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Background and Objectives: Human milk has properties that can be absorbed in terms of quality and quantity, providing the energy and growth of the child. The theory of planned behavior is one of the patterns of behavior change aimed at determining the main behavior. In this model, the intention itself is affected by three independent constructs: attitude, abstract norm, and control. The present study aimed to assess the factors affecting the tendency towards exclusive breastfeeding based on the theory of planned behavior in mothers referring to comprehensive health centers in Abadan and Khorramshahr in 2022-2023. Materials and Methods: This descriptive-analytical cross-sectional study was conducted on 162 nursing mothers in Khorramshahr and Abadan in 2022 using multi-stage sampling. In this study, the theory of planned behavior (TPB) questionnaire was used. Cronbach's alpha coefficient was also used to check the reliability of the tool. Data were analyzed in AMOS software (version 24). Results: This study was conducted on 162 lactating mothers living in Abadan and Khorramshahr. In the descriptive statistics analysis, the highest and lowest mean scores were related to attitude level (34.96) and behavioral intention (11.24). Moreover, the correlation between demographic factors and breastfeeding revealed that some variables, such as parents' education, exerted a marked effect on exclusive breastfeeding. Conclusion: The results of the study pointed out that more than half of the children under six months were exclusively breastfed, and the initiation of breastfeeding in the first two hours of birth is one of the most important factors affecting breastfeeding. Health policymakers need to devote close attention to strengthening the child's breastfeeding attitude as soon as possible.

Abstract Background Smokeless tobacco (SLT) products are gaining popularity around the globe, particularly in Asia, Africa, and the Middle East. Among these products, Nass (aka Naswar) is popular among the Turkmen ethnicity in Iran. Although several studies reported nicotine dependence (ND) among SLT users, psychometric instruments have never been utilized to specifically measure ND among Nass users. Therefore, in this study, we aimed to evaluate the reliability and validity of the Fagerström Tolerance Questionnaire (FTQ) among Turkmen Nass users. Methods A cross-sectional, descriptive study was conducted in June-December 2018 among 411 Turkmen adults who currently (past 30 days) used Nass. Two bilinguals (Persian English) individuals translated and back-translated the FTQ-SLT, which maintained both the questionnaire's accuracy and cultural sensitivity. Construct validity was assessed using exploratory and confirmatory factor analysis. Results The mean age and standard deviation for initiating Nass were 22.5 ± 11.81 years. Exploratory and confirmatory factor analysis indicated a single-factor solution with 8-items that captured several important ND components. Using Nass frequently, soon after waking, when sick, and experiencing a craving were some of the main components. Subgroups comparison revealed that higher scores occurred among those who were married, had Nass user(s) in their immediate family, and consumed bulk form of Turkmen Nass directly without using a tissue. Conclusion Our findings show that the FTQ- SLT is a fairly reliable and valid scale to measure ND among Turkmen Nass users and warrants further testing to accommodate cross-cultural differences in other populations.

Background: The burden of care on caregivers of patients with neurological disorders leads to a reduction in their quality of life, quality of care, and thus reduction in the quality of life of the patient. Identifying the determinants of burden with the aim of improving the quality of caregiver interventions is helpful. The aim of this study was to determine the burden on caregivers of patients with neurological disorders and related factors. Methods: In this descriptive-analytical study, 202 caregivers of patients with neurological disorders of Golestan Province, Iran, that were under care due to neurological damage were selected via convenience method. The instruments were a demographic checklist, Caregiver Burden Inventory (CBI), and General Health Questionnaire (GHQ). The Data were analyzed using descriptive statistics, Mann-Whitney test, and Pearson and Spearman correlation tests by SPSS software. Findings: Eighty-eight percent of caregivers were under the moderate and severe burden of care. It was observed that the mean burden of caregivers of patients with multiple sclerosis (MS) was significantly lower than the mean burden of caregivers of other patients (P = 0.003). The results of the present study also showed that caregivers of patients with very little power experienced significantly more caregiving burden than caregivers of patients with very high power (P = 0.008). Conclusion: According to the findings of the study, due to the high level of burden of care, support of patients' families is effective in reducing this burden. In an effort to minimize these problems and reduce the burden of care, it is appropriate to develop a proper referral system, formal preparation for care, and a family care training program prior to discharge from the hospital.

Background and Objectives The Covid-19 pandemic inevitably turned most classrooms into virtual classrooms. E-learning and classroom management style are two important factors known to affect the quality of education. This study was conducted to investigate the relationship between classroom management styles and teachers' attitudes toward E-learning in Abadan University of Medical Sciences. Material and Methods In this cross-sectional analytical study conducted in 1399, teachers of basic and clinical sciences of Abadan University of Medical Sciences were surveyed by census method. The research tools were two questionnaires: classroom management style and teachers' attitudes toward E-learning. Data analysis was performed using Wilcoxon test and regression through SPSS 21 software. Results 76 male teachers and 69 female teachers paBackground and ObjectivesThe Covid-19 pandemic inevitably turned most classrooms into virtual classrooms. E-learning and classroom management style are two important factors known to affect the quality of education. This study was conducted to investigate the relationship between classroom management styles and teachers' attitudes toward E-learning in Abadan University of Medical Sciences.Material and Methods In this cross-sectional analytical study conducted in 1399, teachers of basic and clinical sciences of Abadan University of Medical Sciences were surveyed by census method. The research tools were two questionnaires: classroom management style and teachers' attitudes toward E-learning. Data analysis was performed using Wilcoxon test and regression through SPSS 21 software.Results76 male teachers and 69 female teachers participated in the study. In the field of E-learning, the highest and lowest mean were related to multimedia education (1/57 ± 3/92) and feeling of satisfaction (1/3 ± 3/04), respectively. In the field of classroom management, education had the highest mean (3/03 ± 0/3) while human resources had the lowest mean (2/49 ± 0/34). No significant relationship was observed between attitudes toward E-learning and classroom management. Conclusion A positive attitude towards E-learning and dissatisfaction with classroom management can make the educational process difficult for both teachers and students. It is recommended to use new educational methods and strengthen the E-learning infrastructure, train and motivate teachers and avoid island management.rticipated in the study. In the field of E-learning, the highest and lowest mean were related to multimedia education (1/57 ± 3/92) and feeling of satisfaction (1/3 ± 3/04), respectively. In the field of classroom management, education had the highest mean (3/03 ± 0/3) while human resources had the lowest mean (2/49 ± 0/34). No significant relationship was observed between attitudes toward E-learning and classroom management.Conclusion A positive attitude towards E-learning and dissatisfaction with classroom management can make the educational process difficult for both teachers and students. It is recommended to use new educational methods and strengthen the E-learning infrastructure, train and motivate teachers and avoid island management. Extended Abstract Background and Objectives The Covid-19 pandemic called for the virtualization of most classes. E-learning and classroom management style are two important factors known to affect the quality of education. University teachers are obliged to transfer their knowledge to students in the teaching process in the classroom, and obviously every student has a different learning background. Thus, teachers must have the ability to resort to different methods of teaching and classroom management to be able to manage these different abilities. In other words, there is no bigger challenge for teachers than to accommodate the individual behavior of students, and certainly individual behaviors cannot be managed if the teacher can draw on only a single method. This study was conducted to investigate the relationship between classroom management styles and teachers' attitudes toward E-learning in Abadan University of Medical Sciences.Material and MethodsThis cross-sectional study was conducted analytically with the aim of investigating the attitudes of the teachers of Abadan University of Medical Sciences towards E-learning and its relationship with management styles in 2020. The study population included all teachers of basic and clinical sciences of Abadan University of Medical Sciences. Sampling was performed through census method. The inclusion criteria was having two years’ experience of teaching, teaching more than two credits per semester (at least in two consecutive semesters), holding regular classes in each semester. Data collection tools included two questionnaires: "Classroom Management" and "E-Learning". Data analysis was performed to compare the mean of attitudes towards E-learning and classroom management with the median value of the potential range of scores. The Wilcoxon signed-rank test was used, in which the mean score considered for E-learning attitude questionnaire was 2.5 ( the scores ranging from 1-4) while it was considered 4 and for the management style questionnaire(the scores ranging from 1-7).In order to examine the relationship between attitudes to e-learning and management style, regression analysis was used in two simple (univariate) modes after adjustment for other (multiple) variables. Data analysis was performed, using SPSS statistical software version 21 at a significance level of 0.05. Results 76 male teachers and 69 female teachers participated in the study. The results showed that concerning attitude towards E-learning, the highest mean was for "multimedia education" and the lowest mean was related to "feeling of satisfaction" in the use of E-learning among the teachers of Abadan University of Medical Sciences. Having studied the three domains of management, we found the domain of "education" to have the highest mean, and the domain of "human resources" the lowest one. But the overall median score of the teachers' classroom management was significantly lower than the median score range. Based on the overall score, the teachers were divided into three groups: interventionist, interactive and non-interventionist professors, of whom 119 (82.1 percent) were interactive professors and 26 others (17.9 percent) were interventionist. Comparing the attitudes of interactive and interventionist teachers towards E-learning, we found interventionist teachers to have a slightly higher mean score of satisfaction with using E-learning and multimedia education than interactive teachers, although these differences were not significant at 0.05 level of significance. Examining the relationship between attitudes toward E-learning and classroom management status, we observed no significant relationship in any of the areas and in general, after controlling for the effect of gender variables and teachers' job status, these relationships were not significant. Conclusion The findings of this study showed that the score of feeling satisfied with E-learning and multimedia training in the group of interventionist teachers is higher than that among interactive teachers. This difference can be due to the use of more educational methods by interventionist teachers compared to their interactive counterparts. Considering the lower score of the human resources management dimension in the present study and the importance of this dimension in the management of learners, it seems that the teachers of Abadan University of Medical Sciences should spend more time initiating interaction and enhancing knowledge of students. Also, measures should be taken to expand the interactive management style by the faculty members. It is recommended to use the desired model and strengthen the e-learning infrastructure, train and motivate teachers and avoid scattered management. Practical Implications of Research According to the results of the present study, the Department of Education can plan to improve the education by planning to teach classroom management methods in virtual education programs to professors and emphasizing proper interaction with students in virtual education. Ethical ConsiderationsIn this study, we kept the participant information confidential and all participants were familiar with the objectives of the study. The protocol of the present study has been approved by the ethics committee of Abadan School of Medical Sciences with the code IR.ABADANUMS.REC.1399.019. Conflict of Interest The authors hereby declare that this work is the result of an independent study and has no conflict of interest with other organizations and individuals. Aknowledgment Researchers would like to express their gratitude to the participants in this study who shared their experiences. The present article is extracted from a research approved by the Research Council of Abadan University of Medical Sciences with the code 98U-578.

