Search

Recent developments in information communication technology (ICT) have resulted in a paradigm shift in e-Learning and there is a growing interest in developing design-based research (DBR) focusing on learners and their involvement in knowledge sharing in a contextualized mode. The present study reports a mobile-assisted language learning (MALL) design with a focus on contextualized student-created content having a seamless learning approach. The students in this study (N = 24) used their mobile devices to take photos and create artifacts to represent English idioms and share them on Padlets with their peers for further discussion and feedback. In the first four weeks of the study, students were taught English idioms and in the following next two weeks they created and shared their own artifacts to represent the learnt idioms. The post-study reflections and results of the interviews and obtained from students and the teacher at the end of study revealed that they favor and support greater learner autonomy achieved by learner-generated context (LGC) which bridges the in-classroom and out-of-classroom learning. The article also highlights the necessity of reconceptualization of teachers and students' perceptions of mobile use in language learning in Iran.

Introduction: Headache is one of the essential symptoms of pituitary adenoma associated with the tumor and the patient’s characteristics. The pattern of adenoma-related headaches varies widely and can significantly impact the patient’s quality of life. Objectives: We aimed to investigate the severity and pattern of headaches in patients with pituitary adenoma in Iran. Patients and Methods: In this cross-sectional study, we investigated 109 patients with an initial complement of headaches. The diagnosis of pituitary adenoma was confirmed. Patients’ demographic characteristics [e.g., gender, body mass index (BMI), and age] and tumor characteristics (e.g., subtype of tumor and size of tumor) were collected by interview, clinical examination, and imaging. We measured the severity of the headache using Headache Impact Test-6 (HIT-6) questionnaire version 1.1. Results: In our study, the most common subtype of pituitary adenoma was prolactinoma, followed by nonfunctional growth hormone (GH)-releasing and adrenocorticotropic hormone (ACTH)-releasing adenomas. Functional adenoma was significantly more common in women; however, the incidence of non-functional adenoma was more in men (61%), indicating the correlation between gender and subtype of adenoma (P = 0.008). Most tumors were functional microadenomas (69%), while macroadenomas were primarily non-functional (50%). The HIT-6 scores demonstrated that functional microadenomas had higher HIT-6 scores and patients with prolactinoma experienced more severe headaches than other subtypes (P = 0.003). Conclusion: Our study revealed significant effects of the type of adenoma on the severity of headaches, as patients with functional microadenomas had more muscular headaches. Additionally, the hormonereleasing function of tumors plays a vital part in the advent and severity of adenoma-related headaches. [ABSTRACT FROM AUTHOR]

The widespread presence of microplastics (MPs) in freshwater systems as an emerging environmental pollutant has caused a global environmental problem. The present study investigates the distribution and abundance of source pathway and abundance of microplastics in surface sediment samples from rivers discharging into the Gorgan Bay, southeast of the Caspian Sea. A total of 57 surface sediment samples were taken from 19 stations to investigate the potential hot spots of pollution in the four rivers leading to the Gorgan Bay. The average level of microplastics was 333 ± 268 particles/kg. The highest amount is in the estuary of the Qarasu River (1080 ± 380 particles/kg) due to the accumulation of fishing, boating and tourism activities and the lowest amount in the forest area (80 ± 19 particles/kg) in the Klak River. The most common type of microplastic was fiber (68%). Microplastic pollution in the studied rivers is mostly black and gray (75.39%), and about 53% of them were sized less than 1000 μm. Spectroscopic analysis (Fourier Transform Infrared (FT-IR) of the MP showed that 37% were polyethylene, polyethylene (37%) and polypropylene (27%) were the dominating groups. The sediments’ size was significantly correlated (p>0.05) with the presence of microplastics. Sediments with a coarse grain (sand) demonstrated a great potential to store microplastics. The results of this study can be used for the management and protection policies of Gorgan Bay. [ABSTRACT FROM AUTHOR]

This article reflects upon foreign-language education in Iran. Contrary to its political and historical reputation in the world, Iran has not been well presented regarding its educational system in general and its foreign-language education in particular. Of course, a critical assessment of the strengths and weaknesses of the Iranian education system requires an in-depth analysis of its structure that goes beyond the scope of this article. However, I will attempt to provide some basic information about the educational system in Iran before the 1979 Islamic revolution, in order to set the background for a description of the post-revolutionary system of foreign-language education in this country. The article ends with a discussion of the problems in EFL education in Iran, along with some suggested solutions. (Contains 3 tables.)

Background: Bipolar Disorder (BD) imposes considerable economic and social burdens on the community. Therefore, the present study aimed to determine the economic burden of bipolar disorder in patients referred to single-specialty psychiatric hospitals at the secondary and tertiary care level in 2022. Methods: This partial economic evaluation was conducted as a cross-sectional study in the south of Iran in 2022, and 916 patients were selected through the census method. The prevalence-based and bottom-up approaches were used to collect cost information and calculate the costs, respectively. The data on Direct Medical Costs (DMC), Direct Non-Medical Costs (DNMC), and Indirect costs (IC) were obtained using the information from the patients' medical records and bills as well as the self-reports by the patients or their companions. The human capital approach was also used to calculate IC. Findings: : The results showed that in 2022, the annual cost of bipolar disorder was $4,227 per patient. The largest share of the costs was that of DMC (77.66%), with hoteling and ordinary beds accounting for the highest expenses (55.40%). The shares of DNMC and IC were 6.37% and 15.97%, respectively, and the economic burden of the disease in the country was estimated at $2,799,787,266 as well. Conclusion: In general, the costs of bipolar disorder treatment could impose a heavy economic burden on the community, the health system, the insurance system, and the patients themselves. Considering the high costs of hoteling and ordinary beds, it is suggested that hospitalization of BD patients be reduced by managing treatment solutions along with prevention methods to reduce the economic burden of this disease. Furthermore, in order to reduce the costs, proper and fair distribution of psychiatrists and psychiatric beds as well as expansion of home care services and use of the Internet and virtual technologies to follow up the treatment of these patients are recommended. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) is a pandemic outbreak of RNA coronaviruses (SARS-CoV-2), associated with acute respiratory distress syndrome, multiple organ failure, and death. The surface electrocardiogram is the first line assessment of cardiac electrical system. We aimed to interpret classically the electrocardiographic parameters at admission and during hospital course and association of them with prognosis in patients admitted with diagnosis of infection with SARSCoV- 2. Methods: Surface electrocardiograms (ECG) were obtained from 180 patients with SARS-CoV-2 infection at a large tertiary referral university hospital at north of Iran in Babol. The electrocardiographic waves, intervals and segments in addition to supraventricular and ventricular arrhythmias were depicted. Our cohort included two groups: discharged alive and dead during the hospital course. We compared the ECG characteristics of patients who died vs. survived ones. Results: Some ECG parameters of 180 hospitalized patients were significantly associated with mortality, like heart rate (p< 0.001), bundle branch block (P= 0.035), fragmented QRS (P= 0.015), ST elevation (P= 0.004), T p-e duration (P= 0.006), premature atrial and ventricular complexes (P= 0.030, P= 0.004) and atrial fibrillation (P= 0.003). Conclusion: The SARS-CoV-2 infection had several impacts on cardiac electrical system which may monitored with a simple and easily accessible tool like ECG. This tool also helpful in the risk stratification of patients. [ABSTRACT FROM AUTHOR]

Background: Occult hepatitis B infection (OBI) refers to the presence of hepatitis B virus (HBV) DNA in the serum or liver of individuals who tested negative for HBV surface antigen (HBsAg). This study aimed to determine seropositivity for antibodies against HBV core antigen (anti-HBc) and the frequency of OBI among the HBsAg non-reactive blood donors in Mashhad, northeastern Iran. Methods: In this cross-sectional study, serum samples of HBsAg-negative blood donors were examined for anti-HBc during June and August 2018. Anti-HBc-positive samples were tested for antibodies against HBsAg (anti-HBs), and those with negative results were classified as isolated anti-HBc cases. The presence of HBV DNA in the C, S, and X gene regions was assessed by a qualitative real-time polymerase chain reaction method in all HBsAg-negative samples. OBI subjects were detected by the presence of at least one HBV genomic region. Results: Of 540 HBsAg-negative donors, 29 (5.4%; 95% confidence interval: 3.6--7.6%) showed seroreactivity for anti-HBc, of whom 18 individuals were also seropositive for anti-HBs. All donors showed negative results for all three HBV genes regardless of their serum anti-HBc status. Conclusion: Based on our findings, we suggest routine screening of Iranian blood donation volunteers for serum anti-HBc and anti-HBs but not HBV DNA. [ABSTRACT FROM AUTHOR]

This article examines Iranian secondary students' (N = 336) life purposes. Economic and hedonistic life goals were the most valued. Relationships in terms of having a family and children were also appreciated. In the students' views, religiousness was associated with social goals such as helping others in need and volunteering in the community. Gender differences in students' life goals occurred only in aesthetic goals, which applied more to girls than to boys. K-Cluster analysis identified four purpose profiles: self-oriented dabblers, beyond-the-self (BTS) dreamers, self-oriented life goal pursuers and purposeful youth. The dominant profile among the youth was self-oriented life goal pursuer (37%). The study validated Damon's conceptual work on purpose profiles in a previously unstudied cultural context.

