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Abstract Background and Aims Endocan is a marker of endothelial damage. Data regarding the association of this proteoglycan and acute respiratory distress syndrome (ARDS) is discrepant. Hence, this study sought to investigate the possible correlation between serum/plasma endocan concentration and ARDS. Methods A systematic review and meta‐analysis of international online databases was conducted following PRISMA guidelines. PubMed, SCOPUS, Embase, and Web of Science were searched in March 2023, with the leading search terms being “ARDS” OR “respiratory distress” AND “endocan” and other associated terms. Studies that measured endocan levels in patients with ARDS and compared it with non‐ARDS controls or within different severities of ARDS were included. We performed a random‐effect meta‐analysis for pooling the differences using standardized mean difference (SMD) and 95% confidence interval (CI). Results We included 14 studies involving 1,058 patients. Those developing ARDS had significantly higher levels of endocan compared to those without ARDS (SMD: 0.47, 95% CI: 0.10–0.84, p = 0.01). Our meta‐analysis of three studies found that endocan levels in ARDS nonsurvivors were significantly higher than in survivors (SMD: 0.31, 95% CI: 0.02–0.60, p = 0.03). Three studies investigated endocan levels in different severities of ARDS. Only one of these studies reported significantly higher endocan levels in patients with worsening acute respiratory failure at Day 15. The other two reported no significant association between ARDS severity and circulating endocan levels. Conclusion Blood endocan levels were significantly higher in patients with ARDS than those without. Additionally, among patients with ARDS, blood endocan values were significantly elevated in nonsurvivors compared to survivors. These findings could help researchers design future studies and solidify these findings and finally, clinicians to take advantage of measuring endocan in clinical settings for assessment of patients with ARDS.

Abstract Post-traumatic olfactory dysfunction (PTOD) is associated with a significant decrease in quality of life. The present study aimed to explore whether PTOD is associated with depression and changes in sexuality. There were two groups in this case–control study. The patient group consisted of patients with PTOD (n = 55), and the control group comprised healthy individuals without the olfactory disorder (n = 115). Olfactory function, depression, partnership, and sexual satisfaction were assessed using the Iranian version of the Sniffin’ Sticks test (Ir-SST), Beck Depression Inventory (BDI), Enrich Couple Scale (ECS) and Sexual Satisfaction Scale for Women (SSSW). The BDI scores were higher in the patient group than in the control group (p

Background & Objective: Carbapenem-resistant Enterobacteriaceae is a growing concern worldwide including Iran. The emergence of this pathogen is worrying as carbapenem is one of the 'last-line' antibiotics for treatment of infections caused by multi drug resistant gram- negative bacteria. The main objective of this study was to determine the prevalence of carbapenem-resistant Enterobacteriaceae in a referral hospital in Tehran, Iran. Methods: In this study, all positive isolates of Enterobacteriaceae recorded in blood, urine, and other body fluids were studied during April 2017 to April 2018 in a referral hospital in Tehran. All cases of resistance to carbapenems were first tested by modified Hodge test. All cases with positive or negative test, after gene extraction, were examined genotypically based on the primers designed for the three Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-β-lactamase (NDM), and OXA-48 genes by conventional PCR method. Result: 108 isolates (13.6%) were resistant to all cephalosporins as well as to imipenem and meropenem. In a genotypic study, including 45 isolates, 13 isolates were positive for OXA-48 gene, 11 isolates for OXA-48 and NDM genes, 11 isolates for OXA-48, NDM and KPC genes, 4 isolates for OXA-48 genes and KPC, 3 isolates for NDM, one isolate for KPC. On the other hand, two isolates were negative for all three genes examined. Conclusion: OXA-48 gene was one of the most common genes resistant to carbapenems in Iran. According to studies, the prevalence of antibiotic resistance in Iran is rising dramatically, which reduces the choice of antibiotics to treat severe infections in the future.

