Effects of Selenium Supplementation on the Indices of Disease Activity, Inflammation and Oxidative Stress in Patients with Rheumatoid Arthritis: a Randomized Clinical Trial

The aim of study was to evaluate the effect of selenium supplementation on disease activity, inflammation, and oxidative stress in patients with rheumatoid arthritis (RA). This study was a randomized double-blind placebo-controlled trial on 59 patients with RA. Participants were randomly divided to receive 200 μg/day of selenium or a placebo for 12 weeks. The disease activity score (DAS.CRP and DAS.ESR), erythrocyte sedimentation rate (ESR), serum levels of C-reactive protein (CRP), fasting blood glucose, lipids, antibodies to cyclic citrullinated protein (anti-CCP), nitric oxide, glutathione, and total antioxidant capacity were assessed. The mean of DAS.CRP and DAS.ESR decreased significantly within both study groups after the intervention. However, the between-group comparisons revealed no significant differences. The CRP levels decreased significantly in the selenium group, and this decrease was near the significance level compared to the placebo (P = 0.05). However, after adjusting for baseline values, the observed difference between groups did not remain significant. In addition, the values of ESR and anti-CCP decreased significantly within the selenium group. Although, between-group comparison did not statistically significant, the change in ESR and anti-CCP in the selenium group was small clinically relevant compared to the placebo [the effect size (95% CI) for ESR: 0.38 (- 0.14, 0.89), and for anti-CCP: 0.32 (- 0.2, 0.83)]. Our study showed that selenium caused a small clinically relevant improvement in some RA biomarkers such as ESR and anti-CCP. Future studies that evaluate the effects of novel forms of supplements such as selenium nanoparticles on the clinical symptoms and biomarkers of RA are suggested. Trial Registration: At www.irct.ir as IRCT20190924044869N1 on 2020-06-14.

Phytoremediation of pollutants in oil-contaminated soils by Alhagi camelorum: evaluation and modeling

Phytoremediation is a cost-effective and environmentally friendly method, offering a suitable alternative to chemical and physical approaches for the removal of pollutants from soil. This research explored the phytoremediation potential of Alhagi camelorum, a plant species, for total petroleum hydrocarbons (TPHs) and heavy metals (HMs), specifically lead (Pb), chromium (Cr), nickel (Ni), and cadmium (Cd), in oil-contaminated soil. A field-scale study spanning six months was conducted, involving the cultivation of A. camelorum seeds in a nursery and subsequent transplantation of seedlings onto prepared soil plots. Control plots, devoid of any plants, were also incorporated for comparison. Soil samples were analyzed throughout the study period using inductively coupled plasma-optical emission spectroscopy (ICP‒OES) for HMs and gas chromatography‒mass spectrometry (GC‒MS) for TPHs. The results showed that after six months, the average removal percentage was 53.6 ± 2.8% for TPHs and varying percentages observed for the HMs (Pb: 50 ± 2.1%, Cr: 47.6 ± 2.5%, Ni: 48.1 ± 1.6%, and Cd: 45.4 ± 3.5%). The upward trajectory in the population of heterotrophic bacteria and the level of microbial respiration, in contrast to the control plots, suggests that the presence of the plant plays a significant role in promoting soil microbial growth (P < 0.05). Moreover, kinetic rate models were examined to assess the rate of pollutant removal. The coefficient of determination consistently aligned with the first-order kinetic rate model for all the mentioned pollutants (R2 > 0.8). These results collectively suggest that phytoremediation employing A. camelorum can effectively reduce pollutants in oil-contaminated soils.

Rapid eye movement sleep behavior disorder and its relation to Parkinson's disease: The potential of graph measures as brain biomarkers to identify the underlying physiopathology of the disorder

Rapid eye movement behavior disorder (RBD) is a parasomnia characterized by the loss of skeletal muscle atonia during the rapid eye movement (REM) sleep phase. On the other hand, idiopathic RDB (iRBD) is considered the prelude of the various α-synucleinopathies, including Parkinson's disease (PD), dementia with Lewy bodies and multiple system atrophy. Consequently, over 40% of patients eventually develop PD. Recent neuroimaging studies utilizing structural magnetic resonance imaging (s-MRI), diffusion-weighted imaging (DWI), and functional magnetic resonance imaging (fMRI) with graph theoretical analysis have demonstrated that patients with iRBD and Parkinson's disease have extensive brain abnormalities. Thus, it is crucial to identify new biomarkers that aid in determining the underlying physiopathology of iRBD group. This review was conducted systematically on the included full-text articles of s-MRI, DWI, and fMRI studies using graph theoretical analysis on patients with iRBD, per the procedures recommended by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The literature search was conducted through the PubMed and Google scholar databases concentrating on studies from September to January 2022. Based on the three perspectives of integration, segregation, and centrality, the reviewed articles demonstrated that iRBD is associated with segregation disorders in frontal and limbic brain regions. Moreover, this study highlighted the need for additional longitudinal and multicenter studies to better understand the potential of graph metrics as brain biomarkers for identifying the underlying physiopathology of iRBD group.

Improving asthma control and quality of life via a smartphone self-management app: A randomized controlled trial

BACKGROUND

Mobile phone applications (apps) show promise for enhancing asthma self-management, but their effectiveness varies. This study examined the effect of a smartphone asthma app on asthma control and quality of life.

METHODS

Using block randomization, 60 patients with asthma were allocated to an intervention group (n = 30) or control group (n = 30) for this single-blind randomized controlled trial. At baseline, both groups completed the Asthma Control Test (ACT) and Asthma Quality of Life Questionnaire-Marks (AQLQ-M). The intervention group used a smartphone-based asthma self-management app plus their regular treatment, while the control group received only usual care. Follow-up ACT and AQLQ-M assessments occurred at 3 and 6 months. SPSS version 26 was used for analysis, including descriptive statistics, non-parametric tests (Wilcoxon and Mann-Whitney U), and analysis of variance with repeated measurements.

RESULTS

Both groups showed improved asthma control and quality of life at 3 and 6 months compared to baseline. However, after 6 months the intervention group had significantly greater improvement than controls (p < 0.05). Repeated measures ANOVA revealed divergent changes in ACT and AQLQ-M scores over time, with the intervention group demonstrating greater enhancement of asthma control and quality of life (p < 0.001).

CONCLUSION

This study demonstrated that use of a smartphone-based asthma self-management app improved asthma control and quality of life after 6 months compared to usual care alone. These findings indicate that guideline-based asthma apps can positively impact outcomes.

Study on diazinon toxicity reduction by electro-Fenton process: A bioassay using daphnia magna

The realm of diazinon reduction from polluted water has witnessed a surge in the significance of advanced oxidation processes (AOPs) in recent times. However, there is a dearth of research focusing on the mitigation of its toxicity through AOPs. Thus, the primary objective of this study was to evaluate the effectiveness of the Electro-Fenton process (EFP) in the eradication and detoxification of diazinon in aqueous solutions. Synthetic wastewater samples with concentrations of 2, 2.5 and 3 mg/L were prepared. A total of 27 samples were determined using Box Behnken Design. Reaction time, pH and iron to hydrogen peroxide ratio (Fe2+/H2O2) were examined as operational parameters under a constant current of 5.4 amps. The quantification of diazinon concentration was performed using High-Performance Liquid Chromatography (HPLC). To evaluate the detoxification of diazinon, the Daphnia magna bioassay was employed as a methodology in this study. According to the results, the EFP could reduce the diazinon to zero and the LC50 values are increased by applying the process. The LC50 values for diazinon were determined using the Daphnia magna bioassay, considering initial concentrations of 2, 2.5, and 3 mg/L at a pH of 5, a reaction time of 15 min, and an iron to hydrogen peroxide molar ratio of 2. The recorded LC50 values were 3.039, 3.076, and 3.106, respectively, indicating the lowest frequency of cumulative death in Daphnia magna. In this case, after 96 h, only 3 cases (30%) of Daphnia magna death were observed. However, for all the mentioned concentrations of diazinon, after 96 h of exposure to samples without applying the Daphnia Magna death process, it was observed between 60 and 100%. Reducing the diazinon concentration and increasing the 96-h LC50 showed that the EFP can reduce the toxicity of diazinon on Daphnia Magna at the same time. Therefore, EFP can be considered a superior method with low ecotoxicity.

