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Background: End-Stage Renal Disease (ESRD) patients under maintenance hemodialysis are at higher risk for COVID-19 and severe outcomes. This study aimed to investigate the association between ESRD patients who underwent maintenance hemodialysis at 5th Azar and Sayad Shirazi Hospital in Golestan Province in 2019 and their risk of contracting and experiencing severe outcomes from COVID-19. Furthermore, this study aimed to provide insights into the epidemic status of COVID-19 in this specific population, contributing to better insight into the unique challenges faced by ESRD patients on hemodialysis during the pandemic. Methods: This retrospective descriptive cross-sectional study was performed on patients who underwent maintenance hemodialysis. The diagnosis was made based on diagnostic criteria and COVID-19 PCR test. Medical information of all participants was collected. Medical information including clinical, laboratory, and radiological data as well as morbidity and mortality were collected and analyzed by experts. Statistical analysis was performed using SPSS version 21. Normality was evaluated using Shapiro-Wilk test and comparison between groups was analyzed using student T-test and Mann-Whitney U tests (p 0.05). No significant difference was observed between the age and BMI of passed away and discharged patients. None of the laboratory parameters in the two groups of passed away and discharged patients with COVID-19 showed a significant difference (p> 0.05). Patients with COVID-19 who had a history of diabetes and hypertension, clinical symptoms, such as cough (p=0.049), weakness, and lethargy (p=0.05), indicated a significant difference in mortality compared to the group that was discharged (p

The upper limb plays a crucial role in daily life activities, self-care, work, leisure, and social activities. It enables a person to perform essential tasks, such as eating, drinking, writing and searching the environment, leading to increased cognition and intelligence in children. Various disorders in children (for instance, Erb palsy, cerebral palsy, hemiplegia, muscular dystrophy, neuropathy) and adults (such as stroke and central, and peripheral nerve damage) can affect the functioning of the upper limb. While mobility aids exist for individuals with lower limb disabilities, there is a lack of suitable technical solutions for those with upper limb disorders because of structural and joint complications. Minimum muscle strength, at level 3 or higher, is necessary for limb movement, and this strength can be affected by neurological and musculoskeletal disorders, resulting in a limited range of motion or no movement.

Introduction: Quality of life (QoL) is a complex and multifaceted concept often used as an indicator in evaluating public policy. This study aimed to predict QoL based on mental health state using a machine learning approach. The analysis was conducted using data from the Urban Health Equity Assessment and Response Tool (Urban-HEART 2) survey conducted in Tehran, Iran. Methods: This secondary analysis utilized data from the second round of the Urban-HEART 2 survey, which included 117,839 participants. Various machine learning (ML) algorithms were employed, including Random Forest, Decision Tree, Support Vector Machine (SVM), Naive Bayes, and Logistic Regression. Additionally, an unsupervised learning method, specifically k-means clustering, was used. Results: Following data preparation, the k-means clustering algorithm identified five clusters based on mental health features. ML algorithms were then utilized to predict each participant's QoL label through distinct scores. The top-performing ML algorithms based on high scores were found to be Random Forest (0.994), Decision Tree (0.991), SVM (0.990), Naive Bayes (0.935), and Logistic Regression (0.934), respectively. Conclusions: By implementing k-means clustering, we identified distinct clusters based on mental health features and assigned labels to each participant accordingly. Machine learning models accurately predicted the QoL label for each participant. All models achieved high scores (above 0.93), indicating that mental health features can reliably predict QoL labels with high accuracy.

Abstract Occult hemorrhages after trauma can be present insidiously, and if not detected early enough can result in patient death. This study evaluated a hemorrhage model on 18 human subjects, comparing the performance of traditional vital signs to multiple off-the-shelf non-invasive biomarkers. A validated lower body negative pressure (LBNP) model was used to induce progression towards hypovolemic cardiovascular instability. Traditional vital signs included mean arterial pressure (MAP), electrocardiography (ECG), plethysmography (Pleth), and the test systems utilized electrical impedance via commercial electrical impedance tomography (EIT) and multifrequency electrical impedance spectroscopy (EIS) devices. Absolute and relative metrics were used to evaluate the performance in addition to machine learning-based modeling. Relative EIT-based metrics measured on the thorax outperformed vital sign metrics (MAP, ECG, and Pleth) achieving an area-under-the-curve (AUC) of 0.99 (CI 0.95–1.00, 100% sensitivity, 87.5% specificity) at the smallest LBNP change (0–15 mmHg). The best vital sign metric (MAP) at this LBNP change yielded an AUC of 0.6 (CI 0.38–0.79, 100% sensitivity, 25% specificity). Out-of-sample predictive performance from machine learning models were strong, especially when combining signals from multiple technologies simultaneously. EIT, alone or in machine learning-based combination, appears promising as a technology for early detection of progression toward hemodynamic instability.

Abstract Background Synovial sarcoma is a rare soft tissue sarcoma, with incidences of 0.81/1,000,000 in children and 1.42/1,000,000 in adults. It is most commonly found in soft tissue and rarely in bone. It often has a slow growth pattern and a benign radiologic appearance. Case presentation This study reports a case of metacarpal synovial sarcoma occurring in the hand-wrist of a 32-year-old Iranian man presented with the chief complaint of a lump on the dorsal ulnar side of his left hand and wrist. Initially, the first physician suspected the case to be a ganglion cyst. After two months of conservative treatment, the size of the lesion gradually increased. Magnetic resonance imaging (MRI) was performed and after an excisional biopsy and a postoperative histological analysis, the tumor was identified as a synovial sarcoma. The patient underwent a scheduled surgical procedure. Unfortunately, he had poor follow-ups and brought the pathologic results two months later when, the tumor had incredible growth, which makes this presentation rare. Conclusions Since early diagnosis can lead to higher survival rates, this report increases doctors' awareness of this extremely malignant tumor that is rarely seen.

