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Abstract Introduction Many COVID-19 patients experience mild to severe symptoms, including respiratory system involvement. Different treatment instructions have been suggested for patients with COVID-19. Echinacea has known antiviral effects. However, there is still not enough evidence that it is effective in treating COVID-19. This study was conducted with the aim of determining the effect of Echinacea extract syrup on the outcomes of the lower respiratory tract in patients with COVID-19. Methods In this single-blind randomized controlled trial, 40 patients with COVID-19 who were inpatients in the hospitals of Mashhad University of Medical Sciences, Iran, were randomly selected and assigned to two equal control and experimental groups (n = 20). In addition to receiving routine care and treatment (oxygen supply, remdesivir, enoxaparin and heparin), the experimental group received 5 cubic centimeter (CC) of Imogen syrup three times a day for 5 days each. The control group only received routine care and treatment. The data were collected on the first, third and fifth days after hospitalization and were analyzed using descriptive and analytical tests in Statistical Package for the Social Sciences (SPSS). The significance level was set at p 0.05). Discussion The consumption of Echinacea extract syrup may not be able to improve the symptoms of acute lower respiratory tract infection in patients with COVID-19 with 3 daily doses for 5 days. More studies should be conducted to investigate the clinical effects of Echinacea extract in the treatment of patients with pulmonary complications. Trial Registration IRCT20130522013423N2.

Abstract With the emergence of new strains of Covid-19, the adoption of preventive behaviors is still considered a requirement to control this disease. Therefore, considering the importance of social cognitive factors in adopting various types of preventive behaviors, the present study was conducted to design and psychometrically measure the social cognitive factors related to Covid-19 preventive behaviors. A cross-sectional study was conducted on 526 people ages 18 and over with multi-stage stratified, cluster and random sampling in Isfahan, Iran in 2022. The questionnaire was validated and formulated in three stages: designing, creating and reducing items. After collecting information and creating a bank of items, qualitative and quantitative methods were used to calculate the tool’s validity. Data analysis was done in SPSS23 software at a significance level of less than 0.05. In the present study, the average age score of the participants was 39.16 ± 11.48. The results related to the construct validity in the exploratory part show that the five factors (Outcome expectations, self-efficacy, social support, self-regulation and barrier self-efficacy) obtained have a specific value higher than one and range from 1.376 to 9.343. Correlation between factors shows that all factors have a relatively high relationship with each other (P

Abstract Background Understanding the motivations driving family members to continue caring for individuals with Alzheimer’s disease is crucial for enhancing social support programs within community health systems. This study specifically explores the factors influencing Iranian family caregivers’ ability to persist in their caregiving roles. Methods This qualitative study was conducted using conventional content analysis with 22 participants in 2022 in Babol (a city in northern Iran). The inclusion criteria for the study included caregivers of Alzheimer’s patients who had been the primary caregivers for at least one year for patients with a confirmed diagnosis of Alzheimer’s disease. The sampling method was purposive, ensuring maximum variation in social position, demographic status, and stages of Alzheimer’s disease after the onset of symptoms. In this research, data were collected from caregivers of Alzheimer’s patients through semi-structured interviews and in-depth individual interviews. The data were analyzed using MAXQDA software. Results One category and four subcategories were identified to explain the continuity of the caring role in family caregivers of Alzheimer’s patients. The category was “on the Fence of the Caring Role.” The subcategories included Commitment to Care (Being Determined, Being Indebted, Feeling Dutiful), Coercion to Care (Giving in to the Caring Role Due to Family Requirements, Patient Care Due to Financial Problems), Socio-Cultural Beliefs and Concerns (Spiritual and Religious Tendencies, Social Stigma and Social Fears), and Attachment and Love for the Patient (Feeling Pity, Feeling Nostalgia for Kinship). Conclusion Family caregivers are deeply engaged in their roles, often feeling trapped by various pressures. Recognizing these dimensions can inform policymakers and health practitioners in developing targeted interventions, such as respite care programs, financial support, and community resources, aimed at alleviating caregiver burden and enhancing the quality of care for patients. By addressing the complexities of the caregiver experience, effective strategies can be implemented to support both patients and their caregivers, ultimately improving health outcomes within the community.

