Tehran University Medical Journal

Background: Dermatophytes create the most common fungal disease in humans, called dermatophytosis. The two species of Trichophyton rubrum and Trichophyton interdigital are responsible for over 80% of types of dermatophytosis. So far, several morphological and physiological methods have been used to differentiate these very similar species, but these methods are generally time-consuming and have low specificity. The purpose of this study was to introduce a simple and rapid duplex polymerase chain reaction (PCR) reaction to differentiate these two species from each other.
Methods: This research was an analytical and experimental study that was carried out from 2017 to 2018 in the Medical Mycology Laboratory, School of Public Health, Tehran University of Medical Sciences, Iran. For this purpose, the nucleotide sequences of the 4 regions of internal transcribed spacer (ITS), beta-tubulin, elongation factor 1 alpha and calmodulin in the two considered species of fungi were conducted bioinformatics analysis. The differences and similarities of nucleotides between two species in each of these genes were studied for selecting the primer. The specificity of selected primers was tested for duplex PCR reaction against sequenced isolates of dermatophyte species.
Results: According to the total data, the specific primers were selected from elongation factor 1 alpha gene. These primers produced a product of 173 and 384 bp, in Trichophyton rubrum and Trichophyton interdigital, respectively. They had high specificity in the face of various dermatophytes. The length of nucleotide sequences found in the genebank of this gene in the two species is between 700 and 770 bp. The similarity of the two species in this region is 94.6% and differs by 78 bp. Of the 107 extracted DNAs from clinical dermatophyte isolates, in duplex PCR 24 isolates were positive with Trichophyton interdigital primer and 71 isolates against Trichophyton rubrum. The remaining isolates, which included 6, were negative in this reaction, which included other dermatophyte species.
Conclusion: This method is a specific and fast differential method compared to conventional methods for identifying Trichophyton rubrum and Trichophyton interdigital from each other.

Background: Iron deficiency in the body is the main cause of anemia, and iron supplementation is probably the best option for iron deficiency and iron deficiency anemia in women and young children. This study aimed to explain the challenges of national iron supplementation in female school’s base on the perspective of the stakeholders.
Methods: This study was a qualitative study of content analysis. The data of this study were conducted by focus group discussion, semi-deep interviews with the participation of the target community of students, parents of students, school principals and school health instructors, general manager of the Office of Community Nutrition (Department of Education) includes manager, deputy and school health officer, from October 2016 to January 2017 in city of Gonabad, Iran. Participants were selected through targeted sampling and data collection continued to saturation. Data were analyzed using contractual content analysis method based on five steps of Graneheim and Lundman. Data management was done with NVivo software, version 11 (QSR International, Victoria, Australia), but data analysis and interpretation were done manually.
Results: The findings from group discussions and semi-deep interviews with stakeholders were categorized into twelve themes. The main strength, perceived in "Perceived Individual Benefits" and "Perceived Executive or Management Benefits". The main perceived weakness was "Physical Disadvantages", "Tablets Disadvantages", "Disadvantages of Programming" and "Disadvantages of the Program". The main perceived barriers was "Educational and Information Barriers", "Barriers of Pill Consumption" and "Management and Administrative Barriers". "Modifying the Executive Program", "Individual Perception Modification" and "Reform the Shape of Pills" were suggested as a corrective mechanism from participants’ view point.
Conclusion: According to the results of this study, the most important challenges of the "Schools Iron Aid National Plan" were "Educational and Information Barriers", "Administrative barriers", and "Barriers to Pill Consumption". Therefore, in order to do better, the Iron Supplementation Program requires intervention at individual, interpersonal, inter-organizational, and intra-organizational levels to provide comprehensive support for the program and, ultimately, increase program productivity.

