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Background and Objectives: For persons with dementia, the relationships between caregiver burden, physical frailty, race, behavioral and psychological symptoms (BPSD), and other associated variables are poorly understood. Only one prior study examined the relationships among these variables but did not include race, which is an important social determinant of health outcomes in the United States. To examine these interactions, we conducted a cross-sectional exploratory study based on a model by Sugimoto and colleagues. Materials and Methods: The sample comprised 85 patient–caregiver dyads (58% White) seen in four centers in diverse regions of New York State. All patients met DSM5 criteria for a major neurocognitive disorder, had a Clinical Dementia Rating sum score of ≥3, and Mini-Mental State Examination (MMSE) score of 10 to 26. Other measures included the SHARE-Frailty Instrument(FI), the Neuropsychiatric Inventory (NPI) to assess BPSD, Zarit’s Caregiver Burden Interview (CBI), Lawton’s Activities of Daily Living (ADL) Scale, the MMSE, the Cumulative Illness Rating Scale for Geriatrics (CIRSG), age, and gender. Results: In our sample, 59% met the criteria for prefrail/subsyndromal or frail/syndromal (SSF) on the SHARE-FI. SSF had significant direct effects on the NPI and significant indirect effects on the CBI mediated through the NPI; the NPI had significant direct effects on the CBI. Race (White) had significant direct effects on the CBI (higher) and SSF (lower) but did not have significant indirect effects on the CBI. MMSE, ADL, and CIRSG were not significantly associated with the NPI or the CBI. Conclusions: Our analysis demonstrated that frailty, race, BPSD, and caregiver burden may directly or indirectly influence one another, and therefore should be considered essential elements of dementia assessment, care, and research. These results must be viewed as provisional and should be replicated longitudinally with larger samples.

Hepatocellular carcinoma (HCC) is the most prevalent type of liver cancer, mainly occurring in Asian countries with an increased incidence rate globally. Currently, several kinds of therapies have been deployed for HCC therapy including surgical resection, chemotherapy, radiotherapy and immunotherapy. However, this tumor is still incurable, requiring novel strategies for its treatment. The nanomedicine has provided the new insights regarding the treatment of cancer that liposomes as lipid-based nanoparticles, have been widely applied in cancer therapy due to their biocompaitiblity, high drug loading and ease of synthesis and modification. The current review evaluates the application of liposomes for the HCC therapy. The drugs and genes lack targeting ability into tumor tissues and cells. Therefore, loading drugs or genes on liposomes can increase their accumulation in tumor site for HCC suppression. Moreover, the stimuli-responsive liposomes including pH-, redox- and light-sensitive liposomes are able to deliver drug into tumor microenvironment to improve therapeutic index. Since a number of receptors upregulate on HCC cells, the functionalization of liposomes with lactoferrin and peptides can promote the targeting ability towards HCC cells. Moreover, phototherapy can be induced by liposomes through loading phtoosensitizers to stimulate photothermal- and photodynamic-driven ablation of HCC cells. Overall, the findings are in line with the fact that liposomes are promising nanocarriers for the treatment of HCC.

Due to the widespread use of computers and measuring equipment in the operation of water distribution networks, a large amount of data is recorded for monitoring and evaluating the performance of water distribution networks and it is used in the modeling and calibration process. The management of these data is very necessary to achieve more accurate models on the one hand and the speed of their processing on the other hand. In this research, the purpose is to process nodal pressure field data to select the best statistical indicators for calibrating the water distribution network model. For this purpose, more than 5500 data collected in 22 stations of Ahar water distribution network and 12 stations of Oshnaviyeh water distribution network have been analyzed. First, by categorizing the data with Sturges experimental method, the probability of the data being placed in the central index categories of average, median, and mode and other categories in different stations in the times of minimum, maximum, and average consumption has been determined, and by summarizing the results, the best central index has been selected. Then, to analyze how the data changes, the minimum and maximum values, the range of variation, and the standard deviation of the data are presented along with the histogram of the categories. The trend of data variations in different stations in the minimum, maximum, and average consumption times shows that there is no specific harmony for data variations, so the maximum or minimum values of the range of variation and the standard deviation of the data are moved spatially in the stations. Also, the process of data allocation to categories shows that in the Ahar water distribution network, most data is allocated to the mode category at about 28.6 percent, followed by other categories at about 26.3 percent. Also, in the Oshnaviyeh water distribution network, the highest allocation is related to other categories with about 30.2 percent, followed by the mode category with 27.2 percent. Considering the multiplicity and dispersion of other categories and the unity of the mode category, the mode category is the best choice for both case studies. In general, by using mode values instead of other central indicators in the calibration of water distribution networks, due to the effectiveness of more field data, more favorable results will be obtained in the construction of the network model.

