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The contamination of fresh meat and meat products like sausages with potentially toxic elements (PTEs) is a worldwide health concern. Consequently, the related investigations concerning the levels of PTEs in sausages among databases such as Scopus, Cochrane, and PubMed were investigated 1 January 2000 to 20 August 2020. Furthermore, the concentration of PTEs in sausages was meta-analyzed based on the random effect model (REM). The findings indicated that the rank order of PTEs in sausage was Fe (432.154 μg/kg) > Cu (152.589 μg/kg) > Zn (93.813 μg/kg) > Cr (6.040 μg/kg) > Pb (1.524 μg/kg) > Ni (0.525 μg/kg) > Cd (0.115 μg/kg) > As (0.066 μg/kg). Our results showed that the PTE concentration in sausages was lower than the permitted limit except for Pb in samples reported from Nigeria, China, and Turkey. Therefore, continuous monitoring of PTEs in such products was recommended., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

In this work, articles regarding the concentration on potentially harmful elements (PHEs) in fillet trout (rainbow and brown) fishes were retrieved from Cochrane, Scopus, and PubMed databases between 1 January 1983 and 30 April 2020. The pooled concentration of PHEs in fillet trout fishes was meta-analyzed using a random-effect model (REM) and following the non-carcinogenic and carcinogenic risks was calculated using the Monte Carlo simulation (MCS) method. The meta-analysis of 42 articles (43 data report) revealed that a sort of PHEs in fillet trout was 19,996.64 μg/kg ww for Fe; 1834.75 μg/kg ww for Co; 772.21 μg/kg ww for Cu; 335.78 μg/kg ww for Ni; 290.46 μg/kg ww for Se; 226.20for Cr; 178.11 μg/kg ww for Pb; 77.40 μg/kg ww for Hg; 19.40 μg/kg ww for Cd; and 3.66 μg/kg ww for inorganic As. The non-carcinogenic risk assessment indicated that the lowest and highest hazard index (HI) in the adults was Pakistan (0.0012) and Turkey (0.2388), respectively, and in children was Pakistan (0.0057) and Turkey (1.114), respectively. The non-carcinogenic risk was acceptable for adult consumers in all countries (HI > 1 value) but non-carcinogenic risk for children was not acceptable in Turkey. The sort of countries based on carcinogenic risk in the adults due to inorganic As was China (1.44E-06) > Iran (9.14E-08) > Turkey (4.45E-08) > Portugal (9.04E-10). The carcinogenic risk was threshold for adult consumers in China (CR < 10 -6 ). Consumption of fillet trout (rainbow and brown) content of PHEs in many countries cannot endanger the health of consumers.

Background: Employees who describe themselves as happy in their work are more likely to be motivated to fulfil their professional duties. Therefore, it is important that healthcare organisations and managers understand how to promote a sense of happiness among nurses., Aim: To investigate the relationship between the concepts of psychological capital, interactional justice, supervisor support and workplace happiness, and how they are mediated by employees' trust in their supervisors., Method: Self-report questionnaires were used to obtain data from nurses on the variables of trust in supervisor, psychological capital, interactional justice, supervisor support and happiness at work. The questionnaires were distributed to 250 nurses working in hospitals in the city of Hamedan, Iran, and a total of 200 respondents completed and returned them. The data were then applied to a proposed model for promoting employees' workplace happiness, which was evaluated using data analysis software., Results: The results showed that the model correctly identified a pathway for promoting workplace happiness in nurses. Moreover, it was found that psychological capital, interactional justice and supervisor support led to improved workplace satisfaction through the mediating role of nurses' trust in their supervisors., Conclusion: The findings of this study indicate that paying attention to employees' psychological capital, interactional justice and supervisor support, as well maintaining employees' trust in their supervisors, could assist healthcare organisations and managers to achieve organisational targets such as increased job satisfaction., Competing Interests: None declared, (© 2021 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

All studies on oxygen-evolution reaction by Mn oxides in the presence of cerium(IV) ammonium nitrate (CAN) have been so far carried out by synthesizing Mn oxides in the first step. And then, followed by the investigation of the Mn oxides in the presence of oxidants for oxygen-evolution reaction (OER). This paper presents a case study of a new and promising strategy for in situ catalyst synthesis by the adding Mn II to either CAN or KMnO 4 /CAN solution, resulting in the formation of Mn-based catalysts for OER. The catalysts were characterized by scanning electron microscopy, energy-dispersive spectroscopy, transmission electron microscopy, X-ray diffraction, Fourier transform infrared spectroscopy, X-ray absorption spectroscopy, and X-ray photoelectron spectroscopy. Both compounds contained nano-sized particles that catalyzed OER in the presence of CAN. The turnover frequencies for both catalysts were 0.02 (mmol O 2 /mol Mn ⋅s)., (© 2020 Wiley-VCH GmbH.)

