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Hemoglobin H (Hb H) disease is a subtype of α-thalassemia caused by deletional and/or non-deletional mutations in three alpha-globin genes in which the various genotypes determine the disease severity. This study was aimed to investigate the frequency of alpha gene mutations and genotypes and their correlation with hematological and clinical characteristics in Iran. Among 202 patients diagnosed with Hb H disease through a national study in Iran according to standard methods, we had access to the hematologic and clinical findings and genetic data of 101 patients in whom genetic study was performed. Genomic DNA from peripheral blood was extracted and analyzed for identification of α-globin gene mutations using Multiplex Gap Polymerase Chain Reaction, Reverse Hybridization Assay, and finally Direct DNA Sequencing method. Twenty-one different mutations and thirty genotypes were detected in 101 patients with Hb H disease. In total, 39 patients (38.6%) were deletional and 62 patients (61.4%) were non-deletional type of the disease. The

This 8‐year (from 2008 to 2016) retrospective study calculated the percentage of carcass and organ (lung and liver) condemnations and estimated the direct financial costs at four slaughterhouses in Sistan‐Baluchestan Province, Southeastern Iran. Each carcass and organ (lung and liver) was thoroughly examined through inspection, palpation and incision following the standard protocol. Identification of the parasites was performed macroscopically. The total direct economic loss due to meat's condemnation was estimated by adding weights of each organ or carcass part and multiplying individual organ totals by their 2016 market unit price. A total of 857,039 cattle were slaughtered during this period, 64,497 livers (7.5%), 31,401 lungs (3.6%) and the carcasses of 1,171 cattle (0.1%) were condemned due to lesions caused by parasites. The main parasitic lesions in the condemned livers were attributed to Echinococcus granulosus (4.2%), Fasciola spp. (3.1%) and Dicrocoelium dendriticum (0.1%). All the condemned lungs were due to E. granulosus (3.6%). Taenia saginata cysticerci were detected in 0.1% of inspected animals. Liver condemnation due to cystic echinococcosis was the highest in fall (4.7%, p, Among the organs examined for the existence of parasitic lesions, 64,497 livers (7.5%), 31,401 lungs (3.6%) and the carcasses of 1,171 cattle (0.13%) were discarded due to parasitic infections. The main parasitic lesions detected in the condemned livers were attributed to Echinococcus granulosus (4.2%), Fasciola hepatica (3.1%) and Dicrocoelium dendriticum (0.1%).

Background Estrogen is involved in the pathogenesis of breast and gynecological cancers. Regular use of aspirin reduces estrogen levels. The present study aimed to evaluate the effect of aspirin on estrogen levels in postmenopausal women. Methods This double-blind, placebo-controlled parallel-group trial was conducted on postmenopausal women referred to an outpatient clinic at a women’s hospital in Tehran. Volunteers were randomly assigned to receive aspirin 100 mg/day or placebo for 6 weeks. Estradiol, sex hormone-binding globulin (SHBG), and testosterone levels at baseline and at the end of the intervention were measured by ELISA. Data were analyzed using SPSS 20, Kolmogorov–Smirnov test, independent samples t-test, and Mann–Whitney U test. Results Twenty-seven and 28 participants were finally analyzed in the aspirin and placebo groups, respectively. There was no significant difference between the two groups in body mass index (BMI), age, or menopausal years. There was a statistically significant difference (p = 0.002) in the amount of change in estradiol levels of the intervention group (median=− 3.5 pg/ml) compared to the control group (median=1.5 pg/ml). In contrast, there were no significant differences between the two groups regarding testosterone and SHBG levels (p = 0.58, p = 0.32). Conclusions Since low doses of aspirin may decrease estradiol levels, it could be considered a promising adjunctive therapeutic candidate in postmenopausal women to decrease BC incidence. However, further studies with larger sample sizes, measurements of estrogen levels and its related compounds in different time points accompanied by long-term follow-ups are needed to better elucidate the potential mechanisms by which nonsteroidal anti-inflammatory drugs (NSAIDs) negatively affect breast cancer. Trial registration IRCT201012195397N1. Date of first registration: 03/01/2011.

