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Extended Abstract Background: Forests are one of the complex ecosystems of natural resources with an important role in the environment and multiple production capacities and functions. The benefit of different human societies from these resources in various forms has various effects and consequences. Without accurate and complete identification of all its stakeholders, logical and acceptable results cannot be achieved in decision-making and policy-making. Therefore, it is essential to fully understand the stakeholders (actors) and their identification criteria in line with basic policies for planning, decision-making, and success in this field. Because decision-making in the management of forest resources always faces challenges and is often associated with complexity, immutability, and uncertainty due to the multi-purpose nature of the benefits and services of these resources, the difficulty of monetary valuation of ecological services, and the great diversity of the stakeholders of their services. Therefore, the stakeholders in the fields of natural resources and forests are considered vital components, and their presence and activity in these fields are undeniable and provide a guarantee of success in cooperative management for the protection of forests. The advancement of the sustainable management goals of natural resources and forests is realized by identifying an active presence of key actors and the most important and effective groups involved, i.e. forest producers and users, along with other identified stakeholders. The primary purpose of identifying those involved is the names of all those who can and should have a role in the planning and management process, and their identification is an important part of the participatory planning process because it is considered a part of the prerequisite for participation. Therefore, identifying and determining the stakeholders make it possible to take advantage of their cooperation in a planned way in the implementation and management of forestry projects and to facilitate the implementation process of the programs. Methods: To identify, weight, and prioritize the stakeholders involved in the Hyrcanian forest ecosystem services using multi-criteria decision-making models, the stakeholders involved in the Hyrcanian forest ecosystem services were first identified and gathered based on the review of various studies. Then, the research questionnaire was designed to answer two important questions in this study: a) who are the people involved in Hyrcanian forest areas? and b) what is their priority? Therefore, the beneficiaries of the economy of Hyrcanian forests were identified by designing a questionnaire scored with a Likert scale, designing items with five priority options, and determining the individuals or groups of stakeholders. In this research, the opinions of 50 experts, academics, and experts of the Natural Resources and Watershed Management Organization at the provincial and regional levels were used to identify the beneficiaries of the ecosystem services of Hyrcanian forests. The questionnaire was validated and confirmed by experts, and its reliability was confirmed with a Cronbach's alpha statistic of α = 0.97. The stakeholders of the forest ecosystem services were weighted with the Step-Wise Weight Assessment Ratio Analysis (SWARA) method, the Simple Additive Weighting (SAW), and Additive Ratio Assessment (ARAS), and the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) was used to prioritize them. Results: By analyzing the findings of the questionnaire using experts' opinions, the Hyrcanian forest ecosystem goods and services stakeholders were identified in 19 groups and five levels, such as international, national, regional, stakeholders outside the forest, and stakeholders inside the forest. Based on the results of the weighting of the stakeholders using the SWARA technique, the forest dwellers and communities downstream of the forest edge are among the most important Hyrcanian forest ecosystem goods and services stakeholders with the highest weight, and other stakeholders were placed in the next priorities based on the received weight. The prioritization of the stakeholders of the goods and services of the Hyrcanian forest ecosystem in the TOPSIS, ARAS, and SAW models showed similar results in terms of the prioritization of the stakeholders of the surveyed services. Conclusion: The results of stakeholder prioritization models were compared using the slope of the service weight curve (R2) in three models. The slope of the relative closeness curve of the weights in the ARAS model was a descending exponential function with an explanatory degree of 0.93, which indicated an obvious difference between the stakeholders of Hyrcanian forest ecosystem services. The slope of the curve of the relative closeness of the weights is higher and closer to one in the ARAS model than in the other two models from different points of view. Based on this result and the consensus of some experts, the prioritization of stakeholders in the ARAS model is closer to reality. Therefore, the ARAS model was proposed as a suitable model for prioritizing the stakeholders of Hyrcanian forest ecosystem services. According to the results of this model, forest dwellers, downstream communities on the edge of the forest, and the off-site users of the forests are considered the major stakeholders of Hyrcanian forest services. Therefore, the role, presence, and influence of these stakeholders cannot be ignored in the management of natural resources and the environment, especially in forestry projects, and it is recommended to optimally use the presence of these communities in cooperative forest management. Furthermore, the human relationship with the natural ecosystem should be at the top of policies and comprehensive management of forest resources. It is necessary to support wood planting projects through subsidy policies and to grant facilities and low-interest loans to forest dwellers and communities downstream of the forest edge. Other necessary measures include efforts to reduce deprivations and increase the socioeconomic development of the villages on the edge of the forest, holding training entrepreneurship courses and classes, introducing handicrafts and non-wood products, identifying target markets, and strengthening the marketing network for the export of non-wood products to increase the share of the forest in the growth and economic development of rural communities on the edge of the forest. Employment programs should also be developed for local communities in the forest protection sectors.

Nanocomposite Zeolitic imidazolate framework (ZIF-8)@ Active Carbon (AC)–co-Chitosan (CS) was employed to fabricate polyether sulfone-based nanofiltration membranes. The ZIF-8@(AC-co-CS) nanocomposite was synthesized using a simple co-precipitation method and examined by field emission scanning electron microscope (FESEM) images, Attenuated total reflectance-Fourier transform infrared (ATR-FTIR) analysis, and X-ray diffraction pattern (XRD). Membrane properties used analyses such as FESEM, ATR-FTR, atomic force microscopy (AFM), porosity, water content, contact angle measurements, roughness assessment, pure water flux (PWF), separation efficiency evaluation, and fouling analysis. The surface roughness of the membrane with 0.01 wt% ZIF-8@(AC-co-CS) was nearly half that of the pristine membrane. Investigation outcomes revealed more excellent hydrophilicity for modified membranes. The water flux measured over three times greater for modified membranes than pristine ones. All modified membranes exhibited noteworthy rejection of sodium sulfate, achieving levels exceeding >93 %. The nanocomposite membrane was also assessed for removing two heavy metal ions, i.e., Cu and Cr. The results indicated a 55.0 % removal for Cu and 62.3 % removal for Cr by the virgin membrane, while that was >94 % and >97 % for the modified membrane, respectively. Also, higher separation efficiency was achieved for chromium ions compared to copper ions by the membranes. The nanocomposite membranes exhibited impressive dye rejection rates: >97 % for Methylene Blue, >95 % for Rhodamine B, >92 % for RB50, >94 % for RB21, >89 % for RY145, and >86 % for RY39. The FRR parameter significantly increased to >97 % for the modified samples. The nanofiltration performance of ZIF-8@AC-co-CS nanocomposite membranes exhibited a remarkable improvement compared to CS-based membranes.

Abstract Background This study aimed to compare anthropometric indices to predict type 2 diabetes mellitus (T2DM) among first-degree relatives of diabetic patients in the Iranian community. Methods In this study, information on 3483 first-degree relatives (FDRs) of diabetic patients was extracted from the database of the Endocrinology and Metabolism Research Center of Isfahan University of Medical Sciences. Overall, 2082 FDRs were included in the analyses. A logistic regression model was used to evaluate the association between anthropometric indices and the odds of having diabetes. Furthermore, a receiver operating characteristic (ROC) curve was applied to estimate the optimal cutoff point based on the sensitivity and specificity of each index. In addition, the indices were compared based on the area under the curve (AUC). Results The overall prevalence of diabetes was 15.3%. The optimal cutoff points for anthropometric measures among men were 25.09 for body mass index (BMI) (AUC = 0.573), 0.52 for waist-to-height ratio (WHtR) (AUC = 0.648), 0.91 for waist-to-hip ratio (WHR) (AUC = 0.654), 0.08 for a body shape index (ABSI) (AUC = 0.599), 3.92 for body roundness index (BRI) (AUC = 0.648), 27.27 for body adiposity index (BAI) (AUC = 0.590), and 8 for visceral adiposity index (VAI) (AUC = 0.596). The optimal cutoff points for anthropometric indices were 28.75 for BMI (AUC = 0.610), 0.55 for the WHtR (AUC = 0.685), 0.80 for the WHR (AUC = 0.687), 0.07 for the ABSI (AUC = 0.669), 4.34 for the BRI (AUC = 0.685), 39.95 for the BAI (AUC = 0.583), and 6.15 for the VAI (AUC = 0.658). The WHR, WHTR, and BRI were revealed to have fair AUC values and were relatively greater than the other indices for both men and women. Furthermore, in women, the ABSI and VAI also had fair AUCs. However, BMI and the BAI had the lowest AUC values among the indices in both sexes. Conclusion The WHtR, BRI, VAI, and WHR outperformed other anthropometric indices in predicting T2DM in first-degree relatives (FDRs) of diabetic patients. However, further investigations in different populations may need to be implemented to justify their widespread adoption in clinical practice.