Background: Post-dural puncture headache (PDPH) is commonly seen after neuraxial block and it usually lasts for up to two days or in some cases for up to two weeks. Several types of regimens have been suggested for treatment, such as theophylline and caffeine. This study aimed to evaluate the effects of aminophylline, paracetamol, and administration of aminophylline and paracetamol concurrently on prevention of PDPH.
Methods: In a double-blind randomized clinical trial, we evaluated 120 patients in four groups (n=30) undergoing spinal anesthesia for extremity surgery in educational hospitals of Isfahan University of Medical Sciences (Alzahra and Ayatollah Kashani Hospitals), Iran, from 2016 to 2017. In group A aminophylline was injected slowly intravenously (1.5 mg/kg), in group B paracetamol (1000 mg) was injected intravenously, in group C aminophylline and paracetamol was injected with the same dose and in control group (n=30) normal saline was injected intravenously. After patients entered the operating room, mean arterial blood pressure and heart rate were measured and oxygen saturation was monitored. Before spinal anesthesia, 15 minutes before leaving the recovery room, every 6 hours in first day and daily in first week after the surgery, incidence of PDPH in each group were evaluated. The frequency of nausea between the four groups was also studied.
Results: 42 patients (35%) out of the 120 ones suffered from headache. 40% of patients who had received aminophylline, 33.3% of patients who had received paracetamol, 20% of patients who had received aminophylline and paracetamol and 46.6% of patients who had not received any drug suffered from headache (P=0.05). The frequency of nausea was not significantly different between the four groups at any time. The average of heart rate, mean arterial pressure and oxygen saturation in recovery and 24 hours after operation were not significantly different between the four groups.
Conclusion: This study shows that intravenous administration of aminophylline and paracetamol significantly reduces the incidence of post-dural puncture headache (PDHP) in lower extremity surgery and we can use this regimen for prevention.

Background: Molecular detection has recently been proposed by nucleic acid amplification, known as polymerase chain reaction (PCR). The aim of this study was to compare the diagnostic method of smear and polymerase chain reaction with culture in terms of sensitivity, specificity, positive and negative predictive value in the diagnosis of pulmonary tuberculosis.
Methods: In this cross-sectional study, sputum samples were collected from 58 patients with suspected pulmonary tuberculosis referred to Ghaem Hospital in Mashhad from the beginning of April 2017 to the end of March 2018. The samples were delivered to the laboratory in less than 72 hours. Patients were sampled for three times. Bronchoscopy and Broncho alveolar lavage were performed in patients who were unable to produce sputum. The smear test was reported by Ghaem’s Laboratory after 24 hours. In our study, the culture method was considered as the gold standard and the sensitivity and specificity of the PCR methods and smear were compared with it.
Results: Patients ranged in age from 18 to 89 years. Among 58 suspected pulmonary tuberculosis, the method of cultivation confirmed the presence of the disease in 25 cases (43.1%). However, with smear, the presence of the disease has been proved in 27 patients (46.6%) and with the method of PCR in 24 patients was (41.4%). Sensitivity of smear in the diagnosis of pulmonary tuberculosis was (100%), and its specificity was 93.9%, the positive predictive value of this test was (92.6%) and the negative predictive value was (100.0%). The sensitivity of the PCR method in diagnosis of pulmonary tuberculosis was 88.0% and its specificity was 93.9%. The positive predictive value of this was (91.7%) and the negative predictive value was (91.2%).
Conclusion: In this study, between the two methods of smear and polymerase chain reaction, the acid fast smear method was more sensitive to the diagnosis of pulmonary tuberculosis than the polymerase chain reaction and the specificity of both methods were the same.

Background: Previous studies have considered patent ductus arteriosus (PDA) a common finding in premature infants, leading to complications such as intracranial hemorrhage, necrotizing enterocolitis and pulmonary dysplasia. The aim of this study was to assess and compare the efficacy of oral ibuprofen and intravenous acetaminophen in the closure of arterial duct in premature newborns. We also evaluated the complications of each drug.
Methods: A cross-sectional and analytical study was conducted at Amiralmomenin Hospital, Semnan City in Iran from April 2012 to December 2017. Subjects were selected through convenient sampling and consisted of all premature infants with patent arterial duct. All of the infants with the diagnosis of PDA were treated with either intravenous acetaminophen or oral ibuprofen. Cardiac echocardiographic findings were assessed in two study groups before and after each treatment course. The complications associated with the two treatment approaches were evaluated in two groups after treatment of each drug.
Results: In general, twenty-four neonates (62.5% females) with the average gestational age of 31.46±3.43 weeks were studied. There was no significant difference in the echocardiographic characteristics in the two treatment groups at the pre and post-treatment periods as well as the side effects of the medications. The average number of treatment cycles in newborns treated with oral ibuprofen (1.06±0.25) was not significantly different compared to those with intravenous acetaminophen (1.25±0.46) (P=0.190). There was no significant difference concerning closure status of the arterial duct in the two treatment groups at the end of the first period (P=0.112) as well as after the second period of treatment (P=0.386).
Conclusion: Our study indicated similar efficacy of oral ibuprofen and intravenous acetaminophen in the closure of the arterial duct. The incidence of complications was not significantly different between the two groups. The results of this study suggest the use of intravenous acetaminophen as a suitable drug for PDA closure, particularly in cases of ibuprofen contraindications.