Background and Objective: Diabetes is one of the most common chronic diseases and also the biggest health problem in all countries. The world health organization has called it a silent epidemic. Self-care is one of the most important factors in controlling blood sugar in diabetics’ patients. This study was done to determine the relationship between self-care and glycosylated hemoglobin level diabetic patients in rural area in Golestan Province, northern Iran. Methods: This descriptive-analytical study was done on 239 male and female patients with type 2 diabetes (56.92±10.70 years) in rural area in Golestan Province, northern Iran during 2016. Data collection tool were a standard diabetes self-care questionnaire with demographic variables and HbA1C test. Completion of data and sampling was done by referring to the health center and calling patients. Results: There was no significant relationship between glycemic controls with any of the self-care items studied. Mean of HbA1c was 8.23±1.85%. 97 patients (40.6%) had good blood sugar control (less than 7.5%). Patientchr('39')s self-care had a mean of 3.58, of which the highest score was related to the dietary regimen (6.60) and the lowest was related to self-monitoring of blood glucose (0.88) and regular physical activity (2.3). Conclusion: Self-care of the patients was moderate. Interventions to increase self-care of patients are recommended in this area.

Background and purpose: Cutaneous leishmaniasis is a skin disease manifested as chronic ulcerative skin lesions. Current standard therapies for this disease are associated with some problems such as high cost, numerous side effects, need for injections, and drug resistance. Sambucus ebulus is used in treatment of skin inflammation. This study aimed at investigating the effects of S. ebulus leaf extract on cutaneous leishmanisis. Materials and methods: This clinical trial was performed in 110 patients who were divided into intervention (n=55) and control groups (n=55). All patients received the standard treatment for leishmanisis. In addition, the intervention group received topical treatment of S. ebulus leaf extract 5%, while the control group received placebo. The therapy was continued until complete epithelialization of the lesions. Before the intervention and at the end of each week (until complete epithelialization of the lesions), healing progress and clinical characteristics of the lesions, including the size, induration, and degree of epithelialization were recorded. Results: The intervention accelerated the decrease in mean diameter of lesions (P

Background and purpose: Spinal cord injury (SCI) is one of the most disabling diseases with various physical and psychological consequences. One of the treatments of SCI is using agents that have neuroprotective effects such as Vitamin C and ubiquinone. This research aimed at investigating the effect of co-administration of these agents on rat experimental model of SCI. Materials and methods: Adult male Wistar rats (n=40) were divided into sham, lesion, AA, CO10, and AA+COQ10 groups. In sham group only laminectomy was performed and in other groups contusion model of SCI was done. After 24 hr, the animals in AA, COQ10, and AA+COQ10 groups received intraperitoneal injection of AA, COQ10 and AA+COQ10, respectively. Then, behavioral assessment and biochemical study were performed. Eight weeks after treatment, the brains were removed and 5µ sections were prepared. Finally, cresyl violet staining was done. Results: There was a significant difference in BBB score of AA, COQ10 groups compared to that of the AA+COQ10 group (P

Background & Objective: The COVID-19 pandemic has impacted medical education worldwide with several opportunities and challenges. This study aims to provide an overview of medical education's opportunities and challenges according to the experience of the COVID-19 pandemic in order to guide future endeavors in conducting the teaching-learning process in post-COVID era support. Material & Methods: In this systematized review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, databases of PubMed, Cochrane, Scopus, Web of Science, and Eric, in addition to Google Scholar as a search engine, were searched to retrieve relevant original peer-reviewed, review, editorial, and commentary articles published from Dec 2019 to the end of Sep 2022. Results: As per the qualitative synthesis, a total of 29 articles were included from the 1534 records that were identified. Reviewing the included articles showed that most of the relevant studies were considered Medical and healthcare students (51.8%) at undergraduate level (72.5%) in University settings (62.1%). As per the qualitative synthesis, a total of 29 articles were included from the 1534 records that were identified. Reviewing the included articles showed that most of the relevant studies were considered Medical and healthcare students (51.8%) at undergraduate level (72.5%) in University settings (62.1%). On the other hand, post-COVID medical education opportunities have been grouped into four main categories, which are teaching and learning processes, psychological impact, accessibility and education equity, and management and administrative affairs. Post-COVID medical education opportunities also consist of four main categories: teaching-learning process, psychological impact, accessibility and education equity, and management and administrative affairs. Conclusion: Changes in teaching and learning processes in medical education caused by the COVID-19 pandemic created opportunities and caused important challenges that should be considered in the post-COVID era. In this regard, blended learning with the integration of technology using a flexible approach could be an effective recommendation.

Background. The health of retirees, as an expanding and vulnerable group, is of particular importance in society, and it is necessary to prioritize their problems in critical situations such as the spread of the coronavirus. The current study aimed to investigate the impact of social and cultural capital on the level of fear of COVID-19 among retired employees of Tabriz University of Medical Sciences (TUOMS). Methods. This survey-based research employed a descriptive-explanatory design and was practical in terms of purpose. This study selected 410 retirees from TUOMS in Iran using a simple random sampling method. The data collection tools in this study included three questionnaires: cultural capital, social capital, and fear of COVID-19. We tested the research hypotheses using SPSS software (version 22). Results. The bivariate results of the study indicated that social capital and its dimensions (social networks, social trust, and social participation) and cultural capital and its dimensions (embodied, objective, and institutional) had a significant and inversed effect on the level of fear of COVID-19 among the retirees. The regression model of fear of COVID-19 also found that both independent variables (social capital and cultural capital) were statistically significant and could explain about 36% and 31% of the changes in the dependent variable (fear of COVID-19 among retirees), respectively. Conclusion. This study indicated a significant and inverse relationship between social and cultural capital and the level of fear of COVID-19 among the retirees of TUOMS. The findings of the present study can be generalized to all retired TUOMS employees. Therefore, healthcare policymakers should take effective measures to increase the funds allocated to diseases such as COVID-19 and reduce the fear of the disease, which is a risk factor for physical and mental diseases.

Background: Ovarian granulosa cells (GCs) are essential for follicular development. Ovarian advanced glycation end-products (AGEs) accumulation is related to GCs dysfunction. Alpha-lipoic acid (ALA) illustrates therapeutic capabilities for infertility-related disorders. Therefore, this study assessed the effects of ALA on AGEs-induced GCs hormonal dysfunction.Methods: The study was conducted from October 2021 to September 2022 at the Department of Medical Genetics, Shiraz University of Medical Sciences. Isolated GCs (n=50) were divided into control, human glycated albumin (HGA), HGA+ALA, and ALA treatments. Steroidogenic enzymes and AGE receptor (RAGE) genes were assessed by qRT-PCR. Steroid hormones and RAGE protein were evaluated using ELISA and Western blotting. Data were analyzed using GraphPad Prism software (ver. 9), and P

