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Abstract Background Several studies pointed out the importance of genetic risk factors such as parental consanguinity (PC) and familial multiple sclerosis (FMS) in the risk of MS. This study aimed to investigate the PC and FMS among people with MS (pwMS) in Isfahan, Iran. Methods This case–control study was conducted on pwMS from the MS clinic of Kashani Hospital, Isfahan, Iran, in October 2023. A group of healthy controls (HC) were also recruited. Data on demographic and clinical characteristics and history of PC and FMS were collected from participants. The relationships between PC, FMS, and developing MS were assessed using multinomial logistic regression analysis. The odds ratio (OR) with a 95% confidence interval (CI) was computed. Results A total number of 4264 pwMS and 400 HCs were included. The prevalence of PC and FMS among pwMS were 29.3% and 24%, respectively. Multinomial logistic regression adjusted for age and sex indicated that the odds of developing MS were significantly associated with a history of PC (OR = 3.03, 95% CI 2.23 to 4.13, p

Abstract The glycocalyx is a complex layer of carbohydrate and protein molecules that surrounds the cell membrane of many types of mammalian cells. It serves several important functions, including cell adhesion and communication, and maintain cell shape and stability, especially in the case of erythrocytes. Alteration of glycocalyx composition represents a cardiovascular health threatening. For example, in diabetes mellitus glycocalyx of erythrocytes and of endothelial cells is known to be impaired, a potential source of blood occlusion in microcirculation, which may lead to blindness, and renal failure of patients. The impact of glycocalyx impairment on erythrocyte aggregation remains a largely unexplored research area. We conduct here in vitro-experiments in microfluidic devices in order to investigate erythrocytes aggregation incubated with amylase, an enzyme that partially breaks down glycocalyx molecules. It is found that incubation of erythrocytes by amylase leads to a dramatic increase of their aggregation and stability and alters the aggregates morphologies. Confocal microscopy analysis reveals a significant degradation of the glycocalyx layer, correlated with enhanced erythrocytes aggregation. An increased erythrocyte aggregation in vivo should affect oxygen and other metabolites delivery to organs and tissues. This study brings new elements about elucidation of microscopic origins of erythrocyte aggregation and their potential impact on cardiovascular pathologies.

Objective: Breast cancer (BC) is the most frequent cancer among women. Many BC patients suffer from sleep problems, which have a negative impact on their quality of life (QoL). Our study aims to investigate sleep problems in BC patients treated with active chemotherapy or in remission in comparison with a healthy control group (HCG), given the importance of sleep disorders and QoL. Materials and Methods: A multicenter, cross-sectional study was conducted. Four different surveys including sociodemographic characteristics questionnaire, Pittsburgh sleep quality index (PSQI), hospital anxiety and depression scale and The European Organisation for Research and Treatment of Cancer core quality of life questionnaire (QLQ-C30) were used to collect study parameters. Results: Of 164 participants, the mean age was 42.0±11.7 years. Overall PSQI median score for all participants was 6 points (range, 3-9 points). PSQI median value was higher in cancer patients compared to the control group, which were 6 points (range, 4-9 points), and 4 points (range, 3-7 points), respectively (p=0.004). The mean depression score was 5 points (range, 3-8 points) in BC patients, and 4 points (range, 2-6 points) in HCGs, respectively (p=0.025). Having BC diagnosis was an independent factor increasing the risk of bad sleep quality in compared to healthy controls (odds ratio: 2.568, 95% confidence interval: 1.169-5.645; p=0.019). Conclusion: There was a close association between poor sleep quality, depression and QoL scores in patients with BC. In patients with breast cancer, appropriate management of associated comorbidities will aid a better quality of life in these patients.

Statement of the Problem: Successful endodontic treatment depends on three-dimensional (3D) root canal filling to prevent the leakage of residual bacteria. Different obturation techniques with different sealers should be compared by employing advanced assessment tools.Purpose: This study compared the obturation quality of warm vertical compaction (WVC) and two different single-cone (SC) techniques using micro-computed tomography (micro-CT).Materials and Method: Thirty-three extracted maxillary molars with mesial root canal curvature of 20‒40º were prepared in vitro with One-Curve files and randomly assigned to three groups (n=11) for root canal obturation with WVC, SC technique with AH Plus sealer (SC-AH), or SC technique with SureSeal bioceramic (BC) sealer (SC-Su). The root canals underwent micro-CT examinations before and after obturation to determine the volume percentages (VPs) of voids and gaps at different distances from the apex (coronal, middle, and apical thirds). Data were analyzed by Kruskal-Wallis and Mann-Whitney U tests. Results: The highest VP of voids and gaps was recorded in the SC-Su group, with no significant difference from other groups (p> 0.05). There were significant differences in VP of gaps at different distances from the apex (p0.05).Conclusion: None of the tested techniques could provide a void-free and gap-free filling. The apical third of the canals showed the highest VP of gaps in all obturation techniques.

Abstract Cardiovascular disease (CVD) can be determined and quantified using the electrocardiogram (ECG) analysis. Identification of the risk factors associated with ECG abnormalities may advise prevention approaches to decrease CVD burden. In this study we aimed to investigate the association between CVD risk factors and minor and major ECG abnormalities in a general Iranian adult population. This study was conducted in 2010 and covered a population of 9035 males and females aged 35 to 65 years recruiting from the phase I of Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) cohort study. The participants were drawn by a stratified cluster random sampling technique. The Bivariate and multinomial logistic regression analysis were conducted considering gender stratification to explore the association of ECG abnormalities with traditional cardiovascular risk factors. There was a significant association between minor and major ECG abnormalities and hypertension (HTN), type 2 diabetes (T2DM), smoking, and physical activity (p 60 years were more likely to have major [ARRR = 2.01, 95% CI 1.49, 2.74] and minor [ARRR = 1.59, 95% CI 1.20, 2.10] abnormalities compared to women aged

Abstract Background Depression and anxiety are commonly observed in people with multiple sclerosis (pwMS). There is a growing body of literature supporting the hypothesis that personality traits can influence the mood disorders. This study aimed to investigate the personality traits and their relationships with depression and anxiety among pwMS. Methods 234 pwMS were involved in this cross-sectional study. Personality traits, depression, and anxiety were assessed using the NEO Five-Factor Inventory (NEO-FFI) and Hospital Anxiety and Depression Scale (HADS), respectively. Pearson's correlation coefficient and generalized linear model were employed to evaluate the relationships between demographic and clinical characteristics, NEO-FFI, and HADS subscales. Results In pwMS, longer disease duration was significantly associated with lower level of conscientiousness (β = − 0.23, p = 0.008) and agreeableness (β = − 0.2, p = 0.01). Moreover, higher expanded disability status scale (EDSS) of pwMS had a significant relationship with higher level of neuroticism (β = 0.89, p = 0.01). Increased level of neuroticism was significantly correlated with lower level of extraversion (r = − 0.28, p

Abstract The monitoring of essential and toxic elements in patients with Opioid Use Disorder (OUD) undergoing methadone treatment (MT) is important, and there is limited previous research on the urinary levels of these elements in MT patients. Therefore, the present study aimed to analyze certain elements in the context of methadone treatment compared to a healthy group. In this study, patients with opioid use disorder undergoing MT (n = 67) were compared with a healthy group of companions (n = 62) in terms of urinary concentrations of some essential elements (selenium (Se), zinc (Zn), copper (Cu), iron (Fe), manganese (Mn), calcium (Ca)) and toxic elements (lead (Pb), cadmium (Cd), arsenic (As), and chromium (Cr)). Urine samples were prepared using the acid digestion method with a mixture of nitric acid and perchloric acid and assessed using the ICP-MS method. Our results showed that the two groups had no significant differences in terms of gender, education level, occupation, and smoking status. Urinary concentrations of Se, Cu, and Fe levels were significantly lower in the MT group compared to the healthy subjects. However, the concentrations of Pb, Cd, As, Mn, Cr, and Ca in the MT group were higher than in the healthy group (p