Evaluation of the effectiveness of a smartphone-based educational intervention on the outcomes of children's burns: A randomized controlled trial

Children's burns are a major public health concern due to their long-term physical, psychological, and social impacts, as well as their high financial burden. This study aimed to evaluate the effectiveness of a smartphone-based educational program on outcomes of children with severe burns. This study was designed as a double-blinded, randomized controlled trial (RCT) to test the effectiveness of a developed mobile application. A total of 93 participants were included in the final analysis. The participants were randomly assigned to either the intervention or control groups. Participants in both groups received usual self-care training at discharge, but those in the intervention group used an Android-based application for 2 months. The primary goal of the burn application was scar recovery, and the secondary goals were to increase child caregivers' satisfaction rate and decrease unplanned hospital readmissions. Data collection was conducted using valid and reliable questionnaires. Data were analysed using SPSS software. The study showed that the mobile application significantly affected the frequency of patient visits to the burn clinic and the satisfaction of caregivers of children with burns with the treatment process (p-value <0.05). Also, there was a significant relationship between the duration of application use and wound healing status ((p-value <0.001). These findings suggest that smartphone-based educational programs can be valuable for optimizing care for children with severe burns. Further research is warranted to explore the long-term impact of this intervention and its potential application in different healthcare settings.

The influence of propolis plus Hyoscyamus niger L. against COVID-19: A phase II, multicenter, placebo-controlled, randomized trial

The incubation period of COVID-19 symptoms, along with the proliferation and high transmission rate of the SARS-CoV-2 virus, is the cause of an uncontrolled epidemic worldwide. Vaccination is the front line of prevention, and antiinflammatory and antiviral drugs are the treatment of this disease. In addition, some herbal therapy approaches can be a good way to deal with this disease. The aim of this study was to evaluate the effect of propolis syrup with Hyoscyamus niger L. extract in hospitalized patients with COVID-19 with acute disease conditions in a double-blinded approach. The study was performed on 140 patients with COVID-19 in a double-blind, randomized, and multicentral approach. The main inclusion criterion was the presence of a severe type of COVID-19 disease. The duration of treatment with syrup was 6 days and 30 CC per day in the form of three meals. On Days 0, 2, 4, and 6, arterial blood oxygen levels, C-reactive protein (CRP), erythrocyte sedimentation rate, and white blood cell, as well as the patient's clinical symptoms such as fever and chills, cough and shortness of breath, chest pain, and other symptoms, were recorded and analyzed. Propolis syrup with H. niger L. significantly reduces cough from the second day, relieving shortness of breath on the fourth day, and significantly reduces CRP, weakness, and lethargy, as well as significantly increased arterial blood oxygen pressure on the sixth day compared to the placebo group (p < 0.05). The results in patients are such that in the most severe conditions of the disease 80% < SpO2 (oxygen saturation), the healing process of the syrup on reducing CRP and increasing arterial blood oxygen pressure from the fourth day is significantly different compared with the placebo group (p < 0.05). The use of syrup is associated with a reduction of 3.6 days in the hospitalization period compared with the placebo group. Propolis syrup with H. niger L. has effectiveness in the viral and inflammatory phases on clinical symptoms and blood parameters and arterial blood oxygen levels of patients with COVID-19. Also, it reduces referrals to the intensive care unit and mortality in hospitalized patients with COVID-19. So, this syrup promises to be an effective treatment in the great challenge of COVID-19.

Dietary Magnesium Intake and Proteinuria: Is There a Relationship?

The possible relationship between dietary magnesium status and proteinuria has been suggested by a number of previous studies. However, human studies on this association are limited. Therefore, the present study aimed to investigate the independent relationship between dietary magnesium intake and urinary protein excretion. The present study was a post hoc analysis of the previous randomized clinical trial that evaluated the effect of dietary phosphorus restriction on proteinuria. The baseline data of 90 participants with proteinuria and chronic kidney disease was used to measure the association between dietary magnesium intake and proteinuria. Participants were asked to record their 24-h food intake for three days a week in a questionnaire. Urinary protein to creatinine ratio (UPCR) in a random urine sample was measured to be a marker for proteinuria. Out of 90 patients included in the study, 47 were men and 43 were women. The mean ± standard deviation of age and body mass index were 59.05 ± 14.16 years and 29.02 ± 5.54 kg/m2, respectively. The patients' average daily dietary intake of energy and magnesium were 2183 kcal and 169.44 mg, respectively. A significant inverse correlation was found between the dietary intake of magnesium and UPCR (r =  - 0.219, p = 0.042). This association remained significant even after adjusting for confounding variables (β =  - 0.222, p = 0.028). The findings of the present study showed a significant inverse relationship between the magnesium intake and proteinuria. Although, the design of the current research was cross-sectional, it has provided a basis for conducting future longitudinal studies and trials to better elucidate such a relationship.

Reconstruction of a lateral thigh defect with a transverse rectus abdominis myocutaneous (TRAM) free flap: A case report

INTRODUCTION

Despite advancements in reconstructive surgery, the repair of large thigh deformities remains challenging. When other options are not feasible, distant flaps become necessary. Successful repairs have been achieved using a transverse rectus abdominis myocutaneous (TRAM) flap for the chest wall, groin, abdominal wall, sternum, and breast.

CASE PRESENTATION

This study presents the case of a 40-year-old man who experienced a large deformity, measuring 20 cm ∗ 10 cm in his left lateral thigh resulting from a road accident that occurred a decade ago. Additionally, he developed osteomyelitis due to exposed bone based on MRI and clinical signs. To address this large defect, a free TRAM flap was utilized, effectively covering the area with a well-vascularized skin graft. This approach eliminated the need for a latissimus flap with a skin graft.

DISCUSSION

In cases of covering large thigh defects, a variety of flaps can also be considered. The latissimus dorsi muscle is mainly used as a free flap, but surgeons should be cautious regarding the use of the latissimus dorsi flap while this flap is an attractive option in many other parts of the body, it's functional loss must be carefully weighed in lower extremity patients who are often crutch- and/or wheelchair-dependent.

CONCLUSION

Based on this experience, the free-TRAM flap has proven to be a highly resilient option for similar defects and ranks among our top choices. It is important to note that in cases of infected and traumatic wounds where fatty tissue is undesirable, the flap may not be the best solution.

Comparison of the predictive value of the Helsinki, Rotterdam, and Stockholm CT scores in predicting 6-month outcomes in patients with blunt traumatic brain injuries

PURPOSE

Despite advances in modern medicine, traumatic brain injuries (TBIs) are still a major medical problem. Early diagnosis of TBI is crucial for clinical decision-making and prognosis. This study aims to compare the predictive value of Helsinki, Rotterdam, and Stockholm CT scores in predicting the 6-month outcomes in blunt TBI patients.

METHODS

This cohort study was conducted on blunt TBI patients of 15 years or older. All of them were admitted to the surgical emergency department of Shahid Beheshti Hospital in Kashan, Iran from 2020 to 2021 and had abnormal trauma-related findings on brain CT images. The patients' demographic data such as age, gender, history of comorbid conditions, mechanism of trauma, Glasgow coma scale, CT images, length of hospital stay, and surgical procedures were recorded. The Helsinki, Rotterdam, and Stockholm CT scores were simultaneously determined according to the existing guidelines. The included patients' 6-month outcome was determined using the Glasgow outcome scale extended. M Data were analyzed by SPSS software version 16.0. Sensitivity, specificity, negative/positive predictive value and the area under the receiver operating characteristic curve were calculated for each test. The Kappa agreement coefficient and Kuder Richardson-20 were used to compare the scoring systems.

RESULTS

Altogether 171 TBI patients met the inclusion and exclusion criteria, with the mean age of (44.9 ± 20.2) years. Most patients were male (80.7%), had traffic related injuries (83.1%) and mild TBIs (64.3%). Patients with lower Glasgow coma scale had higher Helsinki, Rotterdam, and Stockholm CT scores and lower Glasgow outcome scale extended scores. Among all the scoring systems, the Helsinki and Stockholm scores showed the highest agreement in predicting patients' outcomes (kappa = 0.657, p < 0.001). The Rotterdam scoring system had the highest sensitivity (90.1%) in predicting death of TBI patients, whereas the Helsinki scoring system had the highest sensitivity (89.8%) in predicting the 6-month outcome in TBI patients.

CONCLUSION

The Rotterdam scoring system was superior in predicting death in TBI patients, whereas the Helsinki scoring system was more sensitive in predicting the 6-month outcome.

