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BACKGROUND: “Biomedical waste (BMW) is the waste generated during the diagnosis, treatment or immunization of human beings or animals or research activities pertaining thereto or in the production or testing of biologicals” (Management and Handling Rules, 1998 of India). As it is a source of dangerous diseases, the handlers need to have adequate knowledge about the same. MATERIALS AND METHODS: This study assessed the knowledge, attitude, and practice of biomedical waste management among healthcare workers in a Primary Health Centre and tested the association between KAP and selected variables. For this study, one PHC among six in Sikkim was purposively selected and all health providers attached with the PHC were assessed for KAP toward BMW Management. Data was summarized using SPSS version 27. Pearson’s Chi-square test (or Fisher’s exact test) was applied to find the association between KAP and selected variables (P < 0.05 was considered significant). Bivariate and multivariate logistic regression analysis was performed for the significant variables. RESULTS: The mean age of the study participants ranged from 36.42 ± 8.983 years. 66%, 66%, and 60% of healthcare workers had adequate knowledge scores, favorable attitude scores, and good practice scores in BMWM, respectively. CONCLUSION: A knowledge gap was observed among the supportive medical staff as there was a lack of formal training in BMWM. Training of not only medical officers but also for waste handlers should be conducted at the time of appointment as well as refresher trainings should be done for the overall health and safety of all waste handlers.

Background: Systemic sclerosis is an incurable autoimmune fibrotic skin disease. Many factors were described as aetiology of SS, but the impact of nutritional factor is unknown. The aim of this study was to determine the nutritional status and gastrointestinal manifestations in patients with systemic sclerosis in Ilam, Iran.Methods: In a case-control study, 47 people confirmed with systemic sclerosis disorders were enrolled as case group and 47 subjects as control group; while they were matched for age and BMI and compared statistically. Food frequency questionnaire (FFQ) and demographicvariables were collected for all participants.Results: Meat and dairy consumption was higher among case group (Adjusted OR=5.1, p

Abstracts:Background: Food allergy is an increasing health problem in children. Previous studies have reported conflicting results about the diagnostic value of atopy patch test (APT) in food allergies.Objectives: To investigate the accuracy of APT in identifying non-IgE-mediated gastrointestinal food allergy to pasteurized cow's milk, heated cow's milk, white and yolk egg, soy, wheat, walnut, sesame, pistachio, almond, peanut, date and cumin which are popular food ingredients in Iran.Methods: This study was performed on children with GI allergic problems who did not improve after at least 4 weeks of cow's milk protein elimination. Atopic patch test (APT) was performed and the elimination diet was considered according to APT results and after resolving symptoms, introduction of each accused food was done sequentially. Results: 53 children under 7 years old with mean age of 19.6 months underwent APT and the results were verified by open oral food challenge. Sensitivity in the rage of 59%-95%, specifity of 80.7-92.8, positive predictive values of 75-96.4 and negative predictive value of 23-80.7% were calculated depending on the type of food. Compared to the heated raw cow's milk, the pasteurized/homogenized cow's milk reaction was significant. Conclusion: APT can be included in the diagnostic workup of non-IgE-mediated GI allergy because it's safe and has great accuracy. However, several aspects require further investigation especially to enable the standardization of the technique. We should be aware of allegenicity of our foods due to processing and geographic region.

Objectives: No comprehensive analysis has yet been published regarding global trends in childhood sexual abuse (CSA) and bullying victimization (BV). The present study offers a longitudinal perspective on their prevalence worldwide. Methods: CSA and BV rates were extracted from the Global Burden of Disease study, spanning the years 1990 to 2019 across 204 countries. Trends by gender, region, and human development index (HDI) were examined. Results: For both boys and girls, and in both high-HDI and low-HDI countries, CSA rates did not significantly change from 1990 to 2019 (p>0.05). However, BV rates increased significantly in high-HDI and low-HDI countries for both genders (p

Abstract Background Asthma is a prevalent chronic respiratory disease that affects individuals from childhood to adulthood. This study aimed to investigate the association between symptoms and severity of asthma with television viewing, computer and Internet use in adolescents, considering the lifestyle changes in recent decades. Methods This study was conducted in early 2020 as part of the Global Asthma Network 2020 survey, among 13–14-year-olds in Yazd, Iran. Participants were classified into case and control groups based on the presence and severity of asthma symptoms. The data was collected and analyzed using SPSS-20 software to compare the participants based on their screen time. Results The analysis of data collected from a total of 5141 students produced noteworthy results. A significant correlation was identified between the occurrence of wheezing in the past year, the presence of severe asthma, and the amount of time spent watching television, using a computer, or internet. The unadjusted model revealed that screen time of more than three hours, pet ownership, current smoking, and ever smoking were all significant predictors of wheezing and severe asthma. Smoking was the strongest predictor of asthma and its severity. After adjusting for confounding factors, the multiple logistic regression model confirmed that screen time of more than three hours remained a significant predictor of both asthma and its severity. Conclusion This study finds a significant association between media usage and asthma symptoms and severity. However, this association is influenced by lifestyle factors such as physical activity, obesity, diet, and exposure to indoor allergens. Further research is needed to better understand the complex interplay between media usage and asthma, considering the impact of these factors.

