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Purpose: The purpose of this study was to determine career preferences of medical students at the time of entering medical school compared with interns who were graduating; and to determine what factors influence the choice of a special discipline as a career., Methods: A cross-sectional, questionnaire-based survey study involving freshmen and interns at Tehran University of Medical Sciences was conducted in 2006 - 2007. Respondents anonymously completed a specialties questionnaire developed by Feifel et al. The questionnaire was translated into Persian (Farsi) and several items were modified based on the circumstances., Results: The response rate was 91 (73%) among freshmen and 137 (77%) among interns. Forty-six freshman students (50%) and 71 interns (51.8%) indicated that they had not developed a strong decision about any particular field of medicine and needed more time. The preferred specialties among freshmen were surgery and internal medicine; whereas graduating students were more interested in "other specialties". There was no significant difference between pediatrics, gynecology, psychiatry, and general practice among the two groups. There was a significant difference in rating when it came to "anticipated income", "prestige" and "helping patients" of which interns were less interested compared to freshmen in these three areas., Conclusion: Approximately one-half of the medical students were unclear about their future goals. The experience of medical school may play a role in diminishing students' interest in surgery and internal medicine as prospective careers.

Abstract Background Given the geographical sparsity of Rare Diseases (RDs), assembling a cohort is often a challenging task. Common data models (CDM) can harmonize disparate sources of data that can be the basis of decision support systems and artificial intelligence-based studies, leading to new insights in the field. This work is sought to support the design of large-scale multi-center studies for rare diseases. Methods In an interdisciplinary group, we derived a list of elements of RDs in three medical domains (endocrinology, gastroenterology, and pneumonology) according to specialist knowledge and clinical guidelines in an iterative process. We then defined a RDs data structure that matched all our data elements and built Extract, Transform, Load (ETL) processes to transfer the structure to a joint CDM. To ensure interoperability of our developed CDM and its subsequent usage for further RDs domains, we ultimately mapped it to Observational Medical Outcomes Partnership (OMOP) CDM. We then included a fourth domain, hematology, as a proof-of-concept and mapped an acute myeloid leukemia (AML) dataset to the developed CDM. Results We have developed an OMOP-based rare diseases common data model (RD-CDM) using data elements from the three domains (endocrinology, gastroenterology, and pneumonology) and tested the CDM using data from the hematology domain. The total study cohort included 61,697 patients. After aligning our modules with those of Medical Informatics Initiative (MII) Core Dataset (CDS) modules, we leveraged its ETL process. This facilitated the seamless transfer of demographic information, diagnoses, procedures, laboratory results, and medication modules from our RD-CDM to the OMOP. For the phenotypes and genotypes, we developed a second ETL process. We finally derived lessons learned for customizing our RD-CDM for different RDs. Discussion This work can serve as a blueprint for other domains as its modularized structure could be extended towards novel data types. An interdisciplinary group of stakeholders that are actively supporting the project's progress is necessary to reach a comprehensive CDM. Conclusion The customized data structure related to our RD-CDM can be used to perform multi-center studies to test data-driven hypotheses on a larger scale and take advantage of the analytical tools offered by the OHDSI community.

Abstract Background Teledentistry is applied in oral medicine to help dental practitioners and specialists manage complex oral conditions. This scoping review aims to synthesize the available evidence regarding the technical requirements and the provision of security services, as well as the recommendations on standard oral cavity photography methods for using teledentistry in oral medicine. Method The present scoping review was conducted in 2022 according to the Joanna Briggs Institute (JBI) manual. Four databases were systematically searched, including ISI Web of Science, PubMed, Scopus, and ProQuest, from January 1999 to December 2021. After finalizing the search strategy, all the original articles, reviews, editorials, letters, comments, and book chapters were included. All the dissertations uploaded in English with a full-text electronic file were also included to achieve a comprehensive picture of the available literature. Two types of analysis were applied: the quantitative descriptive analysis applying Excel 2016 and the qualitative thematic analysis using MAXQDA version 10. Results The included papers were published during 1999–2021. Most of the included articles were from Brazil (n = 9, 21.43%), India (n = 6, 14.28%), the USA (n = 6, 14.28%), and the UK (n = 5, 11.90%). Social media usage as a teledentistry platform increased considerably between 2019 and 2021. Teledentistry platforms have been classified into four categories, including email, telephone, social network applications (WhatsApp, zoom, Google Meeting, Instagram, line Application, Viber, and Messenger), and teledentistry systems (teledentistry systems, which were designed specially to perform a teledentistry project). Teledentistry has been conducted to store and forward (n = 15, 30.71%), real-time (n = 9, 21.43%), or both (n = 12, 35.71%). According to the thematic results, basic technical requirements have been categorized into four, including teledentistry platform, type of interactions, internet connection, and photography tool. Other thematic results demonstrate seven categories of recommendations, including general factors, light, patient position, phone position, setting of a mobile phone camera, photo sending requirements, and photo visualization. Conclusion According to the results, over the past 7 years, especially during the COVID-19 pandemic, social network applications such as WhatsApp and Zoom have been used more frequently. Also, photography recommendations with a mobile phone camera depend on several factors such as general factors, light, patient position, phone position, setting of the mobile phone camera, and photo-sending requirements. Given the increased use of mobile cameras for oral photography, these recommendations can help improve the quality of images and subsequently improve the reliability of clinical decision-making in managing patients' conditions.

Abstract Alcohol production and consumption have been prohibited in Iran for over four decades, leading to a typical underestimation of its consumption. This study aimed to assess the prevalence of alcohol consumption, its associated factors, and estimate per capita alcohol consumption among Iran’s adult population. In this population-based survey, 27,874 adults from across Iran were selected using systematic proportional-to-size cluster sampling. Alcohol consumption was evaluated through a modified Persian version of the STEPS questionnaires from previous studies, applied over different timespans. Per capita consumption was calculated using the quantity-frequency method, expressed in liters of pure alcohol. Adjusted odds ratios were reported for associates of alcohol consumption concerning metabolic risk factors, sociodemographic elements, and lifestyle variables. The prevalence of lifetime alcohol consumption was 6.9% (95% CI 6.5–7.2) in the adult population, with a notable sex difference (males: 13.7% [95% CI 13–14.4]; females: 1.4% [95% CI 1.1–1.6]). The 12 month prevalence was 3.8% (95% CI 3.6–4.1). For individuals aged 18 and older, the per capita alcohol consumption in Iran was 0.12 L. Factors such as being a lifetime smoker, younger, wealthier, and having 7–12 years of education were significantly linked to higher alcohol consumption. Significant associations were also observed between alcohol consumption and having a history of heart attacks (OR = 2.04, 95% CI 1.44–2.89), and physical injuries (OR = 1.88, 95% CI 1.34–2.64). The estimated lifetime and 12-month prevalence of alcohol use in our study were higher among some of the subpopulations. The findings also revealed a complex relationship between alcohol consumption, behavioral risk factors, and metabolic profiles. Consequently, immediate preventive measures tailored to each factor’s association with alcohol use are recommended.

Abstract Chronic interstitial lung diseases (ILDs) require frequent point-of-care monitoring. X-ray-based methods lack resolution and are ionizing. Chest computerized tomographic (CT) scans are expensive and provide more radiation. Conventional ultrasound can detect severe lung damage via vertical artifacts (B-lines). However, this information is not quantitative, and the appearance of B-lines is operator- and system-dependent. Here we demonstrate novel ultrasound-based biomarkers to assess severity of ILDs. Lung alveoli scatter ultrasound waves, leading to a complex acoustic signature, which is affected by changes in alveolar density due to ILDs. We exploit ultrasound scattering in the lung and combine quantitative ultrasound (QUS) parameters, to develop ultrasound-based biomarkers that significantly correlate (p = 1e−4 for edema and p = 3e−7 for fibrosis) to the severity of pulmonary fibrosis and edema in rodent lungs. These innovative QUS biomarkers will be very significant for monitoring severity of chronic ILDs and response to treatment, especially in this new era of miniaturized and highly portable ultrasound devices.

