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Background The effect of right ventricular (RV) leads on tricuspid valve has been already raised concerns, especially in terms of prognostic implication. For such assessment, three-dimensional transthoracic echocardiography (3D-TTE) has been used previously but there was no data on the use of post-procedural fluoroscopy in the literature. Methods We prospectively enrolled 59 patients who underwent clinically indicated placement of pacemaker or implantable cardioverter defibrillator (ICD). Vena contracta (VC) and tricuspid regurgitation (TR) severity were measured using two-dimensional transthoracic echocardiography (2D-TTE) at baseline. Follow up 3D-TTE was performed 6 months after device implantation to assess TR severity and RV lead location. Results Lead placement position in TV was defined in 51 cases.TR VC was increased after the lead placement, compared to the baseline study (VC: 3.86 ± 2.32 vs 3.18 ± 2.39; p = 0.005), with one grade worsening in TR in 25.4% of cases. The mean changes in VC levels were 1.14 ± 0.67 mm. Among all investigated parameters, VC changes were predicted based on lead placement position only in 3D-TTE (p Conclusion The RV Lead location examined by 3D-TTE seems to be a valuable parameter to predict the changes in the severity of the tricuspid regurgitation. Fluoroscopy findings did not improve the predictive performance, at least in short term follow up.

Background: Obsessive-compulsive disorder (OCD) is a potentially debilitating disease that affects 1-4% of the general population. It is characterized by the presence of obsessions and compulsions which interfere with the individual’s life and functioning. Although conventional treatments such as drug therapies and cognitive behavioral therapy exist for OCD, these treatments are not universally successful and can cause side effects, which has created a demand for alternative and complementary therapies. Methods: In this review, we summarize randomized clinical trials on the effectiveness of herbal medicines for the treatment of OCD, and review the possible mechanisms of action for these medicines. A search in PubMed, Scopus, and The Cochrane Library found 1022 studies, of which 7 were included in our review. Results: The studies that we found were conducted over 6 to 12 weeks, and had an average sample size of 37. The plant species studied included Crocus sativus, Echium amoenum, Hypericum perforatum, Silybum marianum, Valeriana officinalis, and Withania somnifera. The trials demonstrated the effectiveness of all plants as treatments for OCD except H. perforatum. The phytochemicals found in these plants produce their effects through a variety of means such as inhibiting the reuptake of monoamines, GABAergic effects, and neuroendocrine modulation. The small number of studies and their small sample sizes, poor methodology, and lack of replication highlight the need for further research into herbal medicines for the treatment of OCD. Conclusion: Overall, herbal medicines can be used as stand-alone therapies for OCD or in conjunction with other methods.

The current study assesses the effects of platelet-rich plasma-fibrin glue (PRP-FG) dressing along with oral vitamin E and C on wound healing and biochemical markers in patients with non-healing diabetic foot ulcers (non-healing DFU).This randomized controlled trial was performed on 25 patients with non-healing DFU. Patients were treated with PRP-FG dressing plus oral vitamin E and C (intervention group) or PRP-FG dressing plus placebo (control group) for 8 weeks.Eight weeks after treatment, six wounds in the intervention group and two wounds in the control group were completely closed, and also wound size significantly reduced in both intervention and control groups (Our results showed that PRP-FG dressing along with oral vitamin E and C could be used to increase wound healing in patients with non-healing DFU by enhancing the wound healing process and reducing oxidative stress.This trial is registered at ClinicalTrials.gov (CT.gov identifier: NCT04315909).

