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Objective(s): Leishmaniasis is a complex infection against which no confirmed vaccine has been reported so far. Transgenic expression of proteins involved in macrophage apoptosis-like BAX through the parasite itself accelerates infected macrophage apoptosis and prevents Leishmania differentiation. So, in the present research, the impact of the transgenic Leishmania major including mLLO-BAX-SMAC proapoptotic proteins was assayed in macrophage apoptosis acceleration. Materials and Methods: The coding sequence mLLO-Bax-Smac was designed and integrated into the pLexyNeo2 plasmid. The designed sequence was inserted under the 18srRNA locus into the L. major genome using homologous recombination. Then, mLLO-BAX-SMAC expression was studied using the Western blot, and the transgenic parasite pathogenesis was investigated compared with wild-type L. major in vitro and also in vivo. Results: Western blot and PCR results approved mLLO-BAX-SMAC expression and proper integration of the mLLO-Bax-Smac fragment under the 18srRNA locus of L. major, respectively. The flow cytometry results revealed faster apoptosis of transgenic Leishmania-infected macrophages compared with wild-type parasite-infected macrophages. Also, the mild lesion with the less parasitic burden of the spleen was observed only in transgenic Leishmania-infected mice. The delayed progression of leishmaniasis was obtained in transgenic strain-injected mice after challenging with wild-type Leishmania. Conclusion: This study recommended transgenic L. major including mLLO-BAX-SMAC construct as a pilot model for providing a protective vaccine against leishmaniasis.

Background: Given the high prevalence of chronic renal failure worldwide, and the fact that kidneys are the major means of magnesium excretion from the body, it is speculated that the incidence risk of magnesium balance disorder would be high in patients under peritoneal dialysis. The aim of the present study was to evaluate the mentioned patients’ magnesium level and specify the effective factors in this regard. Methods: The present cross-sectional study was performed on 210 patients undergoing peritoneal dialysis that referred to Alzahra and Khorshid hospitals in Isfahan City, Iran. Patients’ demographic data such as age, sex, education status, cause of failure, type of comorbidity, duration of dialysis, and type of dialysis solution were recorded. In addition, the patients’ serum levels of magnesium, calcium, parathyroid hormone, and KT/V renal levels (in which K was dialyzer clearance of urea, T was dialysis time, and V was the volume of distribution of urea in patient's total body) were also assessed. Findings: The patients’ mean magnesium level was 2.39 ± 0.39 mg/dl. There was no significant difference in the magnesium level between the men and women. Moreover, no significant difference was observed among the administrations of various dialysis solutions including dextrose 1.5%, 2.5%, and 4.25% as well as icodextrin 7.5% (P > 0.05). However, hypertension had a significant inverse effect with magnesium level (coefficient effect : -0.100; P < 0.05). Conclusion: According to the results of the present study, the magnesium level was normal in patients under peritoneal dialysis. However, hypertension had a significant reverse effect on magnesium level, which was lower in patients with hypertension.

Background: Some past studies have shown the association of air pollution with heart failure (HF). The present study was conducted to investigate the relationship between suspended particulate matters less than 10 microns (PM10) and hospitalization due to HF. Methods: In a cross-sectional study, the data from 359 patients’ records, admitted to Shahid Chamran hospital in Isfahan City, Iran, due to HF during the years 2017-18, were collected. The inclusion criteria were the echocardiography findings such as the cardiac ejection fraction of less than 50%, and/or additional clinical evidences that confirmed HF exacerbation. The data about hourly concentration of PM10 were collected from the CAPACITY software in the Department of Environment at Isfahan Province that displayed the PM10 data from 6 fixed stations in Isfahan City. To evaluate any relationship between PM10 and hospitalization due to HF, we considered the PM10 concentrations at last 24 hours before hospitalization. Findings: The mean age of 359 patients who diagnosed with heart failure was 63.8 ± 14.6 years, and 82 of them (22.8%) died at the time of hospitalization. There was a significant correlation between hospitalization due to HF and air pollution quartiles. Conclusion: According to the results of present study, there was a positive correlation between the concentration of particulate matters in the air and hospitalization due to heart failure.

Background: Rosacea is a skin chronic inflammation with an unknown cause and cure. Environmental and genetic factors could not entirely explain the disease pathogenesis. Recently, infections like Chlamydia pneumoniae are of more attention in the rosacea progression. This study investigated the relationship between the C. pneumoniae seropositivity and the rosacea disorder. Materials and Methods: We aimed at a cohort of 100 patients with the rosacea disorder (60 active and 40 inactive) and from 100 sex- and age-matched healthy controls in Isfahan and determined the immunoglobulin M (IgM)/IgG antibodies titers to C. pneumoniae in the serum using the enzyme-linked immunosorbent assay method. The groups were compared using the analysis of variance procedure at the significant level of P < 0.05, statistically. Results: The mean of IgG in the controls was significantly higher than the levels in both the active and the inactive rosacea patients (p < 0.022). Also, the titer of serum IgM to C. pneumoniae in the controls was different, compared with the active (p < 0.019) and the inactive (p < 0.02) rosacea patients. In addition, the median titer of serum IgG (not IgM) to C. pneumoniae in the females with the inactive rosacea disorder was lower than the active rosacea disorder (p < 0.019) and controls women (p < 0.008). Furthermore, the serum level of IgG or IgM to C. pneumoniae in the controls males was higher than the males with the rosacea disorder (p < 0.05) and (p < 0.02), alternatively. Conclusion: C. pneumoniae seropositivity in the rosacea patients and controls was insignificant.

