Search

Introduction: Malnutrition impacts on cancer prognosis, and psychological aspects of patients with cancer. This study assessed the correlation between depression, anxiety and stress with nutritional status in newly diagnosed esophageal cancer patients. Methods: This cross-sectional study assessed newly diagnosed esophageal cancer patients between February 2017 to February 2019 admitted at a chemo-radiation referral center in Mashhad, Iran. Anthropometric indices, a Patient-Generated Subjective Global Assessment (PG-SGA) tool, body composition, dietary intake, and depression, anxiety and stress using DASS21 questionnaire were assessed. Results: One hundred and eighty-six patients were enrolled. The mean age of participants was 66.8 ± 11.9 years with a male to female ratio of 96 to 90. Ninety-six (51.6%) of patients had experienced significant weight loss and 56 (30.1%) were underweight at diagnosis. Mean PG-SGA score was 13.1±5.7. Mean fat mass percentage was 21.98±10.8 and fat-free mass index was 16.79±2.9. Median Karnofsky score was 80 (70-90). Mean depression score was 8.5±7; anxiety score, 10.7±9 and stress score 8.7±8. There was only a correlation between Karnofsky score and depression score (p= 0.008) anxiety score (p=0.001) and stress score (p=0.001). No correlation found between DASS and PG-SGA score, fat mass percentage, fat-free mass index, handgrip strength, or energy or protein intake. Conclusion: Malnutrition is prevalent among Iranian cancer patients even at diagnosis. As nutritional status is correlated with physical performance of cancer patients, early nutritional screening, diagnosis and intervention is of essential importance. [ABSTRACT FROM AUTHOR]

ObjectiveMethodsResultsConclusionsAttention Deficit Hyperactivity Disorder (ADHD) is one of the most common mental disorders in children. Evidence regarding the impact of probiotics supplementation in ADHD children is limited and controversial. Thus, this study aimed to assess the effect of probiotics as an adjunctive therapy with Ritalin among ADHD children and adolescents.This study was a triple-blind, randomized controlled trial of 60 Iranian ADHD patients aged four to sixteen. The participants were randomly assigned to receive probiotics supplements containing both Lactobacillus plantarum PTCC 1896™ (A7) and Bifidobacterium animalis subsp. Lactis (BB-12®) (n = 30) or placebo (n = 30) for 8 weeks. ADHD symptoms were assessed using Conners’ Parent Rating Scale (CPRS) and Integrated Visual and Auditory Continuous Performance Test (IVA/CPT) at baseline and during the study.This study showed a significant decrease in the CPRS total score after 4 weeks of intervention in the probiotic group (baseline: 43.96 ± 21.52; fourth week: 37.22 ± 23.01; p = 0.01). However, no significant finding was found for the total score of the CPRS after 8 weeks. Moreover, at the end of the study, a significant increase was observed in score of auditory response control in the probiotic versus the placebo group (probiotic: 91.55 ± 16.69; placebo: 80.55 ± 17.43; p = 0.02).Probiotics supplementation with Ritalin may have some beneficial effects among ADHD children and adolescents, such as improving auditory response control and total score of CPRS. However, further clinical trials are required to clarify the impact of probiotics on ADHD. [ABSTRACT FROM AUTHOR]