Health care needs, eHealth literacy, use of mobile phone functionalities, and intention to use it for self-management purposes by informal caregivers of children with burns: a survey study

BACKGROUND

This study aimed to assess health care needs, electronic health literacy, mobile phone usage, and intention to use it for self-management purposes by informal caregivers of children with burn injuries.

METHODS

This cross-sectional research was carried out in 2021 with 112 informal caregivers of children with burns in a burn center in the north of Iran. The data collection tools were questionnaires that included the participants' demographics, their E-Health Literacy, their current mobile phone usage, and their desires for mobile phone use for burn care services.

RESULTS

Most informal caregivers had smartphones (83.0%) and Internet access (81.3%). Most participants occasionally used phone calls (63.4%), the Internet (45.5%), and social media (42.9) to receive information about psychosocial disorders, infection control, wound care, pain, itch, physical exercise, and feeding. Most participants have never used some of the mobile phone functionalities to receive burn-related information, such as applications/Software (99.1%) and e-mail (99.1%). Nevertheless, most informal caregivers desire to use mobile applications for self-management purposes in the future (88.4%). The mean eHealth literacy score was 25.01 (SD = 9.61). Informal caregivers who had higher education levels, access to the Internet, and lived in urban areas had higher eHealth literacy (P < 001).

CONCLUSION

The current research delivers beneficial information about the healthcare needs of informal caregivers and their preference to use mobile functionality to receive burns-related healthcare and rehabilitation information post-discharge. This information can help design and implement mobile health (mHealth) interventions to enhance the self-care skills of informal caregivers.

Disease-Related Stigma, Stigmatizers, Causes, and Consequences: A Systematic Review

Background

Stigma is a sociological concept that is important in medicine and health because it threatens health as much as the disease itself. We aimed to explore the causes, stigmatizers, consequences and coping strategies related to the stigma of diseases by systematically analyzing relevant literature.

Methods

This systematic review examined 65 articles on Disease-Related Stigma by searching Noormags, Magiran, SID, Google Scholar, and PubMed databases. The articles were published in Persian and English between 2001 and 2022 and conducted in Iran. We used a three-step systematic review process to select articles that met the research criteria.

Results

Conflict in society, lack of knowledge, specific characteristics of the disease, and the contagious nature of disease are the main causes of stigma, leading to stigmatization by different groups such as significant others, generalized others, institutional others, and macro others. Patients experiencing stigma face various psychological, physical, and social complications, and they may use concealment as a coping strategy, which can pose a potential threat to society's general health.

Conclusion

By knowing the causes and stigmatizers of disease-related, it is possible to reduce stigma with less cost and time.

A Smartphone Application for Caregivers of Children With Severe Burns: A Survey to Identify Minimum Data Set and Requirements

Recent advances in digital health and increasing access to mobile health (mHealth) tools have led to more effective self-care. This study aimed to identify the minimum data set (MDS) and the requirements of a smartphone application (app) to support caregivers of children with severe burns. The study was performed in three phases in a burn center in the north of Iran in 2022. In the first phase, a literature review was performed. In the second phase, interviews were conducted with 18 caregivers. The third phase was performed in two stages: first, an initial questionnaire was prepared in which the content validity ratio and content validity index were calculated. The final questionnaire included 71 data elements about the MDS and requirements and open-ended elements. Then, the data elements were surveyed by 25 burn experts using the Delphi technique. The minimum acceptable mean score for each item was 3.75. Out of the 71 elements in the first Delphi round, 51 were accepted. In the second Delphi round, 14 data elements were assessed. The most important elements for the MDS were a family relationship, TBSA, the primary cause of the burn, anatomical location, itch, pain, and infection. User registration, educational materials, caregiver-clinician communication, chat box, and appointment booking were the most highlighted functional requirements. Safe login was the most important element for the nonfunctional requirements. It is recommended that health managers and software designers use these functionalities in designing smartphone apps for caregivers of children with burns.

Design and usability evaluation of a mobile-based-self-management application for caregivers of children with severe burns

Paediatric burns are a major public health issue because of long-term physical, psychological and social consequences and the high cost of treatment. The aim of this study was to design and evaluate a mobile-based self-management application for caregivers of children with severe burns. A participatory design technique was employed to develop the Burn application, which included three main phases: the determination of application requirements, the design and evaluation of the low-fidelity prototype, and the design and evaluation of the high-fidelity prototypes. In the first phase, application requirements were determined via validated paper questionnaires using the Delphi technique. In the second step, a low-fidelity prototype was prepared using conceptual models and evaluated through a focus group with specialists. Seven specialists reviewed the application and evaluated how this prototype meets functional requirements and objectives. The third phase was performed in three stages. First, the high-fidelity prototype was designed and developed by the JAVA programming language. Second, a cognitive walk-through was carried out to show how users can interact with the mobile application and how it works. Third, this program was installed on the mobile phones of 28 caregivers of burned children, eight IT experts, and two general surgeries, and the prototype's usability was evaluated. In the present study, most caregivers of children with burns stated that after discharge, they face problems regarding infection control and wound care (4.07) and how to perform physical activity (4.12). User registration, educational materials, caregiver-clinician communication, chat box, and appointment booking, safe login were the most important characteristic of the Burn application. Mean usability evaluation scores were in the range of 7.92 ± 0.238 to 8.10 ± 0.103, which is considered at a "good" level. From the Burn program design experience, it can be concluded that co-design with health care specialists can significantly support and meet the specialists' and patients' needs and ensure the program's usefulness. In addition, application evaluation by users involved and not involved in the application design process can help enhance usability.

Prevalence of smoking, alcohol consumption, and drug abuse in Iranian adults: Results of Azar Cohort Study

Background

Substance abuse has significant health impacts on families and society as a whole. We aimed to provide detailed prevalence estimates of substance abuse among the Azar Cohort Study respondents in Tabriz, Iran.

Methods

Data on 15006 participants of Azar Cohort Study were analyzed. The variables included tobacco smoking, alcohol use, drug abuse, and socio-demographic characteristics. The prevalence of substance abuse (with a 95% confidence interval) was calculated using the direct standardization method.

Results

Overall, 9.3% and 6.2% of the participants were regular and heavy cigarette smokers, respectively. Also, 1.9% and 2.1% of participants reported a history of using illicit drugs and alcohol, respectively. Substance abuse was more prevalent among males than females. Substance abuse varied significantly with age and socioeconomic variables.

Conclusion

We identified specific demographic and socioeconomic groups with a higher prevalence of all studied behaviors. Such high-risk groups should be targeted when designing substance abuse prevention programs.

The antidepressant effect of combined extracts of Hypericum perforatum and Echium amoenum supplementation in patients with depression symptoms: A randomized clinical trial

Objective

Echium amoenum and Hypericum perforatum dried flowers have been used for therapy of mental disorders in Iranian traditional medicine. In this study, we assessed the efficacy of the E. amoenum and H. perforatum extracts in patients with mild to moderate depression.

Materials and Methods

In an 8-week double-blind, parallel-group trial, 51 patients randomly consumed 20 mg of fluoxetine or 350 mg of herbal medicine twice daily. The Hamilton Rating Scale for Depression (HAM-D) was used to assess depression severity in patients at weeks 0, 4, and 8.

Results

According to the Hamilton score, there were no significant differences between the fluoxetine- and herbal medicine-treated groups after 4 and 8 weeks (p>0.05). Dry mouth was the only reported side effect which was significantly lower in the herbal group (p<0.05) in weeks 2 and 4.

Conclusion

E. amoenum and H. perforatum have anti-depressant properties similar to fluoxetine and they can be used to treat depression as an alternative to fluoxetine.

Effect of bleaching with 15% carbamide peroxide on color stability of microhybrid, nanohybrid, and nanofilled resin composites, each in 3 staining solutions (coffee, cola, red grape juice): A 3-phase study

Background

The literature on the effect of bleaching on stainability and color stability of any composites is scarce and controversial. In the case of some composites and/or bleaching agents or staining solutions, there is no previous study. Therefore, this rather large study was conducted for the first time to examine simultaneously the effects of bleaching and 3 staining solutions on 3 composite types.

Materials and Methods

This 3-phase experimental in vitro study was performed on 18 groups of 5 specimens each: 90 composite discs with 10 mm diameter and 1 mm thickness were fabricated from 3 resin composites (microhybrid, nanohybrid, and nanofilled). Forty-five discs underwent bleaching with 15% carbamide peroxide, and the remaining 45 were immersed in distilled water at room temperature. The color assessment was performed before and after this step, and Δa, Δb, and ΔL color parameters were calculated for each specimen. The specimens were then immersed in coffee, cola, and red grape juice for 2 weeks, and underwent colorimetry again. The simultaneous effects of bleaching and staining agents and composite types on ΔE (color changes) of composite specimens were analyzed using an independent-samples t-test, a Mann-Whitney U-test, and two-way and one-way analysis of variances followed by a Tukey and a Dunnett's T3 tests (α = 0.05).