Background Appropriate treatment reduces the severity and duration of relapses in demyelinating diseases of Central Nervous System (CNS). If high-dose corticosteroids treatment fails, therapeutic plasma exchange (TPE) is considered as a rescue treatment. Objectives This study aimed to investigate early clinical response and complications of TPE and prognostic factors in CNS demyelinating relapses. Design This prospective observational study was designed in a tertiary center during one year. Methods All adult patients diagnosed corticosteroid-resistant Multiple Sclerosis (MS), NeuroMyelitis Optica Spectrum Disorder (NMOSD), idiotypic Transverse Myelitis or Clinical Isolated Syndrome relapses, were eligible. Clinical response is defined based on Expanded Disability Status Scale (EDSS) at discharge. Clinical and laboratory complications recorded. Results Seventy-two patients were analyzed which 58.3% patients were female. MS was diagnosed for 61.1% of cases. Thirty-five patients (48.6%) responded and the mean differences of EDSS significantly decreased 0.60 score (CI95%:0.44-.77). Electrolyte imbalances and thrombocytopenia occurred in 80.6% and 55.6% of cases respectively and 40.3% of patients had systemic reactions. However, 26.4% patients experienced moderate to severe complications. In patients with moderate to severe disability, responders were younger (MD: 8.42 years, CI95%: 1.67-15.17) and had lower EDSS score at admission (median:6, IQR: 5.5-6 against 7.5 IQR: 6.5-8). The risk of failure was higher in active progressive MS patients compared with RRMS patients (OR: 6.06, CI 95%:1.37-26.76). Patients with thrombocytopenia were hospitalized more than others (MD: 1.5 days, CI 95%: 0-3). Females were more prone to hypokalemia and systemic reactions (OR: 3.11, CI 95%:1.17-8.24 and OR: 6.67, CI 95%:2.14-20.81 respectively). Conclusion The most common indication of TPE was corticosteroid-resistant severe MS relapses. About half of the patients presented an early clinical response. Lower disability, younger age and RRMS diagnosis are prognostic factors of better response. One out of four patients experienced moderate to severe complications, mainly electrolyte imbalances and systemic reactions. Appropriate interventions against these complications should be considered during TPE, especially in females.

Hair loss, which is known as telogen effluvium (TE), was reported in COVID-19 patients both during and after their recovery.

Hypothesis: first, poly ether sulfone (PES)-based nanofiltration (NF) membranes were prepared through the phase inversion-immersion precipitation technique. Then, the surface of the membranes made of polymethyl methacrylate (PMMA)-graphene oxide nanoplates (GO NPs) was modified using dip-coating technique. The effect of the active coating layer on the morphology, physical-chemical properties, and antifouling performance and separation ability to remove metal ions from wastewater was studied.Methods: The properties of prepared membranes were studied by scanning electron microscopy (SEM) and Fourier transform infrared (FTIR) analysis. Also, the effect of the formed active layer on the physio-chemical properties of the membrane including water contact angle, water content, flux and sodium sulfate rejection, porosity, mean pore size, heavy metal rejection and anti-fouling performance was investigated. Findings: The obtained results revealed that the surface-modified membrane with 1 % (by wt) MM-0.5% (by wt) GO-NPs had a more appropriate separation performance and better antifouling properties compared to other membranes. SEM images of the cross-sectional area of the membranes showed the formation of a relatively uniform layer on the membrane surface, which became more dense with increase in the amount of GO-Nps. The performance of the modified membrane in the removal of Cu and Cr heavy metal ions was also evaluated and compared with the pristine membrane. The removal percentage of Cu and Cr ions was 51.4% and 49.3% for the neat membrane, whereas it was 81.7% and 75.3% for the superior modified membrane, respectively. Moreover, the total fouling resistance was measured to be 23% for the virgin membrane, while it was 13.2% (Pvalue

Hypothesis: This study constituted the effect of chitosan-zeolite active nanocomposite layer formation on the morphological, physico-chemical and separation properties, as well as the anti-fouling performance of the polyethersulfone-based nanofiltration membrane.Methods: The nanofiltration-based membrane was prepared by phase inversion method and its surface was modified through the dip-coating technique in the polymeric solution. The properties of the prepared membranes were investigated by Fourier transform infrared (FTIR) analysis, scanning electron microscopy (SEM), 3D surface images, contact angle, water content, pure water flux, salt and heavy metal rejection and anti-fouling performance techniques. Findings: The FTIR analysis results confirmed the formation of the chitosan/zeolite nanocomposite layer on the polyether sulfone-based membrane. Moreover, the scanning electron microscopy images of the surface and cross-section of the prepared membranes showed the formation of an active layer on the membrane surface. The results of surface analysis showed that the surface modification reduced the surface roughness of the membrane. In addition, the use of zeolite nanoparticles on the surface layer caused to an increase in the membrane water content. The pure water flux of bi-layer modified membrane showed an increase in water content of > 54% compared to the virgin membrane. The sodium sulfate salt rejection was measured > 70% for the bi-layer modified membrane. The chromium rejection increased from 69% for the virgin membrane to > 95% for the modified bi-layer membrane. The water contact angle results exhibited that the surface hydrophilicity of the membrane increased with the surface modification. The modified membranes showed superior antifouling ability as the flux recovery ratio increased from 85% to 93.6% and the irreversible resistance decreased considerably to 6.4%.

Background: Membrane technology for water purification has gained much attention in many industries and for healthier human life. Also, improving the elimination of toxic heavy metals is a much needed strategy for the filtration of public water supplies. This study investigated the removal of toxic heavy metals from wastewater, using a novel thin-film membrane. Methods: We investigated the structural, physico-chemical, and antifouling properties of the membrane, and its ability to remove toxic elements from water. Seven parameters were examined: Contact angle, water ionic contents, Fourier’s transform infrared (FTIR) spectroscopy, scanning electron microscopy (SEM), 3D-surface imaging, water flux, and antifouling effects. Results: The results indicated that a thin-film layer formed on the membrane. The 3D-images demonstrated that the surface roughness decreased when the polyaniline ratio to nanoparticles increased. The surface hydrophilicity increased by incorporating polyaniline into the surface. The water flux increased from 8.04 (L/m2.h) to 14.74 (L/m2.h) in the virgin membrane. The sodium sulfate rejection was 61% for the virgin membrane whereas it was >67% in the thin-film coated membrane. The data demonstrated excellent anti-fouling properties for the novel membrane, with a flux recovery ratio of >94.65% while it was about 79% for the virgin one. The rejection rates of chromium and copper ions for the novel membrane were >86% and >84%, respectively. These values were significantly higher than those of the virgin membrane (>53% and >51%). Conclusion: The thin-film composite membrane significantly improved the removal rate of toxic heavy metals from the wastewater samples compared to the virgin membrane.

Abstract Background End-stage renal disease (ESRD) is serious global public health challenge in many developing countries. Treatment of ESRD is carried out through renal replacement therapy like peritoneal dialysis (PD). Depression is the most common mood disorder which has a strong impact on the quality of life in patients with ESRD. Little is known about the prevalence and risk factors of depression in peritoneal dialysis patients. Method and materials A multicenter cross-sectional study was conducted on 164 adult ESRD patients undergoing peritoneal dialysis for at least three months who referred to the peritoneal dialysis centers of Al-Zahra, Noor & Ali Asghar hospitals, Isfahan, Iran from May to August 2019. Beck Depression Inventory Second Edition questionnaire was used to measure the symptoms of depression and its severity. Results 43.5% of patients had some levels of depression. Assessing the association of depression with demographic and PD-related factors showed that there was no significant difference regarding age, BMI, dialysis adequacy and residual kidney function, dialysis frequency, type of dialysis solution used, disease duration, and age at the start of dialysis. Ordinal logistics regression analysis showed significant association between depression severity categories and gender (OR = 0.397, CI: 0.160–0.985, p = 0.046), marital status (OR = 2.983, CI: 1.180–7.541, p = 0.021), having a separate room for dialysis (OR = 2.511, CI: 1.108–5.692, p = 0.027). Conclusion As our findings have revealed 43.5% of our participants suffered from mild-to-severe depression, we suggest careful attention and routine evaluation for depression in PD patients, especially women and single patients and those who have low socioeconomic status.

Background: Information on the cause of death is critical in guiding decisions on health infrastructure. However, there is a relative paucity of mortality data in patients with dermatologic diseases. Objectives: We aim to assess the overall mortality from dermatological disorders in a third-level university hospital which serves as a dermatology referral center. Methods: A retrospective medical note review of patients with dermatologic diseases who died during an 11-year period (from March 2008 to February 2020) was undertaken. Results: There were 63 death cases out of 2810 admissions for patients with dermatologic diseases (crude mortality 2.24%). The average age was 61.8 years and the male-to-female ratio was 2.3. Cutaneous malignancies (53.96%) were the primary causes of death, followed by drug reactions (23.8%). Among skin cancers, squamous cell carcinoma (SCC; 47.05%) and melanoma (35.29%) were the leading causes of death. Toxic epidermal necrolysis (53.33%) was the leading cause of death among drug reactions. Sepsis (30.74%) was the most common immediate cause of mortality in this series. A large fraction of patients (73%) had significant underlying comorbidities. Conclusion: The principal cause of mortality was cutaneous malignancies (mainly SCC and melanoma) followed by drug reactions. Sepsis was the most common immediate cause of death.

In recent years, interest in Health-Related Quality of Life (HRQoL) as a major indicator of clinical efficacy and treatment outcome in patients of End-Stage Renal Disease (ESRD) has grown significantly. This study aimed to determine the contributing factors affecting the quality of life (QoL) of ESRD patients undergoing peritoneal dialysis (PD). A cross-sectional study was conducted on PD patients presented at PD centres of Al-Zahra and Noor hospitals in Isfahan, Iran, from May to August 2019. A total of 173 patients having peritoneal dialysis for more than 3 months filled the validated 36-item short-form health survey questionnaire (SF-36). Baseline demographic details and dialysis-related factors were collected from patients’ medical records. The overall QoL score of patients was 50.28 ± 20.87. Male patients had a higher QoL score than female patients (58.18 in males, compared to 48.18 in females; P = 0.04). A significant association between frequency of dialysis and quality of life was observed, where three sessions of dialysis per day yielded the highest quality of life (QoL score = 59.62; P = 0.047). A significant positive correlation was discovered between QoL score and residual renal function (P = 0.013). In addition, a higher QoL score was observed in self-employed patients (60.95), compared to housewives (46.49) (P = 0.001). QoL assessment should be included as an integral part of patient follow-up to evaluate treatment outcomes and implement possible interventions to improve patient’s quality of life.

