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BACKGROUND:Limited evidence exists on the treatment outcome and factors that are associated with the duration from the initiation of treatment to death or treatment failure in children with drug resistant tuberculosis (DR-TB). Thus, we aimed to determine the proportion of treatment enrollment, status of treatment outcome and determine factors that are associated with the duration from treatment initiation to death or treatment failure in children treated for DR-TB in Ethiopia. METHODS:We conducted a retrospective cohort study in children younger than 15 years old who were treated for DR-TB from February 2009 to February 2019 in Ethiopia. We collected data on socio-demographic and clinical characteristics from clinical charts, registration books and laboratory result reports on 155 children. Proportion of enrollment to the treatment was calculated by dividing the total number of children who were receiving the treatment by the total number of DR-TB patients treated during the specified years. We used Cox proportional hazard models to determine factors that were associated with the duration from the beginning of the treatment to death or treatment failure. Data was analyzed using STATA version 14. RESULTS:Of the 3,478 DR-TB patients enrolled into the treatment and fulfilling our inclusion criteria during the past ten years, 155 (4.5%) were children. Of the 155 children, 75 (48.4%) completed the treatment and 51 (32.9%) were cured. Furthermore, 18 (11.6%) children were died, seven (4.5%) lost to follow up and treatment of four (2.6%) children was failed. The overall treatment success was 126 (81.3%). Age younger than 5 years old [Adjusted Hazard Ratio (AHR) = 3.2, 95%CI (1.2-8.3)], HIV sero-reactivity [AHR = 5.3, 95%CI (1.8-14.9)] and being anemic [AHR = 4.3, 95%CI (1.8-10.3)] were significantly associated with the duration from the enrollment into the treatment to death or treatment failure. CONCLUSION:In this study, the proportion of children enrolled into DR-TB treatment was lower than the proportion of adults enrolled to the treatment (4.5% in children versus 95.5% in adults) in last ten years. Our findings also suggest that children with DR-TB can be successfully treated with standardized long term regimen. Further prospective cohort study is required to investigate factors contributing to death or treatment failure.

BACKGROUNDS:Cardiovascular disease (CVD) is the leading cause of mortality all over the globe. Inflammation is believed to play a pivotal role in the pathophysiology of CVD. While there are studies on the interrelationship of telomerase and vitamin D and their involvement in CVD, their independent contributions to long-term outcomes in patients with CVD are not well-defined. This study aimed to investigate the association of both telomerase and vitamin D concentrations with 10-year survival among candidates of coronary artery bypass grafting (CABG) surgery. METHODS:Participants were 404 patients from Tehran Heart Center-Coronary Outcome Measurement (THC-COM) cohort who were recruited from CABG surgery candidates in 2006. In addition to demographic and clinical data including risk factors for coronary artery disease, laboratory parameters such as markers of inflammation as well as baseline serum 25-hydroxy vitamin D [25(OH)D] and telomerase concentrations were measured. Cardiac function indexes alongside outcome measures such as mortality and survival days were recorded for every patient up to 10 years after CABG. Cox-proportional hazard model was used to study the association between all-cause mortality and research parameters. RESULTS:The mean serum telomerase enzyme level was 24.92 ±21.4 nmol/L and the mean serum 25(OH)D was 27.27±10.3 ng/mL. 10-year mortality was reported in 64 (15.8%) patients. 25(OH)D was categorized into three groups (30) and the cut-point for telomerase was set at 25.0 nmol/L. In Cox regression analysis, higher levels of telomerase (>25 nmol/L) were significantly associated with longer survival (p = 0.041), whereas 25(OH)D concentrations were not associated with survival time. Further analysis showed that telomerase concentrations significantly predicted survival only in the presence of insufficient levels of 25(OH)D (20-30 ng/mL) (p = 0.037). CONCLUSIONS:Telomerase can be regarded as a potential predictor of long-term outcomes in patients who underwent CABG. However, the association of telomerase with the mortality may be modified by vitamin D concentrations.

Purpose: To evaluate the correlation of the visual acuity and diabetic retinopathy stage using optical coherence tomography and optical coherence tomography angiography metrics. Methods: In this prospective study, optical coherence tomography and optical coherence tomography angiography images of patients with different stages of diabetic retinopathy were obtained. In optical coherence tomography angiography images, the size of foveal avascular zone, central macular thickness, and vessel density at superficial and deep capillary layers of the macula were measured. In optical coherence tomography images, the presence of intraretinal cyst, disorganization of retinal inner layer, and ellipsoid zone and external limiting membrane disruption were evaluated. The associations between the variables with visual acuity and diabetic retinopathy stage were analyzed. Results: In total, 68 eyes of 38 patients with a mean age of 58.96 ± 10.59 years were included. In total, 34 eyes were categorized as non-proliferative diabetic retinopathy, 14 as active, and 20 as regressed proliferative diabetic retinopathy. Univariate analysis showed deep parafoveal vessel density, central macular thickness, ellipsoid zone disruption, disorganization of retinal inner layer, and external limiting membrane disruption had a significant relationship with visual acuity. However, in multivariate analysis, only central macular thickness and ellipsoid zone disruption had significant association with visual acuity ( p = 0.02 and p = 0.01, respectively). There was a significant difference in deep parafoveal vessel density ( p = 0.04), but not in foveal avascular zone area, between different stages of diabetic retinopathy. Conclusion: In this study, the foveal avascular zone area did not correlate with visual acuity and different stages of diabetic retinopathy. Structural abnormalities on optical coherence tomography images with especial focus on outer retinal disruption provided more reliable predictors for visual acuity outcomes in patients with diabetic retinopathy.

Purpose: To report the demographic data, treatment methods, and outcomes among patients with pellet gun eye injuries. Methods: This study was a retrospective review of all pellet gun eye injuries coming to Farabi Eye Hospital, a referral ocular trauma center in Iran, from February 2009 to November 2013. Patients' demographics, type of injury, choice of management, complications, and post-treatment visual acuity were recorded. Results: One hundred eleven patients with a mean age of 25.7 ± 15.6 years entered the study. The most common age group was younger adults (16–45 years old) (61.3%). The mean uncorrected visual acuity after treatment was 2.05 (20/2240) ±1.5 logMAR. The most prevalent ocular zone was zone III (38.7%), and an intraocular foreign body was present in 97 patients (87.4%). Lid laceration and periocular tissue damage were present in 27 patients (24.3%). Lensectomy and vitrectomy were the most common treatment (31.5%). In most patients (87.4%), the injury was non-deliberate, and the most common time of hospitalization was the same day (45.0%). The only statistically significant indicator of post-treatment visual acuity was ocular trauma score (OTS) at admission (P

Purpose: This study evaluates the correlation between horizontal white-to-white (WTW) distance using Caliper and Orbscan IIz with the ciliary sulcus diameter measured by high frequency ultrasound biomicroscopy (UBM) and presents an adjustment formula to improve the correlation. Methods: We measured horizontal sulcus-to-sulcus (STS) dimension of 273 right eyes of 273 high myopic patients with 35 MHz UBM and horizontal WTW using Orbscan IIz and Caliper. Mean WTW diameter, differences, and the correlation of measurement methods were evaluated. Results: The mean spherical equivalent was −8.79 ± 4.87 diopters. Mean horizontal STS dimension with UBM was 12.13 ± 0.45 mm (range, 10.81–13.42 mm). Mean WTW diameter in the Caliper method was 11.70 ± 0.40 mm (range, 10.6–12.8 mm) and 11.70 ± 0.40 mm (range, 10.5–13.1 mm) in the Orbscan method. Mean difference of UBM STS and WTW with Caliper was 0.48 ± 0.28 mm (range, −0.19 to 1.37 mm). Mean difference of UBM STS diameter and Orbscan WTW was 0.38 ± 0.31 mm (range, −0.64 to 1.29 mm). The Pearson correlations of WTW diameter measured by Caliper and Orbscan with UBM's STS diameter were 0.778 and 0.773, respectively. This difference diminished after adjustment. The 95% limit of agreement was almost the same in Caliper and Orbscan (−0.07 to 1.03 compared with −0.23 to 0.99). Conclusion: There is a significant difference in measurements between STS diameter using UBM and WTW diameter utilizing Caliper and Orbscan. This difference diminished after our recommended adjustment. Keywords: Ultrasound biomicroscopy, Sulcus-to-sulcus diameter, White-to-white diameter, Phakic IOL, WTW adjustment formula