Background Fear of missing out (FoMO) can increase loneliness and smartphone addiction and decrease academic performance in university students. Most studies investigated the relationship between FoMO and smartphone addiction in developed countries, and no studies were found to examine this association in Iran. The mediating role of loneliness and academic performance in the relationship between FoMO and smartphone addiction is unclear. This study investigated the relationship between FoMO and smartphone addiction and the mediating role of loneliness and academic performance in this relationship in Iranian university students. Methods In this cross-sectional study, 447 students from Urmia University of Medical Sciences were investigated. Data were collected using demographic questionnaires, Przybylski's FoMO scale, Pham and Taylor's academic performance questionnaire, Russell's loneliness scale, and Kwon's smartphone addiction scale. Data were analyzed using SPSS ver. 23 and SmartPLS ver. 2. Results FoMO had a positive and direct association with smartphone addiction (β = 0.315, t-value = 5.152, p p p p p > 0.05). FoMO also indirectly correlated with academic performance through students' loneliness (β =—0.368, t-value = 6.377, p Conclusions FoMO can be positively associated with students' smartphone addiction, and loneliness is an important mediator of this association. Since smartphone addiction could harm students' academic performance, thus, healthcare administrators should reduce students' loneliness and improve their academic performance by adopting practical strategies to help students to manage their time and control their smartphone use. Holding self-management skills classes, keeping students on schedule, turning off smartphone notifications, encouraging students to engage in sports, and participating in group and family activities will help manage FoMO and loneliness.

BackgroundIn survivors of critical illness, recall of an intensive care unit stay plays an important role in the development of post–intensive care unit syndrome, which includes psychological impairment after intensive care unit discharge.ObjectiveTo investigate memories of the intensive care unit among survivors in southeast Iran.MethodsIn this descriptive study, the intensive care unit memory tool was used to assess patients’ memories of intensive care units.ResultsAll participants (N = 100) had 1 or more factual memories (89%), memories of feelings (66%), or delusional memories (34%) from the intensive care unit. Patients who received mechanical ventilation were 4 times as likely to have delusional memories as those who did not receive mechanical ventilation. Unmarried patients were 4.8 times as likely as married patients to have memories of feelings from the intensive care unit.ConclusionsSteps should be taken to minimize distressing memories of an intensive care unit admission. Follow-up programs should take into account the psychological problems faced by intensive care unit survivors.

Background: Ideal respiratory support for very low birth weight infants (VLBW) can be selected based on demographic and clinical status at birth. Methods: In this prospective cohort study, we included 163 VLBW neonates treated with either invasive or non-invasive respiratory support in their first 72 hours of life in the neonatal intensive care unit of Mahdiyeh hospital, Tehran, Iran. We used descriptive statistics to describe the data, and multiple logistic regression to determine the factors associated with the success rate of different strategies and the choice of strategy for primary respiratory support. All analyses were done using SPSS version 20 and STATA version 12 at a significance level of 0.05. Results: The success rates of initial respiratory supports with nasal continuous positive airway pressure (NCPAP), noninvasive positive pressure ventilation (NIPPV), and INSURE (intubation surfactant extubation) were 63.20%, 42.10% and 61.90%, respectively. The results of multiple logistic regression analysis showed patent arterial duct (PDA) (yes vs. no: OR = 0.42) had a significant effect on initial respiratory support success (P28 vs. ≤28 weeks: OR = 0.26) and 5-min APGAR (≤6 vs. >6: OR = 9.69) had a significant effect on the choice of initial respiratory support in VLBW infants (PConclusion: The neonatal clinical condition may be a predictor of success for initial respiratory support at birth. Since the arterial duct may be open during the first hours of life, more study is needed to verify if early closure of the arterial duct may help increase the success rate of non-invasive respiratory support.

