Background: Although antibiotics are well-known for their anti-bacterial effects, their inaugurated immunomodulatory roles in chronic inflammatory diseases have not elucidated yet. Anecdotal reports support the beneficial effects of parenteral penicillin in arthritis suggesting an immunomodulatory other than antibacterial effects for penicillin. The present study was designed to address the possible effects of penicillin G sodium (PCN-G) on different T-helper cells differentiation. Materials and Methods: In this experimental study, peripheral blood mononuclear cells (PBMCs) of 10 healthy donors were isolated using Ficoll density gradient. The stimulated PBMCs by anti-CD3, anti-CD28, and anti-CD69 were cultured in the presence of 120 μg/ml of PCN-G. Foxp3, T-bet, RORγT, GATA3 as well as interferon-gamma (IFN-γ) and interleukin (IL)-17A mRNA in stimulated cells were measured by the real-time polymerase chain reaction. Mann–Whitney U-test was used for determining differences between the medium of gene expression levels of stimulated cell population and unstimulated cells by PCN. Correlations between the related genes were determined using the Spearman test. Results: Based on the results, T-bet gene expression levels were similar in stimulated cells by PCN G after 24 and 48 h while significant reduction was observed after 72 incubation with PCN G (difference = 3; 0.09–0.34; P = 0.031). Meanwhile, treated cells with PCN G expressed decreased levels of IFN-γ (difference = 8.0; 0.49–1.07; P = 0.001) and IL-17A (difference = 2.2; 0.05–0.75; P ≤ 0.05) genes comparing to unstimulated cell by PCN-G. GATA3 genes expression levels downregulated by PCN G after 72 h of incubation by PBMCs (difference = 1.1; 0.77–0.88; P = 0.035). Conclusion: Our results confirmed the immunomodulatory role of PCN G by affecting the expression of different cytokines genes in PBMCs.

Background: The present study was conducted to determine the epidemiological status, identify high-risk and low-risk clusters, and estimate the relative risk (RR) of acute lymphoblastic leukemia (ALL) in provinces of Iran. Materials and Methods: This is an ecological study carried out using an Exploratory Multiple-Group design on 3769 children under 15 years of age with ALL from 2006 to 2014. Data analysis was performed using Mann–Whitney U, Global Moran's I and Kuldorff's purely spatial scan statistic tests at a significance level of 0.05. Results: The average annual incidence rate of ALL during 2006–2014 period was 2.25/100,000 children under 15 years of age. The most likely high-risk cluster with log-likelihood ratio (LLR) =327.47 is located in the southwestern part of Iran with a radius of 294.93 km and a centrality of 30.77 N and 50.83 E, which contained 1276 patients with a RR of 2.56. It includes Fars, Bushehr, Kohgiluyeh and Boyer-Ahmad, Khuzestan and Chahar Mahall and Bakhtiari provinces. On the other hand, the most likely low-risk cluster with 517 patients, and a RR 0.49 and LLR = 227.03 was identified in the northwestern part of Iran with a radius of 270.38 km and a centrality of 37.25 N and 49.49 E. It includes Zanjan, Qazvin, Gilan and East Azerbaijan, Ardabil, Alborz and Tehran provinces. Conclusion: High-risk clusters were observed in Southwestern, central, and eastern Iran, while low-risk clusters were identified in Northern and Western Iran.

Background: Visfatin is an adipokine that increased under inflammatory conditions. Moreover, sirtuin-1 possesses regulatory effects on inflammatory factors. In this study, we aimed to evaluate the serum level of visfatin in patients with stable and acute exacerbation of chronic obstructive pulmonary disease (AE-COPD). Materials and Methods: In a case–control study, thirty patients with stable COPD (S-COPD), thirty patients with AE-COPD, and thirty control subjects were enrolled. Pulmonary function tests and blood sampling were performed on all participants. Serum visfatin, sirtuin-1, and interleukin (IL)-6 levels were measured using the sandwich ELISA method and assessed their association with study parameters. Results: The findings of the current study revealed that serum levels of visfatin in AE-COPD patients were higher than those of healthy controls and S-COPD (for healthy control; standardized mean difference [SMD] = 2.63, 95% confidence interval [CI] =1.31–2.83, P < 0.001, and for S-COPD; SMD = 1.53, 95% CI = 0.21–2.85, P < 0.05). On the other hand, the serum levels of sirtuin-1 were higher in healthy controls compared to the S-COPD and AE-COPD patients (for S-COPD; SMD = 1.56, 95% CI = 0.018–3.11, P < 0.05, for AE-COPD; SMD = 1.50, 95% CI = 0.048–3.04, P < 0.05). Conclusion: Elevated visfatin and IL-6 levels demonstrated their pro-inflammatory effects in patients with COPD, especially in AE-COPD patients. In addition, the negative association found between serum visfatin and sirtuin-1 levels suggested the pathophysiologic and therapeutic roles of these factors in COPD patients.