Background: Knee osteoarthritis is highly prevalent and causes debilitating pain, progressive movement limitation, and significant socio-economic costs. Intra-articular corticosteroids are widely used to control it, but only short-term effects have been proven for them. Also, they have shown many local and systemic side effects, including cartilage destruction and infection susceptibility. Knee prolotherapy in various forms of hypertonic dextrose injection has shown significant restorative effects, long-lasting pain and activity improvement, negligible side effects, and low cost. The objective is to compare the early effectiveness of intra-articular dextrose with corticosteroids regarding pain and activity changes in knee osteoarthritis. Materials and Methods: In this short-term blinded randomized clinical trial, 70 participants (knees) with primary osteoarthritis grade II or more were divided (1=1) into two random groups that received a single injection of triamcinolone 40 mg or hypertonic dextrose 20% five cc. Visual analog score (VAS) for pain and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score for activity were assessed before, one week after, and one month after injection. The data was analyzed using independent t-test, chi-square, Fisher's exact tests, Repeated measure test, and the linear mixed model regression. Results: The rest and activity VAS score and WOMAC score were reduced in both groups one week and one month after injection, and the difference between the two groups was non-significant for the VAS score but significant for the WOMAC score in favor of the dextrose group. Conclusion: The early analgesic and activity-improvement effects after hypertonic dextrose injection in the arthritic knee are significant and comparable to corticosteroids.

Background and Aim: Medical tourism refers to travel for receiving health services abroad. The COVID-19 crisis affected a wide range of tourism-related businesses, including medical tourism, and caused a decrease in the supply and demand of health services in this market. This study aimed to investigate the impact of the COVID-19 pandemic on Medical Tourism in Iran. Materials and Methods: This cross-sectional study was conducted in Iran in 2021. The data used in this study were extracted from the information system of the Ministry of Health from 2018 to 2021, which includes the number, origin, and destination of medical tourists, per capita revenue, and monthly revenue two years before and one and a half years after the COVID-19 pandemic. For data analysis, t-tests of independent groups and interrupted time series regression were used in SPSS and EViews 10 software. Results: The COVID-19 pandemic has caused a 42% decrease in the average monthly number of medical tourists, a 45% decrease in the monthly revenue, and a 10% decrease in the per capita income per tourist (P

Background: Colorectal cancer is one of the most prevalent types of cancer in Iran. Detection and removal of polyps in colorectal cancer can significantly decrease the morbidity and mortality of the disease. The present study aimed to describe the characteristics of patients who had been detected with colorectal neoplasia.Method: This descriptive study was conducted on all the people who had been referred to the Research Institute for Gastroenterology and Liver Diseases for receiving colonoscopy services during 2017-2019. Information was collected through questionnaires designed based on four categories, namely personal information, clinical history, pharmacological history, and pathological results. We used logistic regression analysis to investigate the relationship between independent risk factors and colorectal neoplasia.Results: The total number of the patients referred to the hospital was 2826. The percentage of males was 43.06. There was a low statistically significant relationship between gender and having neoplasia (P = 0.053). We found that the history of diabetes was associated with neoplasia (P = 0.007). Watery diarrhea and abdominal pain had a relationship with colorectal neoplasia and P-values; they were both below 0.001. Moreover, weight loss and inflammatory bowel disease had a significant statistical relationship and P-values were 0.02 and

