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Background: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease across all age groups. Limited studies have been conducted to consider the relationship between NAFLD and liver size. This study aimed to compare the size of the liver between NAFLD patients and healthy controls. Methods: This case-control study was conducted on NAFLD patients (n = 300), and healthy subjects (n = 300) referred to the Golestan Hospital of Ahvaz from April to August 2021. All individuals underwent ultrasonography examination, and liver size was measured in the midclavicular line. Fatty liver was divided into three grades, I (mild), II (moderate), and III (severe), according to the disease severity. Anthropometric parameters, including age, sex, weight, height, and body mass index (BMI), were recorded. Finally, the size of the liver and its relationship with NAFLD and anthropometric parameters was evaluated. Results: Patients had significantly higher weight, and BMI mean values than controls (P < 0.001). In comparison to controls, NAFLD patients had considerably larger livers on average. (149.05 ± 12.60 mm vs. 134.51 ± 12.09; P < 0.001). There was a significant tendency for larger liver size in normal to severe fatty liver patients (P < 0.001). In patients with mild, moderate, and severe NAFLD, the mean liver size was 144.34 ± 11.35, 154.21 ± 10.84, and 158.63 ± 13.45 mm, respectively. The mean liver size in both groups was significantly higher in males than females (P < 0.05). Age (P = 0.037), sex (P < 0.001), height (P < 0.001), BMI (P = 0.008), and steatosis (P < 0.001) were independent variables for predicting the liver size. Conclusion: The liver size of persons with fatty liver was substantially more considerable than healthy people. The size of the liver was substantially linked with sex, age, BMI, fatty liver, and hepatic steatosis grade. A straightforward way to predict fatty liver is to use ultrasonography to determine the size of the liver.

Introduction The necessity of wearing personal protective equipment specially facemasks to prevent the spread of COVID-19 to healthcare workers has been emphasized in the current COVID-19 pandemic. This survey aimed to estimate the compliance and perceived side effects causing non-adherence to their use in medical personnel. Methods This cross-sectional survey was conducted in the period from March to June 2021including healthcare workers in a tertiary care isolation hospital in contact with COVID-19 cases. A designed online questionnaire was distributed to all teams and data were obtained with response rate 97.3%. Results The study included 302 participants. Adherence was recorded in 293 (97%) during shifts for mean duration of 6.84 ± 2.9 h. Nearly 53% reported changing masks during shift due mask damage, then contamination with secretions of COVID-19 or suspected patients. The causes of non- adherence were perceived dyspnea then headache in 65.3 and 17%. The most commonly reported side effects in all participants were dyspnea (87.4%), headache (42.7%), and 62.3% of the participants reported that these side effects began within 6 h after wearing the mask and 41.1% said that these side effects disappear after less than 1 h. Conclusion Adherence to use of protective facemask between medical teams during the COVID-19 in our hospital was very satisfactory. The main side effects were perceived dyspnea and headache and recorded after prolonged use. There is a need to follow the burden of these side effects to avoid non-adherence and to take measures to reduce hours of work shifts especially during pandemics.

Background Tuberculosis (TB) commonly affects the lung (pulmonary TB). Extrapulmonary TB (EPTB) can involve many systems. Diagnosis is often difficult. EPTB may be misdiagnosed with many other inflammatory, granulomatous, and neoplastic disorders. GeneXpert mycobacterium tuberculosis /rifampicin is a valuable test in diagnosis of pulmonary TB. There is limited research about its diagnostic role in EPTB. Patients and methods The aim of this study was to assess the diagnostic value of GeneXpert in EPTB. Samples from EPTB cases were sent for standard mycobacterial culture and GeneXpert assay. The sensitivity and specificity of GeneXpert were calculated. Results A total of 100 patients were included. Overall, 61 cases were definitely diagnosed as EPTB, whereas 39 cases were negative according to culture. GeneXpert was positive in 40 cases, which represent 65.6% of EPTB cases, and negative in 21 (34.4%) cases. Sensitivity and specificity of GeneXpert was 65.6 and 97.4%, respectively. The positive predictive value and negative predictive value were 97.4 and 64.4%, respectively. Conclusion GeneXpert is a rapid, valuable tool in diagnosis of patients with EPTB. It is a highly specific test with fair sensitivity. A multicenter study with larger sample size is needed to evaluate the diagnostic role of GeneXpert in different sites of EPTB.

In this study 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetramethylene phosphonic acid (DOTMP) was used as the polyaminophosphonic acid carrier ligand and the therapeutic potential of the bone seeking radiopharmaceutical 47Sc-DOTMP was assessed by measuring its dosage–dependent skeletal uptake and then the absorbed radiation dose of human organs was estimated. Because of limited availability of 47Sc we performed some preliminary studies using 46Sc. 46Sc was produced with a specific activity of 116.58 MBq/mg (3.15 mCi/mg) and radionuclide purity of 98%. 46Sc-DOTMP was prepared and an activity of 1.258 MBq (34 μCi) at a chelant-to-metal ratio of 60:1 was administered to five groups of mice with each group containing 3 mice that were euthanized at 4, 24, 48, 96 and 192 h post administration. The heart, lungs, liver, spleen, kidneys, intestine, skin, muscle, and a femur were excised, weighed, and counted. The data were analyzed to determine skeletal uptake and source organ residence times and cumulated activities for 47Sc-DOTMP. 46Sc-DOTMP complex was prepared in radiochemical purity about 93%. In vitro stability of complex was evaluated at room temperature for 48 h. Biodistribution studies of complex in mice were studied for 7 days. The data were analyzed to estimate skeletal uptake and absorbed radiation dose of human organs using biodistribution data from mice. By considering the results, 47Sc-DOTMP is a possible therapeutic agent for using in palliation of bone pain due to metastatic skeletal lesions from several types of primary cancers in prostate, breast, etc.

Background: Palpable Undescended Testis (PUT) represents a common paediatric problem in many premature and some mature infants. There are several surgical techniques to correct PUT either through combined inguinal and scrotal incision or single transverse scrotal incision. This study assessed single high transverse scrotal incision for the management of PUT as regards to feasibility, postoperative success and final cosmetic results. Materials and Methods: One hundred twenty patients were managed at the Paediatric Surgery Department of Tanta University Hospital with PUT during the period from March 2010 to March 2014. They were all operated at the age of 6-12 months. We excluded recurrent cases, and cases older than 12 months. Through high transverse scrotal incision, the layers were divided, and the canal entered through the external ring, dissecting the PUT and bringing it through the incision. Hernia sac, if present, was ligated at the neck. Creation of the dartos pouch was then made through the same incision. All infants were followed-up at 1 month, 2 months and 6 months to detect any re-ascended cases, testicular atrophy and the final cosmetic appearance. Results: A total of 140 PUTs were operated upon in 120 patients. PUT was bilateral in 20 patients, right-sided in 65 cases and left-sided in 35 cases. Thirty testes were located at the external ring; the others were located within the inguinal canal. No cases needed a redo operation, and there was no case of postoperative testicular atrophy. Conclusion: Single high transverse incision was sufficient to deal with PUT especially, in young infants (age 6 months) with no need for conversion in most cases to the traditional two incisions technique, and good long term follow-up and a better cosmetic results.

The aim of this study was to investigate the outcome of vascular access procedures for hemodialysis and factors affecting access survival and complication rates. A retrospective review was carried out on 276 patients who underwent 404 consecutive vascular access operations performed over seven-years. The overall primary failure rate was 9.2%, while the oneand five-year cumulative access patency rates were 63.8% and 40.6%, respectively. Diabetes mellitus status significantly influenced access survival (P = 0.022). Autogenous arteriovenous fistulas (AVFs) are reliable procedures with access sites often available in the upper limb proximally and distally. Patients with diabetes mellitus have significantly worse patency rates of upper limb AVFs.