Exposure to phosgene, a colourless poisonous gas, can lead to various health issues including eye irritation, a dryand burning throat, vomiting, coughing, the production of foamy sputum, difficulty in breathing, and chest pain. Thissystematic review aims to provide a comprehensive overview of the clinical manifestations and treatment of phosgenetoxicity by systematically analyzing available literature. The search was carried out on various scientific online databasesto include related studies based on inclusion and exclusion criteria with the use of PRISMA guidelines. The quality ofthe studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Thirteen articles were included in thisstudy after the screening process. Inhalation was found to be the primary health problem of phosgene exposure withrespiratory symptoms such as coughing and dyspnea. Chest pain and pulmonary oedema were also observed in somecases. Furthermore, pulmonary crackle was the most common reported physical examination. Beyond respiratory tracthealth issues, other organs involvements such as cardiac, skin, eye, and renal were also reported in some studies. Thesymptoms can occur within minutes to hours after exposure, and the severity of symptoms depends on the amount ofinhaled phosgene. The findings showed that bronchodilators can alleviate symptoms of bronchoconstriction causedby phosgene. Oxygen therapy is essential for restoring oxygen levels and improving respiratory function in casesof hypoxemia. In severe cases, endotracheal intubation and invasive mechanical ventilation are used for artificialrespiration, along with the removal of tracheal secretions and pulmonary oedema fluid through suctioning as crucialcomponents of supportive therapy.

Abstract Next-generation sequencing (NGS) has been proven to be one of the most powerful diagnostic tools for rare Mendelian disorders. Several studies on the clinical application of NGS in unselected cohorts of Middle Eastern patients have reported a high diagnostic yield of up to 48%, correlated with a high level of consanguinity in these populations. We evaluated the diagnostic utility of NGS-based testing across different clinical indications in 1436 patients from Iran, representing the first study of its kind in this highly consanguineous population. A total of 1075 exome sequencing and 361 targeted gene panel sequencing were performed over 8 years at a single clinical genetics laboratory, with the majority of cases tested as proband-only (91.6%). The overall diagnostic rate was 46.7%, ranging from 24% in patients with an abnormality of prenatal development to over 67% in patients with an abnormality of the skin. We identified 660 pathogenic or likely pathogenic variants, including 241 novel variants, associated with over 342 known genetic conditions. The highly consanguineous nature of this cohort led to the diagnosis of autosomal recessive disorders in the majority of patients (79.1%) and allowed us to determine the shared carrier status of couples for suspected recessive phenotypes in their deceased child(ren) when direct testing was not possible. We also highlight the observations of recessive inheritance of genes previously associated only with dominant disorders and provide an expanded genotype–phenotype spectrum for multiple less-characterized genes. We present the largest mutational spectrum of known Mendelian disease, including possible founder variants, throughout the Iranian population, which can serve as a unique resource for clinical genomic studies locally and beyond.

Background and Aim: Doxorubicin is an effective chemotherapeutic agent. However, use of this drug is limited due to its dose-dependent cardiotoxicity. Activation of apoptotic pathways in myocardial tissue plays an important role in doxorubicin- induced cardiotoxicity. Minocycline is an antibiotic that has anti-apoptotic effects. In this study, we investigated the protective effects of minocycline against doxorubicin-induced cardiac toxicity in male rats. Materials and Methods: Forty two adult male rats were divided into control (normal saline), doxorubicin (2.5 mg / kg), minocycline (45 and 90 mg / kg) and treatment (doxorubicin + minocycline 45 and 90 mg / kg) groups. Minocycline was injected intraperitoneally, once a day for 3 weeks. Ejection fraction (EF) and fractional shortening (FS) were measured using echocardiography. The activity of caspase 3/7 and the expression of Bax and Bcli were measured by biochemical methods. Bax and Bcl-2 genes expression levels were estimated by real-time PCR. Results: In the minocycline-treated groups (45 and 90 mg / kg) the activity of caspase 7/3 and the expression of Bax gene were significantly lower and the levels of EF, FS and Bcl-2 expression were significantly higher than those in the doxorubicin group. Conclusion: Minocycline reduces doxorubicin-induced cardiotoxicity. The anti-apoptotic effects of minocycline may play an important role in its protective effects.

Objective: T-cells express two functional forms of the programmed cell death protein 1 (PD-1): membrane (mPD-1) andsoluble (sPD-1). The binding of mPD-1 and its ligand (PD-L1) on tumor cells could lead activated lymphocytes towardexhaustion. Selective deletion of the transmembrane domain via alternative splicing of exon-3 in PD-1 mRNA couldgenerate sPD-1. Overexpression of sPD-1 could disrupt the mPD-1/PD-L1 interaction in tumor-specific T cells. Weinvestigated the effect of secreted sPD-1 from pooled engineered and non-engineered T cell supernatant on survivaland proliferation of lymphocytes in the tumor microenvironment (TME).Materials and Methods: In this experimental study, we designed two sgRNA sequences upstream and downstream ofexon-3 in the PDCD1 gene. The lentiCRISPRv2 puro vector was used to clone the dual sgRNAs and produce lentiviralparticles to transduce Jurkat T cells. Analysis assays were used to clarify the change in PD-1 expression pattern in thepooled (engineered and non-engineered) Jurkat cells. Co-culture conditions were established with PD-L1+ cancer cellsand lymphocytes.Results: CRISPR/Cas9 could delete exon-3 of the PDCD1 gene in the engineered cells based on the tracking of indelsby decomposition (TIDE) and interference of CRISPR edit (ICE) sequencing analysis reports. Our results showed a12% reduction in mPD-1 positive cell population after CRISPR manipulation and increment in sPD-1 concentration inthe supernatant. The increased sPD-1 confirmed its positive effect on proliferation of lymphocytes co-cultured with PDL1+cancer cells. The survival percent of lymphocytes co-cultured with the pooled cells supernatant was 12.5% morethan the control.Conclusion: The CRISPR/Cas9 exon skipping approach could be used in adoptive cell immunotherapies to changePD-1 expression patterns and overcome exhaustion.

Abstract This study aimed to investigate the diagnostic performance of machine learning-based radiomics analysis to diagnose coronary artery disease status and risk from rest/stress Myocardial Perfusion Imaging (MPI) single-photon emission computed tomography (SPECT). A total of 395 patients suspicious of coronary artery disease who underwent 2-day stress-rest protocol MPI SPECT were enrolled in this study. The left ventricle myocardium, excluding the cardiac cavity, was manually delineated on rest and stress images to define a volume of interest. Added to clinical features (age, sex, family history, diabetes status, smoking, and ejection fraction), a total of 118 radiomics features, were extracted from rest and stress MPI SPECT images to establish different feature sets, including Rest-, Stress-, Delta-, and Combined-radiomics (all together) feature sets. The data were randomly divided into 80% and 20% subsets for training and testing, respectively. The performance of classifiers built from combinations of three feature selections, and nine machine learning algorithms was evaluated for two different diagnostic tasks, including 1) normal/abnormal (no CAD vs. CAD) classification, and 2) low-risk/high-risk CAD classification. Different metrics, including the area under the ROC curve (AUC), accuracy (ACC), sensitivity (SEN), and specificity (SPE), were reported for models’ evaluation. Overall, models built on the Stress feature set (compared to other feature sets), and models to diagnose the second task (compared to task 1 models) revealed better performance. The Stress-mRMR-KNN (feature set-feature selection-classifier) reached the highest performance for task 1 with AUC, ACC, SEN, and SPE equal to 0.61, 0.63, 0.64, and 0.6, respectively. The Stress-Boruta-GB model achieved the highest performance for task 2 with AUC, ACC, SEN, and SPE of 0.79, 0.76, 0.75, and 0.76, respectively. Diabetes status from the clinical feature family, and dependence count non-uniformity normalized, from the NGLDM family, which is representative of non-uniformity in the region of interest were the most frequently selected features from stress feature set for CAD risk classification. This study revealed promising results for CAD risk classification using machine learning models built on MPI SPECT radiomics. The proposed models are helpful to alleviate the labor-intensive MPI SPECT interpretation process regarding CAD status and can potentially expedite the diagnostic process.