Background: Small bowel length measurements and estimation have high clinical importance, especially in bariatric surgeries to prevent postoperation malnutrition. This study aimed to investigate the possible correlation between demographic and anthropometric factors with small bowel length. Materials and Methods: This cross-sectional study was performed on 150 patients that were candidates of abdominal surgeries. Anthropometric factors including age, gender, weight, height, body mass index, right wrist and waist circumstance, length of the right hand 2nd and 4th fingers and 2nd to 4th finger ratio, and length of the right hemithorax were obtained. Whole length of the small bowel was measured during surgery from the ligament of Treitz to the ileocecal junction between the mesenteric and antimesenteric border of the intestine. Results: The mean small bowel length was 5.45 ± 1.62 meters and significantly lower in women compared to men (P = 0.003) and had a significant direct relationship with height (r = 0.3, P < 0.001), an inverse relationship to 2nd to 4th finger ratio (= −0.34, P < 0.001). There were the same correlations between small intestine length with height and the 2nd to 4th finger ratio in open surgeries (P < 0.05). There was a correlation between age (r = 0.33, P = 0.032), weight (r= −0.60, P, 0.001), waist circumstance (r = −0.43, P = 0.004), and length of the right hemithorax (r = −0.47, P = 0.001). Conclusions: Using demographic and anthropometric factors, we could predict the small bowel length. These results could be further used in bariatric surgeries to avoid possible malnutrition.

Background: Bullous pemphigoid is one of the most common autoimmune blistering diseases. Incidence of bullous pemphigoid has been estimated 4 new cases per 100000, but new studies show that the incidence rate is increasing. The disease typically happens in the elderly people usually after 70 years. Annual mortality rate for bullous pemphigoid is reported up to 40%. The aim of this study was to evaluate epidemiological features of bullous pemphigoid in center of Iran. Methods: This was a cross-sectional study conducted in Alzahra hospital in Isfahan City. 69 patients with bullous pemphigoid hospitalized during the years 2008-2016 were studied. Findings: 59.45% of the patients were women. The mean and standard deviation of age was 68 ± 13 and 72 ± 14 years in woman and men, respectively (P = 0.01). Mucosal involvement was seen in 55.4%., and the most common underlying disease was hypertension (23.6%). 15.4% of women and 3.7% of men used furosemide, and the most commonly prescribed drugs were antihistamine (98%), antibiotics (97%), and topical (91%) and systemic (88.4%) corticosteroids, respectively. The mean and standard deviation of the dose of prednisolone was 54 ± 12 mg per day. Rise in serum blood sugar was reported in 30% of patients, and 3.6% of men and 15% of women needed intensive care unit (ICU) admission. 42.9% of men and 44.4% of women had relapse after discharge, and 38.64% of patients died during one-year follow-up. Conclusion: It seems that patients with bullous pemphigoid need careful follow up, especially during treatment, and at least for one year, because of their age (> 60), underlying diseases, type of treatment (corticosteroid use), and high mortality and relapsing rates in the first year after diagnosis.

Background: The aim of the study is to explore the risk factors of mortality for hospitalized patients in three designated hospitals in Isfahan province. Materials and Methods: This retrospective cohort study was conducted on all positive coronavirus disease (COVID)-19 patients admitted to Khorshid, Isabn Maryam, and Amin hospitals in Isfahan province. The demographic, clinical, laboratory, and outcome data of patients who were died or discharged from February 24, 2020, to April 18, 2020, were extracted from patient's medical records. Results: Overall 1044 COVID-19 patients were included in this analysis. Based on the findings of this study, older age (≥65 years) (adjusted hazard ratio [aHR]: 2.06; 95% confidence interval [CI]: 1.13–3.76), chronic obstructive pulmonary disease (COPD) history (aHR: 2.52; 95% CI: 1.09–5.83), white blood cell (WBC) counts more than 10 × 10^3/L (aHR: 3.05; 95% CI: 1.42–6.55), Hb level

Abstract Background One of the most critical practices in mass casualty incident management is vacating the victims from scene of the incident and transporting them to proper healthcare facilities. Decision on distribution of casualties needs to be taken on pre-developed policies and structured decision support mechanisms. While many studies tried to present models for the distribution of casualties, no systematic review has yet been conducted to evaluate the existing models on casualty distribution following mass casualty incidents. A systematic review is therefore needed to examine the existing models of patient distribution and to provide a summary of the models. This systematic review protocol is aimed to examine the existing models and extracting rules and principles of mass casualty distribution. Methods This study will comprehensively investigate existing papers with search phrases and terms including “mass casualty incident”, distribution, evacuation, and Mesh terms directly corresponding to search phrases. No limitations on the type of studies, date of publication, or language of the relevant documents will be imposed. PubMed, Web of Science, Scopus, and Google Scholar will be searched to access the relevant documents. Included papers will be critically appraised by two independent reviewers. The data including incidents type, scene characteristics, patient features, pre-hospital resources, and hospital resources will be categorized. Subgroup analysis will be conducted when possible. Discussion To the best of our knowledge, no study has yet addressed the effects and interaction of contributing factors on the decision-making processes for casualty’s distribution. This is the first study that comprehensively assesses and critically appraises the current models of casualty distribution. This study will provide evidences about models and criteria for casualty distribution following mass casualty incidents. Systematic review registration PROSPERO Registration Number: CRD42016049115

Background: C-reactive protein (CRP) is a predictor of cardiovascular diseases in both normal people and patients on hemodialysis .This study aimed to assess the relationship of high-sensitivity C-reactive protein (Hs-CRP) serum level and peritonitis in patients on peritoneal dialysis. Methods: 113 patients on peritoneal dialysis in Isfahan city, Iran, participated in our study in 2015. Serum albumin and Hs-CRP levels were measured in each patient at three times (baseline, and 6 and 12 month after that) and the patients were followed up for 1 year. All the patients were evaluated for peritonitis in every visit. At the end of the study, two groups of patients on peritoneal dialysis with and without peritonitis were compared. Findings: Among 113 patients, 24 were excluded from the study because of death or kidney transplantation and 89 patients were included in final analysis. The mean Hs-CRP levels in patients with peritonitis were 4.83, 5.79, and 7.42 mg/l at baseline, and 6 and 12 month after it, respectively; these levels were 4.47, 3.19, and 2.69 mg/l in patients without peritonitis, respectively. In addition, the mean albumin levels in patient with peritonitis were 3.38, 3.29 and 3.40 mg/l at baseline, and 6 and 12 month after it, respectively; these values were 3.56, 4.05, and 3.51 mg/l in patients without peritonitis, respectively. Conclusion: Results showed that with increase in Hs-CRP level, the risk of peritonitis increased. Besides, the albumin level decreased among patients with peritonitis in comparison with patients without peritonitis; there was no significant correlation between albumin level and peritonitis.