Background: The amount of anterior tibial translation during rehabilitation exercises is a key factor in organizing exercise regimen after anterior cruciate ligament injury. Excessive anterior tibial translation could increase the magnitude of tension imposed on injured and reconstructed anterior cruciate ligament knees. Forward lunge and open-kinetic knee extension exercises are commonly used in anterior cruciate ligament rehabilitation. However, there is insufficient data about the amount of anterior tibial translation in the eccentric and concentric phases of these exercises. This study compared the amount of anterior tibial translation in the eccentric and concentric phase of the lunge and seated knee extension in anterior cruciate ligament deficient and intact knees.
Methods: Using a non-probability sampling method, 14 men with unilateral anterior cruciate ligament rupture were selected for participation in this cross-sectional study. Participants were recruited from the university’s physiotherapy clinics. A uni-plane fluoroscope was used to image the knee joint while participants performed the forward lunge and open-kinetic knee extension exercises with the intact and injured legs in random order. Fluoroscopy imaging was performed in the radiology center at Sina Hospital, Tehran, Iran, from September 2013 to February 2014. Two factorial mixed ANOVA was used to analyze the data.
Results: There were no significant differences in the anterior tibial translation between the limbs and contraction phases during the lunge exercise. During open-kinetic knee extension, the anterior tibial translation in anterior cruciate ligament deficient knees was significantly more than that of healthy knees at 0⁰ (P=0.007). The anterior tibial translation in the eccentric phase of open-kinetic knee extension at flexion angles of 0⁰ (P=0.049) and 15⁰ (P=0.024) was significantly greater than that in the concentric phase.
Conclusion: In the lunge exercise, the amount of anterior tibial translation was similar between the eccentric and concentric phases and the intact and anterior cruciate ligament deficient knees, however, during open-kinetic knee extension exercise, in the eccentric phase was greater than that in concentric, and in the intact knees was greater than that in the intact knees, at 0-15⁰ angles.

Background: Infant mortality is important as a standard indicator for the development of health, educational and social health systems in each country. Considering the fact that in different studies of the country there are different statistics on the prevalence of infant mortality in the intensive care unit and the general statistics on the prevalence of mortality in neonates in the country are unclear and unclear, the aim of this study was systematic review and meta-analysis for determine the prevalence of mortality in infants admitted to the intensive care unit (ICU) of hospitals in Iran.
Methods: A meta-analysis was performed for relevant articles in scientific databases including scientific information database (SID) and Magiran, ScienceDirect, Scopus, Medline (PubMed) and Google Scholar. Entrance criteria included cross-sectional studies between March 2000 to September 2018. The search process in these databases was performed using keywords: Neonatal, Intensive Care Unit, Mortality, and Iran. Non-relevant articles included review articles, interventions, cohorts and case-control studies, excluded from the study list. Heterogeneity of study was checked using I2 index and the possibility of publication bias by funnel plot and Egger test. Data were analyzed using the comprehensive meta-analysis software, version 3 (Biostat, Englewood, NJ, USA).
Results: The overall prevalence of infant mortality in ICU hospitals was 21.8% (95% CI 14.4-31.6%), the highest prevalence of infant mortality in Isfahan was 64.4% percentage (95% CI 57.5-70.9%) and the lowest mortality rate in babies in Babol's intensive care unit with 5.1% (95% CI 3.8-6.7%). The results of the study showed that the prevalence of infant mortality was significantly reduced with increasing sample size (P<0.05). Also, with an increase in years of research, the frequency of infant mortality in the intensive care unit increases, which is also statistically significant respectively (P<0.05).
Conclusion: Considering the high prevalence of infant mortality in ICU hospitals in Iran, health policy makers need to take effective measures to raise awareness of parents as well as effective measures to reduce infant mortality.