Abstract Background and Aims According to the previous studies, herpes zoster (HZ) has been associated with cognitive function and dementia. There is a hypothesis claiming that dementia risk may be reduced by receiving the antiviral treatment for HZ. The purpose of this systematic review and meta‐analysis was to shed light on the association between dementia and HZ in individuals receiving and not receiving antiviral medications. Methods Studies investigating the association between HZ and dementia were identified through a systematic search in PubMed/MEDLINE, Scopus, Embase, Google Scholar, and Cochrane Library databases from January, 2000 to April, 2022. Data on the risk of dementia in HZ‐infected patients under and not under antiviral treatment were extracted. The meta‐analysis was conducted using a random‐effects model. The modified ROBIN‐I tool was used to evaluate the risk of bias assessment. By utilizing the funnel plots, publication bias was investigated. Results Six cohort studies on 538,531 patients were included. The overall risk of bias assessment was moderate. According to evidence‐based cohort studies, there was a significant direct association between HZ and risk of dementia in patients with HZ, who did not receive antiviral treatments (hazard ratio [HR]: 1.15, 95% confidence interval [CI]: 1.03 to 1.28, p = 0.01). On the other hand, there was an inverse relationship between HZ and risk of dementia among patients with HZ, who received antiviral treatments (HR: 0.68, 95% CI: 0.59 to 0.77, p < 0.001). Conclusions This study demonstrated that antiviral therapies may significantly lower the risk of dementia in patients with HZ. This study also confirmed that patients with HZ, without receiving antiviral therapies, may have an increased risk of developing dementia. Further longitudinal research is warranted in this area.

Objective: To compare various labour parameters in partogram among primiparous women and women with one previous caesarean section scar Study Design: Comparative cross-sectional study Place and Duration of Study: Gynaecology and Obstetrics Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Oct 2021 to Sep 2022. Methodology: This study was conducted on primiparous women and women with one previous scar who were booked cases in our department for antenatal checkups and labour. Patients were divided into two groups for comparison. Group-I were primiparous, while Group-II had one previous scar. All women underwent detailed labour records via conventional partogram in the labour room. Duration of the active phase of labour, duration of the second stage, time to progress by 1 cm and time after the alert line were compared in partograms of both the study groups. Results: A total of 390 women who were either primiparous or had one previous caesarean section were recruited for this study. Of the study participants, 226(42.6%) were primiparous, while 164(57.4%) had one previous caesarean section scar. Statistical analysis revealed that the duration of the active phase of labour, time to progress by 1 cm and time after the alert line were statistically significant (p-value

Abstract Background and Aims Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system (CNS). MS results from an inflammatory process leading to the loss of neural tissue and increased disability over time. The role of Epstein Barr Virus (EBV), as one of the most common global viruses, in MS development has been the subject of several studies. However, many related questions are still unanswered. This study aimed to review the connection between MS and EBV and provide a quick outline of MS prevention using EBV vaccination. Methods For this narrative review, an extensive literature search using specific terms was conducted across online databases, including PubMed/Medline, Scopus, Web of Science, and Google Scholar, to identify pertinent studies. Results Several studies proved that almost 100% of people with MS showed a history of EBV infection, and there was an association between high titers of EBV antibodies and an increased risk of MS development. Various hypotheses are proposed for how EBV may contribute to MS directly and indirectly: (1) Molecular Mimicry, (2) Mistaken Self, (3) Bystander Damage, and (4) Autoreactive B cells infected with EBV. Conclusion Given the infectious nature of EBV and its ability to elude the immune system, EBV emerges as a strong candidate for being the underlying cause of MS. The development of an EBV vaccine holds promise for preventing MS; however, overcoming the challenge of creating a safe and efficacious vaccine presents a significant obstacle.

Non-steroidal anti-inflammatory drugs (NSAID) are not recommended for use against pneumonia in humans, but are commonly utilised against bovine respiratory disease. This study aimed to determine if the use of NSAIDs in the early phase of bovine respiratory syncytial virus (BRSV)-infection limits pulmonary inflammation. Four to nine-week old calves were infected with BRSV by aerosol and were treated with either meloxicam intravenously on day (D)4 (n = 5, MEL), acetylsalicylat-DL-lysin intravenously on D4 and D5 (n = 5, ASA), or were left untreated as controls (n = 5, CTR). Clinical signs were monitored daily until necropsy on D7, BRSV-RNA was detected in nasal swabs and bronchoalveolar lavage (BAL) by RT-qPCR, inflammatory cells and proteins were identified in BAL by cytology and label-free quantitative mass spectrometry-based proteomics, respectively, and oxylipids were quantified in BAL and plasma by liquid chromatography tandem mass spectrometry with triple quadrupole mass detectors. The calves developed mild to moderate signs of respiratory disease and, with the exception of one MEL-treated and one ASA-treated calf, limited lung lesions. None of the treatments had a significant effect on virus replication, clinical signs or lung lesion extent. Relative to controls, both treatments initially induced a downregulation of proteins in BAL. Immunoglobulin (Ig)-related proteins, such as the Ig kappa and lambda locus and the joining chain of IgA and IgM, were downregulated in MEL-treated calves compared to controls. In addition, meloxicam induced an increased neutrophil influx in BAL in response to BRSV, possibly related to a reduction in plasma prostaglandin, and to a downregulation of The Liver X Receptor/ Retinoid X Receptor (LXR/RXR), the Farnesoid X Receptor (FXR)/RXR and the 24-Dehydrocholesterol Reductase (DHC24) signalling pathways in the lung. The risk of NSAIDs to increase neutrophil activity during stimulation with BRSV or other toll-like receptor 4 agonists needs to be investigated further. Since augmented neutrophil responses can be detrimental, the results of the present study do not support the use of NSAIDs to prevent the clinical expression of BRSV-infection.

Cancer screening programs are carried out worldwide and in our country to diagnose breast cancer in its early stage, before the disease shows any symptoms. In this study, we aimed to evaluate the knowledge, attitudes, and behaviors of non-physician healthcare professionals about breast cancer screening programs. This study was planned as a cross-sectional survey study, nurses and female non-physician hospital staff from different professions were included. In addition to primary demographic data, various questions were asked to the participants to evaluate their knowledge about breast cancer screening programs and compliance with breast cancer screening programs, and then the data were analyzed. A total of 332 volunteers were included in our study. 317 (95.5%) of them stated that they had heard of the Cancer Early Diagnosis, Screening, and Education Centers (KETEM) before. When asked whether cancer screenings were essential, 327 (98.5%) of the volunteers answered "Yes," considering it is essential, and thus it was thought that non-physician healthcare professionals had a high awareness of this issue. Fifty (15.1%) of the non-physician healthcare professionals stated that they regularly performed breast self-exams once a month, 83 (25.0%) did not do any breast examination, and 154 (46.4%) did it sporadically. Of the population, 66 people were 40 years and older. In this population, 33 (50.0%) of the participants answered "Yes" to the question "Have you ever had a mammogram?"; whereas 33 (50.0%) of them answered "No." In general, the awareness of the participants was high, but it was thought that their level of knowledge about breast cancer screening was insufficient. In addition, it was observed that the compliance rates to cancer screening programs were insufficient. Therefore, an absolute effort should be made to increase the knowledge and awareness of health professionals who play an essential role in public health. [Med-Science 2023; 12(2.000): 527-31]

Background. Depression is a common disorder in rheumatoid arthritis (RA) patients and can affect clinical outcomes. This study was conducted to determine the prevalence of depression and its relationship with disease activity in RA patients. Methods. In this cross-sectional study, 144 patients with RA were recruited from the Rheumatology Outpatients Clinic, Mostafa Khomeini Hospital Ilam, and were examined for disease activity and depression symptoms. Disease activity was assessed by DAS28 using laboratory tests and physical examination. The Beck self-report questionnaire was used for measuring depression disorder. Data were analyzed using the linear regression models in STATA 14 software. Results. The prevalence of depression in the sample was 61%. Multivariate analyses showed that patients with severe disease activity faced a significantly greater risk of depression compared to those with mild disease activity. Average levels increased by about 12.43 points in depression for patients with severe disease activity compared to those with mild disease activity. This association was statistically significant after adjusting for the model's other predictors (P

