Background: The aim of this study was to determine the effect of Livergol on the improvement of fatty liver in patients with cancer undergoing irinotecan- and oxaliplatin-based chemotherapy regimen. Methods: This was an add-on nonrandomized clinical trial study on thirty selected eligible cancer patients undergoing irinotecan (8 patients) and oxaliplatin (22 patients) with diagnosed fatty liver disease-based liver ultrasonography, as well as alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Patients in each group received Livergol at a dose of 140 mg daily for 1 month. ALT and AST levels as well as grade of fatty liver were evaluated before and after intervention. Results: In the oxaliplatin/Livergol group, 40% and 44.4% of patients who were in Grade 2 and 3 before intervention were altered to Grades 1 and 2, respectively (P = 0.005), and in irinotecan/Livergol group, the mentioned percentages were 80% and 66.7% (P = 0.014). The mean levels of ALT and AST enzymes were decreased in both groups after tacking Livergol; however, the observed decreases were not significantly different between groups. Conclusions: It was concluded that the adding of Livergol to oxaliplatin and irinotecan regimens significantly improved the fatty liver of patients and none of them was superior.

Background: Diabetes mellitus is a chronic metabolic disorder of hyperglycemia. Chronic hyperglycemia produces advanced glycation end products such as the methylglyoxal (MGO) which interferes with cell functions, insulin signaling, and β-cell functions. The present study was conducted to determine the effects of berberine (BBR) therapy on serum MGO and insulin resistance in newly diagnosed type 2 diabetic patients. Materials and Methods: The present case–control study was conducted at the Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro/Hyderabad, from March 2016 to January 2017. A sample of 200 newly diagnosed type 2 diabetic patients was divided into two groups. Group 1 received metformin 500 mg (×3 daily) and Group 2 received BBR 500 mg (×3 daily) for 3 months. Blood samples were collected at baseline and after 3 months to analyze biochemical parameters on Roche biochemical analyzer. MGO was assayed by ELISA kit and homeostasis model assessment of insulin resistance (HOMA-IR) model. SPSS version 23.0 (IBM, Incorporation, USA) analyzed the data at 95% confidence interval (P ≤ 0.05). Results: Baseline HOMA-IR (% IR) and MGO were found elevated in metformin and BBR groups. After 3 months of metformin and BBR therapy, the HOMA-IR (% IR) and MGO were decreased to 3.69 ± 1.13 and 2.64 ± 0.76 and 35.84 ± 12.56 and 26.64 ± 10.73 ng/dl, respectively (P = 0.0001). HOMA-IR (% IR) was improved by 40% and 73% (P = 0.0001) and MGO by 43% and 56% in metformin and BBR groups, respectively (P = 0.0001). Conclusion: BBR is more effective in decreasing the serum MGO levels and insulin resistance through improved glycemic control in newly diagnosed type 2 diabetic patients.

Background: There is evidence that regular activity can prevent of cardiovascular diseases. There are many reports that exercise and the consumption of olive leaf extract (OLE) have a positive effect on cardiovascular parameters. This study was conducted to compare the effects of exercise and OLE alone and together on electrocardiographic parameters in rats. Materials and Methods: Male Sprague–Dawley rats were randomly divided into six groups (n = 8 rats in each): Control, exercise, OLE (100, 200, and 400 mg/kg, orally for 14 days), and exercise + OLE (200 mg/kg of extract, orally for 14 days). Exercise training in rats was performed using treadmill for 28 days (1 h/day). Electrophysiological parameters including heart rate, PR interval, QT interval, QT corrected (QTc), RR interval, QRS voltage, and duration were obtained from lead II electrocardiogram (ECG) recorded by a PowerLab system. Statistical evaluation was done by one-way analysis of variance followed by Fisher's least significant difference test and P < 0.05 was considered statistically significant. Results: The amounts of QT (P = 0.0009) and QTc interval (P = 0.0004), RR interval (P < 0.0001), QRS duration (P = 0.004), and QRS voltage (P = 0.003) in the exercise group were significantly higher than those of the control group. However, there were no significant differences in PR interval in comparison with the control group. Exercise (P < 0.0001) and OLE (400 mg/kg, P = 0.043) alone and both in combination (P = 0.007) reduced heart rate and increased the amount of QRS voltage (P = 0.003, P = 0.047, and P = 0.046, respectively) and RR interval (P < 0.0001, P = 0.046, and P = 0.0009, respectively). Conclusion: Results of this study indicated that administration of OLE alone and in combination with exercise has negative chronotropic and positive inotropic effects and also it can prevent of prolongation of QT and QTc interval induced by severe exercise.

Background: The aim of this study was to determine whether insulin resistance, beta-cell function, and their associations with alanine aminotransferase (ALT) are affected by the functional variants of paraoxonase-2 (PON2) as an intracellular antioxidant in patients with type 2 diabetes (T2D). Materials and Methods: Quantitative insulin sensitivity check index (QUICKI) and homeostasis model assessment for beta-cell function (HOMA-BCF) were assessed in T2D patients. Insulin levels were determined using ELISA. The variants PON2-A148G and PON2-S311C were genotyped using polymerase chain reaction-based restriction fragment length polymorphism. Results: According to the PON2-G148A variant, ALT was found to be significantly correlated with QUICKI (r = −0.616, P = 0.005) and HOMA-BCF (r = 0.573, P = 0.01) in the GA + GG group; however, the correlations were not statistically significant in the AA genotypes. Based on the genotypes of PON2-S311C, there was a significant correlation between ALT with QUICKI (r = −0.540, P = 0.031) and HOMA-BCF (r = 0.567, P = 0.022) in the SC + CC group. In the multiple adjusted logistic regression analyses, considering the variants PON2-G148A and PON2-C311S as independent variables and QUICKI and HOMA-BCF as the dependent variables, both variants were significantly associated with the QUICKI (P = 0.019 for PON2-G148A and P = 0.041 for PON2-C311S). Furthermore, PON2-C311S remained significantly associated with HOMA-BCF (P = 0.03). Conclusion: These data implicate a role for the functional variants of PON2 in insulin resistance and beta-cell function as well as underscore the effective role of these variants in the associations between them and ALT. Our data contribute to our understanding of the important physiologic functions of PON2 in glucose metabolism and its related metabolic diseases.

Background: The present study is aimed to evaluate the magnetic resonance imaging (MRI) and electroencephalography (EEG) findings based on characteristics variables in patients with epilepsy. Materials and Methods: In this cross-sectional study, all patients with epilepsy who referred between March 2016 and March 2017 to Al-Zahra and Kashani Hospitals in Isfahan, Iran, were enrolled. The completed files of 199 patients were assessed to collect information about characteristic data and MRI and EEG findings. MRI and EEG findings were recorded as normal or abnormal. The characteristic data and risk factors in patients with normal MRI and EEG were compared with those patients with abnormal MRI and EEG. Results: History of seizures and trauma are reported in 84 (42.2%) and 47 (23.6%) of patients, respectively. The most frequent type of seizures was generalized. MRI finding in 51 patients (25.6%) was abnormal, and EEG finding in 124 patients (62.3%) was abnormal. Patients with abnormal MRI were significantly older than those with normal MRI (37.3 vs. 31.4, respectively, P = 0.024). Abnormal MRI in men patients was significantly more frequent than women (31.2% vs. 18.9%, respectively, P = 0.048). In patients with abnormal EEG, seizure was more frequent than patients with normal EEG (50.8% vs. 28%, respectively, P = 0.002). Other characteristics and risk factors were not significant differences between patients with normal or abnormal MRI or EEG findings. Conclusion: In patients with epilepsy, older age and being a male were the risk factors of having abnormal MRI, and seizure was the risk factor of having abnormal EEG.

Background: Rheumatoid arthritis (RA) is a common chronic autoimmune disorder that leads to damage of human joints. There are various treatment approaches in which different drugs are prescribed which have several alterations in serum lipids. This research aimed to study the effect of RA treatments on the serum lipids. Materials and Methods: Two hundred randomly selected patients with RA were randomly assigned to three different groups. The first group of patients was treated with a combination of prednisolone (PRD) and hydroxychloroquine (HCQ). The second group was treated with three drugs including PRD, HCQ, and methotrexate (MTX). The third group was treated with four medications including PRD, HCQ, MTX, and sulfasalazine. Within each group, the lipid factors such as triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL), and high-density lipoprotein (HDL), erythrocyte sedimentation rate, and visual analog scale were measured at the beginning of the experiment and 6 months after exposing the treatments. For each group, we also calculated the Disease Activity Score-28 (DAS-28). The analysis of variance revealed that the overall DAS-28 was significantly different among the three groups. Results: In the first group, the level of TG and TC significantly decreased (P = 0.015 and P ≤ 0.001, respectively). In the second group, the level of TG and LDL significantly decreased (P = 0.009). In the third group, the LDL level increased considerably (P < 0.001). The HDL level significantly increased in all three groups (P = 0.012, P = 0.014, and P = 0.028, respectively). Conclusion: The treatment PRD + HCQ + MTX was more effective in reducing the LDL level and increasing the HDL level. To reduce the risk of cardiovascular diseases in patients with RA, it is important to prescribe the combination of drugs which leads and normalizes the lipid profile levels.

Background: Patient safety is a priority in all health-care centers across the world. This study aimed to determine the frequency of events that threaten patient safety and the grade threating of events from the perspective of the health-care professionals in the intensive care units (ICUs). Materials and Methods: This cross-sectional study was conducted in 2016. The participants were 306 members of health-care professionals (physicians and nurses) with at least 1 year of work experience in ICUs of educational hospitals affiliated to Isfahan University of Medical Sciences. Data were collected using a three-section self-made questionnaire. Data analysis was done using descriptive statistics (frequency distribution and percentage) and version 16 of SPSS software. Results: A total of 306 questionnaires were completed out of 320 questionnaires handed out among participants. During the last month, 91.2% of the participants had reported at least a case of medication error, 75.6% had reported at least a case of ventilator-associated pneumonia, and 74.2% had reported at least a case of catheter-induced urinary infection in ICUs. Conclusion: The occurrence of events threatening the patient safety in ICUs warrants proper planning by administrators of health-care centers. Medication error was the most frequent and important event of threat to patient safety and falling was the least frequent event of threat to patient safety in ICUs. Considering the frequency and magnitude of medication error in ICUs, a well-adjusted preventive plan should be designed and implemented to improve the patient safety.

Background: Cancer is the second most common cause of morbidity and mortality in children. This study aimed to epidemiologically and demographically assess common cancers in children in Iran. Materials and Methods: This cohort study was conducted on children registered in Mahak Hospital and Rehabilitation Complex (which is a non-governmental organizations (NGO)-related hospital for only malignant diseases). A total of 2232 questionnaires were filled out for cancer patients between 2007 and 2016. The factors including age, gender, race, family history, type of treatment, and type of cancer were entered into Cox regression model to examine their effect on mortality of children diagnosed with cancer. Results: The Cox regression model showed that age, race, type of cancer, family history of cancer, and type of treatment had a significant effect on mortality of children diagnosed with cancer (P < 0.05). The hazard ratio (HR) of mortality in 10–15 years old was higher than that of 1–5 years old (P = 0.03, HR = 1.3). The HR of mortality in patients with brain tumor (P < 0.01, HR = 2.24), sarcoma (P < 0.01, HR = 2.32), and neuroblastoma (P < 0.01, HR = 2.56) was twice the value in patients with leukemia. The HR of mortality in patients who had a family history of cancer was higher than that of patients without it (P < 0.01, HR = 1.33). Patients who had undergone chemotherapy along with surgery and radiotherapy (P = 0.02, HR = 0.68) and patients who received chemotherapy along with surgery (P = 0.01, HR = 0.67) had a lower HR of mortality compared to the chemotherapy group. Conclusion: Young age, multidisciplinary approach, and absence of family history were associated with lower hazard of death in children diagnosed with cancer; brain tumor, leukemia, and sarcoma had higher hazard of mortality compared to leukemia. Children with a family history of cancer should be under regular follow-up. Treatment should be multidisciplinary and comprehensive.