Background: The attentive management of rheumatoid arthritis (RA) has attracted particular attention. The German 7-joint Ultrasound (US-7) is the first scoring system that combines bone erosions and soft tissue lesions in a single composite scoring system. This study aimed to assess the correlation between US-7 and Disease Activity Score Using 28 Joint Counts (DAS28) in clinically active RA patients. The efficacy of a novel ultrasound score-based system, the US-9 score (joints assessed with US-7 plus knees), was also compared with the standard US-7 score. Methods: All the RA patients referred to the outpatient rheumatology clinic of Ghaem Hospital, Mashhad, Iran, during 2019-2020 were included. 28 joints were clinically examined to calculate DAS28. Nine joints were assessed comprising the German US-7 plus knees using grayscale ultrasonography (GSUS) and power Doppler ultrasonography (PDUS). Retrieved data were analyzed by SPSS software, version 22. The Spearman Correlation test was used to find the correlation between DAS28 and ultrasonographic findings. The statistical significance level was set at P<0.05. Results: This study was composed of thirty-five RA patients with a mean age of 49.1±12.0 years. US-7 synovitis scores in GSUS and PDUS were significantly correlated with DAS28 (P=0.02, r=0.38 and P=0.003, r=0.48, respectively). US-9 synovitis scores in GSUS and PDUS were also significantly correlated with DAS28 (P=0.003, r=0.49 and P=0.006, r=0.45, respectively). The synovitis score measured by GSUS was significantly correlated with the GSUS knee synovial score (P=0.01, r=0.42). Conclusion: Ultrasound assessment of large joints such as knees can be an effective approach to determining RA severity. However, it can be proposed that adding more involved joints into the sonographic assessment does not necessarily provide a better clinical correlation. [ABSTRACT FROM AUTHOR]

Background: Following thyroidectomy, radioiodine therapy is the standard management of differentiated thyroid cancer. The effects of such treatment on testicular function remained a concern for cases and clinicians. Objective: We aimed to observe changes in fertility indicators in men treated with ablation. Materials and Methods: In this prospective cohort study, 18 men with differentiated thyroid cancer from June to December 2020 underwent thyroidectomy plus radioiodine therapy. Participants were grouped based on iodine dose (8 men with 30 mCi vs. 10 men with = 150 mCi). Baseline values (VB) of the follicular stimulating hormone, luteinizing hormone, testosterone, and sperm analyses were measured 3 wk before iodine ablation and repeated 3 (V3) and 12 (V12) months later. They were analyzed once as a whole and once based on their groups via ANOVA and Friedman's tests where appropriate. Results: The mean age of participants was 35.61 ± 9.74 yr. Follicular stimulating hormone levels showed a significant trend among all participants (VB: 12.51 ± 1.72, V3: 13.54 ± 1.41, and V12: 13.10 ± 1.67 IU/mL; p < 0.001). Luteinizing hormone showed a similar pattern (VB: 4.98 ± 1.27, V3: 5.65 ± 1.29, and V12: 5.21 ± 0.95 IU/mL; p < 0.001). Testosterone levels did not differ significantly from baseline. Sperm count decreased at the first checkpoint and returned to normal after 12 months (VB: 38.22 ± 19.40, V3: 32.05 ± 17.96, and V12: 36.66 ± 18.81 million/mL; p < 0.001). Sperm motility and morphology did not change significantly. Conclusion: Our research showed that even less than 5 GBq irradiation could induce a transient testicular dysfunction in the first 3 months of therapy, but it was mostly reversible after 12 months. [ABSTRACT FROM AUTHOR]

Background: Tethered cord syndrome (TCS) is a type of occult spinal dysraphism, which necessitates early detection as an essential component of patient management in reducing complications. This study aimed to compare the findings of spinal cord ultrasonography between TCS patients and healthy individuals. Methods: The current study is a case-control study of patients who were admitted to the Akbar and Ghaem Hospitals (Mashhad, Iran) in 2019. The study population comprised 30 children with TCS aged under two years old, and the control group included 34 healthy peers of the same age. The maximum distance of the spinal cord from the posterior canal wall was measured in millimeters using ultrasonography. Demographic and sonographic findings of each participant were recorded in checklists, which were then entered into SPSS software. P values less than 0.05 were considered statistically significant. Results: The study included 30 children with TCS and 34 healthy individuals with a mean age of 7.67±6.39 months. TCS patients had a significantly shorter maximum distance of the spinal cord from the posterior wall of the spinal canal than the control group (1.75±0.62 mm vs. 2.79±0.76, P<0.001). After performing corrective surgery, the TCS patients indicated significant improvement in this interval (1.57±0.54 mm to 2.95±0.49 mm, respectively, P=0.001). Conclusion: In comparison to children without TCS, the spinal cord was substantially closer to the posterior canal wall in TCS patients. However, these outcomes were improved significantly in patients after surgery. [ABSTRACT FROM AUTHOR]