Dysphagia and upper airway obstruction may be post-acute complication of COVID-19. The studied case showed that in people newly infected with SARS-CoV-2, the two mentioned clinical complications probably occur due to the strong immune response and cytokine storm in the throat which can be prevented from oropharynx obstruction by using corticosteroids and antihistamines.

Background: Urinary tract infection (UTI) is one of the most prevalent bacterial diseases worldwide. Escherichia coli is a well-known etiological agent of UTI. The emergence and spread of metallo-beta-lactamase (MBL)-producing E. coli is a serious threat to public health. This study aimed to investigate the antibiotic resistance pattern and prevalence of MBL-producing E. coli isolated from UTI. Methods: From January 2020 to June 2021, 1200 urine specimens were collected from patients suspected of having UTI. Antibiotic susceptibility testing was carried out by the disk diffusion method. The prevalence of MBL (blaVIM, blaIMP, blaSPM, and blaNDM) genes was determined by the polymerase chain reaction (PCR) method. Results: The highest susceptibility was observed against amikacin (96%) and gentamicin (95%). The isolates were mostly resistant against ampicillin (72%) and cephalothin (60%). All carbapenem-resistant isolates were MBL-positive. Based on the results of PCR, 75% of the isolates were blaNDM-positive. Conclusion: Resistance to some antibiotics, such as ampicillin and cephalothin, was high, and their prescription must be restricted. The prevalence of MBL-producing isolates was not high; however, due to the high level of resistance against other antibiotics, continuous monitoring of MBL-producing isolates is highly essential.

Objectives: Accurate scientific planning and societal macro policies require reviewing and evaluating research output. Scientometrics offers a valuable approach for assessing the activity of journals that publish a majority of scientific productions. This study aims to analyze the scientific activity of the Iranian Rehabilitation Journal (IRJ) by examining its publication history in the Scopus database. Methods: This bibliometric analysis adopts a scientometrics approach and includes all documents published in IRJ indexed in the Scopus database. Data collection and analysis were performed using VOSviewer and Excel software. Results: IRJ has been active since 2003, initially publishing seven articles in the Scopus database. The journal boasts an H-index 11 and has produced 701 documents over 20 years. The citation score for the journal in 2022 was approximately 0.6. The University of Social Welfare and Rehabilitation Sciences had the highest number of affiliated articles (n=395). The most productive author was “Dadkhah” with 42 documents; the most cited author was “Masah”. Most documents are articles written in English, and the most frequently used keyword is “Rehabilitation”. Discussion: This study offers an overview of the status of IRJ, indicating an increasing trend in the number of documents published and citations received since its establishment. The research findings can serve as a road map for researchers in the field of rehabilitation, providing valuable insights for future studies. Coresponding author: Marzieh Golchin, E-mail: golchinlib@yahoo.com You can also search for this author in: Google Scholar

Cardiovascular disease (CVD) is one of the most important diseases which controlling its related risk factors, such as metabolic and inflammatory biomarkers, is necessary because of the increased mortality risk of that. The aim of our meta-analysis is to reveal the general effect of vitamin K supplementation on its related risk factors. Original databases were searched using standard keywords to identify all randomized clinical trials (RCTs) investigating the effects of vitamin K on CVD. Pooled weighted mean difference (WMD) and 95 % confidence intervals (95 % CI) were achieved by random-model effect analysis for the best estimation of outcomes. The statistical heterogeneity was determined using the Cochran's Q test and I2 statistics. Seventeen studies were included in this systematic review and meta-analysis. The pooled findings showed that vitamin K supplementation can reduce homeostatic model assessment insulin resistance (HOMA-IR) (WMD: −0⋅24, 95 % CI: −0⋅49, −0⋅02, P = 0⋅047) significantly compared to the placebo group. However, no significant effect was observed on other outcomes. Subgroup analysis showed a significant effect of vitamin K2 supplementation compared to vitamin K1 supplementation on HOMA-IR. However, no significant effect was observed on other variables. Also, subgroup analysis showed no potential effect of vitamin K supplementation on any outcome and omitting any articles did not affect the final results. We demonstrated that supplementation with vitamin K has no effect on anthropometrics indexes, CRP, glucose metabolism, and lipid profile factors except HOMA-IR.

Key Clinical Message The stroke‐like episodes and brain MRI lesions in MELAS usually have a nonischemic pattern, are resolved over time, and have a migrating pattern that helps us distinguish them from ischemic cerebral infarcts. Nevertheless, conditions such as intracardiac thromboses, PFO, and hypercoagulable state may be present concomitantly, leading to mismanagement. Therefore, further investigation and echocardiography are suggested in MELAS patients. Abstract Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke‐like episodes (MELAS) is the most common maternally‐inherited mitochondrial disorder presenting by stroke‐like episodes, seizures, encephalopathy and muscle weakness. We report the clinical, imaging, echocardiography and muscle biopsy findings of a patient presenting by unique characteristics which have not been reported in previous cases of MELAS. The reported case is a 34 year old man with the history of three times hospitalization due to muscle weakness, encephalopathy, progressive cognitive decline, and gradual visual loss. Muscle biopsy revealed Ragged Red Fibers concomitant with mitochondrial disorders. PFO was found in echocardiography leading to mismanagement of this patient and MR imaging showed ischemic lesions with a progressive pattern. This is the first reported case of MELAS accompanying with PFO. All previous reported cases of MELAS have mentioned a fluctuating characteristic for the ischemic lesions; hence this is the first case of MELAS with the progressive pattern of ischemic lesions.

