approach was applied to calculate indirect costs. To collect the required data a researcher-made data collection form was utilized. The data were obtained using the information available in the patients’ medical records and insurance invoices as well as their self-reports or that of their companions. Results The results showed that the annual costs of MS in the first and second lines of drug therapy per patient were $ 1919 and $ 4082 purchasing power parity (PPP), respectively, and in total, $ 2721 PPP in 2019. The highest mean costs in both lines were those of direct medical costs, of which purchasing the main medicines in both lines accounted for the highest. Conclusion Considering the findings of this study and in order to reduce the burden of the disease, the following suggestions are presented: providing necessary facilities for the production of MS drugs in the country; proper and equitable distribution of neurologists; expanding the provision of home care services; and using the technologies related to the Internet, including WhatsApp, to follow up the MS patients’ treatment.

Abstract Introduction Multiple sclerosis (MS) is an inflammatory disease in which the myelin sheaths of the nerve cells in the brain and spinal cord, which are responsible for communication, are destroyed and cause physical signs and symptoms. According to studies, anti-CD20 monoclonal antibodies have significant results in the treatment of this disease. Thus, the aim of the present study was to determine the cost-effectiveness of rituximab against natalizumab in the patients with RRMS in southern Iran in 2020. Methods This is an economic evaluation including cost-effectiveness analysis in which the Markov model with a lifetime horizon was used. The study sample consisted of 120 patients randomly selected from among those referred to the MS Association and the Special Diseases Unit of Shiraz University of Medical Sciences. In this study, the costs were collected from a societal perspective, and the outcomes were obtained in the form of Quality Adjusted Life Years (QALY) and the mean relapse rate. The TreeAge pro 2020 and Excel 2016 software were used for data analysis. Results The comparative study of rituximab and natalizumab showed that the patients receiving rituximab had lower costs ($ 58,307.93 vs. $ 354,174.85) and more QALYs (7.77 vs. 7.65). In addition, the incidence of relapse by rituximab was lower compared to natalizumab (1.15 vs. 2.57). The probabilistic one-way sensitivity analysis showed the robustness of the results. The scatter plots also showed that rituximab was more cost-effective for the patients in 100% of the simulations for the threshold of < $ 37,641. Discussion and conclusion According to the results of this study, rituximab had higher cost-effectiveness than natalizumab. Therefore, it could be a priority for RRMS patients compared to natalizumab because it reduced treatment costs and increased effectiveness.

The outbreak of COVID-19 has had destructive influences on social and economic systems as well as many aspects of human life. In this study, we aimed to estimate the economic effects of COVID-19 at the individual and societal levels during a fiscal year. This cost of illness analysis was used to estimate the economic burden of COVID-19 in Iran. Data of the COVID-19 patients referred to the hospitals affiliated to Bushehr University of Medical Sciences in 2021 were collected through the Hospital Information System (HIS). The study methodology was based upon the human capital approach and bottom-up technique. The COVID-19 pandemic has resulted in 9711 confirmed hospital cases and 717 deaths in Bushehr province during the study period. The direct and indirect costs were estimated to be $1446.06 and $3081.44 per patient. The economic burden for the province and country was estimated to be $43.97 and $2680.88 million. The results showed that the economic burden of this disease particularly premature death costs is remarkably high. Therefore, in order to increase the resiliency of the health system and the stability in service delivery, preventive-oriented strategies have to be more seriously considered by policymakers.

