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Background: Stress-induced childhood-onset neurodegeneration with variable ataxia and seizures (CONDSIAS) is an autosomal recessive disorder caused by defects in the ADP-Ribosylhydrolase Like 2 (ADPRHL2; OMIM: 618170) gene. This gene encodes the ADP-ribosylhydrolase enzyme (ARH3) that eliminates the addition of poly-ADP ribose (PAR) in the cellular stress onto proteins in the ADP-ribosylation process in which adding one or more ADP-ribose moieties onto the target proteins in the post-translational modification have occurred. In this study, we report a new case of CONDSIAS in the Iranian population. A literature review of CONDSIAS is also included., Case Presentation: A four-year-old female patient, born to a consanguineous Iranian family, was referred with various clinical symptoms including impaired speech, variable ataxia, infrequent seizures, and gradual onset of truncal hypotonia. Over time, she developed complete motor and speech regression, bilateral sensorineural hearing loss, infrequent seizures, abdominal distension and gastrointestinal (GI) intolerance, and loss of consciousness. To better molecularly diagnose, trio-whole-exome sequencing (WES) was performed on the proband and her parents. Sanger sequencing was also applied to investigate co-segregation analysis. Using in silico predictive tools, the possible impacts of the variant on the structure and function of ADPRHL2 protein were predicted. All basic metabolic tests were normal, while serial coronal magnetic resonance imaging (MRI) showed progressive cerebral and cerebellar atrophy in addition to cerebral white matter signal changes as a novel neuroimaging finding. GI intolerance was another novelty of clinical scenarios in the patient. An auditory brainstem response test showed a severe bilateral sensorineural hearing loss. An electroencephalogram also confirmed focal seizures. From the molecular perspective, a novel homozygous frameshift variant in the ADPRHL2 gene (NM_017825.2; c.636_639del, p.(Leu212fs)) was identified by WES., Conclusions: CONDSIAS is an ultra-rare neurodegenerative disorder. In the present study, we introduced extra-neurological and neuroimaging findings of this disorder in a female child caused by a novel frameshift variation in the ADPRHL2 gene.

Background: Earthquakes are one of the most destructive natural disasters in which many people are injured, disabled, or died. Iran has only 1 % of the world's population, but the percentage of its earthquake-related deaths is absolutely higher. Therefore, this study aimed to determine the level of earthquake preparedness of households and its predictors using the Health Belief Model (HBM)., Methods: This observational descriptive and analytical study was conducted on 933 households in Hamadan province, located in the west of Iran, in 2019. Multi-stage cluster random sampling was used for selecting the participants. The inclusion criteria were being at least 18 years old and being able to answer the questions. A questionnaire was used for data collection including earthquake preparedness, awareness of earthquake response, predictors of earthquake preparedness based on the HBM, and demographic information. Analysis of variance, independent t-test, and a linear regression model was used., Results: The mean age of participants was 38.24 ± 12.85 years. The average score of earthquake preparedness was low (approximately 30%). There was a significant relationship between earthquake preparedness and gender (P < 0.001), homeownership (P < 0.001), marriage status (P < 0.001), education (P < 0.001), and previous earthquake experience (P < 0.001). Regarding the HBM constructs, perceived benefits (P < 0.001), cues to action (P < 0.001), and self-efficacy (P < 0.001) were significant predictors of earthquake preparedness., Conclusions: Earthquake preparedness was insufficient. Besides, perceived benefits, cues to action, and self-efficacy were predictors of earthquake preparedness. These predictors can be taken into account, for designing and implementing related future interventions.

Common Variable Immunodeficiency (CVID) is a heterogeneous group of disorders characterized by hypogammaglobulinemia and an increased susceptibility to recurrent infections as well as autoimmunity and malignancies. Idiopathic Thrombocytopenic Purpura (ITP) and Autoimmune Hemolytic Anemia (AIHA) are two autoimmune disorders which may be seen in association with CVID. Among 85 CVID patients, seven cases had ITP and/or AIHA (8%). Four of these patients had one or more episodes of ITP, one patient had AIHA, and two patients had both ITP and AIHA (Evans syndrome). Almost, all patients experienced chronic and recurrent infections mostly in respiratory and gastrointestinal systems during the course of the disease. Among the seven patients, five presented their underlying disease with recurrent respiratory and/or gastrointestinal tract infections, while in two remaining patients, CVID was presented with ITP. Three patients died until now; two because of hepatic failure and one due to pulmonary hemorrhage. As CVID is prone to autoimmune disorders, it should be considered as a differential diagnosis of adult-onset ITP and possibly in children. Chronic and recurrent ITP, especially in the presence of propensity to respiratory and gastrointestinal infections mandate the evaluation for an underlying immune dysregulation such as CVID.

Background: Professional autonomy is a crucial component of the nursing profession. It enables nurses to make timely decisions at the patient's bedside. The competency of human resources, especially nurses, is essential in maintaining patient safety and ensuring high-quality services. This study investigates nurses' professional autonomy and its association with patient safety competency. Methods: This descriptive-correlational study was conducted on 200 nurses in educationaltherapeutic hospitals affiliated with Tabriz University of Medical Sciences, Tabriz City, Iran, in 2021. They were recruited utilizing stratified random sampling. Data collection tools comprised a demographic questionnaire, professional autonomy questionnaire, and patient safety competency self-evaluation questionnaire. The obtained data were analyzed using descriptive statistics (frequency, percentage, and median), the Mann-Whitney U test, the Kruskal-Wallis test, the Kendall Tau, and Spearman non-parametric correlation coefficients in SPSS software, version 26. P<0.05 was considered significant. Results: Based on the study of the 200 nurses participating, 120 (60%) experienced a high level of professional autonomy, and 150 (75.0%) reported a moderate level of patient safety competence. There was a strong correlation between the nurses' professional autonomy and their patient safety competence (P<0.001). Conclusion: According to the findings, promotion of professional autonomy is directly related to patient safety competence in nurses, which in turn improves the quality of care. It is recommended to adopt appropriate strategies and necessary policies by managers to improve the professional autonomy of nurses. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to assess professional autonomy among clinical nurses and identify its predictors using a native and contemporary tool, which is in line with the recent advancement in nursing professionalism in Iran. Design: The study used an analytical cross‐sectional design. Methods: A total of 1601 nurses working in medical centres nationwide under the Ministry of Health participated in the study. The research instrument consisted of two parts, including individual and organizational characteristics and a questionnaire on clinical nurses' professional autonomy. Data analysis involved descriptive and inferential statistics as well as multiple logistic regression analysis using SPSS software. Results: The results indicated that the total professional autonomy score among clinical nurses was 75.86 ± 12.03, with the majority (n = 1262, 78.9%) reporting high professional autonomy. Multiple logistic regression analysis revealed that nurses with 5–15 years of experience had 1.82 times higher odds (95% confidence interval: 2.47–1.35) of having high professional autonomy compared to those with less than 5 years of experience. Similarly, nurses with over 15 years of experience had 2.25 times higher odds (95% confidence interval: 1.56–3.26). Head nurses had 4.56 times higher odds (95% confidence interval: 2.60–7.99) of having high professional autonomy compared to clinical nurses. Conclusion: Educational interventions to enhance the professional autonomy of less experienced nurses, with more experienced nurses serving as role models, are recommended. Additionally, measures such as supporting nurses, providing effective communication training and empowering nurses are essential to promote professional mutual respect among nurses. No Patient or Public Contribution: This study explored professional autonomy in clinical nurses in Iran. No patient or public contribution was investigated. [ABSTRACT FROM AUTHOR]