Background: To investigate the role of testosterone (T) in the pathogenesis of ejaculatory symptoms, particularly premature ejaculation (PE). Materials and Methods: A total of 41 male patients with PE as well as 41 controls with no sexual dysfunction were recruited in this cross-sectional study. We used the stopwatch measurement to monitor the intravaginal ejaculatory latency time (IELT). Patients with mean IELT values lower than 60 s were considered to have PE. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), total testosterone (TT) and free testosterone (FT) were measured in patients as well as controls. Patients with thyroid dysfunction, hypogonadism, hypertension and dyslipidemia were excluded from the study. Results: The serum levels of FT and FSH were significantly higher in cases (P = 0.036 and 0.003, respectively). There was no significant difference between TT, LH and PRL levels of the two groups. Conclusion: Patients with PE have higher FT and FSH levels compared with normal men. The causative relationship between these entities and also the clinical importance of this finding has to be determined by more comprehensive studies.

Background: to investigate the effectiveness of bladder mucosal autograft for the treatment of vesicovaginal fistulae. Materials and Methods: Between March 2005 and June 2011, 21 patients with a single vesicovaginal fistula above the trigone, not involving the ureters, underwent surgery. Bladder was approached extraperitoneally and opened in the midline. The mucosa around the fistula was incised and inverting sutures were placed over the fistula opening. The mucosal defect was covered by a free mucosal graft from the edge of cystotomy incision. Results: After catheter removal at 2 weeks, 18 patients (85 %) remained dry while one patient experienced urge incontinence, which resolved in a few days and another one still had urine leakage (although less than before the operation) that improved after another 3 weeks of bladder drainage. Only in one patient, the operation failed. Conclusion : Short duration of hospitalization, simplicity of the procedure, avoidance of extensive bladder dissection, and extraperitoneal nature of the operation, along with a high success rate are the advantages of this procedure. This technique could be recommended for single fistulae not involving the ureters and not secondary to malignancies.

Background: Obesity is a medical condition characterized by augmented body fat mass that can adversely affect human health. Several regimens were suggested to counteract obesity and fat accumulation with limited success. As plants are well-known source of medicinal products, we studied the potential anti-adipogenic activity of the essential oil extracted from Calligonum comosum plants growing in the desert of the United Arab Emirates. Methods: C. comosum essential oil was extracted and fractionated on thin layer chromatography. The effect of total oil extract, the major compound-rich fraction, and the pure compound (cuminaldehyde) were tested on the viability, lipid content, and glucose uptake of 3T3-L1 cells. The capability of cuminaldehyde to reduce the formation of 3D-adipocyte pellets and expression of related transcripts was also tested. Results: The results showed that C. comosum essential oil, particularly its major component cuminaldehyde, caused a significant reduction in the viability of 3T3-L1 cells when compared with fibroblasts, employed as controls. Furthermore, cuminaldehyde caused a significant reduction in the lipid content of 3T3 cells, as determined by Nile red stain, reduction in the glucose uptake, and reduction in the levels of both triglycerides and cholesterol. Moreover, cuminaldehyde significantly reduced the formation of 3D-adipocyte pellets and the expression of adipocyte-specific transcripts, CAAT-enhancer binding protein-alpha, and peroxisome proliferator-activated receptor-gamma. Conclusion: Taken together, these results demonstrated a potential inhibition of lipid accumulation in 3T3 adipocytes after treatment with cuminaldehyde extracted from C. comosum oil. Thus, cuminaldehyde can be considered as a new potential anti-adipogenic agent for the prevention and treatment of obesity.

Background: Watermarking such as other security concepts is an ongoing challenging research issue, especially for medical images, to protect patient privacy. Medical images need to be shared and transferred between hospitals and specialists as quickly as possible for better diagnosis. Fast and simple watermarking is needed as well as the robust transferring of channel noise, such as salt and pepper noise and robust cropping that may occur from specialists and signature encryption for patient privacy. Methods: In this article, a highly robust and simple watermarking method is introduced. The proposed method has very low computational complexity and at the same time, it is very robust to interference and uses simple computations such as (XORs) Exclusive ORs and rotations that can be done in real-time. The proposed method uses a combination of hidden neighboring signature information, Sudoku permutation, and noise pre-processing to achieve high robustness against salt and pepper noise and cropping. Simple signature encryption is also used. Results: The proposed method is examined in different medical image datasets. The experimental results indicate the proposed watermarking system is robust to salt and pepper noise density of up to 90% and about 70% cropping. The number of computations including encryption is five XOR per pixel and a rotation per block of signature size. Conclusion: A novel method for medical image watermarking is presented. The proposed method is in the spatial domain, has encryption, and uses only XOR computation. The proposed method is highly robust to noise and cropping which is necessary for medical uses. The proposed method can be used efficiently for real-time watermarking for medical and nonmedical image datasets.

Socioeconomic scales are used to determine the socioeconomic status of a study subject which in turn affects the health and nutritional status. BG Prasad's scale of socioeconomic status uses only one criterion i.e. income. Therefore, it is easy to calculate and the most used socioeconomic scale to classify a study subject. It is used for both urban and rural areas. The consumer price index for industrial workers measures inflation at household level. As the consumer price index for industrial workers is used to calculate the income ranges for a study subject and it is released for every month by Labour Bureau, Ministry of Labour and Employment, it is imperative to update the BG Prasad's scale every month.

Introduction: This study aimed to compare the fracture resistance using a bioceramic sealer and an epoxy resin-based sealer. Materials and Methods: One hundred maxillary central incisors were randomly assigned to three experimental groups: AH Plus sealer using the single-cone technique, AH Plus sealer using the lateral compaction technique, SureSeal Root sealer, and two positive and negative control groups. Then the fracture resistance of the prepared tooth roots was determined. The data were analyzed with one-way ANOVA and Tukey Post Hoc tests. Results: There were statistically significant differences between the five study groups (P

Introduction: Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis are the two main bacteria that cause periodontitis which is an inflammatory disease of periodontal tissues. Numerous antibacterial agents have been introduced to fight against these periodontal pathogens, but the antibacterial efficacy of concentrated growth factor has not been studied yet. Therefore, this study is aimed to investigate the antibacterial impact of concentrated growth factor on the growth of Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis. Methods: In this study, concentrated growth factor was obtained from blood samples of healthy people with no systemic disease and no antibiotics used for at least 3 months before the experiments. The concentrated growth factor from each blood sample was divided into two parts, i.e., three samples in P. gingivalis group and three samples in A. actinomycetemcomitans group, and a positive control group to verify the accuracy of the procedure and a negative group to rule out any contamination. The minimum inhibitory concentration and minimum bactericidal concentration of CGF against A. actinomycetemcomitans and P. gingivalis were determined by the broth microdilution method. Statistical analysis was performed using SPSS 22 software, and P value significance was set to 0.05. Results: The antibacterial property of CGF on the studied bacteria in concentrations of MIC and ¼ MIC is the same for both bacteria, but in ½ MIC, its impact on A. actinomycetemcomitans is significantly higher than P. gingivalis. Examining the MBC showed that no MBC dose was obtained. Results of the disk diffusion test indicated the lack of the zones of bacterial growth inhibition. Conclusions: Considering the limitations of our study, it can be concluded that CGF has antibacterial effectiveness against A. actinomycetemcomitans and P. gingivalis with no significant difference between two bacteria.

Acinetobacter baumannii is a rare but dangerous gram-negative bacteria causing nosocomial infections, especially in intensive care units. The increased use of antibiotics in the treatment of bacterial infections leads to drug resistance, delays, or failures in treatment. The patient is a 48-year-old man with coronavirus disease (COVID-19) being treated in the intensive care unit. After contracting Acinetobacter baumannii, the patient's condition deteriorated, and he developed severe pulmonary problems. Due to the unknown presence of Acinetobacter baumannii in the patient, this bacterium transmitted to six other patients in the ward, which resulted in their deaths. In this report, we describe the causes and risk factors of the disease, and the results of laboratory tests and therapeutic processes.