Background: Childhood visual impairment is a global public health problem, especially in low and middle-income countries. Its most common causes are avoidable by early diagnosis and treatment., Aims: To assess prevalence of refractive error and visual impairment among school-aged children in Hargeisa, Somaliland, Somalia., Methods: This was a cross-sectional study of 1204 students (aged 6-15 years) in 8 randomly selected primary schools in Hargeisa from November 2017 to January 2018. We used the modified Refractive Error Study in Children to determine prevalence of refractive error and visual impairment, including the following investigations: distance visual acuity, assessed by Snellen Tumbling E-chart; refraction, assessed by retinoscope binocular vision assessment; and examination of anterior and posterior segments., Results: Prevalence of uncorrected, presenting and best-corrected visual impairment of 6/12 or worse was 13.6%, 7.6% and 0.75%, respectively. Only 16 of 91 (17.6%) children were using spectacles and the rest were unaware of the problem. Refractive error was the cause of visual impairment in 76.8% of participants, amblyopia in 22.0%, trachoma in 2.4%, and corneal opacity and cataract in 0.6%. Anterior segment abnormalities were found in 8.3%, mainly vernal keratoconjunctivitis, while posterior abnormalities were observed in 0.7%. Prevalence of myopia was 9.1%, hypermetropia 2.7% and astigmatism 3.9%. Prevalence of visual impairment because of Refractive Error was associated with increasing age, but there was no significant association with school grade or sex., Conclusion: Prevalence of visual impairment among school-aged children in Hargeisa was high, and the leading cause was uncorrected Refractive Error. There are barriers to care and it is critical that they are overcome., (Copyright © World Health Organization (WHO) 2020. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Background: Protecting people against the financial consequences of health-care payments is a key objective of health systems., Aims: We carried out a descriptive analysis of changes in health spending associated with the implementation of the latest health sector reform in the Islamic Republic of Iran, the Health Transformation Plan (HTP)., Methods: The study relied on 2 rounds of data from the Household Expenditure and Income Survey (2014 and 2015). Key indicators of financial protection in health expenditure were estimated. The Kakwani index was used for out-of-pocket (OOP) health expenditure to measure the degree of progressivity in the distribution of such payments., Results: Total OOP per capita health expenditure showed a 2.5% relative decrease in real terms in 2015 compared to 2014. Estimation of the Kakwani index suggested OOP spending became slightly more progressive over the time period of HTP reform. The share of the population facing catastrophic health expenditure also decreased significantly from 2.9% to 2.1% at the national level. However, the incidence of impoverishment due to OOP payments increased slightly between preand post-HTP, from 0.2% to 0.5%., Conclusion: Our findings suggest that the new policies have a positive association in improving financial protection against health costs among Iranians, albeit slightly less so for the poor. Future efforts to increase public spending for financial protection would be challenging and should rely on efficiency gains such as a move from fee-for-service to performance- based payment systems and more organized OOP collection mechanisms involving prepayment and risk pooling., (Copyright © World Health Organization (WHO) 2020. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Background: CCL-11 (eotaxin) is a chemokine with an important role in allergic conditions. Recent evidence indicates that CCL-11 plays a role in brain disorders as well. This paper reviews the associations between CCL-11 and aging, neurodegenerative, neuroinflammatory and neuropsychiatric disorders., Methods: Electronic databases were searched for original articles examining CCL-11 in neuropsychiatric disorders., Results: CCL-11 is rapidly transported from the blood to the brain through the blood-brain barrier. Age-related increases in CCL-11 are associated with cognitive impairments in executive functions and episodic and semantic memory, and therefore, this chemokine has been described as an "Endogenous Cognition Deteriorating Chemokine" (ECDC) or "Accelerated Brain-Aging Chemokine" (ABAC). In schizophrenia, increased CCL-11 is not only associated with impairments in cognitive functions, but also with key symptoms including formal thought disorders. Some patients with mood disorders and premenstrual syndrome show increased plasma CCL-11 levels. In diseases of old age, CCL-11 is associated with lowered neurogenesis and neurodegenerative processes, and as a consequence, increased CCL-11 increases risk towards Alzheimer's disease. Polymorphisms in the CCL-11 gene are associated with stroke. Increased CCL-11 also plays a role in neuroinflammatory disease including multiple sclerosis. In animal models, neutralization of CCL-11 may protect against nigrostriatal neurodegeneration. Increased production of CCL-11 may be attenuated by glucocorticoids, minocycline, resveratrol and anti-CCL11 antibodies., Conclusions: Increased CCL-11 production during inflammatory conditions may play a role in human disease including age-related cognitive decline, schizophrenia, mood disorders and neurodegenerative disorders. Increased CCL-11 production is a new drug target in the treatment and prevention of those disorders.

Background: Obesity has become a common health problem all over the world. Benefiting from a national representative sample, the present study aimed to estimate the prevalence of overweight/obesity and the distribution of Body Mass Index (BMI) levels in the Iranian adult population, by sex, age, and geographical distribution. Methods: This was a large-scale national cross-sectional study of Non-communicable Diseases risk factor surveillance in Iran. Through a systematic random sampling cluster, 31,050 Iranian adult participants aged 18 years and over were enrolled in the study. The main research tools were used to assess three different levels of data, namely: (1) demographic, epidemiologic, and risk-related behavioral data, (2) physical measurements, and (3) lab measurements. Anthropometric measurements were taken using standard protocols and calibrated instruments. Results: In 2016, the national prevalence rates of normal weight, obesity, and overweight/obesity among Iranian adults were, 36.7% (95% CI: 36.1-37.3), 22.7% (22.2-23.2), and 59.3% (58.7-59.9), respectively. There was a significant difference between the prevalence of obesity among males [15.3% (14.7-15.9)] and females [29.8% (29.0-30.5)] ( p < 0.001). The 55-64 [31.5% (30.1-33.0)] and the 18-24 [8.3% (7.3-9.4)] year-old age groups had the highest and lowest prevalence of obesity, respectively. The results show a geographical pattern at provincial level, where the level of BMI increases among populations ranging from the southeastern to the northwestern regions of the country. The highest provincial prevalence of obesity was almost 2.5-fold higher than the lowest provincial prevalence. Conclusion: We found a significant difference between the prevalence of obesity in males and females. Moreover, there was a considerable difference in the geographical pattern of the prevalence of obesity and overweight. Further evidence is warranted to promote strategies and interventions related to prevention and control of factors that are associated with weight gain., (Copyright © 2020 Djalalinia, Saeedi Moghaddam, Sheidaei, Rezaei, Naghibi Iravani, Modirian, Zokaei, Yoosefi, Gohari, Kousha, Abdi, Naderimagham, Soroush, Larijani and Farzadfar.)

