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Background: Iranian Lizard Leishmania (I.L.L) is a nonpathogenic Leishmania strain. Due to its advantages, several recombinant proteins have been produced in this host. However, I.L.L shows a lower yield of recombinant protein expression compared to other commercial hosts. Considering the role of protease enzymes in protein digestion, we selected cysteine protease B (CPB) to investigate its impact on recombinant protein yield in I.L.L. Methods: we generated gene knockouts by utilizing homologous recombination (HR) and CRISPR methods. To assess the efficacy of the designed construct, we compared the yield of recombinant human factor VII (rhFVII) production between cells transfected with the pLEXSY-hyg2-FVII vector and the CMV-promoter-based construct (pF7cmvneo). Results: The knockout of a single CPB gene allele through the HR method or the complete knockout of all alleles through the CRISPR method led to cell death. This outcome suggests that even the deletion of a single CPB gene allele diminishes the protein to a level insufficient for the survival of I.L.L, indicating a critical dependency on the presence of this protein for the organism's viability. rhFVII exhibited a greater expression yield with the pLEXSY construct compared to the pF7cmvneo construct in I.L.L. The lower expression rate of pF7cmvneo may be influenced by epigenetic factors related to the CPC gene or the RNA polymerase used for the expression of that promoter. Conclusion: Therefore, considering alternative integration targets for CMV-promoter-based constructs and incorporating UTR sequences of I.L.L high-expression proteins in the vector may enhance recombinant protein expression rates.

Objective: To understand the consequences of an invalidating environment, it is essential to have a measurement tool with appropriate statistical properties. Thus, the primary aim of this study was to render the ICES (Invalidating Childhood Environment Scale) into Persian and subsequently evaluate the psychometric attributes of this translated version. Method: Data were collected from 1221 nonclinical participants, including 1053 females and 168 males, who were students at medical universities in Tehran, Iran. Several questionnaires, such as the ICES, CTQ (Childhood Trauma Questionnaire), DTS (Distress Tolerance Scale), BIS-11 (Barratt Impulsiveness Scale), Self-Compassion Questionnaire, Dutch Eating Behavior Questionnaire, and EAT-26 (Eating AttitudesTest) were used in the study. The data sets were investigated through SPSS and R language to evaluate the ICES' reliability and construct validity. Additionally, Item Response Theory (IRT) was employed with the Graded Response Model (GRM) to measure the psychometric properties of each item in terms of difficulty and discrimination parameters. Results: Confirmatory factor analysis indicated that both single-factor and two-factor models fit well for both maternal and paternal versions of the ICES. The internal consistency, as assessed by Cronbach's alpha, was high and satisfactory for both maternal (0.87) and paternal (0.87) versions. Notably, the IRT analysis revealed that item 9 performed poorly in both maternal and paternal versions. Compared to the one-factor model, the two-factor model demonstrated a superior fit. Additionally, the test-retest reliability of the ICES over two months demonstrated good reliability for both maternal and paternal versions (0.98). Divergent and convergent validity analysis revealed a significant negative relationship between childhood invalidation environment and distress tolerance (r = 0.175, P < 0.01) as well as self-compassion (r = 0.142, P < 0.01), which were inversely related to the ICES. Furthermore, there was a considerably positive correlation between the invalidating environment experienced during childhood and impulsivity, as evidenced by r = 0.196 and P < 0.01. Conclusion: This study established the favorable psychometric properties of the Persian version of the ICES, indicating that this version is reliable and valid to assess the Invalidating Childhood Environment in the Iranian population. However, further investigations are warranted to reevaluate its validity and reliability.

Objectives: Antibacterial activity against endodontic pathogens is a desirable feature for root canal sealers. The objective of this study was to compare the antibacterial effect of three resin-based endodontic sealers (AH26, Adseal, and Beta RCS) against Enterococcus faecalis in vitro. Materials and Methods: The antibacterial properties of the sealers were assessed against E. faecalis using agar diffusion test (ADT) for fresh state (N=10) and direct contact test (DCT) for freshly-mixed and set states of the materials (N=10). In ADT, the diameter of the zones of inhibition was measured after 24h of contact. In DCT, the colony-forming units of the bacteria were counted after 30 minutes and 180 minutes of exposure. The results were analyzed with two-way ANOVA and independent sample t-test. P0.05). According to ADT, AH26 and Adseal represented the widest and the smallest inhibition zones, respectively (P

Objective: Malignant transformation in dermoid cysts is rare, and Squamous Cell Carcinoma (SCC) is the most common form. This event often occurs in large tumors and middle-aged women. Case report: In this study, two cases are presented. They were menopause, and abdominal pain and adnexal mass was a common manifestation in both. Case 1 with adenocarcinoma arising in mature cystic teratoma had abnormal tumor markers and was diagnosed with a frozen section during surgery, but case 2 with SCC transformation had normal tumor markers, and the frozen section was not helpful in the first surgery. Both underwent complete staging surgery, and due to stage IC1 in case 1, she received chemotherapy, and in case 2, no adjuvant treatment was needed because of stage IA. Conclusion: Considering the rarity of malignant transformation in the dermoid cyst, the best surgical approach and adjuvant therapy indications need further research

This in-vitro study aimed to evaluate the physical properties of three resin-based root canal sealers (BETA RCS, AH26, and Adseal) in terms of flow and film thickness as per ISO 6876/2012. The results revealed that the flow values of BETA RCS, Adseal, and AH26 sealers were 23.06±1.58, 22.5±4.23, and 21.85±1.71, respectively. Moreover, film thickness values for BETA RCS, Adseal, and AH26 sealers were 52.33±2.51, 18.66±0.57, and 52±2, respectively. No significant difference was observed regarding film thickness between AH26 and BETA RCS sealers (P>0.05), while Adseal showed better result in terms of film thickness than other sealers (P˂0.05). The highest solubility was related to BETA RCS (0.6%), and the lowest to Adseal (0.07%). However, all sealers had acceptable solubility and radiopacity. The findings of the current study suggested that all tested root canal sealers had similar properties based on ISO 6876 standard criteria.

Objectives: The aim of this study was to assess how different soft drinks affect the deterioration of conventional and memory orthodontic elastomeric chains. Materials and Methods: We used 500 five-loop segments of elastomeric chains, which were divided into two equal groups of conventional and memory chains. The samples were kept in artificial saliva during the study period. Each group was further divided into 5 subgroups consisting of artificial saliva (controls), Coca-Cola®, non-alcoholic beer (ISTAK®), and carbonated and non-carbonated yoghurt-based drinks (Alis®). Treatment with the soft drinks consisted of immersion in the test liquids twice a day for 3 minutes each time. Force measurements were taken on days 1, 7, 14, 21, and 28. Data were analyzed using One- and three-way ANOVA tests, and independent t-test, with a significance level of 5%. Results: The mean initial force for the conventional and memory elastomeric chains was 3.34±0.112N and 2.49±0.209N, respectively. Conventional chains showed significantly greater degradation than memory chains (P

Introduction: The world has been suffering from COVID-19 since 2020 and the disease continues up to now. COVID-19 patients are at high risk of dysphagia and dysphonia. Accordingly, this study aims to determine the prevalence of dysphonia and dysphagia and identify correlated factors to develop dysphagia and dysphonia in COVID-19 patients admitted to intensive care units (ICU). Materials and Methods: A total of 70 patients with COVID-19 (Mean±SD age of 63.1±18.6; males=39) hospitalized in ICUs were evaluated by an expert on speech and language. The patients were evaluated for swallowing disorder via the Mann assessment of swallowing ability and the Persian version of the functional oral intake scale. The consensus auditory-perceptual evaluation of voice was also used to evaluate voice disorders. Results: Overall, 58.6% of patients presented dysphagia and 74.3% of patients had dysphonia. Meanwhile, 34.3% of the patients were on mechanical ventilation. A correlation was detected between dysphagia severity and the number of mechanical ventilation days, the length of stay, and age (P

