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Background: Various studies and guidelines have been published for the interpretation of electrocardiograms (ECGs) around the world. However, there is insufficient evidence supporting the relationship between race, ethnicity, and ECG parameters in the pediatric population. Objectives: This study is a pioneering effort to create a standardized registry in Iran, aiming to determine normal electrocardiographic parameters for Iranian children. Methodology: This preliminary pilot study was a descriptive cross-sectional type. Digital electrocardiography data (with 12 leads) of 382 boys and girls aged 1–216 months (18 years) who visited 3 children’s hospitals affiliated with Mashhad University of Medical Sciences were collected over 2 years. The main ECG values examined in this study included the P, QRS, T, U waves, PR interval, QT interval, QTc interval, heart rate (HR), and PR segment. For describing quantitative data, measures of central tendency such as mean and median, and measures of dispersion including standard deviation, range, and quartiles were used. For describing qualitative variables, the percentage of frequency was used. Quantitative data descriptions were done separately by gender and age groups. Results: HR and ECG parameters by sex and age group (1 month–18 years) were measured in this study. Conclusion: Our findings differ from those of previous studies. These differences might be due to the limitations of this study, such as the sample size and the diversity of racial backgrounds. To fully comprehend these discrepancies, it is important to establish registries and conduct studies with larger sample sizes.

Abstract Objective The primary goal of this study is to discern the optimal adjuvant treatment for patients diagnosed with bacterial vaginosis, focusing on reducing recurrence rates. Methods This study is a double-blind clinical trial with no previous similar trials conducted to date. The study population consisted of non-pregnant, married women visiting teaching hospitals’ clinics in Mashhad, complaining of vaginal discharge. After informed consent and questionnaire completion, samples were obtained from vaginal discharge surrounding the cervix of clinically diagnosed bacterial vaginosis patients. Using Gram staining, a gold standard method for bacterial vaginosis diagnosis, samples were examined under a microscope according to the Nugent score. After initial treatment with metronidazole, patients were divided into two groups receiving either vaginal or oral probiotics. Results Of the 55 participating women, 20 were in the vaginal probiotic group and 35 were in the oral probiotic group. No significant demographic or clinical differences existed between groups at baseline. The Nugent score decreased from 8.5 to 3 in the vaginal group and from 9 to 3 in the oral group, suggesting the effectiveness of both treatments. While the difference between groups was not statistically significant, each group showed significant improvements from their initial states (p-value

Background: The rapid advancement of digital technology and information has revolutionized teaching approaches, research practices, and evidence retrieval in medical academic settings, highlighting the necessity for adequate digital literacy (DL) among students. This research delved into examining digital literacy and its various components within the medical sciences student population.Method: Surveys about medical sciences students’ DL and related topics were identified by searching of the Web of Science, Scopus, Embase, and PubMed databases. Meta-analysis was done using CMA V.3.3.Results: Out of the 6773 initially identified articles, 54 studies were selected for the final synthesis. The studies showed that the DL of medical science students has improved over the past two decades. However, there were differences in the components of DL, with computer literacy ranking the highest and search literacy ranking the lowest. Result of meta-analysis of 28 studies for estimation of the rate of skilled students in performing tasks using digital devices showed that most students were skilled in using Word Processing (78%) and Presentation (68%) software, while fewer were skilled in using Spreadsheets (49%) and Email (34%).Conclusion: While in recent years, medical science students have made significant progress in DL, a gap remains between their expected competency and the current situation. The COVID-19 pandemic accelerated the adoption of digital technologies for online learning, positively impacting students’ DL. This valuable experience should guide future educational practices, emphasizing continued online and blended learning, and focusing on integrating ICT courses into the medical science curriculum.

Background: During the COVID-19 pandemic, over 1.5 billion learners worldwide were deprived of access to in-person learning. Consequently, there was a significant shift towards e-learning. Social anxiety is a limiting barrier to e-learning. This study aimed to examine the level of social anxiety in e-learning environments among medical students.Method: In this descriptive-analytical cross-sectional study, 150 medical students from Mashhad University of Medical Sciences, selected through convenience sampling, completed the Social Anxiety Scale in E-Learning Environments (SASE) questionnaire. The collected data were analyzed using descriptive statistics and inferential statistics by SPSS20 software.Results: The results of this study showed that the social anxiety of students in e-learning environments was not high, with a range of (1-6). Additionally, the levels of social anxiety were higher in students without academic progress during e-learning (p=0.887) compared to students with academic progress (p=0.702), but this difference was not statistically significant. Furthermore, there was no statistically significant relationship between the level of social anxiety in e-learning environments and variables such as gender, semester, and type of study.Conclusion: Despite the lack of a statistically significant relationship between the variables of present study and social anxiety, and changes in social interaction environments, efforts to reduce the level of social anxiety among medical students and enhance learning are essential. The SASE is a valid and reliable tool for assessing social anxiety in e-learning environments.

ABSTRACT Background Cryptogenic stroke (CS), a subtype of ischemic stroke with undetermined etiology, accounts for approximately 25% of the cases. Patent foramen ovale (PFO) is an important potential cause of CS via paradoxical embolism. While transesophageal echocardiography (TEE) is the current gold standard for PFO detection, transcranial Doppler (TCD) ultrasound offers a noninvasive alternative with potential advantages in sensitivity for right‐to‐left shunt (RLS) detection. This study's main goal is to evaluate the diagnostic performance of TCD compared to TEE for PFO detection in CS patients. Methods We prospectively enrolled 110 patients aged 18–65 years with confirmed CS from 2020 to 2024. All underwent TCD screening for RLS using a standardized protocol. Subsequently, they were categorized based on a simplified version of the Spencer Logarithmic Scale, followed by confirmatory TEE. Clinical characteristics, imaging findings, TCD results, and indications for PFO closure were analyzed. Results The mean age of the cohort was 45 years, with 58.2% being males. TEE identified PFO in 44.5% (49/110) of subjects. TCD accurately detected RLS in 42 of the 49 PFO cases (85.7%) confirmed by TEE. For PFO detection, TCD demonstrated a sensitivity of 85.4%, specificity of 88.5%, PPV of 85.4%, and Youden's index of 0.73. Notably, of the seven PFO cases missed by TCD, none received percutaneous closure based on clinical criteria. Conclusions TCD exhibited high diagnostic accuracy for detecting high‐risk PFO in patients with CS when compared to the gold‐standard TEE. As a noninvasive modality, TCD may serve as an effective screening tool to identify CS patients who could potentially benefit from confirmatory TEE and subsequent PFO closure intervention. The findings support the use of TCD as a screening tool to triage CS patients for confirmatory TEE and potential PFO closure.

Background: The demanding academic and professional environment faced by medical students renders them susceptible to mental health challenges. Tailored academic advising (AA) services are crucial in catering to the distinct requirements of medical students. This study evaluates the quality of AA from the perspective of medical students and proposes improvements in the AA approach.Method: The study comprised 250 pre-clinical year students from Mashhad Medical School. A valid AA quality evaluation questionnaire was used to measure students' perception and attitude towards AA, to evaluate the performance of students and advisors, and factors affecting its quality. Chi-square, t-test, ANOVA, and logistic regression were used for data analysis.Results: Although a majority of medical students exhibited a favorable disposition towards AA, 37% acknowledged never utilizing the AA, with only 10.4% engaging in regular consultations. The satisfaction rate with AA stood at 47%. Obstacles concerning advisor performance were identified as more prevalent reasons for student discontent, including deficiencies in advisory skills, unfamiliarity with educational protocols, low time, and low motivation. Alongside academic concerns, 36% of students sought advice for psychological issues. Logistic regression analysis showed that counselors' performance, students' knowledge, and students' positive attitudes increased the rate of students using AA.Conclusion: Enhancing AA services necessitates augmenting students' awareness regarding the available support mechanisms and upgrading the skills and commitment levels of advisors. While faculty advisors play a pivotal role in career progression, the efficiency of AA services could be heightened by incorporating an assistant psychologist alongside specialized training for faculty advisors.

