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Narges Alizadeh,1 Sharad Ayyoubi,2 Mohammadreza Naghipour,3 Rasool Hassanzadeh,2 Zahra Mohtasham-Amiri,3 Shirin Zaresharifi,4 Kaveh Gharaei Nejad1 1Dermatology Department, School of Medicine, Guilan University of Medical Sciences, 2General Practice, School of Medicine, Guilan University of Medical Sciences, 3Community Medicine Department, School of Medicine, Guilan University of Medical Sciences, Rasht, 4General Practitioner, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Background: Hirsutism can have negative impacts on psychosocial aspects of women’s lives and reduce their quality of life (QOL). The aim of this study was to assess the QOL of these women during laser treatment. Patients and methods: Eighty-eight women with unwanted facial hair underwent laser therapy. Each patient completed a questionnaire consisting of a modified Dermatology Life Quality Index (DLQI) and visual analog scale (VAS) before the first, third, and fifth sessions of laser therapy. Interval between the sessions was 4–6 weeks. Statistical analyses were done using SPSS software version18. Results: The DLQI scores before treatment, and at third and fifth sessions were 7.75±2.36, 5.55±1.88, and 4.14±0.64, respectively (P

Jafar Sadegh Tabrizi,1 Mostafa Farahbakhsh,2 Homayoun Sadeghi-Bazargani,3,4 Roya Hassanzadeh,5 Akram Zakeri,6 Leili Abedi7 1Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 2Research Center of Psychiatry & Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran; 3Road Traffic Injury Research Center, Department of Statistics & Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran; 4WHO Collaborating Center on Community Safety Promotion, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden; 5Department of Health Services Management, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, 6National Public Health Management Center, Tabriz University of Medical Sciences, Tabriz, 7Department of Statistics and Epidemiology, Faculty of Health, Kerman University of Medical Sciences, Kerman, Iran Background: Iranian traditional primary health care (PHC) system, although proven to be successful in some areas in rural populations, suffers major pitfalls in providing PHC services in urban areas especially the slum urban areas. The new government of Iran announced a health reform movement including the health reform in PHC system of Iran. The Health Complex Model (HCM) was chosen as the preferred health reform model for this purpose.Methods: This paper aims to report a detailed research protocol for the assessment of the effectiveness of the HCM in Iran. An adaptive controlled design is being used in this research. The study is planned to measure multiple endpoints at the baseline and 2 years after the intervention. The assessments will be done both in a population covered by the HCM, as intervention area, and in control populations covered by the traditional health care system as the control area.Discussion: Assessing the effectiveness of the HCM, as the Iranian PHC reform initiative, could help health system policy makers for future decisions on its continuation or modification.Trial registration: The study protocol is registered in Iranian Registry of Clinical Trials under the unique code IRCT201402112150N3. Keywords: health reform, health complex model, public private partnership, primary health care, health network, capitation, Iran

Karakul (KAR) is one of the resistant sheep breeds to harsh desert conditions, which is also known for its excelent lamb pelt quality. This study was performed to identify the signature of selections in the KAR breed using whole-genome sequencing data (WGS) compared with five other Iranian native sheep. Three methods, including population differentiation index (Fst), nucleotide diversity (π), and cross-population extended haplotype homozygosity (XP-EHH) applied to detect the genomic signature of selection. Data analysis leads to identifying 38 shared genes among three methods as positively selected genes for the KAR breed. The most of mentioned genes were associated with coat color (KIT, DVL3, YPEL3, ERBB4, ZNF451, and CTSO), fat and energy metabolism (GDPD3, STARD13, ZNF106, MAPK3, RGS6, PHYH, AP2M1, SPAG9, DNAH9, NDUFAF6, and ARSK), muscle function (MYOCD and MCTP1), growth (CPNE4), altitude adaptation (DNAH9 and SERGEF), and reproduction (TBX6, PHYH, SPAG9, and ARSK). Based on our results, these candidate genes may have a positive effect on the adaptation of the KAR breed to a desert environment. [ABSTRACT FROM AUTHOR]

