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HTLV-1 infection causes a chronic progressive debilitating neuroinflammatory disease which is called, HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). One of the host defense mechanisms against viral infection is apoptosis which may control HTLV-1 infection. Therefore, we aimed to investigate this process and its interaction with viral factors in HTLV-1-infected asymptomatic carriers (ACs) compared to HAM/TSP patients. Fas, FasL, TRAIL, perforin, granzyme A, granzyme B, and granulysin gene expression and serum levels of Fas, FasL, TRAIL, and granulysin in the peripheral blood of 21 sex- and age-matched healthy controls (HCs), ACs, and HAM/TSP patients were evaluated. Also, the level of granulysin secretion in the cell culture supernatant was measured. Finally, the correlation of the expression of these molecules with HTLV-1 proviral load (PVL), Tax, and HBZ mRNA expression was analyzed. ACs compared to HAM/TSP patients significantly over-expressed the Fas, FasL, TRAIL, perforin, and granzyme B molecules. Fas, FasL, TRAIL, and granulysin serum levels were not different among studied groups; whereas, the secretion of granulysin was significantly decreased in ACs and HAM/TSP patients compared to HCs. Also, HAM/TSP patients expressed higher levels of HTLV-1 PVL, Tax, and HBZ mRNA. In addition, in ACs, inverse correlations between the Fas, FasL, TRAIL, perforin, granzyme B, and granulysin levels with HBZ mRNA expression were seen. ACs compared to HAM/TSP patients over-expressed the apoptosis- and cytotoxicity-related molecules. It could be concluded that successful control of the HTLV-1 infection and suppression of HAM/TSP development stem from the strong apoptosis and cytotoxic activity in the peripheral blood of ACs.

Background: Globally, female sexual dysfunction is a serious concern based on negative family and social consequences, high side effects of medications and lack of effective treatment. Thus, the evaluation of treatment approach for this problem is an important priority for healthcare systems. Sexual life and its related disorders are considered the main aspects of a healthy lifestyle in traditional Persian medicine (TPM). Objective: The present study aimed to determine and compare the effects of food products containing Daucus carota, TPM-based training program, and a combination of these two interventions on the improvement of female sexual dysfunction. Methods: This randomized clinical trial was conducted on 96 women with sexual dysfunction based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5®), aged 18-35 years who referred to the Gynecology Clinic of Mashhad University of Medical Sciences, Mashhad, Iran, during 2016 and 2017. The patients were randomly divided into three groups (n=32) and received the intervention over an eight-week period. The first group was provided with TPM-based sexual health training, the second group received 30 g of a traditional food product (wild carrot halva: mixed Daucus carota and several herbs with honey) on a daily basis, and the third group received a combination of this traditional food product plus education. Data analysis was http://www.ephysician.ir Page 6578 performed using Chi square test, repeated measures ANOVA, two-way ANOVA, ANCOVA, post hoc Bonferroni, Friedman and Wilcoxon signed-rank test in SPSS version 11.5. Results: According to the results of this study, there was a significant difference in terms of sexual desire (p=0.002), lubrication (p=0.002), orgasm (p=0.004) and pain (p

Pericardial effusion has various underlying etiologies, and clinicians should identify those that require targeted therapy. Pericardial effusion can be drained either with needle aspiration or surgical procedures. In the following article, we opted to report the results of our 8-year experience of surgical pericardial drainage on 235 consecutive patients. We retrospectively analyzed the medical records of 235 consecutive patients with pericardial effusion and/or tamponade who were submitted to surgical drainage (subxiphoid or left anterolateral pericardiostomy) between the years 2005 and 2013. We aimed to assess the etiology of pericardial effusion, total intra- and post-procedure drainage, length of in-hospital stay, effectiveness of surgical procedures, and related in-hospital mortality. We identified 235 patients, 161 (68.51 %) with severe, 63 (26.80 %) with moderate, and 11 (4.68 %) with mild pericardial effusion. Cardiac tamponade was diagnosed in 91 (38.72 %). The most common established etiologies were idiopathic, uremic, and malignant effusion, respectively. Higher total drained volume was more common in pericardial effusions of malignant etiology than idiopathic (mean difference = 272.02, p = 0.005) or iatrogenic (mean difference = 1096.80, p = 0.001). Mean length of post-procedure drainage was 4.6 days. Intra-operative mortality was 0 % and post-operative was 0.8 % (n = 2). Assessing the data, we concluded that surgical pericardial drainage is a safe and effective method for management of adults with pericardial effusion.