Suicide is a global public health issue. 1 Suicide rates have increased by 60% worldwide in the last 45 years.2 World Health Organization (WHO) has estimated that more than 1.5 million individuals will die due to attempting suicide in 2020 which equals 2% of all deaths due to various diseases and injuries.3 However, there is an iceberg phenomenon: suicide at-tempts are up to 20 times more frequent than complet-ed suicides. Many factors affect suicide including psychological, social, biological, cultural and environmental factors.4 However, some of them like personality characteristics, psychopathology, parenting style, family function, and substance abuse have got more attention.5,6 It should be noted that suicide is not even an isolated event, but a continuum of processes starting from suicidal ideation (SI), suicidal plan (SP), suicide attempt (SA), to suicide completion.7 SI which is defined as thoughts of self-killing is an important factor not only for tremendous personal distress, psychological burden or mental-health problems but also for the SP, SA and completed suicide. It has been reported that about one-third of those with SI will finally attempt suicide.8 So, it seems that there must be predisposing factors which push forward a person in suicide continuum: not all individuals with SI perform SA. On the other hand, not all individuals with SA had a prior SP or SI. So there may be different risk factors for each of them. To the best of our knowledge, this issue has not been well studied. There is no doubt that suicide has enduring financial, emotional, and social impact on the friends and family of attempters. Therefore, the prevention of suicide is critical. Some studies have reported that a wide range of interventions including healthy decision making, development of life skills and self-esteem enhancement can reduce suicidal behavior.9,10 However, it seems that effective suicide prevention measures will not be effective unless there is a clear understanding of the patterns of SI/SP.11,12 Countries of the Eastern Mediterranean Region of the WHO including Iran, are traditionally considered to be characterized by low rates of suicidal behaviors (0-3.1 per 100,000). This could be potentially attributed to the cultural messages and Islamic religious beliefs against suicide.13 However, these official reports can be prone to a considerable underestimation due to the stigma of suicide in public culture. A population-based study from the capital of Iran has reported that 12.7% of participants had a lifelong history of SI, 6.2% had a lifelong history of SP, and 3.3% had a lifelong history of SA.14 We did not find any study which focuses on suicidal behavior in suicide attempters. So, the main aim of this study was to identify the main epidemiological characteristics of SI, SP, and SA in suicide attempters. Besides we tried to study the whole suicidal continuum (i.e. from SI to SA) to see in what proportion of suicide attempts the whole cycle happens. These can help us to have a better picture of suicidal behavior.

Objective Previous studies have found an association between HLA-B*1502 allele and lamotrigine-induced Stevens-Johnson syndrome (SJS)/ toxic epidermal necrosis (TEN) spectrum in Han Chinese populations. This study aims to investigate the association between HLA-B*1502 and lamotrigine- or phenytoin- induced SJS/TEN in an Iranian population. Methods The medical records of twenty-eight lamotrigine-induced SJS/TEN patients and twenty-five lamotrigine-tolerant controls as well as eight phenytoin-induced SJS/TEN and twelve phenytoin-tolerant controls were extracted between March 2013 to March 2019 from the university hospitals in Mashhad, Iran. The presence of HLA-B*1502 allele was determined using real-time polymerase chain reaction (PCR). Results Among lamotrigine-induced patients with SJS/TEN, 11 (39.3%) patients tested positive for the HLA-B*1502 while only 3 (12.0%) of the lamotrigine-tolerant controls tested positive for this allele. The risk of lamotrigine-induced SJS/TEN was significantly higher in patients with HLA-B*1502, with an odds ratio (OR) of 4.74 [95% confidence interval (CI) 1.14-19.73, p = 0.032]. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of HLA-B*1502 for lamotrigine-induced SJS/TEN was 39.29%, 88.00%, 78.57% and 56.41%, respectively. The HLA-B*1502 allele was present in 2 (25.0%) of phenytoin-induced SJS/TEN cases and 5 (41.7%) of the phenytoin-tolerant controls tested positive for HLA-B*1502 allele. The risk of phenytoin-induced SJS/TEN was not higher in the patients with HLA-B*1502 (OR = 0.467 [95% confidence interval (CI) 0.065-3.34, p = 0.642]). Significance Lamotrigine-induced SJS/TEN is associated with HLA-B*1502 allele in an Iranian population but this is not the case for phenytoin-induced SJS/TEN.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, while no drugs have been approved for its treatment. The pieces of evidence indicate that propolis as a novel anti-inflammatory agent might be a promising candidate to treat NAFLD. We aimed to evaluate the efficacy of propolis on hepatic steatosis and fibrosis in patients with NAFLD. This randomized clinical trial was conducted on 54 patients with NAFLD. Patients were randomly assigned to receive propolis tablets at a dose of 250 mg twice daily for 4 months or placebo. The improvement in hepatic steatosis and fibrosis was evaluated using two-dimensional shear wave elastography. Improvement in the hepatic steatosis was significantly higher in the propolis group than the placebo group, even after adjustment for baseline value and changes in weight, energy intake, and physical activity (odds ratio [OR]: 5.67; 95% confidence intervals [CI]: 1.41-22.8; p = .014). A significant reduction was observed on the liver stiffness in the propolis group (-0.65 ± 0.56 kPa; p = .001), whereas it increased in the placebo group (0.27 ± 0.59 kPa; p = .037). Also, the intake of propolis significantly decreased high-sensitivity C-reactive protein (hs-CRP) levels compared with the placebo group (-0.371; 95%CI: -0.582 to -0.16 mg/L; p = .01). Changes in serum levels of fasting blood sugar, alanine aminotransferase, aspartate aminotransferase, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, cholesterol, and triglyceride did not differ significantly between the two groups (p > .05). There was no significant improvement in insulin resistance in both groups (p > .05). Propolis seems to have protective effects on hepatic steatosis and fibrosis and to reduce the serum levels of hs-CRP in patients with NAFLD.

