Left ventricular mechanical dyssynchrony after chemotherapy in breast cancer patients with normal rest gated SPECT-MPI

OBJECTIVES

Early diagnosis of chemotherapy-induced cardiotoxicity plays an important role in preventing heart failure. The main aim of our study was to assess left ventricular (LV) dyssynchrony measured by phase analysis of gated single-photon emission computed tomography (SPECT) as an early sign of cardiotoxicity after breast cancer chemotherapy.

METHODS

This cross-sectional study was conducted on patients with stage ≤ 3 breast cancer and no history of cardiovascular disease or diabetes. After mastectomy, the patients underwent rest gated SPECT myocardial perfusion imaging (MPI). Sixty patients with normal gated SPECT-MPI were selected and the imaging was performed after chemotherapy with doxorubicin, cyclophosphamide and paclitaxel. LV function and contractility parameters were extracted by QGS software and the results were compared with the t test method. The abnormality of at least one of the three phase analysis indices was considered as left ventricular dyssynchrony (LVD).

RESULTS

The average LV end-systolic volume and ejection fraction (LVEF) before and after chemotherapy were (16.2 ± 8.0 ml and 21.6 ± 11.6 ml) and (73.4 ± 7.9% and 67.5 ± 9.2%) respectively, which showed a significant decrease (P < 0.05). In 2 patients (3.3%), the LVEF decreased to less than 50% after chemotherapy. The average parameters of left ventricular contractility before and after chemotherapy were, respectively, as follows: PHB (24.1 ± 7.5 and 33.8 ± 16.4), PSD (9.4 ± 6.1 and 5.7 ± 1.9) and entropy (28.9 ± 7.1 and 35.6 ± 9.7), which showed a significant increase (P < 0.05). LVD was observed in 14 patients (23.4%) after chemotherapy and prevalence of LVD was significantly higher in patients who had received a cumulative dose of doxorubicin of more than 400 mg/m2 (P = 0.005). There was no relationship between age and body mass index with the incidence of LVD after chemotherapy (P > 0.05).

CONCLUSION

Using phase analysis of gated SPECT-MPI, chemotherapy-induced LVD was seen in a significant number of patients with breast cancer, especially with a high cumulative dose of doxorubicin. LVD might indicate chemotherapy-induced cardiotoxicity before LVEF becomes abnormal.

Relationship between Vaginal Bacterial Infections and Pregnancy Outcomes: A Systematic Review and Meta-Analysis

Background

Bacterial infections are among the most serious infections worldwide. They can cause miscarriage, premature birth, stillbirth, and ectopic pregnancy in pregnant women. The aim of this study was to investigate the relationship between bacterial infections and pregnancy outcomes through a systematic review and meta-analysis.

Materials and Methods

PubMed, Scopus, Web of Science, and Embase databases were searched from January 2000 to December 2018 using appropriate keywords to identify related articles. The final related studies were selected and evaluated using the Newcastle-Ottawa Scale (NOS).

Results

Results of this meta-analysis based on combining case-control studies showed that the presence of bacterial infections could lead increase in the odds of all pregnancy outcomes like premature infant birth (odd ratio [OR]: 1.50; 95% Confidence Interval [CI], 1.39-1.61), preterm delivery (OR: 1.54; 95% CI, 1.39-1.70), abortion (OR: 1.16; 95% CI, 1.04-1.29), stillbirth (OR, 1.29; 95% CI, 1.12-1.49), and ectopic pregnancy (OR: 1.12; 95% CI, 1.05--1.19). The results showed that the Risk Ratio (RR) of preterm delivery in pregnant women with vaginal infections was 1.57 (95% CI, 1.46-1.67), whereas the RR of abortion was 2.02 (95% CI, 1.72-2.38).

Conclusions

Based on the results of this meta-analysis, the presence of bacterial infections in pregnant women can lead increase in the risk of pregnancy outcomes especially, preterm delivery, abortion, stillbirth, and ectopic pregnancy. Therefore, it is necessary for obstetricians and gynecologists to pay attention to the diagnosis of these infections in women before pregnancy and during pregnancy in order to prevent the consequences of these infections.

Socioeconomic Inequality in Screen Time, Phone, and Tablet Use among Iranian Adolescents: Results of A National Study

Background

Excessive screen time has been associated with a variety of negative health outcomes. We aimed to evaluate screen time and phone and tablet use in Iranian adolescents and their relation to the socioeconomic status of adolescents' families in 2018.

Methods

This descriptive-analytical study was carried out on 10-12-year-old adolescents from Kurdistan, Fars, and Markazi provinces. Cluster sampling was used for sampling. Data were collected by completing demographic questionnaires, calculating the BMI of adolescents and phone and tablet use, screen time, and socioeconomic status of the families. We used linear and logistic regression to estimate the final model. The concentration index was used to measure inequality and the Oaxaca decomposition to examine the different determinants of the inequality.

Results

1590 adolescents (52.58% boys) were enrolled in our study. Screen time activities were significantly higher in boys, older adolescents, higher BMIs, more educated mothers, and 35< year-old fathers (P < 0.05). The use of mobile phones and tablets was significantly higher among boys, ten-year-olds, families with four or fewer members, higher BMIs, adolescents with higher levels of parental education, and more educated mothers (P < 0.05). In addition, the concentration index for screen time activities (C = 0.083) and phone and tablet use (C = 0.536) showed that screen time and phone and tablet use activities were higher in adolescents with high socioeconomic status.

Conclusion

Screen time, phone and tablet use were higher in adolescents with high socioeconomic status. Also, many other factors like gender, age, BMI, parents' education and age can affect screen time, phone and tablet use in adolescents.

The anxiety associated with COVID-19, general health, spiritual health, and job satisfaction in healthcare providers: a cross-sectional study

BACKGROUND

Previous research has shown the impact of pandemic communicable diseases on the mental health of healthcare providers. This study examined the relationship between general health, spiritual health, anxiety associated with COVID-19, job satisfaction, and the mediating role of sex in healthcare providers in Iran in 2021.

METHODS

This was a descriptive-analytical and cross-sectional study performed on 163 healthcare providers of which 71.8% were female and 28.2% were male with an age range between 21 and 58 years, an average work experience of 9.5 years, and working as nurses, doctors, laboratory technicians, etc. in some hospitals in Sanandaj. Data were collected using COVID-19 Anxiety, General Health, job satisfaction, and Spiritual Health questionnaires. Then, the data were analyzed using SPSS-22 software, regression test, and path analysis.

RESULTS

Although women averaged lower levels of general health, job satisfaction, and anxiety associated with COVID-19, and higher scores in spiritual health than men, none of these differences were statistically significant, and sex didn't play a significant role here. Also, general health and spiritual health could significantly predict 17.1% of the variance in job satisfaction in the path analysis. However, sex and Covid-19 anxiety could not significantly predict this variable.

CONCLUSION

The results showed that there was not a significant difference between the male and female workers' general health when facing such pandemics. However, we may prepare interventions to promote their general and spiritual health and to promote healthcare providers' job satisfaction during such pandemics.

The association between nutrients and occurrence of COVID-19 outcomes in the population of Western Iran: A cohort study

INTRODUCTION

The study aimed to determine the association between nutrients (micronutrients, macronutrients, and antioxidants) and the occurrence of COVID-19-related outcomes (morbidity and hospitalization) using a cohort study in Western Iran.

METHODS

The basic study information was collected from February 2019 to February 2020 from the baseline phase of the Dehgolan Prospective Cohort Study (DehPCS). The primary outcomes in this study included risk of contracting COVID-19 and hospitalization due to it at a specific time. To compare these outcomes based on different nutritional groups (macronutrients or micronutrients), Kaplan-Meier chart and log rank test were used. Also, univariate and multivariate regression models were used to investigate the association between different nutritional groups and desired outcomes (risk of contracting COVID-19 and hospitalization due to it at a certain time).