Abstract Background and Aims Ultrasound and computed tomography (CT) scans can be used as methods to help make a more accurate diagnosis in diseases involving the omentum and peritoneum. The present study was conducted to determine etiology and CT scan pattern of peritoneal involvement and compare it with ultrasound findings. Methods Patients referred to Ghaem and Imam Reza hospitals who had undergone CT scans and had involvement of peritoneum in abdominal CT scans were included in the study. The findings identified in the CT scan were recorded. According to the underlying cause determined by laparotomy or laparoscopy sample, each disease's most common pattern of involvement and types of patterns were examined. An ultrasound was conducted for every patient and the obtained information was analyzed. Results A total of 101 patients were included in the study, of which 61 patients (59.8%) were female and the rest were male. The most common involvement patterns in CT scans included nodular (37.6%), mixed (21.8%), and omental cake (17.8%), respectively. In 80 patients (79.2%), CT scan findings were consistent with ultrasound, but in 21 patients (20.8%), CT scan findings were not visible in ultrasound. The most common diagnoses of the patients were colorectal adenocarcinoma and gastric adenocarcinoma (20 cases, 19.8% each), followed by ovarian and uterine adenocarcinoma (19 cases, 18.8%). Conclusion The most common patterns of involvement of peritoneum in CT scans include nodular pattern, mix, and omental cake. The most common diseases that lead to the involvement of peritoneum are gastrointestinal cancers, uterine and ovarian cancers, and peritonitis.

Background Early identification of suspected developmental delays (SDDs) is crucial for planning early interventions. This study aimed to determine the prevalence of SDDs and the associated determinants in children aged 12 months in the northeast of Iran, using the Age and Stage Questionnaire-3 (ASQ-3) as the evaluative tool.Methods This study conducted an analytical cross-sectional design to investigate all children who had completed the ASQ-3 screening form at 12 months of age within the time frame of 2016–2023 in the northeast of Iran. The necessary data were extracted from the electronic health record database associated with Mashhad University of Medical Sciences. To examine the factors associated with SDDs within each domain of the ASQ-3, a multiple logistic regression model was employed, and the results were presented using ORs along with 95% CIs.Results Over 7 years, 236 476 children (96.74%) underwent routine ASQ-3 screening at 12 months. After excluding certain cases, 226 076 children (95.60%) were included. Among them, 51 593 children (22.82%) had a score below −1 SD, indicating SDD prevalence in at least one domain. The social–personal domain had the highest prevalence with 22 980 children (10.16%), while the gross motor domain had the lowest with 5650 children (2.50%). Logistic regression analysis identified strong predictors of SDDs, including hospitalisation at birth (OR=1.85, 95% CI:1.69 to 2.02), prematurity (OR=1.56, 95% CI: 1.37 to 1.79), urbanisation (OR=1.51, 95% CI: 1.45 to 1.57), boys (OR=1.36, 95% CI: 1.31 to 1.40) and lack of exclusive breast feeding until 6 months (OR=1.30, 95% CI: 1.25 to 1.34).Conclusion The prevalence of SDDs highlights the urgency for prompt action, while considering contributing factors. Policymakers can address modifiable risk factors associated with SDDs, including urbanisation risks, support programmes for immigrant families and the importance of exclusive breast feeding until 6 months. Additionally, it is recommended establishing gender-specific local standard cut-off points for the ASQ.

Introduction: Aluminum phosphide (AlP) poisoning, commonly known as rice tablet poisoning, is a lethal method of suicide with no known antidotes. Thyroid hormones have inotropic effects that can potentially reverse hemodynamic instability and improve cardiac output. This study investigated the effects of Triiodothyronine (T3) on the cardiac function of patients with aluminum phosphide poisoning.Methods: In this randomized clinical trial, 24 patients with confirmed ALP poisoning were recruited. The intervention group received T3 treatment in addition to standard treatment, while the control group received only standard treatment. Demographic variables, cardiac parameters, biochemical markers, and oxidative stress tests were evaluated.Results: The majority of participants were men (60%) in their thirties (intervention: 32±17.4 years; control: 30±11.6 years). Following treatment, both systolic and diastolic blood pressures had significantly higher mean differences in the T3 group compared to the control group (18.7±9.3, P=0.05 and 14.1±5.9, P=0.03 respectively). While both groups showed improvement in mean arterial pH, the intervention group exhibited a significantly greater improvement 12 hours after the administration of T3, which was significantly different from both the baseline and control groups (p=0.04, 0.009 respectively). Additionally, the intervention group had a lower QRS and QTc interval compared to admission time.Conclusion: Triiodothyronine administration has been shown to maintain a higher range of SBP, control cardiogenic shock, regulate metabolism, improve acidosis and blood pressure, and ultimately enhance recovery in patients with aluminum phosphide poisoning. Furthermore, it may have cardio-protective effects on these patients.

Abstract Background and Aim The present study investigated the correlation between vertebral artery hypoplasia and fetal‐type variations of posterior cerebral arteries with stroke patterns and imaging findings in individuals with posterior circulation ischemic stroke. Methods In this cross‐sectional study, patients with symptoms of acute ischemic stroke in the posterior circulation system referred to Ghaem Hospital in Mashhad between 2016 and 2022 were investigated. Demographic data, including age, gender, systemic diseases, history of previous stroke or transient ischemic attacks, and clinical manifestations of patients, were recorded using questionnaires and checklists from patient files. The results of imaging studies, including magnetic resonance imaging and computed tomography angiography, were also recorded. The obtained data were analyzed by SPSS statistical software. Results Among 974 patients suffering from posterior circulation ischemic stroke, 155 patients with an average age of 60.44 ± 13.95 years were included in the study, out of which 97 patients (62.6%) were male. Unilateral vertebral artery hypoplasia on the right, left, and bilateral hypoplasia was present in 67 (43.2%), 35 (22.6%), and 5 (3.2%) patients, respectively. There were complete unilateral fetal origin on the right in 38 (24.5%), complete unilateral on the left in 12 (7.7%), partial unilateral on the right in 12 (7.7%), partial unilateral on the left in 6 (3.9%), complete bilateral in 14 (9%), and partial bilateral in 8 (5.2%) patients. There was no significant relationship between vertebral artery hypoplasia and PCA fetal‐type variants with different ischemia locations and infarct patterns (p > 0.05). Also, there was no significant relationship between the age and gender of patients with ischemia location and infarct pattern (p > 0.05). Conclusion Despite previous evidence showing a relation between vertebral artery hypoplasia and PCA fetal‐type variants as risk factors for PC stroke, the present study did not establish a significant correlation between these factors and the location of ischemia and infarct patterns.

Abstract Background and Aims Predicting severe disease is important in provocative decision‐making for the management of patients with the coronavirus disease 2019 (COVID‐19); However, there are still some controversies about the COVID‐19's severity predicting factors. This study aimed to investigate the relationships between clinical and laboratory findings regarding COVID‐19's severity in patients admitted to a tertiary hospital in Mashhad, Iran. Methods A cross‐sectional study was conducted on patients with documented COVID‐19 infection based on the reverse transcription‐polymerase chain reaction test. Clinical symptoms, vital signs, and medical history of the patients were recorded from their medical records. Laboratory findings and computed tomography (CT) study findings were documented. Disease severity was defined based on CT scan findings. Results A total of 564 patients (58.8 ± 16.8 years old) were evaluated. The frequency of severe disease was 70.4%. There was a significant difference in heart rate (p = 0.0001), fever (p = 0.002), dyspnea (p = 0.0001), chest pain (p = 0.0001), diarrhea (p = 0.021), arthralgia (p = 0.0001), and chills (p = 0.044) as well as lymphopenia (p = 0.014), white blood cell count (p = 0.001), neutrophil count (p

Introduction: In addition to the well-known benefits of cardiopulmonary bypass (CPB), there are also certain possible risks, some of which are avoidable and some of which are accidental. In addition to CPB, potentially life-threatening consequences include human error and mechanical disruptions. The purpose of this study is to conduct a retrospective analysis of CPB accidents in Iranian cardiovascular surgery departments.Methods: This study included 151 Iranian perfusionists who were evaluated using a questionnaire created by the researchers. The questionnaire recorded all participants' demographic information as well as their experiences with human errors (e.g., perfusionist fatigue and drowsiness; errors in CPB circuit arrangement; and so on) and mechanical disturbances (cooling-warming circuit, oxygenator failure, electrical disruption, and so on). SPSS Version 16 was used to analyze all of the data.Result: 1) venous obstruction and improper venous return had the highest recurrence rate of 89.4%, 2) Removing the venous cannula and venting the venous path 86.8%, 3) 79.5% were unable to raise (ACT) more than 400. Most significant injuries were caused by clots or thrombi during CPB (2.6%), 2) failure of the oxygenator (2.6%). Most deaths were caused by an air embolism (5.29).Conclusions: Although the occurrence of human errors and mechanical disturbances cannot be predicted, they can be mitigated by the sharing of accidents and mistakes.

