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Abstract: We have previously reported that paraoxon, an organophosphate compound, at submicromolar concentrations effectively suppresses Ca2+ action potentials and modulates the activity of snail neurons. This effect was unrelated to acetylcholinesterase inhibition but was found to involve the direct or indirect modulation of ion channels [Vatanparast, J., Janahmadi, M., Asgari, A.R., Sepehri, H., Haeri-Rohani, A., 2006a. Paraoxon suppresses Ca2+ action potential and afterhyperpolarization in snail neurons: Relevance to the hyperexcitability induction. Brain Res. 1083 (1), 110–117.]. In the present work, the interaction of paraoxon with protein kinase C (PKC) and inositol 1,4,5-trisphosphate (IP3)-mediated Ca2+ release, on the modulation of Ca2+ action potentials and neuronal activity was investigated. Phorbol 12, 13 dibutyrate (PdBu), the activator of PKC, suppressed afterhyperpolarization and increased the activity of snail neurons without any significant effect on the Ca2+ action potential duration. Pretreatment with PKC activator attenuated the suppressing effect of paraoxon on the duration of Ca2+ action potentials. Staurosporine, a selective blocker of PKC, did not block the effect of paraoxon on Ca2+ action potential suppression and hyperexcitability induction. Our findings did not support the involvement PKC in the paraoxon induced Ca2+ action potential suppression and neuronal activity modulation, although activation of this protein kinase could attenuate some effects of paraoxon. Pretreatment with 8-(N,N-diethylamino)octyl-3,4,5-trimethoxybenzoate hydrochloride (TMB-8), an antagonist of IP3-mediated Ca2+ release, abolished the secondary silencing effect of paraoxon, which is observed after primary paraoxon-induced hyperexcitability. It was concluded that slow activation of intracellular cascades by paraoxon could induce an IP3 mediated Ca2+ release from intracellular stores and participate to its secondary silencing effect by mechanisms dependent on intracellular calcium homeostasis. [Copyright &y& Elsevier]

Abstract: Toxicity of paraoxon has been attributed to inhibition of cholinesterase, but little is known about its direct action on ionic channels. The effects of paraoxon (0.3 μM–0.6 μM) were studied on the firing behaviour of snail neurones. Paraoxon significantly increased the frequency of spontaneously generated action potentials, shortened the afterhyperpolarization (AHP) and decreased the precision of firing. Short periods of high frequency-evoked trains of action potentials led to an accumulation in the depth and duration of post-train AHPs that was evidenced as an increase in time to resumption of autonomous activity. The delay time in autonomous activity initiation was linearly related to the frequency of spikes in the preceding train and the slope of the curve significantly decreased by paraoxon. The paraoxon induced hyperexcitability and its depressant effect on the AHP and the post-train AHP were not blocked by atropine and hexamethonium. Calcium spikes were elicited in a Na+ free Ringer containing voltage dependent potassium channel blockers. Paraoxon significantly decreased the duration of calcium spikes and following AHP and increased the frequency of spikes. These findings suggest that a reduction in calcium influx during action potential may decrease the activation of calcium dependent potassium channels that participate in AHP generation and act as a mechanism of paraoxon induced hyperexcitability. [Copyright &y& Elsevier]

Abstract: The effects of organophosphate (OP) paraoxon, active metabolite of parathion, were studied on the Ca2+ and Ba2+ spikes and on the excitability of the neuronal soma membranes of land snail (Caucasotachea atrolabiata). Paraoxon (0.3 μM) reversibly decreased the duration and amplitude of Ca2+ and Ba2+ spikes. It also reduced the duration and the amplitude of the afterhyperpolarization (AHP) that follows spikes, leading to a significant increase in the frequency of Ca2+ spikes. Pretreatment with atropine and hexamethonium, selective blockers of muscarinic and nicotinic receptors, respectively, did not prevent the effects of paraoxon on Ca2+ spikes. Intracellular injection of the calcium chelator BAPTA dramatically decreased the duration and amplitude of AHP and increased the duration and frequency of Ca2+ spikes. In the presence of BAPTA, paraoxon decreased the duration of the Ca2+ spikes without affecting their frequency. Apamin, a neurotoxin from bee venom, known to selectively block small conductance of calcium-activated potassium channels (SK), significantly decreased the duration and amplitude of the AHP, an effect that was associated with an increase in spike frequency. In the presence of apamin, bath application of paraoxon reduced the duration of Ca2+ spike and AHP and increased the firing frequency of nerve cells. In summary, these data suggest that exposure to submicromolar concentration of paraoxon may directly affect membrane excitability. Suppression of Ca2+ entry during the action potential would down regulate Ca2+-activated K+ channels leading to a reduction of the AHP and an increase in cell firing. [Copyright &y& Elsevier]

This study aimed to investigate the validity and factor structure of the Self-Assessed Wisdom Scale (SAWS; Webster in J Adult Dev 10:13–22, 2003) in an Iranian population. Participants (235 male, 340 female) were recruited in Tehran, Iran and ranged in age from 17 to 88 years. Cronbach alpha's for the subscales ranged from.63 to.81, and their inter-correlations ranged from.42 to.53. Exploratory factor analysis extracted 5 factors that were similar with the original structure. Confirmatory factor analysis supported 5-factor model of the SAWS. The SAWS's total and subscale scores positively correlated with two other measures of wisdom (indicating convergent validity). The SAWS correlated weakly with age. Women scored higher in the SAWS subscales of emotional regulation, reminiscence/reflectiveness, and humor, which accounted for a significant gender difference in total wisdom. Although the age differences are consistent with prior research, the gender differences are relatively novel. Overall, results indicate that the SAWS has excellent psychometric properties and can be used in cross-cultural work. [ABSTRACT FROM AUTHOR]