RESULTS

The results showed that people having an insufficient intake of selenium (HR: 1.180; % 95 CI: 1.032-2.490; P: 0.042), vitamin A (HR: 1.119; % 95 CI: 1.020-1.442; p: 0.033), and vitamin E (HR: 1.544; % 95 CI: 1.136-3.093; p: 0.039) were significantly more infected with COVID-19 than the ones who had a sufficient intake of these nutrients. Also, the results showed that people having an insufficient intake of selenium (HR: 2.130; % 95 CI: 1.232-3.098; p: 0.018) and vitamin A (HR: 1.200; % 95 CI: 1.000-2.090; p: 0.043) were significantly hospitalized more than the ones who had a sufficient intake of these nutrients.

CONCLUSION

Insufficient intake of selenium and vitamins A and E can significantly increase the incidence of COVID-19 and hospitalization due to it.

Survival Analysis of Patients with Colorectal Cancer Undergoing Combined Treatment: A Retrospective Cohort Study

BACKGROUND

If colorectal cancer (CRC) is diagnosed in the early stages, the patients will have higher survival rates. Although some other factors might affect the survival rate, the type of treatment available based on existing health and therapeutic facilities is extremely important as well. Accordingly, this study aimed to explore the best type of treatment for CRC patients.

STUDY DESIGN

This study employed a retrospective population-based cohort design.

METHODS

The data of 335 patients with CRC in Kurdistan province were collected through a population-based cancer registry system from March 1, 2009 to 2014. Demographic and clinical-pathologic data of the patients were gathered through their medical records, pathology reports, and reference to patients' homes. The survival rate was calculated using the Kaplan-Meier curve, log-rank test, and univariate and multivariate Cox regression. The data were analyzed using Stata 14 software.

RESULTS

In this study, the mean age±standard deviation at diagnosis was 61.7± 1.05 in men and 60.5± 1.12 in women, respectively, and 203 (60.5%) patients were males. There was less mortality rate among the patients who received both surgical and chemotherapy treatments compared to those who did not receive any treatment (Hazard ratio [HR]=0.57, 95% CI: 0.24-0.93).

CONCLUSION

When CRC patients are treated using both surgical and chemotherapy treatments, they will exhibit a higher survival rate. Therefore, it is suggested to use both treatments for CRC patients.

Effectiveness of different treatment regimens on patients with COVID-19, hospitalized in Sanandaj hospitals: a retrospective cohort study

OBJECTIVES

Different drugs have different effects on the prognosis of patients with COVID-19. This study aimed to evaluate the effect of different drug regimens on patients with COVID-19, hospitalized in Sanandaj city.

METHODS

In this retrospective cohort study, 660 patients with COVID-19, hospitalized in the Tohid, Kowsar and Besat hospitals located Sanandaj (Kurdistan Province, Iran) were studied from February 2020 to February 2021 with clinical symptoms and positive test results.

RESULTS

The results of multivariate regression analysis showed the days of hospitalization for patients who had received the drug regimen 2 (Interferons (ReciGen/Ziphron) or Interferon Vectra (lopinavir/ritonavir)) was 1.92 times higher than those who had received the drug regimen 1 (hydroxychloroquine group or a combination of chloroquine and azithromycin) while a significant association was observed (OR = 1.92, 95% CI: 1.16-3.16, P = 0.011). Also, the hospitalization in ICU was longer in patients treated by the drug regimen 2 (Interferons (ReciGen/Ziphron) or Interferon Vectra (lopinavir/ritonavir)) (OR = 4.63, 95% CI: 1.80-11.82, P = 0.001), however, drug regimens did not show a significant effect on mortality and use of ventilator in patients (P > 0.05).

CONCLUSION

The study results showed the drug regimens 2 and 5 increased the days of hospitalization and hospitalization in ICU, respectively, while the other drug regimens had no significant effect on mortality and use a ventilator in the studied patients and none of the drug regimens had an effect on reducing mortality compared to other ones.

The Pattern of Tuberculosis in Iran: A National Cross-Sectional Study

Background

Despite of the remarkable achievement in control of tuberculosis, it is still a challenging health problem in Iran. Success in any health program depends on monitor the diseases epidemiology and finding the gaps. We aimed to describe the epidemiological profile of TB patients in Iran to find the gaps in the TB program and using the finding to set the program activities.

Methods

This cross-sectional study was performed based on the data of tuberculosis patients registered in Iran in 2016-2017. The information of all TB patients is registered in the TB registry software. The patients were followed during the treatment phase. The data were analyzed by SPSS 23 software using Chi-Square test.

Results

Overall 12% of cases were Afghans and 72.3% of patients had pulmonary tuberculosis. There was a significant difference in the success rate of treatment in smear-positive pulmonary patients by gender, HIV status, marital status, history of hospitalization and incarceration (P <0.01). The highest prevalence of antibiotic resistance was related to isoniazid (9.9%). In close contact persons who requiring prophylaxis, 65.3% of adults and 73.6% of children received full period of prophylaxis.

Conclusion

Despite of the TB treatment success and low prevalence of MDR cases, TB incidence has not been decreased significantly in Iran. Delay in diagnosis, high TB burden in refugees and close contact investigation and prophylaxis are important issues in the TB control program in Iran to be considered in the control planning.

Prevalence of Listeria monocytogenes infection in women with spontaneous abortion, normal delivery, fertile and infertile

BACKGROUND

Listeria monocytogenes with a vast range of natural reservoirs is more known for being a food-borne pathogen. Human infections have shown an impact on pregnancy outcomes, so, this study surveyed the frequency of L. monocytogenes infection involving different groups of women.

METHODS

This study enrolled a total sample consisting of 109 women with spontaneous abortion, 109 women with normal delivery, 100 fertile women, and 99 infertile women aged 19-40 years and willing to participate in the study. The research tool in this study was a questionnaire and Polymerase chain reaction (PCR) test.

RESULTS

According to the results, the frequency of L. monocytogenes infection was 4/109 (3.66%) observed among women with spontaneous abortion, 2/109 (1.83%) among women with normal delivery, 3/100 (3%) among fertile women, and 0/99 (0%) among infertile women.

CONCLUSION

There was no significant relationship between Listeria monocytogenes infection and pregnancy outcomes of spontaneous abortion and infertility.

Oral Administration of Probiotic Enterococcus durans to Ameliorate Experimental Autoimmune Encephalomyelitis in Mice

Introduction

Probiotics, including lactobacilli, have immunomodulatory activities with promising effects on inflammatory diseases. In this study, we evaluate the effect of Enterococcus durans (Edu) and three various strains of lactobacilli (Lacto-mix), including L. rhamnosus, L. casei, and L. plantarum, to prevent Experimental Autoimmune Encephalomyelitis (EAE) features.

Methods

C57BL/6 female mice were inoculated with Myelin Oigodendrocyte Glycoprotein (MOG35-55) in CFA (complete Freund's adjuvant) to induce EAE. Five groups (n=6 in each group) of animals received saline or probiotics by oral gavage with 200 μL of lactobacilli (1.5×108 CFU/mL) for 2 weeks before the immunization and during the test for one month.

Results

Histopathological studies showed an increase in infiltration of inflammatory cells and destruction of the myelin membrane in the EAE group but a decrease in inflammatory cells in the probiotic-treated animals. Pro-inflammatory cytokines (Interleukin [IL]-17 and Interferon [IFN]-γ) concentration in the supernatant of the brain and spinal cord tissues showed a significant increase in the EAE compared with the normal saline group (P<0.01). While in the spinal cord tissue, there was a decrease in IL-17 in those animals treated with the Lactomix and Edu + Lacto-mix (P<0.01) and a significant decrease in IFN-γ in those animals that received Edu (P<0.05). Western blot analysis of matrix metalloproteinase-9 and myelin basic protein showed a decrease and increase in treatment and EAE groups, respectively, compared to the normal control group.

Conclusion

Our data suggest that probiotic Enterococcus durans and Lacto-mix prevents EAE, but further studies are needed to clarify the exact mechanisms and their application in preclinical and clinical trials.

Highlights

Dysfunction of the blood-brain barrier, migration of inflammatory cells into the Central Nervous System (CNS), and an increase in the pro-inflammatory factors, are the hallmarks in the pathogenesis of Multiple Sclerosis (MS) and Experimental Autoimmune Encephalomyelitis (EAE).The optimal effects of probiotic strains may involve the simultaneous use of more than one strain.Probiotic Enterococcus durans and Lacto-mix have a preventive effect against EAE.