Human T cell lymphotropic type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a chronic viral neuroinflammatory disease, which leads to damage of the central nervous system. Inflammatory responses and mediators are both involved in the pathogenesis of the disease and in determining its outcome. High-Mobility Group Box 1 (HMGB1) is a chromatin-associated nuclear protein acting as a signaling molecule in cells after binding to its receptors. Receptor for advanced glycation end products (RAGE) is a transmembrane multiligand receptor that binds to HMGB1. HMGB1-RAGE signaling has an important role in inflammatory and infectious diseases. Inhibition of HMGB1 activity reduces the inflammation in immune-associated diseases. In the present study, we examined the gene expressions and plasma levels of HMGB1 and its receptor RAGE in HAM/TSP patients, HTLV-1-infected asymptomatic carriers (ACs), and healthy controls. Peripheral blood mononuclear cells were collected from all the groups and complementary DNA (cDNA) was synthesized. HMGB-1 messenger RNA (mRNA) expression was quantified by real-time polymerase chain reaction (PCR) TaqMan method, and plasma levels of HMGB1 and soluble RAGE (sRAGE) were measured by enzyme-linked immunosorbent assay (ELISA). The mRNA expression of HMGB1 was the same among the groups (p 0.05). No significant difference in the plasma levels of HMGB1 was observed between the groups (p 0.05). The plasma levels of sRAGE were higher in ACs than HAM/TSP patients, and a significant difference was observed between the two groups (p 0.001). Our results showed that sRAGE could play a potential role in the control of inflammatory response in HTLV-1 carriers through the inhibition of HMGB1 signaling and potentially could be used as an indicator for evaluation of HAM/TSP developing in HTLV-1-infected individuals.

INTRODUCTION: A limited number of risky behaviors cause most morbidity and mortality. The aim of this study was to determine the possible clustering of lifestyle behaviors, including transportation behaviors, diet, physical activity, and smoking in Shiraz, Iran. METHODS: There were 776 representative Shirazi adults who participated in this cross-sectional study. The questionnaires were completed via person-to-person interviews. The datasets were searched for any clustering patterns. Cluster analysis was used for statistical analysis, and the data were analyzed using SPSS version 11.5. RESULTS: Three distinct clusters were identified. Cluster 1 was named "Healthy," and it included non-smokers, safe drivers, appropriate or acceptable fruit, vegetable, and fast-food consumers, and physically-active people. Cluster 2, "Moderately Healthy," was relatively risky drivers who had appropriate behaviors on the rest of the health-related behaviors. Cluster 3, "Unhealthy," was smokers, risky drivers, inappropriate or unacceptable fruit, vegetable & fast-food consumers, and a sedentary lifestyle. CONCLUSIONS: It was obvious that health-related behaviors were clustered together and unhealthy behaviors were not established in isolation. Language: en

BACKGROUND: Recently, the Iranian Ministry of Health estimated about 750,000 deaths are attributed smoking complications. The aim of this study was to apply the transtheoretical model (TTM) on general population of Mashhad city to evaluate the stages of change and possible cultural factors regarding smoking cessation. METHODS: This descriptive, cross-sectional population-based study was conducted in Mashhad, Iran. A total number of 562 participants selected by multistage sampling. They were asked about stages of change for smoking cessation for both hookah and cigarette smoking. Stages of change refer to an orderly sequence of changes in smoking behavior that people progress through according to the TTM. Its six stages are as follows: precontemplation (PC) (no intention to quit smoking within 6 months), contemplation (planning to quit smoking in the following 6 months), preparation (planning to stop smoking within 1 month), action (quit smoking for