Abstract Background Mesenchymal stem cells (MSCs)-based treatment strategy has shown promise in bolstering the healing process of chronic wounds in diabetic patients, who are at risk of amputation and mortality. To overcome the drawbacks of suboptimal cell retention and diminished cell viability at the injury site, a novel nanofibrous biomaterial-based scaffold was developed by using a controlled extrusion of a polymeric solution to deliver the cells (human adipose-derived MSCs (ADMSCs) and placenta-derived MSCs (PLMSCs)) locally to the animal model of diabetic ulcers. Methods The physicochemical and biological properties of the nano-bioscaffold were characterized in terms of microscopic images, FTIR spectroscopy, tensile testing, degradation and swelling tests, contact angle measurements, MTT assay, and cell attachment evaluation. To evaluate the therapeutic efficacy, a study using an excisional wound model was conducted on diabetic rats. Results The SEM and AFM images of scaffolds revealed a network of uniform nanofibers with narrow diameters between 100-130 nm and surface roughness less than 5 nm, respectively. ADMSCs and PLMSCs had a typical spindle-shaped or fibroblast-like morphology when attached to the scaffold. Desired characteristics in terms of swelling, hydrophilicity, biodegradation rate, and biocompatibility were achieved with the CS70 formulation. The wound healing process was accelerated according to wound closure rate assay upon treatment with MSCs loaded scaffold resulting in increased re-epithelialization, neovascularization, and less inflammatory reaction. Our findings unequivocally demonstrated that the cell-loaded nano-bioscaffold exhibited more efficacy compared with its acellular counterpart. In summation, our study underscores the potential of this innovative cellular scaffold as a viable solution for enhancing the healing of diabetic ulcers. Conclusion The utilization of MSCs in a nanofibrous biomaterial framework demonstrates significant promise, providing a novel avenue for advancing wound care and diabetic ulcer management. Graphical Abstract

Background: The management of preoperative anxiety in pediatric patients, as well as its implications, has remained challenging for anesthesiologists. In this study, we compared the safety and efficacy of intranasal dexmedetomidine, midazolam, and ketamine as surgical premedication in children.Methods: This double-blinded randomized clinical trial was conducted at two tertiary hospitals in January 2014, on 90 children aged between 2-7 years old. The participants’ American Society of Anesthesiologists (ASA) physical status was I or II, and they were scheduled for elective unilateral inguinal herniorrhaphy. Using the block randomization method, the patients were randomly assigned to three groups, each receiving intranasal dexmedetomidine (2 µg/Kg), midazolam (0.2 mg/Kg), and ketamine (8 mg/Kg) 60 min before induction of anesthesia. Anxiety and sedation state were evaluated before drug administration, and then every 10 min for the next 50 min. Parental separation anxiety, mask acceptance, postoperative agitation, pain, nausea, and vomiting were also recorded and compared between these groups. All the statistical analyses were performed using SPSS software (version 21.0). P

Background and purpose: Prostate cancer is the most common male urogenital malignancy in many regions of the world, which has been increasing in recent years all over the world, including Asian countries, as well as in Iran. The relative risk of prostate cancer for those who have a family history of this disease in close relatives is almost 2 to 3 times, and the incidence rate increases with the increase in the number of affected relatives. Although family history of prostate cancer is a proven risk factor for this disease, few studies have investigated the relationship between the presence of family history of prostate cancer and the degree of prostate cancer risk. The purpose of this study is to investigate the relationship between the existence of a family history of prostate cancer and the degree of prostate cancer risk at the time of diagnosis. Materials and methods: This case-control study was conducted on 322 patients available prostate cancer patients referred to medical centers affiliated with Babol University of Medical Sciences. Patients were divided into two groups: case (family history of prostate cancer) and control (no family history of prostate cancer). Information about family history, Gleason score, PSA, and clinical stage was extracted from all patients. It was extracted through the file and phone call. A positive family history of prostate cancer is defined as follows: patients who have at least two of their first-degree relatives with prostate cancer at any age. Also, patients who have one first-degree relative and at least two second-degree relatives at any age with prostate cancer. In hereditary prostate cancer, at least 3 first-degree relatives have prostate cancer, or prostate cancer occurs in three consecutive generations of the same family (paternal or maternal). At least two first- or second-degree relatives had early onset prostate cancer under the age of 55. The relationship between the existence of a family history of prostate cancer first-degree relatives include: father, brother, and child, and second-degree relatives include: grandfather, uncle and cousin. the degree of prostate cancer in three groups (Low risk with PSA20 or Gleason score>7) at the time of diagnosis was investigated. Results: The average age of patients when diagnosed with prostate cancer was 67.23±8.97 years, who were in the age range of 43-93 years. 23.3% of the studied patients had a family history of prostate cancer and 1.9% had a hereditary family history of prostate cancer. With the increasing age of diagnosis, the degree of risk of prostate cancer increased, which is statistically significant. Thus, 63.9% of patients who were diagnosed with prostate cancer at the age of 71 years had high-risk prostate cancer, which shows that the risk level of prostate cancer should increase as the age of prostate cancer diagnosis increases (P=0.001). Between the ages of 61 and 70 years, 62 people (44.9%) were at a high risk level, while at the age of 60 years, 33 people were at a high risk level (P

Introduction: Lichen planus is a relatively common and chronic mucocutaneous disease with unknown. Oral lichenoid reaction is clinical and histopathological similar to lichen planus, but the cause of it is different. Mast cells are responsible for the accumulation of inflammatory cells in the connective tissue. The aim of study was evaluation of the role of mast cells in pathogenesis of two groups of lesions. Methods: This cross-sectional study was performed on 26 samples of oral lichen planus, oral lichenoid reaction lesions and 5 samples of irritation fibroma. After the staining with the Giemsa, sections were observed under the optical microscope (x400), and the number of mast cells was counted. The results were analyzed using the SPSS16 software, T test, Mann- Whitney and Chi-squared statistical tests. Results: The total number of mast cells and degranulated mast cells in two groups were significantly higher than the control group (P 0/05). Conclusion: Mast cells play a role in the pathogenesis of lichen planus and lichenoid reaction lesions. The number of degranulated mast cells and the ratio of degranulated to the total mast cells cannot help to differentiate these two groups of lesions. Clinical examinations and proper history and attention to their etiologic factors have a significant role in differentiating them.

Background and aimMalnutrition among intensive care unit (ICU) patients is associated with a higher risk of mortality and prolonged hospitalization. However, the influence of malnutrition on severe outcomes of ICU patients with coronavirus disease 2019 (COVID-19) is unclear. By evaluating the effect of malnutrition on the outcomes of COVID-19 in the ICU in older adult patients, this study will contribute to new knowledge of assessing the nutritional status and recovery of these patients.MethodsIn the current single center prospective study, 310 critically ill COVID-19 patients with an age range of ≥65 years were recruited. Data on demographic characteristics, laboratory parameters, comorbidities, medications, and types of mechanical ventilation were collected in the first 24 h of ICU admission. Malnutrition was defined based on the two-step approach of the Global Leadership Initiative on Malnutrition (GLIM) scale at baseline. During the 45 days after the baseline, we collected data on delirium incidence, mortality, invasive mechanical ventilation (IMV) requirement, length of ICU and hospital admission, and re-hospitalization.ResultsIn this study, the prevalence of malnutrition was 63.4% among critically ill COVID-19 patients. During the 45-day follow-up, 190 (61.3%) COVID-19 deaths were recorded among the baseline 310 patients. After controlling for potential confounders, malnutrition was associated with an increased risk of delirium so malnourished COVID-19 patients had a significantly 35% higher risk of delirium than those without malnutrition (HR: 1.35, 95% CI: 1.01–1.83). Such a significant association was not for COVID-19 mortality and IMV requirement. In addition, malnutrition was associated with a significantly 84% greater odds of prolonged ICU admission (OR: 1.84, 95% CI: 1.09–3.10). No significant association was seen between malnutrition and re-hospitalization and also prolonged hospital admission.ConclusionMalnutrition was associated with an increased risk of delirium and prolonged ICU admission among critically ill older adult COVID-19 patients. Prevention, diagnosis, and treatment of malnutrition could be a key component in improving outcomes in these patients.

Infertility is a global health problem affecting about 15% of all couples, of which 50% are due to male infertility. Although the etiology of infertility is known in most infertile men, idiopathic male infertility remains a challenge. Therefore, there is a need for novel diagnostic methods to detect the underlying mechanisms and develop appropriate therapies. Recent studies have focused on the role of non-coding RNAs (ncRNAs) in male infertility. Circular RNAs (CircRNAs), a type of ncRNAs, are found to play a key role in the development of some pathological conditions, including cardiovascular diseases, diabetes, cancers, autoimmune diseases, etc. Several studies have reported the presence of CircRNAs and their target genes in the human reproductive system. In addition, their expression in testicular tissues, sperm cells, and seminal fluid has been identified. Abnormal expression of CircRNAs has been associated with azoospermia and asthenozoospermia in infertile men. The present narrative review provides a brief description of the role of CircRNAs in spermatogenic cells, male infertility, and reproductive cancers. In addition, some CircRNAs have been identified as potential biomarkers for disease detection and treatment.

Objectives: In recent years, due to the inappropriate quality of distributed water by the public water network in many parts of Iran, especially in the central areas, the use of desalinated water has been widely developed. Therefore, for any planning and intervention, it is very important to have information about the current situation and social, cultural and economic factors affecting this development. As a result, this study was conducted with the aim of Investigating the rate and factors of approach to desalinated water in Kashan and Aran-Bidgol cities in 2018.Methods: This study is an ecological study on the samples of Kashan and Aran-Bidgol people. The tool is a questionnaire completed over the phone. The collected data were analyzed using descriptive statistics and SPSS16 software.Results: About 83.2% of the samples in Kashan and Aran-Bidgol cities use desalinated water for drinking, cooking and tea making, 44.2% of the samples use a small household water purifier and 39% buy purified water from sales centers. The filtration technology in both categories is reverse osmosis.Conclusion: In the studied cities, the salty taste of water taken from the public network and samovar sediments are the most important reasons for consumers to switch to purified water, and demographic characteristics such as age, gender, educational and economic level, etc. did not play a significant role in this approach.