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

Purpose This study aimed to compare the quality of spinal anesthesia between opium-dependent and opium-naive patients. Design A case-control study. Methods Two groups of subjects including opium-dependent and opium-naive patients (30 per group) were enrolled. Spinal anesthesia was performed using 15 mg of bupivacaine. The level of anesthesia was assessed every minute for 10 min and then every 10 min for 180 min. Motor block was recorded at 10, 60, 120, and 180 minutes. The duration of anesthesia was recorded. Findings The mean duration of spinal anesthesia was significantly shorter in opium-dependent patients (101.45 ± 28.670) than in opium-naive patients (126.14 ± 24.206) (P = .003). The mean onset of sensory block was not significantly different between the two groups (4.14 ± 1.62 vs 3.69 ± 1.36, P = .259). Conclusions Substance abuse affects the duration of spinal anesthesia, so it is recommended to use intravenous medications or higher doses of spinal marcaine for these patients.

Cardiovascular disease is a leading cause of death in many societies. Arterial stiffness is an initial sign of structural and functional changes in the arterial wall. Pulse wave velocity (PWV) is the gold standard for non-invasive evaluation of aortic stiffness and a modifiable cardiovascular risk factor. Curcumin is a major component of turmeric with known anti-inflammatory and anti-oxidative effects. Since arterial stiffness is affected by inflammation and oxidative stress, it may be improved by curcumin supplementation. The purpose of this clinical trial was to investigate the potential effects of curcumin on improving arterial stiffness in patients with metabolic syndrome. This placebo-controlled, double-blind, randomized clinical trial was conducted among metabolic syndrome patients. Sixty-six eligible individuals were randomly assigned to active intervention or control groups. The active intervention group received curcumin supplement at a dose of 500 mg daily for 12 weeks, whereas the control group received placebo capsule. Physical activity, daily dietary energy intake, anthropometric body composition, and biochemical hemodynamic and arterial stiffness parameters were evaluated at baseline and at the end of the study. Body weight decreased significantly in the curcumin group compared to placebo. Also, curcumin intervention improved PWV, which remained significant after adjustment for potential confounding factors (p = 0.011). The current clinical trial demonstrated that daily intake of 500 mg of curcumin for 12 weeks can lead to the improvement of arterial stiffness and weight management among subjects with metabolic syndrome.

Kefir is a fermented beverage obtained as a result of lactic-alcoholic fermentation of milk by using kefir grains or a starter culture. Kefir beverage has numerous health benefits owing to its antimicrobial, anti-inflammatory and anti-diabetic properties, while it could also regulate the gut microbiota. This beverage is recommended as a nutritional approach to glycemic control. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the effects of kefir beverage on the glycemic control. For this purpose, a literature search was conducted via databases such as PubMed, Scopus, ISI Web of Science, and Google Scholar for the articles published until July 2020 with no limitation. The indicators of glycemic control were fasting blood sugar (FBS), hemoglobin A1c (HbA1c), and insulin. In total, six RCTs on a total sample size of 323 subjects were selected for the meta-analysis. Inverse-variance weighted mean difference (WMD) with a 95% confidence interval (CI) was calculated for the mean changes in HbA1c, FBG and insulin compared to baseline. Considering the clinical heterogeneity caused by the varied duration and dosage of kefir beverage treatment, a random effects model was used to estimate the pooled WMD. Findings indicated a more significant reduction in the FBS (WMD = -10.28; 95% CI: -16.53-4.02; P = 0.001) and insulin (WMD = -2.87; 95% CI: -3.96-1.78; P 0.00001) in the kefir treatment group. Furthermore, kefir consumption could reduce HbA1c (HbA1c = -0.64 -1.36, 0.08), while this effect was not considered significant (-0.64; 95% CI: -1.36-0.08; P = 0.08). The results of our meta-analysis indicated that kefir beverage could reduce the FBS and insulin levels without a significant effect on HbA1c. In general, our findings showed that kefir beverages may have beneficial effects on glycemic control. However, more clinical data and research into the mechanism of probiotics are required to clarify the beneficial effects of probiotics on glycemic markers.

