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Sports is a vast and universal social phenomenon that is rooted in the lives of young people and adults, and sports participation improves the quality of people's lives and has an obvious effect on physical, psychological and social dimensions. The purpose of this research was to investigate the mediating role of social vitality in the relationship between social marketing and motivation to participate in leisure sports activities (case study: elderly people of Ardabil province). The research method was applied in terms of purpose and descriptive-survey in terms of nature. The statistical population of the present study was the elderly active in sports clubs and parks. To determine the sample size using Cohen's formula, 318 people were determined, which was 10% of the additional sample size and 350 people were determined, and due to the existence of incomplete questionnaires, 339 questionnaires were analyzed. The measurement tools were standard questionnaires, whose content, convergent and divergent validity were confirmed. The reliability of all three questionnaires was confirmed through Cronbach's Alpha Coefficient. To analyze the research hypotheses, the structural equation model was used by SPSS19 and AMOS23 software. The results of this research indicate the effect of social marketing on the motivation to participate in leisure sports activities, the effect of social marketing on social vitality and the effect of social vitality on the motivation to participate in leisure sports activities. Therefore, it can be concluded that creating the motivation to participate in the leisure sports activities of the elderly in the direction of social vitality requires long-term, short-term and medium-term planning and it is better that this type of planning is with a social marketing approach so that the target can be reached. 1. Introduction As individuals age, the significance of social engagement and involvement in maintaining their health and well-being escalates (Liu et al., 2024). A relatively overlooked aspect in research is the impact of gender on motivations and participation levels within brand communities. By gaining deeper insights into the distinct motivations and interaction dynamics of male and female consumers across different age brackets in these communities, marketers can tailor their strategies to better address the needs and preferences of target demographics (Haverila et al., 2024). Engaging in sports activities aids in enhancing individuals' quality of life and yields positive effects on their physical, psychological, and social well-being. In the past, the emphasis on sports activities primarily targeted teenagers and young adults, as there was a prevailing belief that intense physical activity could be detrimental to the elderly, unless it had therapeutic value. These traditional attitudes and perceptions stemmed from perspectives on aging that viewed it as an inevitable process accompanied by physical deterioration (Canella et al., 2021). Numerous studies in the realm of sports activities for the elderly have highlighted many advantages associated with engaging in such activities. Physical inactivity is identified as the fourth leading risk factor for mortality and non-communicable diseases like cardiovascular diseases, cancer, and diabetes. To prevent and delay the onset of chronic illnesses, it is recommended that adults adopt a healthy lifestyle that includes sufficient physical activity (Huang et al., 2022). Physical activities and participation in sports events play a direct role in enhancing social integration, as they are recognized as key components in sustaining and fostering social networks and connections (Stenner et al., 2020). 2. Literature Review Social vitality consisted of three subcategories: experiencing positive emotions, holding positive beliefs and cognitions, and demonstrating commitment and inclination to engage in societal activities. Experiencing positive emotions: Findings from the analysis of numerous interviewees revealed that individuals who are cheerful tend to experience positive emotions within society. Holding positive beliefs and cognitions: Another subcategory within the concept of social vitality pertained to maintaining positive beliefs and cognitions towards authority figures, urban affairs, and community engagements. Demonstrating commitment and inclination to engage: The analysis results indicated that a higher level of commitment and active participation in social undertakings contribute to a more pronounced social vitality (Jolanda, 2021). In simplest terms, marketing involves the strategic management of profitable customer relationships, aiming to attract new customers through added value and retain existing customers by ensuring satisfaction (Shabani Moghaddam, 2011). The core focus of modern marketing is to deliver satisfaction and create value for customers in order to generate interest in the desired product or service, thus aligning marketing with meeting customer needs and demands (Saberi et al., 2017). Cutler and Zaltman highlighted that the distinctive feature of social marketing lies in its objectives, which primarily aim to influence social and human behavior, rather than focusing on profit or personal gains. Social marketing is characterized by its mission to impact societal actions and behaviors, extending beyond mere customer satisfaction through exchanges, with a higher goal of influencing community members' behaviors (Khorshidi and Moghaddami, 2002). Sports is a widely recognized concept in society, captivating interest even among those who may not actively partake in sporting activities, with a prevalent engagement in following global competitions, particularly within specific fields. Recent years have witnessed a significant rise in public knowledge and awareness of sports, accompanied by various initiatives aimed at promoting diverse aspects of sports by relevant bodies and mass media outlets (Fujihira et al., 2016). Sports exert an influence on both the physical and mental well-being of individuals. A well-structured and consistent exercise regimen, grounded in the principles of physical education, can substantially contribute to an individual's physical health and mental vigor. In the physical realm, the primary impact of exercise lies in the development and fortification of different body parts and organs. It is noteworthy that while some individuals possess a favorable physique, they may encounter difficulties in executing even the most basic exercises and sports movements (DiGuiseppi et al., 2014). 3. Methodology The present research utilized a descriptive-survey research design for data collection, employing a quantitative approach and field method. The study focused on the elderly engaged in sports clubs, as well as those participating in outdoor activities in parks and morning sports settings, with a total population of 318 individuals. To account for potential incomplete responses, the sample size was increased by 10% to 350 participants, with 339 complete questionnaires analyzed. A clustered sampling method was employed, selecting cities including Ardabil, Parsabad, Meshkinshahr, Garmi, and Khalkhal for questionnaire distribution. The measurement instruments utilized were: 1- Social Marketing Questionnaire (Sabri et al., 2018), 2- Sports Participation Motivation Questionnaire (Politir et al., 2013), and 3- Social Vitality Questionnaire (Tamizifar and Azizi Mehr, 2017) for tool validation purposes. Three types of validity were employed in the study: content validity, convergent validity, and divergent validity. Content validity was established through expert evaluation. Convergent validity was assessed by calculating the Average Variance Extracted (AVE), which exceeded 0.5. Divergent validity was confirmed by comparing the square root of AVE with the correlations among the real-factor variables within each construct. Reliability of the questionnaires was evaluated using Cronbach's alpha coefficient, which exceeded the minimum threshold of 0.7 in all three questionnaires. Descriptive statistical methods such as mean and standard deviation calculations were utilized for data analysis. In the inferential statistics section, the Kolmogorov-Smirnov test was employed to assess the normality of the statistical population. Furthermore, structural equation modeling was applied to test the research hypotheses, utilizing SPSS 19 and AMOS 23 software. 4. Results The demographic results revealed that out of the total sample, 222 individuals, accounting for 65.5%, were male, while 117 individuals, comprising 34.5%, were female. Regarding marital status, 26 individuals (7.7%) were single, whereas 313 individuals (92.3%) were married. The majority of participants had a diploma as their highest educational qualification, with 167 individuals (49.3%), while only 7 individuals (2.1%) held a doctorate degree or higher. In terms of weekly exercise duration, 117 participants (34.5%) engaged in physical activity for 2-3 hours, whereas the lowest number of participants, 59 individuals (17.4%), exercised for 3-4 hours per week. The most common age range was between 55 and 60 years, with the lowest age group being less than 50 years old. Table 5. Structural model in the estimation mode of standard path coefficients Research assumptions β T-VALUE P Result Mediator type The effect of social marketing on sports participation motivation 0.19 3.288 0.001 confirmation partial mediation The effect of social marketing on social vitality 0.40 5.175 0.000 confirmation The effect of social vitality on the motivation of sports participation 0.63 6.639 0.000 confirmation The effect of social marketing on sports participation motivation (without mediating variable) 0.44 6.286 0.000 confirmation The results from Table 5 of the structural model path analysis indicated that the impact of social marketing on sports participation motivation was 0.19 with a significance level of 0.001, the impact of social marketing on social vitality was 0.40 with a significance level of 0.000, and the impact of social vitality on sports participation motivation was reported as 0.63 with a significance level of 0.000. Since the t-values for all three hypotheses exceeded the critical values (-1.96 and 1.96) at a 99% confidence level, hypothesis H0 was rejected, confirming hypothesis H1. This implies that social marketing has a positive and significant influence on sports participation motivation, and social vitality mediates this relationship. According to Baron and Kenny's criteria, as all three hypotheses with the mediator variable were significant and the effect of social marketing on sports participation motivation was significant even without the mediator variable (social vitality), it can be concluded that social vitality acts as a partial mediator in the impact of social marketing on sports participation motivation among the elderly in Ardabil province. 5. Conclusion Studies have demonstrated that engagement in sports activities can significantly enhance one's sense of belonging in society, boost self-confidence, uplift mood, and alleviate feelings of loneliness and isolation. Furthermore, sports, being a communal endeavor, serve as a foundation for establishing effective social connections and fostering communication. For individuals aged over 50, participating in sports holds paramount importance from both social and environmental perspectives. Such engagements contribute to bolstering self-assurance, enhancing social interactions, promoting health and quality of life, as well as boosting motivation and vitality. Moreover, active involvement in sports aids in fortifying both personal and social identities. Scholarly research underscores that the application of social marketing strategies in preventive interventions can lead to substantial advancements in behavior change within communities. Social marketing initiatives play a pivotal role in augmenting the levels of physical activity and vitality among the elderly population. These strategies encompass leveraging social media platforms to disseminate accurate and credible information regarding the advantages and significance of physical exercise, fostering motivation and social support to encourage participation in physical activities, and crafting tailored exercise programs that cater to the specific needs of this demographic group. The active involvement of older individuals in societal activities not only fosters a sense of worth and empowerment but also serves as a deterrent against feelings of loneliness and isolation. Furthermore, engagement in group-based activities reinforces their social connections, bolsters their sense of community belonging, and contributes to the boost in social vitality.

