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The aim of introducing occupational exposure limits (OELs) is to use them as a risk management tool in order to protect workers' health and well-being against harmful agents at the workplace. In this review we identify OELs for benzene, toluene, ethylbenzene, xylene (BTEX), and styrene concentrations in air and assess occupational exposure to these compounds through a systematic literature search of publications published in West Asian countries from 1980 to 2021. OELs for BTEX and styrene have been set in Iran and Turkey to levels similar to those in European countries and the US. The search yielded 49 full-text articles that cover studies of exposure assessment in six countries, but most (n=40) regard Iran. Average occupational exposure to benzene of workers in oil-related industries is higher than recommended OEL, while average occupational exposure to other compounds is lower than local OELs (where they exist). Currently, information about levels of occupational exposure to BTEX and styrene is insufficient in West Asian countries, which should be remedied through OEL regulation and application. Furthermore, coherent research is also needed to determine actual levels of occupational exposure, dose-responses, and the economic and technical capacity of local industries to address current issues. [ABSTRACT FROM AUTHOR]

The zero-inflated regression models such as zero-inflated Poisson (ZIP), zero-inflated negative binomial (ZINB) or zero-inflated generalized Poisson (ZIGP) regression models can model the count data with excess zeros. The ZINB model can handle over-dispersed and the ZIGP model can handle the over or under-dispersed count data with excess zeros as well. Moreover, the count data may be correlated because of data collection procedure or special study design. The clustered sampling approach is one of the examples in which the correlation among subjects could be defined. In such situations, a marginal model using generalized estimating equation (GEE) approach can incorporate these correlations and lead up to the relationships at the population level. In this study, the GEE-based zero-inflated generalized Poisson regression model was proposed to fit over and under-dispersed clustered count data with excess zeros. [ABSTRACT FROM AUTHOR]

Background. The correlation between endometrial thickness and receptivity has been mentioned in various studies. This study investigated the effect of granulocyte colony-stimulating factor in treating thin endometrium of infertile women who were chosen for in vitro fertilization in our infertility clinic in 2014 and 2015. Methods. In this randomized clinical trial, 28 women who were chosen for in vitro fertilization and had endometrial thickness of less than 6 mm on the day of human chorionic gonadotropin (hCG) injection were included in the study. They were randomly divided into two groups: investigation and control groups. In investigation group (n=13) one granulocyte colony-stimulating factor vial (300 micrograms in 1 mL) was infused into the uterus within five minutes by embryo transfer catheter. In control group (n=15) 1 mL of saline was injected into the uterus with the same catheter. Results. There were significant differences between the two groups in terms of means of endometrial thickness on oocyte retrieval day (P=0.001), embryo transfer day (P=0.001), hCG injections (P=0.001), and implantation rates (P=0.001). Conclusion. Granulocyte colony-stimulating factor can increase endometrial thickness in women treated with in vitro fertilization. RCT Code is 201406046063N2. [ABSTRACT FROM AUTHOR]

Background: Poverty and low socioeconomic status are the most important reasons of increasing the global burden of tuberculosis, not only in developing countries but also in developed countries for particular groups. The purpose of this study was to assess the association between socioeconomic factors and the number of tuberculosis patients using quantile regression for count data. Methods: This cross-sectional study was conducted on 11,320 tuberculosis patients from March 2010 to March 201 in Iran. Data was gathered from the 345 sections of Iran by Ministry of Health and Medical Education and Statistical Center of Iran. The jittering method was applied for smoothing, and then, the quantile regression for count data was fitted. The AIC was used to compare the fitness of quantile regression for count data model and Poisson log-linear model. The R (3.0.1) software and Quantreg and AER packages were used for all analysis and modeling of the data. Results: The results of fitting the quantile regression for count data showed that in all percentiles, the more increase in immigration rate, illiteracy rate, unemployment and urbanization rates, the more tuberculosis morbidity rate was increased. The maximum increase of tuberculosis due to immigration rate, urbanization rate, unemployment rate, and illiteracy rate was in 95th percentile (β ̂=0.315), 85'Th percentile (β ̂=0.162), 75'Th percentile (β ̂=0.114), and 95'Th percentile (β ̂=0.304), respectively. For 50th percentiles and higher percentiles, with increasing the sum of physicians to the number of population, the tuberculosis morbidity rate was decreased, and the maximum decrease was in 95'Th percentile (β ̂=-0.1). For all percentiles, the AIC showed that quantile regression for count data had been a better fit to data. Conclusion: With respect to the relationship between socioeconomic factors and TB rate, health care observers should pay close attention to improving these factors in Iran to reduce the TB mortality and morbidity. [ABSTRACT FROM AUTHOR]

