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To evaluate the diagnostic mismatch (discrepancy) of pathology reports in consulted specimens referred for second opinion.This cross-sectional study was conducted at a major cancer center, Omid Hospital. In this study, 350 primary pathology reports and 350 reviewed pathology reports were extracted from the archives of Omid Hospital from 2011 to 2020 and assessed in terms of the extent of discrepancy, by two pathologists and one oncologist. The required data for each sample were entered into a checklist and then statistically analyzed. Cases with the same diagnosis on both reports were assigned to the matched group and the rest were assigned to the minor or major mismatch (discrepancy) group. Minor mismatches included changes in diagnosis that did not lead to changes in treatment (may lead to changes in prognosis or provide additional information to the oncologist) and major mismatches included changes in diagnosis leading to changes in treatment or remedies.Two hundred seven cases (59.1%) out of three hundred fifty cases had concordant results between the diagnosis of the first pathologist and the reviewing pathologist. In one hundred forty-three cases (40.9%) mismatch (discrepancy) was observed, including eighty- two cases (23.4%) with minor mismatches (discrepancy) and sixty-one cases (17.4%) with major mismatches (discrepancy). In the major mismatch group, fifteen cases (4.3%) changed from malignant to benign, eighteen cases (5.1%) changed from benign to malignant, two cases (0.6%) changed from one stage to another stage of Disease and twenty-six cases (7.4%) had changes in the type of malignancy. In this study, it was found that there was no significant relationship between anatomical areas of sampling and diagnostic mismatch (Compared to most similar studies, the present study reported the highest discrepancy between the diagnosis of the first pathologist and the reviewing pathologist (40.9%).

Aim: In Traumatic brain injury (TBI) patients, a complex cascade of inflammatory responses is frequently observed following trauma. Numerous dietary agents have long been found to have potential in modulating inflammatory responses. This pilot study, designed an enteral formula with low inflammatory properties based on the dietary inflammatory index (DII®) and evaluated its effect on inflammatory and metabolic factors in critically ill TBI patients. Methods: This Single-blind randomized controlled pilot study conducted at the Neurosurgical ICU of Shahid Kamyab Hospital (Mashhad, Iran). A total of 20 TBI patients were randomly assigned to receive either low-DII-score or standard formula at the Intensive Care Unit (ICU). The primary outcomes of the study included clinical status, inflammatory biomarkers, APACHE II, SAPS II, SOFA, and NUTRIC scores. Results: The trial groups did not differ significantly on baseline values. Following 14 days of intervention, there was a statistically significant decrease in the APACHE II, SAPS II, and NUTRIC scores and a significant increase in GCS score in the low-DII-score formula group compared to the standard formula group. Over two weeks, high sensitivity c-reactive protein (hs-CRP) values -2.73 (95% CI: -3.67, -1.79) mg/dL in the low-DII-score formula group vs. 0.65 (95% CI: -0.29, 1.58) mg/dL in controls. Moreover, the length of hospital stay was longer for the standard formula group than for the low-DII-score formula group. Conclusion: The low-DII-score formula improves inflammatory factors (serum hs-CRP) and metabolic biomarkers (LDL-c and FBS). Furthermore, clinical outcomes, including the length of hospital stay and disease severity appear to be enhanced.