In the present numerical study, mixed flow of the non-Newtonian water/Al2O3 nanofluid with 0–4% nanoparticles volume fractions (φ) inside a two-dimensional square cavity with hot and cold lid-driven motion and porous media is simulated at Richardson numbers (Ri) of 0.01, 10 and 100 and Darcy numbers (Da) of 10−4 ≤ Da ≤ 10−2 using Fortran computer code. The obtained results for temperature domain, velocity, Nusselt number and streamlines indicate that by increasing Richardson number and decreasing axial velocity parameter of walls and similarity of flow behavior to natural flow mechanism, variations of velocity are reduced, which is due to the reduction in fluid momentum. By increasing Darcy number, penetrability of fluid motion enhances and fluid lightly moves along the cavity. Figuration of streamlines at lower Richardson numbers highly depends on the Darcy number changes. In case (2), due to the counterflow motion and buoyancy force, distinction of flow domain profiles is more obvious. On the other hand, this issue causes more velocity gradients and vortexes in special sections of cavity (central regions of cavity). In case (2), the behavior of streamlines is affected by some parameters such as variations of Darcy number, nanoparticles volume fraction and Richardson number more than case (1). By increasing Darcy number, flow lightly passes among hot and cold sources and leads to improve the heat transfer. Moreover, reduction in flow penetrability in cavity results in the reduction in fluid flow in its direction, sectional distribution and regions with higher temperature. Consequently, in these regions the growth of thermal boundary layer is more significant. In case (2), at lower Richardson numbers compared to higher ones, the affectability of lid-driven motion contrary to buoyancy force caused by density variations is less because of higher fluid momentum. At Ri = 0.01, because of the strength of lid-driven motion, flow direction is compatible with lid-driven motion. Also, temperature distribution is not uniform, and in these regions, fluid has the minimum velocity which leads to the enhancement of dimensionless temperature. In both studied cases, the increment of nanoparticles volume fraction as well as Darcy number and reduction in Richardson number result in the improvement of temperature distribution and decrease in dimensionless temperature. [ABSTRACT FROM AUTHOR]

Abstract: Recent studies suggest that intermittent and prolonged normobaric hyperoxia (HO) results in ischemic tolerance to reduce ischemic brain injury. In this research, we attempted to see changes in excitatory amino acid transporters (EAATs) and TNF-α levels following prolonged and intermittent hyperoxia preconditioning. Rats were divided into four experimental groups, each of 21 animals. The first two were exposed to 95% inspired HO for 4 h/day for 6 consecutive days (intermittent HO, InHO) or for 24 continuous hours (prolonged HO, PrHO). The second two groups acted as controls, and were exposed to 21% oxygen in the same chamber. Each main group was subdivided to middle cerebral artery occlusion (MCAO-operated), sham-operated (without MCAO), and intact (without any surgery) subgroups. After 24 h from pretreatment, MCAO-operated subgroups were subjected to 60 min of right MCAO. After 24 h reperfusion, neurologic deficit score (NDS) and infarct volume were measured in MCAO-operated subgroups. EAATs expression and serum TNF-α levels were assessed in sham-operated and intact subgroups. Preconditioning with prolonged and intermittent HO decreased NDS and upregulated EAAT1, EAAT2, and EAAT3 and increased serum TNF-α levels significantly. Although further studies are needed to clarify the mechanisms of ischemic tolerance, the intermittent and prolonged HO seems to partly exert their effects via increase serum TNF-α levels and upregulation of EAATs. [Copyright &y& Elsevier]

School age children carry the heaviest burden of morbidity due to intestinal parasitic infections. Our objective was to determine the prevalence of these infections in primary school children living in Tehran and their association with socio-economic factors and hygienic habits. In September 1998, a total of 19213 subjects were invited to participate. Data on health and socio-economic status and health-related behaviours, collected via questionnaires, physical examinations and stool sample analyses, were available for 19209 persons, with a participation rate greater than 99.99%. All participants were subjected to three methods of microscopic examinations on the stool sample and an adhesive cellophane tape slide evaluation. The prevalence rate of intestinal parasitic infection among the students was 18.4%. Coinfection with two or three parasites was seen in 2%. With increase in educational level of parents (especially mothers), the infection rate of children was decreased. Girls showed a significantly higher positive rate than boys. Using piped water, correct method of washing vegetables and increase in the economic score of the family, resulted in a decrease in the infection rate. According to the results, low level of education and consequently poor socio-economic and hygienic condition of families appear to be powerful determinants of infection. [Copyright &y& Elsevier]

Resistance-Nodulation-Division (RND) efflux pumps are responsible for multidrug resistance in Pseudomonas aeruginosa. The present study aimed to evaluate the overexpression of RND efflux pumps and its role in the antibiotic resistance of P. aeruginosa clinical isolates. A number of 122 isolates were obtained from three military hospitals in Tehran, Iran. In order to determine the antibiotic resistance, the isolates were identified and assessed by the disk diffusion and agar dilution methods. This study investigated the gene expression of four multi-drug efflux pump systems (MexAB-OprM, MexCD-OprJ, MexEF-OprN and MexXY (-OprA)) and its correlation with antibiotic resistance. The isolates indicated that the highest resistance rate was against ticarcillin (80%), followed by ciprofloxacin (74%) and meropenem (71%). Most of them expressed mexB (69%), mexC (28.7%), mexE (43.4%), and mexY (74.6%), suggesting that mexB and mexY were highly expressed in the studied strains. The overexpression of mexB and mexY was significantly more prevalent in the ICU wards (p = 0.033). Furthermore, there was a significant correlation between the expression of RND-type efflux pumps and the resistance to most anti-pseudomonal antibiotics. • Pseudomonas aeruginosa , is a Gram-negative bacterium and causes hard-to-treat infections. • RND efflux pumps are responsible for multidrug resistance in P.aeruginosa. • The isolates showed the highest resistance rate against ticarcillin, followed by ciprofloxacin and meropenem. • Most of isolates expressed mexB (69%), mexC (28.7%), mexE (43.4%) and mexY (74.6%). • There is a significant correlation between the expression of efflux pumps and the resistance to antibiotics. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of topical Polyvinylpyrrolidone-iodine (PVP-I) 0.6% on the clinical course of adenoviral keratoconjunctivitis compared with PVP-I 1% and artificial tears., Methods: We prospectively enrolled all patients over 18 years of age with a polymerase chain reaction (PCR)-confirmed diagnosis of adenoviral keratoconjunctivitis who presented to the hospital between November 2022 and June 2023. Patients were randomized into 3 groups: artificial tears (control), PVP-I 1%, and PVP-I 0.6% eye drops, 4 times daily for 5 days. Clinical signs at presentation and at 6 follow-up visits during the 1 st 3 weeks of the acute phase were recorded. Patients were also followed up at 1 and 3 months., Results: Ninety-four patients completed the study, of which 30, 31, and 33 were in the control, PVP-I 1%, and PVP-I 0.6% groups, respectively. The mean age of the patients was 37.2 years (interquartile range: 25-46). The PCR result was positive in 75.6% of patients with the clinical suspicion. PVP-I, regardless of the concentration, was superior to the artificial tears in terms of time to resolution of lid swelling, discharge, and incidence of subsequent subepithelial infiltrates ( P < 0.05). However, a concentration of 0.6% was equivalent to 1%. No significant adverse events were reported in any group., Conclusions: The PVP-I 0.6% topical drops are safe and well tolerated in patients with acute adenoviral keratoconjunctivitis. It can be substituted for the 1% solution as it has comparable effects in improving the clinical course and reducing subsequent complications., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Current Ophthalmology.)