Background: Surgery wards account for a significant portion of hospital costs, followed by patient costs. Improving surgery wards' performance plays a major role in enhancing the accountability and efficiency of the hospital. This study aimed to evaluate the performance of inpatient surgical wards at the hospitals affiliated with Tehran University of Medical Sciences(TUMS). Methods: A descriptive, cross-sectional, retrospective study was performed at all hospitals affiliated with TUMS in 2018. To measure the efficiency of these wards, three indicators have been considered; bed occupancy rate, the average length of stay, and bed turnover. Data have been analyzed using Excel software based on the Pabon Lasso model . Results: Among the 15 active surgical departments, 5 (33.31 %) were categorized in quadrant three, including ophthalmology, obstetrics and gynecology, vascular and trauma surgery, plastic surgery, and infertility department. The oral and maxillofacial surgery and general surgery departments were the poorest in their performance and located in quadrant one. Ten surgical wards out of 38 (26.33 %) have reported a satisfactory performance. Conclusion: Understanding and comparing the performance of clinical departments is also useful in making decisions for standardizing the patterns of health services delivery, evidence-based management in health care centers, and enhancing accountability in the health system. It is suggested that managers revise the departments in the inefficient area to reduce the number of inefficient departments or attract more patients by marketing, diversifying services, and increasing the quality of services.

Myocardial infarction (MI) is one of the leading causes of deaths globally. The early diagnosis of MI lowers the rate of subsequent complications and maximizes the benefits of cardiovascular interventions. Many efforts have been made to explore new therapeutic targets for MI, and the therapeutic potential of non-coding RNAs (ncRNAs) is one good example. NcRNAs are a group of RNAs with many different subgroups, but they are not translated into proteins. MicroRNAs (miRNAs) are the most studied type of ncRNAs, and have been found to regulate several pathological processes in MI, including cardiomyocyte inflammation, apoptosis, angiogenesis, and fibrosis. These processes can also be modulated by circular RNAs and long ncRNAs via different mechanisms. However, the regulatory role of ncRNAs and their underlying mechanisms in MI are underexplored. Exosomes play a crucial role in communication between cells, and can affect both homeostasis and disease conditions. Exosomal ncRNAs have been shown to affect many biological functions. Tissue-specific changes in exosomal ncRNAs contribute to aging, tissue dysfunction, and human diseases. Here we provide a comprehensive review of recent findings on epigenetic changes in cardiovascular diseases as well as the role of ncRNAs and exosomal ncRNAs in MI, focusing on their function, diagnostic and prognostic significance.

Background: Outsourcing as an effective strategy in public management has attracted policy-makers. Awareness of quantity and quality of implementing this strategy can help policy-makers and managers to remove barriers to this policy. This study aimed to investigate outsourced services and the applied models in Bushehr University of Medical Sciences. Materials and Methods: This descriptive cross-sectional study was carried out in Bushehr University of Medical Sciences in 2019 in four separate steps of literature review, shortlisting outsourceable services, data quality assurance and categorization of outsourced services into clinical and non-clinical services. Finally, the collected data were entered into Excel® version 8 to calculate and report descriptive indicators. Results: Result showed that totally 24 types of services have been outsourced. Half of them were clinical and the other haf were non-clinical. Among the outsourcing models, service purchasing model and management outsourcing model were the most and the least applied models, respectively. Conclusion: Although various outsourcing models are available, the type and the number of outsourced services are still limited. Given the diversity of services in health sector especially clinical services, it is possible to use the capacity of outsourcing strategy more effectively.

Objectives: To investigate whether Iranian children and adolescents with Cerebral Palsy (CP) participate in their preferred leisure activities. Methods: A group of children and adolescents (n=152; 59.2% male; aged 7-17 years; Mean±SD of age was 10.93±3.46 years old) diagnosed with CP (39.5% hemiplegic; 28.9% quadriplegic; 31.6% diplegic) were selected to complete the children’s assessment of participation and the enjoyment (CAPE) and Preference for Activities of Children (PAC) questionnaires. Results: Recreational and social activities were the most preferred (PAC mean score=2.13±0.40; 2.08±0.40, respectively), and active-physical activities were the least preferred (PAC mean score=1.60±0.46). Preferences were strongly correlated with leisure participation (P