Purpose: The presence of toxic heavy metals (HMs) in agricultural crops ‎can be considered as a noteworthy threat for consumers. The aim of this study was to assess the content of HMs ‎(Pb, As, Cr, Cd, Co, Hg, and Ag) and their potential health risk in summer crops and vegetables (watermelon, cantaloupe, cucumber, melon, tomato, onion, ‎potato, raw and stewed vegetables) in Ilam province, Iran. Methods: Totally, 31 crop samples were collected from local farms during the 2019 harvest ‎season and the elements ‎ content were evaluated using inductively coupled plasma-mass spectrometry (ICP-MS). The non-carcinogenic health risk of HMs to the adults and children was estimated by Monte Carlo simulation method and target hazard quotients (THQs). Results: In general, the results showed that the concentration of Cr in the studied ‎agricultural crops was higher than other HMs. As well as, the carcinogenic risk (CR) obtained for adults and children were more than the acceptable range for As. Also, CR for As in raw vegetable was the most (‎8.19E-1) and violated the threshold risk limit. The total carcinogenic risk of HMs in children was higher than that in adults. Conclusion: These results suggest that the agricultural crops were not safe for human consumption with potential risks associated. Due to the possible health effects of such products consumption, proper action should be taken to avoid chronic exposure, prevention of further pollution and consequent adverse health implications. [ABSTRACT FROM AUTHOR]

Background and Aims: There is increasing interest worldwide in using alternative and complementary approaches for treating male infertility. This interest has spawned a multitude of published systematic reviews and meta‐analyses. The aim of this Umbrella review was to consolidate the available evidence regarding the effect of complementary and alternative medicine on male infertility to inform clinical decision‐making processes. Methods: A comprehensive search was conducted to identify systematic reviews and meta‐analyses pertaining to the effects of complementary and alternative medicine on male infertility. This search encompassed various databases including MEDLINE, CINAHL, PubMed, Scopus, Proquest, Google Scholar, SID, EMBASE, Magiran, Cochrane Library, Iranmedex, ScienceDirect, SAGE. Subsequently, two researchers independently extracted the data from the selected meta‐analyses and systematic reviews, and evaluated their methodological quality using the assessment of multiple systematic reviews 2 (AMSTAR2). Results: This analysis encompassed 11 studies, with four originating from Iran, two from Korea and five from China. The results regarding the effectiveness of complementary and alternative medicine are controversial, indicating a need for further research. The methodological quality of the systematic reviews and meta‐analyses appraised by AMSTAR 2 was rated as low or critically low. This assessment is attributed to inadequate examination of publication biases in the reviews and a lack of discussion regarding the effect of risk of bias. Conclusion: The existing evidence regarding the effectiveness of alternative and complementary medicine in addressing male infertility is limited. Furthermore, the overall methodological quality of the published systematic reviews and meta‐analyses may have been underestimated as the use of AMSTAR2 appears to be a more precise appraisal instrument compared to its predecessor. [ABSTRACT FROM AUTHOR]

Background and Aim: Removing the chest tube in cardiac patients after surgery is one of the worst experiences of hospitalization in the intensive care units. Various pharmacological and non-pharmacological methods are available to control pain in these patients. This study aimed to investigate the combined effect of reflexology massage and respiratory relaxation on pain following chest tube removal in cardiac surgery patients of Shahid Beheshti Hospital in Shiraz, Iran, in 2023., Methods: This was a double-blind randomized clinical trial performed on 140 patients who underwent heart surgery and had a chest tube in Shiraz, Iran. The samples were randomly divided into four groups: 1- control group, 2- respiratory relaxation group, 3- foot reflex massage group, and 4- a combination of respiratory relaxation and reflexology massage. To collect data, two demographic questionnaires, and a visual analog scale were used., Results: The participants of the four groups were not meaningfully different in terms of age, BMI, duration of surgical operation, gender, job, education, place of residency, number of chest tubes, history of operation (P = 0.99, 0.31, 0.06, 0.81, 0.97, 0.96, 0.17, 0.10, 0.89 respectively). The mean scores of pain intensity during chest tube removal, and 15 min after chest tube removal were not statistically different among the four groups of study (P = 0.15, 0.54 respectively); However, just after chest tube removal, the mean scores of pain intensity differed meaningfully among four groups (P = 0.008)., Conclusion: The results showed that reflexology massage and respiratory relaxation both reduce pain immediately after chest tube removal in heart surgery patients. Also, the combination of these two techniques was more effective in reducing patients' average pain., Competing Interests: Declarations. Ethical approval: The study protocol was approved by the Ethics Committee of Rafsanjan University of Medical Sciences (Code: IR.RUMS.REC.1401.236). Besides, it was registered at the Iranian Registry of Clinical Trial (Code: IRCT20190714044196N1). Consent for publication: All authors declare their full consent for publishing their article in the Journal of Cardiothoracic Surgery. Limitations and recommendations: One of the study’s limitations was the limited number of patients in the study setting. For further research, we can propose using multi-center sampling methods in order to reach a bigger sample size. Another limitation was the limited number of similar studies to compare and support the results. Future studies are recommended to investigate other non-pharmacological methods of complementary and alternative medicine on anxiety caused by chest tube removal and, on average pain in other surgeries and with other variables rather than pain. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: In Iran, there is a lack of information and studies on acute rheumatic fever (ARF), a global health issue. The limited understanding of ARF's prevalence and primary clinical symptoms has led to confusion. This research investigates the characteristics of children aged 3-17 years who experience ARF with monoarthritis as their initial symptom. Methods: A retrospective evaluation of medical records of children diagnosed with ARF was conducted. The study aimed to determine the prevalence of monoarthritis as the first manifestation of ARF and its association with age, gender, family history, and cardiac involvement. Categorical variables were analyzed using the chi-square test with a significance level of < 0.05 and a confidence interval of 95%, using SPSS software (Version 23). Results: The study included 62 patients with ARF, comprising 41 (66.1%) boys with an average age of 8.48±3.27 years. Among these patients, 12 exhibited cardiac involvement according to the revised Jones criteria, with 5 clinical carditis and 7 cases of subclinical carditis. Monoarthritis was the initial symptom in seven patients (11.29%); five (71.4%) also had carditis. There was a significant association (p<0.001) between monoarthritis and carditis. Conclusion: The study concludes that monoarthritis may be an early sign of ARF in children and correlates significantly with cardiac involvement. However, more extensive research with more significant participant numbers is necessary to understand ARF in Iran comprehensively. A thorough cardiac examination is also crucial for patients with ARF and monoarthritis. [ABSTRACT FROM AUTHOR]

Objectives: The population of older adults continues to grow in Iran, with pharmaceutical costs as a leading driver of household health-related costs. The present study was conducted to estimate the out-of-pocket pharmaceutical expenditure and its socioeconomic predictors among households with the elderly in Iran. Method: This study is a secondary analysis using 2019 national household expenditure and income survey data in Iran. The sample size was 9381 households with at least one member older than 65. The double-hurdle model in STATA 16 was used to examine the association between independent variables and households' out-of-pocket pharmaceutical expenditures. Results: The mean out-of-pocket pharmaceutical expenditures for each household with elderly member was $8065 per year. There was a positive association between the (female) gender of the household head, urban residence, employment status, insurance expenditure and a higher level of education of the head of the household with the out-of-pocket pharmaceutical expenditures (P < 0.05). The income of elderly households did not affect these expenditures (P > 0.05). Conclusions: This study showed that the socioeconomic characteristics of elderly families not only influenced their decision to enter the medicine market, but also the rate of medicine purchase. It is helpful to manage and control the pharmaceutical costs among the elderly. [ABSTRACT FROM AUTHOR]