Results

Bleaching had no significant effect on color changes of microhybrid, nanohybrid, or nanofilled composites (P > 0.05). The stainability of composites did not increase after bleaching (P > 0.05). Regardless of the composite type and the presence of bleaching, coffee had the worst effect on color of composite specimens, while cola had the smallest staining effect (P < 0.05).

Conclusion

Stainability of microhybrid/nanohybrid/nanofilled composites did not increase after bleaching with 15% carbamide peroxide. Coffee should be consumed with care, as far as composite coloring is a concern, regardless of the type of composite in use or its bleaching history. Cola was the weakest stainer. Coffee always caused perceptible staining (ΔE >3.7), regardless of the composite in use or its bleaching history. Red grape juice caused such perceptible colorations in most cases. Cola did not cause any perceptible discoloration in most cases.

Factors associated to patients' referral to public or private Covid-19 healthcare centers in Tabriz, Iran

BACKGROUND

In Iran, tracking of patients and its associated data recording in private healthcare centers are poor, and thus a majority of patients suffering from Covid-19 are treated without any control on the isolation and quarantine processes. The present study aims to investigate the factors contributed to referral to private or public healthcare centers that provide Covid-19 care services.

METHODS

This cross-sectional study was conducted from November 2021 to January 2022 in Tabriz, Iran. We invited a total of 258 and 202Covid-19 patients from governmental and private healthcare centers, respectively, to participate in the study by convenient sampling method. Applying a self-administered questionnaire, we collected data on the reason of referring to the healthcare centers, patient's waiting time, quality of healthcare services received by the patients, patients' level of satisfaction, accessibility, insurance coverage, perceived severity of the disease, and the level of staff compliance from health protocols. Logistic regression model was used for data analysis by using SPSS-26 software.

RESULTS

Adjusted for other variables, higher socio-economic status (AOR (Adjusted Odds Ratio) = 6.64), older age (AOR = 1.02), referral of friends and family members (AOR = 1.52), shorter waiting time (AOR = 1.02) and higher satisfaction (AOR = 1.02) were contributed to referral to private centers. Better accessibility (AOR = 0.98) and wider insurance coverage (AOR = 0.99) were also contributed to referral to governmental centers.

CONCLUSION

Providing more appropriate insurance coverage by private healthcare centers, and promoting their level of accessibility seems to promote patients' referral to such centers. Moreover, establishing an accurate system for recording patients' information and follow up in private centers might promote the role of private healthcare centers in managing the overload of patients on healthcare system during such epidemics.

Pregnant women's use and attitude toward Mobile phone features for self-management

BACKGROUND

This study aimed to examine the current use of mobile phones by pregnant women and their attitudes towards the use of a variety of prenatal care services through mHealth.

METHODS

This descriptive cross-sectional study was conducted in Iran in 2021. The study population included 168 pregnant women who referred to specialist obstetrics and gynecology clinic. The data collection tool was a questionnaire that included the demographics of the participants, their current mobile phone usage, and their attitudes toward mobile phone use for prenatal care services. The data were analyzed in SPSS with descriptive and analytical statistics.

RESULTS

The majority of participants (84.2%) had a smartphone and access to mobile internet. More than half of the respondents (58.9%) used their mobile phone for (only) phone calls, and 36.7% occasionally used mobile internet to access prenatal care services. To get information about the pregnancy and to communicate with other pregnant women, the participants mainly used social media, and to get reminders, they preferred phone calls.

CONCLUSIONS

In this study, pregnant women have a positive attitude towards using mobile phones for obtaining health services and prefer social media to seek prenatal care services. There seems to be a need for pregnant women to have high levels of digital health literacy and be advised by healthcare providers on using this technology to access prenatal care services.

Comparison of the shear bond strength in Giomer and resin-modified glass ionomer in class V lesions

Introduction

There are several cosmetic, restorative materials to restore non-carious Cervical Lesions (NCCLs). The aim of this study was to specify and compare the shear bond strength of Giomer and resin-modified glass ionomer in Class V lesions so that whether Giomer showed a better shear bond strength, it could be used instead of RMGI to restore NCCLs because of its better esthetic.

Method

ology: 20 maxillary and 20 mandibular intact premolars were collected. Each group of 20 samples was divided into two 10-tooth subgroups of A and B. A class V preparation was made on the buccal surface of the samples with 2*2*3 mm dimensions using a diamond bur. Also, the crossing path of the universal machine chisel was prepped with 2 mm depth up to incisal edge. For group A, after applying BeautiBond and curing it, Beautifil II Giomer was placed in nylon cylinders and the cylinders were placed in the middle cervical region and cured for 20 s. For group B, 1 spoon powder of Fuji II RMGI was mixed with two drops of its liquid and transported to nylon cylinders and placed in the middle cervical region, then cured for 20 s. The nylon cylinders were removed from all 40 samples. Then, all teeth were thermocycled and then tested using a universal machine with the force of 20 MPa and the speed of 1 mm/min until they fractured to assess their shear bond strength. The obtained data was analyzed using SPSS v.26. The significance level was considered 0.05.

Results

There was no significant difference between Giomer (4.97 ± 2.36) and the resin-modified glass ionomer (3.41 ± 2.71) groups as regards their shear strength (p = 0.059). Likewise, there was no significant difference in shear bond strength between Giomer and RMGI groups as regards jaw type (P = 0.326).

Conclusion

The paper suggests that Giomer and resin-modified glass ionomer groups did not differ significantly in terms of their shear bond strength and that both can be utilized to treat Class V lesions. Furthermore, there was no significant difference between the shear bond strength in terms of jaw type.

Using Structural Equation Modelling to Predict Safety and Health Status among Stone Industries

BACKGROUND

The creation of a working organization with a high safety level ensures employees' health in their workplaces, therefore current study evaluated effect the organizational structure on the safety and health in the stone industry.

METHODS

The study was done among the 100 stone industries in Isfahan, Iran. We asked selected participants to complete the organizational structure questionnaire and ELMERI checklists. tested the hypothesis with Smart PLS 3.0.

RESULTS

The model fit index showed the standardized root mean square (SRMR=0.08), the normalized fit index (NFI=0.9), The coefficient of determination (R2 = 0.362), Effect size (ƒ2 was less than 0.2), and the Predictive relevance of the model (Q2=0.216) which is considered a good fit for mode. Also, the relation between formalization and health and safety was significant (β = -0.47).

CONCLUSION

findings suggest that Organization factors are the basic reasons associated with occupational accidents and the main indicator of safety and health performance.

Dietary Acid Load and Predialysis Serum Bicarbonate Levels in Patients With End-Stage Renal Disease

OBJECTIVES

Maintaining the predialysis serum bicarbonate at a recommended level is critical in patients undergoing hemodialysis. Therefore, the present study investigated the association between dietary acid load (DAL) and serum predialysis bicarbonate levels in patients with end-stage renal disease.

METHODS

Adult patients undergoing hemodialysis were enrolled in this cross-sectional study. Diet was assessed using a semiquantitative food frequency questionnaire. DAL was calculated with 2 validated indices: potential renal acid load (PRAL) and net endogenous acid production (NEAP). Values regarding predialysis serum bicarbonate level and serum electrolytes were obtained from the participant's medical records. The multiple linear regression analysis was used to determine the association between DAL indices and predialysis serum bicarbonate level.

RESULTS

The number of hemodialysis patients eligible for this study was 122. The participants' mean age and body mass index was 57.14 ± 3.8 years and 25.2 ± 4.9 kg/m², respectively. About 65.6% of participants were male. The mean serum levels of predialysis bicarbonate were 21.59 ± 3.1 mEq/L. Also, 47.5% of patients had predialysis serum bicarbonate levels below the recommended value. The mean values of PRAL and NEAP were -2.8 ± 7.48 and 42.7 ± 10.1 mEq/day, respectively. PRAL significantly and inversely predicted predialysis serum bicarbonate level independent of covariates (standardized β = -0.38; P < .001). Also, NEAP was independently and inversely associated with predialysis bicarbonate level (standardized β = -0.40; P < .001). Consuming vegetables such as lettuce, tomato, cucumber, spinach, and dried fruits as well as low-fat milk, plain yogurt, and cream cheese were positively correlated to predialysis serum bicarbonate level. However, the canned tuna had a negative correlation with the predialysis serum bicarbonate.