Abstract Background Multidimensional strategies can promote preventive behaviors to prevent cutaneous leishmaniosis. WhatsApp, the popular messenger of Iranians, can be used as a platform to provide health education interventions. This study aimed to investigate the effect of using an educational intervention in WhatsApp based on social cognitive theory (SCT) on the preventive behaviors of health ambassadors. Methods A randomized clinical trial was conducted from September 2020 to April 2021 on 220 people living in endemic areas of leishmaniosis in Mashhad Province, Iran. By the cluster method sampling, the samples were randomly divided into two intervention and control groups. The intervention was performed for the intervention group over two weeks. Data were collected using a researcher-made questionnaire based on the constructs of SCT before and after the intervention. SPSS 16 was implemented to test multiple statistical analyses. Results Findings from the intervention group compared with the control group showed that the scores of SCT constructs and preventive behaviors were significantly changed (P

Abstract Background Multiple sclerosis (MS) is a debilitating, non-traumatic disease that is common among young adults. Cultural factors, as background factors, can affect how patients adapt and their quality of life. This study aimed to explain the burden of cultural factors on Multiple sclerosis. Methods This study was conducted with a qualitative approach and conventional content analysis among women with Multiple sclerosis in Mashhad. The data were collected through semi-structured interviews with women with MS. Fifteen patients with Multiple sclerosis were selected using purposeful sampling. The Graneheim and Lundman method was used to analyze the collected data. The transferability of the study was evaluated using the Guba and Lincoln criteria. MAXQADA 10 software was used to manage and analyze the data. Results In explanation of the cultural factors of patients with Multiple sclerosis, one category (cultural tensions) and five subcategories (forced communication with spouse’s family, definition of women’s role in society, people’s behavior, social beliefs and isolation of the patient) were extracted. Conclusion The results obtained in this study show that female MS patients face various concerns. Overcoming these challenges require a change in the attitude of people in the society towards women with MS, which is important in the context of formulating practical policies to create a suitable culture. Adopted policies should aim to internalize the culture of changing society’s views of female MS patients. Therefore, the authors argue that there is a need for cultural policies, followed by the systems implementing these policies to consider the challenges mentioned in this study as a priority for MS patients.

ABSTRACT Background and Aims Menopause is a multifaceted condition with several problems. Educational interventions regarding self‐care and limiting exposure to menopausal warning indicators can help to minimize problems. As a result, the study aimed to investigate the influence of educational intervention on variables influencing menopausal adaptation. Methods This study was a randomized controlled trial (RCT) intervention in which the researcher developed a standard questionnaire (kapa = o/99, CVR = 0/81, CVI = 0/96, ICC = 0/89) for 130 participants at four education sessions in Mashhad, Iran, in 2023. This questionnaire was completed before the intervention, shortly afterward, and 3 months later. Results The average age was 52 ± 4 years, with no significant difference between the two groups. According to the regression model findings immediately following the intervention, the factors of education level, income level, and age had no significant influence on the overall score of the questionnaire. The linear regression model revealed that the intervention group had a higher average score of 13.89. The outcomes 3 months after the intervention were identical to those immediately following the intervention. Three months after the intervention, there was a substantial change in the score for encountering warning signals and seeking help and self‐care compared to before (p‐value = 0.002, p‐value

Background and Objectives: The global problem of urinary tract infections (UTIs) caused by antibiotic-resistant bacteria is due to limited treatment options. This study aimed to examine the prevalence, etiology, and management implications of Escherichi coli causing UTI at Imam Hospital Ardabil, Iran. Materials and Methods: 2340 samples of retrospective data on E. coli causing UTIs were collected at Imam Hospital in Ardabil, Iran, spanning from 2012 to 2022. The samples were cultured and isolated, and their antibiotic susceptibility was determined using standard laboratory methods and data were then organized and systematically categorized using Python. Results: It was found that the lowest level of resistance was related to nitrofurantoin, followed by imipenem. In 2018, the number of E. coli patients resistant to trimethoprim was the highest. Cephalexin and ciprofloxacin trends indicate the reduction of the line during this retrospective period. There was a significant correlation between wards and some antibiotics like Cefepime, Cefotaxime, Ceftazidime, and Trimethoprim (P-Value