Background: Renal calculus with increasing prevalence and incidence in recent decades have the highest burden of urologic diseases. While preventive measures could significantly reduce the rate of recurrence, the amount of compliance with the preventive guidelines is unclear among urologists. This study was designated to evaluate the knowledge, attitude, and practice in kidney stones prevention among urologists for the first time in Iran.
Methods: This cross-sectional study was conducted on the participants of the 20th Iranian Urological Association Congress. The questionnaires included questions regarding demographics, educational and occupational information, knowledge, attitude, and practice of urologists in the field of kidney stones prevention. The questionnaires were designed according to the latest guideline of the European Association of Urology and previous studies. Scores related to the knowledge and practice were calculated based on the number of questions with correct answers. The response rate was also calculated. The correlation of knowledge and practice with background variables, including age, work experience, and time since graduation were assessed.
Results: The total response rate was 18.08% (64 out of 354 distributed questionnaires). The mean age of the respondents was 47.25±10.20 and the mean work experience was 15.61±11.70 years. The mean knowledge and practice scores were 8.36±1.48 out of 11 and 4.44±1.45 out of 7 scores, respectively. A total of 96.2% and 73.4% of the urologists earned at least half of the knowledge and practice scores, respectively. There was no significant correlation between knowledge and practice scores (P=0.706). Work experience and time since graduation had a negative relationship with the knowledge scores (respectively, P=0.02 and P=0.026), and faculty membership had a positive correlation with the practice scores (P=0.022). Most respondents had an acceptable attitude regarding the effectiveness of stone prevention.
Conclusion: Although the study participants had good knowledge, attitude, and practice pattern regarding urinary stone prevention, their performance score was less than their level of awareness. However, we could not generalize the results to other urologists due to the low response rate of the study.

Background: Curcuma longa generally known as turmeric includes curcuminoids and sesquiterpenoids as components, which are known to have antioxidative, anticarcinogenic, and anti-inflammatory activities. Iron, magnetite, and hematite as a micronutrient play an important role in physiological and chemical processes. Chitosan is a natural polymer derived from chitin and is recognized as versatile biomaterials because of their high biocompatibility, nontoxicity, and biodegradability to harmless products. The purpose of this research was to design synthesis and loading of nanocurcumin on iron magnetic nanoparticles modified with chitosan which is used as a targeted drug.
Methods: This laboratory research was conducted in Aja University of Medical Sciences from May to November 2017. Loading of nanocurcumin on iron magnetic nanoparticles modified with chitosan was done in two steps. In the first step, after preparing chitosan and iron magnetic nanoparticles, chitosan is placed as a coating polymer on surface of iron magnetic nanoparticles. In the next step, the final reaction is done by adding nanocurcumin on iron magnetic nanoparticles modified with chitosan. This causes nanocurcumin to penetrate into the polymeric layer core shell nanoparticles.
Results: Findings of transmission electron microscope and scanning electron microscope images show structure, morphology, physicochemical and the presence of nanocurcumin layers on chitosan in nanoparticles with diameter of 20 nm well. In Fourier transform infrared spectroscopy (FTIR), the Fe-O peak indicates magnetic nanoparticles and peak of the O-H in nanocurcumin layers on chitosan. Energy dispersive X-ray spectroscopy spectrum showing iron, carbon, oxygen and nitrogen peaks confirms the presence of these elements in the final composition and shows that chitosan and nanocurcumin groups are well dispersed on iron magnetic nanoparticles. The nanocurcumin loaded at 450 nm wavelength was evaluated by ultraviolet-visible spectrophotometry.
Conclusion: Results of Fourier transform infrared spectroscopy (FTIR), field emission scanning electron microscope image, energy dispersive X-ray spectroscopy spectrum, transmission electron microscope image, vibrating sample magnetometer analysis indicated that nanocurcumin has been successfully loaded on iron magnetic nanoparticles modified with chitosan and can be used as a targeted drug.

Background: Botulism is mostly caused by Clostridium botulinum neurotoxin which has been described as a bilateral symmetric descending flaccid paralysis. Preventing and responding to botulism outbreaks is a public health emergency. In this study, the disease is reported in a family.
Methods: In a case series study, during an outbreak, four members of a family with symptoms including paralysis, ptosis, blurred vision, diplopia, weakness, dysphagia, dry mouth, respiratory problems, vertigo, and lethargy, referred to Loghman Hospital of Tehran. Among the patients was an elderly woman and a pregnant woman. All clinical signs and symptoms of the patients were recorded daily in a researcher-made questionnaire from 27 August to 3 September 2018. At the time of admission, vital signs (pulse rate, respiration rate, and body temperature) of patients were stable and within normal limits. Following clinical suspicion of food-borne botulism in these patients, samples of the first two patients, including serum, stool, gastric secretions, and homemade whey were sent to the Botulism Laboratory of Microbiology Department of Pasteur Institute of Iran for the mouse bioassay.
Results: Type A neurotoxin was detected in homemade whey after the mouse bioassay. Therefore, foodborne botulism was confirmed in patients with laboratory results. Patients included two men and two women with a mean age of 52.7 years old. The length of hospitalized days was between 2 and 6 days. Two of the patients were admitted to the intensive care unit (ICU). Patients under study were fully recovered with timely diagnosis of the disease, treatment with antitoxin, and supportive care.
Conclusion: When conscious patients referred to the hospital with symptoms of paralysis, foodborne botulism is an important differential diagnosis. On-time diagnosis and antitoxin treatment can prevent serious complications.

