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This article was administrated to study the effect of training of assertiveness on increasing life quality in school and decreasing of social anxiety of females' students. The statistical population consisted of all females' first grade students of Ahvaz high schools in academic year 2010-2011. In order to do so, 100 students were selected randomly who completed the research questionnaires and 30 students from them that had lowest score were chosen, were assigned randomly in two groups, and one of these groups were selected randomly as experimental group. The instruments used in this research were the Watson and Frend's social anxiety scale (1969) and Anderson and Broock's life quality in school questionnaire (2000). The design of the research was experimental with pre-test and post-test with control group. After carrying out the experimental interventions, that lasts 8 sessions, the degree of social anxiety and life quality were measured. The result of multivariate covariance analysis and also the mean of pre-test and post-test of experimental and control groups indicated the significant differences between these two groups in research variables. It Can be said that the training of assertiveness behavior lead to increasing of life quality in school (p

Introduction: Nutrition is one of the important components of health promotion and disease prevention. However, nutrition literacy of medical students is unclear. This study aims to determine nutritional knowledge of medical students studying in clinical course of Shahid Sadoughi University of Medical Sciences in 2012. Methods: In this cross-sectional study, 114 medical students in clinical course of Shahid Sadoughi hospital were randomly selected. Nutritional knowledge questionnaire was completed. Each correct answer had one score and wrong answers had no score. Results: Of 114 students, 69 students (60.5%) were female and 45 students (39.5%) were male with the mean age of 24.1±1.5 year. The mean score of students in basic nutrition, nutrition in the life cycle and diet therapy was 4.6±2.2, 6.2±3.2 and 6.2±3.8, respectively. There was significant association between the score of nutrition course and nutritional knowledge score in all of the fields. Conclusion: The average of scores was low. Improving the nutrition courses, especially clinical aspects, during clinical education and presence of nutritionist in treatment teams will be helpful.

Introduction: There is limited evidence that ginger (Zingiber Officinale) powder consumption is effective to relieve the pain and inflammation due to special phytichemicals. The aim of this study was to investigate the effect of ginger powder supplementation in pain improvement in patients with knee osteoarthritis. Methods: This double-blind randomized clinical trial was conducted on 120 outpatients with knee osteoarthritis of moderate pain. Patients were randomly assigned to two groups: receiving ginger powder supplement and placebo. Ginger and placebo groups received two identical capsules per day for 12 weeks. Each capsule contained 500 mg ginger powder or starch. Pain severity was measured by VAS (Visual Analog Scale) at first and after 3 months. A responder was defined as a reduction in pain of > 1.5 cm on a visual analog scale (VAS). Results: Before intervention, there was no significant difference between the two groups in severity of pain. However, after ginger supplementation, pain score decreased in ginger group. After 12 weeks, Pain reduction was more significant in ginger group than placebo. Response to intervention was 88% and 14% in ginger and placebo groups, respectively. There was statistically significant difference between both groups in response to intervention (p

Although several reports are available on the distribution of Palygorskite in the soils of arid regions of Iran, there is not much information about the presence and abundance of this important fibrous clay mineral in the soils of Bushehr Province. This research was carried out: (1) to investigate the distribution of Palygorskite and other major associated clay minerals, and (2) to evaluate the relationship between the relative quantity of Palygorskite in clay-sized fraction and the most important soil properties in Dashtestan County, Bushehr Province. Five geomorphic surfaces including eroded rock outcrop, rock outcrop, dissected hill, alluvial fan, and alluvial plain were identified in the study area using Google Earth images and field observations. After sampling representative pedons, the clay mineralogy of two horizons from each pedon was determined. X-ray diffractograms and SEM images showed that in the studied soils, which were classified as either Aridisols or Entisols, Palygorskite was present in different quantities on all geomorphic surfaces. Moreover, Illite, Chlorite, Smectite, irregularly interstratified Chlorite/Illite, and Kaolinite were the other clay minerals that existed in the soils studied. The relative quantity of Palygorskite and Smectite was variable on different geomorphic surfaces. Regardless of the type of geomorphic surface, petrogypsic and gypsic horizons showed the highest quantity of Palygorskite as compared to other horizons which seems to be due to the suitable geochemical conditions of these horizons for the formation and stability of Palygorskite mineral. The higher correlation of Palygorskite content with gypsum, as compared to that with the carbonates, indicates the importance of gypsum in Palygorskite distribution in the soils of the study area. The findings also indicated that the amount of Palygorskite was positively correlated with soluble Mg/Ca ratio, pH, gypsum, and soluble Mg. These parameters appear to control the genesis and distribution of Palygorskite in the soils studied. In general, it is necessary to pay special attention to their clay mineralogy, especially the significant amount of Palygorskite to manage the soils of the study area and to reasonably predict their behavior.

Breast cancer is the most common cancer in women. Multicentric gliomas are uncommon lesions of the central nervous system (CNS) with an unprecise rate of occurrence that diffusely infiltrate large portions of the brain. High grade astrocytoma is the most agressive form of gliomas and often has a distinct neuroimaging pattern with a poor prognosis. We report a case of a 29-year-old woman patient with primary breast carcinoma and high grade astrocytoma subsequently developed. The woman was treated by mastectomy and 20 months post-diagnosis of the cancer she exhibited a transient facial paralysis. Magnetic resonance imaging (MRI) revealed two cranial masses suspicious of metastasis. A complete tumor removal from the brain was performed. On histological examination, this tumor was a high grade astrocytoma. [ABSTRACT FROM AUTHOR]

Background: The high prevalence of multiple substance use (MSU) is concerning, given the weak awareness about this issue and the potential impact this unawareness has on the severity of substance use disorder (SUD) and treatment outcomes. The aim of this study is to identify and elucidate the causes and motivations for MSU from the viewpoints of users and therapists in this field., Methods: In this qualitative study, the conventional content analysis approach and purposive sampling were utilized. Deep semi-structured exploratory interviews were conducted with 17 substance users and 8 addiction therapists (including 4 psychiatrists, 3 general practitioners, and 1 psychologist). Field notes were also taken to identify and explain the motivations and reasons for MSU from the perspectives of users and therapists. The data were analyzed comparatively and simultaneously using the method suggested by Graneheim and Lundman (2004)., Results: Based on the findings of this study, the motivations for MSU are reflected in four main categories: 'Pharmacological factors' with subcategories such as achieving desired states and mitigating the undesirable effects of substances through leveraging the balancing, synergistic, and antagonistic effects of substances, substituting the effects of other substances, self-medication of the undesirable effects of other substances, enhancing the overall consumption experience such as heightened peak experience and enhanced pleasure, moderating the come-down, and seeking euphoria experiences in different substances; 'Biological factors' with subcategories including different neurobehavioral systems, individual differences determining substance dependence and the somatic-neural vulnerability of consumers; 'Psychosocial factors' with the subcategories of undesirable norms like the need for acceptance and social interactions, the context of substance use, consumers' experiences and expectations of substance use, and the maladaptive personality traits of consumers; and 'Addiction's inevitability' with the subcategories of coercion and the need to maintain equilibrium, and the difficulties of substance detoxification., Conclusion: The motivations behind Multiple Substance Use (MSU) behaviors are multifaceted, including pharmacological, biological, psychosocial, and addiction-related factors. Recognizing and comprehending the interplay between these factors and motivations can inform better prevention strategies, assessment of treatment needs, and enhancement of treatment outcomes for individuals dealing with MSU., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

