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Background and Objectives Chelation therapy is essential for beta-thalassemia major. This study aims to determine the complications clinical and laboratory symptoms of monotherapy and combined treatment of iron chelators in beta-thalassemia major patients in Yasuj. Materials and Methods In this cross-sectional-descriptive-analytical study, 103 patients with beta-thalassemia major in Yasuj city were evaluated during 2021-2022. After collecting the demographic, clinical and laboratory information of the patients, the results were reported as mean ± standard deviation and percentage. The degree of statistical differences between ratios was calculated using the Kruskal-Wallis test. Results The average age of our patients was reported to be 24.74 ± 8.34 years. 54.4% (n = 56) of the study patients were men and 45.6% (n = 47) were women. The results of the present study showed that there was a statistically significant difference in mean ferritin among different study groups (p = 0.028). Patients treated with deferoxamine showed the highest mean serum ferritin (5925.5 ± 3397ng%) and patients who took deferoxamine together with deferiprone or deferasirox had a lower mean ferritin compared to deferoxamine alone (3348 ± 2560, 4269 ± 3322 ng%), respectively. Also, the present study showed that after taking iron removers, 47.6% of patients (n = 49) had no clinical complications and 52.4% (n = 54) had at least one complication. Conclusions Our results showed that Deferoxamine can have a great effect in reducing iron deposition and serum ferritin levels in combination with oral drugs. [ABSTRACT FROM AUTHOR]

Background & Aims: Sepsis is the principal cause of death in the first months of life and leads to 30- 50% of infant mortality in developing countries (1). The prevalence of sepsis is reported differently in many countries. In developed countries, the prevalence of sepsis is 1-4 per 1,000 live births, while in poor and developing countries it is almost ten times higher (2). Neonatal sepsis leads to 25.2% of all neonatal deaths in Iran (3). The clinical signs of neonatal sepsis are nonspecific and may be mixed with noninfectious disorders such as aspiration syndrome and respiratory distress syndrome (4,5). The most important factor in reducing infant mortality from sepsis is appropriate and quick treatment (6). On the other hand, the clinical signs of affected infants, including decreased neonatal reflexes, bradycardia, hypo/hyperthermia, respiratory distress, seizures, weakness and lethargy, apnea, and abdominal distension, are not sensitive enough to definitively diagnose sepsis. Blood tests and immunological tests also have less sensitive and specific compared to blood culture (7). Since sepsis is one of the most important causes of mortality and disability in the neonatal stage, with early diagnosis and treatment of the disease and improving the quality of care during delivery, neonatal survival can be increased, the clinical signs, predisposing factors, laboratory findings, treatment and outcome of neonates with the diagnosis of sepsis who admitted to Afzalipour hospital in Kerman were evaluated. Methods: This was a descriptive and cross-sectional study. The statistical population was all infants admitted to Afzalipour Hospital in Kerman from 2015 to 2017.The sample size was determined with the census method (sample size = 200 infants). Infants with Complete Blood Count (CBC), arterial gas measurement, C Reactive Protein (CRP), blood and urine cultures, and Cerebrospinal fluid (CSF) were included in the present study. All neonates with a diagnosis other than sepsis were excluded from the study. Based on clinical and laboratory findings, neonates were classified into three groups: 1- Infants who had positive blood culture sepsis in addition to clinical and laboratory findings. 2- Neonates who had only laboratory and clinical findings of sepsis but their blood culture was negative. 3- Infants who had clinical signs of sepsis but were negative for laboratory findings and blood culture. All infants were treated with antibiotics immediately after the tests. Clinical and laboratory findings as well as the type of antibiotic and maternal and neonatal risk factors were collected using a checklist. Outcomes of treatment were expressed as improvement and discharge, complications, and death. The collected data were analyzed using SPSS software version 25 (version 25, SPSS Inc., Chicago, IL). Quantitative data were presented as Mean ± SD (standard deviation) and frequency and percentage. Results: The highest age of infants was related to the birth group (91%). 59.5% of infants were male and 40.5% were female. The mean duration of admission was 9.76. 1.05 days. The most common clinical signs were tachypnea (74%), poor nutrition (36%), apnea (32%), and hypo/hyperthermia (25%) respectively. The results showed that 91.5% of participants used ampicillin, 93% of them gentamicin, 84% of them used vancomycin, 52% of them used meropenem, 18.5% of them used metronidazole, 19.5% of them used amikacin, 18 % of them took cefotaxime, 19% of them used fluconazole, 1% of them used clindamycin and 1.5% of them used ceftazidime Regarding the frequency distribution of risk factors, the results showed that 23.5% of participants had PROM (Premature rupture of Membrane), 11 % had maternal urinary tract infection, 12 % had maternal fever and 91.5% had low birth weight. The results showed that the mortality rate for participants was 78% and the rate of discharge and recovery was 22%. The results showed that the mean number of white blood cells was 16.468 ± 0.103 × و 103 and the mean CRP of the participants was 22.6 ± 2.8. The results of this study also showed that 14.5% of participants had positive blood cultures and 85.5% of them had negative blood cultures. Conclusion: Systemic and local infections are very common in infants. Sepsis is a systemic response to infection and is divided into early, late and nosocomial types (17). The results showed that 59.5% of the participants who had early sepsis were male and 40.5% of them were female, which is consistent with the results of Khalili et al. (13). While in the textbooks, the incidence of male infants is twice as high as female infants (18). In the study of Arab Mohammadi et al., 60% of patients were boys and 40% were girls. In this study, the most common clinical symptoms were tachypnea (74%), hypo/hyperthermia (25%), and tachycardia (5%), respectively, which is consistent with the results of Hengst et al. (10) while it is not similar to the results of Khalili et al. (13), Santana et al. (9) and Vergnano et al. (14). In other textbooks, the most common clinical symptoms are fever, jaundice, respiratory distress, hepatomegaly, anorexia, vomiting, and cyanosis (19). In the study of Shiva et al. (20), a total of three symptoms of tachycardia, tachypnea, hypothermia had a sensitivity of 53.6% and a specificity of 100% in identifying sepsis with positive blood culture. In the study of Arab Mohammadi et al. (21), hyperthermia, jaundice, respiratory distress, hepatomegaly, anorexia, vomiting, lethargy, and cyanosis were reported as the most common symptoms of sepsis. Investigation of 500 infants suspected of sepsis, temperature instability, and respiratory symptoms were the most common symptoms. The results showed that 14.5% of the participants had positive blood cultures and 85.5% of them had negative blood cultures. This rate (positive blood culture) was 15.4% for the study of Khan et al (22). This rate was 14% in the study of Manucha et al. (23) in India. The reason for the lack of positive blood culture is neonatal SEPSIS is one of the diseases in which the actual number of cases is much less than the number of suspected cases and laboratory-related problems also play an important role in this results (24). The prevalence of sepsis with positive blood culture has been reported in the study of Shiva et al. 25% (20), Samaei et al. 41% (25), and Hosseini et al. The results showed that the mean CRP of the participants in our study was 22.6. 2.8. According to textbooks, if CRP is performed in combination with other tests, it is effective in screening for sepsis, but if used alone as a primary test to look for infection, it helps in less than 10% of definite diagnoses (26, 27). CRP sensitivity has been reported from 46 to 74% in various studies (28). In the meta-analyzes about this subject, the first time CRP sensitivity was 39%, CPR specificity was 92.5%, positive predictive value was 53.2% and negative predictive value was 93.6%. Therefore, it seems that the serum level of CRP for the first time at the time of admission in infants suspected of early neonatal sepsis in the neonatal intensive care unit (NICU) has no value in determining sensitivity (29). In the study by Zecca et al, the negative predictive value of CRP was 100% (30 %). A study by Cetinkaya et al on 100 infants suspected of having early neonatal sepsis showed that the diagnostic power of CRP increased over time and peaked 24 to 48 hours after the onset of sepsis, which is consistent with our study (31). Therefore, if serum CRP levels remain negative 24 hours after the onset of clinical symptoms, the high negative predictive value is 99%, and antibiotic therapy can be discontinued in the absence of strong clinical suspicion of sepsis (32). [ABSTRACT FROM AUTHOR]