Background: A heavy financial burden is imposed on patients suffering from chronic diseases due to medicine out-of-pocket payments. Objectives: This study focuses on assessing the affordability of medications used for chronic respiratory diseases (CRDs) such as asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF) in Iran, specifically on the category R medicines listed in the 2017 Iran drug list (IDL) that are used for the treatment of these diseases, based on the anatomical therapeutic chemical (ATC) drug code. Methods: The affordability of medicines in mono and combination therapy approaches was assessed in CRDs using the World Health Organization/Health Action International (WHO/HAI) methodology. Accordingly, if out-of-pocket payment for 30-days of pharmacotherapy exceeds one day for the lowest-paid unskilled government worker (LPGW), it's considered non-affordable. Results: Based on the monotherapy approach, our finding demonstrates that all generic medicines of category R were affordable. However, branded drugs such as Symbicort®, Pulmicort Respules®, Flusalmex®, Seretide®, Fluticort Plus®, Seroflo®, and Salmeflo® cost between 1.2 and 2.5 days' wage of LPGW and considered unaffordable despite 70% insurance coverage. Moreover, based on the affordability ratio in the combination therapy approach, all medicines used in asthma, COPD, and CF patients with mild respiratory problems are affordable except omalizumab (inj), which is non-affordable due to its high price and no insurance coverage. Conclusion: Results showed that the existing insurance coverage does not protect households from hardship, so more considerations are needed such as different insurance schedules and patient support programs. [ABSTRACT FROM AUTHOR]

Third places are a successful example of public places, which, due to their special characteristics, play an important role in enhancing the social sustainability of cities. Sustainable social development is a significant issue for the metropolis of Isfahan as this city today is facing serious challenges such as inequality and conflict in maintaining and increasing the life quality of its citizens. This research aims to explore the role of third places in promoting social sustainability in the urban districts of the city of Isfahan and to discover their significant dimensions and components. The current applied research employed a library based descriptive-analytic approach together with a field study method. Urban experts and managers comprised the statistical population of whom 25 individuals were selected to form the sample. DEMATEL method was used to discover the trend of classification patterns of sustainability components and the role of third places. The results of the cause and effect analysis through DEMATEL show that dynamism and vitality, and flexibility are the main and the most influential factors in increasing the social sustainability in Isfahan. The results also highlight the impact of combined components and indicators of the third place with different dimensions of social sustainability, especially in the urban districts in Isfahan. [ABSTRACT FROM AUTHOR]

This study aimed at investigating pollution sources and indicators in three study sites, namely, an industrial town (It), landfill (Lf), and wastewater treatment plant (WTP) in the vicinity of Ilam city, west of Iran. To achieve this objective, the sampling was performed from the topsoil (0–10 cm) of three sites (It, Lf, and WTP) with pollution potential. Some soil physico-chemical properties and total concentration of HMs including Cd, Pb, Ni, Cr, and Co, pollution indicators and sources of pollution were evaluated by statistical analysis. The results of the geoaccumulation index (Igeo), enrichment factor (EF), contamination factor (CF), and pollution load index (PLI) showed that the studied areas were contaminated with HMs. The highest average of Cd and Pb were 1.45 and 440.19 mg kg–1, respectively, in the Lf. Whereas, the highest average of Ni and Cr were 106.53 and 43.50 mg kg–1, respectively, in the IT, while the highest average of Co was 81.69 mg kg–1 in the WTP. According to the results of the principal components analysis (PCA) and clustering, a small part of the Pb, Ni, and Co amounts in the soils had the natural origin, while the results confirmed that a significant proportion of Pb, Cd, and Cr concentrations associated with human-caused hazards. Moreover, all areas (especially Lf and WTP sites) were highly contaminated with Cd. Due to the higher mobility of Cd and its human health hazards, this metal should be given more attention in the study sites of Ilam city. In general, based on our results, more paying attention needs to be considered by decision-makers and stakeholders to manage and control pollution production sources in the soils of the study sites. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is one of the main causes of death from cancer around the world, imposing a significant economic burden on the families and healthcare system. The present study aimed at determining the economic burden of breast cancer in the patients referred to the medical centers in Fars province in southern Iran in 2021. Methods: This cross-sectional study is a partial economic evaluation and a cost-of-illness study with a bottom-up and prevalence-based approach, conducted in Fars province in southern Iran in 2021 from the societal perspective. A total of 230 patients were randomly included in the study, and a researcher-made data collection form was used to collect the required data. The data on direct medical costs were collected using the information on patients' medical and financial records. On the other hand, the data on direct non-medical and indirect costs were obtained using self-reports by the patients or their companions. The Excel 2016 software was used to analyze the collected data. Results: The results showed that the annual cost of each breast cancer patient in the studied sample was 11,979.09 USD in 2021. Direct medical costs accounted for the largest share of costs (70.69%, among which the cost of radiotherapy was the highest one. The economic burden of the disease in the country was estimated at 193,090,952 USD. Conclusions: In general, due to the high prevalence of breast cancer and the chronicity of this disease, its medical costs can impose a heavy economic burden on society, the health system, the insurance system, and patients. Thus, in order to reduce the costs, the following suggestions can be offered: the use of advanced radiotherapy techniques, increasing the insurance coverage of required services, establishing low-cost accommodation centers near medical centers for the patients and their companions, providing specialized medical services for the patients in towns, using the Internet and virtual space to follow up the treatment of the patients, and carrying out free screening programs and tests for faster diagnosis of the infected patients and susceptible or exposed people. [ABSTRACT FROM AUTHOR]

This study explores how professional and student writers manifest their authorial identities and project their gender voices in their academic texts. To this end, 38 male-authored and 38 female-authored articles published in seven leading international journals were selected. Moreover, 38 articles written by male students and 38 articles authored by female students were collected from two universities in Iran. Taking an academic writing course, these students handed in their papers as term projects. These academic writings were analyzed based on Hyland's metadiscourse framework comprising two major resources: interactional and interactive metadiscourse resources. The findings indicated the male authors mainly attended to discourse organization using more interactive resources while the female authors mostly solicited solidarity by employing more interactional resources. The professional authors engaged in a more critical stance using self-mentions and attitude markers and the students focused on discourse organization. Attitude markers and self-mentions, as markers of stance-taking, were absent in the students' writing. The professional authors made use of their gender identity to promote their authorial identity instead of suppressing it. These results suggest that EAP programs should inform students how to employ both metadiscourse resources and their gender-based discourse choices to express their authorial identity more effectively. [ABSTRACT FROM AUTHOR]

Background Knowledge of global clarithromycin (CLA)-resistant rates of Helicobacter pylori (H. pylori) is crucial for decision of the most appropriate eradication therapies with good clinical outcomes. Therefore, this review and meta-analysis aimed to evaluate the global prevalence of the CLA resistance in H. pylori to provide some guidance for selecting the first-line antibiotics. Method A comprehensive search was performed for relevant literature until April 2021 in PubMed, Embase, and Web of Science databases. Freeman-Tukey double arcsine transformation was performed to estimate the weighted pooled prevalence of resistance. Results The meta-analysis included 248 articles. The prevalence of CLA-resistant H. pylori was 27.53% (95% CI [25.41–29.69]). The heterogeneity between reports was significant (I² = 97.80%, P < 0.01). The resistance rate increased from 24.28% in 2010–2017 to 32.14% in 2018–2021 (P < 0.01). Iran, with 38 articles, has the most report. Nevertheless, Switzerland, Portugal, and Israel had the highest resistance rates (67.16%, 48.11%, and 46.12%, respectively). The heterogeneity between the continents and the antimicrobial susceptibility methods also interpreted standard guidelines and breakpoints was insignificant (P > 0.05). Conclusion Overall CLA resistance rate was 27.53%, worldwide. The difference in CLA resistance rate among the included studies can be due to several reasons such as differences in antibiotic prescription rates in various geographic areas, use of different breakpoints or inaccurate criteria in performed studies, and the emergence of multidrug-resistant (MDR) strains. [ABSTRACT FROM AUTHOR]