Background: Chronic pulmonary thromboembolism (CTEPH) is an unusual complication of acute pulmonary embolism (PE), which is now considered to be treatable. In modern multi- detector scanners, a detailed evaluation of pulmonary artery geometry is currently possible. This study aimed to evaluate the changes in pulmonary artery bifurcation angle (PABA) in the follow-up computed tomography angiography (CTA) of patients with acute PE. Methods: In this cross-sectional study, the records of two tertiary-level academic hospitals were gathered from 2012 to 2019. Pulmonary artery (PA) bifurcation angle and diameter were measured. Chi square test, independent samples t test, Mann-Whitney, and Pearson's tests were employed to compare data. To evaluate the cut-off point, we utilized receiver operating characteristic (ROC) curve analysis. The accuracy, sensitivity, and specificity of pulmonary artery bifurcation angle changes were calculated. A P value <0.05 was considered to be significant. Results: Forty-six patients were included in the study. No significant differences were found between patients with and without CTEPH, and PABA in the dimeters of PA trunk, right PA, and left PA in the first CTA images (P values of 0.151, 0.142, 0.891, and 0.483, respectively), while in the secondary CTA, the mean PABA was significantly smaller in patients with CTEPH (P=0.011). In the receiver operating characteristic (ROC) analysis, delta angle revealed an area under the curve of 0.745 and an optimal cutoff of 0, leading to a sensitivity of 64%, specificity of 87%, and accuracy of 76% for diagnosing CTEPH. Conclusion: We showed a significant decrease in PABA in patients developing CTEPH. This parameter can be easily measured in lung CTA. [ABSTRACT FROM AUTHOR]

Background: Approximately 25% of the residents' time in each shift is allocated to educating lower-level assistants and interns. Assistants have played a major role in interns' education. Aim: To assess the teaching abilities of emergency medicine assistants in the training and monitoring of medical interns and undergraduate students. Methods: This cross-sectional study was performed in 2015 at the emergency center of Imam Reza hospital in Mashhad University of Medical Sciences. We employed a researcher-made questionnaire to search the capability of emergency medicine residents to assess the teaching capabilities of emergency medicine residents to interns. This questionnaire was completed by 106 interns. The Validity of the questionnaire was confirmed by three specialist experts and reliability of the questionnaire was confirmed by Cronbach's alpha (0.94). This questionnaire consists of 24 questions in six areas. The analysis was performed by descriptive statistics using SPSS 16. Result: The study showed that the least favorable score was related to "residents get feedback on each shift" and the highest score was given to "a friendly relationship with the Interns and residents". Conclusion: Considering the key role of residents in the education and training of future healthcare specialists, training interventions and allocating sufficient time to the proper education of different members of healthcare teams and medical students could largely contribute to the development of clinical training systems. [ABSTRACT FROM AUTHOR]

Introduction: Chronic kidney disease (CKD) is an important health problem in Iran, with an increasing prevalence rate. Knowledge about the prevalence and risk factors of this disease in different health jurisdictions can help in planning to control this condition.Materials and Methods: In this cross-sectional study, 1285 individuals aged between 20 and 60 years old were recruited. Participants were selected from the general population residing in Gonabad, Iran, via simple random sampling in 2012. Demographic data were collected. Urine and blood test were performed, and the glomerular filtration rate was estimated based on the simplified Modification of Diet in Renal Disease equation.Results: Sixty-five participants (5.1%) had CKD (5.1% men and 5% women; P = .90). The mean age was significantly higher in the CKD group (P = .001). Hypertension and diabetes mellitus were significantly more prevalent among the participants with CKD than those without CKD (P < .001 for both). Proteinuria was significantly associated with CKD, whereas a history of urinary tract infection, a history of nephrolithiasis, smoking, serum uric acid level, lipid profile, and blood glucose level were not.Conclusions: Chronic kidney disease has a high prevalence rate in this part of Iran. We suggest further studies in other parts of our country for the better estimation of the prevalence of CKD in Iran and for better planning to prevent and treat this condition. [ABSTRACT FROM AUTHOR]