Plain Language Summary

Multiple Sclerosis (MS) is a myelin-degenerating autoimmune disease in the central nervous system. Experimental Autoimmune Encephalomyelitis (EAE), due to its similar clinical and pathologic features to MS, is widely used in many model studies of this disease. The microbiome refers to a genomic set of germs (bacteria, arches, fungi, and viruses), a commensal flora that lives in the intestine and niche of humans and other mammals. The microbiome affects the host's physiological system, especially the balance between health and disease. Additionally, the importance of the microbiome is evident in regulating the intestine-brain axis, or the coordination of the digestive and the central nervous system. In this regard, probiotics, including lactobacilli, have antioxidant and anti-inflammatory properties in vitro and in vivo. Probiotic strains have a wide range of health-improvement effects, and a combination of strains with specific properties provides a broader range of antimicrobial spectrum and stronger anti-inflammatory effects. Considering the critical role of probiotics in the immune system, this study aimed to investigate the possible role of Enterococcus durans alone or in combination with Lactobacillus mixture (L. rhamnosus, L. casei, and L. plantarum) on the EAE animal model of MS.

Triage Room Principles and Recommendations for 2019 Novel Coronavirus

Triage becomes necessary when resources and time are not sufficient to provide the best possible services to all patients. This condition is more common in situations with a large number of casualties, like infectious epidemics. What is apparent is that, in the case of a widespread outbreak of infectious disease, hospitals are on the front lines of infected patient admission and treatment. Since the training of health-care workers is one of the most important pillars of preventive measures in controlling this pandemic, this study was conducted with the aim of expressing the principles of triage of infectious disease epidemic with a COVID-19 approach.

The Relationship Between Obsessive-Compulsive Disorders and Childhood Chronic Functional Constipation

Chronic constipation is one of the most common problems in children. It can cause anxiety and psychological problems in patients and parents. The purpose of this study was to investigate the relationship between obsessive-compulsive disorders (OCD) in children with chronic functional constipation. This is a case-control study performed at the gastroenterology clinic of Besat Hospital Sanandaj for one year. The children aged 7-14-year-old with chronic functional constipation were selected as a case group, and the healthy children were recruited as a control group, who referred for growth control. Then, the Maudsley questionnaire for obsessive-compulsive disorders was completed by a trained assistant. With this questionnaire, the presence or absence of OCD and its type can be determined. Forty-three children were selected as the case group and sixty-seven children as the control group. The mean age of the case and control group was 9.3±1.5 and 8.8±1.6 years, respectively. Based on the results, there was a significant difference between the groups in terms of checking, cleaning, slowness, doubting, and total obsessive score (P˂0.05). Therefore, all five types of obsessive-compulsive disorder in the case group were greater than the control group. Obsessive-compulsive disorders were more common in children with functional constipation, and the total obsessive score in these children than the healthy children was a significant difference.

The Burden of Cancer in a Sample of Iranian Population

Background: We aimed at estimating the burden of cancer in Kurdistan Province, western Iran during 2011-2017. Methods: In this cross-sectional study, incidence data extracted from the cancer registry system and death data were extracted from the system of registration and classification of causes of death of Kurdistan Province. We applied the WHO’ methods to calculate the disability-adjusted life year (DALYs). Results: The burden of cancer increased from a DALYs of 12309 in 2011 to 13969 in 2017, the YLL from 11644 in 2011 to 12951 in 2017 and the YLD from 665 in 2011 to 1018 in 2017. The top five cancers, according to DALYs (%) in both sex during 2011-2017 were: stomach (25%), lung (14%), liver (9%), esophagus (6%), and colon (6%). The most burden of cancer related to gastrointestinal tract (54% vs. 45%). Totally, more than 25% of DALYs were related to stomach cancer. Conclusion: The increasing DALYs of cancer in Kurdistan Province is one of the major public health concerns as in most developed countries. More than half of the burden of cancer in the Kurdistan Province is related to gastrointestinal tract. Stomach cancer, is accounting for more than 25% of the burden in both sexes. Urgent policy, management and public health measures such as general education, screening, early detection and effective treatment are recommended to reduce the burden of cancers and especially gastrointestinal tract malignancies.  

Nursing care based on the Support-Based Spiritual Care Model increases hope among women with breast cancer in Iran

PURPOSE

Taking care of cancer patients and treating them are among major challenges in the field of health. Several studies have shown that promotion of hope is an efficient strategy for effectively treating this group of patients, reducing their symptoms, and improving the quality of their life. It seems that spiritual care can boost hope in these patients. This study aims to determine the effects of nursing care based on the Support-Based Spiritual Care Model on boosting hope among women with breast cancer.

METHODS

In this controlled clinical trial, 72 patients with breast cancer were selected through consecutive sampling and randomly assigned to two control and intervention groups (n = 36 in each group) based on four randomized blocks. The intervention was carried out based on the Support-Based Spiritual Care Model for the patients and their main caregivers in six sessions. Besides, the Snyder's hope scale was completed before and 1 month after the intervention by the participants in the intervention and control groups.

RESULTS

The results of the independent samples t-test showed no significant difference in the mean scores of hope between the intervention and control groups before the intervention (P > 0.05). However, after the intervention, the mean scores of hope for the intervention and control groups were 46.71 ± 4.61 and 40.40 ± 5.42, respectively, showing a significant intergroup difference as verified by the independent samples t-test (P < 0.05).

CONCLUSION

According to the results of this study, providing nursing care based on the Support-Based Spiritual Care Model can raise hope in patients with breast cancer.

CLINICAL IMPLICATIONS

Healthcare professionals can boost hope in cancer patients through proper planning and adequate support in providing nursing care based on the proposed model.

Prevalence of Neisseria gonorrhoeae in the west of Iran

Neisseria gonorrhoeae (N. gonorrhoeae) is one of the causing factors of sexually transmitted diseases (STDs). This bacterium infects the epithelial cells of the cervix of women and urethra of men. However, the symptoms in the lower genitalia are found only in a small percentage of people. The aim of this study was comparing the frequency of N. gonorrhoeae genital infection among two groups of pregnant women (spontaneous abortion and normal pregnancy).This cross-sectional study was performed in the west of Iran. This study was performed on 417 women who consisted of 109 spontaneous abortions, 109 normal deliveries, 100 fertilities and 99 infertile women. Specific primers were used and DNA was extracted by endocervical swabs; then a Polymerase chain reaction (PCR) test was done for detection of N. gonorrhoeae. Data analysis was carried out using Chi-Square Test and t-Test. In all of the above-said steps, a level of 5% was considered significant.The average age in women with normal delivery (27.8±4.87) in women with spontaneous abortion (29.6±5.9) in fertile women (32.1±5.1) and in infertile women were (29.1±6.3). The total frequency of N. gonorrhea infection was 0 (0%). Prevalence of N. gonorrhoeae infection was zero; also it was not associated with spontaneous abortion and infertility.

Assessment of Serum Level of Vitamin D in Infants with Nephrolithiasis

INTRODUCTION

Detection of nephrolithiasis is readily possible in infants with the advent of new imaging technology. Vitamin D is routinely given to newborn infants shortly after birth during infancy. Vitamin D is known to increase urinary calcium excretion which may be responsible for the increased incidence of nephrolithiasis during infancy. To test this hypothesis we studied the serum level of vitamin D and renal handling of calcium in infants with nephrolithiasis .

METHODS

In this prospective case-controlled study, we measured serum levels of vitamin D and calcium accompanied by urinary calcium level in infants between 1 to 12 months with nephrolithiasis who fed with breast milk and vitamin D supplement and compared these parameters with healthy infants without nephrolithiasis after matching for sex and postnatal age as the control group. All infants with nephrolithiasis were evaluated for metabolic disorders and other risk factors and positive cases were excluded from the study.