Background: Sex reassignment surgery (SRS) is a necessary step in transitioning into the desired gender for male-to-female transgender individuals. This study focuses on a rare complication developed following SRS, aiming to highlight potential complications associated with this procedure., Case Presentation: This report describes a 49-year-old transgender woman with a history of SRS who developed bloody diarrhea and neovaginal bleeding 10 years later. A colonoscopy revealed features compatible with ulcerative colitis, which was confirmed by a biopsy., Conclusions: The unpredictable clinical course of this phenomenon may prompt surgeons to reconsider the use of a rectosigmoid colon to create a neovagina. This case report underscores the necessity of long-term monitoring for gastrointestinal complications in transgender women post-SRS when a rectosigmoid colon segment is utilized for neovaginal construction., (© 2024. The Author(s).)

Background: Opium use is a significant social and public health issue. There are numerous effects of opium documented as affecting the pancreatobiliary system. The aim of the study was to assess the pancreatobiliary changes in patients with opium addiction by endoscopic ultrasonography (EUS). Methods: During the study period, consecutive patients who were referred for EUS of submucosal upper gastrointestinal lesions were included. The history of opium addiction and clinical symptoms were recorded prospectively. Diameters of the common bile duct (CBD), pancreatic duct (PD), size of the ampulla of Vater, and gallbladder abnormalities were evaluated using EUS. Results: A total of 254 patients (53.1% male, mean age of 55.4±14.2 years) were studied. A history of opium addiction was present in 56 patients (22.0%). Choledocholithiasis was found in two patients (3.6%) and one control (0.5%) patient ( P =0.06). Gallbladder stones were found in 13 opium-addict (23.2%) and 16 control (8.1%) patients ( P =0.002). The mean diameter of the CBD, size of the ampulla of Vater ( P <0.001), and PD ( P =0.04) were all significantly greater in patients with opium addiction. Conclusion: Dilation of the biliary and PDs is seen more commonly in patients addicted to opium. However, the clinical implications of these findings need to be further evaluated in future studies., Competing Interests: Competing Interests The authors declare no conflict of interest related to this work., (© 2023 Middle East Journal of Digestive Diseases.)

Introduction: Evidence showed that cardiac complications may occur in coronavirus disease-19 (COVID-19) during the acute and post-infection phases. This study aimed to evaluate the association between the echocardiographic characteristics and in-hospital mortality of COVID-19 patients as well as the changes after one-month follow-up., Method: All adult (≥18 years old) hospitalized COVID-19 patients in need of echocardiography based on the guideline of the Iranian Society of Echocardiography for performing various types of echocardiography during the COVID-19 pandemic were included in this study. An expert cardiologist performed the echocardiography on all patients and also on all available patients one month after discharge., Results: 146 hospitalized cases of COVID-19 and 81 cases available for 1-month follow-up echocardiography were studied in this prospective study. Left ventricle wall hypokinesia, aorta valve stenosis, dilated Inferior Vena Cava (IVC), and Pulmonary Artery Systolic Pressure (PASP) of more than 35 were associated with 3.59 (95% CI: 1.19-10.79, p = 0.02), ‎11 (95% CI: 3.3 - 36.63, p = 0.001), ‎5.58 (95% CI: 1.04-29.41, p = 0.041)‎, and 2.91 (95% CI: 1.35 - 6.3, p = 0.001) times higher odds of mortality than healthy subjects. In 1-month follow-up of patients, deterioration in LVEF (p = 0.03) was detected in the not-fully vaccinated patients, and a significant decrease in PASP was observed in all cases (p = 0.04); but these changes were not clinically important., Conclusion: Left ventricle wall hypokinesia, aorta valve stenosis, dilated IVC, and PASP ≥ 35 were predictors of in-hospital mortality in our study. There were not any potential clinically significant differences in one-month echocardiographic follow-ups of the studied patients., Competing Interests: The authors declare no conflict of interest.