Background: Specific biomarkers for metabolic syndrome (MetS) may improve diagnostic specificity for clinical information. One of the main pathophysiological mechanisms of MetS is insulin resistance (IR). This systematic review aimed to summarize IR-related biomarkers that predict MetS and have been investigated in Iranian populations. Methods: An electronic literature search was done using the PubMed and Scopus databases up to June 2022. The risk of bias was assessed for the selected articles using the instrument suggested by the Joanna Briggs Institute (JBI). This systematic review protocol was registered with PROSPERO (registration number CRD42022372415). Results: Among the reviewed articles, 46 studies investigated the association between IR biomarkers and MetS in the Iranian population. The selected studies were published between 2009 and 2022, with the majority being conducted on adults and seven on children and adolescents. The adult treatment panel III (ATP III) was the most commonly used criteria to define MetS. At least four studies were conducted for each IR biomarker, with LDL-C being the most frequently evaluated biomarker. Some studies have assessed the diagnostic potency of markers using the area under the curve (AUC) with sensitivity, specificity, and an optimal cut-off value. Among the reported values, lipid ratios and the difference between non-HDL-C and LDL-C levels showed the highest AUCs (≥ 0.80) for predicting MetS. Conclusions: Considering the findings of the reviewed studies, fasting insulin, HOMA-IR, leptin, HbA1c, and visfatin levels were positively associated with MetS, whereas adiponectin and ghrelin levels were negatively correlated with this syndrome. Among the investigated IR biomarkers, the association between adiponectin levels and components of MetS was well established. [ABSTRACT FROM AUTHOR]

Objective: The current study aimed to investigate the relationship between resiliency and the prevalence and severity of prenatal anxiety and depression in the context of high-risk pregnancies. Methods: A descriptive cross-sectional correlational survey design was used. A convenience sample of 404 high-risk pregnant women from a maternity department at the National Guard Health Affairs hospital, in Jeddah completed three online scales: the Connor-Davidson Resilience Scale, the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7. Results: Most women (89.85%) had low resilience, while only 1.98% had high resilience. There was a strong negative correlation between resilience and depression (r = -0.81, p < 0.001) and between resilience and anxiety (r = -0.79, p < 0.001). Women with low resilience had higher levels of depression and anxiety than women with high resilience. Additionally, women with high-risk pregnancies who have higher levels of resilience are more likely to have normal vaginal delivery, to be employed, and to have fewer pregnancy complications than those who have lower levels of resilience Conclusion: Resilience is an important factor for the mental health of women with high-risk pregnancies. Interventions to enhance resilience may help reduce the psychological burden of high-risk pregnancies and improve maternal and fetal outcomes. Further research is needed to explore the causal mechanisms and the modifiable factors that influence resilience. [ABSTRACT FROM AUTHOR]

Background: The extent of healthcare expenditure within households stands as a crucial indicator in low and middle-income countries (LMICs). When out-of-pocket healthcare expenses surpass household income or become unduly burdensome, it serves as a significant socio-economic alarm, resulting in a reduced quality of life, a phenomenon referred to as 'catastrophic health expenditure (CHE).' Multiple factors can contribute to the occurrence of CHE. The study's objective was to identify the key uncertainties and driving forces influencing CHE to develop scenarios in Iran on the horizon of 2030. Methods: This study was conducted between December 2021 and January 2023, data were collected through a literature review, and experts' opinions were gathered via questionnaires, interviews, and expert panels. The statistical population included experts in the fields of health policy, health economics, and futures studies. Scenario Wizard software and MICMAC analysis were employed for data analysis, providing valuable insights into potential future scenarios of health expenditures in Iran. Results: Based on the results of the scoping review and semi-structured interview, 65 key factors in the fields of economics, politics, technology, social, and environmental were identified. The findings of the MICMAC analysis presented 10 key variables. Finally, six main scenario spaces are depicted using Scenario Wizard. These scenarios included catastrophic cost crises, sanction relief, selective information access, technological ambiguity, induced demand management, and incremental reforms. Conclusions: Each of the six drawn scenarios provides images of the future of health expenditure in Iranian households on the horizon of 2030. The worst-case scenario from all scenarios was scenario one, with the most probable and critical features to derive Iran's health expenditures. The current study is a valuable addition to the literature depicting the key drivers that all developing nations can consider to decrease exposing households to catastrophic and impoverishing health expenditures. [ABSTRACT FROM AUTHOR]

Dyslipidemia, as a metabolic risk factor, with the strongest and most heritable independent cause of cardiovascular diseases worldwide. We investigated the familial transmission patterns of dyslipidemia through a longitudinal family-based cohort, the Tehran Cardiometabolic Genetic Study (TCGS) in Iran. We enrolled 18,729 individuals (45% were males) aged > 18 years (mean: 38.15 (15.82)) and observed them over five 3-year follow-up periods. We evaluated the serum concentrations of total cholesterol, triglyceride, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol with the first measurement among longitudinal measures and the average measurements (AM) of the five periods. Heritability analysis was conducted using a mixed-effect framework with likelihood-based and Bayesian approaches. The periodic prevalence and heritability of dyslipidemia were estimated to be 65.7 and 42%, respectively. The likelihood of an individual having at least one dyslipidemic parent reveals an OR = 6.94 (CI 5.28–9.30) compared to those who do not have dyslipidemic parents. The most considerable intraclass correlation of family members was for the same-sex siblings, with ICC ~ 25.5%. For serum concentrations, heritability ranged from 33.64 to 60.95%. Taken together, these findings demonstrate that familial transmission of dyslipidemia in the Tehran population is strong, especially within the same-gender siblings. According to previous reports, the heritability of dyslipidemia in this population is considerably higher than the global average. [ABSTRACT FROM AUTHOR]

Despite the spread of reliable technological tools and the availability of computers in Iranian universities, as well as the mounting evidence of the effectiveness of blended learning, many Iranian language teachers are still reluctant to incorporate such tools in their English as a foreign language (EFL) classes. This study inspected the status quo of technology integration in Iranian EFL classes and investigated the obstacles, as perceived by the Iranian EFL teachers, toward implementing CALL in Iran. First, 100 EFL teachers completed the Teacher Technology Integration Survey developed by Vannatta and Banister (2009), to help estimate technology use in EFL classes. Then the researchers interviewed twelve teachers, comprising two EFL teacher educators with no CALL experience, four teachers with the experience of integrating technology in their EFL classes, four EFL teachers who had recently finished an online CALL teacher education program, and two EFL teachers with no CALL experience. The semi-structured interview questions were designed by the researchers, one of whom has extensive experience with CALL, and were revised based on the suggestions of a colleague with expertise in teacher education. One of the researchers conducted the interviews, each of which lasted for 30-50 minutes. The researchers used structural content analysis of the interview transcripts to find themes relevant to the research question. The results suggest that on the whole, Iranian EFL teachers do not usually integrate digital technology into their classes; and the obstacles in implementing CALL in language classrooms could be classified into three categories: teacher, facility, and learner constraints. Each of the categories is discussed in detail and suggestions are provided for promoting CALL in the Iranian context.