Professionalism is a core competency in the medical profession. In this paper, we aimed to confirm the validity, reliability and acceptability of the Professionalism Mini-Evaluation Exercise (P-MEX) instrument for the emergency medicine (EM) residency program. Twenty-two EM attending physicians completed 383 P-MEX forms (the Persian version) for 90 EM residents. Construct validity was assessed via structural equation modeling (SEM). The reliability coefficient was estimated by the generalizability theory, and acceptability was assessed using two researcher-made questionnaires to evaluate the perspectives of residents and assessors. There was a consensus among the participants regarding the content of P-MEX. According to the results of SEM, the first implementation of the original model was associated with a moderate fit and high item loadings. The model modified with correlated error variances for two pairs of items showed an appropriate fit. The reliability of P-MEX was 0.81 for 14 occasions. The perception survey indicated high acceptability for P-MEX from the viewpoint of the residents and increasing satisfaction with P-MEX among the assessors over time. According to the results of the research, P-MEX is a reliable, valid, and acceptable instrument for assessing professionalism in EM residents.

Introduction: Anesthetic gases used in hospitals include N2O and halogenated hydrocarbons (such as sevoflurane) which can be released through leakages and uncontrolled exhalation by the patient into the ambient air of clinical staff. These gases have greenhouse effect and damage to the ozone layer and serious risks such as reproductive, preterm delivery and fetal abnormalities and increased spontaneous abortion on the health of operating room personnel. Therefore, removal of these gases from the workplaces is essential especially in the treatment centers. The purpose of the present study was to investigate the adsorption of sevoflurane from air by using activated Charcoal and also the effect of acid modification on its performance. Material and Method: In this study, two adsorbents of unmodified and modified activated charcoal with nitric acid were used to remove sevoflurane. After preparation, the adsorbents were characterized using XRD, FT-IR, BET and FE-SEM methods. After characterization, the breakthrough and adsorption capacity of sevoflurane on both adsorbents were determined using the modified wheeler equation. Result: The results of characterization showed that acid modification did not affect the crystalline structure of activated charcoal and increased the adsorption and microporous of acid-modified activated charcoal in comparison with unmodified activated charcoal. It also reduces surface functional groups of the activated carbon. The results of determination of adsorption capacity indicated that the adsorption capacity of modified activated charcoal was improved in comparison with unmodified activated charcoal. Conclusion: The results demonstrated that both adsorbents have the ability to absorb sevoflurane and modified activated charcoal have a better performance in this process. This effect may be due to the surface area of adsorption and volume of micro pores more than the unmodified activated charcoal.

Introduction: The Surgical Safety Checklist has been introduced by the World Health Organization (WHO) as a tool for reducing medical errors. Reviewing the results of the checklist application indicates significant reduction in mortality and complications in surgery. Thus, this study aimed to customize and validate surgical safety checklist in order to complying with the surgical protocol in Iran. Material and Method: In this cross-sectional and descriptive study, the WHO Safety Surgery Checklist was first translated. Next, through interviews with specialists and direct observation of activities, those tasks that were susceptible to the incident, identified, prioritized and analyzed using Hierarchical Task Analysis (HTA) and the results presented in form of HTA charts. Then, using Tabulate Task Analysis (TTA) and based on the recommendation and modification commented by expert panel, some questions added to the checklist and a customized version of the Surgical Safety Checklist was provided. Hence, the faced validity, content validity and reliability of the checklist have been evaluated. Result: In the surgery, four major tasks identified for analyzing using the HTA chart. Accordingly, 41 subtasks obtained and analyzed by TTA. The Lavashe method was used to determine the content validity ratio (CVR) and the content validity index (CVI). The question from the checklist, in which, CVI was less than 0.79, modified and replaced with appropriate question. Also, the scores for 3 questions were less than 0.49, and they were removed from the checklist due to the low CVR score. In the reliability assessment, the intra-observer method is used, and the Kappa coefficient obtained was acceptable and it was higher than 0.6, which confirmed the validity of the checklist. Conclusion: In this study, the surgical safety checklist customized in terms of content validity and reliability, in a field study. Considering the compliance of the checklist items with the surgical protocol in Iran, we hope to use it to improve the quality of teamwork and reduce the complications and mortality caused by surgical errors

Abstract Background Occupational accidents are of most important consequences of globalization in developing countries. Therefore, investigating the causes of occupational accidents for improving the job situation and making operational policy is necessary. So the aim of this study was to investigate factors affecting the fatal occupational accidents and also calculate the years of life lost for dead workers. Methods This cross-sectional study was conducted on data related to the 6052 injured workers that was registered in the 2013 registry system of the Ministry of Health and Medical Education of Iran. Variables including sex, education, age, job tenure, injury cause, referred location of injured workers, occupation, shift work, season, accident day, damaged part of the body were chosen as independent variables. The Chi-squared and Fisher exact tests were used for univariate analysis and then exact multiple logistic regression was carried out to identify independent risk factors of fatal occupational accidents. Finally, for dead workers, years of life lost, according to the injury causes was calculated. Results Among the 6052 accidents reported, 33 deaths were recorded. Chi-square and Fisher exact tests showed that factors including: current job tenure (p = 0.01), damaged parts of the body (p

In this research, the villages with water supply systems under the supervision of the Water and Wastewater Company in Poldasht County, Iran in 2015 was studied. 648 samples were taken from 57 villages during 12month period to test for microbial quality according to the latest guidelines of WHO. Fecal coliform, coliform, turbidity, pH and free residual chlorine were analyzed. Also we used linear Regression statistical analysis for collected data. Result of Data showed that 13.6% of the villages under study had contaminated water resources. In 100 percent of the water sample resource the turbidity level was less than Iranian maximum permissible levels (5 NTU). There was a linear relation between the Free residual color and Coliform in different month of follow up (r = −0.154, P < 0.001). Data suggests water resources should be comprehensively planned and monitored keeping in view the WHO recommended parameters. Keywords: Drinking water, Fecal coliform, Residual chlorine, Turbidity, Village of Plodasht

AIM: To determine the relationship between abduction deficit and reoperation among patients with infantile esotropia (IET). METHODS: The records of 216 patients (432 eyes) with IET who underwent surgery, from 2010 to 2015 were studied. Patients with IET whose deviation appeared before 6mo of age and had stable preoperative deviation in two examinations with at least 2wk apart and a minimum 3mo postoperative follow up were included. Cases with early onset accommodative esotropia, congenital cataract, retinopathy of prematurity (ROP), manifest nystagmus, fundus lesions, neurologic and ophthalmic anomalies, 6th nerve palsy and Duane’s syndrome were excluded. Preoperative abduction deficit was considered from -1 to -3 grading scale. Three months after surgery, children were classified into no-need reoperation [deviation≤15 prism diopters (PD)], and need-reoperation groups (deviation>15 PD). RESULTS: In this retrospective study, 117 female and 99 male patients with the mean surgical age of 4.7±6.4y were included. Reoperation rate was 33.3% and 16.0% in IET patients with and without abduction deficit, respectively in patients who had a history of late surgery. Abduction deficit increased the odds of reoperation by 82% [OR=1.82, 95% confidence interval (CI) =1.05 to 3.19, P=0.003] in patients who had a history of late surgery (>2 years old, P=0.021). Abduction deficit was improved significantly after operation (P