Summary: Background: The multifactorial nature of inflammatory bowel disease (IBD), which manifests differently in individuals creates a need for a better understanding of the behaviour and pattern of the disease due to environmental factors. The current study aimed to study the changes in IBD behaviour, presentation, and characteristics in patients over the past two decades with a goal of improving patients’ diagnosis, management and outcomes. Methods: During a 6-month period (1/02/2022–30/07/2022), the information of patients with IBD who attended IBD outpatient clinics of 11 referral centre's in six countries was collected, and based on the first time of diagnosis with IBD, they were allocated as group A (those who were diagnosed more than 15 years ago), group B (those who were diagnosed with IBD between 5 and 15 years ago) and group C (IBD cases who diagnosed in recent 5 years). Then the most prevalent subtypes and characters of the disease are evaluated and compared to make clear if the presenting pattern and behaviour of the disease has changed in the last 2 decades. Findings: Overall 1430 patients with IBD including 1207 patients with ulcerative colitis (UC) (84.5%) and 205 patients with Crohn's disease (CD; 14.3%) included. Mean age of participants at the first time of diagnosis with IBD was 30 years. The extra-intestinal involvement of IBD in groups A and B was more prevalent in comparison with group C. Most of those in groups A & B had academic education but in group C, the most prevalent educational status was high school or diploma (P = 0.012). In contrast to groups A and B, the relative prevalence of medium socioeconomic level in group C had decreased (65%). Relative prevalence of UC subtypes was similar among groups A and B (extensive colitis as most prevalent) but in group C, the most prevalent subtype is left side colitis (38.17%). The most prevalent subtype of CD in groups A and B was ileocolic involvement while in group C, upper GI involvement is significantly increased. The rate of food sensitivity among groups A and B was more than group C (P = 0.00001). The relative prevalence of patients with no flare has increased with a steady slope (P