Background Oral lesions can affect people’s quality of life by interfering with chewing, swallowing, and speech. These lesions may originate from epithelial or mesenchymal tissues. Malignant oral lesions can be life-threatening. Epidemiological data of oral lesions in Iran is limited. Objective This study aims to investigate the frequency of oral lesions in Rasht, Iran. Methods In this cross-sectional study, histopathologic data of oral lesions reported by Razi laboratory in Rasht from 2015 to 2019 were evaluated. The data collected: Patients’ age and sex, histopathologic findings, and location, type and origin of lesions. Non-specific diagnoses and dental and bone lesions were excluded. Results A total of 259 pathologic reports were included. The mean age patients was 52.09±19 years, and 40.2% were male. Oral lesions in patients aged <40 years were mainly benign (64.2%), whereas half of lesions in patients ≥70 years were mostly malignant. Tongue was the most common location of the lesions (34.7%) and the main location for malignant lesions (46.7%). Benign lesions were significantly higher in females whereas malignant lesions were significantly higher in males (P=0.011). Epithelial tissues were the most common site of origin (49%) and salivary glands were the least common site of origin (11.6%) for oral lesions. Conclusion Malignant oral lesions are more common in Iranian men aged >70 years, where the tongue is the most common site of involvement and epithelial tissue is the main site of origin. [ABSTRACT FROM AUTHOR]

Background & Aims: The modern world today allows images to be received and stored digitally. To get better results, it is sometimes necessary to make changes to these images. These changes pursue three main goals: image processing, analysis, and comprehension. For this reason, computer image processing systems have been developed to perform these operations with better speed and accuracy. Four major processes occur in these systems: preprocessing, image quality enhancement, image conversion, and image classification and analysis. In these methods, using mathematics, rules have been created by the computer to simulate human visual elements, and it is an aspect of image analysis that is used for specific purposes. Skin imaging systems provide the ability to process images in high volume and with minimal time and cost, as well as increase the accuracy of diagnosis and classification of diseases. These systems, fatigue, human error and other weaknesses that the diagnostician can suffer. Do not have it (1). The first step in diagnosing skin diseases and analyzing digital images of patients with skin lesions is to take a color photograph of the lesion area. One of the most valid methods for this is the use of a dermoscopic device (2). Dermoscopy, also known as dermatoscopy, is an effective tool for dermatologists involved in early diagnosis. Using dermoscopically evaluated pigmented lesions, abnormal structural features are detected and the border of the lesions is accurately observed (3). Accordingly, benign lesions can be detected without the need for biopsy. Dermoscopy increases the accuracy of the diagnosis and helps GPs to correctly identify people with suspected lesions who need to be referred to a specialist. Dermoscopy is also effective in diagnosing non-pigmented skin lesions and inflammatory dermatoses. In dermoscopy, the skin is examined using a special microscope (4). Methods: The proposed algorithm of this research can be divided into 7 separate steps (loading data set, data integration: data balancing with data amplification or data augmentation technique, data cleaning: clearing images to remove hair noise, slicing images to separate skin from skin Healthy, data conversion: data preparation, convolution neural network design (CNN) and training of the proposed model for image feature extraction, classification combination and mass learning by majority voting method). Which was implemented in Python language in Google Columbine environment and supervised. For this study, 25,331 dermoscopic images consisting of skin lesions were included (70% educational images, 15% experimental and 15% validation). In data preprocessing, the data were balanced, then the data cleaning operation was performed to remove hair noise, and the data reduction operation was performed to segment the images by separating the lesion from healthy skin. In the next process By designing the convolution neural network, training data were extracted for feature extraction, and by combining the classifiers, an automated system for diagnosing skin diseases was created and evaluated in dermoscopic images. Results: In the proposed method of hair noise removal, the quality of images is increased and also the separation of the lesion from healthy skin is optimally designed to accelerate image processing to extract high-level features in the convolutional neural network and increase the accuracy of diagnosis and classification to create An automated diagnostic system is a feature of this study compared to other studies. According to the research results, the use of an automated system for the diagnosis and classification of skin diseases and cancers for health-related care is recommended. Comclusion: Today, the applications of artificial intelligence are not hidden from anyone. Among these, machine learning as one of the most important branches of this field has a special place in all sciences. Deep learning has proven its worth by using the basics of artificial neural networks in solving many issues in the field of medical image processing such as classification. Experts also based on various experiences of using training methods to conclude that there is no single specific training algorithm that can be successful for all applications and has the highest accuracy. Hence they suggest combined learning. According to the important results, although each of the algorithms had a successful performance individually, but combining several algorithms with each other has led to higher accuracy and less error-making decisions. This study is a step towards helping physicians and specialists in diagnosing skin diseases and benign and malignant skin cancers and can help GPs or other physicians to better manage high-risk lesions. Secondary triage as well as avoid unnecessary treatments and minimize biopsy, which is an invasive and costly procedure. This research helps to provide health-related care, forecasting and treatment, as well as cost savings for both patients and health care providers. Also, in deprived areas and far from the specialist, dermoscopic devices with the help of this algorithm can cause timely treatment and reduce patients' costs and time in the field of diagnosis and, if necessary, referral of patients to the desired specialist. Available as a commercial software package. This software package has the ability to connect to dermoscopic devices. By connecting this software package to dermoscopy, a device is created to quickly diagnose skin diseases and cancers. The greatest value of this dissertation is that it is used as a benchmark for designing future studies and evaluating skin cancer diagnosis techniques in patients who are usually examined by a general practitioner and specialist. The findings of the present study are also consistent with the results of Andre and Pachko (2019) research on the diagnosis of skin cancer based on deep learning and entropy for Perth samples (6). [ABSTRACT FROM AUTHOR]