Human T cell leukemia virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP), as the most common neurological emersion related to HTLV-1, is a debilitating and lifelong treating disease with no definitive treatment. Furthermore, it has been determined that dietary compositions (inflammatory and anti-inflammatory) and some micronutrients (such as vitamin D and selenium) have an effect on inflammatory and immune processes and with this background; the study was done to compare the nutritional status between age- and sex-matched with infected and non-infected HTLV-1. In a multi-center setting, 70 healthy controls (HCs), 35 asymptomatic carriers (ACs), and 35 HAM/TSP patients were recruited in the HTLV-1 Foundation, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Nutritional status including anthropometric indices, dietary (micro- and macronutrient) intake, and serum vitamin D, vitamin B12, zinc, and selenium were measured. In anthropometric indices, mean waist circumference (WC) in the carrier group was significantly higher than the patient and the control groups (p = 0.008). In the dietary intake, the patient group received less energy, protein, mono-unsaturated fatty acids (MUFA), and oleic, but more fat than the HTLV-1 carrier and control groups, and these differences were remarkable in three groups (p = 0.002, 0.005, 0.001, 0.01, and 0.001, respectively), whereas the carrier group received more saturated fatty acid and less poly-unsaturated fatty acids (PUFA), linoleic, and linolenic than patient and control groups with a different significant (p = 0.01, 0.007, 0.005, and 0.006, respectively) in three groups. In micronutrient intake, although selenium, zinc, and vitamins B12 and D were lower in the patient group than the carrier and control group, however, no significant differences were observed. In comparison with micronutrient serum concentrations, vitamins B12 and D and selenium in the patient group were lower than the carrier and control groups, but statistically, the considerable difference was found only in the selenium concentration (p = 0.001). The study showed that there were differences in dietary intake (including energy, macronutrients, and fatty acids), WC, and selenium serum levels between HAM/TSP patients and HTLV-1 carriers, suggesting that nutritional statues influence the inflammatory immune response in HTLV-1 infection.

Vitamin D insufficiency and deficiency can be associated with adverse effects on fetus and pregnancy outcomes. This study aimed at evaluating the effect of 1,25VitD3 on specific transcription factor and markers of Tregs and T helper 17 (Th17) cells in peripheral blood mononuclear cells (PBMCs) of women with unexplained recurrent pregnancy loss (URPL) as a case group and PBMCs of healthy women as a control group.Samples from 20 non-pregnant patients with a history of URPL were compared to 20 normal non-pregnant women. PBMCs were divided into three wells for each subject in the presence of 1,25VitD3 (50 nM, for 16 hours), phytohemagglutinin (10 µM; positive control), and without any treatment (negative control). By Real-time PCR (Taqman assay), specific transcription factors of Tregs and Th17 cells, forkhead box P3 (FOXP3), retinoic acid-related orphan receptor γt (ROR-γt), glucocorticoid-induced tumor necrosis factor receptor-related (GITR), and CTLA-4 mRNA expressions in two groups were measured.FOXP3/ROR-γt mRNA expression in PBMCs decreased significantly in women experiencing URPL compared to the control group (p = 0.0001). Although 1,25VitD3 (50 nM) increased FOXP3 gene expression (p = 0.0001), it did not significantly affect ROR-γt gene expression. Besides, 1,25VitD3 treatment significantly increased FOXP3/ROR-γt mRNA expression from baseline in PBMCs of the fetal loss group compared to that of the control group (p = 0.01). The 1,25VitD3 also increased GITR gene expression (p = 0.017) in PBMCs of URPL women compared to the controls.Vitamin D deficiency may be a contributor to recurrent pregnancy loss and suggests that the supplementation of women with Vitamin D pre-pregnancy may be protective against URPL via affecting Tregs signature genes, FOXP3 and GITR.