This study addresses the research problem of enhancing In-Vitro Fertilization (IVF) success rate prediction by integrating advanced machine learning paradigms with gynecological expertise. The methodology involves the analysis of comprehensive datasets from 2017 to 2018 and 2010-2016. Machine learning models, including Logistic Regression, Gaussian NB, SVM, MLP, KNN, and ensemble models like Random Forest, AdaBoost, Logit Boost, RUS Boost, and RSM, were employed. Key findings reveal the significance of patient demographics, infertility factors, and treatment protocols in IVF success prediction. Notably, ensemble learning methods demonstrated high accuracy, with Logit Boost achieving an accuracy of 96.35%. The implications of this research span clinical decision support, patient counseling, and data preprocessing techniques, highlighting the potential for personalized IVF treatments and continuous monitoring. The study underscores the importance of collaboration between gynecologists and data scientists to optimize IVF outcomes. Prospective studies and external validation are suggested as future directions, promising to further revolutionize fertility treatments and offer hope to couples facing infertility challenges., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Sadegh-Zadeh, Khanjani, Javanmardi, Bayat, Naderi and Hajiyavand.)

Electronic learning (E-learning) is a method of acquiring knowledge by using information technology. In this regard, faculty members of medical schools play an important role in the design, development and institutionalization of electronic content education and face many challenges. Hence, the present study was performed to explore the challenges to the development and institutionalization of e-learning content as perceived by faculty members of medical schools in southern Iran. The present study is a descriptive qualitative study. Purposeful sampling was performed. Based on this, 23 individual and in-depth semi-structured interviews were conducted with 23 faculty members of medical schools. Granheim and Lundman's approach was used for data analysis. Three themes and eleven subthemes were extracted based on the qualitative data analysis results. Three main themes included individual challenges, organizational management challenges, and course design challenges. Based on the results of the present study, we should keep in mind that electronic teaching methods and preparation of e-learning content by professors are different from traditional educational methods. Hence, the senior managers of educational system should make necessary arrangements and plans for methodological support, technological and technical support, and all kinds of organizational support and create continuous professional development opportunities for professors to minimize the negative effects caused by the rapid changes of electronics era and educational environments on professors, and consequently on the quality of educational contents and processes., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

In recent years, microRNAs (miRNAs) have garnered increasing attention for their potential implications in cancer pathogenesis, functioning either as oncogenes or tumor suppressors. Notably, angiosarcoma, along with various other cardiovascular tumors such as lipomas, rhabdomyomas, hemangiomas, and myxomas, has shown variations in the expression of specific miRNA subtypes. A substantial body of evidence underscores the pivotal involvement of miRNAs in the genesis of angiosarcoma and certain cardiovascular tumors. This review aims to delve into the current literature on miRNAs and their prospective applications in cardiovascular malignancies, with a specific focus on angiosarcoma. It comprehensively covers diagnostic methods, prognostic evaluations, and potential treatments while providing a recapitulation of angiosarcoma's risk factors and molecular pathogenesis, with an emphasis on the role of miRNAs. These insights can serve as the groundwork for designing randomized control trials, ultimately facilitating the translation of these findings into clinical applications. Moving forward, it is imperative for studies to thoroughly scrutinize the advantages and disadvantages of miRNAs compared to current diagnostic and prognostic approaches in angiosarcoma and other cardiovascular tumors. Closing these knowledge gaps will be crucial for harnessing the full potential of miRNAs in the realm of angiosarcoma and cardiovascular tumor research., Competing Interests: Author AM was employed by Kimia Andisheh Teb Medical and Molecular Research Laboratory Co. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Modarresi Chahardehi, Afrooghe, Emtiazi, Rafiei, Rezaei, Dahmardeh, Farz, Naderi, Arefnezhad and Motedayyen.)

Background: Escherichia coli (E. coli) serves as a common indicator of gut microbiota and is utilized for monitoring antimicrobial resistance determinants in food-producing animals. This study aimed to investigate antimicrobial resistance patterns in virulence gene-positive E. coli isolates obtained from 340 healthy and diarrheic calves., Methods and Results: A total of 340 fecal swab samples were obtained from diarrheic (n = 170) and healthy (n = 170) calves for 12 months from different farms in Kerman, Iran. The samples were phenotypically analyzed to detect E. coli isolates and antibiotic resistance. Also, antimicrobial resistance genes, diarrheagenic E. coli pathotypes, and phylogenetic background were screened by PCR. Fifteen percent (51/340) of E. coli isolates were positive for at least one of the examined virulence genes (VGs); the prevalence of VGs in E. coli isolates from healthy calves (36/170; 21.17%) was higher than that in diarrheic cases (15/170; 8.82%). Out of the 51 VG-positive isolates, six pathotypes including Shiga toxin-producing E. coli (STEC; 27.45%), enterotoxigenic E. coli (ETEC; 23.52%), enterohemorrhagic E. coli (EHEC; 19.6%), necrotoxigenic E. coli (NTEC; 19.6%), enteropathogenic E. coli (EPEC; 15.68%), enteroinvasive E. coli (EIEC; 1.96%) and three hybrid pathotypes including ETEC/STEC, ETEC/EHEC, and STEC/EIEC were detected among the strains. Antimicrobial resistance (AR) was observed in 98.03% of the VG-positive isolates, which was the same for both healthy and diarrheic calves. The maximum prevalence rate of AR was found against trimethoprim/sulfamethoxazole (49.01%; 3/51), while the minimum prevalence rate was against gentamycin (5.88%; 25/51). Among the VG-positives, phylotype A was found to be the most prevalent followed by B1 and D phylotypes., Conclusions: The prevalence of VG-positive E. coli isolates was higher in healthy calves compared to diarrheic cases. AR was widespread among VG-positive isolates. These findings suggest that calves may serve as potential reservoirs of antimicrobial-resistant hybrid pathotypes of E. coli., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Providing care to children with cancer is one of the most challenging areas of ethical care for nurses. Few studies have addressed nurses' perception of the barriers to giving ethical care in oncology departments. Thus, it is essential that the ethical challenges in caregiving as perceived by oncology nurses be investigated., Objective: The present study was conducted to investigate the ethical challenges as perceived by nurses in pediatric oncology units in the south of Iran., Research Design: The present study is a qualitative work of research with a conventional content analysis design. Data were collected via individual semi-structured interviews. The collected data were analyzed using the qualitative content analysis method., Participants and Research Context: The participants were 21 nurses from pediatric oncology units in state hospitals who were selected by purposeful sampling. Sampling continued until the data were saturated. The study lasted from April to October 2022., Findings: Three main themes, promoting psychological safety in the children, respect for the dignity of the children, and expansion of support for families, and nine subthemes were extracted from the data., Ethical Considerations: The study's protocol was approved by the Research Ethics Committee of the University of Medical Sciences and ethical principles were followed throughout the study., Discussion and Conclusion: From the nurses' perspective, the major ethical challenges in providing ethical care in pediatric oncology units were reducing tension toward promoting the patients' psychological safety, showing respect for the identity and dignity of the children with cancer, and expanding support of the patients' families. By creating the right cultural and professional context and establishing proper protocols, healthcare policymakers and administrators can take effective steps toward eliminating the barriers to providing ethical care., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: One of the most common causes of death worldwide is cardiopulmonary arrest. Firefighters are among the first responders at the scenes of accidents and can, therefore, play a key part in performing basic cardiopulmonary resuscitation (CPR) for victims who need it. The present study was conducted to compare the effects of simulation training against workshops on the CPR knowledge and skills of firefighters in the south of Iran., Methods: This experimental (Interventional) study was conducted on 60 firefighters of south of Fars province, Iran. The study was undertaken from March to July 2023. Through random allocation, the participants were divided into two groups: simulation-based training (30 members) and traditional workshop training (30 members). The participants' CPR knowledge and practical skills were measured before, immediately after, and three months after intervention., Results: The findings of the study revealed a statistically significant difference between the pretest and posttest CPR knowledge and skill mean scores of the simulation groups as compared to the workshop group (p < 0.001). As measured three months after the intervention, the firefighters' knowledge and skill mean scores were still significantly different from their pretest mean scores (p < 0.001); however, they had declined, which can be attributed to the fact that the study population did not frequently exercise CPR., Conclusion: Based on the findings of the study, even though both methods of education were effective on enhancing the firefighters' CPR knowledge and skill, simulation training had a far greater impact than training in workshops. In view of the decline in the participants' knowledge and skill scores over time, it is recommended that short simulation training courses on CPR should be repeated on a regular basis., (© 2024. The Author(s).)

