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Aflatoxin M1 (AFM1) is a 2B Group human carcinogens agent and introduces into the human diet by milk consumption. In the present study 257 raw, 143 pasteurized and 61 UHT milk samples were collecte...

Consciousness disturbances are the most common posttraumatic complications. The purpose of this study was to compare the single and combined effects of nature sounds and foot sole reflexology massage on level of consciousness in traumatic comatose patients. This randomized controlled clinical trial was conducted in 2 teaching hospitals in an urban area of Iran. Samples were 120 traumatic comatose patients who were randomly assigned into control, nature sounds, foot reflexology massage, and nature sounds plus foot sole reflexology massage groups. Patients in all groups received routine care. Interventions were performed twice a day for 2 weeks, each time for 30 minutes. The patients' level of consciousness was assessed using the Glasgow Coma Scale before, 1 week, and 2 weeks after the intervention. The groups had no significant differences in the mean scores of the consciousness level before, 1 week after, and the last day of the intervention. Also, there was a significant difference in the number of patients who regained full consciousness (P = .001) in the intervention groups compared with the control group. Significant differences in the number of days of consciousness were reported in at least one of the groups compared with other groups (P = .001). This difference was significant in the control group compared with the foot reflexology massage group (P = .032), as well as the nature sounds plus foot sole reflexology massage group (P = .001). Single or combined interventions can increase the level of consciousness in comatose patients and reduce the duration of coma.

Summary Influenza is of particular importance because of the pace of epidemics, the extent and number of infected people, and the severity of the side effects. The aim of this study was to investigate the epidemiological and clinical aspects of this disease during the last epidemic in southern Iran. The present cross-sectional study was performed on the basis of secondary data analysis and information in medical records of patients with acute lower respiratory system infection in hospitals affiliated to Jahrom University of Medical Sciences. Data were analyzed by SPSS 18 using descriptive statistics, Chi-square test and logistic regression at 0.05 significance level. From 1st September 2015 to 20th March 2016, 108 patients with acute lower respiratory tract infection with a mean age of 42.92 ± 19.65 years were admitted to Jahrom hospitals, of which 43 were diagnosed with definite influenza, all of which (100%) had H1N1 type A influenza. There were eight deaths in all, of which five were positive for H1N1, and of these five cases, three cases had delayed diagnosis and treatment, and four cases had underlying diseases. The results of multivariate logistic regression analysis showed a significant relationship between positive H1N1 cases and history of contact with definite influenza, traveling abroad, and clinical symptoms of chills (p < 0.05). The results of this study showed that 39.81% of the patients with acute lower respiratory tract infections suffered from influenza. Furthermore, the delayed treatment and the underlying diseases were the most important cause of death.

Colorectal cancer is one of the most common cancers, and various studies have shown that many genes, including miRNAs, play important roles in the development of this cancer. Here, we investigated the molecular and cellular effect of miR-3120 and its mirror miRNA, miR-214, in colorectal cancer using bioinformatics and experimental techniques. Microarray data analysis showed that miR-3120/miR-214 expression are deregulated in colorectal cancer tumors and RT-qPCR analysis of these miRNAs showed a negative expression correlation in different colorectal cancer-originated cell lines. Also, RT-qPCR result indicated that miR-3120 and miR-214 affects each other expression. Overexpression of miR-3120 in HCT-116 cell line followed by qRT-PCR showed increased expression of SMAD3, SMAD4 and AKT2 genes, whereas overexpression of miR-214 inversed this effect. In addition, the expression of specific target genes of each microRNA showed a pattern of co-expression with its microRNAs. Also, investigating the effect of miR-3120/miR-214 on the cell cycle, showed their promoting effect on the progression of the cell cycle. Overall, these data suggest that miR-3120/miR-214 may be involved in regulating the molecular pathways of colorectal cancer, and part of this regulation could be related to the interaction of these genes with each other.