Objectives: Propolis has an anti-inflammatory effect induced by inhibiting cyclooxygenase, subsequent inhibition of prostaglandin and nitric oxide synthesis, reduction of inflammatory cytokines, and eventually immunosuppressive activity [1-3]. This study aims to evaluate the impact of propolis on clinical features and specific IgE levels against salsola in perennial allergic rhinitis patients. Methods: Thirty patients diagnosed with perennial allergic rhinitis with salsola-positive skin prick test were enrolled in this randomized controlled clinical trial and divided into two groups. The intervention group received the propolis (200 mg per day), and the control group received a placebo for four months, besides intranasal corticosteroids. At baseline and the end of the intervention, the level of Salsola-specific IgE was measured by the RAST method. To assess the propolis effect on the quality of life and disease severity, miniRQLQ and SNOT22 questionnaires were completed by patients before and after the intervention. Results: According to Table 1, Serum IgE level showed decreasing changes (-0.057) despite increasing changes in the control group (1.039). However, these differences were not statistically significant (P = 0.967). Based on the miniRQLQ questionnaire, quality of life improved in both groups without any significant difference (P = 0.930). According to the SNOT-22 questionnaire, both groups' nasal and sinus problems decreased significantly. However, the intervention type did not affect this decrease and was observed over time in both groups (P> 0.05). Conclusion: Propolis supplementation did not significantly affect various laboratory parameters, clinical symptoms, and quality of life of patients with allergic rhinitis., (© 2023 Jabbari-Azad, Khoshkhui, Khalighi, Mohammadi, Emadzadeh, Aliabadi, HBKU Press.)

Aim: The accuracy of ultrasound findings in predicting the incidence of morbidly adherent placenta has been evaluated previously. In this study, we assessed the sensitivity and specificity of different quantitative findings of color Doppler and grayscale ultrasonography in predicting morbidly adherent placenta., Material and Methods: In this prospective cohort study, all pregnant women over 20 weeks of gestational age with anterior placenta and a history of previous cesarean section were evaluated for inclusion. Various ultrasound findings were measured. The non-parametric receiver operating characteristic curves, the area under the curve, and the cut-off values were assessed., Results: A total of 120 patients were ultimately included for analysis, of whom 15 had morbidly adherent placenta. The two groups were significantly different regarding the number of vessels. Based on color Doppler ultrasonography, in predicting the morbidly adherent placenta, more than two intraplecental echolucent zones with color flow had 93% and 98% sensitivity and specificity, respectively. According to grayscale ultrasonography, more than thirteen intraplacental echolucent zones had the sensitivity and specificity of 86% and 80% in predicting morbidly adherent placenta, respectively. Echolucent zone >11 mm at non-fetal surface had a sensitivity of 93% and a specificity of 66% in detecting morbidly adherent placenta., Conclusions: According to the results, the quantitative findings of color Doppler ultrasound have considerable sensitivity and specificity in detecting morbidly adherent placenta. More than two echolucent zones with color flow are recommended as the main diagnostic parameter indicating the presence of morbidly adherent placenta with a sensitivity of 93% and a specificity of 98%., Competing Interests: Conflict of interest The authors do not report any financial or personal connections with other persons or organizations which might negatively affect the contents of this publication and/or claim authorship rights to this publication., (© 2023 Fatemeh Sadeghi Ardakani, Fatemeh Tara, Amir Mahmoud Ahmadzade, Nafiseh Saghafi, Farrokh Seilanian Toosi, Farzaneh Khoroushi, Maryam Emadzadeh, Sara Mirzaeian, Behzad Aminzadeh, published by Sciendo.)