Background and Aim: Wastewater is one of the most dangerous and important sources of pathogens and their treatment does not always guarantee the elimination of pathogenic bacteria. Enterococci, as opportunistic pathogenic bacteria, fastidious and cause of nosocomial infections, have a wide environmental distribution and one of the routes of their transmission to humans is water and wastewater. The increasing rate of drug- resistance among bacteria indicates the need for investigation of novel antibacterial agents or their combination effects. The aim of this study was to investigate the effect of linezolid in combination with rifampin on the elimination of multidrug- resistant enterococci in two treatment plants in Golestan province. Materials and Methods: Enterococcus species from eighty samples were isolated from treatment plants in two cities of the Golestan Province (North of Iran) including Gorgan and Bandar-e Torkaman during January-June 2021. The isolates were identified based on the most probable number (MPN), filtration, microbiological tests and finally by using specific gene detection by ddlE primer with polymerase chain reaction. Kirby Bauer performed an antibiotic resistance pattern according to CLSI- 2020 guidelines for six classes of antibiotics. The minimum inhibitory concentration of linezolid was determined individually and by synergist effect with rifampin by broth microdilution method. Results: After phenotypic and molecular diagnosis (PCR) of raw and treated wastewater samples, in 32 (40%) wastewater samples, enterococci species were identified and confirmed. Tetracycline was the least effective so, about 100% of Enterococcus faecalis and Enterococcus faecium isolates were resistant to it. The prevalence of linezolid-resistant E. faecalis was 11%. A total of 20 enterococcal isolates (62.5%) had multiple resistance. The concentration of linezolid in combination with rifampin, which inhibited 90% growth of the isolates (MIC90) was 1μg /ml, four-fold lower than linezolid alone (MIC90=4 μg/ml). In addition, none of the enterococci isolates showed resistance to the linezolid/rifampin combination (P=0.001). Conclusion: The results of this research confirmed the presence of enterococci resistant to vancomycin and other antibiotics in the wastewater treatment plant samples in Golestan province. The favorable combination effect of linezolid and rifampin on the inhibition of multi-drug resistant isolates implies their synergy.

Background: Exposure to lead, damages vital organs and is now a global concern. Toxic effects of lead on the liver and thyroid gland have been mentioned previously, sometimes with conflicting results. Therefore, the present study aimed to assess changes in liver and thyroid function tests in patients with lead poisoning. Methods: This case-control study was performed on 100 patients with clinical evidence of lead poisoning who were referred to Loghman-e-Hakim hospital in Tehran from April to December 2018. Also, another 100 participants with the matched sex and age, a history of opium use, and exposure to lead or non-work-related metals, and with normal lead levels, were considered as a control group. Demographic information was collected by a trained researcher by reviewing hospital records or interviewing participants. To monitor lead levels in the control group, 5 ml of venous blood was collected from the antecubital vein at 7 to 8 am in sterile tubes containing EDTA as an anticoagulant. Serum lead levels were assessed by GBC Avanta atomic absorption spectrophotometer. Values in the two groups were compared. SPSS version 16 (SPSS Inc. Chicago, Il, The USA) was used for data analysis. A P-value below 0.05 was considered statistically significant. Results: The mean level of serum lead in case and control groups were 63.0±12.4 μg/dL and 6.0±2.1 μg/dL, respectively with a statistically significant difference (p

Background and Ami: Identifying the genotype of blood groups in different communities will give the decision makers of the health system to take the necessary measures to prevent and identify the possible side effects of blood transfusion, including the production of alloantibodies. Duffy blood group has increased the possibility of alloantibody production in beta-thalassemia major patients who regularly need blood transfusion due to different types of genotype with different prevalence. However, no study has been conducted regarding the frequency of Duffy blood group distribution in beta-thalassemia Kurd patients dependent on blood transfusion. Materials and Methods: This case-control study was conducted on 100 patients with beta thalassemia major, as case group and 50 healthy individuals, as control group, in Bostan Clinic, Kermanshah University of Medical Sciences. After collecting peripheral blood samples from people participating in the study, DNA was extracted from peripheral blood mononuclear cells. Then, using PCR-RFLP and electrophoresis, Duffy genotypes including FYA/A, FYB/B and FYA/B were identified. Results: The results of Chi-square test showed that in the patient group, there is no statistically significant difference between the two genders in terms of the frequency of distribution of Duffy genotypes (P=0.588). On the other hand, in the healthy group too, there was no statistically significant difference between the two sexes in terms of the frequency of distribution of Duffy genotypes (P=0.707). According to nominal regression results, although the distribution ratio rate (95% confidence interval) of FYA/FYA and FYB/FYB genotypes as compared to FYA/FYB genotype (reference category) in the patient group as compared to healthy people was 2.42 (0.7 to 8.34) and 0.76 (0.36 to 1.64) respectively, but there was no statistically significant difference between the case and control groups in terms of the distribution frequency of these genotypes (P

Background: Cholecystectomy is one of the most common abdominal surgeries and its preferred method is laparoscopy. The difficulty of laparoscopic cholecystectomy in diabetic patients is not clear and the preferred method of cholecystectomy in these patients is still under controversy. Therefore, this study was performed to evaluate the difficulty of laparoscopic cholecystectomy in diabetic and non-diabetic patients. Methods: This retrospective analytical study was performed in Shahid Beheshti Hospital and Forghani Educational and Medical Center from April 2019 to April 2020. Samples were easily selected and 86 people in two groups of diabetic and non-diabetic patients were included in the study. All patient records were reviewed based on inclusion and exclusion criteria for factors such as age, sex, diet, duration of surgery, bleeding, adhesions, and open surgery, and finally, diabetes as a risk factor. It was compared between the two groups. Data were analyzed in SPSS software version 22, an independent t-test was used to analyze quantitative data and the chi-square test was used to analyze qualitative data. In this study, a significance level of less than 0.05 was considered. Results: Abdominal scar, palpable gallbladder and gallstone were not significantly different between the two groups (P=0.33). But the history of cholecystectomy attacks was significantly different between the two groups (P0.05) . Hard operations in diabetic patients were more than nondiabetic patients and even two cases of open surgery were seen in the group of diabetic patients, but there was no significant relationship (P=0.09). Intraoperative bleeding was statistically significant between the two groups (P=0.02), But adhesion during the operation was not related (P=0.38). Conclusion: Finally, our study showed that diabetes can be a predictive risk factor for the difficulty of cholecystectomy.

Background: Statins is a class of lipid-lowering drugs and our previous investigations showed that statins have antiviral effects and have a wound healing effect in the lung. This systematic review and meta-analysis aimed to evaluate the effects of statin therapy on mortality and clinical outcomes in COVID-19 patients. Methods: A comprehensive search was conducted in international databases, including MEDLINE, Scopus, Web of Science, and Embase from December 1, 2019 until January 26, 2022 without any restriction in language. The random-effects model was used to estimate the pooled odds ratio (OR). Results: The statin therapy overally was associated with decrease in odds of ventilation [pooled OR (95% CI): 0.85 (0.70 to 0.99)] and mortality [pooled OR (95% CI): 0.73 (0.66 to 0.81)] but had no effects on the ICU admission [pooled OR (95% CI): 0.93 (0.77 to 1.12)], oxygen therapy [pooled OR (95% CI): 0.85 (0.70 to 0.99)], recovery [pooled OR (95% CI): 1.85 (0.35 to 9.92)], kidney failure [pooled OR (95% CI): 1.01 (0.73 to 1.40)], hospitalization [pooled OR (95% CI): 1.45 (0.88 to 2.36)], asymptomatic disease [pooled OR (95% CI): 1.33 (0.24 to 7.44)], and ARDS [pooled OR (95% CI): 1.15 (0.88 to 1.49)]. Conclusions: The present meta-analysis showed that statin therapy was associated with a reduced risk of mortality and ventilation in patients with COVID-19 but had no effects on other clinical outcomes.

