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Objective: Nonautoimmune hyperthyroidism (NAH) is rare and occurs due to a constitutively activating thyroid stimulating hormone receptor (TSHR) mutation. In contrast to other thyroid nodules, no further evaluation for malignancy is recommended for hot thyroid nodules. In the first model for NAH in mice nearly all homozygous mice had developed papillary thyroid cancer by 12 months of age. Methods: To further evaluate these mice, whole exome sequencing and phosphoproteome analysis were employed in a further generation of mice to identify any other mutations potentially responsible and to identify the pathways involved in thyroid carcinoma development. Results: Only three genes (Nrg1, Rrs1, Rasal2) were mutated in all mice examined, none of which were known primary drivers of papillary thyroid cancer development. Wild-type and homozygous TSHR D633H knockin mice showed distinct phosphoproteome profiles with an enrichment of altered phosphosites found in ERK/mitogen-activated protein kinase (MAPK) signaling. Most importantly, phosphosites with known downstream effects included BRAF p.S766, which forms an inhibitory site: a decrease of phosphorylation at this site suggests an increase in MEK/ERK pathway activation. The decreased phosphorylation at BRAF p.S766 would suggest decreased AMP-activated protein kinase (AMPK) signaling, which is supported by the decreased phosphorylation of STIM1 p.S257, a downstream AMPK target. Conclusion: The modified phosphoproteome profile of the homozygous mice in combination with human literature suggests a potential signaling pathway from constitutive TSHR signaling and cAMP activation to the activation of ERK/MAPK signaling. This is the first time that a specific mechanism has been identified for a possible involvement of TSH signaling in thyroid carcinoma development.

Objective: The aim of the study was to identify patients with NTRK fusion-positive or RET fusion/mutation-positive thyroid cancers, who could benefit from neurotrophic tyrosine kinase receptor (NTRK) or receptor tyrosine kinase (RET) inhibitors. Methods: Patients were identified in the Calgary prospective thyroid ca ncer database (N = 482). Patients were ‘pre-screened’ with clinically available MassARRAY® BRAF test, Colon Panel, Melanoma Panel, or ThyroSPEC™. Mutation-negative tumors were ‘screened’ for NTRK fusions and RET fusions/mutations with the Oncomine™ Comprehensive Assay v3 (OCAv3). Results: A total of 86 patients were included in 1 of 2 separate analyses. Analysis A included 42 patients with radioactive iodine (RAI)-resistant distant metastases. After pre-screening, 20 BRAF and RAS mutation-negative patients underwent OCAv3 screening, resulting in the detection of 4 patients with NTRK fusions and 4 patients with RET fusions (8/20, 40% of analyzed patients). Analysis B included 44 patients, 42 with American Thyroid Association (ATA) high and intermediate risk of recurrence and 2 with medullary thyroid carcinoma. During pre-screening, 1 patient with an NTRK fusion, 1 patient with a RET fusion, and 30 patients with BRAF mutations were identified. The remaining 9 patients received OCAv3 screening, resulting in detection of 1 patient with an NTRK fusion and 1 with a RET fusion (4/11, 36% of analyzed patients). Conclusions: Our findings indicate a higher rate of NTRK fusions and RET fusions in patients with thyroid cancer with RAI-resistant distant metastases and ATA high or intermediate risk of recurrence. This highlights the importance of early screening to enable intervention with a NTRK or RET inhibitor.

In the era of Web 3, digital currencies and virtual cities, human decision-making is very special. In It´s crucial to examine human responses alongside artificial intelligence in the healthcare field following an event and to create a collaborative geographic system based on modern technology. The ultimate goal is the restoration of countries´ essential services prioritizing health. In this research, spatial questions were conducted by considering public opinion, stakeholders, and decision makers under varying mental and emotional conditions. additionally, two different statistical and ranking methods were employed to comprehend the intricacies of individuals' mental states in a mathematical environment. All these methods were executed using software designed for location-based decision making under equal conditions. This paper focuses on a specific region, as an example applicable to a country or even to a larger scale. The results showed that time factors are completely related to decision criteria. While emerging technologies are promising, complete reliance on artificial intelligence for decision-making is misguided. Human choices are intrinsic to decision-making, and therefore, all relevant criteria for spatial decision-making have been considered. This pioneering study, conducted for the first time, showed that human choices can be optimal in different situations with similar conditions. Meanwhile, artificial intelligence only makes logical decisions that are not compatible with human thinking. The ongoing research holds potential value for neurologists or mental health specialists emphasizing the significance of geographical sciences in urban development. While it´s conceivable that medical issues and events can be addressed with artificial intelligence it appears that at least for the next few decades, even with the advancement of artificial intelligence, human presence remains essential in healthcare decision-making.