In recent decades, due to the limitations of water resources, much research has been done in relation to the optimal operation of water distribution networks. In this regard, the use of appropriate methods to control and set the performance of pumps, valves, reservoirs and tanks in these systems are of considerable importance. In this paper, the aim is to regulate the optimal number and speed of pumps in pumping stations to maximize the hydraulic performance of water distribution networks. For this purpose, a new index is presented based on the pump speed optimization process to determine the number of turn-on pumps. In addition, the Nodal Pressure Reliability Index (NPRI) is used to evaluate the hydraulic performance of the network. The hydraulic analysis of the network is performed using EPANET and the optimization process is performed using the Modified Standard Particle Swarm Optimization algorithm (MSPSO), both of which are done in MATLAB code. The proposed method has been implemented in the form of four scenarios on the Khomam water distribution network, Gilan province. Scenarios include current status with Single Speed Pumps (SSP), Best Setting of Rotational Speed Pumps (BSRSP), Best Number of Turn on Single Speed Pumps (BNTSSP) and Best Number and Speed of Turn on Rotational Speed Pumps (BNSTRSP). Comparison of the results shows that the BSRSP and BNSTRSP scenarios with the slightest difference have the highest reliability and the lowest leakage. So that they increase the reliability of the network by 66.10 and 66.06 percent, respectively, and reduce the leakage by 23.53 and 23.48 percent, respectively. However, in the BNSTRSP scenario, the number of turn-on pumps is 13.16 percent less than the BSRSP scenario. Also, in the BNTSSP scenario where the number of turn-on pumps is less than the SSP scenario, the reliability of the network increases 21.36 percent and the leakage rate decreases by 10.36 percent, which emphasizes the efficiency of the NTPI index in improving network performance. In general, determining the number of turn-on pumps in pumping stations and optimizing the speed of variable speed pumps has a significant effect on increasing the hydraulic performance of water distribution networks, which can be very effective in saving energy and water resources and increasing network performance.

Abstract Background High-resolution computed tomography (HRCT) is the gold standard for the evaluation of cystic fibrosis (CF) lung disease; however, lung ultrasound (LUS) is being increasingly used for the assessment of lung in these patients due to its lower cost, availability, and lack of irradiation. We aimed to determine the diagnostic performance of LUS for the evaluation of CF pulmonary exacerbation. Methods This cross-sectional study included patients with CF pulmonary exacerbation admitted to Masih Daneshvari Hospital, Tehran, Iran, from March 21, 2020 to March 20, 2021. Age, gender, and body mass index (BMI) of the patients were recorded. All patients underwent chest X-ray (CXR), HRCT, and LUS on admission. Pleural thickening, atelectasis, air bronchogram, B-line, and consolidation were noted in LUS and then compared with the corresponding findings in CXR and HRCT. Taking HRCT findings as reference, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA) of LUS and CXR for the detection of each pulmonary abnormality were determined. Results Of the 30 patients included in this study, with a mean age of 19.62 ± 5.53 years, 14 (46.7%) were male. Of the 15 patients aged 2–20 years, BMI was below the 5th percentile in 10 (66.7%), within the 5–10 percentiles in 1 (6.7%), 10–25 percentiles in 3 (20%), and 25-50 percentiles in 1 (6.7%). The mean BMI for 15 patients > 20 years was 18.03 ± 2.53 kg/m2. LUS had better diagnostic performance compared to CXR for the detection of air bronchogram, consolidation, and pleural thickening (area under the receiver operating characteristic curve [AUROC]: 0.966 vs. 0.483, 0.900 vs. 0.575, and 0.656 vs. 0.531, respectively). Also, LUS was 100% and 96.7% specific for the diagnosis of pleural effusion and atelectasis, respectively. Conclusions LUS appears to be superior to CXR and comparable with HRCT for the evaluation of CF pulmonary exacerbation, especially in terms of air bronchogram and consolidation detection. LUS can be used to lengthen the HRCT evaluation intervals in this regard or utilized along with HRCT for better evaluation of CF pulmonary exacerbation.