Purpose: To perform a population-based screening of four CYP1B1 mutations—p.Gly61Glu, p.Arg368His, p.Arg390His, and p.Arg469Trp—in the province of Gilan, Iran. Previous studies have shown that CYP1B1 is a cause of disease in approximately 70% of Iranian patients with primary congenital glaucoma (PCG), and that these four mutations constitute the majority of CYP1B1 mutated alleles. The carrier frequencies may even justify premarital screenings. Methods: DNA was extracted from the blood samples of 700 individuals recruited in a population-based epidemiology study in Gilan. Screenings were performed using polymerase chain reaction protocols based on restriction fragment length polymorphism or the amplification-refractory mutation system. For confirmation, the DNA of individuals with mutations was sequenced using the Sanger protocol. Results: Five individuals carried the p.Gly61Glu mutation, and seven carried the p.Arg368His mutation. The p.Arg390His and p.Arg469Trp mutations were not observed in any of the 700 individuals screened. The mutations were not geographically randomly distributed in Gilan; four of the p.Gly61Glu-harboring individuals were from Talesh, and six of the p.Arg368His-harboring individuals were from the eastern regions of Gilan. Conclusion: The frequency of individuals who carry either p.Gly61Glu or p.Arg368His is relatively high in Gilan, and notably high in certain localities within Gilan. We suggest further screenings be performed to definitively assess the need for implementing measures to encourage screening for p.Gly61Glu and p.Arg368His before marriage in Talesh and the eastern regions of Gilan, respectively. Finally, our assessment showed that regional frequencies of CYP1B1 mutations do not necessarily mirror national frequencies.

Purpose: To determine the prognostic factors and visual and anatomic outcomes of pars plana vitrectomy (PPV) in patients with dropped nucleus following complicated phacoemulsification (PE). Methods: The records of patients with complicated PE who underwent PPV to remove posteriorly dislocated nucleus fragments from January 2011 to December 2014 were retrospectively reviewed. Results: Of 43 patients, 36 patients (36 eyes) were included with mean age of 73 ± 9.5 years and mean follow-up duration of 23.8 ± 15.3 (range 4–53) months. The mean interval between cataract surgery and PPV was 11.5 ± 9.6 (range 1–45) days. The pre-PPV mean best-corrected visual acuity (VA) was 1.04 ± 0.24 logMAR, which improved to 0.46 ± 0.18 logMAR (P < 0.001). Pre-PPV VA ≥20/200 was significantly associated with good final VA ≥20/40 (P = 0.002). Implantation of intraocular lens (IOL) at the time of complicated PE and complicated course after PPV were significantly associated with poor visual outcome of

The aim of this study was to determine the concentration of fluoride in drinking water, the distribution system, in 22 villages in Shout (A city in West Azerbaijan province). Sampling of springs and underground water was carried out in two warm and cold seasons. Fluoride concentration were determined through spectrophotometer with a model, DR/5000.The fluoride concentration were compared with Iranian standards and WHO guidelines for drinking water. Keywords: Shout, Fluoride, Drinking water, Season

Background: Hemodialysis (HD) represents the main way of renal replacement therapy (RRT) for end-stage renal disease (ESRD) patients in Iran. Few studies have investigated the survival of HD patients in Iran. Objectives: This study conducted to reach better understanding predictors of survival for HD patients. Patients and Methods: This is a retrospective cohort study conducted in 1142 HD patients in Hamadan province during 11 years from 2007 to 2017. The checklist used to gather information was comprised of patient’s demographic and clinical information. The analysis was carried out using Laplace regression and Cox regression model. Results: The most prevalent causes of ESRD were reported to be high blood pressure (BP) (28.9%) and diabetes (24.34%). The probability of survival at the end of 1st, 5th, and 10th year was 0.81, 0.4 and 0.13, respectively. Results of multivariate Cox regression showed that being rural dweller, low albumin, ferritin and hemoglobin level and having positive CRP at diagnosis have a negative significant impact on survival of HD patients (P < 0.05). Conclusions: Being rural dweller, low albumin and hemoglobin level and having positive CRP at diagnosis amongst other factors were possible factors affecting the survival of HD patients in this study. Considering the low survival probability of these patients, efforts should be made to real-time diagnosis of the cause of renal diseases.

Background: Drug abuse is a serious subject that can lead to social, economic, cultural and health problems. The routine approaches in treatment of drug abuse are either medication or non-medication methods. Non-medication approach is focused on mental and social health. Non-drug treatment requires appropriate tools. Objective: To determine the validity, reliability, and structure of the Processes of Change Questionnaire. Methods: In this cross-sectional study, which was conducted in 2016, three hundred sixty-two drug dependents in Sabzevar Substance Abuse Treatment Centers (Iran) were enrolled in the study. Samples were selected through the multi-stage sampling method. They completed the 40-item Processes of Change Questionnaire (drug version). In this study, Backward-Forward method, confirmatory factor analysis (CFA), test-retest, Cronbach's alpha, content validity ratio (CVR) and content validity index (CVI) were used, using AMOS 5.0 and SPSS version 11.5. Results: Findings of the CFA showed the questionnaire has a good fit. The fit index of the CFA was calculated as 0.75. Cronbach’s alpha was 0.93 for the whole questionnaire, and ranged from 0.51 to 0.88 for its different domains. Also, intraclass correlation coefficient (ICC) and content validity were satisfactory. Conclusion: Based on the findings of this study, the processes of change 40-item questionnaire: drug version was a credible, reliable and valid tool to identify effective factors in the treatment drug abuse among the population of the Sabzevar, Iran.

Background The most common chromosomal abnormality due to non-obstructive azoospermia (NOA) is Klinefelter syndrome (KS) which occurs in 1-1.72 out of 500-1000 male infants. The probability of retrieving sperm as the outcome could be asymmetrically different between patients with and without KS, therefore logistic regression analysis is not a well-qualified test for this type of data. This study has been designed to evaluate skewed regression model analysis for data collected from microsurgical testicular sperm extraction (micro-TESE) among azoospermic patients with and without non-mosaic KS syndrome. Materials and Methods This cohort study compared the micro-TESE outcome between 134 men with classic KS and 537 men with NOA and normal karyotype who were referred to Royan Institute between 2009 and 2011. In addition to our main outcome, which was sperm retrieval, we also used logistic and skewed regression analyses to compare the following demographic and hormonal factors: age, level of follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone between the two groups. Results A comparison of the micro-TESE between the KS and control groups showed a success rate of 28.4% (38/134) for the KS group and 22.2% (119/537) for the control group. In the KS group, a significantly difference (P < 0.001) existed between testosterone levels for the successful sperm retrieval group (3.4 ± 0.48 mg/mL) compared to the unsuccessful sperm retrieval group (2.33 ± 0.23 mg/mL). The index for quasi Akaike information criterion (QAIC) had a goodness of fit of 74 for the skewed model which was lower than logistic regression (QAIC=85). Conclusion According to the results, skewed regression is more efficient in estimating sperm retrieval success when the data from patients with KS are analyzed. This finding should be investigated by conducting additional studies with different data structures.

Background: Physical activity (PA) rates decline among most high school female students, and due to cultural restrictions, the reduction of physical activity might be exacerbated in female Iranian adolescents. Objective: To determine the effects of the physical activity education theory-based intervention to promote activity among adolescent girls. Methods: This randomized clinical trial was conducted at public high schools in Tehran, Iran, from September 2015 to July 2016 on 578 girls. The subjects were assigned randomly to two groups of experiment and control (n=289 per group). All participants in the experimental group received an educational program based on a modified TPB. Measures were assessed before and 6 months after the experiment. The data were analyzed using SPSS version 23. We used descriptive statistics, multilevel analysis, Likelihood Ratio (LR) test, P-value less than 0.05 were considered statistically significant. Results: Five hundred and seventy-eight participants with a mean age of 14.26±0.96 years were studied in two groups of experiment (n=289) and control (n=289). Moreover, adjusted for the baseline values, the mean of the scores of the knowledge (84.1±13.6), attitude (31.2±13.6), subjective norm (40.4±11.1), behavioral intention (34.3±14.7), perceived behavioral control (38.4±11.6), perceived parental control (42.9±14.2), behavioral (42.6±17.1) was significantly higher in the experiment group compared with the control group (p

Purpose: To compare the efficacy and side effects of loteprednol versus fluorometholone after myopic photorefractive keratectomy (PRK). Methods: One hundred and twenty four eyes of 62 patients who underwent PRK were enrolled in this study. One eye of each subject was randomized to receive loteprednol 0.5% and the fellow eye was given fluorometholone 0.1%. Patients were followed up for three months. Results: There was no significant difference in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, corneal haze, intraocular pressure (IOP), and ocular discomfort and redness between groups at the final visit. At 3 months postoperatively, 20/25 or better UDVA was achieved in 95% of the loteprednol group and 92% of the fluorometholone group (P > 0.05). There was neither visually significant corneal haze nor ocular hypertension (IOP rise > 10 mmHg or IOP > 21 mmHg) in any group. Conclusion: The efficacy and side effects of loteprednol 0.5% and fluorometholone 0.1% after myopic PRK are comparable.

