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Purpose: To evaluate the lacrimal punctal changes in different age groups using anterior segment optical coherence tomography (AS-OCT). Methods: A cross-sectional observational study was conducted between January 2023 and January 2024 including healthy subjects between 20 and 80 years. The selected eyes from healthy patients were divided into four age groups (21–35 years, 36–50 years, 51–65 years, 66–80 years), and lower lacrimal puncta were analyzed using AS-OCT. Outcome measures included external punctal diameter (EPD, distance between the highest points of the punctal papilla), internal punctal diameter (IPD), vertical canalicular depth (VCD), fluid seen within the punctum, and presence of ampulla. Results: 128 eyes of 64 patients were included with 32 eyes in each group. The mean EPD ranges from 441.5 ± 74.9 μm to 638 ± 138.8 μm among different age groups. The mean IPD varies between 251 ± 22.2 μm and 335 ± 21.6 μm. The mean VCD ranges from 424.2 ± 127.2 μm to 925 ± 144.1 μm among different age groups. The fluid within the punctum in the age group 21–65 years was 85–91%, which decreased notably to 40% in the 66–80 years age group. Ampulla was present in 11 (8.5%) out of 128 eyes. All the punctal parameters were the highest in the premenopausal age group (≤50 years) compared to the postmenopausal age group (P < 0.001). The values of all punctal parameters were higher in males compared to females. Conclusion: AS-OCT is a useful tool to evaluate lacrimal punctal structure in vivo. Age-related correlations were found in the punctal quantitative parameters.

Over the past three years, since the onset of COVID-19, several scientific studies have concentrated on understanding susceptibility to the virus, the progression of the illness, and possible long-term complexity. COVID-19 is broadly recognized with effects on multiple systems in the body, and various factors related to society, medicine, and genetics/epigenetics may contribute to the intensity and results of the disease. Additionally, a SARS-CoV-2 infection can activate pathological activities and expedite the emergence of existing health issues into clinical problems. Forming easily accessible, distinctive, and permeable biomarkers is essential for categorizing patients, preventing the disease, predicting its course, and tailoring treatments for COVID-19 individually. One promising candidate for such biomarkers is microRNAs, which could serve various purposes in understanding diverse forms of COVID-19, including susceptibility, intensity, disease progression, outcomes, and potential therapeutic options. This review provides an overview of the most significant findings related to the involvement of microRNAs in COVID-19 pathogenesis. Furthermore, it explores the function of microRNAs in a broad span of effects that may arise from accompanying or underlying health status. It underscores the value of comprehending how diverse conditions, such as neurological disorders, diabetes, cardiovascular diseases, and obesity, interact with COVID-19.

Abstract Background Systemic Lupus Erythematosus (SLE) affects all organ systems. As a result, fat intake and sedentary life are evident in the modern world. The prevalence of metabolic syndrome, with its components, increased, leading to increased mortality. We aimed to investigate the prevalence of metabolic syndrome in SLE and its relationship with disease activity. Methods A cross-sectional study was conducted on 70 SLE patients at Al Mouwasat University Hospitals in Damascus, Syria, between November 2021 and November 2022. The patients were divided into two groups based on the presence or absence of metabolic syndrome. The SLE Disease Activity Index (SLEDAI) was assessed in each group and compared with different disease parameters. Results Out of the 70 patients, 65 were females. The mean age was 32.19 ± 7.15 years, and the mean disease duration was 4.4 ± 2.96 years. Metabolic syndrome was found in 32 patients (45.7%). Metabolic syndrome in SLE patients was associated with a higher disease activity index, older age, delayed age at first diagnosis, longer disease duration, higher frequency of renal involvement, and use of cyclophosphamide. Conclusion Our study highlights the importance of evaluating and treating metabolic syndrome and its components in patients with SLE, as it may play a role in controlling disease activity. We recommend conducting larger studies in the future to overcome the limitations of this research, such as including a larger number of patients, conducting multicenter studies to generalize the results, and including a healthy control group.

Neuroendocrine tumors are malignant neoplasms arising from neuroendocrine cells. These are increasingly recognized with rising incidence and encompass a diverse range of phenotypes. The large majority of these originate in the gastrointestinal tract however primary neuroendocrine tumors have also been reported to arise in a variety of organs such as lung, breast, prostate, and skin. Primary malignant paratesticular masses are often sarcomatous in origin and metastatic spread to the paratesticular region or scrotum is exceedingly rare. We report a fascinating case of a 56-year-old male who had an unusual initial presentation of paratesticular lesions on a background of an undescended testicle and an incidental umbilical nodule. After a combination of radiological and histopathological investigations, he was diagnosed with metastatic midgut neuroendocrine tumor.

Introduction: functional exercises and consumption of the medicinal plant Ginkgo biloba, a natural source of flavonoids and polyphenolic compounds, have beneficial effects in improving the inflammatory state and physical performance of people exposed to occupational stress. Therefore, the aim of the present study was to investigate the effect of 12 weeks of high-intensity functional training and consumption of Ginkgo biloba extract on the serum levels of interleukin-8 and interleukin-1β in operational male firefighters of Yazd city. Materials and Methods: For this purpose, 48 male firefighters were randomly divided into four groups including high-intensity functional training (HIFT), high-intensity functional training with ginkgo biloba consumption, ginkgo biloba extract consumption, and control-placebo. The training was carried out for 12 weeks and 4 sessions per week. Ginkgo biloba extract (80 mg) was administered as two capsules once a day after breakfast for 12 weeks. Blood samples were taken before and 48 hours after the last training session. Data were analyzed using two-way analysis of variance with SPSS-26 software. Results: The results showed that the interaction effect of exercise and ginkgo biloba extract, as well as the effect of exercise and ginkgo biloba extract alone, caused a significant decrease in the serum levels of interleukin-8 and interleukin-1β (p

Background: This study examined the level of satisfaction of medical and public health students in the management and supervision of Preceptorship in health internships. Method: In this cross-sectional study, all students who have passed their health apprenticeship and internship courses under preceptorship supervision (from 2019 to 2021) were chosen via census method as the study sample (n=208). A modified nursing clinical facilitator questionnaire was used for data collection. Data analysis was done using SPSS 20 through the T-test, ANOVA, and Pearson correlation coefficient. Results: The mean age of the subjects was 23.41±2.46 years, the average academic GPA was 16.85±1.35. The mean satisfaction score with the preceptorship program among public health students was 104.34±23.32 and among medical students was 100.45±24.05. The largest mean was related to the items "the feedback and guidelines of preceptor are honest and correct (10.4±1.10)" and "preceptor does her best to keep the client's secrets confidential and also reminds students to observe this issue (4.50±1.11)". The lowest mean was related to the items "the preceptor gives me the sufficient opportunity for independence in tasks (3.86±1.09)" and "the preceptor attempts to determine and investigate my learning needs and do the training accordingly (3.86±1.11)".Conclusion: This approach could receive a desirable student satisfaction score based on the findings. Thus, the sustenance of this approach can have a good effect on students' training skills. It is suggested that it be implemented and its impact in other fields and internship courses be examined.

Purpose: Ultrasonography (US) can be used to measure the dimensions and the cross-section of muscles. This study aims to investigate the intra- and inter-tester reproducibility of the US measures of the cross-section of the longus colli (LC) muscle at rest and in contraction states in patients with chronic non-specific neck pain (CNSNP) and healthy individuals. Methods: This cross-sectional study was conducted on seven healthy individuals and seven patients with chronic non-specific pains. The cross-section of the LC muscle was measured at rest and in contraction states at the C5-6 vertebrae by two raters using the US on two consecutive days. The data were analyzed by the Pearson correlation coefficient (ICC). Results: The intra-tester reproducibility was excellent in the healthy (ICC>0.97) and patient (ICC>0.95) groups at rest and in contraction. The inter-tester reproducibility was great in the healthy group (ICC>0.97) in both states and at rest (ICC=0.98) and in the contraction (ICC>0.95) in the patient group. Conclusion: The results revealed that the US demonstrated higher agreement in measuring the cross-section of the LC in healthy subjects and patients with CNSNP. Thus, this method is reliable and can be used to measure the cross-section of the muscles.