Abstract Cerebral aneurysms are a silent yet prevalent condition that affects a significant global population. Their development can be attributed to various factors, presentations, and treatment approaches. The importance of selecting the appropriate treatment becomes evident upon diagnosis, as the severity of the disease guides the course of action. Cerebral aneurysms are particularly vulnerable in the circle of Willis and pose a significant concern due to the potential for rupture, which can lead to irreversible consequences, including fatality. The primary objective of this study is to predict the rupture status of cerebral aneurysms. To achieve this, we leverage a comprehensive dataset that incorporates clinical and morphological data extracted from 3D real geometries of previous patients. The aim of this research is to provide valuable insights that can help make informed decisions during the treatment process and potentially save the lives of future patients. Diagnosing and predicting aneurysm rupture based solely on brain scans is a significant challenge with limited reliability, even for experienced physicians. However, by employing statistical methods and machine learning techniques, we can assist physicians in making more confident predictions regarding rupture likelihood and selecting appropriate treatment strategies. To achieve this, we used 5 classification machine learning algorithms and trained them on a substantial database comprising 708 cerebral aneurysms. The dataset comprised 3 clinical features and 35 morphological parameters, including 8 novel morphological features introduced for the first time in this study. Our models demonstrated exceptional performance in predicting cerebral aneurysm rupture, with accuracy ranging from 0.76 to 0.82 and precision score from 0.79 to 0.83 for the test dataset. As the data are sensitive and the condition is critical, recall is prioritized as the more crucial parameter over accuracy and precision, and our models achieved outstanding recall score ranging from 0.85 to 0.92. Overall, the best model was Support Vector Machin with an accuracy and precision of 0.82, recall of 0.92 for the testing dataset and the area under curve of 0.84. The ellipticity index, size ratio, and shape irregularity are pivotal features in predicting aneurysm rupture, respectively, contributing significantly to our understanding of this complex condition. Among the multitude of parameters under investigation, these are particularly important. In this study, the ideal roundness parameter was introduced as a novel consideration and ranked fifth among all 38 parameters. Neck circumference and outlet numbers from the new parameters were also deemed significant contributors.

Abstract Microfluidic devices with complex geometries and obstacles have attracted considerable interest in biomedical engineering and chemical analysis. Understanding droplet breakup behavior within these systems is crucial for optimizing their design and performance. This study investigates the influence of triangular obstacles on droplet breakup processes in microchannels. Two distinct types of triangular obstructions, positioned at the bifurcation (case I) and aligned with the flow (case II), are analyzed to evaluate their impact on droplet behavior. The investigation considers various parameters, including the Capillary number (Ca), non-dimensional droplet length (L*), non-dimensional height (A*), and non-dimensional base length (B*) of the triangle. Utilizing numerical simulations with COMSOL software, the study reveals that the presence of triangular obstacles significantly alters droplet breakup dynamics. Importantly, the shape and location of the obstacle emerge as key factors governing breakup characteristics. Results indicate faster breakup of the initial droplet when the obstacle is positioned in the center of the microchannel for case I. For case II, the study aims to identify conditions under which droplets either break up into unequal-sized entities or remain intact, depending on various flow conditions. The findings identify five distinct regimes: no breakup, breakup without a tunnel, breakup with a tunnel, droplet fragmentation into unequal-sized parts, and sorting. These regimes depend on the presence or absence of triangular obstacles and the specific flow conditions. This investigation enhances our understanding of droplet behavior within intricate microfluidic systems and provides valuable insights for optimizing the design and functionality of droplet manipulation and separation devices. Notably, the results emphasize the significant role played by triangular obstacles in droplet breakup dynamics, with the obstacle’s shape and position being critical determinants of breakup characteristics.

Objective(s): Currently, the most important treatment approach for hemophilia type A is recombinant Factor VIII. However, due to its low retention time in the blood, the patients usually need successive injections. In addition, neutralization of injected proteins by antibodies complicates treatment. We examined the prolongation of the persistence time of injectable FVIII in the blood and the potential effects on survival using promising PEGylated liposomes (PEGLip) utilizing hydrogenated soy phosphatidylcholine (HSPC, Tm= 54.5 ºC) and 1-palmitoyl-2-oleoyl-phosphatidylcholine (POPC, Tm= – 2 ºC).Materials and Methods: Nanoliposomes with different percentages of PEG (3% and 5%) were obtained via the thin film hydration procedure and extrusion. Liposomal FVIII formulation was prepared and characterization was done.Results: The results revealed that the formulations are in the 80–120 nm range with uniform dispersion, which was confirmed using transmission electron microscopy (TEM) imaging. The phase transition temperature (Tm) of the liposomes was obtained by differential scanning calorimetry (DSC). With an attachment efficacy of approximately 87%, proteins bind non-covalently yet with a strong affinity to the exterior of PEGLip. The final formulations underwent additional examination. No significant change was observed in size, charge, and PDI between the FVIII-conjugated liposomal formulations and their liposomal nanoparticles. The selected formulations were injected into BALB/c mice. The circulation time and potential clotting effectiveness of PEGLip-FVIII are vastly improved over free protein, in non-hemophilic mice. Conclusion: The obtained results showed that using phospholipids with high Tm (HSPC) can improve the hemostatic efficiency of liposomes more than phospholipids with low Tm (POPC).

Abstract Among the myriad of nanoparticles, silica nanoparticles (SiO2NPs) have gained significant attention since they are extensively produced and used across several kinds of industries. Because of its widespread usage, there has been increasing concern about the potential health effects. This study aims to evaluate the effects of SiO2NPs on Interleukin-6 (IL-6) gene expression in human lung epithelial cell lines (A549). In this study, A549 cells were exposed to SiO2NPs at concentrations of 0, 1, 10, 50, 100, and 200 µg/mL for 24 and 48 h. The IL-6 gene expression was assessed using Real-Time RT-PCR. Additionally, the impact of SiO2NPs on the viability of A549 cells was determined by MTT assay. Statistical analysis was performed using GraphPad Prism software 8.0. MTT assay results indicated a concentration-dependent impact on cell survival. After 24 h, survival decreased from 80 to 68% (1–100 µg/mL), rising to 77% at higher concentrations. After 48 h, survival dropped from 97 to 80%, decreasing to 90% at higher concentrations. RT-PCR showed a dose–response relationship in cellular toxicity up to 10 µg/mL. At higher concentrations, there was increased IL-6 gene expression, mitigating SiO2NP-induced cytotoxic effects. The study shows that the viability and proliferation of A549 cells are impacted by different SiO2NPs concentrations. There may be a potential correlation between IL-6 gene expression reduction and a mechanism linked to cellular toxicity. However, at higher concentrations, an unknown mechanism increases IL-6 gene expression, reducing SiO2NPs' cytotoxic effects. These effects are concentration-dependent and not influenced by exposure times. Further investigation is recommended to determine this mechanism's nature and implications, particularly in cancer research.

Statement of the Problem: Paxillin (PXN) is one of the proteins involved in cell adhesion. PXN and integrins constitute a key site for the focal adhesion between the cell and extracellular matrix. Several studies have shown that PXN is a factor in tumor formation, progression, invasion, and metastasis.Purpose: This study evaluated PXN expression in four types of odontogenic lesions with different aggressive behaviors.Materials and Method: In this retrospective cross-sectional study, PXN expression was immunohistochemically assessed in 68 paraffin-embedded tissue samples from patients with the confirmed diagnosis of four types of odontogenic lesions, including 14 dentigerous cysts (DC), 20 odontogenic keratocyst (OKC), 16 unicystic ameloblastoma, and 18 solid ameloblastoma. The PXN expression in these samples were scored based on the percentage and intensity of immunoreactivity, and compared among the groups by Chi-square test.Results: The PXN marker was detected in the cytoplasm of tumor cells (unicystic and solid ameloblastoma) and the epithelial layer of cysts (DC and OKC). The intensively stained marker of PXN was observed in 9 cases (64.3%) of the DC, 14 cases (70%) of OKC, 12 cases (75%) of unicystic ameloblastoma, and 13 cases (72.2%) of solid ameloblastoma. However, there was not statistical difference of PXN protein expression between DC and OKC (p Value = 0.51) and unicystic and solid ameloblastoma (p = 0.58), also the same was true for cysts and tumors (p = 0.37).Conclusion: The expression of PXN is not related to the biological behaviors of odontogenic lesions.