Abstract Background: To improve healthcare services’ quality, countries should measure their health systems’ efficiency and performance by robust methods. Objectives: We aimed to develop a national study to measure the efficiency of the health system in Iran. Methods: The literature review identified several methods for measuring efficiency; the most common one was data envelopment analysis (DEA). We adopted DEA, but its findings were simplistic and inaccurate, so we began to modify the method by determining the weight of each indicator. We identified the efficiency measurement indicators, in line with international standards and uniformed units, and then readjusted our input/output indicators according to the study context through four expert panels. We collected data and classified the input/output indicators, followed by determining each indicator’s weight and standard limits. Then we rationalized our previous results by applying the revised model. The initial new results of the refined model were valid, accurate, and consistent with previous studies, as approved by experts. We defined proper modeling to achieve the stated objectives. After investigating various DEA models, we finally designed a new model that was consistent with the existing data and conditions, entitled EDEA (extended DEA), to analyze other subprojects. Conclusions: The conventional DEA methods may not be accurate enough to measure health systems’ efficiency. By modifying modeling process, we propose a modified DEA with a very low error rate. We suggest that others interested in measuring health system efficiency adopt our modified approach to increase accuracy and create more meaningful policy-oriented results. Keywords: Efficiency; Health System; Productivity; Protocol

Ulcerative colitis (UC) is a chronic inflammatory bowel disease, which has a global prevalence. Also, the plants of the Cupressaceae family have prominent anti-inflammatory and wound healing effects, so they can be considered as promising candidates for the treatment of UC. In this study, the therapeutic effects of extract and essential oil of Cupressus arizonica Greene (C. arizonica) fruits in the animal model of UC were investigated. Total of 35 Wistar male rats were treated with essential oil and hydroalcoholic extract for one week after induction of colitis by acetic acid. The colonic segment cut for macroscopic and histological analysis. The total amount of extract phenol and flavonoid content was assayed by Folin–Ciocalteu and aluminum chloride colorimetric method, respectively. The essential oil was analyzed by gas chromatography/mass spectrometer (GC/MS). The extract at doses of 100 mg/kg and 250 mg/kg and essential oil at doses of 0.5 mg/kg showed significant effects on UC (P < 0.05). The total phenolic content of hydroalcoholic extract in terms of mg of gallic acid/ g of extract was 191.625 ± 7.04 and the amount of total flavonoids in terms of mg of rutin/g of extract was 66.52 ± 6.51. Also, according to the results of GC/MS analysis, α-pinene was the major constituent of essential oil. Our results revealed that the extract and essential oil of C. arizonica fruits had therapeutic effects on UC, and this effect may be related to the presence of polyphenolic and terpene compounds.

Acute traumatic injuries to the maxillary incisors may lead to a crown-root fracture. If the fracture is left untreated, the fracture line will propagate and extend apically, resulting in microbial contamination of the attachment apparatus and subsequent bone loss. In cases with extensive periodontal involvement, extraction has been suggested. However, bonding and sealing the fracture line with a biocompatible material seems to be an effective alternative treatment option. In this case report, management of a central incisor with an incomplete crown-root fracture that showed signs and symptoms of vertical root fracture is discussed. As the extension of the fracture line was not clear, intentional replantation and sealing the fracture line with a glass ionomer was performed. The tooth showed no signs and symptoms at six-month follow up, and the radiographic examination exhibited substantial bone repair.

Background: Knowing the conversion risk factors of laparoscopic cholecystectomy to open surgery, helps the surgeon to plan for surgery accordingly. This study aimed to determine the risk factors for converting laparoscopic cholecystectomy to open surgery. Methods: In this analytical study, the case information of 1104 patients who underwent laparoscopic cholecystectomy in Shahid Beheshti Hospital in Qom from April 2013 to April 2017 was evaluated. Inclusion criteria were all cases of acute cholecystitis, chronic cholecystitis, symptomatic gallstones, and biliary pancreatitis who underwent laparoscopic cholecystectomy. The exclusion criteria were patients who underwent laparoscopic cholecystectomy at the same time with other procedures. Data of all patients including age, sex, history of abdominal surgery, emergency or elective surgery, blood transaminase level, blood bilirubin level, white blood cell count, amylase level, and serum alkaline phosphatase were recorded. Finally, potential risk factors were compared between the two groups. Average, standard deviation, frequency and percentage indices were used to describe the data. Independent samples t‐test and Mann-Whitney U test were used for quantitative data analysis and Chi-square test was used for qualitative data analysis. P

Diagnosing and managing pelvic pain during pregnancy is often challenging. This pain can be obstetrical, gynecological, or non-obstetrical_non-gynecological. Ovarian torsion, known as the consequence of ovarian twisting on its supporting ligaments, is one of the causes of gynecological pelvic pain that can occur during pregnancy and cause emergencies. However, early detection can preserve the ovaries and preserve the patient's current and future fertility. Surgery is the gold standard for the diagnosis and treatment of ovarian torsion. It is important to choose the best surgical technique (laparoscopy or laparotomy) to reduce possible complications during and after surgery. Our case is a 7-8 weeks pregnant woman who underwent laparoscopic surgery with an ovarian mass of 85*152 mm and an acute abdomen. It was found that the mass has caused 1260 degrees rotation in the patient's left adnexa. The results during and after surgery, as well as the condition of the mother and baby, were favorable.

Background: Identifying risk factors for conversion to open surgery laparoscopic cholecystectomy and factors are difficult to predict cholecystectomy surgery is required. The aim of this study was to evaluate the findings of preoperative ultrasound in predicting the length of laparoscopic cholecystectomy surgery. Methods: The present study was performed cross-sectional on 122 patients who underwent laparoscopic cholecystectomy in Shahid Beheshti, Forghani and Nekoei’s Hospital in Qom from September 2016 to September 2017. Inclusion criteria: All cases of acute cholecystitis, chronic cholecystitis, symptomatic gallstones and biliary pancreatitis underwent laparoscopic cholecystectomy. The exclusion criteria included patients undergoing laparoscopic cholecystectomy at the same time were other procedures. Before surgery patientschr('39') information such as age, sex, ultrasound findings including gallbladder wall thickness, compressed stone and the presence of fluid around the gallbladder were recorded in the checklist. Finally, the duration of cholecystectomy was divided into two degrees of easy operation (less than 60 minutes and without complications) and difficult operation (above 60 minutes with complications) according to the mentioned variables. Data were analyzed by SPSS software, version 22 (IBM SPSS, Armonk, NY, USA). In this study, a significance level of less than 0.05 was considered. Results: 28 (22.4 percent) males and 97 (77.6 percent) females with a mean age of 44.66 13 13.85 years were studied. There were 35 difficult cases (28 percent) and 90 easy cases (72 percent). Conversion to open surgery occurred in three cases. Among the sonographic findings, there was a significant relationship between the increase in gallbladder wall thickness and Impacted stone with the duration of operation (P≤0.05). But no significant relationship was found between the findings of Presence of pericholecystic fluid and the duration of operation (P>0.05). Conclusion: Overall, the findings of this study showed that preoperative ultrasound is able to provide valuable data in predicting the duration of laparoscopic cholecystectomy.