Objectives: Considering the importance of underground water sources, continuous evaluation of their quality should be considered to prevent chemical pollution. Therefore, the purpose of this research is to investigate the changes in the chemical quality of water in the Qanats (aqueducts) and wells of Ardestan Plain during the years 1995 to 2019.Methods: This research was conducted retrospectively in 2021 based on the data collected by Ardestan Department of Natural Resources during the period of 1995-2019. Data were analyzed by SPSS software, version 2016 and compared to Iranian drinking water quality standards.Results: Data showed that Total Dissolved Solids (TDS) and the Total Hardness of well water were increased 367.3, 168.8 respectively. These parameters were increased by 188.1 and 90 mg L-1 for Qanat water, respectively. And other water quality parameters were increased including magnesium, calcium, sulfate, bicarbonate, chloride and Electrical Conductivity (EC). The trend of TDS and TH showed that in the all of the well water exceeded from the drinking water standard especially in 2019.Conclusion: Paying attention to the process of chemical changes of water in the Ardestan plain reminds us that in the future, water sources will be at risk of damage, especially in the low-altitude parts of the plain.

Objectives: Air pollutants in dentistry offices may cause problems for the health of staff and patients. Accordingly, the present study was performed to the assessment of bacterial bioaerosols and particulate matter (PM) characteristics in the indoor air of dentistry clinics.Methods: The sampling points were restoration, endodontics, and prosthesis wards. The PM specimens were taken using Grimm Dust Monitor and the microbial specimens were taken using QuickTake 30.Results: The maximum and minimum PM10 concentration across the different measure wards occurred as 70.31 and 30.32 μg/m3 in the Ketabchi Clinic restoration and its endodontics ward, respectively. The total number of bioaerosols was 2079. Gram‑positive Staphylococcus spp.(872), Gram‑positive Micrococcus spp.(706), and Gram‑negative Bacillus spp.(501) were present in the indoor air. The results showed a significant relationship for PM1 and PM2.5 in each sampling site.Conclusions: The low PM and bacterial bioaerosols contamination can be due to the coincidence with coronavirus pandemic, as during this period, health and hygienic protocols have been strictly observed.

Background: Several adjuvants, added to local anesthetics, were suggested to induce an ideal regional block with high-quality analgesia. The purpose of this study was to evaluate the particular blocking properties of low-dose bupivacaine in combination with meperidine and fentanyl in spinal anesthesia during Cesarean sections.Methods: A randomized, double-blind clinical trial was conducted at Hafez Hospital affiliated with Shiraz University of Medical Sciences (Shiraz, Iran) from February 2015 to February 2016. A total of 120 pregnant women, who underwent spinal anesthesia during elective Cesarean section were enrolled in the study. Based on block-wise randomization, the patients were randomly assigned to three groups, namely “B” group received 2 mL bupivacaine 0.5% (10 mg), “BM” group received 8 mg bupivacaine and 10 mg meperidine, and “BF” group received 8 mg bupivacaine and 15 µg fentanyl intrathecally. The block onset, the duration of analgesia, and the time of discharge from the post-anesthesia care unit (PACU) were all assessed. Data were analyzed using SPSS software version 21, and P

Background and purpose: Considering the importance of internationalization in medical education, adaptation of successful international and national models can help to promote it. This study aimed at explaining the achievement of the universities of medical sciences in internationalization of medical education in Iran. Materials and methods: This descriptive-adaptive study was conducted in the international relations office at Kerman University of Medical Sciences (KMU). At first, top three universities in England, Pakistan, Ireland, Cyprus, and Greece were selected based on The Times Higher Education World University Rankings. According to the land-use planning classification in Iran, KMU is the university to follow and assess the performance of higher education in these countries. Then, information about the policies of these universities in internationalization of higher education was obtained using their websites or by request. We also collected information of KMU as a representative of eight universities of medical sciences and its affiliated academic and research centers. Results: Data about the ownership of universities, student recruitment strategies, and internationalization policies of the universities were compared with those of KMU and the weaknesses and strengths of KMU were determined. Conclusion: The universities of medical sciences in Iran are suggested to revise their missions, goals, and performance and aim to practice internationalization of higher education as an important strategy in their university prospects.

Background and purpose: Multisystem Inflammatory Syndrome in Children (MIS-C) occurs after having COVID-19. The severity and outcomes of COVID-19 with gastrointestinal symptoms are higher. The aim of this study was to investigate gastrointestinal manifestations in MIS-C patients in selected referral hospitals in Iran to obtain comprehensive information about the treatment and prevention of MIS-C. Materials and methods: In this cross-sectional study, all MIS-C patients

Background: The increasing prevalence of thyroid cancer among the survivors of atomic bomb attacks in Japan, nuclear fallout in the Marshall Islands, and Chernobyl nuclear power plant accident indicate a strong relationship between nuclear radiation and the occurrence of thyroid cancer. Materials and Methods: Systematic researches were conducted in the medical database of the American National Library of Congress, PubMed, using keywords of thyroid cancer, radiation, papillary thyroid cancer. After screening the titles and abstracts of 1791 citations, a total of 77 citations were identified to include in the current study. Results: The latency period for developing nuclear radiation-induced thyroid cancers was 5 to 10 years to decades after exposure. The most important risk factor for developing radiation-induced thyroid cancer was the received radiation dose. A strong dose-response relationship between radiation dose and the incidence of thyroid cancer has been reported (P value

Abstract Background Metabolic syndrome (MetS) is a group of risk factors that increase the risk of death and a variety of chronic diseases. Recent studies have indicated that the imbalance of gut microbiota might contribute to development and progression of metabolic syndrome. Carbohydrate restriction in the diet has been proven to be one of the most effective methods in the management of metabolic syndrome, even in the absence of weight loss. However, no study has examined the effects of a carbohydrate-restricted diet on gut microbiota composition in metabolic syndrome patients. Thus, we will examine the effects of a “moderately restricted carbohydrate (MRC)” diet on gut microbiota, insulin resistance, and components of MetS among Iranian women. In addition, the stability of changes in dependent variables, including gut microbiota, will also be assessed. Methods This is a parallel randomized clinical trial in which 70 overweight or obese women aged 20–50 years with MetS will be randomly assigned to receive either MRC diet (42–45% carbohydrate, 35–40% fats) or a normal weight loss (NWL) diet (52–55% carbohydrate, 25–30% fats) for 3 months. Protein accounted for 15–17% of total energy in both diets. The quantity of gut microbiota including Firmicutes, Bacteroidetes, Bifidobacteria, Lactobacillus, Clostridium, Prevotella, Bacteroidetes, and Akkermansia muciniphila, as well as anthropometric, blood pressure, and metabolic parameters will be measured at study baseline and the end of trail. At the end of this phase, all participants will be placed on a weight maintenance diet for an additional 6 months. After following up study subjects in this duration, all dependent variables will be examined again to assess their stability over this period. Discussion To the best of our knowledge, this is the first randomized controlled trial investigating the effects of a moderately restricted carbohydrate diet on gut microbiota composition and several metabolic parameters during the weight loss and maintenance phases in women with MetS. Trial registration Iranian Registry of Clinical Trials ( www.irct.ir , IRCT20210307050621N1). Registered on May 31, 2021.

Background and Aim: Fam83h Protein is a non-secretory protein that interacts with Casein Kinase1Alpha1(CSNK1A1) through its N-terminal. Materials and Methods: In this study, the C-terminal domains of Fam83h in human and mouse were modeled using the I-TASER software for prediction of protein structure and function. The molecular dynamics (MD) simulations were performed by GROMACS version 5.0.2 to investigate their temporal behavior. FEL analysis was done for each model after MD. Protein-protein docking was done by PIPER to investigate the interaction of Fam83h C-terminal with cytoskeletal keratins5 as a cellular keratin model. Results: The results showed that the human protein is more stable and compact than the mouse protein. Assessment of the interaction between the C-terminal of the mouse Fam83h and Keratin-5 proteins showed the residues Arg378, Pro391, Ser663, Glu710, Arg923 in mouse Fam83h protein made hydrogen bonds with Leu474, Arg417, Tyr453, Glu 397, Gln 396 and Glu 390 of the chain A and B of mouse keratin-5, respectively. Human Fam83h and keratin 5 form hydrogen bonds via residues of Thr433, His447 and Arg477 and Leu473, Gly476, Glu420 and Arg407. Conclusion: According to the previous experimental reports, Fam83h can interact with keratin cytoskeleton and has a role in cancer progression. It can be concluded that Fam83h protein can directly interact with keratin filaments through its C-terminal. Therefore, our hypothesis based on in-silico study is: non-sense mutation in C-terminal of Fam83h protein may lead to truncated protein and subsequently disruption of keratin cytoskeleton bundling which can be regarded as a mechanism involved in cancer progression.