Background and Aims: Colorectal cancer (CRC) is one of the most common human cancers. Currently, carcinoembryonic antigen (CEA) is used as the main standard biomarker of CRC, though this biomarker is not specifically made for CRC and, in a minority of cases, shows inadequate sensitivity. Therefore, searching for novel accessory biomarkers may fill these gaps in clinical management. miRNAs physiologically regulate various metabolic processes and are misregulated in various cancers. Therefore, the present investigation was conducted to evaluate miR-1 levels in CRC samples. Materials and Methods: The CRC and adjacent tissue samples were obtained from 24 patients. In addition, sera were collected from the patient group and 24 healthy controls. Total RNA was extracted from tissue samples, and cDNA was synthesized. Real-time PCR determined the expression of miR-1. Serum levels of CEA were also measured using a Monobind ELISA assay kit. Results: The level of miR-1 in CRC tumors was significantly down-regulated. Moreover, patients with metastasis showed lower expression of miR-1 compared to cases without metastasis; however, this difference was not statistically significant. The ROC curve for miR-1 showed an AUC of 0.69. In addition, ROC analysis revealed a sensitivity of 70.27% and a specificity of 62.96% for miR-1. Conclusion: There is still a need for new upcoming markers in addition to the main CRC biomarker, CEA. The levels of miR-1 in colorectal cancer tissue samples may provide additional information for the management and follow-up of CRC patients; though, the clinical application needs further studies.

Diabetes is one of the most common chronic diseases worldwide. Systemic inflammation (high-sensitivity C-reactive protein (hs-CRP)) and lipid metabolism disruption (lipoprotein A, LipoPr (a)) play a critical role in developing and progressing atherosclerosis and acute coronary syndrome in diabetic patients. The anti-oxidant and anti-inflammatory effects of curcumin have been emphasized previously. Therefore, we aimed to evaluate the impact of nano-curcumin on cardiovascular risk factors in type 2 diabetic patients with mild to moderate coronary artery disease (CAD). We performed a randomized, double-blinded, placebo-controlled clinical trial with type 2 diabetic patients (n = 64), and mild to moderate CAD (70% stenosis in angiography). The patients received nano-curcumin (80 mg/day) or placebo along with optimal medications for 90 days. The biofactors, including hs-CRP and LipoPr (a), and lipid profile, were measured at the admission of patients and end of the study. Nano-curcumin significantly mitigated the hs-CRP and LipoPr (a) levels following 90 days of treatment (P 0.001 and P = 0.043, respectively). In addition, the mean percentage of change (%Δ) in the hs-CRP and LipoPr (a) levels were meaningfully reduced in the nano-curcumin group compared to the placebo group (P 0.001 and P = 0.007, respectively). Surprisingly, nano-curcumin notably propagated the number of patients with mild (34.35%) and moderate (62.5%) hs-CRP level category and strikingly diminished the number of patients with severe hs-CRP level category (3.125%) compared to the placebo group (P = 0.016). Nano-curcumin (80 mg/day) might prevent atherosclerosis progression and, in terms of attenuating hs-CRP levels as an inflammation index, succedent cardiovascular events in diabetic heart patients.

Background: According to the Persian Medicine (PM) point of view, the function of the cardiovascular system and the risk of cardiovascular events would be different between subjects having warm and cold temperaments. Moreover, different foods in terms of temperament may lead to different acute and chronic effects on the body. background: According to the Persian Medicine (PM) point of view, the function of the cardiovascular system and probable future cardiovascular events would be different in warm and cold temperament subjects. Moreover, different foods in terms of temperament may lead to different acute and chronic effects in the body. Objectives: We investigated the postprandial effects of PM-based warm and cold test meals on arterial stiffness indices in healthy men with warm and cold temperaments. objective: We investigated the postprandial effects of PM-based warm and cold test meals on arterial stiffness indices in healthy men with warm and cold temperaments. Methods: Twenty-one eligible warm or cold temperament subjects with a similar range of age, weight, and heights were enrolled in this pilot cross-over randomized controlled trial study during February- October 2020. Two test meals (cold and warm PM-based temperament foods) were designed as different interventions. Pulse wave velocity (PWV) and pulse wave analysis (PWA) was obtained at the baseline state (following 12 hours fasting), 0.5, 2, and 4 hours after the test meal consumption during each test day. Results: Warm temperament participants had higher values of lean body mass, total body water, and protein content (P = 0.03, 0.02, and 0.02, respectively). Cold temperament individuals had higher aortic heart rate (HR) following 12 hours of fasting (P Conclusion: According to the results of the present study, although warm temperament individuals could have higher arterial stiffness at the fasting state, arterial stiffness indices had a greater reduction following warm-temperament meal intake compared to cold-temperament meal. Trial Registration number:: International Clinical Trials Registry Platform IRCT20200417047105N1 (Where the full trial protocol can be accessed) other: Temperament, Arterial stiffness, Complementary medicine