Background: The recent outbreak of Coronavirus 2019 (COVID-19) is a respiratory disorder caused by the Acute Respiratory Syndrome Coronavirus 2. At the start of the epidemic, early intubation was the optimal strategy for managing ARDS caused by COVID-19. Several non-invasive methods for respiratory support in patients with moderate to severe COVID-19 may reduce intubation, disease severity, ventilator use, and hospitalization in the intensive care unit (ICU). In this study, the characteristics of COVID-19 patients who failed NIV therapy were compared with those who had successful NIV., Materials and Methods: The present descriptive-analytical study was conducted at the COVID-19 center of KHORSHID University Hospital. Patients were aged > 18 years with confirmed COVID-19 and hospitalized in the ICU from the beginning of January to the end of March 2021. They had an oxygen level of < 88% despite receiving 15 L of oxygen with reserve masks and were undergoing non-invasive ventilation (NIV) treatment. Data collection included patients' demographic information, vital signs, and test results upon hospital admission, and assessed disease severity using APACHE, SAPS, and SOFA scores. Patients were categorized into responders (R) and non-responders (NR) to determine predictors of non-invasive ventilation (NIV) success, with follow-up based on device tolerance and changes in vital signs., Results: 71 Individuals were candidates for NIV. Twenty patients were excluded from the study, and 51 patients were included in the study. Of these, 35 patients underwent NIV treatment failure (NR). On the other hand, 16 (31.4%) patients completely recovered after receiving NIV (R) and they were discharged from the ICU., Conclusion: Serum Albumin and BMI levels of COVID-19 patients undergoing NIV therapy seem to affect their responses to treatment. Hence, it is recommended to evaluate the nutritional status of patients before the start of NIV ., (Copyright© 2024 National Research Institute of Tuberculosis and Lung Disease.)

Background: The purpose of this research was to investigate and compare the utilization of the revised Geneva score, original PESI, and simplified PESI in predicting the long-term mortality rate of patients with pulmonary embolism (PE)., Methods: This retrospective investigation was conducted in Isfahan between June 2014 and July 2015 on patients with PE who were referred to our medical center. In this study, the revised Geneva score, the original PESI scales, and the simplified PESI scales were utilized. Additionally, diagnostic and treatment procedures were done in accordance with the standard protocol. We collected data of patients including gender, age, any risk factors for venous thromboembolism. After the primary data collection, contacts were made to the patients or their relatives for gathering information about patient's survival. The mortality rates of patients were determined within 10 years after the PE., Results: We analyzed data of 224 patients. Over a 131-month course of following up 224 patients, 105 deaths occurred that were related to PE. The initial PESI factor had a positive and negative predictive value of 83%. Patients with PE who scored extremely high on the PESI had a mortality and morbidity rate 42 times (9.22-87.32) greater than those with PE who scored very low. Furthermore, the death and morbidity rate of high-risk PE patients was 5% (0.67-1.70) in the Geneva score and 62% (0.30-2.31) in the simplified PESI score., Conclusion: The use of original PESI score could predict the long-term mortality of PE patients more accurately than other scores., Competing Interests: None., (AJCD Copyright © 2023.)

Background: Traumatic brain injury (TBI) is one of leading cause of death and disability in Iran that has serious consequences on people's health. Understanding of epidemiology of TBI can be helpful for policy making in health care management. Therefore, this study aimed to examine the epidemiology of TBI in Iran., Methods: PubMed, Web of Science, Scopus, Google scholar, and internal databases including, SID, Magiran, and IranMedex were searched to identify the relevant published studies up to Feb 2022. Moreover, the references list of key studies was scanned to find more records. The Joanna Briggs Institute (JBI) tool was used to assess the quality of included studies. The Excel and Comprehensive Meta-Analysis software were to analyze the data., Results: Overall, 23,446 patients from 15 studies were included in the study. The overall mean age of the patients was 31.36 ± 0.13 yr (95%CI: 31.10 to 31.61). The majority of the patients were male (74.37%), with a male to female ratio of 3:1. The incidence rate of TBI was 15.3 to 144 per 100,000 population. The mortality rate of TBI was estimated to be 10.4% (95%CI: 5% to 19%). The most common causes of injury were road traffic accidents (RTAs) (60%; 95%CI: 49% to 70%), and falling (20%; 95%CI: 16% to 26%), respectively. The most frequent type of head injury was subdural hematoma., Conclusion: Our findings highlight that appropriate control and prevention strategies should be focused on male, road traffic accidents, and the group under 40 yr., (Copyright© 2023 Maleki et al. Published by Tehran University of Medical Sciences.)

Background: Sleep disorders can significantly impair the quality of life and daily functions. Evaluating sleep quality can provide valuable information about working conditions. This study aims to evaluate the sleep quality of faculty members at Isfahan University of Medical Sciences (IUMS)., Methods: This descriptive-analytic study was conducted from 2020 to 2021, involving 106 faculty members from the medical school. A questionnaire collected demographic information, including age, sex, height, weight, body mass index (BMI), level of education, history of faculty membership, major, working hours during the day and night, residency place, and medical history. The Pittsburgh Sleep Quality Index (PSQI) and Symptom Checklist-25 (SCL-25) questionnaire were used to assess participants' sleep quality. Data were compared between clinicians and basic science faculty members., Results: PSQI subtypes were examined among the participants. The total PSQI score was 6.20±3.4. A comparison of PSQI scores and subtypes based on age categories did not show any significant differences (P > 0.05 for all). Clinicians had significantly lower total PSQI scores (P=0.044), sleep latency (P=0.024), sleep disturbances (P=0.012), and daytime dysfunction (P=0.022). Additionally, clinicians had a lower severity of sleep latency (P=0.024), sleep disturbances (P=0.012), and total PSQI score (P=0.044). However, clinicians exhibited a higher intensity of daytime dysfunction (P=0.022)., Conclusion: Faculty members exhibited a high prevalence of sleep disorders, with the most common disorders being sleep disturbance and high sleep latency. The prevalence of sleep disorders was higher among basic science faculty members compared to clinicians., Competing Interests: None., (IJPPP Copyright © 2023.)

