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Sadegh Khorrami,1 Ali Zarrabi,1 Moj Khaleghi,2 Marziyeh Danaei,3 MR Mozafari3 1Department of Biotechnology, Faculty of Advanced Sciences and Technologies, University of Isfahan, Isfahan, Iran; 2Department of Biology, Faculty of Sciences, Shahid Bahonar University, Kerman, Iran; 3Australasian Nanoscience and Nanotechnology Initiative, Monash University, Clayton, VIC, Australia Introduction: Silver nanoparticles (AgNPs) are of great interest due to their unique and controllable characteristics. Different synthesis methods have been proposed to produce these nanoparticles, which often require elevated temperatures/pressures or toxic solvents. Thus, green synthesis could be a replacement option as a simple, economically viable and environmentally friendly alternative approach for the synthesis of silver nanoparticles.Methods: Here, the potential of the walnut green husk was investigated in the production of silver nanoparticles. An aqueous solution extracted from walnut green husk was used as a reducing agent as well as a stabilizing agent. Then, the synthesized nanoparticles were characterized with respect of their anticancer, antioxidant, and antimicrobial properties. Results: Results showed that the synthesized nanoparticles possessed an average size of 31.4 nm with a Zeta potential of -33.8 mV, indicating high stability. A significant improvement in the cytotoxicity and antioxidant characteristics of the green synthesized Ag nanoparticles against a cancerous cell line was observed in comparison with the walnut green husk extract and a commercial silver nanoparticle (CSN). This could be due to a synergistic effect of the synthesized silver nanoparticles and their biological coating. AgNPs and the extract exhibited 70% and 40% cytotoxicity against MCF-7 cancerous cells, respectively, while CSN caused 56% cell death (at the concentration of 60 µg/mL). It was observed that AgNPs were much less cytotoxic when tested against a noncancerous cell line (L-929) in comparison with the control material (CSN). The free radical scavenging analysis demonstrated profound anti-oxidant activity for the synthesized nanoparticles in comparison with the extract and CSN. It was also detected that the synthesized AgNPs possess antibacterial activity against nosocomial and standard strains of both Gram-positive and Gram-negative bacteria (minimum inhibitory concentration =5–30 µg/mL). Conclusion: These findings imply that the synthesized nanoparticles using green nanotechnology could be an ideal strategy to combat cancer and infectious diseases. Keywords: green synthesis, silver nanoparticles, antimicrobial agent, antioxidant agent, anticancer agent, selective cytotoxicity

Pricing and shelf space allocation are two main operational decisions in the retailing industry. This study simultaneously optimizes these two decisions in a supply chain with two manufacturers and one retailer under uncertainty of demand and price sensitivity parameters. Two manufacturers have different conditions in terms of parameters affecting demand and production. A robust optimization model and an exact solution approach are developed to find the optimal solution. The results show that price sensitivity, market potential, and production costs can have a synergistic effect on optimal values. Moreover, the market potential can rely on managerial decisions as it has a significantly positive impact on profitability. This parameter is found to be the most important tool for securing the profitability of supply chain members. [ABSTRACT FROM AUTHOR]

Background and Objectives: Today, lack of knowledge and misconceptions are the most important reasons for anincreasing trend toward waterpipe tobacco smoking (WTS) worldwide. The aim of this study was to determine theknowledge and attitude of adults of city of Kerman towards WTS. Materials and Methods: This descriptive study was performed on 1090 adults selected by multi-stage randomsampling in the city of Kerman in 2017. A researcher-made questionnaire including demographic information,questions about knowledge and attitude towards WTS and a question about the current use of WTS was used. Datawere analyzed using Pearson's correlation coefficient, chi-square test, independent t-test and multiple linear regression. Results: The mean and standard deviation scores of knowledge and attitude of subjects were 8.29±1.84 and28.58±7.20, respectively. There was observed a significant negative correlation between knowledge and attitude score(r= -0.49; p<0.001). The knowledge of current waterpipe users was significantly less than noncurrent waterpipe users(p<0.001) and the attitude of current waterpipe users was significantly more positive than those noncurrent waterpipeusers (p<0.001). People with higher age (p<0.001), women (p<0.001), married (p=0.016) and those with universityeducation (p=0.003) had significantly more knowledge. Conclusion: Considering the inappropriate knowledge and attitude of adults towards WTS, interventions to increase knowledge and change attitude, especially in people at risk should be designed and implemented. [ABSTRACT FROM AUTHOR]