Introduction: As no specific pharmacological intervention has been known for COVID-19, medicinal plants may be a suitable candidate for management of this disease. The aim of this study was to investigate the efficacy of a herbal syrup from licorice as an adjuvant treatment in hospitalized patients with COVID-19., Materials and Methods: 213 hospitalized patients diagnosed with COVID-19 were assigned to receive either standardized licorice syrup as an adjuvant treatment plus standard care [Syrup Group (SYRUP), N = 91], or standard care alone [Standard Group (STANDARD), N = 104], for 7 days. The primary endpoint was duration of hospitalization in survivors. The secondary endpoints included 25% increase in oxygen saturation, C-reactive protein (CRP) difference and lymphocyte difference from baseline, number of death and number of patients transferred to ICU., Results: Mean duration of admission was 5.24 days in SYRUP and 7.14 days in STANDARD (p < 0.001). Oxygen saturation increased in 86 of 91 patients (94.5%) in the licorice group, compared to 83 of 104 patients (79.8%) in the control group (p = 0.002). There was no significant difference between the two groups in the number of patients died during hospitalization (p = 0.837). Five patients in SYRUP and 16 patients in STANDARD were transferred to ICU (p < 0.026). Mean reduction in CRP (p < 0.001) and mean increase in the number of lymphocytes (p = 0.008) in SYRUP were significantly higher than STANDARD., Discussion: Licorice syrup as an adjuvant treatment demonstrated promising results on duration of hospital admission, O2 saturation as well as inflammatory markers in COVID-19 patients; however, further clinical studies with larger sample size are suggested to achieve more conclusive results., Competing Interests: Authors have no conflict of interest., (© 2022 The Authors.)

Background: Severe acute respiratory syndrome (SARS) coronavirus-2 may infect red blood cells (RBCs) and impact oxygenation. We aimed to evaluate the efficacy of RBC exchange as an adjunctive treatment for hypoxemia and the survival rate of patients with severe coronavirus disease 2019 (COVID-19)., Methods: In a randomized clinical trial, we divided sixty patients with severe COVID-19 into two groups. The intervention group received the standard treatment of severe COVID-19 with RBC exchange three to four times in 2 days. The control group only received the standard treatment. Our primary outcomes were improving hypoxemia in 7 days, recovery or discharge, and death in 28 days. We conducted Chi-square test, independent samples t -test, and Fisher's exact test to analyze the results. The ethical committee of Aja University of Medical Sciences approved the study (IR.AJAUMS.REC.1399.054), and the Iranian clinical trial registration organization registered it (IRCT20160316027081N2)., Results: Twenty-nine men and thirty-one women with a mean age of 67.5 years entered the study. The frequency of hypertension and diabetes mellitus was 86.7 and 68.3%, respectively. The most common symptoms of severe COVID-19 were dyspnea (91.6%), cough (75%), and fever (66.6%). Our results showed that hypoxemia improved in 21 of the 30 patients (70%) in the intervention group and 10 of the 30 patients (33.3%) in the control group ( P < 0.004). The recovery and discharge rates were 19 of 30 patients (63.3%) in the intervention group and 2 of 30 patients (6.7%) in the control group ( P < 0.001)., Conclusion: The RBC exchange improved the oxygenation and survival rate in patients with severe COVID-19., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Aminianfar, Soleiman-Meigooni, Hamidi-Farahani, Darvishi, Hoseini-Shokouh, Asgari, Faraji-Hormozi and Asli.)

Background: The combination of sofosbuvir and daclatasvir has shown preliminary efficacy for hospitalized patients with COVID-19 in four open-label studies with small sample sizes. This larger trial aimed to assess if the addition of sofosbuvir/daclatasvir to standard care improved clinical outcomes in hospitalized patients with COVID-19., Methods: This was a placebo-controlled, double-blind, randomized clinical trial in adults hospitalized with COVID-19 at 19 hospitals in Iran. Patients were randomized to oral sofosbuvir/daclatasvir 400/60 mg once-daily or placebo in addition to standard of care. Patients were included if they had positive PCR or diagnostic chest CT, O2 saturation <95% and compatible symptoms. The primary outcome was hospital discharge within 10 days of randomization. Secondary outcomes included mortality and time to clinical events. The trial is registered on the Iran Registry of Clinical Trials under IRCT20200624047908N1., Results: Between July and October 2020, 1083 patients were randomized to either the sofosbuvir/daclatasvir arm (n = 541) or the placebo arm (n = 542). No significant difference was observed in the primary outcome of hospital discharge within 10 days, which was achieved by 415/541 (77%) in the sofosbuvir/daclatasvir arm and 411/542 (76%) in the placebo arm [risk ratio (RR) 1.01, 95% CI 0.95-1.08, P = 0.734]. In-hospital mortality was 60/541 (11%) in the sofosbuvir/daclatasvir arm versus 55/542 (10%) in the placebo arm (RR 1.09, 95% CI 0.77-1.54, P = 0.615). No differences were observed in time to hospital discharge or time to in-hospital mortality., Conclusions: We observed no significant effect of sofosbuvir/daclatasvir versus placebo on hospital discharge or survival in hospitalized COVID-19 patients., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

BACKGROUND : Colonoscopy is generally a safe procedure with a limited number of adverse events. Few studies have addressed the rate of adverse events in teaching hospitals. This study aimed to investigate the rate of complications after colonoscopy performed by gastroenterology fellows in a teaching hospital in Tehran. METHODS : A historical cohort study was carried out to link the colonoscopy reports and the hospital information system to identify serious adverse events leading to unplanned hospitalization, unplanned procedures or interventions (e.g. surgery), prolongation of existing hospitalization, or death within 30 days after colonoscopy. RESULTS : We included 9928 colonoscopies (mean age of the patients 53.0±15.9 years, 52.3% men) in this study. In-hospital patients comprised (34.8%) of the procedures. The indications of colonoscopy included 7137 diagnostic (71.9%), and 2519 screening (25.4%) reasons. Colorectal polyps were found in 2005 (20.2%) patients. Major complications were seen in 17 patients (0.2%), including serious bleeding in seven patients, cardiopulmonary complications in five patients, perforation in four patients, and sepsis in one patient. CONCLUSION : Serious adverse events after colonoscopy are relatively rare. The rate of complications does not appear to be higher in an academic teaching hospital when performed by fellows under supervision., Competing Interests: CONFLICT OF INTEREST The authors declare no conflict of interest related to this work., (© 2022 Middle East Journal of Digestive Diseases.)