Key Clinical Message: Sarcoidosis is a systemic inflammatory disease able to affect any organ within the body. Sarcoidosis may be the body's secondary response to COVID-19 infection and a sign of rehabilitation. Early response to the treatments reinforces this hypothesis. The majority of sarcoidosis patients require immunosuppressive therapies, including corticosteroids., Abstract: Most studies so far have focused on the management of COVID-19 in patients suffering from sarcoidosis. Nevertheless, the current report aims to present a COVID-19-induced sarcoidosis case. Sarcoidosis is a systemic inflammatory disease with granulomas. Still, its etiology is unknown. It often affects the lungs and lymph nodes. A previously healthy 47-year-old female was referred with the following chief complaints: atypical chest pain, dry cough, and dyspnea on exertion within a month after COVID-19 infection. Accordingly, a chest computed tomography revealed multiple conglomerated lymphadenopathies in the thoracic inlet, mediastinum, and hila. A core-needle biopsy from the nodes revealed non-necrotizing granulomatous inflammation, sarcoidal type. The sarcoidosis diagnosis was proposed and confirmed by a negative purified protein derivative (PPD) test. Accordingly, prednisolone was prescribed. All symptoms were relieved. A control lung HRCT was taken 6 months later, showing the lesions had disappeared. In conclusion, sarcoidosis may be the body's secondary response to COVID-19 infection and a sign of disease convalescence., Competing Interests: The authors declared no conflicts of interest in this study., (© 2023 Isfahan University of Medical Science. Clinical Case Reports published by John Wiley & Sons Ltd.)

Background: The COVID-19 pandemic has affected human beings worldwide. After recovery from the disease, the pulmonary function and physiological characteristics of COVID-19 patients are not well documented. The current study aims to assess post-COVID-19 lung function, anxiety, depression, and sleep quality within three months after recovery from the disease., Materials and Methods: Ninety-seven patients (21 outpatients and 76 inpatients) with COVID-19 were followed three months after recovery. They were divided into two groups according to the severity of the disease. The spirometric parameters included FEV1, FVC, and FEV1/FVC. A 6-minute walk test (6-MWT) was recorded. Besides, sleep quality using Pittsburgh Sleep Quality Index (PSQI) and mood status in two dimensions of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) were compared between the groups., Results: More than 70% of the studied population presented at least one of the COVID-19 infection-related symptoms within three months after recovery. spirometric measurements revealed non-significant differences between the patients with severe versus non-severe COVID-19 in terms of FVC (P=0.805), FEV1 (P=0.948), FEV1/FVC (P=0.616), and 6MWT (P=0.409). Based on PSQI, sleep quality was significantly associated with the severity of disease (P=0.031), but HADS assessments were not significant (P>0.05)., Conclusion: This study demonstrated that a significant proportion of COVID-19 patients have corona symptoms and abnormal pulmonary function tests three months after recovery. Besides, sleep quality was considerably affected by the severity of the disease and was directly associated with the post-COVID-19 mood of the patients. It seems necessary to consider and control the long-term consequences of this infection regardless of the disease severity., Competing Interests: Conflict of interest No Conflict of interest, (Copyright© 2023 National Research Institute of Tuberculosis and Lung Disease.)

Background: Patients with cancer are at higher risk of contracting COVID-19 with poor prognosis. Therefore, the present study was conducted to investigate anxiety, spiritual well-being, and resilience levels in patients with cancer undergoing chemotherapy during the COVID-19 pandemic in the south of Fars Province, Iran., Methods: This is a descriptive study with a cross-sectional design conducted on the patients undergoing chemotherapy at Dr. Ali Shariati Hospital in Fasa from November 2021 to February 2022. Cancer patients undergoing chemotherapy were included in the study by census method. Out of 210 patients, 155 participated in the study. Data were collected electronically using the standard instruments of Ellison's Spiritual Well-being Scale, COVID-19 anxiety questionnaire, and Connor-Davidson resilience scale. The collected data were analyzed in SPSS 22 using descriptive statistics, Pearson correlation tests, T-test, ANOVA and multivariate linear regression at a level of significance of P < 0.05., Results: The participants' resilience mean score was 46.35 ± 26.51 and their spiritual well-being mean score was 69.58 ± 9.32. In addition, their COVID anxiety mean, score was found to be 16.85 ± 10.51. The results showed a significant direct correlation between the patients' spiritual well-being and resilience (r = 0.47, P < 0.001) and a significant inverse correlation between the patients' spiritual well-being and COVID-19-related anxiety (r = - 0.275, P < 0.001). In addition, there was a significant inverse correlation between the variables of resilience and COVID-19-related anxiety (r = - 0.637, P < 0.001). Based on multivariate linear regression, the most common predictors in resilience were age and history of infection with COVID-19, and in spiritual health and anxiety, was a history of infection with COVID-19., Conclusion: Enhancement of spiritual well-being and resilience in patients should be an integral part of care as these qualities are valuable resources in fighting cancer and lowering patients' anxiety, especially during the COVID-19 pandemic., (© 2023. The Author(s).)

Retinoblastoma (RB) is a rare aggressive intraocular malignancy of childhood that has the potential to affect vision, and can even be fatal in some children. While the tumor can be controlled efficiently at early stages, metastatic tumors lead to high mortality. Non-coding RNAs (ncRNAs) are implicated in a number of physiological cellular process, including differentiation, proliferation, migration, and invasion, The deregulation of ncRNAs is correlated with several diseases, particularly cancer. ncRNAs are categorized into two main groups based on their length, i.e. short and long ncRNAs. Moreover, ncRNA deregulation has been demonstrated to play a role in the pathogenesis and development of RB. Several ncRNAs, such as miR-491-3p, miR-613,and SUSD2 have been found to act as tumor suppressor genes in RB, but other ncRNAs, such as circ-E2F3, NEAT1, and TUG1 act as tumor promoter genes. Understanding the regulatory mechanisms of ncRNAs can provide new opportunities for RB therapy. In the present review, we discuss the functional roles of the most important ncRNAs in RB, their interaction with the genes responsible for RB initiation and progression, and possible future clinical applications as diagnostic and prognostic tools or as therapeutic targets., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ahangar Davoodi, Najafi, Naderi Ghale-Noie, Piranviseh, Mollazadeh, Ahmadi Asouri, Asemi, Morshedi, Tamehri Zadeh, Hamblin, Sheida and Mirzaei.)

Due to the hypercoagulable status of patients with severe COVID-19 infection, anticoagulants are often used to prevent thrombosis. However, these agents may cause bleeding events such as retroperitoneal hematoma (RPH). We report here on six patients with COVID-19 who developed RPH during treatment. Early evidence of bleeding led to confirmatory diagnosis with imaging. Four patients recovered with supportive treatment (IV fluids and blood transfusions) and two patients recovered by angioembolization. RPH should be considered in COVID patients on anticoagulants as soon as haemoglobin or blood pressure falls. Further studies are required to provide guidance and recommendations on use of anticoagulants in critically ill patients with COVID-19.