Objective: An imbalance has been reported in the oxidant-antioxidant system of infants with febrile convulsion. This study aimed to compare serum vitamin C levels between febrile children with or without seizures. Materials and Method: This multicenter case-control study was conducted on febrile infants and children who were referred to the pediatric emergency wards of Mashhad University of Medical Science. The subjects were equally divided into two febrile groups of case (with seizure) and control (without seizures). Visible Spectrophotometer was used to determine the total vitamin C level.Results: In total, 100 febrile children were included in this study. Based on the results, there was no statistically significant difference between the two groups in terms of age, gender, and family history of febrile convulsion (FC) (P>0.05). The mean vitamin C levels in the case and control groups were 42.73±7.2 and 78.59±11.1 µg/l, respectively. There was a significant difference between the groups regarding the vitamin C level (P

Abstract Dobutamine stress echocardiography (DSE) is a diagnostic tool for determining coronary artery disease. Considering hypotension and hypertension as important complications of DSE, we aimed to evaluate the blood pressure (BP) responses during DSE. Patients without known cardiovascular diseases who underwent DSE were included. We excluded patients who had hypertension, diabetes mellitus, a known history of cardiovascular diseases, and those taking vasoactive medications. Systolic (SBP) and diastolic (DBP) blood pressure were recorded at baseline and peak stress. We included 688 patients with an age of 57.9 ± 12.01 years. During DSE, SBP (+19.72 ± 26.51 mm Hg, p

Abstract Background The effect of right ventricular (RV) leads on tricuspid valve has been already raised concerns, especially in terms of prognostic implication. For such assessment, three-dimensional transthoracic echocardiography (3D-TTE) has been used previously but there was no data on the use of post-procedural fluoroscopy in the literature. Methods We prospectively enrolled 59 patients who underwent clinically indicated placement of pacemaker or implantable cardioverter defibrillator (ICD). Vena contracta (VC) and tricuspid regurgitation (TR) severity were measured using two-dimensional transthoracic echocardiography (2D-TTE) at baseline. Follow up 3D-TTE was performed 6 months after device implantation to assess TR severity and RV lead location. Results Lead placement position in TV was defined in 51 cases.TR VC was increased after the lead placement, compared to the baseline study (VC: 3.86 ± 2.32 vs 3.18 ± 2.39; p = 0.005), with one grade worsening in TR in 25.4% of cases. The mean changes in VC levels were 1.14 ± 0.67 mm. Among all investigated parameters, VC changes were predicted based on lead placement position only in 3D-TTE (p

Abstract Background Early detection and appropriate treatment of precancerous, mucosal changes could significantly decrease the prevalence of life-threatening gastric cancer. Biopsy of the normal-appearing mucosa to detect Helicobacter pylori and these conditions is not routinely obtained. This study assesses the prevalence and characteristics of H. pylori infection and precancerous conditions in a group of patients suffering from chronic dyspepsia who were subjected to gastric endoscopy and biopsy mapping. Methods This cross-sectional study included dyspeptic patients, not previously treated for H. pylori, undergoing esophagogastroduodenoscopy (EGD) with their gastric endoscopic biopsies obtained for examination for evidence of H. pylori infection and precancerous conditions. Demographic and clinical data on the gender, smoking, opium addiction, alcohol consumption, medication with aspirin, corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) and family history of cancer were collected by interviewing the patients and evaluating their health records. The cohort examined consisted of 585 patients with a mean (SD) age of 48.0 (14.46) years, 397 (67.9%) of whom were women. Results H. pylori infection was identified in 469 patients (80.2%) with the highest prevalence (84.2%) in those aged 40–60 years. Opium addiction correlated with a higher a H. pylori infection rate, while alcohol consumption was associated with a lower rate by Odds Ratio 1.98 (95% CI 1.11–3.52) and 0.49 (95% CI 0.26–0.92), respectively. The prevalence of intestinal metaplasia, gastric atrophy and gastric dysplasia was 15.2, 12.6 and 7.9%, respectively. Increased age, positive H. pylori infection, endoscopic abnormal findings and opium addiction showed a statistically significant association with all precancerous conditions, while NSAID consumption was negatively associated with precancerous conditions. For 121 patients (20.7% of all), the EGD examination revealed normal gastric mucosa, however, for more than half (68/121, 56.2%) of these patients, the histological evaluation showed H. pylori infection, and also signs of atrophic mucosa, intestinal metaplasia and dysplasia in 1.7, 4.1 and 1.7%, respectively. Conclusion EGD with gastric biopsy mapping should be performed even in the presence of normal-appearing mucosa, especially in dyspeptic patients older than 40 years with opium addiction in north-eastern Iran. Owing to the high prevalence of precancerous conditions and H. pylori infection among patients with dyspepsia in parts of Iran, large-scale national screening in this country should be beneficial.

Introduction: Obesity is the fifth leading cause of death worldwide. Several approaches are used for the treatment of obesity, and acupuncture has attracted attention globally in this regard. However, the therapeutic effects of acupuncture at a molecular level remain unclear. Obesity is reported to cause oxidative stress through various mechanisms. The glutathione system is one of the main antioxidant defense mechanism. The present study aimed to evaluate the effects of acupuncture on the glutathione system as the most abundant intracellular antioxidant mechanism in overweight and obese individuals. Methods: This study was conducted on 40 obese and overweight individuals with the BMI of ≥24.9 kg/m2 who were selected randomly. The participants received authentic acupuncture (case) or sham acupuncture (control) for six weeks combined with a low-calorie diet. Before and after the intervention, the activity of glutathione peroxidase, glutathione reductase, and reduced/oxidized glutathione levels were measured. Results: Higher glutathione peroxidase activity was observed in both groups after the treatment, while the increase was more significant in the case group compared to the control group (P=0.005). In addition, reduced glutathione levels were observed to increase in both groups after the treatment. Similarly, the rate of increase in the case group was more significant than the control group (P=0.02). A significant increase was also denoted in the reduced glutathione (GSH)/oxidized glutathione (GSSG) ratio in the case group compared to the control group (P=0.02). Conclusion: According to the results, the combination of acupuncture with a standard obesity diet could increase antioxidant activity in the overweight individuals. Furthermore, the approach could further prevent oxidative damage through increasing reduced glutathione and improving the GSH/GSSG ratio.

Abstract Background Self-harm is intentional harmful behavior in the context of emotional distress. Street children are boys and girls under eighteen who are forced to work or live on the streets. These children are exposed to violent situations and high-risk behaviors like self-harm. This study investigated the prevalence of self-harm in street children in Mashhad, the second Metropolis of Iran. Methods In this cross-sectional study, 98 children were assessed with a 22-item of self-harm Inventory (SHI) questionnaire. A trained social worker interviewed the participants who were referred to Mashhad Welfare Office, February-July 2020. Results The mean age of participants was 13.8 (2.3) years old, and 71.4 % of them were male. Of street children 59.2 % have had self-harming behavior, among them 8.6 % had one self-harming behavior, and others have more than one. The self-harmed people who had physical injuries, more frequent injuries were hitting (26.5 %), self-starvation (23.5 %), cutting (21.4 %), respectively. In comparison, common psychological injuries were God-distancing (29.6 %) and self-defeating thoughts (19.4 %). The most important risk factors were having a mental disorder (OR = 6.3, P = 0.002), losing parents (OR = 4.4, P = 0.01), self-harming or suicide history in relatives (OR = 3.2, P = 0.001, OR = 4.3, P = 0.03 respectively), low-educated parents (OR = 4.2, P = 002, OR = 2.8, P = 0.02 for father and mother respectively), and age-increasing (OR = 1.5, P = 0.001). Conclusions The prevalence of self-harming in street children is significantly high. Some of these children are in more high-risk conditions that face them to suffer from self-harming at a younger age. Family factors are more important in predicting self-harming and community health decision-makers should provide educational interventions and psychological support for these children and their families.