Context: Chronic low back pain (CLBP) often presents with a dysfunction in deep abdominal muscles activity during standing tasks. Although some studies indicated that deep abdominal muscle activity improved during some functional tasks following stabilization exercise (SE), there is no study to evaluate the effect of SE on lateral abdominal muscles thickness during standing postural tasks. Objective: The purpose of this study was (1) to evaluate the lateral abdominal muscles thickness in the participants with CLBP while standing on a balance board and (2) to compare the effects of SE and a general exercise (GE) program on the lateral muscles thickness changes. Methods: This was a between-groups, triple-blinded randomized controlled trial design. In total, 40 females with CLBP were randomly assigned into 2 groups: GE (control group) and supervised progressive SE (experimental group). Diagnostic ultrasound imaging was used before and after the intervention to measure lateral abdominal muscles thickness during standing on 2 different levels of platform in the Biodex Balance System. Visual analog scale and Roland-Morris Disability Questionnaire were used to evaluate changes in pain intensity and disability. Results: The results indicated significant increases in transverse abdominis muscle thickness during all standing tasks (P = .02) and significant decreases in pain intensity and disability following SE intervention (P < .001). However, the lateral abdominal muscle thicknesses were not changed after GE intervention while standing postural tasks (P > .05). The GE group revealed only significant decreases in pain intensity after intervention (P = .03). Conclusion: Supervised progressive SE improved the activity of deep abdominal muscles in standing postural tasks in the patients with CLBP. [ABSTRACT FROM AUTHOR]

The first purpose was to investigate the trunk muscle endurance, the second aim was to evaluate the trunk–pelvis kinematics during gait, and the third was to evaluate the relationship between trunk–pelvis kinematics and the trunk muscle endurance. Thirty participants (15 nonspecific chronic low back pain [NCLBP] and 15 healthy) were included. The authors first assessed trunk muscle endurance on endurance testing protocols. The authors next measured the trunk–pelvis kinematics during gait using a 3-dimensional motion capture system. Angular displacement, waveform pattern (CVp), and offset variability (CVo) were also examined. Statistical analysis revealed a significant difference in (1) the trunk muscle endurance and (2) sagittal, frontal, and transverse planes CVp between groups (P <.05). A significant moderate correlation was found between supine double straight-leg raise and frontal CVp (r =.521, P =.03) and transverse planes CVp (r =.442, P =.05). However, a significant moderate correlation was observed between prone double straight-leg raise and sagittal plane CVp (r =.528, P =.03) and transverse plane CVp (r =.678, P =.001). The relationship between (1) lower trunk extensor endurance with transverse and sagittal planes CVp and (2) lower abdominal muscle endurance with transverse and frontal planes CVp suggests that gait variability in these planes may result because of trunk muscle deconditioning accompanying NCLBP. [ABSTRACT FROM AUTHOR]

Introduction: The family physician programme (FPP) was implemented nearly two decades ago as a major health reform. Since the health system and FPP function in a rapidly changing social and economic environment, successful expansion of the programme requires a detailed analysis of its multiple major challenges, including the crucial aspect of its funding system. This systematic review aimed to assess the challenges in the FPP relative to its financing. Methods: All published articles related to the FPP in Iran were included in this study. In particular, original qualitative studies published in English or Persian from 2011 to 2021 were included. In January 2022, international credible scholarly databases and Persian databases were searched. All selected articles were carefully studied, and the data were extracted using the sample, phenomenon of interest, design, evaluation and research type technique. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in preparing the study report. Results: Among 491 articles retrieved from the search strategy, 50 met the inclusion criteria after their titles and abstracts were screened. Twenty-nine studies were excluded after their full texts were reviewed. A total of 11 eligible empirical studies were finally included. Based on the results, six broad categories (budget and funding, insurance system, tariffs, payments, accountability and injustice) were identified as financial challenges. Conclusion: This study identified the challenges associated with financing among family physicians, and the results could provide guidance for policy-making in the expansion of the FPP. [ABSTRACT FROM AUTHOR]

Introduction: Iran is host to one of the world's largest and longest-standing refugee populations. Although Iran has initiated a basic health insurance scheme for refugees throughout the country since September 2015, the population coverage of this scheme is very low, and various factors have caused a significant percentage of refugees to still lack insurance coverage and often face financial hardships when receiving health services. In response, this study aimed to understand barriers to insurance coverage among refugees in Iran and propose effective policies that can address persistent gaps in financial protection. Methods: This qualitative study was conducted in two phases. First, a review of policy documents and interviews with participants were conducted to investigate the common barriers and facilitators of effective insurance coverage for refugees in Iran. Then, a systems thinking approach was applied to visualize the common variables and interactions on the path to achieving financial protection for refugees. Results: Findings showed that various factors, such as (1) household-based premium for refugees, (2) considering a waiting time to be eligible for insurance benefits, (3) determining high premiums for non-vulnerable groups and (4) a deep difference between the health services tariffs of the public and private service delivery sectors in Iran, have caused the coverage of health insurance for non-vulnerable refugees to be challenging. Furthermore, some policy solutions were found to improve the health insurance coverage of refugees in Iran. These included removing household size from premium calculations, lowering current premium rates and getting monthly premiums from non-vulnerable refugees. Conclusions: A number of factors have caused health insurance coverage to be inaccessible for refugees, especially non-vulnerable refugees in Iran. Therefore, it is necessary to adopt effective policies to improve the health financing for the refugee with the aim of ensuring financial protection, taking into account the different actors and the interactions between them. [ABSTRACT FROM AUTHOR]

Background: There are various approaches in primary health care regarding the key role of nurses. This systematic review investigates the roles of nurses, as part of the family medicine team. Materials and Methods: All published articles related to the role of nurses in the family medicine team from January 2000 to March 2022 were the subjects of this study. The eligibility criteria included original articles published in English or Persian in the last two decades. International credible scholarly databases (PubMed, Scopus, Magiran, IranMedex, and SID) were searched using keywords and syntax. Some of the keywords included "Family Health Nurse," "Nurses in Primary Care," "Family Medicine," "Family Physician Care Program," "General Physician Program," "Role," and "Nurse." Data were extracted based on Sample, Phenomenon of Interest, Design, Evaluation, Research type (SPIDER) technique and reported based on the structure of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Of 147 identified publications by the search strategy, eight eligible empirical studies were included. The results showed that besides providing nursing care, nurses play vital roles in communication and teamwork, assessment, securing health services relevant to communities' needs, education, empowerment, clinical practice, health promotion, prevention, reflective research practice, and counseling. Conclusions: This study identified different roles nurses could play in providing primary health care. These findings are helpful for the replanning or reform of primary health care in countries, which aimed to expand the Family Physician Program (FPP) in their countries, including Iran. [ABSTRACT FROM AUTHOR]

Background: Vitiligo is an acquired, auto-immune chronic skin disorder with different treatment modalities. Insufficient adherence to treatment is closely related to the efficacy of a prescribed treatment, and also, there are some associations between adherence behaviour and personality. Therefore, the study aimed to assess a relationship between five-factor personality traits and treatment adherence in patients with vitiligo. Methods: In this cross-sectional study, patients with vitiligo who received Ultraviolet B (UVB) phototherapy were recruited. The Morisky Medication Adherence Scale (MMAS-8) assessed treatment adherence, and personality factors were evaluated by NEO Five-Factor Personality Inventory (NEO-FFI). Data were analysed using t-tests, correlations, and multiple regression. Results: Among 70 participants, 62.9% had low adherence, 24.3% had medium adherence, and 12.9 % had high adherence. There was a positive correlation between neuroticism (p<0.001) and adherence score. Furthermore, a negative correlation between Agreeableness (p=0.13), Conscientiousness (p<0.001), Openness to experiences (p=005), Extraversion (p<0.001), and adherence score was obtained. In the regression analysis method, only the factors of neuroticism (p<0.001) and openness (p=0.001), and conscientiousness (p=0.016) predicted the dependent variable (adherence score) at the significance level. Conclusion: This study demonstrated that openness to experience and conscientiousness positively affected adherence, while Neuroticism negatively affected adherence. Considering these personality factors can effectively screen poor adherence and improve treatment adherence. [ABSTRACT FROM AUTHOR]

Background: Despite the adoption of various policies and strategies in recent decades, the Iranian health system has not succeeded in protecting households against catastrophic health expenditures (CHE) and impoverishment. Accordingly, this qualitative study aimed to critically analyze current policies for reducing CHE. Methods: This qualitative study was conducted as a retrospective policy analysis based on a document review and semi-structured interviews with key informants between July to October 2022. Two theoretical frameworks were used, including the Analysis of Determinants of Policy Impact (ADEPT) model and Walt and Gilson's "Policy Triangle framework." The country's related documents were searched through databases. In total, 35 participants were interviewed. Interviews and documents were analyzed using directed content analysis in MAXQDA v12 software. Interobserver reliability, peer check, and member check were done to confirm the trustworthiness of the data. Results: Twelve main themes and 42 sub-themes emerged from the data. The findings revealed that policy accessibility, policy background, and a clear statement of goals influenced the policy process. However, resources, monitoring and evaluation, opportunities, and obligations negatively affected the implementation process. In addition, a policy analysis based on the policy triangle framework demonstrated that the main factors affecting the policy on reducing CHE in Iran were "conflicts of interest," "contextual factors," "monitoring and evaluation," and "intersectoral relationship" factors. Conclusion: The present study reflected the multifaceted nature of the barriers to reducing CHE in Iran. The implementation of the policy on reducing CHE requires the political will to improve intersectoral collaboration, strengthen the stewardship role of the Ministry of Health, design monitoring and evaluation mechanisms, and prevent personal and organizational conflicts of interest. [ABSTRACT FROM AUTHOR]