RESULTS

Fifty infants between 1 to 12 months with mean postnatal age 6.96 ± 2.29 months with nephrolithiasis and 50 control infants with mean postnatal age 6.94 ± 2.55 months were enrolled in the study. Mean serum level of vitamin D in the case and control groups was 41.49 ± 11.69 and 35.67 ± 6.76 ng/mL, respectively. Mean serum level of calcium in case group was 9.63 ± 0.32 vs. 8.59 ± 1.21 mg/dL in the control group. Mean urinary calcium- creatinine ratio (Ca/Cr) in the study and control groups was 0.15 ± 0.16 and 0.08 ± 0.02, respectively, Differences were statistically significant in all three variables (P < .05).

CONCLUSION

Routine consumption of vitamin D increases urinary level of calcium and in presence of other predisposing factors could accelerate the genesis of nephrolithiasis in infants.

The determinants of methadone maintenance treatment in opioids dependence users: A survival analysis study

Background: Staying in treatment is one of the basic principles in maintenance treatment with methadone and it is considered as a success criterion in the treatment procedure. This study aimed at analyzing effective determinants on staying in treatment in methadone treatment procedure.

Methods: This was a retrospective cohort study, in which 6 MMT centers were randomly selected to be studied. The data were collected using the patients’ medical records. Therefore, 1008 medical record files belonging to the patients who received methadone treatment from April 2013 to August 2017 were investigated. Proportional hazard Cox regression (extended) was used to specify the determinants of the methadone maintenance treatment and STATA 11 was used for data analysis.

Results: The patients’ mean age was 38.8 years (±1.08), and 75.8% were married and only 39.1% had full-time jobs. The mean age for the first substance abuse was at 24.31years (±7.93). The average time of staying in the treatment was 28.8 months. The results of the adjusted Cox proportional hazards regression showed among the 14 variables entered into the model, in the 1-12-month interval age of first drug use (HR=0.945, 95 % CI=0.908-0.983, p=0.005), specific drug use (HR=1.14, 95 % CI=1.026-1.268, p=0.014), and the frequency of treatment (HR=0.974, 95 % CI=0.959-0.990, p=0.002) were significantly correlated with survival status. The 13-36- month interval drug use (HR=0.931, 95 % CI=0.886-0.978, p=0.005) was significantly correlated with survival status. Also, the range of 37-53 month drug use (HR=1.058, 95 % CI=1.001-1.119, p= .044) had a significant relationship with survival status.

Conclusion: This study showed age of first drug use, specific drug use, the frequency of treatment and drug use were correlated with a decrease in staying duration in treatment. Therefore, taking these factors into consideration in designing and administering various interventions in addiction treatment and consulting centers is of paramount importance.

Survival rate of patients with bladder cancer and its related factors in Kurdistan Province (2013-2018): a population-based study

BACKGROUND

Bladder cancer is one of the most common urinary tract cancers. This study aims to estimate the survival rate of patients with bladder cancer according to the Cox proportional hazards model based on some key relevant variables.

METHODS

In this retrospective population-based cohort study that explores the survival of patients with bladder cancer and its related factors, we first collected demographic information and medical records of 321 patients with bladder cancer through in-person and telephone interviews. Then, in the analysis phase, Kaplan-Meier method and log-rank test were used to draw the survival curve, compare the groups, and explore the effect of risk factors on the patient survival rate using Cox proportional hazards model.

RESULTS

The median survival rate of patients was 63.2 (54.7-72) months and one, three and five-year survival rates were 87%, 68% and 54%, respectively. The results of multiple analyses using Cox's proportional hazards model revealed that variables of sex (male gender) (HR = 11.8, 95% CI: 0.4-100.7), more than 65 year of age (HR = 4.1, 95% CI: 0.4-11), occupation, income level, (HR = 0.4, 95% CI: 0.2-0.8), well differentiated tumor grade (HR = 3.2, 95% CI: 1.7-6) and disease stage influenced the survival rate of patients (p < 0.05).

CONCLUSION

The survival rate of patients with bladder cancer in Kurdistan province is relatively low. Given the impact of the disease stage on the survival rate, adequate access to appropriate diagnostic and treatment services as well as planning for screening and early diagnosis, especially in men, can increase the survival rate of patients.

The Effect of Vitamin D Supplementation on Clinical Outcomes of Asthmatic Children with Vitamin D Insufficiency

BACKGROUND

The extensive impacts of vitamin D on the immune system has gathered the attention of scholars in last years. In this regard, studies about vitamin D and incidence of asthma have showed various results. The aim of this study was to evaluate the effect of vitamin D supplements on clinical outcomes in asthmatic children with vitamin D insufficiency.

MATERIALS & METHODS

This before-after interventional study was conducted on all asthmatic children who attended the Be'sat Hospital, Iran. Serum levels of 25(OH)D, asthma severity and pulmonary function tests before and after therapeutic prescription of vitamin D were evaluated. Serum levels of 25(OH)D were measured by enzyme-linked immunosorbent assay.

RESULTS

The mean age of the samples was 10.69±9.78 years and 39 subjects (57.4%) were male. The primary mean level of serum 25(OH)D (18.21±8.22, ng/mL) has significantly (p<0.05) increased after treatment (35.45±9.35, ng/mL). Also, asthma severity, forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC indicators were significantly (p<0.05) increased after treatment.

CONCLUSION

We can conclude that therapeutic prescription of vitamin D is very effective in improving the clinical status of asthmatic children.

Construction of A Synthetic Gene Encoding the Multi-Epitope of Toxoplasma gondii and Demonstration of the Relevant Recombinant Protein Production: A Vaccine Candidate

BACKGROUND

Toxoplasma gondii is a widely-distributed parasite all over the world whose attributed severe afflicting complications in human necessitate the development of serodiagnostic tests and vaccines for it. Immunological responses to monovalent vaccines and the application of diagnostic reagents including single antigens are not optimally effective. Bioinformatics approaches were used to introduce these epitopes, predict their immunogenicity and preliminarily evaluate their potential as an effective DNA vaccine and for serodiagnostic goals.

MATERIALS AND METHODS

A 3D structure of proteins was predicted by I-TASSER server, and linear and conformational B cell and T cell epitopes were predicted using the online servers. Then, the predicted epitopes were constructed and called Toxoeb, and their expression in the prokaryotic and eukaryotic cells was demonstrated using SDS-PAGE. In the next step, Western blotting with pooled sera of mice infected with T. gondii was done.

RESULTS

The current in silico analysis revealed that the B cell epitopes with high immunogenicity for GRA4 protein were located in the residues 34-71, and 230-266, for GRA14 in 308-387, for SAG1 in 182-195, 261-278, and for GRA7 in residues 101-120, 160-176. The T cell epitopes were selected in overlapping regions with the B cell epitopes. The immunogenic region for GRA4 are in the residues 245-253, 50-58, and 40-54, for GRA14 in 307-315, 351-359, and 308- 322, for SAG1 261-269, and 259-267, and for GRA7 in the residues 103-112, and 167-175. The results of the western blotting showed that the expressed protein had immunogenicity.

CONCLUSION

Our constructed multi-epitope of T. gondii could be considered as a candidate for diagnostic and vaccination purposes.

Global prevalence of HCV and/or HBV coinfections among people who inject drugs and female sex workers who live with HIV/AIDS: a systematic review and meta-analysis

Coinfections of hepatitis C virus (HCV) and/or hepatitis B virus (HBV) with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) are associated with high morbidity and mortality and poor prognosis. The main objective of this study was to evaluate the prevalence of HCV and/or HBV coinfections among people who inject drugs (PWID) and female sex workers (FSWs) who live with HIV/AIDS worldwide. Data sources were searched from January 2008 to October 2018 in different databases, including PubMed, Scopus, Web of Science, Embase, and Ovid. Data were analyzed in Stata 14 software using the Metaprop command. The results showed that the prevalence of HCV among PWID and FSWs with HIV/AIDS was 72% (95% CI: 59%-83%) and 40% (95% CI: 0%-94%), respectively. The prevalence of HBV among PWID and FSWs with HIV/AIDS was 8% (95% CI: 5%-13%) and 2% (95% CI: 0%-7%), respectively, and the prevalence of HCV/HBV in PWID with HIV/AIDS was 11% (95% CI: 7%-15%). The highest prevalence of HCV was observed in PWID in the Eastern Mediterranean and Europe regions, and the lowest was observed in the Africa region. The South-East Asia region had the highest prevalence of HBV among PWID, and the Africa region had the lowest prevalence. The high prevalence of HCV coinfection among PWID and FSWs with HIV/AIDS was an alarming health problem and requires appropriate interventions. Therefore, considering that these populations are key populations for HCV elimination, it is recommended to screen them regularly for HCV. In addition, harm reduction and HBV vaccination should be carefully considered.