Objective Wrestling is one of the sports that have a high percentage of injuries. Therefore, the aim of this study was to review physiological and biomechanical injuries in the field of wrestling. Methods The present study was a library-based and systematic review. The search for articles in Persian and Latin was conducted from 2010 to 2022. This search was performed across different databases, including WOS, SID, Magiran, Scopus, PubMed, ISC, and Google Scholar. Fifty-five relevant articles were selected based on inclusion and exclusion criteria. Finally, 12 articles related to the review of physiological and biomechanical injuries in the field of wrestling were analyzed. Results The findings showed that the average injuries in the lower area were about 34%, and in the upper area, it was 33%. In the lower part, most of the injuries were reported in the knee and ankle joints, and in the upper part, they were reported in the shoulder, elbow, and waist joints. Conclusion It seems that excessive weight loss, along with non-observance of the principles of warming up and cooling down in the field of wrestling, is of great importance in the occurrence of injuries in this field.

Introduction: One of the problems caused by COVID-19 is decreased lung function and muscle weakness. Excessive increase in the curvature of the thoracic spine is known as a kyphosis deformity. The purpose of this study was to compare the quality of breathing in COVID-19 patients with that of individuals with and without kyphosis. Material & Methods: This study was a causal-comparative study. The statistical population of this study consisted of individuals aged 18 to 30 years old from the city of Urmia in 2021. Of this population, 30 individuals were selected as a group with kyphosis and 30 individuals without kyphosis according to the inclusion criteria. The respiratory quality of the two groups was measured with the St. George’s Respiratory Questionnaire, and the circumference of the thoracic arch was determined with a flexible ruler. Data analysis was performed with SPSS version 25 using the independent t-test. Findings: The mean scores of individual data, including age, height, and weight, were obtained at 24.50±3.64 years, 164.07±4.87 cm, and 66.07±9.54 kg in the group with kyphosis and 23.57±3.91 years, 163.20±4.77 cm, and 64.37±10.96 kg in the group without kyphosis, respectively. There was no significant difference between the two groups when comparing scores for pulmonary symptoms (P=0.83), activity (P=0.69), social and psychological impact (P=0.71), and total questionnaire score (P=0.65). Discussion & Conclusion: Respiratory physical, psychological, and social complications occurred in both groups with and without kyphosis. Although the complications were more severe in individuals with kyphosis, they were not significantly different from those in the group without kyphosis. It is possible that conducting similar studies examining the lung volumes of people with different degrees of kyphosis abnormalities would yield different results.

Background: Nausea, vomiting, and anxiety are common complications during and after spinal anesthesia. Auriculotherapy as a complementary medicine can be useful for reducing nausea, vomiting, or anxiety. This study was performed to evaluate the effects of auriculotherapy on nausea, vomiting, and anxiety in patients undergoing elective Cesarean Section (CS) with spinal anesthesia. Materials and Methods: The present study was a clinical trial study that was performed on 56 pregnant women selected as CS candidates in Ommolbanin Hospital in Mashhad during the years 2016–2017. In the intervention group, 1 h before spinal anesthesia, auricular acupoint stimulation was performed at four points bilaterally, for 20–30 seconds at each point. Evaluations were done by the following questionnaires: State-Trait Anxiety Inventory (STAI), Visual Analog Scale (VAS), and Vomiting Assessment Form. Results: The mean anxiety (SD) before the intervention in the intervention group and the control group was 47.88 (8.67) and 47.84 (10.49), respectively, and 4 h after the intervention, it was 40.23 (10.19) and 42.88 (12.18) in the intervention and control groups, respectively. These results were significant in the intervention group (p = 0.008). 30–40 min before and 4 h after the surgery, the severity of nausea and vomiting was low in both groups and no significant difference was observed between the two groups during the surgery and in the recovery room (p > 0.05). Conclusions: According to the results, auriculotherapy could reduce anxiety in CS patients with spinal analgesia. The results also showed that auriculotherapy reduced the severity of nausea and vomiting, but these changes were not significant.