Objectives: To determine the role of child factors in the prediction of parental attitudes toward children and adolescents with CP in Iran. Methods: The cross-sectional study design was used. A total of 152 children and adolescents with CP aged 7-17 years (Mean±SD = 10.93±3.46) with a mother aged at least 25 years were selected, using a systematic random sampling method. The Mother-Child Relationship Evaluation questionnaire was used to assess the parental attitude. Simple and multiple linear regression analyses were performed to determine the predictive role of child factors (eg, age, gender, type of CP, dependency in gross and fine motor functions, and IQ) in parental attitudes. Results: Overindulgence and overprotection attitudes were the most common attitudes among mothers. The acceptance attitude was best predicted by the type of CP (r2=0.151). Diplegia, being fully dependent in gross motor functions, and adolescence predicted greater overprotection attitude (r2=0.101). Girls were predicted to be treated more overindulgent (r2=0.045). Femininity predicted lesser rejection attitude while being fully dependent in fine motor functions predicted greater rejection attitude (r2=0.006). Discussion: Child factors influence only a small proportion of parental attitudes toward children and adolescents with CP. Contrary to expectation, child factors, including the child’s disability status, are not the most prominent determinants of the parental attitudes toward children and adolescents with CP in Iran.

Objective: The purpose of the present study was to establish the item analysis and internal consistency of the Persian version of the Child Sensory Profile 2 in 2 groups of typical and atypical children (autism spectrum disorder and learning disabilities) aged 3 to 14 years. Method: The sample of this study included 120 typical and atypical children aged 3 to 14 years who referred to schools and rehabilitation centers in Tehran were selected using multistage sampling method. To collect data, the Child Sensory Profile 2 questionnaire was used, which is a set of questionnaires of the Sensory Profile 2. To analyze the data, the discrimination index was used to determine the discriminant validity of the Child Sensory Profile 2, and the Cronbach's alpha coefficient was used to determine the reliability in terms of internal consistency. Results: Discrimination index was satisfactory for all the items of the Child Sensory Profile 2. The values of Cronbach's alpha ranged from 0.795-0.919 in typical children and 0.617-0.901 in autistic children, and 0.792-0.920 in children with learning disabilities. Conclusion: The Persian version of the child sensory profile 2 is a valid (discrimination with vulnerable populations) and reliable (internal consistency) tool for assessing sensory processing.

Abstract Background A 32-base pair deletion (∆32) in the open reading frame (ORF) of C-C motif chemokine receptor 5 (CCR5) seems to be a protective variant against immune system diseases, especially human immunodeficiency virus type 1 (HIV-1). We aimed to assess the frequency of CCR5∆32 in the healthy Iranian population. Methods In this study, 400 normal samples from Khorasan, northeastern Iran, were randomly selected. The frequency of CCR5∆32 carriers was investigated using PCR analysis. Allele prevalence and the fit to the Hardy-Weinberg equilibrium were analyzed. Results The prevalence of CCR5∆32 in the northeastern population of Iran was 0.016. Four hundred samples were studied, among which one with CCR5 ∆32/∆32 and 11 with CCR5 Wild/∆32 genotype were detected. Conclusion This study was the first investigation for an assessment of the prevalence of CCR5∆32 in northeastern Iran. The low prevalence of CCR5∆32 allele in the Iranian population may result in the increased susceptibility to HIV-1. In addition, this prevalence is the same as that of reported in East Asia, while is lower than that in the Europeans.

The management of cultivation technology and fertilizer application may adjust adverse effects of abiotic stresses such as water deficit on agricultural products. Therefore, a field experiment was carried out on growth, yield, nutrient uptake and anatomical properties of maize under three water regimes (well-watered, moderate stress and severe stress as 25%, 50% and 75% soil moisture depletion), two cultivations methods (direct seeding and transplanting), and two Arbuscular Mycorrhizal Fungi (AMF) levels (inoculated with Glomus mosae and uninoculated). The results showed that in plants under moderate water stress, the AMF inoculation percent was significantly higher than those under well-watered and sever stress condition. Inoculation percent in direct seeding was lower than transplanting. Transplanting plants had higher biological and kernel yield compared to direct seeding plants. Water stress reduced the total chlorophyll (Chl) content. Transplanting had greater Chl content in comparison with direct seeding. In all irrigation regimes, transplanting significantly increased N content. In direct seeding, the highest P content was observed in moderate stress and uninoculated plants. Stomatal density increased under water stress, but stomatal size decreased. Plants under severe water stress showed increased stomatal density compared with well waterbed conditions. In addition, severe water stress enhanced the UCT compared to well-watered condition. This study suggests the use of transplanting with AMF application to cope with the adverse effects of severe water stress on maize.