Objective(s): HBsAg vaccine is unable to induce Th1 immune responses. Here, immune responses and long-lived IgG responses of HBsAg-Alum, HBsAg-MF59, as well as HBsAg-MF59 were compared when formulated with PPD. Materials and Methods: BALB/c mice were injected with the vaccines subcutaneously three times with a two-week interval. Then, specific IgG, long-lived IgG responses up to 220 days, and also IgG1 and IgG2a isotypes were assessed using ELISA. Furthermore, IFN-γ and IL-4 were assessed on spleen cell culture supernatant by ELISA. Results: IFN-γ cytokine response between MF59- and Alum-adjuvanted vaccines did not show a significant difference. HBsAg-Alum vaccine revealed an increase in IL-4 cytokine, as compared with those immunized with HBsAg-MF59 at borderline (P=0.0553). In addition, HBsAg-MF59+PPD 10 µg showed a significant decrease in IL-4 and IFN-γ cytokines, as compared with HBsAg-MF59. Furthermore, the HBsAg-MF59+PPD10 µg group showed a significant increase in the IL-2/IL-4 ratio, as compared with HBsAg-MF59 (P=0.0339). Specific IgG antibody showed a significant increase in HBsAg-MF59, as compared with HBsAg-Alum. Furthermore, HBsAg-MF59 plus PPD showed a significant increase in IgG responses, as compared with HBsAg-MF59 and HBsAg-Alum groups. Long-lived IgG responses up to 220 days after the final shot showed a significant increase in HBsAgMF59 versus HBsAg-Alum group and PPD in the HBsAg-MF59 vaccine formulation, resulting in a significant increase in IgG responses versus HBsAg-MF59 group. In addition, PPD in the HBsAg-MF59 vaccine formulation suppressed IgG1 response versus HBsAg-Alum. However, HBsAg-MF59 showed a significant increase in IgG2α versus the HBsAg-Alum group (P=0.0190). Immunization with HBsAg-MF59+PPD (10 µg) showed a significant increase versus the HBsAg-MF59 group (P=0.0040). Results from the IgG2a/IgG1 ratio in HBsAg-MF59+PPD1µg and HBsAg-MF59+PPD10 µg groups showed a significant increase as compared with HBsAg-MF59 groups (P

Abstract Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy is an inflammatory disease of the central nervous system (CNS), which affects various regions in the CNS, presenting by variable clinical manifestations. Meningoencephalitis is the most common clinical presentation and association with autoimmune disorders has been reported in about 20% of these patients. Diagnosis is confirmed by the presence of CSF or serum immunoglobulin‐G (IgG) against GFAP. The reported case is a 53‐year‐old woman with the history of long‐standing rheumatoid arthritis who first presented with acute‐onset dizziness and gait disturbance, periventricular linear and radial enhancement pattern on MRI, and normal CSF analysis, successfully treated with an increase in the dose of oral steroids. After a year she had a subacute‐onset, moderate to severe holocephalic headache, normal neurologic examination and CSF analysis, and bilateral diffuse, pachymeningeal, and leptomeningeal enhancement on MRI. According to her Brain MRI imaging with relapsing remitting course steroid responsive ataxia and aseptic meningitis, her serum was tested for GFAP IgG antibodies which was positive. The reported patient is the first in the literature reported pachymeningitis in GFAP astrocytopathy. This case highlights the co‐occurrence of rheumatoid arthritis with GFAP‐associated astrocytopathy, and expands on the previously reported cases with similar association. This might also suggest a common immune pathogenesis.

Multiple sclerosis (MS) is a chronic and inflammatory disease of the central nervous system (CNS) that is common in people between the ages of 20 and 40. Although the exact cause of MS is still unknown, evidences shows that genetic and environmental factors have a role in activating immune cells to attack the myelin sheath of the neurons, and causing them to be damaged. In order to control and reduce the disease prevalence, early identification of at risk people and patients in the early stages of the disease is important. Measurement of interferon gamma (IFN-γ), vitamin D, melatonin, neurofilaments, micro RNA-132 (miR-132), miR-155, determination of antibody titer against Epstein-Barr virus (EBV) and human leukocyte antigen (HLA) typing are appropriate methods to diagnose the disease, and ultimately prevent its recurrence.

Introduction: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has taken a toll on humans, and the development of effective vaccines has been a promising tool to end the pandemic. However, for a vaccination program to be successful, a considerable proportion of the community must be vaccinated. Hence, public acceptance of coronavirus disease 2019 (COVID-19) vaccines has become the key to controlling the pandemic. Recent studies have shown vaccine hesitancy increasing over time. This systematic review aims to evaluate the COVID-19 vaccine hesitancy rate and related factors in different communities. Method: A comprehensive search was performed in MEDLINE (via PubMed), Scopus, and Web of Science from January 1, 2019 to January 31, 2022. All relevant descriptive and observational studies (cross-sectional and longitudinal) on vaccine hesitancy and acceptance were included in this systematic review. In the meta-analysis, odds ratio (OR) was used to assess the effects of population characteristics on vaccine hesitancy, and event rate (acceptance rate) was the effect measure for overall acceptance. Publication bias was assessed using the funnel plot, Egger's test, and trim-and-fill methods. Result: A total of 135 out of 6,417 studies were included after screening. A meta-analysis of 114 studies, including 849,911 participants, showed an overall acceptance rate of 63.1%. In addition, men, married individuals, educated people, those with a history of flu vaccination, those with higher income levels, those with comorbidities, and people living in urban areas were less hesitant. Conclusion: Increasing public awareness of the importance of COVID-19 vaccines in overcoming the pandemic is crucial. Being men, living in an urban region, being married or educated, having a history of influenza vaccination, having a higher level of income status, and having a history of comorbidities are associated with higher COVID-19 vaccine acceptance.