Background and Objective: Neuropathic diseases are neurodegenerative conditions and a wide and difficult group of peripheral nerve diseases in humans. Since well-being therapy emphasizes the high levels of six domains of psychological well-being, this study was conducted to investigate the effectiveness of well-being therapy on pain coping strategies and self-efficacy of patients with chronic neuropathic pain. Methods: This clinical trial was conducted on 30 chronic neuropathic patients referred to Ayatollah Rouhani hospital in Babol and a neurologist's private office in two groups of experimental and control (n=15). Well-being therapy was performed in 8 sessions of 120 minutes, once a week for the experimental group, while the control group received the routine treatment. After the follow-up period, the control group also underwent psychotherapy. Both groups completed questionnaires of pain coping strategies (Rosenstiel and Keefe, 1985) and pain self-efficacy (Nicholas, 1989) in the pre-test, post-test and follow-up (two months after the post-test) and were compared. Findings: The results showed that there was a statistically significant difference between the two experimental and control groups in the score of the subscales of pain coping strategies in distraction from pain (23.13±3.88 versus 11.47±7.34) (p<0.001), reinterpretation of pain (17.33±5.56 versus 13.0±8.65) (p=0.114), catastrophizing (10.0±6.24 versus 16.33±5.4) (p<0.001), ignoring pain (24.4±6.67 versus 12.6±5.11) (p<0.001), hoping/praying (29.13±9.97 versus 22.4±5.7) (p=0.031), self-talk (25±4.03 versus 21.2±4.79) (p=0.026), behavioral activation (20.47±4.43 versus 11.20±4.94) (p<0.001) and pain self-efficacy (43.2±9.45 versus 33.33±13.34) (p=0.027). These results were maintained in the follow-up period. Conclusion: The present study showed that wellness therapy can be an effective intervention in improving pain coping strategies and increasing pain self-efficacy in chronic neuropathic patients. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: Neuroticism and extroversion have a high and positive relationship with psychological problems such as anxiety and depression. Since cardiovascular diseases are also considered as psychotic that can be reduced by modifying lifestyles and changing high risk behaviors this study was conducted to compare the effectiveness of emotional schema therapy on neuroticism and lifestyle of cardiovascular patients. METHODS: This cross-sectional study was performed on 30 patients with cardiovascular disease referred to Rouhani Hospital in Babol who were randomly divided into two groups of emotional schema therapy and control. The emotional schema therapy protocol was performed during 12 weekly sessions of 2 hours. Using NEO-FFI (score 12-60) and Health Promoting Lifestyle (HPLPII) questionnaires (score 48-192), before the intervention, after the intervention and one month later, the two groups were evaluated and compared. FINDINGS: There was no significant difference between the two groups in terms of age and sex. The mean scores of neuroticism before and after the intervention in the control group were 38.93±7.31 and 37.80±4.63, respectively, and in the emotional schema therapy group were 37.73±6.94 and 32.53±6.75, respectively. The mean score of promoter lifestyle in emotional schema therapy group before and after the intervention was 113.13±28.25 and 138±32.27, respectively (p<0.05). Implementation of emotional schema therapy had a significant effect on Neuroticism (6.95, 0.014 and 0.205) and lifestyle (11.67, 0.002 and 0.302) and led to the reduction of Neuroticism and the promotion of lifestyle. CONCLUSION: The results of this study showed that emotional schema therapy can be an effective intervention in reducing neuroticism and promoting lifestyle in cardiovascular patients. [ABSTRACT FROM AUTHOR]

Setila Dalili,1 Shahin Koohmanaee,1 Seyyed Amir Reza Nemati,1 Seyyedeh Azade Hoseini Nouri,1 Afagh Hassanzadeh Rad,1 Wesam Kooti2 1Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran; 2Lung Diseases & Allergy Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, IranCorrespondence: Wesam Kooti; Shahin Koohmanaee Tel +989336583929Email wesamkooti@gmail.com; Koohmana@yahoo.comBackground: Diabetes mellitus is one of the most common chronic metabolic diseases in children and adolescents, which changes the cellular metabolism. Phosphorus is an essential element for metabolism. Early in the progression of diabetes, a paradoxical metabolic imbalance in inorganic phosphate (Pi) occurs that may lead to reduced high energy phosphate and tissue hypoxia. While low and high uncontrolled blood sugars can be easily recognized by clinical symptoms, low and high plasma inorganic phosphate remain unrecognizable. Therefore, we aimed to assess the association between hemoglobin A1c (HbA1c) with serum inorganic phosphate in children with type 1 diabetes.Materials and Methods: This cross-sectional study was conducted on 102 patients selected from a pediatric ward in 17th Shahrivar hospital in Rasht, North of Iran. Clinical data including age, sex, height, weight, BMI, duration of diabetes, the level of HbA1c, and phosphorus were gathered. The level of HbA1c was adjusted by age in the final analysis.Results: The mean age of samples was 9.98± 3.91 years old and 46 participants (45.1%) were male. It was found that HbA1c had a reversed and significant relationship with BMI (r=− 0.215 and P=0.03), but there was no correlation between phosphate, age, height and weight, duration of diabetes mellitus, or rate of insulin consumption with HbA1c (P> 0.05).Conclusion: The finding showed that HbA1c had a reversed relationship with BMI but there was no correlation between phosphate and HbA1c.Keywords: phosphate, diabetes mellitus, child, glycated hemoglobin A, Iran