Platelet Indices and CXCL12 Levels in Patients with Intrauterine Growth Restriction

Background

Intrauterine growth restriction (IUGR) is a multifactorial condition, and the precise mechanism is still unknown. In the current study, we aimed to determine the relationship between the platelet (PLT) indices and CXC12 levels in patients with IUGR.

Patients and Materials

In this study, 36 patients with IUGR and 36 healthy pregnant mothers were enrolled as the case and control groups, respectively. Gestational age for both groups was between 24 and 40 years. Blood samples were taken, and platelet indices were examined by a full-diff cell counter. Serum levels of CXCL12 were measured by ELISA, and the data were analyzed using an independent Student's t-test.

Results

In this study, we observed that the mean value of PLT count (154.3 ± 50 vs 236 ± 36) and plateletcrit (0.124 ± 0.038 vs 0.178 ± 0.021) were significantly lower in the case than the control group. In contrast, the mean platelet volume (7.94 ± 0.55 vs 7.62 ± 0.53) and platelet distribution width (17.57 ± 0.7 vs 16.96 ± 0.59) were significantly higher in the case than the control group. More importantly, we found that the serum levels of CXCL12 were significantly higher (5.3 ng/mL± 3.1 vs 2.8 ± 1.6) in the patients compared to the pregnancy controls.

Conclusion

Our data show that platelet indices are changed in IUGR, and the levels of circulating CXCL12 are increased in patients with IUGR. These findings provide a base for further studies to better defining the pathophysiology of IUGR.

Urinary neutrophil gelatinase-associated lipocalin in early detection of diabetic nephropathy; a pilot study

Introduction: Diabetes results in the high prevalence of diabetes and the subsequent high incidence of nephropathy. However, there is no method with high sensitivity for the early detection of diabetic kidney disease. Objectives: The objective of this study was to evaluate the effect of the frequency of neutrophil gelatinase-associated lipocalin (NGAL) in the early diagnosis of diabetic nephropathy. Patients and Methods: Seventy-six diabetic patients who referred to the diabetes clinic of Tohid hospital were randomly selected and enrolled into this cross-sectional study. Patients with hypertension, primary and secondary glomerulopathy, every type of malignancy, infection, heart disease, pulmonary disease and other endocrine diseases, and significant renal failure (estimated glomerular filtration rate; eGFR≤30 mL/min) were excluded from the study. Demographic data were collected and the patients were divided into normal and abnormal groups based on the results of urine tests. Morning urine samples were then taken from the patients to measure creatinine, albumin, urine Alb/CR (albumin to creatinine) ratio and NGAL. Results: Of a total of 76 patients who were enrolled in the study, 39 persons (51.3%) were female. The mean age of the participants was 59.03 ± 11.74 years. In addition, 64 patients (84.2%) were in the normoalbuminuria group and 12 persons (15.8%) were in the microalbuminuria group. Urinary NGAL level was significantly higher in the microalbuminuria group than in the normal group since the difference was significant (P<0.001). We found urinary NGAL level had no significant relationship with eGFR value and the duration of diabetes (P>0.05). There was also a relationship between urinary NGAL and urinary Alb/CR ratio levels (P=0.001). Conclusion: The results of the present study showed a relationship between urinary NGAL and urine Alb/CR ratio levels which could be used as a suitable biomarker in the diagnosis of diabetic nephropathy. Moreover, urinary NGAL level had no significant relationship with eGFR and the duration of diabetes.

The Comparison of the Adverse Events of Pentavalent Vaccine and DPT Vaccine in 2-6 Months Infants in Iran: A National Study

Background

Vaccination is the most remarkable intervention in public health and is an effective strategy in controlling infectious diseases among infants.

Objectives

The aim of this study was to compare the adverse events of Pentavalent vaccine and DPT vaccine in two- to six-month-old infants in Iran.

Methods

This is an analytical cross-sectional study in which healthy infants aged two to six months, having received DPT vaccine in 2013 and Pentavalent vaccine in 2015, were studied for any experienced adverse events related to these vaccines. Percentage, mean, standard deviation and chi-square tests were used to describe and analyze the data (p < 0.05).

Findings

The results showed that 10,464 and 17,561 adverse events, which were associated with DPT vaccine and Pentavalent vaccine respectively, were recorded in the infants who received these vaccines throughout Iran. Mazandaran, Qazvin and Golestan provinces reported the highest number of adverse events, respectively (15.74%, 11.25%, and 9.12%). Moreover, Pentavalent vaccine seemed to have more recorded adverse events compared to DPT, high fever had the highest record rate for DPT vaccine (47.4%) and mild localized complications was the highest for Pentavalent vaccines (31.68%). There was a significant relationship between the kind of vaccine and the type of reaction, adverse event categorization and the country that produced the vaccine (p < 0.05).

Conclusion

Severe localized adverse events including high fever, vomiting, diarrhea and restlessness seemed to be less in Pentavalent vaccine compared to DPT vaccine. Therefore, substituting Pentavalent vaccine for DPT vaccine in infants seems to reduce the adverse events among them.

The association between circulating 25-hydroxyvitamin D and cardiovascular diseases: a meta-analysis of prospective cohort studies

BACKGROUND

There is a controversy about the association between vitamin D and cardiovascular diseases (CVDs). The effect of serum 25-OH-vitD on the risk of CVDs was evaluated.

METHODS

Major electronic databases including Scopus, Science Direct, and PubMed were searched. All prospective cohort studies on the relationship between vitamin D status and CVDs conducted between April 2000 and September 2017 were included, regardless language. The study participants were evaluated regardless of their age, sex, and ethnicity. The Newcastle-Ottawa Scale was used to assess the quality of the studies. Two investigators independently selected the studies and extracted the data. The designated effects were risk ratio (RR) and hazard ratio (HR). The random effects model was used to combine the results.

RESULTS

A meta-analysis of 25 studies with 10,099 cases of CVDs was performed. In general, a decrease in the level of vitamin D was associated with a higher relative risk of CVDs (incidence-mortality combined) (RR = 1.44, 95% CI: 1.24-1.69). This accounts for 54% of CVDs mortality rate (RR = 1.54, 95% CI: 1.29-1.84(. However, no significant relationship was observed between the vitamin D status and incidence of CVDs (RR = 1.18, 95% CI: 1-1.39). In general, low serum vitamin D level increased the risk of CVD by 44% (RR = 1.44, 95% CI: 1.24-1.69). It also increased the risk of CVD mortality (RR = 1.54, 95% CI: 1.29-1.84) and incidence rates (RR = 1.18, 95% CI: 1-1.39).

CONCLUSIONS

The findings showed that vitamin D deficiency increases the CVDs mortality rate. Due to the limited number of studies on patients of the both genders, further research is suggested to separately evaluate the effect of vitamin D status on CVD in men and women.

BIRC5 Gene Disruption via CRISPR/Cas9n Platform Suppress Acute Myelocytic Leukemia Progression

Background:

Acute myelocytic leukemia (AML) is a clonal malignancy resulting from the accumulation of genetic abnormalities in the cells. Human baculoviral inhibitor of apoptosis repeat-containing 5 (BIRC5), encodes survivin, is one of only a handful of genes that is differentially over-expressed in numerous malignant diseases including AML.

Methods:

The BIRC5 was silenced permanently in two AML cell lines, HL‑60 and KG-1, via the CRISPR/Cas9n system. After transfection of CRISPR constructs, genomic DNA was extracted and amplified to assess mutation detection. To evaluate BIRC5 gene expression, quantitative real-time PCR was performed. Also, MTT cell viability and Annexin‑V/propidium iodide flowcytometric staining were performed, and the data were analyzed using the Kolmogorov-Smirnov, Levene's, and ANOVA tests.