Background: Dental waste can be hazardous to humans and the environment. Objective: To determine the current status of dental waste management in private and public dental clinics and private dental offices in Shiraz, southern Iran. Methods: This cross-sectional study was conducted at the Shiraz University of Medical Sciences from February through June 2013. A stratified random sampling method was used to study 86 private offices, 14 private clinics and 10 public clinics. Types of waste studied included mercury and amalgam, lead foil packets, sharps, infectious tissues and fluids, Pharmaceuticals and domestic waste materials. Compliance with established standards by the monitored dental offices and clinics and public clinics were compared. Results: 89.1% of dental offices and clinics disposed their infectious waste with domestic waste. Only 60% of centers used standard method for sharps disposal. None of the dental centers disposed their pharmaceutical waste and x-ray fixer waste by standard methods. Less than 10% of centers recycled the amalgam and lead foil pockets waste to the manufacture. Conclusion: Government agencies should establish monitoring programs for all dental offices and clinics to identify noncompliant activity and enforce recommended regulations. [ABSTRACT FROM AUTHOR]

Occupational exposure to cytotoxic drugs is a global concern. We conducted this cross-sectional study in 2012 to describe the adverse effects experienced by nurses working in one of chemotherapy facilities affiliated to Shiraz University of Medical Sciences, Shiraz, southern Iran, and their proper use of personal protective equipment and educational programs. The frequency of side effects reported by participants was noticeably high. Approximately, 60%of the nurses used all personal protective equipment. There were air conditioner ventilation systems in all facilities, but they were not standard. Clinics did not have any dedicated room.Lack of adequate training was noticeable among all participants. We concluded that establishment of safety regulations, health care workers safety surveillance systems as well as continuous training for nurses are of paramount importance. INSET: TAKE-HOME MESSAGE. [ABSTRACT FROM AUTHOR]

The burden of exposure to blood-borne pathogens (such as hepatitis B and C viruses) is considerable for health care workers. Hepatitis virus transmission requires a non-immune host, an infectious source, and skin or mucous membrane injury. These three aspects are the main fields for preventional interventions. We reviewed major recent studies on this topic to identify precautions health care workers should take to avoid hepatitis B (HBV) and C virus (HCV) infections. Accordingly, this review looks at aspects of epidemiology, risk factors, economy, knowledge, attitudes, practice, and ethics of HBV and HCV that affect health care workers. The risk of transmission depends on the load of pathogen, infectious characteristics and exposure frequency. Health care workers skill levels and the specific hospital department involved appear to be the most important factors in the exposure of health care workers to blood-borne pathogens. However, many health care workers surveyed, believed that educational programs about standard precautions in their setting were not adequate. Obviously, more detailed studies will be needed to clarify risks and opportunities for health care workers precautions aimed at avoiding HBV and HCV infection, especially in emerging health research communities. [ABSTRACT FROM AUTHOR]