Background: Q fever is a generally neglected infection caused by Coxiella burnetii. Slaughterhouse workers exposed to livestock are among occupationally at-risk people. Objectives: This study was conducted to investigate the seroprevalence of anti-Coxiella burnetii (Q fever) IgG antibody among industrial slaughterhouse workers and factors affecting the risk of infection. Methods: In this cross-sectional study serum samples were taken from 91 individuals working at the central industrial abattoir in Mashhad, Iran using a convenient sampling method. Sera were kept at -80°C until assayed for specific anti-Coxiella burnetii IgG antibodies (phase 1) using the commercial ELISA kit. The participants filled out a checklist addressing potential risk factors of acquiring the infection. SPSS 11.5 was used for data analysis considering a significance level of P < 0.05. Results: The participants’ mean age was 38.7 ± 8 years. Fifty-six percent of the studied individuals (51 out of 91) were found positive for anti-Coxiella burnetii antibodies. The most prevalent cases were sheep (29, 57%) and cow (18, 35%) butchers. The odds of Q fever infection increased among those with a history of accidental hand cuts of more than five times during the previous years (OR = 2.56, CI95% = 1.02 - 6.33, P-value = 0.04) and those dealing with sheep as the primary livestock (OR = 2.9, CI95% = 1.09 - 7.66, P = 0.02). Conclusions: The high seropositivity rate of anti-Coxiella burnetii IgG reflects high exposure rate of workers to this potentially serious pathogen in slaughtherhouses; therefore, careful education, follow-up, and revision of decontamination policies and improved occupational care and environmental hygiene should be strictly implemented in slaughterhouses to reduce the risk.

Background: Breast and pelvic cancers are the most prevalent cancers among women globally. Several studies have reported on the effect of cell adhesion molecules on the growth, multiplication, invasion, and metastasis of tumor cells as well as inflammatory biomarkers, which are responsible for harmful inflammatory processes. Objectives: The purpose of the current study was to assess the serum levels of adhesion molecules intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and E-selectin in patients with cancer before and after radiotherapy, compare these with the levels of healthy subjects, and consider the relationship of these levels with the tumor origin. Methods: The present case-control study investigated 14 patients with breast cancer and 14 patients with pelvic cancer who had been referred to Omid Teaching Hospital’s oncology clinic, Mashhad, Iran between 2015 and 2017. Evaluated by the ELISA method for ICAM-1, VCAM-1, and E-selectin were the serum samples of these 28 cancer patients before and after their course of radiotherapy treatment and the serum samples of the 28 healthy subjects who had no history of cancer, radiotherapy or the risk factor of coronary artery disease. Results: The ICAM-1, VCAM-1, and E-selectin serum levels of all patients with cancer before and after a course of radiotherapy were significantly higher than those of the control group (P-value ≤ 0.5). There was no significant difference between the two cancer groups before and after radiotherapy (P-value ≥ 0.05). Conclusions: The current study demonstrated that the serum levels of adhesion molecules in patients with cancer before and after radiotherapy increase significantly regardless of the initial location of the tumor.