CONCLUSIONS

The study's findings showed that the lower DAL was associated with higher predialysis serum bicarbonate levels in patients with end-stage renal disease. Due to the cross-sectional nature of the present study, prospective cohorts or well-controlled clinical trials are needed to confirm our result.

Correlation of sensitization to food allergens in Iranian patients with migraine and tension headaches

OBJECTIVES

Headache is one of the most common neurological disorders around the world. Previous studies have proposed associations of food allergies with headaches. Therefore, this study evaluated the frequency of sensitization to food allergens in patients with migraine and tension headaches and their correlations with these disorders.

METHODS

The study subjects consisted of 20 patients with migraine headache and 20 subjects with tension headache. Headache disorders were confirmed by a specialist. Food allergen sensitization was diagnosed by skin prick test (SPT) or radioallergosorbent test (RAST), clinical history, and physical examination.

RESULTS

There was no significant difference in age and gender between patients with migraine and tension headaches. Other results showed sensitization to food allergens, such as egg, wheat, fish, banana, orange, and soybean, in patients with migraine headache was similar to those in subjects with tension headache. However, patients with migraine headache significantly differed from individuals with tension headache in allergic responses to tree nut (P=0.047), peanut (P=0.028), and cow's milk (P=0.044).

CONCLUSION

The results of this study showed that sensitization to food allergens may relate to migraine headache which their diagnosis can help to better control and manage the disease.

Implementation of Upper Extremity Trauma Registry: A Pilot Study

Background

Hand traumas are common in young men and their complications can have negative effects on their occupation and economic activities. On the other hand, most of the hand injuries are related to occupation accidents and thus necessitates preventive measures. The goal of a clinical registry is assisting epidemiologic surveys, quality improvement preventions.

Methods

This article explains the first phase of implementing a registry for upper extremity trauma. This phase includes recording of demographic data of patients. A questionnaire was designed. Contents include patients' characteristics, pattern of injury and past medical history in a minimal data set checklist. This questionnaire was filled in the emergency room by general practitioners. For 2 months the data were collected in paper based manner, then problems and obstacles were evaluated and corrected. During this period a web based software was designed. The registry was then ran for another 4 months using web based software.

Results

From 6.11.2019 to 5.3.2020, 1675 patients were recorded in the registry. Random check of recorded data suggests that accuracy of records was about 95.5%. Most of the missing data was related to associated injuries and job experience. Some mechanisms of injury seems to be related to Iran community and thus warrants special attention for preventive activities.

Conclusion

With a special registry personnel and supervision of plastic surgery faculties, an accurate record of data of upper extremity trauma is possible. The patterns of injury were remarkable and can be used for investigations and policy making for prevention.

The Clinical Efficacy of Fat Injection on the Repair of Hand Flexor Tendon: A Randomized Clinical Trial

Background

In recent years, special attention has been paid to minimally invasive and conservative methods in addition to conventional surgical methods to repair tendon damage. In this regard, the effect of fat injection and graft has been of great interest due to its potential in accelerating tissue repair. We aimed to assess the clinical efficacy of fat injection along with conventional approach in patients with flexor tendon injury.

Methods

In this randomized clinical trial, 64 patients were randomly scheduled for tendon repair using the usual modified Kessler four-strand method alone or tendon repair using four-strand method and fat injection on the proximal and distal sides of the repair site in the Hazrat Fatemeh Hospital, Tehran Province, Iran in 2022 (IRCT20221206056723N1). Patients were followed-up for eight weeks regarding the function status of the repaired tendon (using Strickland grading test), range of motion (by physical examination) and flexion and extension gaps (by imaging).

Results

In the eighth weeks after the treatment, the average Strickland score was significantly higher in the group receiving fat injection (P: 0.009 ). In the two pointed times, the mean range of motion was significantly higher and the mean flexion and extension gaps were significantly lower in those who received fat injection. None of the procedural side effects were observed in the fifth and eighth weeks after the treatment.

Conclusion

Fat injection along with usual surgical treatment for tendon repair accelerates and improves tendon function and range of motion.

Effect of mobile-based self-management application on stroke outcomes: a study protocol for triple blinded randomized controlled trial

Background

Stroke is the main leading cause of long-term disabilities in the world. This protocol will be implemented for a study to evaluate the effects of an Android-based self-care application on patients with stroke.

Methods

The first stage will include the development of an android-based application using JAVA programming language for developing the user interface and ASP.NET Core for developing Web server. The second stage will be conducted using triple blinded randomized clinical trial (RCT). The sample size will include 60 patients with recent stroke and partial paralysis of limbs, who will be divided into two groups of intervention and control through permuted block randomization method. Patients in both groups will receive usual medical care, but those in the intervention group will also use an Android-based application for a period of two months. Outcomes will be assessed using valid and reliable questionnaires.

Discussion

The assessed outcomes will include stroke severity using National Institute of Health Stroke Scale (NIHSS) score, ability to perform activities of daily living using Barthel Index (BI) score, depression rate using Beck Depression Inventory (BDI-II) score, quality of life using EQ-5D-3L score, medication adherence using Modified Morisky Medication Adherence Scale (MMAS-8) score, patient satisfaction using Patient Satisfaction Questionnaire (PSQ) score and the number and type of complications in patients in two groups. These outcomes will be assessed at baseline, after two months and after three months from the beginning of the intervention. Intervention effects on the measured variables will also be evaluated using appropriate statistical tests based on the type of variable distribution. Potential consequences of the study might be the improvement of the measured variables in the intervention group compared to that of the control group. The expected results are that the intervention may significantly improve the status of the measured variables in the intervention group compared to that of the control group. If the outcomes of the intervention group do not change significantly compared to those of the control group, it can be due to different reasons. However, this can most likely be attributed to incorrect or insufficient use of the application by patients.

Trial registration: This protocol is registered in the Iranian registration of clinical trial (IRCT) on November 7, 2020 with the code IRCT20201015049037N1. URL: https://irct.ir/trial/51674

Investigation of the Factors Related to Mortality and Length of Hospitalization among COVID-19 Patients in East Azerbaijan Hospitals, Iran

BACKGROUND

It is of utmost importance to identify populations with an elevated risk for COVID-19 and the factors influencing its outcomes. The present study aimed to investigate factors affecting mortality and length of stay (LOS) among COVID-19 patients in the hospitals of East Azerbaijan province, Iran, during 15 months of this pandemic.

STUDY DESIGN

The present study followed a retrospective cohort design.

METHODS

This retrospective study was conducted using data in the integrated syndromic surveillance system (ISSS) on patients admitted to the hospitals from February 21, 2020, to April 11, 2021. The association between variables of interest and death, as well as LOS, was investigated via multiple logistic regression and multiple linear regression analyses.

RESULTS

In total, 24 293 inpatients with a mean age of 54.0 ± 19.4 years were included in this study. About 15% of them lost their lives, whose mean age was 69.0 ± 14.6 years, significantly higher than the recovered ones (P < 0.001). Factors, such as above 49 years of age (P < 0.001), male gender (OR = 1.17; 95% CI: 1.08-1.26), and having chronic diseases (OR = 1.32; 95% CI: 1.22-1.42), were correlated with patient mortality. In addition, having chronic diseases (Beta = 0.06; 95% CI: 0.03-0.08) was associated with higher LOS in hospitals.

CONCLUSION

In conclusion, older patients were at a higher risk of mortality and prolonged hospitalization. Furthermore, patients' underlying diseases could cause a severe form of COVID-19, which can lead to death and increase patients' LOS.

Driving Fine and its Relationship with Dangerous Driving Behaviour Among Heavy Vehicle Drivers

Context

There is a significant difference between actual and existing statistics of traffic fines; since some invisible fines and most of the visible traffic violations cannot be recorded by traffic officers. Therefore, dealing with driving fines and road fatalities is considered an important issue in social and public management worldwide.

Aims

Explore the factors associated with unsafe behaviors and getting traffic fines among a sample of Iranian heavy-vehicle professional drivers.

Settings and Design

The present cross-sectional study was conducted in Iran, from February 2019 to September 2020.

Methods and Material

This study used the driver behavior questionnaire (DBQ), demographic and driving characteristics, the number of fines, and structural equation modeling. Also, in this study 320 professional drivers participated.