The MAINTRAC technique as introduced by our coworkers from Jena (RBC lysis, fluorometric detection and analysis on Olympius ScanR) detects more circulating epithelial cells than techniques using enrichment. Also cells with a low EPCAM expression are detected and not only the typical cells with bright expression found after immunomagnetic enrichment. The relative cheapness and reproducibility allows frequent monitoring during and after therapy Using 3 colour detection (EPCAMfitc, DAPI, Vimentin PE) living and dead circulating epithelial cells in EMT, or cells in EMT with stemcell markers (EPCAMfitc, Vimentin-PE, CD44PacBlue) can be detected. In early breast cancer (n = 135) cells can be found in 60% of patients and in 40% higher cell counts (>100 ml are detectable. A control population(n = 100) showed low numbers in 98% (e.g (<100 CECin 1 ml blood). Expression of the mesenchymal marker (vimentin) ranges between 10 and 40% with different expression. CD44 shows also a wide range of expression. Two main cell types can be distinguished: type 1 shows generalized but weaker expression patterns and a second type with very bright dotted expression. The clinical relevance of these subsets is not known and their behavior under therapy has not been analysed in depth yet. In advanced breast cancers high cell counts were detectable in most patients with a less agressive disease course. In the rapidly progressing unfavorable subtypes (TN and Her2+. HRneg) less or none cells were found. During crossvalidation in non cancer patients we found high cell numbers in several forms of liver affections (n = 108). The expression patterns of markers on these cells were not differing from those in cancer patients. So this same cell type merging EMT, stemcell an hypoxic stress markers is detectable in advanced and early breast cancer (n = 40) and in benign disease. These cells disappear or decrease after response to chemo or anti-hormonal therapy in cancer or antioxidant therapy in NAFLD. We believe that the evasion of these cells is driven by the same force in cancer as in non cancer conditions. We suggest that this are the wellknown hypoxic and hyperacidic conditions causing epithelial mesenchymal transition. Cancer cell hijack this functions occurring normally under these conditions to survive and to facilitate evasion. More comprehensive analysis (four colour analysis on the AMNIS Flowsight) is needed and should show differences in expression patterns of liver derived epithelial cells (LDEC) and real tumor derived epithelial cells (TDEC). Further clarification of these phenomena should give new insights of the biological events in early disease and the possibilities and reliability of "fluid biopsy". [ABSTRACT FROM AUTHOR]

This review examines the emerging applications of machine learning (ML) and radiomics in the diagnosis and prediction of placenta accreta spectrum (PAS) disorders, addressing a significant challenge in obstetric care. It highlights recent advancements in ML algorithms and radiomic techniques that utilize medical imaging modalities like magnetic resonance imaging (MRI) and ultrasound for effective classification and risk stratification of PAS. The review discusses the efficacy of various deep learning models, such as nnU-Net and DenseNet-PAS, which have demonstrated superior performance over traditional diagnostic methods through high AUC scores. Furthermore, it underscores the importance of integrating quantitative imaging features with clinical data to enhance diagnostic accuracy and optimize surgical planning. The potential of ML to predict surgical morbidity by analyzing demographic and obstetric factors is also explored. Emphasizing the need for standardized methodologies to ensure consistent feature extraction and model performance, this review advocates for the integration of radiomics and ML into clinical workflows, aiming to improve patient outcomes and foster a multidisciplinary approach in high-risk pregnancies. Future research should focus on larger datasets and validation of biomarkers to refine predictive models in obstetric care., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Objectives: Lactobacilli and Streptococcus mutans are stigmatized as cariogenic bacteria, but few studies have simultaneously examined the quantitative and qualitative aspects of lactobacilli and S. mutans in childhood dental caries. Therefore, this study aimed to detect the presence of S. mutans and lactobacilli in dental caries using Snyder's test, colony counting, and PCR in the primary teeth of Iranian children with dental caries., Material and Methods: A cross-sectional study was conducted in Kerman, Iran, from March to Jun 2024. After dental examinations, 120 eligible children aged 5-9 were chosen using simple random sampling and classified into four groups based on their decayed, missing, and filled (primary) teeth (dmft) index: Group 1 (dmft = 0), Group 2 (dmft = 4-6), Group 3 (dmft = 7-9), and Group 4 (dmft = 10-13). The salivary levels of lactobacilli and S. mutans were calculated using colony counting (CFU/ml). Moreover, Snyder's test was applied to evaluate caries activity. PCR was also performed for molecular detection of lactobacilli (16S rRNA gene) and S. mutans (gftB gene). Lastly, the association between bacterial counting, molecular findings, and Snyder's test was estimated through statistical methods using SPSS 27., Results: Significant differences were found between the age and the PCR results of lactobacilli and S. mutans among all dmft Groups (p < 0.05). Moreover, positive significant correlations were observed between the counts of lactobacilli and S. mutans in dmft Group 1 compared to other dmft Groups (p < 0.05). Furthermore, the counts of these two bacteria differed significantly in Snyder's test (p < 0.05). However, Snyder's test differed significantly from the S. mutans PCR (p < 0.05), but not from the lactobacilli PCR (p > 0.05)., Conclusions: The results of the study could potentially be considered a promising and cost-effective screening program to identify children who are susceptible to dental caries., (© 2024 The Author(s). Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Background and Aim: Celiac disease (CD) has proinflammatory and pathogenic immune responses to gluten in intestinal tissue, leading to structural changes in the mucosa of the small intestine. The association of human leukocyte antigen (HLA)-DQ2 and DQ8 genotypes with CD has been previously reported. This test has a negative predictive value close to 100%, so its main purpose is to rule out the detection of CD completely or almost completely. There is limited information regarding HLA-DQ4/5 in CD. This study was conducted to determine the HLA-DQ4/5 genotypes in a group of Southwestern Iranian children with CD., Methods: We conducted a case-control study in Southwest Iran involving 100 participants, employing a nonprobabilistic sampling method. Samples were taken from participants' oral buccal mucosa at Imam Sajjad Hospital of Yasuj, Iran. Then DNA was extracted from these samples and used to determine the frequency of HLA-DQ4/5 genotypes through Sequence-Specific Primer-Polymerase Chain Reaction assay. SPSS 20 was utilized for statistical analyses., Results: Fifty diagnosed patients with CD (high anti-tissue transglutaminase [tTG]-IgA level [upper limit of normal] with pathological findings of Marsh III) and 50 non-CD individuals (normal anti-tTG-IgA level and normal total IgA level) were enrolled in the study from August 5, 2022 to October 15, 2023. Findings showed that the DQ4a*4b allele has the highest frequency in the CD samples (78%, p  < 0.01) followed by the DQ5a*5b allele (12%, p  < 0.01). Additionally, there was a higher prevalence of DQ4/DQ5 in patients with CD compared to controls (odds ratio = 6.5, confidence interval = 0.84 to 69.46, p  < 0.01). Furthermore, a significant association was found among HLA DQ4/5 genotype, age (>9.5) ( p  < 0.01), and gender (female) ( p  < 0.05)., Conclusion: The observed significant differences among HLA-DQ4 and HLA-DQ5 in Iranian CD samples against controls and the high value of the relative risks showed the significant function of the studied alleles in the prevalence of CD in Iranian patients., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s). Health Science Reports published by Wiley Periodicals LLC.)