Background: Using meal replacement plans is one of the weight loss methods. A study on the effectiveness and efficiency of these methods seems necessary. In this study, we intend to determine and compare the effectiveness of Meal Replacement Therapy (MRT) and the Usual Low-Calorie diet (ULC) on Resting Metabolic Rate (RMR) and body composition in overweight and obese women. Methods: This quasi-experimental clinical trial consisted of two groups of women aged 18 to 50 years with a BMI of 25 to 40. Participants were allowed to choose between MRT and ULC diets based on their preferences. Both groups received equal daily calories (1000-1200 kcal in the first four weeks and 1200-1400 kcal in the second four weeks), which BMI determined. Primary outcomes were BMI, weight, body composition, and RMR. Secondary outcomes were Fasting Plasma Glucose (FPG), insulin, lipid profile, and Physical symptoms. Results: There were 35 participants in each group. There were no significant differences in the baseline anthropometric and metabolic measurements between the two groups (p>0.05). The only significant difference between the two groups was weight and BMI, lower in the MRT group (28.48kg/m2 vs. 30.75kg/m2). RMR did not change in the MRT group but decreased significantly in the ULC group. Metabolic profile improved in both groups, but no significant difference was observed between the two groups (p>0.05). Conclusion: The results of this study showed that meal replacement therapy is a more effective strategy for losing weight.Nevertheless, it is necessary to do further studies on meal replacements. Trial registration The study was approved on January 19, 2020, in the Mashhad University of Medical Sciences (ethics code: IR.MUMS.MEDICAL.REC.1398.744) as well as in the Iranian Registry of Clinical Trials (IRCT code: IRCT20200611047731N1. Registration date: 17-07-2020)

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

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

Background: The genus Acanthamoeba is a free-living opportunistic protozoan parasite, which widely distributed in soil and fresh water. Acanthamoeba keratitis, which causes a sight-threating infection of the cornea, is going to rise in Iran and worldwide. The aim of this study was to compare direct microscopy, culture and PCR for detection of Acanthamoeba spp. in clinical samples and to determine the genotypes of Acanthamoeba spp. by sequencing 18SrRNA gene. Methods: Among patients clinically suspected to AK referred to a tertiary ophthalmology center at Mashhad, northeastern Iran. During 2017-18, twenty corneal scrapes specimens obtained. The samples were divided into three parts, subjected to direct microscopic examination, culture onto non-nutrient agar and PCR technique. Sensitivity, specificity, accuracy and likelihood ratio were evaluated. Results: Among 20 persons clinically suspected to amoebic keratitis, 13(69.2%) patients definitely diagnosed as Acanthamoeba keratitis. Wearing contact lens, eye trauma due to foreign particle and swimming in fresh water were the main predisposing factors. Most of patients suffered from pain and photophobia. Corneal ring infiltration and epithelial defect were common clinical sings. Direct examination had the lowest sensitivity and sensitivity of both Nelson-PCR and JDP-PCR methods were equal and highest. In addition, the results of sequencing identified that all strains belonged to T4 genotype. Conclusion: Amoebic keratitis is a sporadic parasitic keratitis, which is mainly seen in contact lens user in Mashhad. PCR based on 18S ribosomal DNA with JDP primers is a reliable and highly sensitive method for diagnosis of Acanthamoeba keratitis in clinically suspected cases.

Background Botulism occurs periodically or in outbreaks in Iran. Botulism is lethal and accordingly a considerable issue in environmental health, although it is uncommon. This study was performed to evaluate the potential predictive factors in foodborne botulism in a 10-year span. Materials and methods All medical records from patients with foodborne botulism admitted to Imam Reza Hospital in 10 years (2005–2015) were analyzed retrospectively. Results 61 cases were included (38 men, mean age ± SD 28.93 ± 19.14 years). All cases were treated with antitoxin. 6.6% of cases died. Canned beans were correlated with the admission to intensive care unit (ICU), and also, it increased the length of ICU stay significantly (P = 0.007 and 0.023, respectively). The incidence of dizziness and diplopia significantly induced excess demands for higher doses of antitoxin (P = 0.038 and 0.023, respectively). Risk of dysphagia was remarkably higher in cases with ptosis (P = 0.039, odds ratio: 3). While in this study, time elapsed between the onset of clinical manifestations and antitoxin administration was correlated with the occurrence of dysphagia, constipation, and blurred vision, and early treatment did not improve the outcomes. Multiple analysis of potential variables by a logistic regression model disclosed that the independent significant factors affecting mortality were the need for mechanical ventilation (P = 0.000), dyspnea (P = 0.044), general weakness (P = 0.044), and lack of consciousness (P = 0.008) at the time of admission. Conclusions Taking clinical signs and symptoms into account upon patient arrival is important and, of course, is a key to further management in the emergency setting. How to cite this article Saeidi S, Dadpour B, Jarahi L, Ghamsari AA, Nooghabi MN. Clinical Predictive Values in Botulism: A 10-year Survey. Indian J Crit Care Med 2021;25(4):411–415.