Background: Package inserts (PIs) can be a source of information for patients, especially when clinicians do not provide adequate consultations to the patients. Therefore, for the first time, we investigated the state of PIs in Iran and evaluated patients' attitude toward PI. Materials and Methods: In this descriptive study, conducted in a major teaching pharmacy in Isfahan, Iran, in 2016, 100 patients who presented a prescription were interviewed randomly and all medications in their medication bags were examined. The main outcome measures were whether or not the dispensed medications were accompanied by a PI and the behavior of patients in reading these PIs. Results: From the 237 medication items investigated, 129 (54.4%) were dispensed with a PI. Eighty-four percent of patients read the PIs and only 19% stated reading a non-Farsi PI. The level of education was the only significant factor related to reading the PI (P = 0.02). Reading the side effects was the main reason for reading the PI (64%). PIs were considered useful by 83% while 25% kept PIs as a source of drug information. Experience of fear to take the medication after reading the PI was reported by 47%. Conclusion: About half of medications were dispensed along with the PI. Although the majority of patients report reading the PIs and consider them useful, confidence in using the medicine may be diminished after reading the PI. Patients with higher education read the PIs the most.

Background: This paper presents the protocol and primary findings of pregnancy cohort population-based study in Isfahan, Iran. Materials and Methods: In this cohort, 418 pregnant and 438 nonpregnant women were enrolled. In the first phase, serum concentrations of thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), thyroid peroxidase antibody, and urinary iodine concentration (UIC) were measured. Furthermore, the thyroid ultrasound was also performed. According to the results of thyroid function tests in the first phase, local reference range for TSH, FT4, and FT3 in pregnant and nonpregnant women are determined. The 2.5^th and 97.5^th percentiles are determined as limits of the reference ranges. In the second phase, all pregnant women underwent prenatal care visits in each trimester and they followed for 7 days after delivery and the pregnancy outcomes data are reported. Results: The mean ± standard deviation for TSH, FT4, FT3, and UIC in the first trimester of gestation was 1.84 ± 1.32 mIU/L, 1.01 ± 0.15 ng/dL, 4.50 ± 0.64 pmol/L, and 172.0 ± 90.29 μg/L, respectively. In nonpregnant women, these values for TSH, FT4, FT3, and UIC were 2.58 ± 1.77 mIU/L, 1.10 ± 0.21 ng/dL, 4.49 ± 0.57 pmol/L, and 190.0 ± 109.6 μg/L, respectively. Conclusion: The results of the present study could contribute to establish a local thyroid function tests reference ranges in the first trimester of pregnancy. It could possibly be effective on making a local reference value to prevent of thyroid disease misdiagnosis during pregnancy and adverse pregnancy outcomes.

Background: Although posttraumatic endophthalmitis is an uncommon condition, it causes severe complications, so medical and pharmacological interventions for prevention of endophthalmitis after trauma are a major concern. The aim of this study was to evaluate the efficacy and clinical outcome of oral ciprofloxacin versus intravenous cefazolin/gentamicin for the prevention of endophthalmitis after penetrating ocular trauma. Materials and Methods: This was a retrospective, descriptive single-center study, including all cases of penetrating ocular trauma seen in the Feiz Hospital, a Tertiary Referral Eye Hospital in Isfahan, Iran, between 2011 and 2017. Data systemically recorded for each patient included clinical, ophthalmological, and demographic findings by a trained medical record abstractor or ophthalmologist reviewing patient records. Results: Six hundred and forty-five patients in cefazolin/gentamicin and 273 patients in oral ciprofloxacin groups were included in the study. Our study showed that the incidence of endophthalmitis was not significantly different between the two groups (P = 0.463). In patients with either sharp or blunt penetrating ocular trauma. Conclusion: Oral ciprofloxacin as a prophylactic treatment could prevent posttraumatic endophthalmitis as effective as injectable cefazolin/gentamicin. Due to easier consumption of oral ciprofloxacin and lower systemic complications, in all patients with penetrating eye trauma, oral administration of ciprofloxacin is preferable to intravenous or intramuscular types of antibiotics to reduce the risk of posttraumatic endophthalmitis.

Background: Glioblastoma multiform (GBM) is the most common and most malignant of the glial tumors that begins primarily in brain tissue. Genetic background could be considered as an important predisposing factor in GBM. Autocrine motility factor receptor (AMFR) is a cytokine receptor that participates in a lot of physiologic and pathologic processes like: Cellular motility and metastasis. So, it seems that this protein has an essential role in pathophysiology of several cancers and could be a potential diagnostic and or therapeutic target in GBM. The aim of this study is to investigate the association of AMFR (rs2440472, rs373191257) gene polymorphism and GBM in a representative Iranian population. Materials and Methods: This study includes 81 cases of GBM and 117 control subjects. After DNA extraction, polymerase chain reaction - high resolution melting reaction was performed. For each single nucleotide polymorphisms, 12 samples were selected for sequencing. Data was analyzed using Chi-square test and Logistic regression. Results: For rs2440472, frequency of GG genotype in the case group was increased compared to the control group (51.9% vs. 34.2% respectively, P = 0.013). After adjusting for sex and age by logistic regression our results were the same (P = 0.017, odds ratio = 2.056). Allelic frequencies for rs2440472 among cases and controls were not significantly different (P = 0.058). For rs373191257, genotypic and allelic frequencies were not significantly different between two groups. Conclusion: Our results showed the possible association between the AMFR rs2440472 gene polymorphism with susceptibility to GBM.

Background: The objective of this study was to evaluate the effect of weight loss with hypocaloric diet and orlistat treatment in addition to hypocaloric diet on gut-derived hormones ghrelin and obestatin. Materials and Methods: A total of 52, euglycemic and euthyroid, obese female patients were involved in the study. The patients were assigned to two groups: Group 1 (n = 26) received hypocaloric diet alone and Group 2 (n = 26) received orlistat in addition to hypocaloric diet for 12 weeks. Anthropometric measurements, serum lipid, insulin levels, and obestatin and ghrelin values were assessed at the beginning of the study and after 12 weeks of therapy. Results: Baseline clinical characteristics and laboratory parameters including serum ghrelin and obestatin concentrations and ghrelin/obestatin ratio were similar between the two groups. After 12 weeks, mean change in BMI, fat mass, and fat-free mass (FFM) were −1.97 ± 1.56 kg/m² (P = 0.003), −2.63% ±2.11% (P = 0.003), and −1.06 ± 0.82 kg (P = 0.003), respectively, in Group 1. In Group 2, mean change in BMI was −2.11 ± 1.24 kg/m² (P = 0.001), fat mass was −3.09% ±2.28% (P = 0.002), and FFM was −1.26 ± 0.54 kg (P = 0.001). However, fasting glucose, lipid, and insulin levels did not change in Group 1. Furthermore, except serum high-density lipoprotein cholesterol and triglyceride levels, no significant change was observed in Group 2. Although serum ghrelin and obestatin concentrations increased significantly in both groups (Group 1: pGhrelin: 0.047, pobestatin: 0.001 and Group 2: pGhrelin: 0.028, pobestatin: 0.006), ghrelin/obestatin ratio did not change significantly. When the changes in anthropometric assessments and laboratory parameters were compared, no significant difference was observed between the two groups. Furthermore, no correlation was observed between ghrelin or obestatin and any other hormonal and metabolic parameters. Conclusion: Weight loss with diet and diet plus orlistat is both associated with increased ghrelin and obestatin concentrations.

Background: Considering that ethnicity and gestational age (GA) could affect the value of nuchal fold thickness (NFT) in mid-trimester, we aimed to determine the reference intervals of NFT values for each gestational week from 16 to 24 weeks of pregnancy among a group of Iranian pregnant women. Materials and Methods: In this cross-sectional study, medical files of pregnant women who underwent fetal anomaly scanning at 16–24 weeks of gestation were reviewed and the following data were extracted: GA, value of NFT, value of nuchal translucency (NT) in their previous ultrasound study, if available, and head circumference (HC). The 5^th, 25^th, 50^th, 75^th, and 95^th percentiles of NFT for each gestational week were determined. The association between NFT and HC, GA, and NT were also determined. Results: Medical files of 882 pregnant women were studied. The expected 95^th percentile value of NFT between 16^th and 24^th weeks of gestation ranged from 4 mm to 5.9 mm. The mean (standard deviation) of NFT increased with GA from 2.67 (0.90) mm at 16^th weeks to 4.69 (0.71) mm at 24^th weeks. There was a significant positive association between NFT and GA (β = 1.11, p < 0.001), HC (β = 0.21, p < 0.001), and NT (β = 0.351, p < 0.001). Conclusion: The findings of this study revealed that before the 20^th week of gestation, the appropriate cutoff value of NFT is 5 mm, and for 21^st to 24^th weeks, the proper cutoff is 6 mm. However, for providing more conclusive results, further studies with larger sample size and considering the impact of other influencing variables are recommended.

Background: Increased levels of reactive oxygen species is a key factor involved in the pathogenesis of type 2 diabetes mellitus (T2DM). Coenzyme Q₁₀(CoQ₁₀) is a nonenzymatic antioxidant that restores other antioxidants. Materials and Methods: This randomized, double-blind placebo-controlled trial study has been designed to evaluate the effects of CoQ₁₀supplementation on serum values of amylase, adenosine deaminase, catalase (CAT), total antioxidant capacity (TAC) and the quantitative insulin sensitivity check index (QUICKI) in women with T2DM. Serum levels of CoQ₁₀were measured too. Sixty-eight women with T2DM were enrolled in this study and randomly divided into two groups. One group received 100 mg/day of CoQ₁₀supplement for 12 weeks (n = 34), and the other group was given placebo for the same time duration and dosage (n = 34). Results: After the intervention, serum CAT activity (P < 0.001), TAC (P = 0.006), CoQ₁₀(P = 0.001), and QUICKI (P = 0.005) increased and fasting blood sugar (FBS) (P = 0.05) decreased significantly in CoQ₁₀group. Conclusion: This study showed that daily supplementation with 100 mg of CoQ₁₀could increase TAC and CAT activity as, CoQ₁₀and QUICKI and could reduce oxidative stress and FBS in women with T2DM.

Background: The objective of this study is to evaluate the value of neutrophil gelatinase-associated lipocalin (NGAL) for becoming a good endogenous marker of renal function in asphyxial preterm babies. Materials and Methods: This is a two-center retrospective study. Between October 2016 and October 2017, 71 asphyxial preterm infants were included in asphyxia group. Seventy babies were randomly included in control group. Samples were tested at 24, 48, and 96 h after birth. Quantitative data were compared by independent sample t-test or repeated measures ANOVA. For qualitative data, Pearson's Chi-squared test was performed. Draw ROC and compare the area under the curve (AUC), 95% confidence interval for AUC, specificity (Spe), sensitivity (Sen), and Youden index (Sen+Spe-1) at 24-h, 48-h, and 96-h time points. Results: (1) There are no significant differences concerning on baseline data. However, blood gas, Apgar score, and resuscitation showed a significant difference (P < 0.05). (2) In 24-h samples, only uNGAL and estimated glomerular filtration rate (eGFR) showed differences between the two groups (P < 0.05). In 48-h samples, significant differences could be found in uKIM-1, uNGAL, blood urea nitrogen, and eGFR (P < 0.05). In 96-h samples, almost all indicators have significant differences except urine output and eGFR (P < 0.05). (3) All biomarkers showed statistical difference in the three time points (P < 0.05), but only uNGAL showed a downward trend after the increase of expression. (4) uNGAL has better Sen and Spe than other indicators (24-h AUC 0.870, Youden index 0.606; 48-h AUC 0.879, Youden index 0.692; and 96-h AUC 0.806, Youden index 0.606). Conclusion: uNGAL has a better distinguishability in asphyxial neonates compared with other indicators. Certainly, a larger sample, prospective study is still needed.