Abstract Non-small cell lung cancer (NSCLC) has constituted over 80% of the lung cancer population with a poor prognosis. Over the past decade, immunotherapy has been constructed in the enlargement of immune checkpoint inhibitors as a promising approach for NSCLC treatment. Evading the immune system using the PD-1/PD-L1 axis is an intelligent way for cancers, and T cells cannot respond fully and confront cancer. Recently, the miR-138 was reported as a PD-L1 regulator in NSCLC. However, its inhibitory impact on T-cell exhaustion has not been characterized. The present study aims to impair PD-L1 (B7-H1) expression in Adenocarcinoma cell lines using miR-138-5p and determines how it prevents Jurak cell exhaustion. To gain the purpose, first, 18 highly significant dysregulated miRNAs containing hsa-miR-138 and CD274-mRNA network were detected in NSCLC based on bioinformatics analysis. Moreover, our study revealed a high level of miR-138-5p could make significant changes like PDL1 downregulation, proliferation, and mortality rate in A549/Calu6 cells. We also simulate cancer environmental conditions by culturing Jurak cells and NSCLC cell lines under the influence of stimulator cytokines to show how miR-138-5p survives Jurak cells by targeting PD-L1/PD-1pathway.

Abstract Background While the concept of hacking in education has gained traction in recent years, there is still much uncertainty surrounding this approach. As such, this scoping review seeks to provide a detailed overview of the existing literature on hacking in health profession education and to explore what we know (and do not know) about this emerging trend. Methods This was a scoping review study using specific keywords conducted on 8 databases (PubMed, Embase, Scopus, Web of Science, ERIC, PsycINFO, Education Source, CINAHL) with no time limitation. To find additional relevant studies, we conducted a forward and backward searching strategy by checking the reference lists and citations of the included articles. Studies reporting the concept and application of hacking in education and those articles published in English were included. Titles, abstracts, and full texts were screened and the data were extracted by 2 authors. Results Twenty-two articles were included. The findings are organized into two main categories, including (a) a Description of the interventions and expected outcomes and (b) Aspects of hacking in health profession education. Conclusion Hacking in health profession education refers to a positive application that has not been explored before as discovering creative and innovative solutions to enhance teaching and learning. This includes implementing new instructional methods, fostering collaboration, and critical thinking to utilize unconventional approaches.

Abstract Cardiovascular disease (CVD) can be determined and quantified using the electrocardiogram (ECG) analysis. Identification of the risk factors associated with ECG abnormalities may advise prevention approaches to decrease CVD burden. In this study we aimed to investigate the association between CVD risk factors and minor and major ECG abnormalities in a general Iranian adult population. This study was conducted in 2010 and covered a population of 9035 males and females aged 35 to 65 years recruiting from the phase I of Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) cohort study. The participants were drawn by a stratified cluster random sampling technique. The Bivariate and multinomial logistic regression analysis were conducted considering gender stratification to explore the association of ECG abnormalities with traditional cardiovascular risk factors. There was a significant association between minor and major ECG abnormalities and hypertension (HTN), type 2 diabetes (T2DM), smoking, and physical activity (p 60 years were more likely to have major [ARRR = 2.01, 95% CI 1.49, 2.74] and minor [ARRR = 1.59, 95% CI 1.20, 2.10] abnormalities compared to women aged

Abstract Finite element analysis (FEA) is commonly used in orthopaedic research to estimate localised tissue stresses and strains. A variety of boundary conditions have been proposed for isolated femur analysis, but it remains unclear how these assumed constraints influence FEA predictions of bone biomechanics. This study compared the femoral head deflection (FHD), stresses, and strains elicited under four commonly used boundary conditions (fixed knee, mid-shaft constraint, springs, and isostatic methods) and benchmarked these mechanics against the gold standard inertia relief method for normal and pathological femurs (extreme anteversion and retroversion, coxa vara, and coxa valga). Simulations were performed for the stance phase of walking with the applied femoral loading determined from patient-specific neuromusculoskeletal models. Due to unrealistic biomechanics observed for the commonly used boundary conditions, we propose a novel biomechanical constraint method to generate physiological femur biomechanics. The biomechanical method yielded FHD (

Abstract Background Diabetes in pregnancy is associated with increased risk of long-term metabolic disease in the offspring, potentially mediated by in utero epigenetic variation. Previously, we identified multiple differentially methylated single CpG sites in offspring of women with gestational diabetes mellitus (GDM), but whether stretches of differentially methylated regions (DMRs) can also be identified in adolescent GDM offspring is unknown. Here, we investigate which DNA regions in adolescent offspring are differentially methylated in blood by exposure to diabetes in pregnancy. The secondary aim was to characterize the RNA expression of the identified DMR, which contained the nc886 non-coding RNA. Methods To identify DMRs, we employed the bump hunter method in samples from young (9–16 yr, n = 92) offspring of women with GDM (O-GDM) and control offspring (n = 94). Validation by pyrosequencing was performed in an adult offspring cohort (age 28–33 years) consisting of O-GDM (n = 82), offspring exposed to maternal type 1 diabetes (O-T1D, n = 67) and control offspring (O-BP, n = 57). RNA-expression was measured using RT-qPCR in subcutaneous adipose tissue and skeletal muscle. Results One significant DMR represented by 10 CpGs with a bimodal methylation pattern was identified, located in the nc886/VTRNA2-1 non-coding RNA gene. Low methylation status across all CpGs of the nc886 in the young offspring was associated with maternal GDM. While low methylation degree in adult offspring in blood, adipose tissue, and skeletal muscle was not associated with maternal GDM, adipose tissue nc886 expression was increased in O-GDM compared to O-BP, but not in O-T1D. In addition, adipose tissue nc886 expression levels were positively associated with maternal pre-pregnancy BMI (p = 0.006), but not with the offspring’s own adiposity. Conclusions Our results highlight that nc886 is a metastable epiallele, whose methylation in young offspring is negatively correlated with maternal obesity and GDM status. The physiological effect of nc886 may be more important in adipose tissue than in skeletal muscle. Further research should aim to investigate how nc886 regulation in adipose tissue by exposure to GDM may contribute to development of metabolic disease.

Abstract Background and Aims Considering the increasing use of information technology (IT) and the need of the implementation of related projects, the lack of IT specialists in the health system is one of the major challenges that require planning and foreseeing. This study was conducted with the aim of predicting the number of required IT personnel in hospitals of Isfahan University of Medical Sciences based on the modeling of identified and weighed influential factors in 2023. Method First, Delphi method and multi‐criteria decision‐making (MCDM) using the Expository Posthaste Effective Resemblant Tool (ExPERT) were conducted to identify and weigh the components that affect IT staff's workload in hospitals. Then, the model for predicting the required number of IT personnel for the involved hospitals was developed. In all stages, the obtained information and results were checked and confirmed using experts' opinions in Focus Group Discussions. Results Twenty‐one hospitals (57%) out of 37 hospitals are facing a shortage of IT personnel. This varies from 0.5 to 1.6 personnel in different hospitals. Thirteen hospitals (35%) were reported to have adequate IT staffing and three hospitals (8%) had excess IT staffing. Conclusion This study provided a predictive model for required IT staff in hospitals using MCDM through ExPERT which can be used in cases where the use of workload‐based methods such as Workload Indicators of Staffing Need is complex or time‐consuming.

Background and Objectives: Children with intellectual disabilities (ID) not only have impairments in cognitive functioning but also experience difficulties in perceptual and motor skills, which may lead to balance deficits and increased risk of falls. The preset study aimed to assess the relationship between fundamental motor skills and postural control adaptability and compare them in teachable children with ID and normal children. Materials and Methods: This descriptive study involved 34 girls with ID and 30 age-matched healthy peers aged 7-13. Balance variables, including amplitude, variability, and velocity of the center of pressure (CoP), were evaluated using the force plate in Tandem and Feet-together conditions. Fundamental motor skills were also assessed using the third edition of the Test of Gross Motor Development (TGMD-3). The independent t-test and repeated measures were used to examine between-group and within-group differences in balance variables. The Mann-Whitney U-test and Spearman's rank correlation were also employed to assess group differences and the relationship between variables. All statistical analyses were performed using SPSS software. A p-value less than 0.0 was considered statistically significant. Results: The results pointed out that children with ID had lower scores on the TGMD-3 test compared to the control group (P0.05). The correlation analysis also demonstrated that displacement scales and object control had a moderate and significant relationship with balance variables (P

