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Background: Ensuring consistent adherence to antiretroviral therapy (ART) is crucial for effective HIV treatment and achieving viral suppression. Within prisons, the prevalence of HIV is notably high, and incarcerated individuals face an increased risk of transmitting the virus both during and after incarceration. However, facilitators and barriers to ART adherence among these individuals in low- and middle-income countries remain inadequately explored. This study applied the Social Ecological Model (SEM) to investigate how various individual, interpersonal, organizational, community and policy-level factors impact ART adherence among incarcerated populations in Iran during and post-incarceration., Methods: This study employed a phenomenological qualitative approach using semi-structured interviews to gather insights. The research population consisted of people living with HIV (PLHIV) who had experienced incarceration and had been prescribed ART during their latest incarceration. Eleven PLHIV from two prisons located in Kerman and Tehran, Iran, formed the study group. Qualitative findings from the interviews were analyzed using a thematic approach. The findings were organized within the SEM framework to highlight key themes influencing ART adherence during and after incarceration., Results: Participants had an average age of 45.1 years (± 5.6). Various factors influence ART adherence during and post-incarceration. Participants highlighted the individual (e.g., HIV knowledge, previous treatment history, mental and physical health), interpersonal (e.g., family, friends, other incarcerated people, and prison health staff), organizational (e.g., ART treatment interventions, methadone maintenance therapy, and other health protocols), community (e.g., stigma, social isolation, discrimination and lack of access to community health services), and policy (e.g., financial interventions, and providing shelters) level factors influence ART adherence during and post-incarceration., Conclusions: This study provides insights into the multi-level approach to ART adherence among PLHIV during and post-incarceration. It recommends implementing public health activities at the proposed multi-levels to maximize the synergies of intervention for the greatest impact., Competing Interests: Declarations. Ethics approval and consent to participate: Participation in this study was entirely voluntary and oral consent was acquired at the beginning of qualitative interviews. The Research Ethics Committee of Kerman University of Medical Sciences has approved the project following the tenets of the Helsinki Declaration and the national ethical guideline for medical research (IR.KMU.REC.1400.674). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background and Purpose: Despite the increasing integration of information technologies in healthcare settings, limited attention has been given to understanding technostress among health practitioners in hospitals. This study aims to assess the prevalence of technostress creators among health practitioners and explore potential factors contributing to its occurrence, with the ultimate goal of informing strategies to mitigate its impact., Method: Data were collected through a validated questionnaire administered to health practitioners at Tehran Apadana Hospital in Iran. The questionnaire encompassed demographic information and technostress assessment items. Statistical analysis was conducted using SPSS software to examine the relationship between technostress levels and demographic characteristics., Findings: The analysis revealed that approximately 41% of health practitioners experienced medium levels of technostress, with 36% reporting high levels and 23% reporting low levels (χ2F = 55.4; p < 0.001). Notably, technology uncertainty emerged as the primary driver of technostress, followed by techno-overload, techno-complexity, techno-insecurity, and techno-invasion. Surprisingly, no significant relationship was found between technostress levels and demographic characteristics., Conclusion: The study underscores the pressing need to address the prevalent medium to high levels of technostress among health practitioners in hospital environments. By shedding light on the key stressors and their distribution, these findings can inform human resources management strategies within healthcare systems to effectively support practitioners in navigating and managing technostress challenges., Competing Interests: Declarations. Ethics approval and consent to participate: In the research study conducted, informed consent was obtained from the provider participants who completed the questionnaires. Participants were assured that their information would be kept confidential throughout all phases of the study, and their privacy was respected. The Tarbiat Modares University Ethics Committee/IRB has waived the requirement for ethical approval for this study, as it did not involve patients. All methods employed in the study were conducted in accordance with relevant guidelines and regulations, including adherence to the Declaration of Helsinki. Confidentiality of participant information was maintained, and all procedures were carried out with the utmost respect for ethical considerations and participant rights. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Vitamin K2 is an essential nutrient for blood coagulation and cardiovascular health and mainly produced by bacteria strain like B. subtilis. researchers have explored producing strain improvement, cultivation mode, environmental optimization, increased secretion, and using cheaper carbon and nitrogen sources in order to increase vitamin K2 productivity. This study examines the impact of varioius concentration of soapstock, which is a by-product of vegetable oil refining, as an alternative carbon source with lower pirce, in the fermentation medium instead of glycerol on the microbial synthesis of vitamin K2 using B. subtilis natto ATCC 23857., Results: The results demonstrate that when the glycerol in fermentation medium was substituted with soapstock, by 75% concentartion, the fermentation process produced a yield of 158.16 mg/L of vitamin K2 after 72 h; This was 3.8 times more than the control medium containing glycerol. When the entire culture medium was replaced with wastewater, the vitamin K2 concentration reached 21.18 mg/L, 52% of the control medium's concentration. If the carbon sources in the fermentation medium consisted of 20% soapstock and 47.4 g/L glycerol (maintaining the same final glycerol concentration as the control medium), the vitamin K2 concentration reached 35.7 mg/L or 85.8% of the control medium. The analysis of soapstock fermentation medium characteristics reveals that after fermentation with B. subtilis, the COD of soapstock fermentation medium was dramatically reduced from 259,500 mg/L to 57,830 mg/L., Conclusions: Using soapstock as an alternative carbon source for fermentation did not negatively impact the bioprocess and increased vitamin K2 production. Therefore, this research introduces an alternative carbon resource for vitamin K2 production and paves the way for the biorefinement of soapstock., Competing Interests: Declarations. Ethics approval and consent to participate: Ethics approval is not applicable as this article does not describe any studies involving human participants or animals. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Parkinson's disease (PD) is a neurodegenerative disorder that affects millions of people worldwide. Mobile technologies enable Parkinson's patients to improve their quality of life, manage symptoms, and enhance overall well-being through various applications (apps). There is no integrated list of specific capabilities available to cater to the unique needs of Parkinson's patient-focused mobile apps., Objective: This study aimed to identify the key features and capabilities prioritized in developing mobile apps for patients with Parkinson's disease (PWP) and rank the related apps in this field., Methods: We searched iTunes and Google Play for PWP apps with "Parkinson" or "Parkinson's" in their title or description. We evaluated existing mobile apps through a four-step process: identification, screening, eligibility, and feature analysis. We installed apps on Android and iOS devices, categorized their features/capabilities by the "use case model" and other additional identified features. We scored them using a tool called FARM (Feature-based Application Rating Method) and ranked PWP-related apps., Results: Thirty-three apps related to the PWP were included and evaluated. Almost half of the apps were available on both the Android and iOS platforms. Seventy-five percent of the genres were associated with health and fitness. Although the included apps utilized certain features, none of the capabilities were used simultaneously. According to the experts' opinions, 'large font' was the most important feature and was utilized in 70% of the mobile applications. Additionally, the average score for all Parkinson's disease-related applications was 17.71 (SD = 7.92). The app titled 'Swiss Parkinson' had the highest score., Conclusions: Integrating a relevant list of features used for Parkinson's patients' applications yielded valuable insights for the design of mobile applications tailored to patients' needs. These features are highly efficient in dealing with the specific obstacles related to this disease., Competing Interests: Declarations. Ethics approval and consent to participate: In this study, all apps were downloaded directly from the Google Play Store and App Store, and no apps were downloaded illegally. This study was approved by the Research Ethics Committee of the Kerman University of Medical Sciences (I.D. approved: IR.KMU.REC.1401.551). We confirm that all methods were performed in accordance with the relevant guidelines and regulations. We did not include individuals as study participants, so there was no requirement for informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: This study aimed to evaluate the psychometric properties of the Persian version of the Study Anxiety Questionnaire (SAQ)., Methods: This methodological study was conducted in 2024 among 380 medical sciences students at Shahroud University of Medical Sciences, Iran. The face and content validity of the questionnaire were assessed using both quantitative and qualitative approaches following a forward-backward translation process. After confirming the adequacy of the sample, explanatory and confirmatory factor analysis was performed. Convergent and discriminant validity were evaluated using the average variance extracted (AVE), maximum shared squared variance (MSV), composite reliability (CR) values and Heterotrait-Monotrait (HTMT) ratio. To determine reliability, internal consistency was assessed using Cronbach's alpha and Macdonald's omega coefficients, while stability was measured using the intraclass correlation coefficient., Results: No items were removed during the content validity phase. The Maximum Likelihood Exploratory Factor Analysis (MLEFA) identified four components of the SAQ (Motivational, Academic anxiety, Cognitive, and Test anxiety) comprising 19 items in total, which collectively accounted for 51.42% of the total variance. The confirmatory factor analysis results indicated a good fit for the 19-item model of the questionnaire. The AVE, CR, and HTMT values indicate acceptable levels of convergent and discriminant validity. The Cronbach's alpha, Macdonald's omega, and intraclass correlation coefficients were all within acceptable ranges, indicating strong internal consistency and stability for the Persian version of the SAQ., Conclusion: The findings of this study suggest that the Persian version of the SAQ possesses sufficient validity and reliability for assessing study anxiety among Iranian medical sciences students., Competing Interests: Declarations. Ethics approval and consent to participate: This study was carried out in compliance with the principles of the Declaration of Helsinki and was approved by the Ethics Council for Biomedical Research at Shahroud University of Medical Sciences (Approval Number: IR.SHMU.REC.1402.033). Prior to the study’s commencement, participants were thoroughly informed about its objectives and the terms of their involvement. Written informed consent was obtained from each participant. The authors adhered to the guidelines of the Committee on Publication Ethics (COPE) in disseminating their findings. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Motor coordination (MC) is one of the main components of motor competence. Children with Intellectual disabilities (ID) usually have weaknesses in MC and related components. Therefore, the aim of study was to investigate the effect of mini-basketball training (MBT) versus general physical education programs on improving the motor coordination of children with intellectual disabilities ID., Methods: The current study was a semi-experimental and practical research, with a pre-test-post-test design with a control group. The Participants of this study consisted of 30 boy children with ID (aged 11.53 ± 1.87 years old). Then they were randomly assigned to two groups: control (n = 15) and experimental or MBT (n = 15). A developmental coordination disorder (DCD) questionnaire was used to identify DCD, and the Körperkoordinationstest für Kinder (KTK) test was used to evaluate MC. The experimental group performed MBT for 45 min, 3 times/week for 8 weeks. The control group only participated in general physical education programs. The data were analyzed by means of 2 × 2 repeated measures ANOVA followed by post hoc comparison (Bonferroni) at the significance level of (P < 0.05). The statistical analysis was done using SPSS, 25., Results: The results showed that there was a significant difference between the MBT (experimental) and control groups in variables of the walking backwards (F = 25.36; P = 0.001; ES = 0.47), vertical hopping (F = 7.15; P = 0.01; ES = 0.20), lateral jumping (F = 26.83; P = 0.001; ES = 0.48), lateral movement (F = 9.77; P = 0.004; ES = 0.25) and overall score of KTK (F = 27.37; P = 0.001; ES = 0.49)., Conclusion: The results showed that the use of MBT, which is considered a type of sports game, could improve the global motor coordination of the children with ID and DCD. Based on the results, coaches and therapists are advised to use MBT for improving the MC of this population., Trial Registration: No IRCT20190425043370N2 (date of registration on January 10, 2024). registered in the Iranian Registry of Clinical Trials., Competing Interests: Declarations. Ethics approval and consent to participate: All experimental procedures followed the principles of the Helsinki Declaration and were approved by the Ethics Committee in Biomedical Research (ETHICS), Guilan University. (ID IR.GUILAN.REC.1402.063). This research study followed the guidelines set by CONSORT for randomized controlled trials and was duly registered in the Iranian Registry of Clinical Trials (ID: IRCT20190425043370N2, on 10/01/2024). Prior to participation, subjects and their legal representatives provided both verbal and written informed consent after gaining a comprehensive understanding of the experimental protocol along with its potential advantages and drawbacks. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: With the advances in the adhesive science, several conservative treatment options such as non-retentive overlays have been suggested for endodontically treated posterior teeth. However, information is scarce regarding the fracture strength and adaptation of non-retentive overlays compared with endocrowns, and the effect of material type in this respect. Thus, this study aimed to assess the fracture strength and internal and marginal adaptation of lithium disilicate (LDS) and hybrid ceramic endocrowns and non-retentive overlays for endodontically treated molar teeth., Methods: This in vitro study was conducted on 40 endodontically treated molar teeth that were randomly assigned to 4 groups based on the restoration type and material type (n = 10): LDS and hybrid ceramic endocrowns, and LDS and hybrid ceramic non-retentive overlays. The internal and marginal adaptation of restorations were assessed by the silicone replica technique. After cementation and thermomechanical loading, the fracture strength was measured, and the failure mode was determined. Data were analyzed by two-way ANOVA with pairwise comparisons with the Tukey's test, and Fisher's exact test (α = 0.05)., Results: The highest mean marginal and internal gaps were recorded in hybrid ceramic endocrowns, followed by LDS endocrowns, hybrid ceramic overlays, and LDS overlays. All pairwise comparisons revealed significant differences (P < 0.001) except the two endocrown groups, which were not significantly different regarding internal gap (P = 0.998). The mean fracture strength was the lowest in hybrid ceramic endocrowns, followed by hybrid ceramic overlays, LDS endocrowns, and LDS overlays. All pairwise comparisons revealed significant differences (P < 0.05) expect the two hybrid ceramic groups (P = 0.180). No significant difference was found in the failure mode among the groups (P = 0.312)., Conclusions: Type of restoration and material significantly influenced both adaptation and fracture strength. Specifically, LDS overlays on endodontically treated molar teeth yielded the highest fracture strength and superior internal and marginal adaptation in comparison with other material., Competing Interests: Declarations. Ethics approval and consent to participate: All experimental protocols were approved by Research Ethics Committees of Guilan university of medical sciences. All methods were carried out in accordance to the ethical principles and the national norms and standards for conducting Medical Research in Iran. Ethics code is IR.GUMS.REC.1402.278. Informed consent to participate was obtained from all of the participants in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Achieving a stable bond with zirconia requires mechanical and chemical bonding methods. Information regarding the optimal treatment method for zirconia with varying yttrium content is scarce. This study evaluated the effect of different surface treatments on the shear bond strength of zirconia with various yttria contents., Materials and Methods: A total of 168 disc-shaped zirconia specimens were classified into 12 groups based on the surface treatment method, including airborne-particle abrasion (APA), selective infiltration etching (SIE), hot etching (HE), and control group with no treatment; and yttria contents including Zolid Zi (4.5-5.6 wt% yttrium), Zolid HT White (6.7-7.2 wt% yttrium), and Ceramill Zolid FX (9.15-9.55 wt% yttrium). The surface roughness (Ra and Rz) of the specimens and the shear bond strength was measured (α = 0.05)., Results: The results indicated that the mean bond strength of all specimens was higher after different surface treatments compared to the control group, of which the APA method resulted in higher bonding strength in all kinds of zirconia than other methods (P < 0.05). In all types of zirconia, a significant difference was observed in surface roughness (Ra and Rz) resulting from various surface treatment methods (P < 0.001). Interaction of surface treatment methods and zirconia type significantly affected shear bond strength and surface roughness (P < 0.05)., Conclusion: APA significantly enhanced shear bond strength and surface roughness across all zirconia types and yttria contents. The SIE and HE methods also showed promising results. Zolid Zi showed superior bond strength, whereas Zolid FX demonstrated reduced bond strength., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the ethical committee of the Guilan University of Medical Sciences, Rasht, Iran [IR.GUMS.REC.1400.262]. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Declaration of generative AI in scientific writing: While preparing this work, the author used ChatGPT to improve the manuscript’s language., (© 2024. The Author(s).)