This article is part of the Research Topic Health Systems Recovery in the Context of COVID-19 and Protracted Conflict.Risk communication and community engagement (RCCE) is an essential component of emergency preparedness and response. In Iran, RCCE is a relatively new area of public health. During the COVID-19 pandemic in Iran, the national task force relied on conventional methods, which is to utilize existing primary health care (PHC) structure to implement RCCE activities around the country. The PHC network and the community health volunteers embedded in it enabled the country to bridge the health system and communities from the very beginning of the COVID-19 pandemic. The RCCE strategy to respond to COVID-19 was adapted over time with the development of a national program, commonly known as the “Shahid Qassem Soleimani” project. This project consisted of six steps including case detection, laboratory testing through the establishment of sampling centers, scale up of clinical care to vulnerable groups, contact tracing, home care for vulnerable population, and COVID-19 vaccination roll out. Nearly 3 years into the pandemic, the importance of designing RCCE for all types of emergencies, allocating a dedicated team to RCCE, coordinating with different stakeholders, improving the capacity of RCCE focal points, practicing more efficient social listening, and using social insight for better planning were identified as some lessons learned. Further, Iran's RCCE experience during the COVID-19 pandemic underscores the importance of continuing to invest in the health system, particularly PHC.

Background: Appropriate treatment reduces the severity and duration of relapses in demyelinating diseases of Central Nervous System (CNS). If high-dose corticosteroids treatment fails, therapeutic plasma exchange (TPE) is considered as a rescue treatment. This study aimed to investigate early clinical response and complications of TPE and prognostic factors in CNS demyelinating relapses. Methods: This prospective observational study was designed in a tertiary center during one year. All adult patients diagnosed corticosteroid-resistant Multiple Sclerosis (MS), NeuroMyelitis Optica Spectrum Disorder (NMOSD), idiotypic Transverse Myelitis or Clinical Isolated Syndrome relapses, were eligible. Clinical response is defined based on Expanded Disability Status Scale (EDSS) at discharge. Clinical and laboratory complications recorded. Results: seventy-two patients were analyzed which 58.3% patients were female. MS was diagnosed for 61.1% of cases. Thirty-five patients (48.6%) responded and the mean differences of EDSS significantly decreased 0.60 score (CI95%:0.44-0.77). Electrolyte imbalances and thrombocytopenia occurred in 80.6% and 55.6% of cases respectively and 40.3% of patients had systemic reactions. However, 26.4% patients experienced moderate to severe complications. In patients with moderate to severe disability, responders were younger (MD:8.42years, CI95%:1.67-15.17) and had lower EDSS score at admission (median:6, IQR:5.5-6 against 7.5 IQR:6.5-8). Relapsing-Remitting MS (RRMS) patients had more odds of response compared to active progressive MS patients (OR:6.06, CI95%:1.37-26.76). Patients with thrombocytopenia were hospitalized more than others (MD:1.5 days, CI95%:0-3). Females were more prone to hypokalemia and systemic reactions (OR:3.11, CI95%:1.17-8.24 and OR:6.67, CI95%:2.14-20.81 respectively). Conclusion: The most common indication of TPE was corticosteroid-resistant severe MS relapses. About half of the patients presented an early clinical response. Lower disability, younger age and RRMS diagnosis are prognostic factors of better response. One out of four patients experienced moderate to severe complications, mainly electrolyte imbalances and systemic reactions. Appropriate interventions against these complications should be considered during TPE, especially in females.

Objective(s): Leishmaniasis is a complex infection against which no confirmed vaccine has been reported so far. Transgenic expression of proteins involved in macrophage apoptosis-like BAX through the parasite itself accelerates infected macrophage apoptosis and prevents Leishmania differentiation. So, in the present research, the impact of the transgenic Leishmania major including mLLO-BAX-SMAC proapoptotic proteins was assayed in macrophage apoptosis acceleration. Materials and Methods: The coding sequence mLLO-Bax-Smac was designed and integrated into the pLexyNeo2 plasmid. The designed sequence was inserted under the 18srRNA locus into the L. major genome using homologous recombination. Then, mLLO-BAX-SMAC expression was studied using the Western blot, and the transgenic parasite pathogenesis was investigated compared with wild-type L. major in vitro and also in vivo. Results: Western blot and PCR results approved mLLO-BAX-SMAC expression and proper integration of the mLLO-Bax-Smac fragment under the 18srRNA locus of L. major, respectively. The flow cytometry results revealed faster apoptosis of transgenic Leishmania-infected macrophages compared with wild-type parasite-infected macrophages. Also, the mild lesion with the less parasitic burden of the spleen was observed only in transgenic Leishmania-infected mice. The delayed progression of leishmaniasis was obtained in transgenic strain-injected mice after challenging with wild-type Leishmania. Conclusion: This study recommended transgenic L. major including mLLO-BAX-SMAC construct as a pilot model for providing a protective vaccine against leishmaniasis.

Hypothesis: A thin film nanofiltration membrane was modified by poly(vinyl alcohol) (PVA) and chitosan-functionalized activated carbon nanoparticles. The effect of a surface layer formed on the structure and separation properties of prepared membranes was investigated.Methods: Scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), water content, porosity and mean pore size measurements, Na2SO4 and NaCl rejection, water flux as well as membrane flux recovery ratio for the study of antifouling ability were used for characterization of the membranes.Findings: The FTIR results confirmed the formation of hydroxyl and amine groups on the surface of modified membranes. The SEM images also showed the formation of a uniform layer on the modified membranes. As shown in the SEM images, adding functionalized activated carbon nanoparticles into PVA leads to a heterogeneous and dense structure on the surface of modified membranes. Modification of pristine membrane by PVA and modified activated carbon nanoparticles up to 0.25% wt initially increased the water content, and subsequently with increase in nanoparticles ratio from 0.25 to 1.0wt%, the water content decreased. The obtained results showed a larger mean pore size for all modified membranes compared to pristine membrane. Moreover, all modified membranes showed a higher flux in comparison with virgin membrane. In addition, salt rejection revealed that the surface modification of nanofiltration membrane has a positive effect in preventing smaller rejection amount despite the increase in the amount of flux. Sodium sulfate salt rejection was also measured more than sodium chloride salt rejection. Flux recovery ratio was also measured more than 92% for the modified membranes whereas it was more than 66% for pristine membrane that confirms the antifouling ability for the modified membranes.

Hypothesis: Mixed matrix polyether sulfone (PES)-based membranes, containing cobalt-ferrite nanoparticles, were prepared by polymer solution casting technique through phase inversion method in water bath. Methods: The concentration effect of CoFe2O4 nanoparticles, synthesized in polymeric solution, on the morphology and separation performance was studied. Scanning electron microscopy (SEM), atomic force microscopy (AFM), X-ray diffractometry (XRD), Fourier transform infrared spectroscopy (FTIR), porosity measurement, water contact angle, water flux, Na2SO4 rejection as well as membrane antifouling ability were used to characterize the membrane. Findings: The SEM images showed the movement of NPs toward water-membrane interface to reduce surface energy during the fabrication process. The SEM images also showed an asymmetric structure with a dense active layer and a porous sub-layer with finger-like channels for the prepared membranes. The use of cobalt ferrite nanoparticles in the membrane matrix decreased the water contact angle from 71° to 48°. The results of AFM images also showed a smoother surface for the prepared mixed matrix membranes compared to the bare ones, which improved the membrane antifouling property in BSA rejection. Pure water flux (PWF) was initially enhanced by incorporation of cobalt ferrite NPs and then decreased by up to 1 wt% NPs due to NPs agglomeration. Moreover, Na2SO4 salt rejection increased from 60% for the neat membrane to 80% for the modified ones with 1.0 wt% cobalt-ferrite nanoparticles. The mixed matrix membrane containing 1.0 wt% cobalt-ferrite nanoparticles showed better performance compared to others.

BACKGROUND: The relation between air pollution and cardiovascular diseases (CVDs) risk factors, especially blood pressure (BP) levels, has been less frequently assessed. The aim of this study was evaluating the association between air pollutants of less than 2.5 µm [particulate matter (PM2.5)] and BP indices among individuals admitted with CVDs and pulmonary diseases.METHODS: This cross-sectional study was in context of air pollution associated with hospitalization and mortality of CVDs and respiratory diseases (CAPACITY) study. Data of 792 Iranian patients referring to two hospitals in Isfahan, Iran, for cardiovascular or respiratory problems from March 2011 to March 2012 were used for analysis. BP indices including systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) were obtained from patients’ medical forms and mean PM2.5 concentrations during 24 hours prior to admission of each patient were obtained from Isfahan Department of Environment (DOE).RESULTS: Mean ± standard deviation (SD) of participants’ age were 62.5 ± 15.9 years. All BP indices on admission were significantly higher in women compared with men. Adjustment of all potential confounders including age, sex, temperature, wind speed, and dew point revealed that increasing one quartile in PM2.5 concentrations had been associated with 1.98 mmHg raising in SBP at the time of admission [95% confidence interval (CI) = 0.41-3.54, P = 0.010]. Women with cardiac diseases had higher all BP indices with increased PM2.5 concentration [SBP: β: 4.30, 95% CI = 0.90-7.70, P = 0.010; DBP: β: 1.89, 95% CI = 0.09-3.69, P = 0.040; MAP: β: 3.09, 95% CI = 0.68-5.51, P= 0.010, respectively).CONCLUSION: Our findings suggest that increasing PM2.5 concentration has been positively associated with raising SBP in total population and all BP indices among women with cardiac problems at admission time. Several comprehensive studies are required for confirming these relations.