Background and Aims: Nowadays, oral cancer is considered one of the most important diseases related to oral health. The objective of the present study was to determine the dental students’ knowledge in Isfahan about oral cancer and the comparison of the level of students' knowledge in different years of education. Materials and Methods: The present study was a cross-sectional-analytical one conducted in 2013. The population of study included the dental students of private and state University of Isfahan which 255 students were randomly selected. The data were collected using questionnaire and were then analyzed using SPSS software program and Kruskal-Wallis and Mann-Whitney. Results: From private and public dental schools in Isfahan, 56% and 44% of dental students were involved. Regarding performing routine clinical oral examination, 81% of the participants answered positively, which showed no significant difference among the years of education of the participants (P=0.116). Regarding the examination of patients with oral lesions, 46% of them answered positively, which the difference between the years of education was highly significant (P≤0.001). Conclusion: The findings of the research indicated that the level of knowledge of dental students of Isfahan city regarding the detection of oral lesions was not sufficient. Although, the students did not perform common examinations for exploring oral cancer, they did not have sufficient knowledge regarding some of the risk factors and oral lesions related to cancer. Therefore, it is necessary that a comprehensive curriculum be developed in this regard for their education.

Background: Brucellosis is one of the most common infectious diseases worldwide which is caused by direct contact with affected animals or their products. It puts a huge impact on the economy, society, and the environment. Iran is the fourth endemic country for brucellosis in the world. It has been described a new epidemiological feature of the disease and its trends in Isfahan province, as one of the endemic areas of brucellosis in Central Iran. Materials and Methods: This is a cross-sectional, population-based study. Data collection was performed using epidemiological questionnaires through Epi-2006 software from the private and public sectors in 22 districts of Isfahan province over 9 years (2010–2018). The results were obtained by the description statistics using the SPSS Statistics software version 20 (SPSS Inc., Chicago, IL, USA). Results: Altogether, 5751 new brucellosis patients were recorded over 9 years. About 70% of these cases were male. The majority of cases had occurred in the age group of 21–30 years. The average incidence of brucellosis over the 9 years was 14.1 cases/100,000 population including 8.8 in the urban versus 45.2 cases in the rural areas. During the 9-year study period, the incidence of brucellosis was increased between 2010 and 2014. From 2014 to 2017, the trend has been decreasing, but in the last year of the study, the trend has been increasing again. Seasonally, the incidence rate was variable between the lowest from October to January and the highest from June to July. Conclusion: According to the fluctuation of incidence trend of brucellosis during the 9-year study period in Central Iran, it seems some policy changes regarding to the control and prevention of brucellosis have a role, changes that should be fixed and corrected.

مقدمه: درماتیت سبورئیک یک بیماری مزمن است که در بعضی موارد، با وجود درمان مناسب، علایم بیمار ادامه می‌یابد. از این رو، هدف از انجام این مطالعه، بررسی اثربخشی استات روی 2/1 درصد و تأثیر آن در درمان سبورئیک درماتیت بود. روش‌ها: مطالعه‌ی حاضر، یک مطالعه‌ی کارآزمایی بالینی تصادفی یک سو کور بود. جامعه‌ی آن شامل بیماران درماتیت سبورئیک نواحی صورت و اسکالپ که به درمانگاه‌های پوست وابسته به دانشگاه علوم پزشکی اصفهان مراجعه نمودند، بودند. 60 نمونه وارد مطالعه و به دو گروه 30 نفری تقسیم شدند. برای گروه شاهد، درمان درماتیت سبورئیك شامل محلول كتوكونازول 2 درصد + محلول دارونما و برای گروه مورد، محلول كتوكونازول 2 درصد + محلول استات روی 2/1 درصد تجویز شد. بیماران روزانه یک مرتبه به مدت 4 هفته تحت درمان بودند و قبل و بعد از درمان، بر اساس پرسش‌نامه‌ی سنجش میزان خارش و اریتم بیمار، که توسط پزشک معالج تکمیل شد، مورد سنجش و ارزیابی قرار گرفتند. یافته‌ها: میانگین نمره‌ی خارش قبل از آزمون در گروه مورد، 41/2 ± 63/2 و در گروه شاهد 35/2 ± 57/2 و میانگین نمره‌ی خارش بعد از آزمون در گروه مورد 70/0 ± 05/1 و در گروه شاهد 07/1 ± 59/1 گزارش شد. اریتم قبل از آزمون در گروه مورد 43/0 ± 23/1 و در گروه شاهد 58/0 ± 07/1 و بعد از آزمون در گروه مورد 63/0 ± 66/0 و در گروه شاهد 62/0 ± 66/0 گزارش شد. بر اساس آزمون t، تفاوت خارش بین گروه‌های مورد و شاهد، معنی‌دار بود (050/0 > P) و از نظر اریتم، تفاوت معنی‌داری وجود نداشت (050/0 < P). نتیجه‌گیری: هر چند می‌توان توصیه کرد استات روی 2/1 درصد در درمان بیماری استفاده شود تا بتوان با کاهش علایم ناشی از این بیماری، کیفیت زندگی بیماران را بهبود بخشید، اما بهتر است اثرات این ترکیب بر سایر علایم نظیر پوسته‌ریزی نیز سنجیده شود.