Background & Aims: One of the most important tests for the detection of antibodies against neutrophil cytoplasm in autoimmune vasculitis diseases is the Antineutrophil Cytoplasmic Antibodies (ANCA) test. The ANCA test is the first order in the initial diagnosis and screening of patients with suspected autoimmune diseases, including small-vessel vasculitis, as well as the follow-up of patients' treatment, which uses indirect immunofluorescence assay (IFA) to detect the presence of antibodies against antigens in the cytoplasm of neutrophils. In addition to vasculitis, the evaluation of this antibody is used in other autoimmune diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and inflammatory bowel diseases (IBD). To prepare IFA slides for diagnostic purposes, neutrophils extracted from human peripheral blood are used as substrates. The IFA is a common and acceptable method in medical diagnostic laboratories for the detection of these autoantibodies. The first experience in the development of this technique back to the work of Koons and Kaplan, although today, this method has been widely developed in the field of laboratory diagnosis as well as research in basic medical sciences. A distinct advantage of the immunofluorescence assay is its applicability to fresh tissue and fixed cells. This method is based on the specific antigen binding to specific antibodies conjugated with fluorescent dyes and fluorescent light emission. There is two common types of immunofluorescence assay include direct and indirect immunofluorescence used for detection autoantibodies. In the direct immunofluorescence method, specific antibodies are conjugated to fluorescent dyes, and by binding to their specific antigen, the green fluorescent light is recognized under a fluorescent microscope. Although this procedure is faster, it is less often applied in medical diagnostic labs. In the IFA method, a specific antibody against the target antigen (called the primary antibody) binds to the target antigen recognized by a secondary antibody that is against the fixed region of the primary antibody and conjugated with fluorescent dyes, such as fluorescein isothiocyanate (FITC). In the indirect immunofluorescence assay, due to the binding of several secondary antibodies to the primary antibody, the generated fluorescence signals will be amplified, which in turn increases the fluorescence intensity and sensitivity. The aim of this study was to design and prepare slides for antibodies detection against antigens in cytoplasm neutrophils by the indirect immunofluorescence method. Furthermore, the next step by optimizing fluorescent patterns to detect different types of antibodies against neutrophil cytoplasm by indirect immunofluorescence method. Since 1980, the search for antibodies against the neutrophil cytoplasm has been recognized as one of the most effective diagnostic tools for diseases associated with small to medium-sized vasculitis. ANCA in the diagnosis and follow-up of the treatment of vasculitic diseases including granulomatosis with polyangiitis, formerly known as Wegener granulomatosis, microscopic polyangiitis, Eosinophilic granulomatosis with polyangiitis, formerly known as Churg – Strauss syndrome, is used. Most laboratories around the world use IFA for screening and early detection of ANCA. After the ANCA test is positive, the target antigens of the antibodies are evaluated by the ELISA method. The two most common targets of autoantibodies are myeloperoxidase (MPO) and proteinase-3 (PR-3) in patients with vasculitis. However, a clinical association of these vasculitis diseases with other antigens such as elastase, lactoferrin, azurocidin, lysozyme, H-Lamp-2, and other lesser-known antigens has also been observed. Antibodies against neutrophil cytoplasm have also been reported in other small vessel vasculitis diseases such as microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (EGPA), and necrotizing crescentic glomerulonephritis. Initially, the non-commercial ELISA method was used to diagnose PR3-ANCA and MPO-ANCA, but inconsistent results between laboratories showed the global need for standardization of this test . In 1998, fifteen laboratory centers around the world evaluated and standardized the standard method for measuring antibodies against neutrophil cytoplasm (ANCA) and its specific antigens, including PR3 and MPO, by indirect immunofluorescence and ELISA in patients with idiopathic systemic vasculitis. . The result of this standardization increased the detection value of ANCA by immunofluorescence and ELISA methods. One of the most important pillars of the commercialization of a product is the supply of raw materials with appropriate and sustainable quality. The first step in producing ANCA slides is the isolation of high purity and standard quality peripheral blood neutrophil cells. Peripheral blood neutrophils are short-lived, highly sensitive cells that cannot be stored for long periods of time, and it is recommended that these cells be isolated from whole blood immediately after blood sampling. To date, several methods have been proposed to isolate neutrophils from peripheral blood. In this study, it was shown that using the dextran method and subsequent separation by centrifugal gradient method with filament is one of the cost-effective methods with high purity to provide the ANCA test substrate. Methods: Using the Ficoll density gradient centrifugation and dextran solution, neutrophils were isolated from the peripheral blood of healthy individuals (without a history of any disease, especially autoimmune diseases in themselves and first-degree relatives). The purity and efficiency of the isolated cells were evaluated by Wright Giemsa staining, the neobar slide, and an automatic counting machine. Isolated neutrophils were fixed on slides using an ethanol fixative. At this stage, by selecting the best protocol, in terms of time and type of neutrophil fixation stage, they were fixed on the slide. In the next step, using positive and negative samples that have already been determined by ANCA with valid commercial kits (IVD certified), the slides containing fixed cells were fluorescent stained and compared with control samples. Results: The number and purity of neutrophils isolated were evaluated by a Sysmex automatic cell counter. Depending on the peripheral blood neutrophils, the mean(±standard deviation) of the number of isolated neutrophils was 6000(±950) cells per microliter. According to white blood cell differential count, the mean purity of isolated neutrophils was 94.1%. Also, by trypan blue staining, the percentage of viable cells was determined to be more than 85% before fixation. The results of ANCA indirect fluorescent staining on the prepared slides were completely consistent with the results of control samples. Conclusion: The results of this study showed that the method used can be applied for the commercialization and production of ANCA slides. In this regard, in addition to optimizing the steps of separation and fixing the neutrophils, it is necessary to evaluate and optimize the stability of the prepared slides during storage and production in order to produce in large numbers. [ABSTRACT FROM AUTHOR]