Results:

The results indicated that Cas9n and its sgRNAs successfully triggered site-specific cleavage and mutation in the BIRC5 gene locus. Moreover, suppression of BIRC5 resulted in the reduction of cell viability, and induction of apoptosis and necrosis in HL60 and KG1 suggested that the permanent suppression of BIRC5 remarkably dropped the gene expression and cells viability.

Conclusion:

This study reinforces the idea that BIRC5 disruption via Cas9n:sgRNAs has favorable effects on the AML clinical outcome. It thereby can be a promising candidate in a variety of leukemia treatments.

BIRC5 Gene Disruption via CRISPR/Cas9n Platform Suppress Acute Myelocytic Leukemia Progression

Background

Acute myelocytic leukemia (AML) is a clonal malignancy resulting from the accumulation of genetic abnormalities in the cells. Human baculoviral inhibitor of apoptosis repeat-containing 5 (BIRC5), encodes survivin, is one of only a handful of genes that is differentially over-expressed in numerous malignant diseases including AML.

Methods

The BIRC5 was silenced permanently in two AML cell lines, HL‑60 and KG-1, via the CRISPR/Cas9n system. After transfection of CRISPR constructs, genomic DNA was extracted and amplified to assess mutation detection. To evaluate BIRC5 gene expression, quantitative real-time PCR was performed. Also, MTT cell viability and Annexin‑V/propidium iodide flowcytometric staining were performed, and the data were analyzed using the Kolmogorov-Smirnov, Levene's, and ANOVA tests.

Results

The results indicated that Cas9n and its sgRNAs successfully triggered site-specific cleavage and mutation in the BIRC5 gene locus. Moreover, suppression of BIRC5 resulted in the reduction of cell viability, and induction of apoptosis and necrosis in HL60 and KG1 suggested that the permanent suppression of BIRC5 remarkably dropped the gene expression and cells viability.

Conclusion

This study reinforces the idea that BIRC5 disruption via Cas9n:sgRNAs has favorable effects on the AML clinical outcome. It thereby can be a promising candidate in a variety of leukemia treatments.

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

The effect of adding Rosmarinic and Ascorbic acids to vitrification media on fertilization rate of the mice oocyte: An experimental study

Background

Oocytes vitrification is a pivotal step for the widespread and safekeeping of animal genetic resources. Oocytes endure notable morphological and functional damage during cryopreservation. Oxidative stress is one of the adverse effects that vitrification imparts on oocytes.

Objective

In the present study, we investigated the antioxidant effect of Rosmarinic and Ascorbic acids on the quality and fertilizing ability of frozen-thawed mice oocyte.

Materials and Methods

In this experimental study, germinal vesicle oocytes obtained from two-months-old (30–40gr) NMRI mice were randomly divided into four groups. The basic cryoprotectants were 7.5% (v/v) ethylene glycol+7.5% (v/v) Propanediol as an equilibration media. Vitrification medium contained 15% (v/v) ethylene glycol+15% (v/v) propanediol, and 0.5 M sucrose. In the first group (Control), nothing was added to vitrification mediums, whereas, in the second and third groups, 0.5 mmol/L of Ascorbic acid and 105 µmol/L of Rosmarinic acid were added into vitrification medium, respectively. The cumulative concentration of Rosmarinic and Ascorbic acids were added to group 4. Mouse oocytes were vitrified and preserved for one month. The thawed oocytes were transferred into the α-MEM medium (Alpha Minimum Essential Medium) and maintained in this medium for 24 hr, to be matured and reach the metaphase II stage.

Results

The addition of Rosmarinic and Ascorbic acids to the vitrification solution improved the survival, maturation of Germinal vesicles, fertilization rate, and finally development to 4-cell stage. Maturation rates to 4-cell stage for Ascorbic acid, Rosmarinic acid, and both of them together were 80%, 80.76%, and 86.61%, respectively.

Conclusion

These results indicate that the addition of a cumulative concentration of 0.5 mmol/L Ascorbic acid and 105 µmol/L of Rosmarinic acid to the cryopreservation solution for the mouse immature oocytes would be of significant value (p< 0.01).

Using Oaxaca Decomposition to Study Socioeconomic Inequity of Physical Activity among Children Aged 10-12 Years: A Study in West of Iran

Background

Low physical activity (PA) is increasing public health problem. The present study aimed to determine socioeconomic inequality in PA among children aged 10-12 years old in Kurdistan, west of Iran in 2015.

Methods

The present cross-sectional study was conducted on 2506 children aged 10-12 in Sanandaj, Iran, in 2015. Data on the children's level of PA were collected using the Modifiable Activity Questionnaire. The concentration index was used to measure inequality and the Oaxaca decomposition to examine the different determinants of the inequality. The data were analyzed in Stata 13 and SPSS 20.

Results

Of the 2506 participants, 40.90% (38.97-42.82) had insufficient PA. Girls had a lower level of PA than boys (odds ratio [OR] = 0.34; 95% confidence intervals [CI]: 0.28-0.41) and it is directly related to maternal education (OR = 1.71; 95% CI: 1.18-2.47), the family's Socioeconomic status (SES) (OR = 2.18; 95% CI: 1.56-3.05), and the place of residence (OR = 1.68; 95% CI: 1.16-2.44). The concentration index for insufficient PA was -0.25 (95 CI: -0.30 to -0.21), revealing an insufficient PA in the group with a low SES. The prevalence of insufficient PA is 51.38% (95% CI: 48.45-54.31) in poor group and 28.40% (95% CI: 22.80-33.99) in the wealthier group. The Oaxaca decomposition showed maternal education and the place of residence was the most important determinants of inequality.

Conclusions

According to the findings, most of the children especially in the poor groups didn't have sufficient PA and socioeconomic factors could have the important role.

Comparison of the Effect of Vaginal Capsule of Evening Primrose Oil and Misoprostol on Cervical Ripening of Nulliparous Women with Post-term Pregnancy

Background and Objective: Post-term pregnancy (gestational age of ≥294 days [≥42 weeks] is associated with increased perinatal morbidity and mortality. The present study was conducted to compare the effect of vaginal capsule of evening primrose oil and misoprostol on cervical ripening of nulliparous women with post-term pregnancy. Materials and Methods: This research has been conducted with the one-blind randomized trial method on 130 pregnant women with post-term pregnancy visiting to the labor ward of sanandaj Besat Hospital. Samples were divided into two groups of intervention and control with the randomized allocation method. The intervention group receiving 500 mgvaginal evening primrose capsule and 25 micrograms of sublingual misoprostol, and the control group receiving a placebo-vaginal capsule and 25 micrograms of misoprostol sublingually. Data collecting tools include: demographic specifications questionnaire and Bishop Checklist. Data was analyzed through SPSS software version 21 and by using Chi-square, T-test, covariance analysis, one-way ANOVA, and repeated measures. P <0.05 was considered significant. Results: The results showed that the mean Bishope scores of the subjects in the intervention group were significantly higher than the control group (p <0.05). There was no significant difference in uterine contractions, fetal heart rate and vital signs between two groups (p> 0.05). Conclusion: The results of the present study showed that vaginal capsule of evening primrose oil is effective on the rate of cervical ripening in post-term pregnancies. Also, no significant effect on was observed on fetal heart rate, uterine contractions, and vital signs of the mother.

Perceived Stress of Infertile Couples (Male, Female) and the Factors Affecting It

Background and Objectives: In addition to physical and mental problems caused by perception of being impotent, social reactions in the society, and the economic and emotional burden of medical costs, infertility causes emotions such as fear, depression, guilty conscience, denial and uncertainty about the future. Methods: This cross-sectional study was conducted on 560 infertile couples referring to the Kurdistan Infertility Diagnosis and Therapeutic Center in 1397. Data were collected using a demographic checklist, Newton's Perceived Stress Questionnaire, and a Multidimensional Perceived Social Support Scale. Results: The results showed that gender variables, infertility factor and social support had a significant impact on perceived stress in infertile couples (P <0.05). Additionally, if other variables persist, as social support increases, the perceived stress decreases in the infertile couples. For the infertility cause variable, the stress levels of those who were the infertile spouse were high and the stress of the group whose wife was the infertile spouse was low, and those who were still not certain about the cause of infertility had a lower level of stress. Conclusion: According to the results of this study, the perceived stress level in infertile men is more than infertile women and the perceived stress level of respondents who were infertile themselves was more than other factors.