Introduction: Intra-peritoneal collection (IPC) following laparoscopic appendectomy (LA) of complicated appendicitis in children is a serious complication. This is associated with a longer duration of hospital stay, more costs, and psychological upsets of both children and their parents. The aim of this study is to evaluate different factors that may affect the development of IPC following LA of complicated appendicitis. Patients and Methods: Seventy-five children were admitted with acute complicated appendicitis. All of them had LA between January 2016 and October 2020. The following variables were studied: patients' demographics, clinical findings, laboratory and imaging studies and operative parameters. Patients were divided according to their post-operative course into two groups; Group (A): patients with IPC (n = 19), Group (B): patients without IPC (n = 56). Potential risk factors for the development of post-operative IPC were identified by univariate and multivariate logistic regression analysis. Results: Nineteen cases (25.3%), out of 75 patients, presented with post-operative collection. Forty-seven (62.7%) patients were males, the overall median age was 11 (inter-quartile range [IQR] 10–13). The most significant operative variable was the operative time, which was significantly longer in Group A, 78 min (IQR 75–88) versus 56 (50–66), P = 0.001. The following variables were associated with an elevated incidence of post-operative IPC; age, body mass index, total leucocytic count (TLC), duration of symptoms, pediatric appendicitis score, pre-operative morbidity, being on medications, operative time, suction and irrigation or suction only and drain duration. In the multivariate model, TLC (odds ratios [OR]: 1.358, P 0.006), symptoms duration (OR: 2.051, P 0.012), morbidity (OR: 2.064, P 0.041) and operative time (OR: 2.631, P 0.039) were statistically significant and confirmed as being predictors of IPC post-LA in complicated appendicitis. Conclusion: Post-operative IPC is quite common after LA for complicated appendicitis. Increased TLC, prolonged symptoms duration, associated co-morbidity and operative time could be predictors of its occurrence. Improving general condition, surgical technique and reducing operative time help to reduce its incidence.

Background: Moral distress and moral courage among healthcare professionals have received considerable attention in recent years. However, there is a paucity of studies investigating these topics among nurses. Thus, the present study aimed to evaluate the association between moral distress and moral courage among nurses in an Iranian sample population. Materials and Methods: The present cross-sectional study was conducted during February–December 2018. Corley's Moral Distress (MDS-R) and Sekerka's moral courage scales were used to collect the data. MDS-R is a 21-items scale which includes frequency and intensity ranges from 0 (never) to 4 (very frequently) and 0 (none) to 4 (great extent), respectively. In addition, the moral courage scale contains 15 items ranging from “never true” (1 point) to “always true” (7 points). In total, 225 eligible nurses were entered into this study. Finally, SPSS-16 was used for statistical analysis at the α = 0.05 level. Results: The mean scores of the frequency and intensity of moral distress and moral courage were 45.41 (95% CI = 43.37-47.45), 44.24 (95% CI = 42.98-45.42), and 59.63 (95% CI = 58.50-60.87), respectively. Eventually, a significant relationship was found between the moral courage and frequency of moral distress (r = 0.46, p < 0.001) and the intensity of moral distress (r = 0.73, p < 0.001). Conclusions: In general, encouraging healthcare managers and administrators is considered as crucial for developing supportive structures and highly sensitive management which promotes moral courage while reducing moral distress in nurses' work setting.

Introduction: Ultrasound is highly effective, safe, and cost-effective for monitoring the hemodynamics and measuring the cardiac output of patients. This study aims to investigate the value of cardiac output by the measurement of common carotid artery flow, which is an inexpensive, simple, and accessible method. Method: Doppler ultrasound of the carotid artery at thyroid level was obtained from the patients admitted to Golestan and Imam Khomeyni Hospitals in Ahvaz (the result is recorded medially from the bilateral outputs unless otherwise prescribed on one side due to a problem such as a catheter or specific position). A transthoracic echocardiography was also recorded using a portable device to measure the left ventricular outlet of diameter 0.5 cm below the aortic valve in the left parasternal with a long axis view. Results: Of the 94 patients studied between the ages of 25 to 87 years, 53 (56.4%) were males and 41 (43.6%) females with a mean age of 53.61 with a standard deviation of 14.56. There was a direct and significant relationship between age and cardiac output using both echocardiography and color Doppler carotid ultrasound (P < 0.001). Discussion: The results of this study showed that the measurement of cardiac output using color Doppler ultrasound in the case of inaccessible emergency echocardiography is a cheap, simple, and accessible method for the hemodynamic evaluation of patients.

Objective: To assess the effect of short-term gavage of ethanolic extract of Imperata cylindrica L root on the ovarian activity and estrus behavior of female mice. Methods: Eighteen virgin female ddY mice, 8 to 10 weeks of age, weighing 22–25 g with regular estrus cycle, were divided into three groups. Group 1 received 0.5% carboxymethylcellulose, whereas Groups 2 and 3 received the ethanolic extract of Imperata cylindrica L root at 90 and 115 mg/kg body weight (b.w.) per day by gavage for 20 days, respectively. All of the groups were checked before 9 a.m. daily for vaginal cytology to determine the estrus phase. On day 21, the mice were sacrificed to collect serum samples to quantify the concentrations of reproductive hormones using enzyme-linked immunosorbent assay and to determine changes in the reproductive organs based on their reproductive organ weight, histomorphology, and histomorphometry of ovarium and uterus. Results: The reproductive organ weight in the treatment groups was similar compared with that in the control group. The 90 mg/kg b.w. treatment group showed an increase in corpus luteum number when compared with the control group, with few degenerated follicles and diminished oocytes. Moreover, the 115 mg/kg b.w. treatment group showed fewer primordial and primary follicles and an increase in corpus luteum number and a prolonged diestrus phase compared to the control and 90 mg/kg b.w. treatment groups. The histomorphology examination of the uterus showed that the thickness of myometrium and epithelium in the treated animals was similar to the control group. In addition, there was a significant decrease in follicle-stimulating hormone level in the 115 mg/kg b.w. treatment group (P

Introduction: Placenta accreta is the most common cause of bleeding leading to peripartum hysterectomy, and therefore, due to the importance of accreta in the mortality and morbidity of pregnant women, the correct diagnosis of the patient's final outcome is important. Therefore, this study aimed to evaluate the sensitivity, specificity, and accuracy of sonography diagnosis in the evaluation of placenta accreta by examining the two-dimensional (2D) and color Doppler sonography findings. Materials and Methods: Sonography was done for detection of accreta from pregnant women who were suspicious of placenta accreta in the third trimester of pregnancy. They were evaluated to confirm placenta histology for accreta and clinical examination after cesarean surgery at Maternity Ward, Ahvaz Imam Khomeini Hospital. Then they were evaluated as an overview and for the lack of accreta sonography findings. The data collected were analyzed by SPSS V 24. Results: About 58 patients (55.8%) of 103 pregnant mothers suspected of accreta with anterior placenta with an average age of 32.9 years after cesarean section were clinically extraordinarily positive and 45 patients (43.3%) were negative. The overall sensitivity and specificity of sonography for the detection of accreta placenta were 97.7% and 86.2%, respectively, which were most sensitive to diffuse and focal lacunar flow (100%) and the least sensitivity (33.3%) was observed for bladder wall interruption. Accuracy, positive predictive value, and negative predictive value of sonography for the diagnosis of accreta placenta with at least one diagnostic criteria were 91.2%, 84.6%, and 98.3%, respectively. Conclusion: Sonography, as an affordable and inexpensive diagnostic method, can be worthy by examining placenta for the detection of accreta, which can increase the diagnostic accuracy when combining 2D criteria with color Doppler.