The family physician program (FPP) is one of the most significant health care reforms in Iran; however, many studies showed that this program has not been able to achieve its intended objectives because of a variety of challenges. This program, despite the existing challenges, is going to be expanded across the country. To improve the likelihood of its success, identification of the structural and infrastructural challenges is necessary. This systematic review was conducted to assess the structural and infrastructural challenges of FPP in Iran. This systematic review of the literature was conducted in order to investigate the infrastructure and structure needs of the current program in Iran. All published articles related to the FPP in Iran were the subject of this study. The eligibility criteria included original articles, reviews, or case studies published in English or Persian during 2011-2021 related to the challenges in the referral system of FPP in Iran. Data were extracted based on Sample, Phenomenon of Interest, Design, Evaluation, Research type technique and were reported based on the structure of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. International credible scholarly databases were searched. The search strategy was defined based on keywords and the search syntax. This study identified different challenges of the referral system in the areas associated with legal structure, administration, and social structure. The identified challenges in this program should be addressed in order to ensure that this program will lead to improved quality of care and equity in Iran health care system. [ABSTRACT FROM AUTHOR]

Background: Acute coronary syndrome (ACS) is one of the most serious diseases with high mortality. Concerning the influence of age and gender on ACS properties, this study aimed to determine gender and age-based differences in risk factors and symptoms of the ACS in a sample of Iranian patients. Methods: This cross-sectional study was conducted on 450 patients with ACS in Kerman from 10 September, 2018 to 25 February, 2019. The data were collected through face-to-face interviews in the coronary care unit (CCU) after ACS diagnosis. A trained interviewer collected the data using a demographic and clinical information checklist. Statistical analyses were performed using chi-square, Fisher exact test, and Mann‐Whitney U test and through SPSS software (version 23). Results: In this study, more than half of the patients with ACS were males (n=240, 53.4%). In one-third of the patients, ACS symptoms were presented in the age range of 60-69 years (n=145, 32.2%). In the female patients compared to the male patients, there were more cases of underweight [58 (27.6%) versus 45 (18.8%), P value: 0.02], positive family history of coronary heart disease (CHD) [102 (48.6%) versus 92 (38.3%), P value: 0.02], and hypertension [119 (56.7%) versus 113 (47.1%), P value: 0.04]. In contrast, there were no differences in common symptoms and pain severity in patients in various age and sex groups. Conclusion: Attention to the differences in the profile of risk factors and symptoms of ACS in males and females of different ages, would be helpful in choosing the best clinical approach. [ABSTRACT FROM AUTHOR]

BACKGROUND: In this retrospective study, we investigated the outcomes and demographic characteristics of COVID-19 patients with and without a history of CVD. METHODS: This large retrospective, multicenter study was performed on inpatients with suspected COVID-19 pneumonia who were admitted across four hospitals in Babol, Northern Iran. Demographic data, clinical data, and cycle threshold value (Ct) results of Real Time PCR were obtained. Then, participants were divided into two groups: (1) cases with CVDs, (2) cases without CVDs. RESULTS: A total of 11097 suspected COVID-19 cases with a mean ± SD age of 53 ±25.3 (range: 0 to 99) years were involved in the present study. Out of whom 4599 (41.4%) had a positive RT-PCR result. Of those, 1558 (33.9%) had underlying CVD. Patients with CVD had significantly more co-morbidities such as hypertension, kidney disease, and diabetes. Moreover, 187 (12%) and 281 (9.2%) of patients with and without CVD died, respectively. Also, mortality rate was significantly high among the three groups of Ct value in patients with CVD, with the highest mortality in those with Ct between 10 and 20 (Group A = 19.9%). CONCLUSION: In summary, our results highlight that CVD is a major risk factor for hospitalization and the severe consequences of COVID-19. Death in CVD group is significantly higher compared to non-CVD. In addition, the results show that age-related diseases can be a serious risk factor for the severe consequences of COVID-19. [ABSTRACT FROM AUTHOR]

Background: Mycobacterium tuberculosis affects the lungs in 85% of all cases and the remaining 15% through extra pulmonary affecting other parts of the body such as lymph nodes, pleura, and the genitourinary system. This study aimed to investigate extra-pulmonary tuberculosis (TB) associated factors, failure of treatment, and trends between 2004-2017 in Kashan, Iran. Materials and Methods: This study was conducted during 2004-2017 on newly registered extrapulmonary tuberculosis patients referred to TB Referral Center in Isfahan province, Kashan city, Iran. Information (demographic characteristics, related factors of the disease, and treatment status) of 197 extrapulmonary tuberculosis (EPTB) patients was extracted from Medical case records. Results: In total, 527 cases of Tuberculosis were reported, of which, 159 (30.17%) were confirmed extrapulmonary TB. Eighty-five (53.5%) and 74 (46.5%) were male and female, respectively. Also, 74 (46.5%), and 84 (53.5%) of EPTB were from Iran, and Afghanistan immigrants, respectively. The average age of patients was 41.9±2.18. Among underlying diseases in extrapulmonary TB positive, diabetes mellitus (DM) was predominant with a prevalence of 31 (19.5%), while, 128 (80.5%) cases did not show any underlying disease. Most of the patients were in the age group (21-40 years) with a frequency of 60 (37.7%), and the lowest of patients belonged to the age group (>80 years) with a frequency of 9 (5.7%). No correlation was found between related factors and infection with EPTB (p> 0.05). Conclusion: Our findings showed that the prevalence of EPTB in Kashan was relatively high, but, a relative decrease was shown during 2004-2017, which with preventative measures can be reduced the prevalence. [ABSTRACT FROM AUTHOR]

Background: Chronic hepatitis C virus (HCV) infection affects 58 million people globally. The frequency of HCV infection in the general Iranian population is less than 0.5%; however, a concentrated epidemic was reported among people who use drugs, particularly those with a history of drug injection. Objectives: This cross-sectional study was performed to assess the prevalence of HCV infection among high-risk groups outside of prison in northeastern Iran. Methods: A total of 962 participants in Razavi Khorasan province were enrolled from 2018 to 2022. They included drug users referred to drug treatment and harm reduction centers and individuals with a history of crimes such as drug use or imprisonment who worked in a private industrial unit. Serum anti-HCV antibodies were assessed using a rapid or ELISA kit, and seroreactive samples were confirmed by single-step reverse transcriptase or qualitative real-time polymerase chain reactions. A P-value < 0.05 was considered statistically significant. Results: The mean age of 707 males and 255 females was 39.8 ± 10.2 years. Anti-HCV antibodies were detected from 129 samples (13.41%), of which 107 were available for polymerase chain reaction testing. HCV RNA was detected in 88 cases (75.2%); the total viremia rate was calculated as 9.26% (88/950). Logistic regression analysis revealed that HCV infection among drug users was significantly associated with older age (P = 0.002), being single (P = 0.009), and history of drug injection (P < 0.001) or incarceration (P = 0.04). Conclusions: The findings showed a considerably high prevalence of HCV infection among people who use drugs in northeastern Iran. To achieve the global goal of viral hepatitis elimination by 2030, we strongly recommend stricter screening and treatment of this infection among such hard-to-access populations in Iran. [ABSTRACT FROM AUTHOR]

In the present study, kashk samples were collected from two regions of Iran, the Fars (Abadeh) and Razavi Khorasan (Kalat) provinces. Fifteen bacteria were isolated and physiological and biochemical assays were performed. After identification to the genus level, eight isolates were identified as lactic acid bacteria (LAB) and subjected to molecular identification and probiotic properties assays. The results revealed that the isolates were Enterococcus faecium KKP 3772 (KF1), Enterococcus faecium C1 (KF2), Pediococcus pentosaceus H11 (KF3), Pediococcus pentosaceus VNK-1 (KK4), Lactococcus lactis RSg (KK1), Enterococcus faecalis P190052 (KK2), Enterococcus mundtii CECT972T (KK3), and Lactiplantibacillus plantarum PM411 (KK5). Only the numbers of L. lactis RSg (KK1) and Lpb. Plantarum PM411 (KK5) decreased to below 9 Log CFU/mL after acidic conditions (pH = 3) and showed weak antibacterial activity. Enterococcus mundtii CECT972T (KK3) and E. faecium C1(KF2) were highly susceptible to bile salts, while P. pentosaceus VNK-1 (KK4) and P. pentosaceus H11 (KF3) showed the highest resistance. All of the isolates were resistant to tetracycline and sensitive to chloramphenicol and gentamicin. The antimicrobial activity of P. pentosaceus VNK-1 (KK4) and P. pentosaceus H11 (KF3) was higher than other isolates and consequently, their inhibition zones were larger. The adhesion capabilities of LAB isolates to intestinal epithelial cells were evaluated by examining the auto-aggregation factor and cell surface hydrophobicity. The highest and lowest cell surface hydrophobicity and auto-aggregation were obtained from P. pentosaceus VNK-1 (KK4) and E. mundtii CECT972T (KK3), respectively. In general, P. pentosaceus VNK-1 (KK4) and P. pentosaceus H11 (KF3) have shown better probiotic properties as compared to other isolates. [ABSTRACT FROM AUTHOR]