Background: This study aimed to evaluate the psychometric properties of the Persian version of The Bullying Behaviors in Nursing Education (BBNE) scale among Iranian nursing students., Method: In this cross-sectional study, 366 undergraduate nursing students from two public universities in Iran were selected through convenience sampling from April to June 2023. The BBNE scale was translated into Persian, and its content and construct validity, internal consistency and reliability were evaluated., Results: The three extracted factors explained 53.22% of the total variance. The results supported the three-factor model of the BBNE with acceptable goodness-of-fit (χ 2 (112) = 368.59, χ 2 /df = 3.2, CFI = 0.92, IFI = 0.92, TLI = 0.91, PCFI = 0.76, PNFI = 0.74 and RMSEA = 0.079 [CI90%: 0.07, 0.08], good internal consistency (> 0.7), and convergent and discriminant validity., Conclusion: The results supported the three-factor model of the BBNE with acceptable goodness-of-fit, good internal consistency and construct reliability. In order to reduce and eliminate bullying behaviors in the university environment, we should first measure the bullying behavior among nursing students and then teach them how to deal with the consequences., Competing Interests: Declarations. Ethics approval and consent to participate: Online informed consent was obtained from all participants. The participants were informed that they have no obligation to answer the questionnaire, confidential and anonymous information will be published as a group. Participants could not view the online questionnaire items until they clicked the agree button. All methods were carried out in accordance with relevant guidelines and regulation under the Ethics approval and consent to participate. Consent for publication: Not applicable Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Cyclophosphamide is a widely utilized chemotherapeutic agent for pediatric cancers, known to elicit adverse effects, including perturbation of the PI3K/Akt/mTOR and Hippo signaling pathways, thereby diminishing ovarian reserve and fertility potential in females. Consequently, this investigation delves into the mitigative effects of metformin on cyclophosphamide-induced ovarian impairment in prepubertal mice., Methods: Twenty-four 14-day-old NMRI female mice were distributed into four groups: Control (Cont), Cyclophosphamide (Cyc), Metformin (Met), and Metformin plus Cyclophosphamide (Met-Cyc). The Met-Cyc group was given daily doses of 150 mg/kg metformin for 11 consecutive days and in parallel 3 intermittent doses of 65 mg/kg cyclophosphamide once every three days. The Met and Cyc groups were given identical doses of Met or Cyc alone. The control group received normal saline treatment. On the 12 th day, mice were sacrificed for analysis. Stereological methods were employed to measure the overall volume of the ovaries, including the medulla, cortex, and follicles, along with measuring anti-Müllerian hormone (AMH) levels using an ELISA kit. Furthermore, qRT-PCR was utilized to quantify the expression levels of genes, including P53, Bax, Bcl-2, Rad-51, Pten, Mtor, and Yap-1., Results: The findings demonstrate that metformin ameliorates cyclophosphamide-induced ovarian toxicity by increasing AMH levels and attenuating the excessive activation of primordial follicles, the ratio of growing to quiescent follicles, and follicular atresia. This protective effect is mediated by the downregulation of apoptosis-related genes, upregulation of the gene involved in a reparative pathway, and modulation of the PI3K/Akt/mTOR pathway evidenced by increased expression of Pten, Mtor and Hippo pathway by Yap-1 expression., Conclusions: Our results advocate for the potential of metformin as a viable therapeutic option for preserving ovarian function in cyclophosphamide-treated adolescent girls, given its favorable side effect profile and ability to improve cyclophosphamide-induced ovarian damage., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by Royan Institute (approval ID: IR.ACECR.ROYAN.REC.1399.124). Consent for publication: Not applicable.  Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: This retrospective study aimed to compare optic disc vasculature changes in 1 and 3 months after treatment with either panretinal photocoagulation (PRP) or Intravitreal bevacizumab (IVB) in patients with diabetic retinopathy., Methods: A total of 50 eyes of 29 diabetic patients without severe complications were included in this comparative case series. Of these, twenty-eight eyes (15 patients) were assigned to the PRP group, while twenty-two eyes (14 patients) were treated with the biosimilar (IVB) (Stivant ® CinnaGen Co., Iran). Optical tomography angiography (OCTA) was performed to measure optic disc vascular density (VD) as well as retinal nerve fiber layer (RNFL) thickness., Results: The mean age of the enrolled patients was 62.1 ± 8.3 years (40 to 78 years). During follow-up, whole disc VD, inside disc VD and peripapillary VD decreased significantly in the PRP group at month 1 (p = 0.032, p = 0.32, and p = 0.016, respectively) and month 3 (p = 0.004, p = 0.001 and p = 0.011, respectively). There was an insignificant and slight increase for these parameters in the IVB group. (p > 0.05 for all) A comparison of two treatment arms based on mean whole disc VD, inside disc VD, and peripapillary VD changes revealed a significant difference at month 1 (p = 0.009, p = 0.019, and p = 0.002, respectively) and month 3 (p = 0.002, p = 0.015, and p = 0.009, respectively). Peripapillary RNFL thickness increased in the PRP group at month 1 (p = 0.002) and then decreased at month 3 (p = 0.001). During three months of follow-up, the peripapillary RNFL thickness decreased significantly in the IVB group (p = 0.001). Peripapillary RNFL thickness changes were significantly different between treatment groups at month 1 and month 3. (p = 0.001 for both) The RNFL changes during the study did not significantly correlate with peripapillary VD changes in each group (p = 0.231 and p = 372, for PRP and IVB group, respectively)., Conclusion: This study demonstrated that IVB and PRP treatments produced distinct short-term microvascular changes in the optic nerve of diabetic retinopathy patients. PRP treatment significantly reduced vascular density in the optic disc and peripapillary region over 3 months, with an initial increase in RNFL thickness followed by a decrease by month 3. In contrast, IVB treatment led to a slight increase in optic disc vascular density while significantly reducing RNFL thickness. No significant correlation was found between changes in RNFL thickness and peripapillary vascular density within either treatment group., Competing Interests: Declarations. Ethics approval and consent to participate: This study has been approved by the local institutional review board of Tehran University of Medical Sciences (IR.TUMS.FARABIH.REC.1400.038). The study was performed in accordance with the Helsinki Declaration of 1964, and its later amendments; All patients provided informed consent to participate in the study. Consent for publication: Written informed consents were obtained from each participant. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Competency frameworks are used to guide professional education and assessment. An orthodontic graduate needs various competencies. This study aimed to determine competencies and create a basic competency framework for orthodontic graduates., Methods: This descriptive cross-sectional study used the Delphi method. A comprehensive literature review was conducted in the ISI, Scopus, PubMed, Eric, and Google Scholar; the orthodontic curriculum in Iran; and the available orthodontic curricula. The sub-competencies and learning objectives necessary for an orthodontic graduate were extracted. The list of competencies was designed as an electronic questionnaire as the first round of Delphi. Fifty-two orthodontic specialists (university staff) were asked to determine the degree of necessity of competencies for an orthodontic graduate using a five-point Likert scale. In the second round, nine competencies were transferred from the first round of Delphi, and four competencies were extracted from the experts' opinions and were included in the questionnaire., Results: A total of 85 articles and 4 curricula were reviewed and 77 competencies were identified in 11 domains. In the first round of the Delphi, 68 competencies were accepted, for a quota of 70%, and nine were transferred to the second round of the Delphi. At this round, most of the competencies in the field of "data collection and recording", "treatment procedures", "patient-centered treatment", "dental knowledge, "clinical reasoning and moral judgment", "communication skills", "Health Promotion", "Attitude, legal responsibilities and ethical issues (professionalism)", "information management", and "Self-development" through participation were accepted. Finally, the domain of competence "the dentist's role in the health system" was removed, and ten domains (73 competencies) were accepted., Conclusions: The competencies identified in this study can be used in designing competency-based curricula, education, and assessment in post-graduate orthodontic programs., Competing Interests: Declarations. Ethics approval and consent to participate: Informed consent was obtained from all individual participants and the research involved no risk to the subjects and no adversely affect the rights and welfare of the subjects. To conduct this research, an electronic questionnaire was used to collect the opinions of the participants. In the distributed questionnaire, the participants informed consent to participate in the research was asked at first. The following text was sent to the participants at the beginning of the electronic questionnaire: Dear faculty member. This research is conducted to determine the competencies of orthodontic graduates in Iran. If you agree to participate in the research, please complete the following questionnaire, which is related to the competencies of orthodontic specialists. This research has been approved by the research committee of Isfahan University of Medical Sciences (IR.ARI.MUI.REC.1400.010). This manuscript is a part of a thesis report. This thesis was a developmental study entitled “Designing the Evaluation System of the Orthodontic Residency Course in Isfahan University of Medical Sciences based on a Programmatic Approach”. This manuscript was the report of the need assessment in this study. Therefore, it is not registered as a clinical trial. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Childhood malnutrition remains a critical public health challenge in low- and middle-income countries, contributing significantly to morbidity and mortality among children aged 2-5 years. This study was undertaken to assess the nutritional status of 2-5 y children and to explore the main determinants of child malnutrition in eight food insecure provinces of Iran., Methods: In each province, participants were invited to attend the health house/center to complete the questionnaire on the pre-appointed day. In this study, an android application comprising electronic questionnaires was employed for data collection. Anthropometric, dietary, food security and socioeconomic status (SES) assessments were performed. Structural equation modeling (SEM) was done to assess the structural relationship of malnutrition indicators (z-score of height to age (HAZ), z-score of weight to age (WAZ) and z-score of weight to height (WHZ)) with other variables., Results: Overall, 2247 children aged 42.2 ± 0.3 months were enrolled in the study, of whom 1048 (46.6%) were female and 1438 (64%) were urban residents. Based on Z score criteria, 216 (10.1%) of the studied children had less than - 2SD HAZ, 193 (8.4%) had lower than - 2SD WHZ and 188 (8.1%) had lower than - 2SD WAZ. The prevalence rates of stunting, wasting and underweight were not significantly different between boys and girls. Nevertheless, the occurrence of stunting was significantly higher in children residing in rural than in urban areas (p = 0.025). SEM analysis revealed that higher SES had a positive relationship with HAZ (0.089), WAZ (0.163) and WHZ (0.109). The effect of SES was greatest on WAZ, indicated by the highest absolute value of a path coefficient. There were specific indirect effects of father's education on HAZ (0.032, p = 0.001), WHZ (0.045, < 0.001) and WAZ (0.061, < 0.001) through effect on SES and DDS. SES had a direct effect on DDS (0.202)., Conclusions: Our findings using SEM approach provided more concrete evidence for the effect of the household's SES on child's nutritional status. Nevertheless, we still need to monitor the studied population in the context of our surveillance program to document more conclusive causal associations., Competing Interests: Declarations. Ethics approval and informed consent to participate: All participant children’s parents signed a written informed consent. The ethical issues of this study were approved by the Ethics Committee of NNFTRI (code: ir.sbmu.nnftri.rec.1396.170). All methods were carried out in accordance with relevant guidelines and regulations or Declaration of Helsinki. Consent for publication: All participant children’s parents were informed that the results of this study would be published as reports and papers while keeping the confidentiality. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Rising methicillin-resistant Staphylococcus aureus (MRSA) poses a global health threat, contributing to serious infections with high mortality rates. Integrons are recognized as significant genetic elements in disseminating multidrug-resistant (MDR) strains. This study focuses on assessing the prevalence of integron classes 1, 2, and 3 in S. aureus strains from four major cities in Iran., Methods: This cross-sectional study analyzed 183 S. aureus isolates from Shiraz, Tehran, Isfahan, and Yazd in Iran. The isolates were identified using specific biochemical and molecullar tests. The Kirby-Bauer disc diffusion method and microbroth dilution method were employed to determine the susceptibility of the isolates to relevant antibiotics and vancomycin, respectively. The macrolide-lincosamide-streptogramin B (MLS B ) resistance phenotype was also evaluated using the D-test. All isolates were sought for presence of the intI1, intI2, and intI3 genes., Results: Among 183 S. aureus isolates, high resistance rates were noted: 86.3% for erythromycin, 66.1% for ciprofloxacin, and 61.7% for clindamycin, while all isolates were susceptible to linezolid and vancomycin. Of the 183 isolates, 59.6% were identified as MRSA and 78.1% as MDR. According to the D-test results, 112/183 (61.2%), 29/183 (15.8%), 25/183 (13.7%), and 17/183 (9.7%) of S. aureus isolates showed constitutive resistance-MLS B , inducible resistance-MLS B , sensitive, and resistance to macrolide-streptogramin B (MS) phenotypes, respectively. The intI1 gene was found in 14 out of 183 S. aureus isolates (7.6%), while none were positive for the intI2 or intI3 genes. Notably, 11/14 (78.5%) and 13/14 (92.8%) intI1-positive isolates were MRSA and MDR, respectively., Conclusions: The distribution of MRSA and MDR S. aureus isolates in Iran seems concerning. Although the prevalence of intI1 was not as high as in prior studies, almost all S. aureus harbored the intI1 gene were MRSA and MDR., Competing Interests: Declarations. Ethics approval and consent to participate: The Ethics Committee of Jahrom University of Medical Sciences gave their approval for this study with the code number IR.JUMS.REC.1402.057. The informed consent was signed by each participant. Parents or legal guardians provided informed permission for individuals under the age of sixteen. We adhered to all of the World Medical Association Declaration of Helsinki's ethical guidelines for doing research on human subjects in medicine. Participants received assurances that the confidentiality of their data will be protected by Iran's data protection laws during processing. Consent of publication: Not applicable. Competing intrests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: The uptake of HIV partner status notification remains limited in low- and lower-middle-income countries. This mixed-methods systematic review aims to summarize the barriers and facilitators of HIV partner status notification in these settings., Methods: We searched PubMed, Embase, CINAHL, PsychINFO, Scopus, and Web of Science from January 01, 2000, to August 31, 2023, for empirical qualitative and quantitative studies. Two independent reviewers completed the title, abstract, full-text screening, and data extraction. The risk of bias was assessed using a mixed-methods appraisal tool (MMAT), and the study findings were summarized narratively., Results: Out of the 2094 studies identified, 59 relevant studies were included. Common barriers included fear of stigma and discrimination, violence, abandonment, breach of confidentiality and trust, low HIV-risk perception, and limited knowledge of HIV and HIV testing. Facilitators of HIV partner status notification were feelings of love and closeness in marital relationships, feelings of protecting self and partners, and HIV counseling services., Conclusion: Efforts to improve HIV partner status notification in low- and lower-middle-income countries should consider barriers and facilitators across all its components, including notification, testing, and linkage to treatment. In addition, HIV partner services must be adapted to the unique needs of key populations., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: The introduction of antiretroviral therapy (ART) has significantly improved the life expectancy of people living with HIV (PLHIV), leading to an increased prevalence of age-related comorbidities such as osteoporosis. This study investigates the incidence and characteristics of low bone mineral density (BMD) and the treatment effectiveness of low BMD participants among PLHIV in Kerman, Iran., Methods: A longitudinal study utilized dual-energy X-ray absorptiometry (DEXA) to screen 94 PLHIV in Kerman, Iran, for low BMD. Participants were aged 30 or older and had received antiretroviral therapy (ART) for at least 12 months. Those with low BMD were entered into a single-arm clinical trial and received the appropriate treatment. These people were checked to assess the treatment effectiveness 11 months after completion of the treatment. Those with normal BMD entered a cohort study and were checked to determine the cumulative incidence of low BMD. Data on demographics, medical history, and laboratory tests were collected. A chi-square test was used to assess the association between the categorical variables. A t-test (for normally distributed variables), or Mann-Whitney U (for non-normally distributed variables) was used to assess the differences of BMD between the two groups. Statistical significance was set at p ≤ 0.05, with analyses conducted in Stata 17., Results: Among 94 PLHIV at baseline, 48 participants (51%) had low BMD. During the follow-up, 11 participants (11.7%) missed the follow-up visits. In the follow-up, 83 PLHIV (40 with low BMD and 43 with normal BMD at baseline) were available. Among 40 participants who received treatment, 5 had normal BMD (treatment effectiveness: 12.5%). However, among 43 PLHIV with normal BMD at baseline, 7 PLHIV had low BMD at the follow-up visit (cumulative Incidence 16.3%). Those with lower body mass index (BMI) had a higher prevalence of low BMD than those with normal BMI during the follow-up (p-value: 0.003). Lumbar spine BMD increased modestly (0.005 g/cm 2 ), while femoral neck and total hip BMD declined in total participants (0.011, 0.007 g/cm 2 , respectively). Osteocalcin and β-isomerized C-terminal telopeptides (β-CTx) levels were higher in the low BMD group in the follow-up, indicating increased bone turnover., Conclusions: The study highlights the high cumulative incidence of 16.3% and treatment effectiveness of 12.5% of low BMD among PLHIV in Kerman, Iran, with implications for fracture risk. Despite a steady state in spine BMD decline, the risk of fracture remains elevated due to continued femoral neck and total hip BMD reduction. Gender-specific factors and BMI may influence susceptibility to low BMD., Competing Interests: Declarations. Ethics approval and consent to participate: Before the study, the study’s objectives, benefits, and potential risks of participating in the study were explained to eligible participants, and they were asked to sign a written informed consent form. The study protocol and consent form were reviewed and approved by the Ethical Committee of Tehran University of Medical Sciences (Number: IR.TUMS.EMRI.REC.1400.002). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: The topic of patient safety and attitudes toward patient safety among health professionals is a main priority of healthcare systems globally. This study aims to investigate the psychometric properties of APSQ-III among Iranian nursing students., Methods: There were 307 undergraduate nursing students who participated in the cross-sectional methodological study, from December 2022 to January 2023. Content validity, Construct validity and reliability of the APSQ-III was evaluated., Results: In the exploratory factor analysis, three factors were identified from 11 items, accounting for 58% of the total variance. The confirmatory factor analysis indices confirmed the model fit (χ 2 (38) = 91.851, p < 0.001, χ 2 /df = 2.417, CFI = 0.966, PNFI = 0.652, IFI = 0.966, TLI = 0.951 and RMSEA = 0.068). The results of the reliability evaluation indicated that the factors demonstrated a satisfactory level of internal consistency, as evidenced by Cronbach's alpha (α) and McDonald's omega (ω) values. Additionally, the Composite Reliability (CR) and Maximal Reliability H were both above 0.8, further supporting the reliability of the factors., Conclusion: The results of this study support the valid and reliable APSQ-III with 11 items and three factors. This questionnaire can be used to assess patient safety attitude among nursing students., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the ethics committee of Mazandaran University of Medical Sciences (IR.MAZUMS.REC.1401.278). Participants were informed that their participation was voluntary and that their responses would be published anonymously as group data. Participants do not view the online questionnaire items until they agree to participate and click on the “next button”. In fact, they completed the online informed consent form by clicking. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: Virtual reality (VR) technology presents a promising alternative to medical education by creating an immersive and interactive learning environment. This research aimed to examine the effectiveness of virtual reality on medical students' academic achievement in anatomy., Methods: This systematic review included 24 full-text articles in both Persian and English from 10 databases. The search focused on experimental, quasi-experimental, and descriptive studies published between May 28, 2000, and May 24, 2022. At least two researchers reviewed all studies. In cases of disagreement between the two, a third researcher reviewed the article and made the final decision. Results were analyzed according to the four-level Kirkpatrick model. Also, the modified Buckley checklist was used to assess the quality of the study., Results: Twenty-four articles were included. Following Kirkpatrick's levels of evaluation, Nineteen studies explored the first level of training effectiveness (reaction). Twenty-four studies examined the second level (learning). One study investigated the efficacy of education (behavior). No studies have investigated the fourth level (impact)., Discussion: This study argues that Virtual reality improves students' academic progress and learning in medical anatomy when used as a supplementary way to other methods. However, experimental studies are recommended to investigate the impact of various factors on the efficacy of this method., Competing Interests: Declarations. Ethics approval and consent to participate: This research was approved by the Isfahan University of Medical Sciences with the codes of ethics of IR.MUI.RESEARCH.REC.1399.631. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Familial dietary intake can be influenced by both genetic and environmental factors; the current study aimed to examine the role of these two factors on dietary intake by investigating the resemblance in energy, nutrient, and food group intake among spouses and siblings in twin and family-based studies., Methods: The online literature databases, including PubMed, Scopus, Web of Science, and Cochrane Library were systematically searched up to September 2024. The pooled correlation coefficient (r) of studies was calculated using Fisher's z and standard error (SE) of z's of all studies and our final results were reported in six groups including non-twin siblings, monozygotic (MZ) twins, dizygotic (DZ) twins, all-twins, all siblings, and spouse., Results: Our findings on 30 observational studies indicate that siblings, especially MZ twins, tend to have similar dietary intake, with high correlations for vegetables (r: 0.59), red meat (r: 0.58), and fruits (r: 0.56). Among DZ twins, the lowest correlations were observed for eggs (r: 0.07), soft drinks (r: 0.14), and daily intake of simple carbohydrates (r: 0.17). DZ twins did not show significant differences in dietary resemblance compared to non-twin siblings. Among spouses, the highest correlations for dietary intake were found for polyunsaturated fats (r: 0.41), saturated fats (r: 0.40), and total fats (r: 0.39), while the lowest correlation was for protein intake (r: 0.24)., Conclusions: While the greatest similarity in dietary intake was observed among MZ twins, no significant difference in dietary intake similarity was noted between DZ twins and non-twin siblings. Furthermore, spouses exhibited a significant degree of similarity in their dietary consumption. Therefore, dietary intake is shaped by a complex interplay of genetic and environmental factors, warranting further investigation to validate these observations., Competing Interests: Declarations. Ethics approval and consent to participate: The study protocol was approved by the Ethics Committee of the Research Institute for Endocrine Sciences at the Shahid Beheshti University of Medical Sciences. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: The heightened risk of COVID-19 transmission during dental procedures has been a major concern in dentistry. To curb the spread of the virus, breaking the chain of transmission is paramount. This study aimed to assess infection control function in dental clinics using a supervisory checklist developed specifically during the COVID-19 pandemic., Method: In April 2020, Alborz University of Medical Sciences introduced a 46-item checklist to guide infection control. Regular inspections of clinics began in June 2020 and continued every 6 months. Inspectors, accompanied by either the clinic manager or the infection control team, completed the checklist to evaluate protocol adherence. This retrospective cross-sectional study presents findings from the initial round of inspections., Results: Clinics were categorized as adherent or non-adherent based on achieving at least 50% of the total checklist score. Of the 76 clinics evaluated, 66 (86.8%) met the adherence criteria. The highest compliance was observed in question 12 (separation of employee and patient restrooms), with 81.6% adherence. The lowest compliance was in question 31 (use of disposable waterproof shoe covers), with only 26.3% adherence., Conclusion: Over 80% of dental clinics demonstrated satisfactory adherence to COVID-19 infection control protocols. However, to further mitigate the spread of COVID-19, particularly its more contagious variants, enhancing compliance across all infection control measures remains essential., Competing Interests: Declarations. Ethical approval and consent to participate: Participants were informed about the purpose of the study and assured they would receive routine care. They were ensured the privacy and confidentiality of information were reserved. The study protocol was approved by the Ethics Committee of Alborz University of Medical Sciences based on written informed consent (code: IR.ABZUMS.REC.1400.230). All methods used in this study have been performed following the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objective: To evaluate the referral patterns for fetal echocardiography at a tertiary care center in Shiraz, South Iran., Method: This retrospective cohort study analyzed data from 22,600 pregnant women who underwent fetal echocardiography between January 1, 2016, and December 31, 2021. Information was extracted from a centralized electronic medical record system used by medical centers affiliated with Shiraz University of Medical Sciences., Result: Congenital heart disease was detected in 14.5% of fetal echocardiograms. The mean gestational age at the time of examination was 21.8 ± 4.2 weeks (range: 13-40 weeks). Notably, 75.9% of pregnant women were referred after 19 weeks of gestation. The most common reason for referral was abnormal fetal laboratory screening (triple or quad test)., Conclusion: In our center, fetal echocardiography is optimally performed by 19 weeks of gestation. This timing allows for detailed anatomical assessment and aligns with the legal threshold for abortion, ensuring timely counseling and decision-making when necessary. However, in our study, the mean gestational age at the time of echocardiography was 21 weeks, indicating that a significant proportion of patients underwent the procedure later than the optimal timing., Competing Interests: Declarations. Ethics approval and consent to participate: This study protocol was reviewed and approved by the institutional ethics committee of Shiraz University of Medical Sciences (approval number: IR.SUMS.MED.REC.1400.471). Due to the retrospective nature of the study and the use of de-identified data from existing medical records, the ethics committee waived the requirement for individual informed consent from participants. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Pre-exposure prophylaxis (PrEP) significantly reduces HIV transmission, but it is not commonly prescribed in Iran. Therefore, this study aimed to identify facilitators and barriers to PrEP use among four key populations (KPs) in Iran., Methods: We conducted in-depth qualitative interviews with female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and sexual partners of people living with HIV (PLHIV) to obtain deep insights into the participants' experiences, beliefs, and viewpoints. We included HIV experts, including staff from the HIV control department, healthcare providers with HIV experience, health policymakers, infectious disease specialists, and university professors. We performed a content analysis to identify facilitators and barriers to PrEP implementation among KPs., Results: We interviewed seven FSW, seven MSM, four PWID, four sexual partners of PLHIV, and 18 HIV experts. The facilitator's theme emerged in four main categories, including eight different factors: 1) Individual and interpersonal factors (motivations, fear of testing positive for HIV, and safety nets and financial support), 2) Age and sex differences, 3) Organizational factors (appropriate PrEP distribution, information sharing, and receipt of high-quality services, 4) Efficacy of PrEP. The barrier's theme emerged in three main categories, including four factors: 1) Individual factors (insufficient knowledge and awareness, and fragile trust), 2) Cultural barriers, and 3) Organizational factors (inadequate infrastructure and organizational barriers)., Conclusions: We identified key facilitators and barriers to successful PrEP implementation among KPs in Iran. By addressing these barriers, Iran has an opportunity to include PrEP programs in its HIV prevention efforts for KPs., Competing Interests: Declarations Ethics approval and consent to participate  The Ethics committee of Kerman University of Medical Sciences approved the study protocol (Ethics code: IR.KMU.REC.1401.443).Participation in this study was voluntary and anonymous; names or other personal identifiers were not collected as a condition for participation. Participants could refuse to answer any question or stop the interview at any time. Due to the stigma toward HIV and key populations in Iran and the fear of patients signing written documents, verbal informed consent was obtained from all participants in this study. The ethics committee of Kerman University of Medical Sciences approved the procedure for obtaining verbal informed consent. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Hepatitis B virus (HBV) infection is a silent epidemic among people who inject drugs (PWID). HBV testing and vaccination are important for PWID to reduce the risk of infection, prevent chronic complications and contribute to public health efforts in addressing HBV transmission. Our objective was to assess the self-reported lifetime uptake of HBV testing and vaccination among PWID in Iran and their associated factors., Method: This cross-sectional study was conducted among 2,684 PWID in 11 large cities from July 2019 to March 2020 using a respondent-driven sampling method. Participants were interviewed face-to-face and asked about their lifetime experience of HBV testing and vaccination uptake as the outcome. Logistic regression models were built to identify related factors for reporting HBV testing and vaccination uptake., Results: The prevalence of HBV testing and vaccination uptake among PWID was 14.2% (95% confidence intervals [CI]: 12.8-15.6) and 16.4% (95% CI: 14.9-18.1), respectively. Shared needles, syringes, or equipment in the past 12 months decreased the odds of reporting lifetime HBV testing uptake (Adjusted odds ratio [AOR]:0.46, 95% CI: 0.29-0.72). However, having an academic education (AOR: 1.89, 95% CI: 1.09-3.30) and lifetime experience of homelessness (AOR: 1.58, 95% CI: 1.21-2.06) increased the odds of reporting lifetime HBV vaccination uptake., Conclusion: Our study highlighted the low prevalence of HBV testing and vaccination uptake among PWID in Iran. It is essential to understand and address the obstacles preventing PWID from getting tested and vaccinated for HBV. Addressing these barriers could significantly reduce the burden of HBV among this socio-economically marginalized population., Competing Interests: Declarations Ethics approval and consent to participate The protocol of the present study was reviewed and approved by the Ethics Committee of Kerman University of Medical Sciences (IR.KMU.REC.1397.573). The ethics committee also approved the use of verbal consent. So, before the initiation of the study, participants gave verbal informed consent. Consent for publication Not Applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Intrahepatic lipid accumulation (IHL), a hallmark of metabolic disorders, is closely associated with de novo lipogenesis (DNL). Notably, fructose feeding increased the DNL. Lifestyle modifications resulting from dietary changes and increased physical activity/exercise can decrease the IHL content. We examined the effects of vitamin D 3 supplementation (VDS), high-intensity interval training (HIIT), and their combination on the transcription factors and enzymes of the DNL pathway in male Sprague‒Dawley rats fed a high-fructose diet (HFrD)., Methods: Forty male rats were assigned to 5 groups (n = 8): CS (the control group had a standard diet); CF (the control group had HFrD (10% (w/v) fructose solution in tap water)); and FT (HFrD + HIIT: 10 bouts of 4 min of high-intensity running, corresponding to 85-90% of the maximal speed with 2 min active rest periods of 50% maximal speed, 5 days per week); FD (HFrD + intervention of intraperitoneal injection of 10000 IU/kg/week VDS); FTD (HFrD + HIIT + VDS) that were maintained for 12 weeks. ELISA, the GOD-POD assay, folch, western blotting, and oil red O staining were used to determine insulin, fasting blood glucose (FBG), hepatic triglyceride (TG) and cholesterol levels; SREBP1c, ChREBP-β, ACC1, FASN, p-ACC1, AMPK, p-AMPK, and PKA protein expression; and IHL content, respectively., Results: Both HIIT and VDS led to significant increases in the levels of PKA, AMPK, p-AMPK, and p-ACC1, as well as significant decreases in the levels of SREBP1c, ChREBP-β, ACC1, FASN, insulin, FBG, liver TG, liver cholesterol, and IHL. HIIT exhibited superior efficacy over VDS in reducing ChREBP-β, ACC1, insulin, FBG, liver TG and cholesterol, as well as increasing p-ACC1 and PKA. Notably, the combined intervention of HIIT and VDS yielded the most substantial improvements across all the parameters., Conclusions: HFrD causes IHL accumulation and the onset of diabetes, whereas VDS and HIIT, along with their combined effects, prevent the consequences of HFrD., (© 2024. The Author(s).)