Background: Rapid increases in cases of COVID-19 were observed in multiple cities in Iran towards the start of the pandemic. However, the true infection rate remains unknown. We aimed to assess the seroprevalence of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 18 cities of Iran as an indicator of the infection rate., Methods: In this population-based cross-sectional study, we randomly selected and invited study participants from the general population (from lists of people registered with the Iranian electronic health record system or health-care centres) and a high-risk population of individuals likely to have close social contact with SARS-CoV-2-infected individuals through their occupation (from employee lists provided by relevant agencies or companies, such as supermarket chains) across 18 cities in 17 Iranian provinces. Participants were asked questions on their demographic characteristics, medical history, recent COVID-19-related symptoms, and COVID-19-related exposures. Iran Food and Drug Administration-approved Pishtaz Teb SARS-CoV-2 ELISA kits were used to detect SARS-CoV-2-specific IgG and IgM antibodies in blood samples from participants. Seroprevalence was estimated on the basis of ELISA test results and adjusted for population weighting (by age, sex, and city population size) and test performance (according to our independent validation of sensitivity and specificity)., Findings: From 9181 individuals who were initially contacted between April 17 and June 2, 2020, 243 individuals refused to provide blood samples and 36 did not provide demographic information and were excluded from the analysis. Among the 8902 individuals included in the analysis, 5372 had occupations with a high risk of exposure to SARS-CoV-2 and 3530 were recruited from the general population. The overall population weight-adjusted and test performance-adjusted prevalence of antibody seropositivity in the general population was 17·1% (95% CI 14·6-19·5), implying that 4 265 542 (95% CI 3 659 043-4 887 078) individuals from the 18 cities included were infected by the end of April, 2020. The adjusted seroprevalence of SARS-CoV-2-specific antibodies varied greatly by city, with the highest estimates found in Rasht (72·6% [53·9-92·8]) and Qom (58·5% [37·2-83·9]). The overall population weight-adjusted and test performance-adjusted seroprevalence in the high-risk population was 20·0% (18·5-21·7) and showed little variation between the occupations included., Interpretations: Seroprevalence is likely to be much higher than the reported prevalence of COVID-19 based on confirmed COVID-19 cases in Iran. Despite high seroprevalence in a few cities, a large proportion of the population is still uninfected. The potential shortcomings of current public health policies should therefore be identified to prevent future epidemic waves in Iran., Funding: Iranian Ministry of Health and Medical Education., Translation: For the Farsi translation of the abstract see Supplementary Materials section., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Currently no effective antiviral therapy has been found to treat COVID-19. The aim of this trial was to assess if the addition of sofosbuvir and daclatasvir improved clinical outcomes in patients with moderate or severe COVID-19., Methods: This was an open-label, multicentre, randomized controlled clinical trial in adults with moderate or severe COVID-19 admitted to four university hospitals in Iran. Patients were randomized into a treatment arm receiving sofosbuvir and daclatasvir plus standard care, or a control arm receiving standard care alone. The primary endpoint was clinical recovery within 14 days of treatment. The study is registered with IRCT.ir under registration number IRCT20200128046294N2., Results: Between 26 March and 26 April 2020, 66 patients were recruited and allocated to either the treatment arm (n = 33) or the control arm (n = 33). Clinical recovery within 14 days was achieved by 29/33 (88%) in the treatment arm and 22/33 (67%) in the control arm (P = 0.076). The treatment arm had a significantly shorter median duration of hospitalization [6 days (IQR 4-8)] than the control group [8 days (IQR 5-13)]; P = 0.029. Cumulative incidence of hospital discharge was significantly higher in the treatment arm versus the control (Gray's P = 0.041). Three patients died in the treatment arm and five in the control arm. No serious adverse events were reported., Conclusions: The addition of sofosbuvir and daclatasvir to standard care significantly reduced the duration of hospital stay compared with standard care alone. Although fewer deaths were observed in the treatment arm, this was not statistically significant. Conducting larger scale trials seems prudent., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Meaning in life is one of the psychological domains that is most severely affected in patients with life-threatening illnesses. The importance of meaning-making mandates the development of reliable tools to assess this construct. Steger's Meaning in Life Questionnaire (MLQ) is one of the most valid and reliable instruments that determines the search for and presence of meaning in life. The present study was conducted to provide psychometric data on the MLQ in a sample of patients with life-threatening illnesses., Methods: The MLQ was completed by 301 patients (aged 20-80 years) diagnosed with life-threatening illnesses (cancer and multiple sclerosis) and referred to hospitals. Confirmatory factor analysis and Pearson's correlation test were used to determine the construct validity of the questionnaire., Results: The confirmatory factor analysis supported the original two-factor model of the MLQ, comprised of the presence of meaning (five items) and search for meaning (five items). The responses to the MLQ did not differ by sociodemographic factors. Most importantly, contrary to previous findings, the correlation between the two subscales, i.e., search for meaning and presence of meaning, was significant and positive., Conclusion: The results showed that the MLQ is a valid and reliable measure for assessing meaning in life that can be applied in research on meaning in life among other patient populations., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Maede Naghiyaee et al.)

Objectives: An important domain in health-related quality of life evaluations is quality of life perceptions due to having a voice disorder. The objective of this study was to examine the factor structure of the Iranian Voice Quality of Life Profile (IVQLP) based on Exploratory Factor Analysis and confirmatory factor analysis., Methods: The study sample consisted of 280 patients (174 males and 106 females) diagnosed with MTD, benign organic disorders such as polyps and nodules, and unilateral vocal fold paralysis and cancer. To evaluate the different dimensions of the IVQLP, a principal component analysis (PCA) was conducted. Confirmatory factor analysis (CFA) was used to investigate the fitting of extracted dimensions and construct validity of the IVQLP., Results: The results showed that the IVQLP has a 4-factor structure. The first factor has 17 items and refers to Emotions. The second factor has 12 items and refers to Individual/Social Relations. The third factor with 6 items refers to Occupation, and the forth with 5 items relates to Psychosomatic characteristics., Conclusions: The conclusion of this study is that the concept of quality of life in Iranian patients with voice disorders is somewhat different from that of Western patients. This difference can be seen in. the large number of items related to an Emotional factor and the identification of a Psychosomatic factor., (Copyright © 2017 The Voice Foundation. All rights reserved.)