Introduction and purpose: Immigrants are more susceptible to somatic symptom disorder because they often experience a series of traumatic and stressful events in their pre- and post-immigration lives. The present study was conducted to investigate the relationship between demographic characteristics and the severity of somatic symptoms in Iranian immigrants living in Germany. Methods: This correlational and cross-sectional descriptive study was conducted to explore the association between demographic characteristics and the severity of somatic symptoms of Iranian immigrants living in Germany in the summer of 2023. A total of 253 Iranian immigrants in Germany participated in this research, providing their responses via an online questionnaire. The questionnaire consisted of two parts of demographic information (including age, gender, marital status, education, occupation, proficiency in English and German, immigration ways, and length of stay) and a 15-item somatic symptoms questionnaire of the Patient Health Questionnaire by Spitzer et al. (1999). The collected data were subsequently analyzed in SPSS software (version 26) using descriptive statistics and stepwise regression. Results: The participants included 155 women and 98 men, with an average age of 35.15 and a standard deviation of 6.95. The average somatic symptoms in the groups of women (8.97), divorced people (10.9), diploma education and less (9.33), unemployed people (9.39), English language proficiency at the basic level (9.75) and German (9.96), migration through asylum (9.91), and six months stay (8.89) were higher than other groups. The regression model in five steps identified the variables of German language proficiency, gender, English language proficiency, migration ways, and marital status to predict the severity of somatic symptoms. The multiple correlation coefficient was 0.63, and the coefficient of determination (R2) was 0.40, which indicates that demographic characteristics can explain 40% of the changes in somatic symptoms of immigrants. Conclusion: It is essential to pay attention to the demographic characteristics of individuals in researching and treatment of somatic symptoms. Considering the individual-social background and the current situation of the immigrant will be the basis for better guidance in healthcare services.

Abstract Failure to employ suitable measures before administering full anesthesia to patients with obstructive sleep apnea (OSA) who are undergoing surgery may lead to developing complications after surgery. Therefore, it is very important to screen OSA before performing a surgery, which is currently done by subjective questionnaires such as STOP-Bang, Berlin scores. These questionnaires have 10–36% specificity in detecting sleep apnea, along with no information given on anatomy of upper airway, which is important for intubation. To address these challenges, we performed a pilot study to understand the utility of ultrasonography and vowel articulation in screening OSA. Our objective was to investigate the influence of OSA risk factors in vowel articulation through ultrasonography and acoustic features analysis. To accomplish this, we recruited 18 individuals with no risk of OSA and 13 individuals with high risk of OSA and asked them to utter vowels, such as /a/ (as in “Sah”), /e/ (as in “See”). An expert ultra-sonographer measured the parasagittal anterior–posterior (PAP) and transverse diameter of the upper airway. From the recorded vowel sounds, we extracted 106 features, including power, pitch, formant, and Mel frequency cepstral coefficients (MFCC). We analyzed the variation of the PAP diameters and vowel features from "See: /i/" to "Sah /a/" between control and OSA groups by two-way repeated measures ANOVA. We found that, there was a variation of upper airway diameter from “See” to “Sah” was significantly smaller in OSA group than control group (OSA: ∆12.8 ± 5.3 mm vs. control: ∆22.5 ± 3.9 mm OSA, p

Abstract Neurodevelopmental conditions can be associated with decreased health-related quality of life; however, the predictors of these outcomes remain largely unknown. We characterized the predictors of health-related quality of life (HRQoL) in a sample of neurodiverse children and youth. We used a cross-sectional subsample from the Province of Ontario Neurodevelopmental Disorders Network (POND) consisting of those children and young people in the POND dataset with complete study data (total n = 615; 31% female; age: 11.28 years ± 2.84 years). Using a structural equation model, we investigated the effects of demographics (age, sex, socioeconomic status), core features (Social Communication Questionnaire, Toronto Obsessive Compulsive Scale, Strengths and Weaknesses of attention deficit/hyperactivity disorder (ADHD)-symptoms and Normal Behavior), co-occurring symptoms (Child Behaviour Checklist), and adaptive functioning (Adaptive Behaviour Assessment System) on HRQoL (KINDL). A total of 615 participants had complete data for this study (autism = 135, ADHD = 273, subthreshold ADHD = 7, obsessive–compulsive disorder (OCD) = 38, sub-threshold OCD = 1, neurotypical = 161). Of these participants, 190 (31%) identified as female, and 425 (69%) identified as male. The mean age was 11.28 years ± 2.84 years. Health-related quality of life was negatively associated with co-occurring symptoms (B = − 0.6, SE = 0.20, CI (− 0.95, − 0.19), p = 0.004)) and age (B = − 0.1, SE = 0.04, CI (− 0.19, − 0.01), p = 0.037). Fewer co-occurring symptoms were associated with higher socioeconomic status (B = − 0.5, SE = − 0.05, CI (− 0.58, − 0.37), p

Abstract Occupational health must be strictly considered in industries particularly in nanoparticle factories where workers were exposed to different types of chemicals. We measured the serum levels of inflammatory cytokines in workers who developed skin lesions after exposure to silver and silica nanoparticles. Using a questionnaire in this cross-sectional study, we identified 110 workers in nanoparticle industries who were exposed to silver and silica nanoparticles. We also included 40 healthy subjects as controls from the administrative department of the same factories who were not exposed to nanoparticles. Peripheral blood samples used to measure the mRNA levels of inflammatory cytokines by qRT-PCR. In comparison with the control group, the workers who developed skin lesions had significantly higher levels of interleukin IL4, IL6, IL8, and TNF-α, particularly after two or three decades of exposure to silver and silica nanoparticles. Participants who were exposed to silver had higher levels of IL6 and IL8 compared with those who were exposed to silica. Necessary measures must be considered to protect workers in nanoparticle industries against the potential toxic effects of these compounds. Our network pharmacology study suggests corresponding biochemical pathways for these disorders.

Abstract Background The importance of motivation regulation in medical students is highly significant due to their unique educational circumstances, such as clinical exposure. However, the role of clinical exposure in learning motivational self-regulation skills in students has not been explored thus far. This current study aims to investigate the role of clinical exposure on motivational self-regulation skills in medical students based on cognitive apprenticeship model. Method This study was descriptive-analytical research conducted in 2022 on medical students. Data collection involved two questionnaires including Meta motivational Strategies in Medical Students Questionnaire and Maastricht Clinical Teaching Questionnaire. The research comprised two stages including measuring motivational self-regulation strategies in students before entering the clinical exposure phase, and simultaneous measurement of clinical exposure based on the student’s viewpoint and their motivational self-regulation strategies at the end of the first term of clinical exposure. Results The results revealed a significant relationship between six dimensions of the cognitive apprenticeship model, including modeling, coaching, scaffolding, reflection, exploration, and learning environment, with motivational self-regulation strategies. However, there was no significant relationship between the articulation dimension of the cognitive apprenticeship model and motivational self-regulation strategies. Conclusion Clinical exposure indirectly enhances students’ metacognitive skills. Observing the behavior of clinical faculty in the clinical exposure setting leads to the improvement of motivational self-regulation strategies in medical students.

Background and purpose: Access to primary healthcare services, considering equity and equality in the health system, is a right of the global community. To provide primary health services, the rural family physician program was implemented at the beginning of 2005 to achieve universal health coverage in rural areas and small cities (with a population of less than 20,000). The specific goals of this program included the implementation of the referral system, increasing the responsiveness of the health market, increasing people’s access to health services, reducing unnecessary costs in the health market, and increasing service coverage. After approximately 7 years of implementation of this program, the urban family physician program started in Mazandaran and Fars province as a pilot project. The urban family physician program started in the Mazandaran province in 2012 as the first level of providing health services. In line with the better implementation of this program and considering the wide range of expected programs and activities, it is essential to entrust the appropriate activities with the time of the service providers. This study was conducted to assess the expected duration of activities assigned to the family physician. Materials and methods: This cross-sectional study was conducted on 15 urban family physician centers (6 government and 9 private centers) in Golugah, Behshahr, Neka, Ghaemshahr, Noor, and Chalus cities of Mazandaran province. Out of 15 cities with more than 20,000 people participating in this program in Mazandaran province, the six cities mentioned above were randomly selected, and 15 urban family doctors were randomly selected from the existing list. Finally, the target groups were included in the study for convenience sampling. To collect the data, checklists compiled based on care packages corresponding to 8 groups of service recipients (elderly (11 services), middle-aged (7 services), youth (13 services), teenagers (24 services), under 5 years old (6 services), mana (15 services), mothers (3 services), and non-target visit) were used. For each service recipient group, at least three individuals were examined. Central and dispersion indices were used to describe the data. Results: The results of measuring the time of providing service to 297 people (including 90 under 5 years old, 30 people receiving Mana services, 30 people from each of the groups of mothers, teenagers, young people, middle-aged, elderly, and 27 people from non-target visit) showed that the median and mean expected time for providing daily service by an urban family physician to the covered population is 2 h and 52 min and 3 h and 23 min, respectively. The estimated time was different in the groups receiving the service, the highest time of which was related to the visit of the non-target service group with median and mean of 84.17 and 87.20 min, respectively, and the lowest time was related to Mana services with a median and mean of 3.40 and 4.34 min, respectively. Conclusion: Urban family physicians have enough time to provide daily services, and therefore it seems that the health system has not assigned them more than their daily time capacity.