Background: Hepatitis C virus (HCV) infections remain as one of the major public health problems worldwide. The current study aimed at investigating the potential risk factors of HCV+ in a sample of Iranian patients. Materials and Methods: In a case–control study, 436 HCV-infected patients and 531 age-matched HCV antibody negative controls were recruited in a central region of Iran. Sociodemographic characteristics, blood and therapeutic factors, underlying diseases, and behavioral risk factors were evaluated through a standard checklist and compared between two study groups. Results: Although among studied potential risk factors, many of them were significantly associated with infected with HCV; however, in multivariable logistic regression model in the presence of other variables being male gender (odds ratio [OR]: 4.1; 95% confidence interval [CI]: 2.2–7.8), illiterate or less educated (OR: 62.64; 95% CI: 5.94–660.35), having history of intravenous (IV) drug addiction (OR: 33.0; 95% CI: 5.43–250.0), and tattooing (OR: 14.29; 95% CI: 1.82–90.91) increased risk of infection with HCV. Conclusion: In total, the current case–control study documented that socioecomical factors including economical state, marital status, education, and ethnicity and also other expected factors such as hospitalization, imprisonment, dialysis, tattooing, needle sharing, IV drug abuse, and extramarital sexual relationship represent an important source of HCV infection among adults in a central region of Iran. Thus, we suggest further considerations for prevention of HCV infection as most of related factors are preventable by close considerations.

Background: Blood transfusion is essential in severely ill patients whose hemoglobin (Hb) levels are low, but there are some factors that inhibit optimal increase in Hb. The aim of this study was to evaluate the amount of increase in Hb levels after packed red blood cell (PRBC) transfusions in the Intensive Care Unit (ICU) patients and its related factors. Materials and Methods: This cross-sectional study included 124 patients admitted to the ICU, and needed PRBC transfusion. Demographic information, Hb on the 1^st day of admission, blood volume transfusions during the 7 days, and the 7^th day of admission Hb level were extracted from patients' records. Results: The average initial Hb level of patients was reported as 6.17 ± 1.43 g/dl, and after administrating PRBC (4.23 ± 1.87 units during 7 days), the Hb level was 8.09 ± 1.66 g/dl after 7 days (mean difference was 1.91 ± 1.93, t = 11.06, P < 0.001). No significant differences were found between change in Hb level in the terms of age, gender, underlying illness, body mass index, hospitalization history, fever, and duration of hospitalization (P > 0.05). However, the mean increased Hb level in hospitalized patients with internal disorders was the lowest (0.25 g/dl, P = 0.002). Conclusion: The results of our study showed that the increased Hb level based on one unit of received PRBC was low, especially in patients with internal. Therefore, based on high frequency of anemia in ICU patients and relative complications, physicians should pay attention to factors affecting Hb levels after PRBC transfusion such as medical history.

Background: The present study aimed to investigate the effects of serum beta-2 microglobulin (B2M) on the risks of major cardiovascular events (MACEs) and all-cause death in Chinese elderly isolated systolic hypertension (ISH) patients without severe renal insufficiency (estimated glomerular filtration rate [eGFR] <30 ml/min/1.73 m²). Materials and Methods: Serum B2M concentration, creatinine-eGFR, and blood pressure variability were evaluated in 460 elderly patients (mean age, 82.6 years; 28 women) with ISH in this observational study. The Cox proportional hazard model was adopted to calculate adjusted hazard ratios (HRs) of risk factors for cardiovascular events and all-cause deaths. Results: During a median follow-up period of 37.6 months, 63 patients (13.7%) died, and 65 patients (14.1%) had MACEs. Multivariable analysis showed that the higher serum B2M concentration (B2M ≥0.28 mg/dl) was an independent predictor of increased risk of MACEs (nonfatal acute myocardial infarction, acute heart failure, ischemic stroke, and cardiovascular deaths) and all-cause death (HR: 2.62, 95% confidence interval [CI]: 1.46–4.69, P = 0.001 and HR: 3.40, 95% CI: 1.78–6.48, P < 0.001, respectively) adjusting for other multiple confounders including creatinine-eGFR and cystatin C. In addition, blood pressure variability derived from ambulatory blood pressure measurement was not associated with incidence of MACEs and all-cause mortality (P > 0.05). Conclusion: Our data suggest that serum B2M concentration may be individually associated with MACEs and all-cause death in elderly ISH patients without severe renal insufficiency even after adjusted for creatinine-eGFR and cystatin C.

Background: Pathologic scarring is a common problem after burn injury that has functional and esthetic limitations. Conservative and surgical treatments available for these scars are not always satisfactory. Extracorporeal shock wave therapy (ESWT) is a noninvasive modality that has proven positive effects on burn scars and wound healing in few studies. This study was conducted to evaluate the effects of ESWT on improving burn scar in extremities. Materials and Methods: This study was a prospective quasi-experimental on burn patients with burn scar in their extremities that underwent ESWT sessions once a week for 6 weeks. For evaluating pain and itching, visual analog scale (VAS) and for scar appearance, Vancouver Scar Scale (VSS) were used. These scales were measured and compared at the beginning of the treatment, at the end of the treatment, and 1 and 3 months after the end of the intervention. Results: In this study, 17 patients were treated with ESWT with a mean age of 37.94 ± 7.25 years that 47.1% of them were male. The mean of VAS score for pain and itching and VSS score were decreased significantly after the treatment and during follow-ups (All P < 0.001). Conclusion: ESWT can improve the pain, itching, and appearance of the burn scar in human extremities in burn patients.

Background: Awareness of the trends of cancer incidence in each geographic region is an important. The aim of present study was to determine the incidence trends of cancer in Chaharmahal and Bakhtiari (Ch and B) province in Southwest of Iran. Materials and Methods: In this secondary data analysis, retrospective existing data were used from cancer registry reports in Ch and B in Southwest of Iran in 2003–2016. Data on epidemiologic trend were analyzed using Joinpoint software package and annual percentage change (APC) with 95% confidence interval (95% CI) was computed. Results: Age-standardized incidence rate per 100,000 persons in the province in 2003 was 31.74 that increased to 147.14 in 2016. APC during 2003–2016 was 12.58% (CI: 9.3–16) and significant, which was 10.22% (7.4–13.1) and 14.47% (10.2–18.9) in men and women, respectively. Incidence of the stomach, breast, colorectal, thyroid, lymph node, and ovarian cancers is increasing and the highest incidence was observed in two age groups of 25–34 and 55–64 years. Conclusion: In general, cancers are of increasing trend. Surveillance and monitoring the incidence of cancer and studying the causes of environmental or genetic in the cancer changes can help for cancer prevention and control.

Background: Familial Mediterranean fever (FMF) is generally defined as an autosomal recessive disease, characterized by the automatic activation of the innate immune system in the absence of a detectable pathogenic stimulant. We hypothesize that the pathogenic factors, besides the genetic causes, may affect the development of FMF symptoms. To test this hypothesis, we examined the effects of human foamy virus (HFV) positivity on the occurrence of the clinical symptoms of FMF. Materials and Methods: Two hundred and twenty-two FMF patients with definitive diagnosis according to Tel Hashomer criteria (study group 1 [SG1]), 205 symptomatic FMF patients who had definitive diagnosis according to the same criteria but did not carry any of the 12 most commonly occurring MEFV gene mutations (study group 2 [SG2]), and 200 healthy individuals were included as control group (study group 3 [SG3]) in the study. The genetic analysis was applied in the Molecular Genetics Laboratory of the Department of Medical Biology, Faculty of Medicine, Ondokuz Mayıs University. This study was designed as a case-control study. HFV positivity was tested by amplifying the HFV bel1 gene sequence with polymerase chain reaction technique. Statistical analyses were conducted using SPSS version 23.0 software. Results: HFV positivity showed significant differences between the study groups (P = 0.002). While 43 (19.02%) of the 222 SG1 patients were positive for the HFV bel1 gene sequence, 33 (16.09%) of the 205 SG2 patients were positive for the same sequence. Only 15 (7.5%) of the SG3 participants were positive for the presence of HFV bel1 gene sequence. Conclusion: The results of our study suggested that HFV positivity can be a stimulant pathogenic factor of natural immune system which can cause the emergence of FMF symptoms.

Background: Diabetes is associated with oxidative stress and considered as a major risk factor for cardiac disease. We attempted to investigate the role of oral antidiabetic (OAD) agents gliclazide and metformin in lowering the lipid peroxidation and managing the risk for cardiovascular (CV) complications in diabetic patients in comparison with nondiabetic healthy individuals. Materials and Methods: This cross-sectional study was comprised of 150 individuals grouped in three, namely, Group A (n = 60) healthy volunteers, Group B (n = 30) newly diagnosed diabetes, and Group C (n = 60) diabetes treated with OAD. Serum malondialdehyde (MDA), nitric oxide (NO), and Vitamin C were assessed for studying lipid peroxidation status, whereas serum triglyceride (TG) and total cholesterol were monitored as predictors for CV risk. Results: We found significantly higher concentrations of MDA and NO levels (P < 0.001) in both groups of patients (Group B and C) in comparison to control group (Group A). Regarding antioxidants, significantly lower concentrations of Vitamin C (P = 0.046) were found in Group B and C compared to Group A. Moreover, there was significant difference exhibited in concentration level of MDA (P = 0.001) and NO (P = 0.015) between Group B and C, whereas difference of Vitamin C (P = 0.147) was not statistically significant. Conclusion: Our data confirmed that treatment with gliclazide and metformin significantly reduced the lipid peroxidation accompanied with attenuated levels of serum TGs and cholesterol and suggested that oral hypoglycemic agents have great impact to reduce the oxidative stress and increase the antioxidant status in diabetes.

Background: We assess the potency of different Doppler indices in the differentiation of obstructive and nonobstructive hydronephrosis. Materials and Methods: In this study, infants and children who were referred for the evaluation of unilateral hydronephrosis were enrolled. Ultrasonography for the assessment of the degree of hydronephrosis and a voiding cystourethrogram for the exclusion of vesicoureteral reflux was performed. Then, Doppler ultrasonography was done for both kidneys of each patient using four classic Doppler indices as well as the difference (delta) of each index between to kidneys. Diuretic renography with 99 mTc-ethylene dicysteine (99 mTc-EC) was performed for each patient. Results: Thirty-nine patients met the inclusion criteria. After diuretic renography, 29 (74.35%) patients had shown a nonobstructive pattern, and ten (25.65%) patients had a partial (intermediate) or complete obstruction. Using receiver operating characteristic (ROC) curve, none of the classic indices of Doppler duplex (i.e., resistive index [RI], resistance index, end diastolic velocity, and peak systolic velocity) had the ability to make a difference between obstructive and nonobstructive hydronephrosis. However, by calculating the difference (delta) of these indices between two kidneys of each patient, delta RI could differentiate the nonobstructive condition, significantly (P = 0.006). A cutoff value of 0.055 has 60% sensitivity and 82.8% specificity. The area under the ROC curve for delta RI is 0.795 (standard error: 0.086, 95% confidence interval [CI]: 0.626, 0.964). Furthermore, RI ratio between two kidneys of each patient could differentiate the nonobstructive condition, significantly (P = 0.012). A cutoff point of 1.075 has 70% sensitivity and 82.8% specificity. The area under the ROC curve for RI ratio was 0.769 (standard error: 0.104, 95% CI: 0.565, 0.973). Conclusion: This study shows that RI ratio and delta RI with a high specificity could differentiate nonobstructive hydronephrosis and therefore it is a promising way to use especially in the follow-up of children with hydronephrosis.