Background: Septate uterus is the most common congenital malformation of the uterus in normal population and also patients with recurrent abortions. Pathogenesis of the disease is incompletely elucidated. It is clarified that incomplete absorption of paramesonephric ducts in the first trimester is responsible for septum formation. Hysteroscopy is known as the standard diagnostic and therapeutic procedure for septate uterus. In this study, our aim was to evaluated the effects of hysteroscopic septal resection in improving pregnancy outcomes in patients with unexplained infertility or recurrent abortion. Methods: Prospective cohort study was conducted in a Tehran University Medical Sciences affiliated hospital from April 2012 to May 2013. Eight patients were excluded from the study because of non-reproductive related complains. The other 40 patients went through a prospective cohort study and were treated for septate uterus. All patients had complete history taken and underwent physical examination. Septum size was measured by hysteroscopy. Patients underwent hysteroscopic metroplasty with resectoscope with an equatorial semicircular loop cutting 12° with monopolar energy. Some septum resected by 5 french hysteroscopic scissor. The patients were visited 2 month later for evaluated surgical outcome. This assessment was done by hysterosalpingography (HSG). Patient's reproductive outcome were followed for 10.33 (SD:±6.43) months. Results: The mean age in patients was 31.5 (SD;±3.02) years. In whole, 48 patients underwent hysteroscopic metroplasty. In 52.1% length of septum occupied two third of uterine cavity. Eight patients were excluded from the study because of non-reproductive related complains. There were 29 pregnant patients (72.5%). Fifteen patients became pregnant without intervention (51.7%). 14 patients had pregnancy under ART, while the pregnancy did not occur in 11 patients (27.5%) during this period. Among pregnant population there were 9 miscarriage (31%), 3 preterm (13.3%) and 17 term delivery (50%). Live birth rate in our study was 68.9%. In control hysterosalpingography (HSG), no patients had adhesion or residual ridge. Conclusion: The findings of this study indicate that hysteroscopic septoplasty is acceptable for improving reproductive outcomes in patients with septate uterus. [ABSTRACT FROM AUTHOR]

Abstract: Objective:: To compare the effect of HMG and rhFSH on oocyte quality in ICSI cycle. Setting:: Vali-e-Asr university teaching hospital. Method:: Prospective single-blind randomized clinical trial. Subjects:: Sixty women undergoing ovarian stimulation for ICSI were randomized to receive a standard protocol of either HMG or rhFSH in down-regulation cycles. Interventions:: Prior to microinjection, each oocyte was assessed regarding the nuclear maturity, morphology of zona plucida, cytoplasmic appearance and polar body morphology. Fertilization rate was followed. Main outcome:: The percentage of metaphase II oocytes in HMG and rhFSH groups. Statistical analysis:: Statistical analyses were carried out by the Mann–Whitney, Fisher''s exact, χ 2 tests and Student''s t-test. Results:: No significant differences were found between two groups in regard to the demographic data, the ovarian response and pregnancy/implantation rates (P >0.05). The percentage of metaphase II oocytes in HMG and rhFSH groups were 81.3% versus 80.6%, respectively. Conclusions:: There were no significant differences between parameters such as, oocyte quality and percentage of metaphase II oocytes between these two groups. [Copyright &y& Elsevier]