The essay explores the rising popularity of feminist dystopian fiction in literary studies, focusing on Leni Zumas' novel Red Clocks. It investigates how political anxieties are depicted through the interior monologues of four main female characters, highlighting the colonization of the female body as they grapple with unwanted pregnancies and resort to illegal means for abortions. The study suggests that feminist dystopian fiction, exemplified by Red Clocks, can be prophetic, anticipating issues such as abortion rights restrictions in the United States. The paper underscores the genre's role in raising awareness among women, depicting a world where men dictate how women should manage their bodies.

Background and Objective: In the present study, the factors related to the acceptance of the COVID-19 vaccine by the parents of children aged 5-12 years were investigated. Materials and Methods: This web-based cross-sectional descriptive study was conducted on 340 parents of children aged 5-12 in Bojnord City in 2022. The data collection tool included the demographic profile form and the attitude and awareness form about the COVID-19 vaccine for children. The data were analyzed by descriptive statistics, chi-squared, and independent t-tests. Results: More than 60% of parents did not want to vaccinate their children against COVID-19. Most parents declared the danger of the vaccine as their most important concern (45.9%). Besides, most parents evaluated their knowledge and awareness about the COVID-19 disease and its vaccine at an average level (57.4%). There was no significant relationship between the level of knowledge and awareness of parents and their acceptance of the COVID-19 vaccine (P

Background & Aims The family caregivers of patients with spinal cord injury (SCI) suffer from physical, psychological, social, and economic problems, which are called care burdens. The continuous support of these caregivers can reduce their care burden. This study aims to investigate the effect of the continuous care model (CCM) on the care burden of the caregivers of patients with SCI. Materials & Methods This quasi-experimental study was conducted in the winter of 2021 on 94 caregivers of patients with SCI covered by the welfare organization of Kamyaran City. They were selected using a convenience sampling method and randomly divided into intervention and control groups. The collection tools were a demographic form and the Zarit care burden interview (ZBI). The intervention group received the CCM-based intervention as a home-visiting program individually or in group format for three months. The control group received the routine patient care program presented by the welfare organization. The data were analyzed in SPSS v.16 software using descriptive and inferential statistics. Results After the CCM-based intervention, there was a significant reduction in the care burden of caregivers in the intervention was observed (P0.05). Conclusion The CCM-based intervention is effective in reducing the care burden of the caregivers of patients with SCI. It is recommended that the intervention be used on the caregivers of patients with other chronic diseases.

Allah Teâlâ’nın insanları esenliğe ulaştıracak mesajlarını doğru anlayabilmek için, Kur’an’ın ilk muhataplarının sahip oldukları zihniyeti dikkate almak zorunludur. Çünkü ilahî mesaj evvelemirde muhatap kitlenin lisanı üzere ve onların kültür ve zihin kodlarını dikkate alarak nazil olmuştur. Bu yüzden Kur’an-ı Kerim’in Allah’ın muradına uygun olarak anlaşılabilmesi için, dil tahlilleri ve sözlük bilgisiyle birlikte Mekke toplum kültürünün de göz önünde bulundurulması gerekmektedir. Bilindiği gibi Câhiliye Arapları Allah mefhumundan habersiz kimseler değillerdi. Nitekim ilahî kelamın ilk nazil olan surelerinden itibaren onun Allah’ı bilen ve O’na inanan bir topluma hitap ettiği anlaşılmaktadır. Ancak Mekke müşrikleri Allah’ı en yüce tanrı olarak benimsemekle birlikte O’nun yanı sıra bir takım tanrılar da edinmişlerdi ve onlara da Allah’a ibadet ettikleri gibi tazimde bulunuyorlardı. Bu minvalde Mekke toplumunun günlük yaşamı adeta putların etrafında dönüyordu ve şirk zihniyeti toplumun bünyesini tamamen sarmıştı. Müşrikler, ilah edindikleri putlarına tazimde bulunmalarının yanı sıra bu putların onları kötülük ve felaketlerden koruduğuna, ihtiyaç duydukları şeylerin onlar sayesinde elde edildiğine inanıyorlardı. Anlaşıldığına göre Kur’an’ın ilk muhatapları olan Mekke müşriklerinin tanrı tasavvuru, en üst kademede Allah adında yüce bir tanrının bulunduğu bir “tanrılar sistemi”ne benzemektedir. Vahyin nazil olmaya başladığı vasattaki bu özel duruma mukabil Kur’an, şirk müptelası olan Mekkelileri tevhit zihniyetine ulaştırmayı hedeflemiş ve şirkle amansız bir mücadele başlatmıştır. Bu münasebetle özellikle Mekke döneminde nazil olan âyetleri bu konteksti göz önünde bulundurarak anlamaya çalışmak gerekir. Aksi halde Furkân sûresi 77. âyette olduğu gibi tevhit çağrısı dikkatlerden kaçacak ve Kur’an’ın vermek istediği mesaj hedefine ulaşmayacaktır. Nitekim toplumumuzda hutbe, vaaz ve dinî sohbetlerde dua söz konusu olduğunda, araştırılarak ulaşılmış bir sonuç olmaktan ziyade, ezbere dayalı olarak hemen bu âyet-i kerime akla gelmektedir. Hâlbuki âyet, kanaatimizce farklı bir mesaj vermekte ve bir bütün olarak ilgili muhatabına çağrısını iletmektedir. Ayrıca dil ve gramer bakımından da âyetin yapısı bu âyette yer alan iki cümleyi farklı kişileri muhatap alan iki ayrı cümle şeklinde okumaya müsait değildir. İlgili âyet, metin içi ve metin dışı bağlamları dikkate alınarak ve kendi içinde bir bütünlük oluşturacak şekilde değerlendirildiğinde, âyetin öncelikle ve özellikle Mekke müşriklerini ikaz edici mahiyette olduğunu söylemek isabetli olacaktır. Böylece, Allah ile birlikte putları da ilah edinen ve onlara da tazimde bulunan kimselerin O’nun katında hiçbir kıymetlerinin olmayacağı bildirilmiş olmaktadır. Furkân 25/77 âyetinin içerdiği bu açık mesajın, gerek ilk Kur’an sözlüklerinde gerekse klasik tefsirlerde karşılık bulduğu ve bu eserlerde âyetteki Allah’ın vahdaniyetine yönelik vurgunun ifade edildiği görülmektedir. Ancak ülkemizde tedavülde bulunan belli başlı Türkçe Kur’an meallerine bakıldığında, âyetin bağlamının dikkate alınmamasına bağlı olarak âyetteki tevhit vurgusunun ihmal edildiği anlaşılmaktadır.

Abstract Background Limb salvage by ortho-plastic teams is the standard protocol for treating open tibial fractures in high-income countries, but there’s limited research on this in conflict settings like the Gaza Strip. This study assessed the clinical impact of gunshot-related open tibial fractures, compared patient management by orthopedic and ortho-plastic teams, and identified the risk factors for bone non-union in this context. Methods A retrospective review of medical records was conducted on Gaza Strip patients with gunshot-induced-open tibial fractures from March 2018 to October 2020. Data included patient demographics, treatments, and outcomes, with at least one year of follow-up. Primary outcomes were union, non-union, infection, and amputation. Results The study included 244 injured individuals, predominantly young adult males (99.2%) with nearly half (48.9%) having Gustilo-Anderson type IIIB fractures and more than half (66.8%) with over 1 cm of bone loss. Most patients required surgery, including rotational flaps and bone grafts with a median of 3 admissions and 9 surgeries. Ortho-plastic teams managed more severe muscle and skin injuries, cases with bone loss > 1 cm, and performed less debridement compared to other groups, though these differences were not statistically significant. Non-union occurred in 53% of the cases, with the ortho-plastic team having the highest rate at 63.6%. Infection rates were high (92.5%), but no significant differences in bone or infection outcomes were observed among the different groups. Logistic regression analysis identified bone loss > 1 cm, vascular injury, and the use of a definitive fixator at the first application as predictors of non-union. Conclusions This study highlights the severity and complexity of such injuries, emphasizing their significant impact on patients and the healthcare system. Ortho-plastic teams appeared to play a crucial role in managing severe cases. However, further research is still needed to enhance our understanding of how to effectively manage these injuries.