The grieving process in parents of these children is an ongoing and cyclic one since there is no real end to it. We explored the experience of grief and feelings of loss in fathers of children diagnosed with autism spectrum disorder (ASD), in the west and northwest of Iran.This qualitative study was conducted using content analysis. Fourteen fathers took part in a semi-structured interview.Six categories were identified in relation to the stages of grief: 1- "Uncertainty of dealing with the unpleasant unknown"; 2- "Being hurt and broken inside"; 3- "Isolation and concealment as a consequence of the pressure caused by ignorance"; 4- "Search for cause"; 5- "Search for a cure"; 6- "Breaking or blooming".Fathers of children with ASD go through intense and continuous sorrow and grief. According to our findings, it is recommended that health care professionals work collaboratively with fathers and provide support upon receiving the diagnosis of their child.

The aim of the study is to offer integrated access to information and data sources in the libraries of Iranian universities of medical sciences (UMS) as an important feature enhancing the quality and quantity of research. Thus, it is essential to study the status of Iranian libraries of UMS in terms of integration features. Accordingly, the main objective of the present study was the identification of integration in libraries of Iranian UMS in terms of metadata, digital contents, software, hardware, and human force. The quantitative study was conducted with an analytic survey method. The statistical population consists of 66 Iranian UMS, of this, 59 libraries completed the researcher-made questionnaire. To ensure the accuracy of data, interviews and, in some cases, observations were also performed. Statistical estimates of frequency, percentage, cumulative frequency, and diagrams were utilized for data analysis. The results demonstrated that the library software programs of UMS do not have a desirable status in terms of content, human force, software infrastructure, and integration features. These libraries enjoyed an optimal status in terms of hardware which was, however, not properly used. To create integrated access to the contents of libraries of Iranian UMS, it is essential to provide the required infrastructure, including integration features, human force, and appropriate contents such as the metadata and digital contents of data sources

Background Hospitalization could be an unpleasant experience for patients with cardiovascular disease leading to some negative emotional reactions. These emotions can be managed by nursing empathy. There are different methods for improving empathy, but some evidence indicates a dramatic drop in nurses’ empathy. In this study, we aim to provide a protocol for investigating the effect of knowledge brokering on nurses’ empathy with patients receiving cardiac care. Methods This study protocol is developed based on SPIRIT checklist with an experimental design. The study population are nurses working in cardiac wards of three educational hospitals in western Iran, Khorramabad. The quota sampling method is used. The sample size is 100 individuals. The samples will be assigned to two intervention and comparison groups using stratified random allocation method. Permuted block randomization is used in each stratum. To prevent contamination between participants; firstly, the measurements of the comparison group is done. Knowledge brokering intervention is performed in 7 stages based on Dobbins’ knowledge translation framework 2009. Monica’s Empathy Construct Self-Rating Scale is used for measuring empathy. Statistical analyses are performed using SPSS (SPPS Inc. Chicago, Il, version 21). P value below 0.05 is considered as statistically significant. Discussion To our knowledge, there is no similar study using an experimental design to examine the efficacy of a knowledge brokering method to improve humanistic knowledge. It helps nurses to improve their empathy in caring relationships.

Backgrounds and aims Iran has 2.1 and 1.8% of its 15-64-year-old population living with illicit substance and opioid use disorders, respectively. To address these problems, Iran has been developing a large and multi-modality addiction treatment system, spanning the time before and after the Islamic Revolution. Methods Iran's current drug treatment scene is a combination of services, ranging from medical/harm reduction services to punitive/criminal justice programs. Included in this array of services are drop-in centers providing low-threshold harm reduction services, such as distribution of sterile needles and syringes; opioid maintenance treatment clinics providing methadone, buprenorphine and opium tincture; and abstinence-based residential centers. We will review the evolution of this system in four phases. Results In 1980, Iran's revolutionary government shut down all voluntary treatment programs and replaced them with residential correctional programs. The first shift in the addiction treatment policies came 15 years later after facing the negative consequences. Addiction is viewed as a disease, and new voluntary treatment centers offering non-agonist medications and psychosocial services were established. With an increased number of people who inject drugs and HIV/AIDS epidemics, in the second shift an extensive move towards harm reduction strategies and opioid-maintenance programs has been implemented to reduce HIV-related high-risk behavior. The emergence of a methamphetamine use crisis creating an increased number of socially marginalized addicted people resulted in public and political demands for stricter policies and ended in the third shift starting in 2010, with extended compulsory court-based residential programs. Currently, there is a new shift towards reducing the severity of criminal penalties for drug use/sales and promoting proposals for opium legalization. Conclusion Iran's evolutionary experience in developing a large addiction treatment program in a complex combination of medical/harm reduction and punitive/criminal justice addiction treatment can be examined in its political, clinical and pragmatic context.