Metabolic syndrome (MeTS) is a well-known health-related problem with several end-organ damages and the resulted side effects such as rising in the blood glucose and lipid and blood pressure. Although MeTS might show several skin symptoms such as acanthosis nigricans, skin tags, acne, and androgenic alopecia, it could also be implicated in the pathophysiology of numerous dermatologic disorders. Furthermore, some dermatologic drugs might be implicated in the incidence or exacerbation of MeTS. Consequently, MeTS and skin problem could interfere closely with each other and each one could predispose the patient to the other one and vice versa. Remembering these close relationships help us to have better therapeutic choices regarding each inflammatory skin conditions. Moreover, some of the skin symptoms should be followed cautiously to define the underlying MeTS.

Cutaneous leishmaniasis (CL) is endemic in many parts of the world with a high economic and health impact. Despite many treatments that have been suggested for this zoonotic infection, there is still no definite therapy for CL. Meglumine antimony compounds are considered as a standard treatment for leishmaniasis, however, these medications have a relatively high side effect profile and not always effective. Physical modalities including cryotherapy, laser, and heat therapy have also been used for this purpose. As a source of heat therapy, different methods have been used including radiofrequency, ultrasound, infrared, exothermic crystallization thermotherapy, and microwave. We reviewed all of the articles in PubMed regarding the use of heat therapy for the treatment of CL up to January 2020. According to our literature review, heat therapy using different sources showed promising results for the treatment of CL that were comparable to meglumine antimony. In addition, heat therapy has very low side effect profiles that are localized to the treatment area suggesting this method as a safe procedure for CL therapy. This study is a brief review of the literature about the effect of heat therapy on the treatment of CL. Performing randomized clinical trials to compare different methods of heat therapy and to compare it with meglumine antimony compounds is recommended.

Background and Objective: This study was performed to determine the sensitivity and specificity of ultrasound in the diagnosis of traumatic ankle injury in comparison with magnetic resonance imaging (MRI). Materials and Methods: This cross-sectional study was performed on 31 patients with soft-tissue injury or fracture, referring to the MRI imaging center of Alzahra and Kashani Hospitals in Isfahan from October 2018 to March 2019. After an MRI, an ultrasound of the affected ankle was performed for all patients. Sonography and MRI were performed by two radiologists who were blinded to the results of each other's reports. The sensitivity, specificity, positive predictive value, and negative predictive value of sonography were determined. Results: In this study, 31 patients with ankle trauma were studied. The mean age of the patients was 30.73 ± 10.15 years; 32.3% were male and 67.7% were female. The sensitivity of ultrasound relative to MRI to detect damage to the anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL), and calcaneofibular ligament (CFL) was 66.67%, 50%, and 100%, respectively, and the corresponding specificity was 92.86%, 93.10%, and 93.10%, respectively. According to Kappa test, the agreement between ultrasound and MRI methods for detecting injury to ATFL (κ = 0.51), PTFL (κ = 0.35), and CFL (κ= 0.63) was statistically significant (P < 0.05). Conclusion: Ultrasound is an appropriate modality for the diagnosis of injuries to CFL and ATFL and has shown acceptable results for PTFL. It could be used as an alternative in cases where access to MRI is not available.

Background: In situation where there are more than one cause of occurring the outcome such as recurrence after surgery and death, the assumption of classical survival analyses are not satisfied. To cover this issue, this study aimed at utilizing competing risks survival analysis to assess the specific risk factors of local-distance recurrence and mortality in patients with colorectal cancer (CRC) undergoing surgery. Materials and Methods: In this retrospective cohort study, 254 patients with CRC undergoing resection surgery were studied. Data of the outcome from the available documents in the hospital were gathered. Furthermore, based on pathological report, the diagnosis of CRC was considered. We model the risk factors on the hazard of recurrence and death using competing risk survival in R3.6.1 software. Results: A total of 114 patients had local or distant recurrence (21 local recurrences, 72 distant recurrences, and 21 local and distant recurrence). Pathological stage (adjusted hazard ratio [AHR] = 4.28 and 5.37 for stage 3 and 4, respectively), tumor site (AHR = 2.45), recurrence (AHR = 3.92) and age (AHR = 3.15 for age >70) was related to hazard of death. Also based on cause-specific hazard model, pathological stage (AHR = 7.62 for stage 4), age (AHR = 1.46 for age >70), T stage (AHR = 1.8 and 2.7 for T3 and T4, respectively), N stage (AHR = 2.59 for N2), and white blood cells (AHR = 1.95) increased the hazard of recurrence in patients with CRC. Conclusion: This study showed that older age, higher pathological, rectum tumor site and presence of recurrence were independent risk factors for mortality among CRC patients. Also age, higher T/N stage, higher pathological stage and higher values of WBC were significantly related to higher hazard of local/distance recurrence of patients with CRC.

Myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is syndrome with clinical evidence of acute MI (AMI) with normal coronary arteries. This study reports the case of a 23-year-old single woman referring to the hospital with clinical manifestations of MI, with electrocardiography findings of slow ventricular tachycardia or accelerated idioventricular rhythm and atrioventricular dissociation, and high troponin levels, which was admitted with the diagnosis of MINOCA due to mental stress (grief) and was discharged after 4 days of monitoring and following stabilization of conditions and absence of symptoms. Other causes of MINOCA ruled out through imaging studies. Mental stress can lead to MINOCA.

Digital health as a rapidly growing medical field relies comprehensively on human health data. Conventionally, the collection of health data is mediated by officially diagnostic instruments, operated by health professionals in clinical environments and under strict regulatory conditions. Mobile health, telemedicine, and other smart devices with Internet connections are becoming the future choices for collecting patient information. Progress of technologies has facilitated smartphones, wearable devices, and miniaturized health-care devices. These devices allow the gathering of an individual's health-care information at the patient's home. The data from these devices will be huge, and by integrating such enormous data using Artificial Intelligence, more detailed phenotyping of disease and more personalized medicine will be realistic. The future of medicine will be progressively more digital, and recognizing the importance of digital technology in this field and pandemic preparedness planning has become urgent.

Background: We investigated the effects of spirulina under high-intensity interval training (HIIT) on levels of nesfatin-1, omentin-1, and lipid profiles in overweight and obese females. Materials and Methods: This is a randomized, quasi-experimental controlled, single-blind with a pre- and post-test design, in which twenty overweight and obese women (body mass index = 29.32 ± 3.01 kg/m², age = 21.55 ± 1.76 years), were randomly divided into the following groups: HIIT + spirulina (n = 10) and HIIT + placebo (n = 10). Running anaerobic sprint test was used for HIIT protocol consisting of six intervals at 35 m maximal speed runs, with a rest of 10 s in each trial (3 times/week, 4 weeks). HIIT + spirulina group received 500 mg of the spirulina pills twice daily for 4 weeks and the second group took placebo. Results: There was a significant increase in serum levels of nesfatin-1 in HIIT + spirulina (P < 0.0001) but not in HIIT + placebo (P = 0.61) group. Furthermore, results indicated a significant difference between two groups with respect to serum levels of nesfatin-1 (P = 0.04). Serum levels of omentin-1 significantly increased in both groups (P < 0.05). However, there was no significant difference between two groups (P = 0.49). In addition, results showed no significant inter- and intra-group differences in total cholesterol levels, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol between groups (P > 0.05). Conclusion: The spirulina under HIIT increased levels of nesfatin-1 and omentin-1 with no effects on the levels of lipid profiles in overweight and obese females.

Background: Insertion of the advanced airway during induction of general anesthesia can cause undesirable sympathetic stimulation such as increased intraocular pressure (IOP) and hemodynamic parameters. In this study, we compared insertion of three different advanced airway devices; endotracheal tube (ETT), laryngeal mask airway (LMA) and I-gel in terms of IOP, hemodynamic changes and postoperative nausea and vomiting (PONV) following induction of general anesthesia with propofol and remifentanil in children undergoing strabismus surgery. Materials and Methods: A total of 90 children (5.68 ± 1.49 years old) were randomly assigned to one of the three groups, ETT, LMA, or I-gel insertion as advanced airway devices IOP and also hemodynamic variables were measured before (T0 and T1) and immediately after (T2) the insertion of these airway devices, although 2 min (T3) and 5 min (T4) after it. PONV was assessed about 2 h after the completion of surgery in the recovery room. Results: The mean arterial pressure (MAP), IOP, and systolic and diastolic blood pressures were significantly different between the three groups immediately (T2), 2 min (T3), and 5 min (T4) after the insertion of airway devices. The heart rate (HR) was significantly different between the three groups in all measurement times except of T0. Within-group comparisons showed that the three groups had significant changes in MAP, IOP, HR, systolic and diastolic pressure before and after airway insertion (T1 and T2). The trend in the LMA and ETT groups was descending-ascending-descending, whereas in the I-gel group, it was quite descending. There was no significant difference among the three groups in terms of PONV. Conclusion: As a result, our study showed that, compared with LMA and ETT, the I-gel had less impact on undesirable stress responses and seems to be superior to LMA and ETT in children undergoing strabismus surgery.