Background: Myelosuppression is one of the frequent side effects of chemotherapy in breast cancer patients. Granulocyte-colony stimulating factor (G-CSF) and pegylated G-CSF are used for the prevention of neutropenia after chemotherapy. Pegylated G-CSF has longer half-life of action and can be used as a single dose in comparison to G-CSF. The aim of this study is to compare the grade of cytopenia and side effects between G-CSF and biosimilar pegylated G-CSF in breast cancer patients treated with dose-dense chemotherapy. Materials and Methods: In the cross-over clinical trial study, 24 women with breast cancer were randomly divided into two groups and treated with dose-dense chemotherapy. The first group was treated with single dose of 6 mg biosimilar pegylated G-CSF 24 h after the first course of chemotherapy and the second course was followed by 300 μg daily injection of G-CSF for 6 days. The chemotherapy regimen was combination of doxorubicin 60 mg/m² and cyclophosphamide 600 mg/m². The second group was treated with G-CSF after the first course and pegylated G-CSF after the second course. Cell blood count (CBC) and side effects were evaluated 1 and 2 weeks after both courses of chemotherapy. Results: In this study, no significant carryover effect and treatment effect about the CBC parameters was found between pegylated G-CSF and G-CSF. Patients who were treated with biosimilar pegylated G-CSF had significantly higher side effects such as bone pain (P = 0.09) and gastrointestinal effects (P = 0.005) in comparison to G-CSF. Conclusion: G-CSF and biosimilar pegylated G-CSF are effective in reducing cytopenia in breast cancer patients treated with dose-dense chemotherapy, but side effects induced by pegylated G-CSF (Pegagen) are higher.

Background: First-degree relatives (FDRs) of hypertensive (HT) are predisposed to hypertension (HTN) which accelerates cardiovascular aging. Same can be studied noninvasively by pulse wave analysis (PWA), encompassing central hemodynamics such as central blood pressure (cBP), cardiac output, and stroke work (SW) and vascular stiffness parameters such as pulse wave velocity (PWV) and augmentation index at HR 75 ([email protected]). We studied PWA-derived cardiovascular parameters in FDRs of HT compared to controls. Materials and Methods: We conducted a case–control study in 119 FDRs of HT and 119 matched controls. Oscillometric PWA was performed by Mobil-o-Graph (IEM, Germany) and cardiovascular parameters were compared. P < 0.05 was considered statistically significant. Results: Groups were comparable with gender, age, height, weight, body mass index, and physical activity. FDRs of HT had significantly higher brachial and cBPs, SW (101.41 ± 25.44 vs. 88.31 ± 20.25, P = 0.001), rate pressure product-119.40 ± 25.34 vs. 108.34 ± 18.17, P < 0.0001), PWV (5.22 ± 0.46, P < 0.0001), and [email protected] (31.48 ± 9.01 vs. 27.95 ± 9.4, P = 0.002) than control. Dependent study variables correlated with brachial blood pressure more in magnitude and significance level than age or anthropometric variables. PWA results of FDR with maternal inheritance did not differ significantly from those with paternal inheritance. Conclusion: PWA reveals early cardiovascular aging in young FDRs of HTs. It clues to future cardiovascular disease including HTN itself, need for primary prevention, and further study for consolidation of these results.

Background: This study aimed to assess the serum serotonin levels in the newly diagnosed fibromyalgia (FM) and to relate these levels to the presenting signs and symptoms. Materials and Methods: This case–control study included 35 healthy women (Group I) served as controls and 130 women with newly diagnosed FM (Group II). The diagnosis of FM was confirmed by the diagnostic criteria of the American College of Rheumatology-10. The assessment of pain using a revised fibromyalgia impact questionnaire and tender points scoring, blood platelet indices, and serum serotonin levels were determined. Results: Group II patients had significantly (P < 0.001) higher values of mean platelet volume (MPV) (10.60 ± 1.57fL) and platelet width distribution (16.25 ± 1.45%) than the corresponding values in Group I (8.73 ± 0.81fL and 15.0 ± 1.15%). Significant low-serum serotonin levels observed in Group II patients compared with Group I healthy individuals (187.3 ± 50.3 ng/ml vs. 219.5 ± 78.3 ng/ml, P = 0.026). Multiple linear regression analysis showed the nonsignificant correlations between serum serotonin levels and platelet indices in Group II patients. Conclusion: Newly diagnosed FM women have significantly low-serum serotonin levels, which does not correlate with a significant increment of the platelet activity expressed as increase MPV and platelet width distribution percentage. Therefore, this study highlighted that the correction of serum serotonin level by medicines could help the patients.

Background: Depression is a common medical condition with a high prevalence leading to emotional abnormality. Despite some drawbacks, depression currently diagnosed using a combination of patient interviews and self-report questionnaires. Recently, there is emerging emphasis to establish biomarkers to diagnosis and clinical management of depression. This case–control study was designed to develop microRNA (miRNA)-based serum biomarker for depression. Materials and Methods: In this study, 39 patients with depression and 36 healthy controls were enrolled. Serum miRNAs gene expression was measured using real-time polymerase chain reaction (PCR) analysis; finally, the data represent as the 2^–ΔCt followed by further statistical analysis. Results: The serum level of miR-16 was significantly (P < 0.001) down-regulated (mean: 0.9123 and standard deviation [SD]: 0.06) in compared to normal individuals (mean: 1.6848 and SD: 0.09). The concentration of miR-135a was also catastrophically decreased (P < 0.001) in the patients (mean: 1.160 and SD: 0.07) in compared to control (mean: 1.819 and SD: 0.09). The relative miR-1202 expression levels were significantly lower (P < 0.001) in the patients (mean: 0.1755 and SD: 0.01) than in the healthy individuals (mean: 0.2939 and SD: 0.01). The receiver operating characteristic curve analysis indicated the obvious separation between patient and healthy control, with an AUC of 0.75 (95% confidence interval [CI] = 0.642–0.858, P < 0.001), 0.72 (95% CI = 0.607–0.834, P < 0.001), and 0.74 (95% CI = 0.630–0.861, P < 0.001) for miR-16, miR-135a, and miR-1202, respectively. The data suggest that these miRNAs have a potential to be used as a biomarker of depression with sensitivity 77.8% and specificity of 61.5% for miR-16, 94.4% and 41.0% for miR-135a as well as 86.1% and 61.5% for miR-1202, respectively (P < 0.001). Conclusion: Our findings showed that these miRNA can be used as a biomarker of depression diagnosis. MiR-135a and miR-1202 exhibited better sensitivity and specificity, respectively.

Background: The objective of the present study was to determine the association between chemotherapy and infectious complications in patients diagnosed with Hematologic malignancies (HMs). Materials and Methods: The study included 463 patients diagnosed with HMs multiple myeloma (MM), Hodgkin's lymphoma (HL), non-HL (NHL), acute myeloid leukemia (AML), acute lymphocytic leukemia, chronic lymphocytic leukemia, and chronic myeloid leukemia, between January 2014 and June 2015. The patients were followed for 1 year after inclusion, to record the infectious complications. The collected data included age, sex, type of chemotherapy regimen, and several blood tests at admission. All patients received prophylactic treatment with antibiotics and antifungal agents. For each infection, we recorded the microbiological diagnosis and the day of occurrence since HMs diagnosis. Results: In patients with MM, we found that the treatment with growth factors (hazard ratio [HR] 2.2; confidence interval [CI] 95%: 1–4.6; P = 0.03) was associated with a higher chance of infectious complications. In patients with non-Hodgkin lymhoma (LNH), the following drugs were associated with a higher infectious incidence: cytarabine (HR: 2.3; CI 95%: 1–5; P = 0.03), methotrexate (HR: 2.1; CI 95%: 1.8–4; P = 0.01), dexamethasone (HR: 1.7; CI 95%: 0.9–3; P = 0.06), growth factors (HR: 1.7; CI 95%: 0.9–3.2; P = 0.001), and etoposide (HR: 2.5; CI 95%: 1.5–4.2; P = 0.002). Cytarabine (induction) (HR: 2; CI 95%: 1.1–3.7; P = 0.01), cytarabine (consolidation) (HR: 2.1; CI 95%: 1.3–3.5; P = 0.01), and growth factors (HR: 2.1; CI 95%: 1.3–3.5; P = 0.002) were often on the therapeutic plan of patients with AML, which developed infections. Conclusion: Regarding the chemotherapy regimen, the highest incidences of infectious complications were observed for growth factors and cytarabine.

Background: Ulcerative colitis (UC) is a chronic inflammatory bowel disease. Recent studies have shown that dietary factors play an important role in the development of UC. Index of Nutritional Quality (INQ) is a suitable method that analyzes quantitatively and qualitatively single foods, meals, and diets. The aim of this study was to determine the association between INQ and UC. Materials and Methods: Overall, 62 newly diagnosed cases with UC and 124 healthy age- and sex-matched controls were studied in a referral hospital in Tabriz, Iran. INQ scores were calculated based on information on the usual diet that was measured by a valid and reliable Food Frequency Questionnaire consisting of 168 food items. Logistic regression analysis adjusting for age, gender, body mass index, education, smoking, Helicobacter pylori, family history of UC, appendectomy, alcohol, and total energy intake was used to estimate multivariable odds ratios (ORs). Results: After controlling for several covariates, we found inverse associations between UC risk and INQs of Vitamin C (OR = 0.34 [0.16–0.73]) and folate (OR = 0.11 [0.01–0.99]). In crude model of analysis, cases had a higher intake of total energy, protein, carbohydrate, total fat, saturated fatty acid, monounsaturated fatty acid, polyunsaturated fatty acid, niacin, Vitamin B6, Vitamin B12, magnesium, zinc, copper, selenium, and iron compared to controls, whereas controls had higher intakes of Vitamin C, Vitamin D, folate, and biotin compared to cases. Conclusion: Our results indicate that enough consumption of Vitamin C and folate was associated with lower risk of UC.

Background: Diagnosing of obstructive sleep apnea (OSA) is an important subject in medicine. This study aimed to compare the performance of two data mining techniques, support vector machine (SVM), and logistic regression (LR), in diagnosing OSA. The best-fit model was used as a substitute for polysomnography (PSG), which is the gold standard for diagnosing this disease. Materials and Methods: A total of 250 patients with sleep problems complaints and whose disease had been diagnosed by PSG and referred to the Sleep Disorders Research Center of Farabi Hospital, Kermanshah, between 2012 and 2015 were recruited in this study. To fit the best LR model, a model was first fitted with all variables and then compared with a model made from the significant variables using Akaike's information criterion (AIC). The SVM model and radial basis function (RBF) kernel, whose parameters had been optimized by genetic algorithm, were used to diagnose OSA. Results: Based on AIC, the best LR model obtained from this study was a model fitted with all variables. The performance of final LR model was compared with SVM model, revealing the accuracy 0.797 versus 0.729, sensitivity 0.714 versus 0.777, and specificity 0.847 vs. 0.702, respectively. Conclusion: Both models were found to have an appropriate performance. However, considering accuracy as an important criterion for comparing the performance of models in this domain, it can be argued that SVM could have a better efficiency than LR in diagnosing OSA in patients.

Background: The purpose of this study was to assess the diagnostic role of preoperative hematological parameters, especially neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) in germ cell testicular malignancies and their prediagnostic role in staging of testicular cancer. Materials and Methods: In this cross-sectional retrospective study, we analyzed 39 patients who underwent radical orchiectomy due to a testicular cancer (Group 1) and 82 patients on whom varicocelectomy procedure was performed as control group (Group 2) between January 2006 and January 2016 in our clinic. Evaluation of the preoperative hematological parameters in both groups and also the subgroups in malignancy group according to histopathological stages was conducted in this study. Results: When the hematological parameters were compared, a statistically significant difference was found between the two groups in terms of neutrophil counts, NLR, PLR, and MPV. NLR and PLR were significantly higher and MPV was significantly lower in testicular cancer group compared to the control group. NLR was 3.1 ± 1.4 and 2.0 ± 1.5, PLR was 141.3 ± 53.2 and 115.7 ± 44.8, and MPV was 8.9 ± 1.0 and 9.3 ± 1.1 for testicular cancer and control groups, respectively (P < 0.05). Furthermore, differences were observed between only mean corpuscular volume, mean corpuscular hemoglobin, and MPV (P < 0.05) in different stages of malignancy. Conclusion: In accordance with these findings, NLR, PLR, and MPV may be helpful for prediagnosis of testicular malignancies. Hematological parameters will become important in the preoperative assessment for those patients.