Statistical Analysis Used

This article used structural equation modeling for Statistical analysis.

Results

The results of structural equation modeling analysis indicated that the data fit well with the theoretical model proposed in this study. The number of fines was directly predicted by both demographic and driving characteristics and risky driving behaviors. A significant relationship was observed between, driving hours, driving experience, and smoking, respectively, with a mistake, slip, and risky violation. There was a negative correlation between education and all four sub-scales of risky driving behaviors.

Conclusions

In order to reduce traffic fines, training courses on increasing attention and precision in drivers' observations and judgments are useful. The courses can decrease traffic violations by trying to change beliefs, attitudes, and social norms. It is therefore helpful to understand the ways to change the drivers' attitudes.

The effect of melatonin on prevention of postoperative delirium after lower limb fracture surgery in elderly patients: a randomized double blind clinical trial

BACKGROUND

Postoperative delirium is a common complication with a high morbidity rate. This study was designed to consider the effectiveness of melatonin in prevention and treatment of postoperative delirium.

METHODS

Seventy-two patients aged >60 years old with Abbreviated Mental Test (AMT) >8 scheduled for orthopedic surgery under spinal anesthesia, were randomly distributed equally to melatonin or placebo groups. In the melatonin group, the patients were given 5 mg melatonin capsules orally the night before surgery, the night of the operation, and two nights after the surgical operation at 9 pm. Likewise, in the placebo group, the patients received placebo in the same times. For diagnosis of postoperative delirium, the AMT test was used before the operation and three days after that. The Generalized estimating equations model (GEE) with logit link to Multivariate analysis was used in the study and P<0.05 was considered statistically significant.

RESULTS

In total, 72 patients completed the study. Thirty-three patients (45.8%) were male with a mean (SD) age 71.4 (3.6) years. On the first day after the surgery, the incidence of delirium was significantly lower in the melatonin group compared to the placebo group (22.2% vs. 44.4%, P=0.046). On the second and third days after the surgery, the level of delirium in the melatonin group was also significantly lower than that in the placebo one. The GEE model showed a significant interaction between time and treatment groups.

CONCLUSION

The findings of the study showed that melatonin prevented delirium after the orthopedic surgeries in the elderly patients and could be useful for the patients as such.

Functional requirements of a mobile‐based application for stroke self‐management: A Delphi study

This study aimed to determine the functional requirements of a self‐management mobile application for stroke survivors. For extracting the initial functional requirements, a literature review as well as interviews with 17 patients and caregivers were done. The results were analyzed using the content analysis method. The initial extracted requirements were then provided to the specialists by the Delphi technique to determine the final functional requirements. Content validity ratio (CVR) and content validity index (CVI) were calculated according to the Lawshe model. Criteria for item approval included CVR > 0.49 and CVI > 0.79. Finally, the approved items were turned into a five‐point Likert scale questionnaire and were then provided to 53 experts and items with a mean score higher than 3.75 were approved. Functional requirements including creating a user account, educational material, support services, providing reminders and alerts for drugs administration and physician appointments, and rehabilitation exercises (to improve balance, upper and lower extremities rehabilitation, and activities of daily living (ADLs)) were approved. Most of the approved functional requirements were related to rehabilitation exercises for improving upper limb motor function. The experts did not approve the requirements for using splints and slings or the recommendation to take some medications.

Evaluating the Quality of a Clinical Mobile App for Physicians' CT Scan Ordering Using the MARS Rating Scale

Given the lack of literature on the contributing factors to adopt mobile applications (apps) among physicians and the crucial role of the quality of the apps in their widespread use, the aim of this study is using the Mobile App Rating Scale (MARS) to evaluate the quality of the head CT scan appropriateness criteria app(HAC app). It was developed to assist medical interns and residents in ordering head CT scans. MARS is internationally recognized as an app rating tool and consists of four objective and subjective quality subscales quality subscale. Although the overall quality score of the HAC app was favorable (82 out of 100), it had low quality scores in the "information" (73.37 out of 100) and the "engagement" (73.48 out of 100) subscales. The HAC app appears to be functional to the physicians; however, it needs to improve its quality in terms of interactivity and effectiveness.

Measurement of Barriers to Perform Periodic Examinations: Development and Psychometric Properties Scale

PURPOSE

Due to recent changes in workplace risks, it is required to investigate the motivations of employees and employers for occupational examination performance. The present study aims to develop a self-report scale to overcome prior methodological defects and evaluate barriers of performing periodic examinations.

MATERIALS AND METHODS

The study was conducted on 200 participants, including employers, occupational health inspectors, occupational physicians, and occupational health experts working in the industrial sector, aged 25-70. The subjects supplied sociodemographic information and completed the experimental version of the instrument.

RESULTS

Exploratory factor analysis (EFA) provided evidence for a five-factor model, including knowledge, quality, law, capability, and service, with 62.68% variance. Confirmatory factor analysis (CFA) proved stability rates of both models (root mean square error of approximation (RMSEA) = 0.062, comparative fit index (CFI), Tucker-Lewis index (TLI) incremental fit index (IFI), normed fit index (NFI), and relative fit index (RFI) were 0.92, 0.906, 0.921, 0.835, and 0.808, respectively). The scale also revealed appropriate levels of reliability (α = 0.916 and composite reliability (CR) >0.7) and validity (average variance extracted > 0.5).

CONCLUSION

The psychometric characteristics of the scale demonstrated acceptable validity and reliability. This study developed this valid instrument allowing to be used by health decision-makers for assessing barriers of performing periodic examinations.

Correlation of Serum Levels of Interleukine-16, CCL27, Tumor Necrosis Factor-related Apoptosis-inducing Ligand, and B-cell Activating Factor with Multiple Sclerosis Severity

The pathogenic roles of Interleukine-16 (IL-16), CCL27, tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), and B-cell activating factor (BAFF) has been shown in some autoimmune and inflammatory diseases. We aimed to correlate the circulatory changes of such factors with the severity of disease in patients with multiple sclerosis (MS). This case-control study was conducted on 84 MS patients and 83 healthy controls. We measured the serum levels of IL-16, CCL27, TRAIL, and BAFF in all participants by enzyme-linked immune sorbent assay. Using the expanded disability status scale (EDSS), we evaluated the severity of MS. Finally, we assessed the correlation between serum levels of such factors with the severity of MS. We found increased serum levels of CCL27, IL-16, and BAFF in patients with MS compared to those in healthy subjects. However, no difference was found in serum levels of TRAIL between the patients and controls. In addition, a significant positive correlation between serum levels of CCL27, IL-16, TRAIL, and BAFF with disease severity according to EDSS score was determined. We showed higher serum levels of CCL27, BAFF, TRAIL, and IL-16 in MS patients with more severe disabilities than mild forms. Such finding may represent their contribution to the pathogenesis of MS. Blocking such molecules may yield new treatments for MS.

Serum Levels of Growth Differentiation Factor-15 as an Inflammatory Marker in Patients with Unstable Angina Pectoris

Background: Growth differentiation factor-15 (GDF-15), a member of transforming growth factors, is a stress-responsive marker whose levels may significantly increase in response to pathological stresses associated with inflammatory tissue injuries such as unstable angina pectoris (USAP). This study evaluated the diagnostic value of GDF-15 in patients with USAP.

Methods: The present cross-sectional study recruited 39 patients with USAP criteria and 30 patients with stable angina pectoris (SAP), referred to Shahid Beheshti Hospital, Kashan, Iran. All the patients with USAP had at least 1 coronary artery stenosis (>50%) in angiography. The control group comprised 42 healthy individuals. The serum levels of GDF-15 were measured in all the participants by ELISA. Also analyzed were the relationship between GDF-15 levels and thrombolysis in myocardial infarction (TIMI) and the Global Registry of Acute Coronary Events (GRACE) risk scores in the patients with USAP to determine the severity of the disease.

Result: The study population consisted of 111 subjects, 62 women and 49 men, divided into 3 groups of USAP (n=39, mean age=60.07±14.10 y), SAP (n=30, mean age=67.56±9.88 y), and control (n=42, mean age=61.21±7.76 y). The mean serum level of GDF-15 in the USAP group was significantly different from the other 2 groups (P<0.001), while no significant difference was observed in this regard between the SAP and control groups (P=0.797). No correlation was found between the mean GDF-15 serum level and the GRACE (P=0.816) and TIMI (P=0.359) risk scores in the USAP group.