Background: The concurrence of metabolic syndrome (MS) and diabetes mellitus (DM) is increasing worldwide. The long-term complications of these chronic diseases are a threat to patients' well-being. Oxidative stress is involved in the pathogenesis of several diseases. To understand the basic pathophysiological mechanisms of Type-2 DM (T2DM) and its related complications, we aimed to investigate the oxidant/antioxidant status and Na⁺-K⁺ ATPase activity in T2DM with MS. Materials and Methods: A population of ninety individuals including fifty patients diagnosed with T2DM and MS, but without overt diabetes complications, and forty individuals without T2DM or MS as control group participated in this study. Plasma malondialdehyde (MDA), catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx) activities, total antioxidant capacity (TAC), and Na⁺-K⁺ ATPase activity were assessed by standard laboratory methods. Results: Plasma MDA in patients group was statistically significantly higher than that of controls (P ≤ 0.05). Whereas, Na⁺-K⁺ ATPase activity was statistically significantly lower in patient group (P ≤ 0.05). TAC, CAT, SOD, and GPx enzyme activities were not statistically significantly different between two groups (P > 0.05). Results from the patient group showed positive correlations between CAT activity and triglyceride and positive correlations between GPx activity and weight, body mass index (BMI), and waist circumference. In addition, there was a positive correlation between MDA results with high-density lipoprotein-cholesterol (HDL-C) and total cholesterol and a negative correlation with TAC, BMI, and weight (P ≤ 0.05) in controls. Conclusion: Because T2DM patients were without any vascular complications, antioxidant defense results may reflect the lack of progression of diabetes complications in these patients. These results emphasize the need for initial and continued assessment of cardiovascular disease risks in diabetic individuals. Implementation of timely interventions may improve the management of diabetes and prevent the progression of diabetes complications.

Background: We investigated the impact of a home-based exercise intervention (HBEI) on cardiac biomarkers, liver enzymes, cardiometabolic outcomes, and health-related quality of life (HRQL) in clinically stable patients after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). Materials and Methods: The study was a nonrandomized clinical trial conducted in Tehran, Iran, from July 2019 to January 2020. Forty cardiac patients (after the cardiac intervention, CABG, n = 32; PCI, n = 8) were recruited based on the study inclusion criteria and were allocated consecutively to one of two groups: (1) HBEI (n = 18) and (2) conventional center-based exercise program (CBEP, n = 22). The CBEP group performed the routine exercise program of Sadr Heart Clinic, and the HBEI group performed a home-based remotely monitored exercise protocol, both three times per week, for 8 weeks. The following variables were assessed before and after the intervention: anthropometric measures; blood pressure; lipid profile; cardiac biomarkers including cardiac troponin I, creatine kinase, and total and Mb isozyme; liver enzymes including aspartate aminotransferase and alanine aminotransferase; creatinine; urea; exercise capacity; and HRQL. Results: In comparison with pretest in both CBEP and HBEI groups, a significant improvement in all of the measured variables (P < 0.05), but not in ejection fraction was observed (P > 0.05). Moreover, in the CBEP group, a more significant decline in troponin I levels (P = 0.03), and in the HBEI group, a greater reduction in weight (P = 0.01) and body mass index (P = 0.04) occurred. Conclusion: The findings suggest that a properly designed and monitored HBEI may be as effective as conventional center-based cardiac rehabilitation (CR) exercise programs and should be encouraged in those cardiac patients who are unable or uninterested in conventional center-based CR exercise programs.