Background: Obesity hypoventilation syndrome (OHS) is associated with increased mechanical load on respiratory system. Here, we aimed to investigate and evaluate the effects of noninvasive ventilation (NIV) on physical and mental status of patients with OHS., Materials and Methods: The current study is an observational study that was performed in 2020 on 50 patients with OHS in Isfahan, Iran. Beck's Depression Inventory (BDI-II) and Hospital Anxiety and Depression Scale (HADS) questionnaires were also filled for all patients assessing their depression levels that were confirmed by psychiatrists. PO 2 and PCO 2 of patients were evaluated using venous blood gas (VBG) before interventions. Patients with a definite diagnosis of OHS and depression entered the study and underwent treatments with NIV. One month after the interventions with NIV, the blood gases of patients were evaluated using VBG and BDI-II, and HADS questionnaires were also filled for all patients, evaluating their depression., Results: The mean age of the subjects was 63.5 ± 13.5. The mean blood oxygen after the use of NIV in patients with OHS increased significantly ( P = 0.001). The mean of carbon dioxide after using NIV in patients with OHS decreased significantly ( P = 0.001). Based on the BDI-II and HADS scales, the mean score of depression after using NIV decreased significantly ( P = 0.001 for both)., Conclusion: NIV therapies are associated with improvements in blood oxygen and CO 2 of patients with OHS. The levels of depression also decreased after treatments that were confirmed by psychiatrists., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Advanced Biomedical Research.)

Background: Older patients are more vulnerable and prone to abuse and neglect in hospitals and acute care settings. The present study aimed to develop and assess the psychometric properties of a questionnaire for screening abuse in hospitalized older adults., Methods: This study was conducted from October 2017 to September 2019 using the exploratory sequential mixed-methods research design. The participants were selected among those admitted to various wards of six teaching hospitals affiliated with Shiraz University of Medical Sciences, Shiraz, Iran. In the qualitative phase of the study, using the inductive content analysis method, the concept of abuse in hospitalized older adults was extracted through individual in-depth semi-structured interviews with 16 older patients and 11 family caregivers. Based on qualitative findings and a review of existing literature, an initial version of the questionnaire was developed. In the quantitative phase of the study, the psychometric properties (face, content, construct, and convergent validity; internal consistency and stability) of the questionnaire were examined., Results: Based on qualitative findings and literature review, a pool of 154 candidate items was defined. These items were reduced to 37 after initial refinement, qualitative and quantitative face and content validity, and item analysis. The outcome of principal component analysis further reduced the number of items to 27, which were grouped into 5 components, namely "Shortcomings in management and care facility", "Neglect of professional commitments", "Physical and psychological abuse", "Protracted treatment process", and "Invasion of privacy". The explained variance of these 5 components was 50.09% of the overall variability of the questionnaire. The convergent validity of the questionnaire was acceptable (P < 0.00, r = - 0.44). Cronbach's alpha coefficient and intraclass correlation coefficient for the entire questionnaire were 0.89 and 0.92, respectively; indicating high reliability and stability of the questionnaire., Conclusion: The hospitalized elder abuse questionnaire (HEAQ) has acceptable psychometric properties. It is recommended to use HEAQ to screen for suspected cases of abuse of hospitalized older adults., (© 2022. The Author(s).)

Purpose: The aim of this study was to evaluate the ocular disorders in COVID-19 patients, two to three months after infection., Methods: In this cross-sectional, historically controlled study, fifty-one COVID-19 patients were compared with thirty-seven age, and gender-matched healthy individuals. After complete ophthalmological examination, all participants underwent peripapillary and macular optical coherence tomography, and optical coherence tomography angiography (OCTA) measurements (OptoVue Inc, Freemont, CA, USA)., Results: The time between the initial onset of symptoms, and ophthalmologic examination was 63.31±15.21 (40-95 days). Ophthalmic examination of all the recovered COVID-19 patients was within normal range. None of the peripapillary and macular OCTA parameters were significantly different between the two groups with pairwise comparisons, but after adjusting for age, gender, axial length, and signal strength index (SSI), recovered COVID-19 eyes showed a significant increase in peripapillary retinal nerve fiber (RNFL) thickness, superficial, and deep macular vessel densities in parafoveal and perifoveal regions compared with healthy control eyes (p<= 0.05). Inner retinal thickness overall is higher in recovered COVID-19 eyes compared to healthy eyes after adjustment., Conclusion: Patients with moderate-intensity SARS-CoV-2 pneumonia had altered peripapillary and macular vessel density compared to healthy subjects. Further investigation is warranted to analyze the correlation of these changes with disease severity as well as evolution of these changes over time., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: The quality of care that older adult patients receive during hospitalization is directly associated with the perception, knowledge, and skills of the healthcare team. This qualitative study was conducted to explore the concept of age discrimination perceived by hospitalized older adult patients. Methods: The present exploratory qualitative study was conducted using conventional content analysis. The purposive sampling method was used to recruit participants and the sampling continued until data saturation. A total of 21 individuals comprising of 12 hospitalized older adult patients, 5 family caregivers, 3 nurses, and a physician were enrolled in the study. Data were collected through 21 face-to-face, semi-structured, in-depth interviews. Data were analyzed using the qualitative content analysis method as described by Elo and Kyngäs. Results: The analysis of the interview data resulted in 4 main categories, namely injustice perceptions, interactional injustice, procedural injustice, and organizational injustice. Conclusion: The findings of the study indicated that older adult patients perceive the occurrence of age discrimination by healthcare teams and inequalities in the provided care in hospitals. It is therefore important to address ageism and subsequent inequalities through short- and long-term policies and plans, as well as standardization and transformation of the present condition of hospitals to become an age-friendly environment., (© 2022 The Author(s).)

