Background: Cardiovascular disease (CVD) is the most common cause of death among patients with end-stage renal disease especially whom under hemodialysis (HD). Stromal cell-derived factor-1 (SDF-1) and its receptor CXC chemokine receptor type-4 (CXCR4) could contribute to CVD. The main aim of this study was to evaluate the association between SDF-1 and CXCR4 with CVD and its related risk factors in patients under HD. Methods: Sixty patients under HD and 29 healthy subjects were recruited in the study. The serum levels and relative messenger RNA (mRNA) expressions of SDF-1 and CXCR4 were measured using enzyme-linked immunosorbent assay and real-time polymerase chain reaction in patients and controls, respectively. CVD history of the patients was obtained. Results: Twenty patients (33.3%) had a history of CVD. The mean levels of serum and relative mRNA expressions of SDF-1 and CXCR4 were higher in patients than controls and also in patients with a history of CVD than patients without it. The serum levels and relative expressions of SDF-1 and CXCR4 were positively correlated with blood urea nitrogen, parathyroid hormone, and high-sensitivity C-reactive protein and inversely correlated with hemoglobin. The history of CVD was the independent predictor of serum levels of SDF-1 and CXCR4 and also relative mRNA expression of CXCR4. Conclusions: The higher levels of serum and relative mRNA expressions of SDF-1 and CXCR4 were associated with CVD in patients under HD. Furthermore, SDF-1 and CXCR4 were associated with several traditional and uremia-related CVD risk factors in such patients.

Background: Hyperlipidemia and hypertension are the most important causes of ischemic heart disease. There is evidence that flaxseed powder can improve lipid profile and blood pressure. In this study, we want to investigate the effects of flaxseed powder consumption on patients with hyperlipidemia and hypertension. Methods: This randomized double-blind placebo-controlled clinical trial was performed on 80 hyperlipidemic and hypertensive patients (men and women between 20 and 60 years old). In this study, participants were recruited from Imam Khomeini hospital clinics of Shiraz University of Medical Sciences in 2017 randomly allocated to flaxseed powder group and placebo group. The intervention group received 36 g of flaxseed sachet (n = 40), and control group received 12 g placebo sachet (n = 40) for 8 weeks. Serum lipid profiles, blood pressure, fasting blood sugar, and anthropometric indices were measured. Data were analyzed by using SPSS. Results: We found significant reduction (P < 0.001) in anthropometric indices (waist circumference and waist-to-hip ratio) and lipid profiles (triglycerides [P = 0.015], total cholesterol [P = 0.018], and low-density lipoprotein [P < 0.001]) within flaxseed group in comparison with placebo group. Conclusions: Based on beneficial effects of flaxseed on cardiovascular risk factors, it seems that flaxseed consumption can be considered as a useful therapeutic approach for reducing lipid profile and anthropometric indices.

Background: Although there is a critical need for information on economic performance of Iranian general practitioners (GPs) in health policymaking, there is not any scientific evidence in this area. Therefore, in the present report, the characteristics of economic behaviors of Iranian GPs were described. Methods: This was a cross-sectional study in 2015, in which the data were collected from 666 GPs. The variables including monthly gross income, hours of work, and patient visits were studied as the measures of economic behavior of GPs. Descriptive statistics, t-test, and Analysis of Variance were used for analyzing the data. The statistical analysis was performed by STATA12. Results: The annual income of the GPs understudy was 26,000 US dollar (USD) (82,680 purchasing power parity [PPP]). The ratio of this value to gross domestic product per capita and minimum wage of Iran in 2015 was 4.8 and 9.2, respectively. On average, every GP in Iran has an income of 2188.1 USD (6958.16 PPP), works 142 h, and visits an average of 494 patients/month. The results showed that the economic behavior of Iranian GPs has a significant difference in terms of gender, age, marital status, practice experience, practice location, type of practice, being a family physicians, and working in different settings (P < 0.05). Conclusions: The Iranian GPs understudy work less than their counterparts in other (compared) countries. The studied GPs had a higher income (adjusted by hours of work and countries' per capita income) than their counterparts in other (studied) countries. Moreover, there are inequalities between GPs in terms of income, the volume of services provided and the work hours.

Background: Recent therapeutic advances in cardiovascular disease, thanks to the discovery of endothelial progenitor cells (EPCs). Stromal cell-derived factor-1α (SDF-1α), platelet-derived growth factor (PDGF), basic fibroblast growth factor (bFGF), and nitric oxide (NO) play a role in migration, homing, and differentiation of EPCs into mature endothelial cells. The incidence of cardiovascular disease is higher in men than in women. This fact suggests the influence of sex hormones on incidence of cardiovascular disease. Methods: Twenty-four female wistar rats weighing 160–180 g were randomly divided into four groups (N = 6): 1. sham-treated by sesame oil, 2. ovariectomized (OVX)-treated by sesame oil, 3. OVX-treated by 10 μg/kg/day testosterone, and 4. OVX-treated by 100 μg/kg/day testosterone. After 21 days, the animals were euthanized and blood samples were saved for determination of EPC count and serum levels of SDF-1α, PDGF, bFGF, and NO production. Results: High-dose testosterone induced significant increase in EPC count in OVX rats (P < 0.05). Also 100 μg/kg/day testosterone increased serum level of SDF-1α more than OVX-treated by 10 μg/kg/day testosterone (P < 0.05). But 10 μg/kg/day testosterone increased significantly the serum level of PDGF >100 μg/kg/day testosterone-treated group (P < 0.05). The serum level of bFGF in sham-treated by sesame oil was equal with its concentration in OVX-treated by 100 μg/kg/day testosterone. And the serum concentration of NO production in testosterone-treated groups were significantly less than other groups (P < 0.05). Conclusions: This study suggests that testosterone might be effective on cardiovascular disease in females by increasing EPC count through SDF-1α and PDGF mechanisms which are some of the vascular healing factors.

Background: Inflammation is defined as body tissues response to harmful stimuli. Obesity-related inflammation leads to increased risk chronic diseases including diabetic polyneuropathy (DPN). The present study was performed to determine association between body mass index (BMI) and inflammatory markers including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in DPN patients. Methods: In this cross-sectional study, 200 DPN patients with a mean (SD) of age 58.76 (9.53) years were selected. All patients completed the questionnaire including demographic data and chronic disease history. In addition, anthropometric measures and clinical laboratory tests were taken. Multivariate linear regression was used to detect the association between BMI, CRP, and ESR levels. Results: BMI was associated with increase in ESR and CRP levels (β-ESR = 4.67, P < 0.001 and β-CRP = 0.71, P < 0.001). Also, this association remained after adjustment for other different variables. Conclusions: These findings indicate that higher BMI is related to increase inflammatory markers including CRP and ESR in DPN patients. Therapies for DPN and reducing inflammation should target the weight loss among obese patients.

Context: Mitoxantrone (MTX) is an antracyclin drug that is used for treatment of patients with chronic refractory multiple sclerosis (MS). Congestive heart failure (CHF) is a rare complication of this drug that may occur early, during therapy, or late, months or years after termination of therapy. Aims: The aim of this study is to evaluate the long-term adverse effect of MTX on cardiac function. Methods: The study involved 49 MS patients on MTX therapy because of their disease was refractory to other treatments (18 men and 31 women). They were treated in two canters related to Esfahan University of Medical Sciences. The mean age was 34.65 ± 9.56 years. Systolic and diastolic left ventricular (LV) functions were measured by echocardiography. The baseline echocardiographic data were collected from patients' file. Echocardiography was repeated by a single cardiologist in 2016. Results: After MTX therapy, one patient's ejection fraction (EF) reduced below 50% (2%). In spite of their normal diastolic function before therapy, two patients developed diastolic dysfunction (4%). Nonparametric binominal analysis reveals that MTX therapy increased the probability of developing systolic dysfunction, early or late P < 001. Conclusions: MS patients treated with MTX are at increased risk of developing early and late-LV dysfunction, so all patients on MTX therapy must be periodically evaluated for these late complications.

Background: Despite many attempts to discover pathophysiologic mechanisms to explain chronic heart failure (CHF), no conceptual paradigms have been proved yet. Various studies have shown the role of trace elements on heart failure (HF). Among all trace elements, selenium deficiency is regarded as important risk factors for HF. Considering selenium deficiency in our society and high prevalence of HF, we compared selenium level in patients with HF with healthy individuals. Methods: In all, 32 hospitalized patients with HF and 32 healthy controls were enrolled in a case–control study. Demographic characteristics as well as functional class and risk factors were recorded for all two groups. Echocardiography was conducted for patients and all provided data were registered. Then serum selenium levels were compared in case and control groups. Results: The mean (±standard deviation) serum selenium was 92.5 ± 22.44 mg/dL in patients with HF and 109.3 ± 29.62 mg/dL in controls. The level of selenium was significantly lower and the frequency of risk factors was significantly higher in case group. Selenium level did not differ significantly in patients with different HF causes. There were a nonsignificant relationship between selenium level and left ventricular ejection fraction and a significant reverse relationship between selenium level and left ventricular volume and pulmonary artery pressure. Conclusions: Our results showed statistically significant lower level of serum selenium in patients with CHF in comparison to normal individuals. Moreover, selenium level had significant reverse relationship with left ventricular volume and pulmonary artery pressure.

Background: Body of evidence is increasing about the importance of Vitamin D (VD) for normal development of the fetus and for maternal health. As limited data are available regarding the association between maternal VD level and pregnancy-related complications and neonatal anthropometric measures, the present study aimed to evaluate the neonatal anthropometric measures including weight, high, and head circumference and pregnancy-related complications such as preeclampsia, blood pressure, gestational diabetes mellitus, and nausea and vomiting in pregnancy with 25(OH)VD level. Methods: The current prospective observational study was conducted among 812 Iranian pregnant women during the first trimester in Isfahan, Iran. Needed data were collected using validated questionnaires and biochemical examinations. Results: Overall, this study demonstrated an inverse significant association between VD level and chance of having low-weight infant in the adjusted model (odds ratio [OR]: 0.03, 95% confidence interval [CI]: 0.004–0.26, P < 0.001) in the first VD assessment. The same results were obtained in the second VD assessment (OR: 0.08, 95% CI: 0.01–0.40, P < 0.01). However, such associations were not seen about other neonatal measures and pregnancy-related complications. Conclusions: We found that low maternal VD level might be associated with risk of low-weight infant. Such findings could be considered to implement informative interventional programs to control newborn adverse outcomes. Further studies are required to confirm these findings.

Background: Formula milk is prepared as a nutritional substitution for human breast milk, but because of biologic and constituent differences, it might cause obesity and growth disorders in infants. In this study, we compared the growth pattern of formula-fed and breastfed infants living in Yasuj, southwest of Iran. Methods: Infants 7–14 months of age in southwest of Iran were classified as exclusively breastfed (n = 200) and formula-fed (n = 200) in their first 6 months of life. Growth velocity and Z-scores of weight for age, length for age, weight for length, and head circumference were estimated using WHO Anthro Plus software (2010) and SPSS Version 19 (SPSS Inc., Chicago, IL, USA) using World Health Organization reference for growth data. Results: The study showed that Z-score of length for age and head circumference for age at the birth were significantly lower in formula-fed group than exclusively breastfed group (P < 0.05), but the Z-score of weight for length did not differ significantly. At the sixth month of age, Z-score of weight for length was significantly higher in formula-fed group (P < 0.05), but Z-score of length for age had no significant difference and Z-score of head circumference was higher in exclusively breastfed group yet (P < 0.05). Growth velocity, prevalence of obesity, wasting, underweight, and stunting did not differ between two groups. Conclusions: Our findings suggest that formula feeding can lead to greater weight gain and may help the catch up of length, but evidences are not convincing enough to suggest the formula as an obesogenic feeding in the studied area. To make a conclusion, we suggest comparing the privileged and unprivileged areas and controlling for confounding variables including family hygiene and infant feeding practices between formula-fed and breastfed infants.

Background: Antiretroviral therapy (ART) significantly delays the progression from HIV to AIDS. Adherence to ART is the second strongest predictor of progression to AIDS and death, after CD4 count. A very high level of adherence (≥95%) is required for ART to be effective on a long term and to prevent the emergence of resistant viral strains and prevent comorbidities. Methods: A case series study was undertaken at an ART center for a period of 6 months. Non-probability purposive sampling was adapted to select HIV-positive subjects aged >15 years on ART for more than 6 months. A predesigned semi-structured questionnaire was used to obtain the data. Treatment compliance was assessed by self-reported 1-week recall method. Results: A total of 536 HIV-positive people were interviewed, among which 315 (58.8%) of them were males and 214 (39.9%) were females. Nearly two third of the participants (359, 67.0%) reported ≥95% adherence to treatment. Personal commitments (51, 28.8%) and working time inconvenience (42, 23.7%) were the common reasons for less adherence. On bivariate analysis, married people (OR: 1.586, CI: 1.097-2.292), participants residing in rural area (OR: 1.628, CI: 1.130-2.345), participants not having side effects of drugs (OR: 5.324, CI: 3.491-8.181), participants equipped with better knowledge about ART (OR: 2.019, CI: 1.377-2.961), and participants having support of friends and family members (OR: 1.612, CI: 1.019-2.540) showed a higher level of adherence to ART. Conclusions: Demographic factors such as marital status, residing in rural area, and other personal factors like having good knowledge about ART, without side effects to drugs, and having support of friends and family members were found to show a high level of adherence to ART.

Background: Child mortality surveillance system (CMSS) for children aged 1–59 months is a critical issue in the prevention of mortality. This surveillance system like other health programs needs to be evaluated. Therefore, this study aims to evaluate CMSS in Iran. Methods: This evaluation was performed from March 2015 to March 2016 based on selected criteria for assessing the public health surveillance system proposed by the Centers for Disease Control and Prevention. Selected criteria examined in this study included timeliness, simplicity, acceptability, and flexibility. These criteria were evaluated in two ways. First, it included the use of a researcher-made questionnaire. The questionnaires were completed by 100 experts on CMSS. Second, to perform a more exact evaluation of these criteria, 24 of these experts were selected for the focus group. Results: In this study, the response rate was 91% (42% hospital-based and 49% primary care-based). In the timeliness section, 49% of the experts believed that approvals of the child mortality committees have not been sent within the designated time frame; hardware, software, and questionnaires were reported as effective factors in this respect. The structural and administrative problems were effective in simplicity domain and the experts of mortality registration and mood of relatives were effective in acceptability domain. The flexibility of the system was high and appropriate. Conclusions: The findings of the present study reveal that CMSS has some limitations and problems in the timeliness, simplicity, and acceptability criteria, which can be resolved. But this program has an appropriate situation in terms of flexibility.

Background: To compare the umbilical cord diameter (UCD) at early second trimester (at 17–19 weeks of gestation) in trisomy 21 and normal fetuses and determined value of measuring UCD in screening trisomy 21. Methods: This was a case–control study. The UCD was measured in 39 fetuses with trisomy 21 (documented by chorionic villus sampling or amniocentesis) and 39 fetuses in control group at 17–19 weeks of gestation. The control groups were low-risk fetuses for aneuploidy in routine screening and were shown not to have aneuploidy after birth. Results: Mean of UCD in fetuses with trisomy 21 was lower than normal fetuses, but there were no significant differences between them (7.48 ± 0.99 mm vs. 7.66 ± 0.91 mm; P = 0.41). Mean of UCD had no significant difference between other maternal variable, for example, body mass index and obstetric history. Mean of UCD among mothers who had previous cesarean section was significantly lower than without it (7.21 ± 0.97 vs. 7.71 ± 0.97; P = 0.03). Conclusions: At 17–19 weeks of gestation, the UCD of fetuses with trisomy 21 is thinner than normal, but the importance of this difference is too small for using this measurement in screening.

Background: Nomophobia, a state of socio-psychological illness, refers to a fear of lack of access to mobile phone, which is thought to be a modern age disorder that causes negative health risks and harmful psychological effects. This study aimed to determine the relationship between the smartphone use and nomophobia disorder among university students. Methods: The study utilized a cross-sectional method in which 320 students were selected via cluster sampling. Data collection tools included a nomophobia and smartphones use questionnaires. Data were analyzed using SPSS 22 software in two sections: descriptive statistics and inferential statistics. Results: The incidence rate of nomophobia among the students was moderate (3.1), and 73% of the students were moderate smartphone users. Nomophobia had a significant relationship with gender, age group, and level of education; and the frequency of using smartphones had a significant relationship with age group and level of education. There was a positive correlation coefficient between nomophobia and the frequency of using smartphones. The mobile phone use predicted nomophobia with a beta coefficient of 0.402 (P < 0.05). Conclusions: Given the incidence rate of nomophobia disorder was moderate, it is necessary to make preventive decisions and plan educational programs in this regard for the health of university students. Alternative actions are recommended for the treatment in low rate of nomophobia, but drug therapy should be used in more advanced stages; therefore, it is suggested that more attention to be paid to students' free time and entertainments.

Background: The aim of the current study is to determine the Comparison of intellectual structure of International Journal of Preventive Medicine (IJPM) with Medical Subject Headings (MeSH) based on author keywords and index terms of Scopus database and the degree of compatibility among these two groups of keywords. Methods: This study was carried out using a co-word technique, which is one of the bibliometric methods. The study population consisted of 1104 articles published in IJPM and indexed in Scopus database. After retrieval the articles, data for co-word analyses was extracted using UCINET and VOSviewer software applications and centrality criteria. Then, the compatibility of author keywords and MeSH terms was examined by Jaccard's similarity index. Results: During the investigated years and among 2402 author keywords, on average, 561 author keywords (23.36%) were exact matches, 417 author keywords (17.36%) were partial matches, and 1424 author keywords (59.28%) were not matched with the terms contained in the index. Author keywords matching or not matching with index-term categories formed the largest portion of partial match keywords. Conclusions: The use of MeSH as a standard tool by medical journals for the selection of keywords in scientific publications could improve the visibility and retrieval of articles, and increase the number of citations and journals' impact factor.

Background: Hypertension has been one of the early mortality and morbidity in human societies. Training and consequently compliance increase will lead to improve treatment progress and disease control. The study aimed at the effect of training through short message service (SMS) on blood pressure mean and compliance scale in hypertensive patients. Hypertension control is essential to prevent early mortality. Methods: This study is a randomized controlled clinical, uni-center, single-blinded. The study was managed in a health-care center subordinated to Medical University of Isfahan, Iran, in 2017. Sampling was a convenient method therefore the researchers implemented it for 188 hypertensive patients who were allocated randomly into two groups: SMS group and control group. First, all patients filled the compliance questionnaire, and their blood pressure was measured. Afterward, the intervention group would be texting daily for 1 month containing a training text. During 1 and 2 months after intervention, all patients' blood pressure will be measured, and then the questionnaire had been filled 2 months after intervention, again. Results: Systolic blood pressure mean decreased from 136.23 ± 15.91 to 121.70 ± 14.43 and diastolic blood pressure mean decreased from 91.95 ± 8.24 to 86.64 ± 7.86 in the intervention group according to analysis of variance through repeated measurement and is significantly different in comparison with control group (P < 0.001). Compliance scale increased from 72.95 ± 7.65 to 85.40 ± 5.62 based on dependent t-test which was significantly different with the control group (P < 0.001). Conclusions: SMS training would be an effective method to control hypertension.

Background: We aimed to assess general practitioners' (GPs) knowledge, attitudes, and practices (KAPs) toward screening recommendation guidelines of the United States Preventive Services Task Force (USPSTF). Methods: The survey was conducted during a 6-month period in a stratified random sample of GPs, drawn from a national database of GPs in Greece. Participants were queried about their knowledge, attitudes, and self-reported practice patterns regarding screening in a primary care setting. Sociodemographic characteristics associated with vague screening practicing were identified using multivariable logistic regression models. Results: A total of 299 participants agreed and underwent telephonic survey (response rate: 78.2%). GPs agreed on the key role of population-based screening in improving patient care, and nine out of ten reported that their performance would be improved with the adoption of computer-based support systems in clinical practice. GPs, older than 50 years of age, those who those practicing for more than 15 years and GPs working in private sector, were less likely to comply with screening recommendations. Latent class analysis revealed that male physicians and those working in public sector were more likely to comply with USPSTF recommendations. Conclusions: Our findings highlight the need of educational intervention programs for GPs in order to promote the implementation of national evidence-based screening recommendation statements in clinical practice.

Background: Cervical cancer is causing a huge burden in Sub-Saharan Africa (SSA). It mainly affects women in their young ages making female university students at risk of cervical cancer. Knowledge and awareness about cervical cancer and human papillomavirus (HPV) in SSA including Ethiopia is very poor. We aimed to assess the knowledge and awareness of cervical cancer and HPV in University of Gondar (UOG) medicine and health science female students.A cross-sectional study was done. Methods: This study was conducted from April 1 to May 30, 2016 at UOG, College of Medicine and Health Sciences, Gondar, Northwest Ethiopia. Undergraduate female students were included in the study. A 14-item self-administered questionnaire was then provided to each of the participants to measure their level of knowledge and awareness about cervical cancer and HPV. Results: A total of 267 female students participated in the study (mean age 20.58 ± 1.22). More than half of the participants (59.6%) did not know the main cause of cervical cancer, whereas just about a fifth of them (19.5%) identified HPV as the main cause of cervical cancer. As high as 83.9% of the participants did not know other causes of cervical cancer. Binary logistic analysis revealed that students from midwifery (adjusted odds ratios [AOR] = 14.14, P < 0.05), anesthesiology (AOR = 9.66, P < 0.05) and medicine (AOR = 5.84, P < 0.05) departments were associated with knowledge of the main cause of cervical cancer. Conclusions: Knowledge about cervical cancer and its causes were found to be inadequate among higher education female students. Hence, awareness about cervical cancer, causes and its prevention, importance of screening and vaccination should be promoted through university's campaign, curricular changes, and community and research projects.

Background: The amount and type of dietary protein affect glucose metabolism. However, the association between dietary protein intake and gestational diabetes mellitus (GDM) risk is vague. We examined this association. Methods: We included 152 GDM and 168 non-GDM participants (total 320), age 18–45 years from Arash Women's Hospital, Tehran, Iran. Protein intake was ascertained from 168-item Food Frequency Questionnaire at 24–40 weeks' gestation. GDM was defined as fasting blood sugar >95 mg/dL and/or oral glucose tolerance test >155 mg/dL. Dietary data were assessed using N4 software and statistical analysis was performed using SPSS 21. We tested the association between the amount of protein consumed from red and processed meat, poultry, dairy, egg, seafood, and vegetable plus sociodemographic and lifestyle covariates and GDM risk using multivariate logistic regression analysis. Results: There was a significant association between the physical activity (P < 0.035), socioeconomic status (P < 0.013), body mass index, age, and each trimester's weight (P < 0.001), and risk of GDM. No significant association was observed between the intake of protein from major protein sources and risk of GDM. The only significant association was observed for egg consumption which was lower in GDM participants (P = 0.004), yet this association turned nonsignificant after adjustment for confounders, except for the fourth quartile (odds ratio: 0.43, 95% confidence interval: 0.208, 0.893). Conclusions: According to our findings, dietary intake of total and major protein sources could not affect the GDM risk. Differences between Iranian and Western population and the reverse causality might be the main reasons for this nonsignifi cant association.

Background: Avoiding hyperoxia with oxygen saturation monitoring is important in the follow-up of very low birth weight (VLBW) infants. Role of oxygen-derived free radicals in the pathogenesis of necrotizing enterocolitis (NEC) has been well defined. However, a great majority of the evidence supporting the role of hyperoxia in NEC development are data from experimental studies and there are very few clinical studies. In this study, the association between NEC and average oxygen saturation (SpO₂) levels in VLBW infants was researched. Methods: Average SpO₂values of VLBW infants in the last 24 h were recorded prospectively with pulse oximeter. Average SpO₂records were continued at least for 10 days starting from the first day after birth. In the follow-up, the average SpO₂values of the patients who developed NEC and those who did not were compared. Results: A total of 127 VLBW infants were followed up. Thirteen patients developed NEC (Bell's classification ≥ stage II). No differences were found between the average SpO₂levels (94.9 and 94.8%) of the patients who developed NEC and those who did not. It was found that average SpO₂ value higher than 93 or 95 was not a risk for NEC development (P = 0.693 and P = 0.771). Conclusions: In this study, no association was found between average SpO₂values recorded in the first weeks of VLBW infants and NEC.

Background: The neuroprotective effects of duloxetine and neurodegenerative effects of methamphetamine have been shown in previous studies, but their exact mechanism remain unclear. In the current study it involved molecular mechanisms of neuroprotective effects of duloxetine against methamphetamine induced neurodegeneration were clarified. Methods: About 40 adult male rats randomly were divided to 5 groups. Group 1 and 2, as control and methamphetamine treated, received normal saline and methamphetamine (10 mg/kg) respectively. Groups 3, 4 and 5 concurrently treated with methamphetamine and duloxetine at doses of 10, 20 and 30 mg/kg respectively. All treatments were undertaken for 21 days. On day 22 Open Field Test (OFT) were used to examine the level of motor activity disturbance and anxiety in animals. After that hippocampus was isolated from each rat and oxidative, antioxidant, inflammatory factors and also level or expression of total and phosphorylated forms of CREB and P-CREB and BDNF proteins were measured. Results: Duloxetine in all mentioned doses could inhibit the effects of methamphetamine induced motor activity disturbance in MWM. Chronic abuse of methamphetamine could increase malondialdehyde (MDA), tumor necrosis factor-Alpha (TNF-α) and interleukine-1beta (IL-1β) while caused decreases in superoxide dismutase (SOD), glutathione peroxidase (GPx) and glutathione reductase (GR) activities and decreased CREB (both forms) and BDNF proteins, while duloxetine could prevent these malicious effects of methamphetamine. Conclusions: We conclude that P-CREB/BDNF signaling pathways might have critical role in duloxetine neuroprotective effects against methamphetamine induced neurodegeneration.

Background: The aim of this study was to assess the effects of long-term exposure to VOCs on employees' clinical parameters in one of the main petroleum centers in Iran. Methods: In this case-control study, 80 operational and administrative employees with 8–15 years of work experience were considered as the case and control groups. Liver function was evaluated by measuring serum alanine transaminase (ALT) activity and lipid profile was measured. Gas chromatography-mass spectrometry (GC-MS) was used to analyze the VOCs levels at the workplace. Results: There were increased levels of serum ALT (P = 0.003), triglycerides (P = 0.015), total cholesterol (P = 0.003), and LDL-C (P = 0.010) among the operational staffs compared to the administrative staffs. Assessment of the relationship between worksite pollutants and ALT levels revealed that there were significant positive relationship between benzene (r = 0.45, P = 0.004) and styrene (r = 0.37, P = 0.034) with increased ALT concentrations. Conclusions: VOC exposure could be contributed to reduced liver function and impaired lipid profile. Therefore, proper preventive strategies seem to be necessary for reducing hazardous exposure.