Digital, Aims To compare the prevalence of electrocardiogram (ECG)-documented atrial fibrillation (or flutter) (AF) across eight regions of the world, and to examine antithrombotic use and clinical outcomes. Methods and results Baseline ECGs were collected in 153 152 middle-aged participants (ages 35–70 years) to document AF in two community-based studies, spanning 20 countries. Medication use and clinical outcome data (mean follow-up of 7.4 years) were available in one cohort. Cross-sectional analyses were performed to document the prevalence of AF and medication use, and associations between AF and clinical events were examined prospectively. Mean age of participants was 52.1 years, and 57.7% were female. Age and sex-standardized prevalence of AF varied 12-fold between regions; with the highest in North America, Europe, China, and Southeast Asia (270–360 cases per 100 000 persons); and lowest in the Middle East, Africa, and South Asia (30–60 cases per 100 000 persons) (P, Ciencias Médicas y de la Salud

Digital, Objectives This study aimed to examine the association of bedtime with mortality and major cardiovascular events. Methods Bedtime was recorded based on self-reported habitual time of going to bed in 112,198 participants from 21 countries in the Prospective Urban Rural Epidemiology (PURE) study. Participants were prospectively followed for 9.2 years. We examined the association between bedtime and the composite outcome of all-cause mortality, non-fatal myocardial infarction, stroke and heart failure. Participants with a usual bedtime earlier than 10PM were categorized as ‘earlier’ sleepers and those who reported a bedtime after midnight as ‘later’ sleepers. Cox frailty models were applied with random intercepts to account for the clustering within centers. Results A total of 5633 deaths and 5346 major cardiovascular events were reported. A U-shaped association was observed between bedtime and the composite outcome. Using those going to bed between 10PM and midnight as the reference group, after adjustment for age and sex, both earlier and later sleepers had a higher risk of the composite outcome (HR of 1.29 [1.22, 1.35] and 1.11 [1.03, 1.20], respectively). In the fully adjusted model where demographic factors, lifestyle behaviors (including total sleep duration) and history of diseases were included, results were greatly attenuated, but the estimates indicated modestly higher risks in both earlier (HR of 1.09 [1.03–1.16]) and later sleepers (HR of 1.10 [1.02–1.20]). Conclusion Early (10 PM or earlier) or late (Midnight or later) bedtimes may be an indicator or risk factor of adverse health outcomes., Ciencias Médicas y de la Salud

On 14 November 2016, an outbreak of highly pathogenic avian influenza (HPA) was reported from a commercial layer farm located in Malard, Tehran Province, Iran. This study aimed to investigate the HPAI H5N8 outbreaks in Iran. The questionnaire was prepared and completed through interviews with farm owners or field observations at the time of disease onset from November 2016 to February 2017. The HPAI H5N8 infection was confirmed in 30 different locations including 10 villages (33.3%), nine-layer farms (33%), two broiler breeder farms (6.67%), one layer breeder farm (3.3%), one turkey farm (3.3%), one partridge farm (3.3%), five national parks (16.7%), and one wetland (3.3%) in 12 provinces of Iran. The cumulative incidence rates of disease in villages, layer farms, broiler breeder farms, layer breeder farms, partridge farms, and turkey farms were 0.02%, 0.87%, 0.55%, 6.25%, 7.14%, and 0.69%, respectively. The findings reflect that among the investigated variables at infected locations, new birds entering the home in villages, live bird markets, inappropriate biosecurity conditions, transporting manure during the breeding period, close proximity of a common road to infected farms, and poultry movement inside (pullet) and outside were the most frequently observed possible risk factors for these outbreaks. In conclusion, attention should be focused on the study of the dynamics and movements of domestic poultry, investigation and modification of the structure of industrial poultry farms, training for all related people, enhancement of passive surveillance, an increase in biosecurity, raising the awareness of the authorities on the importance of the infection, and provision of the required credits and facilities.