Background: Breast cancer (BrCa) is one of the leading causes of cancer-related deaths. There are several factors for getting BrCa, including some changeable factors related to lifestyle like unhealthy dietary patterns, so modifying them can prevent one third of the complications and deaths caused by BrCa. Therefore, we decided to investigate the relationship between Healthy Beverage Index (HBI) and the risk of BrCa., Methods: In this hospital-based case-control study, 253 patients with BrCa and 267 non-BrCa controls were enrolled. Food consumption was recorded to calculate the HBI score using a semi-quantitative Food Frequency Questionnaire (FFQ). Additionally, by using binary logistic regression analysis with adjustment for confounders, the relationship between HBI and the risk of BrCa were assessed. HBI was established by Duffey et al. and is used to evaluate the overall quality of beverage intake and identify changes in consumption., Results: Mean ± SD of age and BMI of the study participants were 47.92 ± 10.33 years and 29.43 ± 5.51 kg/m 2 , respectively. Patients with BrCa considerably outperformed controls in terms of waist circumference (WC), age at first pregnancy, history of abortion, and number of children(Pvalue < 0.05). Compared with those in the lowest quartile of HBI, subjects in the highest quartile had higher intake of energy, carbohydrate, protein, fat, fiber, sodium, potassium, calcium, magnesium, zinc, vitamin C, E, B9, fruits, vegetables, fish and nut as well as lower BMI and WC (Pvalue < 0.05). After adjustment for potential confounders, individuals in highest compared to lowest quartile of HBI had significantly lower risk of BrCa for total population (odds ratio (OR): 0.40; 95% confidence interval (95%CI): 0.21-0.76, Pvalue < 0.05), premenopausal (OR: 0.38; 95% CI: 0.16-0.92, Pvalue = 0.013), and postmenopausal (OR: 0.27; 95% CI: 0.10-0.78, Pvalue = 0.023)., Conclusion: Findings of this study suggested that higher HBI score decreased the risk of BrCa. However, further investigation is needed., (© 2024. The Author(s).)