Purpose: To assess central corneal thickness (CCT) and its associations in an adult Iranian population. Methods: This was a population-based cross-sectional study of adults aged 40–80 years. Eyes with corneal disorders, previous ocular surgery, or trauma were excluded. All subjects underwent complete ophthalmic examination, general health assessment, laboratory tests, and a detailed interview. CCT was measured with an ultrasonic pachymeter. Intraocular pressure (IOP) was measured with Goldmann applanation tonometry. Except for the report on interocular differences in CCT, only one eye of each subject was used for the rest of statistical analyses. Results: The mean age (±SD) of the 1203 participants, who had CCT measurements and met inclusion criteria, was 51.8 ± 8.5 years. The mean CCT was 544 ± 35, 564 ± 28, and 544 ± 36 μm in the eyes of the normal, ocular hypertension, and glaucoma groups, respectively (P = 0.025). In participants without glaucoma, the mean interocular difference in CCT was 9 ± 12 μm. CCT was not significantly associated with age, sex, or some select systemic factors (body mass index, diabetes, hypertension, and renal failure). While controlling for age and sex, CCT was greater in individuals with higher IOPs (P < 0.001), larger vertical or horizontal cup-to-disc ratios (P = 0.044, and P= 0.025, respectively), and hyperopia (P = 0.009). Conclusion: In this adult Iranian population, CCT was significantly associated with IOP, cup-to-disc ratio, and the refractive status of eye. CCT outside the normal range of 475–613 μm or with interocular asymmetry greater than 33 μm (6%) should prompt evaluation for potential ocular disorders.

Background: More than half of the sexual problems in menopausal women are due to insufficient knowledge or false beliefs about sexual function. Theory of planned behavior (TPB) is one of the important theories that explain the main process of adopting healthy behaviors. This study investigates the effect of education based on TPB over sexual function of menopausal women in Sabzevar, Iran. Materials and Methods: In this quasi-experimental study, the data were collected through a survey. This study included 180 Iranian menopausal women from five health center of Sabzevar city in Iran from 2016 to 2017. Using a questionnaire, demographic, anthropometric, and TPB by SPSS version 22 software were measured and analyzed. Results: After educational intervention, the average rates of knowledge, attitude, perceived behavioral control, and intention to sexual function in education group were increased meaningfully (sig

Purpose: To evaluate the efficacy of vitrectomy, membranectomy, and internal limiting membrane (ILM) peeling on macular thickness and best corrected visual acuity (BCVA) in patients with refractory diffuse diabetic macular edema (DME) and non-tractional epiretinal membrane (NT-ERM). Methods: This prospective interventional case series included eyes with refractory DME (central subfield macular thickness [CSMT] > 300 μm) after at least two intravitreal injections of bevacizumab (IVB) and one intravitreal injection of triamcinolone (IVT), and accompanying NT-ERM. Complete ophthalmic examination, baseline spectral domain optical coherence tomography (SD-OCT), and fluorescein angiography (FA) were performed prior to 23 gauge pars plana vitrectomy with membranectomy and internal limiting membrane (ILM) peeling. Postoperative evaluation was done with clinical examination and SD-OCT. Linear mix model analysis was used to study postoperative results. Results: Twelve eyes from 11 patients (5 males) with a mean age of 60.33 ± 9.01 (range 46–73 years) were included. The mean follow-up time was 13.5 ± 4.48 months (range 4–20 months). A significant reduction in CSMT was found (from 559 ± 89 μm to 354 ± 76 μm; P = 0.001), with a non-significant BCVA change (from 0.84 ± 0.32 logMAR to 0.72 ± 0.2 logMAR; P = 0.967). There was no significant correlation between CSMT and BCVA (partial correlation = −0.115, P = 0.445) and also between estimated mean CSMT change per month and estimated mean BCVA change per month (r = 0.337, P = 0.283). Conclusion: In this series, our results did not show that vitrectomy, membranectomy, and ILM peeling result in significant improvement of BCVA in eyes with refractory DME and non-tractional ERM in spite of central macular thickness reduction.

Purpose: To determine the role of Interactive Binocular Treatment (I-BiT™) as a complementary method of patching in amblyopia therapy. Methods: In this randomized clinical trial study, 50 unilateral amblyopic children (25 male/25 female) between 3 and 10 years with either best corrected visual acuity (BCVA) ≤20/30 in the amblyopic eye or a difference of BCVA≥2 lines between the two eyes were included. They were randomly classified into the case and control groups (25 in each). Patching was recommended in both groups, and cases also received I-BiT™. Cases were asked to play I-BiT™ games through appropriate glasses with conjugate colored filters. Moving and fixed targets were shown to the amblyopic and non-amblyopic eyes, respectively. Playing games was continued 20 min in each session for 5 days a week within one month (total time: 6.6 h). Patching was continued for one month more in both groups to evaluate the continuous effect of I-BiT™. BCVA was measured at baseline, one month after beginning I-BiT™, and one month after cessation of I-BiT™. Results: BCVA of amblyopic eyes in cases and controls were 0.34 ± 0.14 and 0.33 ± 0.17LogMAR at baseline which improved to 0.17 ± 0.14 and 0.26 ± 0.17 at one month, respectively. The difference was significant in each group (p

Background: Using data from different health centers can provide more accurate knowledge of the survival prognostic factors and their effect on the patient’s survival. In this multicenter study, we aimed to investigate the role of prognostic factors on breast cancer survival with large data set. Methods: This historical cohort study was carried out using data from 1785 participants with breast cancer. Data were gathered from medical records of patients referring to 4 breast cancer research centers in Tehran, Iran, between 1997 and 2013. Age at diagnosis (year), size of the tumor, involve lymph nodes, tumor grade, type of surgery, auxiliary treatment of chemotherapy, radiotherapy, recurrence, and metastasis were the prognosis factors considered in this study. A shared frailty model with a gamma distribution for frailty term was used. Results: The median follow-up period was 29.71 months with the interquartile range of 19 to 61 months. During the follow-up period, 337 (18.9%) patients died from breast cancer and 1448 (81.1%) survived. The 1-, 3-, 5-, and 10-year survival rates were 96%, 84%, 76%, and 58%, respectively. In the Cox model by centers, in Center A, the type of surgery, number of nodes involved, and the grade 3 tumor; in center B, age, radiotherapy, metastasis, and between 1 and 3 involved nodes; in center C, age, radiotherapy, recurrence, metastasis, tumor size, and grade 3 tumor; and in center D, chemotherapy, metastasis, and lymph nodes involved were significant. Shared frailty model showed that type of surgery, number of lymph nodes involved, metastasis, radiotherapy, and the tumor grade are the prognostic factors survival in breast cancer. The frailty variance was significant, and it affirmed there was significant variability between centers. Conclusions: This study showed it is necessary to consider the frailty term in modeling multicenter survival studies and confirmed the importance of early diagnosis of cancer before the involvement of lymph nodes and the onset of metastasis and timely treatment could lead to longer life and increased quality of life for patients.