The enzyme deoxyhypusine synthase (DHS) catalyzes the first step in the post-translational modification of the eukaryotic translation factor 5A (eIF5A). This is the only protein known to contain the amino acid hypusine, which results from this modification. Both eIF5A and DHS are essential for cell viability in eukaryotes, and inhibiting DHS is a promising strategy to develop new therapeutic alternatives. DHS proteins from many are sufficiently different from their human orthologs for selective targeting against infectious diseases; however, no DHS inhibitor selective for parasite orthologs has previously been reported. Here, we established a yeast surrogate genetics platform to identify inhibitors of DHS from Plasmodium vivax, one of the major causative agents of malaria. We constructed genetically modified Saccharomyces cerevisiae strains expressing DHS genes from Homo sapiens (HsDHS) or P. vivax (PvDHS) in place of the endogenous DHS gene from S. cerevisiae. Compared with a HsDHS complemented strain with a different genetic background that we previously generated, this new strain background was ~60-fold more sensitive to an inhibitor of human DHS. Initially, a virtual screen using the ChEMBL-NTD database was performed. Candidate ligands were tested in growth assays using the newly generated yeast strains expressing heterologous DHS genes. Among these, two showed promise by preferentially reducing the growth of the PvDHS-expressing strain. Further, in a robotized assay, we screened 400 compounds from the Pathogen Box library using the same S. cerevisiae strains, and one compound preferentially reduced the growth of the PvDHS-expressing yeast strain. Western blot revealed that these compounds significantly reduced eIF5A hypusination in yeast. The compounds showed antiplasmodial activity in the asexual erythrocyte stage; EC50 in high nM to low μM range, and low cytotoxicity. Our study demonstrates that this yeast-based platform is suitable for identifying and verifying candidate small molecule DHS inhibitors, selective for the parasite over the human ortholog.

Background: Esophageal cancer is one of the most common cancers worldwide. Because this disease is usually diagnosed in advanced stages, its treatment is challenging and the survival rate of patients is relatively low. One of the parts that is disturbed in the tumor tissue of esophageal cancer is the tight connections between cells. Claudin-4 (CLDN-4) is one of the tight junction regulatory proteins whose changes are involved in cancer formation. In this systematic review, we examine the changes in CLDN-4 and the factors that affect its level in samples and cell lines related to esophageal cancer. Methods: Scopus, PubMed, and Web of Science databases were searched for articles that examined CLDN-4 gene and protein expression in patients with esophageal cancer or cell lines related to esophageal cancer. A number of 202 manuscripts were obtained in the beginning, and after screening and applying the inclusion and exclusion criteria, six studies remained. Results: Six studies, including 596 patients and seven cell lines related to esophageal tissues, were included in this systematic review. The studies were related to Japan, South Korea, China, and Finland. In these studies, the level of CLDN-4 in cancer samples related to esophageal cancer and their location in esophageal tissue cells have been examined. Conclusion: In summary, it can be concluded that the change in the level of CLDN-4 in the tumor tissues of esophageal cancer altered the tight junctions from the normal state in the normal esophageal tissues, leading to a change in normal barrier function. However, considering the conflicting results in the reports, more studies are needed to accurately interpret the role of CLDN-4 in esophageal cancer.

Background: The use of different educational methods and programs, such as simulation and virtual training, plays an important role in effective Cardiopulmonary Resuscitation (CPR) learning for nursing students. This study was conducted with the aim of comparing mannequin-based simulation training with virtual training on CPR learning among nursing students. Materials and Methods: This parallel randomized controlled trial was conducted in 2022. We selected 73 nursing undergraduate students and randomly assigned them to two groups: mannequin-based simulation and virtual training groups. The knowledge, attitude, and performance of CPR in both groups were evaluated and compared before, immediately after, and 1 month after the intervention. Data analysis was performed using independent t-test and the repeated-measure analysis of variance (ANOVA) using the Statistical Package for Social Sciences (SPSS) software. Results: Within-group differences were significant in both mannequin-based simulation and virtual training groups in terms of knowledge, attitude, and CPR performance before and after training, as well as between before and 1 month after training (p < 0.001). In addition, the mean performance of simulation group students was significantly higher than the virtual group (p < 0.001), but no significant difference was observed between the two groups in terms of knowledge and attitude dimensions before training, after training, and 1 month after training. Conclusions: Both mannequin-based simulation and virtual training methods increase CPR learning. Considering that students’ knowledge and attitude increase significantly using both training methods and the performance of students in the simulation group is better than in the virtual group, the use of a multimodal approach is recommended for CPR training of nursing students.