Abstract Considering that interventions related to lifestyle, especially nutrition have been proposed as the first line of prevention and treatment of polycystic ovarian syndrome (PCOS), and regarding the proven relationship between PCOS and inflammation, the present study was designed to find out the possible association of Diet Inflammatory Index (DII) with the inflammatory markers like C-reactive protein (CRP) and Interleukin-6 (IL-6), and compare the obtained results in PCOS and non-PCOS women. This case–control study was conducted on 45 PCOS and 40 non-PCOS women. Food intake and DII were measured using a 147-item Food Frequency Questionnaire. All participants were tested for the serum levels of IL-6 and CRP. Finally, the obtained results were compared between the two groups of PCOS and non-PCOS women. Significant differences were observed between the two groups in terms of age, menstrual status and number of pregnancies (P 0.05). The difference of DII between the case and control groups were not significant and Pearson's correlation test did not show a significant correlation between DII and IL-6 (P˃0.05). This result can be due to the influence of several factors affecting the determination of DII such as education level, health status, physical activity level, age, and calorie intake. It seems that diet, especially consumption of more carbohydrates plays a role in causing chronic inflammation, as well as the occurrence and exacerbation of PCOS.

Abstract Serpentine microchannels are known for their effective particle focusing through Dean flow-induced rotational effects, which are used in compact designs for size-dependent focusing in medical diagnostics. This study explores square serpentine microchannels, a geometry that has recently gained prominence in inertial microfluidics, and presents a modification of square wave microchannels for improved particle separation and focusing. The proposed modification incorporates an additional U-shaped unit to convert the square wave microchannel into a non-axisymmetric structure, which enhances the Dean flow and consequently increases the Dean drag force. Extensive experiments were conducted covering a wide range of Reynolds numbers and particle sizes (2.45 µm to 12 µm). The particle concentration capability and streak position dynamics of the two structures were compared in detail. The results indicate that the modified square-wave microchannel exhibits efficient particle separation in the lower part of the Dean vortex-dominated regime. With increasing Reynolds number, the particles are successively focused into two streaks in the lift force-dominated regime and into a single streak in the Dean vortex-dominated regime, in this modified square wave geometry. These streaks have a low standard deviation around a mean value. In the Dean vortex-dominated regime, the location of the particle stream is highly dependent on the particle size, which allows good particle separation. Particle focusing occurs at lower Reynolds numbers in both the lift-dominated and lift/Dean drag-dominated regions than in the square wave microchannel. The innovative serpentine channel is particularly useful for the Dean drag-dominated regime and introduces a unique asymmetry that affects the particle focusing dynamics. The proposed device offers significant advantages in terms of efficiency, parallelization, footprint, and throughput over existing geometries.

Objective(s): The use of statistical methods to reach the clustering and ranking of health in the society can give a proper view of the state of health in Iranian provinces. The aim of the current research was to cluster and rank Iranian provinces based on some health indicators. Methods: This was a descriptive study. Clustering and ranking Iranian provinces were carried out according to several items such as the number of employees working in faculties of medical sciences, doctors, paramedics, hospitals, active beds, primary health care providers, laboratories, rehabilitation centers, nuclear medicine centers, clinics and emergency centers. The data were collected from the statistical yearbooks of the provinces. Clustering analysis and data visualizations were performed in R software and ranks were obtained using Topsis software. Results: The results showed that the provinces of Ilam, Yazd, Semnan, South Khorasan, Zanjan, Ardabil, Fars, Kohgiluyeh and Boyer Ahmad, and Chaharmahal and Bakhtiari had the highest health scores and belonged to the third cluster. Their ranks were 1 to 9 respectively. In the first cluster the following provinces were observed: Qom, Tehran, Alborz, and Hamedan with scores of 0.552, 0.540, 0.460, and 0.36 respectively indicating that these provinces had the lowest health scores and their ranks were 28 to 31. The other provinces appeared on the second cluster and ranked 10 to 27 with almost equal scores. Conclusion: In order to achieve health equity, the indicators should be improved in provinces belonged to the first cluster to in order to achieve the standard per capita.

Objective(s): Grief is a natural experience that helps bereaved people process the pain of loss and move toward healing. Throughout the COVID-19 pandemic, the bereaved people were faced with unprecedented conditions due to the absence of mourning ceremonies. The present study was to explore the personal experience by which the bereaved ones encountered the situation. Methods: A qualitative study was conducted with a purposeful sample of Iranians who had lost a family member due to the virus. Data were collected using unstructured interviews until saturation was research. The study was conducted during 2021-2022 Results: We interviewed 16 bereaved people. The data analysis revealed 14 subcategories, 3 categories: failed mourning, bitter loneliness, incomplete gestalt of grief and a core theme as endless sorrow. Conclusion: The findings showed that not holding mourning ceremony during the covid-19 epidemic caused bereaved people with a large number of unfulfilled expectations. It seems that there is need to find a way through the stages of mourning for these people by addressing their expectations and wishes.

Purpose: Chronic non-specific low back pain (CNSLBP) is a common health issue caused by a mix of biological, psychological, and social factors. Cognitive functional therapy (CFT) is a comprehensive way to treat CNSLBP that focuses on changing negative thoughts and unhelpful habits through relaxation techniques. Since the evidence on the efficacy of CFT is still limited, it is essential to conduct clinical trials aimed at the effectiveness of CFT in the treatment of CNSLBP. This study aims to examine the effect of cognitive functional therapy on psychological variables in women with CNSLBP. Methods: Thirty women with CNSLBP were recruited for the clinical trial. They were randomly divided into two experimental and control groups (15 patients in each group). Our experimental group will have 18 individualized CFT sessions, each lasting an hour, over two months. The control group received no intervention. Pain intensity, disability, and kinesiophobia were assessed via the visual analog scale, Oswestry, and Tampa scale, respectively. Two-way repeated measures analysis of variance (ANOVA) was used to compare results between groups. Results: Two-way repeated measures ANOVA results showed that the experimental group compared to the control group in reducing pain (P=0.000, ηp2=0.787), disability (P=0.005, ηp2=0.457) and Kinesiophobia (P=0.000, ηp2=0.561) had a significant difference. Conclusion: CFT reduced pain, disability, and kinesiophobia in patients with CNSLBP. Further evaluation of the efficacy of CFT in high-quality randomized clinical trials among patients with CNSLBP is recommended.

Key Clinical Message Generalized lichen planus pigmentosus significantly improved with the daily administration of Tofacitinib at a dosage of 15 mg.

Key Clinical Message The use of phototherapy is highly effective in treating various skin diseases. In this study, the aim is to present vesicular and blister lesions in patients treated with UVB for psoriasis. It is advisable to consider the possibility of BSLE in cases of vesiculobullous lesions following phototherapy, along with other potential diagnoses. Abstract Bullous systemic lupus erythematosus (BSLE) is a rare form of cutaneous lupus erythematosus that presents as vesicles and blisters on various parts of the body. The pathological appearance of these lesions often shows subepidermal vesicles with deposits of IgG, IgM, IgA, and complement C3 in granular or linear forms under direct immunofluorescence (DIF) examination. Clinical studies demonstrate the effectiveness of phototherapy in treating various skin conditions. While several studies suggest a correlation between phototherapy and the development of vesiculobullous lesions, most of these reports are related to bullous pemphigoid, with limited research on the occurrence of BSLE following phototherapy. In this case report, vesicular and blistering lesions in a 70‐year‐old man undergoing UVB treatment for psoriasis are described. Pathological examination confirmed the diagnosis of bullous systemic lupus erythematosus, and the patient experienced significant improvement after treatment with dapsone tablets. A literature review was conducted on the development of vesiculobullous lesions after phototherapy, comparing different approaches presented in previous studies. Our conclusion highlights the importance of considering BSLE as a possible diagnosis in cases of vesiculobullous lesions post‐phototherapy, alongside other potential conditions.