Background: Geographic information system (GIS) plays an important role in identifying areas with a high incidence of cancer. In the present study, based on a systematic review of studies by Iranian researchers, we performed a scientometric analysis of the published articles on the spatial epidemiology of cancer. In addition, the geographical distribution of certain types of cancer in Iran is presented., Methods: A literature search was conducted using electronic databases such as PubMed and NLM Gateway, Institute for Scientific Information, Scopus, Google Scholar, and Cochrane Library for relevant articles published from 2000 to 2021. The search was performed using a combination of medical subject heading terms and keywords. A narrative synthesis was performed, and descriptive data were expressed as frequency and percentage., Results: Of the 200 identified articles, 31 studies published in 15 different journals were included in this systematic review. Results showed a wide variation in high-risk breast cancer clusters. However, a similar incidence of gastrointestinal cancers has been reported, and high-risk clusters were identified in the north and the northwest of Iran. Skin cancer and acute lymphoblastic leukemia were more prevalent in the central provinces., Conclusion: The current volume of studies on the spatial epidemiology of cancer in Iran, with a CiteScore quartile of Q1, is inadequate to guide health policymakers. The geographical distribution of many prevalent types of cancer has not been assessed by Iranian researchers. Furthermore, the classification of high- and low-risk geographical clusters of cancers was not completely homogeneous., Competing Interests: None declared., (Copyright: © Iranian Journal of Medical Sciences.)