Background: The current study aimed to develop a comprehensive phonological awareness intervention to train all levels of phonological awareness skills and to investigate its effect on the reading abilities of cochlear implanted children. Materials and Methods: This study was the single-subject intervention. Phonological awareness intervention programme was developed and validated by experts' opinions. Six elementary first graders with cochlear implants and weak or delayed reading development, in 5–7-year-old range, were trained in phonological awareness skills. 'Auditory test of phonological awareness skills' was used to evaluate the subjects' phonological awareness skills. Nama reading test was also used to determine the level of reading performance. Results: The results showed that all six subjects with cochlear implants had improvements of both phonological awareness skills and reading skills after participating in the phonological awareness intervention programme. This improvement was not only observed immediately after intervention but was also preserved in follow-up. Conclusion: The findings of this study demonstrated the importance of planning an intervention programme about phonological awareness skills for elementary first graders with cochlear implant, and the important role of such an intervention programme in improving their performance in phonological awareness tasks, and then in reading tasks consequently. The importance of improvement in these skills could considerably affect these children's linguistic and psychological abilities, which may facilitate their education at higher grades.

Background: The H1N1 influenza virus is a highly pathogenic virus that threatens human life. Vaccination is an effective way of preventing and controlling influenza. Production of recombinant hemagglutinin in the baculovirus expression system, in the insect eukaryotic cell substrate (Sf9), has been suggested as an effective strategy. Methods: The H1N1 influenza virus hemagglutinin gene sequence was prepared from National Center for Biotechnology Information (NCBI). After designing a specific primer, the sequence was provided using restriction digestion, cloned into pFastBacHTA plasmid, and transferred to the DH10Bac cell to produce a recombinant bacmid. After extracting the relevant plasmid, it was transfused into the insect cell; and after the expression of the protein by Sf9 cell, the presence of recombinant protein was confirmed using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and Western blot methods. Findings: The hemagglutinin gene (654 bp) was cloned in pFastBacHTA plasmid using the two enzymes of BamHI and Xhol. Sf9 cell expressed a protein weighing approximately 60 kDa after receiving the recombinant bacmid protein. The extracted protein was identified and confirmed using SDS-PAGE and Western blot methods; and protein concentration was measured by Lowry method. Conclusion: The baculovirus system is useful for the production of proteins with complex structures. Generally, it can be concluded that this protein is highly expressed in insect cells. Due to the similarity of this system with the human system, it can be a suitable alternative for embryonic eggs in the future, and can be used in vaccination.

Background The Coronavirus Disease 2019 (COVID-19) pandemic and imposed quarantine have had different effects on the social and psychological aspects of people. The lack of any definitive treatment or preventive method for COVID-19 has caused a great deal of stress and anxiety in people. Objective The aim of this study was to investigate the demographic characteristics and common complaints of callers to the telephone counseling helpline to receive services for anxiety and stress caused by COVID-19. Methods This is a descriptive cross-sectional study. The study samples were 1978 callers to the telephone counseling helpline of the Academic Center for Education, Culture and Research (ACECR) in Iran. Data collection was done by a checklist made by researchers and provided to the consultants. Findings Most of callers (65.8%) were women and married (77.7%) with a mean age of 44.14 years; 41.5% of callers with no any symptoms were afraid and worried about getting infected; 26.6% stated their anxiety was due to worry that their first-degree relatives may get infected, and 8.5% reported that their anxiety was because of fear of economic problems and loss of job or income . Conclusion The main users of the telephone counseling helpline was married women aged 30-39 years. Considering the anxiety and stress caused by COVID-19 outbreak, it seems necessary to provide counseling services.

Background and Objective: Acquired kidney cysts usually occur in end stage renal disease (ESRD) patients undergoing long-term hemodialysis. Increasing growth of cysts is also seen in asymptomatic patients and they can cause complications such as retroperitoneal and intrarenal bleeding, Erythrocytosis, infection of cysts and renal cell carcinoma with distant metastases. This study was designed to evaluate the prevalence of acquired kidney cysts and its related factors in hemodialysis patients. Methods: In this descriptive-analytical study, 123 patients (mean age 55.22+13.23 years) were selected from hemodialysis patients referred to dialysis center. Patients with autosomal polycystic kidney disease, medullary sponge kidney and medullary cystic kidney disease were not included. Diagnosis of acquired kidney cysts of Patients was performed by ultrasonography. Results: The overall prevalence of kidney cysts was 44.6%. 30 percent of diabetic patients had kidney cysts, while kidney cysts were present in 51.2% of nondiabetic patients. 32.4% of patients were received twice a week dialysis and 42.4% of patients were received three times a week dialysis had kidney cysts. Mean±SD of duration of dialysis history in patients with cystic kidneys was 22.02±22.65 months, while these measures in patients with noncystic kidneys were 22.65±14.65 months. There was a relationship between kidney cysts and the numder of hemodialysis per week (P

Abstract Abusing methamphetamine can be considered as an agent that can cause or affect the course of atypical parkinsonian syndromes (APS), which may raise attention regarding preventing abusing these drugs.

Genetics play a prominent role in the development and progression of malignant neoplasms. Identification of the relevant genes is a high-dimensional data processing problem. Pyramid gravitational search algorithm (PGSA), a hybrid method in which the number of genes is cyclically reduced is proposed to conquer the curse of dimensionality. PGSA consists of two elements, a filter and a wrapper method (inspired by the gravitational search algorithm) which iterates through cycles. The genes selected in each cycle are passed on to the subsequent cycles to further reduce the dimension. PGSA tries to maximize the classification accuracy using the most informative genes while reducing the number of genes. Results are reported on a multi-class microarray gene expression dataset for breast cancer. Several feature selection algorithms have been implemented to have a fair comparison. The PGSA ranked first in terms of accuracy (84.5%) with 73 genes. To check if the selected genes are meaningful in terms of patient’s survival and response to therapy, protein-protein interaction network analysis has been applied on the genes. An interesting pattern was emerged when examining the genetic network. HSP90AA1, PTK2 and SRC genes were amongst the top-rated bottleneck genes, and DNA damage, cell adhesion and migration pathways are highly enriched in the network.