Background: The aim of this study was to assess associations of Citrobacter freundii foodborne outbreaks with environmental factors in various regions of Yazd Province, Iran, 2012–2016. Methods: The public health surveillance data were used for one period of five years reported foodborne disease outbreaks in various regions of the Province. Multilevel regression statistical method was used to analyze associations of climatic and demographic variables with outbreaks. Significant associations were tested using likelihood ratio tests. Results: Results showed a significant association between C. freundii outbreaks and air dust conditions, age groups and various regional cities. Conclusion: The current study revealed necessity of etiologic agent identification for use in foodborne disease outbreak guidance in future outbreaks. Systemic surveillance schemes can help prevent and control similar scenarios using reports of environmental effects on foodborne disease outbreaks.

Background: Dual practice by surgery specialists is a widespread issue across health systems. This study aimed to determine the level of dual practice engagement and its related factors among Iran’s surgery specialists. Methods: A pre-structured form was developed to collect the data about surgery specialists worked in all 925 Iran hospitals in 2016. The forms were sent to the hospitals via medical universities in each province. The data were merged at the national level and matched using medical council ID codes, national ID codes and eventually a combination of the first name, surname and father's name. Multilevel logistic regression was used to assessing the association between dual practice with study variables. Results: Overall, 14931 surgeons were participated (93% response rate) and 6405 (57% of) engaged in DP on total. Urinary tract & genital and neurosurgery specialties had the highest rank with 69%. DP was more frequent in specialists with higher age and experience, populated provinces, higher deprivation, and share of private hospitals. Faculty physicians (OR=0.69), full-time geographic physicians (OR=0.17), specialists with more than 25 years’ experience (OR=2.59) and age more than 40 yr (OR=1.3) had significant association with dual practice. Conclusion: Multi-approach strategy is needed to control dual practice through tax regulations, income cap, and limitations in work hours and number of visits in private sector.

Background: Contamination of hair dyes to heavy metals can threaten consumer's health. We investigated the concentrations of some important heavy metals in hair dyes and evaluates their non-carcinogenic effects. Methods: The most commonly used hair dyes were determined through questioners and 32 samples were collected from the market of Tehran in 2014. The concentration of 10 heavy metals (Fe, Ag, Co, Cr, Mn, Ba, Cd, Cu, Pb, and Al) was determined using ICP-MS. Based on the obtained data from distributed questionnaires and Monte Carlo simulation, the exposure to the evaluated heavy metals was estimated. Besides, using hazard quotient (HQ) and chronic hazard (HI), the risk of non-carcinogenic effects of investigated hair dyes consumption was specified. Results: Results indicated the average concentrations of Al, Ba, and Fe as 0.54, 0.86, and 1.19 mg kg-1 and those of Cd, Cu, and Pb as 0.45, 61.32, and 185.34 µg kg-1, respectively. Pb with HQ of 7.46e-4 had the highest risk and Fe with HQ of 3.4e-6 had the lowest level of risk. Among the investigated dyes, the ones made by Iran (HI=2.8e-4) and the dark brown color (HI=1.93e-4) had the highest level of risk among all the studied samples. Conclusion: Two indices of HI and HQ showed that heavy metal contents in the investigated samples had not probable non-carcinogenic risks for the consumers of these products.

Background & Aim: The diagnostic accuracy of a test is the ability to discriminate accuratelybetween patients who have and do not have the target disease. A common problem in assessing thediagnostic accuracy of doctors is the unknown true disease status which in the literature is referredas “absence of a gold standard”. Methods & Material: In this article, a Naïve Bayesian network with hidden class node and a clusteringbased algorithm for categorical data named K-modes are proposed for estimating the diagnosticaccuracy of 5 physicians in diagnosing Diabetic Retinopathy. Also to assess and compare the efficiencies of these models, a simulation study with two different scenarios is conducted. Results: Simulation study indicates that for Naïve Bayesian network and the non-rare disease, say forprevalence 0.1 and 0.2, as the sample size increases so the coverage probability. But for high prevalencevalues, say 0.5, coverage probabilities are not as good as those of non-rare disease. K-modes algorithm's efficiency decreases by the increase in the number of records, but it achieves betterresults when there are a small number of records, prevalence is approximately 0.3 and sensitivitiesare high. Results of the real data set reveal that sensitivities for all physicians except one, were higher than 85% and all specificities were higher than 90%. Also the estimated prevalence happensto be 0.32. Conclusion: Through simulations and data analysis we show that this new approach based on Naïve Bayesian networks provides a useful alternative to traditional latent class modeling approaches usedin this setting.

BackgroundHypothyroidism is one of the adverse drug reactions that associated with Multidrug Resistant Tuberculosis (MDR-TB) medications. Extremely variable magnitude of hypothyroidism in MDR-TB patients has been reported from different parts of the world. However, there is no evidence that tried to estimate the pooled prevalence of hypothyroidism to confirm the rareness of hypothyroidism in MDR-TB patients on treatment. Therefore, we did a systematic review and meta-analysis to estimate the prevalence of hypothyroidism in MDR-TB patients on treatment, and to summarize the demographic and clinical characteristics of the patients.MethodsWe conducted a systematic review and meta-analysis on studies reported around the world on the prevalence of hypothyroidism in MDR-TB patients on treatment. We searched electronic databases: PubMed/Medline, EMBASE, CINAHL, Science Direct, Academic Search Complete and Google scholar for English language articles without limiting publication year. We also reviewed the bibliographies of relevant studies and conducted an electronic search for relevant conference abstracts. Eligible studies were cross-sectional and cohort studies that included at least five participants. We used a random-effects model to estimate the pooled prevalence of hypothyroidism. The registration number of this review study protocol is CRD42018109237.ResultsWe included 30 studies and pooled data on a total of 6,241 MDR-TB patients. The crude prevalence of hypothyroidism was extremely heterogeneous. The pooled prevalence of hypothyroidism in MDR-TB patients on treatment was 17.0% (95% CI: 13.0-20.0). Ethionamide and para-aminosalicylic acid (PAS) were the most frequently reported drugs that associated with the occurrence of hypothyroidism.ConclusionThis review revealed that hypothyroidism is not a rare adverse drug reaction in MDR-TB patients on treatment. Ethionamide and PAS were the most frequently reported drugs that associated with the occurrence of hypothyroidism. Screening of hypothyroidism in MDR-TB patients on treatment is important while targeting patients on Ethionamide and PAS based treatment regimen.

Purpose. To model a community-based telescreening program for diabetic retinopathy (DR) in Iran and to implement a pilot project at the Iranian Diabetes Society (IDS) branch in a Tehran suburb. Methods. In this mixed model study, a web application called the “Iranian Retinopathy Teleophthalmology Screening (IRTOS)” was launched. The educational course for DR screening was established for general practitioners (GPs). Registered patients in IDS branch were recalled for fundus photography; images were transferred to the reading center via IRTOS to be graded by GPs, and patients were informed about the results via mobile messaging. All images were independently reviewed by a retina specialist as the gold standard. Patients who required further assessment were referred to an eye hospital. Results. Overall, 604 subjects with diabetes were screened; of these, 50% required referral. The sensitivity and specificity for diagnosis of any stage of DR by trained GPs were 82.8% and 86.2%, respectively, in comparison to the gold standard. The corresponding values for detecting any stage of diabetic macular edema (DME) were 63.5% and 96.6%, respectively. Conclusions. Telescreening was an effective method for detecting DR in a Tehran suburb. This screening model demonstrated its capacity for promoting diabetic eye care services at the national level. However, the sensitivity for detecting DME needs to be improved by modifying the referral pathway and promoting the skill of GPs.