In a descriptive-analytical study, we investigated academic dishonesty among general medical students during clinical rotations and proposed suggestions for improvement. A total of 106 medical students in the clinical periods were randomly selected for the study. We used a questionnaire consisting of four parts: demographic characteristics, causes of dishonesty, types of dishonesty, and suggestions for reducing dishonesty. The results showed that 50% of the students had a history of dishonesty during their clinical rotations. Marital status and the stage of clinical education were found to be related to dishonesty. The main reasons for dishonesty reported by the students were distress during clinical rotations and a lack of alignment between clinical education and their expectations. Common types of dishonesty during clinical rotations included gathering exam information from previous students and falsifying attendance records. The study concludes that the high prevalence of academic dishonesty among medical students during clinical rotations is concerning. It suggests the need to address distress among students, align clinical education with learners’ expectations, and continuously monitor academic integrity to reduce dishonesty.

Background A digital decision support system in healthcare is a digital health intervention that assists healthcare professionals in decision-making by providing treatment recommendations and enhancing diagnostic accuracy and quality of care. This will be the first study in Pakistan to assess the system’s usability, acceptability and effectiveness in improving healthcare outcomes while also evaluating the perceived quality of care. This comprehensive assessment will inform policy development in areas such as the scale-up of digital health interventions, data privacy and technology interoperability. Measures of effectiveness will include changes in clinical outcomes through a patient exit feedback survey. This study aims to evaluate the role of digital decision support systems in healthcare decision-making, which may be integrated into Pakistan’s tele-primary healthcare system.Methods The study will employ a multimethod approach. The data collection tools are adapted from the WHO’s digital health intervention monitoring and evaluation framework and include a technology assessment, healthcare provider surveys, patient exit interviews and focus group discussions with healthcare providers. Purposive sampling will be used for qualitative interviews with providers (doctors) and patients. Government stakeholders, private sectors, multilateral, academia and policymakers will be engaged through a consultative meeting. We will also conduct a literature review, as well as a comprehensive analysis of existing studies, documents and data relevant to digital decision support systems and digital health interventions implemented globally, and assess the performance, challenges and opportunities.Ethics and dissemination The study has been approved by the Ethics Review Committee at The Aga Khan University (2023-8514-26533). The dissemination of study findings through scientific publications and seminars will enable programme managers and policymakers to design tools to improve the quality of care provided through telemedicine platforms. This will contribute to efficient decision-making, access and quality of care for primary healthcare in low-income and middle-income countries. This study will also inform policy regarding the scale-up of decision support systems in primary care settings, data privacy and technology interoperability.

Vibrio parahaemolyticus infection is a major threat to Pacific white shrimp aquaculture, causing significant shrimp mortality. Bacteriophages (phages) provide a promising antibiotic alternative due to their specificity towards specific bacteria. This research includes essential steps isolating phages from shrimp pond water and characterizing them, including plaque morphology, spot tests, phage density evaluations, host range assessments, and in vitro studies targeting V. parahaemolyticus. In-vitro tests encompassed six treatments, each with three replicates: negative control (K-), positive control (K+), antibiotic control, phage density of 107 (FB7), phage density of 108 (FB8), and phage density of FB109 (FB9). Phages were successfully isolated from shrimp pond water in Banyuwangi, indicated by plaque formation on double-layer agar media. These phages exhibited morphological characteristics, featuring small, round plaques (d= 0.02-0.5 ± 0.08 cm) with flat, wavy edges and clear plaque. Phage plaques were amplified with an average density of 3.5×109 PFU/mL. Host range tests revealed that only V. parahaemolyticus Situbondo was susceptible to the isolated phages, while five other bacterial strains were not. In bacterial inhibition tests, treatments with different phage densities significantly outperformed the negative control, media control, and antibiotic control. However, the antibiotic control performed better than phage density treatments (0.61 ± 0.01). All phage density treatments effectively reduced V. parahaemolyticus density compared to the negative control, with the most favorable results observed in the FB9 treatment at a density of 109 PFU/mL. Keywords: Aquaculture, antibiotic, bacteriophage, vannamei shrimp, Vibrio parahaemolyticus ABSTRAK Penyakit akibat infeksi Vibrio parahaemolyticus menjadi perhatian utama dalam budidaya udang vaname saat ini karena dapat menyebabkan kematian massal pada udang. Penggunaan bakteriofage (fage) dapat menjadi alternatif solusi untuk menggantikan antibiotik, karena fage bersifat spesifik pada bakteri tertentu. Penelitian ini meliputi beberapa tahapan, yaitu isolasi fage dari beberapa sumber air tambak, karakterisasi fage meliputi morfologi plak fage, spot test, dan uji kisaran inang, serta uji in vitro penghambatan V. parahaemolyticus oleh fage. Uji in vitro dilakukan dengan enam perlakuan dan masing masing tiga ulangan yaitu kontrol negatif (K-), kontrol positif (K+), kontrol antibiotik, kepadatan fage 107 (FB7), kepadatan fage 108 (FB8), dan kepadatan fage 109 (FB9). Penelitian ini berhasil mengisolasi fage yang bersumber dari air tambak udang di Banyuwangi ditandai dengan terbentuknya plak pada media double layer agar, dengan ciri morfologisnya berbentuk titik-titik dan bulat besar (d= 0,02 ± 0,08 cm), tepian rata dan bergelombang serta memiliki warna plak yang bening. Plak fage dapat diperbanyak dengan densitas fage rata-rata 3,5×109 PFU/mL. Untuk uji kisaran inang menggunakan 6 jenis bakteri dengan sumber dan strain yang berbeda, menunjukkan bahwa hanya bakteri V. parahaemolyticus Situbondo yang dapat lisis oleh fage hasil isolasi, sedangkan lima jenis bakteri lainnya tidak. Pada daya hambat bakteri, perlakuan dengan penambahan pada setiap densitas fage berbeda nyata dibandingkan dengan kontrol negatif, kontrol media dan kontrol antibiotik, walaupun kontrol antibiotik lebih baik dari perlakuan densitas fage (0,61 ± 0,01). Semua perlakuan kepadatan fage mampu mengurangi kepadatan V. parahaemolyticus dibandingkan dengan perlakuan kontrol negatif. Hasil terbaik terdapat pada perlakuan FB9 yaitu 109 PFU/mL. Kata kunci: akuakultur, antibiotik, bakteriofage, udang vaname, Vibrio parahaemolyticus

Aim: Innovation is vital in emergency departments (EDs), advancing diagnostics, triage, communication, and personalized treatment to save lives and improve patient outcomes. This study aims to assess the self-perceived innovation capacities of employees in the ED of a major quaternary care hospital in Karachi, Pakistan, to establish a baseline and identify areas for improvement. Materials and Methods: This study employed a descriptive cross-sectional design to assess the innovation skills of employees in the Department of Emergency Medicine and the 24/7 Emergency and Acute Care Service Line at the Aga Khan University Hospital in Karachi, Pakistan. The sample size of 130 employees was determined using non-probability purposive sampling. The study used the Innovation Skills Assessment, a close-ended structured questionnaire, to measure employees’ self-perceived strengths and weaknesses in the four pillars of innovation skills. Descriptive statistics and visualizations were used for data analysis. Ethical approval and informed consent were obtained beforehand. Results: The study showed that employees generally had a positive self-assessment of their innovation skills. There were differences between genders, with males scoring slightly higher. Young employees did not perceive themselves as more innovative, whereas older employees scored lower. Postgraduates and nurses self-assessed higher innovation capacities. Overall, employees showed strengths in idea generation and relationship building but had room for improvement in risk-taking and entrepreneurship. Conclusion: This study emphasizes the importance of fostering innovation in EDs in low-resource settings to improve patient outcomes. These findings can inform targeted interventions to enhance innovation skills and promote a culture of innovation and entrepreneurship in EDs globally, and in healthcare organizations overall. Further research is needed to explore the relationship between self-assessed and actual innovation performance.