Background: Reliable assessment of innovative technology readiness is crucial for industrial decision-making. Technology Readiness Assessment (TRA) is an established tool used to qualify technology development and help make investment decisions and deploy systems or technology elements to an end-user in a timely fashion. “Manufacturing readiness levels” (MRLs) and “ATLAS technology method” (technology components evaluation) metrics are commonly employed in TRA to assess the impact of technologies for future R&D programs and development of manufacturing and risk of a given technology, system, and or subsystem. Methods: In this study, E.coli-based recombinants were chosen as the objective. Two questionnaires were designed on their manufacturing process and sent to 13 biopharmaceutical experts in Iran. Results: The findings show that Iranian biopharmaceutical experts validated the proposed MRLs model inspired by the US Department of Defense’s published questionnaire. To run the “ATLAS technology method”, the relative importance of technology components (software, hardware, and human resources) involved in each stage of manufacturing and each stage’s relative importance was determined by experts in the percentage scale. Conclusion: Policymakers and managers must have enough knowledge of how to evaluate manufacturers’ abilities, and in this way, TRA is a usable and exquisite tool. In this article, two TRA methods that appear compatible with Iran’s environment of the biopharmaceutical sector are proposed.

Dens invagination (DI) is a dental anomaly that can cause pulpal and periapical pathoses of the affected tooth. We describe the treatment of a healthy 18-year-old female with a chief complaint of recurrent facial swelling pertaining to a peg-shaped maxillary lateral incisor with DI. Examinations showed necrosis of the involved tooth with symptomatic apical periodontitis. Cone-beam computed tomography corresponded to Oehlers type II DI. Orthograde endodontic treatment was performed. To completely debride the canal and resolve the persistent purulent discharge, various methods and medicaments were used in separate sessions including passive ultrasonic activation of 5.25% sodium hypochlorite solution, calcium hydroxide mixed with 2% chlorhexidine, and double antibiotic paste as intracanal medicament. After resolution of the symptoms, the root canal and the invaginated space were filled by a mineral trioxide aggregate plug and backfilled with thermoplasticized gutta-percha. At the one-year follow-up, complete bone healing was noted in the affected periradicular area.

We want to evaluate the effect of Allium noeanum Reut. ex Regel (Bonsor) known (traditional medicine agent) in calcium oxalate stones in kidney. 36 male rats were divided into 6 groups. I: healthy model + water, II: negative model + 1% ethylene glycol in water, III: 750 mg/kg of total extract +1% of ethylene glycol in water(Prevention), IV: 250 mg/kg flavonoid extract +1% of ethylene glycol in water (Prevention), V: 1500 mg/kg of total extract from 15th day+ 1% of ethylene glycol in water (Treatment), VI: 500 mg/kg of flavonoid extract from 15th of the study + 1% of ethylene glycol in water (Treatment).24-hour urine and blood samples were collected in 30th day for analysis. Pathology of kidneys was checked. Serum urea, uric acid, creatinine and urine calcium and oxalate were significantly increased, urine citrate was decreased in group II Vs I. (P < .05). Extract administration significantly decreased serum creatinine, urea and uric acid. Urine calcium and oxalate significantly decreased in treated groups. Urine calcium levels were significantly decreased in treated rats, but urine citrate levels were increased Vs group II. (P < .05). No crystal accumulation and tubular cast were observed in prevention groups. Hydroalcholic extract of Allium noeanum was able to reduce urine oxalate.

Background: The position of each subject area in scientific production can indicate the ability of the scientific performance of that subject field. Since obstetrics and gynecology is one of the most important clinical sciences discipline of medical science, this study aimed to evaluate the scientific production in the field of obstetrics and gynecology before and after the Iran health reform plan. Methods: This study is a scientometrics, time interval in the study was from 2008 to 2017 on Iranian articles based on the indexes of the number of documents, the number of citations received, the number of citations to each article, and the H-index of obstetrics and gynecology field based on the Web of Science database. It Indicators investigated, was extracted separately from the analysis section of the database. Results: The average citation per article, the number of documents and the number of citations in the 5 years before the health reform plan respectively in the field of obstetrics and gynecology equal to 10.44, 196.6, 1750.6 and after the implementation of the health reform plan, equal to 3.89, 282.6, 1031.4. Also, the level of international collaboration before and after the project is 13.06 and 13.25, respectively. Also in the field of gynecology and obstetrics, Ramezani Tehrani, with 1.91% of all articles was the most reproductive writer, and Tehran University of Medical Sciences, with the highest scientific productions in the field of obstetrics and gynecology by 23.77% of all productions. Finally, the field of obstetrics and gynecology had the highest share of scientific production by 66.88%. Conclusion: The findings showed that the scientific production of obstetrics and gynecology, in terms of quantity (number of documents), after the health reform plan, has been growing, but the quality (citation, H-index) is decreasing. Also, international collaboration has grown after the health reform plan. The findings also showed that before and after the health reform plan, the most cooperation was with the United States and the rate has been lower with Asian countries.

Introduction: Evaluating environmental risks in the oil and gas industry is essential to prevent irreparable damage to the environment. Using classical methods for prioritizing environmental risks does not achieve high-reliable results. Therefore, the aim of this study is to minimize the limitations of classical methods in a typical oil and gas production zone, by using fuzzy logic and Multi Attribute Decision Making (MADM) approach. Material and Methods: After forming an identification and assessment team including experienced experts from different organizational units in a region of exploitation of oil and gas, values of each risk factor (likelihood of occurrence, severity and detectability) related to identified environmental risks are determined according to their qualitative opinions represented by linguistic variables. Relative weights of the risk factors are calculated by applying the group Analytic Hierarchy Process (AHP) in a fuzzy environment on expert opinions. Then, fuzzy aggregation in the linear form by considering the weight of the risk factors and a method that is developed based on the center of gravity are employed in evaluation and ranking of the risks. Results: In this study, the severity factor has the most important contribution in risk assessment compared to the other risk factors, since it has the highest relative weight. Raw sewage aspect resulted from absence of appropriate treatment system has the highest priority and spilling over of acid that is caused by chiller cleaning stands at the second position in the identified environmental risks. Conclusion: The results demonstrate that although the proposed methodology requires greater time than classical methods, it is able to determine the risk ranking more practically because of minimizing the limitations of classical methods: high sensitivity to judgmental errors, considering some risks in the same index group and ignoring uncertainty in experts’ opinions. Proposed method is a proper alternative for classical environmental risk assessment technique, and capable of prioritization and evaluation risks in terms of safety and health.