Abstract Background As a gram-negative and microaerophilic bacterium, Helicobacter pylori (HP) is the main cause of chronic gastritis. Therefore, considering the high prevalence of HP infection worldwide, as well as the increasing prevalence of metabolic disorders, the present study aimed to investigate the relationship between HP infection eradication and metabolic profile. Methods This prospective case-control study was performed on patients with HP infection whom referred to 7 medical centers in 3 countries (Iran, Egypt, and Vietnam) in 2020–2021. The metabolic profile of all of the participants evaluated before starting of treatment for HP eradication and 3 months after the treatment. Then changes of metabolic profile compared between those with successful HP eradication (group A) and subjects who failed to eradicate (group B). Results Overall, 199 patients, including 93 male (46.7%) with the mean age of 44.5 years (18–93 years) included. Based on response to treatment, the participants allocate into group A (those who respond to HP eradication): 164 cases (82.42%); or group B as those who failed to achieve eradication (35 cases, 17.58%). Racially 86.9% of participants were Caucasian and 89% diagnosed as non-ulcer dyspepsia (NUD). The most prevalent comorbidity include hypertension (11.5%) and hyperlipidemia (10%) which were more prevalent in group B (P = 0.002). Three months after therapy, average weight of participants among those who achieved eradication (group A) decreased from 73.1 to 71.4 kg (P = 0.01), but in comparison with group B, was non-significant (P = 0.171). The BMI of patients before and after treatment did not show any significant differences. The biochemical parameters of patients before and after treatment were not significantly different regardless of treatment success (P > 0.05). The levels of total cholesterol and VLDL cholesterol after treatment were not significantly different from baseline values in two groups. HDL and LDL cholesterol levels before and after treatment in the resistant group were significantly higher than the responding group. Average serum TG level decreased significantly after treatment in the group A (P 0.05). The results of logistic regression showed that the eradication of infection has no significant affect any of the metabolic profile parameters. Conclusion HP infection treatment in individuals without significant metabolic disorders does not affect metabolic parameters up to 3 months after eradication. HP eradication among subjects with several comorbidities mandates eradication protocol intensification to avoid treatment failure.

Background: Pancreatitis is one of the most crucial complications following endoscopic retrograde cholangiopancreatography (ERCP). The purpose of the current study was to investigate patient-related post-ERCP pancreatitis (PEP) risk factors in two groups of patients: prophylactic pancreatic stent and rectal indomethacin. Methods: Two different prophylactic modalities were planned and complications were assessed based on the defined inclusion criteria. In this study, the patients were evaluated for the procedure and patient-related risk factors in post-ERCP pancreatitis in the recipient groups of the prophylactic pancreatic stent and rectal indomethacin. Results: Pancreatitis was confirmed in 27 of all 170 selected patients after ERCP. By univariate analysis, two variables were significant with the development of PEP. Regarding the patient-related risk factors, unique subjects with common bile duct (CBD) dilated 10mm were more exposed to an increased chance of PEP (P=0. 015); meanwhile, other factors did not correlate with the increased possibility of PEP in both groups. The only procedure-related risk factor for PEP was the deep cannulation of the pancreatic duct in both groups during the procedure with an incremental significant incidence of pancreatitis (P=0.005). Comparison of prophylactic pancreatic stent and rectal indomethacin showed no effects in term of post ERCP pancreatitis reduction. Additionally, there was no significant difference between these two strategies in the rate of PEP. Conclusion: Prophylactic pancreatic duct stents and administration of rectal indomethacin cannot have particular approaches for reducing the possible occurrence of PEP. The increase in time of deep cannulation and the presence of CBD dilation

This research explores Good Corporate Governance (GCG) and financial governance by using firm size as a control variable. In particular, this study provides empirical evidence that firm size is a control variable. The sample in this research is companies in the Hotel and Tourism sector listed on the Indonesia Stock Exchange (IDX) period 2013-2018. Data analysis using panel data. The results revealed that of the five proposed hypotheses, only two were accepted. The results show that company size does not fully control the independent variable in this research.

Abstract Background The first large serosurvey in Iran found a SARS-CoV-2 antibody seroprevalence of 17.1% among the general population in the first wave of the epidemic by April, 2020. The purpose of the current study was to assess the seroprevalence of COVID-19 infection among Iranian general population after the third wave of the disease. Methods This population-based cross-sectional study was conducted on 7411 individuals aged ≥10 years old in 16 cities across 15 provinces in Iran between January and March, 2021. We randomly sampled individuals registered in the Iranian electronic health record system based on their national identification numbers and invited them by telephone to a healthcare center for data collection. Presence of SARS-CoV-2-specific IgG and IgM antibodies was assessed using the SARS-CoV-2 ELISA kits. The participants were also asked about their recent COVID-19-related symptoms, including cough, fever, chills, sore throat, headache, dyspnea, diarrhea, anosmia, conjunctivitis, weakness, myalgia, arthralgia, altered level of consciousness, and chest pain. The seroprevalence was estimated after adjustment for population weighting and test performance. Results The overall population-weighted seroprevalence adjusted for test performance was 34.2% (95% CI 31.0-37.3), with an estimated 7,667,874 (95% CI 6,950,412-8,362,915) infected individuals from the 16 cities. The seroprevalence varied between the cities, from the highest estimate in Tabriz (39.2% [95% CI 33.0-45.5]) to the lowest estimate in Kerman (16.0% [95% CI 10.7-21.4]). In the 16 cities studied, 50.9% of the seropositive individuals did not report a history of symptoms suggestive of COVID-19, implying an estimation of 3,902,948 (95% CI 3,537,760-4,256,724) asymptomatic infected individuals. Conclusions Nearly one in three individuals were exposed to SARS-CoV-2 in the studied cities by March 2021. The seroprevalence increased about two-fold between April, 2020, and March, 2021.