Introduction: Patients with diabetes are prone to develop complications related to the retina. So far, several genes have been reported in connection with the progression of retinopathy, and a group of these genes is genes involved in angiogenesis. CXCL12 and CXCR4 genes are among the most important genes in this path, which have been less studied and investigated. The aim of this study was to determine the relationship between polymorphism of CXCL12 (rs1801157) and CXCR4 (rs2228014) genes and the risk of proliferative diabetic retinopathy in the population of Yazd City. Methods: In the present case-control study, rs2228014 and rs1801157 polymorphisms were investigated among 103 patients with diabetes in two groups, case and control. In this study, the control group included 49 diabetic patients who did not show retinopathy complications, and the case group consisted of 54 diabetic patients with proliferative retinopathy complications. The Genotyping of rs2228014 polymorphism was examined by ARMS-PCR method and rs1801157 variant by RFLP-PCR technique. The statistical analysis of data was conducted using SPSS software version 16 and chi-square test. Results: Our results represented no association among the rs1801157 and rs2228014 polymorphisms and the risk of proliferative diabetic retinopathy (P>0.05). Conclusion: This study did not confirm association of the rs1801157 and rs2228014 polymorphisms with proliferative diabetic retinopathy and further studies are required to investigate the correlation of polymorphisms of interest with PDR.

IntroductionAccumulating evidence has highlighted the critical role of the gut microbiota and its potential action as a regulator of metabolic disorders including insulin resistance, obesity, and systemic inflammation in polycystic ovarian syndrome (PCOS). Microbiota-modulating interventions, such as probiotics, prebiotics, and synbiotics, could be effective in PCOS management.MethodsWe conducted an overview of systematic reviews (SRs) and meta-analyses to summarize reviews regarding the effectiveness of probiotics/prebiotics/synbiotics on the management of PCOS through a systematic literature search in PubMed, Web of Science, and Scopus databases until September 2021.ResultsEight SRs and meta-analyses were included in this study. Our overview confirmed that probiotic supplementation had a potentially beneficial effect on some PCOS-related parameters including body mass index (BMI), fasting plasma glucose (FPG), and lipid profiles. Evidence shows that synbiotics in comparison with probiotics were less effective on these parameters. The methodological quality of SRs was assessed using the AMSTAR-2 assessment tool and was determined as high for four SRs, low for two SRs, and critically low for one SR. Due to limited evidence and high heterogeneity of the studies, it remains difficult to identify optimal probiotics strains, prebiotics types, length of duration, and doses.DiscussionFuture clinical trials with higher quality are recommended to clarify the efficacy of probiotics/prebiotics/synbiotics on the management of PCOS and provide more accurate evidence.

Summary: Background: The objective of this study is to investigate the trends of exposure and burden attributable to the four main metabolic risk factors, including high systolic blood pressure (SBP), high fasting plasma glucose (FPG), high body-mass index (BMI), and high low-density lipoproteins cholesterol (LDL) in North Africa and the Middle East from 1990 to 2019. Methods: The data were retrieved from Global Burden of Disease Study 2019. Summary exposure value (SEV) was used for risk factor exposure. Burden attributable to each risk factor was incorporated in the population attributable fraction to estimate the total attributable deaths and disability-adjusted life-years (DALYs). Findings: While age-standardized death rate (ASDR) attributable to high-LDL and high-SBP decreased by 26.5% (18.6–35.2) and 23.4% (15.9–31.5) over 1990–2019, respectively, high-BMI with 5.1% (−9.0–25.9) and high-FPG with 21.4% (7.0–37.4) change, grew in ASDR. Moreover, age-standardized DALY rate attributed to high-LDL and high-SBP declined by 30.2% (20.9–39.0) and 25.2% (16.8–33.9), respectively. The attributable age-standardized DALY rate of high-BMI with 8.3% (−6.5–28.8) and high-FPG with 27.0% (14.3–40.8) increase, had a growing trend. Age-standardized SEVs of high-FPG, high-BMI, high-SBP, and high-LDL increased by 92.4% (82.8–103.3), 76.0% (58.9–99.3), 10.4% (3.8–18.0), and 5.5% (4.3–7.1), respectively. Interpretation: The burden attributed to high-SBP and high-LDL decreased during the 1990–2019 period in the region, while the attributable burden of high-FPG and high-BMI increased. Alarmingly, exposure to all four risk factors increased in the past three decades. There has been significant heterogeneity among the countries in the region regarding the trends of exposure and attributable burden. Urgent action is required at the individual, community, and national levels in terms of introducing effective strategies for prevention and treatment that account for local and socioeconomic factors. Funding: Bill & Melinda Gates Foundation.

Background and Aim: Chemotherapy is one of the most common methods available for the treatment of cancer. Resistance to anticancer drugs can result in failures in chemotherapy of cancers. Therefore, investigation is necessary for the discovery of new drugs. Homoisoflavonoids are well-known natural products that possess a wide range of pharmacological activities. Hence, synthesis and assessment of cytotoxicity of homoisoflavonoids containing morpholinoethoxy moiety and their molecular docking simulation were taken into consideration. Materials and Methods: Two 7-morpholinoethoxyhomoisoflavonoids synthesized via three steps including SN2 reaction of 7-hydroxychromanine with morpholino ethyl chloride hydrochloride in the basic media under reflux condition to produce intermediate 3. The second step included aldol condensation of the intermediate with suitable aldehydes in the presence of gaseous HCl in ethanol, and finally neutralization with NaOH 5%. The structures of the products were confirmed using IR, 13CNMR, and 1HNMR techniques. Cytotoxic effects of final products on HT-29 and 3T3 cell lines were assessed. To evaluate the binding mode of compounds with tubulin protein, docking simulation was performed by using MOE. Results: Two morpholinoethoxy homoisiflavonoids were prepared with moderate to good production yield. Cytotoxic evaluation of these compounds showed satisfactory results. The results of molecular docking simulation showed an acceptable binding energy of the interaction between the ligands with the tubulin protein binding site: (E)-7-(2-morpholinoethoxy)-3-(3,4,5-trimethoxybenzylidene) chroman-4-one= -7.3727 Kcal/mol and (E)-3-(4-methoxybenzylidene)-7-(2-morpholinoethoxy) chroman-4-one released -7.6838 Kcal/mol per mole of energy. Conclusion:The results showed that compound (E)-3-(4-methoxybenzylidene)-7-(2-morpholinoethoxy) chroman-4-one has higher cytotoxicity than (E)-7-(2-morpholinoethoxy)-3-(3,4,5-trimethoxybenzylidene) chroman-4-one against HT-29 and 3T3 cell lines. The in-silico results confirmed the results obtained from in vitro experiments and showed three interactions between ligand (E)-3-(4-methoxybenzylidene)-7-(2-morpholinoethoxy)chroman-4-one and αThr179, αThr145, and αTyr224 amino acids in tubulin active site.

Nagla A El-Shitany,1 Amina M Bagher,2 Lenah Saeed Binmahfouz,2 Basma G Eid,2 Haifa Almukadi,2 Shaimaa M Badr-Eldin,3,4 Manal El-Hamamsy,5 Zuhair M Mohammedsaleh,6 Fayez M Saleh,7 Mohammed S Almuhayawi,8 Samar A Alghamdi,9 Rana A Arab,10 Soad S Ali,11,12 Steve Harakeh,12,13 Badrah S Alghamdi14,15 1Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tanta University, Tanta, Egypt; 2Department of Pharmacology and Toxicology, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia; 3Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia; 4Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt; 5Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; 6Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia; 7Department of Medical Microbiology, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia; 8Department of Medical Microbiology/Parasitology and Molecular Microbiology Laboratory, King Abdulaziz University Hospital, Jeddah, Saudi Arabia; 9Department of Oral Biology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; 10Medicine Program, Ibn Sina National College for Medical Studies, Jeddah, Saudi Arabia; 11Department of Histology, Faculty of Medicine, Assiut University, Assiut, Egypt; 12Yousef Abdullatif Jameel Scientific Chair of Prophetic Medicine Application, Faculty of Medicine (FM), King Abdulaziz University, Jeddah, Saudi Arabia; 13King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; 14Department of Physiology, Neuroscience Unit, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 15Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi ArabiaCorrespondence: Nagla A El-Shitany, Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tanta University, Tanta, Egypt, Email nagla_fouad@yahoo.com; naglaa.fouad@pharm.tanta.edu.egBackground: Like other vaccines, Pfizer BioNTech’s COVID-19 vaccine efficacy against SARS-CoV-2 virus infections begins to decline within a few months after the 2nd dose. On August 12, 2021, the FDA allowed additional Pfizer BioNTch’s COVID-19 vaccine dose (3rd or booster dose) for individuals with weakened immunity. This study aimed to evaluate the short-term adverse reactions (ADRs) of the 2nd and the 3rd doses of the Pfizer BioNTech COVID-19 vaccine.Methods: Information for this study was collected by Google Form questionnaire (online survey). The results included responses from 442 people, the majority from Saudi Arabia.Results: The most common local ADRs following the 3rd dose were injection site pain, injection site hypersensitivity, and axillary lymph node swelling. The most common systemic ADRs were fatigue, muscle pain, bone pain, headache, and fever less than 38ºC. Less common systemic ADRs were shivering, fever more than 38ºC, nasal congestion and rhinorrhea, arrhythmia, cough, abdominal pain, chest tightness, nausea, diarrhea, vomiting, and tachypnea. Rare systemic ADRs were constipation, dizziness and vertigo, lack of concentration, sore throat, excessive hair loss, dysmenorrhea and heavy menstruation, and Bell’s palsy. Severe allergic reactions were reported by 2.6% of participants after the 2nd dose, compared with none after the 3rd dose. Nasal congestion and runny nose are more frequent after the 3rd dose. The ADRs of the 2nd and 3rd doses were significantly more prevalent in females. 12% of participants reported ADRs lasting more than one week after the 3rd dose compared to 5% after the 2nd dose. People ≤ 60 years were more affected by the vaccine ADRs.Conclusion: Most of the ADRs reported after the 3rd vaccine dose were consistent with the Pfizer vaccine information sheet and similar to the 2nd dose ADRs.Keywords: Pfizer-BioNTech COVID-19 vaccine, adverse drug reactions, booster dose, second dose, injection site pain, fatigue, online questionnaire