Background: Urinary tract infection (UTI) is the most common infection during childhood. Lower urinary tract dysfunction (LUTD) is a broad term that indicates an abnormal voiding pattern in a child without anatomical and neurological impairment. The purpose of this study was to determine the relationship between UTI and LUTD. Methods: This study was conducted at the Children Medical Center Hospital in 2014–2016. The inclusion criteria of this study were at least one UTI confirmed by a positive urine culture and active urine analysis in children who were well toilet-trained previously. Complete physical examination of the genitourinary and skeletal systems was performed to identify patients with anomalies in these systems. The patients with genitourinary system anomalies and obvious and prediagnosed neurological defects of the urinary system such as neurogenic bladder were excluded from the study. To confirm the presence of LUTD, the scoring system of Akbal et al. was applied. Results: A total of 260 patients including 9.2% of males and 90.8% of females were included in this study. The prevalence of LUTD was 63.8% (166 cases) in these patients. In this study, the prevalence of LUTD in patients with a single episode of UTI was 50.5%, while in patients with recurrence of UTI it was 88.9%. In patients with unilateral kidney scar formation, 90.9% had a recurrence of UTI (P = 0.003) which shows a strong correlation of unilateral scar formation with recurrence of UTI. Conclusions: These data suggest that there is a significant relationship between UTI and LUTD in children, so evaluation of voiding dysfunction is necessary in this group. With early diagnosis and appropriate treatment, we can reduce the possible serious and permanent sequels of LUTD in patients with UTIs.

Background: Nutrient deficiency such as antioxidants is a common problem in the elderly; it can result in different diseases such as cancer. Accordingly, assessment of the dietary intake of antioxidants is necessary to design a specific plan for solving this problem. Methods: This case–control study was conducted on 152 old people (≥60 years) with and without nursing care in nursing care centers in Isfahan, Iran, in 2017. Nutritional assessment was performed by an expert nutritionist using semi-quantitative validated Food Frequency Questionnaire. Nutrition IV software was used as food analyzer. Analysis of covariance and independent t-test were used for data analysis. Results: The mean age of the participants was 68.6 ± 4.9 and 68.9 ± 6.1 years in case and control groups, respectively, and the percentage of male/females in these groups was 46.3%/53.7% and 51.4%/48.6%, respectively. Dietary intake of energy, vitamin E, and selenium was significantly higher (P = 0.041; 0.007; 0.017) while beta-carotene intake was significantly lower in the elderly under nursing care than in the control (P = 0.002). Conclusions: The findings indicated that nursing care leads to improved intake of energy, vitamin E, and selenium, while diminished beta-carotene intake in the elderly. Intake of vitamin E, A, C, zinc, and selenium was high among elderly people with and without care, compared with the dietary reference intake. It seems that further studies are required to confirm these findings.

Background: Inflammatory bowel disease (IBD) incidence has been increased in Iran as a developing country. Surveillance is a standard method for accessing valid data about disease epidemiology to make relevant decisions for disease control, prevention, and management. We designed Isfahan IBD Surveillance Project (IISP) to make a surveillance system in this area. Methods: The project is designed in 3 phases. At the first phase, a model of step-wise approach (core, expanded core, and optional variables) for IBD surveillance was designed and implemented among IBD patients registered at a major referral gastrointestinal diseases clinic in Isfahan. Data bank program and its software were designed with suitable and multifunctional features. A total of 352 IBD cases were registered to data bank and analyzed as a pilot study of IISP. Results: A total of 352 IBD patients, including 245 ulcerative colitis (UC), 80 Crohn's disease (CD), and 27 indeterminate colitis, were registered to the data bank. Bloody stool and abdominal cramp were the most common presentation symptom among UC and CD, respectively. Extensive pancolitis was the most prevalent phenotype (40%) of UC. Over two-thirds of our IBD patients were in remission states. Biologic agents had been prescribed in about 10% of patients during disease. Primary sclerosing cholangitis was detected in about 7% and 10% of CD and UC patients, respectively. Conclusions: Valid data from a standard surveillance system are a relevant, trustworthy tool for making decision by health policy-makers. Integrated comprehensive interventional programs for disease control and management is the second phase of IISP.

Introduction: Childhood obesity has become a global endemic public health problem. Emotional distress has been proposed to be a strong mediator of unhealthy lifestyle behaviors among youth. The aim of this study was to explore the sources and role of stress on developing unhealthy lifestyle practices pertaining to diet and physical activity among overweight and obese adolescents. Methods: This qualitative study was conducted in 2016–2017 in two large cities of Iran, Mashhad and Isfahan. Fifty-two overweight and obese adolescents were selected through purposeful sampling. In-depth semi-structured interviews and focus group discussions were conducted to obtain perceptions and experiences regarding underlying factors of obesity and the sources and role of stress in inducing unhealthy lifestyle. Ten parents were also interviewed. Data were analyzed using conventional content analysis with MAXQDA software. Study rigor was verified using criteria proposed by Lincoln and Guba. Results: After analyzing the data, two main categories which triggered emotional overeating and physical inactivity among adolescents were: “school originated stress” and “family originated stress.” Three subcategories of school originated stress were “Too much homework,” “Frequent exams” and “Priority for studying at both school and home” and family originated stress subcategories were “Parental destructive conflicts,” “Divorce” and “Socio-familial issues.” Conclusions: Our findings highlighted the sources and role of stress in emerging unhealthy lifestyle practices including emotional overeating and physical inactivity among adolescents which could lead to weight gain. Therefore, to improve lifestyle behaviors of students and prevent childhood obesity, addressing school, and family stressors is a crucial subject.

Background: Associations between smoking and health-related quality of life (HRQoL) in the general population remain unclear. The aim of the study was to quantify the independent associations between smoking and HRQoL. Methods: A cross-sectional population-based study was conducted on a total sample of 2197 participants obtained by multistage sampling to investigate the associations between smoking and HRQoL in the general population of southeast and southwest of Iran, aged 18–100 years in 2012–2013. Data were collected using a self-administrated of the 36-Item Short Form Survey (SF-36) questionnaire. Linear regression analyses were used to evaluate the associations between HRQoL and smoking while adjusting for various socioeconomic variables. In this study, P < 0.05 was considered a significant difference. Results: Out of the total of 2197 participants, current smokers and never smokers accounted for 13% and 87%, respectively. The mean HRQoL indices were for the current smokers 66.66 ± 17.86, and never smokers 71.35 ± 18.47 (P < 0.001). Independent associations between smoking and HRQoL were found, including negative associations (P < 0.001). The multivariate associations between smoking status and HRQoL, male smokers had a lower physical functioning, mental health, and total SF-36 score. Conclusions: Smoking was independently related to HRQoL, with large differences according to the gender. This study showed that there is a significant difference in the quality of life related to health in male smokers compared to male nonsmokers.

Background: Polycystic ovary syndrome (PCOS) is a polygenic endocrine disorder in women of reproductive ages which will lead to infertility. This study is aimed to determine changes in levels of hyperandrogenism, hirsutism and menstrual regulation after a period of aquatic high intensity interval training (AHIIT) in women with PCOS. Methods: Thirty patients with PCOS having age between 20 and 35 and body mass index (BMI) ≥30 kg/m² in obstetrics and gynaecology clinics in Isfahan were selected based on Rotterdam Diagnostic Criteria. They were randomly divided into experimental (AHIIT + metformin, N = 15) and control groups (metformin, N = 15). The exercises were done for 12 weeks, three sessions of 20 minutes. Metformin (1500 mg) was taken daily for 3 consecutive days for 12 weeks. Kolmogorov–Smirnov test, t-test, Covariance and Wilcoxon were applied (P value < 0.05). Results: After 12 weeks, no significant difference was observed in waist-to-hip ratio (WHR), but in AHIIT, the BMI and fat mass significantly decreased and levels of follicle-stimulating hormone (FSH), free testosterone (FT) and sex hormone binding globulin (SHBG) increased compared to control group (P < 0.05). While levels of improvement of total testosterone (TT), dehydroepiandrosterone sulphate (DHEAS), FT, luteinising hormone (LH) and free androgen index (FAI) were not significant between the two groups (P > 0.05). Furthermore, there was a significant decrease in homeostatic assessment of insulin resistance (HOMA-IR) and hirsutism severity in experimental group (P < 0.05). In both groups, the order of menstrual cycles improved significantly (P < 0.05). Conclusions: Doing AHIIT besides drug therapy can be effective for PCOS patients.

Background: The growing supply and prevalence of waterpipe (WP) smoking among Iranian adolescents have become a concern for both families and policymakers. The aim of this study was to determine the factors underlying WP use and also to design an intervention program based on social cognitive theory (SCT) aimed to reduce the demand for WP smoking among male adolescents. Methods: This quasi-experimental study involved 189 high-school students in Kerman, Iran, who were split into two groups, an intervention group and a control group. A validated questionnaire based on SCT constructs was used to collect data. The intervention was performed over four sessions with a focus on preventing WP smoking. Results: Before intervention, the lifetime and current-use prevalence of WP smoking across both groups was 48.5% and 20.2%, respectively. In the intervention group, the most change was related to knowledge score from 10.70 ± 4.38 to 16.52 ± 3.89 (P < 0.0001) and outcome values score from 12.40 ± 3.81 to 13.53 ± 4.23 (P = 0.007); however, in the control group, no significant changes were seen in posttest scores. The scores for self-efficacy (P = 0.21), outcome expectations (P = 0.09), and environment constructs (P = 0.06) did not show any statistically significant changes after the intervention in both groups. Overall, there was no significant difference in the rate of WP smoking after the intervention. Conclusions: Based on the results of this study, although some construct scores showed significant differences after the intervention, there was no significant change in the prevalence of WP smoking. More effective educational interventions based on this theory but with a greater focus on self-efficacy and environmental influences may be warranted.

Background: Depression and obesity are among the increasingly publicized health problems, both being related to critical complications, and increasing the risk of substantial morbidity and mortality. An increasing number of documents indicate that obesity affects mental status, low serum cholesterol levels, and is related to depressive symptoms. The purpose of the present study was to evaluate the possible significant difference in lipid profile levels, body mass index (BMI), waist circumference (WC), and blood pressure (BP), between depressive and nondepressive older adults. Methods: This was a case–control study where 107 patients, over 65-year-old, were enrolled in this study. Serum total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol (LDL-C), triglycerides (TG), BP, and fasting blood sugar were measured. Data were analyzed using the statistical SPSS software version 22. Independent t-test was used to compare the results between the two groups and the Chi-square test was used to compare categorical variables. In addition, nonparametric Mann–Whitney test was used to evaluate the data. Results: The depressive group showed significant lower BMI, WC, LDL-C, and TG (P < 0.001, P < 0.001,P < 0.016, and P < 0.014). Furthermore, the findings showed significantly higher systolic and diastolic BP in participants who had shown depressive symptoms (P < 0.035 and P < 0.024). Conclusions: The findings suggest that a low BMI, serum LDL-C, and TG are related to depressive symptoms the Iranian elderly.

Background: Health literacy is a major factor for health promotion and well-being. In spite of several researches on health literacy, information on the subject of the status of health literacy in Asian countries such as Iran is inadequate. Therefore, this study aimed to assess the inequality of health literacy in an Iranian population and its influencing factors. Methods: In this cross-sectional study, 736 families were selected by cluster random sampling. A validated questionnaire was used to measure the health literacy of participants. Socioeconomic status (SES) was calculated by asset-based approach, and principal component analysis (PCA) was performed to estimate the families' SES. Concentration index and curve were used to measure SES inequality in health literacy, and after that decomposed into its determinants. The data were analyzed by Stata software. Results: The mean age of the participants was 34.81 years (standard deviation = 5.98 years). The value of concentration index for health literacy equals 0.2292 (95% confidence interval = 0.168–0.283), and this value indicates that there is inequality in distribution of health literacy in Iran and the inequality disfavors the poor. Conclusions: The results of this study revealed that there is inequality in distribution of health literacy in Iran, and people of higher economic status in Iran enjoy from better health literacy levels.

Background: To test whether gender moderates the effects of baseline depressive symptoms and chronic medical conditions (CMCs) on risk of receiving subsequent psychiatric diagnosis among older adults. Methods: Data came from ten waves of the Health and Retirement Study, a nationally representative longitudinal study. We followed 9794 individuals older than 52 years without any diagnosed psychiatric disorder at baseline for up to 18 years. Baseline depressive symptoms and CMC were the predictors, time to receiving an emotional diagnosis was the outcome, baseline demographics and socioeconomics were controls, and gender was the moderator. We used Cox proportional hazards models for data analysis. Results: In the pooled sample, female gender increased the effect of baseline depressive symptoms (hazard ratio [HR], 1.58; 95% confidence interval [CI], 1.26–2.00) and reduced the effect of baseline CMC (HR, 0.78; 95% CI, 0.63–0.97) on time to receiving a psychiatric diagnosis. Among men, baseline depressive symptoms (HR, 2.36; 95% CI, 1.87–2.97) increased and baseline CMC (HR, 0.81; 95% CI, 0.69–0.95) decreased time to receiving a psychiatric diagnosis. Among women, depressive symptoms (HR, 1.49; 95% CI, 1.21–1.83) but not CMC (HR, 1.06; 95% CI, 0.91–1.23) were associated with time to receiving a psychiatric diagnosis over time. Conclusions: Men and women differ in how depressive symptoms and CMC influence their risk of receiving a psychiatric diagnosis over time. Depressive symptoms are more salient promotor for men than women while CMC is only a barrier for men.

Introduction: Cisplatin is a widely used anti-cancer drug that is commonly administered for the treatment of various cancers. However, nephrotoxicity is the most important side effect of this drug which limits its use. This study aimed to investigate the protective effect of Cystone against nephrotoxicity induced by Cisplatin in patients with cancer. Methods: This pilot clinical trial study was conducted on 43 cancer patients treated with Cisplatin (75 mg/m2 for a period of six months). The subjects were divided into treatment group (receiving Cystone, two per 8 hours; n = 21) and control group (n = 22). The two groups were compared with each other in terms of demographic and laboratory variables. Results: In the intervention group receiving Cystone, serum creatinine-based GFR level (P = 0.453) and 24-hour urine creatinine-based GFR level (P = 0.397) did not change significantly during the studied period, but in the control group, serum creatinine-based GFR level (P = 0.013) and 24-hour urine creatinine-based GFR level (P = 0.016) significantly changed. Serum creatinine-based GFR level increased by 2.3 units in the intervention group and 10.5 units in the control group (P = 0.005) in the six months of the study. At the end of the sixth month, 24-hour urine creatinine-based GFR level increased by 2.2 units in the intervention group and 0.8 unit in the control group (P = 0.008). Conclusions: The use of Cystone resulted in more stable kidney function indices in the intervention group, as compared with the control group. Therefore, Cystone seems to have a protective effect against nephrotoxicity induced by Cisplatin in cancer patients.

Background: Trichomoniasis is a common sexually transmitted disease that is caused by infection with protozoan parasite called Trichomonasvaginalis. Metronidazole is the drug of choice for the treatment of this infection. In this study, design, formulation, and physicochemical evaluation of vaginal cream containing Eucalyptus camaldulensis, Viola odorata, and Mentha piperita extracts for the prevention and treatment of trichomoniasis has been investigated. Methods: Ethyl acetate extract of E. camaldulensis leaves, water fraction of V. odorata root, and hydroalcoholic extract of M. piperita leaves was prepared and used for anti-trichomonas experiments. Then, based on results, different formulations of vaginal cream containing mixed extracts were prepared and physicochemical evaluation was conducted. In the next step, anti-trichomonas effect of selective formulation was tested in vitro. Results: The mixed concentrates containing 2.5 mg/ml E. camaldulensis, 0.06 mg/ml V. odorata, and 1 mg/ml M. piperita showed 100% growth inhibition (GI) during 24 h. Furthermore, the mixture containing 1.25 mg/ml E. camaldulensis, 0.03 mg/ml V. odorata, and 0.5 mg/ml M. piperita showed 92% GI in the first 24 h. The selective formulation passed all of physicochemical test and also showed 100% GI for in vitro anti-trichomonas experiments in the first 24 h. Conclusions: The mixed concentrates containing 2.5 mg/ml E. camaldulensis, 0.06 mg/ml of V. odorata, and 1 mg/ml of M. piperita are the mixture which showed the highest percentage of GI (100%) after 24 h. The selective formulation of vaginal cream containing this mixture of extracts was detected 100% GI in the first 24 h.

Background: Anabolic-androgenic steroids (AASs), when taken in supraphysiologic doses, increase muscle strength and athletic performance. Evidence suggests that long-term use of AAS in supraphysiologic doses have adverse effects on health. Therefore, the study was conducted to find crude estimate of the prevalence of AAS use among attendees of the gymnasium, the factors that could have influenced them for AAS abuse and to assess the short- and long-term side effects as perceived by them. Methods: A cross-sectional study was conducted in selected gymnasiums of a smart city of India using a predesigned and pretested questionnaire. Snowball sampling method was undertaken. The study was from July 2015 to June 2016. Informed written consent was taken. The analysis was done using SPSS v. 20.0. Results: Of 84 bodybuilders approached, 74 participants used AAS. All users were male with mean age of 26.5 + 0.55 years. The mean age of initiation of AAS abuse was 23 years, and 66.2% (49) were unmarried. Eighty-five percent (63) preferred injectable. Seventy percent (52) abusers were influenced by trainers for abuse. Most commonly abused was Nandrolone decanoate (55.4%). Seventy-three percent were not aware of any legal ban on steroids. Reported benefits include increased strength, muscle size, and power, while harms were increased acne, deepening of voice, swelling of feet, increased irritability, depressive thoughts, impaired judgment, panic disorder, and withdrawal effect. Conclusions: Frequency of ASS use was substantial among young bodybuilders. Awareness about side effects was not a deterrent factor. Abusers were highly influenced by coaches. Efforts should be made for preventing easy access to AAS.

Background: Diagnosis of prediabetic stage is very important for prevention of diabetes and complications. This stage may be associated with some oral lesions. Only a few studies are available on the oral status of prediabetic patients and incidence of oral lesions in this population. This study aimed to compare some oral complications between prediabetic and healthy control groups. Methods: The present two-group cross-sectional study was carried out on 302 prediabetic and non-diabetic (healthy) 20- to 60-year-old subjects. In this study, data on age, gender, educational level, medications use, smoking, and some other variables were extracted through history taking. In addition, orodental examination was carried out by an oral medicine specialist to diagnose oral lesions including candidiasis, lichen planus, periodontitis, gingivitis, xerostomia, delayed wound healing, geographic tongue, fissured tongue, and burning mouth sensation. Data entry and analysis was performed by SPSS version 22 software, and P value and odds ratio (OR) were calculated to show statistical relationship between variables. Results: The most common oral lesion in prediabetic subjects was periodontitis (27.2%), followed by gingivitis (14.7%) and xerostomia (11.3%). In the control group, gingivitis (20.5%) followed by periodontitis (11.3%) are common oral lesions. Candidiasis (P = 0.036), periodontitis (P < 0.001), and xerostomia (P < 0.001) in prediabetic subjects were higher than control group that is statistically significant. Regression analysis showed that in the prediabetic group, periodontitis [OR = 2.91, confidence interval (CI): 1.54–5.49] and xerostomia (OR = 18.51, CI = 2.42–141.45) were significantly more prevalent than healthy subjects. Conclusion: Based on the results, glucose intolerance stage exhibited a significantly higher oral problems such as periodontitis and xerostomia than healthy euglycemic stage.

Background: We investigated the effect of thioctic acid (TA) on kidney function, oxidative stress, and inflammatory status in serum and kidney homogenates of a rat subjected to ischemia–reperfusion injury (IRI). Materials and Methods: Thirty male Wistar rats were randomly divided into three equal groups: sham, IR, and IR + TA in 50 mg/kg once-daily intraperitoneal injection for 2 weeks, before IR induction. The levels of urea and creatinine (Cr) in the serum of rats were measured. Malondialdehyde and nitric oxide (NO) as stress oxidative markers; tumor necrosis factor-α, interleukin-6, and myeloperoxidase as inflammatory markers, as well as activities of superoxide dismutase, glutathione peroxidase and catalase, and glutathione (GSH) level in both serum and kidney homogenates were determined. Results: Cr and urea increased in serum of IR group. Furthermore, levels of oxidative stress and inflammatory markers in serum and kidney homogenates of the cited group were higher than the sham group. TA not only decreased the levels of Cr, urea, oxidative stress, and inflammation but also elevated the level of GSH and activities of antioxidant enzymes (P < 0.001). Conclusions: The findings showed that TA protected IR rat against kidney dysfunction and IRI due to reinforcing endogenous antioxidant and subtracting of inflammatory markers.

Background: Incidence and prevalence of type 2 diabetes are one of the major challenges of Iran health system. Despite policies on diabetes prevention and control, Iran is faced with many problems in prevention and control of this disease at the executive level. This study seeks to identify the problems of Type 2 diabetes prevention and control program in Iran. Methods: In this qualitative study, 17 participants were interviewed purposefully. The semi-structured interview guide was designed based on literature review and four initial in-depth interviews. Framework analysis method was used for the analysis of qualitative data. Results: Six themes and 29 subthemes explaining the problems of type 2 diabetes prevention and control program were identified: Referral system, human resources, infrastructure, cultural problems, access, and intersectoral coordination issues. Conclusions: Despite the well-developed policy of type 2 diabetes prevention and control, the implementation is faced with some problems which endangers the effectiveness of the plan. Any attempt to improve the successful implementation of the type 2 diabetes prevention and control program requires effective measures, deep understanding of the problems and solving them.

Background: The aim is to determine the incidence rate of unintentional injuries and its associated factors and determine the pattern of these injuries among laboratory staff in three reference laboratories in Sana'a, Yemen. Methods: A cross-sectional study was conducted among laboratory staff in the three reference laboratories in Sana'a, Yemen. A pretested structured questionnaire was used to collect data on the unintentional injuries during the past 12 months including the type of injury. Results: A total of 93 technicians responded and filled the questionnaires. Of the 93 technicians, 51 (54.8%) technicians reported that they had been injured in the past 12 months. Of all injuries, 38% of technicians were caused by needle sticks, 21% by sharp materials other than needles, 15% by hot materials, 15% by exposure to chemicals, and 11% of them by other exposures. Only 18% of injuries were reported to safety officer in the laboratory. Those who had an experience of <5 years were more likely to experience injury in the past 12 months than those who had 5 years of experience or more (odds ratio = 8.3; 95% confidence interval: 2.2, 27.4; P < 0.005). Conclusions: About half of laboratory technicians in Yemen reported that they had been injured in the past 12 months, with the needle stick being the most common cause of injury. Therefore, there is a need for targeted interventions to laboratory technicians to increase their awareness on the risk of injuries in the laboratory. Bio-safety training among laboratory technicians deemed very necessary.

Introduction: Child nutrition status is very important in all societies, which is influenced by the interaction of multiple factors including food security and socioeconomic status in both genders. The aim of this study was to examine the relationship between food security and socioeconomic status with anthropometric indices among 2–5-year-old urban children in eight different cities in Iran. Materials and Methods: In this cross-sectional study, anthropometric Z scores of 7028 children of urban area were measured by using World Health Organization (WHO) Anthro software based on WHO 2007 standards. Family food security was assessed by using HFIAS 9-item questionnaire. Socioeconomic status as well as health factors were analyzed using the SPSS. Results: Based on the present study, significant correlation was observed between sleep time, birth weight, and food security (P < 0.05) with body mass index (BMI), while the rest of the variables including age, family size, number of children, parents' education, breastfeeding duration, watching TV, playing computer games, playing outdoors, number of main eating, and number of snacks showed no significant relation (P > 0.05). Conclusion: It was shown that 2–5 years old children's life are the most vital and vulnerable to the hazards of undernutrition or overweight and obesity, which could affect the whole health of the person. As food security affects BMI, it is important to focus more on this issue in order to improve child's health status.

Background: Delay in diagnosis of diabetes mellitus (DM) in older adults is more catastrophic than other age groups. This study investigated the prevalence of pre-diabetes, DM, and glycemic control in the elderly. Methods: In this cross-sectional study, a sample of 412 older adults >60 years from Shiraz, Iran, were recruited through a multistage cluster random sampling. Demographic, clinical, and laboratory information were collected by interview, physical examination, and reviewing the medical records. Data were analyzed using SPSS 20. Results: Mean age was 68.1 ± 6.2 years and female-to-male ratio was 1.1. Out of all, 137 (33.2%) were diagnosed as diabetic including 128 (31%) as known cases and 9 (2.2%) as new cases of DM, whereas 275 (66.7%) were diagnosed as new cases of pre-diabetes. Multivariable analysis showed that low level of education (OR = 5.2, 95% CI: 1.5–16.6), hyperlipidemia (OR = 3.5, 95% CI: 2.1–5.8), liver disease (OR = 3.1, 95% CI: 1.4–6.9), and hypertension (HTN) (OR = 1.9, 95% CI: 1.1-3.2) were the most common predictors of DM in the elderly, respectively. Out of all diabetics, 33.6% had FBS >130 mg/dL and 25.5% had HbA1c >8%, whereas these figures were ≥100 mg/dL and ≥5.7% in 36.7% and 21.4% of pre-diabetics, respectively. Conclusions: The pre-diabetic elderly were mostly undiagnosed, while one-third to one-fourth of DMs had poor glycemic indices. These figures show the need for pre-diabetes and diabetes screening in the elderly, especially in those with low level of education, hyperlipidemia, liver disease, or HTN. Furthermore, regular monitoring of glycemic indices in the diabetic and pre-diabetic elderly is recommended.

Background: Based on the World Health Organization definition, mental health is the absence of mental disorders and presence of positive mental health (PMH). As the social determinants of mental disorders and PMH are not the same in different cultures and in order to promote community mental health, social determinants of PMH should be identified, which is the aim of this study. Methods: This was a qualitative study conducted in Tehran. Data were collected through eight focus group discussions with the general population aged between 30 and 60 years and ten semi-structured interviews with mental health professionals from Tehran. Data were analyzed through directional content analysis using Dedoose software. Results: Fifty-one lay people and ten mental health professionals participated in this study. The process of content analysis resulted in two main themes: (a) structural determinants of PMH which consist of socioeconomic and political context and socioeconomic position and (b) intermediary determinants of PMH which consist of working condition, living condition, family factors, lifestyle, psychosocial factors, and health system. Conclusions: Improvement of living conditions, with emphasis on working conditions as one of the intermediary social determinants, will play an important role in promoting PMH.