Background: The coronavirus disease 2019 (COVID-19) pandemic affected working conditions in healthcare systems and caused occupational stress and challenges for the majority of healthcare workers (HCWs). Objectives: This study aimed to examine the prevalence of anxiety, depression, burnout, and career resilience and assess the personal and occupational risk factors contributing to psychological symptoms in Iranian HCWs during the COVID-19 pandemic. Methods: Through a cross-sectional study, HCWs were surveyed within January to February 2022 to evaluate the prevalence of anxiety and depression (using the Hospital Anxiety and Depression Scale [HADS]), burnout (using the Maslach burnout inventory health services survey for medical personnel [MBI-HSS-MP]), and career resilience (using the Career Resilience Questionnaire [CRQ]). The correlation between demographic-occupational factors and psychological symptoms was analyzed. A total of 610 complete responses were received from Iranian HCWs. Results: Approximately 87.9% of HCWs had symptoms of both anxiety and depression (HADS score ≥ 11). The results indicated that most HCWs experienced various signs of burnout (i.e., emotional exhaustion, decreased sense of personal accomplishment, and depersonalization, respectively). The mean score for career resilience reported by the participants was appropriate; however, a fifth of the HCWs had poor career resilience. The highest scores of burnout, anxiety, and depression, in addition to the lowest scores of career resilience, were reported by intensive care unit (ICU) professionals. Conclusions: Marital status, long daily working hours, night shift work, access to personal protective equipment (PPE), and direct exposure to patients with COVID-19 had a significant impact on the anxiety, depression, burnout, and resilience of the HCWs. [ABSTRACT FROM AUTHOR]

Background: Primary dysmenorrhea is considered as one of the women's main problems during reproductive age. The present study aimed to investigate the effect of vitamin D on the severity of dysmenorrhea and menstrual blood loss. Methods: This double-blind, randomized, placebo-controlled trial, was performed on 84 single female college students between 18 and 25 years old who living in dormitories. Students with primary dysmenorrhea and vitamin D deficiency were divided into experimental (n = 42) and control (n = 42) groups. Five days before the putative beginning of their next menstrual cycle, the experimental group received 300,000 IU vitamin D (50,000 IU, two tablets every 8 h), and the control group received a placebo (oral paraffin). The effects of the supplement on the severity of dysmenorrhea and menstrual blood loss were evaluated one cycle before and during two successive cycles. Using the visual analog scale (VAS), verbal multidimensional scoring system (VMS), and pictorial blood assessment chart (PBLAC) questionnaires. Fisher's exact, Chi-square, independent sample t-test and repeated measurements were used. Results: In total, 78 of the 84 students completed the study (39 students per group). The intervention resulted in a significant reduction in the mean scores of both the VAS and VMS in the experimental group, in the first and second menstrual cycles (p < 0.001, p < 0.001, respectively), but not in the means score of PBLAC. Mefenamic acid consumption at the first and second menstruation period, in the experimental group was lower than the control group (p = 0.009, p < 0.001, respectively). Conclusions: The results indicate that vitamin D supplementation could decrease the severity of primary dysmenorrhea and the need to consume pain-relief medications. Contrariwise vitamin D supplementation had no significant effect on menstrual blood loss. Trial registration: This trial was registered in the Iranian Registry of Clinical Trials with code IRCT201305212324N on 18/1/2014. URL of registry: https://en.irct.ir/trial/1964. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the effectiveness of Metformin on ovulation and eventual clinical pregnancy in different phenotypes of polycystic ovary syndrome (PCOS). Materials and methods: A total of 359 subjects who had proven PCOS according to Rotterdam criteria were prospectively selected. Patients' PCOS phenotypes were determined and recorded. All patients were younger than 35 years. Clinical and biochemical assays in all patients were initially obtained. Then patients were divided into two separate groups. One group received both 1,500 mg of Metformin and 1 mg of folic acid per day and the other group received only 1 mg of folic acid for a total of 2 months. Subsequently, all patients underwent ovulation stimulation with 5 mg of Letrozole per day for 5 days followed by an intra-uterine insemination. Finally, ovulation and pregnancy rates were evaluated for all four PCOS phenotypes. Effect of Metformin therapy was evaluated for each group and each phenotype. Results: The pregnancy rate in Metformin and non-Metformin groups were, respectively, as follows: in phenotype A (39.2 vs. 33.7 %, p = 0.270), phenotype B (43.8 vs. 20 %, p = 0.210), phenotype C (44 vs. 20 %, p = 0.064), and phenotype D (36.5 vs. 28.6 %, p = 0.279). Conclusion: Although there was a little improvement in ovulation and pregnancy rates among patients with B and C phenotypes, there was not a statistically significant difference between the two groups. Based on our study, Metformin therapy does not change the ovulation and pregnancy rate. [ABSTRACT FROM AUTHOR]