مقدمه: آلوپسی ‌آره‌آتا (AA یا Alopecia areata) یک بیماری شایع و بدون علامت است که با ریزش سریع مو در یک منطقه مشخص می‌شود. علت آن هنوز به طور کامل شناخته نشده است. بعضی مطالعات ارتباط بین AA و سلیاک را نشان داده‌اند. هدف از انجام این مطالعه، مقایسه‌ی سطح Anti-tissue transglutaminase IgA (Anti-tTg IgA) در بیماران مبتلا به AA با گروه شاهد بود. روش‌ها: این مطالعه، یک مطالعه‌ی مورد- شاهدی بود که گروه مورد آن بیماران مبتلا به AA بودند. در هر گروه، 35 نفر وارد شدند. سپس آزمایش Anti-tTg IgA برای هر دو گروه انجام شد. جواب به صورت مثبت/منفی گزارش‌ گردید. در پایان، توزیع فراوانی این اتوآنتی‌بادی در گروه‌ها با هم مقایسه شد. یافته‌ها: بر حسب آزمون 2χ برای جنس و آزمون t برای سن، تفاوت معنی‌داری بین دو گروه از نظر جنس (151/0 = P) و سن (621/0 = P) مشاهده نشد. در گروه مورد، Anti-tTg IgA تنها در یک فرد (۸/۲ درصد) مثبت بود. در گروه شاهد، هیچ یک از افراد از نظر این آنتی‌بادی مثبت نبودند. بر حسب آزمون 2χ، بین گروه‌ها تفاوت معنی‌داری مشاهده نشد (۳۱۴/۰ = P). شایع‌ترین فرم AA (6/88 درصد) Patchy و شایع‌ترین نوع درگیری ناخن در گروه مورد، Pitting بود. 1/17 درصد گروه مورد، سابقه‌ی خانوادگی AA داشتند. نتیجه‌گیری: توزیع فراوانی Anti-tTg IgA در بیماران مبتلا به AA نسبت به جمعیت طبیعی جامعه‌ی اصفهان بالاتر نمی‌باشد. از این رو، پیشنهاد می‌شود اتوآنتی‌بادی‌های دیگر سلیاک نظیر Anti-gliadin IgA و Anti-gliadin IgG نیز در این بیماران مورد بررسی قرار گیرد.

Backgrpund: Acne vulgaris is a chronic inflammatory skin disease that its side effects like hyper-trophic and atrophic scars and long-term pigmentation has adverse psychological effects on the individual. This study aimed to compare the psychological effects and quality of life in two groups of patients with acne and Healthy individuals. Methods: In this case-control study, 100 patients with and 100 individuals without acne were selected. The prevalence and severity of psychological effects, including depression, anxiety and stress was assessed using Depression Anxiety Stress Scale (DASS) questionnaire and quality of life was assessed using World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire. The data were compared between the two groups. Findings: In two groups of patients and controls, 7% and 8% had minor depression, respectively, 5% of patients had moderate depression and 2% of the control group had severe depression with no significant difference between the both groups (P = 0.070). In patients and control groups, 7% and 5% had mild, 4% and 2% had moderate and 1% and 2% had severe anxiety, respectively with no significance difference between the both groups (P = 0.660). In addition, 8% of patients and 1% of controls suffered from mild stress; the level of stress had significant difference between the both groups (P = 0.017). The score of quality of life was 80.00 ± 11.19 and 79/30 ± 10/73 in patients and controls, respectively with no significant difference between the two groups (P = 0.940). Conclusion: The prevalence of psychological effects was higher in patients. On the other hand, patients with acne (mainly mild and moderate) had a lesser degree of support from others, quality of life and health satisfaction. So, it is necessary to evaluate psychological aspects in patients with mild to moderate acne.

Background: Isfahan province is one of the common foci of the cutaneous leishmaniasis in Iran, particularly the wet or rural zoonotic cutaneous leishmaniasis (ZCL). Due to the lack of information about the epidemiology and prevalence of cutaneous leishmaniasis in Isfahan province, Iran, this study was designed. Methods: Data were collected from the recorded data of patients with leishmaniasis referred to Isfahan Province Health Care Center, Isfahan, Iran. The patients were diagnosed by direct microscopic examination of the samples. Data concerning demographic features, the number and location of lesions, duration of disease, area of residence, work location, the history of travel within the past two months, address, and telephone number of the patients was collected. The epidemiological status of leishmaniasis was determined from the recorded data. Findings: In total, data of 28315 patients with leishmaniasis during 2001 to 2011 were studied. Among them, 10809 (38.2%) patients were women and 17491 (61.8%) were men. The mean age of the patients was 22.40 ± 16.52 years (range: 1-100 years). The incidence of lesions was 12.1% in face, 12.3% in hands and legs, 4.5% in face and hands, 24.1% in legs, 32.3% in hands and 11.5% in the other parts of body. 12163 patients (43%) had one, 6330 (22.4%) had two, 503 (8.1%) had three, and 8008 (28.3%) had more than three lesions. Overall, 17883 patients (63.2%) lived in urban areas and 8241 (29.1%) in rural areas and most of the cases were seen among those who lived in cities and urban areas. Conclusion: Considering the high prevalence of cutaneous leishmaniasis in the Isfahan province, eliminating the leishmaniasis vector and its reservoirs in this endemic area seems to be necessary. During the years, it has been showed that leishmaniasis is endemic in Isfahan province; hence, a more extensive epidemiologic study is recommended.

Background: The pathogenesis of atopic dermatitis (AD) remains to be determined; recently a possible change in the immune system with production of immunoglobulins is proposed. As vitamin E is a potent antioxidant, with the ability to decrease the serum levels of immunoglobulin E (IgE) in atopic patients, we aimed to evaluate the effect of oral vitamin E on treatment of AD. Materials and Methods: This randomized, double-blind, placebo-controlled trial comprised seventy participants with mild-to-moderate AD, based on the Hanifin and Rajka diagnostic criteria. The patients were randomly selected from teaching skin clinics in Isfahan, Iran. They were randomly assigned to two groups of equal number, receiving vitamin E (400 IU/day) and placebo for four 4 months. Each month, the extent, severity, and subjective symptoms including itch and sleeplessness were measured by SCORAD index. Three months after the end of intervention, the recurrence rate was assessed. Results: The improvement in all symptoms, except sleeplessness, was significantly higher in the group receiving vitamin E than in controls (-1.5 vs. 0.218 in itching, -10.85 vs. -3.54 in extent of lesion, and -11.12 vs. -3.89 in SCORAD index, respectively, P < 0.05). Three months after the end of intervention, the recurrence rate of AD was evaluated. Recurrence rate between all 42 individuals, who remained in the study, was 18.6%. Recurrence ratio of the group receiving vitamin E compared to the placebo group was 1.17, without significant differences between the two groups (P > 0.05). Conclusion: This study suggests that vitamin E can improve the symptoms and the quality of life in patients with AD. As vitamin E has no side effects with a dosage of 400 IU/day, it can be recommended for the treatment of AD.