Abstract 3D printing technology is a powerful tool in scaffold engineering for biomedical applications, especially in anticancer activities and drug delivery. The present study developed a 3D-printed gelatin–alginate scaffold incorporating letrozole-loaded niosomes (Let/Nio@Gel-AL-SC) as a more effective drug delivery system. The findings showed that the fabricated niosomes appeared spherical. 3D-printed scaffolds exhibited biodegradability and sustained drug-release properties. The drug release from the scaffold was less prominent under acidic conditions than physiological ones. Cytotoxicity analysis showed that the engineered Let/Nio@Gel-AL-SC scaffold exhibited significant cytotoxicity against MCF-7 cancer cells. Gene expression analysis demonstrated a significant decrease in the expression of BCL2, CCND1, MMP2, and CDK4 genes and a notable increase in the expression of BAX and P53 genes, as well as the activity of Caspase 3/7 enzyme following treatment with Let/Nio@Gel-AL-SC. In addition, flow cytometry analysis revealed that Let/Nio@Gel-AL-SC significantly reduced necrosis and dramatically increased apoptosis. Also, the Let/Nio@Gel-AL-SC formulation exhibited a significantly greater increase in ROS values. The incorporation of letrozole-loaded niosomes into 3D printing gelatin/alginate scaffold has enhanced the efficacy of anticancer therapy. This is demonstrated by the sustained release of drugs, which indicates a promising potential for effective anticancer activity. Consequently, this combination holds promise as a potential future cancer therapy strategy. Graphical abstract

Objective: Health equity is defined as the absence of unequal and avoidable factors in health differences among populations. Several add-on treatments have been suggested for refractory epilepsy and epilepsy unresponsive to usual treatments in systematic reviews. The current study assessed equity concerns in Cochrane systematic reviews and original studies on additive therapies used for refractory focal epilepsy because identifying the reasons for injustice is the first step in eradicating health inequality. Methods: Cochrane systematic reviews and their primary studies on add-on therapy for treatment-resistant focal epilepsy in adults published in the Cochrane library in the last 10 years (until the end of 2022) were gathered. Two researchers independently reviewed the PROGRESS criteria in the studies based on the guide for each of the primary and review studies. Results: In the present study, 7 systematic reviews and 54 primary studies were included. based on the findings of our study, all review studies and 81.5% of the original studies were conducted in high-income countries. none of the articles mentioned the issue of justice in health or PROGRESS criteria. However, all of the articles mentioned gender distribution and patients’ place of residence, and about 35% of the original articles also mentioned patients’ race. None of these factors were analyzed as a criterion for group comparison or as a criterion for influencing the treatment process. Conclusion: The Cochrane-related reviews confirm that PROGRESS criteria are rarely considered in trials of interventions linked to add-on therapies for treatment-resistant focal epilepsy.

Background and purpose: Cancer is considered one of the most common causes of mortality, in today’s world. A growing body of evidence has demonstrated that the global cancer burden is expected to rise significantly in the years to come. Cancer is characterized by the uncontrollable rate of cells growth, ultimately proving fatal if not treated. Both genetic and environmental contributing factors have proven critical in developing differential cancers. Chemotherapy is the most common form of treatment used for cancers all around the world. Despite a high efficiency in treating malignancies, toxicity and targeting of normal healthy tissues are considered the most common side effects of chemotherapeutic agents. Thus, reducing the aforementioned side effects with complementary treatments can prove critical through maximizing therapeutic efficiency while also minimizing unwanted side effects at the same time. Doxorubicin (DOX) is a common chemotherapy drug that, has limitations on its use due to severe side effects such as hepatotoxicity, nephrotoxicity, as well as cardiotoxicity. Metformin is one of the most common drugs originally used for the treatment of type II diabetes. Additionally, coenzyme Q10 is naturally produced by the body and can also be obtained from diet and supplements. Both metformin and coenzyme Q10 have demonstrated protective effects against toxicity and oxidative stress and are attractive candidates for the treatment of diseases with the basis of inflammation and oxidative stress as demonstrated by various studies investigating the effect of metformin as well as coenzyme Q10 against toxicities. This study investigates the protective effects of metformin and coenzyme Q10 alone and in combination against doxorubicin-induced oxidative damage in rats. Materials and methods: In this experiment, 36 male Wistar rats were divided into six groups (n=6). The groups consisted of a normal control group (distilled water), metformin and coenzyme Q10 control group: (metformin+coenzyme Q10), doxorubicin control group (doxorubicin), Metformin pre-treatment group (metformin+ doxorubicin), coenzyme Q10 pre-treatment group (coenzyme Q10+doxorubicin), as well as metformin and coenzyme Q10 pre-treatment group (metformin + coenzyme Q10+doxorubicin). Metformin (200 mg/kg) and coenzyme Q10 (15 mg/kg) were administered orally daily for one week, and doxorubicin (25 mg/kg), was injected on the eighth day. 24 hours after the last injection, blood and liver tissue samples were collected to analyze liver enzymes (i.e. ALT, AST, ALP), oxidative stress parameters (i.e. malondialdehyde, total antioxidant capacity, catalase, superoxide dismutase, glutathione peroxidase), and histological changes. Results: The results showed that doxorubicin significantly elevates the activity of liver enzymes, concentration of malondialdehyde, and tissue damage and decreases total antioxidant capacity, catalase, superoxide dismutase, and glutathione peroxidase activity (P