Background: The aim of this study was to evaluate the health status of the Iranians following the sustainable development goals' (SDGs) introduction and the recent health reform implementation in Iran and to compare with those of the Middle East and North Africa region (MENA) and global average., Methods: This comparative study used secondary data to investigate socio-demographic and health status indicators. The sources included census, population-based surveys and death registries. Global and regional health status indicators were obtained from international databases including WHO, the World Bank and the Institute for Health Metric and Evaluation (IHME)., Results: Life expectancy and human development index improved following the reform implementation. Among causes of death, 74.6% were attributed to non-communicable diseases (NCDs). There was an increasing trend in risk factors for NCDs in Iran, while at the same time neonatal, infant and under-5 mortality rates reduced. Compared to the MENA, Iran has a lower maternal mortality ratio, neonatal, infant, and under-5 mortality rates, and a higher life expectancy. NCDs and road traffic injuries accounted for a larger portion of disability-adjusted life years in Iran compared to the MENA and worldwide., Conclusion: Actions against communicable diseases and road traffic injuries are required together with continued efforts to address NCDs. Although based on the results, Iran has relatively high rankings, there is a need to develop a roadmap to accelerate achieving global health goals and SDGs targets., Competing Interests: Conflict of interest Non-declared., (Copyright© Iranian Public Health Association & Tehran University of Medical Sciences.)

Purpose: In 2014, the Islamic Republic of Iran launched the Health Transformation Plan (HTP), with the goal of achieving universal health coverage (UHC) through improved financial protection and access to high-quality health services among Iranian households. We aimed to investigate the impact of the HTP on the level and pattern of out-of-pocket (OOP) payments for health care., Methods: Using data from two rounds (2013 and 2016) of the Iranian Statistics Centre's Household Expenditure and Income Survey (HEIS), collected before and after implementation of the HTP, we estimate changes in the level and drivers of OOP payments, and the prevalence, intensity, and distribution of catastrophic health expenditures (CHEs) among Iranian households., Findings: Our results indicate that per capita OOP payments on health remained stable during the observed period, with the largest proportion of OOP payments spent on medicines. Using thresholds of 10% and 25% of total consumption, there was a slight increase in the prevalence of CHE. The prevalence of CHE increased from 3.76% to 3.82% at threshold of 25% of total consumption. Using 40% capacity to pay threshold, prevalence diminished modestly from 2.5% to 2.37% and the intensity decreased from 13.16% to 12.32%. At all thresholds, CHE were more concentrated among wealthier households., Conclusion: These results suggest that while financial protection of the poor in Iran has improved due to the HTP, more work is needed to achieve UHC in Iran. For the next phase of health reforms, more emphasis should be placed on shifting away from OOP co-payments for health financing to progressive prepayment mechanisms to facilitate better sharing of financial risks across population groups., (© 2019 John Wiley & Sons, Ltd.)

Listeria monocytogenes , as a foodborne pathogenic bacterium, is considered as major causative agent responsible for serious diseases in both humans and animals. Milk and dairy products are among the main sources of energy supply in the human, therefore contamination of these products with Listeria spp., especially L. monocytogenes , could lead to life threatening infections in a large population of people. Rapid and accurate detection of L. monocytogenes in milk and dairy products, vegetables, meat, poultry, and seafood products is needed to prevent its dissemination through the food chain. Upon contamination of food materials with this pathogen, increase in its antibiotic resistance rate can occur after exposure to preservatives, antibiotics, and stress conditions, which has now become another major public health concern emphasizing the need for special attention on its control along the food chain and management of the disease in the patients. This review provides an overview of researches with respect to the prevalence of Listeria spp., especially L. monocytogenes , in milk and dairy products, methods of their detection and typing, and current status of resistance rates to the antibiotics used for treatment of listeriosis.

Background: Monitoring and evaluation of health system reforms are essential to ensure the achievement of their objectives. The latest heath sector reform in the Islamic Republic of Iran, namely, the Health Transformation Plan (HTP), was launched in 2014 and the country is embarking on the HTP to achieve universal health coverage (UHC)., Aims: The study aimed to develop the most appropriate monitoring and evaluation framework for the HTP in accordance with national and global goals and priorities, and to identify data gaps in its monitoring and evaluation., Method: A case study and evidence-based approach was applied to develop the monitoring and evaluation framework. The model that was proposed jointly by the World Bank and the World Health Organization for monitoring and evaluation of UHC was used as the basis for the potential list of the indicators and key policy documents were reviewed, accordingly. The framework formulation process was carried out through a series of meetings with experts and senior managers working at the Ministry of Health and Medical Education, whose perspectives on the frameworks functionality and usage were regarded as valuable. The final draft was presented to policy-makers for input and approval., Results: A data mapping revealed that at least nine national surveys were required to obtain the indicators for effective monitoring. At the time of framework designing, many indicators were not available or had not been updated for several years due to lack of available and appropriate data sources., Conclusions: Results indicated that the country's health information system had many information gaps that should be filled to enable the tracking of UHC goals and measuring the success of the plan. Applying the proposed framework would increase the comparability of the country's health indicators at the global level and specify a path to successfully achieve the objectives of the reform., (Copyright © World Health Organization (WHO) 2019. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Ferritin is a protein (ca. 12 nm) with a central pocket of 6 nm diameter, and hydrated iron oxide stored in this central cavity of this protein. The protein shell has a complicated structure with 24 subunits. Transmission electron microscopy images of ferritin showed nanosized iron oxides (ca. 4-6 nm) in the protein structure. In high-resolution transmission electron microscopy images of the iron core, d-spacings of 2.5-2.6 Å were observed, which is corresponded to d-spacings of ferrihydrite crystal structure. Our experiments showed that at pH 11, the modified electrode by this biomolecule is active for water oxidation (turnover frequency: 0.001 s -1 at 1.7 V). Using affected by bacteria, we showed that Fe ions in the structure of ferritin are critical for water oxidation.

Achieving universal health coverage (UHC), which means ensuring access to high quality and equitable services by all without financial hardship, requires local evidence. To find interventions appropriate to local needs, local knowledge and evidence are required in addition to global evidence. Thus, every country should have its own plan for research production and utilization and strengthening researchers' capacities to achieve UHC. To accomplish the goals of UHC, the research system should be able to determine the research priorities and agenda, collect resources, improve the capacity for evidence generation, and maximally utilize the country's capacity for finding local solutions by establishing research networks. In this study, inputs for UHC research priority setting in Iran and its challenges have been discussed.