Study on the presence of resistant diarrheagenic pathotypes in Escherichia coli isolated from patients with urinary tract infection

AIM

This article aimed to analyze the diarrheagenic potential of E. coli isolated from urinary tract infection (UTI) and to recognize the presence of antibiotic resistance genes.

BACKGROUND

The marked genome plasticity of Escherichia coli has allowed the emergence of resistant pathogenic strains displaying an unusual arrangement of genes.

METHODS

In this cross-sectional study, 110 E. coli were isolated from patients with the symptoms of UTI in Sanandaj, west of Iran between July and September - 2015. The isolates were examined by the disk diffusion method for antibiotic susceptibility test and by polymerase chain reaction for the presence of genes characteristic of diarrheagenic E. coli (DEC), Uropathogenic E. coli (UPEC) virulence genes, extended-spectrum β-lactamase bla _CTX-M and plasmid-mediated quinolone resistance determinants, qnrA, qnrB, and qnrS.

RESULTS

The most and the least effective antibiotics were nitrofurantoin and cefotaxime (96.4% and 27.3% sensitivity, respectively). Of the 110 UTI isolates, 57.3% carried diarrheagenic genes. The bundle-forming pilus bfpA was the most prevalent diarrheagenic gene (39.1%). The most commonly detected DEC pathotype was enterotoxigenic E. coli (-ETEC, 12.7%). All the pathotypes carried the bla _CTX-M and qnr. The -UPEC hly hemolysin and pap adhesin genes were mainly detected among ETEC isolates.

CONCLUSION

Our results indicated the presence of resistant diarrheagenic pathotypes in UTI-associated E. coli. Such isolates may have the capacity of causing both extraintestinal and intestinal infections. Based on our knowledge, this is the first report of the presence of qnr in ETEC from urine.

The relationship of mental health with resilience among psychiatric nurses

Background & Aim: Psychiatric wards are stressful environments. Resilience can help psychiatric nurses cope with their occupational stress. The aim of the study was to examine the relationship of mental health with resilience among psychiatric nurses. Materials & Methods: This cross-sectional descriptive-correlational study was conducted in 2017 on a sample of sixty nurses purposively recruited from all wards of Qods psychiatric hospital, Sanandaj, Iran. Study data were collected using a demographic questionnaire, the 28-item General Health Questionnaire, and the 25-item Connor-Davidson Resilience Scale. The data were analyzed via the SPSS software v. 16.0 through conducting the independent-sample t test, the one-way analysis of variance, and the multiple linear regression analysis. The level of significance was set at less than 0.05. Results: In total, sixty psychiatric nurses (34 males and 26 females) with a mean age of 33.23±5.45 participated in this study. The mean scores of their mental health and resilience were 57.35±11.12 and 63.9±14.05, respectively. Resilience had significant relationships with age (0.025), marital status (P = 0.013), and work shift (P = 0.005). Moreover, among the subscales of mental health, only the mean score of the anxiety and insomnia subscale had significant relationship with resilience, so that each one point increase in the mean score of this subscale was associated with a 1.029-point increase in the mean score of resilience (P = 0.036). Conclusion: Psychiatric nurses’ resilience can be promoted through managing their stress and promoting their mental health.

Predicting vitamin E and C consumption intentions and behaviors among factory workers based on protection motivation theory

BACKGROUND

Study of antioxidant vitamin consumption behavior, especially in high-risk groups with high exposure to toxic metals to reduce metal toxicity, is emphasized. This study aims to examine the structural relationships between knowledge, protection motivation theory constructs, and vitamin E and C consumption behavior among cement factory workers.

METHODS

Protection motivation theory and food frequency questionnaires were completed by 420 factory workers. Data were subjected to structural equation modeling to examine associations between knowledge, protection motivation theory constructs, and vitamin E and C consumption behavior. Efficacy of current recommended models was also explored.

RESULTS

Structural equation modeling showed high explained variance within the constructs of protection motivation theory for vitamin E and C consumption behavior and intention (56-76%). The overall fit of the structural models was acceptable for both vitamin E and C behavior. Knowledge, self-efficacy, response efficacy, and perceived vulnerability predicted intention, which in turn predicted vitamin consumption behavior. Significant relationships between knowledge and self-efficacy, response efficacy, perceived vulnerability, and perceived severity were also found, while self-efficacy and response efficacy showed significant relationships with vitamin E and C consumption behavior.

CONCLUSIONS

Considering that response efficacy, self-efficacy, and intention showed as strong predictors of vitamin E and C consumption behavior, specific attention should be paid to coping appraisals and intention when designing intervention plans. Additionally, establishing the predicting role of knowledge for protection motivation theory constructs and protective behaviors should be integrated into intervention programs.

Immunofluorescent labeling of CD20 tumor marker with quantum dots for rapid and quantitative detection of diffuse large B-cell non-Hodgkin's lymphoma

Fluorescent semiconductor quantum dots (QDs) are newfound nanocrystal probes which have been used in bioimaging filed in recent years. The purpose of this study is to evaluate the diagnostic value of specific QDs coupled to rituximab monoclonal antibody against CD20 tumor markers for patients with diffuse large B-cell lymphoma (DLBCL). In current study rituximab-conjugated quantum dots (QDs-rituximab) were prepared against CD20 tumor markers for detection of CD20-positive cells (human Raji cell line) using flowcytometry. A total of 27 tumor tissue samples were collected from patients with DLBCL and 27 subjects with negative pathological tests as healthy ones, which stained by QD-rituximab. The detection signals were obtained from QDs using fluorescence microscopy. The flowcytometry results demonstrated a remarkable difference in fluorescent intensity and FL2-H + (CD20-positive cells percentage) between two groups. Both factors were significantly higher in Raji in comparison with K562 cell line (P < 0.05). Lot of green fluorescence signals was observed due to the selectively binding of QD-rituximab to CD20 tumor markers which overexpressed in tumor tissues and a few signals observed on the defined healthy ones. Based on these observations the cut-off point was 46.8 dots and the sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 89.5%, 91.3%, and 100%, respectively (LR+, 9.52; LR-, 0). The QD -rituximab could be beneficial as a bioimaging tool with high sensitivity to provide an accurate molecular imaging technique for identifying CD20 tumor markers for early diagnosis of the patients with DLBCL.

Effect of intravenous vitamin C supplementation on the quality of sleep, itching and restless leg syndrome in patients undergoing hemodialysis; A double-blind randomized clinical trial

Introduction: Poor sleep quality is common among hemodialysis patients and can potentially predict morbidity, mortality and quality of life in these patients. On the other hand, hemodialysis patients are encountered with vitamin C deficiency. Objectives: The purpose of this study was to determine the effect of intravenous vitamin C on sleep quality, itching and restless leg syndrome in hemodialysis patients. Patients and Methods: In this double-blind randomized clinical trial, 90 qualified hemodialysis patients were gone under investigation in Sanandaj in 2016. Patients randomly allocated in two equal intervention and control groups. The main measured outcome was the Pittsburg Sleep Quality Index (PSQI) which consists of seven components. At the end of each hemodialysis session, the intervention group received vitamin C vial (500 mg/5 cc) intravenously, three times a week for 8 weeks and the control group received normal saline as placebo in the same way. Data were collected at pretreatment and after 2 months of treatment. Additionally raises questions related to restless leg syndrome and was assessed by VAS scale for determining the incidence of pruritus. Data were analyzed by independent t test, paired t test, Wilcoxon and chi-square tests. Results: Around 52.2% of subjects were female and 47.8% were male and most of them were in the age group above 50 years old. Results showed a notable difference in the value of itching and restless leg syndrome between the two groups as these values decreased significantly in the intervention group (P=0.0001). There was also a great difference in the quality of sleep disorder in subjective sleep quality, sleep latency and daily function between the two groups and those disorders was significantly lower in the intervention group (P=0.0001). Conclusion: This study showed that intravenous vitamin C can effectively improve sleep quality, itching and restless legs syndrome in hemodialysis patients.