The aim of this paper is to analyze the relation between components of disability with distinguished score of impairment, activity and participation questionnaire based on clinical data of persons with hand injuries. Impairment was evaluated by use of AMA guide 6th edition and disability by DASH questionnaire on Convenience sample of patients (N = 117), with chronic hand injuries. Linking and allocating items of the DASH were done based on the ICF Core Set for Hand Conditions and the opinions of a group of experts from different related fields. Data was analyses by using Kappa index, Chi square test and a set of Pearson, Part and Partial correlations coefficient. Most of the DASH items were allocated to the activity; one to four of the items could not be classified and 0 to 22 were classified as having overlap. Participation and activity scores correlated positively with each other (r > 0.80). Impairment had high correlation with activity and participation scores (>73). With controlling the effect of each or both construct, this relation between them with impairment diminished but still significant between activity and impairment. There is a huge overlap in definition of activity and participation. The most effecting item in relation of disability and impairment is activity restriction. Participation had no relation with impairment.

Background: Any loss or deviation in body function and structure is considered impairment, whereas limitations on activities are fundamental to the definition of disability. Although it seems intuitive that the two should be closely related, this might not be the case; there is some evidence that psychosocial factors are more important determinants of disability than are objective impairments. However, the degree to which this is the case has been incompletely explored., Questions/purposes: The purpose of this study was to determine if disability (as measured by the Disabilities of the Arm, Shoulder and Hand [DASH] and the Michigan Hand Questionnaire [MHQ]) and pain intensity correlate with impairment (as measured by the American Medical Association [AMA] impairment guide). Secondary study questions addressed the effect of pain intensity and symptom of depression on predicting disability., Methods: Impairment and disability were evaluated in a sample of 107 hand-injured patients a mean of 11 months after injury. Impairment rating was performed prospectively. From the patients who came for therapy, they were invited to fill out the questionnaire and evaluated for impairment rating. Response variables of DASH, MHQ, and visual analog scale pain intensity values were collected at the same setting. Other explanatory variables included demographic, injury-related, and psychological factors (symptoms of depression measured with the Beck Depression Inventory). Initial bivariate and multivariate analyses were performed to determine correlations of disability and pain to impairment rating and other exploratory variables., Results: Disability as measured by the DASH showed intermediate correlation with AMA impairment (r = 0 .38, beta = 0.36, p = 0.000). Together with gender, it accounted for only 22% of the variability in DASH scores. Similarly, MHQ score correlated with impairment rating (r = -0.24, beta = -0.23, p < 0.05). However, together with age, injured hand accounted for only 19% of the variability in MHQ scores. However, pain intensity did not correlate with impairment (r = -0.46, p > 0.05). Interestingly, pain intensity did correlate with the time passed from surgery but it was correlated with symptom of depression (r(2) = 0.10, beta = 0.33, p = 0.001)., Conclusions: The limited correlation between impairment and disability emphasizes the importance of factors other than pathophysiology in human illness behavior. These may include physical (pain, dominant injured hand) and conditional factors (time since surgery) or psychological factors such as depression and adapting; all mentioned can be considered as personal factors that may be different in each patient. So considering personal difference and any other condition except the impairment alone can help to better plan interventions and also diminish disability level., Level of Evidence: Level III, therapeutic study.

Central neuropathic pain (CNP) is a complicated medical problem that involves both the spinal and supraspinal regions of the central nervous system. Estrogen, a neuroprotective agent, has been considered a possible candidate for CNP treatment. In this study, we examined the effects of a single dose of 17β-estradiol on glutamate levels in the ventral posterolateral (VPL) nucleus of the rat thalamus. Furthermore, we determined whether there was a correlation between glutamate levels and neuropathic pain induced by unilateral electrolytic spinothalamic tract (STT) lesion. STT lesioning was performed in male Wistar rats at the T8-T9 vertebrae; rats were then administered 17β-estradiol (4 mg/kg, i.p.) 30 min after injury. Glutamate samples were collected using a microdialysis probe and quantified by high performance liquid chromatography. Mechanical allodynia (MA) and thermal hyperalgesia (TH) thresholds were measured pre-injury and 7, 14, and 28 days post-injury. We found that STT lesion significantly increased glutamate levels in the ipsilateral VPL nucleus 14 and 28 days post-injury; this was accompanied by allodynia and hyperalgesia in the hind paws of the rats. Administering 17β-estradiol to the rats decreased glutamate levels in the ipsilateral VPL nucleus and significantly increased MA and TH thresholds. These results suggest that glutamate in the VPL nucleus of the thalamus is involved in the pathology of neuropathic pain after STT injury; furthermore, 17β-estradiol may attenuate this neuropathic pain by decreasing glutamate levels.

Treating an uncooperative, uncontrollable child can be unpleasant for all parties involved. Despite the dentist's best efforts to employ traditional techniques, the behavioral management of challenging pediatric dental patients often requires more than "tell, show, do". Consequently, pre-operative pharmacological intervention may be necessary. Enteral sedation may be the optimal adjunct for the dental treatment of such a challenging patient population. However it must be utilized with caution and is not an appropriate treatment modality for all. This paper will present various considerations for the safe, appropriate and effective use of enteral sedation in contemporary pediatric dentistry. With the strong demand for this service, properly trained practitioners can broaden their practice and provide a win-win scenario for themselves and their patients.