Encephalitozoon cuniculi is a microsporidian which is frequently reported from rabbits. This microorganism can either ravage rabbit farms or transmit to humans from pet rabbits. This study aimed to investigate the prevalence and the genotype distribution of E. cuniculi among pet rabbits. In this study urine samples were collected from 50 pet rabbits, aged 2 months to 3 years, admitted to teaching veterinary hospital. Four races Lop, Dutch, Mix, and Angora were screened for E. cuniculi. The clinical symptoms were recorded and total DNA was extracted from urine samples. E. cuniculi was identified using amplification of the small subunit ribosomal RNA (ssu rRNA) gene and its genotypes were characterized using PCR/sequencing of the polar tube protein (PTP) gene. Phylogenetic tree was drawn to confirm the characterized genotypes. Out of 50 samples, 41 (82 %) of rabbits were asymptomatic, while nine (18 %) had at least one of symptoms including head-tilt, circling, and ataxia. A statistical correlation was seen between mean age + SD and symptoms (P-value = 0.039). The presence of E. cuniculi was confirmed in 16/50 (32 %) rabbits and all of them were identified as the genotype I. Our findings represented no consistency between E. cuniculi PCR – positive and the presence of symptoms (P-value = 0.318). Our results showed positive correlation between symptoms and age; however, the lack of correlation between PCR results with age may signify the latent infection in younger rabbits. All identified E. cuniculi were the genotype I, which is reported from rabbits and humans, highlighting the zoonotic concern for this genotype, particularly among subjects who keep pet rabbits.

Digital, Objectives We aimed to examine the relationship between access to medicine for cardiovascular disease (CVD) and major adverse cardiovascular events (MACEs) among people at high risk of CVD in high-income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low-income countries (LICs) participating in the Prospective Urban Rural Epidemiology (PURE) study. Methods We defined high CVD risk as the presence of any of the following: hypertension, coronary artery disease, stroke, smoker, diabetes or age >55 years. Availability and affordability of blood pressure lowering drugs, antiplatelets and statins were obtained from pharmacies. Participants were categorised: group 1—all three drug types were available and affordable, group 2—all three drugs were available but not affordable and group 3—all three drugs were not available. We used multivariable Cox proportional hazard models with nested clustering at country and community levels, adjusting for comorbidities, sociodemographic and economic factors. Results Of 163 466 participants, there were 93 200 with high CVD risk from 21 countries (mean age 54.7,49% female). Of these, 44.9% were from group 1, 29.4% from group 2 and 25.7% from group 3. Compared with participants from group 1, the risk of MACEs was higher among participants in group 2 (HR 1.19, 95% CI 1.07 to 1.31), and among participants from group 3 (HR 1.25, 95% CI 1.08 to 1.50). Conclusion Lower availability and affordability of essential CVD medicines were associated with higher risk of MACEs and mortality. Improving access to CVD medicines should be a key part of the strategy to lower CVD globally., Ciencias Médicas y de la Salud

Background: The study aims to investigate the treatment of thoracolumbar herniated intervertebral discs (IVD) in dogs using Oxygen-Ozone (O2-O3) intradiscal injection and assess the results using MRI which achieve more accurate details and procedures. Results: All indices were improved after the treatment, while, three were statistically significant at PConclusions: Intradiscal O2-O3 injection reduces the size of the herniated disc via disc shrinkage and decreasing the pressure of herniated part on the spinal cord.

Digital, OBJECTIVE We aimed to compare cardiovascular (CV) events, all-cause mortality, and CV mortality rates among adults with and without diabetes in countries with differing levels of income. RESEARCH DESIGN AND METHODS The Prospective Urban Rural Epidemiology (PURE) study enrolled 143,567 adults aged 35–70 years from 4 high-income countries (HIC), 12 middle-income countries (MIC), and 5 low-income countries (LIC). The mean follow-up was 9.0 6 3.0 years. RESULTS Among those with diabetes, CVD rates (LIC 10.3, MIC 9.2, HIC 8.3 per 1,000 personyears, P < 0.001), all-cause mortality (LIC 13.8, MIC 7.2, HIC 4.2 per 1,000 personyears, P < 0.001), and CV mortality (LIC 5.7, MIC 2.2, HIC 1.0 per 1,000 person-years, P < 0.001) were considerably higher in LIC compared with MIC and HIC. Within LIC, mortality was higher in those in the lowest tertile of wealth index (low 14.7%, middle 10.8%, and high 6.5%). In contrast to HIC and MIC, the increased CV mortality in those with diabetes in LIC remained unchanged even after adjustment for behavioral risk factors and treatments (hazard ratio [95% CI] 1.89 [1.58–2.27] to 1.78 [1.36–2.34]). CONCLUSIONS CVD rates, all-cause mortality, and CV mortality were markedly higher among those with diabetes in LIC compared with MIC and HIC with mortality risk remaining unchanged even after adjustment for risk factors and treatments. There is an urgent need to improve access to care to those with diabetes in LIC to reduce the excess mortality rates, particularly among those in the poorer strata of society., Ciencias Médicas y de la Salud