Background: Fetal exposure to maternal anxiety is associated with low birth weight and maternal stress may be led to constriction of uterine arteries. This study compared the relation of anxiety and uterine artery doppler flow indices in pregnant women with the high and low-risk of Down syndrome., Materials and Methods: This prospective cohort study was conducted among pregnant women in the second trimester that were classified as having a high or low risk according to their prenatal aneuploidy screening outcome. The high risk group underwent amniocentesis. Anxiety was initially assessed using the Spielberger State-Anxiety Inventory (STAI) and uterine artery blood flow indices were evaluated 2 times for the both groups. For the high-risk group first: immediately before amniocentesis and second: after two weeks follow up, when receiving the karyotype results and for the low-risk group in the first admission and two weeks later., Results: Totally, 375 pregnant women participated in our study that sorted into 2 risk populations based on the aneuploidy screening test, low-risk=176 and high-risk women=199. The high-risk group for Down syndrome amniocentesis showed abnormal results in the 23 cases (23/199). The mean state (P=0.003) and trait (P=0.033) of the Anxiety Inventory scores were significantly different between the groups. Baseline uterine artery indices were no significant difference between the groups. Baseline Uterine artery indices in the high-risk group was significantly different with follow-up (in both positive-amniocentesis and negative amniocentesis sub-groups) indices. Also, there was a weak and significant correlation in the uterine resistance index and STAI scores (P=0.008, r=0.137) during the follow-up period., Conclusion: All pregnant women experienced high level anxiety, especially in the high-risk group that may reduce after confirmation of prenatal aneuploidy screening test and also affects the Doppler indices. For all pregnant women; Stress management and emotional support training is recommended before and during pregnancy.

Anemia is a major global disease burden factor linked to an adverse impact on overall prognosis and negatively affects the quality of life. There are some suggested findings for anemia on non-contrast chest CT, like relatively dense interventricular septum (septal sign) or fairly dense aortic wall (aortic ring sign). The measured attenuation value is a reproducible physical density measurement, readily obtainable from a standard CT examination. There is no reliable cut-off for blood attenuation to suggest anemia on the non-contrast chest CT. In the current study, we evaluated subjective and objective criteria' diagnostic accuracy for diagnosing anemia on unenhanced thoracic CT. This study is approved by Mashhad University of Medical Sciences. The patients admitted in the internal medicine ward of our hospital from June 2019 to March 2020 for whom a non-contrast chest CT was acquired for any non-traumatic medical indication, were enrolled in this retrospective study. For the subjective assessment, the radiologists were asked to record the presence or absence of the "aortic ring sign" and "interventricular septum sign". For the objective evaluations, blood density was measured at various anatomic locations. A total of 325 patients were included in this study. There was a significant correlation between blood attenuation in all measured segments and Hb level (0.78 (R 2 : 0.61), p = 0.000). Findings revealed that considering the aortic arch threshold value as 20 HU is the best diagnostic performance for detecting severe anemia. Subjective analysis revealed that the aortic ring sign was more sensitive (82.5%) than the interventricular septum sign (32%) in detecting anemia, whereas the latter character was more specific (87% and 99.2%, respectively). The results suggest that it is possible to detect anemia from an unenhanced chest CT scan. Both objective and subjective criteria show promising sensitivity and specificity., (© 2022. The Author(s).)