Background: Given the increasing prevalence of methadone overdose and the growing number of deaths in Iran, the present study was conducted to determine the mortality rate of methadone detected in the cadavers brought to the Forensic Medicine Organization between 2015 and 2017. Methods: This cross-sectional study was performed on 7,486 cases of substance abuse deaths registered in the Forensic Medicine Organization during 2015-2017. In order to investigate the drug abuse, samples collected from the cadavers were initially examined for their drug contents, such as methadone, by standard screening methods and then confirmed by Thin Layer Chromatography (TLC). Using two checklists, the information collected about each cadaver consisted of the identity, autopsy and laboratory data. After data collection, they were entered into the Stata software version 14 MP. Results: The cadavers’ mean age was 36.6±12.6 years. Over the 3-year duration of the study, the standardized mortality rate increased from 35 to 39 cases per million per year. Of these cases, 6066 were randomly assigned to toxicology, 50.1% had used methadone one month before their death. Approximately 75% of the methadone abusers had taken another drug simultaneously, mostly morphine or methamphetamine. Conclusion: Considering the relatively high prevalence of methadone detected post-mortem, monitoring for methadone entry into public market and identifying the death-related factors in the drug abusers are considered as significant measures to improve upon the current alarming situation in the Iranian society.

Abstract Background The projection studies are imperative to satisfy demands for health care systems and proper response to the public health problems such as inflammatory bowel disease (IBD). Methods To accomplish this, we established an illness-death model based on available data to project the future prevalence of IBD in Asia, Iran in particular, separately from 2017 to 2035. We applied two deterministic and stochastic approaches. Results In 2035, as compared to 2020, we expected a 2.5-fold rise in prevalence for Iran with 69 thousand cases, a 2.3-fold increment for North Africa and the Middle East with 220 thousand cases, quadrupling of the prevalence for India with 2.2 million cases, a 1.5-fold increase for East Asia region with 4.5 million cases, and a 1.6-fold elevation in prevalence for high‐income Asia‐Pacific and Southeast Asia regions with 183 and 199 thousand cases respectively. Conclusions Our results showed an emerging epidemic for the prevalence of IBD in Asia regions and/or countries. Hence, we suggest the need for immediate action to control this increasing trend in Asia and Iran. However, we were virtually unable to use information about age groups, gender, and other factors influencing the evolution of IBD in our model due to lack of access to reliable data.

This paper is devoted to introducing a new viscosity approximation method using the implicit midpoint rules for finding a common element in the set of solutions of a generalized mixed equilibrium problem, the set of solutions of a general system of variational inequalities and the set of common fixed points of a finite family of nonexpansive mappings in a symmetric Hilbert space. Then, we prove a strong convergence theorem regarding the proposed iterative scheme under some suitable conditions on the parameters. Finally, we provide two numerical results to show the consistency and accuracy of the scheme. One of them, moreover, compares the behavior of our scheme with the iterative scheme of Ke and Ma (Fixed Point Theory Appl 190, 2015).

This paper is devoted to the study of reproducing kernel Hilbert spaces. We focus on multipliers of reproducing kernel Banach and Hilbert spaces. In particular, we try to extend this concept and prove some related theorems. Moreover, we focus on reproducing kernels in vector-valued reproducing kernel Hilbert spaces. In particular, we extend reproducing kernels to relative reproducing kernels and prove some theorems in this subject.

Introduction: Seizure is a common complication of tramadol poisoning and predicting it will help clinicians in preventing seizure and better management of patients. This study aimed to develop and validate a prediction model to assess the risk of seizure in acute tramadol poisoning. Methods: This retrospective observational study was conducted on 909 patients with acute tramadol poisoning in Baharloo Hospital, Tehran, Iran, (2015-2019). Several available demographic, clinical, and para-clinical characteristics were considered as potential predictors of seizure and extracted from clinical records. The data were split into derivation and validation sets (70/30 split) via random sampling. Derivation set was used to develop a multivariable logistic regression model. The model was tested on the validation set and its performance was assessed with receiver operating characteristic (ROC) curve. Results: The mean (standard deviation (SD)) of patients’ age was 23.75 (7.47) years and 683 (75.1%) of them were male. Seizures occurred in 541 (60%) patients. Univariate analysis indicated that sex, pulse rate (PR), arterial blood Carbone dioxide pressure (PCO2), Glasgow Coma Scale (GCS), blood bicarbonate level, pH, and serum sodium level could predict the chance of seizure in acute tramadol poisoning. The final model in derivation set consisted of sex, PR, GCS, pH, and blood bicarbonate level. The model showed good accuracy on the validation set with an area under the ROC curve of 0.77 (95% CI: 0.67–0.87). Conclusion: Representation of this model as a decision tree could help clinicians to identify high-risk patients with tramadol poisoning-induced seizure and in decision-making at triage of emergency departments in hospitals.