Introduction: The potential benefit of ultrasonography for detection of thoracic bone fractures has been proven in various surveys but no comprehensive conclusion has been drawn yet; therefore, the present study aimed to conduct a thorough meta-analytic systematic review on this subject. Methods: Two reviewers independently carried out a comprehensive systematic search in Medline, EMBASE, ISI Web of Knowledge, Scopus, Cochrane Library, and ProQuest databases. Data were summarized as true positive, false positive, true negative and false negative and were analyzed via STATA 11.0 software using a mixed-effects binary regression model. Sources of heterogeneity were further assessed through subgroup analysis. Results: Data on 1667 patients (807 subjects with and 860 cases without thoracic fractures), whose age ranged from 0 to 92 years, were extracted from 17 surveys. Pooled sensitivity and specificity of ultrasonography in detection of thoracic bone fractures were 0.97 (95% CI: 0.90-0.99; I2= 88.88, p

Background: The aim of this study was to compare the safety and efficacy of primary trabeculectomy with mitomycin C and Ahmed glaucoma valve (AGV) implantation in patients with Fuchs heterochromic iridocyclitis (FHIC)-related glaucoma, a rare complication of an uncommon form of uveitis. Methods: In this retrospective comparative case series, 26 FHIC-associated glaucoma patients received trabeculectomy (n=12) or an AGV (n=14). Primary outcome measures were surgical success, defined as intraocular pressure (IOP) ≤21 mmHg, decreasing ≥20% from baseline, and no secondary glaucoma surgery. Secondary outcome measures were the number of glaucoma medications, complications, best corrected visual acuity (BCVA), and IOP. Results: The follow-up was 34.0±17.7 months in patients that received trabeculectomy and 33.4±18.6 months in AGV (P= 0.837). The cumulative probability of success rate was 41.7% for trabeculectomy and 85.7% for AGV, with no significant difference in complications (P>0.05). The IOP in patients that received trabeculectomy dropped from 23.4±3.3 mmHg to 21.6±5.2 mmHg at the final visit (P= 0.041). In patients that received AGV, the IOP decreased from 24±7.8 to 17.1±2.6 mmHg (P= 0.003). The number of glaucoma medications at baseline were 3.3±0.5 in those that received trabeculectomy and 3±0.6 in those that received AGV (P=0.233), and decreased to 2.4±1.0 (P=0.008) and 1.7±0.6 (P=0.002), respectively. BCVA was equal in both groups and did not change (P>0.05). Conclusion: Primary AGV had a higher success rate than trabeculectomy, with patients also needing fewer medications for the management of FHIC-associated glaucoma.

BACKGROUND: Cardiovascular diseases are among progressive diseases that begin in childhood and are manifested mainly in adulthood. This study was assessed the validity and reliability testing of the Persian version of the Perceived Health Competence Scale (PHCS) among patients with cardiovascular diseases referred to Shahid Rajaie Heart center in Tehran, Iran. METHODS: In this cross-sectional study, a convenience sample of 700 patients with cardiovascular diseases referring to Shahid Rajaie Heart center in Tehran were recruited (response rate = 100%; n = 700). Content validity was established using translation and back-translation procedure and getting views of the expert panel. The content validity of the questionnaire was measured using content validity ratio (CVR) and content validity index (CVI). Reliability was ascertained using Cronbach's alpha. The stability was confirmed using intra-class correlation coefficients. RESULTS: In this study, CVI = 0.81 and CVR = 0.72 were calculated. Scale reliability was sufficient (α = 0.78; range = 0.73–0.77). Furthermore, reliability based on the stability of the whole scale was 0.75. CONCLUSIONS: The PHCS-Persian confirmed as a valid and reliable instrument to measure perceived health competence. The PHCS-Persian scale could be a useful, comprehensive, and culturally sensitive scale for assessing perceived health competence.

Identifying the learners' problems is important. Besides, many factors are associated with academic failure, among which time management and stress are more important than any others based on evidence. By using a systematic review and meta-analysis, this study aims to synthesize the findings of studies about the correlation of time management and stress with academic failure to suggest a more in-depth insight into the effect of these two factors on academic failure. Four databases were searched from the inception of January 2018. Publication bias was evaluated visually using funnel plots and sized up by Egger's test. Ninety-four articles were found to be qualified for inclusion after full-text review and additional manual reference made. Of these, 8 were studies of educational interventions that were reviewed in this paper. Regarding the relation of stress and academic performance, the Funnel plot (results not shown) and Egger's test showed no publication bias in the studies (P = 0.719). Based on this result, the estimated pooled correlation (reverted by hyperbolic tangent transformation) between stress and academic performance was found to be -0.32 (95% confidence interval: -0.38–-0.25). In conclusion, the review recognized a series of potentially mutable medium-to-large correlates of academic achievement, time management, and stress. It would be essential to have experimental data on how easily such self-regulatory capacities can be altered, and these interventions could help students enhance their potential, providing empirical tests for offered process models of academic achievement.

BACKGROUND: Over the past few decades, significant demographic and epidemiological changes have been occurred and led to serious changes in the health-care needs of the elderly. Integrated care has been emerged as a strategy to provide better care for the elderly in the community. The aim of this study was conducted to evaluate components of integrated health-care program of the elderly. MATERIALS AND METHODS: This quantitative cross-sectional study was conducted in Tehran (Iran) in 2019. For the purpose of the study, a two-stage cluster sampling method was employed. In the firs stage, primary health-care centers were selected, then in the second stage, a systematic random sampling was conducted based on the number of the elderly covered by each center. level of frailty, medication use awareness, and self-care ability were evaluated by the elderly self-report questionnaire. The questionnaire was piloted with thirty respondents. The test–retest reliability score for the questionnaire was r = 0.795, P < 0.001. Data analysis of the questionnaire was conducted using generalized estimating equation model by SPSS software Version 22. Statistical significance for all analyses was set at P < 0.05. RESULTS: Findings of the components showed that the mean ± standard deviation of frailty (80 ± 17) and self-care ability (87 ± 17) were higher than the mean of medication use awareness (49 ± 19). Frailty and self-care ability (β = frailty, self-care) of the elderly had a positive statistical significance with the ones with good financial status (β = 5, 10) and without chronic disease (β = 4, 5). Medication use awareness had a negative statistical significance with illiteracy (β = −9.5). CONCLUSIONS: It is suggested that the medication use awareness of the elderly should be prioritized by improving integrated health-care program.

Objective (s): Physical inactivity is one of the biggest public health concerns. Due to various reasons such as pregnancy, women are more at risk of physical inactivity. This study performed to determine the influence of an educational intervention on promoting postpartum physical activity based on BAZNEF model, among women referred to health centers. Methods: This was a quasi-experimental study which conducted on 168 women referred to health centers during six weeks to one year after delivery. Samples divided in two groups; intervention and control by using a random allocation. Data collected by BASNEF questionnaire and International Physical Activity Questionnaire(IPAQ).. The educational intervention was designed in four sessions. Control group received no intervention except postpartum routine care. Three months after intervention, the questionnaire was completed again in two groups. Results: Pretest results revealed no significant differences in demographic characteristics and BASNEF model constructs in both groups (p>0/05). However, after intervention there was a significant differences between two groups in terms of BASNEF model including knowledge, attitude, normative believes, enabling factors and intention (P

Introduction: The potential benefit of ultrasonography for detection of thoracic bone fractures has been proven in various surveys but no comprehensive conclusion has been drawn yet; therefore, the present study aimed to conduct a thorough meta-analytic systematic review on this subject. Methods: Two reviewers independently carried out a comprehensive systematic search in Medline, EMBASE, ISI Web of Knowledge, Scopus, Cochrane Library, and ProQuest databases. Data were summarized as true positive, false positive, true negative and false negative and were analyzed via STATA 11.0 software using a mixed-effects binary regression model. Sources of heterogeneity were further assessed through subgroup analysis. Results: Data on 1667 patients (807 subjects with and 860 cases without thoracic fractures), whose age ranged from 0 to 92 years, were extracted from 17 surveys. Pooled sensitivity and specificity of ultrasonography in detection of thoracic bone fractures were 0.97 (95% CI: 0.90-0.99; I2= 88.88, pConclusion: Base on the findings of the present meta-analysis, screening performance characteristic of ultrasonography in detection of thoracic bone fractures was found to be higher than radiography. However, these characteristics were more prominent in detection of rib fractures and in cases where was performed by a radiologist.