Clinical management of papillary thyroid cancer depends on estimations of prognosis. Standard care, which relies on prognostication based on clinicopathologic features, is inaccurate. We applied a machine learning algorithm (HighLifeR) to 502 cases annotated by The Cancer Genome Atlas Project to derive an accurate molecular prognostic classifier. Unsupervised analysis of the 82 genes that were most closely associated with recurrence after surgery enabled the identification of three unique molecular subtypes. One subtype had a high recurrence rate, an immunosuppressed microenvironment, and enrichment of the EZH2-HOTAIR pathway. Two other unique molecular subtypes with a lower rate of recurrence were identified, including one subtype with a paucity of BRAFV600E mutations and a high rate of RAS mutations. The genomic risk classifier, in addition to tumor size and lymph node status, enabled effective prognostication that outperformed the American Thyroid Association clinical risk stratification. The genomic classifier we derived can potentially be applied preoperatively to direct clinical decision-making. Distinct biological features of molecular subtypes also have implications regarding sensitivity to radioactive iodine, EZH2 inhibitors, and immune checkpoint inhibitors.

Puporse. The title of air-space in the spatial part is not just a noun, but it is quite effective in determining its conditions. National Participant using new spatial information system including software, hardware in synchronous and asynchronous environments. Also, explaining the role of the National Collaborative Spatial Information System in the effectiveness of urban planning Methods. Introducing the national software in the process of participation along with the spatial information system. Statistical analysis along with interpretations based on statistics, especially Spearman's correlation. Also Using all the criteria and factors that have been used so far to participate with GIS in a spatial and non-spatial way. Results. There are short discussion related to the formation of the software, the formation of the environment and hardware and all the existing criteria, and then the evaluation process, proposed for the participation-oriented information system, continues. The methods are discussed and then the discussion related to the case study and evaluation of the usability of the participatory spatial information system and requirements engineering as a support tool for participatory planning in the municipality was discussed. In the end, statistical analysis along with interpretations based on statistics, especially Spearman's correlation, are discussed and demonstrated. The reason for the topic of decision-making is based on statistical analysis, not just comparing decision-making with analysis, because sudden decisions like early humans are usually made in natural events and away from dangers and the like. This issue has not been seen in any dispute so far. In the following, we realized that the time factor and then being on time are the most important factors along with the economic criterion. Although planners were expected to be decisive, the results showed otherwise. In practice, it was proved that the basis of software, mathematical and statistical analysis decisions of the groups is the reason for the rise of the economic standard, along with the time factors, which are very necessary in improving the participation with GIS. The role of the power and wealth layer is still colorful and unlike the priorities, the fastest and most dominant decisions are made by this. in this study Time is a decisive factor. Conclusions. Based on the results obtained and due to the misleading nature of the time issue, it cannot be managed, and people should not worry about time management, because they lose their focus. Therefore, they should manage their concentration and be focused in the moment. It is only in this way that one can use the time effectively and continue the desired activity. Finally, by programming and creating collaborative decision-making in asynchronous and synchronous environments, NPGIS is introduced in an organizational form.

Rent is defined as surplus or non-productive profits that are pursued to create naturally (inherited) or fabricated scarcity from a specific product. The value of the land is about the natural and fabricated drivers influence on finalization of the land price and the value of the consumption and trading of urban lands causes “rent” and the unequal profit from the production of housing. Building violations in the city refer to processes for the building and use of which are not licensed (or licensed) or in conflict with the building permit issued by the city hall. This research paper is about the occurrence of building violations, land/housing rent, and the performance of the city hall in this regard in Sanandaj from 2003 to 2011. This research is fundamental and applied research, which has been done by the descriptive-analytical method. Data and information about this research were collected through available documents, reports, and library books, field studies, descriptive statistics, and Pearson Correlation Coefficient were interpreted and analyzed. Based on the findings of this study, out of 8,772 building licenses issued in Sanandaj from 2003 to 2011, 2,886 cases (35.75%) resulted in 6,291 violations per plot of 20,4294 square meters. The results of this study have shown that land rent and housing, a licensing process and sales of building surplus and city hall earnings have a significant effect on the occurrence had a significant impact on the spatial distribution of building violations in Sanandaj city. The most of the issuance of building permits (98.22%), sales of the floor area ratio surplus of a building, and building violations occurred in the district 3 of Sanandaj, which enjoyed higher land rent, housing, and a remarkable proportion of the city hall’s revenue, was also provided.