Background:The objective of this study was to compare the levels of vitamin D in non-pregnant women with a history of recurrent pregnancy loss (RPL) who were seropositive or seronegative for autoantibodies (autoAbs). Methods: The study examined 58 RPL patients with autoAbs (ANA, anti-TPO, or APAs), 34 RPL patients without autoAbs, and 58 healthy women with prior successful pregnancies and without autoantibodies. The levels of 25 (OH) D were measured using the sandwich ELISA technique. Results:Our results showed insufficient serum 25(OH) D levels in study groups, with significantly lower levels observed in RPL patients with or without autoAbs compared to healthy women (P=0.0006). In addition, RPL patients with autoAbs had significantly lower 25(OH) D levels compared to RPL patients without autoAbs. We also found that serum levels of 25(OH) D in RPL patients with autoAbs were significantly lower than in RPL patients without autoAbs (20.51 ± 1.15 ng/ml Vs. 23.69 ± 0.74 ng/ml, P=0.0356). Further analysis indicated that RPL patients who were positive for ANA, and APAs, except anti-TPO, had significantly lower than 25(OH)D serum levels than RPL patients without autoAbs. Conclusion: These findings suggest that RPL patients, especially those with APAs or ANA, have lower vitamin D levels compared to healthy women. This may indicate a link between maternal immune dysregulation due to vitamin D deficiency and the presence of autoantibodies in RPL.

Abstract Background The Syrian decade-long war has severely affected the healthcare system, including almost vanishing cancer screening practices, war-destroyed medical facilities, and lack of continuous medical education. This study aims to present data on the affected breast cancer screening practices, methods of diagnosis, and stages distribution in Syria. Methods Medical charts of breast cancer patients treated at Albairouni University Hospital between January 2019 and May 2022 were retrospectively reviewed. Eligible patients were women diagnosed with primary breast cancer. Exclusion criteria included females receiving neoadjuvant chemotherapy and incomplete charts. Data regarding the patient’s age, city of residence, marital status, number of children, smoking habits, method of diagnosis, tumor size (T), lymph nodes (N), and distal metastasis (M) were collected. We used Microsoft Excel and Statistical Package for the Social Sciences (SPSS) to analyze data. Descriptive methodology (frequency [n], percentage) was used. Results The number of charts reviewed was 4,500. The number of remaining charts after applying the exclusion criteria was 2,367. The mean age was 51.8 (SD = 11.3). More than half of the patients (58.3%) came from outside Damascus -where the hospital is located- and its suburbs. Less than 5% of the population detected cancer by screening mammography. Only 32.4% of patients were diagnosed by a biopsy, while surgical procedures (lumpectomy and mastectomy) were used to diagnose 64.8% of the population. At the time of diagnosis, only 8% of patients presented with local-stage disease (stages 0 & I), 73% had a regional disease (stages II & III), and 19% had metastatic breast cancer (stage IV). Conclusion Our retrospective chart review analysis is the first comprehensive review in Syria for female breast cancer patients. We found a significant low percentage of patients diagnosed based on a screening mammogram, much higher surgical biopsies rather than a simple imaging-guided biopsy, and much lower than the national average of early-stage disease. Our alarming findings can serve as the base for future strategies to raise the population’s health awareness, create more serious national screening campaigns, and adopt a multidisciplinary approach to the disease in Syria.

Mantra and Its Function in ZoroastrianismMantra is one of Zoroastrian most essential teachings. Avestan Mantra denotes “Avesta as a sacred book,” “holy discourse,” and certain Avestan prayers whose accurate recitation is crucial. It is claimed that this notion was granted to humanity by Ahura Mazda and the deities via Zoroaster’s teachings. Mantra is regarded as holy since it is linked with divinity and myths. This sacred relationship is represented via rituals. In such rituals, the deities must be summoned through certain sacred chants. The requirement for precision in reading the prayers and performing the rituals necessitates the presence of Zoroastrian clergy, whereas ordinary Zoroastrians must refrain from chanting them. Mantra has several uses in Zoroastrianism, including chanting the holy words in Yasna practices of worship, being used in rites of cleansing and embracing the faith, being used as a healing tool, repelling evil spirits, and being used in prayers. This descriptive-analytical study seeks to analyze the Avesta and other Pahlavi literature and to provide evidence from Zoroastrian experts to define the concept and functions of Mantra.Keywords: Mantra, holy discourse, Zoroaster, Avesta, Pahlavi texts, rituals in Zoroastrianism

This study combined hydrological and water quality simulation models with a water resources planning model to project future water supply conditions under the dam construction in the Harirud River, located at the Afghanistan, Turkmenistan, and the Iran border. The sustainability requirements and possible conflicts among riparian countries were assessed under climate change and future development in Afghanistan's upstream. The water quantity and quality of the Doosti Dam Basin on the Harirud River were investigated based on a contemporary time (1955–2015) to predict the future condition (2020–2099). The representative concentration pathway scenarios were applied based on five bias-corrected climate models. Results showed that most areas of the study area experienced an increase in temperature (1.5–3.8°C) and a decrease in precipitation (19–24%). The Doosti Dam inflow decreased by about 70% after the Salma Dam construction, and the reliability and sustainability of agricultural water supply in Iran and Turkmenistan will reduce to less than 3% under the representative concentration pathways 8.5 climate change scenario. The results show that the Doosti Dam is not a reliable source to supply the domestic water demand of Mashhad, the second most important city in Iran. HIGHLIGHTS Planning water resources and scenario building in transboundary rivers.; Investigating the effects of climate change and upstream development on downstream runoff changes.; Combining simulation and optimization models to determine the appropriate prospect of development.;

Abstract Background The COVID-19 pandemic emerged as an expected source of stress and anxiety as the healthcare workers had to work for long hours in close contact with infected patients, thus increasing the probability of medical errors and threatening the patients’ safety. This study aims to measure the levels of depressive symptoms, anxiety symptoms, and stress among Syrian healthcare workers and their quality of life during the COVID-19 pandemic. Methods A cross-sectional study was conducted in six central hospitals in Damascus, Syria. Data were collected from 1 to 30 June—2021. The Depression Anxiety Stress Scale—21 (DASS-21) was used to evaluate depression, anxiety, and stress among healthcare workers. Quality of life was assessed using the EUROHIS-QOL 8-item index. Results A total of 700 participants were included in this study. 61.6% (n = 431) were males and 38.4% (n = 269) were females. Younger ages (18–29 years old) were significantly associated with higher levels of depression and stress (p

BackgroundArmed conflict injury is a growing public health concern, particularly in regions like the Middle East and North Africa (MENA). The protracted conflicts and political unrest in this region have led to a substantial number of injuries. Despite this, there is still limited understanding of the specific injury patterns stemming from conflicts, such as the 2006 Lebanon conflict. This study aimed to assess the characteristics and burdens of injuries resulting from this conflict, which occurred 16 years prior to this research.MethodsThis retrospective study analyzed data of individuals affected by the 2006 Lebanon conflict, across three tertiary care centers. Demographics, injuries, complications, injury management, and hospitalization expenses were extracted from medical records and analyzed using SPSS version 29.0. Categorical variables were presented as counts and proportions, and continuous variables as mean ± standard deviation (SD). Hospital comparisons utilized chi-square or Fisher’s exact tests for categorical variables, and one-way ANOVAs for continuous variables. Analysis was conducted from September to November 2023.ResultsAcross three hospitals, 341 patients were studied, comprising 73.6% males and 26.4% females. Among them, a notable proportion (57.3% males and 34.1% females) fell within the 18–39 age range. Children and adolescents under 18 years accounted for 15.9% of males and 25.9% of females. Blast-related injuries predominated, with 24.5% resulting from direct damage caused by explosive parts and 33.3% from blast wave forces. Extremity trauma occurred in 49.0% of patients, and head/neck trauma in 24.9%. Common injuries, including penetrating, musculoskeletal, and traumatic brain injuries affected 34.9%, 31.1, and 10.0% of patients, respectively. Wound repair, fracture treatment, and debridement were the most performed procedures on 15.5, 13.5 and 9.7% of the patients, respectively. The total cost of care was USD 692,711, largely covered by the Ministry of Public Health (95.9%).ConclusionConflict-related injuries significantly contribute to the global burden of disease. Therefore, there is a pressing need to improve national guidelines to prioritize life-threatening cases and potential long-term disabilities. Furthermore, enhancing electronic registry systems to collect clinical data on injured patients is essential for conducting research and better understanding the needs of conflict casualties.