Objectives: We aimed to compare cardiovascular (CV) events, all-cause and CV mortality rates, among adults with and without diabetes in countries with differing levels of income. Research design and methods: Prospective Urban Rural Epidemiological (PURE) enrolled 143,567 adults aged 35 to 70 years from 4 high income countries (HIC), 12 middle income countries (MIC) and 5 low income countries (LIC). The mean follow-up was 9.0±3.0 years. Results: Among those with diabetes, CVD rates (LIC 10.3, MIC 9.2, HIC 8.3 per 1000 person years, p Conclusions: CVD rates, all-cause and CV mortality were markedly higher among those with diabetes in LIC compared to MIC and HIC with mortality risk remaining unchanged even after adjustment for risk factors and treatments. There is an urgent need to improve access to care to those with diabetes in LIC to reduce the excess mortality rates, particularly among those in the poorer strata of society.

Background: Eggs are of the few naturally occurring foods that meet the needs of human body in a balanced manner. The present study was conducted to determine the rate of egg per capita consumption in Tehran city in 2018. Methods: The present cross-sectional study was conducted on 4.213 heads of families living in 22 regions of Tehran. Selected randomly using multistage cluster sampling method. The research data were collected through a researcher-made questionnaire completed by interviews. Results: Mean egg consumption per person was 2.58 per week and 134 per capita (95%CI; 134-137). Moreover, 39.59% of the participants believed that brown-shelled eggs had a higher nutritional value and 61.99% were unaware about the presence of omega 3-enriched eggs. Concerning the participants' attitudes towards egg consumption effective factors, the 'recommendations of physicians and nutritionists to use eggs' and knowing about harmlessness of cholesterol found in eggs' received the mean highest scores of 3.47 and 3.31, respectively. Conclusion: Per capita consumption of eggs among families in Tehran was much lower than the recommended standards. Physicians and nutritionists are recommended to try to raise the community awareness about the nutritional value and correct the misconceptions about egg cholesterol.

ObjectivesWe aimed to examine the relationship between access to medicine for cardiovascular disease (CVD) and major adverse cardiovascular events (MACEs) among people at high risk of CVD in high-income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low-income countries (LICs) participating in the Prospective Urban Rural Epidemiology (PURE) study.MethodsWe defined high CVD risk as the presence of any of the following: hypertension, coronary artery disease, stroke, smoker, diabetes or age >55 years. Availability and affordability of blood pressure lowering drugs, antiplatelets and statins were obtained from pharmacies. Participants were categorised: group 1—all three drug types were available and affordable, group 2—all three drugs were available but not affordable and group 3—all three drugs were not available. We used multivariable Cox proportional hazard models with nested clustering at country and community levels, adjusting for comorbidities, sociodemographic and economic factors.ResultsOf 163 466 participants, there were 93 200 with high CVD risk from 21 countries (mean age 54.7, 49% female). Of these, 44.9% were from group 1, 29.4% from group 2 and 25.7% from group 3. Compared with participants from group 1, the risk of MACEs was higher among participants in group 2 (HR 1.19, 95% CI 1.07 to 1.31), and among participants from group 3 (HR 1.25, 95% CI 1.08 to 1.50).ConclusionLower availability and affordability of essential CVD medicines were associated with higher risk of MACEs and mortality. Improving access to CVD medicines should be a key part of the strategy to lower CVD globally.