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

Many antenatal sonographies are out of indication and may be asked due to mothers' requests or other factors. However, these features are not fully understood. This study aimed to assess the association of sociodemographic, obstetric, and attitudinal factors that may affect the number of ultrasound scans. In a cross-sectional study in six hospitals affiliated with Mashhad University of Medical Sciences, 360 mothers who had a delivery or were expected to be near childbirth were enrolled in the study. The mean number of sonographies was compared between different study variables by using Mann–Whitney, Kruskal–Wallis, and Pearson's Chi-squared tests. Moreover, the Spearman Rho test was used to assess the correlation between different variables and the number of sonographies. Totally, 300 cases remained in the study. The mean age of the mothers was 25.95 ± 4.77 years, and the average number of ultrasonographies was 3.50 ± 1.35. In case of sociodemographic features, the level of education (r = 0.23; p 0.05). Furthermore, mothers with higher family income (p = 0.010), those with medical insurance (p = 0.010), those who had male fetuses (p = 0.020), those who were clerk or student (p = 0.003), and those who were not aware of the sonography risks (p = 0.020) had more requests for sonography. It seems that financial factors and awareness of sonography risks play an essential role in sonography requests by mothers.

Background: Household food insecurity is defined as the limited or uncertain access to adequate and safe food or limited ability to obtain food in a socially acceptable manner. Preeclampsia is a severe case of high-risk pregnancy, which endangers the health of women across the world, especially in developing countries. The current study aimed to use the nutritional deficiencies theory in pathogenesis of preeclampsia and determine the correlation between food insecurity and preeclampsia. Methods: This case-control study was conducted on 100 women with preeclampsia and 200 normal pregnant women with the gestational age of 20 weeks. Participants were selected via purposive sampling according to the eligibility criteria. Data were collected using the USDA questionnaire for food insecurity, socioeconomic data, and demographic data through interviews. Results: The findings indicated that the frequency of food insecurity was significantly higher in the preeclampsia women than the healthy women (71% vs. 21%; P < 0.001). Logistic regression indicated that the risk of preeclampsia was six times higher among pregnant women in the unsafe food status group than those in safe food status group [odds = 6.4; 95%CI: 3.3-12.4; P < 0.001]. Among the studied variables, socioeconomic status, history of stillbirth, history of preterm delivery, and ethnicity were significantly associated with preeclampsia during pregnancy (P < 0.05). In addition, women with low socioeconomic status were twice at the higher risk of preeclampsia compared to those with favorable socioeconomic status [odds = 2.7; 95%CI: 1.1-6.2; P = 0.01]. Conclusion: The current study indicated that the prevalence of food insecurity was high in Iranian women with preeclampsia, especially those with a history of preterm labor, history of stillbirth, low socioeconomic status, or non-Persian.