Limited data exists regarding the association between dietary patterns and asthma. This study aims to determine the relationship between empirically derived dietary patterns and the likelihood of asthma among a large population of children and adolescents living in central Iran. Methods: A total of 7667 of male and female students aged 6-14 from 48 public and private schools in YAZD urban areas entered the current cross-sectional study. Data on dietary intakes, as well as asthma symptoms and other possible confounders, were collected using a self-administered questionnaire filled by parents. Factor analysis was applied to find major dietary patterns. Multivariate logistic regression was performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for asthma development across quintiles of dietary patterns. Results: Two main dietary patterns were established. A “traditional diet” was determined by meat, fish, fruits, cooked vegetable, raw vegetable, legumes, cereals, bread, macaroni, rice, margarine, butter, olive oil, milk, yogurt, egg, nuts, potato, and a “western-like diet” was characterized by high intakes of simple sugars, fast food(hamburger), fast food (pizza), soft drinks, jelly, chocolate and biscuits of cocoa, ice cream, and sauce. After adjusting for potential confounders, individuals in the top quintile of traditional diet were 0.31 times less likely to have asthma than those in the lowest quintile (OR=0.69; 95% CI: 0.47-1.00). Moreover, individuals in the top quintile of traditional diet were 0.43 times less likely to have wheezing compared with those in the lowest quintile (OR=0.57, 95% CI: 0.46-0.70). However, individuals in the top quintile of the western diet were 0.35 times more likely to have wheezing than those in the lowest quintile (OR=1.35, 95% CI: 1.10-1.66). Conclusions: According to the results, a traditional diet might be associated with lower odds of asthma; however, a western-like diet might be adversely associated with asthma symptoms.

Abstract Background Based on our observations at the largest outpatient urology clinic in Iran, patients for whom finasteride is prescribed as a secondary drug to tamsulosin tend to experience earlier and more severe sexual side effects without any difference in the amelioration of symptoms. This study aimed to compare the time lag, efficacy, and side effects of combination therapy with varying doses of dutasteride or finasteride added to tamsulosin for benign prostatic hyperplasia (BPH) treatment. Methods In this study 165 were randomized into 5 groups (each N = 33); receiving tamsulosin 0.4mg plus either of A: finasteride 3mg, B: placebo, C: dutasteride 0.25mg, D: finasteride 5mg or E: dutasteride 0.5mg. During the 6-month period of the study, International Prostate Symptom Score (IPSS), post-void residual urine (PVR), International Index of Erectile Function (IIEF-5), prostate volume (PV), prostate specific antigen (PSA) and maximum urinary flow rate (Qmax) were evaluated at baseline and at the 1st, 3rd and 6th month. The differences between each time point and baseline were then compared between groups. Results At 3-month follow-up, group E exhibited a higher decrease in PSA but a greater increase in Qmax compared to group A (p = 0.047 and 0.006, respectively). Group C showed higher Qmax increase compared to group A at 3 and 6 months (p = 0.003 and 0.014) and concurrently a more pronounced PV decrease at 1 and 3 months (p = 0.047 and 0.003, respectively). Group D had a significantly more decrease in their IIEF-5 compared to group A at one-month visit (p = 0.006). Conclusions In summary, at the sixth-month follow-up, dutasteride demonstrated superiority over finasteride solely in enhancing Qmax. Therefore, dutasteride may be marginally more beneficial as a secondary component of combination therapy in BPH. Trial registration IRCT, IRCT20120516009772N2. Registered 18 January 2021 Retrospectively registered, https://irct.behdasht.gov.ir/search/result?query=IRCT20120516009772N2 .

Abstract Astrocytes control brain activity via both metabolic processes and gliotransmission, but the physiological links between these functions are scantly known. Here we show that endogenous activation of astrocyte type-1 cannabinoid (CB1) receptors determines a shift of glycolysis towards the lactate-dependent production of d-serine, thereby gating synaptic and cognitive functions in male mice. Mutant mice lacking the CB1 receptor gene in astrocytes (GFAP-CB1-KO) are impaired in novel object recognition (NOR) memory. This phenotype is rescued by the gliotransmitter d-serine, by its precursor l-serine, and also by lactate and 3,5-DHBA, an agonist of the lactate receptor HCAR1. Such lactate-dependent effect is abolished when the astrocyte-specific phosphorylated-pathway (PP), which diverts glycolysis towards l-serine synthesis, is blocked. Consistently, lactate and 3,5-DHBA promoted the co-agonist binding site occupancy of CA1 post-synaptic NMDA receptors in hippocampal slices in a PP-dependent manner. Thus, a tight cross-talk between astrocytic energy metabolism and gliotransmission determines synaptic and cognitive processes.

Particulate matter (PM) is an extremely overlooked air pollutant with drastic effects on the biome, owing to the industrial and agricultural advancements, significantly exacerbating global environmental contamination levels. The altered atmosphere in urban settings due to PM pollution profoundly influences plants' morphological, physiochemical state and allied responses. PM exposure leads to drastic decrease in plant-height, phytomass, leaf number, leaf length and productivity. PM change the epicuticular wax patterns, penetrates plant tissue through stomata, and denatures the chloroplast pigmentation. It changes leaves' light absorption and reflection patterns, weakening the total radiation that reaches the chlorophyll antenna and ultimately reducing the photosynthetic rate and electron transport chain. Consequently, this alters plants morphology like wax deposits, thick epidermis, and long trichomes near stomata. Moreover, PM stress also adversely effects gluconeogenesis, amino acid biosynthesis, TCA cycle, and photorespiration-associated gene expression. Several transcription factors, such as MYB, C3H, and G2-homologues, are activated as a collective stress response. Additionally, ascorbic acid, proline and soluble sugars accumulate and several antioxidants are produced to scavenge the PM-induced reactive oxygen species (ROS). This review aims to document plants' various responses to PM pollution in their respective eco-geographic settings and investigate ways used by plants to mitigate PM pollution. We also enumerate the consequences of PM pollution on plants and the corresponding phenomic and genetic mechanisms through which plants adapt.