Abstract This study aimed to assess the human health risk of some toxic metals/metalloids [lead (Pb), mercury (Hg), cadmium (Cd), nickel (Ni), chromium (Cr), and arsenic (As)] on infants via consumption of the breast milk of women living in urban areas of Kermanshah city, west of Iran. After collecting milk samples, the carcinogenic and non-carcinogenic risk assessment as well as uncertainty analysis of toxic metal levels were carried out. The order of concentration of heavy metals/metalloids in the breast milk samples was Cr (41.07 ± 23.19) > Ni (19.25 ± 11.81) > Pb (11.5 ± 4.48) > As (1.96 ± 2.04) > Cd (.72 ± 0.42) > Hg (0.31 ± 0.26). The results revealed that the levels of Cr and Pb in the breast milk samples were exceeded the World Health Organization (WHO) tolerable daily intake. In the breast milk samples a high levels of one of the trace elements As, Cd, Cr, Pb, and Ni were observed (over 73%) and in 40% of them the levels of Cr, Pb, Cd, As, and Ni were all above WHO tolerable daily intake. Moreover, the As-related point assessment of target risk factor (THQ) was higher than the allowable limit only for 1-month-old male neonates and 2-month-old female neonates (THQ > 1). In addition, Cr-related THQ scores were higher at all age and gender groups (THQ > 1). In conclusion, our findings suggest a potential risk of some metals for infants via the consumption of mothers' breast milk.

Background Human mpox is a viral disease caused by an Orthopoxvirus, human mpox virus (hMPXV), typically causing fever and a rash. Mpox has historically been endemic to parts of Central and West Africa, with small numbers of imported cases reported elsewhere, but starting May 2022 an unprecedented global outbreak caused by clade IIb hMPXV was reported outside traditionally endemic countries. This prompted the initiation of MOSAIC, a cohort study implemented in Europe and Asia that aims to describe clinical and virologic outcomes of PCR-confirmed hMPXV disease, including those who receive antiviral therapy. The focus of this article, however, is on describing the study protocol itself with implementation process and operational challenges. Methods MOSAIC recruits participants of any age with laboratory-confirmed mpox disease who provide informed consent. Participants enrol in the cohort for a total of six months. Blood, lesion and throat samples are collected at several timepoints from the day of diagnosis or the first day of treatment (Day 1) until Day 28 for PCR detection of hMPXV. Clinical data are collected by clinicians and participants (via a self-completion questionnaire) for six months to characterize the signs and symptoms associated with the illness, as well as short- and more long-term outcomes. Discussion The design and prompt implementation of clinical research response is key in addressing emerging outbreaks. MOSAIC began enrolment within two months of the start of the international mpox epidemic. Enrolment has been stopped and the last follow-up visits are expected in January 2024. ICTRP registration EU CT number: 2022-501132-42-00 (22/06/2022)

Background Human mpox is a viral disease caused by an Orthopoxvirus, human mpox virus (hMPXV), typically causing fever and a rash. Mpox has historically been endemic to parts of Central and West Africa, with small numbers of imported cases reported elsewhere, but starting May 2022 an unprecedented global outbreak caused by clade IIb hMPXV was reported outside traditionally endemic countries. This prompted the initiation of MOSAIC, a cohort study implemented in Europe and Asia that aims to describe clinical and virologic outcomes of PCR-confirmed hMPXV disease, including those who receive antiviral therapy. The study is ongoing. Methods MOSAIC recruits participants of any age with laboratory-confirmed mpox disease who provide informed consent. Participants enrol in the cohort for a total of six months. Blood, lesion and throat samples are collected at several timepoints from the day of diagnosis or the first day of treatment (Day 1) until Day 28 for PCR detection of hMPXV. Clinical data are collected by clinicians and participants (via a self-completion questionnaire) for six months to characterize the signs and symptoms associated with the illness, as well as short- and more long-term outcomes. Discussion The design and prompt implementation of clinical research response is key in addressing emerging outbreaks. MOSAIC began enrolment within two months of the start of the international mpox epidemic. While the number of cases is now low, the study remains open for inclusion. ICTRP registration EU CT number: 2022-501132-42-00 (22/06/2022)

Abstract Background Parkinson's disease (PD) is one of the most common neurodegenerative conditions in the world and, when combined with dementia, can lead to immense cerebral volume loss. Of significant importance among all cerebral regions, is the hippocampus. This region plays a pivotal role in memory, and understanding its pathological alterations can answer vital questions regarding dementia. As such, we designed this study to compare the hippocampal volumes of PD patients with dementia (PDD) versus PD without dementia. Methods PubMed, Web of Science, Scopus, and Embase were searched for relevant studies. We also searched the references sections of all included studies. The original search began in March 2022 and was extended to the end of July 2022. All related data were extracted from the studies. If the studies were conducted on patients from comparable patient groups, the most recent study with the most extensive data set would be included. Results A statistically significant difference was observed comparing the raw hippocampal volumes in participants with PDD and PD (p value = 0.01). In a comparison of normalized hippocampal volume between PDD and PD, there was a statistically significant difference (p value

Abstract We aimed to construct a prediction model based on computed tomography (CT) radiomics features to classify COVID-19 patients into severe-, moderate-, mild-, and non-pneumonic. A total of 1110 patients were studied from a publicly available dataset with 4-class severity scoring performed by a radiologist (based on CT images and clinical features). The entire lungs were segmented and followed by resizing, bin discretization and radiomic features extraction. We utilized two feature selection algorithms, namely bagging random forest (BRF) and multivariate adaptive regression splines (MARS), each coupled to a classifier, namely multinomial logistic regression (MLR), to construct multiclass classification models. The dataset was divided into 50% (555 samples), 20% (223 samples), and 30% (332 samples) for training, validation, and untouched test datasets, respectively. Subsequently, nested cross-validation was performed on train/validation to select the features and tune the models. All predictive power indices were reported based on the testing set. The performance of multi-class models was assessed using precision, recall, F1-score, and accuracy based on the 4 × 4 confusion matrices. In addition, the areas under the receiver operating characteristic curves (AUCs) for multi-class classifications were calculated and compared for both models. Using BRF, 23 radiomic features were selected, 11 from first-order, 9 from GLCM, 1 GLRLM, 1 from GLDM, and 1 from shape. Ten features were selected using the MARS algorithm, namely 3 from first-order, 1 from GLDM, 1 from GLRLM, 1 from GLSZM, 1 from shape, and 3 from GLCM features. The mean absolute deviation, skewness, and variance from first-order and flatness from shape, and cluster prominence from GLCM features and Gray Level Non Uniformity Normalize from GLRLM were selected by both BRF and MARS algorithms. All selected features by BRF or MARS were significantly associated with four-class outcomes as assessed within MLR (All p values

Background: Given the increasing emphasis to the role of renal stone in increasing blood pressure and the limited number of studies of this nature, the current study aimed to assess the correlation between blood pressure and renal calculi in children.Methods: This cross-sectional study was performed on 330 children aged 5 to 18 years (110 with renal stones and 220 healthy children). After confirming the status of renal stones by ultrasound, children's blood pressure was measured and divided into four classes according to the last update of AAP 2017: normal blood pressure, elevated hypertension, grade 1 and grade 2 hypertension. The odds ratio by logistic regression was used to investigate the relationship between renal stone and blood pressure statuses of children.Findings: There was no significant differences between two groups in terms of systolic blood pressure. The children with renal stone had significantly more abnormal diastolic blood pressure than healthy children. About 37.3% of children with renal stone had a parental history of hypertension that was significantly different from healthy children. The odds ratio was 2.69 (95% CI: 1.34, 3.88) for association between diastolic blood pressure status and renal stone.Conclusion: Abnormal blood pressure, especially of the diastolic type, is higher in children with renal stones than in healthy children. Based on this finding, measuring blood pressure is necessary in children with renal stones to prevent further complications is highly recommended.