Introduction Dementia is a progressive and debilitating disease, and people living with HIV (PLWH) often develop dementia much earlier than those not living with HIV. We estimated the incidence and prevalence of dementia and identified its key risk factors in a cohort of PLWH in British Columbia, Canada.Methods This retrospective cohort study used data from the Seek and Treat for Optimal Prevention of HIV/AIDS study. Eligible individuals were diagnosed with HIV, ≥40 years of age, naïve to antiretroviral therapy (ART), had no dementia at the index date and were followed for ≥1 year during 2002–2016. Our main outcome was incident dementia. We examined the effect of sociodemographic and clinical covariates on the incidence of dementia using a cause-specific hazard (CSH) model, with all-cause mortality as a competing risk event.Results Among 5121 eligible PLWH, 108 (2%) developed dementia. The crude 15-year prevalence of dementia was 2.1%, and the age–sex standardised incidence rate of dementia was 4.3 (95% CI: 4.2 to 4.4) per 1000 person-years. Among the adjusted covariates, CD4 cell count

Background: Routine vaccination has remained historically low in major urban pockets of Pakistan, and now lags behind rural vaccination rates. Grossly insufficient publicly funded primary healthcare infrastructure, heterogeneous mix of providers and multi-ethnicity of populations pose challenges in the delivery of essential health services. This paper ascertains factors associated with uptake of routine childhood vaccination, using Pentavalent-3 vaccine, as a proxy indicator for completion of age-appropriate vaccines in urban slums of Karachi, at high risk of Polio and vaccine preventable disease outbreaks. Methods: Data was drawn from baseline assessment of an urban immunization delivery pilot project in urban slums of Karachi, Pakistan. The study sample comprised of 2,097 households with children aged 4–12 months, sampled through a cross-sectional cluster survey, applying a structured questionnaire. Multivariable logistic regression was used to determine the association between Penta-3 vaccination, as the outcome variable, and predictor variables including socio-demographic characteristics and healthcare access factors. Results: The findings showed that the likelihood of being immunized with Penta-3 was higher for non-Pashtun ethnicity [adjusted odds ratio (aOR) 1.69; 95% CI 1.33–2.14], children of educated mothers, secondary or higher [aOR 2.95, 95% CI 2.34–3.71], and those whose fathers were formally employed (aOR 1.53; 95% CI 1.19–1.97). No association was seen by gender of child [aOR 0.89; 95% CI 0.73–1.08], and place of new born delivery [aOR 1.01; 95% CI 0.83–1.24]. Conclusion: Pockets of critically low under-vaccinations within the urban slums of Karachi are associated with Pashtun ethnicity, distance to the vaccination centre, lack of mothers’ education and lack of stable family income as in the case of unemployed and daily wage-earning fathers. Recognition of these factors is required in designing contextually appropriate strategies to address vaccine inequity in urban settings.

Abstract Background and Aims Healthcare workers in particular frequently report Work‐related musculoskeletal diseases (WRMSDs). The purpose of this study is to evaluate the prevalence and features of WRMSDs in residents from different specialties and trainee nurses from educational hospitals in Damascus, Syria. Methods A cross‐sectional survey was undertaken aiming at the medical residents and the trainee nurses working in the public health sector in 11 hospitals. The sample size was found to be 2016. In this study, a modified version of the Standardized Nordic Questionnaire was employed. Results After the inclusion and exclusion criteria was the number of the participants 1855. In general, musculoskeletal pain was in the past week (69%) and the past 12 months (85%). Musculoskeletal pain in medical care practitioners was found to be linked to higher mean age (p = 0.0053) and body mass index (BMI) (p = 0.0437) in the last year. Females had a higher prevalence of WRMSDs than males (p = 0.0036), and those who were married also had a higher prevalence (p = 0.0218). Working longer hours per week and per month were associated with musculoskeletal pain in the previous 7 days (p = 0.0043 and p = 0.0003, respectively). Conclusion WRMSD prevalence was 85% among our study participants in the previous year. The most common complaint was lower back pain. Aging, female gender, and increasing BMI have been associated with higher reporting of WRMSDs. Our results suggested that doctors were twice as susceptible to developing WRMSDs as nurses. These results highlight the increasing urgency for ergonomics training programs and effective interventions to reduce WRMSDs and enhance working conditions for healthcare professionals in Syria.

Abstract Background Peliosis is a rare condition with anatomopathological characteristics that affect the liver. However, splenic peliosis is even more unique and rare. Patients with such abnormality usually exhibit no symptoms. Moreover, this is a lethal condition due to the high probability of splenic rupture accompanied by shock. Case presentation We present a case of a 29-year-old Arab female who was admitted to the hospital with severe upper abdominal pain that started 1 week from the date of admission, associated with nausea, anorexia, low-grade fever, and vomiting, with no past medical history or comorbidities. A computerized tomography scan with contrast showed intraperitoneal free fluid along with multiple hypodense splenic cysts. Hence, an emergent exploratory laparotomy with splenectomy was performed. Splenic peliosis was confirmed by the histopathological examination. Conclusion Further investigations are warranted if peliosis is confirmed in one organ, for example, the liver, to detect its presence in any other potential organs that can be affected by peliosis. Splenic peliosis is extraordinarily rare. Furthermore, such a disease has no established management plan. Definitive treatment is surgical. Many aspects of splenic peliosis remain puzzling requiring more research in the near future.

Abstract This paper proposes an H2‐optimal model order reduction (MOR) method for bilinear systems based on the linear matrix inequality (LMI) approach. In this method, to reduce the computational complexity, at first, a reduced middle‐order approximation of the system is derived based on common bilinear MOR methods. Next, the H2 norm of the error system is minimized to obtain the reduced‐order bilinear model. Generalized Lyapunov equations are added to the optimization problem as LMI constraints to guarantee the specification of type II Gramians of the bilinear system to improve accuracy. Besides, two stability conditions are included to the optimization problem as its constraints to preserve stability of reduced‐order bilinear model. One of advantages of the proposed method is the need for only one of the Gramians of controllability or observability. Since the proposed H2‐optimal MOR problem is a polynomial matrix inequality (PMI) problem, an iterative method is used to convert the PMI to the LMI problems and solve the optimization problem. Three bilinear test systems are considered to show the proposed method's efficiency, while its performance is compared with some classical methods. Results show that the proposed methods lead to a more accurate reduced‐order model than other MOR methods.

Introduction: Chlorine gas inhalation is a toxic respiratory irritant associated with high lung complications. Despite its wide industrial and domestic applications such as bleaching detergents, there is no specific treatment for chlorine gas poisoning yet and common standard treatments are mostly supportive. In this regard, this study aimed to find a new treatment for this pathogenesis from the perspective of Persian medicine (PM). Materials and methods: In this review study, at first, we searched the etiologies and clinical symptoms associated with chlorine gas poisoning in modern medicine and then compared them with similar etiologies and symptoms in valuable Persian medical manuscripts. Then we reviewed the proposed treatments for similar illnesses from the point of view of PM. Results: The pathology of lung damage caused by inhalation of chlorine gas is reactive airway dysfunction syndrome (RADS), which leads to dyspnea, hypoxemia, respiratory tract obstruction, pneumonia, pulmonary edema, and finally acute respiratory distress syndrome (ARDS). In a comparative study, it seems that this pathology has the closest similarity with the Persian term“Varme-e-harr riye”. The treatment strategy for this syndrome in PM is bloodletting at the first and then the application of cold-temperament foods and medications to improve the lungs. Conclusion: According to the compatibility of acute pulmonary edema caused by chlorine inhalation and “varam-e-harr riye” in PM, it seems that wet cupping can be considered as a suggested primary and emergency treatment for this pathology in future clinical studies. Keywords: Reactive airway dysfunction syndrome (RADS), Persian Medicine, Chlorine gas, Acute pulmonary edema

The aims of the present study were to investigate the macrobenthos communities in the Caspian Sea and to investigate the pollution of this ecosystem based on the pollution indices ABC (Abundance Biomass Comparison), BC (Biotic Coefficient) and ABC curve in 2018 (autumn and winter) and 2019 (spring and summer). According to the results, polychaetes, crustaceans, and bivalvia formed the major groups of macrobenthos communities with 4, 11 and 1 species, respectively. The polychaetes (mainly Streblospio gynobranchiata) included about 70% of the total abundance and the group of bivalvia (Cerastoderma glucaum) included about 76-93% of the macrobenthos in all seasons except in spring. The mean values of the Shannon index and evenness indices were calculated as (1.56) and (0.55), respectively. The annual pollution (ABC) and BC indices were obtained as -3.1 and 2.7, respectively. These values along with characteristics of ABC curve indicate severe stress caused by pollution in the Caspian Sea ecosystem. In this study, the percentage abundance of the invasive species S. gynobranchiata in macrobenthos communities was 52%, which is about 10% decrease compared to 2009 and 2010. This decreasing trend can be considered as positive evidence in the improvement process of the ecosystem in this part of the food chain. However the continuity of recovery trend needs more time, no force by new stressors, proper management, and reduced pollutions into the ecosystem.