In recent years, because of the various functions associated with silver nanoparticles (AgNPs) in manufacturing, different ways for their synthesis have been established. The antioxidant and antibacterial effects of terebinth (Pistacia terebinthus) have been proven. In this study, for the first time, using the extract of terebinth, we have synthesized AgNPs using a green method. Ultraviolet-visible spectrophotometry, X-ray diffraction (XRD), Infrared spectroscopy (FTIR), and the field emission scanning electron microscopy (FE-SEM) spectroscopy analyses were applied to evaluate and verify the formation of NPs, and the antioxidant, antibacterial and anticancer activity of synthesized AgNPs was also studied. The highest absorption was obtained 24 h following the synthesis at 420 nm because of the Ag + to Ag0 reduction. The functional groups stabilizing activity was obtained by FTIR. Moreover, size and surface morphology were assessed by FE-SEM. The present research showed the AgNPs had spherical shape and had a 32 nm diameter. The face-centered cubic construction of AgNPs was evaluated through XRD method with peaks at 2θ = 37°, 49°, 63°, and 76° (related to the planes of silver 111, 200, 220, 311), respectively. Antimicrobial assessment revealed that the biosynthesized AgNPs had a great antimicrobial activity in response to Gram-positive and Gram-negative strains. Suppression of 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity was determined to be associated with dosage. In addition, a high anticancer activity, against MCF-7 cell line, was observed for the 25 μg/mL concentration of the AgNPs. Altogether, these results show that biogenic AgNPs can be functioned as beneficial medicinal compounds., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Acromegaly is a chronic disease significantly affects the physical, emotional, and health-related aspects of patients' life. This study aimed to validate the Acromegaly Quality of Life Questionnaire (AcroQoL) for the Persian-speaking population., Methods: This cross-sectional study recruited 73 Iranian patients with a confirmed diagnosis of acromegaly. The content validity of the scales was evaluated by an expert panel of eight endocrinologists applying content validity index (CVI) and content validity ratio (CVR). Construct validity was assessed by using confirmatory factor analysis. Internal consistency was assessed on the basis of Cronbach's alpha, and a goodness-of-fit (GoF) index was calculated to display whether the model fitted the data., Results: CVI and CVR yielded values of 0.85 and 0.80, respectively (Acceptable CVI: > 0.78 and CVR: > 0.75). The average variances extracted (AVE) from physical and psychological dimensions were 0.520 and 0.462, respectively, exceeding the minimum criterion of 0.40. Cronbach's alpha for physical and psychological dimensions equaled 0.868 and 0.866, respectively, indicating the adequate internal consistency of multiple items for each construct. The subscales' R square and path coefficient were greater than the recommended threshold as 0.75 (physical dimension: 0.778, psychological dimension: 0.873), demonstrating the suitability of this criterion. Finally, the GoF value of 0.29 indicated the model's moderate fit., Conclusions: The findings revealed that the Persian version of AcroQoL is of adequate validity and reliability for evaluating the quality of life of Iranian people with acromegaly., (© 2022. The Author(s).)

Glucose phosphate dehydrogenasis (G6PD), the most prevalent enzymatic disease in humans, exists in south-eastern Iran. The geographic correlation of its distribution with the historic malaria endemic suggests that G6PD has increased in frequency as a result of natural selection by malaria. Based on studies, there is a controversy in terms of different analytical methods in terms of resistance to malaria. Fifty malaria patients and 50 healthy individuals from several cities south-east of Iran were included in the study and after obtaining consent, blood samples were taken from them. G6PD enzyme deficiency was investigated using a fluorescent stain test. The age, gender, and nationality of malaria patients were also assessed. The results were analyzed using SPSS software and appropriate statistical tests, and the value of P<0.05 was considered significant. The results showed that in malaria patients only one person had G6PD deficiency, while this number was six in the control group, which is significantly higher than the malaria group (P<0.05). Age group 27-42 years, men and people with Iranian citizenship also showed the highest incidence of malaria. Based on the results, it can be concluded that G6PD enzyme deficiency causes resistance to malaria and the frequency of this enzyme deficiency in malaria patients is significantly lower than in other people.