Background: The aim was to determine validity, reliability, and cutoff of full-mini nutritional assessment (MNA) and MNA-short form (SF) also which one was better for the screening of malnutrition in the Iranian hospitalized elderly. Methods: In this cross-sectional validation study, 96 hospitalized elderly ≥60 years selected from two hospitals in Tehran. Anthropometric measures (body mass index [BMI], mid-arm circumference [MAC], calf circumference [CC], abdomen, and waist skinfold thickness) and laboratory tests (albumin and hemoglobin levels, and red blood cell count were performed. Nutrition tools (full-MNA and MNA-SF), cognition tool (mini-mental state examination, depression scale (Geriatric Depression Scale15 and activities of daily living (ADL) index (Modified Barthel-ADL) were administered. Results: The full-MNA scores were significantly correlated to measures of MAC, BMI, waist, and CC. The MNS-SF scores were significantly related to measures of MAC, waist, and CC. Serum albumin showed a poor correlation with both tools. At cutoff 24 in full-MNA had a sensitivity 75% and specificity 77.8% and the MNA-SF considered 62.5% sensitivity and 65.3% specificity at cutoff 10.50 to detect well-nourished from malnourished subjects. The internal consistencies of both tools were >90%. In exploratory factor analysis, six components found for full-MNA and two components for MNA-SF. Known group validity of full-MNA was reflected significant differences between geriatric patients with expected higher full-MNA scores and patients with expected lower scores (BMI ≥24 vs. BMI <24 or bed ulcer or assisted food intake). Conclusions: It seems the Persian version of full-MNA is more appropriate in comparison to MNA-SF for screening malnutrition in the Iranian hospitalized elderly patients.

Background: Since women's readiness for dietary behavioral change can be one of the most effective fundamental measures for reducing dietary salt intake in line with preventing chronic diseases in developing countries, the present study is aimed to determine the readiness for behavioral change in discretionary salt intake among women living in Tehran. Methods: The present cross-sectional study was conducted on 561 women referring to the women care units across city of Tehran. The self-administered questionnaire included assessment of nutrition-related knowledge on salt intake and its association with diseases, discretionary salt intake, stages of change, and self-efficacy of women. In addition, the logistic regression test was used to determine the predictors of women's readiness for behavioral change in discretionary salt intake. Results: 40% women had someone in the family who had such a limitation (salt intake-limited exposure group), while 81.6% always or often added salt to their foods. Moreover, one-third of the participants were in the stage of pre-contemplation and 41.2% were in the stage of preparation for reducing salt intake. Self-efficacy and salt intake-limited exposure were the two most important determinants of the women's readiness for behavioral change in discretionary salt intake, respectively: (OR = 1.1 95% CI: 1.06--1.14 P < 0.001; OR = 1.58, 95% CI: 1.03--2.42 P < 0.03). Conclusions: Results of the present study showed that increased self-efficacy is associated with higher levels of behavioral change among women. Since self-efficacy is very important for initiating and maintaining the behavioral change, women's empowerment for reducing salt intake necessitates putting the emphasis on increased self-efficacy as well as community-based nutritional interventions.

Background: The aim of this study was to compare the PID with bare skin (without PID) regarding bacterial recolonization and bacterial regrowth of the adjacent skin of surgical incision in lumbar spine surgery patients. Methods: This quasi-experimental study was conducted from February to May 2018 on 88 patients who were candidate for lumbar spine surgery. Patients were assigned to one of two groups, treatment (with PID) and control (without PID). Skin sampling (adjacent of surgical incision) for bacterial culture was done in two steps, immediately after surgical skin prep (IASSP) and immediately after surgical wound closure (IASWC) by researcher. Finally, samples were sent to the laboratory. Results: The mean total bacterial count of patient's skin in stage IASSP was not significantly different between treatment and control groups (0.34 vs 0.27, P = 0.68). However, mean total bacterial count in stage IASWC in treatment group was significantly higher than control group (2.2 vs 0.93, P = 0.03). The frequency distribution of S. aureus (P = 0.04) and S. epidermidis (P = 0.02) was significantly higher in treatment group compared with control group in stage IASWC. Conclusions: The results showed that using PID is unable to reduce recolonization and regrowth of bacteria on patients' skin adjacent to surgical wound in clean lumbar spine surgeries. However, making a definite decision about using or not using of PID requires further studies.

Background: The incidence of breast cancer is on rise in low- and middle-income countries as populations increasingly adopt western lifestyles. Studies on risk factors of cancers including breast cancer are lacking in Yemen. Therefore, this study aimed to determine the risk factors of breast cancer among women registered at Hadramout Valley and Desert Oncology Center (HVDOC). Methods: A case–control study was conducted at HVDOC, Yemen. All women who were registered in HVDOC and diagnosed with breast cancer and confirmed by histopathology during 2011–2015 were selected as cases. Age-matched controls were selected from women who underwent mammography in HVDOC during 2011–2015 and were confirmed to be free of breast cancer. Data were collected using semi-structured questionnaire and clinical data were abstracted from the medical records. Results: A total of 105 patients and 210 controls were included in this study. About 70.5% of cases and 72.4% of control were 50 years old or younger. Compared with married women, divorced women had higher odds of breast cancer [odds ratio (OR) = 2.2]. The odds of breast cancer was higher for women who had never breastfed a child (OR = 1.7). Having hypertension (OR = 2.5), family history of malignancy (OR = 2.4), and postmenopausal status (OR = 2.0) were significantly associated with higher odds of breast cancer in multivariate analysis. Conclusions: The main risk factors for breast cancer among women in Yemen are divorced marital status, never breastfed a child, having hypertension, family history of malignancy, and postmenopause. Regular screening especially among women with high risk is needed.

Background: Disposal and release of plastic bags in the environment can cause environmental, economic, and social problems. The aim of this study was to explore the determinants of the behavior of plastic bag use (BPBU) among residents using socioecological approach (SEA). Methods: In this cross-sectional study, multistage random sampling was employed to enroll 400 residents in Hadishahr County, North West of Iran. A valid and reliable instrument based on SEA variables was used. Results: Hierarchical multiple linear regressions were performed with SEA and BPBU as outcome variables. Predictors of outcome variables were classified into four different blocks. Demographic characteristics and SEA constructs explained 50% of the observed variance in BPBU. In the first block, age (P = 0.03) and purchase frequency (P = 0.902) were significant predictors of BPBU (R² = 0.34), and in the third block, access to alternatives in environment (P = 0.01) was significant predictor for BPBU (R² = 0.49). The majority of residents (47%) were taking home 6 to 10 plastic bags and more than 10 freezer bags after their shopping per week. Conclusions: Health-care providers may consider purchase frequency and SEA as a framework for developing educational, environmental, and social interventions aiming at reducing the consumption of plastic bags.

Background: Overweight, obesity, and underweight are common child health problems in Iran. Child-feeding practices are one of the major factors affecting children's weight through eating behavior and dietary intake. The Comprehensive Feeding Practices Questionnaire (CFPQ), a 49-item measure comprising 12 subscales, assesses parental child-feeding practices. It is used to determine factors that may affect the development of overweight, obesity, and underweight and therefore, helps us plan appropriate preventive action. The aim of this study was to revise and adapt CFPQ to be used for 2–5-year-old children. Methods: This study including, 300 mothers selected by simple systematic random sampling, was conducted in the rural and urban areas of Birjand city, Iran. Health workers interviewed the mothers and completed questionnaire according to the standard protocol. Exploratory factor analysis (EFA), tests for internal consistency, and test–retest reliability were conducted. Results: EFA resulted in a final questionnaire with 39 items distributed over seven factors, including Healthy Eating Guidance, Modeling, Parent Pressure, Monitoring, Emotion Regulation, Child Control, and Restriction. The internal consistency reliability for the proposal scales was acceptable for five out of the seven factors and all of the seven factors demonstrated excellent test–retest reliability. Conclusions: The revised CFPQ is a valid tool for determining the various aspects of parental feeding practices aiming to prevent overweight, obesity, and underweight among 2–5-year-old children.

Background: Primary healthcare system in Iran has played an extensive role in promoting people health in the past decades. However, regarding universal developments in the different global aspects effective on health, the performance of this system has been influenced significantly. The aim of the present research is to identify the future trends of the primary health care in Iran. Methods: The participants of this qualitative case study were experts in primary healthcare, which were selected and interviewed through purposive sampling method. The interview process was saturated after 25 interviews, so we stopped the process at this point. Framework analysis based on STEEP model used to analysis the interviews. Results: The most important social/value, technological, economic, environmental, and political future trends of primary healthcare in Iran included demographic transition, epidemiological transition, social and cultural changes, emergence of modern and advanced technologies, internet and cyberspace, budgeting limitations, resource management, changing paradigm from volume to value in providing health services, environmental pollutions, natural disasters, health governance, intellectual paradigm of senior officials, regional security, international development, and other internal factors of the health system. Conclusions: The identified factors can be turned into opportunities for Iran primary healthcare system if health planners and policymakers have a deep and accurate look at these influential factors and manage them properly.

Background: Osteoporosis and obesity are two major public health problems worldwide. Considering the conflicting results about the association between anthropometric measurement and bone mineral density (BMD) and also differences between various races, this study was designed to examine the relationship between anthropometric measurements and BMD in a sample of Iranian adults. Methods: This cross-sectional population-based study was conducted on 2625 Iranian adults aged 18 and above who were selected using multistage, cluster sampling method from Sanandaj and Arak (two cities of Iran). The evaluated variables included age, sex, height, weight, body mass index (BMI), BMD, and waist and hip circumferences. The correlations between anthropometric measures and BMD in three bone areas (total hip, femoral neck, and spine) were observed in four sex/age groups (men <50 years, men ≥50 years, and pre- and postmenopausal women). Results: Of all the 2625 participants in the Iranian Multicenter Osteoporosis Study, 2022 (1303 women and 719 men) entered into our survey and were stratified into four sex/age groups. According to the results, increasing BMI was directly associated with BMD increase, while an inverse association was observed between waist-to-hip ratio (WHR) and total hip BMD. In a similar analysis on the femoral neck and WHR, the correlation coefficients in premenopausal women and men ≥50 years were reported as being the highest and the lowest, respectively, among the four groups. Conclusions: Our results showed that high BMI is a protective factor (positive correlation), and high WHR is a risk factor for osteoporosis, although it should be reminded that we could not specifically define which factors including lean tissue mass, fat mass, and total weight are really affecting BMD increase in the overweight/obese participants.

Background: One of the most effective parameters in the progression of the prostate cancer is interleukin (IL)-6 through affecting pSTAT3, pERK1/2, and pAKT cell signaling proteins. Carvacrol is an herbal antioxidant with antitumor effects. The purpose of this study was to investigate the effects of carvacrol on IL-6 gene expression, pSTAT3, pAKT, pERK1/2 cellular signaling proteins, and invasion in human prostate cancer PC3 cells. Methods: PC3 cell viability was evaluated by MTT assay with different concentrations of carvacrol (0–800 μM). IL-6 gene expression and cellular concentration of pSTAT3, pERK1/2, and pAKT were investigated using the real-time reverse transcription quantitative polymerase chain reaction (RT-qPCR) and western blotting technic, respectively. PC3 cell invasion was determined by invasion assay test. Results: Carvacrol IC₅₀for PC3 prostate cancer cells was 360 μM. Carvacrol led to a significant reduction (P < 0.05) for IL-6 gene expression in a dose-dependent manner compared to control. IL-6 protein reduced 41.5% and 52.7% when compared with control cells at 360 and 420 μM of carvacrol, respectively. Carvacrol led to a decline in pSTAT3, pAKT, and pERK1/2 above 360 μM compared to control. PC3 potential invasion was significantly reduced after treatment with carvacrol in a dose-dependent manner. Conclusions: Decreased IL-6 protein level by carvacrol resulted in diminishing of pSTAT3, pERK1/2, and pAKT signaling proteins, which leads to the reduction of the cell survival, proliferation, and invasion in PC3 cells.

Background: To address the disproportionate burden of poor mental health among women, we present a community based participatory research (CBPR) model used to develop a women's mental health promotion program for Iranian women. Methods: This is a multi-phase interventional study using a CBPR approach among married women age 18–65 living in Tehran. First, participants described the process of women's mental health. Subsequent steps involved participatory needs assessment, priority setting, intervention design, and evaluation. Finally, a conceptual model of women's mental health promotion was developed. Results: “Seeking comfort” emerged as the core process in women's mental health. To promote mental health, women prioritized training on coping mechanisms to deal with stress. Women receiving this training used more problem-based coping methods and reported a higher quality of life than the comparison group. Conclusions: The resulting conceptual model illustrates the utility of using a CBPR approach to develop women's mental health promotion programs.

Background: Sedentary lifestyle plays a key role in the emergence of many noncommunicable diseases. Given the importance of physical activity (PA) in population-based studies, the present study was conducted to investigate the pattern of PA and its correlates in the pilot phase of Azar cohort study. Methods: In the pilot phase of Azar cohort study, 1236 individuals aged 35–70 years in Khameneh, a city in East Azarbaijan, Iran, were invited to participate in the study. A total of 952 individuals completed the overall and the PA questionnaire, a response rate of 82%. The PA level was evaluated using the classified PA questionnaire based on the equivalent metabolic activities. The general linear model was used to determine the factors affecting PA. Results: The overall mean score of PA was 36.54 (standard deviation = 5.3). In multivariate analysis, after adjustment for sociodemographic variables, total PA score was associated with gender (adjusted β = 0.014, confidence interval [CI] 95% = [0.01–0.82]), occupation (adjusted βs ranged over 0.015–0.059, (CI 95% = 0.01–0.079), level of education (adjusted βs ranged over 0.010–0.018, CI 95% = 0.001–0.026). In other word, sex (mean ranged over 35.49–36.81), educational level (mean ranged over 35.01–36.73) and occupation status (mean ranged over 34.62–39.62) were predictors of PA (all P < 0.05). This variable could also predict 20% of the variance of the PA. Conclusions: The current study identifies that gender, occupation and level of education could be factors that influence on PA level in the study population.

Background: To provide a critical reflection from the literature review to describe the current panorama on the importance of physical exercises in the improvement of the quality of life of the aged, besides the use of medications. While aging brings a high cost to health and demographic pyramid changes, so does the disease. As aging is a biological process and many diseases develop at this time of life, the aged are the fastest growing segment of the Brazilian population due to the natural susceptibility of the organism. With this increase, health costs in the country also increase. In everyday practice, medicine has often been characterized as a therapeutic intervention instrument for the first choice, and a consequence, generates significant and significant economic and social damages. Methods: Search in databases using analysis descriptors as exercises and medicine for the aged. Results: The involvement of the aged in physical exercise programs is an important adjunct to reduce the progressive degeneration associated with natural aging, becoming a powerful instrument to guarantee a healthy, active and independent lifestyle. Conclusions: The physical activity was inversely associated with the number of medications, the more physical activity and fewer drug expenses. The need to implement programs for orientation and for the promotion of health through physical activity was also verified.

Background: Increased consumption of fructose in recent years has increased the risk of developing metabolic syndrome. In this syndrome, induction of oxidative stress, cellular dysfunction, and decrease of antioxidant capacity can change response to pain. Therefore, this study aims to investigate the antinociceptive and antioxidant effects of eugenol on metabolic syndrome induced by a fructose-rich diet in rats. Methods: The rats were randomly assigned to five groups, to be under experiment for eight weeks. The first, control group, the second fructose 10% plus tween 0.5% (Fr + veh), the third fructose 10% (Fr), and the fourth fructose 10% plus a single dose of eugenol 100 mg/kg (Fr + EoS). However, the fifth obtained fructose 10% plus a continuous dose of eugenol 20 mg/kg/day (Fr + EoC) for the last 10 days of the experiment. After formalin test, blood samples were taken from the animals' hearts followed by analysis for biochemical factors. Results: This study shows that fructose administration does not change any pain response and there are not any changes in pain response between Fr group and control group. However, treatment with single and continuous dose of eugenol in Fr + EoS and Fr + EoC groups significantly decreases response to pain in the first and second phase of formalin test in comparison with Fr group (P<0.05). Continuous does of eugenol improved serum malondialdehyde and total antioxidant capacity levels in Fr + Eoc group in comparison with Fr group. Conclusions: In the present work, new findings suggest the beneficial effects of eugenol in pain relief, improved serum glucose, insulin levels, and improved antioxidant activity in metabolic syndrome.

Background: Exposure to hand–arm vibrations higher than permissible standard rates can have destructing effects on workers' health. Pneumatic hammers are among the tools that are used in civil and industrial projects, transferring high vibration acceleration to the workers. This study has considered the probable effects of hand–arm vibrations on the performance of blood coagulation factors in the workers using this tool and exposed to high vibration acceleration. Methods: Five new workers without any experience in exposure with hand–arm vibrations were selected for this interventional study. Blood sample was taken from each worker before they started working for the required analysis. Sampling was repeated in two other stages in 2-month intervals from the first sampling, whereas the workers were then experienced in working with pneumatic hammers. Measuring the vibration of the pneumatic hammer was done according to ISO 28927-10 standard. Results: The point of measuring the vibration acceleration was selected close to the hand, in accordance with the standard. Regarding the exposure time of the workers, the amount of vibration acceleration was obtained 15.54 m/s². Activated partial thromboplastin times of four samples in the second and third stages have shown increases in comparison to the first stage in that respect. On the other hand, a number of red blood cells, white blood cells, and platelets did not show a consistent trend in the three stages. Conclusions: The considered samples showed longer time for blood coagulation as compared to the reference time. Thus, it can be concluded that the main reason is the acceleration in three different coordinate axes of x, y, and z. Hence, the values beyond permissible standard rate of hand–arm vibration in 8 h shifts affect the blood parameters, among which the considered coagulation parameters in this study showed more tangible changes in that respect.

Background: In the present research, we aimed to evaluate dental and periodontal condition in relation to bone mineral density (BMD), to determine the possible association between oral health status and bone density. Methods: Fifty-nine women aged older than 30 years, who had BMD assessment, were enrolled in the study. They were given dental and periodontal examination by the means of oral hygiene index (OHI), periodontal disease index (PDI), and decayed, missing, and filled teeth (DMFT). Participants answered a questionnaire regarding oral hygiene condition, socio-economic status, and physical activity level. Their BMD using dual X-ray energy absorptiometry in femoral and spinal regions was also recorded. Result: In this research, there was a negative correlation between DMFT and T-score of spine and femur but not with Z-scores. There was no association found between PDI and T-scores or Z-scores for BMD (P > 0.05). In addition, there was a significant negative correlation between number of missing teeth and T-score of both femoral and spinal regions; however, such an association was not found with Z-scores. In addition, a strong positive correlation was observed between OHI and DMFT. Conclusions: This investigation suggests a negative association between bone mineral status and oral health condition regarding DMFT and number of missing teeth. It could be concluded that inadequate bone mass could coexist with higher number of missing teeth or a worse oral health condition; nevertheless, further studies are required to assess these relationships precisely.

Background: Factors affecting social health, especially in young adults, are among the most important research priorities. Knowledge of social factors affecting young adults' health will lead to understand them in the social context. The present study is aimed to explain the perspective of young adults on social factors affecting health. Methods: In the present qualitative content analysis study, semi-structured open interviews were conducted through targeted sampling of young volunteers aged 18–30 who were selected from Tehran Province. Interviews were recorded, transcribed, and analyzed. The inclusion criteria for participants were willingness to participate in the study and ability to express their personal experiences. Twenty-one data were collected through collection was done with individual in-depth interviews. Results: Using this qualitative approach, the present study was conducted to identify factors affecting social health from the perspective of young adults. The analysis led to the extraction of three main categories, each with two or three subcategories: expectations regarding the community, expectations regarding the family, and expectations regarding infrastructures. Conclusions: Our findings shown that social support considered as effective elements in providing social health of young adults. The evidence on controlling factors should be considered in promoting the social health of specific target groups. The results of the present study could be used for better planning of interventions in youth social health domains.

Background: Chromium was found to be crucial for several biochemical processes in the human body, including, in particular, carbohydrate and lipid metabolism whereas the exact mechanisms of its actions have yet to be explored. Here, we asked whether low serum chromium levels are present in Jordanian smokers and Jordanians with prediabetes and type 2 diabetes (T2D), with hypertension, with overweight and obesity, and with a family history of diabetes. Methods: A total of 360 patients (120 with T2D, 120 with prediabetes, and 120 healthy controls) were recruited randomly based on the American Diabetes Association criteria. Smokers (n = 26), and patients with hypertension (n = 46), with overweight (n = 47) and obesity (n = 57), and with family history of diabetes (n = 63) were included in the tested population. Serum chromium concentration was measured using the graphite furnace atomic absorption spectrometry. Results: The results from this study revealed significant increase (P = 0.001 univariate,P = 0.038 multivariate) and significant decrease (P = 0.046 univariate,P = 0.038 multivariate) in serum chromium concentrations in smokers and people with T2D and prediabetes, respectively. In addition, serum chromium insignificantly altered (P > 0.05) in people with hypertension, with a family history of diabetes, and with overweight or obesity. Conclusions: Higher levels of serum chromium were observed in smokers, whereas lower levels were found to be present in patients with T2D and patients with prediabetes. In addition, serum chromium level may not be affected by hypertension, overweight and obesity, and family history of diabetes.

Background: The hydatid cyst fluid antigens have high homology with cancer cell antigens and also exhibit considerable immunogenicity. Therefore, their utilization for cancer immunization can cause an effective antitumor immune response. However, the main challenge is identifying the most effective antigens for this purpose. Methods: Hydatid cyst fluid fractions including the glycolipid fraction, glycoprotein fraction, 78 kDa fraction, and antigen B fraction were prepared. Then, the BALB/c mice were immunized against different antigens and, subsequently, 4T1 cells were subcutaneously implanted. The tumors' growth, metastasis, and tumor-bearing mice survival were assessed in different immunized groups. In addition, IL-2, IL-4, IFN-γ, and TNF-α serum levels were estimated to evaluate the immune system response. Results: BALB/c mice immunization against the complete hydatid cyst fluid antigens exhibited more significant inhibition of the tumors' growth and metastasis and increase of tumor-bearing mice survival in comparison with its derived fractions. However, the 78 kDa fraction exhibited the best results according to the same factors in comparison with all the prepared fractions. Conclusions: The 78 kDa fraction of the hydatid cyst fluid was the most effective fraction of hydatid cyst fluid for immunization against 4T1 breast tumors.

Background: Gentamicin-induced-acute kidney injury (AKI) is a multifaceted phenomenon which previously linked to the oxidative stress only. Vinpocetine prevents reactive free radical generation which contributed in reduction of damage. Therefore, objective of the present study was to investigate the renoprotective effect of vinpocetine on gentamicin-induced-AKI in rats. Methods: Thirty Sprague Dawley Male rat were divided into three groups. Control group (n = 10): Rats treated with distilled water + intra-peritoneal injection of normal saline 2 ml/kg/day. Gentamicin group (n = 10): Rats treated with distilled water + intra-peritoneal injection of gentamicin 100 mg/kg/day. Vinpocetine group (n = 10): Rats treated with vinpocetine + intra-peritoneal injection of gentamicin 100 mg/kg/day. Blood urea and serum creatinine were estimated by auto-analyzer. Serum malondialdehyde (MDA), superoxide dismutase (SOD), Neutrophil Gelatinase Associated Lipocalin (NGAL), kidney injury molecules (KIM-1), and Cystatin-c were measured by ELISA kit methods. Results: Vinpocetine led to significant renoprotective effect on gentamicin induced-AKI through amelioration of blood urea and serum creatinine compared with gentamicin group P < 0.01. Vinpocetine improved oxidative stress through reduction of MDA serum level and elevation of SOD significantly compared with gentamicin group P = 0.001 and P = 0.03, respectively. Indeed, vinpocetine reduced glomerular and renal tubular injury via reduction of inflammatory biomarkers including KIM-1, NGALand Cystatin-c sera levels significantly P < 0.01 compared to gentamicin group. Conclusions: Vinpocetine leads to significant attenuation of gentamicin-induced-AKI through modulation of oxidative stress and pro-inflammatory pathway.

Background: Divorce rate reaches up to 50–70%. Indisputably divorce recently became one of the most epidemic factors negatively influencing humans' health whereas its impact on the involved couples and their children is serious and sometimes fatal. The article presents the results of a research study to analyze the most critical grounds for divorce leading to negative health-related consequences. Method: This research adopts a cross-sectional study design with a quantitative approach based on the data from 195 surveyed respondents. A structured questionnaire covering multiple constructs was used to collect and analyze the data. Results: This study found that the most critical causes of the marriage failure are the lack of trust, commitment and communication, sensuality and sexuality (TCS) as they lead to declining of the marginal utility (DMU). These factors not only lead to divorce, but also increase the probability of facing different diseases such as depression, aggression, increasing levels of neuroendocrine, epinephrine and norepinephrine as well as conflict ACTH levels. The regression model shows that communication (C) was the most significant outcome in relation to the MU = 0.45 and P < 0.0) followed by trust and commitment (TC) (β = 0.34 and P < 0.0) and then by S (β = 0.23 and P < 0.0). Conclusions: The marginal utility (MU) is directly and positively affected by TCS. The study suggests that lack of MU, lack of intimacy, sensual, and sexual components can lead to frustration, annoyance, anxiety and relationship failure.

Background: The aim of present study was to compare the effects of negative energy balance with food restriction and/or aerobic exercise on the glucose, insulin, and GLUT4 levels in diabetic male rats. Methods: Fifty-six 10-week old male Wistar rats were randomly assigned to seven groups: a non-diabetic (ND) group and six diabetic groups. After an infusion of type 2 diabetes, the diabetic groups were given labels as well, namely diabetic control (DC) group, exercise (Ex) group, food restriction with standard diet (FRSD) group, food restriction with low-carbohydrate diet (FRLCD) group, food restriction with standard diet combination in exercise (FRSDE) group, and food restriction with low-carbohydrate diet combination in exercise (FRLCDE) group. Further, to induce caloric restriction (CR), food intake was reduced by 20% and given to food restriction consists of both of (FRSD and FRLCD). Hundred percent food consumption for the Ex group was fixed, but instead, 20% of their energy intake in exercise was calculated, and time of daily exercise was determined. Finally, a combination of reduced food intake (10%) and exercise (10%) was applied in each group FRSDE and FRLCDE for 8 weeks. Results: The results showed that type 2 diabetes inductions had reduced glucose, insulin, and GLUT4 gene expression compared to the ND group (P = 0.001). However, there were significant differences in GLUT4 gene expression between groups after 8 weeks of intervention (P = 0.001). A post hoc least significant difference test show that compared to DC group, GLUT4 gene expression level of Ex, FRSDE, and FRLCDE groups was significantly increased 47% (P = 0.004), 60% (P = 0.001), and 65% (P = 0.001), respectively after 8 week of intervention, but it was not significant or with any other diabetic groups (P > 0.05). Moreover, glucose levels were significantly higher in the FRLCDE, FRLCD, FRSD, FRSDE, Ex groups compared with the DC group in the same period (P = 0.0.01). Conclusions: It was concluded that FRSD and FRLCD combination in regular exercise was elevated of GLUT4 gene expression in type 2 diabetes. These results may help to develop new methods for the treatment of obesity and type 2 diabetes mellitus.