Background: Molecular-based studies have revealed heterogeneity in Breast cancer BC while also improving classification and treatment. However, efforts are underway to distinguish between distinct subtypes of breast cancer. In this study, the results of several microarray studies were combined to identify genes and pathways specific to each BC subtype., Methods: Meta-analysis of multiple gene expression profile datasets was screened to find differentially expressed genes (DEGs) across subtypes of BC and normal breast tissue samples. Protein-protein interaction network and gene set enrichment analysis were used to identify critical genes and pathways associated with BC subtypes. The differentially expressed genes from meta-analysis was validated using an independent comprehensive breast cancer RNA-sequencing dataset obtained from the Cancer Genome Atlas (TCGA)., Results: We identified 110 DEGs (13 DEGs in all and 97 DEGs in each subtype) across subtypes of BC. All subtypes had a small set of shared DEGs enriched in the Chemokine receptor bind chemokine pathway. Luminal A specific were enriched in the translational elongation process in mitochondria, and the enhanced process in luminal B subtypes was interferon-alpha/beta signaling. Cell cycle and mitotic DEGs were enriched in the basal-like group. All subtype-specific DEG genes (100%) were successfully validated for Luminal A, Luminal B, ERBB2, and Normal-like. However, the validation percentage for Basal-like group was 77.8%., Conclusion: Integrating researches such as a meta-analysis of gene expression might be more effective in uncovering subtype-specific DEGs and pathways than a single-study analysis. It would be more beneficial to increase the number of studies that use matched BC subtypes along with GEO profiling approaches to reach a better result regarding DEGs and reduce probable biases. However, achieving 77.8% overlap in basal-specific genes and complete concordance in specific genes related to other subtypes can implicate the strength of our analysis for discovering the subtype-specific genes., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Breast Cancer is the most frequent neoplasm diagnosed among women worldwide. Genetic background and lifestyle/environment play a significant role in the disease etiology. According to Genome-wide association studies, some single-nucleotide polymorphisms such as 2q35-rs13387042-(G/A) have been introduced to be associated with breast cancer risk and features. In this study, we aimed to evaluate the association between this variant and the risk of breast cancer in a cohort of Iranian women., Methods: Demographics and clinical information were collected by interview and using patients' medical records, respectively. DNA was extracted from 506 blood samples, including 184 patients and 322 controls, and genotyping was performed using allele specific-PCR. SPSS v16 was used for statistical analysis., Result: Statistically significant association was observed between AA genotype and disease risk in all patients [p adj  = 0.048; OR adj  = 2.13, 95% CI (1.01-4.50)] and also ER-positive breast cancers [p adj  = 0.015; OR adj  = 2.12, 95% CI (1.16-3.88)]. There was no association between rs13387042 and histopathological characteristics of the disease. Furthermore, overall survival was not statistically associated with genotype and allelic models even after adjustment for stage and receptor status (p > 0.05)., Conclusion: There is a statistically significant association between 2q35-rs13387042 and breast cancer risk. rs13387042-AA genotype might be a risk-conferring factor for breast cancer development in the Iranian population. However, further consideration is suggested to confirm its role in risk assessment and probable association with other genetic markers., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Abstract., (This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: As a chronic, disabling disease, multiple sclerosis (MS) has challenged healthcare systems in many ways. MS adversely affects patients' quality of life and self-efficacy and results in psychological stress. The present study was conducted to investigate the effect of peer education based on Pender's health promotion model on the quality of life, stress management, and self-efficacy of patients with MS in the south of Iran., Methods: The present study was a randomized controlled clinical trial. A total of 90 patients were divided into group A intervention group 45 patients) and group B (control group 45 patients). The intervention was peer education based on Pender's health promotion model. Data were collected using the MS Quality of Life Scale, the Self-efficacy Scale, and the Stress Management Scale. Data analyses were conducted using SPSS version 22. To analyze the data, we used descriptive statistics. Thus, inferential statistics applied included Chi-square, independent-samples t-test, and Repeated measures (ANOVA). The significance level was considered p < 0.05., Results: The quality of life, self-efficacy, and stress management mean scores of the intervention group as measured immediately and 3 months after intervention were significant (p < 0.05). As for the control group, however, the difference was not significant., Conclusion: Peer education based on Pender's health promotion model improves patients' quality of life, stress management, and self-efficacy with multiple sclerosis. Nursing managers and health system policymakers can use this educational approach for patients with other chronic diseases to enhance their quality of life and self-efficacy., Trial Registration: Iranian Registry of Clinical Trials: IRCT registration number: IRCT20190917044802N3 ., (© 2022. The Author(s).)

Background: Since the beginning of the coronavirus disease of 2019 (COVID-19) pandemic, concerns raised by the growing number of deaths worldwide. Acute respiratory distress syndrome (ARDS) and extrapulmonary complications can correlate with prognosis in COVID-19 patients. This study evaluated the association of systemic complications with mortality in severely affected COVID-19 patients., Materials and Methods: This retrospective study was done on 51 intensive care unit (ICU)-admitted COVID-19 adult patients who were admitted to the ICU ward of Khorshid hospital, affiliated with Isfahan University of Medical Sciences. Only the patients who had a definite hospitalization outcome (dead vs. survivors) were included in the study. Daily clinical and paraclinical records were used to diagnose in-hospital complications in these patients., Results: The sample was comprised of 37 males (72.5%) and 14 females (27.4%). The median age of patients was 63 years (Min: 20, Max: 84), with the mortality rate of 47.1%. In total, 70.6% of patients had at least one coexisting disorder. Chronic kidney disease was associated with the worse outcome (29.16% of dead patients against 3.70 of survived ones). Mechanical ventilation was used in 58.8% of patients. Patients who had received invasive ventilation were more likely to die (87.50% of dead patients against 7.40 of survivors), Complications including sepsis and secondary infections (odds ratio: 8.05, confidence interval: 2.11-30.63) was the strongest predictors of mortality., Conclusion: Complications including sepsis and secondary infections can increase the risk of death in ICU-admitted COVID-19 patients. Therefore, it is substantial that the physicians consider preventing or controlling these complications., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Research in Medical Sciences.)

This study determined the gap between student expectations and perceptions to achieve a relatively accurate description of student satisfaction. Student expectations and perceptions regarding educational services across a number of different dimensions were evaluated using SERVQUAL model, and the nature of each educational factor was determined using the Kano model. Three characteristics of 30 educational services indicators were placed in the cluster of students' basic needs, 26 characteristics were placed in the performance and one-dimensional needs cluster, and one characteristic was placed in the neutral needs cluster. No characteristics were put in the cluster concerning the motivational needs of students.

The COVID-19 pandemic has raised concerns among physicians and patients with autoimmune disorders about how this viral infection affects the patients receiving immunosuppressive drugs. There are speculations about a higher incidence and severity of COVID-19 in patients receiving a variety of immunosuppressant drugs. However, we reported the rapid recovery from COVID-19 in a 67-year-old male with granulomatosis with polyangiitis who did not experience severe symptoms of the COVID-19 as expected, despite having a history of serious lung involvement due to the autoimmune disease. He received conventional medications to treat COVID-19, though he had been receiving rituximab and corticosteroids before the onset of COVID-19 symptoms. Prevention of the cytokine storm caused by SARS-CoV-2 infection owing to taking the immunosuppressive drugs (rituximab and corticosteroids) could be a reason for these unexpected observations. Therefore, this case showed that taking immunosuppressive drugs is unlikely to be directly related to the increased severity of COVID-19., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Advanced Biomedical Research.)

Background: The new coronavirus outbreak quickly filled hospital beds and stunned the world. Intensive care is required for 5% of patients, and the mortality rate for critically ill patients is 49%. The "cytokine storm" is considered as the main cause of pathogenesis for coronavirus disease-19 (COVID-19)-related respiratory failure, hemoperfusion may be a modality for treatment of disease., Materials and Methods: Thirty-seven an patients with positive real-time polymerase chain reaction for SARStions2 in an upper respiratory tract sample or typical chest computed tomography lesion were eligible for this case-control study. Patients meeting the criteria for hemoperfusion including clinical and laboratory indices, were evaluated for outcomes such as hospitalization length and mortality. Patients were divided into three groups, i.e., patients who received hemoperfusion without a need for mechanical ventilation (MV), patients who received hemoperfusion before MV, and patients who received hemoperfusion after MV., Results: Among 37 patients with COVID-19 respiratory failure, 32% were female with a mean age of 55.54 (standard deviation 14.1) years. There was no statistically significant difference between the three groups in terms of length of hospital stay and intensive care unit (ICU) stay (P-tayns: 0.593 and 0.243, respectively, confidence interval [CI]: 95%). Heart rate, respiratory rate, PaO 2 /FIO 2 , high-sensitivity C-reactive protein, and ferritin significantly improved after the application of hemoperfusion in all groups ( P < 0.05, CI: 95%)., Conclusion: It seems that applying hemoperfusion in the inflammatory phase of the disease, especially before the intubation, reduce the need for MV. However, hemoperfusion does not have any impacts on the duration of hospital and ICU stay., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Research in Medical Sciences.)