The effects of the natural food saffron (90 mg/d) on exercise induced sperm DNA damage, antioxidative and peroxidative biomarkers and seminological profile in male road cyclists were evaluated. Twenty-four healthy nonprofessional cyclists (aged 17–26 years) were randomly assigned to exercise + Saffron (EX + SAF, n = 12) and exercise (EX, n = 12) groups for an experimental period of 16 weeks. After the intervention, the number of terminal deoxynucleotidyl transferase-mediated fluorescein-dUTP nick end labeling (TUNEL)-positive sperm cells and peroxidative biomarkers increased, while antioxidative biomarkers and seminological profile decreased in the EX group. These changes were significantly attenuated in the EX + SAF group. Moreover, for both groups the observed changes in peroxidative and antioxidative biomarkers could be correlated positively and negatively, respectively, with sperm DNA fragmentation. Saffron, rich in carotenoids, flavonoids and vitamins, is therefore a potentially potent functional food for preventing exercise-induced sperm DNA damage, at least in part, through optimizing oxidant/antioxidant equilibrium and attenuation of oxidative stress.

Purpose: To determine the predictive ability of different data measured by the Galilei dual Scheimpflug analyzer in differentiating subclinical keratoconus and keratoconus from normal corneas. Methods: This prospective comparative study included 136 normal eyes, 23 eyes with subclinical keratoconus, and 51 keratoconic eyes. In each eye, keratometric values, pachymetry, elevation parameters and surface indices were evaluated. Receiver operating characteristic (ROC) curves were calculated and quantified by using the area under the curve (AUC) to compare the sensitivity and specificity of the measured parameters and to identify optimal cutoff points for differenciating subclinical keratoconus and keratoconus from normal corneas. Several model structures including keratometric, pachymetric, elevation parameters and surface indices were analyzed to find the best model for distinguishing subclinical and clinical keratoconus. The data sets were also examined using the non-parametric #8220;classification and regression tree#8221; (CRT) technique for the three diagnostic groups. Results: Nearly all measured parameters were strong enough to distinguish keratoconus. However, only the radius of best fit sphere and keratometry readings had an acceptable predictive accuracy to differentiate subclinical keratoconus. Elevation parameters and surface indices were able to differentiate keratoconus from normal corneas in 100% of eyes. Meanwhile, none of the parameter sets could effectively discriminate subclinical keratoconus; a 3-factor model including keratometric variables, elevation data and surface indices provided the highest predictive ability for this purpose. Conclusion: Surface indices measured by the Galilei analyzer can effectively differentiate keratoconus from normal corneas. However, a combination of different data is required to distinguish subclinical keratoconus.

Purpose: To evaluate diurnal variations in intraocular pressure (IOP), central corneal thickness (CCT), and macular and retinal nerve fiber layer (RNFL) thickness in diabetic patients and normal individuals. Methods: This study included 11 diabetic patients with macular edema and 11 healthy individuals. IOP, CCT, and macular and RNFL thickness were measured every 3 hours on a single day between 9 AM and 6 PM. Diurnal variations in IOP, CCT, total macular volume (TMV), central macular thickness (CMT), average macular thickness (AMT), and RNFL thickness were measured. Results: None of the parameters showed a significant absolute or relative change over the course of the day. However, the following non-significant changes were observed. In the control group, all parameters demonstrated the highest values at 9 AM. The lowest IOP, TMV and AMT occurred at 12 PM; lowest CCT and RNFL at 6 PM; and the lowest CMT at 3 PM. Diabetic subjects had the highest values of RNFL, CMT and TMV at 9 AM, and that for IOP, CCT and AMT at 6 PM. The lowest RNFL and CMT values occurred at 6 PM; lowest IOP at 12 PM; and the lowest CCT, TMV and AMT were observed at 3 PM. In the diabetic group, TMV, CMT, AMT and CCT were significantly higher and RNFL was significantly lower than the control group at all time points (all P- values < 0.05). Conclusion: While there were slight decreases in IOP, RNFL thickness and CMT during the day, these changes were not significant between 9 AM and 6 PM and probably do not affect the interpretation of measurements.

This review article aimed to evaluate ocular biometric changes after trabeculectomy. The PubMed database was searched using the keywords “axial length” (AL), “anterior chamber depth” (ACD), “corneal astigmatism,” “corneal topography” and “trabeculectomy.” The extracted studies were categorized based on the evaluated parameters and the biometry method (contact and non-contact). Comparable studies with respect to their sample size were combined for statistical analysis. Twenty-five studies including 690 individuals which met the inclusion criteria were selected. After trabeculectomy, a significant and persistent AL reduction, with a range of 0.1-0.19 and 0.1-0.9 mm measured with contact and non-contact methods, respectively, was observed. With respect to topographic changes, 0.38-1.4 diopters (D) with-the-rule (WTR) astigmatism was induced postoperatively. All studies revealed ACD reduction immediately after surgery, which gradually deepened and approximated its preoperative levels on day 14. ACD reduction was not significant after that period in the majority of cases. In conclusion, changes in ACD is of small amount and of short period, thus it can be ignored; however, reported changes in AL and keratometry are of sufficient magnitude and can affect the refractive prediction of combined cataract surgery and trabeculectomy.

Background: Use of laparoscopy in gynecologic surgeries, including adnexal masses, has increased in recent years. The present research intended to study the role of laparoscopy in adnexal masses surgery. Methods: The algorithm for the use and role of laparoscopy in adnexal masses surgery was designed via using first, the model of Ovarian Malignancy Prediction Score (OMPS1) according to findings related to age and ultrasound with high sensitivity and then, the model of OMPS2 (a more specific model). Findings: In case, the surgeon possesses the skill for the level three of laparoscopy, the patients with OMPS1 of less than 2.3 (rule out of malignancy) may undergo laparoscopy. As concerns other cases, provided that frozen section is available, surgery starts with laparoscopy and shall continue up to the end with complete staging, in case the surgeon possesses the skill for the level four of laparoscopy. Conclusion: In adnexal masses surgery, management of the patients is determined via using frozen section and on the basis of the clinical guideline and this method may be used depending on the skill the surgeon possesses for laparoscopy.

Background: Meticulous examination of frozen section of cone specimens is required to precisely evaluate the resection margin status and rule out invasion in cases with high-grade cervical intraepithelial neoplasia (CIN). Objectives: The aim of the present study was to determine the role of frozen section examination (FSE) of the cone specimen in the evaluation of the resection margin status and to rule out invasion in patients with high-grade CIN. Patients and Methods: This cross-sectional study was performed on 38 patients with high-grade CIN undergoing conization biopsy at Imam Hossein hospital in Tehran from April 2012 through May 2013. Then, FS examination was performed for all patients and the results obtained were compared with those of permanent paraffin sections. Results: Thirty-three (86.8%) out of 38 patients had the same results in frozen and permanent sections of cone biopsy margin specimens (P = 1). Two out of 33 (6.1%) patients had frozen and permanent positive margins and 31 (93.9%) patients had negative frozen and permanent margins. Among the other 5 patients (13.2%), 2 had positive frozen margins and negative permanent margins and 3 patients had negative frozen margins and positive permanent margins. Diagnostic accuracies in cone margin and lesion grading were 63.1% and 44.7%, respectively. Conclusions: In conclusion, in high-grade CIN, FS examination was a rapid, reliable and cost-effective means of evaluating cervical conization specimens.

BACKGROUND: Empowerment is an essential issue in women's lives. Powerful women can act successfully in health-related issues more than others. This study aimed to determine the effectiveness of an educational intervention designed based on theory of planned behavior (TPB) on health care empowerment among married women in reproductive age. METHODS: This randomized controlled trial was carried out among 488 reproductive-age women between 2018 and 2019 in Tehran, Iran. Participants were recruited using randomized cluster sampling and divided into intervention (n = 243) and control (n = 245) groups by random allocation. Data were collected using a self-administered researcher-made questionnaire based on TPB and Health Care Empowerment Questionnaire. Validity (content validity index = 0.87; content validity ratio = 0.89) and reliability of the questionnaires were confirmed (α = 0.96). Intervention was implemented within four sessions (lasting 60 min) using eight health related scenarios based on TPB constructs. Baseline and post intervention data (6 months after the intervention) were analyzed by SPSS25(Inc., Chicago, IL, USA) using independent t-test, Chi-squared test, Fisher's Exact test, Mann–Whitney, path analysis, and regression of generalized estimating equation model. P < 0.05 was considered statistically significant. RESULTS: Results showed the mean ± standard deviation age of the participants was 33.6 ± 7.1. Six months after the intervention, a significant difference was highlighted in health care empowerment domains as well as behavioral intention, attitude toward behavior, subjective norms, and perceived behavioral control (P < 0.001) between intervention and control groups. CONCLUSION: TPB-based educational intervention can significantly improve women's perception about health care empowerment. Tailoring and implementation of TPB-based intervention by health policy makers and health care providers is suggested to achieve better perception of empowerment toward receiving health care among women.