Background: Lamnin has important effects on human immunity system. The current study aimed to assess the role of L-leucine-7-amido-4-methyl coumarin 1 gene polymorphisms on hepatitis B virus (HBV) susceptibility. Materials and Methods: The rs20558, rs20563, rs10911193, rs10911251, and rs1413390 polymorphisms were analyzed using polymerase chain reaction (PCR) and PCR-reaction–restriction fragment-length polymorphism and amplification-refractory mutation system-PCR using three different groups including chronic HBV-infected patients, HBV patients who were resolved their infection spontaneously and healthy volunteers. Laminin concentrations were also measured in the blood of these individuals. Results: People with rs20558C, rs20563G, and rs10911193T alleles have an increased risk of HBV infection. Moreover, we found that CGTAT haplotype was more frequent in chronically infected people who could affect the mechanism of disease. Furthermore, there was a significant relationship between laminin concentration and rs20558, rs20563, and rs10911193 genotypes in patients. Conclusion: According to the statistical analysis, rs20558, rs20563, rs10911193 polymorphisms probably, related to the chronic HBV infection. In addition, no association of the rs10911251, rs1413390 single nucleotide polymorphisms with the disease was found.

Background: In this study, we aimed to retrospectively evaluate treatment outcomes and treatment methods in acromegaly patients. Materials and Methods: The study included 65 acromegaly patients followed in Sakarya University Faculty of Medicine Department of Endocrinology in Turkey between 2004 and 2013. Clinical, biochemical, and radiological data were obtained retrospectively from the medical files of the patients. All cases have been discussed in the endocrinology and pituitary surgery council, and a multidisciplinary treatment approach had been chosen in management. Results: Sixty-five patients were included in the study. Of the patients, 57% were female. Mean age was 45.3 ± 9.2 years old. Of the cases, 12.3% were microadenomas (n = 8, tumor diameter <10 mm) and 87.6% were macroadenomas (n = 57, tumor diameter ≥10 mm). In our study, 70% remission was achieved with the first operation and medical treatment. Patients with invasive acromegaly without remission after the first operation underwent reoperation, medical treatment, and conventional or stereotactic radiotherapy and achieved 45% remission rate. Conclusion: Pituitary surgery is the first treatment option for acromegaly. In patients who could not be remissioned after the first operation, remission can be achieved by combined therapy consist of reoperation, medical treatment, and conventional or stereotactic radiotherapy.

Background: The imbalance of von Willebrand factor (vWF) and a disintegrin and metalloproteinase with a thrombospondin type 1 motif member 13 (ADAMTS13) has been associated with atherosclerosis progression. A high level of vWF which regulates thrombus formation is associated with diabetes mellitus (DM), and some ADAMTS13 and vWF polymorphisms have effects on their levels. Therefore, this study aimed to evaluate the associations of ADAMTS13 and vWF polymorphisms and their levels with DM and severity of coronary stenosis. Materials and Methods: Eighty-seven DM and 84 control individuals were recruited. vWF and ADAMTS13 activities as well as vWF antigen were measured by collagen-binding assay (CBA), residual-CBA, and in-house enzyme-linked immunosorbent assay, respectively. ADAMTS1 3 and vWF polymorphisms were determined by polymerase chain reaction-restriction fragment length polymorphism. Results: The E and G alleles and AA genotype of ADAMTS13 Q448E, rs2073932, and rs652600, respectively, were independently associated with DM (odds ratio [OR] [95% confidence interval (CI)] = 2.5 [1.1, 5.6], 2.3 [1.0, 5.2], and 4.7 [1.2, 18.6], respectively). Moreover, E allele and AA genotype of Q448E and rs652600 were also significantly associated with multi-vessel disease (OR [95% CI] = 2.2 [1.0, 4.8] and 3.2 [1.0, 10.0], respectively), while the E and G allele of Q448E and rs2073932 were associated with high Gensini score (OR [95% CI] = 2.3 [1.1, 4.9] and 2.3 [1.1, 5.1], respectively). Conclusion: Association of ADAMTS13 polymorphisms with DM, number of vessel stenosis, and Gensini score may indicate the possible contribution of ADAMTS13 polymorphisms to atherosclerosis progression and severity of coronary stenosis in DM.

Background: Major neurocognitive disorder (MCD) is an acquired progressive decline in cognitive abilities that causes a drop in specific acquired performance compared to former performances. We tried to investigate the efficacy of herbal combination of sedge, saffron, and Astragalus honey on cognitive and depression score of patients with MCD. Materials and Methods: It was a randomized double-blind clinical trial conducted on sixty patients with MCD, who referred to the geriatric psychiatry clinic of Isfahan University of Medical Sciences in Iran. All the study participants had been using anti-MCD medications. Participants were randomized to receive a combination of sedge, saffron, and Astragalus honey in case group (n = 30) or placebo group for 8 weeks other than anti-MCD medications. Cognitive and depression scores were assessed using Addenbrook's Cognitive Scale and Geriatric Depression Scale, respectively, before intervention and at the 1^st and 2^nd months after intervention. The ANCOVA repeated-measure test was used to analyze the data using SPSS 20 software. Results: The Addenbrook's Cognitive Test score was 32.2 ± 26.5 in intervention and 22.1 ± 15.1 in control group before intervention (P = 0.074) and 38.8 ± 27.7 in intervention group and 22.6 ± 14.1 in control group in control group 1 month after intervention (P = 0.007). In addition, Geriatric Depression Scale score was 14.6 ± 7.9 in intervention group and 14.5 ± 6.9 in control group before intervention (P = 0.945) and 12.9 ± 6.9 in intervention and 14.3 ± 7.1 in control group 1 month after intervention (P = 0.465) and 12.2 ± 6.5 in intervention group and 14.4 ± 7.1 in control group 2 month after intervention (P = 0.224). Conclusion: Our findings suggest that adding the herbal combination of sedge, saffron, and Astragalus honey to the current protocols of treatment of MCD patients could be useful in the improvement of cognitive and depression score of these patients.

Background: A decision analysis model was developed to assess the cost-effectiveness of adriamycin and cyclophosphamide (AC) in comparison with paclitaxel and gemcitabine (PG) in women with advanced breast cancer in Iran. Materials and Methods: This is a cost-effectiveness analysis performed as a cross-sectional study in Namazi Hospital in Shiraz, Iran. Patients were divided into two groups by random numbers, 32 women in the AC group and 32 women in the PG group. The costs were measured using the societal perspective and effectiveness of 2 regimens were assessed using tumor response. By a decision tree, the incremental cost-effectiveness ratio was calculated. In addition, the robustness of results was examined by sensitivity analysis. Results: The estimated total cost of AC and PG per patient was 1565.23 ± 765.31 and 2099.08 ± 926.99, respectively. Response to treatment in AC and PG arm were 84% versus 75% respectively. The incremental cost-effectiveness ratio results showed AC is a dominate alternative. Conclusion: Overall, AC was a simple dominate strategy. In other words, AC was estimated to have a lower cost and greater effectiveness than PG.

Background: This study aims to assess the impact that physiotherapy (PT) has on the quality of life (QoL) of patients who have undergone coronary artery bypass grafting (CABG) surgery. The objective of this study was to assess the effect of PT on physical and mental aspects of patients' QoL. Materials and Methods: The study population consisted of 50 patients who aged between 60 and 70 years and who had previously undergone CABG surgery. The patients were randomly allocated to two groups: a PT group (n = 25) and a control group (n = 25). The physical characteristics of the participants were recorded at the outset of the study. The patients who were allocated to the PT group completed 16 sessions of classic PT. QoL assessments of all participants were performed before and after the program in the form of a short form-36 health survey. An independent sample t-test and an ANCOVA were performed for the purpose of statistical analyses. Results: The QoL scores of the patients (mean age = 62.08 years) who underwent PT significantly improved after the intervention (P < 0.001). A significant difference between groups was observed (P < 0.001) in both the mental component summary and physical component summary variables. Conclusion: PT can help relieve pain, reduce depression, help patients more effectively perform the tasks of everyday living, and help ease the symptoms of other disabilities associated with cardiac surgery. In the current study, the implementation of a PT program improved the patient's mental health and increased their QoL.

Background: The aim of this study was to determine the pathologic causes of renal allograft failure in transplant nephrectomy specimens. Materials and Methods: In this cross-sectional study performed in the referral transplant center of Isfahan, Iran, medical files of all patients who underwent nephrectomy in 2008–2013 were studied. Age at transplantation, sex, donor's characteristics, causes of primary renal failure, duration of allograft function, and pathologic reasons of nephrectomy were extracted. Slides of nephrectomy biopsies were evaluated. Data were analyzed using SPSS. Results: Medical files of 39 individuals (male: 56.4%; mean age: 35.1 ± 16.0 years) were evaluated. The main disease of patients was hypertension (17.9%), and most cases (64.1%) were nephrectomized < 6 months posttransplantation. Renal vein thrombosis (RVT) (51.3%) and T-cell-mediated rejection (TCMR) (41.0%) were the most prevalent causes of transplanted nephrectomy. Cause of primary renal failure was correlated to nephrectomy result (P = 0.04). TCMR was the only pathologic finding in all of patients nephrectomized >2 years posttransplantation. There were 14 cases in which biopsy results showed a relationship between primary disease of patients and pathologic assessment of allograft (P = 0.04). A significant relationship between transplantation-nephrectomy interval and both the nephrectomy result and histopathologic result existed (P < 0.0001). A relationship between primary allograft biopsy appearance and further assessment of nephrectomized specimen (P < 0.001) existed as well. Conclusion: The most pathologic diagnoses of nephrectomy in a period of less than and more than 6 months posttransplantation were RVT and TCMR, respectively. Early obtained allograft protocol biopsy is suggested, which leads to better diagnosis of allograft failure.

Background: The aim of the present study was to assess 2- and 4-h postendoscopic retrograde cholangiopancreatography (ERCP) serum amylase and lipase levels for prediction of post-ERCP, pancreatitis (PEP), and their predictive cutoff values. Materials and Methods: In this cross-sectional study, we evaluated serum amylase and lipase levels before the procedure, 2 h and 4 h after the procedure, and in patients with persisting abdominal pain, 24 h afterward. A total of 300 adult patients who underwent ERCP procedures from March 2014 to June 2015 in referral hospital in Isfahan were studied. The receiver operating characteristic analysis was applied to determine the predictive score of amylase and lipase levels for PEP 2 and 4 h after ERCP. Results: The 2-h serum amylase cutoff values of 241 IU/L (normal range: 28–100 IU/L) had a very high negative predictive value (NPV) (98.7%) but a poor positive predictive value (49.2%) for prediction of PEP (area under curve [AUC]: 0.947; 95% confidence interval [CI]: 0.914–0.979). Based on our results, the patients might be considered for supportive therapy of PEP with the 4-h serum amylase above the cut point of 839.5 IU/L with a specificity of 95.1% (AUC: 0.978; 95% CI: 0.964–0.992). In addition, the 2- and 4-h serum lipase levels at cut points of 216 IU/L (AUC: 0.954; 95% CI: 0.931–0.977) and 656.5 IU/L (AUC: 0.966; 95% CI: 0.945–0.986) (normal value <60 IU/L), respectively, had the best sensitivity (97.1%) and high NPVs (99.6%) for exclusion of PEP. Conclusion: Measurements of serum amylase and lipase 2- and 4-h post-ERCP might be useful in prediction of PEP.