Since the first reported case of coronavirus disease 2019 (COVID-19) in China, SARS-CoV-2 has been spreading worldwide. Genomic surveillance of SARS-CoV-2 has had a critical role in tracking the emergence, introduction, and spread of new variants, which may affect transmissibility, pathogenicity, and escape from infection or vaccine-induced immunity. As anticipated, the rapid increase in COVID-19 infections in Iraq in February 2021 is due to the introduction of variants of concern during the second wave of the COVID-19 pandemic. To understand the molecular epidemiology of SARS-CoV-2 during the second wave in Iraq (2021), we sequenced 76 complete SARS-CoV-2 genomes using NGS technology and identified genomic mutations and proportions of circulating variants among these. Also, we performed an in silico study to predict the effect of the truncation of NS7a protein (ORF7a) on its function. We detected nine different lineages of SARS-CoV-2. The B.1.1.7 lineage was predominant (80.20%) from February to May 2021, while only one B.1.351 strain was detected. Interestingly, the phylogenetic analysis showed that multiple strains of the B.1.1.7 lineage clustered closely with those from European countries. A notable frequency (43.33%) of stop codon mutation (NS7a Q62stop) was detected among the B.1.1.7 lineage sequences. In silico analysis of NS7a with Q62stop found that this stop codon had no considerable effect on the function of NS7a. This work provides molecular epidemiological insights into the spread variants of SARS-CoV-2 in Iraq, which are most likely imported from Europe.

This study was carried out to produce low-emitting biomass pellets biofuel from selected forest trees such as (Cedrus deodara and Pinus wallichiana) and agricultural crop residues such as (Zea mays and Triticum aestivum) in Gilgit-Baltistan, Pakistan using indigenously developed technology called pelletizer machine. Characterization, environmental life cycle impact assessment, and cumulative energy demand of biomass pellets biofuel produced from selected agriculture crops and forest tree residues were conducted. The primary data for biomass pellets production was collected by visiting various wood processing factories, sawmills, and agricultural crop fields in the study area. Biomass pellets are a type of biofuel that is often made by compressing sawdust and crushing biomass material into a powdery form. The particles are agglomerated as the raw material is extensively compressed and pelletized. Biomass pellets have lower moisture content, often less than 12%. Physically, the produced pellets were characterized to determine moisture content, pellet dimensions, bulk density, higher heating value, ash content, lower heating value, and element analysis. A functional unit of one kilogram (kg) biomass pellets production was followed in this study.The life cycle impact assessment of one kg biomass pellets biofuel produced from selected agro-forest species revealed environmental impact categories such as acidification (0.006 kg SO2 eq/kg pellets), abiotic depletion (0.018 kg Sb eq/kg pellets), marine aquatic ecotoxicity (417.803 kg 1,4-DB eq/kg pellets), human toxicity (1.107 kg 1,4-DB eq/kg pellets), freshwater aquatic ecotoxicity (0.191 kg 1,4-DB eq/kg pellets), eutrophication (0.001 kg PO4 eq/kg pellets), global warming (0.802 kg CO2 eq/kg pellets), and terrestrial ecotoxicity (0.008 kg 1,4-DB eq/kg pellets). Fossil fuel consumption was the hotspot source to all environmental impacts investigated. To measure the cumulative energy demand of biomass pellets made from different agroforestry species leftovers showed that the maximum cumulative energy was from wheat straw pellets (13.737 MJ), followed by corncob pellets (11.754 MJ), deodar sawdust pellets (10.905 MJ) and blue pine sawdust pellets (10.877 MJ). Among the various production activities, collection and transportation of primary raw material, crushing, screening, adding adhesives, pelletizing, cooling, final screening, and packing have the maximum contribution to the water scarcity index, followed by lubricating oil (0.00147m3). In contrast, the minimum contribution to water footprint was from electricity (0.00008m3) and wheat starch (0.00005m3). The highest contribution to the ecological footprint impact categories such as carbon dioxide, nuclear, and land occupation was lubricating oil and less contribution of wheat starch and electricity for manufacturing one kg pellets biofuel. It is concluded that physico-mechanical and combustion properties of the biomass pellets biofuel developed in the present study were following the Italian recommended standards. Therefore, it is strongly recommended that the Government of Pakistan should introduce the renewable biomass pellets industry in the country to reduce dependency on fossil fuels for cooking and heating purposes.

Objective(s): Empagliflozin, a sodium-glucose cotransporter-2 (SGLT-2) inhibitor, possesses verified anti-inflammatory and anti-oxidative stress effects against diabetic nephropathy. The present investigation aims to examine empagliflozin effects on the renal levels of high mobility group box-1 (HMGB1), a potent inflammatory cytokine, and its respective receptor toll-like receptor-4 (TLR-4) in STZ-induced diabetic rats.Materials and Methods: Empagliflozin at 10 mg/kg per os (p.o.) was administered for 4 weeks, starting 8 weeks after the induction of diabetes. Renal function, kidney inflammation, oxidative stress, and apoptosis markers as well as renal HMGB1, receptor for advanced glycation end products (RAGE), and TLR-4 levels were assessed.Results: In addition to down-regulating NF-κB activity in renal cortices, empagliflozin reduced renal levels of HMGB1, RAGE, and TLR-4. It alleviated renal inflammation as indicated by diminished renal expressions of inflammatory cytokines and chemokines like tumor necrosis factor-alpha (TNF-α) and monocyte chemoattractant protein-1 (MCP-1) and also decreased urinary levels of interleukin-6 (IL-6) and alpha-1 acid glycoprotein (AGP). Moreover, empagliflozin ameliorated renal oxidative stress as demonstrated by decreased renal malondialdehyde (MDA) and elevated renal activities of superoxide dismutase (SOD) and glutathione peroxidase (GPX). It also suppressed renal caspase-3, the marker of apoptosis; and furthermore, enhanced renal function noticed by the declined levels of serum urea and creatinine.Conclusion: These findings underline that empagliflozin is able to attenuate diabetes-related elevations in renal HMGB1 levels, an influential inflammatory cytokine released from the necrotic and activated cells, and its correspondent receptors, i.e., RAGE and TLR-4.