Background: one of the growing diseases in the world that affects patient life quality is Inflammatory bowel disease (IBD), including ulcerative colitis (UC). Many environmental factors, including nutritional deficiencies, may influence the development of the disease. This study aims to evaluate the role of the level of vitamin D in UC recurrence. Methods: We performed this cross-sectional study at Qom University of Medical Sciences from September 2017 to September 2018 on 50 patients with inactive UC, at least six months after diagnosis, in Shahid Beheshti Hospital in Qom. Patients entered the study sequentially from the target population after describing how to perform the plan and obtaining informed consent. Demographic information, including gender, age, medical history, diseases, and body mass index (BMI), were collected using a checklist. Patients were followed for six months for symptoms and the frequency of disease relapse. During the visits, in terms of adherence to treatment and case of recurrence, the number and severity of recurrence were examined, and the results were recorded in the checklist of each patient. At the end of this period, serum vitamin D level was measured. Data were collected by a checklist and analyzed by independent samples t-test, Chi-square, and variance analysis in SPSS version 18. Results: Examining the correlation between vitamin D levels and demographic variables shows that low vitamin D levels are significantly associated with an increase in the frequency of recurrences. However, there was no significant relationship between disease duration, age, and body mass index. Among 50 patients, 23 (%46) were male, and 27 (%54) were female, with a mean age of 35.24±10.07 and a mean duration of disease for 15.14±6.67 months. The mean frequency of relapse was 1.34±1.89. The mean level of serum vitamin D was 22.30±13.45 ng/dl. It was significantly associated with the frequency of relapse with a P

ABSTRACT Background This multicenter multinational RCT designed to compare the efficacy of suppository indomethacin and NAC for prevention of PEP. Methods: During a 6-month period, all of the ERCP cases in seven referral centers were randomly assigned to receive either 1200 mg oral NAC, indomethacin suppository 100 mg, 1200 mg oral NAC plus indomethacin suppository 100 mg or placebo 2 hours before ERCP. The primary outcomes were the rate and severity of any PEP. Results: A total of 432 patients included (41.4% male). They were originally citizens of 6 countries (60.87% Caucasian). They were randomly allocated to receive either NAC (group A, 84 cases), rectal indomethacin (group B, 138 cases), NAC + rectal indomethacin (group C, 115 cases) or placebo (group D, 95 cases). The rate of PEP in groups A, B and C in comparison with placebo were 10.7%, 17.4%, 7.8% vs 20% (P=0.08, 0.614 & 0.01 respectively). The NNT for NAC, indomethacin and NAC + indomethacin was 11, 38 and 8 respectively. Conclusion: Oral NAC is more effective than rectal indomethacin when compared to placebo for prevention of PEP and the combination of NAC and Indomethacin had the lowest incidence of PEP and may have synergistic effect in preventing of PEP (IRCT20201222049798N1; 29/12/2020).

Abstract Background Neuroendocrine tumors (NETs), as a rare and heterogeneous category of solid tumors, feature various morphologies and behaviors. In recent years, the incidence of NETs has continued to increase. Endoscopic mucosal resection (EMR) is one of the therapeutic modalities for the treatment of gastric and rectal NETs. Methods We evaluated patients with well-differentiated NETs of the stomach, duodenum, or rectum between 2011 and 2018. In this study, all cases with tumors confined to the mucosal or submucosal layers and smaller than 20 mm were resected using the EMR technique. We used EUS, CT scan, or MRI to exclude patients with advanced disease. All patients were actively monitored for recurrence according to the recommended protocols. Results A total of 36 patients with NETs entered the study; 17 (47.2%) were female and the remaining 19 (52.8%) were male, with a total age range of 20–74 years (mean: 52.47 ± 13.47 years). Among the tumors, 31 cases (86.1%) were G1 and the remaining 5 (13.9%) were G2. Based on the pathology reports, 22 tumors (61.1%) were smaller than 1 cm, while the remaining 14 (38.9%) were between 1–2 cm. Twenty-two patients (61.1%) had a margin of specimen involved with the tumor. No recurrence was observed during the mean follow-up time of 63.5 ± 19.8 months (range: 39–103 months). All 36 cases survived during the study period. Conclusion Conventional EMR procedure provides low chance of R0 (complete resection) achievement in gastrointestinal NETs smaller than 20 mm and limited to the mucosa or sub mucosa. However, it could be an option if patients are closely followed. Postoperative marginal involvement is not a reliable predictor of disease recurrence, which may be explained by the deleterious effect of heat coagulation and cauterization applied during tumor removal.

Background: Iran has a high incidence rate for gastric cancer among the Middle East countries. In addition to gastric cancer, peptic ulcer is also life-threatening; thus, investigating the prevalence of Helicobacter pylori infection and other risk factors are essential. The present study was aimed to assess the frequency of H. pylori and the cagA-positive strains in patients with gastric cancer or peptic ulcer at a teaching hospital in Qom, one of the most populated cities of Iran. Materials and Methods: The presence of H. pylori was investigated in gastric cancer and peptic ulcer biopsy specimens using the standard culture method. PCR analysis was performed to detect the presence of the cagA gene. Results: The frequency of H. pylori isolates among 86 investigated biopsies was 20 (23.2%). Likewise, the rate of H. pylori was the highest when samples were examined from patients with gastric cancer (25.8%), while it was 21.8% when obtained from peptic ulcer patients. The frequency of the cagA gene in H. pylori isolates was 9 (56.2%), as confirmed by PCR. Conclusion: Our results indicated that H. Pylori infection and its virulent strains are frequent and widely spread in Qom city. The cagA gene was present in almost half of H. pylori isolates from peptic ulcer or gastric cancer patients. Therefore, it is necessary to screen it in all cases with H. pylori infection for early detection of gastric cancer.