A unique double-layered vehicle was fabricated for the first time based on a millifluidic/direct gelation to encapsulate probiotics. Free probiotic bacteria are usually very sensitive to severe gastrointestinal conditions and maintaining their survival when passing through the digestive tract is essential. The effects of alginate concentration (20-30 g/L), flow rates of alginate (0.8-1.2 mL/min), and W/O emulsion (0.5-0.7 mL/min) on encapsulation efficiency (EE), size, and sphericity of core-shell millicapsules were optimized for encapsulation of Bifidobacterium animalis subsp. lactis and Lactobacillus plantarum. The optimized calcium-alginate millicapsule was spherical (0.97 ± 0.01 SF), with an average diameter of 4.49 ± 0.19 mm, and encapsulation efficiency of 98.17 ± 0.5 %. Two strains were encapsulated separately in W/O emulsion as a core of the millicapsule. After coating with chitosan, the encapsulation yield of the bacteria, survival rates under simulated gastrointestinal (GI) conditions, and viability during storage were determined. Survival efficiency of B. animalis subsp. lactis and L. plantarum after millifluidic encapsulation were found to be 92.33 and 90.81 %, respectively. Cell viability of encapsulated probiotics after passing through the GI system was improved (7.5 log CFU mL -1 for both strains). Although the viability of the encapsulated probiotics stored at -18 °C for five months significantly decreased (p<0.05), the number of live cells was approximately in accordance with the standard definition of long-term probiotic survival (6 log CFU/g). This work provides a pathway for the construction of an innovative delivery system with high efficiency and protective effects for probiotics., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Vitamin D plays an essential role in the regulation of bone metabolism. The current meta-analysis aimed to assess the effectiveness of vitamin D fortification on special bone biomarkers., Methods: Five main databases (PubMed/Medline, ISI Web of Knowledge, Science Direct, Scopus, Cochrane Library as well as Science Direct, and Scopus) were considered for this systematic review, until Jan 2020. All randomized controlled trials were included to evaluate the probable relationship between consumption of vitamin D fortification products and bone biomarkers profile in this review., Results: Among serum bone biomarkers (osteocalcin and telopeptides of type-1 collagen) investigated, only the level of telopeptides of type-1 collagen significantly decreased after fortification of vitamin D in the intervention group. A significant increase in vitamin D was seen in those older than 18 yr old, while the increase in younger children was not statistically significant between intervention and control groups., Conclusion: Vitamin D fortification was not associated with a significant improvement in bone mass density (BMD), while it resulted in decreased PTH levels. Vitamin D fortified foods have some benefits on bone health due to increase in the level of vitamin D and IGF-1; and decreasing PTH and CTx levels., Competing Interests: Conflict of interest The authors declare that there is no conflict of interest., (Copyright © 2022 Emadzadeh et al. Published by Tehran University of Medical Sciences.)

Background: Pelvic fracture is one of the most common fractures in the elderly, especially in the intertrochanteric region. Therefore, in the present study, an external fixator was designed specifically for intertrochanteric fractures. The present study aimed to compare the operating time, amount of bleeding, and mortality rate between the patients who received either dynamic hip external fixators (DHEF) or dynamic hip screw (DHS)., Methods: In 2018, 46 patients with intertrochanteric fracture due to trauma and high anesthesia risk were included in the study and randomly assigned to two groups of control (n=24, patients treated with DHS) and intervention group (n=22, patients treated with the DHEF). Treatment was carried out using the DHEF which was newly designed and placed outside the patient's body under short and light anesthesia. After 3 and 12 months of follow-up, the two groups were compared for some variables, including mortality rate, pain intensity, Harris hip score (HHS), cut-off rate of the device, femoral neck angles before and after the operation, hemoglobin changes, hematocrit levels before and after the operation, the number of injected blood units, and the number of hospitalization days., Results: Mortality rate was higher in open surgery with DHS. The assessment of variables in both intervention and control groups demonstrated that duration of operation (P<0.001), hospitalization length, time to union (P=0.001), pain intensity five days after the operation, as well as changes in Hb and HCT, were significantly higher in the control group than the intervention group. The mean HHS scores of 83.5±14.3 and 78.2±11.5 were gained for the DHEF and DHS groups, respectively (P=0.22)., Conclusion: Considering the superior results of treatment with the external fixator in comparison with the DHS, such as lower mortality rate and fewer complications, a dynamic hip external fixator can be prescribed in patients with intertrochanteric fractures and high anesthesia risk., Competing Interests: All the authors declare that they have no conflict of interest except the first author who has designed the DHEF and has the unique selling proposition (USP) on it (Application number: 15/328632).