According to IPCC Annual Report (AR-5), environmental impact assessment of any product prototype is recommended before its large-scale commercialization; however, no environmental profile analysis of any biodiesel prototype has been conducted in Pakistan. Therefore, objective of this study was to conduct a comprehensive life cycle assessment (LCA), water footprint and cumulative energy demand (CED) of biodiesel production from Jatropha curcas L. (JC) seeds oil in Pakistan. A cradle-to-gate LCA approach was applied for 400 liter (L) JC biodiesel produced in Pakistan. JC biodiesel production chain was divided into three stages i.e., 1). cultivation of JC crop 2). crude oil extraction from JC seeds and 3). crude oil conversion to biodiesel. Primary data for all the stages were acquired through questionnaire surveys, field visits and measurements in the field. Potential environmental impacts were calculated in SimaPro v.9.2 software using Eco-indicator 99 methodology. Results showed that crude oil extraction stage accounted for highest emissions (77%) to the overall environmental impact categories evaluated, followed by oil conversion stage (21%) and JC cultivation stage (02%), respectively. The three stages of JC biodiesel production chain are major contributor to ecotoxicity with a contribution of 57% to this impact category. Higher contribution to ecotoxicity was due to agrochemicals used in the JC cultivation. Similarly, fossil fuels impact category was responsible for 38% of overall environmental impacts. In addition, water footprint of JC biodiesel production chain was 2632.54 m3/reference unit. Cumulative energy required for 400L JC biodiesel production chain was 46745.70 MJ in Pakistan. Fossil diesel consumption, synthetic fertilizers use and purchased electricity were major hotspot sources to environmental burdens caused by JC biodiesel production in Pakistan. By performing sensitivity analysis at 20% reduction of the baseline values of fossil diesel used, synthetic fertilizers and purchased electricity, a marked decrease in environmental footprint was observed. It is highly recommended that use of renewable energy instead of fossil energy would provide environmental benefits such as lower greenhouse gases and other toxic emissions as compared to conventional petroleum fuels. It is also recommended that JC as a biofuel plant, has been reported to have many desired characteristics such as quick growth, easy cultivation, drought resistance, pest and insect resistance, and mainly great oil content in JC seeds (27–40%). Therefore, JC plant is highly recommended to Billion Tree Afforestation Project (BTAP) for plantation on wasteland because it has multipurpose benefits.

Cutaneous leishmaniasis (CL) imposes a major health burden throughout the tropical and subtropical regions of the globe. Unresponsive cases are common phenomena occurred upon exposure to the standard drugs. Therefore, rapid detection, prognosis and classification of the disease are crucial for selecting the proper treatment modality. Using machine learning (ML) techniques, this study aimed to detect unresponsive cases of ACL, caused by Leishmania tropica, which will consequently be used for a more effective treatment modality. This study was conducted as a case-control setting. Patients were selected in a major ACL focus from both unresponsive and responsive cases. Nine unique and relevant features of patients with ACL were selected. To categorize the patients, different classifier models such as k-nearest neighbors (KNN), support vector machines (SVM), multilayer perceptron (MLP), learning vector quantization (LVQ) and multipass LVQ were applied and compared for this supervised learning task. Comparison of the receiver operating characteristic graphs (ROC) and confusion plots for the above models represented that MLP was a fairly accurate prediction model to solve this problem. The overall accuracy in terms of sensitivity, specificity and area under ROC curve (AUC) of MLP classifier were 87.8%, 90.3%, 86% and 0.88%, respectively. Moreover, the duration of the skin lesion was the most influential feature in MLP classifier, while gender was the least. The present investigation demonstrated that MLP model could be utilized for rapid detection, accurate prognosis and effective treatment of unresponsive patients with ACL. The results showed that the major feature affecting the responsiveness to treatments is the duration of the lesion. This novel approach is unique and can be beneficial in developing diagnostic, prophylactic and therapeutic measures against the disease. This attempt could be a preliminary step towards the expansion of ML application in future directions.

The H1N1 influenza virus is known as a serious pandemic threat across the globe. Vaccination is one of the most effective methods of protection against this virus and the way to reduce the seasonal pandemic risk. The commercial vaccine does not adequately respond to pandemic strains. This study examines the potential function of formulated H1N1 hemagglutinin with MF59 adjuvant against A/PR/8/34 (H1N1). To this end, a recombinant hemagglutinin (rHA) gene of influenza A virus was designed and expressed in SF9 cell by the Baculovirus expression system. Four groups of mice were immunized by rHA in combination with MF59, Alum adjuvant, and virus split only. The immunized mice subsequently used for the humoral immune assay and the results compared with untreated mice (negative group). Besides, both treated and control mice groups were challenged with mouse-adapted influenza virus A/PR/8/34(H1N1) through the intranasal drop. Bodyweight, survival, temperature variation, and the medical conditions of the samples were assessed. Mice immunized with the recombinant protein demonstrated a humoral response to the influenza A virus. Upon virus challenging, co-administration of rHA with MF59 adjuvant could lead to 92% survival of the vaccinated mice within 10 days. The MF59-treated group showed slight weight loss and high-temperature body two weeks after infection. This group also displayed a higher hemagglutination inhibition (HI) antibody titer as compared to the group vaccinated with virus split, and Alum adjuvant. Altogether, the results showed that the recombinant protein with the MF59 adjuvant created better safety than the Alum adjuvant, thereby can be considered as a safe and reliable vaccine against the H1N1 virus for further investigations.