Human T-cell lymphotropic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) disease is a chronic neuroinflammatory disease, which is associated with HTLV-1 infection. There is no effective and satisfactory treatment of HAM/TSP. It has been shown that curcumin exhibits modulatory effects on apoptosis and cytotoxicity-related molecules in HAM/TSP patients. In the present study, we examined the effect of curcumin on the gene expression of caspase-8, caspase-10, and anti-apoptotic protein c-FLIP, in HAM/TSP patients. Furthermore, we compared the expression of these molecules between HAM/TSP and asymptomatic carriers. Real-time PCR was performed to examine the mRNA expression of caspase-8, caspase-10, and c-FLIP in studied groups. The mRNA expression of caspase-8 and caspase-10 was similar before and after curcumin treatment in HAM/TSP patients (P > 0.05). The mRNA expression of c-FLIPL and c-FLIPs was higher after curcumin treatment compared with before treatment and significant differences were observed between the two groups (P = 0.004 and P = 0.044, respectively). The mRNA expression levels of caspase-8, caspase-10, c-FLIPL, and c-FLIPs were not statistically significant between HAM/TSP patients and asymptomatic carriers (P < 0.05). In conclusion, our results showed that curcumin increased the expression of c-FLIP in HAM/TSP patients which might suggest that, this molecule is involved in the apoptosis of HTLV-1-infected cells. Further studies with large sample size could be useful to clarify the role of this supplement in HAM/TSP patients.

Traffic injuries are becoming one of the most important challenges of public health systems. Because these injuries are mostly preventable, the aim of this study is to evaluate the four main high-risk behaviors while driving.This cross-sectional study was conducted on a random sample from the population of Mashhad, Iran, in 2014. A checklist and a previously validated questionnaire for the transtheoretical stages of change model (TTM) were used for data collection. Statistical analyses were performed using SPSS 11.5 software with P.05 statistically significant.Totally 431 individuals were included with a mean age of 30 ± 11.3 years. Forty-three percent (183) were male. The TTM model revealed that participants were mostly in pre-actional phases regarding not using a cell phone while driving (80%), fastening the driver's seat belt (66%), front seat belt (68%), and rear seat belt (85%) The penalty was a protective factor only for using cellphone (odd ratio [OR] = 0.82, 95% confidence interval [CI], 0.68-0.98). Lower education (OR = 0.12, 95% CI, 0.01-0.94) and male gender (OR = 0.35, 95% CI, 0.14-0.83) were indicative of lower rates of fastening the front and rear seat belts.The stages of change model among study participants is a proper reflection of the effectiveness of the current policies. More serious actions regarding these high-risk behaviors should be considered in legislation.

BACKGROUND: The development of public transportation (PT) is a crucial issue in the modern societies. The aim of this study was to assess the status of PT usage among the population residing in Mashhad. MATERIALS AND METHODS: In a cross-sectional design, 464 citizens of Mashhad filled a checklist about PT-use (i.e., bus, taxi, and metro) to find their supporting and opposing factors in 2014. Chi-square, Mann–Whitney, Student's t-test, and logistic regressions were used for inferential analysis in SPSS 11.5. RESULTS: Mean age was 30.02 ± 11.24 years and 57% (263) were female. Bus (169, 50%) was the most popular PT means, followed by metro (98, 29%) and taxi (74, 21%). Most transportations were happened at morning (248, 35%) and evening (221, 31%). Increasing age (odds ratio [OR] =1.04, confidence interval [CI] 95% = 1.008–1.07), higher education (OR = 2.91, CI 95% = 1.14–7.38), being homemaker (OR = 2.97, CI 95% = 1.19–7.36), or student (OR = 2.91, CI 95% = 1.14–7.38) were predictors of PT-use. CONCLUSION: Individual preference between PT and driving is associated with social, economic, and cultural aspects of a population. Recognizing the influencing factors can help to design population-oriented services.