Background: Given the high prevalence of chronic renal failure worldwide, and the fact that kidneys are the major means of magnesium excretion from the body, it is speculated that the incidence risk of magnesium balance disorder would be high in patients under peritoneal dialysis. The aim of the present study was to evaluate the mentioned patients’ magnesium level and specify the effective factors in this regard. Methods: The present cross-sectional study was performed on 210 patients undergoing peritoneal dialysis that referred to Alzahra and Khorshid hospitals in Isfahan City, Iran. Patients’ demographic data such as age, sex, education status, cause of failure, type of comorbidity, duration of dialysis, and type of dialysis solution were recorded. In addition, the patients’ serum levels of magnesium, calcium, parathyroid hormone, and KT/V renal levels (in which K was dialyzer clearance of urea, T was dialysis time, and V was the volume of distribution of urea in patient's total body) were also assessed. Findings: The patients’ mean magnesium level was 2.39 ± 0.39 mg/dl. There was no significant difference in the magnesium level between the men and women. Moreover, no significant difference was observed among the administrations of various dialysis solutions including dextrose 1.5%, 2.5%, and 4.25% as well as icodextrin 7.5% (P > 0.05). However, hypertension had a significant inverse effect with magnesium level (coefficient effect : -0.100; P < 0.05). Conclusion: According to the results of the present study, the magnesium level was normal in patients under peritoneal dialysis. However, hypertension had a significant reverse effect on magnesium level, which was lower in patients with hypertension.

Background: Some past studies have shown the association of air pollution with heart failure (HF). The present study was conducted to investigate the relationship between suspended particulate matters less than 10 microns (PM10) and hospitalization due to HF. Methods: In a cross-sectional study, the data from 359 patients’ records, admitted to Shahid Chamran hospital in Isfahan City, Iran, due to HF during the years 2017-18, were collected. The inclusion criteria were the echocardiography findings such as the cardiac ejection fraction of less than 50%, and/or additional clinical evidences that confirmed HF exacerbation. The data about hourly concentration of PM10 were collected from the CAPACITY software in the Department of Environment at Isfahan Province that displayed the PM10 data from 6 fixed stations in Isfahan City. To evaluate any relationship between PM10 and hospitalization due to HF, we considered the PM10 concentrations at last 24 hours before hospitalization. Findings: The mean age of 359 patients who diagnosed with heart failure was 63.8 ± 14.6 years, and 82 of them (22.8%) died at the time of hospitalization. There was a significant correlation between hospitalization due to HF and air pollution quartiles. Conclusion: According to the results of present study, there was a positive correlation between the concentration of particulate matters in the air and hospitalization due to heart failure.

Abstract Background Fear of falling is multifactorial in etiology and is associated with falls. It has been demonstrated that foot problems increase the risk of falls in older people. Therefore, the objective of this study was to investigate the associations of foot and ankle characteristics with fear of falling and mobility in community‐dwelling older people. Method One hundred and eighty‐seven community‐dwelling older adults (106 females) aged 62–90 years (mean 70.5 ± 5.2) from Isfahan, Iran, were recruited. Foot and ankle characteristics (including foot posture, range of motion, muscle strength, deformity, tactile sensation, pain and dynamic function), fear of falling (Fall Efficacy Scale International) and mobility (Timed Up and Go Test) were measured. Two multivariate linear regression analyses identified variables independently associated with fear of falling and mobility. Results Linear regression analysis revealed that less ankle plantarflexor muscle strength, greater pressure‐time integral, foot pain, and reduced tactile sensitivity of the ankle were significantly and independently associated with increased fear of falling. The total variance explained by the model was 59%. Less ankle plantarflexor muscle strength, greater pressure‐time integral, and slower centre of pressure velocity were significantly and independently associated with poorer mobility. The total variance explained by the model was 48%. Conclusion Several foot and ankle characteristics are associated with fear of falling and mobility in older people. Targeting these modifiable risk factors may play a role in reducing fear of falling and enhancing mobility performance in this population.

Background: Rosacea is a skin chronic inflammation with an unknown cause and cure. Environmental and genetic factors could not entirely explain the disease pathogenesis. Recently, infections like Chlamydia pneumoniae are of more attention in the rosacea progression. This study investigated the relationship between the C. pneumoniae seropositivity and the rosacea disorder. Materials and Methods: We aimed at a cohort of 100 patients with the rosacea disorder (60 active and 40 inactive) and from 100 sex- and age-matched healthy controls in Isfahan and determined the immunoglobulin M (IgM)/IgG antibodies titers to C. pneumoniae in the serum using the enzyme-linked immunosorbent assay method. The groups were compared using the analysis of variance procedure at the significant level of P < 0.05, statistically. Results: The mean of IgG in the controls was significantly higher than the levels in both the active and the inactive rosacea patients (p < 0.022). Also, the titer of serum IgM to C. pneumoniae in the controls was different, compared with the active (p < 0.019) and the inactive (p < 0.02) rosacea patients. In addition, the median titer of serum IgG (not IgM) to C. pneumoniae in the females with the inactive rosacea disorder was lower than the active rosacea disorder (p < 0.019) and controls women (p < 0.008). Furthermore, the serum level of IgG or IgM to C. pneumoniae in the controls males was higher than the males with the rosacea disorder (p < 0.05) and (p < 0.02), alternatively. Conclusion: C. pneumoniae seropositivity in the rosacea patients and controls was insignificant.

Background: Small bowel length measurements and estimation have high clinical importance, especially in bariatric surgeries to prevent postoperation malnutrition. This study aimed to investigate the possible correlation between demographic and anthropometric factors with small bowel length. Materials and Methods: This cross-sectional study was performed on 150 patients that were candidates of abdominal surgeries. Anthropometric factors including age, gender, weight, height, body mass index, right wrist and waist circumstance, length of the right hand 2nd and 4th fingers and 2nd to 4th finger ratio, and length of the right hemithorax were obtained. Whole length of the small bowel was measured during surgery from the ligament of Treitz to the ileocecal junction between the mesenteric and antimesenteric border of the intestine. Results: The mean small bowel length was 5.45 ± 1.62 meters and significantly lower in women compared to men (P = 0.003) and had a significant direct relationship with height (r = 0.3, P < 0.001), an inverse relationship to 2nd to 4th finger ratio (= −0.34, P < 0.001). There were the same correlations between small intestine length with height and the 2nd to 4th finger ratio in open surgeries (P < 0.05). There was a correlation between age (r = 0.33, P = 0.032), weight (r= −0.60, P, 0.001), waist circumstance (r = −0.43, P = 0.004), and length of the right hemithorax (r = −0.47, P = 0.001). Conclusions: Using demographic and anthropometric factors, we could predict the small bowel length. These results could be further used in bariatric surgeries to avoid possible malnutrition.

Nanocomposite anion exchange membranes were prepared using polymeric blend of poly(vinyl chloride) and poly(methylmetacrylate) by solution casting method. Also functionalized carbon nanotubes were used as additive. The carbon nanotube nanoparticles were modified using acid mixtures and ethylenediamine solution and then the structure and morphology of prepared functionalized carbon nanotubes were studied using infrared spectroscopy (FT-IR) and field-emission scanning electron microscopy (FE-SEM). The study of the physicochemical and electrochemical properties of prepared membranes showed that the water content, ion exchange capacity, membrane potential, transport number, surface charge density and permselectivity of them were improved by adding up to2% by weight of carbon nanotubes. Also, the permeability, flux, electrical resistance and chemical stability of prepared membranes with carbon nanotube increased compared to the nanotube-free membranes.In fact, the high active level and the effect of the functionalized carbon nanotube on increasing the hydrophilicity and the transfer properties of the membranes have created suitable ion channels and facilitated ion transport. By adding nanoparticles up to 4% by weight, the electrochemical properties of the prepared membranes were reduced slightly. This can be attributed to the blockade of functional groups by nanoparticles and the accumulation of carbon nanotubes.