The quality of irrigation water sources can significantly affect the concentrations of heavy metals (HMs) in cultivated vegetables. This study aimed to investigate the effect of various water resources, including treated wastewater effluent (TWE), river water (RW), and well water with chemical fertilizer (WW+F), on the accumulation of heavy metals (HMs) in the three most widely consumed edible vegetables (Coriander, Radish, and Basil) in Iran. A total of 90 samples of edible vegetables, 13 samples of irrigation water, and 10 soil samples were collected to determine HMs concentrations. Iron (Fe), Zinc (Zn), Copper (Cu), Manganese (Mn), Lead (Pb), Cadmium (Cd), Chromium (Cr), Nickel (Ni,) and Arsenic (As) were analyzed by inductively coupled plasma optical emission spectrometry (ICP-OES). Eventually, the Total Target Hazard Quotient (TTHQ) for the toxic metals of As, Pb, and Cd was determined. The results revealed that the TTHQ of toxic metals in vegetables was less than the allowable limits (TTHQ = 1). Also, TWE was the best irrigation water type since the HMs content of vegetables was low. By comparing the results with national and international standards, it can be concluded that the Gharasou RW for irrigation of edible vegetables was inappropriate. [ABSTRACT FROM AUTHOR]

Objective: Sleep disorders are associated with many health problems including anxiety, depression and coronary artery disease (CAD). This study investigated the prevalence, predictors and health impacts of insomnia and hypersomnia in southeastern Iran as well as the five-year incidence rate (IR) of these sleep disorders. Method: The present study was a cross-sectional, single-stage, cluster sampling study examining nine CAD risk factors (KERCADR study phase two), including sleep disorders, carried out in Kerman on 9997 participants, 15 to 80 years old. Medical examination along with demographic, sleep status, Physical activity level (GPAQ), anxiety and depression status (Beck Inventories) were assessed and fasting blood sample was taken for blood glucose and lipids analysis. STATA v15 software was used for data analysis using survey data analysis package and a univariable survey logistic regression model. Results: From 9997 participants, 59.4% were female. 45.3% of the participants were suffering from insomnia and hypersomnia, which was 15% more than the phase 1 prevalence (P < 0.001). Participants with insomnia had higher chance of being anxious, but participants with hypersomnia had higher chance of being depressed, be a cigarette smoker, opium user, and sedentary (P < 0.001). In regards to marital status, prevalence of hypersomnia was as follows in ascending order of prevalence: singles > married > widowed > divorced. While the IR of insomnia was higher in females, males had higher IR of hypersomnia. In addition, the IR of both sleep disorders was higher in participants with Low Physical Activity (LPA). Conclusion: The results showed high current prevalence and increasing trends of sleep disorders in the past five years. If left unaddressed, burden of CVDs in the community will demonstrate a significant increase in the future as a result of sleep disorders and other associated risk factors. [ABSTRACT FROM AUTHOR]

Background: Cigarette and tobacco smoking are closely associated with chronic cardiovascular disease and lung cancer. We aimed to assess the prevalence and 5-year incidence rate (IR) of these two risk factors for cardiovascular diseases in Kerman, southeastern of Iran. Methods: 10 015 individuals aged 15-80 were recruited to the study between 2014 and 2018 (Kerman coronary artery disease (CAD) risk factors study, KERCADRS) of which 2820 had also participated in the first phase (5 years earlier). We took fasting blood samples and collected demographic information and data on cigarette and water-pipe tobacco smoking (WPTS) through interviews. Findings: The overall prevalence of cigarette smoking increased from 8.1% in phase1 to 8.8% in phase 2. During the same period, the prevalence of WPTS increased from 10% to 14%, especially in the age groups of 15-45 years. The prevalence of opium dependance was higher among cigarette smokers compared to WPT users. The overall 5-year IR of cigarette and WPTS was 3.6 and 4.65 per 1000 person-years respectively. The highest IRs of cigarette smoking and WPTS were reported in the age group of 15-39 years, and IR of WPTS was higher among women. Obesity, diabetes, and hypertension associated with a reduced IRs of cigarette and WPTS. Conclusion: Over the past five years, the prevalence of cigarette smoking has increased slightly, but WPTS has increased more rapidly, especially among women. The highest prevalence of cigarette and WPT smoking was in the age groups of 15-39 years. Smoking is shifting from cigarette smoking to WPTS. Age- and gender-oriented interventions would help correct the unhealthy life style in the community and prevent further smoking-related morbidities and mortalities. [ABSTRACT FROM AUTHOR]

Background: Diabetes imposes an enormous burden on patients, families, societies, and healthcare systems. Determining the affordability of medications is an important complicated and vague task, especially in low- and middle-income countries (LMICs). This study aimed to assess the affordability of diabetes medication therapy in Iran's health system. Methods: This paper presents a scenario-based assessment of the affordability of all registered anti-diabetes medications in Iran in 2017. To this end, 4 medication therapy scenarios were defined as mono, dual, triple, and insulin therapy in accordance with the existing guidelines and clinicians' opinions. Then the affordability ratio of each treatment scenario was determined for type 1 and type 2 diabetes drawing on the World Health Organization (WHO)/Health Action International (HAI) Methodology. If the affordability ratio for treatment schedules was more than 1, the patients' out-of-pocket (OOP) expenses exceeded the lowest-paid unskilled government worker (LPGW)' wage per day, and the treatment was labelled as non-affordable. Results: The results revealed that the mono, dual, and triple (non-insulin) medication therapies in type 2 diabetes were affordable, despite an increase in the dosage or a switch from the monotherapy to the combination therapy of oral medications. However, some treatment scenarios in the triple therapy, including oral plus insulin and some insulin only therapies, were proved to be non-affordable. In type 1 diabetes, only insulin glulisine, detemir, and lispro were nonaffordable in monotherapy. Regarding the combination therapy, only isophane insulin with aspart or regular insulin were affordable treatments. Conclusion: Although oral medication therapies were documented to be affordable, insulin therapy, with current coverage conditions, for patients with lowest paid wages and those receiving even less is unaffordable and a major barrier to treatment; hence, policy-maker should consider targeting and more financial protection policies to improve the affordability of insulin therapies among this group of patients. [ABSTRACT FROM AUTHOR]

Due to limited fossil fuel resources, population growth, and the need to save energy and prevent the emission of pollutants, solar heating is of great importance as a strategic solution. Due to these cases, in the present work, for the first time, the use of flat plate solar water heaters (SWHs) in Shahrekord located in the cold climate of Iran has been studied. The aim is to supply heating for space, sanitary hot water, and swimming pool of a residential apartment. Also, technical-economic-energy-environmental analyses have been done. Three low, medium, and high solar fraction scenarios have been selected for evaluations, and one-year dynamic analysis has been performed by TSOL 2018 commercial software. The required climatic data have been extracted by Meteonorm 7.3 software. The results showed that in most cases of heat supply, i.e., high solar fraction scenario, the percentage of solar heat supply for sanitary hot water, space heating, and swimming pool is 97.8%, 22.3%, and 44.3%, respectively, and the total solar fraction is 41%. Also, in this case, the release of more than 4 tons of CO2 pollutants has been prevented. Energy balance diagrams for different scenarios showed that 60% of losses are optical and thermal and also the highest rate of losses was related to the swimming pool. The lowest cost of heat generated and the lowest payback time were $ 0.028/kWh and 11.4 years, respectively, which were related to the high solar fraction scenario. [ABSTRACT FROM AUTHOR]