Background: Although cervical malignancy rate had grown up in recent years, primary cervical lymphoma is so rare. It must be high index of suspicious for primary cervical lymphoma diagnosis in patient with malignancy-like signs and symptoms for early detection. Primary cervical lymphoma has no standard treatment or follow-up protocol; so the management still is in doubt and based on previous case reports. In the other hand, the precise prognosis of patient is undetermined. In the present study, a case of primary cervical lymphoma is presented which was misdiagnosed at first. The patient accurate diagnosis was made at last due to multidisciplinary team working.
Case presentation: A 51-year-old woman, gravida 2, para 2, presented with complaint of abnormal vaginal bleeding and discharge, with no abnormal finding in cervical cytology and sonography, so uneventfully a diagnostic error had happened in the assessment of her. After several months and multiple different treatment, the patient referred to the Oncology Department of Obstetrics and Gynecology Center, Ghaem Hospital, Mashhad, Iran in May 2017. Re-assessment was performed by biopsy and imaging, and the final pathologic diagnosis of diffuse large B-cell non-Hodgkin's lymphomas was confirmed.
Conclusion: Primary cervical lymphoma is an uncommon malignancy; the diagnosis could be missed simply by low suspicious due to low accuracy of Pap smear and imaging in this situation. So an accurate evaluation and pelvic examination, high suspicious and close communication between clinician and pathologist are needed. By timely diagnosis of patient in early stage and appropriate approach, the prognosis could be excellent most of the time.

Neurodegeneration with brain iron accumulation (NBIA) is a rare set of inherited neurodegenerative disorders with abnormal accumulation of iron in basal ganglia. It is a clinically and genetically heterogeneous disorder that is characterized by movement disorders, dystonia, dysarthria, Parkinsonism, intellectual disability, and spasticity. The age at onset varies from childhood to adulthood and the rate of progression is different among affected individuals. Although there is no information about the exact prevalence of NBIA in the world-wide, it is estimated less than 1/1,000,000 in population. NBIAs are inherited in autosomal recessive, autosomal dominant or X-linked fashions. Until now more than 10 genes have been identified for this group of disorders. Among these, only two genes encode proteins that directly involved in iron metabolism. Therefore, how iron contributes to the pathogenesis of NBIA remains unknown. The remaining NBIA-causing genes participate in lipid metabolism, lysosomal functions or autophagy process, and the roles of some of them remain unknown. NBIA is categorized based on the genetic cause of the disease. PKAN, PLAN, MPAN, and BPAN are the most common forms of the disease result from mutations in the PANK2, PLA2G6, C19orf12, and WDR45 genes, respectively. The diagnosis of NBIA is usually based on clinical features and a specific pattern of brain MRI which results from the abnormal accumulation of iron. For example, the pattern of “eye of the tiger” is observed in the brain MRI of PKAN cases. Since, clinical evaluations and neuroimaging have failed in the diagnosis of the disease in some NBIA cases, genetic testing will be helpful. Development of whole-exome sequencing (WES) has facilitated the identification of disease-causing genes but it seems some of NBIA-genes have remained unknown, yet. Identification of novel genes and molecular pathways will enable a deeper understanding of the underlying molecular bases and our knowledge about the pathogenesis of the disease. There is currently no comprehensive study about the NBIA in Iran, however, the latest discovered NBIA gene, GTPBP2, has been identified in an Iranian family.