Background & Aims: Nanotechnology is one of the newest, most important and most efficient sciences in the world. It is an interdisciplinary technology that has caused significant changes and developments in the sciences by solving problems and shortcomings. Nanoscience and nanotechnology is the production of nanometer-sized material that has recently attracted the attention of many researchers in the fields of medicine, agriculture and industry. The great importance and application of this technology has attracted much attention. Nanoparticles are particles about 1 to 100 nm the properties of these materials depend on their nanometer size. Nano materials have unique properties including lightweight and small nanoparticles, High surface-to-mass ratio, using in small quantities, saving consumables, being multifunctional and safe for the environment. Chitosan is a linear amino polysaccharide that has been taken into consideration for its properties such as non-toxicity, antibacterial properties, adhesion properties, unique structure, multidimensional properties and high performance. Physical and chemical methods are mostly used to produce nanoparticles. Although these methods may be successful and well-known, they are generally expensive, time-consuming, and dangerous to the environment and humans. Therefore, alternative methods such as microorganisms, fungi, plants, plant extracts and plant biomass should be used instead, which have less environmental hazards. Among the methods of synthesis of chitosan nanoparticles, green synthesis using plant extracts is more beneficial than other methods. Many plant biomolecules such as polyphenols, flavonoids, amino acids, polysaccharides, alkaloids, alcohols, vitamins and proteins can play a role in the formation and stabilization of nanoparticles. The aim of this study was to develop a green method using the extract of the aerial parts of the Russian knapweed to prepare and produce chitosan nanoparticles. Methods: In this study, chitosan nanoparticles were synthesized in a process by the extract of Russian knapweed (Acroptilon repens L.) which containing phenolic compounds. In order to preparation the materials needed for the experiment, the aerial parts of the Russian knapweed in the pre-flowering stage were collected from a land in Ardabil with severe contamination. The collected plant was transferred to the weed laboratory and dried at 60 °C for 72 h in the oven. The dried samples were powdered by a grinding (mill) machine. The aqueous extract was prepared by maceration method. 100, 150 and 200 grams of Russian knapweed powder in to erlenmeyer flask spilled and then added a certain amount of twice distilled water until the final volume reaches of 1000 ml. Then they were placed on the shaker at 25 °C for 24 hours. The obtained extracts were smoothed using Whatman filter paper. At the final stage, the extracts were centrifuged at 5000 rpm for 15 minutes and supernatant were extracted as pure extract and were kept at 4 °C for testing. Chitosan nanoparticles were prepared using ionic gelation method. In the present study, commercial chitosan with medium molecular weight was used. At first, 3 g of chitosan was dissolved in 300 ml of distilled water and placed on a magnetic stirrer at 550 rpm to dissolve completely and evenly at room temperature (with one magnet). To adjust the pH =5, some acetic acid was added. Then a certain amount of Russian knapweed extract was added to it. In the next step, 0.5 g of sodium polyphosphate (TPP) in 50 ml of distilled water was completely dissolved and added drop by drop to the chitosan solution, that was stirring on a magnetic stirrer, and the stirring process continued for 60 minutes. This was repeated for all 3 concentrations of Russian knapweed extract separately. After the reaction time, the final solution was centrifuged for 5 min and after smoothing, the top solution of sediments deposited in the oven was dried for 24 h at 60 °C. Results: Basic techniques for investigation and determination of nanoparticle properties including: thermogravimetric analysis (TGA), Fourier transform infrared (FT-IR), X-ray diffraction (XRD) and Scanning Electron Microscope (SEM) tests. The samples obtained by these tests were analyzed. Infrared spectroscopy was used to investigate the vibrational frequencies of chemical compounds. Thermal weight measurement analysis method, which is based on weight changes during sample heating, was performed to investigate the difference in thermal stability of the samples in the temperature range of 0-700°C. X-ray diffraction pattern of the samples was performed using Cu-Ka radiation. Surface morphology and particle distribution were also obtained using scanning electron microscopy with accelerator voltage k 15. In Spectrophotometric analysis, the presence of a peak in the range of 700 nm indicates the biological synthesis of these nanoparticles with extract of Russian knapweed. FTIR spectroscopy showed the biomolecules present in the extract and involved in the synthesis, which confirms the process of green synthesis of chitosan nanoparticles. In the FTIR spectrum obtained from chitosan nanoparticles with aqueous extract of Russian knapweed and pure extract of Russian knapweed, the presence of factor groups confirming the existence and presence of effective antioxidant compounds such as phenols and flavonoids in the plant extract is used. Based on this, the participation and involvement of phenolic compounds in the Russian knapweed in the synthesis of chitosan nanoparticles is quite clearly observed and understood. The size and morphology of biologically synthesized nanoparticles were determined by scanning electron microscopy, and it was found that the shape of the nanoparticles produced is approximately spherical with an average size of about 33 to 76 nanometers. One of the main reasons for the difference in the shape and size of the synthesized nanoparticles is the different concentrations of the plant extract used. The results of X-ray diffraction analysis also showed the nanocrystals synthesized by the extract of Russian knapweed. Conclusion: According to the results, it can be said that the polyphenolic compounds in the Russian knapweed extract were acted reducing agents, and also as a complexing agent synthesize chitosan nanoparticles and make them sustainable. The process of ion reduction and synthesis of nanoparticles are done by primary and secondary metabolites such as antioxidants, flavonoids, flavonoids, isoflavones, anticyanidins, isothiocyanates, carotenoids and polyphenols present in the extract. According to the obtained results, plant extracts have a good compatibility with the environment, so that they can be used for rapid production of chitosan nanoparticles, which is a simple, green and efficient method for the synthesis of nanoparticles at room temperature. It is a reducing and inhibiting agent without the use of any chemicals. [ABSTRACT FROM AUTHOR]