Abstract Background Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) that is widely identified worldwide. This study aimed to investigate the phenotypic characterization and molecular typing of Clostridium difficile isolates among patients with UC at an inflammatory bowel disease clinic in Iran. Methods In this cross-sectional study, conducted from April 2015 to December 2015, 85 UC patients were assessed for C.difficile infection (CDI). C. difficile isolates were characterized based on their toxin profile and antimicrobial resistance pattern. Multi-locus sequence typing analysis (MLST) and PCR ribotyping were performed to define the genetic relationships between different lineages of toxigenic strains. Results The prevalence of C. difficile isolates was 31.8% (27/85) in patients, of those 15 patients (17.6%) had CDI. Three different sequence types (STs) identified based on MLST among the toxigenic isolates, that is ST54 (33.3%), ST2 (53.3%), and ST37 (13.6%). C. difficile strains were divided into four different PCR-ribotypes (012, 014, 017 and IR1). The most common ribotype was 014 accounting for 48.3% (7/15) of all strains. The strains isolated during the first episode and recurrence of CDI usually belonged to PCR ribotype 014 (ST2). A high rate of CDI recurrence (14.1%, 12/85) experienced in UC patients. Colonization of the gastrointestinal tract with non-toxigenic C. difficile strains was frequent among patients with mild disease. All C. difficile isolates were susceptible to metronidazole, and vancomycin, 86 and 67% of isolates were resistant to clindamycin and erythromycin respectively. There was no correlation between the toxin type and antibiotic resistance (p > 0.05). Conclusion Overall CDI is rather prevalent in UC patients. All patients with CDI experienced moderate to severe disease and exposed to different antimicrobial and anti-inflammatory agents. Close monitoring and appropriate management including early detection and fast treatment of CDI will improve UC outcomes.

Poly (phenylene-ether-ether) sulfone membrane was fabricated and characterized by efficient glycerol/biodiesel separation produced from waste cooking oils trans-esterification. The membrane preparation was processed by phase inversion technique. The morphology, Physico-chemical properties and separation behavior of membranes were studied at various PPEES concentration. A uniform surface was observed for the prepared membranes by scanning electron microscopy. AFM images exhibited that surface roughness was decreased from 9.24 to 7.26 nm by the increase of PPEES concentration from 12 to 15 %wt. Similar trend was found for the membrane Flux, water content, and porosity by the increase of PPEES content ratio up to 15 %wt. The efficiency of glycerol removal and mechanical strength was also improved by the increase of polymeric matrix concentration.

Background: Bullous pemphigoid is one of the most common autoimmune blistering diseases. Incidence of bullous pemphigoid has been estimated 4 new cases per 100000, but new studies show that the incidence rate is increasing. The disease typically happens in the elderly people usually after 70 years. Annual mortality rate for bullous pemphigoid is reported up to 40%. The aim of this study was to evaluate epidemiological features of bullous pemphigoid in center of Iran. Methods: This was a cross-sectional study conducted in Alzahra hospital in Isfahan City. 69 patients with bullous pemphigoid hospitalized during the years 2008-2016 were studied. Findings: 59.45% of the patients were women. The mean and standard deviation of age was 68 ± 13 and 72 ± 14 years in woman and men, respectively (P = 0.01). Mucosal involvement was seen in 55.4%., and the most common underlying disease was hypertension (23.6%). 15.4% of women and 3.7% of men used furosemide, and the most commonly prescribed drugs were antihistamine (98%), antibiotics (97%), and topical (91%) and systemic (88.4%) corticosteroids, respectively. The mean and standard deviation of the dose of prednisolone was 54 ± 12 mg per day. Rise in serum blood sugar was reported in 30% of patients, and 3.6% of men and 15% of women needed intensive care unit (ICU) admission. 42.9% of men and 44.4% of women had relapse after discharge, and 38.64% of patients died during one-year follow-up. Conclusion: It seems that patients with bullous pemphigoid need careful follow up, especially during treatment, and at least for one year, because of their age (> 60), underlying diseases, type of treatment (corticosteroid use), and high mortality and relapsing rates in the first year after diagnosis.

Abstract Background Clostridium difficile infection (CDI) is known as one of the most important causes of nosocomial infections. The main objective of this study was to evaluate the presence of Clostridium difficile in the stool of hospitalized patients with diarrhea as well as in their environments. Methods C. difficile isolates were characterized according to the presence of toxin genes and antibiotic resistance. Multilocus Sequence Typing Analysis (MLST) was applied for finding the genetic polymorphism and relationship among strain lineages. Results A total of 821 samples (574 stools and 247 swabs) were collected between April 2015 and May 2017. The prevalence of C. difficile isolates was 28.6% (164/574) in patients and 19% (47/247) in swabs taken from medical devices, hands of healthcare workers and skin patient sites. Finally, 11.5% (66/574) toxigenic C. difficile strains isolated from stool samples of inpatients and 4.4% (11/247) from hands of healthcare workers and skin patient sites. All the toxigenic isolates were inhibited by a low concentration of vancomycin (MIC

Background: As an important inflammatory marker, study of C-reactive protein (CRP) changes over time may lead to better identification of risk factors of cardiovascular disease. We evaluated the relationship between CRP changes and lifestyle, metabolic syndrome (MS) and body mass index (BMI) in middle-aged women and explored potential bias from attrition. Materials and Methods: We studied 1234 participants in the Isfahan cohort study – a longitudinal population-based study of adults older than 35 years living in urban and rural areas of three counties in central Iran. Data were collected every 6 years since 2001 (3 points). Random effects model was used to evaluate the effects of behavioural risk factors and MS on CRP, with pattern mixture model to account for cohort attrition. Results: Mean CRP levels decreased over time (Est = −0.066, P < 0.001). MS (Est = −0.195, P < 0.001), BMI (Est = 0.022, P < 0.001), physical activity (Est = −0.009, P = 0.002) and history of smoking (Est = −0.399, P = 0.002) were independently associated with increases in CRP. Pattern mixture model showed that CRP decreased in participants with monotone measurement (Est = −0.032, P < 0.001), as well as intermittent measurement (Est = −0.022, P < 0.001), with no association in participants who responded at all points (Est = −0.015, P = 0.083). Conclusion: In this study, the rate of changes in CRP level in middle-aged women over time was higher in participants who were irregularly measured than those who measured continuously. MS, BMI and physical activity may be related to the CRP changes over time in middle-aged women.

Introduction: Chronic kidney disease (CKD) is a progressive and irreversible disorder that now is introduced as one of the most important problems of general health (1). Serum levels of inflammatory mediators such as C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) elevate in patients with end-stage renal disease (ESRD). Systemic inflammation is correlated with cardiovascular disease. Furthermore, parathyroid hormone (PTH) causes releasing of IL-6 from liver and osteoblast. IL-6 increases lifetime and activity of neutrophils. Therefore, PTH may have a direct correlation with neutrophil-to-lymphocyte ratio (NLR). Objectives: In this study, we aimed to determine the performance of NLR in hemodialysis and its possible correlation with PTH. Patients and Methods: This is a cross-sectional study to evaluate the correlation of NLR and serum intact PTH (iPTH), Ca (calcium) and P (phosphorus) and also Ca×P products (mg2 /dL2 ) in a group of stable hemodialysis patients, including male and female gender subgroups, diabetic versus non-diabetic patients, and also patients with or without chronic hypertensive disease. Results: This study consisted of 136 hemodialysis patients. Our study showed no statistically significant correlation between iPTH (intact parathormone) and NLR in hemodialysis patients (P>0.05). In addition, we test their correlation in other subgroups including hypertensive and normotensive, diabetic and non-diabetics, and male versus female patients. We found no significant correlation between iPTH and NLR in the mentioned subgroups, too. Conclusion: Observed correlation between PTH and NLR in hemodialysis patients may be due to our small sample size. Therefore, further studies on this subject are suggested.

Background: There has been a great interest in joint modeling of longitudinal and survival data in recent two decades. Joint models have less restrictive assumptions in multivariate modeling and could address various research questions. This has led to their wide applications in practice. However, earlier models had normality assumption on the distribution in longitudinal part that is usually violated in real data. Hence, recent research have focused on circumventing this issue. Using various skewed distributions has been proposed and applied in the literature. Nevertheless, the flexibility of the proposed methods is limited especially when the data are skew positive. Methods: In this paper, we introduce the use of Birnbaum-Saunders (BS) distribution in joint modeling context. BS distribution is more flexible and could cover a wide range of skew, kurtotic or bimodal data. Results: We analyzed publicly available ddI/ddC data both with normal and BS distributions in Bayesian setting and compared their fit by Widely Applicable Information Criterion (WAIC). The joint BS model showed a better fit to the data. Conclusion: We introduced and applied BS distribution in joint modeling of longitudinal-survival data. Using multi-parameter distributions such as BS in Bayesian setting could improve the fit of models without limitations that arise in transformation of data from original scale.

Introduction In the aftermath of mass casualty incidents, many resolutions need to be made in a fast and influential manner within high pressure environment to assign the limited resources among the numerous demands. This study was planned to rank the criteria influencing casualty’s distribution following trauma-related mass casualty incidents. Material and Methods This study utilized a modified Delphi methodology, concentrating on extracted criteria attained from preceding systematic literature review. All 114 extracted criteria classified into eight sections including space, staff, stuff, system and structures, triage, treatment, transport, and uncategorized criteria and were imported into an online survey tool. In first round experts were asked to rank each criteria on a five-point Likert scale. Second round incorporated feedbacks from first round stated as percent and median scores from the panel as a whole.  Experts then were called upon to reassess their initial opinions regarding uncertain remarks from first round, and once again prioritize presented criteria. Results Fifty-seven criteria were accepted relevant to the following sections: space: 70% (7/10); staff: 44% (4/9); system / structure: 80% (4/5); stuff: 39.1% (9/23); treatment; 66.7% (6/9); triage: 73.7% (14/19); transport: 38.7% (12/31) and other sections: 12.5% (1/8). The ï¬rst round achieved nearly 98% (n=48) response rate. Of 114 criteria which were given to the experts, 68 (almost 60%) were approved. The highest percentage of agreement was relevant to the system and structures sections (4/5=80%). The response rate for the second round was about 86% (n=42). From the 68 criteria presented to experts, nearly 84% (57) criteria could obtain consensus. Conclusion  “Casualty Level of Triage on the Scene†and “Number of Available Ambulance†were two criteria that obtained the maximum level of consensus. On the other hand, “gender of casualtyâ€, “Number of Non-Medical staffs in each Hospital†and “Desire to transport family members together†got lowest level of consensus. In this modified Delphi study, the criteria that have been identified influential on the distribution of casualties following trauma-related MCIs, were prioritized. This sorted list could be used as a catalogue for developing decision support system or tool for casualty distribution following mass casualty incidents.