Background: Limited investigations have focused on the association between the Mediterranean dietary (MeD) and asthma among children and adolescents. We aimed to study the associations between a modified Mediterranean dietary pattern and asthma symptoms in children living in Iran. Method: This cross-sectional study was conducted among 7667 children and adolescence. Data on dietary intakes, asthma symptoms and other possible confounders, were collected using a questionnaire completed by parents. The relationship between Mediterranean diet (MeD) and asthma was assessed using logistic regression. Results: We found that participants in the highest quartile of MeD score had 32% lower odds of wheezing in the past 12 months in the whole population when compared with those in the lowest quartile (OR: 0.68; 95% CI: 0.51–0.90; Ptrend

Abstract Background The Dietary Approaches to Stop Hypertension (DASH) diet, which has a lot of emphasis on the consumption of fruits, vegetables, and whole grains, and on the other hand, the consumption of red meat and sodium is limited, due to its anti-inflammatory properties, which can be related to reducing the risk of asthma. Objectives The aim of this study was to determine the relationship between the DASH diet and asthma symptoms among children and adolescents. Methods This cross-sectional study was conducted among7667 children (3414 boys and 4253 girls) aged 6–7 and 13–14 years living in central Iran. Dietary food consumption was assessed using a multiple-choice questionnaire. Logistic regression was used to obtain odds ratios for the association between the DASH-like diet with current asthma and asthma symptoms. Results Our findings revealed that higher adherence to a DASH-like diet resulted in lower odds of asthma confirmed by a doctor among the whole population (OR = 0.53; 95%CI: 0.36–0.76) and also in females (OR = 0.47; 95%CI: 0.29–0.78). Moreover, the higher adherence to the DASH-like diet was inversely associated with the chance of wheezing in the past 12 months in all subjects (OR = 0.67; 95%CI: 0.51–0.86) and in boys (OR = 0.57; 95%CI: 0.38–0.85). Conclusion The findings of the present study showed that following the DASH diet can be associated with the improvement of asthma symptoms in children and adolescents. However, more research is needed to improve dietary recommendations for asthma prevention.

Abstract Background The dietary inflammatory index (DII) serves as a tool to assess the inflammatory impact of an individual’s diet. This study aimed to investigate the association between DII and some cardio-metabolic risk indices among patients with T2DM. Methods Data from the Hoveyzeh Cohort Study, encompassing 2045 adults with T2DM, were analyzed. DII scores were calculated based on food frequency questionnaires. Anthropometric measurements and biochemical tests were performed to assess cardio-metabolic risk factors. Results Higher DII scores were positively associated with elevated triglyceride levels, triglyceride-glucose (TyG) index, lipid accumulation product (LAP), anthropometric indices including a body shape index (ABSI), body roundness index (BRI), body mass index (BMI), hip, waist circumferences (WC), and waist-to-height ratio (all Ptrend < 0.05). Notably, no significant association was observed between DII and fasting blood sugar (FBS) levels (Ptrend > 0.05). Additionally, dietary intake analysis revealed a negative correlation between DII scores and intake of fiber, fruits, vegetables, legumes, fish, seafood, dairy products, magnesium, and vitamins A, C, D, and E (all Ptrend < 0.05). Conversely, higher DII scores were associated with increased consumption of red meat, processed meat, refined cereals, potatoes, and soft drinks (all Ptrend < 0.05). Conclusion This study underscores the critical link between dietary inflammation, assessed by the DII score, and a multitude of cardio-metabolic risk factors in patients with T2DM. Notably, while the study did not find a significant association between DII and fasting blood sugar levels, it identified robust associations with novel anthropometric and biochemical indices indicative of cardio-metabolic risk. These findings highlight the potential of dietary interventions as a cornerstone strategy for managing T2DM and mitigating its associated complications.

Abstract Several risk factors including environmental exposures, socioeconomic status, and dietary factors including dietary patterns have been considered for childhood Asthma. The present study tried to examine the association between a western-style pattern and the likelihood of asthma and its symptoms in Yazd, Iran. In the present cross-sectional study, dietary intakes of elementary and high-school children were obtained through a validated GAN questionnaire. The GAN questionnaire, derived from the ISAAC questionnaire was used to assess the symptoms of allergic diseases and their related risk factors. A western dietary pattern score considered 9 food groups including chicken eggs, margarine, butter, sugar, fast foods, soft drinks, snacks, sauce, and chocolate. In total 7667 children aged 10.9 ± 3.35 years were included in the current investigation. Boys with higher adherence to western dietary pattern had a higher risk of wheezing in the past 12 months (OR 1.37, 5% CI 1.01–1.87, P = 0.04) and this association was also observed in the whole population (OR 1.30, 5% CI 1.05–1.60, P = 0.01). However, after adjustment for confounders this relation did not remain significant in boys. Our results support the hypothesis that a western dietary pattern is associated with an increased risk of wheezing in the past 12 months in children with asthma. Future prospective studies are needed to confirm this finding.