Context: Heat Shock Protein 60 (HSP60) is a chaperone protein which is involved in proteins transfer and re-folding of proteins., Objective: Importance of HSP60 in sperm capacitation and facility of sperm-oocyte membrane binding was confirmed, therefore in this study the effect of HSP60 on the rate of in vitro fertilization and the cleavage rate in mouse embryo was investigated., Design: Ten male mice and twenty five female mice were involved to collect sperms and oocytes required for this study., Subjects and Methods: Sperms were collected from the epididymis of male mouse and oocytes were collected from the oviduct of female mouse following ovarian hyperstimulation. Then, capacitated sperms and oocytes were placed together in fertilization medium in four groups in the presence of different concentrations of HSP60 (10, 50 and 100 ng/mL) and in the absence of HSP60. After calculation of the fertilization rate, zygotes were transformed into the other medium for development and the cleavage rate was monitored to blastocyst stage., Results: There was not a significant difference in the rate of fertilization between 10 ng/mL HSP60 group and the control group. The rate of fertilization and two-cell embryo development decreased significantly (P≤0.05) in 100 ng/mL HSP60 compared to other experimental and control groups. Further, the rate of two-cell embryo development increased significantly (P≤0.05) in 10 ng/mL HSP60 compared to other experimental and control groups., Conclusions: The present study demonstrated that HSP60 in low dose had a positive effect on two-cell embryo development, however it did not have any significant effect on the fertilization rate. Conversely, HSP60 had adverse effects on the fertilization and cleavage rates at higher doses., Competing Interests: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Objectives: Since many Millennium Development Goals (MDGs) were not achieved, countries including Iran-despite achieving some of the MDGs-need regular planning to achieve the Sustainable Development Goals (SDGs) by 2030. This article examines maternal and child health indicators in the early years of the SDGs in Iran relative to several other countries., Methods: This study was carried out through a secondary analysis of maternal and child health indicators in Iran. The results were compared with data from other countries divided into three groups: countries with upper-middle income levels, countries in the Eastern Mediterranean region, and the countries covered by the Outlook Document 1,404 (a regional classification). Then, the relationship between these indicators and the Human Development Index was investigated., Results: Iran has attained better results than other countries with respect to maternal mortality, family planning, skilled birth attendance, under-5 deaths, incidence of hepatitis B, diphtheria-tetanus-pertussis vaccination coverage, and antenatal care. In contrast, Iran performed worse than other countries with respect to under-5 wasting, under-5 stunting, and care-seeking behavior for children., Conclusions: Overall, among the 11 indicators surveyed, Iran has attained better-than-average results and seems to be improving. We recommend that Iran continue interventions in the field of maternal and child health.

Background: The World Health Organization (WHO) aims to promote strategies that ensure efficacy, safety, suitability, and cost-effectiveness of medicine prescription. Health systems should design effective mechanisms to monitor prescription and rational use of medicines at all healthcare settings. This study aimed to determine and analyze prescription patterns of general practitioners and specialists in Kerman/Iran from 2005 to 2015., Methods: This is an explanatory mixed method study. Data were gathered during two phases. At the first phase, prescriptions issued by physicians during 2005-2015 were reviewed to extract information required to develop eight main prescription indicators. In the second phase, the indicators trends were presented to experts participating in expert panel to have their opinions and analyses on the data obtained in the first phase. Experts were selected based on their experience and expertise in medicine and/or health policy and/or experience in implementation of polices to promote rational use of medicines. Some experts attending the panel were a sample of physicians whose prescriptions were included in the first phase., Results: Findings revealed that two indicators of the average price of prescriptions and the maximum number of medicines in each prescription had an increasing trend over the study period. Reasons including unprecedented devaluation of the Iranian Rial and willingness of young physicians to prescribe more medications were proposed as the primary contributors to the observed increasing trends. However, other indicators including types of prescribed medicines, average number of medicines per prescription, the percentage of prescriptions with more than four medications, a percentage of encounters with a corticosteroid prescribed, a percentage of encounters with an antibiotic prescribed, and a percentage of encounters with an injection prescribed decreased in the study period. Reasons of controlling initiatives adopted by the Ministry of Health, the higher responsibility of physicians, adoption of continued medical education (CME) programs, and improved knowledge of pharmacists, physicians, and patients about irrational use of medicines were proposed by participants as the main reasons for the decreasing trend., Conclusion: Findings indicated that prescription indicators were better in Kerman than those of country average over the study period based on comparing the results of this study and others in Iran. However, they were non-desirable when compared to the international average. The number of factors contributes to the irrational use of medicines, including lack of knowledge among healthcare providers and patients, patients' misunderstanding about the efficacy of some particular medicines, the high cost of drug development and manufacturing, and unavailability of effective medicines., (© 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: The financial protection against catastrophic and impoverishing health expenditures is one of the main aspects of the universal health coverage. This study aimed to present a clear picture of the financial protection situation in Iran from 2003-2014., Study Design: This is an analytical study on secondary data of Statistical Center of Iran (SCI). The study has some policy implications for policy makers; therefore, it is an applied one., Methods: Data related to the Iranian rural and urban household payments on health expenditures was obtained from annual surveys of the SCI. WHO researchers' approach was used to calculate the Fairness of Financial Contribution Indicator (FFCI), the headcount and overshoot ratios of catastrophic and impoverishing health expenditures. A logistic regression was conducted to identify the determinants of probability of occurrence of catastrophic health expenditure among Iranian households in 2014., Results: The mean of FFCI for rural and urban households was 0.854 (0.41) and 0.867 (0.32), respectively. The average headcount ratios of catastrophic and impoverishing health expenditures were 1.32% (0.24) and 0.33% (P=0.006) for rural households and 1.4% (0.6) and 0.28% (P=0.001) for urban households. Concerning rural households, the overshoot of catastrophic and impoverishing health expenditures was 14.94% (P=0.001) and 7.22% (0.53); it was 15.59% (1.54) and 7.76% (0.52) for urban households., Conclusions: No significant and considerable change was found in the headcount ratios of catastrophic and impoverishing health expenditure and in their overshoot or gap amounts. This suggested a lack of well-designed and effective schemes for materializing the financial protection in Iran.