Conclusion: The mean serum level of GDF-15 exhibited a rise in our patients with USAP. GDF-15 may be a diagnostic biomarker of USAP and its severity.

Food security, mental health, and socioeconomic status: A cross-sectional study among medical college students in central part of Iran, Kashan

Background and Aims

Food security is a complex and multidimensional issue that has been recognized as a serious public health problem all over the world for the past two decades. The present study was designed and conducted to determine the prevalence of food insecurity among college students at the Kashan University of Medical Sciences and some related factors including socioeconomic and mental health determinants.

Methods

The present study is a cross‐sectional study conducted on 358 students who were currently studying at the Kashan University of Medical Sciences. The students who were pregnant or had a special diet to follow were excluded. Samples were selected by the systematic method. Food security was measured using United States Department of Agriculture. Food Frequency Questionnaire, 21‐items Depression Anxiety Stress Scales, and Socioeconomic Questionnaire were used to investigate the nutrients intake, depression/anxiety status, and socioeconomic factors, respectively. Chi‐square, independent t‐test, and logistic regression were used to analyze the data.

Results

Based on the findings of the present study, 16.8% of students experienced different levels of food insecurity, and 83.2% of participants were categorized as food secure. Gender, financial assistance, health insurance, depression, and students' occupation are associated with food insecurity (P < .05). Additionally, the results of the logistic regression analysis showed that depression (OR 1.04; 95% CI 1.01‐1.07), and students' jobs (OR 0.43; 95% CI 0.23‐0.80) have the greatest impact on students' food insecurity.

Conclusion

The findings of the present study show that economic factors and gender have a significant impact on students' food security. Moreover, the association of food insecurity with mental disorders such as depression was demonstrated in the current study. However, we could not detect any significant association between daily energy intake and macronutrients which indicates the requirement for more detailed studies.

The Effect of Short Messaging System-Based Feedback on Physicians' Head CT Scan Ordering Behavior in Neurology and Neurosurgery Departments

Short messaging system (SMS) works as one of the most popular strategies for physicians' behavior change via sending feedback and reminder messages. One of the areas in which SMS feedback can be effective on physicians' behavior is CT scan ordering. This study investigates the effect of mobile phone SMS feedback on residents' head CT scan ordering at a general teaching hospital in Iran. Through a three-month before-after experimental study, an intervention was conducted, and the CT scans ordered by an individual resident were evaluated every two weeks. Consequently, personal SMS-based feedback was provided to the residents, and the rate of CT per patient in the two phases of the study was analyzed. The mean CT scan ordered per patient decreased from 1.98 ± 1.09 to 1.74 ± 1.45, and this decrease was insignificant (P = 0.106). SMS-based feedback can reduce head CT scan ordering among residents; whereas this decline was not significant further studies are required to investigate its effectiveness.

Effects of Computer-Aided Decision Support Systems on Appropriate Antibiotic Prescribing by Medical Interns: A Quasi-Experimental Study

Literature suggests that the adoption of guidelines for antibiotic prescribing has a significant impact on improving prescription practices of physicians; thus, this study aimed to assess the effectiveness of computer-aided decision support systems (CA-DSS) on antibiotic prescribing among medical interns. A prospective before-and-after interventional study was conducted on 40 medical interns. The interns were asked to use the CA-DSS during a one-month internship course at the infectious disease department. The main outcome measure was the knowledge of medical interns regarding the type, name, volume, usual dosages, and administration route of antibiotics prescribed. Paired t-test was applied to assess the change of medical interns' knowledge before and after the study. There was a statistically significant difference between the mean score of interns' medical knowledge before 5.4±2 and after 9.1±2.8 using the CA-DSS (p = 0.000). CA-DSS as an IT-based training intervention was effective for the knowledge of medical interns to prescribe the right antibiotics for acute respiratory infections.

Epidemiological Features and the Incidence Trend of Brain Cancers in Iran (2004-2008)

Background

The objective of this research is to consider the incidence of brain cancers in Iran during the years 2004-2008 to improve reporting, distribution of the disease.

Methods

In this cross-section study, the study population was all brain cancer cases diagnosed in Iran between 2004 and 2008. Age-standardized rate (ASR) per 100,000 persons and crude rate were calculated using direct standardization. Data were analyzed using Statistical Package for the Social Sciences (SPSS version 16) and Microsoft Office Excel 2010.

Results

During the period 2004-2008, the ASR and crude rate of brain cancers among males were 2.37, 2.46, 2.77, 2.84, 4.16 and 2.13, 2.11, 2.40, 2.49, 3.61, respectively, and among females the ASR and crude rates were (1.64, 1.67, 2.04, 2.17, 3.09) and (1.45, 1.45, 1.76, 1.84, 2.62), respectively.

Conclusions

According to the study results, a significant increase in the incidence of brain cancer was observed over a 4-year period in Iran. Hence, screening and early detection programs for this type of cancer are highly recommended.

Validation of Persian Version of Hyperacusis Questionnaire

Background

One of the most common hearing disorders is hyperacusis, characterized by decreased sound tolerance or noise sensitivity.

Objective

The present paper aimed to evaluate the validity of the Persian version of the hyperacusis questionnaire.

Methods

The sample was comprised of 434 students evaluated at the Kashan University of Medical Science, Isfahan, between July 2019 and February 2020. After translation and retranslation of questionnaire, the content validity was assessed by 15 occupational health experts using content validity index (CVI) and ratio (CVR). Validity and reliability of the scale were examined by using confirmatory factor analysis, the Cronbach alpha, composite reliability (CR), and the average variance extracted (AVE) tests.

Results

: In the exploratory analysis of the Persian version of Khalfa hyperacusis questionnaire, 14 items were created based on three subscales) attentional, social, and emotional dimensions) which explained 46.5% of the total variances. Content validity of 14 questions was approved with CVR > 0.49 and CVI > 0.7. The Cronbach alpha, AVE, and CR indexes were calculated 0.811, 0.761, and 0.901, respectively, which showed that reliability of the scale was adequate.

Conclusions

: It was concluded that this Persian version of the hyperacusis questionnaire has relatively acceptable validity and reliability in Iran. Given that the tool has a small number of questions, it is easily used in different studies.

Effects of Isoflavone Supplementation on the Response to Medroxyprogesterone in Premenopausal Women with Nonatypical Endometrial Hyperplasia: A Randomized, Double-Blind, Placebo-Controlled Trial

OBJECTIVE

The purpose of this study was to evaluate the impact of isoflavone supplementation compared with placebo on endometrial histology and serum estradiol levels in premenopausal women with nonatypical endometrial hyperplasia.

MATERIALS AND METHODS

The present double-blindplacebo-controlled clinical trial was conducted on 100 women with nonatypical endometrial hyperplasia in the age range of 30 to 45 years. Participants were randomly assigned to receive 50 mg of isoflavone (n = 50) or placebos (n = 50) daily for three months. Both groups received the standard treatment of nonatypical endometrial hyperplasia. Endometrial biopsy and blood samples were taken at the baseline and three months after the intervention. The incidence of drug side effects was assessed as well.

RESULTS

After three months, 88.4% of isoflavone-administered subjects had a significant histological improvement compared to 68.9% subjects in the placebo group (P=0.02). There were no significant differences between the two groups in the changes of serum estradiol levels and the incidence of drug side effects.

CONCLUSION

The findings of the present study demonstrated that the coadministration of 50 mg of isoflavones and medroxyprogesterone acetate increases the treatment efficacy in women with nonatypical endometrial hyperplasia. Clinical Trial Registration. This trial was registered on the Iranian website for clinical trial registration (https://www.irct.ir/trial/53553).