The research applied a semi-experimental method using pre-test and post-test with control group. The statistical community is made up of all hypertension stricken patients, extracted from Babol based Shahid Beheshti Hospital during three months from August to October 2015 among the mentioned hospital files. Out of this, 32 patients have been selected via nonrandom sampling method and randomly included in the experimental and control groups; The experimental group has been provided with eight 2.5 h sessions of mindfulness-based cognitive therapy (MBCT). The data have been collected through Intolerance of Uncertainty Scale (IUS). To compare the two experimental and control groups' mean scores, the effect of pre-and post-tests scores and other interventive variables on post-test sores has been applied. The covariance test results indicated that pre-test didn't exert remarkable effect on post-test derived results and also MBCT led to the experimental group's IU decrease. The findings imply that applying MBCT has directly affected the hypertension sufferers' IU drop [ABSTRACT FROM AUTHOR]

A convergent product is an assembly shape concept integrating functions and sub-functions to form a final product. To conceptualize the convergent product problem, a web-based network is considered in which a collection of base functions and sub-functions configure the nodes, and each arc in the network is considered to be a link between two nodes. The aim is to find an optimal tree of functionalities in the network, adding value to the product in the web environment. First, an algorithm is proposed to assign the links among bases and sub-functions. Then, numerical values, as benefits and costs, are determined for arcs and nodes, respectively, using a mathematical approach. Also, customer value corresponding to the benefits is considered. Finally, the Steiner tree methodology is adapted to a multi-objective model optimized by an augmented ε-constraint method. An example is worked out to illustrate the proposed approach. [ABSTRACT FROM AUTHOR]

This study will discuss the impacts of financial constraints and agency costs on the investment efficiency regarding limited resources and growing importance of investment efficiency. In order to achieve this goal, two hypotheses have been formulated and logistic regression has been used to test hypotheses. Meanwhile in this study regression (ols) has been used to measure investment efficiency and agency costs. This research has been done in 95 listed companies in Tehran Stock Exchange based on data contained in financial reports between 2001 - 2012. In this study, financial constraints has been measured using two models of Kaplan and White and wu. Results showed that financial constraints using White and Wu model does not have any effect on investment efficiency but, financial constraints using Kaplan has significant and positive effect on the investment efficiency. Agency costs have significant and negative effect on investment efficiency. [ABSTRACT FROM AUTHOR]

Considering convergent product as an important manufacturing technology for digital products, we integrate functions and sub-functions using a comprehensive fuzzy mathematical optimization process. To form the convergent product, a web-based fuzzy network is considered in which a collection of base functions and sub-functions configure the nodes and each arc in the network is to be a link between two nodes. The aim is to find an optimal tree of functionalities in the network adding value to the product in the web environment. First, a purification process is performed in the product network to assign the links among bases and sub-functions. Then, numerical values as benefits and costs are determined for the arc and the node, respectively. Also, a fuzzy customers' value corresponding to the arcs is considered. Next, the Steiner tree methodology is adapted to a multi-objective model of the network to find the optimal tree. A fuzzy multi-objective solution methodology is developed for solving the proposed problem. Finally, an example is worked out to illustrate the proposed approach. [ABSTRACT FROM AUTHOR]

Objective. Our current practice of screening for latent TB infection (LTBI) using universal T-SPOT assays is not in line with British Thoracic Society (BTS) recommendations. We set out to determine the clinical benefit and cost effectiveness of blanket TSPOT.TB (T-SPOT) testing as a screening tool for patients awaiting anti-TNF-α therapy. Methods. 130 consecutive rheumatology patients were investigated for LTBI before commencing anti-TNFα therapy at Gartnavel General Hospital, Glasgow, an area of low TB prevalence and high BCG vaccination. Chest radiograph and clinical interview were used to identify risk factors for LTBI. The annual risk of TB was calculated using tables from BTS recommendations and then compared to the risk of drug-induced hepatitis. All patients were given a T-SPOT according to current local policy. Indeterminate T-SPOTs were recorded and repeated. Results. For 130 patients, a total of 160 tests were required resulting in a cost of £24,000. 99 (76%) patients had no TB risk factors and a total of 22 repeat tests were required before returning negative results. This equates 121 T-SPOTs and potential cost savings of £18,150. Conclusion. In the absence of risk factors for TB and an abnormal chest radiograph, the use of T-SPOT as a first line test for LTBI may result in unnecessary risk of TB chemoprophylaxis-induced hepatitis, increased costs, and a delay in early anti-TNFα therapy. [ABSTRACT FROM AUTHOR]