Background: Vitamin D (Vit D) deficiency/insufficiency is an important risk factor for several chronic conditions. We aimed to evaluate the knowledge and behavior of female adolescents with respect to the association between sunlight exposure, sunscreen use, and Vit D status.Methods: This cross-sectional survey was performed in northeastern Iran, among 940 female adolescents in January 2015. Each subject completed a questionnaire containing items about demographic characteristics, knowledge about Vit D and their use of sunscreen. Serum Vit D levels were measured using an electrochemiluminescence method and dietary intake of Vit D was assessed using a Food Frequency Questionnaire. Statistical analyses were conducted using SPSS software. A P value < 0.05 was considered statistically significant.Results: Few of the participants were aware of the biological functions of Vit D (8.8%), the causes of Vit D deficiency (16.7%), and the sources of Vit D (9.3%). Less than half of the participants used sunscreen during the day. The serum levels of Vit D in subjects who used sunscreen were significantly lower than those who did not (p = 0.004). However, there was no significant association between their knowledge about Vit D and serum Vit D, or dietary intake of Vit D.Conclusion: There appears to be a lack of coherence between lifestyle, behavior and knowledge that may affect the Vit D status of adolescent girls in northeastern Iran. This information provides a basis for developing public health planning (workshops or training at the college level) for the prevention of Vit D deficiency especially in adolescent girls. [ABSTRACT FROM AUTHOR]

Background. The aim of this study was to identify germline mutation of the RET (rearranged during transfection) gene in patients with medullary thyroid carcinoma (MTC) and their first-degree relatives to find presymptomatic carriers for possible prophylactic thyroidectomy. Methods/Patients. We examined all six hot spot exons (exons 10, 11, 13, and 14–16) of the RET gene by PCR and bidirectional Sanger sequencing in 45 Iranian patients with MTC (either sporadic or familial form) from 7 unrelated kindred and 38 apparently sporadic cases. First-degree relatives of RET positive cases were also genotyped for index mutation. Moreover, presymptomatic carriers were referred to the endocrinologist for further clinical management and prophylactic thyroidectomy if needed. Results. Overall, the genetic status of all of the participants was determined by RET mutation screening, including 61 affected individuals, 22 presymptomatic carriers, and 29 genetically healthy subjects. In 37.5% (17 of 45) of the MTC referral index patients, 8 distinct RET germline mutations were found, including p.C634R (35.3%), p.M918T (17.6%), p.C634Y (11.8%), p.C634F (5.9%), p.C611Y (5.9%), p.C618R (5.9%), p.C630R (5.9%), p.L790F (5.9%), and one uncertain variant p.V648I (5.9%). Also, we found a novel variant p.H648R in one of our apparently sporadic patients. Conclusion. RET mutation detection is a promising/golden screening test and provides an accurate presymptomatic diagnostic test for at-risk carriers (the siblings and offspring of the patients) to consider prophylactic thyroidectomy. Thus, according to the ATA recommendations, the screening of the RET proto-oncogene is indicated for patients with MTC. [ABSTRACT FROM AUTHOR]

Background: Accumulating evidence indicates that vitamin D deficiency has been increased globally over the last two decades. However, the majority of these studies are concerned with cities and there is scant information regarding the prevalence of vitamin D in rural areas. The main aim of this study was to investigate the prevalence of vitamin D deficiency and its associated risk factors among the rural population in Bushehr province which shares the longest border with the Persian Gulf. Methods: The rural inhabitants of more than 25 years old from three mountainous, plain, and seashore areas of Bushehr province were selected through a stratified multi-cluster random sampling method. After obtaining the participants' demographic and anthropometric data and their past medical history, serum 25-hydroxyvitamin D [25(OH)D] was measured using ELISA. Results: A total of 1806 (means ±SD, 46± 14years old) rural subjects (35 % males and 65 % females) participated in this study. The prevalence of vitamin D deficiency, insufficiency, and sufficiency were 28 %, 50 %, and 22 %, respectively. The deficiency of vitamin D in women was higher than in men (OR=1.27, 95 % CI: 1.05 to 1.54, P=0.04). There was a positive significant correlation between age and serum vitamin D levels. Men with vitamin D deficiency had higher BMI (P=0.008); this association was not observed among women (P=0.7). There was no significant difference between the food item's consumption frequencies, and vitamin D status (P>0.05). The mountainous, and plain areas had the highest and lowest vitamin D levels, respectively. Conclusions: Although, Bushehr province is located in a sunny part of Iran, the prevalence of vitamin D deficiency was high among its rural population. The shift of their lifestyle patterns and rapid industrialization in these rural areas may be responsible. Therefore, the enrichment of dietary sources with vitamin D and the use of vitamin D supplements are recommended to tackle the high prevalence of vitamin D deficiency in the rural population of the northern part of the Persian Gulf. [ABSTRACT FROM AUTHOR]

The current work was conducted to study the concentrations of heavy metals (HMs) in farming soil and wheat and compute their geological and health indexes, including geo-accumulation index (Igeo), chronic daily intake (CDI), hazard index (HI), hazard quotient (HQ), and cancer risk (CR). In general, 256 samples were collected from agriculture soil (AS) and wheat in Kalaleh and Aq Qala areas, northern Iran. The average rates of Cd, Cu, Pb, and Zn were detected to be 0.28, 25.24, 15.44, and 60.33 mg·kg−1, respectively, for AS and 0.01, 8.85, 0.73, and 33.81 mg·kg−1 for wheat, respectively. Based on the results, the HQ and HI levels for investigated HMs were lower than l. So, the health risk of HMs exposure for adults and children was low. CR levels for Pb in AS for both children and adults were observed greater than the threshold value. Accordingly, lead-contaminated soil will be carcinogenic if ingested by children. On the other hand, the exposure to Pb (through wheat) and Cd (through both soil and wheat) had the acceptable CR level for all groups. As a result, for an extended period, there are no significant health consequences for children and adults. [ABSTRACT FROM AUTHOR]

Background: Nitrate content is one of the most critical factors to determine the quality of vegetables, and its permissible limits in food chain is important to the human health. Due to the harmful effects of nitrate, many studies have been conducted on its accumulation in crops in recent years. This study assessed the nitrate concentrations in some edible vegetables and the associated health risks. Methods: In this descriptive study, raw agricultural produce, such as leafy vegetables, tubers, cucurbits, kitchen produce and edible grains were collected in the winter and summer. The samples were then transferred to a laboratory by maintaining the temperature-controlled supply chain. After preparing the samples, the nitrate content was determined in each, using an Ultraviolet-Visible spectrophotometric (UV/Vis) unit. The data were analyzed statistically on SPSS v. 26. Results: The mean nitrate contents in leafy and kitchen produce, grains, and tuber vegetables were approximately 130, 48, 101, and 61ppm, respectively. The average nitrate content in the winter was around 38ppm and in the summer about 44 ppm. The highest nitrate content was documented in spinach (1100.15 ppm) and the lowest in tomatos (20.97 ppm). Conclusion: The results indicated that the highest nitrate content was found in leafy produce grown in northern Iran. The highest health risk for non-carcinogenic conditions was likely to be linked to the consumption of spinach and other edible vegetables, wheat, rice, and potatoes. [ABSTRACT FROM AUTHOR]

Introduction: Musculoskeletal pain syndromes (MSPS) are among the most common disorders of societies today. Excessive use and inappropriate posture when using mobile phones seem to play a role in MSPS. In this study, the relationship between mobile phones use and MSPS and its predictive factors in southeastern Iran, Kerman, was investigated. Method: This cross-sectional community-based study was performed on 1,135 people aged 15-80 years. A questionnaire containing demographic information, risk factors, musculoskeletal pain (types and symptoms), cell phone models, and the duration and how to use mobile phone in the preceding year, was completed. Results: 51.1% of the participants were male. The overall prevalence of MSP was 71.30%, which was higher in female subjects (86.5%) than male subjects (56.7%). The risk of MSPS in people who used a smartphone was 45% higher than those who did not use a smartphone (Adjusted Odds Ratio (AOR) = 1.45, 95% CI: 0.98- 3.1). The AOR was 2.02 (1.36-3.01) in female subjects relative to male subjects and reached 2.38 (1.50-3.76) in the age group over 55 years. The AOR was 1.98 (95% CI: 1.05-3.73) in diabetic and depressed individuals, 1.65 (1.22-2.23) in obese people, 1.63 (1.12-2.36) in hypertensive individuals, 1.55 (1.23-1.96) in anxious individuals, 1.94 (1.1-3.35) in employed people, 3.08 (1.53-6.22) in housewives, and 0.68 (0.47-0.98) in people with high physical activity. Conclusion: 71% of the sample population of Kerman suffered from MSPS. The use of smartphones has contributed to this syndrome, and female gender, age, obesity, diabetes, hypertension, anxiety, depression, low physical activity, and being employed have exacerbated the disease. Taking educational measures regarding the rate of use and body position when using mobile phones is necessary. [ABSTRACT FROM AUTHOR]