Background: Diabetes mellitus is a metabolic disorder and its subsequent complications such as retinopathy, nephropathy, ulcers, disability, and amputation increase the burden of the disease. Patient knowledge-improving programs are employed to prevent disease progression and to improve the quality of life of the patients. In this way, we need to characterize the groups of patients in urgent need for more and rich-in-content programs. In the present study, we used piecewise regression to evaluate the trends of diabetic nephropathy prevalence in patients registered in the Sedigheh-Tahereh Research Center and to identify patients who were in need of more attention. Materials and Methods: Piecewise regression, used in this study, is a statistical method to identify change points, if any, in the trends of mortality rates, prevalence of a disease, or any other trends. Available information for 1,935 patients were retrieved from the database. Joinpoint program 3.5.3 and Statistical Package for the Social Sciences (SPSS) 20 was used to fit piecewise regression and obtain descriptive statistics, respectively. Results: We assessed the trend of diabetic nephropathy in different groups of diabetic patients with respect to sex, blood pressure status, education, family history of diabetes, and age. The results showed an increasing trend in females, patients without family history of diabetes, and eover th recent years. The prevalence of diabetic nephropathy in patients with academic education was high. Conclusion: The groups with high prevalence or increasing trends need more preventive intervention and detailed assessment of the present trends. Exploring high-risk groups is beneficial for better policy-making in the future. However, discovering the reasons for the increased trend of the disease is really helpful in controlling diabetes complications.

Background: Reference percentile curves are usually used as a screening tool to determine growth disorders. Anthropometric indices are population-dependent and may differ according to ethnicity, dietary pattern and lifestyle habits. This study aims to compare the curves of anthropometric measures obtained in two national studies conducted among Iranian children and adolescents in 2003-2004 and 2009-2010. Materials and Methods: Anthropometric measures obtained in two nationwide surveys conducted in 10-18-year-old Iranian students were compared. Lambda-mu-sigma (LMS) Chart Maker Pro program was used to develop age- and gender-specific percentiles and to smooth and fit the model. Results: In 2003-2004, the mean and standard deviation (SD) of body mass index (BMI) and waist circumference (WC) were 18.98 ± 3.81 kg/m 2 and 67.50 ± 11.05 cm in boys; and 19.44 ± 3.78 kg/m 2 and 66.55 ± 9.89 cm in girls, respectively. In 2009-2010, the corresponding figures were 19.16 ± 4.07 kg/m 2 , 69.42 ± 11.43 cm, 19.63 ± 4.11 kg/m 2 , and 67.29 ± 9.69 cm, respectively. Height curves did not show considerable changes in two studies. Comparison of two series of studies showed that the weight, BMI, WC, and waist-to-height ratio were lower in adolescent girls than boys especially in higher percentiles. Moreover, in both genders, weight, BMI, and WC percentiles decreased. Conclusion: The growth charts of Iranian children and adolescents aged 10-18 years have changed over 5 years. The reference growth curves change over time in the pediatric age group, repeated surveys should be conducted to update the age- and gender-specific reference curves in different populations.

Objective: To evaluate predictive factors of adolescents′ appraisal of their health. Methods: The nationwide study, entitled "Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Diseases (CASPIAN) study," was conducted in 2010 among Iranian school students, aged 10-18. In addition to demographic factors and physical examination, variables as family structure, nutrition habits, physical activity, smoking, hygienic habits, violence, school attachment, family smoking, and family history of chronic diseases were assessed. The dependent variable is the self-rated health (SRH) and it was measured by 12 items, which had already been combined through latent class analysis. We had taken a dichotomous variable, i.e. the higher values indicate better SRH. The dependent variable was regressed on all predictors by generalized additive models. Results: 75% of adolescents had a good SRH. The linear and smooth effects of independent variables on SRH were observed. Among all the variables, physical activity had a positive linear effect on SRH (β = 0.08, P value = 0.003). Smoking, violence, and family history of disease associated to SRH non-linearly (P value < 0.05). Family smoking (β = -0.01) and hygienic habits (β = 0.27) related to SRH both linearly and non-linearly. Conclusions: Physical health and high risk behavior, either of linear or non-linear effect, are factors, which seem to shape the adolescents′ perception of health.

Background: The aim of this study was to show up-to-date estimates of incidence and prevalence in Isfahan for all cancers, except non-melanoma skin cancer over the period 2001-2010 to provide projections up to 2015, based on a statistical method that uses mortality and cancer patients′ survival data. Methods: Mortality data in Isfahan province were collected from various sources such as hospitals, medical forensic, cemetery, and health centers. In addition, population data by sex, age, location, and calendar year in the period of 2001-2010 were acquired from the Statistical Center of Iran. Relative survival probabilities for all cancers combined and for selected specific cancers were estimated based on observed cancer death and expected mortality data. Incidence and prevalence estimates were computed with Mortality-incidence Analysis Model (MIAMOD) method. Results: The estimated age-standardized cancer incidence rate had higher increase rate for urban females than for males. Also, the number of prevalent cancers was higher among females, which was mostly due to better cancer survival rates in women. Age-adjusted incidence was estimated to increase by 6.9 and 8.7 per 100000 annually, between 2001 and 2015, in males and females, respectively. The prevalence is to increase by 24 and 40 and mortality by 2.8 and 2.5 per 100000 between 2001 and 2015. Conclusion: The present study does not only show the incidence and prevalence estimates of all cancers combined, but also gives information about cancer burden, which can be used as a bases for planning healthcare management and allocating recourses in public health.