Background Stimulants substances use, particularly methamphetamine use, is increasing globally, including in Iran. This study assessed the drug use and risk behaviour profile, and prevalence of HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) among a large population using methamphetamine as their primary drug in Iran. Methods This cross-sectional study was conducted in eight provinces of Iran. Individuals using methamphetamine for ≥3 months during the past three years, with no life-time history of injecting opioid drugs were enrolled. Drug use and risk behaviour data were collected through interviews. Blood samples were tested for HIV antibodies (HIV Ab), HCV antibodies (HCV Ab), and HBV surface antigen (HBs Ag). Result Among 567 participated, 84% were men and mean age was 36 years. Smoking with pipe was the most common method of methamphetamine use (53%), while 13% had a history of injecting methamphetamine, among whom 30% shared needles or syringes. Among those having sex during intoxication phase (n = 270), 48% never used condom. The prevalence of HIV Ab, HCV Ab and HBs Ag was 6.7% (95%CI: 4.7–9.1), 19.4% (95%CI: 16.2–22.9) and 1.4% (95%CI: 0.6–2.7), respectively. Age ≥ 30 years (adjusted OR [aOR]: 2.10, 95%CI: 1.18–3.76), lower education (high school vs. tertiary education, aOR: 13.95, 95%CI: 1.90–102.60), and injecting methamphetamine (aOR: 1.92, 95%CI 1.10–3.35) were significantly associated with HCV exposure. No factor was found associated with HIV infection. Among those reporting no potential injecting or sexual risk factors, 19.8% and 6.8% have HCV Ab positive and HIV Ab positive, respectively. Conclusion High prevalence of injecting and sexual risk behaviours, HIV infection and HCV exposure were found among individuals using methamphetamine as their primary drug, demonstrating them as an emerging population at risk of HIV and HCV in Iran. Targeted screening and harm reduction programs for this population are required.

Data registries are organized systems that facilitate collection, storage, and analysis of data related to a specific disease in a defined population. Here we introduce a data registry system which was designed to cover the four most common urologic cancers (prostate, bladder, renal and testis).All contributing centers can enter data into the system after logging in with their unique usernames and passwords. In this system, the information of each individual patient will be entered in several structured forms covering various steps of management of the patients.Our proposed registry is an interactive, web-based database designed to collect complete data of patients with common urological cancers. We devised a council that functions as the central committee that will initiate, supervise, and monitor all steps of the projects including data collection, data audit, as well as data analysis and publication. To facilitate manuscript publication, the system will provide assistance and support throughout all the steps of statistical analysis and manuscript preparation.This proposed registry can have a national target and is designed to provide evidence-based information that could support strategic planning and national multi-centric studies.

An unprecedented public health crisis confronts the world. Iran is among the hardest-hit countries, where effects of the COVID-19 pandemic are stretched across society and felt by the most marginalised people. Among people who use drugs, a comprehensive response to the crisis calls for broad collaboration, coordination, and creativity involving multiple government and non-government organisations. This commentary provides early insights into an unfolding experience, demonstrating the operational and policy impact of an initiative, bringing together a diverse array of harm reduction stakeholders to address the pandemic. In the context of lived experiences of social and economic marginalization, this initiative intends to lead efforts in developing an equitable response to the COVID-19 pandemic.