Abstract Background A phylogenetic network is a generalization of phylogenetic trees that allows the representation of conflicting signals or alternative evolutionary histories in a single diagram. There are several methods for constructing these networks. Some of these methods are based on distances among taxa. In practice, the methods which are based on distance perform faster in comparison with other methods. The Neighbor-Net (N-Net) is a distance-based method. The N-Net produces a circular ordering from a distance matrix, then constructs a collection of weighted splits using circular ordering. The SplitsTree which is a program using these weighted splits makes a phylogenetic network. In general, finding an optimal circular ordering is an NP-hard problem. The N-Net is a heuristic algorithm to find the optimal circular ordering which is based on neighbor-joining algorithm. Results In this paper, we present a heuristic algorithm to find an optimal circular ordering based on the Monte-Carlo method, called MC-Net algorithm. In order to show that MC-Net performs better than N-Net, we apply both algorithms on different data sets. Then we draw phylogenetic networks corresponding to outputs of these algorithms using SplitsTree and compare the results. Conclusions We find that the circular ordering produced by the MC-Net is closer to optimal circular ordering than the N-Net. Furthermore, the networks corresponding to outputs of MC-Net made by SplitsTree are simpler than N-Net.

Convolutional neural networks (CNN) show great promise for translating decades of research on structural abnormalities in temporal lobe epilepsy into clinical practice. Three-dimensional CNNs typically outperform two-dimensional CNNs in medical imaging. Here we explore for the first time whether a three-dimensional CNN outperforms a two-dimensional CNN for identifying temporal lobe epilepsy-specific features on MRI. Using 1178 T1-weighted images (589 temporal lobe epilepsy, 589 healthy controls) from 12 surgical centres, we trained 3D and 2D CNNs for temporal lobe epilepsy versus healthy control classification, using feature visualization to identify important regions. The 3D CNN was compared to the 2D model and to a randomized model (comparison to chance). Further, we explored the effect of sample size with subsampling, examined model performance based on single-subject clinical characteristics, and tested the impact of image harmonization on model performance. Across 50 datapoints (10 runs with 5-folds each) the 3D CNN median accuracy was 86.4% (35.3% above chance) and the median F 1-score was 86.1% (33.3% above chance). The 3D model yielded higher accuracy compared to the 2D model on 84% of datapoints (median 2D accuracy, 83.0%), a significant outperformance for the 3D model (binomial test: P < 0.001). This advantage of the 3D model was only apparent at the highest sample size. Saliency maps exhibited the importance of medial-ventral temporal, cerebellar, and midline subcortical regions across both models for classification. However, the 3D model had higher salience in the most important regions, the ventral-medial temporal and midline subcortical regions. Importantly, the model achieved high accuracy (82% accuracy) even in patients without MRI-identifiable hippocampal sclerosis. Finally, applying ComBat for harmonization did not improve performance. These findings highlight the value of 3D CNNs for identifying subtle structural abnormalities on MRI, especially in patients without clinically identified temporal lobe epilepsy lesions. Our findings also reveal that the advantage of 3D CNNs relies on large sample sizes for model training., Competing Interests: None of the authors have any conflict of interest to disclose., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Guarantors of Brain.)

Background: Predicting mortality and relapse in children with acute lymphoblastic leukemia (ALL) is crucial for effective treatment and follow-up management. ALL is a common and deadly childhood cancer that often relapses after remission. In this study, we aimed to apply and evaluate machine learning-based models for predicting mortality and relapse in pediatric ALL patients., Methods: This retrospective cohort study was conducted on 161 children aged less than 16 years with ALL. Survival status (dead/alive) and patient experience of relapse (yes/no) were considered as the outcome variables. Ten machine learning (ML) algorithms were used to predict mortality and relapse. The performance of the algorithms was evaluated by cross-validation and reported as mean sensitivity, specificity, accuracy and area under the curve (AUC). Finally, prognostic factors were identified based on the best algorithms., Results: The mean accuracy of the ML algorithms for prediction of patient mortality ranged from 64 to 74% and for prediction of relapse, it varied from 64 to 84% on test data sets. The mean AUC of the ML algorithms for mortality and relapse was above 64%. The most important prognostic factors for predicting both mortality and relapse were identified as age at diagnosis, hemoglobin and platelets. In addition, significant prognostic factors for predicting mortality included clinical side effects such as splenomegaly, hepatomegaly and lymphadenopathy., Conclusions: Our results showed that artificial neural networks and bagging algorithms outperformed other algorithms in predicting mortality, while boosting and random forest algorithms excelled in predicting relapse in ALL patients across all criteria. These results offer significant clinical insights into the prognostic factors for children with ALL, which can inform treatment decisions and improve patient outcomes., (© 2024. The Author(s).)