مقدمه: تحقیقات اخیر در ارتباط با بیولوژی سرطان کولون نشان می‌دهد که رشد تومور توسط سلول‌های بنیادی سرطان کولون هدایت می‌شود. سلول‌های بنیادی سرطانی مسؤول آغاز، حفظ، گسترش و عود تومور می‌باشند. هدف از این مطالعه، جداسازی و تکثیر سلول‌های بنیادی کولون در محیط in vitro بود. روش‌ها: نمونه‌های توموری تازه‌ی سرطان کولون مورد هضم مکانیکی و آنزیمی قرار گرفتند. بعد از عبور سوسپانسیون سلولی از فیلتر سلولی، سلول‌ها شمارش شده و درصد حیات آن‌ها مشخص شد. سپس سلول‌های توموری در محیط کشت اختصاصی (محیط DMEM/F12 غنی شده با فاکتورهای رشد و فاقد سرم) کشت داده شدند. رشد سلول‌های توموری در این محیط توسط میکروسکوپ معکوس مورد بررسی قرارگرفت. یافته‌ها: بعد از حدود سه هفته از کشت سلول‌ها در محیط کشت اختصاصی، سلول‌های بنیادی سرطان کولون به صورت کولونی‌های سلولی گرد (اسفیر) ظاهر شدند، در حالی که سلول‌های تمایز یافته‌ی توموری و سالم قادر به رشد نبودند. اسفیرهای سرطان کولون در محیط کشت اختصاصی سلول‌های بنیادی قادر به تکثیر و پاساژ بودند. نتیجه‌گیری: جداسازی و تکثیر سلول‌های بنیادی توموروژنیک در محیط in vitro می‌تواند به ایجاد روش‌های تشخیصی و درمانی سرطان کولون کمک کند. از این سلول‌ها می‌توان برای مطالعات سیگنالینگ و بررسی اثر داروهای ضد سرطان استفاده کرد.

مقدمه: به منظور کاهش درد ناشی از لیزر تاکنون از بی‌حس کننده‌های موضع چون کرم EMLA استفاده شده است. هدف ما در این مطالعه، بررسی اثر ژل پیروکسیکام در کاهش درد بیمار در حین انجام لیزر و پس از آن و کاهش التهاب و اریتم پوست بیماران و پیگمانتاسیون متعاقب آن بود. روش‌ها: این مطالعه به صورت کارآزمایی بالینی دو سوكور در مركز نوین لیزر بر روی ۱۲۲ نفر از بیماران ۱۸ تا۶۰ سال که کاندید انجام لیزر فراکسل Co2 بودند، انجام گرفت. جمعیت مورد مطالعه قبل از لیزر در یک طرف صورت از ژل پیروکسیکام و در طرف دیگر از ژل لوبریکات استفاده کردند. درد، شدت اریتم و پیگمانتاسیون پس از لیزر در دو طرف صورت در زمان‌های مشخص به کمک آزمون Repeated measures ANOVA و نرم‌افزار SPSS نسخه‌ی 18 با یکدیگر مقایسه شد. یافته‌ها: ژل پیروکسیکام نسبت به ژل لوبریکانت در کاهش درد ناشی از لیزر فراکسل مؤثرتر بود (01/0 > P)، ولی از نظر شدت اریتم و پیگمانتاسیون پس از لیزر بین دو ژل تفاوت معنی‌داری وجود نداشت. نتیجه‌گیری: ژل پیروکسیکام می‌تواند به عنوان یک داروی مطمئن و مؤثر، بدون عارضه‌ای ناخوشایند برای کاهش درد ناشی از لیزر فراکسل استفاده شود ولی این دارو روی اریتم و پیگمانتاسیون ناشی از لیزر اثری ندارد.

Background: Acne scarring is treatable by a variety of modalities. Ablative carbon dioxide laser (ACL), while effective, is associated with undesirable side effect profiles. Newer modalities using the principles of fractional photothermolysis (FP) produce modest results than traditional carbon dioxide (CO 2 ) lasers but with fewer side effects. A novel ablative CO 2 laser device use a technique called ablative fractional resurfacing (AFR), combines CO 2 ablation with a FP system. This study was conducted to compare the efficacy of Q-switched 1064-nm Nd: YAG laser and that of fractional CO 2 laser in the treatment of patients with moderate to severe acne scarring. Methods: Sixty four subjects with moderate to severe facial acne scars were divided randomly into two groups. Group A received Q-Switched 1064-nm Nd: YAG laser and group B received fractional CO 2 laser. Two groups underwent four session treatment with laser at one month intervals. Results were evaluated by patients based on subjective satisfaction and physicians′ assessment and photo evaluation by two blinded dermatologists. Assessments were obtained at baseline and at three and six months after final treatment. Results: Post-treatment side effects were mild and transient in both groups. According to subjective satisfaction (p = 0.01) and physicians′ assessment (p < 0.001), fractional CO 2 laser was significantly more effective than Q- Switched 1064- nm Nd: YAG laser. Conclusions: Fractional CO2 laser has the most significant effect on the improvement of atrophic facial acne scars, compared with Q-Switched 1064-nm Nd: YAG laser.

مقدمه: بیماری دیابت یکی از بیماری‌های شایع در جهان به شمار می‌رود و رتینوپاتی دیابتی به عنوان یک بیماری چشمی، این گروه از بیماران را به شدت درگیر می‌نماید و یکی از عوامل کوری آنان در سنین بالا به شمار می‌رود. با توجه به شیوع بالای دیابت نوع II در جامعه و همچنین خطر بالای رتینوپاتی در این گروه از بیماران، در این مطالعه سعی گردید تا با توجه به مدل رده بندی درختی CART (Classification and Regression Tree) یک الگوی پیش‌گویی و رده‌بندی برای این بیماران معرفی شود. روش ها: این بررسی با توجه به اطلاعات 3734 بیمار دیابتی نوع II انجام شد. بیماران به صورت تصادفی به دو گروه نمونه‌ی آزمون و یادگیری تقسیم شدند. با توجه به نمونه‌ی یادگیری، مدل رده بندی درخت CART معرفی و دقت آن با توجه به نمونه‌ی آزمون مشخص گردید. نتایج به دست آمده از الگوی درختی CART با نتایج به دست آمده از مدل تابع تشخیص برای کل بیماران مقایسه شد. یافته ها: در این مطالعه، مدل رده بندی درختی با دقت 67/0 با توجه به دوره بیماری، فشار خون سیستولیک، سن، جنسیت، تری‌گلیسیرید، کلسترول و قند خون ناشتا به دست آمد. این الگوی رده بندی از حساسیت 71/0 و ویژگی 62/0 برخوردار بو. در این بررسی میزان دقت رده بندی درختی معرفی شده با میزان دقت الگوی رده بندی بر اساس تابع تشخیص تقریبا یکسان بود. نتیجه گیری: در این بررسی مشخص گردید که دوره‌ی بیماری دیابت یکی از مهمترین عوامل تعیین کننده‌ی رتینوپاتی می‌باشد؛ به طوری که خطر رتینوپاتی در بیماران دیابت نوع II که از بیماری دیابت آن‌ها بیشتر از 5/7 سال می‌گذرد نسبت به سایر بیماران بیشتر است. واژگان کلیدی: درخت رده بندی، تحلیل ممیزی (تابع تشخیص)، رتینوپاتی، دیابت نوع II.