Introduction: Emission large amounts of air pollutants can cause many problems in the environment and human health. The purpose of this review study was evaluating consequences and health effects of toxic air pollutants and expressing strategies for controlling these pollutants. Material and methods: A narrative review of the literature was done based on searched databases. All relevant studies published 1998 until 2021 gathered. According to the databases, 360 articles were retrieved. 24 studies were screened after review and 16 full-text articles entered into the analysis process. Finally, 9 articles were selected in this study. Results: The results of this study showed that industrialization, increasing urbanization, technological development, rapid population growth, increased desertification and deforestation, occurrence of dust phenomenon, uncontrolled growth of motor vehicles, entry of various pollutants and environmental degradation cause a phenomenon called air pollution. Based on the results, the toxic air pollutants causes many health endpoints in human such as respiratory disease, asthma, chronic lung disease, respiratory and cardiovascular system dysfunction, decreased immune system, headache, dizziness, gastrointestinal disease and increased risk of cancer (lung, stomach, intestine, eye, liver and brain). Conclusion: According to research related to the subject, air pollution is a positive function of energy consumption, volume of industrial activities, and the uncontrolled increase of human activities. The most vital factors are increasing the level of public awareness, reducing the exposure to toxic air pollutants, improving quality of the products and consumption of consumed fuels.

Abstract Background The role of common bile duct (CBD) stenting in the establishment of bile stream in the elderly patients and the ones who are not good candidates for surgery due to not responding to treatments was well documented in previous studies. The current study aimed at investigating the effect of adding Ursodeoxycholic acid (UDCA) to CBD stenting alone in order to reduce the size of large and multiple CBD stones. Methods Clinical outcomes including success rates in CBD stones clearance, incidence of pancreatitis, perforation, bleeding, as well as, decrease in size of stones and liver enzymes after a two-month period were assessed in the UDCA + CBD stenting group. Results A total of 64 patients referring to Shahid Beheshti Hospital in Qom, Iran with multiple or large CBD stones (above three or larger than 15 mm) received standard endoscopic therapies and UDCA + CBD stenting (group B) and controls only received standard endoscopic therapies with only CBD stenting (group A). The mean reduction in the size of stones in group B was significantly higher than that of group A (3.22 ± 1.31 vs 4.09 ± 1.87 mm) (p = 0.034). There was no difference in the incidence rate of complications including pancreatitis, cholangitis, bleeding, and perforation between the two groups (P > 0.05). Conclusion Adding UDCA to CBD stenting, due to decrease in the stone size and subsequently facilitation of the stones outlet, can be considered as the first-line treatment for patients with large and multiple CBD stones. Also, in the cases with large or multi stones may be effective in reducing size and subsequently stone retrieval. Trial registry The study protocol was approved by the Ethics Committee of Qom University of Medical Sciences (ethical code: IR.MUQ.REC.1397.075); the study was also registered in the Iranian Registry of Clinical Trials (No. IRCT20161205031252N8). This study adheres to CONSORT guidelines.

Lichen planus (LP) is a relatively uncommon, chronic inflammatory disease with idiopathic pathogenesis that usually involves skin, nails, and mucous membranes. Esophageal involvement in LP is rarely seen, despite the classification of the esophagus as a mucous membrane. Esophageal lichen planus is common in middle aged women, with symptoms such as dysphagia and odynophagia. This paper presents the case of a middle aged woman with dysphagia to solid foods. She underwent diagnostic measures including upper esophagogastroduodenoscopy which showed severe stenosis in upper and middle third of the esophagus. In multiple times, the patient underwent endoscopic dilation due to recurrence of stenosis but the effect was slight and transient. Fibrosis was reported in repeated biopsies taken from esophagus. According to clinical and endoscopic findings and a high suspicion of LP, biopsy of the lip was done which confirmed lichen planus. Due to frequent recurrence of stenosis in this area, along steroid therapy, removable fully covered stent was placed for four weeks. The patient was under follow-up for two years and the stenosis did not recur.

The factors affecting the dynamics of lengthening of symptoms and serologic responses are not well known. In order to see how the serologic responses change in relation to the clinical features, we selected a group of 472 adults with a positive IgM/IgG antibody test result from a baseline study of the anti-SARS-CoV-2 seropositivity, assessed their COVID-19 and past medical histories, and followed them up in about 3 months. Nearly one-fourth of the subjects were asymptomatic at the baseline; 12.8% subjects became symptomatic at the follow-up (FU) when 39.8% of the subjects had some persisting symptoms. At the baseline, 6.1% showed anti-SARS-CoV-2 IgM positive, 59.3% only for IgG, and 34.5% for both. At the FU, these figures declined to 0.6, 54.0, and 4.4%, respectively, with the mean IgM and IgG levels declining about 6.3 and 2.5 folds. Blood group A was consistently linked to both sustaining and flipping of the gastrointestinal (GI) and respiratory symptoms. The baseline IgM level was associated with GI symptoms and pre-existing cirrhosis in multivariate models. Both of the baseline and FU IgG levels were strongly associated with age, male, and lung involvement seen in chest computed tomography (CT)-scan. Finally, as compared with antibody decayers, IgM sustainers were found to be more anosmic [mean difference (MD): 11.5%; P = 0.047] with lower body mass index (BMI) (MD: 1.30 kg/m2; P = 0.002), while IgG sustainers were more commonly females (MD: 19.2%; P = 0.042) with shorter diarrhea duration in the FU (MD: 2.8 days; P = 0.027). Our findings indicate how the anti-SARS-CoV-2 serologic response and COVID-19 clinical presentations change in relation to each other and basic characteristics.