Introduction: Smell Identification Tests (SIT) are routinely utilized for the clinical evaluation of olfactory function. Since Iran consists of various ethnic subgroups, the reliability and validity of this test as a national SIT are required to be evaluated across the country. Materials and Methods: This cross-sectional study evaluated the cultural adaptation of SIT administered to 420 healthy volunteers from 6 various ethnic subgroups (i.e., Fars, Turk, Kurd, Lor, Baluch, and Arab) living in 7 cities (one city for each subgroup, and Tehran [capital of Iran] with mixed ethnicities). The SIT consists of pens pre-filled with 24 odorants. The correct identification response rate was evaluated in all and each subgroup. The test was performed twice on 60 participants with a 2-week interval to assess its reliability. The SIT was further administered to 150 cases with documented abnormal olfactory function to evaluate its validity. Results: The correct identification response rate was estimated at 70% for all odorants in all and each subgroup. The mean odor identification score was 21.41±1.37 (score range: 17- 24) with no significant difference among various subgroups. Moreover, the test-retest correlation coefficient was obtained at 0.77. The mean odor identification score in patients with olfactory impairment was 10.69±3.76, which was significantly different from that in healthy participants (P

Abstract Background Healthcare-associated infections (HAIs) challenge modern medicine. Considering their high prevalence in Iran, we aimed to provide knowledge on the subject, and to teach about the importance of infection prevention and control (IPC) to a broad audience of pre-graduate healthcare professionals, focusing on education as the cornerstone of IPC. Main body We invited Iranian medical students to present ideas on “how to reduce HAIs.” Projects were eligible if being original and addressing the call. Accepted projects were quality assessed using a scoring system. Forty-nine projects were submitted, of which 37 met the inclusion criteria. They had a mean score of 69.4 ± 18.3 out of the maximum possible score of 115. Four reviewers assessed the 37 projects for clinical applicability, impact on patient safety, and innovation, and selected the best 12 to compete at the 2nd International Congress on Prevention Strategies for Healthcare-associated Infections, Mashhad, Iran, 2018. The competition took place in three rounds. The selected teams presented their projects in the first round and debated one by one in a knockout manner, while the jury reviewed their scientific content and presentation skills. In the second round, the top 5 projects competed for reaching the final stage, in which the teams presented their ideas in front of a panel of international IPC experts to determine the first three ranks. At the end of the contest, the participants gained valuable criticisms on how to improve their ideas. Moreover, by its motivating atmosphere, the contest created an excellent opportunity to promote IPC in medical schools. Conclusions Using innovation contests in pre-graduates is an innovative education strategy. It sensitizes medical students to the challenges of IPC and antimicrobial resistance and drives them to think about solutions. By presenting and defending their innovations, they deepen their understanding on the topic and generate knowledge transfer in both ways, from students to teachers and vice versa.

Abstract Background Neonatal diabetes mellitus with hyperglycemia during the first 6 months of life is a rare disorder that can occur in all races and societies. Case presentation In this study, we introduced an Iranian (Persian) 65-day-old patient with neonatal diabetes mellitus with novel homozygous mutation in the pancreatic and duodenal homeobox 1, PDX1, gene, which is also known as IPF1 gene, located in exon 2. This case was a newborn boy born in Vali-Asr Hospital, Tehran; he was diagnosed as having hyperglycemia on 28th day. Genetic analysis detected a homozygous mutation on PDX1 gene on chromosome 13. It is a novel homozygous mutation in the PDX1 gene (NM_000209.3), p.Phe167Val. This mutation was confirmed by Sanger sequencing. There was no evidence of agenesis of the pancreas. Conclusions We reported a case of neonatal diabetes mellitus due to novel homozygous mutation in the PDX1 gene without exocrine pancreas manifestations.