Background: Poor health condition may increase the risk of occupational problems and reduces an organization's productivity. Also, there is a direct, bilateral relationship between occupation and health., Objective: To evaluate the health status of health care workers (HCWs) in the largest tertiary general and teaching hospital in southern Iran., Methods: This cross-sectional study (Sep2014-Dec2016) was conducted on HCWs, who were referred to Prevention and Health Promotion Clinic of Shiraz Namazee hospital. The participants' health status was assessed and after the risk assessments and necessary physical examinations, the laboratory and para clinic tests were requested. Using descriptive and analytical tests, all data were analyzed., Results: Totally, 963 HCWs were enrolled, that 64.4% were women, with mean ± SD age of 35.51 ± 8.9 years. Eighty-eight percent and 77.4% of the participants had history of ergonomic and psychological exposures. Impaired glucose tolerance and abnormal serum cholesterol were seen in 13.6% and 29.9%, respectively. Body mass index was a predictive factor for abnormal blood pressure (OR: 1.12; 95%CI: 1.02-1.22), impaired glucose tolerance (OR: 1.08; 95%CI: 1.01-1.16), and abnormal serum cholesterol (OR: 1.17; 95%CI: 1.10-1.25), respectively. Male gender (OR: 1.83; 95%CI: 1.08-3.03) was a predictive factor for abnormal serum cholesterol., Conclusions: The health status of HCWs is not good enough in Iran. They did not have an appropriate lifestyle. They were exposed to different occupational hazards. The prevalence of chronic diseases was notable. Overweight, obesity, and inactivity were the most important causes of metabolic diseases., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 International Journal of Preventive Medicine.)

Background: Prior research has shown that around 5%-7% of patients in breast cancer centers in Germany participate in the discussion of their own case within a multidisciplinary tumor conference (MTC). The PINTU study is one of the first to research this practice. The objective is to describe (a) how patient participation in MTCs is implemented, (b) what is the role of patients, and (c) how patients experience MTCs., Methods: MTCs in six breast and gynecological cancer centers in North Rhine-Westphalia, Germany, with and without patient participation, are studied prospectively by (non)participatory, structured observation. Breast and gynecological cancer patients completed surveys before, directly after, and 4 weeks after MTC participation. Data are analyzed descriptively., Results: Case discussions of a sample of n = 317 patients (n = 95 with MTC participation and n = 222 without) were observed. Survey data were obtained from n = 242 patients (n = 87 and n = 155). Observational data showed heterogeneity in the ways MTC participation was practiced. Among participating patients, 89% had the opportunity to express their opinion and 61% were involved in decision-making. Whereas most patients reported positive experiences and would recommend participation, some had negative experiences and regretted participating., Conclusions: Due to a lack of recommendations, hospitals implement patient participation in MTCs in many different ways. So far, it is unknown which setting and procedures of MTC participation are beneficial for patients. However, existing evidence on communication in cancer care together with this exploratory study's findings can build the basis for developing recommendations for hospitals that invite their patients to MTCs., Clinical Trial Registration Number: German Clinical Trials Register Nr. DRKS00012552., (© 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Background: Happiness is considered an index of the development of human society and well-being in the world., Aims: The aim of this study was to measure the level of happiness in a middle sized Iranian city (Kerman) using 2 instruments and the predictor factors., Methods: In a cross-sectional study, 1000 adults were questioned using multi-stage cluster sampling in 2016. The LoH was assessed using the Oxford Happiness Inventory (OHI) and a self-report questionnaire. The level of physical activity and the religion index were assessed using standard questionnaires., Results: The results of 2 questionnaires had a statistically significant correlation with measuring level of happiness (Pearson correlation coefficient 0.69; P-value < 0.001). Around 90% of participants stated that they had moderate to high LoH, but the mean happiness score based on the OHI was 43.2 (43.7 in men, 42.7 in women). Illiteracy, unemployment, divorce, living in deprived areas, high level of stress, weak religious beliefs and practice, lower income, and poor health significantly decreased the LoH score., Conclusion: Level of happiness is relatively low in Kerman. There are effective evidence-based interventions that might promote the LoH of the population, including promoting the level of community health, educating for stress management and improving access to urban facilities in deprived areas., (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).)

The co-occurrence of different types of hemo-lymphopoietic malignancies within a family provides clues about the pattern of inheritance and common environmental risk factors. A family presented with developing hemo-lymphopoietic cancers in three female first-degree relatives: a mother and her daughters. Case 1 was diagnosed with Walden Strom's macroglobulinemia at age 57. Case 2 and 3 presented with chronic myelogenous leukemia at age 32 and diffuse large B-cell lymphoma at age 28, respectively. There were not any significant common environmental risk factors in this family, but all three cases suffered from skin dermatitis and one of them, who suffered from chronic myelogenous leukemia, was diagnosed with morphea. This family had a sedentary and stressful lifestyle. Genetic is the foundation of some familial aggregation of cancers. Common lifestyle habits and environmental etiologies are important. Morphea as an autoimmune disease could have the essential role in developing hematolymphoid malignancies.