BACKGROUND Determining severity of mitral stenosis (MS) by planimetry of mitral valve orifice area (MVA) has been a challenging issue in clinical practice, especially for less experienced cardiologists. Mitral leaflet separation (MLS) has shown a good correlation with MVA measurements. However, it has never been validated against multiplane 3DTEE planimetry (MVA3D ). We aimed to evaluate the accuracy of MLS index (MLSI2D ) in predicting MS severity. METHODS We prospectively enrolled 144 patients with MS who underwent clinically indicated 2DTTE and 3DTEE. MLSI2D was yield by averaging the maximal leaflet tip distance in diastole, in parasternal long-axis and apical four-chamber views. MVA3D was used as the reference method. RESULTS MLSI2D showed an excellent discriminatory ability between different grades of MS (P

The aim of this study is to investigate psychopathologies and the temperament-character profile of Alopecia Areata patients and to compare them with healthy controls. Patients and controls who presented at a dermatology clinic were selected by convenience sampling to respond to Temperament and Character Inventory (TCI), SCL-90-R, and a checklist about the demographic data and their dermatologic and psychiatric history. Patients reported higher harm avoidance and reward dependence than controls (Cohen's d = .93 and = .94). A significant correlation between Harm Avoidance (r = -0.33, p = .02) and Reward Dependence (r = -0.28, p = 0.05) with sex was found (females scored higher). Lifetime history of AA relapse was significantly associated with higher psychiatric symptoms; the effect sizes were large for Obsessive-Compulsive (d = .81) and Paranoia Ideation (d = .89). The higher psychological symptoms in AA patients with the history of relapses in this study have a practical message for clinicians.

Cystic echinococcosis and toxoplasmosis are two human parasitic diseases. Butchers and slaughterhouse workers are in close contact with body fluids and tissues of ruminants. To investigate the prevalence of Toxoplasma and Echinococcus IgG antibodies in slaughterhouse workers in Northeast of Iran, Mashhad, 2016. This cross-sectional study was performed on all personnel working at the largest industrial slaughterhouse of Khorasan Province. Serum samples were taken and kept frozen until used. IgG against Echinococcus and Toxoplasma were quantified using commercial ELISA kits. A questionnaire addressing possible risk factors of infection acquisition was filled by participants. Out of 91 male participants, 58.2% were positive for toxoplasmosis, 5.5% were positive for cystic echinococcosis and 3.3% were positive for both. Except using gloves, and gown and boots, other personal protective equipment (PPE) were not completely used by all personnel; mask 38%, tool disinfectants: 12%, face and hand disinfection: 14.3%. There was a high risk of Toxoplasma in slaughterhouse workers, however, such finding was not observed in Echinococcus parasite. Importance of PPE and tool disinfectants to reduce the risk of zoonotic infections in the workplace should be emphasised.

The purpose of this research was to investigate the effect of Urtica dioica in comparison with placebo, acupuncture and combined therapy on hot flashes and quality of life in postmenopausal women.In a double-blinded randomized controlled trial, patients were treated for 7 weeks then followed up 4 weeks. Seventy-two postmenopausal women who reported at least 20 hot flashes attacks per week were randomly allocated into one of the 4 groups of Urtica dioica 450 mg/day and acupuncture 11 sessions (A), acupuncture and placebo (B), sham acupuncture and Urtica dioica (C), and sham acupuncture and placebo (D). The primary outcomes were the change in hot flashes score from baseline to the end of treatment and follow up; and the change in the quality of life (MENQOL) from baseline to the end of treatment. Secondary outcomes included changes in FSH, LH, and ESTRADIOL levels from baseline to the end of treatment. The trial was conducted from October 2017 to July 2018 in Acupuncture clinic of a teaching hospital in Iran.A total of 72 women 45-60 years old were enrolled, and 68 were included in the analyses. The median (IQR) hot flashes score decreased in the A group by 20.2 (31.7) and 21.1 (25.1), B group by 19 (18) and 17.3 (27), C group by 14.6 (25.4) and 20.8 (13), and D group by 1.6 (11.6) and 1 (13.3) at the end of treatment and follow up (P 0.0001, P 0.0001); no significant difference between A, B and C groups. The mean (SD) of MENQOL score decreased in the A group by 42.6 (21.1), B group by 40.7 (29.8), C group by 37.8 (26.8) and D group by 9.8 (14.3) at the end of treatment (P = 0.001); no significant difference between A, B and C groups.Urtica dioica can decrease menopausal hot flashes and increase the quality of life of postmenopausal women better than placebo-sham control but same as acupuncture. The combination of Urtica dioica and acupuncture did not add to the effects of those therapies.