Abstract Background Mesenchymal stem cells (MSCs) have been suggested as an appropriate source for diabetes cell-based therapies. The high proliferation and differentiation capacity of fetal MSCs and the role of fetal pancreatic-derived MSCs (FPMSCs) in islet generation make them good candidates for diabetes treatment. To manufacture clinical-grade MSCs, animal-free culture protocols are preferred. The current study aimed to establish a xeno-free/GMP-compliant protocol for FPMSCs manufacturing. The focus was on the effects of fetal bovine serum (FBS) replacement with pooled human serum (HS). Material and methods FPMSCs were isolated and expanded from the pancreas of legally aborted fetuses with few modifications in our previously established protocol. The cells were expanded in two different culture media, including DMEM supplemented with 10% FBS or 10% pooled HS. A side-by-side comparison was made to evaluate the effect of each serum on proliferation rate, cell cycle, senescence, multi-lineage differentiation capacity, immunophenotype, and tumorigenesis of FPMSCs. Results Flow cytometry analysis and three-lineage differentiation ability demonstrated that fibroblast-like cells obtained from primary culture had MSCs’ characteristics. The FPMSCs displayed similar morphology and CD markers expression in both sera. HS had a higher proliferative effect on FPMSCs than FBS. In FBS, the cells reached senescence earlier. In addition to normal karyotypes and anchorage-dependent growth, in vivo tumor formation was not seen. Conclusion Our results demonstrated that HS was a better serum alternative than FBS for in vitro expansion of FPMSCs. Compared with FBS, HS increased FPMSCs’ proliferation rate and decreased their senescence. In conclusion, HS can effectively replace FBS for clinical-grade FPMSCs manufacturing. Graphical abstract

ObjectivesGut dysbiosis is believed to be one of the several mechanisms that are involved in the pathogenesis of gout. This systematic review aimed to summarize the role of gut dysbiosis in gout disease and uncover the underlying mechanisms.MethodsA comprehensive search was conducted on PubMed, Web of Science, and Scopus databases up to October 2021. Animal studies and human observational studies, including case-control, cross-sectional, and cohort studies assessing the association between gut microbiota composition and gout were included. The quality of included studies has been evaluated using the Newcastle–Ottawa Quality Assessment scale (NOS) and the SYRCLE's risk of bias tool.ResultsInitially, we found 274 studies among which 15 studies were included in this systematic review. Of them, 10 studies were conducted on humans and 5 studies were conducted on animals. Increased abundance of Alistipes and decreased abundance of Enterobacteriaceae alters purine metabolism, thereby aggravating gout condition. Moreover, a higher abundance of Phascolarctobacterium and Bacteroides in gout modulates enzymatic activity in purine metabolism. Butyrate-producing bacteria such as Faecalibacterium, prausnitzii, Oscillibacter, Butyricicoccus, and Bifidobacterium have higher abundance in healthy controls compared to gout patients, suggesting the anti-inflammatory and anti-microbial role of short-chain fatty acids (SCFAs). Lipopolysaccharides (LPS)-releasing bacteria, such as Enterobacteriaceae, Prevotella, and Bacteroides, are also involved in the pathogenesis of gout disease by stimulating the innate immune system.ConclusionExploring the role of gut dysbiosis in gout and the underlying mechanisms can help develop microbiota-modulating therapies for gout.

Background: The goal of this study was to make a dosimetric comparison between the absorbed dose distribution of the prostate and the organ at risk (OAR) using two different approaches: three-dimensional conformal radiotherapy (3D-CRT) and Intensity-modulated radiotherapy (IMRT), assesed via treatment planning system (TPS) and thermoluminescence dosimetry (TLD). Methods: In this study, 35 patients with prostate cancer undergoing radiation therapy at Milad Hospital in Isfahan were included. Prostate as target and rectum, bladder and femoral head as healthy organ at risk (OAR) were contoured according to Radiation Therapy Oncology Group (RTOG) criteria. Two separate dosimetry programs IMRT and 3D-CRT have been developed for each patient in order to evaluate the dosimetric status of both methods comparatively. These results were then compared with those of the phantom. Findings: The doses to the bladder, rectum, and femoral head were 50.3, 58.6, and 16.4 in IMRT and 59.6, 68.8, and 34.8 in 3D-CRT, respectively. The dose measured by TLD in all organs in the phantom was higher than the dose calculated by TPS software in the phantom. Conclusion: The IMRT method is a better method than 3D-CRT due to better coverage of the target volume and reduction of the cumulative dose of organs at risk (OAR). The dose measured by TLDs was higher than the dose calculated by the treatment planning system, which may be due to the fact that the treatment planning system does not calculate the share of scattered radiation in the absorbed dose of organs.

Male survivors of childhood cancer have been known to be afflicted with azoospermia. To combat this, the isolation and purification of spermatogonial stem cells (SSCs) are crucial. Implementing scaffolds that emulate the extracellular matrix environment is vital for promoting the regeneration and proliferation of SSCs. This research aimed to evaluate the efficiency of nanocomposite scaffolds based on alginate, chitosan, and graphene oxide (GO) in facilitating SSCs proliferation. To analyze the cytotoxicity of the scaffolds, an MTT assay was conducted at 1, 3, and 7 days, and the sample containing 30 µg/mL of GO (ALGCS/GO30) exhibited the most favorable results, indicating its optimal performance. The identity of the cells was confirmed using flow cytometry with C-Kit and GFRα1 markers. The scaffolds were subjected to various analyses to characterize their properties. FTIR was employed to assess the chemical structure, XRD to examine crystallinity, and SEM to visualize the morphology of the scaffolds. To evaluate the proliferation of SSCs, qRT-PCR was used. The study’s results demonstrated that the ALGCS/GO30 nanocomposite scaffold exhibited biocompatibility and facilitated the attachment and proliferation of SSCs. Notably, the scaffold displayed a significant increase in proliferation markers compared to the control group, indicating its ability to support SSC growth. The expression level of the PLZF protein was assessed using the Immunocytochemistry method. The observations confirmed the qRT-PCR results, which indicated that the nanocomposite scaffolds had higher levels of PLZF protein expression than scaffolds without GO. The biocompatible ALGCS/GO30 is a promising alternative for promoting SSC proliferation in in vitro applications.

BackgroundGestational diabetes mellitus (GDM) is a health challenge during pregnancy and is associated with adverse effects. Dysbiosis of the gut microbiota may play a role in developing inflammation and insulin resistance observed in GDM. Probiotics are supposed to be influential in preventing GDM since they can alter the composition of microbiota in the intestine. Despite the existing studies on the therapeutic effects of probiotics in women with GDM, in this study we aim to systematically review and meta-analyze the results of randomized control trials (RCTs) on the beneficial effects of probiotics supplements on the prevention of GDM in healthy pregnant women.MethodsWeb of science, Scopus and PubMed databases were searched via a precise strategy to gather RCTs related to our study. Duplication removal, screening and data extraction were conducted by two researchers, independently. Quality assessment of eligible studies was conducted by Cochrane risk of bias tool. Meta-analysis was conducted using the random effects model due to substantial heterogeneity among studies.ResultsTen articles met our eligibility criteria from our initial search of 451 articles. Two thousand nine hundred and twenty-one participants without previously diagnosed glucose disturbance were included in our analysis. Probiotics reduced GDM incidence by 33% (RR = 0.67, 95% CI: 0.47, 0.95), while greater effect was detected in trials using multiple-strains probiotics (RR = 0.65, 95% CI: 0.42, 0.99). We did not detect any significant benefits or harms related to probiotics supplements on secondary outcomes including GDM related infantile and maternal complications including preeclampsia, caesarian section, mothers' weight gain during pregnancy, prematurity, macrosomia, hypoglycemia, NICU admission, and birth weight.ConclusionProbiotics supplementation may reduce the incidence of GDM and help control glucose parameters in pregnant women. Further studies are warranted regarding the GDM-related maternal and infantile complications.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022315550, identifier: CRD42022315550.