ObjectivesThis study described the demographic characteristics, clinical presentation, treatment, and outcomes of solid organ transplant recipients who were admitted to our center for infection. It also determined factors associated with a poor outcome, and compares early and late period infections.MethodsIn this retrospective observational study, conducted at a tertiary care center in France between October 2017 and March 2019, infectious outcomes of patients with solid organ transplant where studied.ResultsA total of 104 patients were included with 158 hospitalizations for infection. Among these 104 patients, 71 (68%) were men. The median age was 59 years old. The most common symptoms on admission were fever (66%) and chills (31%). Lower respiratory tract infections were the most common diagnosis (71/158 hospitalizations). Urinary tract infections were frequently seen in kidney transplant recipients (25/60 hospitalizations). One or more infectious agents were isolated for 113 hospitalizations (72%): 70 bacteria, 36 viruses and 10 fungi, with predominance of gram-negative bacilli (53 cases) of which 13 were multidrug-resistant. The most frequently used antibiotics were third generation cephalosporins (40 cases), followed by piperacillin-tazobactam (26 cases). We note that 25 infections (16%) occurred during the first 6 months (early post-transplant period). Patients admitted during the early post-transplant period were more often on immunosuppressive treatment with prednisone (25/25 VS 106/133) (p = 0.01), mycophenolic acid (22/25 VS 86/133) (p = 0.03), presented for an urinary tract infection (10/25 VS 25/133) (p = 0.04) or a bacterial infection (17/25 VS 53/133) (p = 0.01). Patients with later infection had more comorbidities (57/83 VS 9/21) (p = 0.03), cancer (19/83 VS 0/21) (p = 0.04) or were on treatment with everolimus (46/133 VS 0/25) (p = 0.001). During 31 hospitalizations (20%), patients presented with a serious infection requiring intensive care (n = 26; 16%) or leading to death (n = 7; 4%). Bacteremia, pulmonary and cardiac complications were the main risk factors associated with poor outcome.ConclusionInfections pose a significant challenge in the care of solid organ transplant patients, particularly those with comorbidities and intensive immunosuppression. This underscores the crucial importance of continuous surveillance and epidemiologic monitoring within this patient population.

This study assessed the effects of concurrent intra-articular injection and Tibial Plateau Leveling Osteotomy (TPLO) plate surface treatment with leukoreduced platelet rich plasma (lPRP) on outcomes of dogs undergoing TPLO. A retrospective study of medical records for cases presenting from January 2018 to December 2020 was performed. Client-owned dogs with naturally occurring cranial cruciate ligament rupture that underwent TPLO surgery were divided into two groups. The lPRP group included cases that underwent intra-articular injection and plate surface treatment at the time of their TPLO. The control group (C) underwent TPLO without PRP treatment. Data analyzed included: presence of surgical site infection, implant removal rate, degree of change in OA progression score, lameness score progression and radiographic bone healing. The short- and long-term complication rate, hospitalization and antibiotic therapy were also compared between the groups. Descriptive statistics, comparison analyses (Chi square test, t-test, Fisher's exact test) and multi-level logistic regression models were used for statistical analysis. A total of 110 cases met the study inclusion criteria: 54 = lPRP, 56 = C. There were no significant differences between groups with regard to gender, age, presence of meniscal tear, weight, or body condition score. Significant findings included: improved radiographic healing of the osteotomy in the lPRP group, improved global OA scores in the lPRP group, and improved lameness score at recheck examination in the lPRP group. There was no significant difference between the lPRP and C group with regard to surgical site infection and implant removal rate. Concurrent intra-articular injection and plate surface treatment with leukocyte reduced PRP at the time of TPLO, is beneficial in slowing the progression of OA, hastening the radiographic evidence of osteotomy healing, and improved lameness score on recheck examination. Leukocyte reduced PRP was not a significant factor in reducing SSI or implant removal rate.

This study assessed the effects of concurrent intra-articular injection and Tibial Plateau Leveling Osteotomy (TPLO) plate surface treatment with leukoreduced platelet rich plasma (lPRP) on outcomes of dogs undergoing TPLO. A retrospective study of medical records for cases presenting from January 2018 to December 2020 was performed. Client-owned dogs with naturally occurring cranial cruciate ligament rupture that underwent TPLO surgery were divided into two groups. The lPRP group included cases that underwent intra-articular injection and plate surface treatment at the time of their TPLO. The control group (C) underwent TPLO without PRP treatment. Data analyzed included: presence of surgical site infection, implant removal rate, degree of change in OA progression score, lameness score progression and radiographic bone healing. The short- and long-term complication rate, hospitalization and antibiotic therapy were also compared between the groups. Descriptive statistics, comparison analyses (Chi square test, t-test, Fisher’s exact test) and multi-level logistic regression models were used for statistical analysis. A total of 110 cases met the study inclusion criteria: 54 = lPRP, 56 = C. There were no significant differences between groups with regard to gender, age, presence of meniscal tear, weight, or body condition score. Significant findings included: improved radiographic healing of the osteotomy in the lPRP group, improved global OA scores in the lPRP group, and improved lameness score at recheck examination in the lPRP group. There was no significant difference between the lPRP and C group with regard to surgical site infection and implant removal rate. Concurrent intra-articular injection and plate surface treatment with leukocyte reduced PRP at the time of TPLO, is beneficial in slowing the progression of OA, hastening the radiographic evidence of osteotomy healing, and improved lameness score on recheck examination. Leukocyte reduced PRP was not a significant factor in reducing SSI or implant removal rate.

Background and Aim: Considering the importance of childhood obesity and easier correction of related factors in this age group, the present study aimed to investigate the role of some factors related to family, nutrition, and lifestyle on childhood obesity. Methods & Materials: This age-matched case-control study was performed on 150 obese and 150 healthy children, aged 2-15 years referring to Amir-Kabir Hospital in Arak City, Iran. Obesity was calculated based on Body Mass Index (BMI). Required information, including family factors, nutritional factors, and lifestyle characteristics were collected by a checklist. Ethical Considerations: This study was approved by the Ethics Committee of Arak University of Medical Sciences (Code: IR.ARAKMU.REC.1396.119). Results The results of Odds Ratio (OR) with 95% of Confidence Interval (CI) were in favor of father’s age of 25-35 and over 35 years (0.24), respectively, father’s overweight and obesity (3.87 and 3.57), mother’s overweight and obesity (3.81 and 5.5)7, more than three children per household (3.33), low and high consumption of fruits and vegetables (0.3 and 0.19), breakfast eating (0.43), dietary supplementation (2.68), consuming fast food (3.98), more than two hours of playing a computer game (3.5), chewing well (0.38), using food as a reward (1.89), as well as participating in food and table preparation (3.14). We found a dose-response association between children’s obesity and parents’ BMI, the number of children, and computer games. Conclusion: Obesity is associated with some factors related to the family, such as nutrition, computer games, and lifestyle characteristics. Due to various risk factors and adjustable safeguards, it is necessary to provide families and children with proper education to reduce obesity.

Background and purpose: Cardiac magnetic resonance imaging (MRI) is a costly method to assess cardiac iron overload. The presence of fragmented QRS (fQRS) indicates changes due to iron overload in cardiac tissue. The aim of this study was to evaluate the correlation between fQRS and cardiac iron overload using cardiac MRI in patients with β-thalassemia major (β-TM). Materials and methods: This analytical cross-sectional study was conducted in 40 β-TM patients admitted to Arak Amir-Kabir Hospital, Iran 2018-2019. Cardiac T2* MRI was performed and values of less than 20 ms were considered as cardiac iron overload. The patients were divided into two groups (20 ms). The presence of fQRS was assessed on 12-lead surface electrocardiogram (ECG) and compared between two groups. Results: There was a positive correlation between T2*MRI and serum ferritin (r= 0.041, P=0.657) and hemoglobin levels (r=0.057, P=0.540). The mean T2*MRI in patients with fQRS (18.43±7.24) was significantly lower than patients without fQRS (26.47±6.15) (P=0.001). We found a negative correlation between T2*MRI and fQRS (r= -0.048, P=0.001). Conclusion: The presence of fQRS on ECGs could be a good predictor of cardiac iron overload in β-TM patients. It is believed that fQRS can indicate this change in electrocardiography and shows the need for more accurate monitoring for cardiac overload and aggressive chelation therapy.