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Introduction. The prevalence of metabolic syndrome has increased in recent decades around the world and is currently reaching epidemic levels as it is a major public health and clinical concern. The aim of this study was to evaluate the prevalence of metabolic syndrome and its related demographic factors in a population-based study. Methods. In this cross-sectional study, the target population consisted of 10520 individuals aged 35–70 years in Phase 1 of the Persian Guilan cohort study (Guilan site/Some'e Sara) that was conducted in 2014–2017. Demographic, anthropometric, blood pressure, and biochemical data were used in this study. The IDF definitions were used to diagnose the metabolic syndrome. Results. The prevalence of the syndrome according to IDF and ATP definition was 42.87% (95% CI: 41.92–41.81) and 40.68% (95% CI: 39.74–41.62), respectively. The prevalence of components for central obesity, high triglyceride, HDL cholesterol, blood glucose, and hypertension components was 75.8%, 43.1%, 40.6%, 39.2% and 37.9%, respectively. All demographic variables were related to the syndrome, and among them age, gender, and residence were identified as independent and strong predictive variables in the regression model. More than 92% of the population had at least one component of the syndrome. Conclusion. The results of the study show a high prevalence of metabolic syndrome risk factors. It is essential to educate healthy lifestyle behaviors and further health education in the high-risk groups identified in this study, especially the elderly, women, and rural residents. [ABSTRACT FROM AUTHOR]

In this study, the length-weight relationships (LWRs) and condition factors were estimated for 445 specimens belonging to three gobiid species viz. Ponticola bathybius (Kessler, 1877), Neogobius caspius (Eichwald, 1831) and Neogobius pallasi (Berg, 1916) from the Southern Caspian Sea basin. Total length and total weight of the examined specimens ranged 4.9-28.3 cm and 0.64-263.4 g, respectively. The length-weight parameter b of the studied species found between 2.47 (N. caspius) and 3.45 (N. pallasi) with r 2 ranging 0.831 to 0.988. LWR and K parameters are reported first time for N. pallasi from the Caspian Sea basin. The condition factor estimated was calculated from 0.94 (N. pallasi) to 0.98 (N. caspius) and 1.00 (P. bathybius). The basic biological information on the LWRs of these three gobies will be useful as baseline information for further biological research in the region. [ABSTRACT FROM AUTHOR]

Background: Many causes can lead to childhood rickets. We aimed to investigate the biochemical symptoms of childhood rickets with systematic review and meta analysis. Materials and Methods: Seven articles published from 1975 to 2018 were recruited. The literature search was performed in the Scientific Information Database, Google Scholar, PubMed, and Elsevier databases using related keywords. For meta analysis, the results of the studies were pooled using the random effects model. The heterogeneity between the studies was checked using Q test and I² index. Results: The total sample population consisted of 933 children with biochemical symptoms of rickets (133 participants per article). According to our findings, the mean serum levels of PO4, Ca, and alkaline phosphatase in children with rickets were 4.18 (95% confidence interval [CI]: 3.75-4.61, I² = 98.3%, P < 0.001), 9.23 (95% CI: 8.78-9.68, I² = 99.6%, P < 0.001), and 1.33 (95% CI: 1.23-1.44, I² = 95.6%, P < 0.001), respectively. Conclusion: Characterizing the biochemical symptoms of rickets in children can help to early diagnose and prevent the disease in children. Furthermore, educating parents about biochemical symptoms can lead to early diagnosis and successful treatment of rickets in children. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is one of the most common neurological disorders and is one of the main causes of disability. The prevalence and incidence of MS in Iran is reported to range from 5.3 to 89/ 100,000and 7 to 148.1/ 100,000, respectively. There are no systematic and meta-analysis studies on MS in Iran. Therefore, this study was conducted to investigate the prevalence and incidence of MS in Iran using meta-analysis. Method: A systematic review of the present study focused on MS epidemiology in Iran based on PRISMA guidelines for systematic review and meta-analysis. We searched eight international databases including Scopus, PubMed, Science Direct, Cochrane Library, Web of Science, EMBASE, PsycINFO, Google Scholar search engine and six Persian databases for peer-reviewed studies published without time limit until May 2018. Data were analyzed using Comprehensive meta-analysis ver. 2 software. The review protocol has been registered in PROSPERO with ID: CRD42018114491. Results: According to searching on different databases, 39 (15%) articles finalized. The prevalence of MS in Iran was estimated 29.3/ 100,000 (95%CI: 25.6–33.5) based on random effects model. The prevalence of MS in men and women was estimated to be 16.5/ 100,000 (95%CI: 13.7–23.4) and 44.8/ 100,000 (95%CI: 36.3–61.6), respectively. The incidence of MS in Iran was estimated to be 3.4/ 100,000 (95%CI: 1.8–6.2) based on random effects model. The incidence of MS in men was estimated to be 16.5/ 100,000 (95%CI: 13.7–23.4) and the incidence of MS in women was 44.8/ 100,000 (95%CI: 36.3–61.6). The meta-regression model for prevalence and incidence of MS was significantly higher in terms of year of study (p<0.001). Conclusions: The results of this study can provide a general picture of MS epidemiology in Iran. The current meta-analysis showed that the prevalence and incidence of MS in Iran is high and is rising over time. [ABSTRACT FROM AUTHOR]

Background: Drug abuse is one of the major socio-medical problems of our time with a global scope. Abusing street drugs is on the rise among adults and is considered as a public health concern. In addition, limited studies are available in this regard. The aim of this study was to investigate the frequency of street drug poisoning in the Razi Hospital of Ahvaz in Iran during 2008-2013. Methods: This is an epidemiological cross-sectional study based on hospital information. All admitted cases with street drug poisoning were included during 2008 to 2013 (70 patients). Data were analyzed by SPSS software using descriptive statistics and Chi-square. Results: In the current study, out of 70 cases aged 13-53 years old, the highest frequency of abusers was related to 30 years of age, and male/female ratio was 4 to 1. Among the drugs used, methamphetamine accounted for the highest rate. In this study, 55.7% of the cases needed to be admitted to the intensive care unit and 2 deaths were observed. The most common symptom among poisoned patients includes loss of consciousness and the least common symptom is respiratory distress. Conclusion: According to the results, it can be concluded that the poisoning will be rarely fatal in case of dangerous exposure, if they are under supervision of emergency medical attentions, including the careful management of airways and respiratory failure, hypotension monitoring, seizure and impaired management of body temperature. [ABSTRACT FROM AUTHOR]

Background: Heavy metal contamination via mining activity is a serious problem around the world. This study was conducted to evaluate the total non-cancer hazard quotient (THQ) and excess lifetime cancer risks of lead (Pb) and cadmium (Cd) to different population groups via soil, wheat and barley ingestion, soil-dermal contact, and inhalation soil particulates around Shahin mine located in Shazand County. Methods: Soil and plants were sampled randomly from 60 agricultural fields around Shahin mine. The samples Pb and Cd concentrations were determined using atomic absorption spectroscopy (AAS). The THQ and the excess lifetime cancer risks of Pb and Cd were estimated using the formulas suggested by the U.S. Environmental Protection Agency (USEPA). The Pb non-cancer risk for children (<6 years old) was assessed using the integrated exposure uptake bio-kinetic (IEUBK) model. Results: The mean contents of Pb (234.47 mg kg−1) and Cd (1.89 mg kg−1) in soil samples were higher than the background values. The mean Pb and Cd concentrations in wheat grains were 0.44 and 0.23 μg g−1 respectively, which were about 6.5 and 5.8 times higher than that was observed in barley grains, respectively. The THQ of Pb and Cd for all groups were greater than 1. The excess lifetime cancer risks of Pb via wheat and barley consumption for all receptor groups were greater than 1 × 10−6. Conclusions: Crop ingestion and soil inhalation had the greatest and lowest portions to increase the THQ and excess lifetime cancer risks of Pb and Cd in the study region, respectively. [ABSTRACT FROM AUTHOR]