Introduction: Abnormal placental adhesion is often associated with severe life-threatening bleeding that requires peri-delivery emergency hysterectomy and can increase the risk of complications such as Disseminated intravascular coagulation, respiratory distress and renal failure for mother. This study was performed with aim to investigate the maternal and neonatal complications in patients with abnormal placental adhesion. Methods: This cross-sectional study was performed on 70 pregnant women with abnormal placental adhesion in the educational hospitals of Mashhad University of Medical Sciences in 2017-2018. Patients with abnormal placental adhesions who were diagnosed through Doppler or MRI and given a clinical diagnosis during cesarean section and then confirmed in pathology results entered the study. Data collection tool was a researcher-made checklist. Based on the pathology sample, the patients were divided into 3 groups of abnormal placental adhesions. Maternal and neonatal complications were evaluated for each group based on the amount and degree of adhesion. Qualitative data were reported as frequency and percentage. Chi-square test was used to compare their frequency distribution. One-way analysis of variance and Kruskal-Wallis tests were used to compare the means of quantitative variables. P

Background: Breast cancer is the most frequent malignancy and the leading cause of cancer-related death among women all around the world. In Iran, the mean age of the patients is approximately 10 years younger than that in other countries. We conducted the present study to assess the risk factors of breast cancer among Iranian women in Mashhad. Method: This case-control study was carried out between February 2016 and January 2018 on 460 women (230 cases and 230 controls) in the academic hospitals of Mashhad. The data from our cases and controls were collected and analyzed using SPSS version 18.0 software (SPSS Inc., Chicago, IL, USA). We employed logistic regression models and frequency tables to estimate odds ratio (OR) and to examine the predictive effect of each factor on breast cancer risk. P < 0.05 was considered to be significant. Results: According to multivariate analysis, there was significant associations between breast cancer risk and body mass index (BMI) (Odds ratio (OR), 1.1; 95% Confidence interval (CI), 1.0-1.2), age at menarche (OR, 0.56; 95% CI, 0.47-0.68), menopausal age (OR, 1.1; 95% CI, 1.0-1.1), family history of non-breast malignancies (OR, 7.9; 95% CI, 2.2-21.1), and oral contraception pills (OR, 3.1; 95% CI, 8.34- 1.16). Conclusion: This study revealed that age at menarche, family history of nonbreast cancer malignancies, BMI, menopausal age, and oral contraception pills were significantly associated with breast cancer.

Background: Cardiopulmonary bypass (CBP) prime solution in pediatric heart surgeries is critical to avoid adverse effects resulting from dilution of coagulation factors, red blood cells, and other plasma protein. This study aimed to evaluate clinical and laboratory outcomes of administration of albumin and fresh frozen plasma (FFP) in CPB prime solution in children candidates for arterial switch surgery. Methods: This cross-sectional study was performed on 30 transposition of the great arteries (TGA) patients, candidates for the arterial switch in Tehran Children's Medical Center, Iran. As CBP prime solution, 15 patients received albumin (1 gr/kg Albumin 20%) and 15 patients received FFP (15 cc/kg). also, clinical and laboratory parameters were measured in different intervals. The statistical analysis were performed by SPSS v.20. Results: The volume platelet infusion in the ICU was higher in FFP-received patients (40.00 ±20.70 ml) than albumin-received patients (26.67 ±25.82 ml; p-value =0.01). Upon entry into ICU, the mean of Hb and Hct in FFP-received patients (11.55 ±0.64 g/l and 34.44 ±2.44 %) was significantly higher than patients who received albumin (11.08 ±0.87 g/l and 31.44 ±3.97 %; p-value =0.04 for both). Upon entry into ICU and also 48 hours after admission into the ICU, the Cr level in the FFP-received group (median: 19 mg/dl) was significantly higher than the albumin-received group (median: 12 mg/dl; p-value =0.03). Conclusion: FFP in CPB prime solution reduces the hemostatic complications and infusion of blood products, as well as to stabilizes Hb and Htc. Therefore, FFP is more suitable as CPB prime solution.

Introduction: Delirium is a fluctuating type of cognitive impairment and is common in hospitalized patients and after open heart surgery has been reported up to 90%, which leads to increased risk of dementia and hospitalization costs, reduced quality of life, risk of falls. Needs long-term care and etc. Activation of the deep inflammatory response dependent on the blood response and the cardiopulmonary pump circuit is one possible reason for this. Therefore, in this study, two anti-inflammatory drugs, dexamethasone and methylprednisolone, were used in Prime solution in cardiac surgery patients and then the occurrence of delirium was evaluated Methods and Materials: In this clinical trial study with a sample volume size 43 patients in open-heart surgery by on-pump method, after random assignment to two groups including dexamethasone and methylprednisolone that were added to prime solution. Inclusion criteria were EF more than 30%, candidate for mitral valve surgery, absence of cognitive impairment and preoperative delirium and age range 30-65 years. In the first group with 21 patients received dexamethasone at a dose of 0.1 mg/ kg and in the second group with 22 patients at a dose of 0.4 mg/Kg in prime solution. Then delirium examined with standard CAM-ICU instruments after extubation and then the results were analyzed with SPSS 21 version. Results: The results showed that only 18% of patients who received methylprednisolone primer solution and 28% of patients who received dexamethasone primer solution had delirium, and this difference was non-significant (P. value: 0.448). Conclusion: In this study, the anti-inflammatory drug methylprednisolone were not superior to each other and had a similar effect on delirium

Abstract Background Prior studies have shown that meal composition may affect the metabolic responses and arterial stiffness indices, and these responses may be different in lean and obese adults. The primary objective of this study is to determine the feasibility of conducting a trial to compare the effect of three test meals in lean and obese men. Due to the lack of a comprehensive study that concurrently compares metabolic responses and vascular stiffness indices after receiving three different meals in lean and obese men, this pilot study will be conducted with a three-phase parallel design, aiming to investigate the effects of meal composition on the metabolic parameters and arterial stiffness indices of lean and obese adults. Methods This pilot, a parallel clinical trial will be performed on 24 male adults aged 18–35 years since January 2021 and will continue until March 2021 who are disease-free and selected based on the inclusion and exclusion criteria at Mashhad University of Medical Sciences, Iran. The subjects will complete three interventions at a 1-week interval, including high carbohydrate (70% carbohydrates, 10% protein, 20% fat), high protein (30% protein, 50% carbohydrates, 20% fat), and high-fat meal (50% fat, 40% carbohydrates, 10% protein). Postprandial effects will be assessed within 360 min after each meal, including the energy expenditure component (resting energy expenditure, thermic effects of feeding, respiratory quotient, and substrate oxidation) and arterial stiffness indices (augmentation index and pulse wave velocity). In addition, blood sampling will be performed to measure glucose, insulin, free fatty acids, and lipid profile. Discussion The differences in the postprandial responses can affect the metabolic and vascular parameters due to different meal compositions, thereby providing beneficial data for the establishment of new strategies in terms of nutritional education and metabolic/vascular improvement. Also, the results from this pilot study will inform intervention refinement and efficacy testing of the intervention in a larger randomized controlled trial. Trial registration Iranian Registry of Clinical Trials; code: IRCT20190818044552N1 ; registered on August 26, 2019

Objective: There are several studies reporting the therapeutic effects of Berberis vulgaris on liver diseases. This study was done with the purpose of examining the effect of B. vulgaris oxymel (BO) in patients with refractory primary sclerosing cholangitis (PSC) and primary biliary cholangitis (PBC), who did not respond to current treatment. Materials and Methods: Patients with PSC or PBC who were receiving ursodeoxycholic acid (UDCA, 13-15 mg/kg/day) for at least six months, but their serum levels of alkaline phosphatase (ALP) were still 1.5 folds higher than the normal upper limit during the last six months, were asked to participate in this quasi-experimental study. Patients were asked to take 0.5 ml/kg/day of BOtwo times a day for three months along with UDCA. At the end of the study, serum levels of ALP, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), total bilirubin (TB), direct bilirubin (DB), and creatinine as well as prothrombin time (PT), international normalized ratio (INR) and quality of life (QOL) based on PBC-40 questionnaire were assessed as outcomes. Results: Our results showed that BO notably attenuated the serum levels of ALP, AST, ALT, GGT, TB, and DB, as well as PT and INR and significantly improved QOL. Conclusion: For first time, we showed that additional therapy with BOhas a promising effect in the treatment of refractory PSC and PBC.