Background: Post-dural puncture headache (PDPH) is one of the most common side effects of spinal anesthesia. Several strategies and drugs have been suggested for the treatment and/or prevention of this headache. The aim of this study is evaluating the effects of intravenous prescription of neostigmine plus atropine 15 minutes after dural puncture on incidence and severity of PDPH during 5 days of follow-up in the setting of lower limb orthopedic surgeries. Materials and Methods: In a randomized, controlled, double-blind clinical trial, 99 patients of lower limb orthopedic surgeries were randomized into study (49 patients) and control groups (50 patients). Fifteen minutes after dural puncture, participants in the two groups intravenously took neostigmine (40 μg/kg) plus atropine (20 μg/kg) and placebo (normal saline), respectively. Side effects of the studied drugs and incidence, severity, and duration of PDPH were evaluated 5 days after surgery. Results: A total of 20 patients in the study group and 31 in the control group showed a headache-with-PDPH profile during 5 days of follow-up (P-value = 0.035). The mean duration of PDPH was 1.15 ± 0.48 and 1.32 ± 0.54 days in the study and control groups, respectively (P-value = 0.254). Conclusion: Preventive administration of 40 μg/kg neostigmine plus 20 μg/kg of atropine may be effective in reducing the incidence and severity of PDPH after spinal anesthesia in lower limb orthopedic surgeries.

Objective: Testicular cancer (TC), although it is one of the most unusual cancers, seems to be increasing. There is no accurate information on the incidence of this cancer in Iran. The present study is conducted to evaluate the incidence rates of TC in Iran. Methods: A systematic search was conducted on all published studies of TC incidence using Medline/PubMed, Scopus, Embase, Web of Science, Google Scholar and four Iranian databases (Scientific Information Database, MagIran, IranMedex and IranDoc) until June 2018. This systematic review was done according to the preferred reporting items for systematic reviews and meta-analyses. Result: The database searching yielded 132 potentially relevant studies. A total of 11 studies were included in the study. The results of the random-effects model were demonstrated that the age-standardised rate (ASR) of TC was 1.13, 95% confidence interval (0.97–1.29) among Iranian males. Conclusion: ASR for TC in Iran is lower than the world average; however, it has a higher incidence than other Asian countries.

Purpose: Increased intracranial pressure (ICP) is one of the prevalent symptoms of trauma, especially traumatic headache, which requires quick action for the diagnosis and treatment. The optic nerve sheath diameter (ONSD) is a newly proposed technique for the detection of an increase in ICP. The aim of this study was to assess the efficacy of this new diagnostic method in patients with increased ICP induced by trauma. Methods: This prospective study was conducted between December 2016 and February 2017. The patients with traumatic headache and who had been diagnosed with increased ICP using clinical signs and computed tomography scan were compared to the voluntary healthy group. In each patient, measurements were performed employing ultrasound three times on each eye in an axial region, and the mean of these sizes was obtained as the ONSD. Results: A total of 112 participants were examined. The mean ONSD measurement of the patients and the voluntary healthy group was 6.01 ± 0.76 and 3.41 ± 0.56 mm in the right eye, 6.11 ± 0.75 and 3.39 ± 0.54 mm in the left eye, and 6.06 ± 0.75 and 4.02 ± 1.07 mm in both sides, respectively. The ONSD in the right and left sides had high and significant correlation in the patients (r = 0.929, P < 0.000) and voluntary healthy (r = 0.630, P < 0.000) group. The mean ONSD of one of the patients was 6.24 ± 0.56 mm, and in another patient with no clinical sign of increased ICP, the mean ONSD was 4.61 ± 0.09 mm. Conclusions: Ultrasound performed on the diaphragm of the optic nerve with acceptable sensitivity can detect patients with an increase in ICP and can be efficacious in expediting the action needed to reduce ICP. Due to the sensitivity and specificity of the ultrasound and high accuracy of the diameter of optic nerve sheath in detecting increase in ICP, as well as considering the fact that ultrasound is a noninvasive and available technique; it can be performed at the patient's bedside.

Introduction and Objective: Urodynamic testing (urodynamics) is widely used for evaluating bladder function as a result of high detrusor compliance. This aggressive and uncomfortable test is especially difficult for children. This study aimed to determine the sensitivity of shear wave ultrasound elastography (SWE) as a new method for evaluating the biomechanical characteristics of bladder to measure the anterior bladder wall pressure in children with neurogenic bladder (NB). Materials and Methods: The present prospective clinical study was carried out on 30 children with allegedly NB and 20 healthy children as control group. These children referred to Ahwaz Golestan Hospital in 2018. After clinical evaluations, urodynamics was performed for children with NB and detrusor compliance was measured in cm/H2O. The ultrasonography of the SWE was performed on the anterior wall of the bladder (Estimated bladder capacity (EBC) 50%) for the two groups. The relationship between shear wave speed (SWS) and detrusor compliance was estimated using Pearson's correlation coefficient. Independent t-test was used to compare SWS between two groups. Results: In patients with NB, there was a significant relationship between the mean SWS of the anterior bladder wall and detrusor compliance (R = 0.89, P = 0.0001). The comparison between normal and NB groups showed that the mean SWS of the anterior bladder wall in the patients was significantly higher than the healthy group (1.88 ± 0.88 m/s vs. 0.94 ± 0.15; P = 0.0001). There was also no significant relationship between SWS, gender, age, weight, and body mass index of patients (P > 0.05). Conclusion: The results showed that SWE can be used as a useful alternative for urorodynamic testing in the evaluation of NB (bladder dysfunction) in children.

Context: Depression in patients with a skin condition can lead to severe consequences that affect the quality of life. To our knowledge, the estimated prevalence of depression in patients who visited dermatological clinics in Jeddah remains unknown. Aims: To assess the prevalence of depression among patients with dermatological conditions and evaluate the association between clinical and demographic characteristics and depressive symptoms. Settings and Design: A cross-sectional study was conducted among dermatological patients at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. Materials and Methods: The Patient Health Questionnaire-9 (PHQ-9) was used for screening depression. Statistical Analysis Used: Chi-square test and odds ratios (ORs) were used to determine the association among variables. Results: The study included 273 participants. More than two-thirds (194) of the participants were women (71.1%). Depressive symptoms were prevalent in 43 (15.8%) participants. Depression was the most prevalent among patients with psoriasis (39.5%, P < 0.001), followed by those with acne (30.2% P = 0.04) . Conclusion: Psychosocial assessment should be addressed when evaluating and treating dermatological diseases. Screening tools, including PHQ-9, can facilitate the early detection of depressive symptoms and improve clinical outcomes. Addressing psychosocial aspects of skin conditions may help in reducing exacerbation of symptoms, mainly for conditions aggravated by stress, including dermatitis and psoriasis.

Background and Aims: Gas accumulation around the tracheamay is observed in neck and thoracic CT scans making the radiologist suspect whether these symptoms are associated with a pathologic process. This study was designed to evaluate the prevalence of partharesal cysts and their association with lung disease. Methods: The results of 400 patients evaluated for thoracic routine were analyzed for presence of paratracheal cysts. The location of cysts, size, shape and their relationship with the trachea were studied. The patients' results were compared with and without paratracheal cysts. The collected data were analyzed using SPSS software version 22. Results: Paratracheal cysts were found in 30 patients (7.5%) including 12 males and 18 females (P = 0.07). The age range was between 3 to 78 years old and the mean ages in patients with and without paratracheal cysts were 54 and 38 years, respectively (P < 0.0001). More than 60% of patients had cysts associated with the trachea. The mean AP level in patients with paratracheal cysts was significantly higher (P = 0.04). In addition, it was observed that the incidence of paratracheal cysts in patients with lung disease and especially COPD patients was higher (P < 0.0001). Conclusion: In general, the results of this study showed that paratracheal cysts had a high prevalence and had a significant correlation with the presence of COPD. It was also observed that the incidence of these cysts increases in older people, which indicates that paratracheal cysts have an acquired mechanism.