Background: The outcome of congenital diaphragmatic hernia depends on associated anomalies, degree of pulmonary hypoplasia, and hypertension. We evaluated the postnatal prognostic factors which can be used to predict the outcome. Methods: This study was conducted at a tertiary center (Vali-e-Asr Hospital, Imam Khomeini Complex, Tehran, Iran) during 2013-2019. The predictors of survival were evaluated. Results: A total of 49 infants with congenital diaphragmatic hernia were born during 2013-2019. The patients’ mean gestational age and weight at birth were 37.51±1.75 weeks and 2871±562 g, respectively. The mortality rate in patients with surgery (n = 41) was 31.3% and eight patients died before surgery. Mortality had significant relationships with five-minute Apgar score, peak inspiratory pressure before and after surgery, partial pressure of arterial oxygen (PaO2), and pH during first 24 hours after birth (p= 0.01, 0.001, and 0.01, respectively). The predicted and true survival rates in the patients were 66% and 52%, respectively (p= 0.001). Conclusion: Predicting survival rate after birth is remarkable but controversial. This estimate should not affect patient care and should only help parents in the process of decision-making.

Background & Aim: The treatment of Parasagittal Meningioma (PSM) is always a challenge, especially when the tumor has already invaded the critical structures like venous sinuses. This study aims at evaluating the outcomes of Gamma Knife Radiosurgery (GKRS) in patients with PSM. Methods and Materials/Patients: In this descriptive retrospective study, we reviewed the medical records of 61 patients with PSM, who had undergone GKRS from 2003 to 2013. We reviewed their demographic characteristics, medical history, radiotherapy history, tumor volume, and the characteristics of radiosurgery. We also evaluated radiological tumor control following the treatment during the follow-up period. Results: In this study, 32(52.5%) patients were men, and 29(47.5%) were women. Of 61 patients, 45 had a history of operation or and radiotherapy. Their Mean±SD tumor volume was 11.35±9.20 mL (range: 1-37.9mL). The Mean±SD follow-up time was 30.28±27.48 months, and during this time, five patients died. Radiologic tumor control was achieved in (91.8%) of the patients, in whom the tumor volume decreased in 30(49.2%) patients and remained unchanged in 26(42.6%) ones. The tumor volume increased in five (8.2%) patients. Overall, the progression-free survival of the patients was (98.6%) during 12 months, and their Mean±SD percentage was 67.04±13.4% during 60 months. The edema incidence rate was (18%). There was no significant difference in GKRS characteristics, tumor volume, the history of operation, and radiotherapy among the patients, whose tumors were controlled and the patients, who experienced an increase in the tumor volume. Conclusion: Our study suggests that GKRS can be the first or second choice of treatment to control PSM. There was no association between the treatment outcome, tumor characteristics, and radiosurgery parameters. As radiosurgery management in PSMs has some limitations, a long-term follow-up is recommended to diagnose life-threatening complications, including brain edema.

Introduction: Processing odor information by the olfactory system depends greatly on the odor concentration. In order to use an odorant in a smell identification test (SIT), the minimum identification concentration (MIC) needs to be determined. Materials and Methods: This study was conducted in 60 healthy native individuals aged 20 to 60 years, selected from patients’ companions in a tertiary hospital. In the first step, 25 odorants were presented to evaluate familiarity among the subjects. Then, the MICs for the eligible odorants were measured using the ascending method of limits. Results: Out of 25 odorants, only one (cacao) was distinguished by less than 70% of the subjects, and was therefore removed from the list. The MICs of the remaining 24 odorants ranged from 6.87±2.74% for menthol to 27.62±18.98% for cantaloupe. There was significant correlation between age and the MIC only for coffee (P=0.02, r=−0.300). There was a significant difference in MIC between men and women only for hazelnut (P=0.03). Conclusion: We present the MICs of 24 culturally-familiar odorants in a sample of the Persian population in a SIT.