Aim: Glioblastoma multiforme (GBM) is one of the malignant brain tumors that occur most frequently. Despite advances in therapy techniques, the cure of GBM is a major concern. Accordingly, there is a lot of interest in devising novel approaches, such as stem cell therapy, to treat patients with GBM. The aim of this study was to investigate the effects of human bone marrow stem (BMS) cells as well as human olfactory ensheathing cells (OECs) on the outgrowth of U87 glioma in rats., Material and Methods: OECs and BMS cells were obtained from volunteers. After verification of the stem cell type by flow cytometry and immunocytochemistry (ICC), cells were labeled and injected into human glioma-bearing rats. Magnetic resonance imaging (MRI), Hematoxylin and Eosin (H&E), and Immunohistochemistry (IHC) were utilized to assess the properties of the groups., Results: We found extensive migration and homing of the OECs and BMS cells towards the tumor area. H&E and IHC staining indicated that the grafted OECs survived and prevented the development of glioma. BMS cells supported proliferation and new vessel formation, and metastasis in glioma tissue., Conclusion: OECs and BMS cells can pass the blood brain barrier and reach the glioma mass. Therefore, this approach can be a potentially powerful method for the delivery of therapeutic agents to malignant brain tumors. In addition, these cells may be genetically modified in order to specifically express tumor-suppressive factors.

Root cause analysis (RCA) has been widely used for retrospective investigations of patient safety incidents. To increase patient safety competencies, RCA has recently been introduced in Iranian hospitals. The aims of the current study were to explore team members' experiences and perceptions of RCA and to identify the challenges and benefits of using it in Iranian hospitals from their perspective. A qualitative study was conducted consisting of 32 semi-structured interviews with health professionals who participated in the national training programme and were involved in RCA investigations. Data were analysed using the thematic analysis method. The participants encountered a range of obstacles while conducting RCA, including time constraints, a lack of resources, the blame culture and unsupportive colleagues. They stressed the need for further leadership support and cultural change within the Iranian healthcare system to facilitate the application of RCA. RCA was perceived as a beneficial analytical tool that improved patient care, fostered teamwork and communication among staff and promoted safety culture. This study concluded that applying RCA in the Iranian healthcare setting has had a significant impact on improving commitment to safety. However, the general adoption of this method is hindered by the lack of workplace and system supports. To maximize profits from RCA, clinical leaders must assign a high priority to RCA investigations and support RCA team efforts. Copyright © 2016 John Wiley & Sons, Ltd., (Copyright © 2016 John Wiley & Sons, Ltd.)

Aim: Glioblastoma (GBM) is an aggressive brain tumor in humans. The median survival rate of patients is one year after the diagnosis. So, development of an animal model is necessary for the advances in the research treatment of GBM. The aim of this study was to investigate the capability of human glioma cells in inducing glioma tumors in rats with intact immune system., Material and Methods: U87 cells were implanted in the frontal lobe of rats without suppressing the immune system. We used magnetic resonance imaging (MRI), Hematoxylin-Eosin (H&E) and Immunohistochemical (IHC) staining to assess characteristics of tumor., Results: At the 10th and 14th days of tumor inoculation, MRI images contained the tumor areas in the brain. All tumor-bearing rats developed tumors. The rats retained the morphology and histological characteristics of human glioma. Animals mimic GBM characteristics, such as mitotic activity, invasion, neovascularization, necrosis and pseudopalisading cells. IHC staining revealed tumor growth and progression in the tumor-bearing rats., Conclusion: This model is a standard system for studying the tumor phenotype, genotype, and for evaluating the efficacy of anti-cancer agents. It is a reliable, simple, inexpensive, and easily reproducible model, which may be a way for pre-clinical studies.

The brucellosis with multi-organ involvement in a patient with a history of the composite aortic graft (Bentall procedure) and Hepatitis B infection is rare. A 35-year-old man presented to us with fever and loss of consciousness. Four years ago, he was IDU and underwent cardiac surgery because of endocarditis. Recently lumbar spondylodiscitis was diagnosed. The Wright (1/320) and Coombs Wright tests (1/640) were positive. After CNS imaging, lumbar puncture was done. The CSF pleocytosis was lymphocyte dominant. In cardiac echocardiography, large vegetation on prosthetic aortic valve leaflets was seen. The brain MRI was reported abnormal. Treatment of brucellosis started with Ceftriaxone, Doxycycline, Rifampin and Gentamycin. After 4 days, he became oriented, and fever was disappeared then we continued the treatment for 16 days. The patient discharged and followed by daily phone calls. As symptoms of abdominal pain and jaundice were presented on the fifth day, he re-admitted. The patient expired because of hepatorenal and cardiac insufficiency. Drug side effects, activation of Hepatitis B and embolism of cardiac vegetation to other organs were suspected causes of death. We do not suggest medical therapy without cardiac surgery in such cases. When combination therapy is necessary for brucellosis in an HBsAg-positive patient, hepatitis virus activity should be assess by HBV-DNA PCR and the dose of drugs with known hepatotoxic effects such as rifampin and co-trimoxazole should be adjust. Combination therapy with quinolones instead of hepatoxic drugs is one of our suggustions.

Background: Hepatitis B infection is a universal concern. This infection can lead to chronic liver disease and hepatocellular carcinoma. Neonates born to HBsAg-positive mothers are at high risk of chronic hepatitis B virus (HBV) infection, especially for HBeAg-positive mothers or neonates who have not received hepatitis B immunoglobulin (HBIg) and HBV vaccines., Objectives: The aim of this study was to evaluate the efficacy of post-exposure prophylaxis in these infants to prevent infection., Patients and Methods: Thirty-eight infants born to HBsAg-positive mothers between September 2006 and September 2013 were followed. The investigation evaluated whether the standard prevention protocol of neonatal HBV transmission including HBIg at birth and receiving three doses of vaccine at birth and 2 and 6 months of age was performed, followed by post-vaccination tests (evaluation of HBsAg and HBsAb titer at 9 to 18 months of age) to determine subsequent infection. HBsAb titer ≥ 10 was considered as criterion for effectiveness of the prophylaxis procedure. The acquired data were analyzed using SPSS software (Version 18). The results are reported in descriptive tabulations., Results: Ninety seven percent (97%) of infants received HBIg at birth in the hospital. Generally, all of them received the first, second and third doses of vaccine at birth, 2 months, and 6 months after birth, respectively. Information for 35 mothers infected with HBV and 38 infants was available. The mean age of the mothers was 30.3 years. The results indicated that 20% of mothers were HBeAg positive. HBsAg was positive in one (2.6%) infant born to an HBeAg-positive mother. Around 94% of infants' HBsAb titers were ≥ 10, and 5.8% were reported as non-responders., Conclusions: The vertical transmission prevention program used in the study population in Tehran, which had an appropriate sample size, is effective. Additional doses of the vaccine can be useful in raising the effectiveness of immunoprophylaxis for infants at high risk of HBV infection. Also, emphasis must be set on post-vaccination testing.