Background: Primary mucosa-associated lymphoid tissue (MALT) lymphoma is a rare malignancy. We found only 8 cases of MALT lymphoma in literature. Case Presentation: We report here another case of primary prostatic MALT lymphoma which is presented by hematuria and diagnosed primarily as BPH. Immunohistochemistry studies demonstrate the diagnosis and MALT lymphoma. Six months after starting the treatment the patient was alive and well. Conclusions: Prostatic MALTomas are mainly presented with urinary obstruction or hematuria and have an indolent growth with a good prognosis.

Objective(s): In this study, for the first time, MF59 adjuvant was used to develop a cholesteryl ester transfer protein (CETP) vaccine. The efficacy of the vaccine was compared with the efficacy of CETP vaccine formulated with Alum/CpG, the formulation that its immunogenicity has been already demonstrated in rabbit and mice. Materials and Methods: Tetanus toxoid- CETP peptide (TT-CETP) was mixed with Alum/CpG or MF59-like and administered subcutaneously for total five times in rabbit model of atherosclerosis. Anti-TT-CETP specific antibody, CETP activity in sera and mRNA level of cytokine IL-4 and IFN-γ in peripheral mononuclear cells were determined. Therapeutic response was also examined by tracking serum lipoprotein levels and pathologic observation of atherosclerotic lesions at aortic site. Results: More anti-TT-CETP antibody was found in Alum/CpG vaccinated rabbits compared to buffer (P

OBJECTIVE: One of the major goals of cancer treatment is the monitoring of chemotherapeutic protocols. Quantitative and comparative cytokine expression profiling could be reliable to be used for biomarkers in deadly and fast-growing cancers such as acute myeloid leukemia (AML). The present study aims to assess and further validate cytokines with probable effects on proliferation and maturation of blood cells in AML. METHODS: Gene expression levels of IL-1β, IL-10, IL-8, TNF-α, and IFN-γ were analyzed before and after chemotherapy and after granulocyte colony-stimulating factor (G-CSF) therapy in 46 AML patients by an in-house quantitative comparative RT-PCR method. RESULTS: Our findings indicated that although the gene expression level of TNF-α was almost constant in all 3 samples, IL-1β, IL-8, and IL-10 expression levels showed a decrease after chemotherapy and an increase after G-CSF therapy. On the other hand, the expression level of IFN-γ had a different pattern with an increase after chemotherapy and a decrease after G-CSF therapy. CONCLUSION: Taken together, the results of this study are in support of the idea that the analyzed cytokines could be useful biomarkers for AML treatment monitoring. However, further molecular epidemiological investigations are suggested to elaborate more cancer monitoring biomarkers.

Background: Organizational citizenship behavior just referred to a set of discretionary workplace behaviors that exceed one’s job requirements. The main objective of this study was to determine the relationship between organizational perceived justice and organizational citizenship behavior. Methods: This cross-sectional study was done in Shahid Sadoughi Hospital in Yazd, Iran in 2013. A total of 100 hospital employees contributed in the study. The required data was gathered using 2 valid questionnaires, including the Moorman & Niehoff organizational perceived justice questionnaire and the McKinsey organizational citizenship behavior questionnaire. Data were analyzed using SPSS version 16. Descriptive statistics, Chi square, and Pearson’s correlation coefficient were used for data analysis. Results: There was a significant positive relationship between organizational perceived justice and organizational citizenship behavior among the studied hospital’s employees (P ≤ 0.05, R = 0.33). Conclusion: This study confirmed that any policy that leads to better organizational justice perception will contribute in better organizational citizenship behavior which will increase the hospital's productivity.