Background: Unlike public awareness around the world, osteoporosis is still underdiagnosed in most cases till bone fractures. Currently, the dual-energy X-ray absorptiometry (DEXA) is the gold standard diagnostic method of osteoporosis, but unfortunately this method is not available in all diagnostic centers, especially in developing countries. Aims: To evaluate the accuracy of tibial cortical thickness in the diagnosis of osteoporosis compared with DEXA. Materials and Methods: In this descriptive--analytic study, patients suspicious of osteoporosis who referred to Imam Khomeini Hospital, Ahvaz from 2016 --2017 were recruited. Data was collected for each patient including age, sex, radiography, and DEXA. The total thickness of the tibia cortex (sum of the two sides) was measured using knee anteroposterior radiography at 10 cm from the proximal tibial joint. The bone mineral density (BMD) was measured by DEXA method and reported as T-score. Results: In this study, 62 patients (90% female) were evaluated. The mean age of the patients was 57 years (range 45--80 years). T-score had a direct significant correlation with TCT level (r = 0.51, P < 0.0001). Also, T-score had a reverse and significant correlation with age of patients (r = −0.280, P = 0.028). The area under the curve (AUC) was 77%. Also, the sensitivity and specificity for the TCT level less than 4.37 mm (as cutoff point) was 100% and 39.1%, respectively. Conclusion: The findings of this study indicate that TCT has a direct significant correlation with the T-score obtained by the DEXA method. It has also been shown that TCT can be a relatively accurate diagnostic tool for predicting osteoporosis.

Background: Brain tumours (BTs) constitute approximately 88% of all central nervous system tumours. The present study aimed to determine the age-standardised rate (ASR) of BTs in Iran. Methods: A comprehensive search was conducted on all studies of BTs incidence using Medline/PubMed, Scopus, Embase, Google Scholar and Web of Sciences as international databases and Scientific Information Database, MagIran, IranMedex and IranDoc as Iranian databases until April 2018. This systematic review was done based on the preferred reporting items for systematic reviews and meta-analyses. Results: The primary search yielded 312 relevant studies. A total of 17 studies were included after more detailed retrieval. The results of the random-effect model were demonstrated the ASR of BTs was 4.16 (95% confidence interval [CI], 3.20–5.12) for males and 3.40 (95% CI, 2.67–4.13) for females. Conclusion: The incidence of BTs is lower in Iran compared to other parts of the world. The incidence of nervous system cancers is increasing base on region, geographical, and economic conditions in Iran. Hence, training programmes can be considered to reduce the risk factors, complications of nervous system cancers and early diagnosis of nervous tumors.

Introduction: Laparoscopic splenectomy (LS) became the standard choice for splenectomy in children with benign hematological disease. There are few reports about pancreatic injury during LS. The purpose of this study is to spot on factors increasing the risk of pancreatic injury during LS in children. Patients and Methods: A total of 140 children had LS for benign causes. Children were categorized into A and B groups. LigaSure™ was used to control pedicle in Group A, while endoscopic staplers were used in Group B. Preoperative levels of amylase, lipase, and lactate dehydrogenase (LDH) were obtained. The mean of pancreatic enzymes and LDH values was calculated on the 3 postoperative successive days. Results: A total of 71 boys and 69 girls had LS. The mean splenic size was 13.50 cm in Group A and 12.51 cm in Group B. The mean operative time in Group A was 41.91 min and in Group B was 56.36 min. The mean level of amylase was 42.99 IU/ml in Group A and 75.70 IU/ml in Group B (P = 0.001). The mean level of lipase was 37 IU/ml in Group A and 76.66 IU/ml in Group B (P = 0.001). Conclusion: Pancreatic injury during LS is a rare complication usually presented on biochemical level. We believe that it is a hemostatic-dependent complication rather than splenic size or nature of disease.

Introduction: Deliberate self-harm (DSH) is an act with nonfatal outcome, in which an individual deliberately initiates a nonhabitual behavior that, without intervention from others, will cause self-harm, or deliberately ingests a substance in excess of prescribed or generally recognized therapeutic dosage. Here, the objective of the present study was to demonstrate the sociodemographic profile and intention of DSH in our context. Methods: This prospective observational study was done during 1 year. A total of 51 cases were recruited. Sociodemographic data were collected and intension to DSH was assessed using Beck's Suicide Intent Scale. All patients were followed up until discharge, and data were analyzed using the SPSS-20. Results: Among all 51 cases female were the most common 48 (94.1%), Muslims were more 41 (80.4%), 31 (60.8%) were from urban origin, most were homemaker, 20 (39.2%) were single, 16 (31.4%) were poor, and most were at age group

BACKGROUND AND PURPOSE: Cardiovascular diseases (CVDs) are the most important cause of death in Iran and the Kermanshah province. One of the most important problems that cardiovascular patients are dealing with is the psychological consequences of their illness. This study aimed at investigating the effectiveness of Meaning-Centered Group Psychotherapy (MCGP) intervention in improving spiritual well-being and reducing anxiety in cardiovascular patients. MATERIALS AND METHODS: The study population included all patients referred to specialized cardiovascular centers in Kermanshah province in 2019. The participants consisted of 30 patients who were randomly assigned into experimental and control groups after the primary and secondary screening. The experimental group received routine treatment + MCGP (8 weeks and 90–120 min per session) and the control group only received routine treatment. The dependent variables were assessed by Spiritual Well-Being Scale and Beck Anxiety Inventory before and after receiving the treatment and 2 months after the treatment. ANCOVA and multivariate analysis of covariance were applied to the data through SPSS-22. IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp. RESULTS: The results of covariance analysis showed that MCGP increased spiritual/existential well-being and decreased anxiety in the experimental group (P < 0.001), while no significant difference was traced in the control group. CONCLUSION: The findings of this randomized controlled trial provide good evidence for the effectiveness of MCGP as a treatment to improve the psychological and spiritual/existential distress in patients with CVDs.

BACKGROUND: Medical equipment plays an important role in the diagnosis, treatment, and medical education, and each year the major share of hospital costs (about 5%–15% annually) is allocated to the purchase of medical equipment. The selection and allocation of medical equipment should be appropriate and in line with the actual needs of the medical centers, clinical goals, human resources, and the conditions required to ensure safety. The purpose of this study was to study and evaluate current systems of medical equipment management and identify their strengths and weaknesses in Isfahan educational hospitals in 2018. MATERIALS AND METHODS: This is a descriptive-applied research that was done in a cross-sectional way in 2018. The statistical population of the research is the authorities of medical equipment and other persons related to the management of medical equipment of selected educational hospitals in Isfahan. The data collection tool is a questionnaire. RESULTS: The result of this study was gathered in four areas: medical equipment management, safety, preventive maintenance, and training. CONCLUSION: According to this study, there is no comprehensive program in hospitals for how to manage medical equipment, which itself causes the loss of material and equipment capital of the organization. In most cases, the lack of a system for planning and controlling the amount of inventory and purchasing and maintaining medical equipment creates many problems, such as the accumulation and depreciation of equipment or the lack of these facilities in critical situations. In this study, it is suggested initially a scientific control system. Medical equipment is designed so that the hospital's need for equipment at any time of year and the amount of its equipment are clear so that it can be easily decided in this field.