Background and Objectives: Congenital heart disease (CHD) is the most common type of birth defect that accounts for 25% of all congenital anomalies. This study was conducted to identify the risk factors od congenital heart disease in southeast Iran. Methods: In this case-control study, 353 cases were selected from children aged 0 to 59 months who suffered from congenital heart disease and were referred to the Children’s Heart Clinic of Zahedan. Moreover, 353 controls were selected from healthy children aged 0 to 59 months who presented to health centers in Sistan and Baluchistan Province. The cases and controls were matched for age, sex and place of residence. The data were collected using interviews with children’s mothers and analyzed using independent t-test, chi-square test, and multiple logistic regression models. Results: This study showed that the lack of folic acid consumption in pregnancy (OR =11.8), mot using multivitamins during pregnancy (OR = 4.1), history of CHD in first-degree relatives of parents (OR=3.4), history of abortion (OR =3.4), presence of telecommunication rig in the vicinity of the house (OR=3) and exposure to secondhand smoke (OR=2.9) significantly increased the chance of a CHD (P

Background and Objectives: In 1995, a huge revolution occurred in Iran’s health system when the entire medical-related educa-tion program was integrated into the Ministry of Health. This paper was conducted to provide a review of all studies investigating this integration and to synthesize their results. Methods: This study was a systematic review and qualitative meta-synthesis of the papers on integration using the Walsh and Downe process. An extensive search of the databases of ScienceDirect, PubMed, EMBASE, ISI, Google Scholar, Scopus, SID, Magiran, and Irandoc revealed 187 articles of which 25 were selected. The content of the studies was analyzed and combined using the Walsh and Downe technique. Results: The results showed 5 main concepts, including the goals and reasons of the medical education integration, integration achievements, challenges, and barriers to achieving the goals of integration, and the future of integration. The greatest success of the integration program was related to health services, while the least positive effects were related to medical education and research. Conclusion: A review of available documents shows that not all dimensions of integration have been well analyzed and their economic, social, developmental and scientific effects have not been studied. The majority of the limited studies in this regard were surveys and overview studies and few studies used economic analysis and modeling. Therefore, the effects of the integration cannot be evaluated using the available studies.

Background and Objectives: Before any development in scientific health activities, we have to observe its scope and compare it with health sector. Accordingly, the aim of this study was to determine the quality and quantity of the health-prioritized disciplines mentioned in the comprehensive health plan of Iran. Methods: This scientometric cross-sectional study was done during 2010-2017. The study population was 26 prioritized areas in three categories of survival, excellence, and infrastructure according to comprehensive health plan of Iran in 2010. The data collection tool was the SCImago database. The number of documents, citation indicators, and h-index were analyzed by Excel. Results: The findings of the research showed that the highest h-index of Iran in the excellence, survival, and infrastructure category was in Nano (90), infectious diseases (67), and systematic ecology (56), respectively. Moreover, the highest ranked citations in three categories of survival, infrastructure, and excellence were related to traditional medicine, family medicine, and dentistry with a global rank of 8, 9 and 15, respectively. In categories of excellence, survival and infrastructure; public health, bioinformatics, and infectious diseases had the highest number of products with 7045, 5371 and 5135 articles. Conclusion: There has been a marked improvement in the quality and quantity of all the subject categories over time. The general domains of excellence, survival, and infrastructure categories had the highest mean H-index, and the highest average growth rate of scientific productions was related to excellence, infrastructure and survival categories, respectively.

Background and Objectives: Plagiarism is the most prevalent type of scientific misconduct, and various rules and strategies have been proposed to combat it in different countries. A review of other countrieschr('39') experiences in this area contributes to good policymaking. The present study was conducted to introduce preventive interventions of plagiarism in the leading countries. Methods: The present study was a qualitative review study of applied practices. In this study, preventive interventions of scientific plagiarism in the 27 European ::::::::union:::::::: countries were studied due to the appropriate coherence and structural similarity at national, organizational, and individual levels. The national-level interventions were analyzed using the content analysis method in mentioned countries. Results: The results of analyzing the national-level interventions were categorized into eight main themes, including reaching a national agreement on examples of scientific plagiarism and misconduct; policy development; monitoring and supervision; financial support development; development of databanks and software; compiling educational programs for faculty members and students; dissemination and use of successful experiences; and eventually establishment of laws related to scientific misconduct, plagiarism, and punishments activities. Conclusion: Using preventive interventions at a national level proves the commitment and determination of policymakers to control and prevent plagiarism. Proper use of preventive interventions at a national level strengthens the controlling and preventive infrastructures of this issue at the organizational level, and enhances moral commitment and professional skills among the countrychr('39')s researchers.

Background and Objective: Poor sleep is one of the most common problems in old age and menopause. The aim of this study was to investigate the effect of tele-nursing-based sleep health education on sleep quality in postmenopausal elderly women. Materials and Methods: In this quasi-experimental study, 70 elderly people over 60 years of age who referred to urban community health centers of Gonabad City, Iran, and met the inclusion criteria were selected through a systematic sampling and were equally assigned into controland intervention groups. Participants completed a questionnaire that included the demographic questionnaire and Pittsburgh Sleep Quality Index (PSQI). After completing the pre-test in the intervention group, the sleep health education program was conducted as a face-to-face training session and a telephone follow-up during two months (12 follow-ups). The control group received routine health care. Post-test was performed in both groups after 2 months. Results: We did not find any significant difference between two groups at bassline variables. Besides, there was no statistically significant difference in the mean score of sleep quality before intervention in the experimental and control groups (P = 0.127), the mean score of sleep quality after the intervention showed a significant difference between the two groups (P < 0.001). Conclusion: The sleep health education program based on telephone follow-up can improve the sleep quality of postmenopausal elderly women. Therefore, teaching this non-pharmacological approach to health care workers, staff of community health centers, and caregivers is recommended to improve the sleep quality of postmenopausal elderly women.

This study aimed to explore the prevalence, antimicrobial resistance levels, and serotype distribution of S. pneumoniae in the Middle East region. We conducted a systematic literature review by searching several databases including PubMed, ISI Web of Science, Scopus, Google scholar through 2000 to 2017 by using the following keywords: “Streptococcus pneumoniae”, “pneumococcus”, “serotype”, “Antibiotic resistance,” and “Middle East “in combination with “OR” and “AND” Boolean Operators within Title/Abstract/Keywords fields. We used a random-effects model to calculate the pooled prevalence and 95% confidence intervals (CIs) for binomial variables. All statistical analyses were done using STATA 12.0 (STATA Corp, College Station, TX). We found 73 articles appropriate, on the word of inclusion and exclusion criteria, for inclusion in this systematic review and meta-analysis. The result revealed that the pooled prevalence of S. pneumoniae carriage was 35% (95% CI: 26-44%). The most frequent pneumococcal serotypes were19, 19F, 6, 23 and 6A/B which were found in 19%,12%, 11%, 10% and 10% of isolates respectively. Pneumococcal resistance reported for azithromycin, cefaclor, clarithromycin, chloramphenicol, erythromycin, and tetracycline were 24%, 37%, 23%, 11%, 26%, and 29% respectively, while vancomycin resistance was not reported. The highest resistant prevalence was reported against co-trimoxazole (Trimethoprim/sulfamethoxazole). For this antibiotic, a pooled resistance prevalence of 43% was identified. The present review demonstrates that the prevalence of S. pneumoniae carriage was high in the Middle East region. Surveillance must be continued in this region to evaluate. The resistance pattern and serotype distribution.

Objectives: Toothpastes and mouthwashes contain chemicals that may be harmful to oral tissues. This study assessed the cytotoxicity and antibacterial activity of toothpastes and compare the Iranian and foreign toothpastes and mouthwashes available in the Iranian market in this respect. Materials and Methods: Twenty samples (13 toothpastes and 4 mouthwashes) were selected. The cytotoxicity of 1, 10, and 50 mg/mL of toothpastes and 0.05, 2 and 10 µL of mouthwashes was measured after 1, 15 and 30 min of exposure to human gingival fibroblasts, each in triplicate. The methyl thiazolyl tetrazolium (MTT) assay was used for cytotoxicity testing. The serial dilution method was utilized to determine the minimum inhibitory concentration (MIC) of each sample against Lactobacillus acidophilus (L. acidophilus) and Streptococcus mutans (S. mutans). Two-way ANOVA and Tukey’s test were used for data analysis. Results: A significant difference in cytotoxicity was noted among different products (P=0.00). The difference in cytotoxicity of each sample was not significant at 1, 15 and 30 min (P=0.08). The obtained MIC for all toothpastes and mouthwashes was between 0.0039 mg/mL and 0.0156 mg/mL, except for Sensodyne toothpaste and Oral B mouthwash. Conclusion: Some brands of toothpastes have higher cytotoxicity due to their composition, and their cytotoxicity should not be overlooked. The antibacterial activity of the samples was almost equal when they were in contact with L. acidophilus and S. mutans except for the Irsha mouthwash, Sehat, Darugar and Bath toothpastes. The antibacterial effect of toothpastes and mouthwashes increased with an increase in exposure time.