Abstract Introduction Chronic stress can interrupt personal life and cause fatigue, inability to concentrate, and irritability. This study aims to determine the prevalence of stress and its associated factors among medical students in Syria and whether social support could be a protective factor against stress. Methods A cross-sectional study was conducted in the faculty of medicine of five Syrian universities. The Medical Student Stressor Questionnaire (MSSQ) was used to evaluate the stress caused by the possible sources of stress. And Social Support Questionnaire – short version (SSQ – short version) was used to assess the social support that medical students received from family, friends, and their fellow medical students using six questions. Results A total of 1472 medical students participated in the study. Among the total participants, 671 (45.6%) were males, and 801 (54.4%) were females. The majority of the participators had mild (50.6%; n = 745) and moderate (37.0%; n = 545) stress levels. Academic-related stressors were the most important cause of stress among undergraduate medical students. Social support was provided equally to both genders, and genders reported the same degree of satisfaction. Conclusion Our results emphasize the importance of improving the curricula, providing mental health consultants for students, and paying more attention to the mental health of female students. Finally, students in their clinical years should also receive mental health care, decreasing their duties and providing more self-free time.

Non-Hodgkin lymphoma (NHL) is the 11th most common cancer worldwide and the 4th most common pediatric cancer. The GI tract is the most common extranodal site of NHL, making up about 30–40% of extranodal cases. The median age at diagnosis for gastrointestinal NHL (gNHL) is around 61. On the other hand, gNHL is very rare in the pediatric population. Herein, we report the case of a 15-year-old girl who complained of abdominal pain and vomiting after meals, with severe B symptoms (fever, night chills, and severe weight loss). Esophagogastroduodenoscopy showed a mass in the lesser curvature of the stomach. Subsequent biopsy and immunostaining of the sample confirmed the diagnosis of diffuse large B-cell lymphoma. CT and PET-CT scans indicated the involvement of mesenteric and lesser omental lymph nodes. Later on, the patient started an R-CHOP chemotherapy regimen. In this report, we aim to shine the light on such a rare disease in this age group.

The present study was aimed at providing a smart model of professional development of second high school principals in Tehran province. This study was based on a combined strategy of successive explorations. The research method was qualitative case study and in the form of content analysis. The selection of the sample in the qualitative section was made by a targeted sampling method with a criterion-based technique. The sample size was up to 20 people emerging in order. The data collection tool consisted of two sections, semi-structural interviews in the field and a review of upstream documents and training documents in the library section, and data analysis in the qualitative section based on the content analysis using ATLASTI software. The quality of this study was observed, from the point of view of experts , and 6 dimensions and 29 components were considered in the professional development of second high school principals. The identified dimensions are educational, research, service, ethical, cultural, and executive. This is not only an evaluation of the candidates for the second-high school administrative candidates in the field, but also the role of a way to promote the material and the competence of these scholars. Due to the limited resources of some organizations, it is not possible to set up an office or deputy for the subject of digital transformation.

This study aims to immunize the koi fingerlings immersion using the formalin-killed and freeze-dried E. coli DH5α carrying plasmid for the KHV DNA vaccine. 200 fish on each tank in a total water volume of 20 L. Each tanks consists of different vaccination group: PBS as control (10 mL; C), empty E. coli DHα (10 mL at 108 CFU mL-1; E), formalinkilled E. coli DHα:ORF81 (10 mL at 108 CFU mL-1; KE), freezedried E.coli DHα:ORF81 without formalin inactivation (10 mL at 108 CFU mL-1; FE), and formalin-killed and then freeze-dried E. coli DHα:ORF81 (10 mL at 108 CFU mL-1; KFE). The bath vaccination was conducted for 1 × 30 min. For the challenged test, fish were immersed with the 100 mL of LD50 dose of KHV (10–2 dilution from the KHV stock) for 30 min. The vaccination using E. coli DH5α:ORF81 could significantly modulate the innate and adaptive immunity of the fish and result in higher fish survival after KHV infection. The vaccination using formalin-killed or formalin-killed and freezedried E. coli DH5α:ORF81 will be further developed as an alternative to the costefficient koi or carp fingerlings vaccination method.

Graphical Abstract Highlight Research • vB_Vp_TSK01 and vB_Vp_JKT02 a specific parahaemolyticus bacteriophage were isolated from the shrimp aquaculture water. • Compared to control vB_Vp_TSK01 reduced 11.46±1.35% of bacterial growth, and by 9.86±5.92% for vB_Vp_JKT02 treatment. • Their cocktail had the highest parahemolyticus growth inhibition by 30.92±3.89%. • The phage treatment increased the survival of the Artemia by 28.57% compared to infection control. Abstract Acute Hepatopancreatic Necrosis Disease (AHPND) caused by V. parahaemolyticus infection was one of the major diseases in shrimp culture in recent years. The Vibrio could also affect the survival of Artemia as the shrimp's main live feed in the hatchery and they become the possible carrier for the AHPND. Phage therapy in shrimp aquaculture could reduce the application of the antibiotic as an antibacterial agent for the AHPND. The present study aimed to isolate the specific lytic phage for the Indonesian strain of V. parahaemolyticus (Vp) and evaluate the phage therapy for the brine shrimp Artemia infected with the Vp. The Vp-specific phage was isolated from the shrimp farm's water at Tasikmalaya, and North Jakarta City, Indonesia. After isolation and plaque assay, brine shrimp were used as a model to evaluate the phages' anti-Vibrio activity The Vp-lytic phage was successfully isolated from shrimp culture water at North Jakarta and Tasikmalaya (Vb_Vp_TSK01 and Vb_Vp_JKT01, respectively) and the results showed that both isolated phages and their cocktails were capable to inhibit the growth of Vp with the highest inhibition shown at the cocktail treatment (p

Abstract Background and aim Fear of coronavirus disease 2019 (COVID-19) and its complications may result in stigmatization of individuals who may carry the virus. This is of special concern to healthcare workers who tolerate additional physical and emotional stress at times of pandemic. The aims of this study are to (1) develop and validate the COVID-19 Stigma Scale (COVISS-HCWs) survey; and (2) investigate the experience of stigma among healthcare workers possibly dealing with COVID-19 patients in five major public hospitals in Damascus, Syria. Methods We divided the sample into two parts and then underwent EFA on the first 350 participants, dividing the 14 questions into two dimensions. Furthermore, CFA was conducted on the other 350 participants to confirm how correctly a hypothesized model matched the factor structure by EFA, as described above. Moreover, the coefficient of determination (R2) and item–scale correlations (standardized factor loading) were estimated to establish the acceptability of the final structure of the COVISS-HCWs. Through a cross-sectional study, a convenience sample of 700 healthcare workers participated in a self-administered questionnaire containing a section for demographic variables and another for newly designed COVISS-HCWs. The scale comprises 14 adapted and novel items that measure two subscales: feelings of perceived harm and inferiority, and avoidance. Descriptive statistics, reliability, and validity were evaluated. Results The 14 COVISS-HCWs items were reduced to 11 items with a high Cronbach’s α of 0.909. A significant correlation was observed between the responses to each COVISS-HCWs item and the corresponding subscale, and between each subscale and the overall scale. Feeling stigmatized was reported by 9.86% of the participants. Younger age, low socioeconomic status, and higher intensity of contact with COVID-19 patients significantly correlated with higher stigmatization. Conclusions The novel COVISS-HCWs is a reliable and valid tool to evaluate stigma among healthcare workers during the COVID-19 pandemic. The Stigma prevalence among healthcare workers was 9.86%. Therefore, this must be addressed to prevent possible psychosocial and public health repercussions.