Introduction: Atherosclerosis is an inflammatory disease and is one of the leading causes of cardiovascular disease. Vascular plaques are formed on the inner surface of hardened arteries and gradually develop, reducing the diameter of the arteries. CXCR4 is one of the most important chemokine receptors, whose presence has been confirmed in cardiac plaques. Our aim was to determine the relationship between genetic diversity of CXCR4 gene (rs2228014) and atherosclerosis among the population of patients. Methods: The present study included 254 participants who referred to the Cardiac Angiography Department of Afshar Hospital in Yazd City. The main criteria for admission to the case group were coronary artery stenosis with angiography testing, and in the control group, the clients did not have coronary artery disease. The age and sex matching of the two groups were considered. Blood specimens were taken, and after DNA extraction, the SNP genotype of the CXCR4 gene was determined using ARMS-PCR. Statistical analysis of the data carried out using SPSS software version 19 and Chi-square test. Results: Genetic models of rs2228014 variant were evaluated in patients with atherosclerosis in comparison with the control group and a significant difference between allelic (P = 0.333), homozygous (P = 0.087), heterozygous (P = 849.0), dominant (P = 0.570) and recessive (P = 0.086) genetic models of rs2228014 polymorphism was not observed. Conclusion: In the current study, no significant difference was observed between genetic models of rs222801 polymorphism in patients with atherosclerosis and healthy individuals. Based on our findings, the rs222801 polymorphism of the CXCR4 gene might not be considered as a predisposing factor for atherosclerosis.

Background and purpose: In recent years, drug therapies have played an increasing role in management of drug-related crimes due to decrease in efficacy of other anti-crime methods. This study investigated the relationship between methadone maintenance therapy and frequency of drug-related crimes. Materials and methods: This cross-sectional study was conducted in 420 patients attending private addiction treatment centers who received agonist therapy in Kurdkuy and Gorgan in Golestan province, Iran. Data were collected using a researcher-made questionnaire consisting of demographic characteristics and items on history of drug abuse, history of crimes, domestic violence and conflicts, divorce and remarriage, and work and employment. The questionnaires were completed at admission time and six months after initiation of methadone treatment through face to face interviews. Data analysis was done in SPSS V23. Results: The majority of patients were married (88%), had low educational levels (75%) and were Persian (88%). The most commonly used narcotic drug was opium used oral or inhaled. There was a significant inverse relationship between methadone maintenance treatment and cases of crime and domestic violence and a significant direct relationship between the treatment and cases of divorce or remarriage, and work and employment before and after treatment (P

Introduction: Kangaroo mother care (KMC), as a complement to incubator care, is one of the ten recommendations of the World Health Organization (WHO) for the care of preterm infants. The KMC stabilizes the heart rate, improves oxygen saturation, makes weight gain better, and reduces crying in the infant. In order to launch KMC unit, the barriers for implementing this type of care should be recognized. Methods: This qualitative research was conducted using a focus group discussion and individual semi-structured interview with nurses, doctors, executive and management staff of a neonatal unit of a third level teaching hospital in Tabriz, northwest Iran. The participants were selected using purposeful sampling. Content analysis was used for analyzing data. Data were analyzed by MAXQDA 10 software. Results: After analyzing data, four main themes were extracted including mother-related barriers, father-related barriers, physician- related barriers, and system-related barriers. Conclusion: Based on the findings of the research, it seems that in order to facilitate practicing continuous KMC, much emphasis should be placed on training the parents and health care providers. Furthermore, in some cases, reforming the payment system for physicians, providing an instruction for performing continuous KMC, and continuous assessment of hospitals annually are necessary.

Background: lumbar disc degeneration is a multifactorial degenerative disease which is affected by genetic inheritance and environmental factors. Type XI collagen is important for organization of the extracellular matrix and cartilage collagen construction. Rs1676486 is a SNP that causes the conversion of C-T, resulting in a change in the expression of the collagen 11 alpha chain. The T allele reduces the alpha 1 chain transcription of collagen 11 and ultimately leads to an imbalance in gene expression. Methods: This study aims to determine the genetic variant of alpha1 type11 collagen is associated with the progress of intervertebral disc degeneration. All patients were selected from the AL-Zahra Hospital of medical university of Isfahan, Iran, between April 2016 and September 2017. SNP rs1676486 of alpha1 type11 collagen was genotyped in 100 patients and 100 healthy controls. The inclusion criteria for patients were: individuals who had typical clinical and imaging symptoms and signs of intervertebral disc degeneration. Exclusion criteria were: patients with trauma, metabolic and neuromuscular diseases, and congenital disorder of the spine. The Genomic DNA was extracted from peripheral blood samples by a Whole Blood Genomic DNA Extraction Kit. The chi-square test and fisher’s exact test were evaluated to determine differences of genotype and allele distributions between intervertebral disc degeneration patients and healthy controls. To compare the relationship between genotypes and clinical features the Mann-Whitney U test was used. Results: The mean age was 39.54±9.52 years for the patients and 28.14±5.32 years for the controls, respectively. The mean BMI were 26.3±3.18 kg/m2 and 27.3±3.52 kg/m2 for the patients and the controls, respectively. In addition, the results showed that the prevalence of surgical disc in patients with L4-L5 levels was 52.1% and L5-S1, with 31.1%. This study showed, rs1676486 in alpha1 type11 collagen gene was associated with modified intervertebral disc degeneration at age ≤50 years and this gene increases intervertebral disc degeneration risk at age >50 years. SNP rs1676486 had the significant association with the intervertebral disc degeneration (P=0.019), and patients were found to have higher frequency of AA than the controls. Conclusion: This observation shows that type XI collagen is related to age and genetic factor in intervertebral disc degeneration disease.

Abstract Background Motor neurons (MNs) are distinct types of cells in the dorso-ventral axis of the spinal cord. These cells are developed in the presence of two main morphogens, including Sonic hedgehog (Shh) and retinoic acid (RA). On the other hand, human bone marrow mesenchymal stem cells (hBM-MSCs) are known as a multipotent type of cells with neural differentiation capacity. In this regard, the aim of this study was to quantitatively evaluate the expression of MN-related genes and the potent epigenetic regulatory genes involved in neurogenesis, including Enhancer of zeste homolog 2 (EZH-2) and P300, during hBM-MSC differentiation into MN-like cells, using RA and Shh. After isolating and inducing the cells with Shh and RA, the results were evaluated using immunocytochemistry and qRT-PCR. Results Our findings showed that the treated cells could express choline acetyltransferase (ChAT) and insulin gene enhancer binding protein-1 (Islet-1) antigens at the protein level, 2 weeks after induction. Moreover, at the second week after induction, the induced cells expressed MN-related genes (ChAT and ISLET-1) and epigenetic regulatory genes (EZH-2 and P300) at significant levels compared to the control (non-treated BM-MSCs) and to the induced cells at the first week (day 7). In addition, the expression of EZH-2, as a histone-modifying gene, was also significantly upregulated at the first week compared to the control. No significant upregulation was detected in the expression of motor neuron and pancreas homeobox 1 (MNX-1) in the treated groups compared to the control group. Conclusion We concluded that epigenetic modifiers, P300 and EZH-2, are important mediators for regulating the process of motor neuron differentiation induced by RA and Shh.

The spiritual dimension of health is the subject of much controversy; since it is not seen as a purely scientific and quantifiable aspect of health. However, it is exactly this quality of spiritual health that makes the thorough examination of the concept worthwhile. Furthermore, a comprehensive assessment of the theoretical concepts associated with it should be prioritized. The present study is a combination of a literature review followed by a series of expert interviews. First, articles addressing the different aspects of spiritual health were identified and acquired from academic databases. After a thorough assessment and evaluation, the findings were listed and prioritized in order to determine the most important aspects of spiritual health. Then, the most significant features were specified and interpreted. The interpretations were then sent to a group of experts for assessment and evaluation. The expert reviews and comments were then collected and analyzed in order to refine and improve the primary interpretations. The responsibilities of the health sector do not end with the provision and maintenance of the physical aspects of health or even the non-medical population. It includes not only promoting spiritual health in health sector graduates and personnel, but also conducting profound scientific studies, providing documentation, and interpreting the evidence for beneficiaries. However, establishing a new university major to train professionals exclusively for pursuing this objective and even adding new university credits in this field does not seem to be necessary from the point of view of experts and studies. In addition to providing the education necessary for students and personnel of each organization, providing adequate spiritual health and promoting the essential education and related skills are also the responsibilities of the health sector. Instead, it is suggested that an active secretariat be established to oversee the promotion of spiritual health in all sectors using the minimum independent facilities and manpower.