Background: The genus Acanthamoeba is a free-living opportunistic protozoan parasite, which widely distributed in soil and fresh water. Acanthamoeba keratitis, which causes a sight-threating infection of the cornea, is going to rise in Iran and worldwide. The aim of this study was to compare direct microscopy, culture and PCR for detection of Acanthamoeba spp. in clinical samples and to determine the genotypes of Acanthamoeba spp. by sequencing 18SrRNA gene. Methods: Among patients clinically suspected to AK referred to a tertiary ophthalmology center at Mashhad, northeastern Iran. During 2017-18, twenty corneal scrapes specimens obtained. The samples were divided into three parts, subjected to direct microscopic examination, culture onto non-nutrient agar and PCR technique. Sensitivity, specificity, accuracy and likelihood ratio were evaluated. Results: Among 20 persons clinically suspected to amoebic keratitis, 13(69.2%) patients definitely diagnosed as Acanthamoeba keratitis. Wearing contact lens, eye trauma due to foreign particle and swimming in fresh water were the main predisposing factors. Most of patients suffered from pain and photophobia. Corneal ring infiltration and epithelial defect were common clinical sings. Direct examination had the lowest sensitivity and sensitivity of both Nelson-PCR and JDP-PCR methods were equal and highest. In addition, the results of sequencing identified that all strains belonged to T4 genotype. Conclusion: Amoebic keratitis is a sporadic parasitic keratitis, which is mainly seen in contact lens user in Mashhad. PCR based on 18S ribosomal DNA with JDP primers is a reliable and highly sensitive method for diagnosis of Acanthamoeba keratitis in clinically suspected cases.

Background: Household food insecurity is defined as the limited or uncertain access to adequate and safe food or limited ability to obtain food in a socially acceptable manner. Preeclampsia is a severe case of high-risk pregnancy, which endangers the health of women across the world, especially in developing countries. The current study aimed to use the nutritional deficiencies theory in pathogenesis of preeclampsia and determine the correlation between food insecurity and preeclampsia. Methods: This case-control study was conducted on 100 women with preeclampsia and 200 normal pregnant women with the gestational age of 20 weeks. Participants were selected via purposive sampling according to the eligibility criteria. Data were collected using the USDA questionnaire for food insecurity, socioeconomic data, and demographic data through interviews. Results: The findings indicated that the frequency of food insecurity was significantly higher in the preeclampsia women than the healthy women (71% vs. 21%; P < 0.001). Logistic regression indicated that the risk of preeclampsia was six times higher among pregnant women in the unsafe food status group than those in safe food status group [odds = 6.4; 95%CI: 3.3-12.4; P < 0.001]. Among the studied variables, socioeconomic status, history of stillbirth, history of preterm delivery, and ethnicity were significantly associated with preeclampsia during pregnancy (P < 0.05). In addition, women with low socioeconomic status were twice at the higher risk of preeclampsia compared to those with favorable socioeconomic status [odds = 2.7; 95%CI: 1.1-6.2; P = 0.01]. Conclusion: The current study indicated that the prevalence of food insecurity was high in Iranian women with preeclampsia, especially those with a history of preterm labor, history of stillbirth, low socioeconomic status, or non-Persian

Introduction: Candida vulvovaginitis is one of the most common vaginal infections in women and in women with diabetes. Although C. albicans has been reported to be the most common cause of this infection, but there have been recent changes in the pattern of Candida causing Candida vulvovaginitis. This study was performed with aim to investigate the frequency of dominant Candida isolates in patients with Candida vulvovaginitis in Torbat-e Jam and its relationship with diabetes. Methods: In this cross-sectional study, 428 women with suspected Candida vulvovaginitis referred to Torbat-e-Jam medical centers were assessed in 2019. Two specimens of vaginal secretions were taken from each patient. The first specimen was cultured on sabouraud dextrose agar (SDA) medium, and the second one was directly examined using wet mount microscopy. The Candida colonies were passaged on CHROMagar Candida medium to identify the species. Demographic and diabetes characteristics of the patients were evaluated. Data were analyzed by SPSS software (version 16) and Chi-square test. p

BACKGROUND: Acute promyelocytic leukemia (APL) is a well-defined subtype of acute myeloic leukemia (AML) and known by t (15;17)(PML-RARA) mutation. About 20%–40% of AML patients indicate FMS-like tyrosine kinase 3 (FLT3) mutations. FLT3 mutations contain two famous mutations: FLT3-internal tandem duplication (ITD) and FLT3-tyrosine kinase II domain. OBJECTIVES: Many studies have been done on FLT3-ITD. In these studies have been acknowledged that the FLT3-ITD mutation had a poor prognosis of on AML patients. This study was performed on two APL and APL + FLT3-ITD groups. This study aimed to compare the differences in blood laboratory assays between APL and APL + FLT3-ITD patients. METHODS: This study contained 73 patients which divided into two groups: APL and FLT3-ITD + APL. The study methods included: cell counting and peripheral blood smear, extraction of mRNA and DNA, and cDNA synthesis electrophoresis. RESULTS: This study was ruled out on patients involved with APL in GHAEM hospital Mashhad, Iran. All patients were diagnosed with t (15;17) (PML-RARA). The age range of patients was 7–63 years (mean: 30.86). Fifty-eight (79.5%) of patients (male: 22 and female: 36) were involved solely with APL and 15 (20.5%) of them (male: 10 and female: 5) were APL + FLT3-ITD mutation. Blood parameters that were analyzed included white blood cell, red blood cell, hemoglobin, hematocrit, mean cell volume, and platelet count. Each group of patients' population was categorized into high risk factors and low risk factors. CONCLUSIONS: the consequence of the current study demonstrated that FLT3-ITD mutation had a bad effect on laboratory assays in patients involved with APL.

Background: This study was conducted to determine the prevalence and intensity of nematode infections in sheep located in northeastern Iran from Apr 2018 to Mar 2019. Methods: Gastrointestinal nematodes of 300 sheep were inspected. The season of slaughter, anatomic location where the parasite was located, the animal’s sex, infection prevalence and intensity were recorded. Seasonal differences in arrested larvae numbers also were assessed using Cochran's Q test. Results: Overall, 4,331 adult nematode specimens were collected. Among the examined sheep, 53% (159/300) were infected with one or more nematode species. Among infected sheep, 42.8% were infected with a single species of nematode, 26.4% were infected with two species of nematodes, and 30.8% were infected with three or more species of nematodes. Marshallagia marshalli (13.3%) was the most common nematode recovered from the abomasums of infected sheep, while Trichostrongylus vitrinus (4.6%) was commonly recovered from the small intestines, and Trichuris ovis (25.6%) was commonly recovered from the large intestines. In total, 463 arrested larvae were found in the abomasums of 7.5% of infected sheep and 104 arrested larvae were found in the small intestines of 8.8% of infected sheep. A significantly higher numbers of arrested larvae were found in summer compared to autumn (P

Background Different studies have confirmed the role of nutritional factors in the etiology of Multiple sclerosis (MS). However, dietary patterns associated with the risk of MS remain unknown. Objectives This study aimed to investigate the possible relationship between the existing dietary patterns and the risk of MS. Methods This case-control study was conducted in Mashhad city, Iran in 2015. In total, 197 MS patients and 200 control subjects (matched in terms of age, gender, education level, and body mass index) were enrolled in this study. The required data were collected through interviews and questionnaire completion. Moreover, the data on the usual dietary intake of each participant during the past year were evaluated using a valid and reliable semi-quantitative food frequency questionnaire (160 items). Logistic regression analysis was applied to discover the associations between dietary patterns and the risk of MS. Results Four major dietary patterns were identified in this study, including Unhealthy, Western, Healthy, and Traditional. After adjustment for smoking habits, the family history of autoimmune diseases and the duration of breastfeeding, the highest tertile of Healthy dietary pattern was found to be associated with the reduced risk of MS by 74% (OR = .26; P < .001), whereas the Unhealthy dietary pattern was associated with a three-fold increased risk of MS (OR = 3.04; P < .001). However, no correlation was observed between the Western and Traditional dietary patterns and the risk of MS. Conclusion According to the results of this study, a healthy diet may reduce the risk of MS, whereas an unhealthy dietary pattern may.