Introduction. Celiac disease (CD) is a chronic and common cause of dyspepsia with a rising prevalence worldwide. This study is aimed at investigating the prevalence of CD in dyspeptic patients based on serology and biopsy, determining the associated factors, and assessing the necessity of regular duodenal biopsies from normal mucosa in diagnosis of CD among dyspeptic patients. Methods. This cross-sectional study was performed on 530 adult dyspeptic patients who underwent gastroduodenoscopy in Imam Reza hospital, Mashhad, during 2016-2018. Demographic characteristics, clinical data, and laboratory analyses were extracted from hospital records. CD was diagnosed based on intestinal biopsy and serum antitissue transglutaminase (anti-TTG) levels. Mucosal lesions were classified according to the modified Marsh classification. Data were analyzed in SPSS with P < 0.05 being considered significant. Results. Overall, 163 males (30.8%) and 367 females (69.2%) with an average age of 46.38 ± 15.54 years were studied. High anti-TTG levels were seen in 36 (6.8%) patients, and duodenal pathologies were seen in 23 (4.5%) patients. Fifteen (2.8%) were diagnosed with CD based on both serology and biopsy. Bloating was the most common type of dyspepsia in CD patients (7, 46.7%), followed by epigastric pain (6, 40%), and postprandial fullness (2, 13.3%). Two CD patients (13.3%) reported a positive family history for CD. Logistic regression model showed that iron deficiency anemia (IDA), anti-TTG level, and Helicobacter pylori infection were predictors of histological changes of CD, whereas IDA was the only independent predictor of CD in dyspeptic patients ( OR = 17.65 , 95 % CI = 1.53 ‐ 202.52 , and P = 0.021 ). Conclusion. CD is prevalent in dyspeptic patients, but routine biopsy from normal-appearing duodenal mucosa is not recommended for all patients. Serological studies, complete history, and careful endoscopic evaluation may provide better cost-effective clinical solutions to improve the diagnostic yield of celiac disease in dyspeptic patients.

Background. Lophomonas blattarum is a flagellate protozoan which is known as an emerging parasite in the human respiratory system. Organ transplant recipients are considered as immunocompromised patients due to prescription of immunosuppressive drugs. This group of patients is susceptible to opportunistic infection as well as lophomoniasis. This study aims to investigate the prevalence and clinical manifestation of pulmonary infections caused by L. blattarum in kidney transplant recipients. Methods. This is a case-control study including 50 kidney transplant recipients and 50 controls. The sputum samples were collected from 50 kidney transplant recipients with bronchopulmonary infection signs suspected to lophomoniasis admitted in Montaserieh and Imam Reza hospitals, Mashhad, Iran. 50 healthy individuals as the control group were matched for sex and age with case ones. The consent form, checklist, and required information were provided for each patient. All samples were microscopically examined for the flagellated protozoan, L. blattarum, using direct smear. Results. Among 50 kidney transplant recipients suspected to lophomoniasis, L. blattarum was identified in sputum samples of 4 (8%) participants of the case group including one female and three males. None of the samples were positive among the control group. Symptoms in patients of this study were high fever (4 out of 4 patients), cough (3 out of 4 patients), and dyspnea (2 out of 4 patients). Three patients showed a positive response to metronidazole treatment. Conclusion. The results of this study suggest that L. blattarum should be considered as a pathogenic agent in kidney transplant recipients. It is necessary to examine sputum samples in posttransplant pneumonia patients, especially in those resistant to antibacterial therapy.

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

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

Introduction To compare the effects of Hypericum perforatum with lifestyle modification and acupuncture for appetite and weight control in obese or overweight patients. Methods The planned sample size is 88. Participants in group I will receive electroacupuncture, Hypericum perforatum, and lifestyle modification; group II, electroacupuncture, placebo, and lifestyle modification; group III, sham electroacupuncture, Hypericum perforatum, and lifestyle modification, group IV, sham electroacupuncture, placebo, and lifestyle modification. The primary outcome is change in serum nesfatin-1 level at week 6 comparing to baseline. Secondary outcomes include appetite score and anthropometric indices. Outcomes will be assessed at baseline, week 2, 6, 12 and 24. The statistical analyses will be performed using SAS and SPSS version with a 2-sided P value of less than 0.05 considered statistically significant. Conclusions By implementing placebo for both Hypericum perforatum and acupuncture, this study may help improving the methodology of comparative effectiveness studies of different complementary medicine interventions.