Obesity and overweight are major public health problem. Different-strategies have been developed for body contouring including Radiofrequency(RF) and Ultrasound(US). The aim of this study was to investigate changes in serum-leptin as a potential-modulator of food/energy intake, in overweight-women receiving RF/US and diet-therapy as well as the effect of therapy on modulation of lipid-profile and body-fat-mass.Fifty overweight-females were enrolled in current randomized-clinical-trial and randomly divided into two groups. The case group received RF/US twice a week for 5 weeks with a low calorie diet whilst the control-group received just a low calorie diet. Demographic, biochemical markers as well as serum-leptin were determined.The level of leptin was reduced from 1.29 ± 0.32 ng/ml to 1.14 ± 0.34 ng/ml in case group, before and after therapy, respectively, whilst no significant differences were observed in the serum leptin levels of subjects in the control group. The combination of RF and US decreased the leptin-level. In particular, the mean reduction of abdominal-circumference and waist-circumference was significant (P 0.05) after therapy. This reduction was inversely correlated with LDL levels. Weight was reduced in case and control groups and in both was significant, but no statistically significant differences were detected for weight between the groups(P 0.93).Our findings demonstrated the reduction of the leptin after treatment with the combination of Radiofrequency/Ultrasound cavitation, which was associated with reduced body-fat-mass.

The aim of this study was to evaluate the efficacy of the herbal tea based on Foeniculum vulgare, on inducing regular bleeding in women with oligomenorrhea and secondary amenorrhea( oligo/amenorrhea).Forty women aged 18- 40 with oligo/amenorrhea were enrolled in this randomized controlled clinical trial and were allocated to two groups equally. The women in the first group were treated by Fomentex (Foeniculum vulgare / Mentha longifolia / Vitex agnus-castus) herbal tea 11.2 g/day in 2 divided doses for 2 weeks and the second group were treated by medroxy progesterone acetate (MP)10 mg/day for the last 10 days of their menstrual cycles. The intervention was repeated in three cycles of menstruation in both groups. Bleeding pattern was documented by the patient on diary cards. The occurrence (yes/no) of bleeding, the regularity of bleeding pattern, the interval of cycles, the duration of bleeding, the volume of blood flow, the hormonal parameters (total testosterone, free testosterone luteinizing hormone and follicle-stimulating hormone), and the endometrial thickness in sonography before and after the intervention were evaluated and compared as outcomes.The number of women with bleeding during the first cycle was in the Fomentex group and the MP group 83.3% and 94.1% respectively (p = 0.61). The regularity of bleeding did not significantly differ in patients treated with Fomentex from those given MP (66.7% vs. 94.1%; p = 0.088). Mean interval of cycles decreased in both groups after intervention (P0.001). Mean duration decreased significantly in MP group after the intervention but it was not different in patients treated with Fomentex. The difference between 2 groups was not significant (P=0.705). Volume of blood flow, with regard to Pictorial Blood Assessment Chart (PBAC), increased significantly in MP group after the intervention (P=0.001) and it was not different in patients treated with Fomentex (P=0.757); however, difference between 2 groups was not significant (P=0.063). The percentage of patients with on time menstruation in the next (drug-free) episode, was higher in the Fomentex group compared with the MP group (50% vs. 23.5%; p = 0.105). Secondary outcomes such as dysmenorrhea, acne and hirsutism reduced in the Fomentex group (P≤0.05), while they increased in the MP group (P=0.007). At the end of the treatment, there was a significant decrease in luteinizing hormone, total testosterone and free testosterone in patients taking Fomentex. The decrease of endometrial thickness, was significant in both groups after the intervention (P=0.001), but the difference between 2 groups was not significant (P=0.58). No notable complication or side effect was reported in relation to Fomentex.Fomentex herbal tea is a safe, well-tolerated, and effective choice in inducing bleeding and maintaining regular bleeding in women with oligo/amenorrhea.