IntroductionA landslide is one of the mass movements on the top surface of the earth. Landslides have resulted in notable injury and damage to human life and destroyed infrastructure and property. Landslides represented approximately Nine percent of the natural disasters worldwide during the 1990s. According to studies, this trend is expected to continue due to increased human development. Many studies have been done to determine the factors affecting mass movement. In large part of Iran including the mountain areas, tectonic activity and seismic high with diverse geological and weather conditions led to many countries prone to landslide. Landslides cause wide damage to natural resources, human settlements, infrastructure, mud floods, and filling reservoirs. Landslides cause extensive property damage and occasionally result in loss of life. Besides, should not be ignored the social and environmental impacts resulting from the occurrence of this phenomenon, such as immigration and unemployment. One of the strategies for reducing losses due to a range of movements is the identification and management of unstable slope areas. To identify unstable regions pay to landslide hazard mapping. The main purpose of this research is to assess the effective parameter on landslide occurrence and to compare different machine learning models including SVM, GP regression, and RF for landslide susceptibility zoning. Materials and Methods The study area is a part of the Haraz Watershed, Mazandaran Province, Iran, occurrence many landslides are damaged after each heavy rain. So, it was selected as a suitable Watershed to evaluate the landslide susceptibility mapping (LSM). The vegetation covers and land mainly consists of rangeland. The geology of the study area consists mainly of Quaternary and Shemshak formations. The first step for the assessment of landslide susceptibility is gathering the necessary data and preparing information. These data were determined based on several factors. Considering the literature review, the local conditions, and previous studies. In this study, nine parameters such as slope angle, slope aspect, elevation, geology, land use, the distance of fault, the distance of the road, the distance of the river, and precipitation were identified as key factors for the prediction of landslide susceptibility. To assess the effectiveness of GP-PUK, GP-RBF, SVM-PUK, SVP-RBF, AND RF to estimate the landslide susceptibility map (LSM), data used in the present study were taken from field data. In this study, the dataset contains 148 observations of landslide occurrence and landslide non-occurrence points. The landslide data have been randomly separated into training (70% of landslides; 103) and testing (30% of the landslides; 45). To judge the performance of the soft computing techniques, statistical evaluation parameters were used. In this research, three statistical evaluation parameters were used. These parameters are the correlation coefficient (C.C.), root mean square error (RMSE), and Nash–Sutcliffe model efficiency (NSE). Results and DiscussionAccording to the results of the comparison of methods, RF was the best model and the accuracy of the RF model was more suitable for the estimation of the landslide occurrence. So, in this study, RF was used for the landslide susceptibility map. Single-factor ANOVA test suggests that there is an insignificant difference between observed and predicted values of landslide occurrence and landslide non-occurrence using GP_PUK, GP_RBF, SVM_PUK, SVM_RBF and Random Forest approaches. According to the results of the comparison of methods, RF was the best model and the accuracy of the RF model was more suitable for the estimation of the landslide occurrence. The map of landslide susceptibility map was divided into five classes from none susceptible to very high susceptibility. According to the final Landslide susceptibility map, the area belonging to the “non-susceptible” class covers 35.86 km2, “low susceptibility” class 36.19 km2, “moderate susceptibility” class 15.06 km2, “high susceptibility” class 10.95 km2 and “very high susceptibility” class 14.46 km2 of Haraz Watershed. Sensitivity analysis was performed to find the most significant input parameter in the prediction of landslide occurrence and landslide non-occurrence. The result shows that aspect has a major role in predicting landslide occurrence and landslide non-occurrence in comparison to other input parameters, respectively. Conclusion Due to all results, some zones are potentially dangerous for any future habitation and development. Thus, there is an immediate need to implement mitigation measures in the very high-hazard and high-hazard zones, or such zones need to be avoided for habitation or any future developmental activities. The results of this research can be used by the local authority to manage properly, and systematically and plan development within their areas.

ABSTRACT Background Hepatocellular carcinoma (HCC) represents a primary liver tumor characterized by a bleak prognosis and elevated mortality rates, yet its precise molecular mechanisms have not been fully elucidated. This study uses advanced bioinformatics techniques to discern differentially expressed genes (DEGs) implicated in the pathogenesis of HCC. The primary objective is to discover novel biomarkers and potential therapeutic targets that can contribute to the advancement of HCC research. Methods The bioinformatics analysis in this study primarily utilized the Gene Expression Omnibus (GEO) database as data source. Initially, the Transcriptome analysis console (TAC) screened for DEGs. Subsequently, we constructed a protein–protein interaction (PPI) network of the proteins associated to the identified DEGs with the STRING database. We obtained our hub genes using Cytoscape and confirmed the results through the GEPIA database. Furthermore, we assessed the prognostic significance of the identified hub genes using the GEPIA database. To explore the regulatory interactions, a miRNA‐gene interaction network was also constructed, incorporating information from the miRDB database. For predicting the impact of gene overexpression on drug effects, we utilized CANCER DP. Results A comprehensive analysis of HCC gene expression profiles revealed a total of 4716 DEGs, consisting of 2430 upregulated genes and 2313 downregulated genes in HCC sample compared to healthy control group. These DEGs exhibited significant enrichment in key pathways such as the PI3K‐Akt signaling pathway, nuclear receptors meta‐pathway, and various metabolism‐related pathways. Further exploration of the PPI network unveiled the P53 signaling pathway and pyrimidine metabolism as the most prominent pathways. We identified 10 hub genes (ASPM, RRM2, CCNB1, KIF14, MKI67, SHCBP1, CENPF, ANLN, HMMR, and EZH2) that exhibited significant upregulation in HCC samples compared to healthy control group. Survival analysis indicated that elevated expression levels of these genes were strongly associated with changes in overall survival in HCC patients. Lastly, we identified specific miRNAs that were found to influence the expression of these genes, providing valuable insights into potential regulatory mechanisms underlying HCC progression. Conclusion The findings of this study have successfully identified pivotal genes and pathways implicated in the pathogenesis of HCC. These novel discoveries have the potential to significantly enhance our understanding of HCC at the molecular level, opening new ways for the development of targeted therapies and improved prognosis evaluation.