Background & aims: Ultra-processed foods (UPF) are formulations of ingredients, resulting from a series of industrial processes. Excess intake of UPF is associated with an increased risk of obesity and chronic disease. The present study investigates the interaction between the consumption of UPF and genetic risk score with body composition, body adiposity index (BAI), and appendicular skeletal muscle mass (ASM) in overweight and obese women. Method: The study is cross-sectional with 376 overweight and obese women aged 18–65 years. The food consumption was obtained with 147-item food frequency (FFQ), and food items were grouped according to the level of processing as per the NOVA classification. Three single nucleotide polymorphisms (SNPs), including Caveolin_1 (Cav_1), Melanocortin4 receptor (MC4R), and cryptochrome circadian regulator 1 (CRY1), were used to calculate GRS. The individual risk allele for each SNP was calculated using the incremental genetic model. Each SNP was recoded as 0, 1, or 2 based on the number of risk alleles associated with a higher body mass index (BMI). Subsequently, the unweighted GRS was computed by summing the number of risk alleles across the three SNPs. The GRS scale spans from 0 to 6, with each point representing a risk allele.Anthropometric measurements and some blood parameters were measured by standard protocols. Results: After controlling for confounders such as age, energy intake, and BMI a significant interaction was found for appendicular skeletal muscle mass (β = −1.65, P = 0.04) and appendicular skeletal muscle mass index (β = −0.38, P = 0.07) on the NOVA classification system and GRS. Conclusions: The findings of this study showed a significant interaction between GRS and the NOVA classification system on some body composition, including appendicular skeletal muscle mass. A higher intake of ultra-processed foods may be associated with lower appendicular skeletal muscle mass in people with high obesity-GRS.

Abstract Background and Aim One of the complications of using catheters is the occurrence of thrombosis, which can be dangerous for patients. The main objective of this study is to compare the effect of heparin, reteplase, and taurolock in the prevention of thrombosis in hemodialysis catheters. Methods The present study is a clinical trial, in which the effect of three drugs, heparin, reteplase, and taurolock, in the prevention of thrombosis in hemodialysis catheters, has been investigated. The research units were studied in two intervention and control groups. The stratified random allocation method was used to assign patients to five groups (control, Heparin 50, Heparin 1000, reteplase, and taurolock), with strata based on the patient's age (20–70 years), gender, and duration of dialysis. Within each stratum, patients were also assigned to groups using the randomized block permutation method and a random number table tool. To prevent bias, this study is triple‐blinded. This means that the patient, the thrombosis assessor, and the statistical analyst are unaware of the type of intervention received by the patient. Results Gender (p

Key Clinical Message Here we present a case of a 4‐year‐old girl who suffered from vulvovaginitis caused by Enterobius vermicularis. All members of her family were also infected by this helminth. Treatment with mebendazole was administered to all family members and it was found that the entire family had been cured. Abstract Vulvovaginitis, an inflammation of the vulvovaginal mucous membranes, is a common reason for pediatric gynecology consultations. One of the causes of this condition is a parasitic worm known as Enterobius vermicularis (E. vermicularis). In girls, adult worms can infiltrate the vagina and release eggs, leading to the development of vulvovaginitis. Furthermore, these worms have the ability to invade the endometrial cavity too. Here we present a case of a 4‐year‐old girl who suffered from vulvovaginitis caused by E. vermicularis. All members of her family were also infected by this parasitic helminth. In the vaginal sample, apart from the eggs, the female adult worm was observed under the microscope. Treatment with mebendazole was administered to all family members, and their progress was followed for a period of 3 weeks, during which it was found that the entire family had been cured. This patient experienced significant improvement in symptoms related to severe anxiety, nervousness, vaginal inflammation, itching, and vulvovaginitis caused by E. vermicularis. To prevent infection by E. vermicularis, it is crucial to disinfect underwear and bed sheets. In kindergartens, the spread of this parasite should not be underestimated, and asymptomatic individuals who have been exposed to infected persons should receive treatment to prevent an epidemic. Maintaining cleanliness and hygiene, especially after using the toilet, is of the most importance, particularly for girls who are more susceptible to E. vermicularis infection. Additionally, it is essential for all family members to be aware of the transmission routes of this parasite.

While exagamglogene autotemcel (Casgevy) and lovotibeglogene autotemcel (Lyfgenia) have been approved by the US Food and Drug Administration (FDA) as the first cell-based gene therapies for the treatment of patients 12 years of age and older with sickle cell disease (SCD), this treatment is not universally accessible. Allogeneic hematopoietic stem cell transplant (HSCT) has the potential to eradicate the symptoms of patients with SCD, but a significant obstacle in HSCT for SCD is the availability of suitable donors, particularly human leukocyte antigen (HLA)-matched related donors. Furthermore, individuals with SCD face an elevated risk of complications during stem cell transplantation due to SCD-related tissue damage, endothelial activation, and inflammation. Therefore, it is imperative to consider optimal conditioning regimens and investigate HSCT from alternative donors. This review encompasses information on the use of HSCT in patients with SCD, including the indications for HSCT, conditioning regimens, alternative donors, and posttransplant outcomes.

Key clinical message Subungual Onycholemmal Cyst (SOC) is a rare nail abnormality with different clinical presentations which can mimic different nail malignancies, such as melanoma, SCC, or glomus tumor. It is necessary for dermatologists and dermatopathologist to be aware of this pathology to make the proper diagnosis and treatment. SOC is a rare nail abnormality which affects the dermis of the nail bed. SOC has different clinical presentations, including onychodystrophy, ridging, clubbing, thickening, pigmentation, or even normal appearance. It can mimic different nail malignancies, such as melanoma, SCC, or glomus tumor. In this report, we describe a 54‐year‐old man with unilateral second right finger nail onychodystrophy and onycholysis for 1 year. He did not have any history of recent trauma, pain, or bleeding. It was completely resected by surgery. Nail biopsy can contribute to the early diagnosis of SOC and improvement of treatment outcomes.

Background and purpose: Chronic obstructive pulmonary disease (COPD) is a progressive pulmonary ailment characterized by prolonged respiratory symptoms and airflow constriction. COPD stands as the third most prominent cause of mortality on a global scale. It is commonly linked to numerous extra-pulmonary conditions, such as cardiopulmonary disorders, musculoskeletal frailty, and anemia. Osteoporosis, regarded as one of the principal systemic complications arising from COPD, represents an elevated susceptibility to osteoporotic fractures and imposes a significant financial burden. Considering the clinical significance surrounding the emphysema phenotype in COPD, as well as the lack of investigation on this matter in the country, the objective of this study is to determine the comparative prevalence of osteoporosis and osteopenia in COPD patients, with and without emphysema, who receive medical attention at Tubi Sari Clinic and Imam Khomeini Hospital in Sari. Materials and methods: This cross-sectional study was conducted in 2021 on patients referred to the rheumatology and lung clinic, and COPD patients admitted to Imam Khomeini Hospital in Sari. In this study, 50 patients with COPD with emphysema as a case group and 50 patients with COPD without emphysema as a control group were included in the study. Then, using densitometry and examining the bone mass density of all COPD patients, the patients were divided into two groups: with and without osteoporosis. Then, the patient's information was entered into SPSS software and analyzed. Results: There was no significant difference in vitamin D serum levels, vertebral fracture score, or BMD between emphysema and non-emphysema patients (P=0.09, P=0.098). Multivariate analysis showed that (in a model including age, BMI, FEV1, PaO2, emphysema score, CRP, and dyspnea score) only BMI, FEV1, and PaO2 decreased as independent risk factors for low BMD. Conclusion: Our findings showed that emphysema is an independent risk factor for osteoporosis according to the multivariate model. Low BMI, severity of COPD, and hypoxia play a dominant role in the development of osteoporosis.