This study aimed to determine the prevalence of and demographic factors associated with domestic violence among Iranian older adults based on the Urban HEART-2 project in Tehran, Iran. The study was a part of the second round of the Urban Health Equity Assessment and Response Tool (Urban HEART-2) project, which was a large, population-based, cross-sectional study. Individuals aged ≥ 60 years were selected randomly through a multistage, cluster sampling method from 368 neighborhoods of 22 districts of Tehran. A total of 15,069 older adults, 79% married and 45.22% female, were included in the study. The mean age of the participants was 68.93 ± 7.27 years. The overall prevalence of physical domestic violence was 2.32%. Factors such as age, gender, schooling, and having a disability were significantly associated with domestic violence (p < .05). These results are likely to be an underestimate of what really happens in the community, as many authors have men-tioned previously. Therefore, it is necessary to broaden our perspectives on the phenomenon of domestic vio-lence against the elderly, especially in the fields of public health and nursing.

Objectives To compare narrative skills between fourth and fifth grades of Persian-speaking students with hearing impairments and typical hearing students of the same grade and also to evaluate the effects of group, sex, hearing age, and educational grade of the students on their spoken/written narrative performance. Methods The subjects were 174 students aged 10–13 years, 54 of whom wore cochlear implants, 60 suffered from moderate to severe hearing losses and wore hearing aids, with the remaining 60 students being typical hearing in terms of the sense of hearing. The micro- and macrostructure components of spoken and written narrative were elicited from a pictorial story (The Playful Little Elephant) and then scored by raters. Results Compared to the typical hearing, the students with hearing impairments had significantly lower scores in all of the microstructure components of narratives. However, the findings showed no significant difference among different groups in macrostructure components of narratives. It was also revealed that the students had equal performance in spoken and written narrative. Finally, factor analysis manifested that group, sex, hearing age, and educational level of children might alter the outcome measures in various interactions. Conclusion Although cochlear implantation was more effective than hearing aid on spoken and written narrative skills, the Persian-speaking students with hearing impairments were seen to need additional trainings on microstructure components of spoken/written narrative.

Introduction: Folic acid, also known as folate, is one of the water-soluble B vitamins which its derivatives are involved in many metabolic reactions as cofactor, that are mostly contributed in cell growth. Regarding the role of derived cofactors from this vitamin in reactions such as methylation, production of thymidine and purines; seems that there is a relationship between this vitamin and cancer. Methods: We searched Medline/Pubmed, Scopus, Embase and Web of Science (2000-2017) using term folic acid, carcinogenesis, diagnose and treatment. Our focused was on the articles published within the past 5 years and type of study in culture media, animal models and clinical trials were in our favor. Results: Candidate mechanisms in carcinogenesis for folic acid include 1: changes in DNA and RNA methylation 2: Damage to the integrity and stability of DNA 3: disruption in repair system of DNA. Conclusion: Folic acid in carcinogenesis acts as a double-edged sword. The activity type of folic acid depends on the physiological conditions, dosage of the vitamin, age, individual genotypes, target tissues and stage of the disease in patients. High growth rate of cancer cells leads to increase in cell requests of the vitamin, and on the other hand the cells enhance the number of receptors improving the vitamin absorption. Therefore, increasing number of cell surface receptors, it can be applied for non-invasive diagnosis and target therapy.

Objective: To reveal the effects of 9-cis retinoic acid (RA) on cortical granules (CGs) migration and in vitro embryo production (IVP) rate in meiosis Π vitrified bovine oocyte. Methods: Following in vitro maturation (IVM) in a medium containing 5 nM of 9-cis-RA, 60 oocytes were vitrified and then thawed. Then, half of them were evaluated for CGs migration and the other half were used for in vitro fertilization and IVP (on day 3). In addition, the other 60 oocytes were considered as the control group, which did not receive RA in IVM medium. The data were presented to one way analysis of variance (ANOVA) and Duncan's test. Results: Results showed that IVP rate (4-8 cells embryos) was significantly (P

Background and purpose: Lung cancer is a public health problem worldwide. Identifying the epidemiological characteristics of involved patients can play an important role in designing analytical studies. The aim of this study was to identify the epidemiology of patients with lung cancer attending Tooba clinic and Imam Khomeini Hospital in Sari, Iran. Materials and methods: In this descriptive study, a sample size of 229 patients with lung cancer were chosen using census sampling. SPSS V22 was used for data analysis applying descriptive and analytic tests. Results: Of 229 patients, 74.2% were males. The mean ages of male and female patients were 63.4±12.6 and 64.6±12.01, respectively, indicating no significant difference between the two groups (P=0.534). The majority of samples (78.6%) had non-small-cell-lung cancer and the method of diagnosis was biopsy in 88.9%. The most and least common sites of involvement were the upper edge of the right lung (22.3%) and the upper lobe of the left lung (18.8%), respectively. Among the patients, 85.1% were in stage IV and chemotherapy was the main treatment in most of the patients (57%). Conclusion: This study showed that men were more infected with lung cancer. We found that the average age of female patients was slightly more than that of male patients. Most of the patients were diagnosed with non-small cell lung carcinoma. The majority of patients were diagnosed at higher stages that were made at advanced and metastatic stages.

Objective: To evaluate the effect of adding different values of polymyxin B (PMB) to bull semen on various motility parameters of post-thawed semen such as total motility, progressive motility and velocity parameters using kinetic parameters of sperm by Computer Assisted Sperm Analysis.Methods: Gram negative bacteria release lipopolysaccharide, which induces the apoptotic pathway. Antibiotics are added to semen in order to prevent bacterial contaminations in bovine semen. These antibiotics kill the bacteria especially gram negative bacteria. Therefore, their endotoxins are released during bacteriolysis and bind to the head region and midpiece of sperm. PMB is a bactericidal antibiotic against multidrug resistant gram-negative bacteria and is able to neutralize the toxic effects of the released endotoxin. This study was performed on 3-year old Taleshi bulls.Results: The results showed both positive and negative significant effects of PMB on semen quality. Total motility and progressive motility were significantly increased (P

Objective: To examine adding polymyxin B (PMB) if is effective and appropriate to bull extender, and decrease bacteria damage. Methods: PMB were added to extender (Andromed®) in different values (0, 50, 100, 500, 1000 μg/mL). The prepared samples were cryopreserved, thawed and analyzed for viability (by eosin–nigrosin staining) and plasma membrane function (by hypo osmotic solution test) in 3 different times (immediately, 1 h & 2 h later). Results: The result showed that both parameters significantly increased in 50 and 100 μg/mL treatments. Moreover, by passing time, plasma membrane function significantly increased. But, in high dosage (1000 μg/mL), the toxicity effect of PMB was seen, and in both parameters the differences were significantly lower than the control treatment (0 μg/mL). Conclusion: Our study indicates that adding PMB to bull extender is efficient and appropriate, but, it must be mentioned that addictive amount will be due to extender composition, existence of other antibiotics and, importantly, the load of bacterial contamination in the semen.