Background: Gastroesophageal reflux disease (GERD) is a common upper gastrointestinal disorder with a negative impact on the quality of life. This study was aimed to assess the effect of adding duloxetine to lansoprazole on the symptom and quality of life improvement in GERD patients. Materials and Methods: Seventy adult patients with a complaint of heartburn and regurgitation were enrolled in this randomized trial. Patients with a history of atypical symptoms, advanced systemic disease, medication-induced symptom, structural lesion in endoscopy, allergy to the medication, and unco-operative were excluded. The patients randomly (computer generated table) assigned in Groups A who received lansoprazole 30 mg plus placebo daily and Group B, in which duloxetine 30 mg daily replaced by placebo during 4 weeks. All of participants, care-givers, and outcomes assessors were blinded. Basic demographic data, symptom severity score, depression and anxiety Beck score, and quality of life questionnaire were recorded at the starting and ending of treatment. Results: Fifty-four patients have completed the study. The mean difference of Anxiety Beck score (13, 95% confidence interval [CI] [10–16], P = 0.001) and total raw score of quality of life (7, 95% CI [3.89–10.11], P = 0.043) were significantly improved in Group B. Complete and overall heartburn improvement rates were significantly better in Group B (odds ratio [OR] Adj: 2.01, 95% CI [1.06–2.97] and OR Adj: 1.31, 95% CI [1.05–1.57], respectively). Conclusion: We found that the combination of duloxetine and lansoprazole is a safe and tolerable regimen, and it can significantly improve anxiety, heartburn, coffee consumption, the quality of sleep, and life in patients who suffer from the symptoms of GERD.

Background: E-cadherin (CDH1 gene) is a protein involved in cell-cell adhesion. There are reports on the association of –160C > A (rs16260) and –347GA > G (rs5030625) polymorphisms in the 5′-promoter region of the CDH1 gene with tumor development and progression of gastric cancer. This study aimed to examine the potential relationship between these two polymorphisms and gastric cancer in patients from Mazandaran province, Northern Iran. Materials and Methods: A case–control study was conducted to test 97 patients and 95 healthy controls. Genomic DNA was extracted from peripheral blood followed by polymerase chain reaction amplification. Genotyping analysis was carried out using restriction fragment length polymorphism analysis for two potentially functional polymorphisms. Results: Heterozygous genotype GA/G versus GA/GA of rs5030625 (–347 GA > G) was found to be associated with increased risk of gastric cancer in the people studied (odds ratio = 5.73, 95% confidence interval = 2.11–15.56, P = 0.001). Furthermore, AA or CA genotype in –160C > A polymorphism did not show any increased risk of gastric cancer (P = 0.559). Conclusion: The present study revealed that GA/G genotype of rs5030625 (–347 GA > G) polymorphism is associated with gastric cancer in Northern Iran.

Background: Hyperglycemia over-activates glucose reduction to sorbitol by aldose reductase (ALR) leading to osmoregulation disruption and cellular damage that cause diabetic complications. We investigated the association of C106T polymorphism of ALR2 gene with the severity of diabetic retinopathy (DR) in Jordanian Type 2 diabetic patients in this case-control study at the Ophthalmology clinic of the National Centre of Diabetes, Endocrinology, and Genetics. Materials and Methods: A total of 277 subjects participated in the study (100 diabetics without retinopathy, 82 diabetics with retinopathy, and 95 controls). Blood samples were withdrawn followed by DNA extraction. C106T polymorphism was examined by polymerase chain reaction followed by restriction fragment length polymorphism and gel electrophoresis. Statistical analysis was performed by SPSS software using analysis of variance, multiple logistic regression or Chi-square test. Results: The CT and TT genotypes were significantly more prevalent in DR patients than those without DR (CT 50% vs. 38%, TT 16.7% vs. 8%, P = 0.02 and 0.01, respectively). DR patients had T allele more frequently than those without it (41.7% vs. 27%, P = 0.007). Diabetics without retinopathy showed similar genotype and allele frequency to those of nondiabetic controls. No correlation between CT/TT genotypes and the severity of DR in affected subjects was found (χ²: 3.049, P = 0.550). Conclusion: C106T polymorphism increased the risk to develop retinopathy in Jordanian Type 2 diabetic patients. T allele of ALR2 was associated with DR. The severity of DR did not show an association with this polymorphism.

Hydatid cyst (HC) is a serious health problem in endemic areas. Liver and lung are the most common involved organs while the involvement of muscles, heart, kidney, brain, and spleen is rare. The involvement of these rare locations for HC is mostly in association with infestation of common sites. We report a case of 43-year-old man with a history of surgery of HC in brain and heart who complained from chest pain. In imaging modalities, three cystic lesions were seen in heart and kidney which were confirmed to be recurrence of HC by serologic tests. However, no evidence of involvement of liver and lungs as the most common infected organs of HC was seen in recent and previous imaging mo®dalities. The patient refused another surgery and just accepted anthelmintic drugs. The practical point of this case report is that when we see any cystic lesion in imaging modalities in uncommon sites for HC, while common sites are spare, we should still consider the possibility of HC and not rule out it just because of lack of simultaneous infestation of its common involved organs.