Background: Peste des petits ruminants (PPR) is a disease with high morbidity and mortality in small ruminants. A clinical report of this disease in camels has been made in Iran; however, no accurate information is available about infection with this virus in the camel population of Iran., Objectives: This study was designed and conducted to detect any trace of seroconversion in dromedary camels in Iran., Methods: A total of 100 serum samples were collected from a slaughterhouse in Khorasan Razavi Province and analysed using a competitive enzyme-linked immunosorbent assay to detect antibodies against the PPR virus., Results: The results of this study indicated that the frequency of PPR virus exposure in camels in Khorasan Razavi Province was 3% (3 positive cases out of 100 camels). All the positive cases were female., Conclusion: The seroconversion without any history of clinical disease among these camels indicated their exposure to the PPR virus in this region and their resistance to clinical disease. The resistance and sensitivity to this disease in camels have yet not been fully determined and require further studies. However, stressful risk factors such as transportation may contribute to the occurrence of clinical forms of PPR in camels. The detection of antibodies against the PPR virus in camels in this study reveals the fact that camels may be considerable contributors to the epidemiology of PPR in Iran., (© 2024 The Author(s). Veterinary Medicine and Science published by John Wiley & Sons Ltd.)

Resting-state functional magnetic resonance imaging (rs-fMRI) has increasingly been used to study both Alzheimer's disease (AD) and schizophrenia (SZ). While most rs-fMRI studies being conducted in AD and SZ compare patients to healthy controls, it is also of interest to directly compare AD and SZ patients with each other to identify potential biomarkers shared between the disorders. However, comparing patient groups collected in different studies can be challenging due to potential confounds, such as differences in the patient's age, scan protocols, etc. In this study, we compared and contrasted resting-state functional network connectivity (rs-FNC) of 162 patients with AD and late mild cognitive impairment (LMCI), 181 schizophrenia patients, and 315 cognitively normal (CN) subjects. We used confounder-controlled rs-FNC and applied machine learning algorithms (including support vector machine, logistic regression, random forest, and k-nearest neighbor) and deep learning models (i.e., fully-connected neural networks) to classify subjects in binary and three-class categories according to their diagnosis labels (e.g., AD, SZ, and CN). Our statistical analysis revealed that FNC between the following network pairs is stronger in AD compared to SZ: subcortical-cerebellum, subcortical-cognitive control, cognitive control-cerebellum, and visual-sensory motor networks. On the other hand, FNC is stronger in SZ than AD for the following network pairs: subcortical-visual, subcortical-auditory, subcortical-sensory motor, cerebellum-visual, sensory motor-cognitive control, and within the cerebellum networks. Furthermore, we observed that while AD and SZ disorders each have unique FNC abnormalities, they also share some common functional abnormalities that can be due to similar neurobiological mechanisms or genetic factors contributing to these disorders' development. Moreover, we achieved an accuracy of 85% in classifying subjects into AD and SZ where default mode, visual, and subcortical networks contributed the most to the classification and accuracy of 68% in classifying subjects into AD, SZ, and CN with the subcortical domain appearing as the most contributing features to the three-way classification. Finally, our findings indicated that for all classification tasks, except AD vs. SZ, males are more predictable than females., Competing Interests: No authors have competing interests., (Copyright: © 2024 Hassanzadeh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Dysmenorrhea is the most common periodic pain, which affects more than 50% of women with regular menstruation. Fenugreek is one of the medicinal plants with analgesic properties. This study aimed to determine the effect of fenugreek application in the severity of dysmenorrhea and its side effects in women with dysmenorrhea. PICO: Population: women with dysmenorrhea; Intervention: fenugreek; Comparison: control groups; and Outcome: reduction in the severity of dysmenorrhea and its side effects., Methods: English database (PubMed, Cochrane Library, Scopus, and Web of Science) and Persian database [SID (Scientific Information Database) and Magiran] were used for research until February 11, 2023, using the keywords "Dysmenorrhea [Mesh]," "Foenum [Mesh]," "fenugreek [Mesh]," and "Trigonella [Mesh]." The reference list of the selected articles was also checked. The quality assessment was conducted through the Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0. The RevMan 5.3 software was used to analyze and report the data of the entered studies. Meta-analysis results were reported with the standardized mean difference (95% confidence interval). A subgroup analysis was performed based on the type of control groups. The quality of evidence was assessed using the GRADE approach., Results: After removing duplicates and ineligible cases, four articles were included in the systematic review out of the 1526 records obtained. The results showed that the pain intensity caused by primary dysmenorrhea decreased