BACKGROUND: The purpose of this study was to develop a simple risk score as screening tool for retinopathy in type II diabetic patients.METHODS: A cross-sectional study was carried out recruiting 3734 atients with type II diabetes in an outpatient clinic in Isfahan ndocrinology and Metabolism Research Center (IEMRC), Iran. The logistic regression was used as a model to predict diabetic retinopathy. The cut-off value for the risk score was determined using the Receiver perating Characteristic (ROC) curve procedure.RESULTS: According to final models, being male, having lower body mass index (BMI), being older, longer duration of diabetes and higher HbA1c were correlated with increased risk of diabetic retinopathy. Area under the Curve (ROC) was 0.704 (95% CI: 0.685-0.723). A value ; 52.5 had the optimum sensitivity (60%) and specificity (69%) for determining diabetic retinopathy.CONCLUSIONS: The results indicated that risk factors for retinopathy were sex, BMI, age, duration of diabetes and HbA1c levels. In onclusion, applying developed retinopathy risk score is a practical way to identify patients who are at high risk for developing diabetic retinopathy for an early treatment.KEYWORDS: Retinopathy risk score, sensitivity, specificity, receiver operating characteristic curve.

Background: The present study was performed to develop a scoring system for predicting cure status in patients with cutaneous leishmaniasis (CL). Materials and Methods: This study included 199 patients with CL from Skin Diseases and Leishmaniasis Research Center (Isfahan, Iran). Data were collected as longitudinal in each visit of patients. We applied ordinal logistic generalized estimating equation regression to predict score on this correlated data. To evaluate the fitted model, split sample validation method was applied. SPSS software was used for data analysis. Results: The regression coefficients of the fitted model were used to calculate score for cure status. Based on split-sample validation method, overall correct classification rate was 82%. Conclusion: This study suggested a scoring system predict cure status in CL patients based on clinical characteristics. Using this method, score for a CL patient is easily obtained by physicians or health workers.

Background: Lichen planopilaris is an inflammatory cicatricial alopecia, and its management is a challenge for dermatologists. We aimed to compare the efficacy of methotrexate and hydroxychloroquine on refractory lichen planopilaris. Methods: In a randomized clinical trial, 29 patients were randomly allocated to receive either 15 mg methotrexate/week or 200 mg hydroxychloroquine twice a day for 6 months. Side effects, symptoms/signs, and laboratory tests were assessed periodically. Lichen Planopilaris Activity Index (LPPAI) was measured before intervention and at 2, 4, and 6 months after. The changes from baseline to the end of the study were analyzed within each group and between the two groups by per-protocol and intention-to-treat analysis. Results: After 2 months, mean (standard deviation [SD]) decrease in LPPAI in methotrexate group was significantly more than that in hydroxychloroquine group (1.68 [1.24] vs. 0.8 [0.71], respectively,P = 0.047). Furthermore, after 6 months, mean (SD) decrease in LPPAI in methotrexate group was significantly higher than that in hydroxychloroquine group (3.3 [2.09] vs. 1.51 [0.91], respectively,P = 0.01). The following symptoms/signs showed significant improvements in frequency and/or severity in methotrexate group after intervention: pruritus (P = 0.007), erythema (P = 0.01), perifollicular erythema (P = 0.01), perifollicular scaling (P = 0.08), spreading (P = 0.001), and follicular keratosis (P = 0.04). In hydroxychloroquine group, only erythema (P = 0.004) showed significant improvement. Conclusions: Methotrexate was more effective than hydroxychloroquine in treating refractory lichen planopilaris.

Background: This study aims to evaluate the effect of some factors, including birth weight, sex, age, waist circumference, family history of obesity, as well as some lifestyle factors as frequency of breakfast days and physical activity, on the body mass index among a nationally representative sample of Iranian children and adolescents by using bootstrapping regression. Materials and Methods: This study was conducted as the third survey of a school-based surveillance system (CASPIAN-III study). Total participants were 5570 school students, aged 10-18 years, selected by multistage random cluster sampling from urban and rural areas of 27 provinces of Iran. Multiple linear regressions was used to evaluate the effect of various factors on obesity, but in our data the assumptions of this model violated, and possible solutions were not appropriate, therefore the bootstrapping regression based on the observations and errors resampling approaches was used as an alternative. Results: The tests of significance showed that the effects of sex, age, waist circumference, family history obesity and frequency of breakfast days were clearly significant (P < 0.001). The effect of vigorous level of physical activity was significant in comparison to mild physical activity (P = 0.01). In comparison to low birth weight, medium and high birth weight had significant effect on obesity. Conclusions: Bootstrap method is preferable in linear regression because of some theoretical properties like having any distributional assumptions on the residuals and hence allows for inference even if the errors do not follow normal distribution or constant error variance.