Background: Nowadays, the prevalence of onychomycosis caused by non-dermatophyte molds is increasing. As Aspergillus is the most common etiologic agents of the disease, this study was performed to evaluate the susceptibility of clinical isolates of Aspergillus as the cause of onychomycosis to itraconazole, voriconazole, and amphotericin B. Methods: This cross-sectional study was performed on 50 Aspergillus strains isolated from the patients with onychomycosis referred to diagnostic laboratories of university hospitals in Mashhad, Iran. According to the phenotypic and molecular analysis of Aspergillus isolates, the most frequent species was Aspergillus flavus (A. flavus) with 34 cases. The drug susceptibility test was performed according to Clinical and Laboratory Standards Institute-M38-A2 (CLSI-M38-A2) protocol, and the minimum inhibitory concentration (MIC) of the drugs was determined. Findings: From 50 patients with dystrophic nails, 13 were men and 37 were women. 15 patients had fungal infection of fingernails, and 33 patients had fungal infection on toenails; 2 patients had both infections of finger and toe nails. 14.7% of A. flavus isolates with MIC > 2 μg/ml to amphotericin B were considered as resistant clinical isolates. The sensitivity to itraconazole and voriconazole was 100%. MIC90 of amphotericin B, itraconazole, and voriconazole were obtained by broth microdilution method for A. flavus species as 4, 0.25, and 1 μg/ml, respectively. Significant difference was observed in MIC between itraconazole and amphotericin B (P < 0.050). Conclusion: All Aspergillus species are susceptible to itraconazole and voriconazole, and these two drugs are more effective than amphotericin B on Aspergillus species. Due to the different susceptibility of these species to antifungal agents, it is necessary to perform drug susceptibility testing in order to select the appropriate drug.

Objective(s): Coronary artery disease (CAD) is known as a life threatening disease, worldwide. In this study the role of HTLV-1 infection was evaluated on cardiac involvement in an endemic region of northeastern Iran.Materials and Methods: Serologic and molecular tests for HTLV-1 infection were carried out in subjects who had coronary angiography. A real-time PCR, TaqMan method, to quantify HTLV-1 proviral load (PVL), and routine hematological and biochemical tests were performed for study subjects. Results: Twenty nine patients were HTLV-1+CAD+ and 13 cases were HTLV-1+CAD-. Although, there were no significant differences for risk factors like FBS, HDL, triglyceride, systolic and diastolic blood pressure (Cbp, Dbp), waist circumference (WC), hip circumference (WL), cholesterol (P=0.003), and LDL (P=0.007) levels, and monocyte count (P=0.05) had meaningful differences. The mean HTLV-1 PVL in HTLV-1+CAD+ subjects was 992.62±120 which was higher compared with HTLV-1+CAD- group (406.54±302 copies/104 PBMCs). Moreover, HTLV-1 PVL in males (833±108) was lower compared with females (1218±141 copies/104 PBMCs) (P=0.05). Patients with HTLV-1-PVL of more than 500 copies/104 had more diffused atherosclerosis plaque than patients with less than 500 (OR=6.87, 95% CI=1.34-35.05; P=0.016). Furthermore, patients with diffused coronary atherosclerosis had significantly higher levels of HTLV-1 PVL than patients with middle, proximal, and normal location of coronary sclerotic lesions (PConclusion: Taken together, in endemic area, HTLV-1 infection, more likely is a facilitating factor for heart complications and the high HTLV-1 PVL might affect CAD manifestations.

Introduction: PI3K/Akt/mTOR pathway is important in inducing resistance to hormone therapy in patients with hormone positive breast cancer. One regulator of this pathway is the PTEN gene. This study was performed with aim to compare the expression of PTEN gene in hormone receptor positive breast cancer patients between patients with sensitive and resistant to tamoxifen. Methods: This cross-sectional and retrospective study was performed on 80 hormone receptor positive breast cancer patients who had referred to oncology clinics of Mashhad University of Medical Sciences from 2006 to 2016. Tissue samples of tamoxifen-sensitive and -resistant patients (recurrence/metastasis occurring during the first 5 years of adjuvant hormone therapy) were immunohistochemically evaluated for PTEN expression. Data were analyzed by SPSS software (version 16) and Independent t-test, U Mann-Whitney and chi-square tests. P

Background and Purpose: Dermatophytes are a group of fungi specialized in invading humans and other vertebrate keratinized tissues. These fungi cause a variety of skin, nail, and hair disorders, called dermatophytosis (tinea). In some cases, drug resistance to antifungals necessitates special treatment. Among the antifungal agents, sertaconazole (i.e., a third-generation imidazole) has a broad-spectrum against dermatophyte species. Regarding this, the present study was conducted to investigate the antifungal susceptibility of dermatophytes obtained from patients with dermatophytosis in Mashhad located in northeastern Iran. Materials and Methods: A total of 75 clinical dermatophyte isolates, including Trichophyton mentagrophytes (n=21), T. interdigitale (n=18), T. tonsurans (n=16), Epidermophyton floccosum (n=11), Microsporum canis (n=5), Nannizzia fulvum (n=2), T. benhamiae (n=1), and T. verrucosum (n=1), were evaluated against five antifungal agents of sertaconazole, itraconazole, clotrimazole, terbinafine, and griseofulvin based on the CLSI M38-A2 guideline. Results: According to the results, the minimum inhibitory concentration (MIC) ranges of sertaconazole, terbinafine, griseofulvin, itraconazole, and clotrimazole were estimated at 0.125-16, 0.002-1, 0.5-4, 0.031-4, and 0.016-4 μg/ml, respectively, for dermatophyte species. In addition, the geometric mean (GM) values of the MIC of sertaconazole, terbinafine, griseofulvin, itraconazole, and clotrimazole were obtained as 3.39, 1, 1.44, 1.52, and 1.93, respectively. Conclusion: Among the tested antifungals, terbinafine and griseofulvin were the most effective agents against dermatophyte isolates. However, sertaconazole, a third-generation imidazole, did not show any significant effect. Furthermore, M. canis and E. floccosum showed the best response to the antifungal agents.

Background: The accurate differentiation of perinatal torsioned ovarian cysts (PTOCs) in neonates is of utmost importance. This importance is due to the fact that if PTOCs are diagnosed properly, minimally invasive or conservative management approaches can be offered. The present study aimed to describe the ultrasound findings of PTOCs and compare the results with pathological findings.Methods: This prospective cross-sectional study was conducted in Mashhad University of Medical Sciences, Mashhad, Iran, within 2014-2019. All infants with an intra-peritoneal cyst underwent meticulous ultrasound examination. Patients were followed up until reaching the final diagnosis. In surgically approved PTOCs, the correlation between sonographic and pathologic findings was examined.Results: Twenty two cases (aged 2 days to 6 months, mean age = 6 weeks) with PTOC were diagnosed during this time. Cysts were mainly on the right side (86%) with mean diameter of 51 mm (27-73mm). The ultrasonogrphic signs of fluid debris level, triple-layer wall and wrinkled inner layer were observed in almost all of patients.The pathologic triple-layer of perinatal torsioned ovarian cysts included necrotic content with granulation, stroma, and epithelium layers was observed by ultrasound as a uni-locular cyst containing fluid debris level with an echogenic wrinkled inner layer, a hypoechoic uneven non-uniform middle layer and echogenic outer epithelial surface.Conclusion: Sonographically detected triple-layered pattern for PTOCs was completely in agreement with pathologic results. Then, this specific ultrasound pattern is pathognomonic for PTOC.