ObjectivesGranulocyte colony-stimulating factor (G-CSF) is routinely administered after autologous hematopoietic stem cell transplantation (auto-HSCT) to decrease the duration of neutropenia and diminish the incidence of febrile neutropenia. Nevertheless, the most advantageous timeframe for administering G-CSF in the transplantation setting remains elusive.Material and MethodsWe conducted a cross-sectional study of 200 patients diagnosed with hematological malignancies who underwent auto-HSCT between July 2017 and January 2022. Patients were divided into two groups of 100 individuals based on the timing of G-CSF administration after auto-HSCT. In the first group, G-CSF was administered on post-transplantation day +1, while in the second group, G-CSF was administered on post-transplantation day +5. Patient demographics and clinical outcomes, including time to neutrophil engraftment, time to platelet engraftment, length of hospital stay, duration of fever, and incidence of bacterial and fungal bloodstream infections, were compared between the two groups.ResultsWe identified a significantly shorter platelet engraftment time in the day +5 group than in the day +1 group (P

Abstract Background Child marriage of girls is one example of human rights violations, and is increasingly recognized as a key obstacle to global public health. Given the importance of a comprehensive understanding of the motivations for child marriage, this study aimed to identify socio-ecological factors contributing to gills child marriage. Methods A comprehensive search was conducted of all English-language studies measuring causes of child marriage between 2000 and October 2022 in the Web of Science, PubMed, Scopus, PsycInfo, ProQuest, Poplin and Google Scholar databases. Girl child marriage is defined as a marriage under the age of 18. In this study, the CASP evaluation checklist was used to collect data. Two independent reviewers reviewed all articles. Results A total of 34 eligible qualitative articles were included. The most salient causes of child marriage among girls include low skills and knowledge, internal and external beliefs and motivations, and physical advantages at the individual level. Family characteristics and structure contribute to child marriage at the interpersonal level, while environmental and economic factors play a role at the community level. Social factors and cultural norms, as well as the shortcomings and weaknesses of legislation, are also contributing factors at the society level. Conclusion The results showed that cultural beliefs supporting gender inequality and economic status were the most important causes of child marriage. These results can help policymakers and decision-makers implement strategies to reduce gender inequality to prevent child marriage.

Driven by the widespread adoption of deep learning (DL) in crop mapping with satellite image time series (SITS), this study was motivated by the recent success of temporal attention-based approaches in crop mapping. To meet the needs of beekeepers, this study aimed to develop DL-based classification models for mapping five essential crops in pollination services in Quebec province, Canada, by using Sentinel-2 SITS. Due to the challenging task of crop mapping using SITS, this study employed three DL-based models, namely one-dimensional temporal convolutional neural networks (CNNs) (1DTempCNNs), one-dimensional spectral CNNs (1DSpecCNNs), and long short-term memory (LSTM). Accordingly, this study aimed to capture expert-free temporal and spectral features, specifically targeting temporal features using 1DTempCNN and LSTM models, and spectral features using the 1DSpecCNN model. Our findings indicated that the LSTM model (macro-averaged recall of 0.80, precision of 0.80, F1-score of 0.80, and ROC of 0.89) outperformed both 1DTempCNNs (macro-averaged recall of 0.73, precision of 0.74, F1-score of 0.73, and ROC of 0.85) and 1DSpecCNNs (macro-averaged recall of 0.78, precision of 0.77, F1-score of 0.77, and ROC of 0.88) models, underscoring its effectiveness in capturing temporal features and highlighting its suitability for crop mapping using Sentinel-2 SITS. Furthermore, applying one-dimensional convolution (Conv1D) across the spectral domain demonstrated greater potential in distinguishing land covers and crop types than applying it across the temporal domain. This study contributes to providing insights into the capabilities and limitations of various DL-based classification models for crop mapping using Sentinel-2 SITS.