Objective: This study aimed to evaluate the potential risk factors of lifetime urolithiasis occurrence on a nationwide scale in Iran. Methods: All data regarding urinary stone events were extracted from the cross-sectional Iran National Stone Survey (INSS) study, and the possible determinants of urolithiasis incidence were evaluated. Results: Our multivariable logistic regression suggested that while older age at presentation, male sex, and a positive family history of urolithiasis in either of the patient’s parents or siblings were all significantly associated with an increased odds of lifetime urolithiasis occurrence (all P < .001), a positive family history in one’s sister (odds ratio; OR=5.56) or brother (OR=4.70) were the most significant predictors. Moreover, belonging to Baluch ethnicity (i.e., an ethnical group indigenous to the south eastern regions of Iran) and residing in regions with higher water hardness (i.e., total concentration of dissolved minerals) were also associated with an increased odds of urolithiasis occurrence (P < .001 and P=.023, respectively). Conversely, living in regions with higher mean humidity decreased the chances of developing a urinary stone event during one’s lifetime (OR=0.62, P < .001). Conclusion: Our results indicated that a constellation of demographic, ecological, and familial risk factors are associated with an elevated risk of developing urinary stones during one’s lifetime. These findings can assist in implementing novel regional healthcare policies, considering the specific demographic and ecological characteristics. They also support tailoring personalized preventive strategies, particularly for individuals with multiple nonmodifiable risk factors.

Abstract In this cross-sectional investigation, the primary objective was to explore the correlation between the consumption of polyphenols and the likelihood of non-alcoholic fatty liver disease (NAFLD) in the adult population participating in the Hoveyzeh cohort. Data from the Hoveyzeh cohort study, part of the Persian Cohort Study, involving 10,009 adults aged 35–70, were analyzed. Exclusions were made for missing data, extreme energy intake, and liver cancer patients. Dietary habits were assessed using a food frequency questionnaire, and polyphenol intake was calculated using the Phenol Explorer database. Logistic regression analyses, adjusted for confounders, were performed to assess the relationship between polyphenol subclasses (total polyphenols, total flavonoids, phenolic acid, and lignin) and NAFLD. Among 9894 participants, those in the highest quintile of total polyphenol (OR 0.65, CI 0.5–0.84; P = 0.007), phenolic acid (OR 0.67, CI 0.52–0.86; P

Abstract Background Human polyomaviruses contribute to human oncogenesis through persistent infections, but currently there is no effective preventive measure against the malignancies caused by this virus. Therefore, the development of a safe and effective vaccine against HPyV is of high priority. Methods First, the proteomes of 2 polyomavirus species (HPyV6 and HPyV7) were downloaded from the NCBI database for the selection of the target proteins. The epitope identification process focused on selecting proteins that were crucial, associated with virulence, present on the surface, antigenic, non-toxic, and non-homologous with the human proteome. Then, the immunoinformatic methods were used to identify cytotoxic T-lymphocyte (CTL), helper T-lymphocyte (HTL), and B-cell epitopes from the target antigens, which could be used to create epitope-based vaccine. The physicochemical features of the designed vaccine were predicted through various online servers. The binding pattern and stability between the vaccine candidate and Toll-like receptors were analyzed through molecular docking and molecular dynamics (MD) simulation, while the immunogenicity of the designed vaccines was assessed using immune simulation. Results Online tools were utilized to forecast the most optimal epitope from the immunogenic targets, including LTAg, VP1, and VP1 antigens of HPyV6 and HPyV7. A multi-epitope vaccine was developed by combining 10 CTL, 7 HTL, and 6 LBL epitopes with suitable linkers and adjuvant. The vaccine displayed 98.35% of the world's population coverage. The 3D model of the vaccine structure revealed that the majority of residues (87.7%) were located in favored regions of the Ramachandran plot. The evaluation of molecular docking and MD simulation revealed that the constructed vaccine exhibits a strong binding (-1414.0 kcal/mol) towards the host's TLR4. Moreover, the vaccine-TLR complexes remained stable throughout the dynamic conditions present in the natural environment. The immune simulation results demonstrated that the vaccine design had the capacity to elicit robust immune responses in the host. Conclusion The multi-parametric analysis revealed that the designed vaccine is capable of inducing sustained immunity against the selected polyomaviruses, although further in-vivo investigations are needed to verify its effectiveness.

Abstract Background Maternal vitamin D deficiency during pregnancy has been associated with various maternal adverse events (MAE). However, the evidence regarding the effect of vitamin D supplementation on these outcomes is still inconclusive. Methods This secondary analysis utilized a case–control design. 403 samples with MAE and 403 samples without any outcomes were selected from the Khuzestan Vitamin D Deficiency Screening Program in Pregnancy study. Random forest (RF) analysis was used to evaluate the effect of maternal vitamin D changes during pregnancy on MAE. Results The results showed that women who remained deficient (35.2%) or who worsened from sufficient to deficient (30.0%) had more MAE than women who improved (16.4%) or stayed sufficient (11.8%). The RF model had an AUC of 0.74, sensitivity of 72.6%, and specificity of 69%, which indicate a moderate to high performance for predicting MAE. The ranked variables revealed that systolic blood pressure is the most important variable for MAE, followed by diastolic blood pressure and vitamin D changes during pregnancy. Conclusion This study provides evidence that maternal vitamin D changes during pregnancy have a significant impact on MAE. Our findings suggest that monitoring and treatment of vitamin D deficiency during pregnancy may be a potential preventive strategy for reducing the risk of MAE. The presented RF model had a moderate to high performance for predicting MAE.