Introduction: Clinical dishonesty is one of the components of academic dishonesty that deals with the unprofessional behavior of students in hospital and clinic environments (medical students, nursing students, etc.). Psychological distress and low moral intelligence among students can be known as predisposing factors in performing dishonest clinical behaviors. The present research addresses a gap in the scientific literature by investigating dishonest behavior among medical students., Methods: This cross-sectional study examined medical students' clinical dishonesty, psychological distress, and moral intelligence. Rafati et al.'s questionnaire was used to investigate clinical dishonesty, Kessler's Psychological Distress Questionnaire (K6) was used for psychological distress, and Lenik and Keil's (2005) questionnaire was used to determine moral intelligence. Cochran's formula was used to calculate the sample size and the simple random sample (SRS) method was used for sampling. Data were statistically analyzed in SPSS version 27 (SPSS Inc., Chicago, IL, United States). a P-value less than 0.05 was considered significant., Results: 317 medical students were included in this study, of which 176 (55.5%) were male and 141 (44.5%) were female. We found a direct and significant statistical correlation between clinical dishonesty and students' distress (Correlation Coefficient: 0.162, P-value < 0.001). In addition, there was a statistically significant inverse correlation between clinical dishonesty and moral intelligence (Correlation Coefficient: -0.241, P-value: 0.004). Moreover, there was a higher rate of clinical dishonesty among senior medical students (P-value < 0.001). Moreover, the most dishonest clinical behaviors are as follows: [1] Disclosure of patient information in public or with non-medical personnel (76%), Incorrect examination of vital signs and physical examinations (69.4%), Not reporting incidents or errors of others involving patients (41.6%)., Conclusion: Finally, most students have experienced engaging in at least one clinically dishonest behavior. Such actions increase with the progress of the educational level so that it reaches its peak at the internship stage. Moral intelligence is a learnable concept, and mental distress also has its own treatments. Therefore, improving these two factors can reduce clinical dishonesty among medical students., (© 2024. The Author(s).)