To investigate the effects of narrative group counseling combined with diet modification and exercise plans on weight loss in Iranian women with obesity.Parallel 2-arm clinical trial.Fifty-six Iranian women with obesity (aged 18-50 years).The intervention group included weekly diet, exercise, and narrative-focused group counseling, whereas the comparison group included dietary modification and exercise sessions for 8 months (32 sessions).Anthropometric and body composition parameters, blood biochemical parameters (high-density lipoproteins, low-density lipoproteins, triglycerides, fasting blood sugar, ghrelin, obestatin), physical activities, and appetite scores.McNemar test was used for the variables that were not normally distributed and for scaling. Furthermore, t tests were used to compare quantitative variables with normal distributions. The original P (0.05) was adjusted to P = 0.0031 using the Bonferroni correction.Weight, body mass index, body fat proportion, and hip circumference decreased significantly in the intervention vs comparison group. Serum low-density lipoproteins, triglycerides, total cholesterol, fasting blood sugar, appetite score, and ghrelin decreased, whereas obestatin increased significantly in the intervention vs comparison group.Narrative-focused group counseling combined with traditional strategies was effective in achieving significant changes in weight, body mass index, and appetite. Future studies with a more diverse audience and a longer follow-up are warranted.

Introduction Iran has an human immunodeficiency viruses (HIV) epidemic that is concentrated among people who inject drugs (PWID), who have higher risks of progression from latent tuberculosis infection (LTBI) to active disease. The aim of this study is to measure prevalence of LTBI, HIV infection and any risk behaviors among PWID in Iran. Methods The cross-sectional study was conducted from August to December 2013 in six cities across Iran. A total of 420 PWID were recruited from drop-in centres using convenience sampling. Trained interviewers collected data on socio-demographic characteristics, drug use history and drug-related risk behaviors across the study sites. A tuberculin skin test (TST) was performed, and HIV infection was assessed by a rapid test. Multivariable modified Poisson regression and logistic regression were used for data analysis. Results Prevalence of positive TST and HIV positivity was 35.7% and 8.6%, respectively. The prevalence of LTBI and HIV was significantly different across the cities of this study. Positive TST was independently associated with older age (APR 1.03, 95% CI 1.01, 1.05) and being HIV positive (APR 1.89, 95% CI 1.45, 2.47). HIV infection was associated with lifetime history of sharing syringes (AOR 3.28, 95% CI 1.44, 10.71) and lifetime number of imprisonment (AOR 1.09, 95% CI 1.03-1.14). Discussion and conclusions Prevalence of LTBI infections among PWID is high and independently associated with HIV infection. Given that there are currently no TB services available within drop-in centres, programs which integrate TB case finding, TB preventive therapy, referral and care services for PWID are urgently needed.

Background: The Global burden of disease and injuries study (GBD 2015) reports expected measures for years of life lost (YLL) based on socio-demographic index (SDI) of countries, as well as the observed measures. In this extended GBD 2015 report, we reviewed total and cause-specific deaths and YLL for Iran and all its neighboring countries between 1990 and 2015. Methods: We extracted data from the GBD 2015 database. Observed YLL measures were calculated by multiplying the number of deaths by standard life expectancy at each age. SDI was a composite index, calculated based on income per capita, average years of schooling, and total fertility rate. The GBD world population was used for age standardization. Results: All-ages crude death rate in Iran reduced from 665.6 per 100,000 population (95% uncertainty interval: 599.3–731.6) in 1990 to 487.2 (414.9–566.1) in 2015. The ratio of observed to expected YLL (O/E ratio) for all-causes ranged between 0.54 (Turkey) and 1.95 (Russia) in 2015. For Iran, the all-causes O/E ratio was less than 1 in all years (19902015), except 2003. However, cause-specific O/E ratio was more than 1 for some causes, including the top leading causes of YLL (ischemic heart disease, road injuries, and cerebrovascular disorders). Ischemic heart disease was the first or second cause of YLL in all comparator countries except Afghanistan. Conclusion: The leading YLL causes with high O/E ratios should be prioritized in public health efforts. In addition to research evidence, countries with low O/E ratios should be scrutinized to find feasible innovative interventions.