A PRISMA systematic review and meta-analysis on Chlamydia trachomatis infections in Iranian women (1986-2015)

BACKGROUND

Chlamydia trachomatis (CT) is the cause of genital tract infections in women. Some evidence has shown the role of this infection with CT in spontaneous abortions. The purpose of this study is to study the frequency of CT infection in Iranian women.

METHODS

This study was performed based on PRISMA guidelines. A total of 75 articles published in Google Scholar, PubMed, ISI Web of Science, Biological abs, Iranmedex, SID, and Scopus databases were found (1986-2015) using the following keywords: CT in women, CT and Iranian women, CT and infection in Iran, CT and pregnancy in Iran, CT and preterm delivery in Iran, CT and preterm labor in Iran, CT and fertility in Iran, CT and infertility in Iran, and CT and abortion in Iran. Finally, 40 studies from different regions of Iran were included. Statistical analyses were performed using R3 and STATA 12.

RESULTS

From 1986 to 2015, the lowest rate of prevalence was from 2010 to 2011 (3.9%) and the highest prevalence rate was in 2009 (69.39%) in northern Iran. Fixed effects for different parts of Iran (North, South, East, and West) were Pooled proportion: 0.13 (95% confidence interval [CI] = 0.12-0.14) and for samples (cervical, vaginal, urine, and blood) the pooled proportion was = 0.14 (95% CI = 0.12-0.14).

CONCLUSION

CT infection in this study was prevalent in urine samples and the rate of CT was observed from culture methods in comparison to other methods. Because women with CT play an important role because of sexual activity for transmission and untreated women are at risk of developing sequels. Also, most studies in Iran use sensitive polymerase chain reaction tests for the detection of genital CT infections.

Distribution of Virulence Factors According to Antibiotic Susceptibility among Escherichia coli Isolated from Urinary Tract Infection

Escherichia coli is the major causative pathogen of urinary tract infection (UTI) in humans. Virulence and drug resistance play important roles in the pathogenesis of E. coli infections. The aims were to investigate the presence of uropathogenic virulence genes and to evaluate a relationship between antibiotic resistance and virulence in E. coli from UTI. A total of 132 E. coli were collected between April and June 2015 in two hospitals of Sanandaj, Iran. Isolates were examined for susceptibility to 16 antibiotic disks using the disk diffusion method and for possession of virulence genes by polymerase chain reaction. Associations between antimicrobial resistance and virulence genes were investigated. A P < 0.05 was considered significant. Of the 132 isolates, the most prevalent virulence gene was pap (31.1%), followed by cnf (28.8%), hly (16.7%), and afa (10.6%). Different patterns of virulence genes were identified. A significant association was detected between the simultaneous presence of hly and pap. The most effective antibiotics were nitrofurantoin, cefoxitin, and imipenem and the least effective were ampicillin, trimethoprim-sulfamethoxazole, and cefotaxime. An association was seen between the presence of cnf and susceptibility to the certain antibiotics, whereas strains with a reduced susceptibility to the certain antibiotics were associated with a significantly increased prevalence of afa and hly (P < 0.05). These findings suggest a correlation between the presence of virulence gene and resistance in E. coli strains from UTI. The results indicate that there is a need for surveillance programs to monitor drug resistance in pathogenic E. coli.

Association of p53 codon 72 Arg>Pro polymorphism and risk of cancer in Iranian population: A systematic review and meta-analysis

Background: Different studies have investigated the association between p53 codon 72 Arg>Pro polymorphism and cancer risk. Because of the lack of consensus of the results in individual studies, we conducted this meta-analysis by pooling all currently available case-control studies to estimate the effect of p53 codon 72 Arg/Pro polymorphism on cancer susceptibility in Iranian population. Methods: A comprehensive search was undertaken and primary data from all peer-reviewed journals indexed in PubMed, Google Scholar, Scopus, Magiran, Scientific Information Databank (SID), Iran Medex, and CAB abstract electronic were used to conduct this meta-analysis. We considered some exclusion and inclusion criteria to select the articles. Statistical heterogeneity was explored using the I-square. Publication bias was assessed graphically and statistically by Begg's funnel plot and Egger test. All statistical analyses were performed using StatsDirect software and a two- tailed test. P-value less than 0.05 was considered statistically significant for any test. Results: Our dataset, which included 35 case-control studies, consisted of 2426 cancer cases and 2928 controls. Pooled OR and 95%CI indicated that codon 72 Arg>Pro polymorphism was not associated with odds of developing cancer among Iranian population in the dominant model (Pro/Pro+Arg/Pro vs. Arg/Arg: OR= 0.96, 95%CI= 0.74 to 1.24 chi2= 0.06, p= 0.8). Moreover, no significant association was detected in variant allele (Pro vs Arg: OR= 1.075, 95%CI= 0.91 to 1.25), homozygous (Pro/Pro vs Arg/Arg: OR=0.911 95%CI= 0.66 to 1.25), and heterozygous (Arg/Pro vs Arg/Arg: OR= 0.84, 95%CI= 0.7 to 1). Conclusion: Our study revealed that p53 codon 72 Arg>Pro polymorphism was not associated with overall cancer odds in Iranian population.

Development and psychometric properties of a questionnaire to measure drug users' attitudes toward methadone maintenance treatment (DUAMMT) in Iran

Background

Assessing drug users’ attitudes towards different kinds of addiction treatment is necessary to design tailored strategies. The aim of the present study is to develop and examine the psychometric properties of a new scale, called the DUAMMT, for assessing drug users’ attitudes toward methadone maintenance treatment in Iran.

Methods

A multi-phase development method was applied in developing an instrument from February to December 2016. The item generation and scale development were performed through literature review, a qualitative approach, and interviews with an expert panel. Then, the psychometric properties of the scale were evaluated by means of cross-sectional studies with drug users. We performed an exploratory factor analysis, a confirmatory factor analysis, and item-scale correlations; and we tested the internal consistency of the scale. Furthermore, test-retest reliability was evaluated among an Iranian sample of drug users.

Results

The mean age of participants was 34.12 years. The exploratory factor analysis revealed four factors (perceived barriers, perceived concerns, methadone side effects, and perceived positive effects) containing 17 items that jointly accounted for 60.53% of the observed variance. The confirmatory factor analysis showed a model with appropriate fitness for the data. The Cronbach’s alpha coefficient for the subscales ranged from .70 to .79. The intra-class correlation coefficient (ICC) ranged from .774 to .970, which is well above the acceptable threshold.

Conclusions

The findings of the present study suggest that the DUAMMT is a valid and reliable instrument to measure drug users’ attitudes toward methadone maintenance treatment. The DUAMMT can be applied at the start of treatment so that clinical intervention can be targeted to promote retention in treatment.

Association of XRCC1 Trp194 allele with risk of breast cancer, and Ki67 protein status in breast tumor tissues

Objectives:

To evaluate the role of this polymorphism as a risk factor for breast cancer in Kurdish patients and to investigate the possible association between Arg194Trp x-ray repair cross-complementing group 1 (XRCC1) gene polymorphisms with clinical and histopathological outcomes of patients with breast cancer.

Methods:

A total of 100 breast cancer patients and 200 cancer-free controls in Kurdish population of Kurdistan state admitted to Tohid Hospital, Sanandaj, Kurdistan, Iran between January 2012 and May 2015 were enrolled in this cross-sectional study. Tissue expression of estrogen receptor (ER), progesteron receptor (PR), human epidermal growth factor receptor 2 (Her2/neu), and Ki67 were evaluated by immunohistochemistry (IHC). The Arg194Trp genotypes were determined by polymerase chain reaction- restriction fragment length polymorphism method.

Results:

Our data showed that the risk for breast cancer increased significantly among the Trp variant of XRCC1. Statistically significant association was found between codon 194 polymorphisms and tissue expression of Ki67.

Conclusion:

The Trp allele of codon 194 XRCC1 is a potential risk factor for breast cancer in Kurdish ethnicity. Furthermore, effect of this polymorphism on clinical and histological features of breast cancer was significant.