Background: A healthy lifestyle is important because of its long-term benefits; however, there is a paucity of information concerning health choices among Iranians. We evaluated personal health behaviors, attempts to change unhealthy behaviors, and factors affecting attempts at change., Methods: The design of this cross-sectional study was to assemble a representative cadre of >18-year-old adults in Shiraz, Iran, using a multistage cluster sampling technique. Validated questionnaires collected participant's demographic information, such as weight, height, cigarette smoking history, physical activity, and attempts at lifestyle changes during the previous year. To determine predictors of attempts to change unhealthy lifestyle and to identify confounders, we applied single and multivariable logistic regression methods, respectively. A confidence interval of 95% was calculated for each odds ratio., Results: The prevalence of attempts to change unhealthy lifestyle was 42%, 64.8%, and 27.8%, respectively, for losing weight, being more physically active, and smoking cessation. Unemployment, low levels of education, and decreased socioeconomic status have important roles in attempts to change lifestyle conditions. Low socioeconomic status was a risk factor for quitting smoking. Occupation (unemployed/homemaker) and low level of education were two significant factors for being more physically active., Conclusions: The prevalence of inadequate physical activity and being overweight or obese was considerable in Shiraz, Iran. Attempts to change unhealthy lifestyle were less than ideal. Social determinants of health factors including unemployment and low levels of education and socioeconomic status play important roles in attempts to change current lifestyles., Competing Interests: There are no conflicts of interest.

Background: Waterpipe smoking is a growing public health threat worldwide. The aim of this study was to assess waterpipe smoking prevalence and its associated factors among Iranian adults., Methods: This cross-sectional study was conducted in Kerman, Iran, recruiting 1090 adult participants using multistage sampling in 2016. A self-reported researcher-designed questionnaire was used. The socio-demographic characteristics and waterpipe smoking behaviors such as pattern, duration, and the most common place of waterpipe use, the type of tobacco, and the concurrent use of alcohol and substances were assessed. Data analyses were performed using chi-square, independent t-test, and multiple logistic regression., Findings: The prevalence of ever, current and daily waterpipe smoking were 43.8%, 28.8%, and 7.2%, respectively. Men initiated to use waterpipe in more early ages than women (P < 0.001). Café or restaurant (34.4%) and friends' house (36.8%) were the most frequent places for waterpipe using by men and women, respectively. Men used waterpipe 2.8 times more frequently than women. Waterpipe smoking was 4.9 times more likely in the 18-24 years age range compared to the 45 years or older. Waterpipe use was 2.4 times greater in the unemployed than in housewives. People with a university education were 1.4 and 1.7 times more likely to use waterpipe compared to people with high school diploma and illiterates, respectively., Conclusion: The present study revealed that men, high level of education, younger age and unemployment were associated with waterpipe smoking. Therefore, we need to design and implement more effective interventions, especially for vulnerable target groups.

Background: The purpose of this study was to determine the prevalence and related factors of low birth weight (LBW) in the Southeast of Iran., Methods: This cross-sectional study was carried out in Kerman province. Data were collected from Iranian Maternal and Neonatal Network at public and private hospitals. All live births from March 2014 to March 2015 considered as the source population. The risk factors including maternal age, gravida, parity, abortion, pregnancy risk factors, maternal nationality, maternal education, maternity insurance, place of living, consanguinity, neonate sex, preterm labor, place of birth, delivery manager, and delivery type were compared between LBW and normal birth weight groups., Results: The prevalence of LBW was 9.4% in the present study. Preterm labor (odds ratio [OR]: 22.06; P < 0.001), neonate female sex (OR: 1.41; P < 0.001), low parity (OR: 0.85; P < 0.001), pregnancy age <18 years (OR: 1.26; P = 0.012), pregnancy age >35 years (OR: 1.21; P = 0.001), delivery by cesarean section (OR: 1.17; P = 0.002), pregnancy risk factors (OR: 1.67; P < 0.001), maternal illiteracy (OR: 1.91; P < 0.001), living in the rural area (OR: 1.19; P < 0.001), consanguineous (OR: 1.08; P = 0.025), and delivery by obstetrician (OR: 1.12; P = 0.029) were identified as significant factors associated with LBW in this study., Conclusions: Prevention of preterm labor, consanguineous marriage, pregnancy age <18 and >35 years old, and maternal medical risk factors are some critical interventions to reduce its burden. Increasing the access to high-quality health-care services in rural and deprived areas is another effective strategy for the prevention of LBW., Competing Interests: There are no conflicts of interest.