Background: The objective of the study is to comparatively evaluate performance of human papillomavirus (HPV) hybrid capture 2 (HC2) and cytology as triage tests among visual inspection after application of 3–5% acetic acid (VIA) screen positive women, thus aiming to reduce the referral burden. Methods: The community-based cross sectional cervical cancer screening with VIA was conducted among women aged between 30 and 65, residing in selected low socio-economic areas of Mumbai, India, during October 2010–March 2017. After obtaining informed consent, delivering health education and collecting socio-demographic data, participants were offered VIA screening by trained primary health workers. The VIA screen positive women underwent cytology, HPV HC2 and diagnostic colposcopy at nodal hospital. Women with positive colposcopy underwent cervical biopsies. Results: 231 VIA positive women underwent cytology and HPV HC2 test, followed by colposcopy. Cervical biopsies were obtained in 83 cases. The sensitivity and specificity in detecting ≥ CIN 2 were 77.8 and 92.3 for HC2 and 66.7 and 98.2 for cytology. The false positivity and negativity rates were 7.7 and 22.2 for HC2 and 1.8 and 33.3 for cytology. Conclusions: HPV HC2 reduces referrals to larger extent and misses fewer cases compared to cytology, thus appearing a better triage test among VIA positive women.

Background: Periimplant diseases are inflammatory diseases. Thus, the level of preinflammatory cytokines which has important role in the inflammation processes can consider as biomchemical markers for early diagnosis and prevention of periimplant diseases. The aim of this study was to determine and compare the level of interleukin (IL)-17 and IL-10 in patients with periimplant mucositis and periimplantitis. Methods: This case--control study was conducted on 51 patients with implants which were loaded at least 1 year previously, 17 patients with periimplant mucositis, 17 patients with periimplantitis, and 17 individuals with healthy implants. After clinical examination, gingival crevicular fluid sampling was carried out by paper point number 25 for 4 min and the mean value of IL-17, IL-10 in samples was measured using enzyme linked immunosorbent assay (ELISA), least square differences (LSD) reader in laboratory. The data was analyzed using statistical software SPSS 22. Quantitative analysis was done using One-way analysis of variance (ANOVA) test and LSD past test. Results: The results of analysis showed that there was a significant difference in the mean value of IL-17 and IL-10 between the three study groups (P < 0.001). Individuals with healthy implants showed a significant lower level of IL-17 than patients with periimplantitis (P = 0.001) and for patients with periimplantitis, the level of IL-17 was significantly lower than that of patients with periimplant mucositis (P < 0.001) and IL-10 level was significantly lower in mucositis than periimplantitis (P < 0.001). Conclusions: The level of IL-17 and IL-10 increased in patients with periimplant compared to individuals with healthy periimplant tissues and the results showed that the highest concentrations of IL-17 and IL-10 were observed in patients with periimplant mucositis and periimplantitis, respectively.

Introduction: Assuring completion of a continuum of maternal health care is a key program strategy to minimize morbidity and mortality of maternal and child. We aimed to examine completion of a continuum of care and its associated factors. Methods: This cross-sectional study was analyzed from the 2016 Ethiopian Demographic and Health Survey data. Multilevel logistic regression was used to assess the relationship between completion of a continuum of care and independent variables, in which each individual woman (level-1) nested within a community (level-2). Results: About 9.1% of Ethiopian women complete the continuum of care. Odds of completing continuum of care was more likely among those women formally employed (odds ratio, OR = 2.14; 95% confidence interval, CI: 1.37–3.35), from the female-headed household (OR = 1.58; 95% CI: 1.08–2.31), and gave birth at health facility (OR = 4.85; 95% CI: 1.75–13.37) than their counterpart. Maternal health services during antenatal care, such as blood pressure measured (OR = 4.31;95% CI: 2.47–7.52), informed about pregnancy complication (OR = 1.57;95% CI 1.61–2.11), and received tetanus injection (OR = 2.04; 95% CI: 1.42–2.92) were associated with completion of continuum of care. Similarly, the perception of women that money is not a problem in accessing healthcare (OR = 1.40; 95% CI: 1.03–1.90) was significantly associated with completion of a continuum of care. Conclusions: Most women failed to complete the continuum of care. Factors related to individual, community, access to health services, and services provided during antenatal care were positively affect completion of the continuum of care. Therefore, effort should focus on the integration of maternal health care services and targeting those factors facilitating the completion of the continuum of care.

Background: Autism Spectrum Disorder (ASD) is a life -long neurodevelopmental disorder and significantly influences the quality of life in children. The screening of ASD in children aged between 16-30 months to early detection and early intervention for better prognosis. Methods: This cross-sectional study was conducted in the southwest of Iran (Yasuj) with dominant Lore ethnicity in 2017. A total of 1504 mother- child pairs with children aged between 16-30 months were selected through simple random sampling from the integrated national health system as the framework. ASD screening was implemented using the Modified checklist for autism in toddlers- revised, with follow-up interview (M-CHAT-R/F). Demographic data such as sex of children, and parental age at their time of pregnancy were collected for all children. Results: Risk of ASD was low, moderate and high in 1447 (96.2%), 54 (3.6%) and 3 (0.2%) in screening, respectively. The estimated rate of ASD prevalence was 80 per 10000 (12 out of 1504) or 1 in 125. Mother's age ≥35 (P value = 0.002, OR = 11.65, CI_95%: 2.49-54.35) and father's age ≥40 (P value = 0.0001, OR = 19.64, CI_95%: 4.89-78.82) were predicting factors of ASD in toddlers aged 16-30 months. Conclusions: Given that, increasing the age of marriage in Iran and recent trend towards delayed childbearing; children born to older parents are at a higher risk for having ASD. So, increasing the public awareness is necessary.

Background: Recognizing the mental health literacy condition among the people is an important step towards promotion of mental health of a society. This study has been conducted to evaluate the depression literacy among Tehran city and its suburban residents. Methods: This is a cross-sectional study of 18- to 68-year-old residents in Tehran city and suburb in 2017. Sampling in Tehran city was conducted using Random Digit Dialing (RDD) and 1340 people were recruited. In suburb Shamsabad and Salehabad from south of Tehran were considered as clusters and data gathering conducted by face to face interview. Depression literacy was assessed by a structured questionnaire. After introducing a vignette with a psychiatric disorder, participants were questioned in the domains of recognition of the disorder, intention to seek help and attitudes toward social stigma. Results: Correct recognition was 52.2% and 30% and intention to seek help was 54% and 33.3% in Tehran city and suburb, respectively. Female gender (P < 0.001), age increasing (P = 0.002) and higher education (P < 0.001) significantly scaled up the chance of correct recognition of depression, when female gender (P = 0.001), increasing age (P < 0.001), and being married (P = 0.01) could significantly improve the probability of seeking help. Results also showed that being married (P = 0.005) and higher education (P < 0.001) predicted lower stigma. Conclusions: Overall depression literacy in Tehran city and suburb was low, so intervention among target population in order to increase the depression literacy seems to be necessary.

Background: Our main aim was to investigate whether the employment condition modifies the use patterns of the screening mammography in workers insured by the Mexican government (Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE; medical facilities of the Mexican government). Methods: A case–control study age-matched was done in women insured by the Mexican government, aged 40–69 years, attending a general hospital (ISSSTE). All subjects were submitted to an interview and anthropometric data registry. In the interview were obtained: demographic data, of schooling, breast cancer family history, and reproductive history; besides, mammography history during the past 2 years and place of performance (in or outside of the ISSSTE). Finally, it was evaluated whether the mammography use in the ISSSTE was related to their employment condition: Active workers (cases) vs. dependents or retired workers (controls). Results: The sample was of 252 women: 126 cases and 126 controls. Cases obtained less mammograms in the ISSSTE (P = 0.03, odds ratio = 0.54, 95% confidence interval, CI 0.30–0.96), than their dependents or the retired workers. Furthermore, cases with high education (university or higher) also obtained fewer mammograms in the ISSSTE (P = 0.03, odds ratio = 0.26, 95% CI 0.05–0.93). Conclusions: Women active workers with higher education are obtaining less screening mammograms in the ISSSTE than their dependents or the retired workers.

Background: Driving is a challenging job. Drivers always face the high risk of musculoskeletal disorders (MSDs). Educational interventions could be effective in preventing and controlling these disorders. The present study aims to assess the effectiveness of an educational physical activity intervention in preventing MSDs among bus drivers in Isfahan, Iran. Methods: This quasi-experimental study was conducted on 60 urban bus drivers, who were selected using multistage sampling. They were evaluated at two time points, namely before and three months after the intervention. The intervention was conducted in three 90-minute sessions. The HBM-based educational content was delivered through lectures, PowerPoint presentations, videos, practical demonstrations of corrective exercises, and educational pamphlets. Data were analysed using the SPSS program, version 20, the paired t-test, and the independent t-test. Results: Before the intervention, there was no significant difference between the two groups with respect to the mean scores of the HBM constructs. However, later on, the mean scores of perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and behaviour increased significantly in the intervention group, compared with those in the control group. (P < 0.001). Conclusions: The results showed that the physical activity as an HBM-based educational intervention had a positive effect on the prevention of MSDs in urban bus drivers.

Introduction: Parkinson's disease (PD) is a chronic, progressive disorder that mainly affects the central nervous system and, consequently, the patient's functional status. This study aimed to compare the effect of 8-week rebound therapy-based exercise program and weight-supported exercises on the range of motion, proprioception, and the quality of life in patients with PD. Methods: Twenty patients were randomly divided into two equal groups of weight-bearing exercises and rebound exercise with no significant differences in age, weight, and height. The variables of the range of motion, proprioception, and the quality of life were assessed in pre- and posttest. Data were analyzed using repeated measure ANOVA and t-test at a significant level of P < 0.05. Results: All of the variables in the two groups were significantly improved after 8 weeks of exercise, whereas the improvement rate in the rebound therapy group was more than the weight-bearing exercises group in range of motion (134.60 ± 13.22 vs. 118.38 ± 12.48), proprioception (7.60 ± 3.22 vs. 10.38 ± 2.48), and the quality of life (147.60 ± 13.22 vs. 118.38 ± 12.48) of the patients (P < 0.001 for all variables). Conclusions: Given that both rebound and weight-supported exercises are effective on improving the range of motion, proprioception, and the quality of life of people with PD, it is recommended that the benefits of these exercises to be used in physical rehabilitation programs. However, rebound therapy exercises have had a greater effect on people with PD, and it seems better to use these exercises more than others.

Background: Validation study of Barthel Index for elderly patients being attended in outpatient and rehabilitation clinics in Iran. Methods: Face-to-face interview with 395 out patients geriatric 60+ years was done in a cross-sectional study. The internal consistency Barthel-ADL was used to approve reliability. Criterion validity and factor analysis were used to verify validity. Results: Reliability the Iranian version BI was significant at 0.938. In criterion validity analysis, the high correlation tools included Functional Ambulation Category (FAC) and Foot and Ankle Ability Measure (FAAM-subscales ADL) at 0.947 and –0.945, respectively. In factor analyses, two domains obtained, the variance of 10 items achieved 69.79%; also, the Item Total Correlation (ITC) of each item was measured. Conclusions: The Barthel Index shows a good validity and reliability, and recommended to use in the Iranian geriatric outpatients in evaluating physical ability.

Background: Tongue cancer is the most common malignancy of the mouth. In recent decades, reported tongue cancer incidence and mortality rates have increased all over the world while survival has not improved that sometimes is related to mutation, especially in gene P53 (such R249, R248 mutations). Hence, this study aimed to identification of R249 mutation in P53 gene of tumor tissue in tongue cancer. Methods: In a cross-sectional study, 48 patients with squamous cell carcinoma (SCC) of tongue were selected, and mutation of R249 was investigated in sample of tumors. In addition, demographic data and medical history of patients were determined and registered in a collected data form. Finally added data were entered to computer and analyzed by SPSS software. Results: Polymerase-chain reaction test done on tissue samples from cancer patients showed that in a studied sample of 48 patients, 4 of them (8.3%) had R249 mutation. After selecting the codon 249 as a hotspot in oral cancer, forward and reverse primers for amplification of exon 7 were obtained from the articles. Conclusions: Considering the findings of our study, R249 mutation in P53 gene in patients with SCC is relatively high. Age and alcohol consumption were factors affecting incidence of the mutation. It is necessary to take an early treatment with a single lesion of tongue to prevent severe disease and prevent disease in patient's family with screening test and prevent cancer in future with gene therapy.

Background: The aim of the present study is identifying the outputs of middle-aged health checks program (MAHCP) in Isfahan province in central of Islamic Republic of Iran. Methods: This is a cross-sectional study. During 30 months, from March 2014 to September 2016, 30–59 years old females and males were screened for abdominal obesity, overweight, obesity, physical inactivity, dyslipidemia, hypertension, diabetes, and also breast, skin, cervix, colorectal, and prostate cancers in all health houses, health posts, and health centers in the province. Based on the data bank of the family health office of the health center of Isfahan province, we estimated the outputs of MAHCP. Results: The utilization rate of MAHCP was 0.39–273.06 per 1000 middle-aged population (MAP). The utilization rate in 2015 was higher for women (43.02–273.06 per 1000 MAP), particularly in rural areas (273.06 per 1000 MAP). The case detection rate of physical inactivity was 26.40–498.6, abdominal obesity was 16.50–428.38, overweight was 38.73–365.59, obesity was 3.30–261.99, and body mass index (BMI) ≥25 was 63.21–593.41 per 1000 MAP. Also dyslipidemia was 21.51–171.62, hypertension was12.33–53.88, and diabetes mellitus was 10.71 – 36.99 per 1000 MAP. Cancers detection rate in women included: breast cancers (99.52–330.32), skin (14.24–245.52), cervix (11.94–87.43), and colorectal (0–47.4) per 100,000 MAP. Cancer detection rate in men included: skin (0–59.18), colorectal (0–80.06), and prostate (0–42.03) per 100,000 MAP. Conclusions: The MAHCP utilization rate in both the genders, particularly in men, was lower than it had been expected.

Background: Certain enzymatic biomarkers such as matrix metalloproteinase (MMPs) are instrumental in the breast cancer. Hence, they are viewed as predictive biomarkers in the primary prognosis of this type of cancer. Furthermore, they enjoy a predictive value in the evaluation of the disease, recurrence of tumor, invasion of tumor cells to other areas as well as therapeutic outcomes. The present study aimed to determine the association between the expression of the three tissue inhibitors of metalloproteinases-1 (TIMP1), MMP2, and MMP9 genes and axillary lymph nodes involvement in patients with breast cancer. Methods: Patients in this study were categorized into two groups, first with axillary lymph nodes involvement (as the case group) and second group without the involvement of axillary lymph nodes (as the control group) referred to Cancer Institute at Imam Khomeini Hospital in Tehran in 2016. The gene expression was assessed using the reverse transcription polymerase-chain reaction technique. Results: There was no significant difference in the mRNA level of MMP2 and MMP9 genes between the cancer tissues with and without axillary lymph node metastasis in comparison with normal samples. However, the mRNA level of TIMP1 gene was considerably higher in the cancer tissue with axillary lymph node metastasis as compared to the samples without metastasis. In other words, the presence of axillary lymph node metastasis induced a 77.8-fold increase in mRNA expression when compared to condition without metastasis.Conclusions: The expression of TIMP1 gene is strongly associated with axillary lymph node metastasis in breast cancer patients.

Background: Renal ischemia-reperfusion (IR) injury has numerous deleterious effects on the kidney function. An experimental investigation was conducted to determine the possible protective role of testosterone (TES) and zinc (Zn) supplementations on the kidney function after IR injury in orchiectomized rats. Methods: Orchiectomized rats (n = 32) were divided into the five groups as sham operated (Group 1), IR (Group 2), IR pretreatment with TES (IR + TES, Group 3), Zn (IR + Zn, Group 4), and TES + Zn (IR + TES + Zn, Group 5). Twenty-four hours' post-IR injury, the animals were sacrificed and the required parameters were measured. Results: The results revealed that there were not any significant difference in serum levels of creatinine (Cr), nitrite and malondialdehyde (MDA), Cr clearance (ClCr), renal sodium (Na) load, and percentage of Na excretion (ENa%) between sham and IR groups. The pretreatment with TES and Zn either alone or combine did not alter the serum levels of Cr, nitrite and MDA, and ClCr, Na load, and ENa%. However, pretreatment with Zn, TES, or combined altered kidney weight, kidney tissue levels of nitrite and MDA, and urine flow in IR groups. Conclusions: The orchiectomy itself performed protective effect against renal IR injury. However, pretreatment with Zn or TES may not alter kidney function against renal IR in orchiectomized rats.

Introduction: Increasing rate of type 2 diabetes (T2D) prevalence during the recent years has caused concern about significant risks for the public health. Dietary patterns have recently attracted great attention in the evaluation of the relationship between diet and health. In the present study, we investigated the relationship between the major identified dietary patterns and T2D. Methods: In this matched case–control study, 315 individuals (125 newly diagnosed cases and 190 controls); 18–60 years of age were selected. A valid semiquantitative food frequency questionnaire was used to collect dietary intakes of individuals. Anthropometric characteristics and blood pressure were measured with standard instructions and body mass index and waist to hip ratio were calculated. Factor analysis was used to identify major dietary patterns. The relationship between major food patterns and T2D was assessed by logistic regression analysis. Results: Two dietary patterns were identified: healthy and Western dietary patterns. The second tertile of the healthy dietary pattern had significantly association with decreased risk of T2D in the crude model (Odds ratios [OR]: 0.51, 95% Confidence interval [CI]: 0.29–0.9;P for trend = 0.018), Model II (OR: 0.5, 95% CI: 0.27–0.9;P for trend = 0.019), and Model III (OR: 0.56, 95% CI: 0.23–1.4P for trend = 0.048). The inverse association of the second tertile of Western dietary pattern score with the T2D was significant in crude (OR: 9.25, 95% CI: 4.95–17.4;P for trend <0.001) and multivariable-adjusted model (OR: 16.65, 95% CI: 2.99–92.84;P for trend <0001). Conclusions: Our study found an inverse relationship between adherence of healthy pattern and direct association with Western dietary pattern and the risk of T2D.

Background: Prevalence of migraine, as a chronic neurovascular disorder, was approximately 10.3 and 23.1% among men and women, respectively, mostly in people younger than 40 years old. Migraine is prevalent in different geographic areas worldwide. The present study was designed to compare the impact of intranasal lidocaine 4% and peppermint essential oil drop 1.5% on migraine attacks. Methods: In this double-blind, parallel, randomized controlled trial, 120 adult patients with a diagnosis of migraine based on the International Headache Society criteria were treated with intranasal lidocaine drop 4% or peppermint essential oil drop 1.5% or placebo. Patients expressed their symptoms 5 and 15 min after dripping, and if they still had a headache after 15 min, they were given the second dose. Patients with a second dose of medication, 15 min later recorded their headache rate. All patients recorded their symptoms after 30 min. Symptoms of the patients were followed by a researcher through the phone and in-person after 2 months. Then, the questionnaires were filled. Results: In the present study, there was a significant difference among groups in headache intensity after treatment (P < 0.001). In 40% of the patients in the peppermint oil and lidocaine groups, the intensity of headache decreased. In the placebo group, fewer patients responded highly to the treatment, whereas 41.5% of patients in the lidocaine group and 42.1% of patients in the peppermint oil group responded to the treatment considerably. Conclusions: Concerning the findings of the present study, nasal application of peppermint oil caused considerable reduction in the intensity and frequency of headache and relieved majority of patients' pain similar to lidocaine. On the basis of findings of this study, it can be concluded that nasal menthol, such as lidocaine, can be used to relieve migraine headaches.

Introduction: This study investigated the effects of resistance training and Eurycoma longifolia Jack supplementation on isokinetic muscular strength and power, Wingate anaerobic power, and testosterone: epitestosterone (T/E) ratio in young males. Methods: Forty young males were weight-matched and assigned into four groups: control (C), Eurycoma longifolia jack (ElJ), resistance training (RT), and Eurycoma longifolia Jack plus resistance training group (ElJ & RT). Participants in ElJ and ElJ & RT groups consumed 200 mg Eurycoma longifolia Jack daily, whereas participants in the C and RT groups consumed placebo capsules daily for 8 weeks. Resistance training program which consisted of 10 different exercises was conducted three times per week for 8 weeks. Participants' isokinetic muscular strength and power, anaerobic power, and urinary TE ratio were measured before and after the intervention period. This is a randomized placebo-controlled intervention study. Paired t-test and one-way analysis of variance were used for statistical analysis. Results: The mean average power of knee flexion at 300°/s in the RT and ElJ & RT groups was significantly (P < 0.05) higher in the posttest compared with pretest. Wingate relative peak power in the RT group increased significantly (P < 0.05) compared with respective pretest value, whereas peak power in the combined ElJ & RT group was significantly (P < 0.05) higher in posttest compared with pretest. There was no significant difference in T/E ratio between pre- and posttests in all the groups. Conclusions: The prescribed resistance training program, either with or without ElJ supplementation, improved isokinetic power of the lower limb. Resistance training alone improved relative anaerobic power, whereas combined Eurycoma longifolia Jack and resistance training improved peak power output. ElJ consumption of 200 mg daily for 8 weeks did not affect the urinary T/E ratio.

Background: Crimean-Congo hemorrhagic fever (CCHF) is the most medically significant hemorrhagic fever. Afghanistan as an endemic region of CCHF has shown a rapidly growing incidence of the CCHF recently, but there is no data on the characteristic of the disease in this country, here we study the epidemiological, clinical, and paraclinical features of this disease in patients with CCHF, based on the collected data from the patients document records from March 2017 to January 2018 in the referral infectious diseases hospital of Afghanistan (Kabul Antani Hospital). Methods: A cross-sectional study in 120 patients admitted in Kabul ANTANI hospital was carried out from March 2017 to January 2018. All of the patients were included based on the standard case definitions by World Health Organization. Results: Among the 120 patients admitted to CCHF ward, 29 were confirmed by ELISA (18% IgM, 8% IgG+) and the reminders defined as “probable cases” according to WHO case definition. Case fatality rates were calculated as 15% and the overall mean ages were 35 years. The peak of the disease incidence occurred between August and July. Almost all patients reported fever, bleeding, and thrombocytopenia. Conclusions: Early detection plays an important role in patients' outcome. Considering that the most cases of the disease are associated with some contacts around Eid-Adha and death attributable to CCHF usually occur in the first 7 days of disease onset, educating population, and especially slaughters, gloves using by housewives during contacts with meat or animal products, and early detection and immediate treatment would have essential roles in primary and secondary prevention of CCHF. Hemorrhagic manifestations and low platelet count provide a clue to early detection of disease. Vaginal bleeding can be a sign of CCHF and needs immediate action.

Background: Carbon monoxide (CO) poisoning results in hundreds of deaths and thousands of emergency department visits all over Iran annually. In this study, we aim to provide an epidemiologic analysis of this poisoning in different consciousness levels. Methods: This single-center retrospective study was conducted at a referral poison center from March 21, 2007 to March 19, 2012 in Tehran, Iran. All CO poisoned children and adults who hospitalized were evaluated based on their on-arrival consciousness level. Results: Two-hundred-sixty patients with pure CO poisoning were enrolled with the majority of males (55.4%). CO exposure was unintentional in 99.6% of cases. The average period between CO exposure and the patients' hospital admission was 6.4 hours (SD = 11.2). Most of the toxicities had occurred at home (73.5%). On arrival acid-base status revealed respiratory acidosis cases in 11.9% of cases. Central nervous system imaging revealed 6.2% abnormal finding. Typically, patients presented with vomiting (25.8%), nausea (22.7%), and dizziness (11.3%). Twenty-nine patients (11.2%) needed intubation and mechanical ventilation. Thirty-six patients admitted to ICU with a median [IQR] hospital stay of 6 [2, 18] days. Ultimately, 202 (78.6%) patients discharged and 47 (18.3%) left the hospital against medical advice, 5 (1.9%) died, and 10 (3.8%) experienced sequellae. Two patients (0.8%), were transferred to other hospitals for specialized care. Conclusions: The incidence and mortality rate of CO poisoning in the current study are still higher than many other parts of the world. Ongoing health prevention strategies are not efficiently working. Hence, constant public education and warning about CO toxicity should be highlighted.

Background: Social issues have short- or long-term as well as positive or negative effects on health systems. Identifying and analyzing events and trends help managers to make the vision and strategic planning. The purpose of this study is to identify the social trends and their impacts on the future of the Iranian health system. Methods: Focus group discussion (FGD) was used to collect the data in 2017--18. The participants were selected through purposive sampling and the snowball method. The discussions were all written and recorded with the consent of the participants. A qualitative content analysis was used to analyze the data. Results: The participants believed that the most important social trends affecting future of health system in Iran are increase health literacy, demographic transition, nutritional pattern, migration and urbanization, marginal settlement, rising unemployment, and increased usage of personal cars. Conclusions: The increase in health problems, healthcare costs, and mortality because of social behaviors and trends are considered as threats to the health system. Therefore, policymakers should reduce their negative effects by taking into account and focusing on these trends and making appropriate plans.

Background: Altmetrics is a newly emerging scholarly tool measuring online attention surrounding scientific research outputs. With respect to increasing demand of disseminating research findings on the World Wide Web, this study aims to analyze the altmetric statues of Iranian medical journals. Methods: On February 27, 2019, the list of Iranian medical journals extracted from http://journals.research.ac.ir/ and consequently altmetric data token out from Altmetric database (Altmetric LLP, London, UK). The science mapping done via keyword co-occurrence, co-citation and co-authorship, network analysis using the VOSviewer. The Pearson coefficient was then employed for the correlation analysis using R. Results: Among a total of 104 journals, 7518 articles were mentioned in Altmetric data resources (Mean: 72.28, Confidence Level (95.0%): 16.8), total mentions were 27577 (Mean: 265.16, Confidence Level (95.0%): 79.9). Considering the total mentions of articles, International Journal of Preventive Medicine achieved the first rank, followed by Journal of Research in Medical Sciences and Iranian Journal of Public Health. Notably, Twitter was the most popular altmetric resource followed by Facebook and news outlets. Tweets were generally from the United States and United Kingdom. Among top 5% popular Iranian medical articles multiple sclerosis, cancer, and anxiety was hot topics. Conclusions: Iranian biomedical journal editors and research scientists needs to be more dynamic in World Wide Web using social media, post-publication peer review tools, Stack Exchange (Q and A) sites, research highlight tools, Wikipedia, and etc. In spite, more attention to the concept of evidence-based policymaking, by Iranian government along with the health policymakers seems necessary.

Background: Theory-based tobacco use prevention programs in schools were implemented to evaluate the effectiveness of this peer-led intervention on tobacco use-related knowledge, attitude, normative beliefs, and intention to tobacco use of school children aged 14–17 years old. Methods: A school-based cluster randomized controlled intervention study was conducted among 1^st, 2^nd, and 3^rd grade high school children in Sanandaj City, Iran. 4-h integrated tobacco use prevention program comprising of four structured modules was developed and delivered to the intervention group by trained peer educator. Outcome measures comprised changes in students' smoking-related knowledge, attitude, normative beliefs, and intention to tobacco use from baseline to 6-month follow-up through validated anonymous questionnaire. Results: The present study showed an intervention effect on tobacco use-related knowledge, normative beliefs, and intention to tobacco use but not attitude. The results indicated that there was significant decrease in intention to tobacco use (P ≤ 0.013) observed after 6-month postintervention. The intervention module was also effective in improving smoking knowledge (P ≤ 0.001), normative beliefs with regard to perceived prevalence of cigarette smoking and water-pipe use among adults and adolescents (P ≤ 0.001) in intervention group 6-month postintervention. Conclusions: Participation in the peer-led education program to tobacco use prevention may have improvement in knowledge, normative beliefs, and intention to tobacco use. An implementation of the peer-led behavioral intervention components in the school setting may have a beneficial effect on public health by decreasing intention to tobacco use among nonsmoker adolescents.