Introduction and Objective: Ethical practice is a vital aspect of nursing interventions. Complying with the ethical aspects of the intervention procedure in a stressful nursing environment is not easy and nurse managers always face ethical challenges which are in conflict with their personal values and norms. Identifying and solving these challenges improves the efficiency and effectiveness of nursing care activities. Therefore, this research was done to explain the ethical challenges of nurse managers and practical solutions from their perspective. Material and Method: It is a qualitative study that was carried out based on the phenomenological method in 2022. The participants of this study were 20 nurse managers of Arak hospitals who were selected by purposive sampling until data saturation. The data were collected through semi-structured interviews for 30 to 90 minutes. Data collection was carried out with the participant's consent, using a digital recording device and verbatim transcription, and then it was analyzed using Van Manen's six-step hermeneutic phenomenological approach. Findings: The results of this study could provide a clear picture of ethical challenges and their practical solutions from the nurse managers' perspective in the form of four themes of managerial ethical challenges which include challenges facing physicians, organizations, employees, managers, and three themes for practical solutions, including organizational solutions, interpersonal solutions, and educational solutions which were manifested. Conclusion: Nurse managers are always faced with ethical challenges in their daily activities. To deal with these challenges, they must be familiar with the rules and principles of professional ethics, practical standards, and laws related to patients' rights. Ethical principles and awareness of the ethical decision-making process are useful and effective in having capable and ethical nurses who provide competent care. To deal with ethical challenges, it is suggested to consider self-care strategies and structural and specialized support in each center, which will ultimately lead to the improvement of service quality and the promotion of ethics in care-treatment environments.

Abstract The COVID-19 pandemic has substantially affected people and healthcare systems. One of the main challenges was the reduction and change in the pattern of non-COVID-19 diseases and conditions. Moreover, due to the mental burden of the pandemic, the trend of poisonings and abuses changed. In this study, we aimed to assess the trends of poisonings from different agents before and during the COVID-19 pandemic using the interrupted time series method. This study was conducted at one of the main Tehran referral centers for poisoning, Baharloo Hospital. Pre-COVID-19 period was defined as April 2018 to January 2020 while the COVID-19 time was from February 2020 to March 2022. The total number of monthly poisoning cases in addition to eight categories of drugs/substances/agents were identified, including drugs (such as psychiatric drugs, cardiovascular drugs, and analgesics), opioids, stimulants, methanol, ethanol, cannabis, pesticides, and carbon monoxide. Interrupted time series analysis was performed to compare the pre-pandemic trend of total monthly cases from each category in addition to the proportion (%) of each one. In total, 13,020 cases were poisoned during the study period, among which 6088 belonged to the pre-pandemic period and 6932 were admitted during the COVID-19 era. There was no significant difference in terms of demographic characteristics of patients before and during the pandemic (p-value > 0.05). At the beginning of the pandemic, there was a sudden fall in the number of poisoning patients (− 77.2 cases/month, p-value = 0.003), however, there was a significant increasing trend during the COVID time (3.9 cases/month, p-value = 0.006). Most of the categories had a sharp decrease at the beginning of the pandemic except for methanol and ethanol which had increases, although not significant. Cannabis also had a significant change in slope (− 0.6 cases/month, p-value = 0.016), in addition to the sudden decrease at the beginning of the pandemic (− 10 cases/month, p-value = 0.007). Regarding the proportion of each category from total monthly poisoning cases, methanol, and ethanol had immediate rises of 4.2% per month and 10.1% per month, respectively (both significant). The pandemic had significant effects on the pattern of poisonings from different agents in Iran, the most important of which were alcohol (ethanol and methanol). These differences had policy implications that can be helpful for policymakers and healthcare systems in combating similar situations in the future.

This study investigates the thermal performance and exergy destruction of parabolic trough collector by Response Surface Methodology. This collector is simulated by the Monte Carol Ray Tracing method and the results are coupled to the Computational Fluid Dynamics. Thermo-hydraulic performance and the characteristics of the thermodynamics second law are studied with the turbulence-inducing elements and hybrid nanofluid. The absorber tube features elements with a helical profile along its wall. New correlations are presented to describe thermal performance and exergy destruction, and the modeling output shows that these correlations have high prediction accuracy. Response Surface Methodology results also show that turbulators have a nonlinear effect on thermal performance while the Reynolds number has a nonlinear effect on exergy destruction. Fe3O4 nanoparticles and carbon nanotube lead to an increase of 13 % and 10 % of Nusselt number, respectively, at Re=12000. Also, it leads to a decrease of 7 % and 6.7 % of exergy destruction, respectively. Increasing the working fluid flow rate from 12000 to 22000 improves thermal performance up to 73 %, and decreases exergy destruction up to 48 %. The maximum value of thermal performance is equal to 2.1, and this value is related to the highest Reynolds number and the absorber tube including turbulence-inducing elements.

This research zeroes in on improving the freezing process by synergistically employing a wavy wall and fins. To enhance cold penetration, the phase change material (PCM) is enriched with nanoparticles, and a single-phase model is adopted due to the low nanoparticle concentration. The numerical simulations leverage the Galerkin method and the validation procedure affirms the precision of the code, extensively evaluating the impacts of φ (concentration of additives) and dp (particle diameter). With an increase in particle diameter (dp), there is an initial 19.76% decrease in the required time, succeeded by a subsequent 50.56% increase when φ = 0.04. Furthermore, an escalation in φ results in an 11.04%, 40.91%, and 26.36% reduction in completion time for dp values of 50, 40, and 30 nm, respectively. Without the inclusion of powders, the solidification process lasts for 84.8 s. However, with the introduction of the optimal powder size, this duration significantly reduces to 50.1 s. This emphasizes the efficiency improvements attained through the strategic integration of a wavy wall, fins, and PCM infused with nanoparticles.