Background: Variations in learning styles among students could explain many differences in students' acquisition of knowledge. This study examined the association between learning styles and academic achievement among students at Tabriz University of Medical Sciences in the northwest of Iran. Methods: This research is part of a longitudinal study entitled, "Health and Lifestyle of University Students" among undergraduate, medical, dentistry, and pharmacy students at Tabriz University of Medical Sciences who entered the university in October 2014. A self-administered questionnaire that consisted of general information and Kolb's learning style was completed by these students during the first eight weeks of their first semester. Academic achievement was assessed using grade point average (GPA) in the following semesters (1 and 2) of the academic year. Results: A total of 452 students were included in this study with a mean age of 19.16 ±1.03. The most prevalent learning style was convergent and the second most common was accommodative. The average GPA of the students was 15.74 ± 1.57 out of a possible 20. The results of a multivariate regression showed that the effect of learning style on academic achievement, in the presence of other variables, was not statistically significant. Sex was able to predict academic progression (ß = 0.188, P = 0.001). In addition, GPA was higher among dentistry students (ß = 0.128, P = 0.012) and lower among nursing and medical students (ß = =-0.211, P = 0.001; ß = -0.127, P = 0.015 respectively). Conclusion: Although students' academic achievement was correlated with their learning style, the popularity of convergent and accommodative styles should be considered in that acknowledging the prevailing learning styles of students could promote academic achievement. [ABSTRACT FROM AUTHOR]

This article applies rational choice theory to analysis three reformative periods in 19th century Iran: the reforms of AmirKabir, Naser-ed-Din Shah and Sepahsalar. It analyses the arguments of the advocates and opponents of reforms, as well as the reasons and counterarguments of reformers. Using the method of agreement and the method of concomitant variation, it examines the triangular rational interaction of opponents, reformers, and advocates of reforms. Based on a nominal comparison of the arguments of opponents, the reasons they offer in all three reformative periods include: "endangerment of Shah's household", "homeland security disturbance", "the danger of losing territorial integrity of Iran", "political dependency of the reformer and/or his advocates on foreign countries", "neglecting people's rights", "neglecting the opponents' position and threatening their class benefits", and "personal manner of the reformer and/or his advocates". Based on an ordinal comparison, the most repetitive arguments offered by distinct groups of opponents include: "endangerment of Shah's household", "neglecting the opponents' position and threatening their class benefits", "neglecting traditions by the reformer and/or his advocates", and "personal manner of the reformer and/or his advocates". Analysing the triangular interaction of the reformer, advocates, and opponents of reforms indicates that the reform of Sepahsalar is the only one that demonstrates an interaction among reformer, advocates, and opponents. Further, it is the only period in which the reformer and the advocates react to the most repetitive arguments of opponents. [ABSTRACT FROM AUTHOR]

Zagros Mountains are like an island in the Middle East and they are subjected to changes in climate. Daphne mucronata Royle is an important medicinal plant species preserved in the high elevation regions in these mountains. Maxent species distribution model was used to integrate presence data (2413 points) and environmental variables to model the current and future potential distribution of D. mucronata in Iran. The most important variables were Bio19 with 50.5% contribution, followed by Bio8 and Bio2 with 30% and 11.4% contributions, respectively. The best Maxent model included seven variables, 4 feature types (linear, quadratic, product, and hinge), and had a test AUC value of 0.894. The current potential distribution indicated that 8% of Iran's drylands are suitable for growing D. mucronata and this area could decrease to 5.2% under representative concentration pathway (RCP) 4.5, and 3.1% under RCP 8.5 due to climate change. Our results suggest that D. mucronata may lose overall about 2.8% and 4.9% of its current distribution under RCP 4.5 and RCP 8.5, respectively, by 2050. There would be only 0.7 and 0.2% gains under RCP 4.5 and 8.5, respectively. The species would locally disappear between 1500- and 2000-m elevation under RCP 4.5 and 8.5, respectively. The establishment of some stations for monitoring the changes in transition zone or lost areas especially on the southeastern parts of Zagros Mountain can help in detecting changes in the future. Additionally, stable habitats may be good target areas for future conservation planning., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Various allergens are implicated in the pathogenesis of allergic diseases in different regions. This study attempted to identify the most common allergens among patients with allergies based on the results of skin prick tests in different parts of Iran. Relevant studies conducted from 2000 to 2016 were identified from the MEDLINE database. Six common groups of allergen types, including animal, cockroach, food, fungus, house dust mite, and pollen were considered. Subgroup analysis was performed to determine the prevalence of each type of allergen. The Egger test was used to assess publication bias. We included 44 studies in this meta-analysis. The overall prevalence of positive skin test results for at least one allergen was estimated to be 59% in patients with allergies in various parts of Iran. The number of patients was 11,646 (56% male and 44% female), with a mean age of 17.46±11.12 years. The most common allergen sources were pollen (47.0%), mites (35.2%), and food (15.3%). The prevalence of sensitization to food and cockroach allergens among children was greater than among adults. Pollen is the most common allergen sensitization in cities of Iran with a warm and dry climate; however, sensitization to house dust mites is predominant in northern and southern coastal areas of Iran. [ABSTRACT FROM AUTHOR]

The present study aimed to evaluate the sources of pollution and the potential human and ecological risks of hazardous elements (HEs) in 40 hotspot sites of the agricultural soil around the Arvand River, Iran. The mean concentrations of As, Cd, Co, Cr, Ni, Pb, Zn, and Hg were measured to be 7.2, 0.8, 14.0, 67.9, 69.5, 63.0, 296, and 0.66 (mg kg -1 ), respectively. With the exception of Ni, the mean concentrations of all the elements were found to be higher than those in the background. The spatial distribution of HEs in the study area indicated an increasing trend of contamination from the north to the south. Pb, Zn, and Hg were the most enriched elements, resulting in a high pollution load. Moreover, the agricultural soil of the study area was threatened by a very high ecological risk due to the contribution of Hg, Cd, and Pb. Multivariate statistical analyses determined that the pollution sources are specified by the oil refinery emissions and effluents, irrigation with polluted water, fertilizers, dust storms, and airport emissions. The carcinogenic risk of HEs in both adults and children revealed an acceptable level; however, children faced a great chance of non-carcinogenic risk. The results provide a scientific basis for monitoring HEs and managing health risks via effective methods in the agricultural areas of the Arvand River basin.