Background and purpose: A bone marrow examination is necessary to diagnose some hematologic diseases. In this study, we compared the effects of acetaminophen and promethazine versus intravenous injections of midazolam and pethidine on pain reduction after bone marrow sampling. Materials and methods: In this study, 88 patients were divided into two groups. The first received one gram of acetaminophen as an infusion and 25 milligrams of promethazine syrup 30 minutes before the procedure. The second group received intravenous injections of 25 milligrams of pethidine and 5 milligrams of midazolam five minutes before the procedure. In two groups, local anesthesia with lidocaine was given before the procedure. The pain and presence of anxiety in the patients were assessed using a 10-point Likert scale. Results: We analyzed the results of 88 patients. At 30 minutes after sampling, patients in the pethidine-midazolam group reported lower pain compared to those in the promethazine-acetaminophen group (1.18±0.90 vs. 1.77±0.99) (P=0.004). This difference was particularly notable among men (0.90±0.98 vs. 0.99±1.67) (P=0.001). Among men, those older than 30 years showed a reduction in pain (1.01±0.9 vs. 0.99±1.46) (P=0.049). No significant difference was observed between the two groups in terms of pain immediately after sampling. The administration of promethazine and acetaminophen showed a more positive future perspective in patients older than 46 years (P=0.033). Additionally, the average incidence of anxiety 30 minutes after the procedure was 27.3% in the pethidine-midazolam group and 22.7% in the promethazine-acetaminophen group. However, there was no significant difference in the level of anxiety between the two groups (P=0.806). Conclusion: Based on our data, the combination of promethazine and acetaminophen had similar analgesic effects to the combination of pethidine and midazolam immediately after sampling. As a result, according to the various side effects of pethidine and midazolam, especially in patients with respiratory diseases and outpatients, the combination of promethazine and acetaminophen can be used. (Clinical Trials Registry Number: IRCT20200427047215N2)

Abstract Background Aspergillus spp. are among the fungal pathogens that can cause life-threatening infections in patients with a history of COVID-19. Case presentation We present the case of a 58-year-old Iranian woman with post-COVID-19 Aspergillus fumigatus endocarditis complicated by numerous thromboembolisms. She underwent mitral valve replacement surgery and multiple lower extremity embolectomies and was treated with voriconazole, which led to her final recovery. Conclusions Aspergillus endocarditis should be considered in any patient with suspected endocarditis who has a history of COVID-19 infection and does not respond to routine antibiotic and antifungal therapy, as COVID-19 interferes with proper immune function, and lack of underlying cardiac conditions and immunodeficiencies does not preclude the diagnosis. Culture and histopathological evaluation of vegetations and emboli, as well as PCR, can confirm the diagnosis. Early initiation of antifungal therapy and surgical removal of infected valves and emboli can improve prognosis in patients with Aspergillus endocarditis.

Objective: Trichomoniasis is the most common sexually transmitted protozoan infection worldwide. Metronidazole is widely considered as the drug of choice for treating of trichomoniasis but considering its potential side effects, we aimed to assess the therapeutic influences of hydro-alcoholic extracts of Quercus brantii and Artemisia aucheri Boiss as alternative medications against Trichomonas vaginalis (T. vaginalis). Methods: The trophozoites were cultured in TYI-S-33 medium at a density of 5x105 trophozoites/mL. Subsequently, they were incubated with varying concentrations of the plant extracts (32, 64, 125, 250, 500, and 1,000 μg/mL) and metronidazole (16, 32, 64, 125, 250, and 500 μg/mL), as the positive control. The number of trophozoites in each well plate was quantified after 2, 4, 6, 24, 48, and 72 hours using trypan blue staining. Finally, the viability of the parasite was assessed by vital methylene blue staining. Results: The hydro-alcoholic extracts of Q. brantii and A. aucheri Boiss at concentrations of 125, 250, 500, and 1,000 μg/mL demonstrated significant efficacy against the parasite. Our findings indicated that the minimum effective concentrations were 125 μg/mL and hydro-alcoholic extracts of Q. brantii and A. aucheri Boiss have the ability to effectively eliminate T. vaginalis after 48 and 72 hours of treatment. Conclusion: The findings of the present study showed that hydro-alcoholic extract of Q. brantii and A. aucheri Boiss can induce death in T. vaginalis. However, further complementary in vivo studies are needed to assess the components of these plants in the treatment of T. vaginalis.

Statement of the Problem: Early detection of caries and the extent of carious lesions for appropriate treatment planning are very important and lead to introduction of new diagnostic tools.Purpose: This study aimed to compare the diagnostic accuracy of VistaCam IX Proxi and bitewing radiography for detection of posterior interproximal caries.Materials and Method: This in vitro study was performed on 40 extracted posterior teeth without cavitated carious lesions. Bitewing radiographs were obtained, infrared (IR) examination was performed, and the teeth were sectioned for histopathological analysis under a stereomicroscope as the gold standard for detection of caries and determination of the extent of carious lesions. Data were analyzed with Cohen’s kappa statistic, and Wilcoxon rank sum test.Results: The specificity of VistaCam IX Proxi and bitewing radiography was 71.4% and 87.7%, respectively. Their sensitivity was 100% and 40% for enamel caries, 72.8% and 54.5% for external half dentin caries, and 82.3% and 58.8% for internal half dentin caries, respectively (p= 0.048).Conclusion: Bitewing radiography had a higher specificity and lower rate of false positive results. However, VistaCam IX Proxi had higher sensitivity for caries detection with lower rate of false negative results. Considering the higher sensitivity and significantly lower frequency of false negative results by VistaCam IX Proxi, it may be reliably used for caries detection specially enamel caries, and can serve as an adjunct to bitewing radiography.

Abstract Background Bacterial and fungal superinfections are commonly reported in patients with coronavirus disease 2019. Case presentation We report the first case of brain and intramedullary abscesses caused by Pseudomonas aeruginosa and a rare case of brain abscesses caused by Aspergillus fumigatus in two post-coronavirus disease 2019 patients. The first patient—34-year-old Iranian woman—presented with weakness of the left upper limb, headaches, and lower limb paresthesia. She had a history of undiagnosed diabetes and had received corticosteroid therapy. The second patient—45-year-old Iranian man—presented with right-sided weakness and had a history of intensive care unit admission. Both patients passed away despite appropriate medical therapy. Conclusion The immune dysregulation induced by coronavirus disease 2019 and its’ treatments can predispose patients, especially immunosuppressed ones, to bacterial and fungal infections with unusual and opportunistic pathogens in the central nervous system. Pseudomonas aeruginosa and Aspergillus fumigatus should be considered as potential causes of brain infection in any coronavirus disease 2019 patient presenting with neurological symptoms and evidence of brain abscess in imaging, regardless of sinonasal involvement. These patients should get started on appropriate antimicrobial therapy as soon as possible, as any delay in diagnosis or treatment can be associated with adverse outcomes.

As the foundation of nutritious foods lies in the soil, the consumption of crops grown in contaminated soils may pose an elevated risk of health issues through the soil-plant-human pathway. The impact of heavy metals (HMs) and metalloids on the physiological and biochemical responses of plants can have adverse effects on both growth and yield. The excessive accumulation of these substances in plant tissues poses a significant challenge to public health. HMs possess the capability not only to function as carcinogens but also to act as co-carcinogens, thereby activating specific chemical compounds. According to the World Health Organization (WHO) reports, the target values, representing the desirable maximum concentrations of HMs in the soil, follow the order: Cr > Pb > Zn > Cu > Ni > Cd. This implies that Cd poses the highest potential risk, given its target value of 0.8 mg/kg, while Cr carries the lowest potential risk, with a target value of 100 mg/kg. Various agricultural management practices are recognized as significant pathways that induce the accumulation of metals in the soil and the surrounding environment. Hence, understanding the origin and status of HMs in the environment, along with assessing their potential risks and developing strategies to mitigate these risks, becomes crucial. This study aims to evaluate different facets of the soil-human health continuum concerning potentially toxic metals.