Background: The aim of the study is to explore the risk factors of mortality for hospitalized patients in three designated hospitals in Isfahan province. Materials and Methods: This retrospective cohort study was conducted on all positive coronavirus disease (COVID)-19 patients admitted to Khorshid, Isabn Maryam, and Amin hospitals in Isfahan province. The demographic, clinical, laboratory, and outcome data of patients who were died or discharged from February 24, 2020, to April 18, 2020, were extracted from patient's medical records. Results: Overall 1044 COVID-19 patients were included in this analysis. Based on the findings of this study, older age (≥65 years) (adjusted hazard ratio [aHR]: 2.06; 95% confidence interval [CI]: 1.13–3.76), chronic obstructive pulmonary disease (COPD) history (aHR: 2.52; 95% CI: 1.09–5.83), white blood cell (WBC) counts more than 10 × 10^3/L (aHR: 3.05; 95% CI: 1.42–6.55), Hb level

Background: Cutaneous manifestations of coronavirus disease 2019 (COVID-19) range from mild skin rashes to severe vasculitis. In the current study, we evaluated the demographic characteristics of the patients with cutaneous vasculitis following COVID-19 infection. Materials and Methods: In the current study, we evaluated 799 hospitalised patients with COVID-19 infection for development of cutaneous vasculitis. Demographic and clinical characteristics of the patients were obtained using questionnaires and patients' records. Cutaneous vasculitis of the suspected patients were confirmed using skin biopsy and direct immunofluorescence. Results: We detected 24 hospitalised cases with cutaneous vasculitis presenting with petechia, purpura, livedoretcularis and acrocyanosis. Our data showed a significant relationship between male sex, advanced age, C-reactive protein (CRP) level and presence of comorbidities with development of cutaneous vasculitis. In addition, we found a positive association between the severity of COVID-19 infection and occurrence of cutaneous vasculitis. Conclusion: Our findings are suggestive that clinicians must be aware of cutaneous vasculitis risk as prognostic value in the patients with severe COVID-19 infection.

Polyvinylchloride (PVC) based heterogeneous cation exchange membranes were prepared by the solution casting technique. The effect of super activated carbon nanoparticles concentration as filler additive in membrane matrix on ionic transfer behaviors of the membrane was studied. SOM images showed uniform particles distribution and relatively uniform surfaces for the membranes. The membrane water content was improved initially by using of super activated carbon nanoparticles up to 0.5 %wt in the casting solution and then began to decrease by more increase of nanoparticles content ratios from 0.5 to 4 %wt. Utilizing of activated carbon nanoparticles in the casting solution also led to increase of water contact angle, membrane ion exchange capacity, fixed ionic concentration, membrane potential, transport number and membrane selectivity obviously.An Opposite trend was observed for the membrane electrical resistance. The sodium flux/permeability was also enhanced initially by increase of nanoparticles concentration up to 0.5 %wt and then decreased slightly by more increase of nanoparticles loading ratios from 0.5 to 1 %wt. The sodium flux was sharply enhanced again by more increase of nanoparticles concentration form 1 to 4 %wt. The membrane transport number and selectivity were increased initially by increase of electrolyte concentration and then showed decreasing trend. The membranes showed higher transport number and selectivity at neutral pH compared to other pH values. The ED results showed that dialytic rate of lead ions was increased by utilizing of super activated carbon nanoparticles in the membrane matrix.

BACKGROUND: Considering the high level of air pollution and its impact on health, we aimed to study the correlation of air pollution with hospitalization and mortality of cardiovascular (CVD) and respiratory diseases (ResD) (CAPACITY) to determine the effects of air pollutants on CVD and ResD hospitalizations and deaths in Isfahan, Iran.METHODS: Hourly levels of air pollutants including particulate matter (PM), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3), information of CVD and ResD admissions and death certificate were obtained respectively from Department of Environment (DOE), Iran, hospitals and cemetery. Time series and case-crossover model were used to find the impact of air pollutants. This paper only summarizes the descriptive findings of the CAPACITY study.RESULTS: The total number of hospitalized patients were 23781 in 2010 and 22485 in 2011. The most frequent cause of hospitalization and death was ischemic heart diseases in both years. While the mean annual levels of O3, CO, and PM10 were lower in 2011 than in 2010, NO2 and SO2 levels higher in 2011. In both years, PM10 was similarly increased during last month of fall, late spring and early summer. In 2011, the PM2.5 and PM10 monthly trend of change were similar.CONCLUSION: The CAPACITY study is one of the few large-scale studies that evaluated the effects of air pollutants on a variety of CVD and ResD in a large city of Iran. This study can provide many findings that could clarify the effects of these pollutants on the incidence and burden of both disease groups.

Abstract Background One of the most critical practices in mass casualty incident management is vacating the victims from scene of the incident and transporting them to proper healthcare facilities. Decision on distribution of casualties needs to be taken on pre-developed policies and structured decision support mechanisms. While many studies tried to present models for the distribution of casualties, no systematic review has yet been conducted to evaluate the existing models on casualty distribution following mass casualty incidents. A systematic review is therefore needed to examine the existing models of patient distribution and to provide a summary of the models. This systematic review protocol is aimed to examine the existing models and extracting rules and principles of mass casualty distribution. Methods This study will comprehensively investigate existing papers with search phrases and terms including “mass casualty incident”, distribution, evacuation, and Mesh terms directly corresponding to search phrases. No limitations on the type of studies, date of publication, or language of the relevant documents will be imposed. PubMed, Web of Science, Scopus, and Google Scholar will be searched to access the relevant documents. Included papers will be critically appraised by two independent reviewers. The data including incidents type, scene characteristics, patient features, pre-hospital resources, and hospital resources will be categorized. Subgroup analysis will be conducted when possible. Discussion To the best of our knowledge, no study has yet addressed the effects and interaction of contributing factors on the decision-making processes for casualty’s distribution. This is the first study that comprehensively assesses and critically appraises the current models of casualty distribution. This study will provide evidences about models and criteria for casualty distribution following mass casualty incidents. Systematic review registration PROSPERO Registration Number: CRD42016049115

Background: C-reactive protein (CRP) is a predictor of cardiovascular diseases in both normal people and patients on hemodialysis .This study aimed to assess the relationship of high-sensitivity C-reactive protein (Hs-CRP) serum level and peritonitis in patients on peritoneal dialysis. Methods: 113 patients on peritoneal dialysis in Isfahan city, Iran, participated in our study in 2015. Serum albumin and Hs-CRP levels were measured in each patient at three times (baseline, and 6 and 12 month after that) and the patients were followed up for 1 year. All the patients were evaluated for peritonitis in every visit. At the end of the study, two groups of patients on peritoneal dialysis with and without peritonitis were compared. Findings: Among 113 patients, 24 were excluded from the study because of death or kidney transplantation and 89 patients were included in final analysis. The mean Hs-CRP levels in patients with peritonitis were 4.83, 5.79, and 7.42 mg/l at baseline, and 6 and 12 month after it, respectively; these levels were 4.47, 3.19, and 2.69 mg/l in patients without peritonitis, respectively. In addition, the mean albumin levels in patient with peritonitis were 3.38, 3.29 and 3.40 mg/l at baseline, and 6 and 12 month after it, respectively; these values were 3.56, 4.05, and 3.51 mg/l in patients without peritonitis, respectively. Conclusion: Results showed that with increase in Hs-CRP level, the risk of peritonitis increased. Besides, the albumin level decreased among patients with peritonitis in comparison with patients without peritonitis; there was no significant correlation between albumin level and peritonitis.

Background and Aims: Nowadays, oral cancer is considered one of the most important diseases related to oral health. The objective of the present study was to determine the dental students’ knowledge in Isfahan about oral cancer and the comparison of the level of students' knowledge in different years of education. Materials and Methods: The present study was a cross-sectional-analytical one conducted in 2013. The population of study included the dental students of private and state University of Isfahan which 255 students were randomly selected. The data were collected using questionnaire and were then analyzed using SPSS software program and Kruskal-Wallis and Mann-Whitney. Results: From private and public dental schools in Isfahan, 56% and 44% of dental students were involved. Regarding performing routine clinical oral examination, 81% of the participants answered positively, which showed no significant difference among the years of education of the participants (P=0.116). Regarding the examination of patients with oral lesions, 46% of them answered positively, which the difference between the years of education was highly significant (P≤0.001). Conclusion: The findings of the research indicated that the level of knowledge of dental students of Isfahan city regarding the detection of oral lesions was not sufficient. Although, the students did not perform common examinations for exploring oral cancer, they did not have sufficient knowledge regarding some of the risk factors and oral lesions related to cancer. Therefore, it is necessary that a comprehensive curriculum be developed in this regard for their education.