Background and objective Gabapentinoids are the first-line drugs for neuropathic pain. These drugs are the substrate of organic cation transporter (OCTN1) for renal excretion and absorption across the intestinal epithelium. Gabapentinoids exhibit wide interindividual variability in daily dosage and therapeutic efficacy which makes titration regimens prolonged for optimal efficacy. The present study aimed to investigate the possible influence of the single nucleotide polymorphism (SNP) of OCTN1 on therapeutic efficacy and safety of gabapentinoids in neuropathic pain patients of the Pakistani population. Methods Four hundred and twenty-six patients were enrolled in the study. All participants were genotyped for OCTN1 rs1050152 and rs3792876 by PCR-RFLP method and followed up for eight weeks. The therapeutic outcomes of gabapentinoids, reduction in pain score, inadequate or complete lack of response, adverse events (AEs) in responders and discontinuation of treatment on account of AEs were recorded for all patients. Results There was no significant association of genotypes and alleles of both SNPs on the clinical response of gabapentinoids (P ˃ 0.05). Similarly, significant differences were not found in the reduction of pain scores and AEs among different genotypes in the responders. The present study has reported the association of OCTN1 rs1050152 and rs3792876 polymorphisms with clinical outcomes of gabapentinoids for the first time in the real-world clinical setting. Conclusion Our results suggest a lack of influence of OCTN1 genetic variants in the determination of clinical response to gabapentinoids in patients with neuropathic pain in the Pakistani population. These findings signify the role of renal functions in predicting the interindividual variability to therapeutic responsiveness of gabapentinoids.

‘Az’ (greed) is one of the concepts of practical philosophy that is manifested in the thoughts, speeches, and actions of human beings. This concept is represented in Iranian classical literature represented in various narrative and non-narrative literary forms. The Iranian epic poetry, due to the narrative structure and importance of the actions in the typical human beings (heroes and anti-heroes), has more features to illustrate this concept more precisely. Regarding the reflection of the concept of "Az" in the epic literature, researchers have mainly focused on Shahnamehand did not paid attention to the epics after Shahnameh. Therefore, this study aims at specifying the origin of the concept of "Az" and its representation in the narrative structure of the two athletic poems after Shahnameh, Koush Nameh and Faramarz Nameh, in three parts of the conception, the mode of expression and action of the heroes and the anti-hero by a descriptive-analytical method. The theme of "Az" is manifested in both poems, but in Koush Nameh the content is obvious in all parts of the story, and there is not much narration in the main world of Faramarz Nameh. In both poems, the strong connection between Khosrovani and Islamic philosophy is fully perceptible in specifying the meaning of "Az". Speakers speaking about the "Az" in both poems are divided into narrators and heroes.

Background and Aim: Nesfetin-1 is known as the Neuropeptide which interfere in appetite and glucose hemostasis. Its amount in healthful persons than diabetes sick is variable and changes according to the exercise. The aim of the present study is to investigate the effects of acute aerobic exercise on nesfatin-1 gene expression in diabetic rats. Materials and Methods: In this experimental study, has utilized the diabetic wistar stagy rats with STZ (12 week-age, 220-240 gr-weight). Animals into 4 groups: continuous exercise (COE-0) and control (CO), (who died immediately after exercise) and continuous (COE-2) and control (C-2), (who died two hours after exercise), respectively. Group COE performed exercise speed of 18 meters per minute for 40 minutes on the treadmill. Hypothalamus tissue was excised for determination of nesfatin-1 gene expression by RT-PCR methods. Data was analyzed by using an independent t-student test. All statistical calculations were performed using SPSS version 20. Results: The current results indicated that the levels of nesfatin-1 gene expression, increased significantly in training group immediately and two hours after exercise when compared with Control group yourself. Conclusion: It seems a session of continuous exercise may increase the hypothalamic expression of male Wistar rats with diabetes nesfatin -1 immediately and two hours after the exercise.