Purpose - The purpose of this paper is to apply Bow-tie methodology, a proactive risk assessment technique based on systemic approach, for prospective analysis of the risks threatening patient safety in intensive care unit (ICU). Design/methodology/approach - Bow-tie methodology was used to manage clinical risks threatening patient safety by a multidisciplinary team in the ICU. The Bow-tie analysis was conducted on incidents related to high-alert medications, ventilator associated pneumonia, catheter-related blood stream infection, urinary tract infection, and unwanted extubation. Findings - In total, 48 potential adverse events were analysed. The causal factors were identified and classified into relevant categories. The number and effectiveness of existing preventive and protective barriers were examined for each potential adverse event. The adverse events were evaluated according to the risk criteria and a set of interventions were proposed with the aim of improving the existing barriers or implementing new barriers. A number of recommendations were implemented in the ICU, while considering their feasibility. Originality/value - The application of Bow-tie methodology led to practical recommendations to eliminate or control the hazards identified. It also contributed to better understanding of hazard prevention and protection required for safe operations in clinical settings.

Objectives: In open heart surgery using cardiopulmonary bypass, perfusion of the lower extremities is markedly reduced which may induce critical ischaemia in patients with pre-existing peripheral artery disease. Whether these patients have an increased risk for amputation and should better undergo peripheral revascularization prior to surgery remains unclear., Methods: From 1 January 2009 to 31 December 2010, 785 consecutive patients undergoing open heart surgery were retrospectively included. In 443 of these patients, preoperative ankle brachial index (ABI) measurements were available. The cohort was divided into four groups: (i) ABI < 0.5, (ii) ABI 0.5-0.69, (iii) ABI 0.7-0.89 or (iv) ABI ≥ 0.9. Follow-up data of 413 (93.2%) patients were analysed with regard to mortality and amputations., Results: The groups differed significantly in terms of age, cardiac risk factors, performed cardiac surgery and renal function. Postoperative delayed wound healing was significantly associated with lower ABI (25.9, 15.2, 27.0 and 9.6% in Groups I-IV, respectively, P = 0.003), whereas 30-day mortality was not significantly higher in patients with lower ABI (0, 4.3, 8.1 and 3.9%, respectively, P = 0.4). Kaplan-Meier models showed a significantly lower long-term survival over 4 years in patients with reduced ABI (P = 0.001, long-rank test) while amputations occurred rarely with only one minor amputation in Group II (P = 0.023)., Conclusions: Patients with reduced ABIs undergoing heart surgery showed more wound-healing disturbances, and higher long-term mortality compared with those with normal ABIs. However, no perioperative ischaemia requiring amputation occurred. Thus, reduced ABIs were not associated with increased peripheral risks in open heart surgery but ABI may be helpful in selecting the site for saphenectomy to potentially avoid delayed healing of related wounds in legs with severely impaired arterial perfusion., (© The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Introduction: Uneven geographic distribution of physicians is a major healthcare issue in Iran. This study aimed to explore the relationship between personal characteristics of the recently graduated specialist physicians in Iran and their choice of practice location., Methods: A cross-sectional study was conducted to extract information with regard to 3825 recently graduated specialist physicians from all medical schools across Iran between 2009 and 2012. The relationship between physicians' personal attributes and their desire to practise in underdeveloped areas was analyzed using χ2 test and logistic regression analysis., Results: Birthplace, sex, exposure to rural practice before residency program, place of residence, and year of graduation were associated with physicians' desire to practise in an underdeveloped area. The logistic regression showed that female physicians were less likely to choose underdeveloped areas to practise as compared with their male counterparts (OR=0.659, 95%CI, 0.557-0.781, p≤0.001). Physicians who lived in underdeveloped areas were nine times more likely to choose underdeveloped areas to practise as compared with those living in other areas (OR=8.966, 95%CI, 4.717-17.041, p≤0.001). Physicians who did not have previous exposure to rural practice were 28% less likely to choose to serve in the underdeveloped areas as compared to those who had such exposure (OR=0.780, 95%CI, 0.661-0.922, p=0.004). Neither physicians' marital status nor their success in the board certification exam was associated with their choice of practice location., Conclusions: It seems that increasing the enrollment of physicians with a rural background in residency programs may solve the problem of uneven distribution of specialist physicians in Iran. Because female physicians are less willing to work in the underdeveloped areas than male physicians, increasing the number of male student admissions to residency programs, particularly in certain specialties that are more in demand in the underdeveloped areas, could alleviate the problem of uneven distribution of physicians in the short run. Further, programs that support raising the admissions of female students with a rural background into local medical universities along with providing incentives to encourage them to live and work in rural areas should be put on the policy agenda.

Aim: To explore nurses' and physicians' attitudes and perceptions relevant to safety culture and to elicit strategies to promote safety culture in an intensive care unit., Background: A strong safety culture is essential to ensure patient safety in the intensive care unit., Method: This case study adopted a mixed method design. The Safety Attitude Questionnaire (SAQ-ICU version), assessing the safety climate through six domains, was completed by nurses and physicians (n = 42) in an academic intensive care unit. Twenty semi-structured interviews and document analyses were conducted as well. Interviews were analysed using a framework analysis method., Result: Mean scores across the six domains ranged from 52.3 to 72.4 on a 100-point scale. Further analysis indicated that there were statistically significant differences between physicians' and nurses' attitudes toward teamwork (mean scores: 64.5/100 vs. 52.6/100, d = 1.15, t = 3.69, P < 0.001) and job satisfaction (mean scores: 78.2/100 vs. 57.7/100, d = 1.5, t = 4.8, P < 0.001). Interviews revealed several safety challenges including underreporting, failure to learn from errors, lack of speaking up, low job satisfaction among nurses and ineffective nurse-physician communication., Conclusion: The results indicate that all the domains need improvements. However, further attention should be devoted to error reporting and analysis, communication and teamwork among professional groups, and nurses' job satisfaction., Implications for Nursing Management: Nurse managers can contribute to promoting a safety culture by encouraging staff to report errors, fostering learning from errors and addressing inter-professional communication problems., (© 2013 John Wiley & Sons Ltd.)