Identification of hard tick species and their hosts are essential for the development of control and prevention programs for tick-borne diseases. In this descriptive cross-sectional study, ticks were collected from the sheep, goat, and camel in different regions of South Khorasan province, Iran in 2018 through cluster sampling method. Fauna and frequency of ticks were recorded and analyzed in SPSS software (version?). In total, 977 ticks were collected, such as: Hyalomma spp, including Hy. dromedarii (40.5%), Hy. anatulicum (30.7%), Hy. marginatum (12.5%), Hy. asciaticum (6.8%), Hy. schulzei (4.4%), Hy. detritum (3.2%), and Hy. scupense (1.1%); Rhipicephalus spp, including Rh. bursa (0.3%), Rh. sanguineus (0.2%); and Haemaphysalis spp, including Ha. concina (0.2%), and Ha. punctate (0.1%). The ticks have a high frequency in the region and the identified species in this study were vectors of Crimean Congo Hemorrhagic Fever (CCHF). Moreover, the Hyalomma species is dominant and prevalent throughout the studied region in spring and summer. Therefore the health system of the province has to put into consideration the essential care, education and informing about the CCHF disease.

Objective COVID-19 has recently emerged as a serious threat to global health. This study examined the laboratory investigations of patients with COVID-19, with an emphasis on liver enzymes. Methods This retrospective, single-center study was performed on patients with COVID-19 who were admitted to Imam Reza Hospital, Iran from March 2020 to February 2021. Laboratory tests included a complete blood cell count, white blood cell (WBC) count, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio, and levels of aspartate aminotransferase, alanine aminotransferase (ALT), and alkaline phosphatase. Patient survival was among the outcome measures investigated in association with laboratory findings. Results We enrolled 77 patients with COVID-19 and 63 healthy controls. In comparison with the control group, patients with COVID-19 showed COVID-19 increased ALT, WBC, neutrophils, NLR, and PLR, and decreased platelet counts and lymphocytes. Conclusion Although elevated levels of AST, NLR, PLR, and LMR were found in patients with COVID-19, they were not linked to mortality. Given the presence of AST in other tissues, the influence of SARS-CoV-2 on the liver should be interpreted with caution.

Nagla A El-Shitany,1,2 Steve Harakeh,3 Shaimaa M Badr-Eldin,4,5 Amina M Bagher,1 Basma Eid,1 Haifa Almukadi,1 Badrah S Alghamdi,6 Ahlam A Alahmadi,7 Nibal A Hassan,8 Nariman Sindi,9 Samar A Alghamdi,10 Hailah M Almohaimeed,11 Zuhair M Mohammedsaleh,12 Turki M Al-Shaikh,13 Mohammed S Almuhayawi,14 Soad S Ali,15 Manal El-Hamamsy16,17 1Department of Pharmacology and Toxicology, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia; 2Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tanta University, Tanta, Egypt; 3Special Infectious Agents Unit, King Fahd Medical Research Center, Yousef Abdullatif Jameel Chair of Prophetic Medicine Application, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 4Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia; 5Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt; 6Department of Physiology, Neuroscience Unit, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 7Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia; 8Department of Biology, Faculty of Science, Taif University, Taif, Saudi Arabia; 9Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia; 10Department of Oral Biology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; 11Department of Basic Science, Faculty of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; 12Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia; 13Department of Biology, College of Science and Arts at Khulis, University of Jeddah, Jeddah, Saudi Arabia; 14Department of Microbiology and Medical Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 15Department of Histology, Faculty of Medicine, Assiut University, Assiut, Egypt; 16Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia; 17Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, EgyptCorrespondence: Nagla A El-ShitanyDepartment of Pharmacology and Toxicology, Faculty of Pharmacy, King Abdulaziz University, Al-Sheekh Kamal Street, Alsulimaniah, Jeddah, Saudi ArabiaTel +966 545923440Email nagla_fouad@yahoo.comBackground: The Pfizer-BioNTech COVID-19 vaccine has recently received emergency approval from the US FDA. The mRNA technology was used to manufacture the Pfizer vaccine; however, as a pioneering technology that has never been used in the manufacture of vaccines, many people have concerns about the vaccine’s side effects. Thus, the current study aimed to track the short-term side effects of the vaccine.Methods: The information in this study was gathered by a Google Form-questionnaire (online survey). The results included the responses of 455 individuals, all of whom are Saudi Arabia inhabitants. Adverse effects of the vaccine were reported after the first and the second doses.Results: The most common symptoms were injection site pain, headaches, flu-like symptoms, fever, and tiredness. Less common side effects were a fast heartbeat, whole body aches, difficulty breathing, joint pain, chills, and drowsiness. Rare side effects include Bell’s palsy and lymph nodes swelling and tenderness. Flu-like symptoms were more common among those under 60 years of age, while injection site pain was more frequent among recipients who were 60 years and older. The study revealed a significant increase in the number of females who suffered from the vaccine side effects compared to males. Difficulty of breathing was more reported among recipients who had been previously infected with the coronavirus compared to those who had not been previously infected.Conclusion: Most of the side effects reported in this study were consistent with Pfizer’s fact sheet for recipients and caregivers. Further studies are required to determine the long-term side effects.Keywords: Pfizer-BioNTech COVID-19 vaccine, side effects, injection site pain, hypersensitivity, flu-like symptoms, online survey

Background and purpose: Generational health analysis on the acquisition, application, and transfer of intergenerational values is an important issue from the perspective of religion and genetics. Healthy generation means generational solidarity and lack of disruption or crisis in generations despite generational differences. The purpose of this study was to identify the common points and solutions about healthy generation in religion and genetics. Materials and methods: This qualitative content analysis was done by studying documents. First, to find research concepts (data), religious and scientific texts were searched using the following keywords: generation, uterus, coupling, inheritance, nature, gene, genetics, and epigenetics. Data was then processed according to scientific and religious fields and analyzed on the basis of valid interpretative theories and empirical studies. Results: The creation of generation is a continuous, regular, and formative process that begins before selecting the spouse and continues until late adulthood. Religious propositions and genetic findings are similar despite having their own arguments. The study found that parental traits are transmitted through genes, but, education and behavioral patterns play significant roles in generational health. Conclusion: Specific training styles with emphasis on five stages of human life (1- pre-spouse selection, 2- spouse selection, 3- before sperm coagulation, 4- embryonic and pregnancy periods, 5- childhood to adulthood) are effective in generating health and excellence and minimizing the role of abnormal genome, and should be considered in intergenerational education.

Diabetes and obesity are among the most important metabolic disorders which are of worldwide concern. Today, it has been proven that the diversity and composition of the intestinal microbiota play a key role in the incidence and control of metabolic diseases via regulating the metabolism and immune responses of the host. Previous studies reported links between Akkermansia muciniphila, a commensal bacterium in the gut microbiota, and obesity and diabetes. Human and animal studies have shown that this mucin-degrading bacterium is effective in preventing obesity and diabetes by reducing intestinal wall permeability and preventing metabolic endotoxemia and inflammation, as well as modulating energy and fat metabolism. New evidence shows that both forms of the A. muciniphila (live bacterium or its pasteurized form) can control the disease. Considering the difficulties of the survival and cultivation of this anaerobic bacterium and in order to help optimal use of A. muciniphila in clinical treatments of metabolic diseases, in this study we compared the effect of live and pasteurized A. muciniphila. Besides, we investigated the effects of this bacterium as the next generation of probiotics on obesity and management of diabetes.

Polycystic ovary syndrome (PCOS) is a complex endocrine disorder that affects 8-13% of women at reproductive age worldwide. This disorder is usually associated with menstrual disorders, infertility, obesity, and insulin resistance. The underlying cause of this syndrome is unknown, however in recent years, researchers have shown an association between intestinal microbiota alterations )dysbiosis( and many types of endocrine diseases. Therefore, this review article aimed to improve understanding about the role of intestinal microbiome in development and progression of polycystic ovary syndrome and the underlying mechanisms of this disease. Based on recent findings on the role of intestinal microbiota in the development of this disease, metabolic control may help to prevent that, however it is not yet conclusive. Exploring possible underlying mechanisms is of particular importance for providing new treatment approaches in women with polycystic ovary syndrome. Studies showed that modification of intestinal microbiome in women with PCOS using probiotics, prebiotics, synbiotics, and fecal microbiota transplantation could be effective in improving many of the symptoms of this syndrome and preventing further complications. Therefore, gut microbiota modification is recommended to be considered along with other common treatments. Of course, more research is needed in this field.

Background and purpose: There are some evidences about the effects of probiotics on controlling different types of diabetes and reviewing these studies could be of great help in clarifying the efficacy of these dietary supplements in management of diabetes. Thus, we aimed to review the role of probiotics on glycemic control and other biochemical parameters in patients with diabetes. Materials and methods: An umbrella review of systematic reviews, meta-analyses, systematic reviews and meta-analysis in English and Persian were performed by thorough search in PubMed and Scopus. Eligible studies on the effects of probiotics in patients with diabetes published up to 30 September 2020 were selected. Results: Thirty one eligible papers were identified. In these studies, the effects of probiotic supplements or probiotic food products on glycemic status (n=18), lipid profile (n=12), inflammatory and oxidative stress factors (n=11), blood pressure (n=4), and Body Mass Index (n=2) in patients with type 2 diabetes and gestational diabetes were investigated. Conclusion: Findings revealed positive effects of probiotic supplements on glycemic status, lipid profile, blood pressure, oxidative stress and inflammation in patients with type 2 diabetes, and gestational diabetes. However, due to high heterogeneity in some parameters, further high quality double-blind clinical trials can shed light on the effectiveness of these supplements.