Anogenital wart (AGW) resulting from human papilloma virus (HPV) is one of the most common sexually transmitted diseases worldwide. Herein, we aimed to evaluate the effects of AGW on patients'marital satisfaction and sexual function. This cross-sectional study was consisted of 74 consecutive patients including 37 patients with AGW and 37 healthy controls. ENRICH Marital Satisfaction Scale and Arizona Sexual Experience Scale were completed and analyzed for all patients. ENRICH scale items were not significantly different between the two groups. Sexual function was found to be lower in female than male patients (P

Nasal airway patency has long been considered a major factor in ear health. The aim of this study was to determine the effect of sinonasal polyposis on middle ear and eustachian tube (ET) functionality. Forty-four individuals with polyposis, 23 with non-polyposis nasal obstruction, and 23 healthy controls were enrolled. Demographic, clinical and imaging data of all participants were collected and ET function tests and audiologic tests were performed. Hearing loss (p = 0.02), flat tympanogram (p = 0.02), disturbed Toynbee and Valsalva tests (p = 0.01), and the prevalence of allergy (p = 0.04) and purulent nasal discharge (p < 0.001) were significantly higher in the polyposis group than the other groups. Regression analysis revealed that infection and allergy have more important roles in ET function than the nasal obstruction. Polyposis could impede ET function; however, it is probably not because of its obstructive nature, but because of the associated increased risk of infection.

Background: Surgical techniques used in the treatment of patients with high grade lumbar spondylolisthesis (> 50% slippage) are usually associated with a great deal of controversies. We aim to evaluate the surgical outcomes of high grade spondylolisthesis treated with an intraoperative temporary distraction rod. Methods: We retrospectively studied 21 patients (14 females and 7 males), aged 50.4 ± 9.2 years, who had high grade lumbar spondylolisthesis that was treated with intraoperative temporary distraction rods, neural decompression, pedicular screw fixation, and posterolateral fusion involving one more intact upper vertebra. The mean follow-up period was 39.2 months. Radiologic and clinical outcomes were measured by slip angle, slip percentage, correction rate, Oswestry Disability Index (ODI), visual analogue scale (VAS), patient’s satisfaction rate in the pre- and postoperative period. Data were analyzed by SPSS ver. 11.5. Results: Analysis of the preoperative visits and final follow-up visits indicated that surgery could improve ODI, lumbar VAS, and leg VAS from 60.5% to 8.2%, from 6.7 to 2.2, and from 6.9 to 1.3, respectively. Slip angle and slip percentage were also changed from –8° to –15° and from 59.2% to 21.4%, respectively. Mean correction rate at the final follow-up visit was 64.1%. Loss of cor rection was insignificant and a neurologic complication occurred in one patient due to misplacement of one screw. Excellent and good levels of satisfaction were observed in 90.5% of the patients. Conclusions: In the surgical treatment of refractory high grade spondylolisthesis, the use of a temporary distraction rod to reduce the slipped vertebra in combination with neural decompression, posterolateral fusion, and longer instrumentation is associated with satisfactory clinical and radiologic outcomes.

Transurethral lithotripsy (TUL) is a major modality for the endoscopic management of ureteral stones. Ureteral spasm makes access for ureters difficult, which causes impaction of the ureteroscope, ureteral dislodge, and a low success rate of endoscopic surgeries. This study described the outcomes of a new endoscopic surgical experience by use of 40-degree warm saline irrigation during TUL compaired with routine ambient air irrigation in TUL.In this randomized clinical trial from 2014 to 2015, 150 patients with ureteral stone with balanced randomization were divided into two parallel groups. Patients underwent TUL in the first group with 20-25 degree saline irrigation and in the second group with 40-degree saline irrigation. One surgical team with the same semi-rigid instrument performed all TULs and the other steps were similar in both groups. Complete stone fragmentation was measured as the primary outcome and the duration of procedure, retrograde stone migration and all and any intraoperative complications were the secondary measurements.While comparing warm saline irrigation with cold saline irrigation, the rate of access to upper ureter was 95% versus 72%, stone retropulsion frequency was 10.7% versus 30.7% and the stone-free rate was 96% versus 76% respectively (P.05). There was no ureteroscope impaction and ureteral dislodge in both groups.Using warm saline irrigation in endoscopic surgeries results in better surgical outcomes including a lower ureteral spasm rate, greater ureteral muscle relaxation and better access to the upper ureteral zone, and a lower rate of complications, such as ureteroscope impaction, ureteral dislodge and stone retropulsion.