Synthetic hydrogels have been replaced by natural hydrogels due to their properties such as being long-lasting, more capacity for water absorption, high strength, and resistance. Recently, hydrogels have been defined as two- or multi-component systems consisting of three-dimensional networks of polymer chains that fill the space between macromolecules. Their water absorption efficiency depends on both polymeric nature and the capacity of the polymer network connections. Because of climate change and frequent droughts, fresh water supply has become a limiting factor for sustainable aquaculture development in Iran. Therefore, wastewater treatment and reuse can be a reasonable solution to meet the required water for expanding the aquaculture industry. The present study assessed the efficiency of a new hydrogel prepared from sugarcane waste (bagasse) to remove nitrogen and phosphate compounds from the effluent of fish farms. First, the hydrogel was prepared during the polymerization process, and then, in order to determine the optimal absorption, it was tested in a discontinuous system by performing absorption isotherm calculations. In cellulose/chitosan nanocrystalline hydrogel nanosorbent, the removal rates for nitrate, nitrite, and phosphate were 84.3%, 86%, and 90.9%, respectively. Optimal adsorption was determined at acidity of 6, time of 30 min, temperature of 40 ℃, concentration of 100 mg/L, and adsorbent dose of 0.5 g. A comparison of adsorption isotherm models showed more conformity with Freundlich and Tamkin absorption models with correlation coefficients of 0.99 and 0.97 for nitrate, 0.98 and 0.91 for nitrite, and 0.99 and 0.93 for phosphate, respectively. [ABSTRACT FROM AUTHOR]

Background: Obesity is a major public health concern in developed and even developing countries worldwide. Adiponectin is a protein secreted by adipose tissue that modulates many metabolic processes and plays a vital role in obesity. This study aimed to determine the association of four variants of the ADIPOQ gene with serum adiponectin, cortisol levels and obesity status. Methods: This case-control study was performed on 164 obese individuals compared by 156 control from the Tehran Lipid and Glucose Study (TLGS). Standard procedures obtained anthropometric measures and metabolic parameters. Cortisol and adiponectin levels were measured by ELISA method. rs1501299, rs266729, rs17300539, and rs17366743 on the ADIPOQ gene were genotyped using the PCR-RFLP. The correlation between adiponectin gene SNPs and obesity were calculated by Additive, dominant, and recessive genetic models. Pearson's or Spearman's found correlations between adiponectin levels and metabolic and anthropometric variables. Data were analyzed using SPSS software Version 20. Results: Adiponectin and cortisol levels were significantly lower in obese subjects compared to the control group (p < 0.05). There was a significant negative correlation between serum adiponectin level and BMI, waist circumference (WC), waist-hip ratio, hip circumference (HC), Fasting blood sugar (FBS) Triglyceride (TG), Total cholesterol (TC), Systolic blood pressure (SBP), Diastolic blood pressure (DBP) (r = − 0.147, r = − 0.324, r = 0.371, r = − 0.179, r = − 0.299, r = − 0.277, r = − 0.041, r = − 0.134, and r = − 0.149, respectively). A positive correlation was found between adiponectin and high-density lipoprotein cholesterol (HDL-C) (r = 0.29), but no significant correlations were found between adiponectin and Low-density lipoprotein cholesterol(LDL-C) and cortisol. ADIPOQ variant rs1501299 was significantly associated with cortisol levels in subjects with BMI ≥ 25 (P-value =0.039). Conclusions: Adiponectin and cortisol levels were associated with obesity. No ADIPOQ gene variants and haplotypes were associated with cortisol, Adiponectin, and obesity. [ABSTRACT FROM AUTHOR]

Numerous factors have been involved in exercise-induced acute kidney injury (EIAKI), such as using non-steroidal anti-inflammatory drugs following exercise and idiopathic renal hypouricemia (IRHUC). IRHUC is an autosomal recessive inherited disorder characterized by impaired tubular uric acid transfer, impaired reabsorption, and accelerated uric acid secretion. Some IRHUC patients have been shown to have EIAKI. A 27-year-old police officer was admitted to the hospital due to anorexia and a serum creatinine level of 18 mg/dL, after a "tug-of-war" game. After one dialysis sessions per day over five days, his creatinine dropped to 1.3 mg/dL. Six months later, he developed bilateral flank pain and red discoloration of urine, following a 300-meter chase of a convict, and his creatinine level increased to 2.3 mg/dL, which was corrected with proper hydration alone. Recurrent acute kidney injury can be due to hereditary renal hypouricemia, which should be considered among differential diagnoses for patients. [ABSTRACT FROM AUTHOR]

Onychomycosis, a nail fungal infection, is normally caused by dermatophytes. However, yeasts and non‐dermatophyte moulds (NDM) are among pathogens that cause nail disease. Regarding, this study aimed to describe the molecular epidemiology of Fusarium onychomycosis in the North of Iran. Two hundred and fifty seven nail samples collected from the patients clinically suspected of onychomycosis were subjected to direct microscopy, calcofluor white staining and culture. Fusarium isolates were identified at a species level through determination of multi‐locus sequences for internal transcribed spacer and translation elongation factor 1 alpha. Based on the findings, Fusarium species were isolated from onychomycosis patients (n = 27). According to a previous partial genes analysis, the species in the recent study belonged to the members of F. fujikuroi species complex (n = 14), Fusarium incarnatum‐equiseti species complex (n = 1) and F. solani species complex (n = 12). In this study, F. proliferatum was the dominant Fusarium species collected from the samples. The correct identification of Fusarium species is essential regarding the increased prevalence of Fusarium onychomycosis and the inherent resistance of these agents to a wide spectrum of antifungals. The obtained results indicated variation in the epidemiology of Fusarium species isolated from onychomycosis. Moreover, the minimum inhibitory concentration (MIC) of luliconazole and lanoconazole was in the range of 0.001–1 μg/ml, with the geometric mean of MICs obtained at 0.0103 and 0.0343 μg/ml against Fusarium species, respectively. These findings can increase researchers' knowledge regarding diversity of species, distribution of onychomycosis and the choice of a proper treatment. [ABSTRACT FROM AUTHOR]

Background: C-peptide offers potential as a marker to indicate childhood metabolic outcomes. Measuring C-peptide concentration might have better future utility in the risk stratification of neonates born to overweight or diabetic mothers. Prior research has tried to bring this matter into the light; however, the clinical significance of these associations is still far from reach. Here we sought to investigate the associations between fetomaternal metabolic variables and umbilical cord blood C-peptide concentration.Methods: For the present study, 858 pregnant women were randomly selected from among a sub-group of 35,430 Iranian pregnant women who participated in a randomized community non-inferiority trial of gestational diabetes mellitus (GDM) screening. Their umbilical cord (UC) blood C-peptide concentrations were measured, and the pregnancy variables of macrosomia/large for gestational age (LGA) and primary cesarean section (CS) delivery were assessed. The variation of C-peptide concentrations among GDM and macrosomia status was plotted. Due to the skewed distribution of C-peptide concentration in the sample, median regression analysis was used to identify potential factors related to UC C-peptide concentration.Results: In the univariate model, positive GDM status was associated with a 0.3 (95% CI: 0.06 - 0.54, p = 0.01) increase in the median coefficient of UC blood C-peptide concentration. Moreover, one unit (kg) increase in the birth weight was associated with a 0.25 (95% CI: 0.03 - 0.47, p = 0.03) increase in the median coefficient of UC blood C-peptide concentration. In the multivariate model, after adjusting for maternal age, maternal BMI, and macrosomia status, the positive status of GDM and macrosomia were significantly associated with an increase in the median coefficient of UC blood C-peptide concentration (Coef.= 0.27, 95% CI: 0.13 - 0.42, p < 0.001; and Coef.= 0.34, 95% CI: 0.06 - 0.63, p = 0.02, respectively).Conclusion: UC blood concentration of C-peptide is significantly associated with the incidence of maternal GDM and neonatal macrosomia. Using stratification for maternal BMI and gestational weight gain (GWG) and investigating molecular markers like Leptin and IGF-1 in the future might lay the ground to better understand the link between metabolic disturbances of pregnancy and UC blood C-peptide concentration. [ABSTRACT FROM AUTHOR]