Introduction: The Questionnaire for Olfactory Dysfunction (QOD) is a self-reporting olfactory-related quality of life questionnaire. The aim of this study was to determine the reliability and validity of the Persian version of this questionnaire. Materials and Methods: One hundred and thirteen patients with olfactory problems were enrolled in this study. The English version of the QOD was first translated into Persian. The reliability was then tested by determining the Cronbach alpha coefficient to assess internal consistency. The QOD was reviewed by a panel of experts, followed by calculating the content validity index to determine the content validity. Results: Based on the reliability analysis, the total Cronbach alpha was 0.88. The items in the “life quality” and “parosmia” domains had a good internal consistency in total, as well as in both genders and in different age subgroups. For the “sincerity” domain, however, low internal consistency was revealed (Cronbach alpha = 0.25). When questions related to the sincerity domain were omitted, the Cronbach alpha reached 0.89. The overall scale validity index for clarity and relevance were 0.88 and 0.87, respectively. Conclusion: The Persian version of the QOD seems to be a reliable and valid tool for the assessment of quality of life in patients with olfactory dysfunction. The “sincerity” domain cannot be used separately or should be substantially modified in order to be applicable to the Iranian population. However, there is no need to change the whole format of the questionnaire.

Introduction:Vitamin D has been suggested to play a considerable role in the function of the immune system in various infectious, inflammatory, and autoimmune conditions. Otitis media with effusion (OME), defined as the presence of non-purulent fluid within the middle ear without signs or symptoms of suppurative otitis media, has a number of inflammatory predisposing factors. This study was designed to explore the association between vitamin D deficiency and OME.Materials and Methods:In this cross-sectional study, 74 children aged 2–7 years with an obstructive indication for adenotonsillectomy were included. Patients were divided into two groups based on the need for ventilation tube insertion for OME. Thirty-two children were enrolled in the OME group and 42 in the control group. The mean vitamin D level was compared between the two groups.Results:Mean vitamin D concentration in all patients was 11.96±5.85 ng/ml (9.79±4.36 ng/ml in the OME group and 13.61±6.33 ng/ml in the control group; P=0.003). There was also a significant difference in levels of vitamin D in patients referred in winter (9.0±2.94 ng/ml) compared with the summer (19.85±4.21 ng/ml; P=0.001). Data analyzed based on the season in which the patients were referred showed no significant difference between the OME and the control group.Conclusion:Although our results showed lower serum levels of vitamin D in OME patients, the difference was not significant when seasons were taken into consideration. Therefore, the season is an important confounding factor in any research related to vitamin D due to the effect of sun-induced vitamin D.

Since administration of androgens has been considered appreciable in hair follicle growth and wound healing, therefore the main objective in this study is evaluation the effect of sheep testis extract on improvement and growth of hair follicle and regeneration of injured Wistar rat skin. In this experimental study, rats were randomly divided into 7 groups, control (negative control), sham (treatment with physiologic serum), experimental group 1 (treatment with 100% sheep testis extract), experimental group 2 (treatment with 75% extract), experimental group 3 (treatment with 50% extract), positive control 1 (treatment with honey) for evaluation of wound healing and positive control 2 (treatment with Minoxidil) for evaluation of hair follicle growth. Then, rats were killed after and removed approximate wound skin, fixed in 10% formalin, kept in paraffin block. In addition, it was prepared serial section with 6 µm thickness and performed hematoxylin eosin staining. Then, epidermal thickness, the number of fibroblast, basal cells, inflammatory cells, vessel bud and hair follicle were assessed. Statistical analysis was performed by one way ANOVA, Tukey test at p ˃0.05. The results showed that wound healing process, hair follicle formation, the re-epithelialization, angiogenesis, the number of basal cell, fibroblasts, and the number of follicles was significantly improved in the experimental group 1, 2, rather than control group (p ˃0.05). Results of this study demonstrated that the sheep testis extract induced improvement in regeneration process, wound healing and hair follicle growth in rats which can be suggested as an appreciable candidate due to rich source of androgen and growth factors in clinical wound healing studies.