Background: Coronavirus disease 2019 (COVID-19) has led to considerable morbidity and mortality worldwide and myocardial injury has been one of the most common findings in the affected patients. However, published evidence of cardiac evaluation by imaging techniques including echocardiography is rare. We aimed to evaluate myocardial involvement by echocardiography in patients with severe COVID-19., Methods: We studied 64 patients with severe COVID-19 who were admitted in the intensive care unit (ICU) in Khorshid Hospital, Isfahan, Iran, from February 20, 2020 until May 20, 2020. Demographic characteristics, laboratory tests, and electrocardiography (ECG) data were collected and transthoracic echocardiography (TTE) using a focused time-efficient echocardiography protocol was performed., Results: Mean age of the participating patients was 66.40 ± 14.14 years (range: 34.0-92.0 years), and 35 patients (54.7%) were men. Reduced left ventricular (LV) systolic function was seen in 20 (32%) patients. Only 4 patients had LV ejection fraction (LVEF) less than 40%. Cardiac troponin I (cTn-I) was elevated (over 15 pg/ml) in 39 (60.9%) patients and was significantly associated with higher mortality in these patients (P = 0.05). In addition, dynamic ST and T wave changes and new bundle branch blocks had a significant association with adverse clinical outcome (P = 0.05 and P = 0.02, respectively)., Conclusion: New LV systolic dysfunction (LVSD) in patients with severe COVID-19 was mild to moderate and not uncommon and had no significant adverse effect on the prognosis of these patients, although elevation of cardiac biomarkers could predict mortality and had an adverse effect on clinical outcome., (© 2021 Isfahan Cardiovascular Research Center & Isfahan University of Medical Sciences.)

Since the outbreak of the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the control of virus spread has remained challenging given the pitfalls of the current diagnostic tests. Nevertheless, RNA amplification techniques have been the gold standard among other diagnostic methods for monitoring clinical samples for the presence of the virus. In the current paper, we review the shortcomings and strengths of RT-PCR (real-time polymerase chain reaction) techniques for diagnosis of coronavirus disease (COVID)-19. We address the repercussions of false-negative and false-positive rates encountered in the test, summarize approaches to improve the overall sensitivity of this method. We discuss the barriers to the widespread use of the RT-PCR test, and some technical advances, such as RT-LAMP (reverse-transcriptase-loop mediated isothermal amplification). We also address how other molecular techniques, such as immunodiagnostic tests can be used to avoid incorrect interpretation of RT-PCR tests., (Copyright © 2021 Elsevier GmbH. All rights reserved.)

Digestive system cancer tumors are one of the major causes of cancer-related fatalities; the vast majority of them are colorectal or gastric malignancies. Epidemiological evidence confirmed that allium-containing food, such as garlic, reduces the risk of developing malignancies. Among all compounds in garlic, allicin has been most researched, as it contains sulfur and produces many second degradation compounds, such as sulfur dioxide, diallyl sulfide (DAS), diallyl trisulfide (DATS), and diallyl disulfide (DADS) in the presence of enzymatic reactions in gastric juice. These substances have shown anti-inflammatory, antidiabetic, antihypertensive, antifungal, antiviral, antibacterial, and anticancer efficacy, including gastrointestinal (GI) cancers, leukemia, and skin cancers. Herein, we summarize the therapeutic potential of allicin in the treatment of GI cancers., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Sarvizadeh, Hasanpour, Naderi Ghale-Noie, Mollazadeh, Rezaei, Pourghadamyari, Masoud Khooy, Aschner, Khan, Rezaei, Shojaie and Mirzaei.)

Purpose: The aim of this study was to assess the effects of neck radiation on the results of Doppler sonography of carotid arteries in head and neck cancer patients., Methods: In this prospective, cross-sectional study, 25 consecutive patients with head and neck cancers were assessed for carotid artery stenosis (CAS) by carotid color Doppler sonography before external radiotherapy and six months after external radiotherapy. Main outcome measures were peak systolic velocity (PSVs), end-diastolic velocities (EDVs) of the internal carotid artery (ICA), ICA/common carotid (CCA) ratios, and degree of stenosis., Results: The age of the enrolled patients at the initiation of radiotherapy was 57.9±11.8 years (mean±SD; range, 43-91 years), and only 4 (16%) of the 25 patients were female. The findings showed significant changes in the plaque degree and stenosis degree, and plaque size before and after external radiotherapy (P<0.05). Changes in degree of stenosis were significantly correlated with age (p=0.021)., Conclusion: After neck irradiation changes in the carotid artery may occur and cause subsequent neurologic events., (Copyright © 2021. Published by Elsevier Inc.)

Purpose: To report the clinical course of a woman treated with intravitreal bevacizumab during pregnancy., Case Report: A 27-year-old female with poorly controlled diabetes and a history of two previous miscarriage was referred to our hospital with sudden deterioration in visual acuity (VA) in her right eye. Ocular findings revealed severe Proliferative Diabetic Retinopathy (PDR) complicated with preretinal hemorrhages in her right eye, and after maximal Panretinal Photocoagulation (PRP) bilaterally, she was treated with intravitreal injection of bevacizumab (IVB) into the right eye. Twenty four hours after the bevacizumab injection, she reported vaginal bleeding, and ultrasound confirmed a 12-week pregnancy of which the patient was unaware. The patient suffered from pregnancy loss., Conclusion: Use of intravitreal anti-VEGF by pregnant woman may only be justified if the potential benefit outweighs the potential risk to the fetus and only if clearly needed. Intravitreal bevacizumab during pregnancy in women with a history of miscarriage should be used with caution., (© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Introduction: There are no determined treatment agents for severe COVID-19. It is suggested that methylprednisolone, as an immunosuppressive treatment, can reduce the inflammation of the respiratory system in COVID-19 patients., Methods: We conducted a single-blind, randomised controlled clinical trial involving severe hospitalised patients with confirmed COVID-19 at the early pulmonary phase of the illness in Iran. The patients were randomly allocated in a 1:1 ratio by the block randomisation method to receive standard care with methylprednisolone pulse (intravenous injection, 250 mg·day -1 for 3 days) or standard care alone. The study end-point was the time of clinical improvement or death, whichever came first. Primary and safety analysis was done in the intention-to-treat (ITT) population., Results: 68 eligible patients underwent randomisation (34 patients in each group) from April 20, 2020 to June 20, 2020. In the standard care group, six patients received corticosteroids by the attending physician before the treatment and were excluded from the overall analysis. The percentage of improved patients was higher in the methylprednisolone group than in the standard care group (94.1% versus 57.1%) and the mortality rate was significantly lower in the methylprednisolone group (5.9% versus 42.9%; p<0.001). We demonstrated that patients in the methylprednisolone group had a significantly increased survival time compared with patients in the standard care group (log-rank test: p<0.001; hazard ratio 0.293, 95% CI 0.154-0.556). Two patients (5.8%) in the methylprednisolone group and two patients (7.1%) in the standard care group showed severe adverse events between initiation of treatment and the end of the study., Conclusions: Our results suggest that methylprednisolone pulse could be an efficient therapeutic agent for hospitalised severe COVID-19 patients at the pulmonary phase., Competing Interests: Conflict of interest: M. Edalatifard has nothing to disclose. Conflict of interest: M. Akhtari has nothing to disclose. Conflict of interest: M. Salehi has nothing to disclose. Conflict of interest: Z. Naderi has nothing to disclose. Conflict of interest: A. Jamshidi has nothing to disclose. Conflict of interest: S. Mostafaei has nothing to disclose. Conflict of interest: S.R. Najafizadeh has nothing to disclose. Conflict of interest: E. Farhadi has nothing to disclose. Conflict of interest: N. Jalili has nothing to disclose. Conflict of interest: M. Esfahani has nothing to disclose. Conflict of interest: B. Rahimi has nothing to disclose. Conflict of interest: H. Kazemzadeh has nothing to disclose. Conflict of interest: M. Mahmoodi Aliabadi has nothing to disclose. Conflict of interest: T. Ghazanfari has nothing to disclose. Conflict of interest: M. Sattarian has nothing to disclose. Conflict of interest: H. Ebrahimi Louyeh has nothing to disclose. Conflict of interest: S.R. Raeeskarami has nothing to disclose. Conflict of interest: S. Jamalimoghadamsiahkali has nothing to disclose. Conflict of interest: N. Khajavirad has nothing to disclose. Conflict of interest: M. Mahmoudi has nothing to disclose. Conflict of interest: A. Rostamian has nothing to disclose., (Copyright ©ERS 2020.)