Background: Vaccination is one of the most common painful procedures in infants. The irreversible consequences due to pain experiences in infants are enormous. Breast feeding and massage therapy methods are the non-drug methods of pain relief. Therefore, this research aimed to compare the vaccination-related pain in infants who underwent massage therapy or breast feeding during injection. Materials and Methods: This study is a randomized clinical trial. Ninety-six infants were allocated randomly and systematically to three groups (breast feeding, massage, and control groups). The study population comprised all infants, accompanied by their mothers, referring to one of the health centers in Isfahan for vaccination of hepatitis B and DPT at 6 months of age and for MMR at 12 months of age. Data gathering was done using questionnaire and checklist [neonatal infant pain scale (NIPS)]. Data analysis was done using descriptive and inferential statistical methods with SPSS software. Results: Findings of the study showed that the three groups had no statistically significant difference in terms of demographic characteristics (P > 0/05). The mean pain scores in the breast feeding group, massage therapy, and control group were 3.4, 3.9, and 4.8, respectively (P < 0.05). Then the least significant difference (LSD) post hoc test was performed. Differences between the groups, i.e. massage therapy and breast feeding (P = 0.041), breast feeding group and control (P < 0.001), and massage therapy and control groups (P = 0.002) were statistically significant. Conclusion: Considering the results of the study, it seems that breast feeding during vaccination has more analgesic effect than massage therapy. Therefore, it is suggested as a noninvasive, safe, and accessible method without any side effects for reducing vaccination-related pain. [ABSTRACT FROM AUTHOR]

Primary immunodeficiency diseases (PIDs) consist of a group of genetic disorders that predispose the patients to immune-mediated complications. The aim of this study was to assess the knowledge of Iranian general practitioners and pediatricians about PIDs. A questionnaire consisting 52 closed questions on clinical symptoms, laboratory data, associated syndromes and management of PIDs patients was made valid and reliable by a pair pilot study. Then the questionnaire was filled by pediatricians, general practitioners and pediatric residents from different regions of Iran. Totally, 333 physicians (50 general practitioners, 52 pediatric residents, 182 pediatric specialists, and 49 pediatric sub specialists) participated in this study. The mean total score was 55.9±14.3 (i.e. about 29 correct answers out of 52 questions). One hundred and five participants (31.9%) answered correctly more than two third of all questions. In order to qualitatively compare the groups a ranking system was used. Total scores was significantly different between physicians groups (p<0.01). Pediatric subspecialties gained the highest rank, which was significantly over the other participants (p<0.05). This study showed that there is a considerable lack of awareness on PIDs in physicians. This may be one of the major reasons in late diagnosis and the delay in adequate treatment deteriorating patients' morbidity and mortality. Retraining classes and reconsidered educating schedules are needed as an efficient strategies and improving physicians' knowledge about PIDs. [ABSTRACT FROM AUTHOR]

Simple statistical methods on Normalized Difference Vegetation Index (NDVI) and bands 3 and 4 data of relatively coarse resolution Thematic Mapper (TM) and Enhanced Thematic Mapper plus (ETM + ) imageries were used to investigate the impacts of air pollution on the deterioration of the vegetation cover in the Sarcheshmeh copper complex of central Iran. Descriptive statistics and k-means cluster analysis indicated that vegetation deterioration had already started in the prevailing wind directions. The results show that combination of simple statistical methods and satellite imageries can be used as effective monitoring tools to indicate vegetation stress even in regions of sparse vegetation. Despite various possible perturbing factors upon NDVI, this index remains to be a valuable quantitative vegetation monitoring tool. [ABSTRACT FROM AUTHOR]

Pediatric immunology came into sight in the second half of 20th century, when pediatricians and basic immunologists began to give attention to diagnosis and treatment of children with primary immunodeficiency diseases (PIDs). Understanding the genetic and mechanistic basis of PIDs provides unique insight into the functioning of the immune system. By progress in basic and clinical immunology, many infrastructural organizations and academic centers have been established in many countries worldwide to focus on training and research on the immune system and related disorders. Along with progress in basic and clinical immunology in the world, pediatric immunology had a good progress in Iran during the last 33-year period. Now, patients with PIDs can benefit from multidisciplinary comprehensive care, which is provided by clinical immunologists in collaboration with other specialists. Patients with history of recurrent and/or chronic infections suggestive of PIDs are evaluated by standard and research-based testing and receive appropriate treatment. The progress in PIDs can be described in three periods. Development of training program for clinical fellowship in allergy and immunology, multidisciplinary and international collaborative projects, primary immunodeficiency diseases textbooks, meetings on immunodeficiency disorders, improvement in diagnosis and treatment, and construction of Iranian primary immunodeficiency association, Students' research group for immunodeficiencies, Iranian primary immunodeficiency registry, and the immunological societies and centers were the main activities on PIDs during these years. In this article, we review the growth of modern pediatric immunology and PIDs status in Iran. [ABSTRACT FROM AUTHOR]

X-linked Agammaglobulinemia (XLA) is a hereditary immunodeficiency, characterized by an early onset of recurrent bacterial infections, hypogammaglobulinemia and markedly reduced B lymphocytes number. In order to determine the association of neutropenia among Iranian patients with XLA, hospital records of 30 patients with confirmed XLA in Children Medical Center Hospital, were reviewed. Eight out of 30 XLA patients (26.7%) developed neutropenia during the course of the disease. In two patients, episodes of neutropenia were identified before or at the time of diagnosis of XLA. Other six patients whom were not visited regularly and did not receive periodical immunoglobulin replacement therapy experienced neutropenia after diagnosis of XLA. Neutropenia in XLA is mainly associated with infection and is resolved with intravenous immunoglobulin replacement and antibiotics therapy. [ABSTRACT FROM AUTHOR]

Potentially toxic elements (PTE) are considered to be dangerous threats, both for human health and the environment. Here, the contamination level, sources, and ecological risks posed by PTE were investigated in 19 topsoils from agricultural lands in the Bandar Abbas County on the southern coast of Iran. The soil fraction <63 μm was used for the analysis of the pseudototal contents of PTE (arsenic, cadmium, cobalt, chromium, copper, lead, manganese, molybdenum, nickel, vanadium, and zinc). The results were analyzed using principal component analysis (PCA) and Pearson's correlations, different pollution indices [enrichment factor (EF), contamination factor (Cf), and modified degree of contamination (mCd), and the potential ecological risk index (PERI). The results of the pollution indices showed that the contamination levels of the studied agricultural soils are low to moderate, while the average PERI values indicate that the ecological risks of PTE range from low to high in the soils of the studied area. Correlations and PCA analyses suggest that studied elements have three possible origins: geogenic (chromium, cobalt, copper, manganese, vanadium, and zinc), anthropogenic (cadmium, nickel, phosphorus and lead) and atmospheric (arsenic) sources. These findings are helpful for the long-term assessment of PTE in the Bandar Abbas County. [ABSTRACT FROM AUTHOR]

Introduction: Infertility prevalence as well as its various complications have made society face major challenges. According to statistics published by WHO, 11 percent of infertility reasons are unknown. Hundreds years of experience of traditional medicine in Iran puts forward some reasons and treatments that can be helpful in the treatment of some parts of infertility caused by unknown reasons. Materials and Methods: We examined the reasons of infertility and its treatment initially with foods and then with medicines by exploring traditional medical books such as al-Asbab and al- Alamat by Najib al-Din Samarghandi. Results: In this research, from the view point of Iran traditional medicine (ITM), all the existing things in the world and around it are made up of four elementary essences including: fire, air, water, and soil and nine temperaments are created through their combinations that are classified into four single, four combined and one mild temperament. Individuals have their own unique temperament and temperament disorder causes disorder in the activity of organs of body like uterus. Regarding traditional medicine, diseases are divided into two singular and compound groups. We can consider singular diseases as ʽill temperament‘. It happens when the temperament of a person or organ is not normal. In this case, one part of the body or the entire body gets away from mild temperament that is appropriate for it. Sometimes the temperaments can be controlled by controlling our appetite and by balancing the temperament as the result of which of the temperament of body‘s organs is controlled and their functions of the activity would improve. Diseases related to the temperament are categorized into two kinds: plain and material. Kloniger has pointed out the qualities and temperaments and their classifications. Uterus ill tempeament is considered as one of the key reasons of uterus diseases and infertility and sometimes unusual temperament causes disorder in uterus activity. Conclusion: Discovering theses ill temperaments predict fertility to some extent. Nowadays, recognizing these temperaments as the first step in infertility treatment caused by unknown reasons seems essential. These findings and discussions can be extremely helpful in treating infertility diseases. [ABSTRACT FROM AUTHOR]