Background: In this study, the anti-Streptococcus mutans and anti-Lactobacillus casei properties of a restorative glass-ionomer cement (GIC) modified with extract powder of Salvia officinalis as a safe and effective herbal extract at weight concentration levels of 0.5%, 0.75%, 1%, and 1.25% are investigated. Methods: The S. officinalis extract powder is provided by doing a multistep laboratory procedure and is filtered to obtain particles smaller than 50 μ. The GIC powder is modified by adding extract powder in weight concentrations of 0.5% (Group II), 0.75% (Group III), 1% (Group IV), and 1.25% (Group V) to form experimental groups, each of 1 g. Five disk-shaped samples, 1 cm in diameter and 2 mm height, of each group (including control group [Group I]) are prepared for each bacterial category of S. mutans and L. casei. The twenty-five samples for each category are tested in vitro against strains of S. mutans and L. casei. Following Agar diffusion tests, the inhibition zone diameters are recorded. The data are tested for normality by means of Kolmogorov–Smirnov procedure. The Kruskal–Wallis and Mann–Whitney tests are used to perform a one-way ANOVA and to do pair-wise comparisons, respectively, at 5% significance level. Results: The mean diameter of the inhibition zones are significantly different among the test groups and also the test groups and the control group except for the group with 0.5% in L. casei category which shows no significant difference with the control group. Conclusions: The present study revealed direct inhibitory activities of S. officinalis-containing GIC against S. mutans and L. casei in a dose-response manner.

Background: Brucellosis is a serious disease affecting many individuals in the world and in Iran. The aim of this study was to investigate the epidemiological and clinical features of patients diagnosed with brucellosis in Kohgilouyeh and Boyerahmad province, southwest of Iran. Methods: This retrospective descriptive-analytic study included all individuals diagnosed with brucellosis during 2009–2015. The clinical and epidemiological information were gathered from recorded data available in the health center of Kohgilouyeh and Boyerahmad province, the southwest of Iran. Results: The total number of patients diagnosed with brucellosis during the study period was 658, of whom, 339 (51.5%) were males. A total of 541 (82.2%) patients resided in rural and tribal areas, and the others lived in urban regions. The mean age of diagnosis was 39.59 ± 17.28 years and the most prevalent age groups were 31–50 (277, 42.1%) and 11–30 (178, 27.1%)-year olds. The most affected groups were housekeeper women (229, 34.8%) and ranchers (152, 23.1%). The relationship between jobs and disease was significant (P < 0.001). Transmission through either suspected dairy products (582, 88.4%) or close contact with infected livestock (537, 81.6%) comprised the most common routes of brucellosis dissemination. The clinical presentation was acute in the majority (581, 88.3%) of the patients. The highest titer for both wright and Coombs wright tests was 1:320. The most frequently administrated drugs were doxycycline and streptomycin (183, 27.8%). The most commonly observed clinical symptom was bone pain (477, 72.5%). Arthritis (12, 1.8%) comprised the most frequent drug-associated complication. Either relapse or treatment failure was recorded collectively in four (0.6%) patients. Conclusions: Due to the prevalence of the disease in the nomadic areas, timely detection and control of the disease is essential. Furthermore, livestock vaccination along with educating farmers and physicians about brucellosis can be helpful.

Background: Nowadays, stress has been tagged a global phenomenon. Many undergraduate students undergo considerable stress, and a variety of sources of stress have been identified among university students. The aim of this study is to identify the level of perceived stress and its predictors among medical and nonmedical Minia University students. Methods: This was a cross-sectional study comparing between medical and nonmedical students in Minia University, conducted during the period from March to April 2017. The sample consisted of 314 medical and 291 nonmedical students chosen through cluster random sampling as a section was chosen randomly from each academic year and collectively form the final sample. Data were collected through interview by a questionnaire inquiring about sociodemographic data, common stressors as academic, financial, family, and transportation stressors and Cohen Perceived Stress Scale 10. Results: The prevalence of perceived stress was slightly higher (88.9%) among medical students than among nonmedical students (83.5%). Severe stress was found among (18.8%) of medical students compared to (12.4%) among nonmedical students (P < 0.05). The significant predictors of perceived stress were academic stressors, no exercise and being female among medical students, and were academic and financial stressors among nonmedical students. Conclusions: Medical students perceived more stress than nonmedical students. The academic stressors were significant predictors among all students; hence, there is a need for the establishment of students counseling unit, to facilitate coping with the stress of study and examination.

Background: Peripheral arterial disease (PAD) is an important marker of cardiovascular (CV) risk and the risk of PAD is markedly increased in patients with type 2 diabetes mellitus (T2DM). Consequently, early diagnosis and treatment of PAD in patients with T2DM are critically important to reduce the risk of CV events. The aim of this study was to determine the prevalence of asymptomatic PAD in patients with T2DM and to investigate the demographic and clinical associations of PAD among them. Methods: This cross-sectional study included 2423 diabetic patients >20 years old, who were regularly followed up at the regional diabetes clinic, Galle, Sri Lanka. Data were obtained using structured questionnaires for information on demographic characteristics and risk factors. Assessment of ankle-brachial pressure index (ABPI) was performed in all. PAD was diagnosed when ABPI was < 0.9 on either leg. Results: The overall prevalence of PAD was 15.3% with no significant age or gender difference. Patients with PAD had significantly higher systolic blood pressure (SBP) (127 vs 125 mmHg, P = 0.002) and diastolic blood pressure (DPB) (80 vs 78 mmHg, P = <0.001) and significantly lower estimated glomerular filtration rate (eGFR) (80 vs 84 ml/min, P = 0.007) than those without PAD. No significant relationships were found between the duration of diabetes mellitus, hypertension, dyslipidemia, and PAD. Conclusions: Prevalence of PAD was relatively high in the diabetic population of this study when compared with findings from other countries. There is a significant association of subclinical PAD with reduced eGFR among patients with T2DM.

Background: We aimed to explore the association between resting heart rate (RHR) and the severity and complexity of atherosclerosis in coronary artery disease (CAD). Methods: Clinical and laboratory data of 388 patients who underwent coronary angiography were evaluated retrospectively. SYNTAX and Gensini scores were calculated based on angiographic findings. These scores which indicate the severity of atherosclerosis was calculated for all the patients. Patients were divided into three main groups according to RHR. Group 1 composed of patients with RHR ≤70 (n = 217), group 2 composed of patients with RHR between 70 and 89 (n = 133), and group 3 composed of patients with RHR ≥90 beats per min (bpm) (n = 38). Gensini and SYNTAX score values of the three study groups were compared. Also, Gensini score was tested for whether it showed a positive correlation with RHR and SYNTAX scores. Results: All patients had an average age of 61.3 years, and the mean for RHR was 72 bpm. Mean Gensini score in the general CAD population was 24.4 ± 22.5, and mean SYNTAX score was 13.6 ± 8.1 points. The Gensini and Syntax score values of the group 3 were significantly higher than that of the other two groups (59.8 ± 31.2, P < 0.001 and 26.0 ± 6.5, P < 0.001, respectively). There was a significant correlation with Gensini score and RHR, SYNTAX score, C-reactive protein (CRP), and left ventricular ejection fraction [(r = 0.725, P < 0.001), (r = 0.680, P < 0.001), (r = 0.543, P < 0.001), (r = −0.224, P < 0.001), respectively]. Conclusions: RHR is an effective easily available marker for the assessment of severity and complexity of CAD.

Background: Today, the importance of physical activity as a preventative way for cardiovascular disease has attracted much attention. The aim of this study is to investigate the effect of 6 weeks of interval training with or without extract of Ziziphus jujuba on lipocalcin-2 (LCN2) and adiponectin levels in heart tissue in male Wistar rats with myocardial infarction. Methods: Thirty male Wistar rats (mean weight, 180–220 g and age, 2–3 months) were divided into five groups, including (1) Healthy control; (2) Isoprenaline-treated group (ISO); (3) ISO + jujube extracts (JE); (4) Trained ISO rats; and (5) Trained ISO rats + JE. Exercise was performed (5 days/week, for 6 week including 54-min cycles with speed of 23 m/min and 54-min cycles with speed of 15 m/min). After 48 h of the last training session, the rats were sacrificed, and their heart tissue was excised. The significant level of statistical data was analyzed by one-way ANOVA test. Results: LCN2 levels significantly decreased in trained ISO rats + JE group after 6 weeks of interval training with JE consumption, compared to ISO group. However, the consumption of jujuba extracts with and without interval training did not show any significant changes in adiponectin levels of rat's heart tissue, compared to ISO (P < 0.05). Conclusions: Because the LCN2 inflammatory factor decreased after 6 weeks of exercise and consumption of the extract, it seems that performing interval training with JE consumption can be an effective method in the cardiac rehabilitation phase after a heart attack.

Background: Epilepsy surgery is a fundamental treatment in refractory epilepsy. Video electroencephalographic (v-EEG) monitoring plays an essential role in presurgical evaluation of patients. However there are reports of favorable outcome based on interictal and magnetic resonance imaging (MRI) findings without any need for v-EEG monitoring in patients with temporal lobe epilepsy (TLE). This study aimed to investigate the prognostic effect of concordance between interictal findings and ictal and MRI data on postsurgical outcome of TLE and extratemporal lobe epilepsy (ETLE). Methods: A retrospective study was conducted on 199 patients with refractory focal epilepsy who were admitted for presurgical evaluation. The concordance between irritative zone (IZ) and seizure onset zone (SOZ) and also IZ and MRI lesion was registered, and subsequently the prognostic effect of relevancy on 1-year follow-up result based on Engel criteria was investigated. Results: In TLE and ETLE regarding relevancy between IZ and SOZ, 77.8% and 73.2% were concordant, 2.5% and 0% were discordant, and 19.6% and 26.8% had overlap, respectively. Concordance between IZ and MRI lesion was found in 76.6% and 51.2% of patients with TLE and ETLE while discordance was recorded in 2.5% and 12.2% and overlap registered in 20.9% and 36.6%, respectively. The concordance of interictal findings had no effect on postsurgical outcome of patients with TLE and ETLE. Conclusions: Our study showed that concordance of IZ with SOZ and MRI has no independent effect on postsurgical outcome of patients with TLE and ETLE. We suggest that excluding exceptional cases, v-EEG monitoring should be considered as the mainstay of presurgical evaluation.

Background: There has been no report of the vitamin D status of the professional athletes from Iran to date. This study was performed to evaluate the efficacy of weekly vitamin D supplementation on athletic performance in Iranian athletes expedited to Asian competition in Taipei, China, 2015. Methods: This study was a randomized controlled clinical trial. Seventy subjects were enrolled in the study. The athletes were randomly divided into two groups: vitamin D supplement (D; received 50,000 IU of vitamin D supplement weekly) and control (P, received a placebo weekly). Duration of the study was 8 weeks. Anthropometric, dietary, athletic performance, and biochemical evaluations were performed for all subjects in the beginning and in the end of the intervention period. Results: A significant rise in circulating 25(OH)D concentration was observed in D group (17.3 ± 16.9 ng/mL, P < 0.001), whereas in P group, there was a statistically significant decrement (−3.1 ± 8.4 ng/mL, P = 0.040). There were no either within- or between-group significant differences in Ergo jump, vertical jump, and agility tests. In strength leg press tests, both groups showed a significant improvement. However, comparisons of changes revealed that the improvement in D group was significantly higher than in P group (P = 0.034). Moreover, in sprint test (one repetition-Max, 1RM), only D group had a significant within-group improvement (P = 0.030). Conclusions: Weekly supplementation with 50,000 IU vitamin D resulted in nearly 17 ng/mL increment in circulating calcidiol. This increase was associated with significant improvement of power leg press and sprint tests in D-supplemented group.

Background: Tobacco use in pregnancy is linked with various negative health effects. The aim of this study was to examine the prevalence of maternal tobacco use during pregnancy and sociodemographic and health correlates. Methods: Data of ever pregnant women from the cross-sectional “South African National Health and Nutrition Examination Survey (SANHANES-1) 2011-12” were analyzed. The sample included 5089 adolescents and adult women aged 15–55 years. They responded to questions on tobacco use, sociodemographic and health indicators. Results: Results indicate that 5.0% [95% confidence interval (CI) = 4.3, 5.9] of South African women had engaged in tobacco use during their pregnancy. In adjusted analysis, being Colored and White population groups, poor self-rated health status, and having chronic medical conditions were associated with tobacco use during pregnancy. Conclusions: Findings suggest links between sociodemographic and health variables and prenatal tobacco use, which may have public health policy implications.

Background: Traffic injuries are considered as the most important health issues for different countries in the world, especially developing countries that are experiencing rapid social changes. The purpose of this study was to investigate the prevalence of road traffic injuries (RTIs) and its socioeconomic differences among road users in Iran as it is one of the countries with high rates of accidents in the world. The study population included all people in Iran. The target sample was 3,096 clusters consisting of 2,187 urban and 909 rural households. Methods: Source of the raw data was the Iran's Multiple Indicator Demographic and Health Survey (IrMIDHS) 2010, which is a multi-stage stratified cluster-random cross-sectional study. The logistic regression has been performed for investigating the socioeconomic determinants which influence the RTIs among pedestrian, vehicle, and motorcycle users. Results: The prevalence of RTIs is 13.8 (95% CI: 13.1, 14.5) per 1,000 people in the year leading up to the study. The injured groups included pedestrians (14.37%), vehicles (38.36%), motorcyclists (43.37%), and 3.9% of users injured with other vehicles. A total of 78.3% of the injured people underwent outpatient treatment or were hospitalized. The mean age in these three groups was significantly increased (27.9, 32.5, 33.4, respectively), and the proportion of men decreased (89.2, 75.2, and 60.6). Conclusions: RTIs in Iran are higher than previous estimates due to consideration of non-hospitalized cases. Considering the high contribution of human factors in developing countries, these measures should prioritize vulnerable groups.

Background: The nicotine content of cigarettes plays a key role in the pathogenesis of kidney disease. Harmine is a harmal-derived alkaloid with antioxidant properties. This study was designed to evaluate the effects of harmine against nicotine-induced damage to the kidneys of mice. Methods: In this study, 64 male mice were randomly assigned to eight groups: saline and nicotine-treated groups (2.5 mg/kg), harmine groups (5, 10, and 15 mg/kg), and nicotine (2.5 mg/kg) + harmine-treated groups (5, 10, and 15 mg/kg). Treatments were administered intraperitoneally daily for 28 days. The weights of the mice and their kidneys, kidney index, glomeruli characteristics, thiobarbituric acid reactive species, antioxidant capacity, kidney function indicators, and serum nitrite oxide levels were investigated. Results: Nicotine administration significantly improved kidney malondialdehyde (MDA) level, blood urea nitrogen (BUN), creatinine, and nitrite oxide levels and decreased glomeruli number and tissue ferric reducing/antioxidant power (FRAP) level compared to the saline group (P < 0.05). The harmine and harmine + nicotine treatments at all doses significantly reduced BUN, kidney MDA level, creatinine, glomerular diameter, and nitrite oxide levels and increased the glomeruli number and tissue FRAP level compared to the nicotine group (P < 0.05).Conclusions: It seems that harmine administration improved kidney injury induced by nicotine in mice.

Background: Tobacco is one of the world's leading avoidable causes of premature death, disease, and disability. According to the World Health Organization (WHO) survey 2020, there are about 120 million tobacco users in India, and WHO estimates that about 4.9 million die due to tobacco annually, and that by 2020 it will be the principal cause of death and disability. This study is done with objectives to access the prevalence of tobacco consumption, evaluate the impact of health education and intervention. Methods: It was community-based health educational interventional study conducted in urban slum setting in Bhopal India, comprising 1598 subjects, and out of these 520 participants were assessed for final outcome with 3 months study duration. A predesigned, pretested questionnaire proforma was developed containing the study variables including socio-demographic, education, age, occupation, type of tobacco product consumed and so on and distributed to all study participants in pre-interventional phase and only in tobacco consumers of post-interventional phase and then was finally evaluated. Results: The prevalence of tobacco use was 32.50% among the tobacco user; 87% were males and rest were females. In post-interventional phase there was a significant difference (P < 0.0001) observed in tobacco consumption frequency, impact of staring with criticism, condemnation, denigration and total number of tobacco quitter. Conclusion: After the health educational interventional motivation, majority of users are ready to quit, so we have to help them in quitting which must include the effectual intervention to control the tobacco use by making an effective strong policy by increasing their knowledge by means of IEC and health education.

Background: Breast cancer is one of the most frequent women malignancies in the world. The cytochrome P450 1A1 (CYP1A1) is a key enzyme in xenobiotics metabolism. Moreover, CYP1A1 plays a critical role in the etiology of breast cancer by involving in 2-hydroxylation of estrogen. Therefore, single-nucleotide polymorphisms (SNPs) of its coding gene have been verified to be important in cancer susceptibility. The aim of the study was to evaluate the association of CYP1A1 M2 (A2455G) includes rs1048943 of this SNP polymorphism with the risk of breast cancer in Mazandaran province. Methods: Ninety-six breast cancer patients with known clinicopathological characters and 110 healthy women as control were genotyped for CYP1A1 M2 polymorphisms by the restriction fragment length polymorphism technique. Results: The analysis of CYP1A1 gene (polymorphism M2) showed that the frequency of homozygous wild genotypes (AA), heterozygous (AG), and mutant genotype (GG) in the patient group, respectively, 78%, 22%, and 0%, and also the frequency of genotypes AA, AG, and GG in healthy included 82%, 16%, and 2%, respectively. Statistical analysis by Logistic regression model at P < 0.05 showed no significant correlation between polymorphisms in CYP 1A1M2 and breast cancer risk (odds ratio = 0.84, confidence interval = 0.33–2.17). Conclusions: The results indicated that the M2 allelic genotypes were significantly associated neither with breast cancer risk nor with clinicopathological characteristics in Mazandaran province.

Background: The objective of the study is to evaluate elastography ultrasound findings in patients with scleroderma (SS) and to clarify the effectiveness of elastosonography to differentiate scleroderma lesions from any skin lesion considering tissue elasticity. Methods: Thirty-six SS patients definite diagnosis of systemic sclerosis according to American College of Rheumatology criteria and 36 healthy subjects were enrolled. Volar aspect of the middle forearm and arm in addition to the dorsal aspect of the fingers were evaluated by sonoelastography. The RGB (red, green, blue) image is a three-dimensional matrix. A color image RGB is an M × N × 3 array of color pixels. The total pixels, total blue pixels, and blue index compared between SS cases and controls. Results: Mean age of patients was 41.3 ± 10.3 years and mean age of controls was 39.8 ± 9.3 years. Mean-modified Rodnan skin score of the whole body was 11.9 and mean duration of disease was 6.2 years. Mean total blue pixels in the arm were significantly different between cases and controls. Mean total image pixels, total blue pixels, and blue index in the forearm were significantly different between cases and controls. Elastography findings in the finger were not significantly different between cases and controls. Conclusions: Sonoelastography could be used for evaluating skin of forearm in sclerodermic cases which will be helpful for disease evaluation in clinical course.

Background: This study was performed to evaluate the effects of carnitine administration on carotid intima-media thickness (CIMT) and inflammatory markers in women with polycystic ovary syndrome (PCOS). Methods: This randomized, double-blind, placebo-controlled trial was conducted among 60 women diagnosed with PCOS according to the Rotterdam criteria, aged 18–40 years. Participants were randomly allocated into two groups to intake either 250 mg/day carnitine (n = 30) or placebo (n = 30) for 12 weeks. High-resolution carotid ultrasonography was conducted at baseline and after the 12-week intervention. Results: After the 12-week intervention, compared with the placebo, carnitine supplementation resulted in a significant decrease in maximum levels of the left CIMT (−0.01 ± 0.02 vs. +0.002 mm ± 0.006 mm, P = 0.001), mean levels of the left CIMT (−0.01 ± 0.02 vs. +0.001 mm ± 0.01 mm, P = 0.001), maximum levels of the right CIMT (−0.01 ± 0.02 vs. +0.006 mm ± 0.01 mm, P < 0.001), and mean levels of the right CIMT (−0.01 ± 0.02 vs. +0.002 mm ± 0.01 mm, P = 0.001). Change in plasma nitric oxide (NO) (+2.4 ± 3.6 vs. +0.2 ± 2.3 μmol/L, P = 0.007) was significantly different between the supplemented patients and placebo group. We did not see any significant effect in serum high sensitivity C-reactive protein (hs-CRP) following the supplementation of carnitine compared with the placebo. Conclusions: Overall, carnitine administration for 12 weeks to participants with PCOS had beneficial effects on CIMT and plasma NO, but did not affect serum hs-CRP levels.

Background: The aim of the study was to highlight the importance of adequate anticoagulant therapy and the correlation of higher risk of stroke. Methods: This study analyzed data obtained from 103 patients with diagnosis of atrial fibrillation (AF) (39 of them had a stroke). Patients were divided into groups according to the CHADS₂, CHA₂DS₂-VASc, and HASBLED scores. Results: An analysis showed that anticoagulant drugs were more often prescribed to subjects <75 years of age (P = 0.001). Patients with a higher CHADS₂ score had a higher CHA₂DS₂-VASc score and vice versa (rho = 0.513; P = 0.0001). According to the CHA₂DS₂-VASc, 91.3% of the patients examined were prescribed an anticoagulant medication as a therapy at discharge from the hospital. The result was statistically significant compared to the practice where an anticoagulant was prescribed to 55.9% of high-risk subjects as estimated by the CHA₂DS₂-VASc score (P < 0.05). Our results also show that rivaroxaban is more commonly prescribed as a discharge therapy than warfarin (χ² = 12.401; P = 0.0001). Furthermore, a significantly higher number of patients who were being prescribed aspirin (38.5%) had a stroke compared to 12.8% of patients who were being prescribed warfarin (χ² = 12.259; P = 0.0001). Conclusions: Novel oral anticoagulants (NOACs) seem to be a better choice as a pharmacological therapy in the treatment of AF, due to a lack of adequate monitoring of patients' international normalized ratio (INR) values. CHA₂DS₂-VASc and HASBLED scores must be used as a part of routine clinical diagnostics when dealing with patients with AF.

Background: Breast cancer (BC) is the most common cancer among women globally and also in India. Early detection by screening is likely to reduce mortality and improve survival. To study the determinants of compliance to BC screening and referral by women in a community based BC screening programme in urban India. Methods: A community-based one-time cancer screening programme, implemented in the urban slums of Mumbai, India. The programme involves screening for breast cancer by Clinical Breast Examination (CBE) performed by trained primary health workers (PHWs), referral of screen-positive women to the nodal hospital for further investigations, confirmation of diagnosis and treatment. Univariate and multivariate logistic regression analysis in SPSS version 16 was used. Results: The compliance to screening, referral and treatment were 90.58%, 74.22% and 100% respectively. The results of multivariate logistic regression analysis demonstrate literate women, having family history of cancer, with tobacco habit, being treated for breast abnormalities, being ever pregnant and having history of contraceptive use were positive predictors while, women belonging to Muslim religion or speaking mother-tongue other than Marathi or Hindi were negative predictors of participation to screening. Educational status was the only significant predictor of compliance to referral. Screen-positive women with education of secondary school level or more were more likely to comply with referral. Conclusions: The programme ensured good compliance with screening, referral and treatment indicating feasibility and acceptability of CBE based BC screening programme by the community.

Background: Low physical activity (PA) is increasing public health problem. The present study aimed to determine socioeconomic inequality in PA among children aged 10–12 years old in Kurdistan, west of Iran in 2015. Methods: The present cross-sectional study was conducted on 2506 children aged 10–12 in Sanandaj, Iran, in 2015. Data on the children's level of PA were collected using the Modifiable Activity Questionnaire. The concentration index was used to measure inequality and the Oaxaca decomposition to examine the different determinants of the inequality. The data were analyzed in Stata 13 and SPSS 20. Results: Of the 2506 participants, 40.90% (38.97–42.82) had insufficient PA. Girls had a lower level of PA than boys (odds ratio [OR] = 0.34; 95% confidence intervals [CI]: 0.28–0.41) and it is directly related to maternal education (OR = 1.71; 95% CI: 1.18–2.47), the family's Socioeconomic status (SES) (OR = 2.18; 95% CI: 1.56–3.05), and the place of residence (OR = 1.68; 95% CI: 1.16–2.44). The concentration index for insufficient PA was −0.25 (95 CI: −0.30 to −0.21), revealing an insufficient PA in the group with a low SES. The prevalence of insufficient PA is 51.38% (95% CI: 48.45–54.31) in poor group and 28.40% (95% CI: 22.80–33.99) in the wealthier group. The Oaxaca decomposition showed maternal education and the place of residence was the most important determinants of inequality. Conclusions: According to the findings, most of the children especially in the poor groups didn't have sufficient PA and socioeconomic factors could have the important role.

Background: This study was designed to evaluate the effect of the size of plate, spoon, and fork on food and energy intake during a meal in obese or overweight staff. Methods: This was a crossover randomized controlled trial that was conducted on 40 obese or overweight clerical staff of the university. The staff was invited to have lunch randomly, receiving either a large or a small set of plate, spoon, and fork. Washout period was 3 weeks, and the participants were then invited to have lunch in a second intervention period and received opposite sizes of dishes compared to the first period sizes. The meal was composed of roasted chicken (kebab), cooked rice, vegetable salad, dairy drink, and soda. Changes in food intake between large and small utensils (plate, spoon, and fork) were analyzed with paired t-test. Results: Rice intake using small or large eating utensils was different (P = 0.02). But total energy intake was not different. The Pearson correlation test demonstrated a positive and significant correlation between rice consumption and waist-to-hip ratio (P = 0.02). Soda (P = 0.02), carbohydrate (P = 0.01), and total energy intake (P = 0.03) were negatively correlated with the age of the participant. Conclusions: It seems that only the amount of grain products consumption changes with changing in dishware size with no significant effect on total energy intake. It is recommended that the independent effect of visual cues on food intake for foods with different textures be investigated in future studies.

Background: Few scientific studies have been conducted about the effect of yoga on biochemical variables such as total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), and C-reactive protein (CRP) to lay a scientific foundation regarding benefits of yoga, but its effect is not clearly detected yet. This study was conducted to assess the effect of yoga on lipid profile and CRP in women. Methods: This research was designed as an interventional study. After reviewing inclusion and exclusion criteria, selected biochemical variables such as TC, HDL-C, LDL-C, TG, and CRP were measured for each participant. Yoga instruction was done three times a week for 26 weeks by an experienced yoga instructor. After 26 weeks of yoga intervention, the above-mentioned dependent variables were assessed. SPSS Ver. 16 was used for data analysis. Results: After a 26-week follow-up for participants, only 24 women had the necessary criteria to be included in the study. The mean TG was 157.33 ± 68.416 mg/dL and 134.33 ± 58.80 mg/dL before and after the intervention (P = 0.108), respectively. The mean TC was 234.83 ± 48.47 mg/dL and 183.33 ± 55.09 mg/dL before and after the intervention (P = 0.014), respectively. The mean HDL-C was 31.58 ± 14.22 mg/dL and 38.25 ± 13.5 mg/dL before and after the intervention (P = 0.118), respectively. The mean LDL-C was 171.75 ± 42.69 mg/dL and 142.91 ± 36.4 mg/dL before and after the intervention (P = 0.030), respectively. The mean CRP was 0.57 ± 0.22 mg/L and 0.71 ± 0.77 mg/L before and after the intervention (P = 0.779), respectively. Conclusions: The result showed that yoga reduced TC and LDL-C significantly, but had no significant effect on TG, HDL-C, and CRP.