Background and purpose: Pulmonary problem is one of the non-cardiac causes of exertional chest pain in children. The aim of this study was to evaluate and compare pulmonary function in children with exertional chest pain during rest. Materials and methods: This descriptive analytical cross sectional study was conducted in 200 children aged 10-15 years old in Arak, Iran 2018. The case group (n=100) included children with exertional chest pain and control group (n=100) were healthy children (without exertional chest pain). Respiratory function was assessed using spirometry after complete training and one test session. Data analysis was done in Stata 11. Results: The mean values for forced expiratory volume in the first second (FEV1), the forced vital capacity (FVC), FEV1/FVC, and peak expiratory flow (PEF) were 3.98±1.56 and 4.31±2.1 L/s, 4.81±2.16 and 5.2±2.8 L, 0.73±0.13 and 0.75±0.11, and 6.89±1.65 and 7.24±1.59 L/m in case group and healthy group, respectively. The values did not show significant differences between the two groups (P=0.209, P=0.272, P=0.242, and P=0.128, respectively). Conclusion: According to current study, spirometry evaluation in children with exertional chest pain during rest does not seem to be helpful for diagnosis of exercise-induced bronchospasm.

Background and purpose: Chest pain is the most prevalent reason for referral to pediatric cardiologist. The condition is mainly associated with non-cardiac disorders such as ribs and cartilaginous problems, trauma, muscle elongation, and pulmonary causes. This study was conducted to evaluate the association between low calcium and vitamin D levels and musculoskeletal chest pain in children. Materials and methods: This age and gender matched case-control study, was conducted in 100 children (5-15 years of age) with chest pain and 100 healthy controls in Amir Kabir Hospital, Arak, Iran 2019. Informed consent was obtained from all participants and the levels of calcium and Vitamin D were evaluated. Data analysis was done in SPSS V11. Results: The mean values for age, height, and weight were not significantly different between the cases and controls. The mean calcium levels in children with chest pain and healthy control were 9.39±0.83 and 9.26±0.6, respectively (P=0.206). The mean levels of Vitamin D in children with chest pain and in healthy controls were 22.51±4.96 and 40.33±9.81, respectively indicating significant differences between the two groups (P=0.002). The Odds Ratio (OR) of association between vitamin D deficiency and chest pain was 7.63 (95% CI: 3.86-15.23). Conclusion: The study suggests an association between vitamin D deficiency and chest pain in children, so, evaluation of Vitamin D is needed in children with musculoskeletal chest pain.

Background and Aim: Considering the importance of childhood obesity and easier correction of related factors in this age group, the present study aimed to investigate the role of some factors related to family, nutrition, and lifestyle on childhood obesity. Methods & Materials: This age-matched case-control study was performed on 150 obese and 150 healthy children, aged 2-15 years referring to Amir-Kabir Hospital in Arak City, Iran. Obesity was calculated based on Body Mass Index (BMI). Required information, including family factors, nutritional factors, and lifestyle characteristics were collected by a checklist. Ethical Considerations: This study was approved by the Ethics Committee of Arak University of Medical Sciences (Code: IR.ARAKMU.REC.1396.119). Results The results of Odds Ratio (OR) with 95% of Confidence Interval (CI) were in favor of father’s age of 25-35 and over 35 years (0.24), respectively, father’s overweight and obesity (3.87 and 3.57), mother’s overweight and obesity (3.81 and 5.5)7, more than three children per household (3.33), low and high consumption of fruits and vegetables (0.3 and 0.19), breakfast eating (0.43), dietary supplementation (2.68), consuming fast food (3.98), more than two hours of playing a computer game (3.5), chewing well (0.38), using food as a reward (1.89), as well as participating in food and table preparation (3.14). We found a dose-response association between children’s obesity and parents’ BMI, the number of children, and computer games. Conclusion: Obesity is associated with some factors related to the family, such as nutrition, computer games, and lifestyle characteristics. Due to various risk factors and adjustable safeguards, it is necessary to provide families and children with proper education to reduce obesity.

Background and purpose: Plasmid-medicated quinolone resistance (PMQR) genes play an important role in resistance to quinolones. The aim of this study was to determine the frequency of PMQR genes in extended-spectrum β-lactamase-producing (ESBL) Escherichia coli. Materials and methods: This study was done on 240 isolates of E.­coli from urine samples of patients in Kermanshah, Iran. The susceptibility of isolates to selected antibiotics was tested using disc diffusion and broth microdilution methods. The isolates were screened for ESBL-producing phenotype by combined disc diffusion test. The qnrA, qnrB, qnrS, aac (6­')­-­Ib, and qepA genes were detected by PCR. All PCR products for aac­(6')­-Ib gene were digested by BtsCI for detection of aac­(6')­-Ib-cr variant. Data analysis was done using statistical methods. Results: Of 66 ESBL-producing isolates, 45 (68.1%) were resistant to ciprofloxacin and levofloxacin and 56 (84.8%) were found to be resistant to nalidixic acid. The qnrA, qnrB, qnrS, and qepA genes were detected in 28.7%, 40.9%, 4.5%, and 3% of the isolates, respectively. The aac­(6')­-Ib gene was found in 65.1% of the isolates amongst which 88.4% were aac­(6')­-Ib-cr variant. Conclusion: Our results indicate a high prevalence of PMQR genes in ESBL-producing E.coli isolates in Kermanshah. A correlation was observed between resistance to beta-lactams and quinolones which may indicate the cotransfer of quinolone genes by plasmids carrying the ESBL. As a result, identifying E. coli strains with ESBL may indicate a high resistance to quinolones. So, before using quinolones, the screening test for ESBL is recommended to prevent the increasing resistance to this class of drugs.

Background: Diabetes mellitus can lead to structural disorders in the brain. Aloe vera has antidiabetic, antioxidant, and neuroprotective effects. This study was designed to evaluate the effects of Aloe vera gel on the morphometric changes in the brain of streptozotocin-induced diabetic rats. Methods: 25 male Wistar rats were randomly divided into 5 groups including: control (normal saline), diabetic (normal saline), Aloe vera gel (400 mg/kg/day; gavage), diabetic + Aloe vera gel (400 mg/kg/day; gavage) and diabetic + Neutral Protamine Hagedorn (NPH) insulin (10 IU/kg/day; subcutaneous). Experimental diabetes was induced by streptozotocin injection (60 mg/kg; intraperitoneal). All groups treated for 8 weeks. At the end of treatment course, the rats' brains were removed intact immediately after sacrifice for morphometric measuring by caliper. Histological brain sections were also prepared to assess morphometry of cerebral cortex and hippocampus via ammonium iron (III) sulfate staining. Findings: Diabetes induction reduced weight and dimensions of brain, and diameters of the hippocampus, and white and gray matter of cerebral cortex compared to the control group after 8 weeks (P < 0.05); while treatment of diabetic rats with Aloe vera gel or insulin significantly decreased the structural alterations of the brain and improved the blood glucose level of diabetic rats (P < 0.05). Conclusion: The results showed that oral administration of Aloe vera gel in diabetic rats improves structural disorders of brain and ameliorates diabetes-induced hyperglycemia.

Background and purpose: Iran is one of the endemic focuses of cutaneous leishmaniasis (CL) in the world. The disease is commonly seen in some tropical regions of Kermanshah province (West of Iran). In this study, patients with CL were diagnosed and identified using RFLP-PCR and DNA sequencing. Materials and methods: In this descriptive study all suspected cases of CL attended a clinic affiliated with Kermanshah University of Medical Sciences in 2015 were diagnosed by microscopic and molecular methods. The Leishmania species were identified by PCR-RFLP and genomic sequencing. Results: There were 65 patients of whom 47 (72.3%) were detected as CL including 64.6% males and 35.4% females. Among the patients 49.2% were resided in Kermanshah, and 50.8% lived in other cities of the province. It was found that 47.7% of the patients had history of travel to other provinces in previous months. Leishman bodies were detected in 50.8% and 72.3% of the patients by microscopic observation and PCR technique, respectively. By RFLP-PCR, 14.9% and 84.1% of positive samples were identified as Leishmania tropica and Leishmania major, respectively. The PCR product sequences of 5 samples confirmed the results of PCR-RFLP in identification of the Leishmania species. Conclusion: Leishmania major is the main cause of CL in Kermanshah province. PCR is believed to be more sensitive than microscopic method for detection of CL and RFLP-PCR is an appropriate technique for identification of Leishmania species.