INTRODUCTION: Diet adherence may cause diabetes complications to be diminished. OBJECTIVES: This study aimed at identifying determinants of diet adherence among patients with Type 2 diabetes based on the health action process approach (HAPA). METHODS: In this cross-sectional study, 734 patients with Type 2 diabetes, attending to South Tehran health centers, were recruited during June–December 2018. The dietary regimen scale (nine items) and a researcher-designed questionnaire consisting of HAPA constructs were used to gather the data. Data were analyzed using the Mann–Whitney test, Pearson Chi-squared test, Fisher's exact test, and linear regression test. All statistical tests were assessed using SPSS (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY, USA: IBM Corp.). RESULTS: The level of nonadherence to diet was 91.1%. Diet adherence was significantly associated with family income (P = 0.005), level of education (P < 0.001), and age (P = 0.009). The linear regression showed that 55% of the variance of diet adherence was determined by HAPA variables. Diet adherence was associated with intention (P < 0.001), action planning (P = 0.005), and barriers (P = 0.003). CONCLUSION: Most of the patients did not adhere to their diet. Appropriate programs should be designed to promote diet adherence among the patients, especially those with low literacy and patients living in poor communities.

Background: The aim of this study was to develop and evaluate the psychometric properties of a questionnaire for the measurement of reproductive health among female adolescents in Iran. Methods: This cross-sectional study was conducted among 289 female students aged 12-15 yr in Tehran, Iran from 2015-2016. The participants were selected using multi-stage random cluster sampling. In addition, the Belief-Based Reproductive Health Questionnaire (BBRHQ) was designed using the properties of the Theory of Planned Behavior (TPB). Results: Exploratory factor analysis of 104 items identified a six-factor solution. These factors jointly accounted for 67% of the observed variance of outcome variable. The confirmatory factor analysis indicated a good fit to the data. In addition, the Cronbach’s alpha coefficient showed an excellent internal consistency (alpha=0.92). Conclusion: Belief-Based Reproductive Health Questionnaire (BBRHQ) is a valid and reliable instrument for measurement of reproductive health behaviors of adolescents.

Background & Aim: In medical sciences, the outcome is the time until the occurrence of an event of interest. A multi-state model (MSM) is used to model a process where subjects’ transition takes place from one state to the next. For instance, a standard survival curve can be thought of as a simple MSM with two states (alive and dead) and the transition between these two-state models is a method used to analyze time to event data. The most important aspect of this model is that it considers intermediate events and models the effect of covariates on each transition intensity. Some diseases like cancer, human immunodeficiency virus (HIV), etc. have several stages. In the present study, these models were reviewed using cardiac allograft vasculopathy (CAV) data focusing on different approaches. Methods & Materials: The data of 576 CAVs were collected. A time dependent simple Cox regression model (CRM) was fitted and a three-state illness-death model was considered for the MSMs. Results: In the simple CRM, only the individuals with the age of > 50 were significant, however for Cox Markov model (CMM) and Cox semi-Markov model (CSMM), the donor’s age > 40, sex, and the individuals with the age of > 50 were other significant covariates. Conclusion: The CMM and CSMM showed more accurate results about risk factors compared to the simple CRM.

Background: Parkinson's disease (PD) is characterized by proteinopathies and these proteinopathies seem to interact synergistically and lead to protein aggregations and changes in protein cerebrospinal fluid (CSF) levels. In this study, we aimed to explore the longitudinal changes of CSF a lpha-synuclein (α-syn), total tau (t-tau), phosphorylated tau (p-tau), and beta-amyloid (Aβ1−42) and their relationships with each other and with baseline clinical entities like REM sleep behavior disorder (RBD), cognitive impairment, motor symptoms, and olfaction dysfunction.Method: One hundred and twelve non-demented PD patients and 110 controls were recruited from Parkinson's Progression Markers Initiative (PPMI).We used a linear mixed model within groups to assess longitudinal protein changes over 6 and 12 months and a random regression coefficient within the linear mixed model to investigate the correlation between proteins and their baseline clinical characteristics.Results: P-tau was lower in PDs only at baseline, but during a year, p-tau increased more rapidly in PDs than controls. Aβ1−42 was not significantly different between groups at any separate timepoint; however, when assessed longitudinally, Aβ1−42 showed significant changes in both groups. Conversely, t-tau and α-syn differed significantly between groups, but their longitudinal changes were not significant in either of the groups. Moreover, all proteins' baseline levels, except p-tau, could determine estimated longitudinal tau changes. Baseline RBDSQ scores but not UPDRS III, MoCA, or UPSIT scores were predictive of longitudinal increase in α-syn levels.Conclusion: Longitudinal changes in levels of CSF proteins are related to each other and could help researchers further understand PD pathology. In addition, RBD seems to be a potential prognostic factor for PD progression. However, in order to reach a consensus, longer follow-up times are required.

Background: Pilocarpine is commonly used after angle surgery for glaucoma despite a host of side effects and risks. We hypothesized that a pharmacological miosis during the first two months does not improve short- and long-term results of trabectome-mediated ab interno trabeculectomy. Methods: In this retrospective comparative 1-year case series, we compared 187 trabectome surgery eyes with (P+) or without (P-) 1% pilocarpine for two months. Primary outcome measures were the surgical success defined as intraocular pressure (IOP) ≤ 21 mmHg and decreased ≥ 20%, and no secondary glaucoma surgery. Secondary outcome measures were the number of glaucoma medications, complications, and IOP. Results: We categorized 86 (46%) eyes as P- and 101 (54%) eyes as P+. The mean age was 69.8±10.1 in P- and 70.5±9.4 in P+ (P=0.617) with equal gender distribution (P=0.38). The cumulative probability of qualified success at 12 months was 78.1% in the P- and 81% in the P+ (P=0.35). The IOP was decreased significantly from 20.2±6.8 mmHg at baseline to 15.0±4.8 mmHg at 12 months follow-up in P- (P=0.001) and 18.8±5.3 and 14.7±4.0, respectively (P=0.001). The medications decreased significantly from 1.4±1.2 in P- and 1.4±1.2 in P+ at baseline to 1.0±1.2 and 0.7±1.0, respectively (P=0.183). P- and P+ did not differ in IOP or medications (all P>0.05). In Multivariate Cox Regression models, the baseline IOP and central corneal thickness were associated with failure. Conclusions: Use of postoperative pilocarpine does not improve the efficacy of trabectome surgery.

PURPOSE:To classify subjects with primary angle closure into clusters based on features from anterior segment optical coherence tomography (ASOCT) imaging and to explore how these clusters correspond to disease subtypes, including primary angle closure suspect (PACS), primary angle closure glaucoma(PACG), acute primary angle closure (APAC) and fellow eyes of APAC and reveal the factors that become more predominant in each subtype of angle closure. METHOD:A cross-sectional study of 248 eyes of 198 subjects(88 PACS eyes, 53 PACG eyes, 54 APAC eyes and 53 fellow eyes of APAC) that underwent complete examination including gonioscopy, A-scan biometry, and ASOCT. An agglomerative hierarchical clustering method was used to classify eyes based on ASOCT parameters. RESULTS:Statistical clustering analysis produced three clusters among which the anterior segment parameters were significantly different. Cluster 1(43 eyes) had the smallest anterior chamber depth(ACD) and area, as well as the greatest lens vault (p