ST2 is a member of IL-1 receptor family expressed on Th2 cells and regulates Th2 responces. The gene of ST2 encodes soluble ST2 (sST2) and the transmembrane ST2 (ST2L) isoforms through alternative mRNA splicing. The discovery of IL33/ ST2 signaling pathway, has drawn a great scientific attention to this system. sST2 has been shown to be an indacating factor in various infl ammatory conditions. This study aims to evaluate serum sST2 levels in HTLV-1 infected patients. This study included 49 HTLV-1 seropositive cases of which 14 were sympthomatic. Controls consisted of 30 healthy volunteers. sST2 level was measured using a quantitative ELISA assay and the results of the study groups were compared. Corroborating the previous reports, sST2 was lower in females (P = 0.003). The sST2 levels was slightly increased in HTLV-1 patients, though such increase was not statistically significant (P = 0.91), in addition sST2 level did not correlate significantly to the disease duration (P = 0.78). Despite some other chronic viral infection, HTLV-1 seems not to induce high serum sST2. However owing to relatively high normal variation of sST2 levels and rather small sample size, we stongly recommend further reseach with preferably larger sample size to evalute sST2 in HTLV-1 infected patients.

Many aspects of the pathogenesis of Human T-cell lymphotropic virus type 1 (HTLV-1) still need further elucidations. Previous studies have indicated that oxidative stress occurs during infection with the other retrovirus, human immunodeficiency virus 1 (HIV-1). Similar results have been observed in some other chronic viral infections including hepatitis B (HBV) and hepatitis C (HCV). In order to reveal possible oxidative stress in HTLV-1-infected patients, we evaluated serum total antioxidant capacity (TAC) as an indicator of oxidative stress in these patients. Forty-four HTLV-1-seropositive individuals were included in this study, consisting of 12 symptomatic and 32 asymptomatic (carrier) cases. Controls consisted of 36 apparently healthy, HTLV-1-, HIV- and hepatitis-seronegative individuals. All symptomatic patients had HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Serum TAC levels in patients and healthy individuals were measured using a quantitative TAC assay. The antioxidant capacity in HTLV-1-seropositive cases was significantly reduced compared to control group (P = 0.001). In addition, TAC was lower in patients with more than 5 years history of HAM/TSP compared to those with ≤5 years duration of the myelopathy (P = 0.03). Our results show a depletion of TAC during HTLV-1 infection, which intensifies along with the disease progress. This finding indicates a role of the oxidative stress in pathogenesis of HTLV-1. These results may prompt further research to evaluate any possible therapeutic effect of antioxidant dietary supplements for HTLV-1 infected individuals.

Despite the strong evidence of child safety seats (CSSs) effectiveness in reducing injuries, it is still rarely used in some societies. The purpose of this study was to determine prevalence and predictors of CSS use in Mashad, Iran. Five hundred ninety kindergarten children whose parents owned a car were enrolled in the study. Parents were asked about using CSS for their children, reasons for CSS use/non-use, demographics, history of road traffic injuries and receiving any advice on CSS. Of families, 25.5% expressed that they used CSS for their child at present or any time in the past, but only 6.3% of children travelled restrained in CSS at the time of study. Age-appropriate CSS use was reported in 14.5% of infants and 2.3% of 1-5-year-old children. A significant relationship was observed between lower child age, higher maternal education and high family income with CSS use. The main reasons for CSS none-use were reported as not feeling the need (42%), followed by its high price (22%). Use of CSS was uncommon. The financial concerns and information gap about the essential need for CSS should be considered as priorities for action especially among lower socio-economic groups of society.

Background Iran has one of the highest rates of road traffic crash death rates throughout the world and road traffic injuries are the leading cause of years of life lost in the country. Using child car safety seats is not mandatory by law in Iran. The purpose of this research was to determine the parental willingness to pay (WTP) for child restraints in Mashad, the second most populated city in Iran with one of the highest rates of road traffic-related deaths. Methods We surveyed 590 car-owner parents of kindergarten children who were willing to participate in the study in the year 2009. We asked them about the maximum amount of money they were willing to pay for car safety seats using contingent valuation method. Results The mean age of children was 33.5 months. The median parental WTP for CSS was about $15. Considering the real price of CSSs in Iran, only 12 percent of responders could be categorized as being willing to pay for it. Family income level was the main predictor of being willing to pay. Conclusions The median parental WTP was much lower than the actual price of the safety seats, and those who were of lower socio-economic class were less willing to pay. Interventions to increase low-income families' access to child safety seats such as providing free of charge or subsidized seats, renting or health insurance coverage should be considered.