Sharp-object penetration into the chest is rare and may lead to life-threatening complications, hence the significance of early detection and removal. We present an uncommon case of the accidental penetration of a sewing needle into the chest of a 5-year-old girl, with the needle traveling from the entrance site to the right ventricle through the lung tissue. Due to the possibility of cardiovascular accidents, the patient was transferred to a special ward. For positioning and correct actions, TTE and CT scan of the chest with and without contrast were performed and the presence of a tangential needle with the right ventricular wall and inside the pericardium was reported. The patient was taken to the operating room, and after exploring, a 2 cm needle was inserted into the right ventricle and removed. The patient was discharged after 5 days.

Background: Listeria monocytogenes show high mortality among pregnant women and newborns. This study aimed to detect L. monocytogenes in pregnant women with a history of abortion and assess the serotypes, antibiotic susceptibility patterns, and its resistance genes. Methods: Overall, 400 vaginal swabs were taken from pregnant women with a history of abortion in the past few years in a tertiary care hospital in Tehran, Iran, during 2015-2018. Antibiotics susceptibility to a panel of 10 antibiotics was determined using the standard disk diffusion method and the isolates serotyped by the agglutination method. The antimicrobial-resistant isolates were also screened for the presence of tetM, ermB and dfrD genes by PCR. Results: Overall, 22 L. monocytogenes isolates were identified. High rates of resistance were observed for trimethoprim (50%; n=11), sulphamethoxazole (50%; n=11), tetracycline (45.45%; n=10) and gentamicin (36.36%; n=8). From 22 L. monocytogenes isolates, 13 (59.10 %), 5 (22.73%), 3 (13.63%) and 1 (4.54%) belonged to serotypes 4b, 1/2a, 1/2b, and 3c, respectively. The genetic determinant tetM was detected in 70% of the tetracycline-resistant isolates. Out of 11 trimethoprim-resistant isolates, 27.27% isolates contained dfrD. Moreover, the ermB gene was found in 83.33% of the erythromycin-resistant isolates. Conclusion: Ampicillin and partly penicillin consider to be suitable antimicrobial agents to treat human listeriosis. Moreover, due to resistance against many antibiotics, it is necessary to continue monitoring and managing antimicrobial resistance.

Objective: Intrauterine insemination (IUI) is an assisted conception technique that involves the deposition of a processed semen sample in the upper uterine cavity, overcoming natural barriers to sperm ascent in the female reproductive tract. Hence, we compared the results of doing intra-uterine insemination 36 and 42 hours after human chorionic gonadotropin (hCG) hormone injection to achieve clinical and chemical pregnancy rates. Materials and methods: One hundred and sixty infertile women with unexplained infertility participated in this clinical trial. They were divided into two groups: those who underwent IUI 36 hours after hCG injection (control group), and those who underwent IUI 42 hours after hCG injection (case group). Statistical analyses were done using IBM-SPSS 25.0. and Chi-square test were used for data analysis. Results: The percentages of clinical and chemical pregnancies were significantly higher in the 42h group compared to the other group (P = 0.038 vs. P = 0.009, respectively). There was no significant difference regarding frequency of abortion, twin and ectopic pregnancies between the two groups (P > 0.05). Conclusion: Doing IUI 42 hours after hCG injection can significantly increase chances of fertility compared to doing it 36 hours after hCG injection.

Introduction: Stroke is the third most common cause of death in world after heart diseases and cancer. Due to the higher rate of stroke and less attention to its occurrence, assessing the prevalence of ischemic brain stroke and its clinical patterns across countries and nations such as Iran could be valuable and important. Objectives: The aim of this study was to assess the epidemiological, Risk factor and clinical characteristics of ischemic stroke in Ardabil province. Materials and Methods: This descriptive cross-sectional study has been done on 676 patients with ischemic stroke who referred to Ardabil city hospital during at year 2018. Data collected by using a checklist including demographic and clinical data of patients. Collected data were analyzed by statistical methods in SPSS version 21. The p-value less than 0.05 was considered as significant. Results: Of all patients, 294 (43.5%) were female and rest of them were male. The mean age of patients was 69.3±13.2 years. Of all patients, 25.3% arrived to the hospital in less than 4.5 hours. The difference between arrival time to the hospital in rural and urban patients was significant. The most risk factors were seen in both sexes was HTN and in female only was DM and in male only was CVA. The results of CT and MRI showed that 30% and 64.9% of patients had lesion respectively that of them the most lesion in MRI was SMALL VESSEL and in CT was Middle Cerebral Artery (MCA). Conclusion: Results showed that the patients who live in urban areas arrive to emergency sooner than rural patients. The significant relation was seen between AF, residence place and valvular with arriving time to hospital.

Vitamin D plays a variety of physiological functions, such as regulating mineral homeostasis. More recently, it has emerged as an immunomodulator player, affecting several types of immune cells, such as regulatory T (Treg) cells. It has been reported that vitamin D exerts some mediatory effects through an epigenetic mechanism. In this study, the impacts of calcitriol, the active form of vitamin D, on the methylation of the conserved non-coding sequence 2 (CNS2) region of the forkhead box P3 (Foxp3) gene promoter, were evaluated. Fourteen C57BL/6 mice were recruited in this study and divided into two intervention and control groups. The CD4+ T cells were isolated from mice splenocytes. The expression of Foxp3, IL-10, and transforming growth factor-beta (TGF-β1) genes were relatively quantified by real-time PCR technique, and the DNA methylation percentage of every CpG site in the CNS2 region was measured individually by bisulfite-sequencing PCR. Vitamin D Intervention significantly (p

Adipose tissue-derived hormones known as adipokines, like leptin, have multiple bioactions. Notwithstanding the key roles of leptin in regulating energy homeostasis and metabolism, its cardiovascular functions are complex and not fully understood. This study aimed to investigate the association between serum concentrations of leptin and lipid profiles in patients with valve calcification. Seventy-two patients with valve calcification and 72 healthy individuals participated in this case-control study. The serum levels of biochemical markers and leptin were measured by the standard enzymatic methods and enzyme-linked immunosorbent assay (ELISA) technique, respectively. Significantly increased serum concentrations of FBS (P=0.001), urea (P

Background: In the fingertips, the glomus tumors usually involve the subungual areas with typical triad symptoms including pain, tenderness to palpation, and cold sensitivity. The glomus tumor of volar aspect of digits is rare. Case Presentation: A case of glomus tumor was presented at the volar side of the distal phalanx of the ring finger of a 52-year-old woman. The tumor was painful and tender to palpation, yet insensitive to cold. The atypical location and insensitivity to cold led to a 4-year delay in diagnosis. After the surgical excision of the lesion, the extracted mass was sent for histologic evaluation and the diagnosis of glomus tumor was confirmed. One-year follow-up of the patient was event-free. Conclusions: Atypical glomus tumor should be considered in the differential diagnosis of finger pain, even in the absence of characteristic diagnostic features