Background: Rare TREM2 variants are significant risk factors for Alzheimer's disease (AD)., Methods: We used next generation sequencing of the whole gene (n = 700), exon 2 Sanger sequencing (n = 2634), p.R47H genotyping (n = 3518), and genome wide association study imputation (n = 13,048) to determine whether TREM2 variants are risk factors or phenotypic modifiers in patients with AD (n = 1002), frontotemporal dementia (n = 358), sporadic (n = 2500), and variant (n = 115) Creutzfeldt-Jakob disease (CJD)., Results: We confirm only p.R47H as a risk factor for AD (odds ratio or OR = 2.19; 95% confidence interval or CI = 1.04-4.51; P = .03). p.R47H does not significantly alter risk for frontotemporal dementia (OR = 0.81), variant or sporadic CJD (OR = 1.06 95%CI = 0.66-1.69) in our cohorts. Individuals with p.R47H associated AD (n = 12) had significantly earlier symptom onset than individuals with no TREM2 variants (n = 551) (55.2 years vs. 61.7 years, P = .02). We note that heterozygous p.R47H AD is memory led and otherwise indistinguishable from "typical" sporadic AD., Conclusion: We find p.R47H is a risk factor for AD, but not frontotemporal dementia or prion disease., (Copyright © 2014 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.)

Background and Aims: Bupropion was introduced for smoking cessation following a pivotal trial showing that it gave improved efficacy over the nicotine patch and also suggesting combination treatment was beneficial. We tested in clinical practice for an effectiveness difference between bupropion and nicotine replacement therapy (NRT), whether the combination improves effectiveness and whether either treatment might be more beneficial for certain subgroups of smokers., Design: Open-label randomized controlled trial with 6-month follow-up., Setting: Four UK National Health Service (NHS) smoking cessation clinics., Participants: Smokers (n = 1071) received seven weekly behavioural support sessions and were randomized to an NRT product of their choice (n = 418), bupropion (n = 409) or NRT plus bupropion (n = 244)., Measures: The primary outcome was self-reported cessation over 6 months, with biochemical verification at 1 and 6 months. Also measured were baseline demographics, health history, smoking characteristics and unwanted events during treatment., Findings: Abstinence rates for bupropion (27.9%) and NRT (24.2%) were not significantly different (odds ratio = 1.21, 95% confidence interval = 0.883-1.67), and the combination rate (24.2%) was similar to that for either treatment alone. There was some evidence that the relative effectiveness of bupropion and NRT differed according to depression (χ(2) = 2.86, P = 0.091), with bupropion appearing more beneficial than NRT in those with a history of depression (29.8 versus 18.5%). Several unwanted symptoms were more common with bupropion., Conclusion: There is no difference in smoking cessation effectiveness among bupropion, nicotine replacement therapy and their combination when used with behavioural support in clinical practice. There is some evidence that bupropion is more beneficial than nicotine replacement therapy for smokers with a history of depression., (© 2013 Society for the Study of Addiction.)

Disseminated tuberculosis (TB) is commonly seen in HIV-infected patients and is major cause of death in these patients. In HIV-infected patients disseminated tuberculosis is frequently undiagnosed or misdiagnosed. In this article we report a case of disseminated TB in a HIV-infected patient with a relatively long history of fever and other complaints without definite diagnosis. Diagnosis of disseminated TB was confirmed by bone marrow biopsy and polymerase chain reaction analysis (PCR) of the ascitic fluid. With anti-TB treatment signs and symptoms improved.

Objective: The aim of this study was to use intra-oral radiographs to evaluate changes in marginal bone levels around three different implant designs after 1 year., Materials and Methods: Three implant designs; two with a straight and one with a conical design, were placed adjacent to each other in the partially edentulous areas of 25 patients. The patients received 46 implants with a straight design (All fit SSO and SPI-element) and 29 implants with a conical design (SPI-contact). Two-way repeated analysis of variance (ANOVA) was used to evaluate the marginal bone changes in each group at 12 months follow-up (p < 0.05)., Results: None of the implants had failed by the end of this study. After 12 months, significant differences were noted in the amount of alveolar bone loss recorded between the All fit SSO and SPI implants (p < 0.05). Mean crestal bone loss was 0.88 ± 0.43 mm for the All fit, 0.61 ± 0.34 mm for the SPI contact and 0.54 ± 0.27 mm for the SPI element implants., Conclusions: The results of this study demonstrate that straight (cylindrical) implants with shorter high polish surface displayed less bone resorption.

Intestinal tuberculosis is an uncommon presentation of tuberculosis (TB) and has clinicopathological similarities with Crohn's disease. In regions where TB is endemic clinicians must aware of this condition and fully evaluate their patients when Crohn's disease is diagnosed. We recommend all pathologic specimens be evaluate effectively for TB.Smear,culture and PCR for Mycobacterium.tuberculosis from samples aside the pathological reviews help for better diagnosis. Here we present a case of intestinal tuberculosis which initially diagnosed as Crohn's disease but after starting immunosuppressive agents he presented with disseminated tuberculosis.

Dementia is starting to attract attention following decades of comparative neglect relative to other disease areas. England has been at the forefront of this sea change as one of the first countries in the world to develop a National Dementia Strategy (in 2009). Events leading up to the publication of this strategy and since will be examined here together with a glimpse at the international landscape.