Background and purpose: Helicobacter pylori is a gram-negative, micro-aerophilic, and spiral-shaped bacillus. Infection with this bacterium can lead to gastritis, ulcers, and even gastric cancer. This study was conducted to evaluate the presence of the cagA gene among patients with gastritis and gastric cancer. Materials and methods: This study was performed in patients with gastritis (n=40) and gastric cancer (n=40). Presence of H. pylori infection in gastritis specimens and in cancerous tissues was investigated by urease test and Giemsa staining, respectively. Using PCR, 16S rRNA and cagA genes were investigated. Results: Pain and weight loss were the most common complaints of patients. Dyspepsia and duodenal ulcer were the most frequent endoscopic findings. According to pathologic results, intestinal-type G1 adenocarcinoma was detected in most cases. All positive-H. pylori cases were also positive for 16S rRNA. The cagA gene in patients with gastritis and stomach cancer was present in 13 (32.5%) and 11 (27.5%) cases, respectively. Conclusion: Compared to other studies, low presence of the cagA gene in Qom could be an indication of less virulent strains in this province, but, further studies are recommended to evaluate other genes.

Lead may cause toxicity in case of frequent occupational exposure or non-occupational exposure as a result of water, soil, and air pollution. Opium abuse is an important cause of lead poisoning among the people in Middle East, including Iran. Symptoms are not specific and include fatigue, impaired concentration and memory, and non-specific abdominal pain. The abdominal pain which is known as lead colic is in differential diagnosis with other common and emergent causes of abdominal pain. The key to making an accurate diagnosis in these cases, is to focus on a precise history to investigate any probable exposure. Measurement of the serum lead level will help in making definite diagnosis in suspected cases. The present article introduces a young man attending an emergency department with abdominal pain. He ignored any occupational lead exposure or opium abuse. When all clinical and para-clinical investigations failed to detect the cause of pain, serum lead level was tested which revealed lead poisoning. After taking more precise history, he finally disclosed using oral opium. He underwent treatment with Dimercaprol 10 mg 3 times per day for 5 days, then twice a day and all symptoms resolved within two weeks.

BACKGROUND Gastrointestinal endoscopic procedures are widely used for diagnostic and therapeutic measures. Analgesia and sedation/anesthesia are inseparable parts of these studies and their related complications are inevitable. METHODS In a retrograde descriptive study in Shahid Beheshti Hospital, affiliated to Qom University of Medical Sciences, Qom, Iran from March 2013 to March 2017, we gathered information regarding common anesthesia related complications and analyzed them. RESULTS 44659 procedures were performed during the study period and records of 21342 men (47.79%) and 23317 women (52.21%) were evaluated. Hemodynamic instability (9998; 22.39%), dysrhythmia (1600; 3.58%), desaturation (608; 1.36%), prolonged apnea (34; 0.08%), aspiration (43; 0.10%), postoperative nausea and vomiting (PONV) (636; 1.42%), headache (106; 0.24%), delirium (51; 0.11%), aphasia (1; 0.00%), masseter muscle spasm (1; 0.01%), myocardial infarction (2; 0.00%), and death (5; 0.01%) were seen in the patients. CONCLUSION Sedation/anesthesia is enough safe in gastrointestinal endoscopic procedures to enhance the patients’ satisfaction and cooperation. If anesthesia with spontaneous breathing and unsecure airway is selected for this purpose, vigilance of anesthesia provider will be the key element of uneventful and safe procedure.

Background and Objectives: Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD), which is identified by inflammation and damage to colonic mucosal cells and leads to ulceration and bleeding. This study aims to investigate the relation of demographic and clinical variables with the severity of the disease in patients with UC relapse. Methods: This cross sectional study was conducted on 65 patients with UC relapse referred to Shahid Beheshti hospital during 2017-2018. Demographic, clinical, and laboratory data were collected using a checklist. Data were analyzed by statistical tests of ANOVA and Chi-square. Results: In this study, among 65 participants, 35 were male and 30 were female. The mean age of the patient was 36±14 years, of whom, 40% had mild and 60% moderate and severe relapse of the disease. From all studied variables, young age (p=0.050), higher body temperature (p=0.019), higher pulse rate, lower level of hemoglobin, and higher levels of ESR and WBC (all with p

Background and Objectives: Nowadays, Silybum Marianum (Milk thistle) is used for prevention and treatment of disorders, such as liver failure, non-alcoholic fatty liver disease, diabetes, and infectious, hematologic, and skin diseases. The aim of this review study was to investigate the view of Iranian traditional medicine on this plant and its comparative analysis with new studies. Methods: In this review study, at first Silybum Marianum and its therapeutic use, were searched in Iranian traditional medicine references. Then, its therapeutic effects were studied in databases, such as PubMed, Google scholar, and SID using terms, such as diabetes, liver and kidney disease, cancer, and skin ; then, the uses of this plant in new medicine and Iranian traditional medicine, were compared. Results: In traditional medicine, Silybum marianum has been introduced as "Harshfe Barry" and uses for the treatment of liver, gallbladder, and skin diseases, swelling, and strengthening digestion; Today, in many studies, the effects of this plant have been studied, and properties, such as treatment of liver, kidney, and skin diseases, blood glucose control and lipid metabolism, strengthening the immune system and its anticancer effects have been proven. Conclusion: The results of this study showed that some of the properties of Milk thistle, such as protection and the treatment of liver diseases, treatment of skin disorders, and anticancer effects that have been proven in recent studies are referred to in traditional medicine texts; therefore, it seems that traditional medicine combinations can be useful in modern medical interventions.