Cancer is one of the most dangerous health problems of today modern societies which has an increasing rate especially in developing countries. There are many diverse ongoing treatment attempts trying to defeat cancer. Despite that, scientists have been unable to find a permanent cure for this disease. In many cases although there is a successful first response in patients, cancer cells are finally able to withstand therapeutic procedures and even use chemo-resistance to take advantage of treatments to facilitate tumor growth, resulting in cancer remission. Therefore, and mostly in recent two decades, scientists have been trying to choose their treatments just as smart to be able to conquer cancer. One of the best methods of this smart defense is to target weak points of neoplastic cells and use them for designing drugs. In this case it would be most probable for cancer cells not to have a chance to confront and cause chemo-resistance. Total endeavors to fulfill this goal are named “targeted cancer therapy”. This therapeutic approach is mostly consisted of two different procedures: 1- designing and using specific drugs to target cancer cells’ mutated genes; which will be defined by checking the genetic background of tumor cells for each specific cancer type. EGFR, RAS, VEGF and HIF-1α are among the pathways that have already been used as targets. 2- The other procedure could be methods that would carry drugs directly to unhealthy cells to prevent further side effects for normal cells of patients. It would be possible by designing specific antibodies to target antigens of neoplastic cells. Ribonucleic sequences (miRNAs and siRNAs) are also very promising as new drugs and nanoparticles have enabled us to increase drug concentration in tumors. The ultimate goal of these new experiments is to suggest specific drugs for each patient based on the nature of one's disease and genetic background, which will bring about "personalized medicine" era. Using valid new references, this review article first presents targets that are currently being used for this targeted therapy, their logic of choice and the drugs that have already been produced for clinical trials. Smart methods of drug delivery are also presented and discussed afterwards.

Background and Objective: Natural antimicrobial compounds have a valuable capacity to be used in a variety of foods to inhibit growth of foodborne pathogens and spoilage bacteria. The aims of this study were to produce active biodegradable films by incorporation of different percentage of oregano essential oil (OEO) and ethanolic extract of propolis (EEP) into poly-lactic acid (PLA) films, and to evaluate physical and antimicrobial properties of the resulting films. Materials and Methods: The active films were produced by solvent casting method, and their thickness and major color parameters were measured using a digital micrometer and a colorimeter instrument, respectively. Afterwards, antibacterial effects of the films were assessed against four common foodborne pathogens, including Staphylococcus aureus, Escherichia coli, Vibrio parahaemolyticus and Listeria monocytogenes, by means of disk diffusion test. Results: Physical examinations showed that thickness of resultant films significantly was increased (p

Background and Objectives: The aim of this study was to provide a clear description of the pre-hospital emergency setting and risk management in accidents and disasters in accordance with current Iran’s standards in different regions of the country. This study was part of the national project "Iran Roadmap (Neda 2026)". Methods: The data of the major medical equipment was gathered from 48 medical universities covering all of the countrychr('39')s 32 provinces. Goal standards were obtained from the “Ministry of Health” and the “Department of Statistics for Medical Accident and Emergency Management Centers” in all universities. Coefficient of dispersion was calculated to evaluate any dispersion in major medical equipment. Results: The results of this study showed that in 2017, the highest and lowest coefficient in “pre-hospital facilities” was related to the ambulance engine (301%) and the operational base personnel (93%), respectively. Nio national standards were implemented in “Risk Management in accidents and disasters needs” in most provinces of Iran. In 2026 estimates, all of the factors improved and dispersion decreased. Conclusion: Despite the poor distribution of prehospital indicators in 2017, forecasting showed desirable conditions in distribution of facilities in the pre-hospital emergency and risk management of accidents and disasters.

Background and Objectives: The imbalance between the existing human resources and future needs of the health system disturb the service delivery process. The present study aimed at determining human resources needs in the health sector for a 10-year planning program. For this purpose, the researchers examined the geographical distribution of different groups of health system staff in 2016 and 2026. Methods: This descriptive-analytic study was carried out in 2016. The population of this study included 46 universities of medical sciences. Data of the number and distribution of health care staff working in public, private, charity, and semi-public sectors of medical departments of medical universities were collected. The Qlik View software was used for data integration and designing information dashboards. Results: At the beginning of 2016, the ratio of nurses, nursing groups, midwives, pharmacists, dentistry and general physician per 100,000 individuals was 133, 199, 32, 17, 22, and 53 respectively, which are estimated to reach 223, 272, 37, 26, 27, and 79 in 2025, respectively. The coefficient of dispersion variation of the above was 39%, 32%, 43%, 33%, 43%, and 44% in 2016, respectively, which are estimated to reduce by 2026 if the Iran medical roadmap is implemented. Conclusion: The high dispersion index of the medical personnel relative to the population in the cities covered by medical universities indicates unbalanced distribution. If the estimates of the Iranchr('39')s 2026 medical roadmap are implemented, more appropriate distribution of the medical staff is expected.

Background and Objectives: The distribution of specialists is important in two ways: geographical and specialty. In this study, we provided a description of the distribution of specialists in Iran in 2016 and its estimates in 2026. Methods: This descriptive-analytical study was conducted in 2016 to estimate the number of specialists in 2026. Data were gathered through a census of specialists working in each of 439 cities in the country, including those in public and private sectors. Coefficient of variation and the number of specialists in 100000 populations were applied as distribution measures. Results: In the year 2016, there were 46 specialists per 100,000 populations, and it is estimated that considering the full-time equivalent index of 1.2, 63 specialists per 100,000 populations will be required in the year 2026. The highest and lowest ratio of specialists per population in the year 2016 was reported in Tehran (89 per 100,000 populations) and Jiroft (10 per 100,000 populations), respectively. The gynecologist group and geriatric specialists group were the largest (4747 specialists) and smallest group (4 specialists), respectively. Conclusion: There was a considerable disparity between different regions of the country in terms of access to specialists. Furthermore, the ratio of specialist per population in different specialty groups varied from one province to another. Upon implementation of the Iran Roadmap, according to 2026 estimates, this dispersion will be reduced to some extent; however, part of the dispersion related to the regionalisation pilicy.

Background and Objectives:Among health sector resources, hospital beds are the primary unit of calculation for the capacity of the health service and vital capacity in patient care. Lack of appropriate distribution in different parts of the country leads to transfer of patients and irreparable problems. The aim of this study was to provide accurate information on the number and distribution of hospital beds in the country in 2016 and to estimate the number of beds required by 2026. Methods:This descriptive-analytic study was conducted in 2016. The population of the study comprised 439 counties covered by 46 medical universities of the country. In this study, the data of 2016 were used and information about the number and ownership of beds and the size of hospitals were obtained from the treatment deputies of medical universities. Results:The number of active beds in the country was 117580 in 2016, and it is estimated that in order to meet the needs of the community, this number should reach 194471 beds by 2026. There were 1.47 beds for 1,000 people in 2016, which will increase to 2.9 in 2026 by implementing the NEDA project. The coefficient of variation in 2016 was 36%, which will reach 19% by 2026 according to estimates in the Iranchr('39')s roadmap project. Conclusion:The distribution of beds was differed in different regions of the country and there are not enough hospital beds in some areas. If the Iran roadmap is implemented, 2026 beds will be distributed more evenly across the country.

Background and Objectives: Iran is a large country that is often an importer of major medical equipment. There is no comprehensive databank of the status of the equipment in the country. The present study provides a clear description of the dispersal status of major medical equipment in the country in 2016 and the estimated number of required devices in 2026. Methods: This study was conducted in 2016 in Iran. The study included 8 MRI, CT scan, gamma camera, linear accelerator, PET scan, cardiac angiography, peripheral angiography, and CT angiography devices. The data of the number of equipment in each city were collected through a census of devices. Results: At the beginning of the year 2016, 3.5 MRI devices, 6.93 CT scans, 2.18 gamma cameras, 1.23 linear accelerators, 0.04 PET scans, 2.3 cardiac angiography devices, 0.27 peripheral angiography devices, and 0.25 CT angiography devices per million population were active in Iran. CT scan and MRI devices were the most available equipment. It is estimated that the same pattern should be maintained in 2026, but the distribution of devices as well as the total number of devices in the country should improve. Conclusion: In 2016, for most of the devices, the proportion of the device to the population in the whole country was close to the global average, but there was a large accumulation of devices in large cities. This problem has been identified and interventions have been planned to move towards reducing inequalities In Iranchr('39')s Health Roadmap.