Electromagnetic field is a stress factor which can interfere with the functions of body organs. This study aims to evaluate the protective impact of the aqua extract of Persian Gulf sea cucumber on damages induced by low frequency electromagnetic field in male gonads of Balb/C mice. Mice were divided into control, sham-exposed and 5 experimental groups. The experimental groups were then exposed to electromagnetic field (for 10 days and 4 hours per day). Experimental groups 2-5 also received extract of sea cucumber (6h before electromagnetic field). The samples were fixed for histological studies and stained by H & E method. The measurement of the diameter and number of seminiferous tubules, testis diameter, testis and epididymis weight, tunica albuginea thickness, the number of spermatogenic cells including spermatogonia, spermatocytes, spermatids, Sertoli cells and Leydig cells was then executed. The results showed that the impact of electromagnetic field exposure was not significant on epididymis weight, seminiferous tubules diameter and tunica albuginea thickness, while its impact on the reduction of the testis diameter and weight, the number of seminiferous tubules and spermatogenic cells was significant in experimental group 1. In addition, the experimental groups pre-treated with sea cucumber extract indicated significant increment, as compared with experimental group 1.The results proved the destructive effect of electromagnetic field on testis tissue parameters, while sea cucumber extract prevents damages induced by electromagnetic field on male sexual glands of mice.

Background: Segmental pigmentation disorder (SegPD) is a rare type of cutaneous dyspigmentation. This hereditary disorder, first described some 20 years ago, is characterized by hypo and hyperpigmented patches on the trunk, extremities and less likely on the face and neck. These lesions are considered as a type of checkerboard pattern. Case Presentation: Herein, we present a 26-year-old male who presented with hyperpigmented patches on his trunk, neck and upper extremities. Considering the clinical and histopathological findings, the diagnosis of SegPD was confirmed. Conclusion: SegPD is a somewhat neglected entity which should be considered in differential diagnosis of pigmentation disorders.

Protein S (PS) is an antithrombotic plasma protein that plays essential roles in limiting thrombus formation in the anticoagulant system. Protein S deficiency is related with recurrent thrombosis. Here, the authors report a case of a term neonate with severe PS deficiency in year 2015, Imam Hospital, Tehran, Iran, that had seizures and intraventricular hemorrhage (IVH) since the age of 3 days. Nine-month follow-up did not show any developmental problems and MRI showed no hemorrhage.

Background: Tuberous Sclerosis Complex (TSC) is an autosomal-dominant hereditary disorder. This syndrome is characterized by tumor-like malformations in several organs, as well as the heart. This report summarizes a case of TSC in a premature infant, born at 34 weeks' gestation with ascites. After birth, multiple cardiac mass, subependymal cysts and hypopigmented macules were detected. To our knowledge, this is the first case report of early onset of TSC with chylous ascites in Iran.

Abstract Orf is caused by a parapoxvirus. We present a recurrent, giant digital orf case in a female patient with a history of hairy cell leukemia. In spite of shave excision, the lesion progressed and recurred after digital amputation. Treatment with topical imiquimod cream and systemic subcutaneous interferon alfa‐2a was successful.

There is a most useful method in order to simultaneously study thousands of gene expression levels of a simple experiment, called DNA microarray. The average value of fluorescent intensity can be calculated through a microarray experiment. The calculated intensity values are close to the expression levels of a specific gene. Therefore, the appropriate determination of every spot position (specific gene) will lead to the accurate measurement of the intensity amount, and as a result, accurate classification of normal and abnormal gene expression levels within the microarray image. In this paper, first, a preprocessing step is performed in order to cancel the noise and artifacts in DNA microarray images using the nonlinear diffusion filtering method. Then, the coordinate center of each spot is determined utilizing mathematical morphology operations. Finally, pixel classification is performed using the independent component analysis (ICA) algorithm. Performance of the proposed algorithm has been assessed on the microarray images of the Stanford Microarray Database (SMD). Realization results illustrate that the classification accuracy of the proposed algorithm of the noisy microarray cells is close to 98%, while this amount is equal to 100% for noiseless cells.

Background ― Osteoporosis is a chronic multi-factorial disease characterized as low bone density and microarchitecture disturbance of bone tissue. Osteoporosis is known as a major health problem, but it can be prevented and treated in a great extent. Objective ― The aim of the present study was to determine the rate of Iranian female employees’ awareness of osteoporosis. Methods and Results ― In a cross-sectional study, 400 female employees in Kerman were studied. Data were gathered using a researcher-made questionnaire. Mean awareness score of participants was 11.69±3.76 that shows poor awareness. Participants with bachelor or higher degrees showed better awareness (p