Abstract It is well known that vitamin D plays a pivotal role in immune system modulation; however, its role in liver transplantation (LT) has not yet been well elucidated. This study aimed to assess the association between vitamin D status and LT outcomes. This retrospective cohort study was conducted on 335 registered cirrhotic patients with end-stage liver disease (ESLD) who underwent LT during 2019–2021 and had measurement of serum vitamin D before LT. The association of vitamin D levels before LT with the odds of acute cellular rejection (ACR) and risk mortality was assessed by applying logistic and cox regression, respectively. The mean MELD-Na and serum level of vitamin D were 20.39 ± 9.36 and 21.52 ± 15.28 ng/ml, respectively. In the final adjusted model, there was a significant association between vitamin D deficiency in the pre-transplant period and odds of ACR (odds ratio [OR] 2.69; 95% confidence interval [CI] 1.50–4.68). Although in the crude model, vitamin D deficiency in the pre-transplant period was significantly associated with an increased risk of mortality after two years of follow-up (Hazard ratio (HR) = 2.64, 95% CI 1.42–4.33), after adjustment for potential confounders, the association of vitamin D status and mortality became non-significant (HR = 1.46, 95% CI 0.71–3.00). The present study provides evidence that pre-transplant serum vitamin D levels may be a predictor for ACR in patients with cirrhosis undergoing LT.

Abstract Background The acute respiratory disease caused by the coronavirus (COVID-19) has spread rapidly worldwide yet has not been eliminated. The infection is especially deadly in vulnerable populations. The current studies indicate that pregnant women are at greater risk of getting seriously ill. Even though fetuses protect against disease, the additional finding showed that the COVID-19 pandemic could increase fetal and maternal morbidities. In a situation where COVID-19 and new strains of the virus are still not controlled, scientists predicted that the world might experience another pandemic. Consequently, more research about the effects of COVID-19 infection on pregnancy outcomes is needed. This study aimed to compare the pregnancy outcomes of Iranian pregnant women in the first year of the pandemic with the previous year. Methods This prospective cross-sectional study was performed to compare the pregnancy outcome during the COVID-19 pandemic among Iranian pregnant women who gave birth during the pandemic and one year before the pandemic (2019–2020 and 2020–2021). The sample size was 2,371,332 births registered at hospitals and birth centers platforms. The studied variables include stillbirth, congenital anomaly, birth weight, preeclampsia, gestational diabetes, cesarean section, ICU admission, mean of the gestational age at birth, preterm births, NICU admission, neonatal mortality and the percentage of deliveries with at least one complication such as blood transfusion and postpartum ICU admission. Analyzing data was done by using SPSS version 25 software. Results We found statistical differences between pregnancy and birth outcomes during the COVID-19 pandemic compared to one year before. The risk of preeclampsia, gestational diabetes, cesarean section, preterm birth and NICU admission were clinically significant. Also, there was a significant decrease in mean gestational age. Conclusion The COVID-19 pandemic has affected the pregnancy outcome by increasing morbidities and complications during pregnancy, birth, and postpartum. In addition, extensive quarantine outbreaks disrupted the healthcare system and hindered access to prenatal services. It is necessary to develop preventive and therapeutic care protocols for similar pandemic conditions.

Abstract Introduction This study explores the trend of urolithiasis in various countries and categorizes the countries in terms of how their urolithiasis incidence rate has changed over time. Methods The incidence rate of urolithiasis in 204 countries from 1990 to 2019, extracted from the Global Burden of Disease study, has been analyzed. Results According to the results, all regions had experienced an increasing trend in urolithiasis rate, except for Eastern Europe, Central Europe, and Southeast Asia regions (decreasing rates of -71.4, -56.2, and -9.2 per 100000, respectively). Moreover, the Caribbean region had the highest increasing trend of urolithiasis rates, and Central Asia was in the next rank (increasing rate of 48.3 and 34.3 per 100,000, respectively, p-value

The primary objective of this study was to assess the impact of cognitive-social education and coaching education on self-awareness among female high school students. The research employed a quasi-experimental approach with a pretest-posttest design involving a control group. The study's target population encompassed all female high school students in District 2 of Tehran in 2022. A total of 45 participants were included in the study (with 15 individuals in each group, comprising 15 in Experimental Group 1, 15 in Experimental Group 2, and 15 in the Control Group). The research instrument employed in this study consisted of the Copper Self-Awareness Questionnaire. In the experimental groups, both the Cognitive-Social Education program and the Coaching Training program were administered, while the control group did not receive any intervention. The findings revealed that both cognitive-social education and coaching training had a significant impact on self-awareness scores. Furthermore, the results indicated that cognitive-social education was more effective in enhancing students' self-awareness compared to coaching education. Consequently, cognitive-social education proved to be a more effective approach for enhancing students' self-awareness. Overall, the results of this study offer valuable insights for psychologists and school counselors, providing effective strategies for boosting self-awareness among high school students.