Background: The objective of this study was to analyze the effects of strength training on plasma homocysteine levels and cardiovascular risk factors in patients with type 2 diabetes. Methods: The sample consisted of 14 diabetic women with a mean age of 68 ± 6 years. Biochemical evaluations and anthropometric measurements were taken before and after training. Training sessions lasted 50 min and comprised three sets of 8–12 repetitions each. The established load was 60% of 1 repetition maximum. Results: After the training program, it was observed that the levels of homocysteine (average before 13.4 ± 2.9 and after 12.8 ± 3.3, P = 0.40), very low-density lipoprotein (LDL) (average before 41.9 ± 17.0 and after 36.2 ± 11.8, P = 0.47), total cholesterol (average before 214.4 ± 60.6 and after 190.2 ± 62.3, P = 0.09), triglycerides (average before 209.3 ± 85.4 and after 181.5 ± 59.2, P = 0.47), and blood glucose (average before 123.5 ± 30.4 and after 110.1 ± 24.7, P = 0.26) showed no significant changes, but the LDL (average before 129.1 ± 63.4 and after 95.7 ± 53.3, P = 0.04), high-density lipoprotein (average before 43.2 ± 12.0 and after 58.2 ± 15.6, P = 0.01), lean mass (average before 41.1 ± 5.7 and after 42.8 ± 5.4, P = 0.008), fat mass (average before 31.4 ± 8.8 and after 29.7 ± 8.5, P = 0.001), and percentage fat (average before 42.6 ± 4.0 and after 40.3 ± 4.6, P = 0.000) showed significant changes. Conclusions: This study concluded that strength training does not improve homocysteine levels, but help to improve the lipoprotein profile in type 2 diabetic patients.

Background: Gastric cancer (GC) is the first and the third prevalent cancer among males and females in Iran, respectively. The aim of this study was mainly to identify high-risk areas of GC by assessing the spatial and temporal pattern of incidence, and second, to explore some risk factors of GC in ecological setting. Methods: In this cross-sectional ecological study we used Bayesian hierarchical space-time model to measure the relative risk and temporal trends of GC in Iran from 2005 to 2010 based on available data. Data analysis was done by the use of integrated nested Laplace approximation Bayesian approach in R software. Results: Overall trend of GC was significantly decreasing during the study period. Ardabil, Khorasan Razavi, West Azarbaijan, Zanjan, and Mazandaran provinces had the highest risk of incidence. Overweight and smoking were directly and significantly associated with GC risk. Conclusions: During the study period, GC has decreased in Iran. Nevertheless, GC risk was generally high in Northern and Northwestern provinces of Iran. Different health policies according to GC risk and trend are required for each province. Improvements in screening and education programs and conducting further epidemiological studies could help to reduce the incidence of GC in high risk provinces.

Introduction: Iran's western provinces have higher suicide rate compared to the other provinces of the country. Although suicide rates fluctuate over time, suitable statistical models can describe their underlying stochastic dynamics. Methods: This study was conducted to explore the fluctuations of the monthly suicide rates in the most populated western province of Iran using exponential smoothing state space model to compute the forecasts. For this reason, the monthly frequencies of completed suicides were converted to rates per 100,000 and a state-space approach was identified and fitted to the monthly suicide rates. Diagnostic checks were performed to determine the adequacy of the fitted model. Results: A significant seasonal variation was detected in completed suicide with a peak in August. Diagnostic checks and the time series graph of the observed monthly suicide rates against predicted values from the fitted model showed that in the study period (from March 2006 to September 2013), the observed and predicted values were in agreement. Thus, the model was used to obtain the short-term forecasts of the monthly suicide rates. Conclusions: In this study, we had no significant trend but seasonal variations in the suicide rates that were identified. However, additional data from other parts of the country with longer duration are needed to visualize the reliable trend of suicide and identify seasonality of suicide across the country.

Background: Recently, it has been found that Vitamin D can affect cardiometabolic risk factors. However, these findings have not been confirmed in younger population. We aimed to assess the associations of serum 25-hydroxyvitamin D (25(OH)D) and metabolic syndrome (MetS) components in Iranian children. Methods: This cross-sectional study was conducted on 240 children aged 6–9 years old. Anthropometric indices (weight, height, waist circumference, and body fat), biochemical parameters (low-density lipoprotein, high-density lipoprotein, triglyceride [TG], fasting blood sugar, and serum 25(OH)D), systolic blood pressure (SBP) and diastolic blood pressure (DBP) blood pressure, and dietary intake and physical activity were measured. Multivariate linear regression analysis was used to assess the association of MetS components and serum 25(OH)D. Results: Mean age of children was 7.8 ± 1.06 year. Mean serum 25(OH)D concentration was 14.6 ± 10.64 ng/ml, and the prevalence of Vitamin D deficiency (serum 25(OH)D lower than 10 ng/ml) was 41.66%. Dietary intake of Vitamin D was 1.91 ± 1.8 mcg/day. Serum 25(OH)D was inversely associated with TG (β = −0.16; CI: −0.27, −0.04) after adjusting by age, gender, body mass index, physical activity, and some dietary components. Serum 25(OH)D was negatively associated with SBP (β = −0.02; CI: (−0.05, −0.004), and DBP (β = −0.02; CI: −0.05, −0.003); however, it was not significant anymore after adjustment for sodium, potassium, and fiber. Conclusions: Vitamin D deficiency is alarming among Iranian children. Among the components of MetS, lower serum Vitamin D concentration was only associated with TG that could contribute in onset and progression of cardiometabolic disorders later in life.

Background: The prevalence of mental diseases is 23.6% in Iran. Taking intersectoral measures is said to be effective in promoting mental health and reducing the burden of the diseases caused by social determinants. The aim of this study was to determine the role of national organizations in promoting mental health in Iran. Methods: An applied descriptive qualitative method was used. The data were collected by reviewing the literature, interviewing with experts, and holding focus group discussions. To identify the roles of organization, a two-dimensional matrix was drawn. Results: The roles of 31 national organizations in five groups were determined. Then, the intersectoral organizational expectations in two key areas were extracted. The key roles determined were mostly related to the Ministry of Education, Islamic Republic of Iran Broadcasting, Ministry of Labor and Social Welfare, and the Ministry of Sports and Youth. Conclusions: Due to the growing burden of mental disorders in the country, informing national organizations and attracting their active participation based on intersectoral expectations and developing interaction mechanisms among them can be an effective step in promoting mental health and reducing the environmental factors threatening mental health.

Background: Poor retention in the prevention of women in prevention of vertical transmission programs remains a formidable common setback in elimination of HIV/AIDS. It creates new problems such as poor health outcomes and increased incidence of vertical transmission of HIV. There is a dearth of qualitative information to explain poor retention of women in prevention of mother-to-child transmission (PMTCT) programs in Zimbabwe. The purpose of the study was to explore the enablers and barriers of retention of women in PMTCT programs. Methods: This was a basic qualitative study conducted at four health centers in Zimbabwe. Four audiotaped focus group discussions were conducted with 34 pregnant or breastfeeding women coming for PMTCT services at the health centers. Descriptive statistics was used for sample demographics. Transcripts were analyzed through latent content analysis based on the Graneheim and Lundman method. Results: Maternal determination, a four-tier support system, and an inspiring health package were enablers to retention in the PMTCT program while uninspired individual engagement, paternalism, and undesirable PMTCT-related events were barriers to retention of women in the PMTCT program. Conclusions: Reinforcing hope for the women and their children, active management of side effects of antiretroviral medicine, consistent peer support, enhancing confidentiality among community cadres, and commitment from community or religious leaders may improve retention of women in PMTCT programs; for women with HIV during pregnancy, delivery and post-natal care.

Background: Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders with significant impact on quality of life (QOL). Considering the role of stress in the clinical course of IBS, we investigated associations between stress coping skills and symptoms and QOL in IBS patient. Methods: A cross-sectional study was conducted on 95 IBS patients referring to tertiary care centers. Coping skills (Jalowiec coping scale), IBS symptom severity scale, disease-specific QOL (IBS-QOL), and symptoms of depression and anxiety (Hospital Anxiety and Depression Scale [HADS]) were evaluated by questionnaires. Bivariate and multivariate analyses were performed to investigate association among these parameters. Results: Disease severity was positively correlated with emotive (r = 0.30) and fatalistic (r = 0.41) and negatively correlated with optimistic (r = −0.25) and confrontive (r = −0.24) coping strategies. Psychological dysfunction (total HADS score, B [95% (confidence interval) CI] = 2.61 [0.001–5.21]) and fatalistic coping (B [95% CI] = 35.27 [0.42–70.13]) were significant predictors of IBS severity. Conclusions: However, IBS patients involved in this study utilized adaptive coping strategies more frequently. Our study showed that use of maladaptive coping strategies had positive correlation with symptom severity and degree of anxiety and depression among patients, while implementation of optimistic strategies were found to be negatively correlated to severity of symptoms and also utilization of adaptive coping styles was associated with lesser degree of anxiety and depression.

Background: Currently, in low- and middle-income countries, the problem of overweight and obesity is increasing at alarming rate. Along with well-known factors, psychosocial factors such as low self-efficacy highly associated with these problems. Hence, it is necessary to assess individual self-efficacy in weight management consultations using valid instrument. The aim of this study was to determine psychometric properties of the Persian version of the Weight Efficacy Lifestyle Questionnaire-Short Form (WEL-SF). Methods: A cross-sectional study carried out on 400 women referring to urban community health centers in Kerman Province, Iran. Data collected using a questionnaire contained demographic data and Persian version of WEL-SF. The reliability of the questionnaire determined using Cronbach's alpha. The construct validity evaluated by exploratory principal component analysis (PCA) and confirmatory factor analysis. Data were analyzed by SPSS version 19 and Lisrel 8.8. Results: Internal consistency of WEL-SF was 0.83 using Cronbach's alpha. In the PCA, two factors were extracted with the total amount of 62.6% explained variance. In confirmatory factor analysis, the model had acceptable goodness of fit indices. Conclusions: The Persian version of WEL-SF had excellent psychometric properties.

Background: The purpose of this study was to assess socioeconomic status (SES) inequality in life satisfaction (LS) and good self-perceived health (SPH) in Iranian children and adolescents. Methods: This nationwide study was conducted as part of a fourth national school-based surveillance program performed on 14880 students aged 6–18 years who were living in urban and rural areas of 30 provinces of Iran between 2011 and 2012. Using principle component analysis, the SES of participants was constructed as single variable. SES inequality in LS and good SPH across the SES quintiles was assessed using the concentration index (C) and slope index of inequality (SII). The determinants of this inequality are investigated by the Oaxaca Blinder decomposition method. Results: Frequency of LS along with the SES quintiles shifted significantly from 73.28% (95% CI: 71.49, 75.08) in the lowest quintile to 86.57% (95% CI:85.20, 87.93) in the highest SES quintile. Frequency of favorable SPH linearly increased from lowest SES quintile (76.18% (95% CI: 74.45, 77.92)) to highest SES quintile (83.39% (95% CI: 81.89, 84.89)). C index for LS and good SPH was negative, which suggests inequality was in favor of high SES group. SII for LS and SPH was 15.73 (95% CI: 12.10, 19.35) and 8.21 (95% CI: 5.46, 10.96)]. Living area and passive smoking were the most contributed factors in SES inequality of LS. Also passive smoking and physical activity were the most contributed factors in SES inequality of SPH. Conclusions: SES inequality in LS and good SPH was in favor of high SES group. These findings are useful for health policies, better programming and future complementary analyses.

Background: Recurrences are common in neurally mediated syncope. The aim of this study is the evaluation of the effectiveness of nonpharmacologic treatments alone in preventing of syncope relapse. Methods: 70 patients (age 5–20 years) with neurally mediated syncope were enrolled. Thirty patients received pharmacologic therapies along with nonpharmacological methods, and 40 patients received just nonpharmacological treatments then followed them for 36 months. The incidences of different outcomes were analyzed with descriptive statistics using percentages. Results: The recurrence rate of syncope was significantly higher in pharmacological group than in nonpharmacological group in each period of the follow-up (P < 0.001). Conclusions: Nonpharmacologic treatment is very effective in the prevention of syncope relapses and can be a substitute for pharmacologic drugs in the initiation of treatment and if done correctly.

Background: Zinc (Zn) knows as essential microelement which prevents oxidative stress. The effect of Zn supplement on renal function parameters in rats subjected to renal ischemia-reperfusion (IR) injury was investigated. Methods: Male and female rats were subjected to renal IR with and without Zn sulfate (10 mg/kg/day for 5 days) supplementation. The kidney function markers and histology findings in Zn-treated group were compared with sham and control groups. Results: The serum levels of blood urea nitrogen and creatinine (Cr) and kidney tissue damage score were increased significantly after renal injury (P < 0.05) gender dependently, but no alterations were observed for these markers in Zn-treated animals after renal IR injury. Cr clearance was significantly different between genders (P < 0.05); however, Zn supplementation increased the Cr clearance and kidney nitrite level significantly in male rats (P < 0.05). Zn also increased urine flow in female (P < 0.05), but it did not alter urine load of Na (U_NaV) and percentage of Na excretion (E_Na%). Conclusions: Zn may improve renal function after IR injury gender dependently.

Background: Spread of multidrug-resistant tuberculosis (TB) is a threat to India's TB control program. We conducted this study with the objective to determine the risk factors for the development of secondary multidrug-resistant TB. Methods: We conducted an unmatched case–control study involving 247 multidrug-resistant TB patients as “cases” and 494 individuals who were declared as “cured” after category I DOTS treatment as “controls.” Data were collected through face-to-face interviews and review of treatment records. Multivariable logistic regressions were used to analyze the collected data. Results: The mean duration for which cases took first-line anti-TB drug was 19.7 months. The mean duration between initial diagnosis of TB and diagnosis of multi-drug resistant TB (MDR-TB) was 28.3 months. In our study, 26.7%, 50.2%, and 23.1% of MDR-TB cases had one, two, or more previous episodes of TB before being diagnosed as MDR-TB. In multivariable analysis, low or no formal education (album-oriented rock [AOR] =1.63 [confidence interval (CI) = 1.03–3.11]), labor occupation (AOR = 2.15 [CI = 1.18–3.90]), smoking (AOR = 2.56 [CI = 1.19–3.26]), having HIV (AOR = 9.45 [CI = 6.80–15.9]), migration for job (AOR = 3.70 [CI = 1.96–5.67]), stopping TB treatment due to comorbid conditions (AOR = 8.86 [CI = 5.45–11.2]), and having type 2 diabetes (AOR = 3.4 [CI = 1.96–5.16]) were associated with MDR-TB. Conclusions: Government of India should devise strategy to prevent interruption of treatment to stop the emergence and spread of MDR-TB. We need to better integrate TB control activities with diabetes and tobacco control programs for better health outcome among patients.

Background: High prevalence of malnutrition across India poses a significant obstacle to achieving desirable child health outcomes. For addressing childhood malnutrition, the government of Chhattisgarh during 2010–2014 established Nutrition Rehabilitation Centers (NRCs) in selected health units for the timely, adequate, and appropriate feeding of children, and for improving skills of mothers and caregivers on age-appropriate caring, counseling, and growth monitoring. This study examined the functioning of NRCs in three districts; assessed perception of mothers and carers of children admitted in the NRC; and assessed the perspectives of service providers. Methods: Four out of 46 NRCs were purposively chosen. Monthly performance reports of 2012–2014 were reviewed. Fifty mothers/carers of under-five children were interviewed; and ten in-depth interviews were conducted with the service providers. Descriptive statistics, co-relational, and regression models were used for data analysis; qualitative data were analyzed thematically. Results: Vacancy of staff ranged from 7.4% to 70%. The mean age of children during admission was 23.8 ± 6.2 months. The mean percentage weight gain was 11.6%, whereas the mean duration of stay in the NRC was 10.7 ± 3.5 days. Weight gain was directly related to the weight during admission. Follow-up visit and follow-up card issuing, counseling to mothers, special diet preparation, timely receipt of incentives, and training on diet preparation needed immediate attention. Conclusions: Regular review and supportive supervision could play a crucial role in improving the quality of services. The awareness level and expectation of mothers could be improved through NRC-based education and outreach services.

Background: Quality of life (QoL) is an important tool for evaluating the effect of a disease as well as effects of treatment interventions. The present study is aimed to investigate QoL of the patients with various prevalent chronic diseases in Iran. Methods: In a cross-sectional study, 625 patients with one of the prevalent chronic diseases were assessed. Participants were recruited via convenient sampling method in special clinics of chronic diseases in three educational hospitals in Qazvin, Iran, from May to December 2016. Data were collected using WHOQOL-BREF and demographic questionnaire through interview. Data were analyzed using independent t-test, ANOVA, Pearson's correlation coefficient, and multiple linear regression method. Results: Significant difference in QoL scores was found in different chronic disease; patients with diabetes and hypertension had higher scores and patients with asthma and chronic obstructive pulmonary disease (COPD) had the lowest scores. Multivariate analysis showed that age, economic status, and type of disease were among the significant variables in predicting the QoL of the patients with chronic diseases. Conclusions: Some patients, such as those with asthma and COPD, had less QoL than other patients and should be prioritized while planning for the promotion of healthcare services. Due to the negative effects of economic status on QoL, the financial support programs should be among the major priorities of the patients' QoL improvement programs.

Background: Urinary tract infection (UTI) is a common reason for referral to the emergency department (ED) especially in unwell infants. Upper UTIs are particularly at risk of significant complications later in life. Rapid dipstick urinalysis and microscopy are often used in unwell children as a screening tool to guide early diagnosis and treatment. This study aims to evaluate the sensitivity of dipstick urinalysis and microscopy in the diagnosis of UTI. Methods: A retrospective review of children aged 16 years and below with positive urine culture (UC) over a 3-year period was done. The results of urine dipstick and microscopy were compared with the positive UC and sensitivities calculated. Results: Dipstick urinalysis and microscopy of 262 children were studied. Female-to -male ratio of 1.8:1. Median age was 0.79 (range: 0.02–15.95) years. The sensitivity of nitrite, blood, and leukocyte esterase (LE) were 0.54, 0.74, and 0.86 (95% confidence interval [CI] = 0.46–0.62, 0.68–0.80, and 0.82–0.91), respectively. The sensitivity of pyuria of ≥100 cells/mm³ was 0.92 (95% CI = 0.89–0.95). The presence of any of the 3 dipstick parameters increased the sensitivity to 0.97 (95% CI = 0.95–0.99). The lowest sensitivity 0.49 (95% CI = 0.40–0.58) was found with combined positive LE and nitrite. There was a significant comparison between positive LE dipstick test and pyuria (P = 0.000004). Conclusions: Dipstick urinalysis may not be reliable in ruling out UTI in children. However, considering both positive dipstick and pyuria will be more useful in making the diagnosis.

Background: Data on the effects of omega-3 fatty acid supplementation on clinical symptoms and metabolic profiles in patients with endometrial hyperplasia (EH) are limited. This intervention was performed to assess the effects of omega-3 fatty acid supplementation on clinical symptoms and metabolic profiles in patients with endometrial hyperplasia (EH). Methods: This randomized, double-blind, placebo-controlled trial was conducted among 40 women diagnosed with simple endometrial hyperplasia (EH). EH diagnosis was performed based on specific diagnostic procedures of biopsy. Participants were randomised into two groups to intake 1,000 mg omega-3 fatty acid supplements from flaxseed oil (n = 20) or placebo (n = 20), twice a day for 12 weeks. Fasting blood samples were taken at baseline and after the 12-week intervention to determine related markers. Results: Compared with the placebo, omega-3 fatty acid supplementation significantly decreased fasting plasma glucose (FPG) (-7.1 ± 9.6 vs. +2.0 ± 4.9 mg/dL, P = 0.001), serum insulin levels (-1.5 ± 4.6 vs. +1.6 ± 3.9 μIU/mL, P = 0.02) and homeostasis model of assessment-insulin resistance (HOMA-IR) (-0.4 ± 1.1 vs. +0.4 ± 1.0, P = 0.02). In addition, a significant increase in plasma total antioxidant capacity (TAC) (+102.6 ± 69.6 vs. +5.0 ± 37.1 mmol/L, P < 0.001) and total glutathione (GSH) levels (+63.6 ± 84.9 vs. -3.0 ± 69.4 μmol/L, P = 0.01) were seen following the supplementation of omega-3 fatty acid compared with the placebo. Omega-3 fatty acid supplementation had no significant effect on regression, lipid profiles, and other biomarkers of inflammation and oxidative. Conclusions: In conclusion, we found that omega-3 fatty acid administration for 12 weeks to subjects with EH significantly improved FPG, insulin, HOMA-IR, TAC and GSH levels, but did not influence regression, lipid profiles, and other biomarkers of inflammatory and oxidative stress.

Background: Interest in using peritoneal dialysis (PD) shows global and national increase. However, it remains a challenge to prevent the progression of PD-associated fibrosis in clinical practice. Here, we assessed the status of scientific publications in prevention and management of PD-associated fibrosis in a scientometric study. Methods: We retrieved the bibliometric data by search terms “encapsulating peritoneal fibrosis,” “treatment or prevention,” and their synonyms in the Scopus databases until December 2, 2017. Data were analyzed using Scopus analysis tools, SPSS version 15 and Visualizing Scientific Landscapes viewer version 1.6.5. Results: Number of publications showed a steady significant increase (P < 0.001) reaching to 390 documents. Japan had the highest share (21.3%) followed by United Kingdom. Coauthorship network assessment assigned “Ikeda M.” from Japan as the top author. The top source of documents was “Peritoneal Dialysis International.” Most of documents were original articles focusing on prevention and management of malignant fibrosis of peritoneum (72.6%). The documents were cited totally 5636 times with average citations per article of 14.45, and relatively high H-index of 38. Conclusions: Despite the global increasing trend in scientific output in this field, contribution of our country is very small. Perhaps more national and international collaboration is required to encourage our researchers for producing more scientific products.

Background: Diabetes as a chronic and progressive disease leads to multiple complications. Therefore, it is important to control and treat it. More effective control of this condition and the provision of therapeutic approaches require awareness and active participation of patients in self-care. In this regard, a smartphone that is accessible to most people at anytime and anywhere and is easily applicable can be useful in self-care diabetes, with the ability to install various applications. This study aimed to develop a diabetes self-care mobile application as a suitable solution for self-managing diabetes for Iranians. Methods: We conducted a mixed methods study in three Phases: (1) comparative study of existing mobile applications; (2) developed its object-oriented conceptual model; and (3) developed the initial version of “Aryan” that was approved for production. Results: This application was designed for the appropriate diabetes self-care, with following functionalities: The user ID and his/her personal page setting; generating self-care reports such as blood glucose, nutrition, physiological indicators, physical activities, and patient history reports; care setting; providing patient training materials; nutrition control; insulin and other medications control; blood glucose and key tests control; and other paraclinical tests. Conclusions: “Aryan” has been designed in compliance with Iranian experts' opinions. It is expected “Aryan” plays an effective role in self-care of patients with diabetes.

Background: Magnesium is the calcium natural physiological antagonist; it also antagonizes N-Methyl-D-aspartate receptors, therefore, providing antinociceptive properties. The reason for effective role of treatment with magnesium on decreasing opioid usage, less dissatisfaction, and good sleep quality is proposed theoretically yet. This study aimed to evaluate the effect of magnesium sulfate on decreasing opioids requirement after surgery of the lower limbs fracture by spinal anesthesia. Methods: A total of 60 patients aged from 45 to 75 years with the lower limb fractures (femur and hip) candidate for surgery by spinal anesthesia. In a randomized double-blind method, patients were divided into two groups as Magnesium Group (M) and Control Group (C). Group M received a bolus of 5 mg/kg magnesium sulfate plus (250 CC) normal saline and Group C received (250 CC) normal saline in the same condition. Results: Pain score and the physical dissatisfaction were reduced at 12, 24, and 48 h after surgery in Group M as compared with Group C (P = 0.000). Total opioid requirement at the end of 48 h and at the first 24 h after surgery were reduced in Group M as compared with Group C (P = 0.001). The endurance of spinal block was increased in Group M as compared with Group C (P = 0.000). Conclusions: A low dose of magnesium sulfate reduced the pain score, opioid requirement, and physical dissatisfaction while increased endurance of spinal block.

Background: This study aimed to examine nurses' job stress based on Karasek's demand-control-support model and assess its relationship with different aspects of fatigue. Methods: This cross-sectional study was conducted on 522 nurses working in educational hospitals. Job stress dimensions and fatigue were measured by the Persian version of Job Content Questionnaire (JCQ) and Multidimensional Fatigue Inventory (MFI), respectively. Results: The results showed that psychological and physical job demands obtained high scores, but social support and decision latitude got low scores. MFI results indicated that the highest score was related to the general fatigue. Moreover, the results showed a significant positive relationship between psychological job demands and general fatigue, but a significant negative correlation to reduced activity. Conclusions: Considering the effects of job stress on nurses' fatigue, it is necessary to develop a suitable interventional program for nurses in healthcare centers, especially hospitals, to decrease job stress and improve working conditions.

Background: There is evidence that cessation programs can be effective for hospital inpatients. Hence, the aim of this study was to investigate the effects of such programs and factors that may affect success. Methods: This study was carried out on in-patient users of tobacco in Shiraz Hospital, Iran in 2015. After implementing the inclusion criteria, a study population was selected using a convenience sampling method. Participants were contacted monthly by study personnel concerning certain aspects of their tobacco cessation program. The study lasted 6 months. Data analyses involved survival analysis using Kaplan–Meier analysis, log-rank test, and multivariate Cox regression modeling. Results: The study included 425 in-patient smokers of which 328 (77.2%) were male. Median follow-up time was 96 days (interquartile range: 20–150). Cessation survival rates were 76% at 1 month, 63% at 2 months, and 61% at 3 months. From the 4^th month onward rates remained unchanged at 60%. Univariate analyses with variables such as time since last smoking, consumption type, interval between wake-up and consumption, the severity of dependence and interest in smoking cessation were statistically significant as to cessation survival rate (P < 0.05). After adjusting the confounding variables based on multivariable analyses, results indicated that consumption type, the severity of dependence and interest in smoking cessation were the most important predictors of cessation survival rates among in-patient smokers. Conclusions: Findings indicated that application of the cessation program among our group of inpatients appears to have been an effective intervention that produced an extended period of no smoking.