Background: Mild cognitive impairment (MCI) and Alzheimer's disease (AD) are significant neurodegenerative disorders with increasing prevalence worldwide. Lifestyle and dietary factors, including micronutrients, have been suggested as modifiable risk factors for disease development. This study aims to investigate the association between micronutrients and cognitive ability in these diseases., Methods: A cross-sectional study involving 105 participants with MCI and AD was conducted. Dietary assessments were performed using a validated food frequency questionnaire (FFQ), and micronutrient intake was calculated based on nutrient content. Disease severity was evaluated using the Functional Assessment Staging Tool (FAST). Statistical analyses, including correlation coefficients and multiple regression models, were employed to examine the association between micronutrients and disease progression., Results: The results revealed significant correlations between disease severity and several micronutrients, including omega-3 fatty acids (B = -0.2, P = 0.01), carotenoids (B = -0.19, P = 0.02), dietary antioxidant compounds, including vitamins A, C, D, E (B = -0.19, P = 0.02), selenium (B = -0.17, P = 0.03), alpha-carotene (B = -0.16, P = 0.04), beta-carotene (B = -0.17, P = 0.03), and lycopene (B = -0.16, P = 0.04). Multivariate regression analysis showed that higher intake of omega-3 fatty acids was associated with slower disease progression. Furthermore, the levels of these micronutrients declined in advanced stages of the disease., Conclusion: Omega-3 fatty acids and carotenoids may affect the cognitive ability and disease progression. Further longitudinal studies are warranted to establish causality and explore the therapeutic implications of these findings for the prevention and management of MCI and AD., (© 2024. The Author(s).)