Medical laboratories have significant role in diagnosis, management and follow up of the patients. Occasionally, some results are “critical”, meaning that urgent/emergent intervention is required in order to prevent major morbidities or mortality. During the last 40 years, significant attention has been paid to these results by laboratory specialists or clinicians. Rapid communication and reporting of critical results to management team has been emphasized and been considered as a requirement by some regulators. While rapid reporting of critical values has been accepted universally, the details of confirmation and rout of reporting has not been standardized. Herein, we present a brief review of various aspects of critical value results, such as how to diagnose, confirm and report them and describe theses process in our country and through the world in order to reach a rather harmonized protocol capable of being established based on regional conditions. [ABSTRACT FROM AUTHOR]

In this study, the hydraulic characteristics of the flap gates are installed at the end of the trapezoidal channels were investigated by laboratory study. In the physical model, three trapezoidal channels and four gates with different weights were used (12 gates for three channels). Based on several experiments, equations for estimating of flow rate for each side slope (each channel) were developed using dimensional analysis. In this research, five forms of discharge-stage relationship were used to obtain relationships for each side slop to estimate flow rate, separately. The results show that none of the discharge-stage relationships forms as a single relationship for all flap gates in a certain channel are suitable for estimating discharge. But the first, second, and third forms of the discharge-stage relationship are very suitable for estimating the flow rate in a certain channel for a certain flap gate. In other words, for each gate with a specific weight, a separate (unique) relationship is obtained to estimate the flow rate in the form of the first to the third discharge-stage relationship in a certain channel. To estimate of flow rate by using the first form of the discharge-stage relationship, the maximum values of statistical parameters of RMSE, ME, and MARE, among all three channels, are 0.0001 m³/s, 0.00022 m³/s, and 0.22 percent, respectively. The values of all the above statistical parameters for the first, second, and third forms of the discharge-stage relationship are presented in the article. [ABSTRACT FROM AUTHOR]

Oxidation of lipids in foods is one of the most important chemical events during food frying.The resulting chemical indices contribute to various diseases such as atherosclerosis, cancer, premature aging, respiratory distress syndrome and various liver disorders. The overall objective of this study was to investigate the chemical factors of the oils used in Fried falafels. and then compared with the case controlled conditions in the laboratory.This study was performed on 50 samples prepared in the shop. Peroxide, anisidine number, total oxidation value (TOTOX) and Kreis test were measured to investigate the destructive effect of falafel compounds on oil, then was compared with the case controlled samples according to the relevant standards in the laboratory.In this study, more than half of the samples could not be used and only 42% of the samples were approved.The mean and standard deviation for this values in the control sample were 4.39±0.62, 6.09±0.87 and 15.68±2.09 respectively.Also, there was a positive correlation between the values of peroxide, anisidine and TOTOX with Kreis's test.Based on the results, it was found that most of the chemical factors in the samples were above the permissible limit and used oils on the shops are unhealthy and unusable. Therefore, due to the dangers of primary and secondary oxidation on human health, implementation of training programs and application of the proper way to prepared foodfor the staff of these centers is essential. [ABSTRACT FROM AUTHOR]

Background and Aims: Escherichia coli O157:H7 is one of the main causes of transmitted diseases by food, including meat and meat products. The purpose of this study was to investigate the prevalence of E. coli O157:H7 contamination in Mashhad with the detection of rfbE gene. Materials and Methods: For this study, 148 slaughtered beef samples from Mashhad (spring to winter, 2018) were randomly collected and transferred to the laboratory. The identification of E. coli O157:H7 was performed by biochemical methods and rfbE gene was detected by PCR colony method. Results & Discussion: Based on biochemical tests, E. coli O157:H7 was isolated in 7 (4.73%) samples of slaughtered beef and after PCR colony; only 2 (1.35%) of these 7 samples were approved. According to the results of this study, it can be concluded that beef can be considered as a major reservoir for E. coli O157:H7 and there is a potential for transmission of this pathogen to humans through the consumption of beef and its products. Also, the specific primers of rfbE gene were able to differentiate the E. coli O157:H7 colonies from other cultured colonies on the culture medium during the PCR process. The present research was performed for the first time in the city of Mashhad. [ABSTRACT FROM AUTHOR]

Background and Objective: Clinics, laboratories and health care centers are considered as one of the main waste generating sources in solid waste management. The problems associated with the generated health-care waste in clinics, laboratories and health care centers have been rarely investigated in Iran. Therefore, the present study was developed to investigate the status of health care waste in clinics, laboratories and health care centers of Mahmoudabad, Mazandaran in 2017. Methods and Materials: This cross-sectional study was conducted to determine the status of solid waste management in 117 medical centers in Mahmoudabad, Mazandaran, 2017. The solid waste data in terms of waste generation rate, storage, collection, and disposal were surveyed through interview and questionnaire that were validated by Iran’s ministry of health. Results: The average health-care waste generation in medical centers in Mahmoudabad was found to be 248 g/day. The mean and standard deviation for environmental health criteria in all medical centers were 248.3 and 41.1, respectively. In addition, there was a statistically significant difference between the amount of waste generation in private and governmental medical centers (p=0.111). Conclusion: The results obtained from the present research indicated that the medical waste management in Mahmoudabad, particularly in private centers, face serious problems. Improper waste collection technology, mixing municipal and medical waste, requirement for training the personnel in medical waste management and surveillance can be considered as important concerns in healthcare waste management in Mahmoudabad. [ABSTRACT FROM AUTHOR]