Regular physical-activity is necessity for a healthy lifestyle. Despite public health efforts, a minority of population are involved in healthy levels of physical-activity. This study provides evidence about exercise patterns and predictors of Mashhad-Iran population according to TTM change stages. In this cross-sectional study, we surveyed a total number of 564 participants from Mashhad in 2014 by using stages of change questionnaire. Analysis showed 23.4% of participants were in pre-contemplation stage, 18 in contemplation, 24.6% in preparation, 8.10% in action, 14.4% in maintenance and 11.5% were in termination phase. Age, gender, BMI, alcohol consumption, sleep duration, having compeer and encouragement were identified as predictors of pre-contemplation stage. Genders, having company and using bicycle for transportation were predictors of termination phase. Tailor interventions based on the predictors to enhance the physical activity among specific subgroups would be of interest.

Background Insufficient information is available on the barriers that explain low rates of thrombolytic therapy for acute ischemic stroke (AIS) in developing countries compared with rates in developed societies. By the present study, we aimed to assess the implementation of thrombolytic therapy in the northeast of Iran to explore the gaps and hurdles against thrombolysis as the generally accepted treatment for AIS. Methods In a 1-year cohort study among AIS patients admitted to the second largest tertiary neurologic referral center in Iran, those who met the prespecified selection criteria were treated with intravenous recombinant tissue plasminogen activator (rtPA). Results Among 1,144 patients admitted with AIS, only 14 (1.2%) were treated with rtPA. The mean onset-to-needle and door-to-needle times were 172 and 58 minutes, respectively; 980 (85.6%) patients were initially excluded from the study because of late arrival. Additionally, 60 patients in total were omitted because of either their high age (3.7%) or passing the gold standard time limit for rtPA therapy after preliminary evaluations (1.6%), and 90 more patients (7.9%) were considered not suitable for thrombolysis because of the severity of the symptoms or the higher risk of bleeding on rtPA. Conclusions Access to thrombolytic therapy for AIS in Iran is less than in most developed countries but comparable with other developing countries. Awareness campaigns are needed to minimize barriers and improve access to thrombolysis and specialized stroke care in Iran.

Biking has proven health, environmental and traffic benefits. To prevail biking at community infrastructures and "Bicycle Sharing Systems (BSS)" have been developed, but their effectiveness is dependent on people's attitudes and perceptions. We aim to investigate attitudes of people toward biking and related infrastructures with regard to demographic factors in Mashhad, Iran-a metropolis with unsuccessful BSS. The present work was conducted as a cross-sectional study at Mashhad, Iran, in 2015. In a multistage sampling, adult inhabitants were selected and data about their perceptions of benefits and barriers of biking were collected through a researcher-designed questionnaire. of 437 study participants with a mean ( ± SD) age of 29.9 ( ± 11.3) years, 250 (57.3%) were female. Only 3 (0.7%) of respondents used bikes. Positive attitudes were significantly associated with gender, marital status and occupation of participants. Car ownership was accompanied by higher perceptions of "tiredness of biking"(p = 0.02), its "low safety" (p = 0.02) and "time wasting" (p = 0.01). According to the results, cultural interventions are needed for biking promotion regardless of their socioeconomic status. Educational programs at academic settings are also valuable. Safety, convenience, and affordability of different groups of populations (like elderly and deprived people) should be regarded during designing and constructing biking infrastructures and setting participation rules.

Background: Screening allows early detection of diseases or the predisposing factors, and has the potential for improved treatment and reduction of probable mortalities, if followed by acceptable and appropriate treatment. Aims & Objectives: To study the predictors of screening programs adherence in the population of Shiraz, Iran. Materials and Methods: This cross sectional study suggests the predictors of using the screening tests and exams among a representative sample of Shirazi adults. Results: About half of eligible participants never perform the Pap test, breast exam and fecal occult blood test. And about a quarter of them never did the prostate and skin exam. Age, sex, marital status, occupation, educational level, residential place and smoking history as well as stress level could be the predictors of using the screening tests and exams. Conclusion: Overall, the rate of using the screening tests and exams is unacceptably low. This emphasizes the urgent need of developing strategies to promote it.