Background: Cystic craniopharyngiomas are the most frequent intracranial neoplasm of nonglial origin in children. Follow-up data were analyzed to assess the value of intracavitary irradiation with stereotactically applied 32P radioisotopes for the treatment of patients with craniopharyngioma cysts admitted to Shohada Tajrish Hospital, Tehran, Iran, between 1998 and 2005., Methods: Patients with predominantly cystic craniopharyngiomas, who underwent stereotactic intracavitary irradiation, were followed for tumor response and complications. Beta-emitting 32P isotopes were injected into cysts using a computed tomography-guided and computer-assisted three-dimensional stereotactic treatment planning and application system. The cumulative dose to the inner surface of the cyst wall was 250 Gy., Results: Twenty-two (12 females and 10 males) patients with a mean+/-SD age of 14.0+/-6.6 (range: six to 35) years were studied. The tumor response rate gained with 32P-labeled chromic phosphate was 73% (16 of 22 cysts). The mean+/-SD survival after intracavitary irradiation was 25.4+/-6.8 (95% CI: 12.0 - 38.7) months., Conclusion: Intracavitary irradiation using 32P is highly effective in the treatment of cystic craniopharyngiomas. In patients with solitary cyst treated exclusively with this method, it has been the only necessary therapy over a long period. It seems reasonable to recommend intracavitary irradiation as the initial treatment for selected patients and as palliative therapy in those with recurrence.

Background: Endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy has become widely available for the treatment of pancreatobiliary diseases; however, it has mortality and complications. The aim of this study was to compare the success rates and complications of two different methods of common bile duct cannulation., Methods: From June 2003 though February 2004, patients who were candidates for endoscopic retrograde cholangiopancreatography and/or endoscopic sphincterotomy were randomly divided into two groups: standard cannulation (group A) and suprapapillary needle-knife fistulotomy (group B). Postendoscopic retrograde cholangiopancreatography pancreatitis, cholangitis, bleeding, and perforation were evaluated., Results: Two hundred and eighteen cases (86 males and 132 females with a mean+/-SD age of 56.2+/-17.5 years) were enrolled in this study. Group A, contained 112 patients and group B included 106 patients. In group A, the final cannulation success was achieved in 100 patients (89.3%). Cannulation was successful in 88 patients (83.0%) in group B. Difficulty in cannulation occurred more frequently in group A (25.5% vs. 2.6%, P=0.002). There were two patients in group B and three patients in group A who developed pancreatitis after endoscopic retrograde cholangiopancreatography. Perforation occurred in one patient in group B, which was improved with medical support. Bleeding and cholangitis were not occurred in any of the groups. The overall complication rate was 3/112 in group A and 3/106 in group B., Conclusion: Needle-knife fistulotomy is safe and can be applied as an effective alternative to standard technique for common bile duct cannulation in expert hands.

We have previously reported that paraoxon, an organophosphate compound, at submicromolar concentrations effectively suppresses Ca2+ action potentials and modulates the activity of snail neurons. This effect was unrelated to acetylcholinesterase inhibition but was found to involve the direct or indirect modulation of ion channels [Vatanparast, J., Janahmadi, M., Asgari, A.R., Sepehri, H., Haeri-Rohani, A., 2006a. Paraoxon suppresses Ca2+ action potential and afterhyperpolarization in snail neurons: Relevance to the hyperexcitability induction. Brain Res. 1083 (1), 110-117]. In the present work, the interaction of paraoxon with protein kinase C (PKC) and inositol 1,4,5-trisphosphate (IP3)-mediated Ca2+ release, on the modulation of Ca2+ action potentials and neuronal activity was investigated. Phorbol 12, 13 dibutyrate (PdBu), the activator of PKC, suppressed afterhyperpolarization and increased the activity of snail neurons without any significant effect on the Ca2+ action potential duration. Pretreatment with PKC activator attenuated the suppressing effect of paraoxon on the duration of Ca2+ action potentials. Staurosporine, a selective blocker of PKC, did not block the effect of paraoxon on Ca2+ action potential suppression and hyperexcitability induction. Our findings did not support the involvement PKC in the paraoxon induced Ca2+ action potential suppression and neuronal activity modulation, although activation of this protein kinase could attenuate some effects of paraoxon. Pretreatment with 8-(N,N-diethylamino)octyl-3,4,5-trimethoxybenzoate hydrochloride (TMB-8), an antagonist of IP3-mediated Ca2+ release, abolished the secondary silencing effect of paraoxon, which is observed after primary paraoxon-induced hyperexcitability. It was concluded that slow activation of intracellular cascades by paraoxon could induce an IP3 mediated Ca2+ release from intracellular stores and participate to its secondary silencing effect by mechanisms dependent on intracellular calcium homeostasis.

Background: Endoscopic third ventriculostomy has become the preferred treatment for obstructive hydrocephalus. The purpose of this paper is to present our experience with ventriculostomy at our center., Methods: Twenty-four patients underwent ventriculostomy for the treatment of obstructive hydrocephalus between May 2000 and May 2006. The follow-up period lasted between one and 51 (median: four) months. The mean age of the patients was 31 (range: 0.5 - 67) years. It was determined that the obstructive hydrocephalus was caused by space-occupying lesions in nine patients (eight tumors and one with calcified arteriovenous malformation), aqueductal stenosis in 14 patients, and shunt infection and entrapped fourth ventricle in one patient. Kaplan-Meier survival analysis showed that the proportion of functioning ventriculostomies became stable at rates of 80% to 90% after the third postoperative month., Results: There was no statistically significant difference in the aqueductal stenosis and tumor subgroups (P=0.716). A high rate of functioning ventriculostomies was found in both subgroups: 12 of 14 in the aqueductal stenosis subgroup and eight of nine in the tumor subgroup. In cases of intraventricular tumors, in addition to ventriculostomy, biopsy was performed that successfully helped the patient management. In the present study, the procedure failed in three patients (13%). Ventriculostomy failures occurred within three months after the operation. The cases of treatment failure were one with aqueductal stenosis, one with Chiari I, and one with pineocytoma. There was no permanent morbidity after ventriculostomy in our patients., Conclusion: The results indicated that ventriculostomy is an effective treatment in cases of obstructive hydrocephalus that is caused by aqueductal stenosis and space-occupying lesions. This procedure is worthy for controlling hydrocephalus without shunt and its complications. Early clinical picture after the operation plays an important role in predicting patient's outcome after endoscopic third ventriculostomy.