Background: Alopecia areata (AA) is a noncicatricial (nonscarring) alopecia. The association between AA and celiac disease (CD) is debatable. Several studies declare the relationship between AA and CD as measurement of celiac autoantibodies (anti-gliadin IgA and anti-gliadin IgG), but a few studies consider anti-tissue transglutaminase IgA. The aim of this study was to evaluate the frequency distribution of celiac autoantibodies (all of them) in patients with AA compared with controls. Methods: This study is a case-control study. Thirty-five patients entered in each group. Anti-gliadin IgA, anti-gliadin IgG, and anti-tissue transglutaminase IgA were tested in all patients. Samples were examined in ELISA method with binding site′s kits, and the result was reported as positive/negative. Finally, the frequency distribution of autoantibodies was examined. Results: The age average did not show a significant difference between two groups (P = 0.62). In addition, there was no significant difference between the two groups based on gender (P = 0.15). The prevalence of antibody in case and control groups was 2.85% and 0%, respectively. There was no significant difference between the two groups (P = 0.31). Conclusions: There may be a relationship between CD and AA, but the absence of statistical association between AA and CD does not mean that there is no relationship between gluten and AA in certain patients. Thus, we have shown here that the biological tests to search for CD do not bring information and proof enough, and it is why we recommend another approach to disclose gluten intolerance in AA patients.

Background: Acne vulgaris is a chronic inflammatory disease of the pilosebaceous follicles and one of the most common skin diseases. The peeling method has been recently found to be effective for acne treatment. This study aimed to compare the efficacy of pyruvic acid 50% and salicylic acid 30% peeling in the treatment of mild to moderate acne. Materials and Methods: In a prospective single-blinded clinical trial, 86 patients with acne were randomly assigned into two groups. In both groups, the routine treatment of acne (topical solution of erythromycin 4%, triclorocarban soap, and sunscreen) were used twice a day for 8 weeks. In addition, salicylic acid 30% for the control group and pyruvic acid 50% for the case group were used. In both groups, acne severity index (ASI) was calculated before and at week 2, 4, 6, and 8 of the treatment. Patient satisfaction was assessed at the end of the treatment. Side effects were recorded using a checklist. Results: In both groups, the reduction in the number of comedones, papules, and ASI were statistically significant (P < 0.001) in the course of treatment. However, it was not significant regarding the number of pustules (P = 0.09). None of the number of comedone, papules, pustules, and ASI was statistically different between study groups. Both treatment groups had similar side effects except for scaling in the fifth session, which was significantly lower in salicylic acid - treated patients (P = 0.015). Conclusion: Both pyruvic acid 50% and salicylic acid 30% are effective in the improvement of mild to moderate acne with no significant difference in efficacy and side effects.

Background: Multiple sclerosis (MS) is an autoimmune disease of the central nervous system. Etiology of the disease is not well understood; however, it is more common in women than in men and occurs mainly during reproductive age. The aim of this study was to evaluate some risk factors in women of childbearing age with MS in Isfahan Province. Methods: This analytic case-control study was conducted in MS Clinic in Isfahan, 2014. The study was done on 200 patients with MS and 200 nonpatients (matched controls) that were randomly selected for inclusion in the study. The data collection tool was a researcher-designed questionnaire consisting of three parts: Demographics, disease characteristics, and some risk factors related to reproductive age. Data were analyzed by SPSS version 20, using descriptive and inferential statistics. Results: The results showed that risk of MS had a significant relationship with age at menarche (P < 0.001), prior use of oral contraceptives (OCs) (P = 0.002), duration of use of OCs (P = 0.008), and number of pregnancies (P < 0.001). However, there was no significant relationship between age of onset of use of OCs (P = 0.80) and age at the first pregnancy (P = 0.45) with the risk of MS. Conclusions: Results of this research determined that the following risk factors were associated with developing MS, age at menarche, history, and duration of use of OCs and number of pregnancies.

Background: There is a variation in trends of oral cancers all over the world. Many studies have reported evidence of increasing incidence in oral cancers during recent years. The purpose of this study was to investigate time trends and changes in demographic distribution of oral cancers incidence in Isfahan during 1991-2010. Materials and Methods: In this retrospective analytic study, we collected and recorded data on patients with oral cancers at Oral Pathology Department of Dental School of Isfahan University of Medical Sciences during 1991-2010. Collected data include age at presentation, gender, primary site, and histologic type of cancer. Statistical analysis performed using Jointpoint Regression Program version 3 and SPSS version 18. Results: We analyzed data from 231 Pathology reports. The most frequent cancer was squamous cell carcinoma. Comparing the two time intervals (1991-2000) and (2001-2010), we found that carcinomas and salivary gland tumors had decreased while there was an increase in incidence of sarcomas and lymphomas. Gingiva was the most common site (46%) of oral cancers followed by tongue with (18%) through these 20 years. Male to female ratio was decreased from 1.4 to 1.1 during these two decades of study. Conclusions: According to this study, there might be some changes in risk factors as well as changes in the diagnosis of oral cancers in Isfahan that calls for further investigations.

Background: SAHA (Seborrhea, Acne, Hirsutism and Androgenetic Alopecia) syndrome is a dermatologic disorder, with variant response to treatment. Triad of cutaneous hyperandrogenism included nodulocystic or severe acne, female pattern hair loss and hirsutism. Aim: The aim of this study is to compare the effectiveness of isotretinoin and cyproterone compound in the treatment of nodulocystic acne, in patients with SAHA syndrome or triad of cutaneous hyperandrogenism. Materials and Methods: 30 female patients with SAHA syndrome were divided randomly into two groups. Group A was treated with cyproterone compound from day 5 of menstrual cycle onwards for 3 weeks and a week without it and group B received isotretinoin, with a dose of 0.75 mg/kg per day from the beginning of menses onwards for 4 months. The results were evaluated by a blind dermatologist using Acne Severity Index (ASI) score at baseline and monthly for 4 months. Results: Despite a continuous reduction in ASI score in both the groups, according to both physician (P = 0.63) and patient (P = 0.25) assessment, cyproterone compound was not statistically more effective than conventional treatment of nodulocystic acne at the end of the study. Side-effects were reported in patients in both groups, generally being mild and tolerable except in two subjects. Conclusion: This study indicates that cyproterone compound is not superior to isotretinoin in the treatment of nodulocystic acne in patient with SAHA syndrome or triad of cutaneous hyperandrogenism. Indeed, other studies are needed to evaluate the effect of cyproterone compound (regardless of androgen level) and isotretinoin in subjects with only nodulocystic acne.