Objective: To evaluate the synergistic effects of omeprazole and metformin on glycemic control among patients with type 2 diabetes. Method: This randomized interventional clinical study was conducted in the Department of Pharmacology and Therapeutics, Basic Medical Sciences Institute, Jinnah post graduate medical Centre Karachi. Total study period was 10 months (august 2014-June2015) with individual study period of 3 months (90 days), Eighty(80) type 2 diabetic patients (40 in each group) of either sex, ages ranged from 30 to 60 years without any known comorbidities were included. Group-A was treated with metformin alone and Group-B was treated with metformin plus omeprazole. Efficacy was evaluated by means of FBG, and HbA1C. Results: Out of 80 patients, 74 had completed the study. Group B showed significant reduction (P=0.001) in terms of FBS and HbA1c level when comparison was done on day 90 with Group A and within group as compared to day 0. Conclusion: Addition of proton pump inhibitor with metformin was found effective in achieving better glycemic control in type 2 diabetic patients.

Background: To evaluate the effects and safety profile of Paroxetine on hot - flashes in post - menopausal women. Methods: It was prospective open label control clinical trial. This study is conducted in the Department of pharmacology & Therapeutics in collaboration with the Department of Obstetrics & Gynecology JPMC. The patients were selected from outpatients department (OPD) of Obstetrics & Gynecology. Duration of the study was 12 month from January 2014 to January 2015. Enrolling 180 outpatients who had menopause with hot flushes divided into three groups. The Greene Climacteric Score Scaling was applied to observe the effects of 12.5mg, 20mg Paroxetine on frequency of hot flashes as compared to Placebo. Results: Mean GCS scoring frequency in 12.5mg Paroxetine group at 12 week was 1.97±0.31 and the baseline 2.64±0.29. In 20mg Paroxetine mean GCS at baseline was 2.76±0.23 and 12 week 2.04±0.12. Where as in Placebo mean GCS scoring frequency at 12 week was 2.80±0.24 and at baseline 2.76±0.24. Conclusion: The frequency of hot flashes with Paroxetine 20mg and 12.5mg, is significantly reduced in post menopauseal women as compared to Placebo.

ABSTRACT: Objective: To evaluate the anti-diarrheal effect of Methanol extract of Curcuma Longa, and to compare it with Loperamide in albino rats. Methodology: This experimental animal study was performed in the Department of Pharmacology and Therapeutics, Basic Medical Sciences Institute (BMSI), Jinnah Postgraduate Medical Center (JPMC), Karachi, in collaboration with BMSI Animal house, from May 2013 to December 2014. Dried rhizomes of Curcuma longa were purchased from local market of Karachi and soaked in 100% methanol, which was later evaporated to yield a semisolid extract. Seventy-two albino rats were used, which were randomly assigned into 3 groups of 24 rats. Each group was further divided into 4 subgroups. In each group, one subgroup was control, one was standard (loperamide group) and two subgroups were given 100mg/kg and 200mg/kg of methanol extract of Curcuma Longa orally. Anti-diarrheal effect was assessed by counting total number of feces after castor oil-induced diarrhea, castor oil-induced enteropooling and gastrointestinal motility test. Results: The methanol extract of Curcuma Longa showed significant anti-diarrheal activity evidenced by the reduction in defecation, decreased intestinal transit of charcoal meal and decreased enteropooling after castor oil-induced diarrhea. Conclusion: Curcuma Longa had potent anti-diarrheal affect and can replace synthetic drugs like loperamide. These effects were related to phytochemicals present in it.

Objective: To study the role of combination therapies in the treatment of rheumatoid arthritis. Methodology: This open-label, randomized 180-day clinical trial was conducted in the Department of Pharmacology and Therapeutics, BMSI and Medical unit ward 6, after approval of JPMC ethical committee, in which enrolled patients were 89. Patients were divided into two groups, A and B. 44 patients of group A received methotrexate (MTX) 7.5-20 mg/ week orally and Leflunomide (LEF) 10-20 mg/ day orally as maximally tolerated. 45 patients of group B were given MTX 7.5-20 mg/ week orally and Sulfasalazine (SSZ) 500 mg to 1 gm daily orally as maximally tolerated. Result: Comparing the combination of group A with group B, group B showed highly significant improvement in mean swollen joint count (1.9±0.9) and morning stiffness (46.0=19.06) as compared to group A (2.9=1.71, 54.4=10.14). The drugs of group A showed significant improvement in mean pain (2.9= 1.71), physician’s global assessment (2.80±0.97) and patient’s global assessment (1.4=0.66) as compared to group B (1.9= 1.45, 3.8±1.22, 2.0=0.99). Therefore, our study revealed that patients receiving combination of MTX and LEF responded slightly better than MTX and SSZ. Both the combination treatments were well tolerated. Conclusion: Both combinations of MTX & SSZ and MTX & LEF were well tolerated but the efficacy of MTX and LEF was marginally superior to combination of MTX and SSZ.