Background: Galactomannan Enzyme Immunoassay (GM‐EIA) is proved to be a cornerstone in the diagnosis of COVID‐19‐associated pulmonary aspergillosis (CAPA), its use is limited in middle and low‐income countries, where the application of simple and rapid test, including Galactomannan Lateral Flow Assay (GM‐LFA), is highly appreciated. Despite such merits, limited studies directly compared GM‐LFA with GM‐EIA. Herein we compared the diagnostic features of GM‐LFA, GM‐EIA and bronchoalveolar lavage (BAL) culture for CAPA diagnosis in Iran, a developing country. Materials/Methods: Diagnostic performances of GM‐LFA and GM‐EIA in BAL (GM indexes ≥1) and serum (GM indexes >0.5), i.e. sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) and areas under the curve (AUC), were evaluated using BAL (n = 105) and serum (n = 101) samples from mechanically ventilated COVID‐19 patients in intensive care units. Patients were classified based on the presence of host factors, radiological findings and mycological evidences according to 2020 ECMM/ISHAM consensus criteria for CAPA diagnosis. Results: The Aspergillus GM‐LFA for serum and BAL samples showed a sensitivity of 56.3% and 60.6%, specificity of 94.2% and 88.9%, PPV of 81.8% and 71.4%, NPV of 82.3% and 83.1%, when compared with BAL culture, respectively. GM‐EIA showed sensitivities of 46.9% and 54.5%, specificities of 100% and 91.7%, PPVs of 100% and 75%, NPVs of 80.2% and 81.5% for serum and BAL samples, respectively. Conclusion: Our study found GM‐LFA as a reliable simple and rapid diagnostic tool, which could circumvent the shortcomings of culture and GM‐EIA and be pivotal in timely initiation of antifungal treatment. [ABSTRACT FROM AUTHOR]

Objective: With the increasing effects of stress caused by the COVID-19 pandemic and occupational stress on the mental health of frontline nurses, it is imperative to further investigate how these stresses affect nurses' mental health and secondary traumatic stress syndrome. This research aimed to investigate the relationship of nurses' occupational stress and concerns about COVID-19 with secondary traumatic stress syndrome, and also to investigate the mediating effect that concerns about the COVID-19 pandemic have on the relationship between nurses' occupational stress and secondary traumatic stress syndrome. Method: A cross-sectional design was adopted. The population of the study was defined as all front-line nurses in Shiraz hospitals, from which 225 nurses of two corona care hospitals were selected using convenience sampling. The degree of secondary traumatic stress, concerns about the COVID-19, and nurses' occupational stress were assessed using Bride's Secondary Traumatic Stress Scale (STSS), an adopted version of Level of Concerns about the COVID-19 questionnaire, and the Nurses' Occupational Stressor Scale (NOSS) among Hospital-based Healthcare Workers. Structural equation modeling (SEM) was used to examine the relationships among variables. Results: Results showed that nurses' occupational stresses presented a direct effect on nurses' level of concern about the COVID-19 pandemic (β = 0.85, P < 0.001), and concern about the COVID-19 pandemic was directly related to frontline nurse's secondary traumatic stress syndrome (β = 0.83, P < 0.001). In addition, nurses' level of concern about the COVID-19 pandemic fully mediated the effects of nurses' occupational stresses on their secondary traumatic stress (β = 0.70, P < 0.001). This indirect effect has explained 68% of the variance in nurses' secondary traumatic stress. Conclusion: These results emphasized the indirect effect of nurses' occupational stresses on secondary traumatic stress syndrome via mediating the level of concern about COVID-19. Therefore, to reduce the secondary traumatic stress of nurses who have dealt directly with COVID-19 patients, it seems necessary to pay serious attention to the sources of their occupational stress, which probably existed even before this pandemic and increased their concerns in pandemic conditions. [ABSTRACT FROM AUTHOR]

The antifungal resistance in non-fumigatus Aspergillus spp., as well as Aspergillus fumigatus, poses a major therapeutic challenge which affects the entire healthcare community. Mutation occurrence of cyp51 gene paralogs is the major cause of azole resistance in Aspergillus spp. To obtain a full map of genomic changes, an accurate scan of the entire length of the Aspergillus genome is necessary. In this study, using whole genome sequencing (WGS) technique, we evaluated the mutation in cyp51A, cyp51B, Cdr1B, AtrR, Hmg1, HapE and FfmA genes in different clinical isolates of Aspergillus fumigatus, Aspergillus niger, Aspergillus tubingensis, Aspergillus welwitschiae and Aspergillus terreus which responded to minimum inhibitory concentrations of itraconazole above 16 µg mL−1. We found different nonsynonymous mutations in the cyp51A, cyp51B, Cdr1B, AtrR, Hmg1, HapE and FfmA gene loci. According to our findings, Aspergillus species isolated from different parts of the world may represent different pattern of resistance mechanisms which may be revealed by WGS. [ABSTRACT FROM AUTHOR]

DNMT1, as a critical enzyme affecting epigenetics through methylation of DNA cytosine-rich sequences, regulates gene expression. Exterior factors including long-term infections, in this study Helicobacter pylori infection, could change host cells' epigenetics by affecting DNMT1 gene expression. This study investigated the statistical correlation between H. pylori virulence genes and DNMT1 gene expression in gastric antral epithelial cells of gastric adenocarcinoma and gastritis patients. In a case-control study, 50 and 53 gastritis and gastric adenocarcinoma antral biopsies, including 23 and 21 patients with H. pylori infection, respectively, were collected from hospitals in the west of Iran. Having extracted total RNA from gastric biopsy samples, cDNA was synthesized and virulence genes of H. pylori were detected by using the PCR method. Relative real-time RT PCR was used to detect ΔΔCt fold changes of the DNMT1 gene expression in divided groups of patients based on H. pylori infection and clinical manifestations. The results showed that along with increasing patients' age, the DNMT1 gene expression will increase in gastric antral epithelial cells of gastric cancer patients (P ≤ 0.05). On the other hand, the biopsy samples with infection of H. pylori cagA, cagY, and cagE genotypes revealed a direct correlation along with increased DNMT1 gene expression. This study revealed the correlations of H. pylori cag pathogenicity island genes with increased DNMT1 gene expression. [ABSTRACT FROM AUTHOR]

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

Background: Immunization against the coronavirus disease 2019 (COVID-19) began in January 2021 in Iran; nonetheless, due to a lack of vaccination among children under 12, this age group is still at risk of SARS-CoV-2 infection and its complications.Case Presentation: SARS-CoV-2 infection was diagnosed in a 6-year-old girl who had previously been healthy but had developed a fever and pancytopenia. The bone marrow aspiration/biopsy demonstrated just hypocellular marrow without signs of leukemia. She was worked up for primary and secondary causes of pancytopenia. Except for a repeated reactive HIV antibody/Ag P24 assay, all test results were inconclusive. After a thorough diagnostic investigation, the cross-reactivity of the HIV antibody/Ag P24 test with SARS-CoV-2 antibodies was confirmed. The patient did not develop any COVID-19-related signs and symptoms, but she did get a severe invasive fungal infection and neutropenic enterocolitis. She died as a result of disseminated intravascular coagulopathy.Conclusion: It is critical to recognize children infected with SARS-CoV-2 who exhibit atypical clinical manifestations of COVID-19, such as persistent pancytopenia. SARS-CoV-2 infection can cause severe and deadly consequences in children; thus, pediatricians should be aware of COVID-19's unusual signs and symptoms mimicking other conditions such as aplastic anemia. [ABSTRACT FROM AUTHOR]