Brain stimulation modulates the excitability of neural circuits and drives neuroplasticity. While the local effects of stimulation have been an active area of investigation, the effects on large-scale networks remain largely unexplored. We studied stimulation-induced changes in network dynamics in two macaques. A large-scale optogenetic interface enabled simultaneous stimulation of excitatory neurons and electrocorticographic recording across primary somatosensory (S1) and motor (M1) cortex (Yazdan-Shahmorad et al., 2016). We tracked two measures of network connectivity, the network response to focal stimulation and the baseline coherence between pairs of electrodes; these were strongly correlated before stimulation. Within minutes, stimulation in S1 or M1 significantly strengthened the gross functional connectivity between these areas. At a finer scale, stimulation led to heterogeneous connectivity changes across the network. These changes reflected the correlations introduced by stimulation-evoked activity, consistent with Hebbian plasticity models. This work extends Hebbian plasticity models to large-scale circuits, with significant implications for stimulation-based neurorehabilitation.

Introduction: Nursing concepts has been developed and made in academic education. Nursing education in Iran has experienced many ups and downs by far. Once viewed as a technical discipline, nursing has changed to the paradigm of nursing as a science and as an art. It has become a university discipline in Iran also but the quality of nursing care and clinical knowledge transfer faced serious challenges. In this study we explore the challenges in four areas of teacher, student, lesson plans, and teaching environment. Methods: This review article was developed through searching scientific databases and literature published during 1995-2013 on academic education of nursing discipline in Iran. Search engines and databases used in this study were Elsevier, Wiley Blackwell, PubMed, Iran Medex, SID, and Medlib. Totally 60 articles in this field were retrieved and according to their appropriateness with challenges in academic nursing education, 19 articles were used in the study. Results: The most important challenges in nursing education were as follows: there are no fundamental concepts of nursing in lesson plans in bachelors’ level and the dominant biomedical paradigm in lessons, moves students toward becoming a physician assistant. Professional attitude of nursing teachers are far different from ideal conditions expected in nursing and the academic image provided by teachers is not identical to a clinical nursing image. Nursing students also do not have an appropriate attitude toward their own profession to the extent that they know nursing as a job, and not as an evolutionary specific profession. Academic environment also, not only doesn’t develop critical thinking but also suppresses this ability. Conclusion: The consequences of ineffective academic education in Iran are: lack of applicable knowledge for dealing with real clinical situation, students confusion about university education inconsistency of the academic staff with clinical staff, and failure to view the proper image of nursing by clients and community. With regard to the before mentioned challenges, it seems necessary to invest on academic nursing education in order to solve these problems.

BACKGROUND AND OBJECTIVES: The rate of consanguineous marriage is high in Middle Eastern countries such as Iran. The relationship between consanguineous marriage and congenital heart disease is discussed in some studies, but there is not much data for relationship between atrial septal defect (ASD) and consanguineous marriage. The aim of this study was to evaluate the relationship between consanguineous marriage and ASD echocardiographic characteristics. DESIGN AND SETTINGS: This was a cross-sectional study approved by Mashhad University of Medical Sciences ethics committee and took place in Mashhad, Iran, for a period of 3 years from August 2008 till September 2011. METHODS: In this cross-sectional study, 113 ASD patients participated and they were categorized into 3 groups on the basis of family relationship between their parents: first group—“no relationship,”ݠsecond group— “third-degree relationship,”ݠand third group— “far relationship.”ݠRESULTS: Among the 54 male and 59 female ASD patients, the most prevalent type of ASD was ASD secundum (85.0%) followed by sinus venosus (8.8%). A total of 56% patients were present in the first group and 15% and 29% in the second group and the third group, respectively. The relationship between consanguinity and type of ASD (P

Objective: Recently, development of multifunctional contrast agent for effective targeted molecular computedtomography (CT) imaging of cancer cells stays a major problem. In this study, we explain the ability of Triptorelinpeptide-targeted multifunctional bismuth nanoparticles (Bi2S3@ BSA-Triptorelin NPs) for molecular CT imaging.Materials and Methods: In this experimental study, the formed nanocomplex of Bi2S3@ BSA-Triptorelin NPswas characterized using different methods. The MTT cytotoxicity test was performed to determine the appropriateconcentration of nanoparticles in the MCF-7 cells. The X-ray attenuation intensity and Contrast to Noise Ratio (CNR) oftargeted and non-targeted nanoparticles were measured at the concentrations of 25, 50, and 75 μg/ml and X-ray tubevoltages of 90, 120 and 140 kVp.Results: We showed that the formed Bi2S3@ BSA-Triptorelin NPs with a Bi core size of approximately ~8.6 nm are nontoxicin a given concentration (0-200 μg/ml). At 90, 120, and 140 tube potentials (kVp), the X-ray attenuation of targeted cells were1.35, 1.36, and 1.33-times, respectively, more than non-targeted MCF-7cells at the concentration of 75 μg/ml. The CNRvalues at 90, 120, and 140 kVp tube potentials were 171.5, 153.8 and 146.3 c/ϭ, respectively.Conclusion: These findings propose that the diagnostic nanocomplex of Bi2S3@ BSA-Triptorelin NPs can be appliedas a good contrast medium for molecular CT techniques.

Definitions of resistance in multidrug-resistant tuberculosis (MDR TB) and extensively drug-resistant tuberculosis (XDR TB) have been updated. Pre–XDR TB, defined as MDR TB with additional resistance to fluoroquinolones, and XDR TB, with additional resistance to bedaquiline or linezolid, are frequently associated with treatment failure and toxicity. We retrospectively determined the effects of pre-XDR/XDR TB resistance on outcomes and safety of MDR TB treatment in France. The study included 298 patients treated for MDR TB at 3 reference centers during 2006–2019. Of those, 205 (68.8%) cases were fluoroquinolone-susceptible MDR TB and 93 (31.2%) were pre-XDR/XDR TB. Compared with fluoroquinolone-susceptible MDR TB, pre-XDR/XDR TB was associated with more cavitary lung lesions and bilateral disease and required longer treatment. Overall, 202 patients (67.8%) had favorable treatment outcomes, with no significant difference between pre-XDR/XDR TB (67.7%) and fluoroquinolone-susceptible MDR TB (67.8%; p = 0.99). Pre-XDR/XDR TB was not associated with higher risk for serious adverse events.

Abstract Background Combination prevention is currently considered the best approach to combat HIV epidemic. It is based upon the combination of structural, behavioral, and biomedical interventions. Such interventions are frequently implemented in a health-promoting manner due to their aims, the approach that was adopted, and their complexity. The impact evaluation of these interventions often relies on methods inherited from the biomedical field. However, these methods have limitations and should be adapted to be relevant for these complex interventions. This systematic review aims to map the evidence-based methods used to quantify the impact of these interventions and analyze how these methods are implemented. Methods Three databases (Web of Science, Scopus, PubMed) will be used to identify impact evaluation studies of health promotion interventions that aimed at reducing the incidence or prevalence of HIV infection. Only studies based on quantitative design assessing intervention impact on HIV prevalence or incidence will be included. Two reviewers will independently screen studies based on titles and abstracts and then on the full text. The information about study characteristics will be extracted to understand the context in which the interventions are implemented. The information specific to quantitative methods of impact evaluation will be extracted using items from the Mixed Methods Appraisal Tool (MMAT), the guidelines for reporting Statistical Analyses and Methods in the Published Literature (SAMPL), and the guidelines for Strengthening The Reporting of Empirical Simulation Studies (STRESS). This review will be conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Discussion The impact evaluation of HIV prevention interventions is a matter of substantial importance given the growing need for evidence of the effectiveness of these interventions, whereas they are increasingly complex. These evaluations allow to identify the most effective strategies to be implemented to fight the epidemic. It is therefore relevant to map the methods to better implement them and adapt them according to the type of intervention to be evaluated. Systematic review registration PROSPERO CRD42020210825