Acute Kidney Injury (AKI) is frequently observed in hospitalized patients in intensive care units, often caused by renal ischemia-reperfusion injury (IRI). IRI disrupts the function of various 'remote organs' such as the lungs, pancreas, intestine, liver, heart, and brain through inflammation, oxidative stress, apoptosis, leukocyte infiltration, and increased urea and creatinine levels. Gender differences in renal IRI-induced injury are noted. H2S, an endogenous gaseous modulator, shows potential in vasodilation, bronchodilation, and hypotension and can regulate apoptosis, inflammation, angiogenesis, metabolism, and oxidative stress. This study aims to investigate the protective effects of NaHS on brain, heart, and lung injuries following renal IR and to assess the oxidative system status as a potential mechanism in male and female rats.Forty-eight Wistar rats were randomly divided into eight groups (n = 6): Control/Saline, Sham/Saline, IR/Saline, and IR/NaHS in both sexes. Forty-five minutes of bilateral renal ischemia followed by 24-hour reperfusion was induced in the IR groups. NaHS (100µM/Kg, IP) was administered 10 min before clamp release in treated groups. BUN, SCr, BUN/SCr, albuminuria, histopathology, and oxidative stress biomarkers of the brain, heart, and lung were assessed as remote organs. IR increased serum markers of renal function, albuminuria, malondialdehyde levels, and tissue injury scores while reducing nitrite levels and superoxide dismutase and glutathione peroxidase activities. NaHS treatment reversed the adverse effects of IR in remote organs in both sexes, although it showed limited improvement in renal function. Our findings demonstrate that NaHS has a beneficial effect on remote organ injury following renal IR by mitigating oxidative stress, with noted tissue-specific and gender-specific differences in response. These findings suggest NaHS as a potential therapeutic agent for mitigating multi-organ injury after renal IR, with effects varying by tissue and gender., (© 2024. The Author(s).)

Purpose: Despite suffering from the same disease, each patient exhibits a distinct microbiological profile and variable reactivity to prescribed treatments. Most doctors typically use a standardized treatment approach for all patients suffering from a specific disease. Consequently, the challenge lies in the effectiveness of this standardized treatment and in adapting it to each individual patient. Personalized medicine is an emerging field in which doctors use diagnostic tests to identify the most effective medical treatments for each patient. Prognosis, disease monitoring, and treatment planning rely on manual, error-prone methods. Artificial intelligence (AI) uses predictive techniques capable of automating prognostic and monitoring processes, thus reducing the error rate associated with conventional methods., Methods: This paper conducts an analysis of current literature, encompassing the period from January 2015 to 2023, based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)., Results: In assessing 25 pertinent studies concerning predicting neoadjuvant treatment (NAT) response in breast cancer (BC) patients, the studies explored various imaging modalities (Magnetic Resonance Imaging, Ultrasound, etc.), evaluating results based on accuracy, sensitivity, and area under the curve. Additionally, the technologies employed, such as machine learning (ML), deep learning (DL), statistics, and hybrid models, were scrutinized. The presentation of datasets used for predicting complete pathological response (PCR) was also considered., Conclusion: This paper seeks to unveil crucial insights into the application of AI techniques in personalized oncology, particularly in the monitoring and prediction of responses to NAT for BC patients. Finally, the authors suggest avenues for future research into AI-based monitoring systems., (© 2024. The Author(s).)

Introduction: People who inject drugs (PWID) are a key population at risk of HIV in Iran. We measured the prevalence and covariates of HIV-related risk behaviours among PWID in Iran., Methods: We conducted a respondent-driven bio-behavioural surveillance survey among PWID from July 2019 to March 2020 in 11 major cities. We assessed PWID's recent (i.e., last three months) HIV-related risk behaviours using a four-level categorical variable: Only unsafe injection (i.e., sharing needles/syringes or injecting equipment), only unsafe sex (i.e., unprotected sex), dual HIV risk (i.e., both unsafe injection and unprotected sex), and safe injection and sex. Data were summarized using RDS-weighted analysis. Multinomial logistic regression models were built to characterize HIV-related risk behaviours and relative risk ratio (RRR) with 95% confidence interval (CI) were reported., Results: Overall, 2562 men who inject drugs (MWID) were included in the regression analysis. The RDS-weighted prevalence of dual HIV risk was 1.3% (95% CI: 0.8, 1.9), only unsafe injection was 4.5%, and only unsafe sex was 11.8%. Compared to the safe injection and sex group, dual HIV risk was significantly and positively associated with multiple partnership (RRR = 15.06; 3.30, 68.73). Only unsafe injection was significantly associated with homelessness in the last 12 months (RRR: 3.02; 95% CI: 1.34, 6.80). Only unsafe sex was significantly associated with multiple partnership (RRR = 6.66; 4.27, 10.38), receiving free condoms (RRR = 1.71; 1.01, 2.89), receiving free needles (RRR = 2.18; 1.22, 3.90), and self-received risk for HIV (RRR = 2.51; 1.36, 4.66). Moreover, history of HIV-testing in the last three months was significantly associated with only unsafe injection (RRR = 2.71; 1.84, 3.80). Among the 90 women who injected drugs, none reported dual HIV risk behaviours., Discussion and Conclusions: While the low prevalence of dual HIV risk among PWID is encouraging, unprotected sexual practices among PWID is concerning. Expanding sexual health education and care services as well as tailored interventions aimed at reducing high-risk sexual activities among PWID are warranted. Additionally, tackling potential misperceptions about risk of HIV transmission among PWID in Iran is warranted., (© 2024. The Author(s).)

Background: This study aimed to evaluate the effectiveness of DeepLabv3+with Squeeze-and-Excitation (DeepLabv3+SE) architectures for segmenting the choroid in optical coherence tomography (OCT) images of patients with diabetic retinopathy., Methods: A total of 300 B-scans were selected from 21 patients with mild to moderate diabetic retinopathy. Six DeepLabv3+SE variants, each utilizing a different pre-trained convolutional neural network (CNN) for feature extraction, were compared. Segmentation performance was assessed using the Jaccard index, Dice score (DSC), precision, recall, and F1-score. Binarization and Bland-Altman analysis were employed to evaluate the agreement between automated and manual measurements of choroidal area, luminal area (LA), and Choroidal Vascularity Index (CVI)., Results: DeepLabv3+SE with EfficientNetB0 achieved the highest segmentation performance, with a Jaccard index of 95.47, DSC of 98.29, precision of 98.80, recall of 97.41, and F1-score of 98.10 on the validation set. Bland-Altman analysis indicated good agreement between automated and manual measurements of LA and CVI., Conclusions: DeepLabv3+SE with EfficientNetB0 demonstrates promise for accurate choroid segmentation in OCT images. This approach offers a potential solution for automated CVI calculation in diabetic retinopathy patients. Further evaluation of the proposed method on a larger and more diverse dataset can strengthen its generalizability and clinical applicability., (© 2024. The Author(s).)