Background: The primary side effect of adjuvant chemotherapy with taxanes is the taxane-induced peripheral neuropathy (TIPN), which may have substantial negative impacts on patients' quality of life (QOL). We investigated the effect of pregabalin and duloxetine on QOL of breast cancer patients who experienced TIPN. Materials and Methods: This was a randomized, double-blind clinical trial conducted at a chemotherapy center of Mazandaran University of Medical Sciences, Sari, Iran. Breast cancer patients 18 or more years old were included if they received paclitaxel or docetaxel and experienced neuropathy grade one or higher; and neuropathic pain score of four or more. Patients were treated with pregabalin or duloxetine until 6 weeks. Assessment of sensory neuropathy and QOL was performed at baseline, and 6 weeks after the initiation of the treatment. Results: At baseline, the mean score of global health status/QOL scale for pregabalin and duloxetine groups were 61 (standard deviation [SD]; 5.11) and 60.28 (SD; 5.44), respectively (P = 0.54). After 6 weeks, both interventions were associated with improvement of global QOL compared to baseline. The global health status/QOL score was not different between two groups after 6 weeks. While the emotional functioning was improved more favorably with duloxetine (P < 0.001); pregabalin was associated with more improvement in insomnia and pain scores (P = 0.05 and P < 0.001, respectively). Conclusion: Pregabalin as well as duloxetine improve the global QOL of breast cancer patients with TIPN. Different effects of treatments on subscale of QLQ-C30 could help clinicians to select the appropriate agent individually.

Background: Significance of platelet distribution width (PDW) and mean platelet volume (MPV) in assessing disease activity of systemic lupus erythematosus (SLE) remains unclear. This study was aimed to evaluate PDW and MPV as potential disease activity markers in adult SLE patients. Materials and Methods: A total of 204 study participants, including 91 SLE patients and 113 age- and gender-matched healthy controls, were selected in this cross-sectional study. They were classified into three groups: control group (n = 113), active SLE group (n = 54), and inactive SLE group (n = 37). Demographic, clinical, and laboratory data were analyzed. Results: In patient group, PDW was statistically higher than that in control group (13.54 ± 2.67 vs. 12.65 ± 2.34, P = 0.012), and in active group, PDW was significantly increased compared to inactive group (14.31 ± 2.90 vs. 12.25 ± 1.55, P < 0.001). However, MPV was significantly lower in SLE group than in control group (10.74 ± 0.94 vs. 11.09 ± 1.14, P = 0.016). PDW was positively correlated with SLE disease activity index (P < 0.001, r = 0.529) and erythrocyte sedimentation rate (P = 0.002, r = 0.321) and negatively correlated with C3 (P < 0.001, r = −0.419). However, there was no significant association between MPV and these study variables. A PDW level of 11.85% was determined as a predictive cutoff value of SLE diagnosis (sensitivity 76.9%, specificity 42.5%) and 13.65% as cutoff of active stage (sensitivity 52.6%, specificity 85.3%). Conclusion: This study first associates a higher PDW level with an increased SLE activity, suggesting PDW as a novel indicator to monitor the activity of SLE.

Background: In this study, we investigated the associations of erythrocytes fatty acid composition, activities of delta-5 desaturase (D5D) and delta-6 desaturase (D6D), and other metabolic risk factors, with type 2 diabetes (T2D) risk to determine if rs174583 polymorphism of FADS2 gene had any effect on these associations. Materials and Methods: Fatty acid profile of erythrocytes was determined using gas chromatography-mass spectrometry in 95 T2D patients and 95 apparently healthy participants. The genotypes of single-nucleotide polymorphism (SNP) of FADS2 gene were determined using the polymerase chain reaction-restriction fragment length polymorphism technique. Other biochemical parameters were measured in the serum using standard analytical procedures. Results: D6D activity was increased (P < 0.001) and D5D activity was decreased in T2D patients (P < 0.001) compared to controls. Homeostatic model assessment insulin resistance (HOMA-IR) index was positively correlated with D6D (r = 0.34, P < 0.001) and negatively correlated with D5D (r = −0.19, P = 0.02). Palmitic acid (P < 0.001) and dihomo-gamma-linolenic acid (P = 0.03) were higher and linoleic acid (P < 0.001) and arachidonic acid (AA) (P < 0.001) were lower in T2D patients. The distribution of rs174583 genotypes which includes C/T, C/C, and T/T was not different in the two groups (P = 0.63). Conclusion: In the population studied, there was a strong association in the erythrocytes fatty acid composition, D5D and D6D activities and other metabolic risk factors between non-T2D and T2D patients. In addition, there was a strong association in erythrocytes DGLA and AA contents and D5D activities between rs174583 genotypes in all participants. However, the distribution of rs174583 genotypes did not differ significantly between T2D patient and controls, and it did not appear to be an association between rs174583 SNP and incident of T2D.

Background: Lower gastrointestinal (GI) bleeding is a common clinical problem in young patients. The management of this disease in patients is challenging. The aim of this study is to compare sigmoidoscopy with full colonoscopy in these patients. Materials and Methods: In this cross-sectional study, 120 eligible patients under 50 years old with acute rectal bleeding were enrolled. After cleaning the colon, initially the patients underwent sigmoidoscopy. Pain, the comfort of the test by physician and patient, duration of the procedure, and pathologic findings were recorded. The procedure continued until the splenic flexure passed in the ileocecal valve, and this stage was considered as proximal colonoscopy. Pain, easy performance by physician and the patient, duration of procedure, and pathologic findings were recorded in this stage too. The variables in the two stages were compared with each other. Results: There were 66 women (55%) and 54 men (45%) and the mean of age was 41 ± 7.9 years. Proximal colonoscopy from splenic flexure to reach cecum was relatively easier for the physician and the patient than sigmoidoscopy (P < 0.001). Furthermore, the time spent to carry out proximal colonoscopy was less than the time taken for sigmoidoscopy (P < 0.001). Pathologic findings recorded in full colonoscopy were more than sigmoidoscopy (P < 0.001). Therefore, full colonoscopy that includes sigmoidoscopy and proximal colonoscopy is relatively easier than sigmoidoscopy for patients, and it also proves more advantageous than sigmoidoscopy for physicians to perform in Iranian patients because of more tortuous and elongated sigmoid colon in these patients. Conclusion: It is advised to perform full colonoscopy than sigmoidoscopy in young patients with lower GI bleeding.

Background: Since the increase in some tubular damage biomarkers can be observed at the early stage of diabetic nephropathy, even in the absence of albuminuria, we aimed to investigate if urinary albumin is superior than tubular damage marker, such as serum retinol-binding protein 4 (RBP4), in predicting renal function decline (defined as estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m²) in the cohort of patients with type 2 diabetes mellitus (T2D). Materials and Methods: A total of 106 sedentary T2D patients (mean [± standard deviation] age 64.9 [±6.6] years) were included in this cross-sectional study. Anthropometric and biochemical parameters (fasting glucose, glycated hemoglobin [HbA1c], lipid parameters, creatinine, RBP4, high sensitivity C-reactive protein [hsCRP], urinary albumin excretion [UAE]), as well as blood pressure were obtained. Results: HsCRP (odds ratio [OR] =0.754, 95% confidence interval [CI] (0.603–0.942), P = 0.013) and RBP4 (OR = 0.873, 95% CI [0.824–0.926], P < 0.001) were independent predictors of eGFR decline. Moreover, although RBP4 and UAE as single diagnostic parameters of renal impairment showed excellent clinical accuracy (area under the curve [AUC] = 0.900 and AUC = 0.940, respectively), the Model which included body mass index, HbA1c, triglycerides, hsCRP, and RBP4 showed statistically same accuracy as UAE, when UAE was used as a single parameter (AUC = 0.932 vs. AUC = 0.940, respectively; P for AUC difference = 0.759). As well, the Model had higher sensitivity and specificity (92% and 90%, respectively) than single predictors, RBP4, and UAE. Conclusion: Although serum RBP4 showed excellent clinical accuracy, just like UAE, a combination of markers of tubular damage, inflammation, and traditional markers has the higher sensitivity and specificity than UAE alone for prediction renal impairment in patients with T2D.

Background: Elevated blood pressure is still one of the major risk factors for diseases and disabilities and also a public health challenge worldwide. In the present longitudinal study, we aimed to evaluate the association between risk of hypertension and dietary advanced glycation end products (AGEs) as a recently discussed potential risk factor. Materials and Methods: Dietary assessment of 1775 participants in the third phase of Tehran lipid and glucose study to obtain dietary intake of AGEs was performed using a validated semi-quantitative food frequency questionnaire, and they were followed up for a mean duration of approximately 6 years. To determine the incidence of hypertension across quartiles of AGEs intake, logistic regression models with adjustment for potential confounding variables were used. All statistical analyses were conducted using SPSS, and P < 0.05 was considered statistically significant. Results: Higher hypertension occurrence risk was generally attributed to higher AGEs intake quartiles after adjusting for age in men (odds ratio [OR] = 1.48, 95% confidence interval [CI] = 1.11–1.52, P = 0.038) and additional adjustment for smoking, drugs, and physical activity in women (OR = 1.38%–95% CI = 1.09–1.42, P = 0.042). Moreover, across the increasing trend of dietary AGEs intake, the percentage of fat intake increased and that of carbohydrate significantly decreased (P < 0.0001). Conclusion: In conclusion, it is highly recommended to limit dietary AGEs consumption to prevent and manage hypertension and its complications.

Background: People of all ages can suffer from Henoch-Schönlein purpura (HSP), but it is the most common vasculitis in childhood. The most important involving gene is located on chromosome 6p21.3, a region coding for human leukocyte antigens (HLAs). Among HLA genes, because of the high rate of polymorphisms, HLA-DRB1 is estimated to have a strong association with HSP. In this study, we aimed to assess the association of HLA-DRB1 alleles with HSP in Iranian children. Materials and Methods: This study consisted of thirty Iranian children with HSP and 35 healthy controls. Genomic DNA was extracted, and HLA typing was performed by polymerase chain reaction with sequence-specific primers technique. Results: The results have shown that HLA-DRB1*01 and HLA-DRB1*11 (P = 0.002, odds ratio [OR] = 7.579, confidence interval [CI] = 1.934–29.697 and P = 0.039, OR = 3.333, CI = 1.030–10.788), respectively, are the most frequent alleles associated with HSP in Iranian children population. The frequency of other alleles was not significantly different in both groups. The results also show no correlation between HLA types and disease manifestations. Conclusion: According to these results, there is an association between HLA-DRB1*01 and HLA-DRB1*11 gene polymorphisms and susceptibility to HSP in our study group.

Background: Doppler ultrasonography (Doppler US) plays an important role in evaluating patients with liver cirrhosis. This study aims to investigate the hemodynamic alterations of hepatic artery and portal vein among children with liver cirrhosis and portal hypertension (esophageal varices). Materials and Methods: We conducted an analytical cross-sectional study in Imam Hossein Children's Hospital, Isfahan, Iran, in 2016. A number of 33 cirrhotic children with or without esophageal varices were selected through convenience sampling method to be compared with 19 healthy children as controls using color and spectral Doppler US. Results: Portal vein mean velocities were 15.03 ± 7.3 cm/s in cirrhotics, 16.47 ± 6.4 cm/s in controls (P = 0.51), 11.6 ± 4.7 cm/s in patients with varices, and 17.9 ± 7.3 cm/s in patients without varices (P = 0.015). Mean diameters of caudate lobe, portal vein, and splenic vein, as well as the mean values of liver and spleen span, were significantly higher in cirrhotic children. The frequency of flow reversal (hepatofugal flow) was not detected significantly different in cirrhotics. Peak systolic velocity, end diastolic velocity, pulsatility index, and resistive index for hepatic artery as well as liver vascular index were not significantly different in cirrhotics in comparison with controls. Conclusion: Alterations in Doppler parameters of portal vein including diameter and velocity may be the helpful indicators of liver cirrhosis and esophageal varices in children, respectively. Parameters of hepatic artery may not differentiate children with liver cirrhosis.