Lifestyle modifications have been recommended as an essential treatment approach for cardiovascular diseases. Recent studies have shown that eating frequency (EF) correlates with hypertension and related risk of organ damage. This study aimed to examine critical clinical implications to evaluate the association of EF with arterial stiffness parameters as an early marker of atherosclerosis manifestations.A cross-sectional descriptive study was performed on 658 participants of the PERSIAN Organizational Cohort study in Mashhad, aged 30-70 years. Arterial stiffness was assessed by measurement markers of arteriosclerosis, including arterial age, augmentation index (AIx), augmentation pressure (AP), carotid-femoral pulse wave velocity (Cf-PWV), and central blood pressure. Differences in anthropometric indices, blood indices, and arterial stiffness parameters were evaluated across EF groups.Our data demonstrate that EF was positively correlated with total daily energy intake, and favourable profiles of adiposity and blood lipids. Subjects with an increased EF, had significantly lower AIx, AP, Arterial Age and Central blood pressure (P for trend0.001) as compared to Lowest EF and not significant with PWV (P for trend, 0.19). Arterial stiffness was also significantly lower in those with increased EF compared with subjects with low EF. By Linear regression analysis, after adjustment for Confounding factors, except PWV, EF showed the associations with all of the non-invasive arterial stiffness parameters.Increased EF is associated with a lower wave reflection and blood pressure in the central arteries.

Background: Substance abuse treatment is challenging in pregnancy, and methadone maintenance therapy (MMT) is a therapeutic choice. Methadone can cross the placenta and is poorly secreted in breast milk. Given these inconsistent findings of methadone effect on neonatal outcomes, this study was done to investigate the results in neonates of mothers treated with methadone in Mashhad. Methods: In this retrospective cohort study, mothers referring to two academic hospitals of Mashhad University of Medical Sciences, Mashhad, Iran were studied. Three groups were considered: MMT, other drug abusers, and healthy control. Maternal information, including demographic characteristics, fertility characteristics, and methadone treatment-related characteristics, and neonatal information, including demographic characteristics and neonatal outcomes, were assessed. Results: Overall, 122 pregnant women with a mean age of 29.14 ± 4.44 years were studied in three groups: control (n = 59), MMT (n = 32), and other drug abusers (n = 31). Baseline characteristics (mothers’ age, residence, chronic hypertension, preeclampsia, diabetes, heart disease, thyroid disease, and other diseases) were not different between the three groups. The highest history of miscarriage was seen in other drug abusers (35.5%) (P = 0.023). The mean weight, height, and head circumference of neonates in the control group were significantly higher than the MMT group (P < 0.001), and in the MMT group was higher than in the other drugs abusers (P < 0.001). The highest prevalence of malformations (16.1%) and hospitalization in the NICU (51.6%) was observed in infants of other drug abusers. After adjusting for confounding variables, the odds ratio (OR) of low-birth-weight infants was 13.7 in the MMT group and 1946 in the other drugs group compared to the healthy control group. The OR of neonates less than 50cm in height was 11.4 in the MMT group and 22.5 in the other drugs. Besides, the OR of neonates less than 35cm was 4.7 in the MMT group and 7.3 in other drugs. Conclusions: Although the neonates of mothers who used methadone had a higher rate of inappropriate intrauterine growth indices than control group, methadone consumption compared to other drugs had significantly reduced unacceptable outcomes in neonates. Increased gestational age and reduced preterm delivery risk were observed in methadone-treated mothers.