Objective: Acne vulgaris is a disease of pilosebaceous unit with multifactorial pathogenesis and threats patients' social functioning. There is a growing research to find faster, more effective, and easy to use treatments. The aim of this study is to evaluate the efficacy of benzoyl peroxide 5% (BP) with and without concomitant intense-pulsed light (IPL) therapy in mild-to-moderate acne vulgaris. Methods: In this controlled trial, 58 eligible patients with mild-to-moderate acne and Fitzpatrick skin phototype III and IV were randomly allocated to two groups. All patients were asked to use a thin layer of BP every night. The IPL therapy was administered at the end of first, 2nd, and 3rd months. Acne Global Severity Scale (AGSS), Acne Severity Index (ASI), and total lesion counting (TLC) along with patient satisfaction were recorded. Patients were also examined 1 month after the final therapeutic visit. Findings: The IPL group showed greater reduction in AGSS (P < 0.001) and TLC (P = 0.005) than the control group. However, the difference in ASI was not significant (P = 0.12). Patients in IPL groups were more satisfied than control group (P < 0.001). Conclusion: Adding IPL to BP can result better response to BP alone. In acne treatment, combination therapy such as IPL and other topical agents should be kept in mind.

Objective: This study was conducted to compare the effect of low-dose isotretinoin with its conventional dose in patients with moderate and severe acne. Methods: This was a clinical trial conducted on 60 male and female patients with moderate and severe acne vulgaris. The patients were divided into two treatment groups: 0.5 mg/kg/day isotretinoin capsule and low-dose isotretinoin capsule (0.25 mg/kg/day). Patients in both groups received 6-month treatment. At the end of the 6th month and 12th month (6 months after the end of the treatment), they were examined again, and their improvement was determined and compared. Findings: The average severity of acne in the two treatment groups did not differ significantly within any of the study periods. The most common side effects were nose dryness in the low-dose group (17%) and hair thinning and loss in the conventional - dose group (33.2%), although all the patients had dry lips. Conclusion: According to the same severity of the acne in two groups in different study periods, as well as fewer side effects and more patients' satisfaction, the low-dose isotretinoin can be considered in the treatment of acne.

Background: Brucellosis is one of the most common infectious diseases worldwide which is caused by direct contact with affected animals or their products. It puts a huge impact on the economy, society, and the environment. Iran is the fourth endemic country for brucellosis in the world. It has been described a new epidemiological feature of the disease and its trends in Isfahan province, as one of the endemic areas of brucellosis in Central Iran. Materials and Methods: This is a cross-sectional, population-based study. Data collection was performed using epidemiological questionnaires through Epi-2006 software from the private and public sectors in 22 districts of Isfahan province over 9 years (2010–2018). The results were obtained by the description statistics using the SPSS Statistics software version 20 (SPSS Inc., Chicago, IL, USA). Results: Altogether, 5751 new brucellosis patients were recorded over 9 years. About 70% of these cases were male. The majority of cases had occurred in the age group of 21–30 years. The average incidence of brucellosis over the 9 years was 14.1 cases/100,000 population including 8.8 in the urban versus 45.2 cases in the rural areas. During the 9-year study period, the incidence of brucellosis was increased between 2010 and 2014. From 2014 to 2017, the trend has been decreasing, but in the last year of the study, the trend has been increasing again. Seasonally, the incidence rate was variable between the lowest from October to January and the highest from June to July. Conclusion: According to the fluctuation of incidence trend of brucellosis during the 9-year study period in Central Iran, it seems some policy changes regarding to the control and prevention of brucellosis have a role, changes that should be fixed and corrected.

مقدمه: درماتیت سبورئیک یک بیماری مزمن است که در بعضی موارد، با وجود درمان مناسب، علایم بیمار ادامه می‌یابد. از این رو، هدف از انجام این مطالعه، بررسی اثربخشی استات روی 2/1 درصد و تأثیر آن در درمان سبورئیک درماتیت بود. روش‌ها: مطالعه‌ی حاضر، یک مطالعه‌ی کارآزمایی بالینی تصادفی یک سو کور بود. جامعه‌ی آن شامل بیماران درماتیت سبورئیک نواحی صورت و اسکالپ که به درمانگاه‌های پوست وابسته به دانشگاه علوم پزشکی اصفهان مراجعه نمودند، بودند. 60 نمونه وارد مطالعه و به دو گروه 30 نفری تقسیم شدند. برای گروه شاهد، درمان درماتیت سبورئیك شامل محلول كتوكونازول 2 درصد + محلول دارونما و برای گروه مورد، محلول كتوكونازول 2 درصد + محلول استات روی 2/1 درصد تجویز شد. بیماران روزانه یک مرتبه به مدت 4 هفته تحت درمان بودند و قبل و بعد از درمان، بر اساس پرسش‌نامه‌ی سنجش میزان خارش و اریتم بیمار، که توسط پزشک معالج تکمیل شد، مورد سنجش و ارزیابی قرار گرفتند. یافته‌ها: میانگین نمره‌ی خارش قبل از آزمون در گروه مورد، 41/2 ± 63/2 و در گروه شاهد 35/2 ± 57/2 و میانگین نمره‌ی خارش بعد از آزمون در گروه مورد 70/0 ± 05/1 و در گروه شاهد 07/1 ± 59/1 گزارش شد. اریتم قبل از آزمون در گروه مورد 43/0 ± 23/1 و در گروه شاهد 58/0 ± 07/1 و بعد از آزمون در گروه مورد 63/0 ± 66/0 و در گروه شاهد 62/0 ± 66/0 گزارش شد. بر اساس آزمون t، تفاوت خارش بین گروه‌های مورد و شاهد، معنی‌دار بود (050/0 > P) و از نظر اریتم، تفاوت معنی‌داری وجود نداشت (050/0 < P). نتیجه‌گیری: هر چند می‌توان توصیه کرد استات روی 2/1 درصد در درمان بیماری استفاده شود تا بتوان با کاهش علایم ناشی از این بیماری، کیفیت زندگی بیماران را بهبود بخشید، اما بهتر است اثرات این ترکیب بر سایر علایم نظیر پوسته‌ریزی نیز سنجیده شود.

مقدمه: آلوپسی ‌آره‌آتا (AA یا Alopecia areata) یک بیماری شایع و بدون علامت است که با ریزش سریع مو در یک منطقه مشخص می‌شود. علت آن هنوز به طور کامل شناخته نشده است. بعضی مطالعات ارتباط بین AA و سلیاک را نشان داده‌اند. هدف از انجام این مطالعه، مقایسه‌ی سطح Anti-tissue transglutaminase IgA (Anti-tTg IgA) در بیماران مبتلا به AA با گروه شاهد بود. روش‌ها: این مطالعه، یک مطالعه‌ی مورد- شاهدی بود که گروه مورد آن بیماران مبتلا به AA بودند. در هر گروه، 35 نفر وارد شدند. سپس آزمایش Anti-tTg IgA برای هر دو گروه انجام شد. جواب به صورت مثبت/منفی گزارش‌ گردید. در پایان، توزیع فراوانی این اتوآنتی‌بادی در گروه‌ها با هم مقایسه شد. یافته‌ها: بر حسب آزمون 2χ برای جنس و آزمون t برای سن، تفاوت معنی‌داری بین دو گروه از نظر جنس (151/0 = P) و سن (621/0 = P) مشاهده نشد. در گروه مورد، Anti-tTg IgA تنها در یک فرد (۸/۲ درصد) مثبت بود. در گروه شاهد، هیچ یک از افراد از نظر این آنتی‌بادی مثبت نبودند. بر حسب آزمون 2χ، بین گروه‌ها تفاوت معنی‌داری مشاهده نشد (۳۱۴/۰ = P). شایع‌ترین فرم AA (6/88 درصد) Patchy و شایع‌ترین نوع درگیری ناخن در گروه مورد، Pitting بود. 1/17 درصد گروه مورد، سابقه‌ی خانوادگی AA داشتند. نتیجه‌گیری: توزیع فراوانی Anti-tTg IgA در بیماران مبتلا به AA نسبت به جمعیت طبیعی جامعه‌ی اصفهان بالاتر نمی‌باشد. از این رو، پیشنهاد می‌شود اتوآنتی‌بادی‌های دیگر سلیاک نظیر Anti-gliadin IgA و Anti-gliadin IgG نیز در این بیماران مورد بررسی قرار گیرد.

Backgrpund: Acne vulgaris is a chronic inflammatory skin disease that its side effects like hyper-trophic and atrophic scars and long-term pigmentation has adverse psychological effects on the individual. This study aimed to compare the psychological effects and quality of life in two groups of patients with acne and Healthy individuals. Methods: In this case-control study, 100 patients with and 100 individuals without acne were selected. The prevalence and severity of psychological effects, including depression, anxiety and stress was assessed using Depression Anxiety Stress Scale (DASS) questionnaire and quality of life was assessed using World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire. The data were compared between the two groups. Findings: In two groups of patients and controls, 7% and 8% had minor depression, respectively, 5% of patients had moderate depression and 2% of the control group had severe depression with no significant difference between the both groups (P = 0.070). In patients and control groups, 7% and 5% had mild, 4% and 2% had moderate and 1% and 2% had severe anxiety, respectively with no significance difference between the both groups (P = 0.660). In addition, 8% of patients and 1% of controls suffered from mild stress; the level of stress had significant difference between the both groups (P = 0.017). The score of quality of life was 80.00 ± 11.19 and 79/30 ± 10/73 in patients and controls, respectively with no significant difference between the two groups (P = 0.940). Conclusion: The prevalence of psychological effects was higher in patients. On the other hand, patients with acne (mainly mild and moderate) had a lesser degree of support from others, quality of life and health satisfaction. So, it is necessary to evaluate psychological aspects in patients with mild to moderate acne.