Background: Clinical governance (CG) is among the different frameworks proposed to improve the quality of healthcare. Iran, like many other countries, has put healthcare quality improvement in its top health policy priorities. In November 2009, implementation of CG became a task for all hospitals across the country. However, it has been a challenge to clarify the notion of CG and the way to implement it in Iran. The purpose of this action research study is to understand how CG can be defined and implemented in a selected teaching emergency department (ED)., Methods/design: We will use Soft Systems Methodology for both designing the study and inquiring into its content. As we considered a complex problem situation regarding the quality of care in the selected ED, we initially conceptualized CG as a cyclic set of purposeful activities designed to explore the situation and find relevant changes to improve the quality of care. Then, implementation of CG will conceptually be to carry out that set of purposeful activities. The activities will be about: understanding the situation and finding out relevant issues concerning the quality of care; exploring different stakeholders' views and ideas about the situation and how it can be improved; and defining actions to improve the quality of care through structured debates and development of accommodations among stakeholders. We will flexibly use qualitative methods of data collection and analysis in the course of the study. To ensure the study rigor, we will use different strategies., Discussion: Successful implementation of CG, like other quality improvement frameworks, requires special consideration of underlying complexities. We believe that addressing the complex situation and reflections on involvement in this action research will make it possible to understand the concept of CG and its implementation in the selected setting. By describing the context and executed flexible methods of implementation, the results of this study would contribute to the development of implementation science and be employed by boards and executives governing other clinical settings to facilitate CG implementation.

Varicella-zoster viruses complications involving the CNS are estimated to occur rarely, transverse myelitis after Varicella-zoster virus in most patients is characterized by an abrupt onset of progressive weakness and sensory disturbance in the lower extremities , like other viruses. We describe the case of 17 year-old boy who experienced cervical transverse myelitis after chickenpox with inability to walk and with urinary retention. He was not treated with any medication but complete recovery has been occurred.

Identification of acid-fast bacilli (AFB) in sputum or tissue samples is among definite diagnostic methods of tuberculosis. However, this method of diagnosis is restricted by certain limitations. Serologic diagnosis of tuberculosis (TB) has been used for a long time. The aim of this study was to determine the sensitivity and, specificity of Antigen 60 (A60) IgG, IgA, IgM test results in TB diagnosis. Mycobacterial A60-based ELISA was used to measure specific IgA, IgM and IgG antibodies in the sera of 127 adult TB patients (consisted of 74 pulmonary and 53 extra-pulmonary cases), and 95 controls (46 healthy volunteers and 49 patients with various acute or chronic diseases other than tuberculosis). Data from A60 IgG-based ELISA, chest radiography, AFB culture and pathologic evaluation for AFB were obtained .The cutoff value of A60 IgG, IgA and IgM were chosen according to a receiver operating characteristic (ROC) analysis. The sensitivity, specificity and positive likelihood ratio were determined. The mean levels of IgG, IgA and IgM were significantly higher in patients with pulmonary tuberculosis when compared with control groups. Sensitivity of IgG test was 54.3 %, while the specificity was 84.2%. The IgA test showed a sensitivity of 70.1% with a specificity of 80 %. Combination of the IgG and IgA tests showed a total sensitivity of 45.7 % and a specificity of 94.7% and the positive likelihood ratio of 8.62. Chosen cutoff values of IgG, IgA, and IgM sets were 285,265 and 0.9 ELISA units respectively. Our study results showed a good specificity (94.7%) and a reasonable positive likelihood ratio (8.62) of the test when combined IgA and IgG with new cutoff points were considered on diagnosis of tuberculosis in adult patients. Combined use of both IgG and IgA tests results allows an increased accuracy in diagnostic of tuberculosis.

Background: The hepatitis C virus is a major cause of hepatocellular carcinoma. Extrahepatic manifestations of hepatitis C include mixed cryoglobulinemia which can result in ischemic damage to multiple organs. The management of these sequelae in posthepatectomy patients is unclear., Case Report: A 49-year-old male with hepatitis C was found to have a 4 cm hepatocellular carcinoma on surveillance imaging. He underwent portal vein embolization followed by hepatectomy. His postoperative course was complicated by the development of splenic infarcts, small bowel ischemia, skin lesions, and liver damage. Findings of elevated cryocrit and elevated rheumatoid factor suggested the diagnosis of cryoglobulin-related vasculitis. The patient improved on supportive care., Conclusion: Cryoglobulinemia is associated with hepatitis C and may complicate the care of this patient population. The treatment of cryoglobulinemia posthepatectomy patients is complicated by concerns over how medications may affect the regenerating liver. Steroids should be used with caution in this setting., Summary: Brief report of hepatectomy complicated by vasculitis in the context of hepatocellular carcinoma secondary to hepatitis C addresses the management of mixed cryoglobulinemia in post-hepatectomy patients.

Subdiaphragmatic abscess has not yet been reported as a manifestation of tuberculosis. We report an IgA deficient patient with recurrent episodes of unusual extrapulmonary manifestations of tuberculosis including subdiaphragmatic abscesses and metacarpophalangeal osteomyelitis that was improved each time with antituberculosis drugs. There was not any resistance to the drugs used against mycobacterium despite repeated courses of antituberculosis regimens. In such recurrent cases, one should rule out any immunodeficiency states.

The study of social cognition in psychiatric disorders has become increasingly popular in recent years. This is due to the its proposed link to social functioning and the inability of general neurocognitive skills to explain the spectrum of impairments observed in patients. This article reviews research into two of the processes thought to underlie social cognition (emotion perception and theory of mind) in schizophrenia and autism. This is followed by a look at neuroimaging studies and their efforts to localize the neural correlates of emotion perception and theory of mind in the two disorders. We concluded that while a specific impairment in emotion perception and theory of mind skills cannot be generalized to all individuals with autism and schizophrenia, there are subpopulations that have lingering deficits of social cognition tasks. Neuroimaging work consistently points to the involvement of the fusiform gyrus and amygdala in emotion processing, while the medial prefrontal and frontal cortex are implicated in tasks invoking theory of mind. We propose that deficits of social cognition may benefit from cognitive remediation therapy and pharmacological cognitive enhancers.