Background: To evaluate the severity of respiratory failure among newborns with respiratory distress syndrome (RDS), oxygenation index (OI) has been implemented. In the present study, we assessed the accuracy of oxygen saturation index (OSI) in determining the severity of respiratory failure.Methods: A cross-sectional study was carried out in the NICUs of two Iranian Hospitals (Tehran, Iran) in 2018. Preterm neonates with RDS entered the study. Immediately after admission, the severity of RDS was determined based on RDS scoring system. Then, 2 CC of arterial blood was withdrawn and sent to laboratory determining blood gases. Simultaneously, the level of peripheral capillary oxygen saturation (SpO2) was read using pulse oximeter and recorded. OI and OSI were measured using the formulae. Receiver Operating Characteristic curve, Kappa agreement coefficient and accuracy, sensitivity and specificity was used to compare the OI and OSI results.Results: In the study, 95 neonates were considered. Based on ROC curves, the appropriate cut off with AUC = 0.99 for severe respiratory failure was OSI >8. The sensitivity, specificity, negative predicted value, and positive predicted value for the OSI Cut off >8 were 100, 98, 0.97 and 100%, respectively. The overall accuracy and Kappa agreement between OSI and OI was 0.96 and 0.98%, respectively.Conclusion: Our results showed that OSI with high sensitivity, specificity values could predict the severity of respiratory failure in preterm neonates with RDS. [ABSTRACT FROM AUTHOR]

HUS is a leading cause of AKI in infants. Though new classification of HUS is based on underlying disease, it traditionally defines as diarrhea positive (typical) and negative (atypical). We have no figure of the incidence and prevalence of HUS, the underlying disease and the outcome in Iranian patients. This meta-analysis of Iranian studies deals with this matter. We used relevant medical search engines and national databases from 1985 to 2019. We searched manually to detect admissible cross references. All studies assessed for the aspects and the risk of distort by three appraisers. Metaprop package of STAT applied to calculate point prevalence, proportion, and incidence with 95% confidence intervals. A total of 27 articles and one abstract of congress containing 7084 cases met all the inclusion criteria and qualified for the final analysis. Considering 1397 patients with HUS over 33 years of study, the pooled prevalence was 28% (95% CI: 15 to 44) and 18.38 pmp (0.55 pmp/y). In children less than 15 years, the prevalence was 79.82 pmp (2.41 pmp/y). Between 1985 and 2019, atypical HUS was identified in 488 patients with the prevalence of 27.88 pmp (annual prevalence of 0.84 pmp/y of children aged less than 15 years old). The incidence was 9.4 pmp (0.28 pmp/y), contributed to 9.9% (95% CI: 3 to 20) of AKI, and 5.48% (95% CI: 3.5 to 7.9) of CKD and ESRD. The rate of HUS diagnosis was increasing during the previous four decades. HUS consists of a significant number of AKI and ESRD. It needs further prospective longitudinal study. [ABSTRACT FROM AUTHOR]