Background: Fatigue is a common symptom in office workers. The purpose of this study was to assess the psychometric properties of the Persian version of the Multidimensional Assessment of Fatigue (P-MAF) scale and its association with productivity among Iranian office workers. Methods: In order to validate the MAF scale, using “forward-backward” translation, cognitive debriefing, and cultural adaptation procedure, the English version of the MAF was translated into Farsi. A total of 129 Iranian office workers with at least 1-year job experience were included in the study. The Persian version of the Health and Work Questionnaire was used for assessment of the productivity in the participants. Results: Internal consistency for all subscales of the P-MAF scale was acceptable (α ≥ 0.854). The correlation of convergent validity and the correlation of discriminant validity for all subscales ranged from 0.466 to 0.948 and 0.121 to 0.5, respectively. Internal consistency of each subscale of P-MAF for sex, marital status, job tenure, and daily working hours was high (0.810–0.952). Factor analysis of the P-MAF scale revealed that its items were related to severity, distress, timing of fatigue, interference with activity at home, and interference with activity away from home. The results showed significant correlations between the score of fatigue and some subscales of P-MAF, including concentration/focus (r = 0.649, P < 0.001) and impatience/irritability (r = 0.334, P = 0.001). Conclusions: The P-MAF had appropriate structural characteristics, was a valid and reliable instrument, and could be used for measuring fatigue among Iranian office workers.

Background: Previous studies indicated the effect of fat on autoimmune diseases. The present study was aimed to investigate the association between fat intake and vitiligo. Methods: This case–control study was conducted in the Skin and Leishmania Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Intakes of fatty acids were examined for their relation to risk of vitiligo among 100 cases and 110 controls. We included patients who suffered from generalized or localized vitiligo for <5 years that was approved by a dermatologist via the Vitiligo European Task Force criteria and the vitiligo area scoring index. Fat intake was assessed through individual interviews by a standardized food frequency questionnaire. Results: Vitiligo group consumed more saturated fatty acid (SFA) and less eicosapentaenoic acid and docosahexaenoic acid than control group, while other fatty acids were not significantly different among two groups (P > 0.05). Crude analysis showed that total fat (odds ratio [OR] = 3.33, 95% confidence interval [CI]: 1.46–7.58) and SFA (OR = 2.22, 95% CI: 1.04–4.90) intakes were associated with an increased risk of vitiligo (for highest quartile vs. lowest quartile). Results demonstrated a decrease in the risk of vitiligo for those within the highest quartile of monounsaturated fatty acids intake (OR = 0.41, 95% CI: 0.18–0.92). However, this relationship disappeared after adjustment for confounders as energy, age, sex, and body mass index, except for total fat (OR = 2.84, 95% CI: 1.63–5.44). Crude and adjusted analyses for polyunsaturated fatty acids and cholesterol intake were not statistically significant. Conclusions: Total-fat content of the diet had more impressive role than the specific subclasses of fats on the incidence risk of vitiligo. High-fat diet escalated the vitiligo risk. Regarding the role of fats on skin autoimmune diseases especially vitiligo, future studies are crucial.

Background: Gestational diabetes mellitus (GDM) is defined by World Health Organization as glucose intolerance diagnosed for the first time during pregnancy; GDM affects 7% of pregnancies. Women with earlier GDM have higher risk to develop type 2 diabetes (T2D). The aim of our study was to evaluate the outcomes of GDM and to assess the impact of recalling patients in the postpartum stage by phone, the target was to assess T2D or impaired glucose tolerance in women with a history of GDM. Methods: This prospective study included 200 patients with GDM that have received education sessions regarding the major interest of screen T2D using 75 g of oral glucose tolerance testing in the 3^rd month after birth. Results: Only 22.5% (n = 45) women spontaneously complied to assess T2D. About 15% have had developed T2D and 28% prediabetes. Risk factors of T2D onset were younger gestational age at the occurrence GD, higher fasting blood glucose, and frequent use of insulin. Conclusions: Women with GD history demonstrated high risk of developing T2D. Simple changes of lifestyle were shown to be an efficient prevention protocol. Despite therapeutical education, few women spontaneously complied with T2D screening. The telephone reminders could improve the screening observance therefore patient's outcome.

Background: The aim is to investigate the association between diet quality and daily price of foods consumed among Iranian diabetic patients. Methods: This cross-sectional study was conducted among 200 patients with type 2 diabetes mellitus (T2DM) aged 30–70 years. General information, socioeconomic status, anthropometric and biochemical characteristics, and food prices were collected by pretested questionnaires. Dietary intakes were assessed using a semi-quantitative reliable and valid food frequency questionnaire. Modified nutritionist IV and SPSS software were used for analyses. Results: The results of the present study indicated a direct relationship between total daily price of diet and nutrient adequacy ratio of Vitamin D, Vitamin B1, selenium, zinc, magnesium, potassium, and mean adequacy ratio of 11 micronutrients (Vitamin C, Vitamin E, Vitamin D, Vitamin B1, Vitamin B6, Vitamin B12, selenium, zinc, calcium, magnesium, and potassium) (P < 0.05). Furthermore, the total daily price of diet had a positive association with dietary intakes of protein, Vitamin D, Vitamin B1, selenium, zinc, magnesium and potassium among type 2 diabetic patients (P < 0.05). However, no significant relationship was observed between the total daily price of diet and anthropometric indices, biochemical characteristics, and socioeconomic status of participants in the present study (P > 0.05). Conclusions: This study showed that dietary quality and dietary intakes of energy, protein, and micronutrients were directly associated with the total daily price of foods among Iranian patients with type 2 diabetes.

Background: Workplace acts as an efficient target for health promotion activities. Pedometer can act as a motivator and monitor of physical activity. Aims: The aim of the study was to assess the effect of pedometer usage in increasing physical activity and the level of adherence among employees of a software company in Puducherry. Methods: An interventional study was conducted with a prepost design. A single group of software company employees (n = 46), age ≥30 years selected by simple random sampling, was included in the study. Intervention consisted of health education program on physical activity, goal setting, and instructions regarding the use of pedometers for 1 week. Physical activity levels were measured at baseline and endline using global physical activity questionnaire. Results: Out of the 46 participants, 93% of the participants used the pedometer for at least 6 days. The difference between maximum observed step count during the week (median 9834 steps) and at baseline (6963 steps) was significant. Overall, 93.5% found pedometers to be useful for improving physical activity. Proportion of individuals with adequate physical activity based on Metabolic equivalents (MET) minutes increased from 41.3% (n = 19) at baseline to 69.6% at endline (n = 32) (P = 0.004). Conclusions: This study shows that a pedometer-driven walking intervention in the workplace setting is feasible and effective in increasing physical activity over a short term. Further research is required to test the effect of supportive strategies and long-term effectiveness of pedometer use.

Background: Musculoskeletal disorders is defined as a musculoskeletal strain reported by an individual. Physical activity prevents many disabling diseases and musculoskeletal disorders. Low level of physical activity is associated with a higher prevalence of musculoskeletal disorders. In Saudi Arabia and among medical students, lowest rates of physical activity were found. Our aim is to assess the prevalence of musculoskeletal disorders and its correlation to physical activity. Methods: A cross-sectional study of 392 health specialty students in Taif University was carried out from January 1 to March 1, 2018, using a predesigned questionnaire, including demographic characteristics, an International Physical Activity Questionnaires–short form to assess the level of physical activity, and Standardized Nordic Questionnaires for the analysis of musculoskeletal symptoms. Results: Our study found that 64.8% of the students had musculoskeletal disorders. The highest prevalence was among medical students; 48.4% of them were having musculoskeletal disorders (P < 0.05). The most frequent region was the lower back (33.4%). There is a significant association between the musculoskeletal disorders and the level of physical activity, with 42.9% of the students with a moderate level of physical activity having musculoskeletal disorders (P < 0.05). Conclusions: The prevalence of musculoskeletal disorders is higher among medical than pharmacy and health science students. Most of the affected students were having a moderate level of physical activity. Psychosocial stress seems to be a major contributor to musculoskeletal disorders, rather than physical activity level.

Background: There is a very limited information on the obscenity of cigarette and hookah smoking among adolescents. Using a large and representative longitudinal sample of adolescents (n = 4820) aged 14–19 years from Tabriz (a metropolitan city in northwestern Iran), this study aimed at comparing the obscenity of cigarette and hookah smoking and assessing factors associated with obscenity of smoking. Moreover, we examined how the obscenity of cigarette and hookah smoking affected by the progress in the stages of cigarette and hookah smoking. Methods: In this longitudinal study, a random sample of high-school students was selected in Tabriz in 2010. Using a valid and reliable self-administered questionnaire, the data from the sampled students were collected twice at two points in time, 12 months apart. Multivariate backward logistic regression was used to determine the effect of the transition in cigarette (or hookah) smoking stages on the obscenity of cigarette (or hookah) smoking. Results: While 3,079 (63.9%) students expressed that obscenity of cigarette smoking is higher than obscenity of hookah smoking, 1,741 (36.1%) students expressed that obscenity of hookah smoking is higher than obscenity of cigarette smoking. The results of multivariate backward logistic regression indicated that the transition in cigarette (hookah) smoking stages was not related to the obscenity of cigarette (hookah) smoking. Conclusions: The results showed that obscenity of hookah smoking was less than obscenity of cigarette smoking, especially among females. Further study is required to understand the effect of obscenity on smoking and transition to different stages of cigarette and hookah smoking.

Background: The objective of this study was to provide biometric charts for Iranian fetuses. Methods: One thousand four hundred and twenty-two women enrolled. Four hundred and eighty-four were in the second trimester of pregnancy and 940 were in the third trimester. Data were presented as mean ± standard deviation for continuous variables. Percentiles (5^th, 50^th, 75^th, and 90^th) reported. Results: Mean femoral length ranged from 16 to 53 mm in our study in the second trimester and 55–79 mm in the third trimester. Mean biparietal diameter (BPD) for fetuses with in the second trimester was between 14 and 71 and for fetuses in the third trimester was between 74 and 98 mm. Mean abdominal circumference (AC) in our cases with gestational age between 14 and 41 ranged between 86 and 365 mm. Conclusions: We have provided normal reference ranges and percentiles for BPD, AC, femur length, and weight during the second and third trimester of pregnancy in an Iranian population.

Background: Malathion is one of organophosphate pesticides that is widely used in agriculture and crops to control insects. Malathion affects body organs such as the reproductive system by inhibiting acetylcholinesterase activity and induction of oxidative stress. This study is aimed to investigate the effects of malathion on glutathione (GSH) and malondialdehyde (MDA) level in testis of male rats, as well as to study the protective role of Ascorbic Acid. Methods: In this study, 30 adult male Wistar rats weighing approximately 200–250 g were divided into 5 groups of 6 rats each. These groups include a control group (no intervention), sham (normal saline 0.9%), experimental Group 1 (malathion 50 mg/kg), experimental Group 2 (Malathion 50 mg/kg + Ascorbic Acid 200 mg/kg), and experimental Group 3 (Ascorbic Acid 200 mg/kg). Malathion, solvents, and ascorbic acid were injected intraperitoneally. After 6 weeks, all groups were anesthetized, and the right testis was used to measure levels of MDA and GSH. MDA as a marker of lipid peroxidation and GSH content was used. Results: The results showed that malathion increased MDA level and decreased GSH level compared with the control group (P < 0.001). It was also found that administration of malathion in combination with ascorbic acid reduced MDA level and increased the GSH level. Conclusions: Malathion-induced lipid peroxidation and oxidative stress in the testis of rats. In addition, it seems that ascorbic acid, due to its antioxidant capabilities, can improve malathion-induced poisonous changes.

Background: We assessed fast-food consumption including frequency, type, and reasons among college students from the Kuwait University, and whether there were any key sex differences. Methods: A cross-sectional survey was conducted from January–March 2016 with 421 students (297 women, mean age = 20.99 ± 3.14 years). Students completed self-administered fast-food questionnaires and weight and height measurements were obtained. Results: Most (81.4%) consumed fast food more than twice per week and more men than women were overweight or obese (54.8% vs. 38.7%, respectively; P = 0.002); however, there were no differences in the fast-food frequency per body mass index or sex. Taste was the most reported motivator to consume fast food (46.7%) and women were significantly more likely to value taste as compared to men (49.8% vs. 38.9%, respectively; P = 0.005). Conclusions: Fast food is a key part of college students' diet in Kuwait; therefore, students should be educated on the negative effects of frequent fast-food consumption. University health promotional activities should include nutrition education on healthier fast-food options and how to prepare easy-to-cook meals at home.

Background: Attention deficit hyperactivity disorder (ADHD) is one of the prevalent neuropsychiatric disorders in childhood. In general, diagnoses of ADHD include inattention, hyperactivity, and impulsivity. Recent studies have reported increased oxidative stress in psychiatric disorders such as ADHD, but the results are conflicting. This research aimed to study the relationship between antioxidant status and ADHD in children of 6–13 years old. Methods: From schools, 32 ADHD students whose diseases were diagnosed by child and adolescence psychiatrist based on Diagnostic and Statistical Manual of Mental Disorders-IV index were recruited; moreover, 32 healthy subjects, which according to the medical history questionnaire of psychiatric disorder had not had chronic disease, were selected. Total antioxidant capacity (TAC), catalase (CAT), glutathione (GSH), and malondiadehyde (MDA) were measured. General information, health history, and medication history were collected. All participants completed a 168-item food frequency questionnaire. Dietary intakes of antioxidants were obtained through this questionnaire. Results: There was no significant difference between mean of energy intake and Zn, Se, vitamin E, C, and β-carotene as antioxidants between the two groups. The mean of serum TAC, GSH level, and CAT level in the patients were significantly lower than the healthy group (P < 0.001), but the mean of MDA was not significantly different between the two groups (P = 0.18). Conclusions: The result of this study indicates that, in ADHD, the serum levels of GSH, CAT, and TAC decrease; the level of antioxidant in the serum has been compromised to fight oxidative stress. More perspective studies with large sample sizes are essential to confirm these findings.

Background: Population studies have demonstrated that there is an inverse association between dietary intake of vitamin D and the mean blood pressure in elderly in particular. So, we investigated the correlation between vitamin D intake and the mean blood pressure in the elderly with and without nursing care. Methods: Based on a cross-sectional design, this study was conducted on 152 old people with and without nursing care. Assessment of the dietary intake of nutrients was done by an expert dietitian using food frequency questionnaire and nutritionist IV software analyzer. Also, the mean blood pressure was extracted from participants' files. The independent samplet-test, Chi-square test, and partial correlation test were used for data analysis. Results: Mean ± SD age, weight, height, body mass index (BMI) of participants, and the percentage of male/females were 68.7 ± 5.5 years, 63.5 ± 7.9 kg, 162.5 ± 7.1 cm, 24.1 ± 3.4 kg/m² and 48.7/51.3, respectively. Also, a significant negative relationship was observed between vitamin D intake and systolic blood pressure in all participants (P value = 0.028, r = −0.179). There was no significant correlation between vitamin D intake and diastolic blood pressure (P value = 0.558, r = −0.048). Conclusions: The findings revealed that the nursing care can improve dietary intake of vitamin D in the elderly population. Also, a negative correlation was found between vitamin D intake and systolic blood pressure among all the elderly.

Background: Gastrointestinal cancers make for nearly half fatal cancers with colorectal and stomach cancers' being listed among the ten most common in Iran. This research aims to determine the spatial pattern and temporal trend of death risk due to colorectal and stomach cancers among provinces of Iran and estimate the effect of shared and specific components as surrogates of risk factors for the aforementioned cancers on changes of death due to the cancers over time and place. Methods: In this ecological study, the data regarding death causes in colorectal and stomach cancers during 2006–2011 were obtained from the death registration system of the Iranian Ministry of Health. The estimation of relative risk (RR) of death due to the target cancers was performed applying Bayesian spatiotemporal shared component (SC) model in OpenBUGS software. Results: North-Western provinces ranked first regarding stomach cancer RR of death (RR >1.75). Furthermore, some North-Western and central provinces had the highest RR of death due to colorectal cancer (RR >1.5). The SC surrogating the risk factor shared between both cancers had the most effect in Northern, North-Western and western provinces, and the least effect in Southern and South-Eastern ones. Conclusions: North and North-West of Iran found to be the high-risk area for death due to both stomach and colorectal cancers and South-East and South provinces shown to have the lowest RR. The obtained results can be illuminating to health resource allocation to the health policymakers.

Background: the aim of this study is to evaluate the prevalence and effect of depression and anxiety on the shoulder range of motion, as well as the objective and subjective symptoms in patients suffering from frozen shoulder. Methods: Between 2013 and 2014, in a cross-sectional study, we evaluated 120 patients with idiopathic frozen shoulder. We collected the demographic data for each patient and measured shoulder range of motion in four directions in both limbs. All patients filled out visual analog scale (VAS) for pain and the disabilities of the arm, shoulder, and hand (DASH) questionnaires. Both Hamilton anxiety and depression questionnaires were filled out for each patient. Results: A total of 92 patients (77%) with idiopathic frozen shoulder showed symptoms of depression, while only 32 (27%) of them experienced anxiety. Thirty-two patients (27%) showed symptoms of both depression and anxiety. Although elevation and abduction were not affected by depression, internal and external rotations were more restricted among patients who had symptoms of depression. DASH and VAS scores were higher in patients with symptoms of depression. In terms of anxiety, only VAS and DASH were different between two groups. In multivariable analysis, DASH score was correlated with severity of both anxiety and depression symptoms. Conclusion: While there is no definitive relationship between symptoms of depression or anxiety and shoulder range of motion in patients suffering from frozen shoulder, patients who suffer from depression or anxiety experienced increased pain and limb disability.

Background: Lead may be added to the opium by drug smugglers. It can cause elevated blood lead level (BLL) in opium-addicted patients. Erythrocyte pyrimidine 5′-nucleotidase (P5N) activity is susceptible to high BLL. The aim of this study was to find out whether opium-addicted patients show erythropathy and elevated liver enzymes explainable by high BLL and decreased P5N activity. Methods: Forty orally opium-addicted subjects and 40 normal healthy volunteers were enrolled in this study. BLL was measured in whole blood specimens using atomic absorption spectrometry instrumentation. Enzymatic activity, protein amount of P5N, and erythrocyte purine/pyrimidine ratio were determined. Blood films were analyzed for the presence of basophilic stippling of red cells and hemolytic anemia. The level of liver function enzymes was measured. Results: The mean BLL for opium-addicted patients was significantly higher than control group (P < 0.001). On the contrary, P5N activity showed a valid decrease in opium-addicted patients when compared with control group (P < 0.001). In line with repressed P5N activity, erythrocyte purine/pyrimidine ratio in patients was lower than control group (P < 0.001). A statistically significant reverse correlation was found between BLL and P5N activity (P < 0.05, r = −0.85). The prevalence of both basophilic stippling (P < 0.001, z = 6.62) and hemolytic anemia (P < 0.001, z = 6.52) in study population was significantly associated with elevated BLL. We could not find any significant correlation between serum level of liver enzymes and BLL. Conclusions: Opium-addicted patients in Tehran, Iran, are at high risk of lead poisoning which may result in hematologic problems and possibly hepatic damage.

Background: Proteinuria is a common laboratory finding among children and adolescents. It can be identified as either a transient or a persistent finding and can represent a benign condition or a serious disease. Methods: Pertinent medical literature for asymptomatic proteinuria in children and adolescents published in English was searched between January 1980 and May 2017 using PubMed, MEDLINE, EMBASE, and Google Scholar research databases. Of the 64 reviewed articles, 24 studies were eligible for inclusion. Results: Random spot urine protein-to-creatinine (PCR) ratio is widely used to reliably detect proteinuria. The normal value for the spot PCR in children aged 2 years or older is less than 0.3. In children aged below 2 years, the PCR can be as high as 0.5. Orthostatic proteinuria is defined as urine PCR greater than 0.3 detected in a urine specimen during the daytime activity but less than 0.3 on the first morning void specimen. PCR above 3.0 signifies heavy proteinuria as seen in nephrotic syndrome. Orthostatic proteinuria is a frequent cause of proteinuria in asymptomatic children and adolescents, which require no specific therapy except for health maintenance follow-up. Pediatric nephrologist referral is indicated when the proteinuria is constant and persists over 6 months or is associated with hematuria, hypertension, or renal dysfunction. Conclusions: We provide a simplified diagnostic algorithm for evaluation of proteinuria in primary care adolescents who appear well and in whom proteinuria is incidentally discovered during a routine examination.

Background: Antiepileptic drugs (AEDs) may lead to an increase in the plasma concentration of homocysteine. There is limited information, especially from Iran, regarding the risk in patients who are treated with levetiracetam as a new type of AED. The aim of the present study was to investigate the effect of levetiracetam on plasma homocysteine, vitamin B12, and folate levels in adult patients with epilepsy. Methods: We conducted a case-control study and enrolled adult patients with epilepsy who had received monotherapy with levetiracetam for at least 6 months at some time prior to the study. homocysteine serum, vitamin B12, and folate were measured, and folate and vitamin B12 intake was determined by the food frequency questionnaire (FFQ). Results: Thirty-three patients on levetiracetam and 35 control subjects aged between 18 and 60 years were enrolled. No statistically significant differences in the means of the serum markers of vitamin B12, FA, and homocysteine levels were found between the two groups. In the first model,i.e., the crude model, no significant differences were observed in the serum concentrations of homocysteine, vitamin B12, and folate. In the second model, education was considered, and body mass index and folate intake was controlled with no significant difference being observed in the mean homocysteine serum level. Conclusions: Treatment with levetiracetam in patients with epilepsy has no effect on the serum levels concentrations of homocysteine, vitamin B12, and folate. This medication is suggested for patients who use AEDs on a long-term basis and at high dosages.

Background: Caregiver burden is always a neglected domain, and assessment of burden with available instruments developed in one country is neither reliable nor valid because of different cultural, ethical, religious, and other personal values. This study is an attempt to develop an appropriate instrument which can assess the burden on caregivers from the Indian subcontinent and other Asian countries. This work is an attempt to develop and standardization of CBS-IP using content and construct validity. Methods: The study was conducted with a total of 125 (55 – initial interview + 25 – pilot study + 45 – construct validity) caregivers of individual with chronic neurologically ill patients. Content and construct validation was performed as follows: (1) search of relevant electronic databanks and use of experts and caregivers' opinions to prepare appropriate content, review, and correction of the content through discussions with experts. (2) Content validity has been established by computing content validity index (CVI). (3) Construct validity has been established by correlating (Pearson's-r) with another standardized instrument (Eysenck Personality Questionnaire-Revised) using multitrait procedure. Results: Using CVI procedure, scale-level CVI (S-CVI) universal agreement is 0.889; S-CVI average is 0.898. The item-level CVI is 0.90. The Pearson product-moment correlation coefficient (r) was obtained by comparing caregiver burden scale-Indian population (CBS-IP) total with extraversion, r = −0.440, n = 45, P = 0.002; CBS-IP total with neuroticism, r = 0.228, n = 45, P = 0.132; and CBS-IP total with psychoticism, r = −0.011, n = 45, P = 0.942. Conclusions: We believe that the new tool CBS-IP is a good empirical instrument for evaluating stressors on informal caregivers in India and possibly in some other countries in Asia.

Background: The unfair distribution and delivery of health-care resources have been recognized as a problem in the worldwide. In the past 18 years, Turkey has undergone rapid social, cultural, and economic changes. The lifestyle and dietary habits of its people have also been changing, and the rates of diabetes, obesity, cancer, and other chronic diseases have increased dramatically over the past two decades. The health transformation program (HTP) has improved the Turkish health-care system since 2003. The main goal of HTP was to progress government, to provide equality between citizens, to give satisfaction to users and providers, and to subsidise the health-care system in Turkey. Aim: The aim of this study is to assess health-care services and health care quality delivery in the Republic of Turkey with special emphasis on governmental hospitals, university hospitals, primary healthcare centers (PHC) and to make comparison with low-, medium- and high-income countries. Methods: This is a retrospective, descriptive study. The ministry of health Annual Reports, websites of the Central Intelligence Agency (CIA), The World Fact Book, organization for economic cooperation and development report, Compendium of Health Statistics, the Google engine, and PubMed were searched for information about Turkey's health-care system and its history. Papers and websites in English were evaluated. There was no restriction on types of articles and sources. Results: Turkey has made outstanding reforms in health status in the last two decades, especially after the implementation of the HTP. The doctor's perception has more influence regarding consultation length and visit than the patient's. The results of consultations in volunteer practices in Istanbul showed that the mean and SD of the consultation length for the whole sample of 360 patients was 7.95 ± 4.38, (with range = 3–25 min). Consultation time has been affected by the patients' diseases, genders that women got longer consultation time, medical practices at the urban or rural areas, and ages which older patients required longer consultation time. The current study revealed that increasing doctor's workload leads to decrease the length of consultations. Moreover, average life expectancy reached 75.3 for men and 80.7 for women in 2015. The infant mortality rate decreased to 10.7/1000 live births in 2015, down from 117.5 in 1980. The leading causes of death are diseases of the circulatory system followed by cancer. Conclusions: The Turkish health system and health-care delivery have been improved over the last decade. Still far from perfect, there is a particular planning to increase medical workforce in PHC including well-trained staffs for a specific area. An urgent need is to acquire more accurate and reliable data from hospital and PHC centers in Turkey. Additional some attempts should be made to assess quality of healthcare in relation to services and process.

Background: Sarcopenia describes the inevitable deterioration in muscle mass and strength that accompanies biological aging. The purpose of this study was to investigate the effects of resistance training (RT) on quadriceps hypertrophy and related biochemistry in sarcopenic and healthy elderly men. Methods: A total of 31 elderly men (55–70 years old) were classified as sarcopenic and nonsarcopenic and were divided into two groups. Both groups participated in a progressive RT program for 8 weeks. Results: Data indicated that the strength in the sarcopenic group increased more than the healthy group (P < 0.05). Quadriceps cross-sectional area also increased more in the healthy group (P < 0.05). Myostatin concentration decreased in both groups after training (P < 0.05). Follistatin and testosterone increased in the healthy group; in contrast, only testosterone increased in the sarcopenic group after training (P < 0.05). Conclusions: The findings from this study suggest that RT improves muscle cross-sectional area and biomarker-related muscle loss in both healthy and sarcopenic elderly men. The findings also demonstrate that growth factor profiles at baseline and changes in testosterone levels play an important role in muscle hypertrophy observed in both groups.

Introduction: Dental caries and obesity are multifactorial diseases with diet being a common contributory factor. Many studies have reported varied outcomes about the association between dental caries and body mass index. But, there is no published study that investigates this association among female students in Tehran. The main aim of this study was to examine the relationship between dental caries and body mass index (BMI) in a sample of female students in Tehran. Methods: In this cross-sectional study, 416 students aged between 10 to 12 years was examined for dental caries using WHO standard diagnostic criteria. The Decayed, missing and filled of permanent teeth (DMFT) were recorded. The student's weight and height were measured by two trained examiner and their BMI were calculated. BMI-for-age and dental caries categories were analyzed with Pearson correlation coefficient, Chi-square, and t-tests using SPSS computer software. Results: The mean DMFT score and BMI of the study population was 1.03 ± 1.41 and 18.11 ± 3.33 respectively. The findings showed that 58.9% of the children had a normal weight, 27.9% were overweight, 10.3% were obese, and only 2.9% of the students were thin when they were compared with WHO standard of BMI for children with the same age. The respective mean DMFT values for BMI groups (thin, normal, overweight and obese) were 1.25, 0.73, 1.42, and 1.65, respectively. There was a significant association (P < 0.05) between dental caries and high BMI. Conclusions: This study demonstrated a significant association between caries frequency with high body mass index. For these reasons, the evaluation of nutritional status in students should be implemented in control programs for dental caries both on the community, schools, and individual levels.