Abstract The excessive release of greenhouse gases, especially carbon dioxide (CO2) pollution, has resulted in significant environmental problems all over the world. CO2 capture technologies offer a very effective means of combating global warming, climate change, and promoting sustainable economic growth. In this work, UiO-66-NH2 was synthesized by the novel sonochemical method in only one hour. This material was characterized through PXRD, FT-IR, FE-SEM, EDX, BET, and TGA methods. The CO2 capture potential of the presented material was investigated through the analysis of gas isotherms under varying pressure conditions, encompassing both low and high-pressure regions. Remarkably, this adsorbent manifested a notable augmentation in CO2 adsorption capacity (3.2 mmol/g), achieving an approximate enhancement of 0.9 mmol/g, when compared to conventional solvothermal techniques (2.3 mmol/g) at 25 °C and 1 bar. To accurately represent the experimental findings, three isotherm, and kinetic models were used to fit the experimental data in which the Langmuir model and the Elovich model exhibited the best fit with R2 values of 0.999 and 0.981, respectively. Isosteric heat evaluation showed values higher than 80 kJ/mol which indicates chemisorption between the adsorbent surface and the adsorbate. Furthermore, the selectivity of the adsorbent was examined using the Ideal Adsorbed Solution Theory (IAST), which showed a high value of 202 towards CO2 adsorption under simulated flue gas conditions. To evaluate the durability and performance of the material over consecutive adsorption–desorption processes, cyclic tests were conducted. Interestingly, these tests demonstrated only 0.6 mmol/g capacity decrease for sonochemical UiO-66-NH2 throughout 8 consecutive cycles.

Abstract Introduction Simultaneous pancreas kidney (SPK) transplantation is an invaluable procedure to enhance the quality of life of insulin-dependent patients with advanced renal disease. The creation of vascular anastomoses of the donor’s pancreas vessels to the recipient’s, is of utmost importance to predict the graft outcome and surgical complications. In the study we introduce a novel technique for arterial reconstruction during SPK transplantation. Methods Conventionally, during the SPK transplantation, a so-called Y-graft is anastomosed between donor’s superior mesenteric and splenic artery to the recipient’s right iliac artery. In the study we adopted a new technique by preparing an extra extension using the donor’s carotid artery, to be anastomosed to the Y-graft and the iliac artery. In this non-blinded randomized clinical trial we compared the surgical complications and early outcomes between the 2 groups of patients with the traditional and new arterial reconstruction techniques during 3 months after transplantation. Results Thirty adult patients were included in the study. The incidence of pancreatitis, vascular thrombosis and surgical site infection was lower in the new Y-graft and extension technique, which was not statistically significant. However, the calculated Cohen’s d index showed the medium effect of new Y-graft and extension technique on complication after SPK transplantations. Conclusion The post-operative complications tend to be lower in the novel arterial reconstruction technique, however a study on a larger patient group is encouraged to confirm our primary results. Trial registration The study was registered at the Iranian Registry of Clinical Trials on 12/05/2022; IRCT 20210625051701N2; ( http://www.irct.ir/ ).

Abstract Finite element (FE) models have been widely used to investigate knee joint biomechanics. Most of these models have been developed to study adult knees, neglecting pediatric populations. In this study, an atlas-based approach was employed to develop subject-specific FE models of the knee for eight typically developing pediatric individuals. Initially, validation simulations were performed at four passive tibiofemoral joint (TFJ) flexion angles, and the resulting TFJ and patellofemoral joint (PFJ) kinematics were compared to corresponding patient-matched measurements derived from magnetic resonance imaging (MRI). A neuromusculoskeletal-(NMSK)-FE pipeline was then used to simulate knee biomechanics during stance phase of walking gait for each participant to evaluate model simulation of a common motor task. Validation simulations demonstrated minimal error and strong correlations between FE-predicted and MRI-measured TFJ and PFJ kinematics (ensemble average of root mean square errors 0.9 for translations and ρ > 0.8 for rotations), except for TFJ mediolateral translation and abduction/adduction rotation. For walking gait, NMSK-FE model-predicted knee kinematics, contact areas, and contact pressures were consistent with experimental reports from literature. The strong agreement between model predictions and experimental reports underscores the capability of sequentially linked NMSK-FE models to accurately predict pediatric knee kinematics, as well as complex contact pressure distributions across the TFJ articulations. These models hold promise as effective tools for parametric analyses, population-based clinical studies, and enhancing our understanding of various pediatric knee injury mechanisms. They also support intervention design and prediction of surgical outcomes in pediatric populations.

Abstract Over the past three years, the COVID-19 outbreak has become a major worldwide problem, affecting the health systems and economies of countries. The mean delays, the expected time to observe the average effect of the number of new cases on the number of deaths, are gold times for decision-making regarding disease control and treatment facilities to reduce the fatality rate. The interest of the present study is estimating the mean delays and adjusted fatality rates of COVID-19 with the new application of Distributed Lag Models (DLM) and their spatial distributions. The daily cases and deaths data of COVID-19 for 39 European countries was obtained from two sources; the "European Centre for Disease Prevention and Control" and the "Our World in Data" database. The mean delay and the Adjusted Fatality Rate (AFR) for each country at three-time intervals; the first and subsequent peaks before and after vaccination were estimated by the Distributed Lag Models. The spatial analysis was applied to find the spatial correlation of the mean delays and adjusted fatality rates among European countries. In the three-time intervals, the first and the subsequent peaks before vaccination, and after vaccination, the median and interquartile range of the mean delays; and AFRs were: 1.1 (0.4, 3.2); 0.024 (0.016, 0.044), 9.2 (6.2, 12.40); 0.013 (0.005, 0.020) and 7.3 (4.4, 11.0); 0.001 (0.001, 0.005), respectively. In the subsequent peaks before vaccination, the mean delays considerably increased, and the AFRs decreased for most European countries. After vaccination, the AFRs decreased considerably. Except for the first peak, the spatial correlations of AFRs were not significant among neighboring countries. Consecutive outcomes will occur with delays in outbreaks of infectious disease. Also, the fatality rates for these outcomes should be adjusted on delays. Estimating the mean delays and adjusted fatality rates by Distributed lag Models and the spatial distributions of theme in outbreaks showed that prevention and medical policies after the first peak as well as vaccination were effective to reduce the fatality rate of COVID-19, but these effects were different between countries. These results recommended policymakers and governments assign prevention and medical resources more effectively.

Abstract A novel catalyst was fabricated in this study based on zirconium MOF modified with pyridine carboxaldehyde in a solvothermal reaction, embedded with cerium. In order to confirm the catalyst structure, various characterization techniques, including FTIR, Far IR, EDX, XRD, TGA, FE-SEM, ICP, and BET analyses, were employed. The results indicated that the UiO-66-Pyca-Ce (III) catalyst had a Langmuir surface area of 501.63 m2/g, a pore volume of 0.28 cm3/g, and a pore size of 2.27 nm. To study catalytic activity, a sequential approach of Knoevenagel condensation and Michael addition was used to synthesize various polyhydroquinoline derivatives. The reaction took place at ambient temperature. The UiO-66-Pyca-Ce (III) catalyst demonstrated high efficacy (90%) and reusability in asymmetric synthesis of polyhydroquinoline derivatives for several reasons, including the possession of three Lewis acid activation functions.

Abstract Lack of absolute treatment for premenstrual syndrome (PMS), its cyclic nature, considerable prevalence (70–90%), and its mental and physical burden imply necessity of effectiveness comparison of various treatments. Although antidepressant and hormonal drugs are well-known medications for PMS, in affected women who can’t tolerate, or don’t have compatibility or compliance with these drugs, other effective treatments have always been important concern. This study aimed to compare effectiveness of online positive-oriented counseling, taking vitamin D3 tablet, and online lifestyle modification training on alleviating PMS. 3-armed parallel randomized clinical trial was performed on 84 20–40-year-old eligible women with PMS. 84 women were randomly ( www.random.org/sequenc ) allocated into three groups, but data of 77 women (1, n = 25) online positive-oriented counseling group (6 sessions), (2, n = 27) vitamin D3 tablet group (one vitamin D3 tablet weekly for 6 weeks), and (3, n = 25) online lifestyle training group (6 sessions) were analyzed. Vitamin D3 was measured at baseline, week6 and fallow up week10. Primary outcome variable PMS was measured with Premenstrual Symptoms Screening Tool (PSST) at baseline, week 6, and follow-up week 10. Primary outcome satisfaction with intervention method was measured using satisfaction scale at week 6 and follow-up week 10. ANOVA, Repeated Measures, and Paired samples t-test were used for statistical analysis. There was no statistically significant difference in PMS at baseline between three groups respectively (33 ± 5.8, 34.1 ± 7.1, & 35.2 ± 6.4, P = 0.500). However, at follow-up week 10, there was statistically significant difference between three groups (22.3 ± 4.3, 25.4 ± 6.5, & 31.8 ± 6.5; P