Background: Head and neck squamous cell carcinoma (HNSCC) is the malignancy of squamous cells (the epidermal layer of skin) in cavities in head and neck includes: larynx, pharynx, paranasal sinuses and oral cavity. The main goal of this research was to understand the effect of mutations in two important genes (KRAS and BRAF) in RAS/MAP kinase (EGFR) signaling pathway in tumor cells with head and neck squamous cell carcinoma in Iran. Methods: The present cross-sectional study performed from October 2015 to September 2016 on 40 patients suffering from head and neck squamous cell carcinoma, all confirmed by pathology department of Imam Khomeini hospital. Tumor samples were achieved from the surgical cancer department of Imam Khomeini hospital and stored in liquid nitrogen until starting tests. The tests done in genetic laboratory of Tehran University of Medical Sciences. Techniques we used in this research, were DNA extraction based on phenol-chloroform approach, Multiplex PCR (M-PCR) to amplify mentioned exons and KRAS/BRAF strip assays to detect mutations in mutated hotspots in exon 2 of KRAS and codon V600E in BRAF gene. Results: In this study, we observed 7 mutations in codons 12 and 13 exon 2 in KRAS gene (about 17.5%) and 4 mutations in codon V600E in BRAF gene (about 10%) of obtained tumor samples. The hotspot mutation in codon 12 were Asp (10%) and Ser (5%) respectively. In BRAF, the most common mutation, as we expected according to other researches, was observed in codon V600E. We also observed that 29 people of these patients were male (about 72.5%) and 11 patients were female (about 27.5%). Moreover, 28 patients were over 50 years, while 7 patients were below the age of 50. Conclusion: The results of this study showed that mutations in genes KRAS and BRAF especially in studied hotspots, and the effects on their molecules in EGFR signaling pathway are important in involving head and neck squamous cell carcinoma, as other cancers. These findings may be considered in choosing drugs for targeted chemotherapy.

Background: Adherence to medical recommendations is very important to control gestational diabetes mellitus (GDM), as one of the most important disorders during pregnancy. In this study, we explored the impact of socio-economic status (SES) on the adherence of a cohort of GDM in Iran. Methods: In this prospective study, 230 pregnant women with confirmed GDM were followed from Feb to Jun 2013 in a referral diabetic care center in Iran. The SES of subjects were quantified using a combined score generated by principal component analysis (PSA). Medical adherence score of subjects was measured in three follow up visits in a range of 0 to 10 and were linked to SES using linear regression model. Results: The adherence scores women in the first, second, and third follow up visits were 5.06±2.12, 5.46±2.06, and 5.08±1, respectively. Women fourth quartile of SES (the highest level of SES) has a least compliance to medical orders in comparison to first quartile of SES (the lowest level of SES) with the OR -2.75 (95% Cl: -3.17, -2.23). Conclusion: The medical adherence of pregnant women with GDM is significantly poorer in high SES groups. Therefore, as an important determinant, we may target high SES pregnant women to control the adverse effects of the disorder more efficiently.

Background: Autosomal recessive non-syndromic hearing loss (ARNSHL), one of the global public health concerns, is marked by a high degree of genetic heterogeneity. The role of GJB2, as the most common cause of ARNSHL, is only

Background: Neospora caninum is protozoan parasitic disease now described as the major cause of abortion and other reproductive issues. The aim of this study was to determine the seroprevalence of N. caninum in cattle breeds of the Sistan region, southeastern border area of Iran. Methods: Using an ELISA kit (ID.VET, France), the antibodies against N. caninum in cattle of Sistan was evaluated in 2016. Overall, 184 blood samples from apparently healthy cattle in the eastern border area of Iran Sistan were collected for assessment of antibodies against N. caninum. The values greater than or equal to 50%, were considered positive based on manufacture’s manual for ELASA kit. Results: 3.8% of 184 cattle have antibody against N. caninum. Chi-square test showed that the seroprevalence among Holsteins, Sistan and cross-breed was 9.4%, 0%, and 4.3%, respectively. No significant difference was observed among the breeds (P>0.05). The seroprevalence was decreased as the age of cow increased and there is no significant difference between the prevalence of N. caninum and different city area. No statistically significant relationship between the seroprevalence of N. caninum and history of abortion, lactation number and infertility was observed. Although there was no significant difference between the cattle breeds of the Sistan region all the Sistani cows were negative for the antibody against N. caninum. Conclusion: Infection rate with N. caninum in bovine population in Sistan region is very low. Environmental and management factors are the major causes, which influence the regional prevalence.

Introduction: Many countries in the arid and semi-arid regions of the world encounter dust storms phenomenon, that is one of the meteorological problems leading to daily life disturbances, financial losses, public health risks and the destructive environmental impacts. Materials and methods: Although the dust storm is historically recorded as an old event in some provinces of Iran, nowadays it becomes a new event in the other provinces such as Ilam in the west of Iran. Dust storms have been remarkably increased since 2007 in a period of 20 years (1997-2017) of daily frequency of dust storms in Ilam station. The dust storm is mostly observed in Ilam city (center of Ilam province) in 2011, after the years of rainfall deficiency. Results: After statiscal investigation of dust storms in Ilam province and factors affecting its formation, the dust storm from 3nd to 6th July 2016 are studied that reduced visibility so much in West and SW of Iran. On the of 3rd- 4th of July of the same year, the intensity of the dust storm was so high that made the visibility decresses severely in Ilam city. The source of this dust storm was the eastern areas of Syria and central Iraq. This fact also appeared in the satellite images and in the output of HYSPLIT MODEL. The output of WRF-Chem Model clearly shows the dust mass over East-Syria, Central and East Iraq and West and SW Iran. Conclusion: Model outputs in intensity of surface dust concentration of MACC-ECMWF, NASA-GEOS, NCEP-NGAC, NMMB-BSC, and BSC-DREAM8b models are compared to the observation of the aerosol concentration in Ilam city and results show that NASA-GEOS model has better performance, based on the results compared to the other models. In display of dust dispertion on Iran, the middle of all models is more compatible with reality.

Background: Bariatric surgery is efficiently associated with the long-term resolution of obesity and its related morbidities. Not only can this surgical modality improve the metabolic profile, diastolic and systolic cardiac functions, and the clinical symptoms of heart failure or cardiomyopathy, but it can also reduce the atherosclerosis risk, ventricular mass, and pericardial fat thickness. The aim of the present study was to evaluate the effects of weight loss on echocardiographic parameters 1 year after sleeve gastrectomy. Methods: This quasi-experimental study, conducted in Modarres Hospital, Tehran, Iran, from September 2016 to September 2017, recruited 101 patients. Those with morbid obesity (body mass index ≥40 kg/m2) had undergone surgery 1 year before the study commencement. All the patients underwent sleeve gastrectomy. The data of echocardiographic indices before and 1 year after surgery were recorded and analyzed. Results: The mean age of the participants was 37.11±9.81 years. The majority of the study participants were female (n=77, 76.2%). During the first postoperative year, the mean weight loss was 43.82±14.53 kg. The mean systolic blood pressure was 137.96±19.60 mmHg and 123.37±9.60 mmHg before sleeve gastrectomy and 1 year afterward, respectively (P