Background: The objective of the study was to determine whether serum levels of procollagen type 1 N propeptide (P1NP), a bone formation turnover marker, differs between diabetic foot ulcer with osteomyelitis (DFO) and diabetic foot ulcers without osteomyelitis serving as controls. It was also aimed to assess the usefulness of P1NP in diagnosing DFO compared to other common inflammatory markers. Materials and Methods: A case–control study was designed comparing the aforementioned groups. Patients were classified as osteomyelitis and controls based on the International Working Group diagnostic criteria. Serum P1NP and three other inflammatory markers, namely, C-reactive protein (CRP), white blood cells (WBC), and platelets were analyzed on patients with DFO and controls. Results: The mean serum P1NP levels were significantly higher in the DFO group (n: 16), 10.5 ± 5.2 (ng/ml), than the control group (n: 11) 3.1 ± 2.8 (ng/ml), P = 0.001. P1NP showed the highest sensitivity/specificity 86.7%/80% compared to 70.6%/80%, 56.2%/45.4%, and 50%/37% for CRP, WBC and platelets, respectively. Receiver operator characteristic curves showed the best value of area under the curve of 0.9 for P1NP compared to 0.85, 0.54, and 0.46 for CRP, WBC, and platelets. Conclusion: We found marked elevation of serum P1NP in diabetic foot ulcer with bone infection with potential value in using it to diagnose DFO.

Background: Spleen is the most common viscera that may be hurt in blunt abdominal trauma. Operative or nonoperative management of splenic injury is a dilemma. The American Association for the Surgery of Trauma (AAST) is the most common grading system which has been used for the management of blunt splenic injuries. The new recommended grading system assesses other aspects of splenic injury such as contrast extravasation, pseudoaneurysm, arteriovenous fistula, and severity of hemoperitoneum, as well. The aim of this study is to compare and prioritize the cutoff of AAST grading system with the new recommended one. Materials and Methods: This is a cross-sectional study on patients with splenic injury caused by abdominal blunt trauma referred to Isfahan University of Medical Sciences affiliated Hospitals, Iran, in 2013–2016. All patients underwent abdominopelvic computed tomography scanning with intravenous (IV) contrast. All images were reported by a single expert radiologist, and splenic injury grading was reported based on AAST and the new recommended system. Then, all patients were followed to see if they needed surgical or nonsurgical management. Results: Based on the findings of this study conducted on 68 patients, cutoff point of Grade 2, in AAST system, had 90.3% (95% confidence interval [CI]: 0.73–0.97) specificity, 51.4% (95% CI: 0.34–0.67) sensitivity, 86.4% (95% CI: 0.64–0.95) positive predictive value (PPV), and 60.9% (95% CI: 0.45–0.74) negative predictive value (NPV) for prediction of surgical management requirement, while it was 90.3% (95% CI: 0.73–0.97) specificity, 45.9% (95% CI: 0.29–0.63) sensitivity, 85% (95% CI: 0.61–0.96) PPV, and 58.3% (95% CI: 0.43–0.72) NPV for the new system (P = 0.816). Conclusion: In contrast to the previous studies, the new splenic injury grading method was not superior to AAST. Further studies with larger populations are recommended.

Background: Oral lichen planus (OLP) is a common mucocutaneous disease with malignant transformation potential. Several etiologies such as humoral, autoimmunity, and viral infections might play a role, but still there is no definite etiology for this disease. The aim of this study was to investigate the presence of Epstein–Barr virus (EBV) genome in Iranian patients with OLP as compared to people with normal mucosa. Materials and Methods: The study was carried out on a case group including 38 tissue specimens of patients with histopathological confirmation of OLP and a control group including 38 samples of healthy mucosa. All samples were examined by nested polymerase chain reaction (PCR) method to determine the DNA of EBV. Results: Twenty-two (57.9%) female samples and 16 (42.1%) male samples with OLP were randomly selected as the case group, and 20 (52.6%) female samples and 18 (47.4%) male samples with healthy mucosa as the control group. There was a statistically significant difference in the percentage of EBV positivity between the case (15.8%) and the control groups (P < 0.05); in the case group, three female samples (13.6%) and three male samples (18.8%) were infected with EBV; the difference between the genders was not statistically significant (P = 0.50). Conclusion: Results emphasized that EBV genome was significantly higher among Iranian patients with OLP so antiviral therapy might be helpful.

Background: Chronic hepatitis type-C virus (HCV) infection is one of the most common worldwide viral disorders, which leads to various clinical complications as well as extrahepatic manifestations. Furthermore, Vitamin D3 has also been reported to have relationship with the mentioned complications. The aim is to evaluate the correlation between Vitamin D3 level and extrahepatic manifestation in chronic HCV patients. Materials and Methods: This cross-sectional study has been carried out on 90 patients with chronic hepatitis C. The level of Vitamin D3 was assessed in plasma of 90 patients with chronic HCV. Genotyping was done and clinical and sign and symptoms of recruited patients were gathered. Extrahepatic manifestations were evaluated and the correlation of blood, hepatic, and immunological factors and the level of Vitamin D3 were assessed. Results: Most of our patients were male (92% vs. 8%). Twenty-nine percent had the insufficient amount of Vitamin D3 (21–30 ng/ml), and the remains had the Vitamin D3 level between 13–20 ng/ml. Furthermore, our assessment demonstrated that deficiency of Vitamin D3 was associated with the extrahepatic manifestations such as purpura (odds radio [OR] [95% confidence interval (CI) 95%] = 8.80 [1.74–44.47], P = 0.004), vasculitis (OR [95% CI] = 11.70 [3.01–45.41], P < 0.001), arthralgia (OR [95% CI] = 20.26 [4.21–97.47], P < 0.001), myalgia (OR [95% CI] = 4.00 [1.01–17.27], P = 0.048), and glomerulonephritis (P = 0.021). Conclusion: According to our results, the extrahepatic manifestation in the patients with sufficient levels of Vitamin D3 would be less possible. In fact, it could be stated that deficiency in the Vitamin D3 can have a significant relationship with these manifestations.

Background: Renal colic is a painful medical emergency, needs urgent intervention to reduce pain. Nonsteroidal anti-inflammatory drugs, opioids, and entonox are pain-relieving agents. This study was aimed to compare fentanyl + entonox (nitrous oxide + O₂) versus fentanyl + oxygen. Materials and Methods: One hundred and twenty patients with acute renal colic presenting to the emergency department were enrolled. First, 50 μg fentanyl was infused for all patients. Then, patients divided into two groups receiving masks of entonox and oxygen, respectively. Quantitative measurement of pain was performed by visual analog scale, before the intervention, after 3, 5, 10, and 30 min of that. If the pain was not relieved after 30 min, 50 μg fentanyl was infused. If the pain was still continued, ketorolac and ketamine were used. Hospitalization duration and severity of pain at specified times were compared between patients in two groups. Results: The mean (standard deviation) time of hospitalization was 211 (59) and 236 (61) min in fentanyl + entonox and fentanyl + O₂ groups, respectively (P = 0.024). The decrease in pain severity after 10 and 30 min in fentanyl + entonox group were significantly greater than fentanyl + O₂ group (P = 0.002 and 0.001, respectively). Mean (standard error) of needed time for renal colic pain to get better was 11.27 (1.23) and 20.47 (1.71) min in fentanyl + entonox and fentanyl + O₂ groups, respectively (P < 0.001). Proportion of patients relief from pain in fentanyl + entonox in the second, third, and fourth measurements were significantly more than fentanyl + O₂ group (P = 0.036, P < 0.001, and P < 0.001, respectively). Conclusion: Entonox is more effective to decrease the duration of hospitalization and reduction of pain than O₂ in renal colic patients.

Background: We aim to compare the degree of pain control and complications in three types of anesthesia using periprostatic nerve block (PPNB) plus intrarectal local anesthesia (IRLA), low-dose spinal anesthesia, and intravenous (IV) sedation in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy. Materials and Methods: In this clinical trial study, 106 patients were participated from December 2015 to December 2016 at Alzahra Hospital, Isfahan, Iran. Patients were randomly allocated into three groups to receive PPNB plus IRLA (n = 36), low-dose spinal anesthesia (n = 35) and IV sedation (n = 35) before TRUS-guided prostate biopsy. Pain scores were recorded using a 10 point visual analog scale right after the biopsy was done. Early and late complications were assessed using a questionnaire after the procedure and in follow-up of patients. Results: Overall, the pain score in the low-dose spinal anesthesia group was significantly lower than PPNB plus IRLA and IV sedation groups (P < 0.001). The differences in pain scores between PPNB plus IRLA group and IV sedation group were not significant (P = 0.30). Urinary retraction and fever were significantly more frequent in low-dose spinal anesthesia and IV sedation, retrospectively (P = 0.04, P = 0.03). No significant difference in late complications was found among the groups. Conclusion: This study demonstrates that low-dose spinal anesthesia is superior to PPNB plus IRLA and IV sedation in terms of pain controlling and was associated with higher tolerance of the examination and patient comfort.

Background: Metabolic control is a major concern in preventing diabetic complications. Saffron as a natural source of antioxidants could play a role in alleviating diabetes insults. The aim of this study was to investigate effect of saffron hydroalcoholic extract on metabolic control in type 2 diabetes (T2D) mellitus. Materials and Methods: This randomized triple blind study was included 54 T2D patients which randomly received either saffron (Group 1) or placebo (Group 2) twice daily other than routine antidiabetic treatments for 8 weeks. Serum concentration of fasting blood sugar (FBS), 2-h plasma glucose, hemoglobin A1c (HbA1c), total cholesterol, triglyceride (TG), low-density lipoprotein, and high-density lipoprotein were measured as the markers of metabolic control. Anthropometric measures and blood pressure were also measured at the baseline, every 2 weeks during the intervention and the end of the study. Data analyzed using repeated measure analysis of variance test. Results: The baseline metabolic parameters were the same in two group (P > 0.01). FBS serum level significantly decreased within 8 weeks in the saffron group (128.84 ± 31.86) as compared to the placebo (153.76 ± 41.23), (P < 0.001). There was no statistical difference in other metabolic parameters such as serum lipids, blood pressure, and HbA1c (P > 0.01). Conclusion: Saffron hydroalcoholic extract may improve blood glucose control by reducing FBS in T2D patients. However, saffron extract has no significant effect on other aspects of diabetic control in diabetic patients.

Background: Early prediction of adverse neonatal outcome would be possible by Doppler impedance indices of middle cerebral artery (MCA), umbilical artery (UmA), and descending aortal artery (AO) that result in decrease neonatal morbidity and mortality rate. The aim of the present study was a determination of optimal value for the ratio of MCA to descending aorta blood flow (MCA/AO) impedance indices and its comparison with the ratio of MCA to UmA (MCA/UmA) impedance indices and their relationship with neonatal outcome. Materials and Methods: This was a prospective cohort study on 212 pregnant women with gestational age 36 weeks or more, in three hospitals in Tehran, from April 2012 to April 2013. We investigated AO, MCA, and UmA impedance indices Doppler ultrasound every 2 weeks till delivery. The mother was monitored for adverse pregnancy outcome (hypertension [HTN], fetal growth retardation, and other maternal complications) then infant birth weight, cord blood of pH, and Neonatal Intensive Care Unit (NICU) admission during the first 24 h after delivery were assessed. Finally, we investigated relationships between Doppler indices and neonatal outcomes include neonatal body weight (NBW), cord blood of pH, and NICU admission. Results: MCA/AO resistance index (RI) and MCA/AO pulsatile index (PI) showed an area under the receiver operating characteristics curve (area under the curve) of 0.905 (95% confidence interval (CI): 0.850, 0.959) and 0.818 (95% CI: 0.679, 0.956), respectively. The cutoff values for pH (≥7.2 vs. <7.2) based on MCA/AO RI and MCA/AO PI indices were 0.951 (sensitivity, 80% and specificity, 86%) and 0.853 (sensitivity, 91% and specificity, 83%), respectively. The cutoff value for NBW (≥2500 vs. <2500 g) based on MCA/UmA PI index was 1.467 (sensitivity, 73% and specificity, 63%). The cutoff value of NICU admission of child based on MCA/AO PI index was 1.114 (sensitivity, 73% and specificity, 54%). Conclusion: In the end of third-trimester pregnancies with the assessment of MCA and AO artery Doppler ultrasonography, it is possible to prevent many cases of neonatal acidosis caused by prenatal asphyxia as well as inappropriate interventions which are applied on mother. If MCA/AO PI was <0.85, the fetus needs to be evaluated further because it is at risk for acidosis.