Abstract Background Catheter-related right atrial thrombosis (CRAT) is an under-studied complication of a long-term implantable venous access devices (IVAD), particularly in children with incidence rates extrapolated from the adult literature ranging between 2 and 29%. This is a single-center retrospective review of electronic medical records of children who underwent insertion of IVADs and had at least one echocardiogram performed prior to catheter removal between 2008 and 2018. Data collection included demographic information, development of CRAT, systemic infection, and administration of thrombogenic chemotherapeutic agents. We identified six patients who developed CRAT and compared them to 120 control patients. We also performed a detailed chart review for the patients who developed CRAT. Data was entered and analyzed using SPSS. Results A total of 764 patients underwent IVAD placement between 2008 and 2018. Six (0.79%) patients developed CRAT, and 120 patients were identified as controls that match the CRAT patients based on definitive criteria that include age, gender, chemotherapy type, steroid therapy, reason of line insertion, site of catheter insertion, tip-location at insertion, and history of systemic infections. In the CRAT group, 3 (50%) patients had their catheter tips placed in the superior vena cava-right atrial junction and 3 (50%) in the right atrium, whereas in the control group, all patients had their catheter tips placed in the superior vena cava-right atrial junction (p=0.000). Five (83.3%) patients in the CRAT group received L-asparaginase as compared to 75 (62.5%) patients in the control group (p=0.301). In the CRAT group, all patients had a history of systemic infection compared to 47 (39.2%) in the control group (p=0.180). Conclusion We identified 6 (0.79%) children with CRAT. Catheter-tip location within the right atrium is a potential risk factor for CRAT development in children.

Background: Gastric disorders are one of the most common human ailments, which impose a huge economic burden on countries. In Persian Medicine (PM), it is possible to predict the susceptibility to gastric diseases with diagnosis of gastric Mizajes (temperaments) and dystemperaments. The semiology of gastric dystemperaments has been investigated in PM textbooks, although the value of each sign and symptom is not mentioned. Consequently, this research is designed to determine the major and minor criteria for classifying gastric dystemperaments on the basis of valid manuscripts and with the help of PM specialists in the present era. Methods: This was a consensus-based study consisting of four phases. In the first phase, reference PM textbooks were studied. Symptoms and signs of gastric dystemperaments were collected and listed in four groups. In the second phase, semi-structured interviews with a sample of PM experts were carried out. Phase three included a focused group discussion with experts. Eventually, findings were integrated from the three study phases in a two-day meeting in Sari City. Results: Selected criteria included eight major and eight minor criteria for hot-cold dystemperament, as well as six major and eight minor criteria for wet-dry gastric dystemperament. Conclusion: Modern lifestyles and the interfering factors are responsible for some changes in diagnostic signs and symptoms according to PM. This was the first step to coordinate PM diagnostic criteria for gastric dystemperaments. Further studies are recommended to reach a unique protocol in the field of PM diagnostics. The next step includes design and validation of national diagnostic tools.

Given the significance of the Islamic Revolution role-playing and increasing importance of the role of new social movements in the world arena, the present paper investigates the relations between new social movements and the Islamic Revolution and the effect of these movements on the promotion of the Islamic Revolution in the world arena. The research requires examining mutual relations between new social movements and the Islamic Revolution. Therefore, according to Alain Touraine’s theoretical basics about new social movements and using a qualitative method, this paper comparatively studied components of identity in the Islamic Revolution and the Environmental movement as one of the new social movements in the world arena. It also extracted, compared, and examined the relations between these movement-stimulant components using categorization and encoding techniques. According to the findings of this study, it can be said that the Islamic Revolution has an identity beyond environmental movement. However, there is no contradiction between their components and therefore there is an overlap between the Islamic Revolution and environmental movement in the world arena.

Background and Purpose: Considering that exercise and consumption of medicinal plants with antioxidant properties have a significant effect on the redox status of people with type-2 diabetes, it seems necessary to study the interactive effect of high-intensity interval training and curcumin consumption in people with type-2 diabetes. Therefore, the aim of this study was to evaluate the effect of 12 weeks of high-intensity intermittent exercise and curcumin consumption on oxidative indices in obese men with type-2 diabetes.Materials and Methods: In this quasi-experimental double-blind study performed with a pre-test and post-test design with a control group, 60 men with type-2 diabetes mellitus (mean age 38.76 ± 2.05 years, height 169.53 ± 2.81 cm, BMI 31.09 ± 1.56 kg/m2) randomly divided into four groups: HIIT, HIIT-curcumin, curcumin, and control.Exercise intervention three sessions per week (including 10 stages of training, each stage includes 30 seconds with an intensity of 80 to 85% HRR and 90 seconds of active rest with an intensity of 50 to 55% HRR) and taking 2100 mg of curcumin three times a day performed for 12 weeks. Sampling was performed in two stages, pre-test and post-test to measure the plasma concentrations of paraoxonase-1, superoxide dismutase, glutathione peroxidase and malondialdehyde. Data were analyzed using Shapiro-Wilk, one-way analysis of variance and two-way covariance method. The significance level was set at P < 0.05.Results: The results showed that the interactive effect of exercise and curcumin consumption significantly increased paraoxonase-1(P=0.014), superoxide dismutase (P=0.0001), glutathione peroxidase (P=0.023) and significantly reduced malondialdehyde (P=0.0001). Also, the effect of exercise alone significantly increased serum levels of paraoxonase-1 (P= 0.010), superoxide dismutase (P=0.002), glutathione peroxidase (P= 0.015) and malondialdehyde (P=0.0001) decreased. However, the effect of curcumin alone did not cause significant changes in serum levels of paraoxonase-1 (P= 0.053), superoxide dismutase (P=0.092), glutathione peroxidase (P= 0.055) and malondialdehyde (P=0.079). The highest significant increase from pretest to posttest in paraoxonase-1 (19.26%, P=0.0001), superoxide dismutase (18.37%, P=0.011), glutathione peroxidase (17.20%, P=0.0001) and the most significant decrease in malondialdehyde (24.47%, P=0.014) was observed in the exercise alone with curcumin group. The greatest effect on paraoxonase-1 (86%), superoxide dismutase (92%), glutathione peroxidase (81%) and malondialdehyde (88%) was the interactive effect of exercise and curcumin.Conclusion: The results of the present study showed that the effect of exercise alone is associated with significant changes in serum levels of antioxidant enzymes and malondialdehyde index. However, the effect of curcumin was not associated with significant changes. Finally, the main finding of the present study indicates that the interactive effect of exercise and curcumin, compared to the effect of each alone, is more suitable for improving the antioxidant and peroxidant activity of obese men with type-2 diabetes with hyperlipidemia.

Background: Neonatal hypoxic-ischemic encephalopathy (HIE) is one of the most common causes of long-term neurological disabilities among children. Various types of cellular stress stimuli, including oxidative stress, inflammation, and hypoxia, induce heme oxygenase-1 (HO-1) enzyme for different kinds of tissues. The purpose of this study was to evaluate the plasma level of HO-1 enzyme in neonatal HIE patients and to determine the relationship between HO-1 enzyme level and clinical severity of HIE.Methods: In this case-control study, the plasma level of HO-1 enzyme was measured through sandwich ELISA in 28 newborns with a proven diagnosis of HIE and 31 healthy full-term newborns admitted to Bentolhoda Hospital, Bojnourd, Iran. Newborns with HIE were classified according to the Sarnat staging to mild, moderate, and severe HIE. Maternal and neonatal data were recorded in checklists and compared between the two groups.Results: The mean plasma level of HO-1 enzyme in HIE patients was significantly higher than that in the control group (104.0 ± 4.01 and 91.63± 2.67 pg/ml, respectively, P=0.011). We also found that plasma HO-1 levels were significantly higher in severe neonatal HIE patients compared to mild and moderate neonatal HIE patients (121.0 ± 8.48Vs. 91.23 ± 3.35 and 105.5 ± 5.76, P ˂ 0.001). Conclusion: Our findings suggested that HO-1enzyme may be associated with the pathophysiology and clinical severity of neonatal HIE. We suggest further research on the correlation of plasma level of HO-1 enzyme at birth with the multi-organ dysfunction and abnormal neurodevelopmental outcomes in full-term newborns with HIE.