The COVID-19 is rapidly scattering worldwide, and the number of cases in the Eastern Mediterranean Region is rising. Thus, there is a need for immediate targeted actions. We designed a longitudinal study in a hot outbreak zone to analyze the serial findings between infected patients for detecting temporal changes from February 2020. In a hospital-based open-cohort study, patients are followed from admission until one year from their discharge (the 1st, 4th, 12th weeks, and the first year). The patient recruitment phase finished at the end of August 2020, and the follow-up continues by the end of August 2021. The measurements included demographic, socio-economics, symptoms, health service diagnosis and treatment, contact history, and psychological variables. The signs improvement, death, length of stay in hospital were considered primary, and impaired pulmonary function and psychotic disorders were considered main secondary outcomes. Moreover, clinical symptoms and respiratory functions are being determined in such follow-ups. Among the first 600 COVID-19 cases, 490 patients with complete information (39% female; the average age of 57±15 years) were analyzed. Seven percent of these patients died. The three main leading causes of admission were: fever (77%), dry cough (73%), and fatigue (69%). The most prevalent comorbidities between COVID-19 patients were hypertension (35%), diabetes (28%), and ischemic heart disease (14%). The percentage of primary composite endpoints (PCEP), defined as death, the use of mechanical ventilation, or admission to an intensive care unit was 18%. The Cox Proportional-Hazards Model for PCEP indicated the following significant risk factors: Oxygen saturation < 80% (HR = 6.3; [CI 95%: 2.5,15.5]), lymphopenia (HR = 3.5; [CI 95%: 2.2,5.5]), Oxygen saturation 80%-90% (HR = 2.5; [CI 95%: 1.1,5.8]), and thrombocytopenia (HR = 1.6; [CI 95%: 1.1,2.5]). This long-term prospective Cohort may support healthcare professionals in the management of resources following this pandemic., Competing Interests: No authors have competing interests.

Introduction: Depression and anxiety during pregnancy have a negative impact on prenatal health and reduces mother's child care capability. Up to 20% of the pregnant women experience mood disorders. Objective: The aim of this study was evaluating the relationship between serum anti-TPO antibody levels and mood disorders in pregnant euthyroid women. Materials and methods: Serum anti-TPO antibody levels were measured in the first trimester of gestation in euthyroid pregnant women. Then, the women were divided into two groups of positive and negative anti-TPO antibody. Depression and anxiety were evaluated by Hamilton depression rating scale (HAM-D) and Hamilton anxiety rating scale (HAM-A) during the first, second, and third trimester of pregnancy (all women had three assessments during pregnancy). Results: Thirty women with high serum anti-TPO antibody levels (case group) and 32 women with normal serum anti-TPO antibody levels (control group) were compared. Mean anti-TPO levels were 105.63 ± 54.17 and 5.57 ± 1.80 IU/mL in case and control groups, respectively ( p = .000). The baseline characteristics and initial HAM-A and HAM-D scores were not significantly different in the two groups except for anti-TPO. Pair t -test showed that the level of anxiety and depression has increased significantly during pregnancy in both groups. Comparison of anxiety and depression level in both groups showed that in anti-TPO antibody positive group, anxiety, and depression levels were significantly higher than the anti-TPO antibody negative group. Conclusion: Depression and anxiety of euthyroid pregnant women in the second and third trimester of pregnancy have a significant correlation with serum anti-TPO antibody levels of the first trimester of pregnancy.

Objectives: In Iran, pigeons are kept and bred on the roofs of houses, which indicates the potential significance of pigeons in the dispersal of antimicrobial resistant Escherichia coli strains. Here we characterized antimicrobial resistance genotypes in relation to phenotypic presentations and phylogenetic backgrounds of the E. coli isolates from household pigeons in Kerman in southeast Iran., Methods: Totally, 152 faecal E. coli isolates from domestic and household pigeons were screened for 13 antimicrobial resistance genes, bla TEM , bla SHV , bla CTX-M , sulI, sulII, dhfrI, dhfrV, aadA, aac(3)-I, tetA, tetB, floR and qnrA, by conventional polymerase chain reaction (PCR) technique. Clermont phylogenetic background of E. coli strains was studied and antibiotic resistance of all strains was assessed for seven antibiotics., Results: The antimicrobial resistance genes bla TEM , tetA, tetB and aadA were detected in 52.6%, 6.5%, 6.5% and 5.9% of the isolates, respectively. PCR phylotyping revealed that a significant number of isolates within A 0 (54%), A 1 (70%), B1 (57.6%), B2 2 (75%) and D1 (87.5%) phylogroups were positive for the studied resistance genes. One phenotypic resistance pattern (trimethoprim-sulfamethoxazole) was associated with the presence of the corresponding gene sul2., Conclusions: An alarming rate of phenotypic resistance was observed in this study. Many isolates were positive for the screened resistance genes. According to the phylogenetic background, most resistant isolates belonged to the commensal phylotypes, representing significant role of commensal strains as a source of resistance genes. These findings highlight the role of the pigeon as disseminator of resistant E. coli strains., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Acrocyanosis and digital necrosis, which caused by microangiopathic and immunothrombosis phenomenon, may accompanied by microvascular involvement of other organs. Therefore, this finding can play a prognostic role in covid-19 outcome., Competing Interests: The authors declare no conflict of interest., (© 2020 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

The incidence of non-tuberculous mycobacteria (NTM) attributed diseases are rising and they are responsible for an increasing proportion of mycobacterial diseases, worldwide. However, their diagnosis is still a big challenge. In this study, a 77-year-old diabetic woman with familial history of lung cancer and 40 pack/year smoking history was presented. She described significant weight loss, shortness of breath, yellow productive sputum, fever, and chills from 4 months ago. The empirical antibiotic therapy didn't cause a significant improvement in the patient's health condition. Also, the sputum smear, culture, and polymerase chain reaction-based (PCR) tests were negative for Mycobacterium tuberculosis (MTB). Computed tomography scanning identified a consolidation at the right upper lobe which was susceptible to malignancy. Non-caseous granulomatous inflammation with the presence of acid-fast bacillus was detected in the biopsies. Therefore, the patient's sputum was reexamined. Although PCR was negative, both smear and culture became positive. PCR-based amplification of a 596 bp fragment of 16S rRNA gene of the isolated bacteria, followed by almost full 16S rRNA sequencing, identified the Mycobacterium fortuitum strain. No malignant cell was detected at pathology evaluations. Due to the increase of NTM attributed diseases which can exhibit negative PCR for MTB and low reliability of negative results of sputum smear and culture, multiple repetitions of the sputum evaluations and, utilizing from 16S rRNA sequencing is recommended to diagnose NTM related lung disease., (Copyright © 2019 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)