Aims To investigate the association of estimated total daily sleep duration and daytime nap duration with deaths and major cardiovascular events. Methods and results We estimated the durations of total daily sleep and daytime naps based on the amount of time in bed and self-reported napping time and examined the associations between them and the composite outcome of deaths and major cardiovascular events in 116 632 participants from seven regions. After a median follow-up of 7.8 years, we recorded 4381 deaths and 4365 major cardiovascular events. It showed both shorter (≤6 h/day) and longer (>8 h/day) estimated total sleep durations were associated with an increased risk of the composite outcome when adjusted for age and sex. After adjustment for demographic characteristics, lifestyle behaviours and health status, a J-shaped association was observed. Compared with sleeping 6–8 h/day, those who slept ≤6 h/day had a non-significant trend for increased risk of the composite outcome [hazard ratio (HR), 1.09; 95% confidence interval, 0.99–1.20]. As estimated sleep duration increased, we also noticed a significant trend for a greater risk of the composite outcome [HR of 1.05 (0.99–1.12), 1.17 (1.09–1.25), and 1.41 (1.30–1.53) for 8–9 h/day, 9–10 h/day, and >10 h/day, P trend < 0.0001, respectively]. The results were similar for each of all-cause mortality and major cardiovascular events. Daytime nap duration was associated with an increased risk of the composite events in those with over 6 h of nocturnal sleep duration, but not in shorter nocturnal sleepers (≤6 h). Conclusion Estimated total sleep duration of 6–8 h per day is associated with the lowest risk of deaths and major cardiovascular events. Daytime napping is associated with increased risks of major cardiovascular events and deaths in those with >6 h of nighttime sleep but not in those sleeping ≤6 h/night.

Background and Objectives: Researchers and health specialists are increasingly using self-reports to obtain information on chronic illnesses. This study was conducted to assess the validity of self-reports of diabetes based on a recent field survey in Mashhad. Methods: In this cross-sectional study, we used the results of 2015 census in Mashhad, a population based survey of people over the age of 30 (n =307103), to determine the proportion of self-reported diabetes. The patient records of Sina Electronic Health Record system (SinaEHR®) coded as E11 and E12 approved by doctors were used as a reference. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated with 95% confidence intervals. Results: The sensitivity, specificity, PLR, NLR, PPV, and NPV of self-reported diabetes was 24.59% (95% CI: 23.97-25.21), 98.04% (95% CI: 97.99-98.09), 12.56% (95% CI: 12.11-13.02), 0.77% (95% CI: 0.76-0.78), 44.77% (95% CI: 43.89-45.67), and 95.27% (95% CI: 95.23-95.31), respectively. The sensitivity of self-reported diabetes was higher in men, Iranian individuals, single subjects, people aged 60 and over, individuals with a BMI of 18.5-25, and those with university education. Conclusion: Although the sensitivity of self-reported diabetes was poor in this study, its specificity and positive and negative predictive values were good. Furthermore, the sensitivity of self-reported diabetes was higher in men, Iranian individuals, single subjects, people aged 60 and over, individuals with a BMI of 18.5-25, and those with university education. It seems that caution should be exercised in using self-reported data in epidemiological studies.

Background: While many dental procedures induce pulpal damage by increase the temperature, this study was established to evaluate the thermally effect of different laser methods on pulp, oral soft and hard tissues. Objectives: In this study, laser irradiation applied to measure how increased in power output can influence on dental pulp by using CT images. Methods: Ten adult New Zealand white rabbits were divided into 2 groups receiving 3 and 5 watt for 15 second respectively on left side cheek teeth after shortening of third upper and first lower premolars. Right cheek teeth trimmed as well and served as control. CT scans were taken immediately after lasing and repeated every week for one month. Results: The statistical analysis of dental measurements shows that teeth length of right and left third upper premolar was significantly different during time (P0.05). Only third upper premolar in fourth week showed a significant difference between two groups (P=0.047). Conclusions: laser radiation could influence on tooth growth in both groups. This study revealed that the higher laser power would have been more effective on reduction of growth rate of teeth. In addition, 3D CT scans could be an appropriate tools for dental growth investigation.