Objective: This clinical trial compared the effect of a dual trigger treatment (combination of gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (hCG) and hCG alone on oocyte quality and metaphase II oocytes' number. Methods: It was done on infertile couples who were undergoing intracytoplasmic sperm injection with GnRH-antagonist cycles in two infertility centers of Tehran. The main outcome measures were metaphase II oocytes' number, clinical pregnancy, abortion, and implantation rates per cycle. Results: A total of 126 normal responder women who were considered for in vitro fertilization were equally divided into two groups: control (hCG trigger) and investigation (dual trigger) groups. The control group received the hCG trigger (10,000 IU) and the investigation group received the dual trigger (0.2 mg of Triptoreline plus 5000 IU of hCG). The metaphase II oocytes' numbers, rates of clinical pregnancy, abortion and implantation were not significantly different between the two groups (P = 0.42, 0.70, 0.77, 0.80, respectively). Good quality embryos was significantly higher in the dual trigger group (P = 0.04). Conclusion: Final oocyte maturation with dual trigger improves the number of good quality embryos in normal responder women. Further research with larger sample size is needed to characterize the effect on oocyte quality and pregnancy rate. [ABSTRACT FROM AUTHOR]

Introduction: The Glasgow Coma Scale (GCS) has some limitations when evaluating the unconscious patient. This study aims to validate the Persian version of the FOUR (Full Outline of Unresponsiveness) score as a proposed substitute.Methods: Two nurses, two nursing students, and two physicians scored the prepared Persian version of the FOUR and GCS in 84 patients with acute brain injury. The inter-rater agreement for the FOUR and the GCS scores was evaluated by the weighted kappa (κ w). The outcome prediction power of the scales was assessed by the area under the curve (AUC) in the ROC curve.Results: The inter-rater agreement of the FOUR was excellent (κ w = 0.923, 95 % CI, 0.874-0.971) and comparable with the one of the GCS (κ w = 0.938, 95 % CI, 0.889-0.987). The area under the curve (AUC) for predicting in-hospital mortality (modified Rankin Scale: 6) was 0.835 for the FOUR (95 % CI, 0.739-0.907) and 0.772 for the GCS (95 % CI, 0.668-0.856) (P = 0.01). AUC for predicting poor outcome (modified Rankin Scale: 3-6) for the total FOUR score was 0.983 (95 % CI, 0.928-0.999), which is comparable with 0.987 for the total GCS score (95 % CI, 0.934-1.000).Conclusions: The researchers conclude that the Persian version of the FOUR score is a reliable and valid scale to assess unconscious patients with traumatic brain injury and can be substituted for the GCS. [ABSTRACT FROM AUTHOR]

Background/aims: To assess uterine cavity with office hysteroscopy in order to diagnose and treat pathologies in patients who have started their first intracytoplasmic sperm injection (ICSI) cycles and evaluate its impact on pregnancy rate.Methods: A number of 220 infertile women scheduled for ICSI participated in this prospective randomized study. They were randomly divided into 2 equal groups. Group I (intervention) underwent office hysteroscopy before starting assisted reproductive techniques (ART) cycle. Group II (control) started ART cycles without office hysteroscopy. All women had normal transvaginal ultrasonography and hysterosalpingography. The detected intrauterine abnormalities were treated during hysteroscopy. Four weeks after embryo transfer, ultrasonography was done for detecting clinical pregnancy.Results: Abnormal findings were seen in hysteroscopy in 22.7% of the intervention group. The pregnancy rate in the intervention group (48.20%) was significantly higher than that in the control group (38.60%; p = 0.004).Conclusion: Routine office hysteroscopy before ICSI cycles provides direct evaluation of uterine cavity. Also, pregnancy rate improves after correction of endometrial cavity abnormalities. [ABSTRACT FROM AUTHOR]