Background/aim: Familial resemblance in dietary patterns has been a subject of interest, with both genetic and environmental factors playing crucial roles. This study aims to investigate trends in macronutrient intake correlations over a 9-year period among different familial pairs, including parent-offspring, siblings, and spouses, using data from the Tehran Lipid and Glucose Study (TLGS)., Methods: This longitudinal study, conducted within the framework of the TLGS, analyzed data from 1,814 families over a 9-year period. Dietary intakes were assessed using a validated 168-item food frequency questionnaire. Macronutrient intakes were calculated and adjusted for age. Familial correlations were estimated using intraclass correlation coefficients for various familial pairs (parent-offspring, siblings, and spouses) across four consecutive surveys. Changes in correlations were analyzed over 3-year, 6-year, and 9-year intervals, as well as across all four surveys, to determine overall trends in macronutrient intake correlations., Results: The results revealed diverse trends in intake correlations for carbohydrates, proteins, fats, and specific fatty acids across familial relationships. Parent-offspring dyads exhibited varied patterns, with some nutrients showing regression to the mean. Sister-sister pairs demonstrated strengthening correlations for energy, carbohydrates, fats, and saturated fatty acids over time. Conversely, brother-sister pairs displayed weakening correlations for most macronutrients, particularly energy, proteins, cholesterol, and fiber. Spouse correlations tended towards regression to the mean for energy, carbohydrates, and fats, and fiber., Conclusions: The present study illuminates the dynamic nature of familial dietary correlations over time. The contrasting trends between sister-sister and brother-sister dyads suggest a significant influence of gender on shared dietary patterns. These findings underscore the complex interplay of genetic and environmental factors in shaping family dietary behaviors and highlight the importance of considering both gender and relationship type when examining familial nutritional habits., (© 2024. The Author(s).)

Background: This case series presents five cases of adult atlantoaxial rotatory subluxation (AARS) following traumatic events, focusing on treatment strategies and long-term outcomes., Case Presentation: This paper includes four Iranian male patients and one Iranian female patient with ages ranging from 25 to 46 years old. Each case involved unique presentations and management approaches. Initial conservative treatments, including skull traction and orthoses, were attempted, but surgical intervention became necessary due to inadequate response. Surgical fixation significantly improved functional status and alleviated symptoms in all patients, leading to long-term relief. Radiological assessments demonstrated successful outcomes post-surgery., Conclusions: This study underscores the importance of considering both conservative and surgical options in managing adult atlantoaxial rotatory subluxation to achieve optimal outcomes., (© 2024. The Author(s).)

Background: The possible role of the insulinemic potential of diet in the etiology of type 2 diabetes (T2D) has recently received significant attention in observational studies. This meta-analysis aimed to synthesize available evidence and quantify the potential association between the empirical dietary index for hyperinsulinemia (EDIH) score and T2D risk., Methods: Various electronic databases, including Scopus, PubMed, and Web of Science, were comprehensively searched up to January 2024 using related keywords to identify relevant studies. The hazard ratios (HR) or odds ratios were extracted from eligible cohort studies, and a random-effects model with an inverse variance weighting method was used to calculate the pooled effect size, which was expressed as HR., Results: The analysis included six cohort studies (four publications), with sample sizes ranging from 3,732 to 90,786 individuals aged 20 to 79 years. During follow-up periods of 5 to over 20 years, 31,284 T2D incidents were identified. The pooled results showed that a higher EDIH score was associated with an increased risk of T2D incidence (HR: 1.47; 95%CI 1.21-1.77; I 2  = 91.3%). Significant publication bias was observed in the present meta-analysis (P = 0.020). Geographical region and follow-up period can be as sources of heterogeneity (P heterogeneity <0.001)., Conclusion: Our meta-analysis of observational studies suggested that a diet with a higher EDIH score may be associated with an increased risk of incidence of T2D., (© 2024. The Author(s).)

Introduction: The Fear of Pain Questionnaire (FOPQ) is a self-report tool designed to measure an individual's fear of pain (FOP). While the Persian version of the FOPQ (FOPQ-P) has been developed, its validity and reliability have not yet been assessed in the Iranian context. This study aims to evaluate the psychometric properties of the FOPQ-P among Iranian patients after surgery., Methods: A methodological study was conducted in 2023 involving 400 post-surgery patients selected with a convenience sampling. The FOPQ was translated into Persian, and its psychometric properties were analyzed using network analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), as well as assessments of convergent and discriminant validity. Internal consistency was measured using Cronbach's alpha, McDonald's Omega, average inter-item correlation coefficient, Composite Reliability, and Maximal Reliability., Results: The EFA results with Promax and Kaiser Normalization rotation identified two factors that explained 54.32% of the variance, comprising seven items. The CFA confirmed the model's validity. Both convergent and discriminant validity were established. The reliability analyses showed that Cronbach's alpha, McDonald's omega, composite reliability, and MaxR for all constructs were above 0.7. Additionally, the average inter-item correlation coefficient was greater than 0.5, indicating strong internal consistency and construct reliability., Conclusion: The findings suggest that the FOPQ-P possesses a valid structure and was acceptable reliability in patients cultural context of Iran post-surgery, making it a suitable instrument for measuring fear of pain in this population., (© 2024. The Author(s).)

Background: Human papillomavirus type 16 (HPV-16) infection is strongly associated with considerable parts of cervical, neck, and head cancers. Performed investigations have had moderate clinical success, so research to reach an efficient vaccine has been of great interest. In the present study, the immunization potential of a newly designed HPV-16 construct was evaluated in a mouse model., Results: Initially, a construct containing HPV-16 mutant (m) E6/E7 fusion gene was designed and antigen produced in two platforms (i.e., DNA vaccine and recombinant protein). Subsequently, the immunogenicity of these platforms was investigated in five mice) C57BL/6 (groups based on several administration strategies. Three mice groups were immunized recombinant protein, DNA vaccine, and a combination of them, and two other groups were negative controls. The peripheral blood mononuclear cells (PBMCs) proliferation, Interleukin-5 (IL-5) and interferon-γ (IFN-γ) cytokines, IgG1 and IgG2a antibody levels were measured. After two weeks, TC-1 tumor cells were injected into all mice groups, and subsequently further analysis of tumor growth and metastasis and mice survival were performed according to the schedule. Overall, the results obtained from in vitro immunology and tumor cells challenging assays indicated the potential of the mE6/E7 construct as an HPV16 therapeutic vaccine candidate. The results demonstrated a significant increase in IFN-γ cytokine (P value < 0.05) in the Protein/Protein (D) and DNA/Protein (E) groups. This finding was in agreement with in vivo assays. Control groups show a 10.5-fold increase (P value < 0.001) and (C) DNA/DNA group shows a 2.5-fold increase (P value < 0.01) in tumor growth compared to D and E groups. Also, a significant increase in survival of D and E (P value < 0.001) and C (P value < 0.01) groups were observed., Conclusions: So, according to the findings, the recombinant protein could induce stronger protection compared to the DNA vaccine form. Protein/Protein and DNA/Protein are promising administration strategies for presenting this construct to develop an HPV-16 therapeutic vaccine candidate., (© 2024. The Author(s).)

Background/aim: In the current study, we aimed to assess the association of carbohydrate quality index (CQI) with the risk of non-alcoholic fatty liver disease (NAFLD) in Iranian adults., Methods: This case-control study was conducted on 225 newly diagnosed NAFLD patients and 450 controls, aged 20-60 years. A food frequency questionnaire was used to calculate the CQI and its components, including fiber intake, glycemic index, whole grains: total grains ratio, and solid carbohydrates: total carbohydrates ratio. Multivariable logistic regression was used to estimate the odds ratio (OR) of NAFLD across the tertile of CQI and its components., Results: The participant's mean ± SD of body mass index and age were 26.8 ± 4.3 kg/m 2 and 38.1 ± 8.8 years, respectively. The median (interquartile) CQI score in participants of the case and control groups was 20 (15-25) and 23 (18-28), respectively. In the multivariable-adjusted model, the risk of NAFLD decreased significantly across the tertiles of the CQI [(OR: 0.20; %95CI: 0.11-0.39), P trend <0.001)]. Also, the odds of NAFLD decreased across tertiles of solid carbohydrates to total carbohydrates ratio [(OR: 0.39; 95%CI: 0.22-0.69), P trend <0.001)]. However, a high dietary glycemic index (GI) was associated with increased odds of NAFLD [(OR:7.47; 95%CI: 3.89-14.33, P trend <0.001)]. There was no significant relationship between other CQI components, including fiber intake and whole grain/total grains and the risk of NAFLD., Conclusions: Our results revealed that a diet with a high quality of carbohydrates, characterized by higher intakes of solid carbohydrates, whole grain, and low GI carbohydrates, can be related to a reduced risk of NAFLD., (© 2024. The Author(s).)

Background: This study aimed to adapt mental health first aid guidelines to support individuals with or at risk of developing eating disorders in Iran. This adaptation seeks to enhance the support available for the Iranian population dealing with these disorders., Methods: We employed the Delphi expert consensus method, utilizing two panels: health professionals (n = 37 in the first round; n = 29 in the second) and individuals with lived experience (n = 20 in the first round; n = 18 in the second). The health professionals panel was selected from the graduates of various eating disorders associated scientific fields who had a history of providing services to or conducting research on people with eating disorders, and the lived experience panel had a history of eating disorders themselves or in their family. The panel of individuals with lived experience included those who had personal or familial histories of eating disorders. Efforts were made to ensure cultural, gender, and age diversity in the selection of panel members. Panellists rated the importance of each item for inclusion in the guidelines for Iran based on the English-language Mental Health First Aid guidelines for eating disorders. Items deemed essential by at least 80% of both panels were included in the final guideline. Additionally, panel members were invited to suggest any missing items., Results: A total of 57 participants took part in the first round of the survey, and 47 participated in the second round. In the first round, 204 items across 11 categories were assessed, with 174 items endorsed by the panels. Thirteen items were re-scored in the second round, and 17 items were rejected. Participants suggested 11 new items in the first round. In the second round, 18 out of 24 items were endorsed, while six were rejected. Ultimately, 192 items were incorporated into the Iranian guidelines., Conclusions: The adaptation process considered Iran's social and cultural characteristics, including the stigma associated with mental health disorders, religious beliefs and rituals such as fasting, linguistic differences between English and Farsi, distrust of strangers, the influence of friends and family, differences in food access, and low mental health literacy. We recommend piloting the adapted guidelines in high schools, universities, and non-governmental organizations to evaluate their feasibility and effectiveness in real-world settings. Furthermore, it is essential to establish mechanisms for feedback, update content based on the latest evidence, and collaborate with the media to promote educational programs and public participation., (© 2024. The Author(s).)