Abstract COVID-19 can cause acute respiratory distress syndrome, leading to death in many individuals. Evidence of a deleterious role of the innate immune system is accumulating, but the precise mechanisms involved remain unclear. In this study, we investigated the links between circulating innate phagocytes and severity in COVID-19 patients. We performed in-depth phenotyping of neutrophil and monocyte subpopulations and measured soluble activation markers in plasma. Additionally, anti-microbial functions (phagocytosis, oxidative burst, and NETosis) were evaluated on fresh cells from patients. Neutrophils and monocytes had a strikingly disturbed phenotype, and elevated concentrations of activation markers (calprotectin, myeloperoxidase, and neutrophil extracellular traps) were measured in plasma. Critical patients had increased CD13low immature neutrophils, LOX-1 + and CCR5 + immunosuppressive neutrophils, and HLA-DRlow downregulated monocytes. Markers of immature and immunosuppressive neutrophils were strongly associated with severity. Moreover, neutrophils and monocytes of critical patients had impaired antimicrobial functions, which correlated with organ dysfunction, severe infections, and mortality. Together, our results strongly argue in favor of a pivotal role of innate immunity in COVID-19 severe infections and pleads for targeted therapeutic options.

Abstract Background Vaccination is expected to change the epidemiology and management of SARS-CoV-2 epidemics. Methods We used an age-stratified compartmental model calibrated to French data to anticipate these changes and determine implications for the control of an autumn epidemic. We assumed vaccines reduce the risk of hospitalization, infection, and transmission if infected by 95%, 60%, and 50%, respectively. Results In our baseline scenario characterized by basic reproduction number R0=5 and a vaccine coverage of 70–80–90% among 12–17, 18–59, and ≥ 60 years old, important stress on healthcare is expected in the absence of measures. Unvaccinated adults ≥60 years old represent 3% of the population but 43% of hospitalizations. Given limited vaccine coverage, children aged 0–17 years old represent a third of infections and are responsible for almost half of transmissions. Unvaccinated individuals have a disproportionate contribution to transmission so that measures targeting them may help maximize epidemic control while minimizing costs for society compared to non-targeted approaches. Of all the interventions considered including repeated testing and non-pharmaceutical measures, vaccination of the unvaccinated is the most effective. Conclusions With the Delta variant, vaccinated individuals are well protected against hospitalization but remain at risk of infection and should therefore apply protective behaviors (e.g., mask-wearing). Targeting non-vaccinated individuals may maximize epidemic control while minimizing costs for society. Vaccinating children protects them from the deleterious effects of non-pharmaceutical measures. Control strategies should account for the changing SARS-CoV-2 epidemiology.

Introduction: Non shivering thermogenesis is partly yielded by a futile-calcium-cycle mechanism that is regulated by Sarco/Endoplasmic Reticulum ATPase2 (SERCA2) and Ryanodine Receptor2 (RYR2). This study aimed to investigate the effect of a high-fat diet and endurance training under near-thermoneutrality (in which humans live) on the gene expression of SERCA2 and RYR2 in inguinal subcutaneous adipose tissue in mice. Material & Methods: A total of 28 C57BL/6 male mice were assigned into four groups of seven animals per group. The groups included 1) control 2), high-fat diet (HFD), 3) endurance training (ET), and 4) HFD-ET. The environment temperature was set out at 26°C. The mice in the HFD group were fed a high-fat diet (fat=42%) for 12 weeks. The mice in the ET group underwent ET on the treadmill for six weeks. The mice of the HFD-ET had both the HFD and ET. The real-time-PCR method was used to measure the gene expression of SERCA2a, SERCA2b, and RYR2 in adipose tissue. (Ethic code: ABRU.AC.IR/15664-96.44) Findings: Two-way ANOVA showed that the relative gene expression of SERCA2a, SERCA2b, and RYR2 were not significantly affected by HFD, ET, and HFD-ET (P>0.05). Discussion & Conclusion: The HFD and ET did not change the regulatory proteins of the futile-calcium-cycle under near-thermoneutrality in the beige adipose tissue. Therefore, it was speculated that the non-shivering thermogenesis that is induced by these conditions might occur independently of futile-cycle-calcium.

Background and aims: Beta-adrenergic signaling deficiency has been established to be related to obesity and related diseases. Beta3- adrenergic receptor (Adrb3) and beta-arrestin2 (Barr2) are pivotal agents in the beta-adrenergic-signaling pathway. This study aimed to investigate the preventive effect of aerobic training on dysregulation of Adrb3 and Barr2 gene expression that was induced by high-fat diet (HFD) in inguinal white adipose tissue of mice. Materials and Methods: Twenty-one C57BL/6 mice were assigned to three groups as follows: 1) control group (n=7), 2) high-fat diet-induced overweight (HFD-OW) (n=7), and 3) high-fat diet with aerobic training (HFD-AT) (n=7). The HFD-OW group were fed with a HFD for 12 weeks. The HFD-AT group had aerobic training for six weeks on a treadmill in addition to feeding with the HFD. The real-time polymerase chain reaction (PCR) method was used to measure the gene expression of Adrb3 and Barr2 in inguinal white adipose tissue. Results: The gene expression of Adrb3 did not significantly change between groups (P>0.05). However, the expression of Barr2 in HFD-OW group was significantly increased as compared to the control group (1.5-fold: P=0.001). Interestingly, the Barr2 expression in HFD-AT group was significantly lower compared with HFD-OW group (P=0.045). Conclusion: The results indicated that aerobic training could inhibit the upregulation of Barr2 induced by HFD. It seems that a portion of the preventive effect of aerobic training on the development of obesity may be mediated by inhibiting the Barr2 expression in adipose tissue.

Background and Aim: Patent Ductus Arteriosus (PDA) is a common problem in premature neonates, especially in neonate’s low birth weight (LBW). This study aimed to compare the effectiveness of oral and intravenous ibuprofen in the management of PDA. Methods & Materials: We enrolled 40 low birth weight neonates (gestational age

Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) that causes COVID-19 disease could progress to Acute Respiratory Distress Syndrome (ARDS). The immune cells’ migration in response to the virus leads to cell death by releasing oxidizing free radicals. These oxidizing free radicals mediate NF-κB (Nuclear Factor ‘kappa-light-chain-enhancer’ of activated B-cells) activation and induce transcription of cytokine-producing genes that eventually causes cytokine storm and septic shock. The over-expression of oxidative stress and enhancing Reactive Oxygen Species (ROS) and Reactive Nitrogen Species (RNS) production activate transcription factors like NF-κB. So repeating this cycle intensifies the host’s inflammatory responses. In this way, antioxidants as compounds that inhibit oxidation by terminating chain reactions are suggested to alleviate COVID-19 symptoms. In the present review study, the pathogenesis of the virus, the virus immunopathology, and the balance between immune responses and oxidative stress are discussed. Also, in this review, due to the importance of oxidative stress in the pathogenesis of the disease, some of the most important antioxidant agents whose therapeutic effects have been shown in improving many viral infections, ARDS, and acute lung injury, are recommended to improve the patient’s condition infected with SARS-CoV-2. Besides, the recent COVID-19 clinical studies in this field are summarized in this review article. In the present review study, the pathogenesis of the virus, the virus immunopathology, and the balance between immune responses and oxidative stress are discussed. Also, in this review, due to the importance of oxidative stress in the pathogenesis of the disease, some of the most important antioxidant agents whose therapeutic effects have been shown in improving many viral infections, ARDS, and acute lung injury, are recommended to improve the patient’s condition infected with SARS-CoV-2. Besides, the recent COVID-19 clinical studies in this field are summarized in this review article. According to these studies, melatonin through promoting sleep quality, decreasing vascular permeability, reducing anxiety, and regulating blood pressure; vitamin C through decreasing the mortality rates and the requirement for mechanical ventilation; glutathione through decreasing respiratory distress in the pneumonia of COVID-19 patients; and high selenium levels could improve the COVID-19 patients’ clinical outcomes.