Background: Hepatitis B DNA polymerase chain reaction (HBV-DNA PCR) is a test that is used in the evaluation and treatment of hepatitis B but this test is pretty expensive and may not be available everywhere. Quantitative test of serum hepatitis B surface antigen may be a surrogate test, which is available with much low price. The aim of this study was to compare the accuracy of these two tests. Materials and Methods: Patients with positive HBsAg who referred to Boali laboratory in Yazd, Iran for HBV DNA test in 2012-2014 were selected and divided into three groups as inactive carriers, those at the beginning of treatment, and those on treatment (30 patients in each group). HBV DNA PCR was performed with real-time PCR method with sensivity of 150 IU/mL. HBsAg and HBeAg levels were measured by electrochemiolance. The level more than 0.05/mL was considered positive for HBsAg. Results: Serum hepatitis B surface antigen quantitative level was significantly different between group one and group two, and also between group one and group three (p = 0.001) but it was not different between group two and three (p = 0.7). Serum HBV quantitative level and HBV DNA had a positive relation (p = 0.001, R = 0.527). There was a relation between HBsAg and viral load in group one (p = 0.017, R = 0.431) and group two (p = 0.023, R = 0.427) but there was not such a correlation in group three (p = 0.27, R = 0.22). Conclusion: HBsAg quantitative measurement may be a surrogate test for evaluation of patients with hepatitis B because it is simpler and economic. [ABSTRACT FROM AUTHOR]

Background and Aims: High prevalence of Methicillin Resistant Staphylococcus Aureus isolates (MRSA) as well as the multi-drug resistance in this bacterium causes difficulties in the treatment of infections due to these bacteria. Hence, detection of MRSA isolates by rapid and accurate methods is necessary. PCR-ELISA is an accurate and molecular technique that is used for the detection of several pathogens. The aim of this study is the detection of MRSA using PCRELISA. Materials and Methods: Specific primers for mecA gene were designed. Then, dNTP labeled with Digoxigenin was applied for amplifying mecA gene. DIG-labeled PCR products were seeded on the well coated streptoavidin and identified by anti-DIG-peroxidase conjugate. Furthermore, Biotin-labeled DNA probe specific for mecA gene was used. Sensitivity and specificity of the method was determined. Resistance to methicillin among 70 clinical isolates was determined by the disk diffusion, agar dilution and PCR-ELISA methods. Results: MecA gene of S. aureus was amplified using gene specific primers resulted in a fragment with 310 bp length. Findings from the PCR-ELISA technic showed no cross-reactivity with Klebsiella Pneumoniae, Bacillus subtilis and Esheriashia coli as control bacteria and its sensitivity was 0.5 ng. The prevalence of MRSA clinical isolates by the disk diffusion, agar dilution and PCR-ELISA methods was 60%, 58.5% and 60%, respectively. Conclusion:The PCR-ELISA technique was known as an accurate and rapid test for the detection of infection agents using their specific gene. This technic can applied as an appropriate alternative method for time-consuming, less sensitive and expensive techniques such as Real-time PCR and differential biochemical tests which are currently used in laboratory. [ABSTRACT FROM AUTHOR]

Background and Aim: In recent years, Multidrug resistance has been increasing among Klebsiella isolates. The aim of this study was to survey existence of integrons and its relation with antibiotic resistance among clinical isolates of Klebsiella. Materials and Methods: From Jun 2015 to May 2016, 129 Klebsiella isolates collected from Karaj hospitals and laboratories. Statistical population included 80.6% female and 19.4% male. Antimicrobial susceptibility was performed using Kirby-Bauer disk diffusion and ESBLs producer were screened. Integrons were detected using PCR. Ethical Considerations: This study with research ethics code IR.IAU.K.REC.1396.16 has been approved by research ethics committee at Islamic Azad University of Karaj, Iran. Findings: The highest and lowest percentage of sensivity were found to ofloxacin (89.1%) and amoxcicillin (6.2%), respectively. 82.9% of isolates were resistant to more than two antibiotics from different classes. Among 129 isolates, 19.3% of the isolates harbour integrons. Frequencies of MDR among integron-positive isolates were 100%. Also, 71.3% and 28.7% of isolates were ESBLs positive and negative respectively. Conclusion: Results showed integron elements were prevalent among MDR isolates. Integron-associated resistance genes can be served as reservoirs of multi drug resistance within clinical isolates and presence of integron can be used as a marker to identify MDR isolates. Prevalence of ESBLs among clinical isolates of Klebsiella showed that antibiotics like ampicillin or amoxicillinclavulanic acid are not effecvtive anymore in treatment of UTIs. [ABSTRACT FROM AUTHOR]

Background and Aims: Cervical cancer is the second most common cancer in women worldwide. The presence of HPV has been implicated in more than 99% of cervical cancer worldwide. Human papillomavirus is a heterogeneous virus, categorized to two groups of highrisk and low-risk genotyped according to the level of infection that leads to cervical cancer. HPV screening is recommended for the further evaluation of abnormal pap test or during follow-up after treating precancerous lesions. Genotyping of different high-risk HPV (hrHPV) types obtained from smear tests has not yet gained widespread acceptance in clinical practice. Genotyping of hrHPV could be helpful for the risk stratification of HPV-positive. Materials and Methods: In this study 143 women residual samples were available for HPV assays in Masoud laboratory in Tehran. After extracting DNA by kit, for genotyping detection of human papillomavirus PCR amplification, Reverse dot blot hybridization methods was used. Results: Among these samples, 34.2% were HPV positive. In this research, the most common genotype was HPV-18 from high risk HPV genotype and HPV-6 was the most common from low risk genotype of HPV. The most Age category that has been detected positive HPV from category 26-35 years. Conclusions: The variety of HPV genotype detection in cervical cancer screening increases the importance of epidemiological study controversially in world. Therefore for characterizing genotype of HPV, Reverse dot blot hybridization can be of great help in this regard. [ABSTRACT FROM AUTHOR]

Background and Aim: The quality of healthcare services is determinant in patients’ improvement process, upgrading their satisfaction, ranking healthcare centers, and preventing patients’ repeated referrals leading to more costs for healthcare centers and insurance companies. The purpose of this study was to evaluate the quality of services -- from the perspective of patients -- given by the laboratories having contract with Iran Health Insurance Organization (IHIO). Materials and Methods: In this cross-sectional study, the opinions of 302 patients having referred to the laboratories in contract with IHIO in Tehran were surveyed with a researcher-developed questionnaire. Descriptive and inferential statistical tests were used to analyze and report the results. Results: The sample included 43.5% males and 56.5% females. Most of the participants were married (71/3%). Based on the results, the patients' perception of the quality of laboratory services was 78%. Their expectation of services was 85%. The gap between perception and expectation of clients in all dimensions was statistically significant (p<0/001). Conclusion: The gap between clients’ perception and expectation in all dimensions suggests that there is some room for improving the quality of laboratory services. The results of this assessment can surely affect the way IHIO treats with laboratories in terms of extending contracts and strategic purchase of services from these centers. In addition, patients' opinions will be important in improving the quality of services. Keywords: Private Laboratories, Iran Health Insurance Organization (IHIO), Tehran, Patients' Perception and Expectations, Service Quality [ABSTRACT FROM AUTHOR]