Purpose: To compare the performance of OKULIX ray-tracing software with SRK-T and Hoffer Q formula in intraocular lens (IOL) power calculation in patients presenting with cataract. Methods: In this prospective study, 104 eyes of 104 patients with cataract who underwent phacoemulsification and IOL implantation were recruited. Three IOL brands were used and for all eyes, IOL power calculation was performed using SRK-T, Hoffer Q formula and also OKULIX ray-tracing software. For all patients, axial length and keratometry data was obtained with IOLMaster 500 device and IOL power was determined using Hoffer Q and SRK-T formula. The IOL powers were also calculated using the OKULIX ray-tracing software combined with CASIA AS-OCT and IOLMaster 500 device. Optically measured axial length of eyes were inserted to OKULIX software from IOLMaster 500 device, and anterior and posterior tomographic and corneal pachymetry data was imported from CASIA AS-OCT into the OKULIX. The performance of each calculation methods was measured by subtracting the predicted postoperative refraction from the postoperative manifest refraction spherical equivalent (MRSE). For each of the 3 methods, the mean absolute prediction error was determined, too. Results: The mean value absolute prediction error by OKULIX, SRK-T and Hoffer Q formulas, respectively, were 0.42 (±0.03), 0.36 (±0.02) and 0.37 (±0.02). The mean absolute prediction error by OKULIX had no significant difference between three IOL groups (P = 0.96), and it was confirmed that there was no meaningful statistically difference in mean absolute prediction error between the OKULIX, SRK-T and Hoffer Q formula. (P = 0.25). Also in each group of implanted IOLs, all three formulas worked with the same accuracy. The prediction error using OKULIX were within ±0.50 diopter in 63.5% of eyes and within ±1.00 diopter in 94.2% of eyes. Conclusion: OKULIX ray-tracing IOL power measurements provides reliable and satisfactory postoperative results, which are comparable to other 3rd generation formulas of SRK-T and Hoffer Q.

Background: Hydrogen gas is the cleanest energy carrier and could be produced by biological process. Dark fermentation is one of the biohydrogen production methods that carried out just on organic wastes conversion. Methods: In this study, the batch tests were conducted to compare the biohydrogen production and glucose fermentation via acetate-butyrate and acetate-ethanol metabolic pathway induced by NaOH and KOH (10 M) pretreatment. In batch test, the glucose concentration in the feed was varied from 3.75 to 15 g/L under mesophilic conditions (37°C ± 1°C). In order to sludge pretreatment, NaOH and KOH (as an alkaline agent) was used. Results: Batch tests showed that maximum biohydrogen production under NaOH (2.7 ± 0.5 L) and KOH (2.2 ± 0.7 L) pretreatment was achieved at 15 g/L of influent glucose. In the batch test, with increasing influent glucose concentration, the lower yields of hydrogen were observed. The biohydrogen reactions had good electron closure (5.2%–13.5%) for various glucose concentrations and pretreatments. For NaOH and KOH pretreatment, the biohydrogen yield decreased from 2.49 to 1.63 and from 2.22 to 1.2 mol H2/mol glucose, respectively, when glucose concentration increased from 3.75 to 15 g/L. Conclusions: By applying alkaline sludge pretreatment by NaOH and KOH, the glucose fermentation was followed with acetate-butyrate and acetate-ethanol metabolic pathway, respectively. The lower biohydrogen yields were observed under acetate-ethanol metabolic pathway and related to metabolically unfavorable for biohydrogen production.

Background: Low back pain (LBP) is one of the most common musculoskeletal abnormalities. Epidural corticosteroid injections (ESIs) have been used long time ago for treatment of lumbar radiculopathy or discogenic back pain in case of failed medical and conservative management. Different techniques for ESIs include the interlaminar, the caudal, and the transforaminal approaches. Purpose: The aim of our study is to compare between the efficacy of infraneural transforaminal ESI and lumbar paramedian nerve root targeted interlaminar steroid injection in reduction of unilateral radicular pain secondary to disc prolapse. Patients and Methods: This prospective double-blind randomized study was performed on 40 patients randomized into two equal groups, each of 20: the infraneural transforaminal ESI (IN group) and the interlaminar parasagittal ESI (IL group). Patients with backache without leg radiation, or with focal motor neurological deficit, previous spine surgery, S1 radiculopathy, lumbar ESI in the past month, systemic steroid used recently within 4 weeks before the procedure, allergy to any medication or addiction to opioids, and pregnancy were excluded from the study. The duration and efficacy of pain relief (defined as ≥40% reduction of pain perception) by 0–10 visual analog scale (VAS) is the primary outcome. Functional assessment using Modified Oswestry Disability Questionnaire (MODQ) and possible side effects and complications are the secondary outcomes. Results: The VAS and MODQ scores were significantly lower in both groups in comparison with the basal values. There was also a lower VAS in the infraneural group than the parasagittal (IL) group up to 6 months after injection. Conclusion: The infraneural (IN) epidural steroid is more favorable than the parasagittal (IL) interlaminar epidural steroid owing to its long-term improvement in physical function than the parasagittal technique with no serious side effects.

Purpose: To determine the one-year incidence of needle stick and sharp injuries (NSIs and SIs) and their associations with visual function among Iranian nurses. Methods: In this cross-sectional study, 278 nurses working at one hospital were selected through stratified random sampling. After applying the exclusion criteria, the final analysis was performed on the data of 267 nurses. The data of occupational injuries were collected through a researcher-administered questionnaire. Visual function indices including distance and near best corrected visual acuities (BCVAs), color vision, stereoacuity, distance and near heterophorias, accommodative amplitude and facility, contrast sensitivity (CS) for high and low spatial frequencies (SFs), near point of convergence (NPC), saccadic and pursuit eye movements, distance and near convergence and divergence fusional reserves and peripheral vision were evaluated through optometric examinations using standard protocols. Results: The one-year incidence of NSIs and SIs was 41.2% [95% Confidence interval (CI): 35.3–47.1] and 19.1% (95% CI: 14.4–23.8), respectively. Color vision deficiency, pursuit deficiency, abnormal near heterophoria, and decreased CS for high SF had a significant association with the increased incidence of NSIs with odds ratios of 3.26, 2.32, and 1.35, respectively. Moreover, saccadic deficiency, abnormal near heterophoria, and decreased near fusional divergence reserve were significantly associated with the increased incidence of SIs with odds ratios of 2.42, 2.40, and 1.27, respectively. Conclusions: Our findings showed a relatively high incidence of NSIs and SIs in Iranian nurses and their associations with some visual function indices. Therefore, pre-employment and periodic visual examinations are recommended to detect and remove the corresponding visual risk factors. Moreover, preventive strategies should be adopted to decrease the occurrence of the aforementioned injuries. Keywords: Needle stick injuries, Sharp injuries, Visual function, Nurses

Context: Today, attention has increasingly been focused on the studies which include patient-centered consequences. Aims: The study aims to investigate the attitude of parents and children toward the application of stainless steel crown (SSC) on primary molars. Settings and Design: This cross-sectional descriptive study included eighty 4–6-year-old children having treated with SSC over the past 3–6 months. Subjects and Methods: Eventually, a validated child- and parent-centered self-report questionnaire was filled, having 14 questions about demographic information, six questions about childrens' attitude, and eight questions about parents' attitude. Statistical Analysis Used: Data analysis was conducted using t-test and one-way ANOVA at significant level P < 0.05. Results: In general, the score of children's attitude was positive, and the mean of attitude scores was obtained to be 9.9 ± 2.6; attitudes of 82.43% of children were good. Parents had neutral attitude; the mean of their attitude was obtained to be 20.2 ± 4.8. Only 53% of the parents scored good attitudes. Conclusions: The attitude score of children toward SSC was good and independent of age, gender, career, and education of the parents. Although the parents were not satisfied with how it appeared, the majority of them reported that their child had well accepted the crown.