Objective: Liver transplantation is the gold standard approach for decompensated liver cirrhosis. In recent years, stem cell therapy has raised hopes that adjusting some clinical and laboratory parameters could lead to successful treatments for this disease. Cirrhotic patients may have multiple systemic abnormalities in peripheral blood and irregular cell populations in bone marrow (BM). Correcting these abnormalities before BM aspiration may improve the effectiveness of cell-based therapy of liver cirrhosis. Materials and Methods: In this controlled clinical trial study, 20 patients with decompensated liver cirrhosis were enrolled. Patients were randomly assigned to control and experimental groups. Blood samples were obtained to measure vitamin B12, folate, serum iron, total iron bonding capacity (TIBC) and ferritin before any intervention. Furthermore, the iron storage and fibrosis level in BM biopsies, as well as the percentage of different cell populations, were evaluated. Prior to cell isolation for transplantation, we performed palliative supplement therapy followed by a correction of nutritional deficiencies. Mononuclear cells (MNCs) were then isolated from BM aspirates and transfused through peripheral vein in patients in the experimental group. The model of end-stage liver disease (MELD) score, The international normalized ratio (INR), serum albumin and bilirubin levels were assessed at 0 (baseline), 3 and 6 months after cell transplantation. Results: The MELD score (P=0.0001), INR (P=0.012), bilirubin (P

Background: In the last 10 years, co-infection of human immunodeficiency virus/human T-cell leukemia virus-1 (HIV/HTLV-1) has emerged as a worldwide health problem. These viruses has the same route to infect human but different effects on CD4 positive T-cells. There was controversial results about the influence of co-infection HIV/HTLV-1 pathogenesis. This study compared clinical course and laboratory findings in HIV/HTLV-1 co-infection with HIV mono infection. Methods: This historical cohort study carried in Mashhad Consultation Center of Infective and Behavior Diseases, Mashhad, Iran, from April 2013 to march 2017. Persons who referred evaluated by the enzyme-linked immunosorbent assay (ELISA), then patients with positive ELISA test rechecked by ELISA and Western blot. Platelet count, WBC count, neutrophils count, positive CD4 T-cells, staging and disease severity evaluated at diagnosis, in starting and after of antiretroviral therapy in mono and co-infected patients. Demographic characteristics, including age, educational level, occupational state, marriage situation, past medical history and high-risk behaviors were extracted from the files. Results: Of 64 patients enrolled in this study, 61 persons were male. Of 64 participants patients, 42 persons were infected with HIV (35 persons of them were positive for hepatitis C virus), other 22 positive HIV cases, were co infected by HTLV-1 too (18 persons were positive for hepatitis C virus (HCV). Co infected patients had more history of high-risk situations specially intravenous drug abuse. The most common opportunistic infections was cryptogenic tuberculosis (TB), candidiasis and military TB. Opportunistic infections and lab findings (except for CD4 positive T-cell) were the same in both group. Clinical severity and disease staging did not differ significantly between two groups. Death was more common in co-infected group. Conclusion: Clinical course in human T-cell leukemia virus-1 (HTLV-1) co-infection has not obvious differences with previously HIV patients compare with only HIV infected patients. In co-infection with the onset of treatment the increase in the level of CD4 positive cells was higher than that HIV infection.

Background: Acute Kidney Injury (AKI) is an abrupt decrease in kidney function, leading to the retention of urea and other nitrogenous waste products. Poisoned patients admitted to the Intensive Care Unit (ICU) may develop AKI due to some reasons. This study was done to evaluate the AKI in poisoned patients admitted to ICU. Methods: 146 patients, admitted to the ICU of Imam Reza Hospital from March 2017 to March 2018 were studied. AKI status was assessed using Acute Kidney Injury Network (AKIN) and Risk, Injury, Failure, Loss of kidney function and End-stage kidney disease (RIFLE) classification. Data analysis was done through SPSS V. 22 software. Results: Opioids, organophosphates, aluminum phosphide, multiple drugs, and other types of poisoning were the main five poisoning classes. Opioid toxicity was had the highest frequency with 51 patients; cases in this group experienced longer length of hospitalization stay and higher serum creatinine level than others did. Among 146 patients, 19 patients (12.8%) died, and 97 patients (66%) were transferred to the ICU. Of all cases, 18 patients (12.3%) had renal dysfunction (six patients were at risk, five patient at injury, and seven patients were at failure phase based on the RIFLE criteria). Renal replacement therapy was required in 24 cases (16.4%). Conclusion: It is unlikely to detect a significant difference in the occurrence of AKI between the main poisoning classes. Being the largest group of intoxicated patients admitted to the ICU, the opioid poisoning had the highest rate of AKI

Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML). APL is famed with some special blood coagulation disorders such as disseminated intravascular coagulation (DIC). The therapeutic methods of APL contain All Trans Retinoic Acid (ATRA), arsenic trioxide (ATO) or/and chemotherapy. Many studies have been done on APL blood disorders and its treatment. These studies have shown different results. In this systematic article, we tried to review the effect of ATO therapy with or without ATRA and chemotherapy on DIC parameters (D.dimer, Prothrombin Time, Activated Partial Thrombin Time, Platelet count) in APL patients. The result of included studies demonstrated that although ATO can reduce the number of malignant cells in the bone marrow and peripheral blood, it does not have enough potential to attenuate the danger of high score DIC that is usual in APL patients and should be better to be used with other therapeutic methods.

Introduction. Celiac disease (CD) is a chronic and common cause of dyspepsia with a rising prevalence worldwide. This study is aimed at investigating the prevalence of CD in dyspeptic patients based on serology and biopsy, determining the associated factors, and assessing the necessity of regular duodenal biopsies from normal mucosa in diagnosis of CD among dyspeptic patients. Methods. This cross-sectional study was performed on 530 adult dyspeptic patients who underwent gastroduodenoscopy in Imam Reza hospital, Mashhad, during 2016-2018. Demographic characteristics, clinical data, and laboratory analyses were extracted from hospital records. CD was diagnosed based on intestinal biopsy and serum antitissue transglutaminase (anti-TTG) levels. Mucosal lesions were classified according to the modified Marsh classification. Data were analyzed in SPSS with P

Background. Lophomonas blattarum is a flagellate protozoan which is known as an emerging parasite in the human respiratory system. Organ transplant recipients are considered as immunocompromised patients due to prescription of immunosuppressive drugs. This group of patients is susceptible to opportunistic infection as well as lophomoniasis. This study aims to investigate the prevalence and clinical manifestation of pulmonary infections caused by L. blattarum in kidney transplant recipients. Methods. This is a case-control study including 50 kidney transplant recipients and 50 controls. The sputum samples were collected from 50 kidney transplant recipients with bronchopulmonary infection signs suspected to lophomoniasis admitted in Montaserieh and Imam Reza hospitals, Mashhad, Iran. 50 healthy individuals as the control group were matched for sex and age with case ones. The consent form, checklist, and required information were provided for each patient. All samples were microscopically examined for the flagellated protozoan, L. blattarum, using direct smear. Results. Among 50 kidney transplant recipients suspected to lophomoniasis, L. blattarum was identified in sputum samples of 4 (8%) participants of the case group including one female and three males. None of the samples were positive among the control group. Symptoms in patients of this study were high fever (4 out of 4 patients), cough (3 out of 4 patients), and dyspnea (2 out of 4 patients). Three patients showed a positive response to metronidazole treatment. Conclusion. The results of this study suggest that L. blattarum should be considered as a pathogenic agent in kidney transplant recipients. It is necessary to examine sputum samples in posttransplant pneumonia patients, especially in those resistant to antibacterial therapy.

Introduction: Galectin-3 is known as a biomarker in patients with heart failure. This protein participates in different mechanisms involved in atherosclerosis including inflammation and plaque formation. This study was conducted to investigate whether this factor could be a predictive biomarker for the severity of atherosclerosis. Materials and Methods: The study group consisted of 80 patients with coronary atherosclerosis referred to the Department of Cardiac Surgery of Ghaem Hospital, affiliated to Mashhad University of Medical Sciences, Mashhad, Iran. The serum level of galectin-3 was measured using a commercial enzyme-linked immunosorbent assay kit. The severity of coronary artery disease (CAD), evaluated by the serum levels of galectin-3, was expressed as the number of involved vessels. Results: Galectin-3 concentration was directly correlated with the number of involved vessels.The serum level of galectin-3 was significantly higher in patients with four involved vessels (20.76±7.20 ng/ml) than those with three-vessel disease (14.31±4.45 ng/ml; P

Background: Empathy is one of the essential components of physician-patient relationship that has a significant effect on treatment outcomes. Objective: The aim of this study was to assess the empathy score among medical students in Mashhad, Iran. Methods: In this cross-sectional study in 2015, 624 medical students at Mashhad University of Medical Science (Iran) completed the Jefferson Scale of Physician Empathy (JSPE). Data were analyzed by SPSS ver. 16, using independent-samples t-test, Chi-square, MANOVA, Spearman correlation, and Confirmatory factor analysis. Results: Of the 38.4% males and 65% females who participated in this study, the mean score of JSPE in the sample was 103.67 (±15.34) which was higher in women than in men. Also, the mean scores for each of the three factors of the scale were calculated. The total empathy score, compassionate care, and taking perspectives among different age groups were significant (p=0.000). Furthermore, students having high interest in their field were more empathic (p=0.008). Empathy of interns in relation to three areas of basic sciences (the first year, the second year and the first half of the third year), physiopathology (the second half of the third year, and the fourth year), and clinical trainings (the fifth year, and the first half of the sixth year), experienced significant reduction (p≤0.001). Conclusions: This study showed that empathy was higher in women in their first medical year and who were of younger age. The overall rate of empathy in the basic sciences period was more than that in the clinical period. Therefore, the initial exposure to clinical education, especially patient education and empathy, has a very prominent effect on the ability of medical students.