Objective: Serotonin reuptake inhibitors are frequently used in first-line treatments for patients ‎with obsessive-compulsive disorder. Nevertheless, many of these patients do not ‎respond well to initial therapy. The hypothesis of glutamatergic dysfunction in specific ‎brain regions has been proposed in the pathophysiology of obsessive-compulsive ‎disorder. This study was designed to evaluate the possible efficacy of lamotrigine, a ‎glutamatergic agent in Serotonin reuptake inhibitors-resistant patients with obsessive-‎compulsive disorder.‎ Method: This study was a 12-week, double blind, randomized, placebo-controlled trial of ‎adjunctive fixed-doses of lamotrigine (100 mg) to Serotonin reuptake inhibitors therapy ‎in obsessive-compulsive disorder. Eligible subjects who had a total Y-BOCS of 21 or ‎above were randomly assigned to receive adjunctive treatment with either lamotrigine ‎‎(n = 26), or placebo (n = 27). Response to lamotrigine was defined as clinical ‎improvement (>25% decrease in the total Y-BOCS score), which was administered at ‎weeks 0, 8 and 12.‎ Results: At the endpoint (week 12), significant differences were observed in obsession, ‎compulsion, and total Y-BOCS scores comparing lamotrigine to placebo (P = 0.01, ‎‎0.005 and 0.007 respectively). The mean reduction in obsession, compulsion and total ‎scores in lamotrigine group was about 4.15, 4.50 and 8.73, respectively. Similarly, the ‎mean reductions in the placebo group were 2.52, 2.56 and 5.07. Effect sizes for efficacy ‎measures were calculated by Cohen’s d, and it was calculated as 0.54 for the total ‎YBOCS.‎ Conclusion: Our findings provide evidence that this augmentation is well tolerated and may be an ‎effective strategy for patients with refractory obsessive-compulsive disorder.‎‎

Background: Allopurinol is the most frequently used antihyperuricemic drug. Fenofibrate, a derivative of fibric acid, is commonly used in the treatment of hyperlipidemia. Fenofibrate treatment has been shown to decrease serum uric acid levels. This study was conducted to assess the efficacy and safety of fenofibrate in patients with hyperuricemia. Material and Method: Sixty hyperuricemic patients with serum uric acid level 7.0mg per deciliter or above were enrolled and assigned to take either allopurinol 300mg or fenofibrate 200mg daily for 12 weeks. Drug efficacy was assessed by measuring percentage of subjects achieving serum uric acid level less than 6mg per deciliter at day 90. Drug efficacy was also assessed by measuring percent change in serum uric acid level from day 0 to day 90. Safety of the drug was assessed by reviewing adverse effects (AEs) and laboratory values. Results: Comparison of percentage of subjects reaching serum uric acid level less than 6.0mg per deciliter at day 90 between the two groups was significant (P=0.14). However, percent change in serum uric acid level from day 0 to day 90 was highly significant between the two groups (P=0.001). Proportions of subjects experiencing any adverse event were higher in fenofibrate group, though the adverse effects leading to treatment withdrawal were higher in allopurinol group. Conclusion: Fenofibrate 200mg once daily is an effective antihyperuricemic agent.