Background and purpose: Bariatric surgeries are effective treatments for morbid obesity, among which sleeve gastrectomy (SG) has become more popular. One of the most serious complications of this method is anastomosis leak which is treated by reoperation or endotherapy. The use of clips is recently proposed as a safe and effective option for treatment of leaks following bariatric surgeries. This article presents the case of a woman with sepsis following sleeve gastrectomy who was diagnosed with anastomosis leak. A 57 year -old woman weighing 140 kg (BMI: 54.6) underwent sleeve gastrectomy due to menopause obesity and sleep apnea. She had abdominal pain, fever, and leukocytosis following surgery. With suspicion of surgical complications, the patient underwent gastrografin study and leakage was seen at the junction of cardia and fundus. Oral feeding stopped immediately and intravenous antibiotics started. Then, signs of sepsis were seen and the patient underwent upper GI endoscopy and the fistula was closed using an Ovesco clip. She was discharged four days later in good general situation. Anastomosis leak is a rare complication following sleeve gastrectomy which is associated with significant mortality and morbidity. Patient’s follow-up and a clinical suspicion help clinicians to make appropriate decisions for management of these patients.

Coronavirus disease 2019 (COVID-19) is a worldwide public health problem that has attracted much attention due to its clinical findings. Measurement of IgG and IgM antibodies is of great importance for researchers and it will help to develop a new diagnostic and therapeutic method in clinical care. In this cross-sectional study, we aim to measure the IgG and IgM antibody levels in 401 suspected COVID-19 volunteers. We also measure the time duration for the appearance of IgG and IgM antibodies from the onset of symptoms to sampling time. Of 401 participants enrolled in the study, 255 (63.59%) were healthy, 79 (19.70%) were a carrier, 59 (14.71%) were cured and 8 (1.99%) were borderline. Of 142 subjects diagnosed with COVID-19, 41 (28.87%) presented with gastrointestinal (GI) symptoms, 83 (58.45%) had no GI symptoms, and 18 (12.68%) were asymptomatic. According to our findings, the measurement of IgG and IgM antibodies will provide the tool for the diagnosis of COVID-19 and significantly boost research into novel diagnostic and therapeutic approaches.

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Mesenteric ischemia is a rare disease with a high rate of mortality because of the non-specific symptoms which leads to delay in diagnosis and intervention. The main symptom is abdominal pain; which has a broad list of differential diagnosis. This study introduces a 17 years old girl who presents to the emergency department with severe abdominal pain and hematemesis. Further evaluations revealed thrombosis in the mesenteric vein which leads to ischemia and gangrene of the small intestine. Her past medical history and drug history was negative, except she was taking Levonorgestrel and cyproterone acetate for a 5 months period. Since long-term treatment with oral contraceptive pills, counts as a risk factor for venous thrombosis, this case seems to be uncommon.

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in children. With increasing prevalence of childhood obesity, NAFLD is increasingly seen in children. The prevalence varies according to the population studied (race and ethnicity) and the definition of NAFLD used in the study. In Iran, the prevalence of NAFLD in obese children ranges from 50% to 55% and in the general population of children is about 17%. Most patients with NAFLD are asymptomatic. However, abdominal pain may be present in the right and upper extremity, and hepatomegaly or non-specific symptoms such as abdominal discomfort, weakness, fatigue or attention disorder may also be seen. Diagnostic methods of NAFLD include laboratory tests, biomarkers, biopsy, and imaging studies such as ultrasound, CT, MRI. There is no definitive treatment for non-alcoholic liver disease. Modification of some risk factors such as obesity, diabetes, and hyperlipidemia are often recommended, but weight loss is more beneficial. Early diagnosis of NAFLD in children and its management can reduce further complications. Therefore, in this study, we reviewed the articles published on NAFLD in children (until 2017) using electronic databases, including PubMed, ProQuest, Scopus, and Google Scholar. We reviewed the signs of NAFLD, its epidemiology, etiology, complications, laboratory findings, different diagnostic methods, treatments, and follow up procedures.

Accumulation of free fluid in the peritoneal cavity is called ascites. The first step in identifying its etiology is to determine the serum-ascites albumin gradient (SAAG). According to this parameter, a high SAAG is regarded as a gradient greater than 1.1 g/dL. This condition has some differential diagnoses such as liver cirrhosis, Budd-Chiari syndrome, heart failure, and idiopathic portal fibrosis. In the present article, we present a young man with abdominal distention due to a high SAAG. Further evaluation of the abdominal and thoracic cavity revealed a mass in the posterior mediastinum, which had compressed the inferior vena cava and left atrium and led to Budd-Chiari syndrome. Evaluation of the biopsy sample showed fibrosarcoma. Mediastinal fibrosarcomas, though rare, should be considered in the differential diagnosis of mediastinal masses.