Background and Objectives: The incidence of rifampin-resistant strains of Mycobacterium tuberculosis has attracted more attention than the tuberculosis infection due to laborious treatment and control. Recognizing the Mycobacterium tuberculosis genotypes involving in drug resistance via multiplex PCR, a simple and rapid genotyping method, is an emergency for better treatment and control of tuberculosis. This study was designed to specify the frequency of rifampin-resistant strains of Mycobacterium tuberculosis isolated from patients by multiplex allele-specific Polymerase Chain Reaction assay (MAS-PCR).Methods: In this study, 88 Mycobacterium tuberculosis positive samples were included from Qaem Hospital, Mashhad. MAS-PCR was used to detect the rifampin resistance associated mutations in rpoB gene. Results: Mutations in three codons of rpoB gene causing rifampin resistance were detected in 51 isolates (58.96%). The detected mutations in codons 531, 526, and 516 were 55.68%, 38.63%, and 13.63%, respectively. The simultaneous mutations were detected in 11 isolates (12.50%) in codons 531, 526 and 516, in 21 isolates (23.86%) in codons 531 and 526, and in one isolate (1.13%) in codons 526 and 516. Conclusion: According to the results of this study, the frequency of rifampin-resistant strains of Mycobacterium tuberculosis isolated from Khorasan province patients (North-East of Iran) was high. The developed MAS-PCR assay can be used for rapid detection in clinical diagnostic laboratories in areas with high prevalence of multidrug-resistant Mycobacterium tuberculosis strains. In this respect, MAS-PCR is simple, rapid, and highly sensitive method for drug susceptibility tests for detecting multidrug-resistant Mycobacterium tuberculosis.

Objectives: This study aimed at evaluating the correlation between mother-child relationship and the rate of participation of children and adolescents with cerebral palsy in leisure time activities. Methods: This study is a descriptive and correlational research. The statistical population included cerebral palsy children aged 7-17 years with a mother who is at least 25 years old. A sample size of 152 children was selected using systematic random sampling. The children filled the King assessment of participation and enjoyment questionnaire, whereas the mothers responded to a survey of Roth mother-child relationship evaluation. We collected the data and analyzed them (Spearman correlation test, One-way ANOVA, Kruskal-Wallis, and Mann-Whitney) using SPSS 16 software. Results: The results showed that there is a correlation between mother-child relationship and the rate of participation of cerebral palsy children in leisure time activities. There was a significant correlation between acceptance of child and the increasing involvement in leisure activities in case of cerebral palsy children. Over protection, excessive ease, and child rejection in a mother-child relationship was associated with reduction in the participation rate of the cerebral palsy children and adolescents in leisure activities. In case of quadriplegic children, the acceptance of child and participation rate was low compared to hemiplegic and diplegic children. Excessive ease of a mother-child relationship in girls was more than boys, but boys experienced more child rejection of a mother-child relationship than girls. Discussion: Participation rate, frequency (how often), and the enjoyment of participation in leisure time activities were correlated with mother-child relationship. Participation differences were existed among CP groups.