Background: DNA-based computing is an emerging research aspect that enables the in-vivo computation and decision making with significant correctness. Recent papers show that the expression level of miRNAs are related to the progress status of some diseases such as cancers and DNA computing is introduced as a low cost and concise technique for detection of these biomarkers. In this paper, DNAbased logic gates are implemented in the laboratory to detect the level of miR-21 as the biomarker of cancer. Materials and Methods: At the first, required strands for designing DNA gates are synthesized. Then, double stranded gate is generated in laboratory using a temperature gradient that followed by electrophoresis process. This double strand is the computation engine for detecting the miR-21 biomarker. miR-21 is as input in designed gate. At the end, the expression level of miR-21 is identified by measuring the generated fluorescent. Results: at the first stage, the proposed DNA-based logic gate is evaluated by using the synthesized input strands and then it is experimented on a tumor tissue. Experimental results on synthesized strands show that its detection quality/correctness is 2.5x better than conventional methods. Conclusion: Experimental results on the tumor tissues are successful and are matched with those are extracted from real time PCR results. Also, the results show that this method is significantly more suitable than real time PCR in view of time and cost. [ABSTRACT FROM AUTHOR]

Background: Acinetobacters are aerobic gram-negative bacteria which are distributed widespread in soil and water. The bacteria are isolated from cultured skin, mucous membranes, secretions and hospital environment. Acinetobacter baumannii, is a strain that more frequently isolated. Acinetobacter strains are often resistant against antimicrobial agents. Materials and Methods: The method of this study was based on field, observation and test. On August and October 2015, samples were isolated from the soil and water of the Sadeghieh Square river in Tehran, respectively, and were transferred to the laboratory in the ice pack. 50 baumannii samples were isolated by biochemical methods (TSI, SIM, OF and gram test). November 1394, 100 clinical samples were isolated from Imam Khomeini hospital by biochemical method, and in the culture media Mueller Hinton agar plates were transferred to the laboratory. Antibiogram test for 150 baumannii samples was performed. Biofilms formation of Acinetobacter baumannii environmental and clinical samples was investigated by Congo red agar and culture plate methods. Results: In all samples (clinical and soil), most of antibiotic resistance was 92% for imipenem and the resistance of water samples to imipenem was 99.9%. Biofilm formation by Congo red agar in water, soil, and clinical samles was resprctively 44%, 40% and 1%. All isolates were negative biofilm culture plate. Conclusion: Considering Acinetobacter baumannii resistance to antibiotics and the lack of biofilm formation of in clinical and environmental isolates, it was concluded that there wasn't any relationship between antibiotic resistance and biofilm formation [ABSTRACT FROM AUTHOR]

Background and Aim: Nowadays, clinical laboratories play important roles in health care systems and well-trained staff are in need more than ever before. Thus, educating students in this field is one of the best approaches in saving energy and expenditure of health-care systems in any community. The aim of this descriptive study was to assess the different aspects of the pedagogical curriculum for Iranian laboratory science students compared with that of world's leading universities. Materials and Methods: In 2014, pedagogical curriculum of this major in Iran was compared to the curriculum of 17 prestigious universities in the world. Also, a questionnaire was filled out by the faculty members of medical universities who were involved in training clinical laboratory science's students. Results: The results showed that the Iranian curriculum has various drawbacks in clinical apprenticeship for students, and is short of specific credits such as Microbiology and Immunohematology. In addition, lack of practical or applied credits like Urine Analysis, Body Fluids, Microscopy and Medical Ethics was noticed. It was discovered that little attention was paid to preparing students for research. Conclusions: Considering the findings of the current survey, decreasing the credits offered in each semester with proper training course scheduling and monitoring the students, will not only help the students to proper learning, but also lead to the delivery of other goals. Also, due to the significant role of these students in the healthcare system, it is necessary to hold practical and theoretical exams of this course before entrance of students to the labor market in order to prevent the probable detrimental impacts on the healthcare system. [ABSTRACT FROM AUTHOR]

Introduction: Neonatal hypoglycemia is an emergency condition requiring immediate treatment to prevent serious outcomes. Today, blood glucose meter is a current method for detecting blood glucose in the health centers of our country, while the hypoglycemia can not be confirmed or denied certainly with glucometer. Objective: This study aimed to evaluate the accuracy of blood glucose meter in comparison to that of laboratory method and determine the optimal cut- 0ff point in detecting neonatal hypoglycemia by glucometer. Materials and Methods: This cross-sectional study was conducted in the neonatal intensive care unit of Al Zahra Hospital from September 2013 to March 2014. In infants with risk factors of hypoglycemia blood glucose was tested with blood glucose meter (ACCU CHEK - Performa), if the blood glucose was under 60 mg/dl. Simultaneously, the venous blood glucose values were done on (Selectra2) auto analyzer by glucose oxidase method. Sensitivity, specificity, and positive and negative predictive values of glucometer were determined. Results: Hypoglycemia was observed in 32% and 33% of neonates, respectively with glucometer and laboratory methods. A weak correlation was observed between the results of glucometer and laboratory methods (r=0.275). In this study, the optimal cut - off point by glucometer was found to be 54 mg/dl and sensitivity, specificity, accuracy, positive predictive value and a negative predictive values of glucometer were 45.45%, 74.6%, 65%, 46.8% and 73.5% respectively. According to ROC curve area under the curve (AUC) was 0.616. Conclusion: According to the results obtained in this study, glucometer has not sufficient diagnostic value to detect neonatal hypoglycemia. Blood Glucose meter results should be confirmed using a laboratory method. [ABSTRACT FROM AUTHOR]