Abstract This study aimed to assess the surface quality of cap, stroma and lenticular surfaces created using low-energy femtosecond laser lenticule extraction (Ziemer FEMTO LDV Z8). Twenty-four porcine eyes were divided into four groups (n = 6 each): two with optimal laser power (32%) with posterior curvature equivalent to a spherical correction of -2D and -5D, respectively and the other two with high power (64%) with spherical correction of -2D and -5D respectively. Samples were analysed using scanning electron microscopy (SEM). Surface morphology was evaluated using a standard scoring system; surface relief, surface regularity, extent and position of irregularities were graded by four independent clinicians. Eyes with 32% power and -2D correction had significantly less size of the irregular area than those with -5D; however, no significant difference was found between the two groups with 64% power. When comparing eyes with -2D correction, the size of the irregular area was lesser with 32% power. Surface relief was lesser with -5D correction with 32% power than 64% power. Low-energy femtosecond laser lenticule extraction (Ziemer FEMTO LDV Z8) produces good surface quality results. There is a tendency for smoother surface stromal quality with lower power settings than a higher power.

Abstract Background Mantle cell lymphoma is the rarest subtype of non-Hodgkin’s lymphoma. It can exhibit diverse extranodal manifestations. However, renal involvement is uncommon, and if it occurs, it usually only gets detected postmortem. There are several mechanisms by which mantle cell lymphoma can damage the kidneys. Renal failure is a potential complication, and prompt evaluation and diagnosis are critical steps to prevent long-term complications. Case presentation We present the case of a 75-year-old non-Hispanic White male with past medical history significant for hypertension and dyslipidemia, presenting with fever, weight loss, and night sweats. Work-up showed markedly elevated white blood cells, multiple enlarged lymph nodes, and a kidney mass. The patient was diagnosed with mantle cell lymphoma with kidney involvement confirmed with a kidney biopsy. His disease was positive for cyclin D1 overexpression despite t(11; 14) absence. The patient received six cycles of alternating vincristine, rituximab, cyclophosphamide, doxorubicin, and prednisone then dexamethasone, high-dose cytarabine, and oxaliplatin, after which he was maintained on ibrutinib and rituximab, with resolution of symptoms and disease regression. Conclusion We present a case of a rare presentation of Mantle cell lymphoma while describing the clinical presentation and diagnostic and treatment approaches. This case report can assist physicians in the clinical work-up and treatment of patients with similar diagnosis or presentation.

The research sheds light on the Islamic creed from linguistic and idiomatic perspective and explains the effect of the Islamic faith on an individual especially in liberating him from worldly bondages. He entrusts his all in Allah in all times. It has an impact on preserving society from extremism and racism, spreading love and affection, making society coherent and interconnected as the Prophet (PBUH) exemplified in the state of Medina.

Selenium is an essential micromineral that the body needs in modest amounts (0.2–12 mg/kg), yet it has important effects on the antioxidant defense, immune system, and digestive performance of aquatic species. This study aimed to analyze the growth of catfish (Clarias gariepinus) supplemented with feed additives containing selenium peptide through the coating method on feed. There were four different treatments, namely K (feed without feed additive), and feed with additive supplementation: A (3 g/kg feed), B (6 g/kg feed), and C (9 g/kg feed). A total of 15 catfish at an initial weight of 21.80 ± 0.29 g were reared in a 90×40×45 cm3 aquarium filled with water at a volume of 108 L, for 45 days. Fish were fed three times a day at satiation. Water quality management was carried out by the use of simple filtration in the container and water replacement to ensure optimum water quality values for catfish growth. The results showed that the final biomass of catfish fed with selenium peptide was significantly different (p

Objectives Non-adherence to antipsychotics is the greatest obstacle to treating schizophrenia. We assessed the economic and clinical impacts of adherence to antipsychotics among people living with HIV/AIDS (PLWH) and schizophrenia in British Columbia, Canada.Design and setting A population-based cohort study in British Columbia, Canada.Methods Eligible PLWH were enrolled in the Seek and Treat for Optimal Prevention HIV/AIDS population-based cohort during 2001–2016, diagnosed with schizophrenia, on antipsychotics for ≥1 day, and followed for ≥1 year from schizophrenia diagnosis date or 1 January 2001, whichever occurred last.Primary and secondary outcome measures A two-part model assessed the marginal effect of adherence on healthcare costs (in 2016 Canadian dollar), while logistic regression examined the effect on virological failure, and generalised linear mixed models examined the effect on hospital readmissions within 30 days and length of hospital stay.Results Among 726 PLWH with schizophrenia, ≥80% adherence to antipsychotics increased from 25% (50/198) in 2001 to 41% (225/554) in 2016. In most years, we observed no difference in adherence to antipsychotics among those who used only injectables, only non-injectables, and a combination of both, or among those who have ever consumed typical/first-generation antipsychotics and who consumed only atypical/second-generation antipsychotics. Overall healthcare costs were higher in the non-adherent group ($C2185), driven by the average annual hospitalisation costs ($C5517), particularly among women ($C8806) and people who ever injected drugs (PWID) ($C5985). Non-adherent individuals also experienced higher hospital readmissions (adjusted odds ratio (aOR) 1.48, 95% CI 1.23 to 1.77), and longer hospital stays (adjusted mean ratio 1.23, 95% CI 1.13 to 1.35) in comparison to adherent individuals. We found no difference in virological failure by adherence groups, except when we stratified by gender where the aOR for women was 2.48 (95% CI 1.06 to 5.82).Conclusions Our results showed that implementing strategies and interventions to increase antipsychotic adherence, particularly among women and PWID, will be critical in addressing this public health challenge.

Mononuclear NiL complex was prepared by the use of bis-N,N'-salicylidene-1,3-propanediamine and Ni(II) salts. NiL was treated with ZnBr2 and pyrazole and 3,5-lutidine coligands in a dioxane medium to prepare the following diheteronuclear complexes: [NiL·ZnBr2·(pyrazole)2] and [NiL·ZnBr2·(3,5-lutidine)2]. The complexes were characterized by elemental analysis, TG, IR and mass spectrometry. The effects of heterocyclic one- and two- nitrogen atoms containing co-ligands were also examined. Theoretical formation enthalpies, dipole moments and the relative levels of HOMO and LUMO energies were determined by the use of Gaussian09 program. The occupancy levels of the atomic orbitals were determined by the NBO analysis of Gaussian09. The effect of pyrazole and lutidine upon the complex formation was evaluated by the use of X-ray diffraction, TG and theoretical calculations. NiL complex with lutidine forms a square pyramidal conformation since lutidine is a much stronger coligand than pyrazole.

Introduction: The association of maternal vitamin D status with preterm labor has been considered in the recent decade, although reported findings have been inconsistent. This study was performed aimed to compare serum 25-hydroxy vitamin D levels between women with idiopathic preterm labor and women with term labor. Methods: This case-control study was performed in 2020 on 60 women aged 18-35 years who had referred to Bentolhoda Hospital in Bojnourd for delivery. Serum levels of 25-hydroxyvitamin D were determined in 30 women with idiopathic preterm delivery with gestational age of 28 to 37 weeks (case group) and 30 women with term delivery (control group) by sandwich ELISA. Patients' information including demographic information, clinical status and pregnancy history were collected through a questionnaire. Data were analyzed by SPSS 16 software (version 16) and Chi-square and Pearson correlation coefficient test. P

Pediatric Basic Life Support is the initiation of cardiopulmonary resuscitation (CPR) until advanced life support is available. The American Heart Association (AHA) 2015 guideline recommend the people to perform CPR. YouTube is a video sharing site where internet users can learn about many topics, including health. Everyone can upload videos easily. Therefore, there is no control mechanism for the accuracy and up-to-dateness of the videos. Thus, there is a risk of spreading incorrect or inaccurate information. After the pediatric CPR and BLS guidelines were updated in 2015, we aimed to evaluate the quality and content of the videos published in English on YouTube. The YouTube website was searched in 15th June, 2020, using the terms “pediatric cardiac massage” and “pediatric BLS”. A total of 200 videos were evaluated.by two anesthetists in terms of instructional, content, up-to dateness and resource. 33 videos included in the study were evaluated according to Azer SA criteria. 14 videos were found to be useful and 19 of them as misleading. The average total viewing times and daily viewing numbers of useful videos were found to be higher. When evaluated in terms of content, similar results were obtained in both groups. This shows that viewers value videos more being educational than content. For this reason, we think that while editing videos, Azer criteria should be taken into account as an objective criterion and their content should be prepared according to current guidelines.