Objectives A lack of donors continues to be a significant problem. Kidney donors with a body mass index ≥ 30 kg/m² are not suitable for laparoscopic donor nephrectomy; however, some studies have suggested that an obese donor could be an appropriate donor with similar surgical outcomes. Here, we report the results of our 10-year experience of laparoscopic donor nephrectomy, examining the effects of body mass index on the surgical results of laparoscopic donor nephrectomy. Materials and methods We retrospectively reviewed medical records of patients who underwent laparoscopic donor nephrectomy at the Shahid Beheshti University Medical Science, Urology Center (Tehran, Iran) from 2005 to 2015. The collected information included pretransplant and posttransplant serum levels of hemoglobin and creatinine. We also collected data on surgical outcomes (operation time, cold and warm ischemia, need for blood transfusion, and conversion to open surgery, length of hospital stay, and complication rates) with respect to body mass index categories (≤ 24.9, 25-29.9, and ≥ 30 kg/m²). Results Of 1083 kidney donors, 732 donors had body mass index of ≤ 24.9 kg/m², 256 had body mass index between 25 and 29.9 kg/m², and 95 had body mass index of ≥ 30 kg/m². Differences among groups were not significant in terms of operation time (P = .558), warm or cold ischemic time (P = .829 and .951, respectively), blood transfusion (P = .873), and length of hospital stay (P = .850). Conclusions The laparoscopic approach for donor nephrectomy is a safe and effective method in obese donors without significant postoperative complications.

The growing rate of smoking cigarettes among the youths necessitates examining its contributing factors. Accordingly, we aimed to compare smoking and nonsmoking university students in their attachment styles, perceived loneliness, and psychological well-being. To this end, we recruited 100 current smokers and 100 nonsmoking students by using a convenience sampling method from Shahid Beheshti University, Tehran, Iran. All participants completed the Adult Attachment Scale, Loneliness Scale, and General Health Questionnaire. Data analysis indicated that compared to nonsmokers, smokers had a more anxious attachment style and they felt lonelier. Moreover, current results showed that smokers suffered from higher rates of psychological problems than nonsmokers. These results suggest that smoking is influenced by a set of psychological factors and therefore, prevention and treatment programs targeting these factors may be effective in reducing the rate of smoking cigarettes among university students.

Background Methylene-tetrahydrofolate reductase (MTHFR) gene variant may play an important role in the pathophysiology of diabetes and its complications due to its influence on plasma homocysteine levels and also its effect on scavenging peroxynitrite radicals. Diabetic peripheral neuropathy (DPN) is one of the most common diabetic chronic complications. The aim of this study was to investigate the relationship between diabetic neuropathy and MTHFR gene C677T and 1298A ⁄C polymorphisms. Method Patients with type 2 diabetes N = 248 were enrolled in the study, consisting of patients with neuropathy (N = 141) and patients without neuropathy (N = 107). MTHFR C677T polymorphism was analyzed using polymerase chain reaction followed by restriction fragment length polymorphism (PCR-RFLP) of genomic DNA for genotyping of samples. 1298A/C polymorphism was evaluated using ARMS-PCR. Result There was a significant difference in MTHFR polymorphism between the groups with and without neuropathy. Conclusion Our results suggest that MTHFR 677 variant confer risk for diabetic neuropathy among Iranian patients with type 2 diabetes.

To present the safety and efficacy of fluoroscopy-free ultrasound-guided PCNL for the treatment of renal calculi in pediatric patients of all ages. 30 children with mean age of 5 years (6 months–12 years) underwent totally ultrasound-guided PCNL from March 2013 to August 2016. The pyelocalyceal system was punctured in prone position using only ultrasonography guidance, and the tract was dilated using a single shot dilation technique. No fluoroscopy was used during any of the stages of renal access. The procedure was performed using adult-sized instruments. The mean stone size was 27.1 ± 8.7 mm. Mean access time was 4.3 ± 2 min. Mean nephroscopic time was 34.6 ± 15.2 min. Mean hospital stay of patients was 3 days (range 2–5). 21 patients were stone-free after the procedure (70% success rate). Only four patients out of 30 experienced postoperative complications. The results of this study showed that fluoroscopic-free ultrasound-guided PCNL in pediatric patients of all ages is safe, highly efficient, and minimizes potential radiation exposure risks associated with the procedure.