Toxoplasmosis is a zoonotic disease caused by an intracellular protozoan of Toxoplasmagondii, that has not been examined in Lorestan yet; this study aimed at the prevalence rate of IgG in the domestic ruminants, based on the variable factores of species, sex and Geographic region. Therefore, from October toFebruary 2012, 572 blood samples (174 Cattles and 398 sheep) were collected from the slaughterhouses of Khoramabad, Boroujerd and Aligoudarz. The serum samples of sheep, were examined by indirect ELISA method, and the result was calculated based on the ratio of the absorbancevalues of the samples to the positivecontrol, so that ≤30% as negative, and ≥50% was considered as positive.The Cattle serum samples,were examined via Indirect Immunoflourecence antibody test, and the Titer ≥ 1:16 was considered as positive. In this study, the IgG prevalence rate in cattles and sheep was 28.73% and 53.01% respectively, and the statistic analysis of the results, demonstrated that based on the sex and species, there was a considerable statistic difference, so the lowest infection rate was observed in cattle, and the most infection rate was observed in the sheep, The prevalence rate in females was higher than that in males but there was no significant difference geographically (P

Theileriosis is caused by an intracellular protozoan that causes great economical losses to animal husbandry in different regions of Iran . The present study was done in order to identify of Theileriaovis in hard ticks in Lorestanprovince . Amongst five different regions in Lorestan, and during the April-to-july period of the year 2012, 265 cases of hard ticks were collected from the ear and the body surface and 100 blood smears from ear veins of anemic and feverish sheep. DNA extraction was done from the salivary glands of collected ticks and PCR test was performed using a pair of 520 bp specific primer of SSurRNA gene of T. ovis . The microscopic examinations of blood smears showed that 12 samples of blood smears ( 12 %) contained the piroplasmic forms of Theileriaspcies. The PCR revealed that 37 out of 152 Rhipicephalussanguineus (24/34 % ) were positive for T. ovisgenum including 21 female (13/81%) and 16 male (10/52%) ticks while the other ticks were not infected by this parasite. Out of total of 265 tick samples, R.sanguineus was highest (38.35%) and Haemaphysalispunctatahad the lowest (3/01%) frequencies. Regarding the vast distribution of R.sanguineus in the area, it seems that this tick may be the main vector of T.ovis in Lorestan province, Iran.

This paper aims at identifying paramount hydraulic factors in energy dynamics of water mains, using Principal Components Analysis (PCA). The proposed method is applied to two large ensembles of leaky and non-leaky pipes comprising over 40,000 pipes selected from 18 North American water distribution systems to guarantee the versatility of pipe characteristics and statistical significance of the explored patterns. PCA mono-plots indicate energy metrics such as Net Energy Efficiency, Energy Lost to Friction and Energy Lost to Leakage serve better in identification of low from high efficiency pipes. In addition, PCA mono-plots and bi-plots reveal relative importance of hydraulic parameters and that average flow rate, hydraulic proximity to major components and average unit headloss can have more tangible effects on energy dynamics of pipes compared to leakage and average pressure. Some factors such as elevation, diameter and CHW are not as influential as expected in distinguishing high-efficiency from low-efficiency pipes. Further, a comparison between the approach used in this paper and a simplified common-practice replacement strategy points out the difference energy considerations can make, if included in a bigger asset management landscape.

Objective: The papers primary goal is to report the devastating impact of carbon tetrachloride (CCl4) on rat testicular tissue and the possible protecting function of propolis against CCl4 based on its free radical scavenging and inflammatory relief properties. Materials and Methods: A total of 24 adult male albino rats had been classified into four groups (six rats/group). Rats of group 1 served as control, whereas groups 24 received propolis (200 mg/kg/day), CCl4 (3 ml/kg/day), and propolis/CCl4, respectively. After 4 weeks, the collected sera were applied for the estimation of lipid profile and sex hormones. Also, histopathological picture, malondialdehyde, and tumor necrosis factor alpha (TNFα) gene profile was measured in collected testicular tissues. Results: The present information revealed a noteworthy change (p < 0.05) in lipid profile, decrease in testicular weight, testosterone, antioxidants values along with a prominent increase (p < 0.05) in estradiol, lipid peroxidation values, and expression of TNFα in rats administrated with CCl4 com¬pared to control. Moreover, the histopathological profile showed the degeneration of the epithe¬lium. Interestingly, propolis attenuated the destructive effect of CCl4 on rat testes. Conclusion: The examined dose of propolis reduced oxidation, and inflammatory reactions resulted from CCl4 exposure and proved that it might have a helpful part in free radicals inter¬ceded diseases. [J Adv Vet Anim Res 2021; 8(1.000): 70-77]