Purpose: To compare dry eye signs and symptoms between patients with preoperative low and normal Schirmer test after Photorefractive keratectomy (PRK). Methods: In this prospective, nonrandomized, comparative case series, 76 eyes of 76 patients were preoperatively categorized into two groups according to selected criteria for characterization of tear film status: the low Schirmer test value (STV) group and the normal STV group. For the tear function assessment, we performed a Schirmer test with and without anesthesia, tear break-up time (TBUT) test, and measurement dry eye symptoms using the Farsi translation of Ocular Surface Disease Index (OSDI) questionnaire pre- and 3 months post-operation. Results: Postoperatively, the Schirmer and TBUT values were significantly lower in both groups than preoperatively (all p

Introduction: Little is known about the epilepsy patients attending in a psychiatry outpatient department (OPD) in the context of Bangladesh. Hence, the aim of our study was to see the frequency and pattern of patients of epilepsy attending in a psychiatry OPD in our context. Methods: One-year patient data were explored from January 2016 to December 2016 recorded in a register book of the psychiatry OPD by consultants themselves and data were extracted manually. The diagnosis was collected, and data were analyzed by Microsoft Xcel. Results: Among the total of 1474 patients visiting the OPD in the year 2016 at the psychiatry OPD, total epilepsy cases were found in 209 (14.2%) patients. Among them, generalized tonic–clonic seizure was found 144 (9.8%), absence seizure 38 (2.6%), partial seizure 5 (0.3%), temporal lobe epilepsy 4 (0.3%), myoclonus 1 (0.1%), and unclassified 17 (1.2%). Electroencephalography confirmation was done in 60 cases which was 4.1% of total patients. Hence, confirmed cases of epilepsy were 4.1%, and probable cases were 10.1% of total patients attending OPD. Conclusion: In conclusion, we can say that visiting of epilepsy patients in a psychiatry OPD is a common behavior and we need to develop expertise in this field more.

BACKGROUND: Measurement of the essential risk factors for work-related musculoskeletal disorders is a fundamental step in predicting the problem and identifying high-risk individuals. In this regard, Maastricht upper extremity questionnaire (MUEQ) has not been validated in Iran. This study aimed to develop a valid and reliable Persian version of MUEQ. MATERIALS AND METHODS: In this descriptive study, the computer users employed in a governmental informatics administration in Tehran, Iran, were included during the end of 2018 and early 2019. Face and content validity of the MUEQ was conducted, and a six-part questionnaire was provided. The reliability of the questionnaire was obtained using Cronbach's α and test–retest. Concurrent validity was assessed with Nordic Musculoskeletal Questionnaire (NMQ). Exploratory and confirmatory factor analysis, comparison test of independent mean, internal consistency coefficient, test–retest, and Pearson correlation were carried out using the AMOS and SPSS 22 software. RESULTS: Participants consisted of 282 computer users (110 males) with a mean age of 35.17 ± 7.65 years. The mean duration of computer use in a working day was 6.68 ± 2.10 h with a range of 1–12 h. The most prevalent symptoms were existed in the neck (39.1%), back (31.0%), and lower back (30.3%) areas. KMO test and Bartlett's test of sphericity showed that a significant correlation existed among questions. Cronbach's alpha coefficient of the questionnaire varied from 0.61 to 0.83 and test–retest coefficient was higher than 0.7. Correlation coefficient was between NMQ and body posture (r = 0.23, P = 0.004) and between NMQ and work environment (r = 0.28, P = 0.000). Evaluations related to the construct validity and concurrent validity demonstrated that the questionnaire has acceptable construct validity. Six factors of the MUEQ in Root Mean Squared Error Approximation (RMSEA) index (0.062) were acceptable and satisfactory in Parsimony Comparative Fit Index (PCFI), Comparative Fit Index (CFI), Normed Fit Index (NFI), and Parsimony Goodness of Fit Index (PGFI) (0.732, 0.8000, 0.680, and 0.680, respectively). CONCLUSIONS: The Persian version of the MUEQ represented a satisfactory validity and reliability and was suitable for computer users in the assessment of their risk factors of musculoskeletal complaints.

Purpose: This study reports the characteristics of corneal higher order aberrations (HOAs) in eyes with normal topographic pattern using the Pentacam scheimpflug system. Methods: In this prospective, observational, comparative study, 165 eyes of 97 patients separated into five groups based on corneal topographic patterns were enrolled. All eyes received a comprehensive ophthalmologic examination including corneal tomographic analysis with the Pentacam system. Keratometry, corneal cylinder, and corneal aberrometric data were recorded and analyzed. Root mean square values (RMS) were calculated for corneal HOAs up to the 6th order, total coma, total trefoil, total spherical aberration, total tetrafoil, and higher order astigmatism. Evaluation of these data to discriminate between the five groups was assessed using the analysis of variance test by Generalized Estimation Equation Linear Model. Results: Corneal HOAs were found to be significantly higher for Asymmetric Bow Tie and Irregular groups than other groups (p =

Context: Laparoscopic splenectomy (LS) is considered the standard approach for the treatment of children with nonmalignant hematological diseases due to the advances in the minimal invasive surgery over the conventional splenectomy (CS). Different techniques are involved in the operation to secure the hilum. Aim: The use of (Ligasure™) is a safe, effective, less time consuming and with less complications rate. Materials and Methods: Sixty children (33 with thalassemia, 20 with immune thrombocytopenic purpura [ITP] and seven with spherocytosis) were operated during the period from June 2007 to December 2014. These children had undergone LS using (Ligasure™). Three ports were used in small-sized spleens while four ports were used in large spleens. Results: There were 60 children (37 girls and 23 boys) with a mean age of 10.2 years had LS using Ligasure™ with mean operative time of 85 min for cases of ITP and 120 min for other cases. There was no mortality. Two cases were converted to CS. Conclusions: Use of Ligasure™ alone was safe, less time consuming with less complications rates.

Introduction: Mental disorders constitute a higher burden on low- and middle-income countries like Bangladesh. Mental disease is poorly recorded, and data are not easily available in countries like Bangladesh. Hence, the aim of the present study was to observe the pattern of mental diseases found in a tertiary care center during 1-year survey. Methods: One-year patient data were explored from January 2015 to December 2015 and were extracted manually manually from the register book. All diagnosis were collected, and data were analyzed using Microsoft Excel. Results: Among the 1474 patients, most were in the age group of 11–20 years (388 [26.3%]) and 21–30 years (437 [29.6%]), next age group was 31–40 years (243 [16.5%]). One-hundred and twenty (8.1%) and 33 (2.2%) patients were found in two extremes of age 61 years, respectively. Males were 736 (49.9%) and females were 738 (50.1%). Male:female ratio was 1:1. Schizophrenia (360, 24.4%) was the most common psychiatric disease found which was next to major depressive disorder (187, 12.7%). Bipolar mania was found in 175 (11.9%) cases, and bipolar depression was found in 19 (1.3%) cases. Some other diseases such as generalized anxiety disorder was found in 57 (3.9%), obsessive-compulsive disorder in 35 (2.4%), phobic anxiety in 12 (0.8%), and panic disorder in 76 (5.2%) cases. Conclusion: In Bangladesh, burdens of mental disorders are high but largely unrecognized and underresearched area. To improve the mental health services in Bangladesh, further well-designed epidemiological and clinical research is required.

Background: Today, cardiovascular disease is one of the main causes of mortality and disability in most developed and developing countries. The prediction of the major causes of deaths all over the world at all ages shows that 61% of deaths are due to chronic diseases, of which 30% is due to cardiovascular disease. The aim of this study was to assess the cost-utility analysis of atorvastatin for the prevention of cardiovascular diseases using the Markov model. Methods: Markov model with a lifetime horizon was developed to evaluate economic and health outcomes for atorvastatin drugs for the prevention of cardiovascular diseases for a cohort of 1,000 patients. The effectiveness indicator in this study was quality-adjusted life-years (QALYs); robustness of results was examined by one-way and probabilistic sensitivity analysis. Results: The results showed that the use of atorvastatin compared to no drug intervention was highly cost-effective with USD173 per additional QALY. The results of one-way and probabilistic sensitivity analysis confirmed the results of this study. The findings of this study also showed that the highest cost items were hospitalization costs in the cardiac care unit (CCU). Also, the highest cost items in para-clinical services were related to echocardiography costs, and troponin constituted the largest cost of laboratory tests.Conclusions: Based on the results of this study, it is recommended that cardiologists use atorvastatin in the prevention of cardiovascular disease.