Background: Isfahan province is one of the common foci of the cutaneous leishmaniasis in Iran, particularly the wet or rural zoonotic cutaneous leishmaniasis (ZCL). Due to the lack of information about the epidemiology and prevalence of cutaneous leishmaniasis in Isfahan province, Iran, this study was designed. Methods: Data were collected from the recorded data of patients with leishmaniasis referred to Isfahan Province Health Care Center, Isfahan, Iran. The patients were diagnosed by direct microscopic examination of the samples. Data concerning demographic features, the number and location of lesions, duration of disease, area of residence, work location, the history of travel within the past two months, address, and telephone number of the patients was collected. The epidemiological status of leishmaniasis was determined from the recorded data. Findings: In total, data of 28315 patients with leishmaniasis during 2001 to 2011 were studied. Among them, 10809 (38.2%) patients were women and 17491 (61.8%) were men. The mean age of the patients was 22.40 ± 16.52 years (range: 1-100 years). The incidence of lesions was 12.1% in face, 12.3% in hands and legs, 4.5% in face and hands, 24.1% in legs, 32.3% in hands and 11.5% in the other parts of body. 12163 patients (43%) had one, 6330 (22.4%) had two, 503 (8.1%) had three, and 8008 (28.3%) had more than three lesions. Overall, 17883 patients (63.2%) lived in urban areas and 8241 (29.1%) in rural areas and most of the cases were seen among those who lived in cities and urban areas. Conclusion: Considering the high prevalence of cutaneous leishmaniasis in the Isfahan province, eliminating the leishmaniasis vector and its reservoirs in this endemic area seems to be necessary. During the years, it has been showed that leishmaniasis is endemic in Isfahan province; hence, a more extensive epidemiologic study is recommended.

Objective: Hypertension and hyperlipidemia are two major risk factors for cardiovascular disease in continuous ambulatory peritoneal dialysis (CAPD) patients. This study was designed to investigate the effect of omega-3 fatty acids on blood pressure (BP) and serum lipids in CAPD patients. Methods: This study was a randomized double-blind clinical trial in which 90 CAPD patients were randomly assigned to either the omega-3 or the placebo group. Patients in omega-3 group received 3 g/day omega-3 for 8 weeks, whereas patients in the control group received placebo. At baseline and at the end of 8 weeks, the patients’ BP was controlled, and serum biochemistry was measured. Findings: Mean systolic BP decreased (–22.2 ± 14.2 mmHg) in the omega-3 group at the end of the study while in the placebo group increased (+0.5 ± 30.2 mmHg) (P < 0.0001). Mean diastolic BP of the omega-3 group decreased more (–11.95 ± 11.9 mmHg) comparing with the placebo group (–1.1 ± 17.3 mmHg) (P = 0.001). There were no significant differences between the two groups in mean changes in serum triglyceride, and total, high-density lipoprotein, and low-density lipoprotein cholesterol. Conclusion: The results of this study indicate that omega-3 reduced BP significantly but had no effect on lipid profile in our CAPD patients.

Background: The pathogenesis of atopic dermatitis (AD) remains to be determined; recently a possible change in the immune system with production of immunoglobulins is proposed. As vitamin E is a potent antioxidant, with the ability to decrease the serum levels of immunoglobulin E (IgE) in atopic patients, we aimed to evaluate the effect of oral vitamin E on treatment of AD. Materials and Methods: This randomized, double-blind, placebo-controlled trial comprised seventy participants with mild-to-moderate AD, based on the Hanifin and Rajka diagnostic criteria. The patients were randomly selected from teaching skin clinics in Isfahan, Iran. They were randomly assigned to two groups of equal number, receiving vitamin E (400 IU/day) and placebo for four 4 months. Each month, the extent, severity, and subjective symptoms including itch and sleeplessness were measured by SCORAD index. Three months after the end of intervention, the recurrence rate was assessed. Results: The improvement in all symptoms, except sleeplessness, was significantly higher in the group receiving vitamin E than in controls (-1.5 vs. 0.218 in itching, -10.85 vs. -3.54 in extent of lesion, and -11.12 vs. -3.89 in SCORAD index, respectively, P < 0.05). Three months after the end of intervention, the recurrence rate of AD was evaluated. Recurrence rate between all 42 individuals, who remained in the study, was 18.6%. Recurrence ratio of the group receiving vitamin E compared to the placebo group was 1.17, without significant differences between the two groups (P > 0.05). Conclusion: This study suggests that vitamin E can improve the symptoms and the quality of life in patients with AD. As vitamin E has no side effects with a dosage of 400 IU/day, it can be recommended for the treatment of AD.

Background: A number of treatments for reducing the appearance of acne scars are available, but general guidelines for optimizing acne scar treatment do not exist. The aim of this study was to compare the clinical effectiveness and side effects of fractional carbon dioxide (CO 2 ) laser resurfacing combined with punch elevation with fractional CO 2 laser resurfacing alone in the treatment of atrophic acne scars. Materials and Methods: Forty-two Iranian subjects (age range 18-55) with Fitzpatrick skin types III to IV and moderate to severe atrophic acne scars on both cheeks received randomized split-face treatments: One side received fractional CO 2 laser treatment and the other received one session of punch elevation combined with two sessions of laser fractional CO 2 laser treatment, separated by an interval of 1 month. Two dermatologists independently evaluated improvement in acne scars 4 and 16 weeks after the last treatment. Side effects were also recorded after each treatment. Results: The mean ± SD age of patients was 23.4 ± 2.6 years. Clinical improvement of facial acne scarring was assessed by two dermatologists blinded to treatment conditions. No significant difference in evaluation was observed 1 month after treatment (P = 0.56). Their evaluation found that fractional CO 2 laser treatment combined with punch elevation had greater efficacy than that with fractional CO 2 laser treatment alone, assessed 4 months after treatment (P = 0.02). Among all side effects, coagulated crust formation and pruritus at day 3 after fractional CO 2 laser treatment was significant on both treatment sides (P < 0.05). Conclusion: Concurrent use of fractional laser skin resurfacing with punch elevation offers a safe and effective approach for the treatment of acne scarring.

Background: Diabetes mellitus is a metabolic disorder and its subsequent complications such as retinopathy, nephropathy, ulcers, disability, and amputation increase the burden of the disease. Patient knowledge-improving programs are employed to prevent disease progression and to improve the quality of life of the patients. In this way, we need to characterize the groups of patients in urgent need for more and rich-in-content programs. In the present study, we used piecewise regression to evaluate the trends of diabetic nephropathy prevalence in patients registered in the Sedigheh-Tahereh Research Center and to identify patients who were in need of more attention. Materials and Methods: Piecewise regression, used in this study, is a statistical method to identify change points, if any, in the trends of mortality rates, prevalence of a disease, or any other trends. Available information for 1,935 patients were retrieved from the database. Joinpoint program 3.5.3 and Statistical Package for the Social Sciences (SPSS) 20 was used to fit piecewise regression and obtain descriptive statistics, respectively. Results: We assessed the trend of diabetic nephropathy in different groups of diabetic patients with respect to sex, blood pressure status, education, family history of diabetes, and age. The results showed an increasing trend in females, patients without family history of diabetes, and eover th recent years. The prevalence of diabetic nephropathy in patients with academic education was high. Conclusion: The groups with high prevalence or increasing trends need more preventive intervention and detailed assessment of the present trends. Exploring high-risk groups is beneficial for better policy-making in the future. However, discovering the reasons for the increased trend of the disease is really helpful in controlling diabetes complications.

Background: Reference percentile curves are usually used as a screening tool to determine growth disorders. Anthropometric indices are population-dependent and may differ according to ethnicity, dietary pattern and lifestyle habits. This study aims to compare the curves of anthropometric measures obtained in two national studies conducted among Iranian children and adolescents in 2003-2004 and 2009-2010. Materials and Methods: Anthropometric measures obtained in two nationwide surveys conducted in 10-18-year-old Iranian students were compared. Lambda-mu-sigma (LMS) Chart Maker Pro program was used to develop age- and gender-specific percentiles and to smooth and fit the model. Results: In 2003-2004, the mean and standard deviation (SD) of body mass index (BMI) and waist circumference (WC) were 18.98 ± 3.81 kg/m 2 and 67.50 ± 11.05 cm in boys; and 19.44 ± 3.78 kg/m 2 and 66.55 ± 9.89 cm in girls, respectively. In 2009-2010, the corresponding figures were 19.16 ± 4.07 kg/m 2 , 69.42 ± 11.43 cm, 19.63 ± 4.11 kg/m 2 , and 67.29 ± 9.69 cm, respectively. Height curves did not show considerable changes in two studies. Comparison of two series of studies showed that the weight, BMI, WC, and waist-to-height ratio were lower in adolescent girls than boys especially in higher percentiles. Moreover, in both genders, weight, BMI, and WC percentiles decreased. Conclusion: The growth charts of Iranian children and adolescents aged 10-18 years have changed over 5 years. The reference growth curves change over time in the pediatric age group, repeated surveys should be conducted to update the age- and gender-specific reference curves in different populations.