Context: Polypropylenimine (PPI), a cationic dendrimer with defined structure and positive surface charge, is a potent non-viral vector. Dexamethasone (Dexa) conveys to the nucleus through interaction with its intracellular receptor. Objective: This study develops efficient and non-toxic gene carriers through conjugation of Dexa at various percentages (5, 10 and 20%) to the fourth and the fifth generation PPIs (PPIG4s and PPIG5s). Materials and methods: The 21-OH group of Dexa (0.536 mmol) was modified with methanesulfonyl chloride (0.644 mmol) to activate it (Dexa-mesylate), and then it was conjugated to PPIs using Traut's reagent. After dialysis (48 h) and lyophilization, the physicochemical characteristics of products (PPI-Dexa) including zeta potential, size, buffering capacity and DNA condensing capability were investigated and compared with unmodified PPIs. Moreover, the cytotoxicity and transfection activity of the Dexa-modified PPIs were assessed using Neuro2A cells. Results: Transfection of PPIG4 was close to PEI 25 kDa. Although the addition of Dexa to PPIG4s did not improve their transfection, their cytotoxicity was improved; especially in the carrier to DNA weight ratios (C/P) of one and two. The Dexa conjugation to PPIG5s enhanced their transfection at C/P ratio of one in both 5% (1.3-fold) and 10% (1.6-fold) Dexa grafting, of which the best result was observed in PPIG5-Dexa 10% at C/P ratio of one. Discussion and conclusions: The modification of PPIs with Dexa is a promising approach to improve their cytotoxicity and transfection. The higher optimization of physicochemical characteristics, the better cell transfection and toxicity will be achieved.

Objectives: Social development in children is influenced by several factors, including family, school friends, television, gender, race, socioeconomic status, and locomotor activity, and depending on the situation and how they react to it, social development and maturity might get accelerated or get undermined. Therefore, in this study, we aimed to investigate the relationship between fine motor skills and social development and maturity in children. Methods: This is a descriptive-analytical study that included 85 children in the age group of 6-8 years (41 boys and 44 girls). We used a two-stage random sampling method in order to select samples from elementary schools in Regions 14 and 15, Tehran. Information was collected through the General Health Questionnaire and demographic questionnaire, which was filled by the parents. Fine motor skills test consisting of three subtests, i.e., response speed, visual-motor control, and upper-limb speed and dexterity, was measured using Bruninks-Oseretsky Test of Motor Proficiency. Social maturity was measured using Vineland social maturity scale. The entire process lasted for a month and the mean, standard deviation, range of changes, minimum, and maximum values were analyzed. Mann-Whitney test was used to compare mean scores of variables between male and female groups and significance level for statistical tests was analyzed at α=0.05. Results: Significant correlation between social quotient and total score of fine motor skills variable was obtained (P

Myocardial infarction (MI) (i.e., heart attack) is the irreversible death (necrosis) of heart muscle secondary to prolonged lack of oxygen supply (ischemia) which accounts for a large number of deaths in the hospital. Diagnosis of myocardial infarction is confirmed based on clinical manifestations and electrocardiographic changes along with increased cardiac enzymes. Electrocardiogram (ECG) is one of the safest and easiest methods in the first place. Therefore, this study aimed to investigate the diagnostic value of standard electrocardiogram in the diagnosis of acute right ventricular infarction following lower cardiac infarction. This research was carried out at a time interval of one and a half years to diagnose acute primary infarction. In this method, the diagnostic value of ST↓ in lead I, ST↓ in lead aVL and I ST↓ + aVL, compared with ST↑ in lead V4R was investigated for diagnosis of right ventricular infarction. ST↑ in the lead V4R is a gold standard for the detection of right ventricular MI. All the patients who had the inclusion criteria were allowed to participate in the study. A total of 66 patients participated in the study. Accordingly, 58 (87%) were male and 8 (13%) were female. The mean age of the population was 54.9 ± 11.41. According to the ST↑ standard in lead V4R, 26 patients (39%) had right ventricular myocardial infarction. There was no significant relationship between angina pectoris and premature infarction (P-Value = 0.869). In this study, the right ventricular was most commonly involved in right coronary artery (RCA) (78%). There was no significant relationship between the occlusion of right coronary artery and right ventricular infarction in 60 patients (P-Value = 0.94). The results showed that electrocardiogram manifestations help determine the occlusion site and the area at risk (ST↓ in lead aVL and aVL + I, sensitivity = 96%). In myocardial infarction, symptoms such as the ST-Segment elevation in lead aVR and ST-Segment depression in the lower leads are possible. Accordingly, in the lower infarction, ST changes in the leads V1-V6 are helpful in detecting patients at risk. Thus, the use of electrocardiogram in acute myocardial infarction (AMI) helps detect more invasive patients and prevents extensive myocardial damage and other complications.