Background and purpose: Cutaneous leishmaniasis is endemic parasitic disease in different regions of the world especially in Iran. Khorasan province is endemic for anthroponootic and zoonotic cutaneous leishmaniasis with unequal outbreak. Identification of species could have important implications for the disease and reservoirs control and finding the epidemiologic map. There is no study on this protozoa disease in Fariman, northeast Iran. The aim of this study was to determine the protozoa genotyping in this area. Materials and methods: A cross-sectional study was done in 50 suspected cases in Fariman 2015-2016. After light microscope checking, scrapings from all smears were done for DNA extraction and species identification was done using kDNA- PCR. Results: Among 50 suspected cases, 40 patients (80%) were found positive with direct smears and 42 (84%) were identified by PCR. Leishmania tropica was identified in 13 (31%) and 29 (69%) were infected with Leishmania major. Two negative smears were positive with PCR. The disease mainly involved those aged 11-20 years (28.6%) and the most common site of lesions was hands (38.1%) as ulcerative form (58%). From 13 cases of Leishmania tropica 75% and 25% were in urban and rural districts, respectively. Also, from 29 cases of Leishmania major 17.2% and 82.8% were in urban and rural districts, respectively. This difference was statistically significant (P= 0.004). Conclusion: Fariman is a zoonotic leishmaniasis foci in northeast Iran. Further studies on disease reservoirs and vectors seems necessary to control and reduce the number of people affected.

Introduction: Breast cancer is the most common cancer among women. Mammography is the standard method for breast cancer screening, while it has lower sensitivity in the patients with dense breasts. Therefore, women with dense breasts could be screened with other imaging modalities, such as ultrasound. The present study aimed to evaluate the ultrasonography findings in the women with dense breasts in mammography. Methods: This cross-sectional, descriptive-analytical study was conducted on all the women with dense breasts in mammogram screening at Imam Reza Hospital in Mashhad, Iran during March 2015-February 2016. Ultrasonography findings of each patient were recorded, including fibrocystic or mass changes, description of mass imaging, and sonographic BI-RADS. Data analysis was performed in SPSS version 16 using the Chi-square test at the significance level of P

Anogenital warts (AGW) are one of the most common venereal diseases. Psychosocial complications and quality of life (QoL) of AGW patients have been considered only in recent years. Herein, the QoL and psychopathology in patients with AGW are evaluated. In total, 37 AGW patients and 37 healthy controls were recruited in the present cross-sectional study. All participants were provided with the symptom checklist 90-R (SCL-90-R) and short-form (SF-36) questionnaires. All analyses were performed using the SPSS software, version 16.0.1 for Windows. QoL was not significantly different between the study groups (P=0.12). The data showed that mental health, general health, and social functioning were significantly decreased in AGW patients (P

Background: In women’s health, literacy determines their participation in self and family health promotion. Low health literacy is as barrier for understanding medical recommendations, disease prevention and health care. Aim: To assess women’s health literacy and relative factors in Mashhad (Iran). Methods: Women referring to healthcare centers in Mashhad in 2012 and 2013, participated in this cross- sectional study by stratified sampling method. The validated Persian version of Rapid Estimate of Adult Literacy in Medicine-revised questionnaire was used. Vocabulary comprehension and reading scores of health literacy was assessed. Comparisons were done in demographic subgroups by ANOVA, Mann-Whitney U, Kruskal-Wallis, Pearson correlation coefficient, and Chi-Square tests. Results: In total, 250 women with a mean age of 32.1±10.23 years and the mean education level of 10.58±3.67 years were studied. The mean reading score was 11.58±2.51 and the mean vocabulary comprehension score was 17.24±4.73. Participants' health literacy score had positive correlation with age and education, and significant difference in health literacy scores between occupational groups was seen. Housewives' health literacy scores were lower than others (p

Introduction: Preeclampsia is a multisystem disorder with unknown etiology which raises the risk of developing cardiovascular diseases in later life. On the other hand , recent studies have shown that increase in Carotid intima-media thickness (IMT) could be an independent predictor for early detection of atherosclerotic cardiovascular Diseases. According to Endothelial dysfunction as a common pathogenetic mechanism in preeclampsia and atherosclerotic process, we compared the carotid IMT of women with preeclampsia to healthy controls. Methods and Materials: In this cross-sectional study in the years 1394-95, IMT of common carotid artery was measured by ultrasonography in 30 pregnant women who admitted due to preeclampsia , 30 healthy pregnant women and 30 healthy non-pregnant women who were matched for age and gestational age. Then the data were coded and imputed to the software. Statistical analysis was done using SPSS software (version 11.5) and appropriate statistical tests. The level of statistical significance considerate as lower than 0.05. Results: The Mean IMT of carotid arteries was 0.77 ± 0.29 mm in pregnant women with preeclampsia , 0.52± 0.09 mm in healthy normotensive pregnant women and 0.55± 0.07 mm in healthy non-pregnant women with significant statistical difference among three groups.p value:

Background and Aim: Gentle music has relaxing and pain reducing effects. In this study, the effect of music on patients' vital signs and pain was investigated before and after endoscopy. Methods: This clinical trial study was conducted on 100 children from seven to fourteen years of age in Gha'em Hospital, Mashhad in 2015. Children were divided into two equal groups (case group=50 and control group=50). The control group received endoscopy according to the standards, without any other procedure. For the case group, a classic musical piece by Clayderman was played during endoscopy (from the time of entering the endoscopy room to the end of the process). After conducting endoscopy, FALCC scale and Baker-Wong pain scale were filled for both groups. In addition, children's vital signs including: heart rate (pulse), diastolic and systolic blood pressure were measured before and after endoscopy for both groups. Data analysis was conducted using SPSS16 with the help of Mann-Whitney and Chi-square tests. Results: No significant difference was found in age, gender distribution of case or control groups (p>0.05). Heart rate and diastolic blood pressure was significantly lower in the music (case) group compared to the control group before endoscopy (p=0.012). In addition, pain score in patients of the music group was lower than the control group (p

Introduction: Providing appropriate care, in the right place and at the right time, is the main goal of emergency medical services (EMS) to save lives. The present study aimed to assess the pre-hospital EMS in Mashhad, the second largest metropolis in Iran. Materials and Methods: In this research, data were extracted from the pre-hospital emergency mission forms, which were collected from the EMS stations in Mashhad and suburbs through systematic random sampling. In addition, supplementary information was obtained from the ambulance dispatch cards and emergency communication center forms. Results:Automobile accidents (33.7%) and cardiovascular events (17.8%) were the most common causes of contacts to the EMS. In the city and road stations, the mean response time was 2.6 and 1.6 minutes, while the mean time of arrival at the scene was 13.2 and 11.4 minutes, and the mean evacuation time was 13.2 and 11.4 minutes, respectively. Individuals aged 20-29 (25.2%) and more than 60 years (23.9%) constituted the majority of the cases receiving EMS. Conclusion: According to the results, the ‘golden time’ for emergency care was of great importance in the patients injured in car accidents or affected by cardiovascular events. Furthermore, a significant difference was observed in the time indices of EMS in Mashhad city with the EMS standards due to the lack of human resources or EMS facilities. Some contacts to the EMS were unnecessary, and no expert team aid was needed in some cases. It is recommended that citizens be trained on solving the problems associated with road traffic by implementing mobile emergency, while transfer units must be established for the better provision of emergency care by the EMS in Mashhad.