Background: Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department (ED) is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in emergency department services in an Iranian hospital ED and to propose scenarios to reduce its queue and waiting time., Methods: This is a cross-sectional study in which simulation software (Arena, version 14) was used. The input information was extracted from the hospital database as well as through sampling. The objective was to evaluate the response variables of waiting time, number waiting and utilization of each server and test the three scenarios to improve them., Results: Running the models for 30 days revealed that a total of 4088 patients left the ED after being served and 1238 patients waited in the queue for admission in the ED bed area at end of the run (actually these patients received services out of their defined capacity). The first scenario result in the number of beds had to be increased from 81 to179 in order that the number waiting of the "bed area" server become almost zero. The second scenario which attempted to limit hospitalization time in the ED bed area to the third quartile of the serving time distribution could decrease the number waiting to 586 patients., Conclusion: Doubling the bed capacity in the emergency department and consequently other resources and capacity appropriately can solve the problem. This includes bed capacity requirement for both critically ill and less critically ill patients. Classification of ED internal sections based on severity of illness instead of medical specialty is another solution.

Introduction: Today, development of professionalism is a critical aim of medical schools. Studies have demonstrated that medical students' perceived level of professionalism is inadequate worldwide. This study aimed to investigate the medical students' perceptions of their colleagues' professional behavior., Methods: This study is a cross-sectional study with 280 medical students at Shiraz University of Medical Sciences in their fifth to seventh year of study as the sample. The study was performed during one month in 2013, using stratified random sampling method. The instrument of the study was the Persian version of the questionnaire of the American Board of Internal Medicine (ABIM).The questionnaire includes demographic information, questions about the meaning of the professionalism, history of medical ethics education programs and 12 behavioral questions. The data were analyzed using student t-test and Pearson correlation test. The significance level was set as 0.05., Results: Forty percent of respondents did not know the meaning of professionalism. The mean±SD score of behavioral questions was 5.91±1.2 on a scale from 0 to 10. The mean±SD score of excellence questions was 4.94±1.7. It was 7.05±1.9 for 'honor/integrity', and 6.07±2.1 for 'altruism/respect' questions. There was a significant association between gender and excellence score (p=0.007)., Conclusion: Medical students assessed their colleagues' professional behavior as poor. They did not have proper information about professionalism. Medical students are future general practitioners and respecting medical ethics by them is very important in a perfect health system. Universities should emphasize the importance of teaching professionalism to medical students and faculty members, using innovative education methods.

Background and Objectives: Medical waste management is a major concern for healthcare facilities. One important element is the segregation of infectious waste from domestic, non-infectious waste. The aim of this qualitative study was to identify factors that negatively affect proper segregation at Nemazee Hospital, which is affiliated with Shiraz University of Medical Sciences., Methods: Study data came from focus groups involving hospital workers. Participants expressed their opinions regarding barriers to proper segregation of medical wastes. The participants gave their permission to have their comments recorded. Data analyses were based on a grounded theory approach., Results: The results indicated that managerial weakness was an important factor in suboptimal disposal of medical waste. It appears that hospital authorities should pay better attention to educational planning, organizational resources and supervision. Together, these considerations should help reduce waste-management errors. The results also suggest that healthcare worker training needs improvement. In general, patients and their companions, as well as the local population, did not appear to have sufficient knowledge concerning disposal of infectious medical waste., Conclusions: Hospital authorities should conduct a broad review of medical waste management, including improved employee training. This step should have a positive effect on local health, as well as the environment. Improvement is also needed in the infection prevention performance of hospital healthcare workers. This approach should reduce additional production of infectious waste and costs associated with healthcare., (Copyright © 2014 King Saud Bin Abdulaziz University for Health Sciences. All rights reserved.)