with fenugreek compared to placebo (pooled result SMD: -2.21; 95% CI: -3.26 to -1.17; Z: 4.17; p <0.001). There was no significant difference between fenugreek with mefenamic acid (SMD: 0.05; 95% CI: -0.57 to 0.67; Z: 0.17; p = 0.86) and fenugreek with Chandrasura churna (SMD: 0.06; 95% CI: -0.56 to 0.68; Z: 0.19; p = 0.85). Bias, in terms of incomplete outcome data and selective reporting, was low risk in all studies, and the available evidence was low quality according to the GRADE approach., Conclusion: The results showed that the effect of fenugreek on pain intensity in dysmenorrhea is highly uncertain. The true effect is likely to be substantially different from the estimate of effect. Regarding the importance of the health and quality of life of women of reproductive age and the low quality of evidence of the studies, clinical trials with stronger methodology are suggested in this field., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: This study aimed to investigate the intestinal carrier status of Enterococcus spp. among children in a pediatric intensive care unit (PICU) and reveal the role of hospitalization in the alteration of resistance phenotypes and clonal diversity of the isolates during admission and discharge periods., Methods: Two separate stool samples were collected from hospitalized patients in the pediatric intensive care unit at admission and discharge times. The culture was done, and Enterococcus species were tested for antimicrobial susceptibility and carriage of vanA-D gene subtypes. Random Amplified Polymorphic DNA (RAPD)-PCR was used for a phylogenetic study to check the homology of pairs of isolates., Results: The results showed carriage of Enterococci at admission, discharge, and at both time points in 31%, 28.7%, and 40.1% of the cases, respectively. High frequencies of the fecal Enterococcus isolates with vancomycin-resistance (VR, 32.6% and 41.9%), high-level of gentamicin-resistance (HLGR, 25.6% and 27.9%), and multi-drug resistance phenotypes (MDR, 48.8% and 65.1%) were detected at admission and discharge times, respectively. Resistance to vancomycin, ampicillin, and rifampicin was higher among E. faecium, but resistance to ciprofloxacin was higher in E. faecalis isolates. The increased length of hospital stay was correlated with the carriage of resistant strains to vancomycin, ampicillin, and ciprofloxacin. While the homology of the isolates was low among different patients during hospitalization, identical (9%) and similar (21%) RAPD-PCR patterns were detected between pairs of isolates from each patient., Conclusions: The high rate of intestinal carriage of VR, HLGR-, and MDR-Enterococci at admission and during hospitalization in the PICU, and the impact of increased length of hospital stay on the fecal carriage of the resistant strains show the importance of antibiotic stewardship programs to control their transmission and spread in children., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objective: We systematically assessed all available evidence on the efficacy and safety of sacral neuromodulation (SNM) in pregnancy., Methods: On September 2022, a thorough search was done on Ovid, PubMed, Scopus, ProQuest, Web of Science, and The Cochrane Library. We chose studies that included pregnant women who had SNM previously. Two authors independently evaluated the quality of the study using a standardized tool of JBI. Studies were given a risk of bias rating of low, moderate, or high. Given the descriptive nature of this study, we utilized descriptive statistics to report demographic and clinical features. For continuous variables, we used mean and standard deviation, and for dichotomous data, we used frequencies and percentages., Results: Out of 991 abstracts screened, only 14 studies met our inclusion criteria and were included in the review. Overall, the quality of the evidence available from the literature is low based on the design of the included studies. Fifty-eight women, including 72 pregnancies, had SNM. The indication of SNM implantation was filling phase disorders in 18 cases (30.5%), voiding dysfunction in 35 women (59.3%), IC/BPS in two cases (3.5%), and fecal incontinence. In 38 pregnancies (58.5%), the SNM status was ON during pregnancy. Forty-nine cases delivered a full-term baby (75.4%), 12 cases had pre-term labor (18.5%), two miscarriages, and two postterm pregnancies happened. The most complications in patients with devices were urinary tract infection in 15 women (23.8%), urinary retention in six patients (9.5%), and pyelonephritis in two cases (3.2%). The findings revealed that when the device was deactivated, 11 cases out of the 23 patients (47.8%) had full-term pregnancies, while in ON status, 35 out of the 38 pregnant women (92.1%) had full-term pregnancies. Nine preterm labors in OFF (39.1%), and two in ON status (5.3%) were recorded. The results revealed that this difference was statistically significant (p = 0.002), and those who turned SNM of them off had more preterm labor. Although the studies reported all neonates had a healthy status, two children had chronic motor tic problems and a pilonidal sinus in a case with an active SNM in pregnancy. However, there was no association between the SNM status and pregnancy or neonatal complications (p = 0.057)., Conclusion: SNM activation in pregnancy seems safe and effective. The choice of whether to activate or deactivate SNM should be made on an individual basis given the current SNM evidence., (© 2023 Wiley Periodicals LLC.)