Background: Furazolidone has been effective against Helicobacter pylori in Iran, with no resistance, but with intolerable side effects in the second week. One-week regimens have not been useful here. We compared the efficacy and side effect profiles of three anti-H. pylori regimens., Methods: Patients with peptic ulcer disease and positive H. pylori infection were randomly allocated into three groups. The patients in group A received omeprazole 20 mg + amoxicillin 1g + metronidazole 500 mg, and bismuth subcitrate 240 mg twice daily each, for two weeks; the patients in group B received the same regimen but metronidazole was replaced by furazolidone 200 mg twice daily; and the patients in group C received regimen B for the first week and regimen A for the second week. H. pylori eradication was verified with 13C-urea breath test at the tenth week., Results: Three hundred and fourteen patients were enrolled; 107, 104, and 103 patients in groups A-C, respectively but 278 patients completed the study. Seven, three, and six patients discontinued their medication in groups A-C, respectively. Fever, dizziness, and weakness were more common in group B than group C (P < 0.05). Vomiting, pruritus, and rash were more common in group C than group A (P < 0.05). Per-protocol eradication rates were 83.1%, 95.2%, and 95.3% in groups A-C, respectively (P = 0.005, groups A and C). Intention to treat eradication rates were 74.5%, 87.0%, and 86.6% in groups A-C, respectively (P = 0.02, groups A and C)., Conclusion: One-week furazolidone followed by one-week metronidazole regimen is as efficient as two-week furazolidone regimen but with fewer side effects. Furazolidone-based regimens are superior to metronidazole-based ones for H. pylori eradication in Iran.

Background: Histology is the unique method for diagnosis of silent liver diseases; so, we aimed to determine the prevalence of fatty liver and other silent liver diseases among those who passed away for causes other than liver diseases in Tehran., Methods: Over a two-year period (2002 - 2004) we enrolled autopsies performed at the Forensic Medicine Center in Tehran. Demographic information, history of known acute and chronic liver diseases, and causes of death were determined. Samples from the right and left lobe and one sample from deeper areas of the liver as well as specimens from any grossly visible lesions were obtained in each case. Tissue sections stained by hematoxylin and eosin were evaluated. Reticulin and Masson's trichrome stains were also performed for evaluation of liver architecture and degree of fibrosis when necessary., Results: Satisfactory tissue samples for histologic evaluation were available in 896 cases (777 males) with a mean age of 43.8 years. Normal histology was found in 467 cases (52.1%). Important findings included: steatosis in 283 (31.6%), steatohepatitis in 19 (2.1%), chronic hepatitis in 23 (2.6%), and cirrhosis in 7 (0.8%) cases. Causes of death were: trauma (35%), acute myocardial infarction (30%), opiate overdose (13%), cerebrovascular accidents (4%), infectious diseases (3%), and others (15%)., Conclusion: Silent diseases of the liver are not uncommon. Steatosis is the most common finding but inflammatory disorders comprise a significant minority.

Background/objective: A high prevalence of Helicobacter pylori infection has been reported in Iran. Although the importance of H. pylori in the induction of peptic ulcer disease is clearly defined, only few studies have addressed its role in bleeding from peptic ulcers. We evaluated the role of H. pylori in peptic ulcer bleeding., Methods: Patients with acute peptic ulcer bleeding (PUB) and those with peptic ulcer disease without bleeding ('controls') were enrolled. Upper GI endoscopy and rapid urease test were performed in both groups. Histological study for detection of H. pylori was performed in patients with active bleeding, if RUT was negative. Other variables evaluated included sex, age, smoking, previous history of bleeding, non-steroidal anti-inflammatory drugs use, ulcer size, ulcer location, and duration of acid-peptic disease. Multivariate logistic regression analysis was performed to identify independent risk factors., Results: 161 patients with PUB and 287 control patients were enrolled. H. pylori infection was seen more frequently in patients with duodenal ulcer than gastric ulcer (88.9% vs. 60.5%, p< 0.001). Univariate analysis showed that patients with PUB were more often male, older in age, used NSAID, had history of PUB in the past, had ulcer located in the stomach and not in the duodenum, and more often had large ulcer (>1 cm). Logistic regression analysis showed that H. pylori infection was protective in PUB after controlling for confounders (OR 0.41, 95% CI 0.21-0.79), when ulcer location was not entered in the model. A second model including ulcer location (to test for a residual effect) showed that H. pylori infection was not a significant risk factor in PUB (OR 0.61, 95% CI 0.30-1.24)., Conclusions: H. pylori may not be an independent factor in bleeding from peptic ulcers. The lower frequency of this infection in these patients can be described by the higher frequency of bleeding from gastric ulcers, which are less H. pylori related compared with duodenal ulcer.

Aim: The healthy ranges for serum alanine aminotransferase (ALT) levels are less well studied. The aim of this study was to define the upper limit of normal (ULN) for serum ALT levels, and to assess factors associated with serum ALT activity in apparently healthy blood donors., Methods: A total of 1,939 blood donors were included. ALT measurements were performed for all cases using the same laboratory method. Healthy ranges for ALT levels were computed from the population at the lowest risk for liver disease. Univariate and multivariate analyses were performed to evaluate associations between clinical factors and ALT levels., Results: Serum ALT activity was independently associated with body mass index (BMI) and male gender, but not associated with age. Association of ALT with BMI was more prominent in males than in females. Upper limit of normal for non-overweight women (BMI of less than 25) was 34 U/L, and for non-overweight men was 40 U/L., Conclusion: Serum ALT is strongly associated with sex and BMI. The normal range of ALT should be defined for male and female separately.