Background: Intrauterine injection of human chorionic gonadotropin (hCG) at embryo transfer (ET) has been shown to improve the outcome of assisted reproductive techniques. The aim of this study was to confirm previous findings. Methods: In this randomized controlled trial, 483 infertile women who were candidates for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) for the first time were randomly assigned to receive an intrauterine injection of 500 IU hCG or placebo (tissue culture media) before ET. The main outcome measures were implantation and clinical pregnancy rates. Results: Both the hCG-treated group (n = 240) and control group (n = 243) were similar at baseline in terms of demographic and obstetrical characteristics.There were significant differences between the two groups regarding the implantation rate (23.6 vs. 12.2%, p < 0.001), pregnancy rate (54.6 vs. 35.8%, p < 0.001), clinical pregnancy rate (50 vs. 32.1%, p < 0.001), ongoing pregnancy rate (15.3 vs. 9.2%, p < 0.001) and live delivery rate (14.3 vs. 8.4%, p < 0.001). The rate of fertilization and abortion rates were not statistically different. Conclusion: Intrauterine injection of hCG before ET improves implantation and pregnancy rates and may be considered an adjuvant in IVF/ICSI. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the effect of vaginal progesterone as luteal phase support on pregnancy rates in controlled ovarian stimulation and intrauterine insemination cycles in couples with unexplained or mild male factor infertility. Study design: 290 Patients who met the inclusion criteria were included in a prospective randomized controlled trial. All patients underwent controlled ovarian stimulation and intrauterine insemination: 148 patients were randomized to start with a supported cycle and 142 patients with an unsupported cycle. In supported cycles, patients received vaginal progesterone once daily from the day after insemination until 12 weeks of pregnancy or, in non-pregnant women, for 14 days. No progesterone was given during unsupported cycles. The main outcome measures were clinical pregnancy rates per cycle. Results: In total, 148 cycles with luteal phase support and 142 cycles without luteal phase support were performed. The clinical pregnancy rates per cycle were higher for cycles with luteal phase support than for the unsupported cycles (24.3% vs. 14.1% respectively, p =0.027). Conclusion: The use of vaginal suppositories as luteal phase support significantly improved clinical pregnancy rates in controlled ovarian stimulation and intrauterine insemination in patients with unexplained or mild male factor infertility. [Copyright &y& Elsevier]

Background: Ovarian hyper stimulation syndrome (OHSS) and its consequences, especially thromboembolic events, are of the most dangerous complications of assisted reproductive technologies (ART). It is unclear whether a thrombophilic predisposition or changes in blood components during clinical presentation of OHSS increase thrombotic risks. Testing for certain thrombophilias in selected high risk patients may help risk assessment and decision-making about prophylactic measures. Methods: In this study carried out in April 2010 to March 2011, 108 in vitro fertilization candidates with ≥20 follicles following ovarian stimulation were recruited. Protein S, protein C, antithrombin, lupus anticoagulant and anticardiolipin antibodies were measured. Blood tests were compared between severe and non-severe OHSS groups and their changes were traced after onset of clinical OHSS in 43 patients presenting with severe symptoms by repeating the tests at hospital admission. Results: Mean protein S activity was lower in severe OHSS group (101.7±16.3 vs. 118.4±17.0; P<0.001). After clinical presentation of severe OHSS, this level decreased to 91.6±20.1 (P<0.001). Antithrombin levels decreased 2.09% after the onset of symptoms in the group with severe OHSS, but this difference was not statistically significant (P=0.051). Protein C, lupus anticoagulant and anticardiolipin antibodies were not correlated to severe OHSS development. Conclusion: Patients with relatively lower protein S activity were at higher risk for the development of severe OHSS, and its dangerous consequences. During clinical OHSS presentation, protein S decreased even more, and patients were more vulnerable to hypercoagulability states. These points should be kept in mind in risk assessment and adoption of prophylactic strategies. [ABSTRACT FROM AUTHOR]