Background: Today, because of increasing immigration and the prevalence of drug-resistant tuberculosis in Iran, identifying intra-community cases is necessary in the country. It will be possible through the use of molecular epidemiologic methods. In this inquiry, in order to determine the role of immigrants in the transmission of specific strains to Iran, the studies have been examined which had been conducted based on molecular epidemiologic methods among Iranians and non-Iranians people. Methods: All studies from 1997 to the end of March 2017 were examined in three databases of PubMed, Scopus, and Google Scholar and finally, 16 studies were selected. Results: The common clustering rate between Iranians and non-Iranians was determined to be 19.8, and the intra-community recent transmission rate was from 0% to 49% with average of 18.1%. The rate of multidrug-resistant tuberculosis (MDR-TB) was 12.5%, which was higher among immigrants, especially Afghans, and a significant number of the strains were Beijing. Conclusions: The studies have shown that migrants, especially Afghans, are more effective in transmitting specific strains of tuberculosis to migratory areas. To control tuberculosis, it is necessary to register of immigrant's health information, while enter to the country, so that, by doing appropriate diagnostic tests, the curing the patients, the transmission of tuberculosis to the country would be prevented.

Objective: To evaluate the effect of maternal employment on birth weight and gestational age. Methods: In this project, 1 272 pregnant women were recruited from whom referred to Tehran hospitals during 1 year via randomized sampling. Data were gathered through history taking and medical records. In this study, 564 employed women were classified as exposure group and 708 housekeepers were as the control group. Chi square test, t-test, One-way ANOVA and logistic regression were used to analyze data. Results: In this study, mean mother age was 25.01 years and mean birth weight was (2 884±684) g. The mean birth weight in housekeepers was significantly higher (2 991±457 g) than employees (2 726±476 g) (P=0.002). The infants' mean birth weights in farmer were the lowest and in office workers (2 831±526 g) was the highest (P

Introduction: Permanent hearing loss is one of the most common congenital disorders with estimated incidence of one to three per thousand live births. The best early diagnostic method for hearing impairment in newborns is Universal Newborn Hearing Screening (UNHS). This study surveys history of hearing screening, prevalence of hearing loss in newborns and results of various protocol of newborn hearing screening in Varamin city. Materials and Methods: This cross- sectional study was conducted on 29476 neonates with TEOAE-TEOAE (Transient Evoked Otoacoustic Emission-Transient Evoked Otoacoustic Emission) protocol during 1380-1390 years and TEOAE-AABR (Transient Evoked Otoacoustic Emissions-Automated Auditory Brainstem Response) protocol during 1390-1391 years. If the responses in both sessions were desirable, the infants were referred for a final diagnosis with ABR (Auditory Brainstem Response) test and examination by Otolaryngologist. Rehabilitation interventions were done for hearing impaired newborns. Results: The prevalence of hearing loss in first protocol was 1/6 per thousand live births and in second protocol was 2 per thousand live births. 55% of them had risk factors of hearing impairment and 45% of them didn’t have any risk factors. Conclusion: According to the calculated prevalence of hearing impairment in this study, UNHS is necessary for all of newborns and to protect parents from concerns due to a false positive test results, we must improve the method of newborn hearing screening to decrease the false positive rate. Keyword: Hearing loss, Universal newborn hearing screening, Transient evoke otoacoustic emission, Auditory brainstem response

Burn patients are specifically threatened by nosocomial infections [1]. In these patients, the body’s first line of defense is destroyed and immune system functions are decreased, especially in the first week after the burn. As a result, opportunist pathogens quickly attack the patient's body [2]. One such pathogen that greatly threatens the life of a burn patient is Pseudomonas aeruginosa [3, 4]. This study was done on 151 positive-cultured burn patients (with samples taken from the burn scars) hospitalized in Sina Hospital in Tabriz, the only burn treatment hospital in northwestern Iran, from early March 2015 until the end of that year. Among these patients, 60 (39.7%) had Pseudomonas aeruginosa, 37 cases (24.5%) had Acinetobacter, 29 cases (19.2%) had Staphylococcus aureus, 14 cases (9.3%) had Klebsiella, 6 cases (4%) were of E. coli, and 5 cases (3.3%) had Enterobacteriace. This study compared the results of this study and those obtained by Dr. Nahaei et al. regarding the multidrug resistance of isolated Pseudomonas aeruginosa [5] tested on 135 isolated bacteria in the same hospital in the past 10 years (2006). After 10 years, unfortunately, a noticeable increase in resistance to the nine essential, common antibiotics used to treat these strains was observed in both studies (Figure 1). The highest rates of increase were seen with the 3 antibiotics imipenem (25 times), amikacin (4.5 times), and cyprofloxacin (3.7 times), and ceftazidim and pipracilline showed the lowest increase. To identify resistant strains, it seems necessary to periodically survey the burn patients’ hospital equipment, based on the culturing process, and the use of Pseudomona polyvalent anti-sera in treatment is essential to reducing the rate of increase in the drug resistance of this bacterium. Sadly, it must be confessed that the production of new generation drugs used to fight against this deadly microorganism seriously lags behind the rate of its face-off against antibiotics.