Morphology and feature selection are key approaches to address several issues in fisheries science and stock management, such as the hypothesis of admixture of Caspian common carp (Cyprinus carpio) and farmed carp stocks in Iran. The present study was performed to investigate the population classification of common carp in the southern Caspian basin using data mining algorithms to find the most important characteristic(s) differing between Iranian and farmed common carp. A total of 74 individuals were collected from three locations within the southern Caspian basin and from one farm between November 2015 and April 2016. A dataset of 26 traditional morphometric (TMM) attributes and a dataset of 14 geometric landmark points were constructed and then subjected to various machine learning methods. In general, the machine learning methods had a higher prediction rate with TMM datasets. The highest decision tree accuracy of 77% was obtained by rule and decision tree parallel algorithms, and "head height on eye area" was selected as the best marker to distinguish between wild and farmed common carp. Various machine learning algorithms were evaluated, and we found that the linear discriminant was the best method, with 81.1% accuracy. The results obtained from this novel approach indicate that Darwin's domestication syndrome is observed in common carp. Moreover, they pave the way for automated detection of farmed fish, which will be most beneficial to detect escapees and improve restocking programs. [ABSTRACT FROM AUTHOR]

Background: Psychiatric patients are at increased risk of exposure to Toxoplasma gondii infection, which may be linked to their living facilities and behaviors. Limited knowledge on the prevalence of T. gondii infection and its associated risk factors in psychiatric patients are available to the international medical communities. Thus, the aim of the current study was to assess seroprevalence of T. gondii and its associated risk factors in psychiatric inpatients in Fars Province, southern Iran. Methods: This cross-sectional study was carried out on psychiatric patients hospitalized in Ibn Sina Hospital affiliated to Shiraz University of Medical Sciences, Fars Province, southern Iran, March to July 2021. Blood samples were collected from 318 psychiatric patients and assessed for the detection of IgG against T. gondii using enzyme-linked immunosorbent assay (ELISA). Moreover, structured questionnaires were completed for the participants at the time of sampling. Logistic regression analysis was used to assess possible associations between the latent toxoplasmosis and the variables. Results: The overall seroprevalence of anti-T. gondii IgG in psychiatric inpatients was 22.3% (71/318; 95% CI = 17.9-27.3). Multivariate analyses revealed that age > 30 years [adjusted odds ratio (AOR) = 2.24, 95% CI = 1.10-4.60, p = 0.03], contact with cats (AOR = 2.52, 95% CI = 1.14-5.58, p = 0.03), raw vegetable consumption (AOR = 3.65, 95% CI = 1.74-7.65, p = 0.001), raw/undercooked meat consumption (AOR = 4.30, 95% CI = 1.47-12.63, p = 0.008), suicide attempt (AOR = 3.77, 95% CI = 1.58-8.97, p = 0.003) and cigarette smoking history (AOR = 0.38, 95% CI = 0.17-0.83, p = 0.02) were independent risk factors for T. gondii infection. Conclusion: The current results demonstrated that contact with cats, raw vegetable consumption and raw/undercooked meat consumption were independent risk factors for T. gondii seropositivity. Moreover, the current study showed significant associations between seropositivity of T. gondii and suicide attempts as well as negative associations between seropositivity of T. gondii and cigarette smoking in psychiatric inpatients using multivariate logistic regression. [ABSTRACT FROM AUTHOR]

Backgrounds: This randomized controlled trial aimed to investigate the effects of replacing red meat with legumes in the dietary approach to stop hypertension (DASH) diet on inflammatory markers over 16 weeks in overweight and obese individuals with type 2 diabetes. Also, the modulatory effects of TCF7L2 rs7903146 variant on this effect were assessed. Methods: In this trial, 300 participants with type 2 diabetes, aged 30–65 years with an identified TCF7L2 rs7903146 genotype, were studied. The participants were randomly assigned to the DASH diet or the legume-based DASH diet over 16 weeks. In the DASH diet group, the participants were instructed to follow the standard DASH diet. The legume-based DASH diet was similar to the standard DASH diet, with the exception that one serving of red meat was replaced with one serving of legumes at least five days a week. At the beginning of the study and 16-week follow-up, venous blood samples were collected from all participants who fasted for 12–14 h overnight. The serum concentration of High-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) was measured using an enzyme-linked immunosorbent assay (ELISA) kit. Also, the serum malondialdehyde (MDA) concentration was assessed based on a colorimetric method using a commercial kit. The primary outcome was the difference in hs-CRP changes between the diets. A secondary outcomes was the difference in IL-6, TNF-α, and MDA between the groups among total population and based on TCF7L2 rs7903146 risk allele (CT + TT) and non-risk allele (CC) separately. Results: The hs-CRP level reduced in the legume-based DASH diet group as compared to the DASH diet group in the 16-week follow-up group. The levels of TNF-α, IL-6, and MDA reduced after the legume-based DASH diet relative to the DASH diet. Reduction of inflammatory markers was observed in both carriers of rs7903146 risk allele and non-risk allele. Conclusions: Substituting one serving of red meat with one serving of legumes in DASH diet, at least five days a week, could improve the hs-CRP, TNF-α, IL-6, and MDA in participants with type 2 diabetes regardless of having rs7903146 risk or non-risk allele. Trial registration IRCT, IRCT20090203001640N17. [ABSTRACT FROM AUTHOR]

Background: The epidemiology and prevalence of the Human T-cell leukemia virus type-1 (HTLV-1) infection represent a recommended priority by global health agencies. An in-depth revision to update the status of this infection in countries including those of the Eastern Mediterranean Regional Office (EMRO) of the World Health Organization is hence required. Methods: Ninety-seven studies evaluating the HTLV-1 infection in low- and high-risk populations in EMRO countries were retrieved from the international electronic databases and were used to assess the epidemiological status of the infection in these countries. Results: Most epidemiologic reports were published from Iran, with more than 50% of Iranian prisoners and around 4% of healthy individuals reported to have the infection. In Egypt, a considerable prevalence of the virus spans around 1.11% of blood donors. Foci of HTLV-1 infection are also present in some countries and require a careful epidemiological evaluation. In the other EMRO countries, a lower prevalence that does not exceed 1% was reported. Conclusion: The epidemiology and prevalence of HTLV-1 in the EMRO countries require a tight revision and update. Published studies reveal a scarce distribution of the virus in the African countries of EMRO, while a lower prevalence is denoted in the Asian countries of EMRO, except in Iran, where the prevalence is high. [ABSTRACT FROM AUTHOR]

Purpose: The study aims to evaluate the relationship among architectural identity, physical identity and neighborhood attachment in a residential neighborhood in the core of Sanandaj, Iran. Design/methodology/approach: This quantitative study conducted a survey of 208 residents in a historic neighborhood. The study hypothesized the mediating role of physical identity on the relationship between architectural identity and neighborhood attachment. Structural equation modeling using analysis of a moment structures (AMOS) software was used to test the research hypotheses. Findings: Research findings show the reliability and validity of the proposed model. The results indicate a significant relationship between architectural and physical identity and a significant direct relationship between physical identity and neighborhood attachment. However, no significant direct relationship is found between architectural identity and neighborhood attachment, and only a significant indirect effect is found through physical identity. Therefore, architectural identity elements contribute to increasing physical identity and subsequently attach to the neighborhood. Originality/value: Given the necessity for revitalizing the neighborhoods in the historical core of the cities to prevent the migration from old neighborhoods and the destruction of the valuable fabrics, establishing emotional relationships between residents and the place and improving interactions among residents is required. The mental values of residents change over time. Although the identification and use of identity elements in residential buildings is a significant way to revitalize the historic residential fabrics, only a few studies have experimentally assessed the impact of architectural identity elements in the creation of physical identity on the residents' attachment to the historic neighborhood. [ABSTRACT FROM AUTHOR]

Secondary anemia in hemoglobinopathies like thalassemia can cause expansion of the bone marrow cavities because of compensatory marrow hyperplasia. This case demonstrates spontaneous osteonecrosis of the distal left femur in a patient with β-thalassemia that may be secondary to ischemic infarction secondary to occlusion of the microvasculature within the expanded cancellous bone. This subject was referred to Hazrat Rasool Akram Hospital because of fever, cough, and bone pain. In the CT scan she had scattered peripheral CGO in both lungs due to COVID-19 with two paravertebral masses due to extramedullary hematopoiesis. The patient had also generalized bone pain so the physician asked for a whole-body bone scan and incidentally, we found a cold lesion with a rim of increased uptake in the distal left femur that with bone biopsy it was consistent with osteonecrosis. This case illustrates the importance of performing a whole-body bone scan in β-thalassemia for the management of patients and diagnosis of occult osteonecrosis. [ABSTRACT FROM AUTHOR]