Abstract Background Controversy persists regarding the superiority of partial nephrectomy (PN) versus radical nephrectomy (RN) in pT2a renal cell carcinoma (RCC) tumors. In this study we aimed to compare survival and clinical outcomes between these two techniques in Iran. Methods In this retrospective cohort, 96 patients who underwent either RN or PN for their pT2a RCC tumors were included. Overall survival (OS), cancer specific survival (CSS), recurrence free survival (RFS), major postoperative complications and postoperative renal function were compared, subsequently. Results During a mean follow-up time of 57.3 ± 24.0 months, OS, CSS, RFS, postoperative bleeding, postoperative urinary leak, postoperative prolonged wound drainage and length of hospital stay were not statistically different between RN versus PN patients (p = .09, .42, .09, .27, .27, .06 and .78, respectively). Nevertheless, post-operative creatinine was significantly lower in PN patients compared to RN patients (p = .01). Our multivariable cox regression models indicated that higher Fuhrman grade detrimentally affected CSS (p

Abstract Objectives To evaluate the effects of two vitamin D repletion therapies (cholecalciferol) on serum levels of 25-hydroxyvitamin D (25(OH)D) and 24-h urine calcium in patients with recurrent calcium kidney stones and vitamin D deficiency (VDD). Design, setting, participants A parallel-group randomized controlled clinical trial on patients who referred to Labbafinejad kidney stone prevention clinic, Tehran, Iran. From 88 recurrent calcium stone formers, 62 patients completed the study. The age of participants was 18–70 years who had serum 25(OH)D levels of 10–20 ng/ml. Intervention Participants received oral cholecalciferol 2000 IU daily for 12 weeks or 50,000 IU weekly for 8 weeks. Main outcome measures Study variables including 24-h urine calcium, supersaturations of calcium oxalate and calcium phosphate, serum 25(OH)D and parathyroid hormone were measured at the beginning of the study and after 12 weeks. Results The 24-h urine calcium significantly increased in both groups (β = 69.70, p

Background and objectiveDairy products may be associated with an increased risk of asthma, although there is little scientific evidence to support this association. The goal of this study was to explore the association between dairy consumption and asthma symptoms.Materials and methodsThis cross-sectional study was conducted on children and adolescents aged 6–8 and 13–14 years living in central Iran. Dietary food consumption was assessed using a multiple-choice questionnaire. Logistic regression was used to obtain odds ratios for the association between milk, other dairy products, and total dairy consumption with the risk of asthma symptoms.ResultsIn total, 7,667 participants (3,414 boys and 4,253 girls) were included in the current study. Milk intake and total dairy consumption were not associated with the likelihood of wheezing, asthma confirmed by a doctor, current asthma, and asthma medication use. In addition, there was no association between other dairy product intake and the odds of wheezing in the past 12 months in the crude model. However, after adjusting for several confounders, those in the top category had lower odds of wheezing in the past 12 months than those in the bottom category (OR: 0.58; 95% CI: 0.40–0.85).ConclusionThe consumption of dairy products other than milk, including cheese and yogurt, might reduce the likelihood of wheezing in children and adolescents.

BackgroundThe increasing prevalence of colorectal cancer (CRC) in Iran over the past three decades has made it a key public health burden. This study aimed to predict metastasis in CRC patients using machine learning (ML) approaches in terms of demographic and clinical factors.MethodsThis study focuses on 1,127 CRC patients who underwent appropriate treatments at Taleghani Hospital, a tertiary care facility. The patients were divided into training and test datasets in an 80:20 ratio. Various ML methods, including Naive Bayes (NB), random rorest (RF), support vector machine (SVM), neural network (NN), decision tree (DT), and logistic regression (LR), were used for predicting metastasis in CRC patients. Model performance was evaluated using 5-fold cross-validation, reporting sensitivity, specificity, the area under the curve (AUC), and other indexes.ResultsAmong the 1,127 patients, 183 (16%) had experienced metastasis. In the predictionof metastasis, both the NN and RF algorithms had the highest AUC, while SVM ranked third in both the original and balanced datasets. The NN and RF algorithms achieved the highest AUC (100%), sensitivity (100% and 100%, respectively), and accuracy (99.2% and 99.3%, respectively) on the balanced dataset, followed by the SVM with an AUC of 98.8%, a sensitivity of 97.5%, and an accuracy of 97%. Moreover, lower false negative rate (FNR), false positive rate (FPR), and higher negative predictive value (NPV) can be confirmed by these two methods. The results also showed that all methods exhibited good performance in the test datasets, and the balanced dataset improved the performance of most ML methods. The most important variables for predicting metastasis were the tumor stage, the number of involved lymph nodes, and the treatment type. In a separate analysis of patients with tumor stages I–III, it was identified that tumor grade, tumor size, and tumor stage are the most important features.ConclusionThis study indicated that NN and RF were the best among ML-based approaches for predicting metastasis in CRC patients. Both the tumor stage and the number of involved lymph nodes were considered the most important features.

This article explores the acceleration of discharge speed through the introduction of nanoparticles. Utilizing simulations based on the Galerkin method, the study has developed and examined the effects of various variables. The utilized tank has been equipped with fin and additives with various shape factor (m) and volume fraction (φ) have been dispersed into water. The denser mesh near the ice front was considered in each time stage involving adaptive grid approach. Also, a validation test was presented to illustrate the precision of modeling. Contours and curves for different ranges of parameters were exemplified in results. The quickest process takes 641.19s while the longest process takes 877.17s. Increasing m causes conductivity to increase and speed of process enhances about 6.96 %. Moreover, augmenting the value of φ makes period of process reduce about 26.9 %.

The solidifying phenomena have been scrutinized in current work and techniques for expedition of process have been incorporated. The shape of geometry and shape of nanoparticles can alter the productivity of the unit. Utilizing higher concentration and bigger value of shape factor can accelerate the process. The present unsteady phenomena were simulated via Galerkin approach and to augment the accuracy, the shape of the mesh was adapted with location of the ice front. The existence of nanoparticles within water can enhance the freezing rate by about 26.73 %. The required time alters from 232.63s to 216.4s, when powders with bigger shape factor utilizes. Augment of concentration of powders from 0.02 to 0.04 can drop the solidification time around 13.78 %.