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

Introduction: Human T-cell lymphotropic virus type 1 (HTLV-1) is known to be endemic in the population of northeastern Iran. This study was conducted with the aim of investigating the knowledge and attitude of medical students of Mashhad University of Medical Sciences about the HTLV-1 virus.Material and Methods: The present study was a descriptive-analytical study that was conducted in Mashhad Medical School from April to June 2014. The research population included all medical students studying at the time of the study (307 people). The tool of data collection was a questionnaire including 4 parts of demographic characteristics, the amount of information resources used, the level of awareness about HTLV-1 infection and measuring the attitude of students towards HTLV-1 infection. The data was analyzed in the form of descriptive statistics using SPSS 16.0 software.Results: A total of 271 people responded to the questionnaire (response rate: 88/27). Among the participants, 130 were male and 141 were female. The majority of students, 161 people got their information from the classroom and 157 people were natives of Mashhad. The information obtained from the description of the questions and the percentage of correct answers to the questions showed that the level of students' knowledge about this infection was average with an average score of 16.66 out of 40 points, and the average score of the students' attitude was reported as 68.11 with an average level.Conclusion: The obtained results reported the level of knowledge of the target group as medium-low, and the level of attitude of this group as medium-high. Also, there was a direct relationship between the amount of information and the level of attitude with the year of entering the university and studying in the university, which reports the slope of this change as low.

Background: This study was conducted to determine the prevalence and intensity of nematode infections in sheep located in northeastern Iran from Apr 2018 to Mar 2019. Methods: Gastrointestinal nematodes of 300 sheep were inspected. The season of slaughter, anatomic location where the parasite was located, the animal’s sex, infection prevalence and intensity were recorded. Seasonal differences in arrested larvae numbers also were assessed using Cochran's Q test. Results: Overall, 4,331 adult nematode specimens were collected. Among the examined sheep, 53% (159/300) were infected with one or more nematode species. Among infected sheep, 42.8% were infected with a single species of nematode, 26.4% were infected with two species of nematodes, and 30.8% were infected with three or more species of nematodes. Marshallagia marshalli (13.3%) was the most common nematode recovered from the abomasums of infected sheep, while Trichostrongylus vitrinus (4.6%) was commonly recovered from the small intestines, and Trichuris ovis (25.6%) was commonly recovered from the large intestines. In total, 463 arrested larvae were found in the abomasums of 7.5% of infected sheep and 104 arrested larvae were found in the small intestines of 8.8% of infected sheep. A significantly higher numbers of arrested larvae were found in summer compared to autumn (P

Objectives: The aim of this study was to evaluate the effect of high-flow nasal cannula (HFNC) after early extubation on children undergoing cardiac surgery. Methods: This randomized controlled clinical trial was performed among 92 children aged 1 to 24 months undergoing cardiac surgery from March 5 to August 30, 2020, in a pediatric post-cardiac surgery intensive care unit (ICU). The patients were randomized to receive either HFNC or conventional oxygen therapy after extubation. Arterial blood samples were collected after anesthesia induction, after the end of the surgery, at the time of entering the ICU while they were intubated, 6 hours after entering the ICU, before removing the endotracheal tube, immediately after extubation, as well as 1, 6, 12, 24, and 36 hours after extubation. The patients were compared regarding PaCO2, PaO2/FiO2 ratios, respiratory failure, need for reintubation, development of atelectasis, pneumothorax, pleural effusion, and length of ICU stay. Results: The patients were similar regarding demographic characteristics, the duration of surgery, and mechanical ventilation (P > 0.05). On the first and second days after the surgery, the mean modified radiologic atelectasis score (m-RAS) was lower in the HFNC group compared to the conventional oxygen therapy group (P < 0.05). The frequency of respiratory failure did not differ in the groups before and after the surgery (P > 0.05). PaCO2 was lower in the HFNC group than in the control group after extubation (P < 0.001). PaO2/FIO2 ratio was significantly higher in the HFNC group one hour after extubation and afterward in comparison to the control group (P < 0.001). The need for re-intubation (P < 0.013) and the length of ICU stay (P < 0.001) were significantly lower in the HFNC group compared to the control group. Conclusions: It was found that HFNC could improve the respiratory parameters and reduce postoperative pulmonary complications in infants following a congenital heart surgery.

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