The aim of this research was to evaluate the antibacterial activity of the muscle wall extracts of sea cucumber, Stichopus horrens, against Lactococcus garvieae, Streptococcus iniae, Aeromonas hydrophila, and Yersinia ruckeri bacteria in rainbow trout using the disk-diffusion and well-diffusion methods. In this study, nine sea cucumbers (with the mean weight of 1690 ± 12.18 g) were randomly obtained from two locations in Chabahar Bay, Iran in November 2018. The muscle wall of the body was extracted with each of the ethyl acetate, methanol, and acetone organic solvents. The antibacterial activities of extracts were determined. Only the ethyl acetate extracts of S. horrens in the concentrations at 8 and 12 mg/mL had an inhibitory effect on all the examined bacteria. Y. ruckeri and A.hydrophila bacteria were sensitive to the acetone extracts. The best property was recorded with the S.horrens ethyl acetate extracts, with the MIC value of 0.625 mg/mL against S. iniae and L. garvieae. The MIC values ranging from 0.626 to 1.25 mg/mL were also displayed with the acetone extracts against Y. ruckeri and A. hydrophila, respectively. In conclusion, the ethyl acetate extracts of S. horrens displayed the best spectrum of bactericidal effect obtained from four bacteria strains examined. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine allograft fibrosis by measuring LS using TE in children after liver transplantation at Shiraz Organ Transplant Center. Background: Liver stiffness (LS) assessment using fibro-scanning (transient elastography-TE) is a non-invasive method for evaluating liver fibrosis. Methods: All children undergoing liver transplant from 2012 to 2016 were included in the study. Data on demographics, graft types, immunosuppressive drugs, as well as clinical and paraclinical data were obtained from patients' records. TE was performed to determine LS in all patients. Liver fibrosis was also confirmed based on Metavir score. Results During this period, more than 400 liver Tx were done in children, but only 54 patients, comprising 20 (37%) girls and 34 (63%) boys who underwent liver transplantation, were available and willing to participate in this study. The mean age of the patients was 12.96 ± 5.32 years. Correlations between FS score (LS) and AST (p = 0.01), total bilirubin (p = 0.002), albumin (p = 0.001), PT (p = 0.03), and INR (p = 0.001) were significant. There was no significant relationship between FS score (LS) and type of allograft (p = 0.79) and underlying disease (p = 0.36). Positive and significant correlations were observed between Metavir score and AST (p = 0.01), total bilirubin (p = 0.01), INR (p = 0.004), and cholesterol (p = 0.001). The severity of fibrosis significantly and negatively correlated with albumin (p = 0.004) and glucose (p = 0.003). Also, there was no significant relationship between Metavir score and allograft type (p = 0.7). Conclusion: The current study demonstrated that 14.9% of LT patients had a METAVIR ≥ F2. The time between LT and TE was significantly correlated with LS and the degree of liver fibrosis based on Metavir score. However, there was no significant relationship between LS with allograft type or underlying liver disease. [ABSTRACT FROM AUTHOR]

Abstract In this present study, for the first time, we evaluated the cystic fibrosis (CF) patients for the Scedosporium species and their antifungal susceptibility against eight antifungal agents. During one-year period, 90 Sputum samples were collected from Iranian CF patients. All samples were evaluated by direct microscopic examination, culture onto four different media including Malt extract agar, Inhibitory mold agar, Brain Heart Infusion and Scedo-Select III. The mold isolated fungi were identified by PCR-Sequencing of ITS and β-tubulin genes. In-vitro antifungal susceptibility was performed according to the Clinical & Laboratory Standards Institute (CLSI) M38-A2 guidelines. Out of 90 CF patients, 47 (52.2%) were male. The age of the patients ranged from 1 to 34 years (median of 15.84 ± 7.41 years). Overall, 3 (3.3%) cases were positive for Scedosporium spp. of which two isolates were characterized as Scedosporium boydii and one isolate as S. ellipsoideum. Among Aspergillus genus, A. flavus (29.4%) was the most prevalent species followed by A. tubingensis (24.7%), A. niger (17.0%) and A. fumigatus (14.5%). The minimum effective concentration ranges of micafungin, anidulafungin, and caspofungin were 0.008–0.031 μg/mL, 0.0625–0.25 μg/mL, and 0.0625–0.25 μg/mL, respectively. All isolates of Scedosporium species showed high minimum inhibitory concentration to the triazoles tested, except voriconazole. Our results showed that A. flavus and Scedosporium species are the most prevalent molds isolated from CF patient populations in Iran. Our findings have also showed that Scedo-Select III can be used as a reliable culture media for isolation of Scedosporium spp. in clinical samples. Highlights • The prevalence of Scedosporium species In Iranian patients with cystic fibrosis was 3.3%. • A. flavus was the most common species within the Aspergillus genus. • Scedo-Select III can optimize the growth of Scedosporium species within a mixed samples. • Scedosporium species showed an increased MIC against the main antifungal agents. [ABSTRACT FROM AUTHOR]

Lumpy skin disease was first reported in the western provinces of Iran in 2014, and this was followed by several outbreaks throughout the country. In this study, 10 Iranian lumpy skin disease virus (LSDV) samples collected during the period of 2014-2018 were characterized by sequence analysis of the GPCR, LSDV142, and IL10LP genes. Sequence comparison of the respective genes revealed a close relationship between Iranian LSDV isolates and viruses from Asia and Europe. Interestingly, some nucleotide sequence diversity was also observed in the IL10LP genes of the Iranian field isolates. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Cell‐based therapeutics are among the latest advances in health care technologies. The rapid evolution of stem cell science in Iran has necessitated the application of scientific achievements in clinical settings. However, various issues hindered their translation, in particular, impediments in the interactions of basic stem cell scientists and clinicians. We highlighted the impediments in the interactions of stem cell scientists and physicians involved in the opinion of professionals from both groups. Method: This qualitative research was conducted with thematic analysis, performed by purposive sampling. Thirty‐two distinguished stem cell scientists and clinicians were interviewed to identify their perspectives on this matter. MAXQDA 2018 was used to classify the axial codes based on factors related to communications inefficiencies. The analysis of coded data recognized 18 subthemes and six major themes. Results: Central themes include different registers of the two parties, counterproductive clusters hampered networking, external communication barriers, the competition to access resources, leadership conflicts, and the dissatisfaction of stakeholders with their share. Conclusions: Most of the impediments were seemingly global, for example, the incoherent medical and basic science educational systems, the vulnerable career path of physician‐scientists, and an increasing tendency towards overspecialization. However, some local specific issues were also described, for example, limited funding opportunities and the negative impacts of the division of medical education from the ministry of science, research, and technology in Iran. Proposed interventions include the reinforcement of physician‐scientist programs, designing a distributed leadership model, and bringing back the scientific integrity to higher education in Iran. [ABSTRACT FROM AUTHOR]

Recurrent vulvovaginal candidiasis (RVVC) is one of the most prevalent fungal infections in humans, especially in developing countries; however, it is underestimated and regarded as an easy-to-treat condition. RVVC may be caused by dysbiosis of the microbiome and other host-, pathogen-, and antifungal drug-related factors. Although multiple studies on host-related factors affecting the outcome have been conducted, such studies on Candida -derived factors and their association with RVVC are lacking. Thus, fluconazole-tolerant (FLZT) isolates may cause fluconazole therapeutic failure (FTF), but this concept has not been assessed in the context of Candida -associated vaginitis. Iran is among the countries with the highest burden of RVVC; however, comprehensive studies detailing the clinical and microbiological features of this complication are scarce. Therefore, we conducted a 1-year prospective study with the aim to determine the RVVC burden among women referred to a gynecology hospital in Tehran, the association of the previous exposure to clotrimazole and fluconazole with the emergence of FLZT and fluconazole-resistant (FLZR) Candida isolates, and the relevance of these phenotypes to FTF. The results indicated that about 53% of the patients (43/81) experienced RVVC. Candida albicans and C. glabrata constituted approximately 90% of the yeast isolates (72 patients). Except for one FLZT C. tropicalis isolate, FLZR and FLZT phenotypes were detected exclusively in patients with RVVC; among them, 27.9% (12/43) harbored FLZR strains. C. albicans constituted 81.2% of FLZR (13/16) and 100% of the FLZT (13/13) isolates, respectively, and both phenotypes were likely responsible for FTF, which was also observed among patients with RVVC infected with fluconazole-susceptible isolates. Thus, FTF could be due to host-, drug-, and pathogen-related characteristics. Our study indicates that FLZT and FLZR isolates may arise following the exposure to over-the-counter (OTC) topical azole (clotrimazole) and that both phenotypes can cause FTF. Therefore, the widespread use of OTC azoles can influence fluconazole therapeutic success, highlighting the necessity of controlling the use of weak topical antifungals among Iranian women. [ABSTRACT FROM AUTHOR]