Investigating the Correlation between Growth Differentiation Factor 15 Serum Level and Its Gene Expression with Psoriasis and Its Severity

Psoriasis is a chronic inflammatory dermatitis characterized by an inflammatory epidermal hyperproliferation. Growth differentiation factor-15 (GDF-15), a member of the transforming growth factor-β family, has immune modulatory roles in autoimmune condition of Psoriasis. This study aimed to evaluate the relationship between GDF-15 serum levels as well as gene expression with psoriasis and its severity. This case-control study was performed on 45 patients with psoriasis Vulgaris and 45 healthy individuals. The severity of the disease was determined based on the psoriasis area and severity index (PASI score). Serum levels of GDF-15 were measured by enzyme-linked immunosorbent assay (ELISA) and its gene expression in peripheral blood mononuclear cells was quantified by real-time polymerase chain reaction (RT-PCR). The mean serum levels of GDF-15 in patients and controls were 1.98±1.57 ng/mL and 0.93±0.48 ng/mL, respectively. GDF-15 gene expression was measured as 9.7±6.6% in the patient group and 7.6±2.5% in the healthy group. The mean of GDF-15 serum levels in mild, moderate, and severe cases of psoriasis were 0.45±0.35, 2.27±0.7, and 3.5±1.6 ng/mL, respectively, indicating that elevated serum levels of GDF-15 correlate significantly with disease severity. The mean of GDF-15 gene expression in the mild, moderate, and severe forms of psoriasis were 5.25±3.2, 7.6±2.8, and 17.8±5.7, respectively which indicate a significant relationship between GDF-15 gene expression and psoriasis severity. Based on this study, in psoriatic patients, GDF-15 serum levels and gene expression are significantly higher than those in healthy controls. Such values were correlated with disease activity, especially in severe cases. Therefore, GDF-15 may be used as a prognostic marker of psoriasis.

Incidence and related factors of surface eye disorders in traumatic intensive care unit patients in Iran

BACKGROUND

Intensive care unit (ICU) patients are exposed to several surface eye disorders ranged from minor complications like corneal dryness to more serious ones such as corneal perforation and blindness. This study is then to assess the incidence of the ocular complications and related factors.

MATERIALS AND METHODS

During a prospective cross sectional study in a general adult ICU, ocular complications of the patients were assessed by an ophthalmologist. Data were analyzed using descriptive analysis. A P-value of ≤0.05 was considered significant.

RESULTS

Out of 155 patients, 130 cases (260 eyes) were covered during the study period, 2016-2017. The most common complications among the patients included dry eye and corneal abrasion (25.8%) followed by conjunctivitis (25%). The mean time of occurrence for dryness and corneal abrasion was 4±2.93 days after admission to the ICU. Lower Glasgow coma scale (GCS) and longer hospital stay were significantly associated with ocular complications in the ICU (P<0.05).

CONCLUSION

Eye surface complications are commonplace in critically ill patients admitted in the ICU. Dry eye, corneal abrasion, and conjunctivitis have been revealed as the most prevalent complications in this study. Lower GCS and longer stay in the ICU predisposed the cases to these complications. Efficient eye care protocol and training the ICU staff are both recommended to reduce complication rates as such.

The Relationship between Serum and Gene Expression Levels of RANK, RANKL and Osteoprotegerin Inflammatory Pathway with Unstable Angina: A Case-control Study

 Osteoprotegerin (OPG), receptor activator of nuclear factor-kappa B (RANK) and receptor activator of nuclear factor-kappa B ligand (RANKL), the members of the tumor necrosis factor (TNF) family, have multiple effects on bone metabolism, endocrine functions and, as an inflammatory pathway, in the immune system. This study tried to determine the association of the OPG/RANKL/RANK axis with the severity of unstable angina (UA) as an inflammatory condition. Our study involved 50 patients with UA and 50 healthy people. Serum and peripheral blood mononuclear cells were isolated from all participants. Serum levels and gene expression of OPG, RANKL, and RANK in mononuclear cells were measured by enzyme-linked immunosorbent assay (ELISA) and real-time polymerase chain reaction (RT-PCR), respectively. For each patient with UA, the thrombolysis in myocardial infarction (TIMI) and the global registry of acute coronary events (GRACE) scores were determined to evaluate the severity of the disease. Then we analyzed the relation of OPG, RANKL, and RANK levels with TIMI and GRACE scores in patients with UA. Discriminate analysis was used to predict the combinational models of such factors on the prediction of UA. Serum levels of OPG and RANKL (p<0.001) and gene expression of RANKL (p<0.001) were significantly more in patients than those in healthy ones. No relation was seen between the OPG/RANKL/RANK axis and the severity of UA according to TIMI and GRACE scores. Our study shows that serum level, as well as gene expression of OPG/RANKL/RANK axis neither, predicts the occurrence of UA nor shows any relationship with its severity.

A meta-analysis study of worldwide prevalence of mortality in cocaine-consuming motorcyclists

For this meta-analysis, the aim is to estimate the prevalence and to determine the factors associated with changes in this prevalence in the world. A systematic review of PubMed/Medline, ISI Web of Knowledge, Scopus, and Science Direct, SID, and Google Scholar from 2011 to April 2020 was performed. Point prevalence was analyzed with a 95% confidence interval. The variances of each study were calculated using a two-sentence distribution formula, and the heterogeneity between the studies was assessed by the Q-Cochran test with a significance level of less than 0.1. Also, the index of changes attributed to I² was examined. Due to the heterogeneity between the studies, the random-effects model was used to combine the results of the studies. All statistical analyses were performed by the STATA software version 11 using Meta-Analysis commands. The significance level of the tests was considered to be P < 0.05. The prevalence of mortality in motorcyclists in six studies was reported to be 12% (0.05-0.18 = 95% CI). We stratified this study by participant geographical region and age group. In this study, the highest prevalence of mortality was in the under-30 age group. Furthermore, planning educational campaigns and advertisements by state authorities that are pointing out the harmful effects of motorcyclists' cocaine and/or other substances consumption is necessary.

Contamination of obsterics and gynecology hospital air by bacterial and fungal aerosols associated with nosocomial infections

Bacterial and fungal bioaerosols are a global concern due to nosocomial infections, especially in developing countries. Our study aimed to detect fungal and bacterial bioaerosols in different wards of an obstetrics and gynecology hospital air samples. 240 bioaerosol samples were collected by performing impaction method from different wards of a hospital in the central part of Iran, during two seasons. Fungi genera and bacteria species are recognized by cultivation. Concentrations of bacteria and fungi were ranged from 44 to 75 CFU/m3 and 8 to 22 CFU/m3, respectively. Labor Delivery and Recovery (LDR) and Emergency room had first and second most contaminated air among all the hospital wards. No significant difference between microbial load of wards which used natural ventilation and heating, ventilating, and air conditioning (HVAC) system was observed. The microbial load was not affected significantly by temperature, working shift, and Inpatient Bed Occupancy Rate (IBOR). Fungal load related significantly with relative humidity. Staphylococcus aureus (detected in 48.3% of samples) and Penicillium (27%) were the most predominant isolated bacteria and fungi, respectively. The results revealed that the level of bacteria and fungi responsible for nosocomial infections in the air of this hospital is very low. Although levels of microbial contamination are relatively low, it is important to investigate the effect of bioaerosols on nosocomial infections, especially in neonates.

Effects of Potential Probiotic Enterococcus casseliflavus (EC-001) on Growth Performance, Immunity, and Resistance to Aeromonas hydrophila Infection in Common Carp (Cyprinus carpio)

The effects of different levels of dietary Enterococcus casseliflavus (EC-001), as a potential probiotic, were investigated on the growth performance, hemato-biochemical parameters, immune responses, and resistance to Aeromonas hydrophila infection in common carp (Cyprinus carpio) fingerlings. Accordingly, fish (N = 720; 12.0 ± 0.5 g) were distributed into four treatments receiving different dietary levels of E. casseliflavus, EC-001 (0 [control], 1 × 10⁷, 10⁸, and 10⁹ CFU g^-1 feed), for 8 weeks. The fish fed with a diet containing 10⁹ CFU g^-1 showed the highest weight gain and specific growth rate, along with the lowest feed conversion ratio, compared with the control group (P < 0.05). Red and white blood cells, hemoglobin, hematocrit, neutrophils, and monocytes significantly increased in the fish fed with 1 × 10⁸ and 10⁹ CFU g^-1 (P < 0.05). Dietary inclusion of 1 × 10⁸ and 10⁹ CFU g^-1 significantly increased serum total protein, albumin, and immunoglobulin content (P < 0.05). Feeding the fish with 1 × 10⁹ CFU g^-1 resulted in a significant increase in serum and skin mucus lysozyme activity compared with the other groups (P < 0.05). Complement component 3 and skin mucus protease activity were also significantly higher in all the fish treated with dietary E. casseliflavus (EC-001) compared with the control group (P < 0.05). The cumulative mortality in the treated fish was lower (ranging from 10 to 22%) than the control group (31%) after challenging the fish with A. hydrophila infection, while the fish fed with E. casseliflavus (EC-001) at 1 × 10⁹ CFU g^-1 exhibited the lowest mortality rate (P < 0.05). In conclusion, our results revealed the potential probiotic effects of E. casseliflavus (EC-001) for enhancing growth performance, immunity, and disease resistance of common carp.