Objective: Comparison of efficacy and safety profile of Gabapentin and Carbamazepine in painful diabeticneuropathy. Study Design: open label 12 weeks randomized controlled trial. Settings: The present study was conducted in Department of Pharmacology & Therapeutics Basic Medical Sciences Institute (BMSI), Jinnah Postgraduate Medical Center (JPMC) in collaboration of Diabetic Clinic of Medical Unit III of JPMC Karachi. Study Period: December 2010 to May 2011. Subjects and Methods: 60 diagnosed patients of painful diabetic neuropathy were selected for 12 weeks trial after taking written consent. The patients were randomly placed into two groups, 30 patients each. One group received Gabapentin (n=30) while the other received Carbamazepine (n=30). Results: The primary outcome was reduction in pain scale. It was compared on 11-point numerical visual analog scale (VAS). In Gabapentin group the reduction in pain VAS was 6.17±0.15 on day 0 to 3.5±0.15 on day 90. The percentage of change was 43.3% from baseline (p-value 0.001). In carbamazepine group the reduction in pain VAS was 6.07±0.13 on day 0 to 4.23±0.13 on day 90. The percentage of change was 30.4% (p-value 0.001). The secondary outcome was improvement in sleep interference that is measured on 11-point numerical VAS of sleep interference. It also improved in both groups which is highly significant. Conclusion: In patients of diabetic painful neuropathy treatment of Gabapentin and Carbamazepine both are effective but Gabapentin is superior in relieving symptoms than Carbamazepine

Objective: Comparative role of topical Betamethasone valerate (0.1%) and topical Calcipotriol (0.005%) inthe treatment of plaque psoriasis. Materials and Methods: This 12 weeks research project was conducted in the Department of Pharmacology and Therapeutics, BMSI, JPMC, Karachi. Total 80 psoriatic (mild and moderate) patients were included in the study and they were divided into two groups, A and B; 40 patients in each group. The patients of group A were treated by Betamethasone valerate (0.1%) and the patients of group B were treated by Calcipotriol (0.005%). To observe any significant changes, the PASI parameter was applied at the end of study period. Results: Psoriasis severity improvement was monitored by Psoriasis Area Severity Index (PASI). As comparedto day 0, the mean PASI score changes in both treated groups i.e group A (Betamethasone valerate) and groupB (Calcipotriol) was highly significant at day 90 but the changes in mean PASI score was more marked ingroup B. In mild psoriasis, Calcipotriol causes 71.61% improvement in PASI score whereas Betamethasonevalerate causes 63.2% improvement. In moderate psoriasis, Calcipotriol causes 69.21% improvement in PASI score whereas Betamethasone valerate causes 60.44% improvement. Conclusion: Topical Calcipotriol was more effective in improvement of mild and moderate plaque psoriasis as compared to Betamethasone valerate in local population.

Population pattern in Guilan province represents a dramatic increase in youth population. Regarding high prevalence of substance use among them, its destructive effects and consequences and paucity of previous related studies, this research was performed to determine the prevalence of substance use among students of Guilan University of Medical Sciences (GUMS). We conducted a cross-sectional study in a representative sample of 845 students in 2005-2006. Data were collected by a questionnaire including demographic data and history of substance use and were analyzed by EPI 2002 software and chi-square. 30.1% of students had a history of substance use at least once during their lives. Cigarette (26.36%), alcohol (17.04%) and opium (3.86%) were the most prevalent used substances. Substance use was significantly associated with male gender, higher age groups, living with friends or alone and being married. There were significant relationships between substance use during past 30 days and studying medicine or dentistry and substance use during life and past 30 days was significantly higher in residency period. This study demonstrated substance use between our samples was considerable and specific interventions to reduce it seem necessary.

Background: Methamphetamine-induced psychotic disorder (MIP) cannot be easily differentiated from other psychotic disorders. Some studies have reported that patients with MIP and schizophrenia have differences in their cognitive functioning. We hypothesized that their performance would be different on neuropsychological tests which assess executive functions and visual memory. Materials and Methods: In a cross-sectional study, 30 patients with MIP, 31 patients with schizophrenia, and 31 healthy controls were assessed by Rey–Osterrieth complex figure (ROCF) test and visual search and attention test (VSAT). One-way analysis of variance was performed to compare the mean scores of tests. Tukey's HSD test was used for post hoc analysis. Results: Three groups had significant differences according to ROCF test (F = 15.76, P < 0.0001), VSAT (F = 39.78, P < 0.0001), left VSAT (F = 37.96, P < 0.0001), right VSAT (F = 40.40, P < 0.0001), and the time of the test administration (F = 3.26, P = 0.04). The post hoc analysis showed that the mean score of ROCF test and VSAT (total, right, and left) was significantly higher in the control group than in the other two groups. The time of administering the test in the control group was significantly shorter than in the MIP group (P < 0.03) and nonsignificantly shorter than in the schizophrenia group (P = 0.54). The mean score of right side VSAT was significantly higher in the MIP group than in the schizophrenia group. Conclusion: ROCF could not differentiate MIP from schizophrenia. The better performance of patients with MIP on right side VSAT that is reported in this and in the previous study needs to be reevaluated in more controlled studies.