Because groundwater quality representatives for drinking usage (i.e., Schuler method, Nitrate and Groundwater Quality Index) have been abruptly changing due to extreme events induced by global climate change and over-abstracting, applying an efficient tool for their assessments is vitally important. While hotspot analysis is introduced as an efficient tool concentrating on sharp changes in groundwater quality, it has not been closely examined. Accordingly, this study is an attempt to determine the groundwater quality proxies and assess them through hotspot and accumulated hotspot analyses. To this end, a GIS-based hotspot analysis (HA) applying Getis-Ord Gi* statistics was used. The accumulated hotspot analysis was launched to identify the Groundwater Quality Index (AHA-GQI). Moreover, Schuler method (AHA-SM) was utilized to determine the maximum levels (ML) for the hottest hotspot and the lowest levels (LL) for the coldest cold-spot, and compound levels (CL). The results revealed that a significant correlation (r = 0.8) between GQI and SM was observed. However, the correlation between GQI and nitrate was not significant and the correlation between SM and nitrate was so low (r = 0.298, sig > 0.05). The results also demonstrated that using hotspot analysis on only GQI, the correlation between GQI and SM increased from 0.8 to 0.856, while using hotspot analysis on both GQI and SM increased the correlation to 0.945. Likewise, when GQI was subjected to hotspot analysis and SM underwent accumulated hotspot analysis (i.e., AHA-SM (ML)), the correlation degree increased to the highest extent (i.e., 0.958), indicating the usefulness of including the hotspot analysis and accumulated hotspot analysis in the evaluation of groundwater quality., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Trauma is one of the most critical public health issues worldwide, leading to death and disability and influencing all age groups. Therefore, there is great interest in models for predicting mortality in trauma patients admitted to the ICU. The main objective of the present study is to develop and evaluate SMOTE-based machine-learning tools for predicting hospital mortality in trauma patients with imbalanced data., Methods: This retrospective cohort study was conducted on 126 trauma patients admitted to an intensive care unit at Besat hospital in Hamadan Province, western Iran, from March 2020 to March 2021. Data were extracted from the medical information records of patients. According to the imbalanced property of the data, SMOTE techniques, namely SMOTE, Borderline-SMOTE1, Borderline-SMOTE2, SMOTE-NC, and SVM-SMOTE, were used for primary preprocessing. Then, the Decision Tree (DT), Random Forest (RF), Naive Bayes (NB), Artificial Neural Network (ANN), Support Vector Machine (SVM), and Extreme Gradient Boosting (XGBoost) methods were used to predict patients' hospital mortality with traumatic injuries. The performance of the methods used was evaluated by sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), accuracy, Area Under the Curve (AUC), Geometric Mean (G-means), F1 score, and P-value of McNemar's test., Results: Of the 126 patients admitted to an ICU, 117 (92.9%) survived and 9 (7.1%) died. The mean follow-up time from the date of trauma to the date of outcome was 3.98 ± 4.65 days. The performance of ML algorithms is not good with imbalanced data, whereas the performance of SMOTE-based ML algorithms is significantly improved. The mean area under the ROC curve (AUC) of all SMOTE-based models was more than 91%. F1-score and G-means before balancing the dataset were below 70% for all ML models except ANN. In contrast, F1-score and G-means for the balanced datasets reached more than 90% for all SMOTE-based models. Among all SMOTE-based ML methods, RF and ANN based on SMOTE and XGBoost based on SMOTE-NC achieved the highest value for all evaluation criteria., Conclusions: This study has shown that SMOTE-based ML algorithms better predict outcomes in traumatic injuries than ML algorithms. They have the potential to assist ICU physicians in making clinical decisions., (© 2023. The Author(s).)