Background: Rotator cuff disorders are a leading cause of shoulder symptoms. Accurate imaging, detecting the type of the involved muscle, and severity of the injury have important effects on the choice of treatment. Accordingly, the current study was conducted to evaluate the diagnostic accuracy of ultrasound for rotator cuff disorders in patients suffering from shoulder pain and to explore the precision of ultrasound in determining the exact dimensions of a tear in comparison with magnetic resonance imaging (MRI)., Methods: This prospective research was performed on patients clinically suspected of rotator cuff tendinopathy. An ultrasound of the shoulder was initially performed for the candidates. In this study, MRI was regarded as the modality of choice for examining the images of shoulder disorders. The European Society of Musculoskeletal Radiology (ESSR) guidelines were used to design the protocols and implement imaging measures. Based on the reference standard of MRI, the specificity and sensitivity as well as positive and negative predictive values of ultrasound in detection of rotator cuff disorders were calculated., Results: A total of48 patients (22 women, 23 dominant right hands) with an average age of 51.6±8.3 years were enrolled in this study. Based on MRI findings, rotator cuff disorders were detected in 43 patients (89.5%). The most commonly observed disorders were partial-thickness rotator cuff tear (n=17, 35.4%), full-thickness rotator cuff tear (n=16, 33.3%), and tendinopathy (n=10, 20.8%). Among rotator cuff disorders, the highest sensitivity of ultrasound was observed in the detection of full-thickness tear (93.7%) and rotator cuff tendinopathy (90%). The highest specificity was found in the detection of full-thickness rotator cuff tear (100%) and partial-thickness rotator cuff tear (96.7%)., Conclusion: Based on our findings, ultrasound could be considered as a high-quality diagnostic tool to rule in partial and full-thickness rotator cuff tears and rule out the rotator cuff pathologies.

Background: Recently, the Iranian Ministry of Health estimated about 750,000 deaths are attributed smoking complications. The aim of this study was to apply the transtheoretical model (TTM) on general population of Mashhad city to evaluate the stages of change and possible cultural factors regarding smoking cessation., Methods: This descriptive, cross-sectional population-based study was conducted in Mashhad, Iran. A total number of 562 participants selected by multistage sampling. They were asked about stages of change for smoking cessation for both hookah and cigarette smoking. Stages of change refer to an orderly sequence of changes in smoking behavior that people progress through according to the TTM. Its six stages are as follows: precontemplation (PC) (no intention to quit smoking within 6 months), contemplation (planning to quit smoking in the following 6 months), preparation (planning to stop smoking within 1 month), action (quit smoking for <6 months), maintenance (stopped smoking for 6 months or more), and termination (will never smoke again). Data were analyzed using tests such as Chi-square, Kruskal-Wallis, and logistic regression by SPSS 11.5., Results: About 18% and 19% of people in this study were regular hookah and cigarette smokers, respectively. There was significant difference between cigarette smoking and sex ( P < 0.001) and marital status ( P = 0.01). There was a statistically significant difference between stages of change in men and women from the point of cigarette smoking ( P < 0.001). Male sex, hookah smoking, and alcohol abuse were predictors of PC, and age was the only predictor of termination stage for cigarette smoking. Sex did not have any role in hookah smoking., Conclusion: Targeted education based on gender and marital status warrant attention. Community-wide education and interventions such as increasing the price of cigarettes are desired., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Education and Health Promotion.)

Background: Of the pharmacological modalities for knee osteoarthritis (OA), intra-articular injections including ozone (O3) and hyaluronic acid (HA) are commonly used for reducing pain and improving function. In this systematic review and meta-analysis, we aimed to compare the effect of O3 versus HA in reducing pain and increasing function in patients with knee OA., Methods: After searching databases, we included 6 randomized controlled trials on patients with knee OA that compared the effects of intra-articular injection of ozone versus HA. The primary outcome was visual analogue scale (VAS) of pain. The secondary outcome was Western Ontario and McMaster Universities Arthritis Index (WOMAC) score., Results: There was a total of 237 patients in the HA group and 230 patients in the Ozone group. Of 6 studies, 4 were in English, 1 was in Persian, and 1 was in German language. The overall Standardized Mean Difference (SMD) for VAS pain did not show a significant difference between the groups although it favored HA injection (1.27 [95%CI: (-0.12)-2.66]). Total WOMAC score showed a significant difference over the time favoring HA injection (4.5 [95%CI: 1.1-8]). However, no single time point showed any significant difference between groups., Conclusion: This meta-analysis showed no significant difference between HA and ozone in reducing pain and improving function in patients with knee OA, although the overall results favored HA over ozone. Since previous studies have shown comparable results between HA and placebo, ozone seems to fall in the same category with more placebo effect rather than a real disease-modifier.