Primary pericardial malignant mesothelioma (PMPM) is extremely rare with an incidence less than 0.0022%. It comprises 0.7% of all mesothelioma cases. To date, approximately 350 cases of pericardial mesothelioma have been reported in the literature. Its typical presentation is insidious, with nonspecific signs and symptoms, and usually results in constrictive pericarditis, cardiac tamponade and congestive heart failure either by a serous effusion or by direct tumorous constriction of the heart. With the exception of several case reports, the outcome is uniformly fatal, and patients typically die within six months of diagnosis. Here we report a 72-year-old Caucasian male with persistent pericardial and pleural effusion. He was diagnosed with PMPM after pericardectomy. He had only one cycle of chemotherapy with cisplatin and pemetrexed. He developed acute kidney injury as result of chemotherapy. He died 1 month after diagnosis and 6 months after the first symptoms.

Population pattern in Guilan province represents a dramatic increase in youth population. Regarding high prevalence of substance use among them, its destructive effects and consequences and paucity of previous related studies, this research was performed to determine the prevalence of substance use among students of Guilan University of Medical Sciences (GUMS). We conducted a cross-sectional study in a representative sample of 845 students in 2005-2006. Data were collected by a questionnaire including demographic data and history of substance use and were analyzed by EPI 2002 software and chi-square. 30.1% of students had a history of substance use at least once during their lives. Cigarette (26.36%), alcohol (17.04%) and opium (3.86%) were the most prevalent used substances. Substance use was significantly associated with male gender, higher age groups, living with friends or alone and being married. There were significant relationships between substance use during past 30 days and studying medicine or dentistry and substance use during life and past 30 days was significantly higher in residency period. This study demonstrated substance use between our samples was considerable and specific interventions to reduce it seem necessary.

The objective of this study was to find out the most suitable date of seed sowing in respect to quantitative and qualitative growth of Pinus brutia and Cupressus sempervirens var. horizontalis seedlings in forest nursery from September 2003 to September 2005. In respect to quantitative parameters of both studied species (mean collar diameter, mean height), the sowing date in autumn was better than the spring (P

Under the 21st Century Cures Act of 2016, a summary of the evidence used to support local coverage determinations, which represent the vast majority of Medicare's coverage decisions for new technologies, must be made publicly accessible. Using reports from the Medicare Coverage Database on local coverage determinations and the medical literature, we examined the availability of these decisions and the quality of evidence cited for therapeutic drugs, biologics, and moderate- or high-risk devices during the period 2015-22 to understand whether evidence strength and generalizability differed for indications with favorable versus unfavorable coverage decisions. Evidence summaries were publicly available for 26 percent of coverage decisions originally effected during 2015-18 and 100 percent during 2019-22. Among the latter, when compared with noncovered indications, indications with favorable coverage decisions cited twice the number of evidence sources (median, four versus two) and more often cited studies with a mean patient age of sixty-five and older (78 percent versus 47 percent). Fewer than one-third of all studies reported race or ethnicity data. There was no significant association between indication coverage and the study design strength of cited clinical studies. Although the 21st Century Cures Act enhanced transparency, clinical evidence that better reflects the Medicare beneficiary population is needed to inform local coverage determinations.