Background: This study aimed to investigate the frequency of intestinal colonization by vancomycin-resistant Enterococcus (VRE) carrying vanA and vanB genes in patients at ICU admission and at discharge from ICU in Mofid children's Hospital, Tehran, Iran., Method: Sampling was performed using rectal swabs and vancomycin susceptibility testing for Enterococcus spp. was carried out using a minimum inhibitory concentration (MIC) assay on Muller Hinton Agar (MHA) medium using an E-test kit. The molecular detection of VRE isolates was performed by the PCR method using the vanA and vanB resistance genes., Results: A total of 234 and 186 non-duplicate rectal swab samples were collected from patients at ICU admission and at discharge from ICU, respectively. Enterococcus spp. was detected in 34.6% (n = 81/234) of rectal swab samples collected from patients at ICU admission, of which 44.4% (n = 36/81) were VRE isolates. In contrast, the prevalence of Enterococcus spp. and VRE isolates among patients at discharge from ICU was 17.7% (n = 33/186) and 57.6% (n = 19/33), respectively. Out of 19 VRE isolated from patients at ICU admission, 4 (21%) and 1 (5.3%) contained vanA and vanB genes, respectively. In contrast, out of 36 VRE isolated from patients at discharge from ICU, 11 (30.5%) were positive for the vanA gene., Conclusion: Results revealed that the prevalence of Enterococcus spp. among patients at ICU admission was high. However, VRE was frequently isolated from patients who were hospitalized for several days in ICUs. The implementation of proper infection control strategies and the use of suitable protocols to guide the appropriate prescribing of antibiotics are necessary., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Assessment of women's childbirth experience is an important indicator in maternity services. Positive childbirth experiences improve mothers' health, whereas negative childbirth experiences can cause psychological stresses and, in extreme cases, may lead to postpartum depression., Methods: In this cohort study, 204 women at 35-37 weeks of gestation were selected using cluster sampling from the health centers of Tabriz, Iran. Women were divided into three groups (68 women in each group) based on their attendance in childbirth preparation classes: (a) non-attenders (did not attend any sessions), (b) irregular attenders (attended 1-3 sessions), and (c) regular attendants (attended 4-8 sessions). Interviews were conducted at one month postpartum to complete the Childbirth Experience Questionnaire (CEQ) and Edinburgh Postnatal Depression Scale (EPDS). The general linear model (GLM) was used to identify associations between women's attendance to the classes and either their childbirth experience or postpartum depression scores., Results: Based on the GLM, the mean score of childbirth experience among the regular attenders was significantly higher than women who were irregular attenders ( p = .032) or non-attenders ( p < .001). In addition, the mean score of postpartum depression scale was significantly lower among regular attenders compared with non-attenders ( p < .001). However, there was no significant difference in postpartum depression score among regular and irregular attenders ( p = .257)., Conclusions: Attending prenatal classes was associated with positive childbirth experience and low postpartum depression score.

Objective: Sleep disorders are common during prenatal and postpartum periods which can be associated with physical and psychological maternal and neonatal outcomes. The aim of this study was to determine the psychometric properties of the Persian version of Postpartum Sleep Quality Scale ., Methods: In this study, 280 women who had given birth two to four months prior to the study were selected using cluster sampling in the year 2020. Construct validity of Postpartum Sleep Quality Scale was assessed through exploratory and confirmatory factor analyses. Internal consistency and test-retest were used to determine the reliability of the scale., Results: The content validity index of the scale was 0.88 and the content validity ratio was 0.94. In the exploratory factor analysis, the single-factor structure was extracted. The fit indices confirmed the model validity. The Cronbach's alpha coefficient was 0.78 and the intra-class correlation coefficient (95% confidence interval) was 0.97 (0.94 to 0.98). The criterion validity also showed the positive correlation of the scale with the Pittsburgh Sleep Quality Index., Conclusion: The present study indicates that the Persian version of Postpartum Sleep Quality Scale is a valid and reliable tool for evaluating the postpartum sleep quality in Iranian women., Supplementary Information: The online version contains supplementary material available at 10.1007/s41105-022-00405-5., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© The Author(s), under exclusive licence to Japanese Society of Sleep Research 2022, corrected publication 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)