Background and Aim: This study was conducted to assess customers' perceptions of the quality of services in clinical diagnostic laboratories. Materials and Methods: Based on the SERVEIMPERF model, different dimensions of quality of services in terms of performance (current situation) and importance (weight) of each of the dimensions were assessed. A sample of 328 persons consulting Tehran clinical diagnostic laboratories, selected by stratified random sampling, was included in the study. Data were collected using a questionnaire. Results: The customers' scores for perceptions of the quality of services and its dimensions were higher than average. Dimensions of reliability with a mean score of 3.49 and that of empathy with a mean score of 2.73 were considered to be the highest and lowest dimensions, respectively. As regards importance of dimensions of service quality, the customers' perceptions of assurance with a mean score of 4.448 was assessed to be higher than other dimensions, while the dimension of tangibility with a mean score of 3.983 was considered to be lower than other dimensions. Conclusion: In can be concluded that different customers do not have the same perception of the various dimensions of quality of services and do not evaluate them in the same way. Thus, the differences should be taken into consideration when designing plans to improve the quality of services and deciding about priorities. It seems that the dimension of trust in the customers' perceptions of the quality of services in clinical diagnostic laboratories is the most important and the first priority. [ABSTRACT FROM AUTHOR]

Background: Brucellosis is a major cause of zoonosis disease and is endemic in hamadan Province in Iran. The purpose of this study was to isolate Brucella species from brucellosis patients and identify different species of this bacterium in order to determine the prevalence of the species. Materials and Methods: This study was descriptive- cross sectional and fifty blood samples were obtained from brucellosis patients with clinical symptoms. The samples were cultured in BACTEC system and incubated for 14 days. Then, the samples were cultured on Brucella agar and biochemical tests were done for identification of bacteria. Finally, Polymerase Chain Reaction (PCR) applied for confirmation and isolated identification with specific primers. Results: Seven Brucella strains were isolated from 50 blood samples of the patients with brucellosis by blood culture and PCR. The PCR results on blood specimens showed 4 positive in spite of the negative results of blood culture. PCR and biochemical methods revealed that all the 11 isolated bacteria were Brucella Melitensis. Conclusion: This study was designed to evaluate PCR technique as a diagnostic tool for brucella spp in comparison to conventional techniques. This study showed a high prevalence of brucellosis due to Brucella Melitensis in Hamadan Province and efforts in this region should be aimed at the eradication of this bacterium. [ABSTRACT FROM AUTHOR]

Background and Aim: Clinical laboratories, due to their succeptibility to potential risks, are priorities in all activities concerning safety issues in hospitals. Total Quality Management (TQM) is a model considered by WHO for clinical laboratories safety development. This study aimed to assess how safety standards were followed at the clinical laboratories of hospitals affiliated with Tehran University of Medical Sciences (TUMS) based on TQM safety regulations. Materials and Methods: This descriptive study was conducted on a research population including TUMS hospitals clinical laboratories in 2012. For data collection, census was applied and sampling was not considered. The data gathering instrument was a checklist measuring seven safety components based on TQM. The validity of the instrument was determined through content validation, and Cronbach alpha was calculated to be 0.82. For the analysis of the results, descriptive statistics including frequency percentage of scores was employed. Results: The safety of research population turned out to be suitable in terms of four factors: designing, existence of general safety items, conducting standard safety activities, and safe disposal of laboratory wastes. Besides, implementation of safety programs and increase in employees’ knowledge to cope with accidents were relatively acceptable. The emergency evacuation program, however, was estimated as poor. Conclusion: The studied laboratories enjoy relatively safe conditions, but imperfect implementation of safety protocols can endanger safety conditions. Therefore, it is necessary to take the required correcting measures to ensure full safety in clinical labs. [ABSTRACT FROM AUTHOR]

Background: In recent years, both alpha and beta thalassemia have been screened in couples before marriage. The severe form of alpha thalassemia, i.e. hydrops fetalis, is found in fetuses and causes fetal death. We tried to determine the need for prenatal diagnosis of hydrops fetalis among couples referred to Alzahra Genetic Laboratory. We also evaluated the cost-effectiveness of alpha thalassemia screening. Methods: This descriptive study included all individuals that had been referred to the genetic laboratory from various health centers in Isfahan (Iran). The subjects had mean corpuscular volume less than 80 fL, mean corpuscular hemoglobin less than 27 pg, and hemoglobin A2 less than 2.5 percent. Moreover, one month of iron supplementation had failed to normalize their blood indexes. DNA was duplicated with polymerase chain reaction and examined with gel electrophoresis. Findings: During the 27 months and nine days of the study (2009-2012), 642 eligible couples were referred to Alzahra Genetic Laboratory. Of these, 75 couples (11.6%) had beta-beta genotype, 343 couples (53.4%) had alpha-alpha genotype, and 224 couples (34.8%) had genotype alpha-beta. Of the 343 couples who had alpha-alpha genotype, three couples (0.87%) required to have prenatal diagnosis. Conclusion: Considering the very few fetuses that required prenatal diagnosis, the cost-effectiveness of alpha-thalassemia screening in preparing couples for marriage has to be further evaluated at the country level. On the other hand, as fetuses with hydrops will not survive and will abort (only one fetus had hydrops in this study), children with thalassemia major will not be a problem. [ABSTRACT FROM AUTHOR]

Background: Cancer prevention besides detection and treatment has a very important role in control of cancer disease. Since some chemical compounds that are used in laboratories, especially in pathology laboratory are potentially mutagens, lab assistances that are working with chemicals such as Benzene, Xylazine and Formaldehyde for long period of time may be exposed to overload of these carcinogens. Therefore, it is necessary to use an indicator for detecting these occupational exposures. Ames test has been recommended in biomonitoring of environment that has high risk carcinogenicity characteristic. Methods: A total of fifty seven urine samples of forensic medicine laboratory personnel's were extracted by C18 column and then tested by TA100 and TA98 standard strains of Ames assay. Each sample was analyzed with and without activator to detect mutagen and promutagen materials. Results: Levels of mutagenicity were found by TA98 strain without activator in one case as well as with activator in two cases of urine samples of pathology laboratory personnel's. These cases were working in laboratory for long time in all of the workdays. Conclusion: Personnel's working in pathology laboratories may have greater risk of cancer and should be take care from these occupational exposures. [ABSTRACT FROM AUTHOR]