Background: Persistent infection with high-risk (HR) human papillomavirus (HPV) causes cervical cancer, the fourth most frequent cancer in the Kingdom of Bahrain, with an annual incidence of four per 100,000 women. The aim of this study was to assess the prevalence and type distribution of HPV in Bahraini and non-Bahraini women attending routine screening. HPV prevalence was assessed by risk factors and age distribution. Health-related behaviors and HPV awareness were also studied., Methods: This observational study was conducted between October 2010 and November 2011 in the Kingdom of Bahrain (NCT01205412). Women aged either ≥20 years attending out-patient health services for routine cervical screening or ≥16 years attending post-natal check-ups were enrolled. Cervical samples were collected and tested for HPV-DNA by polymerase chain reaction and typed using the SPF10 DEIA/LiPA25 system. All women completed two questionnaires on health-related behavior (education level, age at first marriage, number of marital partners, parity and smoking status) and HPV infection awareness., Results: HPV DNA was detected in 56 of the 571 women included in the final analysis (9.8%); 28 (4.9%), 15 (2.6%) and 13 (2.3%) women were infected with single, multiple and unidentifiable HPV types, respectively. The most prevalent HPV types among the HPV positive women were HR-HPV-52 in eight (1.4%), HR-HPV-16, -31 and -51 in six women each (1.1%); low-risk (LR)-HPV-6 in four (0.7%); and LR-HPV-70, -74 in three women each (0.5%). Co-infection with other HR-HPV types was observed in 50% HPV-16-positive women (with HPV-31, -45 and -56) and in both HPV-18-positive women (with HPV-52). None of the health-related risk factors studied were associated with any HR-HPV infection. More than half of women (68.7%) had never heard about HPV, but most women (91.3%) in our study were interested in HPV-vaccination., Conclusion: HPV prevalence in Bahraini women was 9.8%. The most frequently observed HPV types were HR-HPV-52, -16, -31 and -51 and LR-HPV-6, -70 and -74. These are useful baseline data for health authorities to determine the potential impact of preventive measures including the use of prophylactic vaccines to reduce the burden of cervical cancer.

Context: Thyroglobulin (Tg) may be a valuable indicator of improving thyroid function in children after salt iodization. A recently developed Tg assay for use on dried whole blood spots (DBS) makes sampling practical, even in remote areas., Objective: The study aim was to develop a reference standard for DBS-Tg, establish an international reference range for DBS-Tg in iodine-sufficient children, and test the standardized DBS-Tg assay in an intervention trial., Design, Participants, and Interventions: Serum Tg reference material of the European Community Bureau of Reference (CRM-457) was adapted for DBS and its stability tested over 1 yr. DBS-Tg was determined in an international sample of 5- to 14-yr-old children (n = 700) who were euthyroid, anti-Tg antibody negative, and residing in areas of long-term iodine sufficiency. In a 10-month trial in iodine-deficient children, DBS-Tg and other indicators of iodine status were measured before and after introduction of iodized salt., Results: Stability of the CRM-457 Tg reference standard on DBS over 1 yr of storage at -20 and -50 C was acceptable. In the international sample of children, the third and 97th percentiles of DBS-Tg were 4 and 40 microg/liter, respectively. In the intervention, before introduction of iodized salt, median DBS-Tg was 49 microg/liter, and more than two thirds of children had DBS-Tg values greater than 40 microg/liter. After 5 and 10 months of iodized salt use, median DBS-Tg decreased to 13 and 8 microg/liter, respectively, and only 7 and 3% of children, respectively, had values greater than 40 microg/liter. DBS-Tg correlated well at baseline and 5 months with urinary iodine and thyroid volume., Conclusions: The availability of reference material and an international reference range facilitates the use of DBS-Tg for monitoring of iodine nutrition in school-age children.

Background: Goiter prevalence in school-age children is an indicator of the severity of iodine deficiency disorders (IDDs) in a population. In areas of mild-to-moderate IDDs, measurement of thyroid volume (Tvol) by ultrasound is preferable to palpation for grading goiter, but interpretation requires reference criteria from iodine-sufficient children., Objective: The study aim was to establish international reference values for Tvol by ultrasound in 6-12-y-old children that could be used to define goiter in the context of IDD monitoring., Design: Tvol was measured by ultrasound in 6-12-y-old children living in areas of long-term iodine sufficiency in North and South America, central Europe, the eastern Mediterranean, Africa, and the western Pacific. Measurements were made by 2 experienced examiners using validated techniques. Data were log transformed, used to calculate percentiles on the basis of the Gaussian distribution, and then transformed back to the linear scale. Age- and body surface area (BSA)-specific 97th percentiles for Tvol were calculated for boys and girls., Results: The sample included 3529 children evenly divided between boys and girls at each year ( +/- SD age: 9.3 +/- 1.9 y). The range of median urinary iodine concentrations for the 6 study sites was 118-288 micro g/L. There were significant differences in age- and BSA-adjusted mean Tvols between sites, which suggests that population-specific references in countries with long-standing iodine sufficiency may be more accurate than is a single international reference. However, overall differences in age- and BSA-adjusted Tvols between sites were modest relative to the population and measurement variability, which supports the use of a single, site-independent set of references., Conclusion: These new international reference values for Tvol by ultrasound can be used for goiter screening in the context of IDD monitoring.