Background: Drug abuse is one of the most prevalent public health problems around the world and Iran too. Drug abuse is influenced by various psychosocial factors. This study aimed to explain the relationship model of drug abuse based on perceived criticism, mindfulness, and emotion regulation in Isfahan male adolescents. Methods: This was a correlational cross-sectional study. A total of 350 male students were randomly selected from different high schools in Isfahan during the period of 2015–2016 academic year. Four questionnaires including the probability of drug abuse questionnaire, emotion regulation inventory, Mindful Attention Awareness Scale, and perceived criticism scale were employed. Data were analyzed using Chi-square and correlation coefficient, besides; Structural equation modeling was used to model the direct and indirect relationships between variables. In this regard, SPSS and AMOS softwares were used. Results: Out of the whole subjects, 49.7% had score above the median, indicating more likely to be drug abuser. There was a significant correlation between emotional reappraisal (r = −0.40), expressive suppression (r = −0.38), mindfulness (−0.57), and criticism (r = 0.57) with drug abuse among male adolescents (P < 0.001). Moreover, criticism through the emotional self-regulation had indirect effects on drug abuse. Totally 69% of the variance in drug abuse was explained by the study variables. Conclusions: In total, the results of this study revealed that high levels of drug abuse among students can be considered as a crucial issue, regarding the significant effects of psychological factors, adaptive emotion-regulation strategies, as well as school and family-based Psycho-social skills, are recommended.

Background: Detecting pressure ulcer is an important nursing diagnostic and care requirement in patients hospitalized in Intensive Care Unit (ICU). The purpose of this study is to examine the effect of Lawsonia plant on pressure ulcer grade one in ICU patients. Methods: In this clinical trial, 72 patients eligible for hospitalization in hospitals of Isfahan University of Medical Sciences were divided randomly into two control and intervention groups. The standard program of skin care was implemented on both groups; in addition, a mixture of Lawsonia (henna) and distilled water was applied topically in the intervention group. The classification form of the International Pressure Ulcer Advisory Panel was used to identify grade one ulcers. Data were collected on the 1^st day through demographic information questionnaire and Braden pressure ulcer risk assessment scale. An infrared thermometer was used to record local temperature of the ulcers on a daily basis. Assessments were made based on Pressure Ulcer Scale for Healing (PUSH), and the pressure ulcer area was examined per square centimeter on the 1^st, 4^th, and 7^th days. The data were analyzed using SPSS 16. Results: The average change in the ulcer area per square centimeter in the control group increased by 29.9 ± 37.93 whereas it decreased by 3.54 ± 33.91 in the intervention group. The mean PUSH score decreased in the intervention group (5.36 ± 3.12) while it increased in the control group (1.91 ± 1.53). The average changes of PUSH score before and after the intervention showed a significant difference in both groups. Conclusions: With regard to the effect of henna on the reduction of ulcer area and the average PUSH score in ICU patients, the application of henna is recommended for healing grade one pressure ulcers.

Background: Chorionic villus sampling (CVS) and amniocentesis are two methods for prenatal diagnosis. The goal of this study was to compare amniocentesis and CVS-related complications in a large sample of Iranian women. Methods: Medical records of 1624 women who underwent amniocentesis or CVS due to medical indications between 2008 and 2016 were reviewed. Data regarding age, gravidity, parity, gestational age, type of procedure, neonatal weight (and percentile), trisomia, abortion, intrauterine growth restriction (IUGR), severe IUGR, preeclampsia, and gestational hypertension were recorded. Results: Finally, 1215 cases were evaluated. Mean maternal age, gravidity, and gestational age were significantly different between two groups. Preeclampsia, gestational hypertension, IUGR, severe IUGR, and intrauterine fetal death were not significantly different between two groups. Trisomy 18 and 21 were common in cases underwent amniocentesis. Conclusions: Women who underwent CVS are not at higher risk for developing hypertensive disorders than women underwent amniocentesis.

Background: Birth asphyxia is considered as one of the biggest challenges faced by perinatal care experts. According to the WHO, in 2005, one-fourth of infant mortality cases occurred due to birth asphyxia. Methods: This study is a retrospective study done on the newborn population with gestational ages of 36 weeks or higher during the years 2013, 2014, and 2015 to find the relationship between the number of birth asphyxia cases and the years. As a secondary objective, the relationship between the mode of delivery and the cases of birth asphyxia were investigated using logistic regression test. The inclusion criteria consisted of three cases, namely, gestational age of 36 weeks or higher, 5 min Apgar of <5, and umbilical cord pH of <7.1. The exclusion criteria involved hydrops fetalis, cyanotic heart disease, chromosomal abnormality, and congenital infections. Results: From the two independent variables of the study, only the variable “year” showed a significant difference between the years 2013 and 2015 (P < 0.01). The delivery mode did not have any statistically significant influence on the newborns' affliction with birth asphyxia (P = 0.993). Conclusions: According to the results, there is a significant difference between the rate of birth asphyxia in Iran and its global rate in 2015, and regarding its multiple growth from 2013 to 2015, conducting a more comprehensive and extensive research on birth asphyxia risk factors at a delivery time seems justified and inevitable.

Background: Hemodialysis (HD)-associated ocular abnormalities are one of the causes of morbidity among people undergoing HD. This study evaluates the frequency of ocular abnormalities in end-stage renal disease (ESRD) patients undergoing HD and their potential link to HD and demographic parameters. Methods: This cross-sectional study examined 242 eyes of 121 patients with ESRD undergoing regular HD after excluding the ineligible subjects. The study was designed in two parts. Medical histories of each patient including age, gender, family history, medication history, past medical history, and duration of HD collected using a structured check list. All patients underwent complete ophthalmologic examination for evaluation of the best corrected visual acuity (BCVA), intraocular pressure (IOP), and anterior and posterior segments. Results: In total, 121 patients, including 68 (56.2%) males and 53 (43.8%) females, were enrolled in the study. The mean ± SD age of the patients and their mean duration of dialysis were 51.59 ± 16.01 and 3.40 ± 2.75 years, respectively. The most prevalent etiology for HD was diabetes mellitus (39.67%), followed by hypertension (38.84%), and the most common ocular findings included cataract (142 eyes; 58.7%) and ectopic calcification of the conjunctiva and cornea (78 eyes; %32.2). There was at least one abnormal ocular finding in 89.3% of the cases. The BCVA was equal to or less than finger count in 70 eyes (28.92%). There was a significant relationship between conjunctival calcification and the duration of dialysis (P = 0.02). There was significant association between etiology of HD and conjunctival calcification (adjusted odds ratio, 2.44; 95% CI, 1.05–5.67; and P value, 0.03). Such significant associations were present for corneal calcification (P = 0.009), cataract (P = 0.02), and optic atrophy (P = 0.01). Conclusions: Regular ophthalmologic examinations are recommended due to the prevalence of clinical ocular abnormalities in HD patients.

Background: The aim of this study was to investigate the effect of hydroethanolic Nigella sativa L. extract on skin wound healing in diabetic male rats. Methods: This experimental study was conducted on 49 male Wistar rats weighing 220–250 g divided into 7 groups of 7 each: control (nondiabetic untreated), sham (nondiabetic eucerin-treated), nondiabetic phenytoin (1%)-treated, diabetic untreated, and three diabetic groups treated independently with phenytoin 1%, hydroethanolic N. sativa extracts 20% or 40%. Diabetes was induced with 60 mg/kg streptozosin in one administration. After anesthesia, 2 × 1 cm² wounds were made on the rats' backs and each group was administered with its own respective treatment until the wounds were healed completely. Tissue specimens were prepared for histological examinations. The areas of the wounds were measured every 3 days. The data were analyzed by ANOVA and Tukey's post-hoc test. Results: The mean duration of wound healing was 27 and 24 days for diabetic untreated and diabetic phenytoin-treated groups, respectively. Wounds were healed completely in nondiabetic untreated, sham, and nondiabetic phenytoin-treated groups on days 23, 24, and 21, respectively. The shortest duration of wound healing was seen in diabetic N. sativa extract (40%)-treated group (15 days) followed by diabetic N. sativa (20%)-treated group (18 days). These two groups were found to have the lowest mean wound area during the study with a significant difference from mean wound area in the controls (P < 0.05). Conclusions: N. sativa extract significantly promoted wound healing in diabetic rats in comparison with control groups. Although the beneficial mechanism of the promotion of wound healing was not specifically studied, it is believed that the anti-inflammatory and antimicrobial properties of N. sativa would contribute to this enhanced wound healing.

Background: Vitamin D plays an important role in nervous health and depression. Vitamin D deficiency and anxiety affect diabetic status. The purpose of this study was to determine the effect of vitamin D supplementation on anxiety, depression, and inflammation in diabetic women with anxiety. Methods: In this randomized controlled trial, totally 51 women with type 2 diabetes (T2DM) and vitamin D deficiency were randomly allocated to receive one oral pearl of 50,000 IU vitamin D3 (26 women) or a placebo (25 women) fortnightly for 16 weeks. Anthropometric indices, sun exposure, dietary intake, depression, anxiety, and stress scores and biochemical biomarkers including high sensitivity C-reactive protein (hs-CRP) and interleukin-10 (IL-10) were measured at the baseline and after 16-week supplementation. Results: Mean ± SD age of participant was 47.43 ± 9.57 years old. Baseline values were not different between the groups. Anxiety score changes were significantly lower in vitamin D group than the controls (P = 0.001). Within group comparison indicated that depression in supplement group with lower vitamin D levels was significantly reduced. Serum hs-CRP reduced (P = 0.01), while IL-10 concentrations increased (P = 0.04) in the intervention group. Conclusions: Vitamin D supplementation can improve mood status and anti-inflammatory biomarkers in female diabetics with anxiety and vitamin D deficiency.

Objective: There are some evidence that Vitamin D supplementation may be beneficial for patients with irritable bowel syndrome (IBS). The aim of this study was to evaluate the effects of Vitamin D supplementation on symptoms and quality of life (QOL) in patients with IBS. Methods: In a randomized, double-blind, placebo-controlled clinical trial, 116 patients with IBS were supplemented weekly with either a pearl of 50,000 IU Vitamin D or an identical pearl of placebo containing medium chain triglyceride for 6 weeks. Results: Mean age of patients was 42.24 ± 12.26, and 40.06 ± 13.37 in Vitamin D and placebo groups, respectively. Dietary intakes were similar between and within groups. Serum concentration of 25-hydroxy Vitamin D increased significantly from 21.10 ± 5.23 to 36.43 ± 12.34 in the Vitamin D group (P < 0.001), while it was not significantly different before and after the trial in placebo group. The IBS symptoms severity scores (SSSs), disease-specific QOL, and total score were evaluated at weeks 0 and 6. IBS-SSS, IBS-QOL, and the total score were improved significantly more in Vitamin D group in comparison to the placebo group (P < 0.05). Conclusions: This study indicates that Vitamin D therapy can improve the severity of symptoms and QOL in patients with IBS; however, the long-term effects remained to be elucidated. Trial registration at IRCT: IRCT201402234010N11 IRB Number: 116/3976

Background: There is no statement on the ability of obesity indices in prediction of lipid abnormalities among young adults. The present study was conducted to determine the ability of obesity indices as predictors of lipid abnormalities among a group of young adults. Materials and Methods: A total of 353 medical university students aged 18–25 years (188 males and 165 females) participated in this cross-sectional study in 2014. Weight, height, waist circumference (WC), and hip circumference were measured to calculate obesity indices including body mass index (BMI), waist-to-hip ratio, and waist-to-height ratio (WHtR). Serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) were measured by commercially available kits and were applied to calculate low-density lipoprotein cholesterol (LDL-C) and atherogenic parameters including LDL-C/ HDL-C ratio, TC/HDL-C ratio, non-HDL-C, and atherogenic index of plasma (AIP). Results: Subjects with BMI ≥25 kg/m² had a greater value of all lipid profiles and atherogenic parameters (P < 0.05) except for HDL-C (P > 0.05) compared to subjects with BMI <25 kg/m². In logistic regression model, BMI ≥25 kg/m² was significantly associated with the highest odds for elevated TC (odds ratio [OR] = 7.67, P = 0.003), LDL-C (OR = 3.24, P = 0.01), TC:HDL-C (OR = 4.98, P = 0.01), and non-HDL-C(OR = 4.32, P = 0.001) in males, as well as high values of TG (OR = 8.80, P = 0.002), LDL-C:HDL-C (OR = 3.64, P = 0.01), and AIP (OR = 9.65, P < 0.001) in females. In terms of central obesity indices, males with WC ≥102 cm and females with WC ≥88 cm had the highest odds of increased LDL-C:HDL-C (OR = 6.71, P = 0.01) and TC:HDL-C (OR = 3.25, P = 0.050), respectively. In addition, females with WHtR ≥0.50 had the highest odds of high TC (OR = 3.56, P = 0.02) and non-HDL-C (OR = 2.70, P = 0.02). Conclusions: Overall, the findings of the present study showed that BMI was a stronger index for prediction of classical lipid parameters and atherogenic parameters than central obesity indices in medical students.

Background: Reforming the health care system to improve suitable health care model for diabetic patients is essential. This study aimed to implement, identify, and overcome the challenges of implementing the Chronic Care Model in diabetes management in a clinic. Methods: This study is a qualitative technical action research with the Kemmis and McTaggart model including planning, action, reflection, observation, and revision plan which was conducted in the specialized polyclinic from 2015 to 2017 in Isfahan city – Iran. Data were gathered through qualitative and quantitative methods. Diabetes team and 17 patients with type 2 diabetes participated in semi-structured interviews that were purposively chosen. Qualitative data were analyzed using content analysis and then quantitative data collected. Results: The qualitative findings of this research are in five main categories: System design upgrade, self-management upgrade, decision support, health care organization, and clinical information system upgrade. Results of quantitative data showed that most metabolic indicators like HbA1c have statistical meaningful changes (P value < 0.05). Conclusions: Implementing the Chronic Care Model became feasible despite serious challenges and two groups of ready and active team and active patients were developed. The study showed that one important lost link of diabetes management is underestimating the nurses' capabilities in the management of this disease. Inevitably, serious investment on maximum use of nurses' knowledge and skills in improving diabetes management will help diabetes care upgrade significantly.

Background: The aim of the study was to determine the effects of coenzyme Q10 (CoQ10) supplementation on biomarkers of inflammation and oxidative stress among diabetic hemodialysis (HD) patients. Methods: Sixty diabetic HD patients participated in the randomized, double blind, placebo-controlled clinical trial. They were randomly assigned into two groups to intake either 60 mg CoQ10 supplements (n = 30) or placebo (n = 30) twice a day for 12 weeks. Results: After 12 weeks of intervention, CoQ10 supplementation significantly increased total antioxidant (TAC) (54.921 ± 26.437 vs. −126.781 ± 26.437, P < 0.001) and nitric oxide (NO) levels (4.121 ± 1.314 vs. −1.427 ± 1.314, P = 0.006) and decreased C-reactive protein (CRP) (−1.302 ± 0.583 vs. 0.345 ± 0.583, 0.042) levels compared with the placebo. We did not observe any significant effect of CoQ10 supplementation on malondialdehyde (MDA) and glutathione (GSH) levels compared with the placebo. Conclusions: Overall, our study showed that CoQ10 supplementation to diabetic HD patients for 12 weeks was associated with increased levels of TAC and NO levels and decreased level of high-sensitivity CRP (hs-CRP) levels, but did not have any beneficial effects on MDA and GSH.

Background: Diabetes has a genetic predisposition and is generally not diagnosed for many years because hyperglycemia develops gradually, without presenting the classic symptoms of diabetes. The aim of this study is to verify whether, in a potentially genetically predisposed population, men and women under the age of 50 years, at the time of the study, not suffering from diabetes can be detected using parameters derived from initial metabolic alteration indices of the possible evolution of pathology. Methods: In the hereditary and healthy group, salivary concentration of malondialdehyde, total mucins, and pH were determined. All participants in the two groups had fasting glucose level below 110 mg/dL. The results were statistically analyzed using Pearson correlation test, Mann–Whitney test, and –Student's t-test. Results: Salivary concentration of malondialdehyde statistically increased in the hereditary group vs the healthy group (P = 0.0368) as the mucins (P ≤ 0.005). The salivary pH decreased but, the values were not statistically significant (P = 0.085). Some alteration processes occur without increase in glucose levels, produced by changes in metabolic redox processes along with an increase in the salivary malondialdehyde index of oxidative stress in the body. The modification of the salivary buffer system lowers the pH, whereas increase in salivary mucins alters the value of spinnbarkeit, which measures the capacity of the mucous layer to adhere to the epithelium, causing alterations of the oral mucosa. Conclusions: This study shows that it is possible to predict in hereditary predisposition conditions the development of diabetes, and the related dangerous consequences by monitoring two salivary parameters – mucins and malondialdehyde.

Background: The HIV control and prevention program is one of the Public Health programs that confronts with many ethical challenges. This study aimed to explore ethical considerations from the viewpoint of headquarters experts on HIV and AIDS prevention and control strategic plan. Methods: In this qualitative study with content analysis design, focus group discussion method was utilized. After purposeful introduction of the experts and previous coordination about subject and time, two discussion sessions were held with the participation of six ministry and university headquarters experts of HIV control program. After frequent reviews of the data and using deductive content analysis, main themes and subthemes were categorized. In order to transformability of the findings to similar situations, the data were checked by three external reviewers. Results: The participants agreed that HIV/AIDS control requires focusing on prevention, treatment, and support services, and considering the general population and all vulnerable groups. In this study, five main themes were emerged: informing and empowering to make autonomous decisions, observing confidentiality, prohibiting stigma and discrimination, and being accountable. Conclusions: The viewpoint of participants indicates on the more need to pay attention the mentioned ethical considerations when compiling and finalizing the program. Moreover, in addition to instructing moral norms in PH programs with a special look to HIV/AIDS and how to apply them in the formulation and implementation of program, systematic evaluation of the program by an ethical framework is recommended to ensure the achievement to the goals of program.

Background: Insulin-like growth factor-1 (IGF-1) and interleukin-2 (IL-2) play an essential role in pathophysiology of several chronic diseases. As a stressor, fasting in Ramadan may increase inflammatory markers such as IGF-1 and IL-2 in Muslims. The aim of this before–after study was to investigate the effects of fasting in Ramadan on IGF-1 and IL-2 levels in individuals. Methods: In all, 34 men age 16–64 years were selected out of the overall number of individuals who were ready for fasting entirely throughout Ramadan. A sample of blood was drawn from the contributors before and after Ramadan, and plasma IGF-1, IL-2, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were determined. To identify differences between the initial and final values of test results of the study for plasma IGF-1, IL-2, and lipid parameters, we used paired sample T-test. Results: Paired sample T-test illustrated a significant decrease in IGF-1 and IL-2 levels after Ramadan fasting compared to before Ramadan. The concentration of TG, cholesterol, and LDL-C levels underwent significant decreases over the period of the study. HDL-C levels did not change significantly during the study. A significant decrease in weight, waist circumferences, calorie, carbohydrate, and fat intake were observed in participants during Ramadan fasting. Conclusions: It is concluded that fasting in Ramadan independent of anthropometric measures attenuates inflammation and is beneficiary to health.

Introduction: Abu Bakr Mohammad Ibn Zakariya Al-Razi (865–925 CE), who was known as “Rhazes” in the west, was a famous scientist of medieval ages. He has more than 200 books and treatises. His masterpiece on medicine “Kitab Al-Hawi Fi Al-Tibb” contains around 900 case reports. Some of the diseases which seem to be recently reported have been stated previously, but not well described. Considering symptoms of the patient described at that time, differential diagnosis will be discussed. Case presentation: Rhazes described a patient with bilious fever. He had developed bloody urine and stool on the fourth day and fatigue. Subsequently, the patient's urine and stool color turned into dark and black, respectively, and died the following day. According to Rhazes attitude, it was malignant measles. Meyerhof in his book has referred to post-measles acute glomerulonephritis, but more appropriate differential diagnoses are compatible with this patient. Discussion: One of the best diagnoses for this case can be Weil's syndrome. Presence of fever, icterus, hemorrhage and renal injury, all suggest Weil's syndrome without pulmonary involvement. The other probable diagnosis is thrombotic thrombocytopenic purpura (TTP). Meningococcal sepsis is the other possible diagnosis. Conclusion: To sum up, as three compatible diseases with the case; have been described more than a thousand years after Rhazes (Weil's syndrome 1886, TTP 1925 and meningococcemia 1805); if the case is either Weil's or TTP or meningococcal sepsis, it is the first report of the disease in the world by Rhazes.

Background: Cyclophosphamide (CP), as a chemotherapy drug, causes severe damage in testicular tissue through producing free radicals. Cerium oxide nanoparticles (NC) exhibit antioxidant and anti-inflammatory properties. The purpose of this study was to investigate the protective effect of NC on CP-induced testicular damage in mice. Methods: In this experimental study, thirty-two male mice were divided into four groups (eight mice in each group). The control group was received intraperitoneally (IP) normal saline, NC group was received NC for three consecutive days (100 μg/kg, IP), CP group was received CP (200 mg/kg, IP), and the CP + NC group received NC, three consecutive days before receiving CP. After 2 days, testicles were assessed for biochemical, histomorphometrical, histopathological, and immunohistochemical analyses. Results: CP administration caused statistically significant increases in sperm abnormality, malondialdehyde, protein carbonyl levels, reactive oxygen species, level and apoptosis, and decreases in sperm count, sperm viability, testosterone, glutathione activity, the mean thickness of the germinal epithelium, diameter of seminiferous tubules in mice. Degeneration, necrosis, arrest of spermatogenesis, congestion, and atrophy in testicular tissue confirmed the low Johnsen's Testicular score in CP group. Administration of NC significantly ameliorated the CP-induced adverse effects on testis compared with the CP group. In addition, pretreatment mice with NC significantly reduced caspase-3 immunoreactivity induced by CP in testis. Conclusions: This study showed that NC with scavenging free radicals and antiapoptotic properties enable to reduce the side effects of CP in the testicular tissue.

Background: This study was conducted to assess the effects of folate supplementation on carotid intima-media thickness (CIMT), biomarkers of inflammation, and oxidative stress in carbamazepine-treated epileptic children. Methods: This randomized, double-blind, placebo-controlled trial was carried out in 54 epileptic children aged 2–12 years old receiving carbamazepine monotherapy. Participants were randomly allocated into two groups to receive either 5 mg folate supplements or placebo (n = 27 in each group) for 12 weeks. Results: After the 12-week intervention, compared with the placebo, folate supplementation resulted in a significant reduction in plasma homocysteine (Hcy) (changes from baseline − 2.1 ± 2.5 vs. +0.1 ± 0.4 μmol/L, P < 0.001), serum high-sensitivity C-reactive protein (hs-CRP) (changes from baseline − 1.5 ± 3.5 vs. +0.4 ± 1.4 mg/L, P = 0.01), a significant increase in plasma nitric oxide (NO) (changes from baseline + 1.9 ± 5.8 vs. −2.0 ± 6.4 μmol/L, P = 0.02), and total antioxidant capacity (TAC) concentrations (changes from baseline + 88.6 ± 116.0 vs. +1.8 ± 77.4 mmol/L, P = 0.002). We did not observe any significant effects in mean levels of left and right CIMT, maximum levels of left and right CIMT, and total glutathione (GSH) and malondialdehyde (MDA) levels following the supplementation of folate compared with the placebo. Conclusions: Overall, folate supplementation at a dosage of 5 mg/day for 12 weeks among epileptic children receiving carbamazepine had beneficial effects on Hcy, hs-CRP, NO, and TAC levels, but did not affect CIMT, and GSH and MDA levels.

Background: Due to high content of fructose, honey has been introduced as a suitable natural sweetener for patients with type 2 diabetes. We investigated the effect of honey consumption on glycemic control and anthropometric measures of patients with type 2 diabetes. Methods: This randomized controlled crossover clinical trial was conducted on 53 patients with type 2 diabetes. The participants were randomly divided into groups of control (weight maintenance diet) or treatment (weight maintenance diet +50 g/day honey) for 8 weeks. After a 4-week washout, the second phase began, in which the role of the groups was interchanged. Blood glycated hemoglobin (HbA1c), glucose, insulin, and anthropometric characteristics were measured. Statistical analysis was performed with SPSS. Repeated measures of ANOVA were used to test differences within- and between the two conditions. Results: Forty-two patients completed the study. HbA1c significantly decreased in control (−0.22%, P = 0.03) and nonsignificantly increased in honey condition (+0.17%, P = 0.22). There was a significant difference between the two conditions (P = 0.02). Fasting glucose did not significantly change in either honey or control condition but insulin concentrations (−0.85 μU/ml, P = 0.01) and insulin secretion (−10.7%, P = 0.01) decreased significantly in the control condition. There was no significant difference in any of these parameters between the two conditions. Waist circumference decreased by honey treatment with a significant difference between the two conditions (P = 0.02). Conclusions: Eight weeks consumption of 50 g/day honey increased HbA1c and decreased waist circumference of patients with type 2 diabetes.

Background: To examine the associations among nutritional label use, medically diagnosed hypertension, and sociodemographic factors among teachers. Methods: A cross-sectional study of elementary and secondary school teachers in Londrina, Paraná, Brazil, was conducted. Data regarding sociodemographic variables, hypertension diagnosis, and the reading of nutritional information on food/beverage labels were collected in 2012–2013. Associations were analyzed using Chi-square test or Fisher's exact test, and multivariate binary logistic regression models were used to adjust for possible confounders; odds ratios (ORs), 95% confidence intervals (CIs), and adjusted P values were calculated. Results: Of the 978 teachers interviewed, 15% were diagnosed with hypertension, and 62.5% read nutritional information in the 12 months prior to the survey (41% frequently or always). No differences were found between teachers with and without hypertension with regard to frequent reading (frequently/always) of nutritional labels. The frequent use of nutritional labels was significantly associated with female sex (OR = 1.39; 95% CI = 1.04–1.85) and the highest monthly family income level (OR = 1.82; 95% CI = 1.07–3.11). Teachers with hypertension reported checking for sodium more frequently than those without (adjusted P value = 0.040). Medical advice (adjusted P value <0.001) and choosing healthier foods (adjusted P value = 0.002) were the major reasons for reading labels provided by teachers with and without hypertension, respectively. Conclusions: Checking for sodium values on nutritional labels was significantly higher among teachers with hypertension, which most likely results from medical advice, and was the major reported reason for reading these labels.