Background: Hemoconcentration (HC) has been suggested to be a useful biomarker for determination of optimum diuretic therapy in acute heart failure (HF), but role of this factor in rehospitalization and death was still controversial. In this study, we aimed to define relation between HC and readmission and mortality rate among Iranian patients with acute HF. Methods: This was a prospective cohort study done from March 2017 to March 2018 using data of a HF section of Persian Registry Of cardioVascular diseasE. From a total number of 390 registered HF individuals aged 18 years or older, 69 ones showed alterations in hemoglobin (Hb) levels. Hb levels were measured at admission and discharge time. HC was defined as any increased level in Hb during hospitalization. The relation of HC with readmission and death rate was done using multiple logistic regression and Cox proportional hazard model, respectively. Results: The mean age of study population was 70.5 ± 11.9 years with the dominant percentage of male participants (66.9%). Patients showing HC during admission did not reveal any significant decreased likelihood of rehospitalization compared to negative ones. In comparison to HC negative patients, those showing increments in Hb levels had a borderline significant lower likelihood of mortality (hazard ratio: 0.82, 95% confidence interval, CI = 0.07–1.18, P = 0.08). Conclusions: Our data suggested that HC was associated marginally with reduced mortality rate 6 months post HF attack and could be utilized as a useful biomarker for risk stratification of HF patients. Several prospective longitudinal population-based studies are necessary proving these associations.

Background: Proper blood pressure (BP) measurement frequency method is less evaluated to optimize hypertension (HTN) status among different nations due to cultural patience variations. The aim of this study was to compare the first (BP1), second (BP2), and the mean of first and second (BP1,2) and all the three (BP1,2,3) with the second and third BP measurements in Iranian individuals. Materials and Methods: This cross-sectional study was done on 2264 individuals aged 18 years or more living in Isfahan city, Iran. Their BPs were assessed from right arms by the standard tools and methods after 5 min of rest in a quiet room by a trained staff. The mean second and third readings were considered as reference, and the other aforementioned variables were compared with it. Results: The mean age of total population was 40.9 ± 16.1 years (males: 52%). Men had significant higher means of systolic BP (SBP) and diastolic BP (DBP) with any measurement frequency methods than women (P < 0.001 and P = 0.009). Considerable clinical significant (≥5 mmHg) ranges were mostly observed in BP1compared with BP2,3. SBP2and DBP2indices showed insignificant differences compared with reference mean. Moreover, abnormal BP levels (≥140/90 mmHg) were mostly observed in terms of BP1measurement with no remarkable variability in BP2reading in comparison to the reference. Conclusion: Our considerable data suggested that BP2could appropriately categorize BP status similar to BP2,3and it may be rational for physicians considering this mean and excluding the first BP measurement as a sole criterion for HTN assessment in Iranian adults. Multiple researches are necessary quantifying appropriate frequencies of BP reading.

Aims: This study was carried out to investigate the effect of predators' growth on biological excess sludge reduction of adsorption/bio-oxidation process (A/B process) as a modification of activated sludge system. Materials and Methods: The real municipal wastewater after screening and gritting was pumped into A/B pilot plant which consists of two aeration and sedimentation tanks in series. The hydraulic residence time for A and B stages was set at 1 and 4 h, respectively, at an average flow rate of 32 L/h. During operation, the mixed liquor suspended solids (MLSS) in A and B stages was gradually increased. In this period, the operational parameters including dissolved oxygen, pH, volatile suspended solids (VSS), MLSS, alkalinity, biochemical oxygen demand (BOD5), chemical oxygen demand (COD), phosphorus, nitrogen, and sludge volume index were monitored. Results: The results showed that with increasing solid retention time (SRT) from 0.6 to 56.8 days in Stage A, the biomass yield (Y) decreased from 1.29 to 0.23 g VSS/g COD. Similar results were observed in Stage B and correspondence to 67% reduction of Y as SRT increased from 1.6 to 123.8 days. During the A/B operation, overall tBOD5and tCOD removal was 70% ± 20% and 57% ± 24%, respectively. Conclusion: Based on the results, A/B process operation with high SRT led to predator growth enhancement and lower biological excess sludge production.

Background: Considering the effectiveness of craniofacial photographic analysis for diagnosis and management of obstructive sleep apnea-hypopnea syndrome (OSAHS) as well as ethnic differences in indexes measured by this method, this study designed to compare the surface facial dimensions, including nose width, intercanthal width and mandibular width of Iranian patients with mild, moderate and severe OSAHS. Materials and Methods: In this cross sectional study subjects with mild, moderate and severe OSAHS based on apnea-hypopnea index, were studied. To determine cephalometric measurements, face and neck digital photographs were taken from participants following a standardized procedure. Cephalometric measurements including face, intercanthal and mandibular widths were compared between studied groups. Results: In this study, 100 participants enrolled. From which 20 (20.8%), 35 (36.45%) and 41 (42.7%) of them had mild, moderate and severe OSAHS, respectively. Mean of nose, intercanthal and mandibular width were significantly higher in patients with severe OSAHS than those with mild or moderate OSAHS (P < 0.05).In both genders, mandibular width were higher in severe forms of OSAHS. Disease severity was significantly associated with increased age and mandibular width (P < 0.05). Conclusion: Mandibular width was the most important index, which had a significant association with the disease severity. It seems that our results could be used both for diagnosis and follow-up of OSAHS management. They could be used as baseline information as well as a clinical and research tool in the field of OSAHS.

Background: Several studies have showed an increased prevalence of airflow obstruction in first degree relatives of individuals with chronic obstructive pulmonary disease (COPD). Considering no specific research had evaluated airway resistance in offspring of patients with severe COPD, we utilized a spirometry and a impulse oscillometry (IO) to evaluate this population. Materials and Methods: In this case control study, from November 2011 to July 2012, we consecutively evaluated 54 offsprings of severe COPD patients (case group) admitted in the pulmonary ward, affiliated to the Isfahan University of Medical Sciences and control group. Pulmonary function tests and the IO were obtained for both groups. Student′s t-test was used for inter-group comparisons, and P values below 0.05 were taken as significant. Results: Abnormal increased airway resistance was seen in cases in comparison with controls (R5 Hz [46.29%, P = 0.01], R25 Hz [42.59%, P < 0.001]). Also, considering the spirometry, case group had pulmonary function parameters less than control group (forced vital capacity [FVC]; P = 0.02, forced expiratory volume in 1 st s; P < 0.001, forced expiratory flow (FEF) 25-75; P < 0.001, FEF 25-75/FVC; P < 0.001) but they were in normal range. Conclusion: This study demonstrated increased airway resistance among the severe COPD offsprings. The IO may be a sensitive tool for detection of high risk subjects in families with COPD.

Background: Elderly patients are susceptible to post-induction hypotension. Volume loading and vasopressors for prevention of hypotension in elderly patients may increase perioperative cardiovascular risks. Ondansetron by blocking Bezold-Jarisch reflex (BJR) through inhibition of serotonin receptors has been effective in the prevention of post-spinal hypotension, and bradycardia. Bradycardia frequently accompanies post-induction hypotension in elderly patients, which signifies a possible preventing role for ondansetron. No previous study has evaluated the prophylactic effects of ondansetron for the prevention of post-induction hypotension. Materials and Methods: In this randomized placebo-controlled clinical trial, ondansetron 4 mg was given intravenously to 65 elderly patients, 20 min before induction of general anesthesia, and the rate of post-induction hypotension defined as 25% or more reduction in mean arterial blood pressure, compared with a placebo groups. Results: A total of 114 patients completed the study (58 in ondansetron and 56 in the placebo group). Proportions of post-induction hypotension were 9 (16%) and 25 (45%) in ondansetron and placebo groups, respectively, (P = 0.001). Forty-five patients (40%) developed bradycardia. Rates of bradycardia were not significantly different between two groups. Conclusions: The results of this study show the effectiveness of intravenous ondansetron for prevention of post-induction hypotension in elderly patients. The mechanism of this effect largely is unknown. Role of ondansetron for prevention of post-induction hypotension may not fully understandable by its interaction with BJR, as has been shown in post-spinal hypotension.