Background: Basal cell carcinoma is the most prevalent skin cancer, most characterized by local aggressiveness but with low metastatic potential, and bone metastasis is quite heterogeneous, thus the incidence profile is variable size from 0.0028% to 0.5%. We have this patient with an unusual example of basal cell carcinoma with bone metastases to add to the scarce report on this matter., Case Description: Here we document a 48-year-old Persian man with a background of being exposed to the sun for a long time. He was diagnosed with an ulcer on the cheek, which was clinically characterized and further confirmed by biopsy as morpheaform basal cell carcinoma. Following the first round of excision, multiple relapses eventually metastasized to the bone. The latter was found on follow-up radiologic scans. This case is characterized by the aggressive nature of the disease and the heterogeneity of basal cell carcinoma growth, thus challenging the conventional view of basal cell carcinoma behavior. Treatment included surgical excision of the primary lesion, which was treated with radiotherapy afterward. However, the skeleton improved slowly during follow-up, and palliative care was eventually pursued to control symptoms and improve quality of life., Conclusions: This was a rare case of basal cell carcinoma metastasis to non-bone organs, which reminded us to consider basal cell carcinoma metastasis, especially in the case of atypical basal cell carcinoma. Therefore, risk-aware patient management is essential. Moreover, these findings highlight the role of further research into the mechanisms of basal cell carcinoma metastasis, leading to improved therapeutic strategies that may lead to potential improvements in patient outcomes., (© 2024. The Author(s).)

Background: Cardiovascular progenitor cells (CPCs) derived from human embryonic stem cells (hESCs) are considered valuable cell sources for investigating cardiovascular physiology in vitro. Meeting the diverse needs of this application requires the large-scale production of CPCs in an in vitro environment. This study aimed to use an effective culture system utilizing signaling factors for the large-scale expansion of hESC-derived CPCs with the potential to differentiate into functional cardiac lineage cells., Methods and Results: Initially, CPCs were generated from hESCs using a 4-day differentiation protocol with a combination of four small molecules (CHIR99021, IWP2, SB-431542, and purmorphamine). These CPCs were then expanded and maintained in a medium containing three factors (bFGF, CHIR, and A83-01), resulting in a > 6,000-fold increase after 8 passages. These CPCs were successfully cryopreserved for an extended period in late passages. The expanded CPCs maintained their gene and protein expression signatures as well as their differentiation capacity through eight passages. Additionally, these CPCs could differentiate into four types of cardiac lineage cells: cardiomyocytes, endothelial cells, smooth muscle cells, and fibroblasts, demonstrating appropriate functionality. Furthermore, the coculture of these CPC-derived cardiovascular lineage cells in rat tail collagen resulted in cardiac microtissue formation, highlighting the potential of this 3D platform for studying cardiovascular physiology in vitro., Conclusion: In conclusion, expandable hESC-derived CPCs demonstrated the ability to self-renewal and differentiation into functional cardiovascular lineage cells consistently across passages, which may apply as potential cell sources for in vitro cardiovascular studies., (© 2024. The Author(s).)

Background: Various fixation devices are available for bunion osteotomy. In this study, we evaluated the radiographic outcomes, postoperative complications, and recurrence rate in a series of hallux valgus deformities treated with various osteotomy procedures using a pin for the fixation of the osteotomy., Methods: Two-hundred forty-seven patients with hallux valgus deformity managed with a Simple, Effective, Rapid and Inexpensive (SERI) osteotomy, distal chevron osteotomy, or proximal crescentic osteotomy and K-wire fixation were included. The mean follow-up of the patients was 53.9 ± 8.9 months. Radiographic evaluations included the assessment of the Hallux valgus angle (HVA), intermetatarsal angle (IMA), and union. Clinical evaluations included the assessment of the range of motion, pain in the first metatarsophalangeal joint, and patient satisfaction., Results: In the last visit, the mean improvement of HVA was 23.9 ± 9.1º (P < 0.001). The mean IMA improvement was 6.1 ± 6º (P < 0.001). The mean metatarsophalangeal flexion and extension were 33 ± 10.7º and 34.6 ± 9.2º, respectively. Postoperative complications included pin tract infection in eight (3.2%) patients, deep infection in five (2%) patients, and early pin complication in four (1.6%) patients. Recurrence was observed in five (2%) patients. Twenty-three (9.3%) patients had slight pain in the last follow-up. The mean surgical time was smaller in the SERI osteotomy (P < 0.001). The mean hospitalization period was longer in the proximal osteotomy group (P = 0.039). The mean metatarsophalangeal flexion and extension were significantly smaller in the distal chevron osteotomy (P = 0.046 and P = 0.037, respectively). 90% of patients were satisfied or very satisfied with the surgical outcomes., Conclusion: K-wire fixation is a safe and effective device for the fixation of bunion osteotomy, and this effectiveness is even higher with SERI and proximal crescentic osteotomy., (© 2024. The Author(s).)

Background: Today, addressing issues related to the use of virtual space is of paramount importance due to its significant impact on mental well-being. This is especially crucial when the research community consists of teenagers who are cyber bullies or their victims who have higher vulnerability. The aim of the present study was to investigate the mediating role of alexithymia in the relationship between cyberbullying and psychotic experiences in adolescents., Methods: The research method employed in this study was correlational, and the study population consisted of all male and female middle school students in Tehran during the 2022-2023 academic years. As for data collection, the Cyber-Bullying/Victimization Experiences questionnaire, Community Assessment of Psychic Experiences, and the Toronto Alexithymia scale were applied. A total of 602 samples were gathered by using multi-stage cluster sampling from Tehran in Iran. Four selection of the sample, the regions in Tehran were selected randomly according to the geographical directions of them and then some schools and classes were chosen randomly. Sample was included in the analysis after data entry into SPSS software and subsequent structural equation modeling using AMOS software., Results: According to the findings, cyberbullying (β = 0.11,p < 0.05) and cyber victimization(β = 0.41, p < 0.001) were significant predictors of psychotic experiences. Alexithymia partially mediated the relationship between cyberbullying and psychotic experiences with the mediation effect of 0.28 and cyber victimization and psychotic experiences with the mediation effect of 0.18., Conclusions: These findings underscore the importance of identifying cyber victims or cyberbullies in order to prevent alexithymia and psychotic experiences in future, in order to prevent more serious problems and becoming psychotic., Trial Registration: The goals and conditions of this research were investigated and approved by the Ethics Committee of Alzahra University in Tehran (code: ALZAHRA.REC.1402.055) on 13th September 2023., (© 2024. The Author(s).)

Background: Copy number variants (CNVs) have become increasingly instrumental in understanding the etiology of all diseases and phenotypes, including Neurocognitive Disorders (NDs). Among the well-established regions associated with ND are small parts of chromosome 16 deletions (16p11.2) and chromosome 15 duplications (15q3). Various methods have been developed to identify associations between CNVs and diseases of interest. The majority of methods are based on statistical inference techniques. However, due to the multi-dimensional nature of the features of the CNVs, these methods are still immature. The other aspect is that regions discovered by different methods are large, while the causative regions may be much smaller., Results: In this study, we propose a regularized deep learning model to select causal regions for the target disease. With the help of the proximal [20] gradient descent algorithm, the model utilizes the group LASSO concept and embraces a deep learning model in a sparsity framework. We perform the CNV analysis for 74,811 individuals with three types of brain disorders, autism spectrum disorder (ASD), schizophrenia (SCZ), and developmental delay (DD), and also perform cumulative analysis to discover the regions that are common among the NDs. The brain expression of genes associated with diseases has increased by an average of 20 percent, and genes with homologs in mice that cause nervous system phenotypes have increased by 18 percent (on average). The DECIPHER data source also seeks other phenotypes connected to the detected regions alongside gene ontology analysis. The target diseases are correlated with some unexplored regions, such as deletions on 1q21.1 and 1q21.2 (for ASD), deletions on 20q12 (for SCZ), and duplications on 8p23.3 (for DD). Furthermore, our method is compared with other machine learning algorithms., Conclusions: Our model effectively identifies regions associated with phenotypic traits using regularized deep learning. Rather than attempting to analyze the whole genome, CNVDeep allows us to focus only on the causative regions of disease., (© 2024. The Author(s).)

Background: We report a rare and unusual case of intravesical migration of an intrauterine device with stone formation. The intrauterine device (IUD) is the most common method of reversible contraception in women. However, its insertion is not without risk, it can cause early or late complications. IUD can perforate the uterus wall and migrate into adjacent structures., Case Presentation: A 35 year-old female 5 gravid, 4 para has been benefited from intrauterine contraceptive device (IUCD) 5 years ago, she was presented to gynecological consultation for chronic pelvic pain with urinary symptoms. There was history of a good IUD insertion 5 years ago, considered expelled after one month of its pose. Physical examination was normal, but a pelvic ultrasound and a plain abdominal radiography allowed the detection of an IUD outside the uterine cavity, but inside bladder. A diagnostic and therapeutic cystoscopy was performed, and the IUD with calculus was successfully removed. There were no postoperative complications., Conclusion: This case is reported to highlight and to reiterate the need to think about one of the rare complication of IUD insertion, which every practitioner must know, it's the transuterovesical migration, before concluding wrongly to its expulsion. It's a consequence of, non-compliance with the rules for inserting an IUD and poor monitoring. The evolution towards calcification is a certain consequence; its screening involves rigorous clinical monitoring., (© 2024. The Author(s).)