Background: This study aimed to compare the effects of combined endurance-resistance training (CT) versus endurance training (ET) on some cardiovascular markers in patients with heart failure after percutaneous coronary intervention (PCI). Materials and Methods: The study applied a randomized, controlled design in which 75 patients with heart failure who had undergone PCI were randomly assigned to one of three groups: ET, CT, and control. The ET group performed ET for 45 min, three times a week for 7 weeks. The CT group performed the same ET for 30 min followed by a resistance exercise protocol. The control group received usual care. Functional capacity, N-terminal pro-brain natriuretic peptide (NT-pro BNP), and high sensitivity C-reactive protein (hs-CRP) levels were measured. Results: After the intervention, functional capacity was improved (P < 0.001) and NT-pro BNP level was significantly reduced (P = 0.004 in the CT group, P = 0.002 in the ET group). Hs-CRP level was significantly reduced only in the ET group (P = 0.030). The control group showed no significant changes in any cardiovascular parameters (P ≥ 0.05). Changes in functional capacity (P < 0.001) in both training groups were significantly different from the control group. No significant differences were found between the ET and CT groups regarding changes in all outcomes after exercise training (P ≥ 0.05). Conclusion: Exercise training is safe and feasible in post-PCI patients, even in those with reduced ejection fraction. CT was as effective as ET in reducing NT-pro BNP level and improving functional capacity in heart failure patients after PCI.

Background: Genetically, predisposed children are considered as at-risk individuals for cardiovascular disease. In this study, we aimed to compare the frequency of four-lipid regulatory polymorphism in obese and normal-weight children with and without cardiometabolic risk factors. Materials and Methods: In this nested case–control study, 600 samples of four groups of participants consisted of those with normal weight with and without cardiometabolic risk factors and obese with and without cardiometabolic risk factors. Allelic and genotypic frequencies of GCKR (rs780094), GCKR (rs1260333), MLXIPL (rs3812316), and FADS (rs174547) polymorphisms were compared in the four studied groups. Results: Data of 528 samples were complete and included in this study. The mean (standard deviation) age of participants was 15.01 (2.21) years. Frequency of tt allele (minor allele) of GCKR (rs1260333) polymorphism was significantly lower in normal weight metabolically healthy participants than metabolically unhealthy normal weight (MUHNW) and obese children with and without cardiometabolic risk factor (P = 0.01). Frequency of ga allele of GCKR (rs780094) polymorphism was significantly higher in normal weight children with cardiometabolic risk factor than in their obese counterparts with cardiometabolic risk factor (P = 0.04). Frequency of cg and gg alleles (minor type) of MLXIPL (rs3812316) polymorphism in normal weight metabolically healthy participants was significantly higher than MUHNW (P = 0.04) and metabolically healthy obese children (P = 0.04). Conclusion: The findings of our study indicated that the minor allele of GCKR (rs1260333) single nucleotide polymorphisms (SNPs) could have pathogenic effect for obesity and cardiometabolic risk factors. Ga allele of GCKR (rs780094) SNPs had a protective effect on obesity. Minor alleles of MLXIPL (rs3812316) could have a protective effect for obesity and cardiometabolic risk factors.

Background: Hyperlordosis is defined as an abnormal increase in the lumbar arch of >40°. This study compared two taping techniques include abdominal muscles and hamstrings taping for the treatment of lumbar hyperlordosis. Materials and Methods: The randomized clinical trial was performed in Shiraz, Iran, during June and September 2014. Thirty women aged 20–45 years old with at least 40° lumbar lordosis participated. The women were randomized into two groups (n = 15). Abdominal muscles taping was performed for the first group, whereas the other group underwent hamstrings taping with 30% tension. Lumbar lordosis was measured before, immediately after, and 24 h after taping. The two-way repeated measures analysis of variance was used to compare the two groups for lumbar lordosis angle. Results: No significant differences were detected between the lumbar lordosis angles before and immediately after taping in the two groups (P > 0.05). However, a significant reduction was observed in lordosis angle in the abdominal group and the hamstring group 24 h after taping relative to before intervention (P < 0.01). Conclusion: Taping of the abdominal and hamstring muscles was not effective immediately, whereas it decreased lordosis after 24 h.

Background: Postoperative bleeding is a common problem in cardiac surgery. We tried to evaluate the effect of topical tranexamic acid (TA) on reducing postoperative bleeding of patients undergoing on-pump coronary artery bypass graft (CABG) surgery. Materials and Methods: One hundred and twenty-six isolated primary CABG patients were included in this clinical trial. They were divided blindly into two groups; Group 1, patients receiving 1 g TA diluted in 100 ml normal saline poured into mediastinal cavity before closing the chest and Group 2, patients receiving 100 ml normal saline at the end of operation. First 24 and 48 h chest tube drainage, hemoglobin decrease and packed RBC transfusion needs were compared. Results: Both groups were the same in baseline characteristics including gender, age, body mass index, ejection fraction, clamp time, bypass time, and operation length. During the first 24 h postoperatively, mean chest tube drainage in intervention group was 567 ml compared to 564 ml in control group (P = 0.89). Mean total chest tube drainage was 780 ml in intervention group and 715 ml in control group (P = 0.27). There was no significant difference in both mean hemoglobin decrease (P = 0.26) and packed RBC transfusion (P = 0.7). Topical application of 1 g TA diluted in 100 ml normal saline does not reduce postoperative bleeding of isolated on-pump CABG surgery. Conclusion: We do not recommend topical usage of 1 g TA diluted in 100 ml normal saline for decreasing blood loss in on-pump CABG patients.

Background: Due to the high incidence and prevalence of infection in neonatal ward, especially Neonatal Intensive Care Units (NICUs) reported by different studies and the important role of colonization with hospital germs in the development of nosocomial infections, we intended to evaluate the risk of colonization with hospital germs in neonates and its associated risk factors. Materials and Methods: This cross-sectional, descriptive-analytical study was conducted in 2016 in a Teaching Center in Iran. In total, 51 neonates were selected based on the inclusion criteria, and after recording their information in a checklist, samples were taken by swab from outer ear, axilla, and groin for culture. Neonates with negative culture from mentioned regions were enrolled in the study. The swab samples again were taken and sent for culture from mentioned regions in at least 3 days after hospitalization. Culture results from first and second sampling were collected and analyzed statistically. Results: This study was conducted on 51 neonates. The mean gestational age among the neonates ranged from 35.25 (Week) ± 2.98. 22 girls (43.1%) and 29 boys (56.9%), most of them were born by cesarean. Based on the results of logistic regression, a significant association was found between the occurrence of colonization of hospital flora and the place hospitalization of the newborns (odds ratio (OR): 4.750; 95% confidence interval (CI): 1.26–17.85). Conclusion: This study revealed that the only risk factors of colonization with hospital flora in neonates are the type of delivery and place of hospitalization. Based on findings of the study, it is recommended to focus on efforts in increasing the rate of natural birth as well as improving conditions of infection control in NICUs to reduce the number of incidences of colonization with hospital flora in neonates.

Background: Awareness of observed and expected incidence of cancers is so important in managing cancer as the third mortality cause in Iran. In the present study, we evaluated observed and the expected incidence of common cancers in Chaharmahal and Bakhtiari province. Materials and Methods: This study is a Secondary data analysis. All data about pathology-based cancer registration (Cancer diagnosis was based on pathological laboratory, ICD-O2) in Chaharmahal and Bakhtiari in Southwestern Iran in 2010–2014 was used. By dividing the number of registered cases of each cancer in every age group into the total observed cancers in that age group, the observed ratio of each cancer in that age group was calculated. Then, using the proposed coefficients Parkin and age-standardized cancer ratio method, the expected ratios in each age group, were calculated. Results: In 5 years study, 2918 new cases of cancer were recorded. Out of them, 1735 (59.46%) were male. The annual average total occurrence of all cancers in this province was 68.2/100,000 populations. The observed incidence ratios of common cancers, including stomach, breast, colorectal, thyroid, lymph nodes, ovaries, gall bladder, the bladder and the brain, were 0.11, 0.12, 0.09, 0.06, 0.02, 0.03, 0.01, 0.08, and 0.05, respectively. The expected incidence ratios of above-mentioned cancers are 0.11, 0.13, 0.1, 0.06, 0.02, 0.03, 0.01, 0.08, and 0.05, respectively. Based on observed (O) and expected (E) comparison, breast and colorectal cancer had higher incidence than expected ratio. Conclusion: Our results showed that in our area, treatment programs and health plans should focus on cancer registration, especially on common cancers and reevaluate breast and colorectal cancer occurrence. Therefore, the plan for the control and prevention of this cancer must be a high priority for health policymakers.

Background: In this study, the effect of testosterone gel administration during ovulation induction on the fertility rate was examined in women with a poor ovarian response in in vitro fertilization (IVF) cycles. Materials and Methods: The current study is a single-blinded, randomized clinical trial. Patients who met inclusion (Bologna) criteria were placed in the antagonist cycle group. The patients were randomly divided into two groups each included 25 participants treated with a placebo (lubricant gel, the controls) and testosterone gel (intervention). Fertility outcomes were compared between two study groups. Results: The mean ± standard deviation (SD) age of intervention (41.04 ± 3.77) versus control group (39.69 ± 3.29) was not statistically different. The two studied groups were not statistically different in terms of follicle-stimulating hormone; antral follicle count, IVF, anti-Mullerian hormone, and the duration of infertility. The mean ± SD of oocyte 2.48 ± 1.64 versus 1.17 ± 1.27 and embryo 1.60 ± 1.58 versus 0.39 ± 0.58 in intervention group was significantly higher than control group (P < 0.01). The rate of pregnancy 16% versus 0% and embryo of quality A–B was significantly higher in intervention group than control (60% versus 17.4%, P < 0.05). Conclusion: The results of the current study showed that the testosterone gel has a significant impact on the fertility rate in women with a poor response in the IVF cycles. Further, randomized clinical trials with larger sample sized are recommended.

Background: Normal size of mesenteric lymph nodes has not been well evaluated, as these lymph nodes are small but may be seen frequently in computed tomography (CT). The aim of this study is to determine the prevalence of mesenteric lymph nodes at root of mesentery and mesentery itself. Materials and Methods: This is a cross-sectional study on traumatic patients with normal multidetector CT (MDCT) referred to Al-Zahra Hospital in 2014–2016. The largest short axis of lymph nodes was recorded. Their location was divided into three groups of mesenteric root, peripheral mesentery, and mesentery of the right lower quadrant (RLQ).Size and number of lymph nodes in terms of locations were recorded. A number of more than 6 nodes in a position was defined as cluster nodes. Data were analyzed using SPSS software version 20. P < 0.05 was considered statistically significant. Results: Four hundred traumatic patients underwent MDCT scanning. The mean age of these patients was 36.6 ± 13.4 years. The number of lymph nodes was <3 in 49.3%, 52.5%, and 52.2%; 3–6 in 45.8%, 42.8%, and 42.8%; >6 in 5%, 4.8%, and 4.8% of central, peripheral, and RLQ mesentery, respectively. The average size of largest central, peripheral, and RLQ lymph nodes was 4.53 ± 1.33, 4.37 ± 1.68, and 4.37 ± 1.68, respectively (P = 0.64). Largest size of short axis in patients with cluster lymph nodes was significantly more than noncluster nodes (P < 0.001 for all regions). Conclusion: Mean size of mesenteric lymph nodes was similar to the previous study, but the largest nodes were considerably larger. Furthermore, largest short axis of cluster nodes was significantly more than noncluster ones.