Background: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma (NHL), which is the most common type of lymphoma. NHL comprises a group of clinically and biologically diverse diseases, which range from indolent to aggressive clinical courses. Despite treatment advances in the last three decades with the use of combination immunotherapy, a significant fraction of patients relapses or are refractory to these treatments. Actually, there is no standard method for detection of recurrence. The purpose of this study was to evaluate the level of this enzyme in the patients with recurrent DLBCL compared to healthy controls.
Methods: In this randomized double-blind, placebo-controlled trial, the serum level of pyruvate dehydrogenase (PDH) enzyme in total of 26 patients with DLBCL recurrence in compare with 26 healthy individuals in the Sayed Al-Shohada Hospital, Isfahan University of Medical Sciences in Iran from September 2016 to September 2018, were assessed. The clinical data including age criteria, the Eastern Cooperative Oncology Group (ECOG) score rating, total bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), prothrombin time and international normalized ratio (PT/INR), CT-scan, serum creatinine, platelet count, the absolute number of neutrophils, and the interval until the last treatment were gathered. After obtaining informed consent, blood samples were taken. and the PDH enzyme was measured in case and control groups.
Results: Fifty-three percent of patients were male and the mean age of participants in case and control groups was 37.2±17.3 and 34.8±8.9, respectively. Subsequently, the PDH levels were measured according to the enzyme protocol. The levels of enzyme in patients with relapse were significantly lower than normal ones (P=0.0003). The PDH serum level was also evaluated by age and sex, which did not show any significant differences (P=0.86). 
Conclusion: In patients with relapsing B-cell lymphoma, the pyruvate dehydrogenase (PDH) enzyme serum levels were significantly lower than healthy subjects, but this difference was not related to age and gender. In the case of further studies and comparisons beyond this study, this enzyme could be a good candidate, used as an alternative diagnosis tool, in patients with recurrent lymphoma.

Background: Non-viral Nano carriers such as liposomes and cationic polymers based on engineered properties are regarded in gene delivery field. Although these carriers do not have weaknesses of viral vectors, but they are less efficient than viruses and they still need to be improved as favorable gene delivery carriers. Amongst non-viral carriers, cationic liposomes have been proposed for clinical applications, but limitations such as low nucleic acid transfer and endosome escape and conduction of plasmid to the nucleus have challenged their use in clinical trials. Therefore, the combination of liposomes and cationic polymers for nucleic acid transfer has been considered because this approach makes it possible to use the desirable properties of liposomes and polymers so that it is even suggested for the gene treatment of some diseases such as Parkinson's. In this study, a combination of liposomes and cationic polymers were used for the preparation of lipopolyplexes. This approach allows simultaneous utilizing of the desirable properties of liposomes and polymers.
Methods: This interventional-experimental study was conducted in the medical faculty of Mashhad University of Medical Sciences from April 2017 to February 2018. In this study, PEI-based lipopolyplex with a molecular weight of 25 and 10 kDa and a liposome-to-polymer ratio of 1:1 were combined with plasmid containing the GFP (Green Fluorescent Protein) marker. The physicochemical properties of the synthesized carriers such as size, cytotoxicity and gene transferability in human prostate cancer (PC3) cells were evaluated.

Background: One of the main causes of maternal death in developing countries is postpartum hemorrhage. Cesarean section is one of the most common surgeries all around the world. In comparison with normal vaginal delivery, cesarean section is a greater risk factor for postpartum hemorrhage and need for blood transfusion. The risk of postpartum hemorrhage will increase when other risk factors such as multiple pregnancies, polyhydramnios, severe preeclampsia, peripartum hemorrhage, protracted labor, labor induction, and obesity are present. Oxytocin is conventionally used for the prevention of uterine atony during the cesarean section. The aim of this study was the evaluation of the effect of sublingual misoprostol in combination with oxytocin in reducing blood loss during and after cesarean delivery.
Methods: This randomized clinical trial was performed in Ommolbanin hospital; an academic hospital that is affiliated to Mashhad University of medical sciences from September 2016 to January 2018. The subjects were 90 pregnant women with a term pregnancies who were candidates for emergent cesarean delivery under spinal anesthesia and were at high risk for postpartum hemorrhage. All participants received 40 IU oxytocin in 1 liter of normal saline after delivery, and then they were randomly assigned to the intervention group who received 400 μg sublingual misoprostol in combination with oxytocin infusion, and the control group who received only oxytocin infusion without adding misoprostol.

Background: Studies have shown that 75% of men and 35% of women over the age of 10 have hamstring tightness. Hamstring tightness is one of the major causes of hamstring injury and loss of function. Dry needling which is a common intervention used by physiotherapists for the treatment of common various conditions can improve hamstring flexibility in less time than other interventions. So, the present study aimed to investigate the effect of dry needling on flexibility and electrophysiological indices in healthy men with hamstring tightness.
Methods: In this two-way blind clinical trial with a control group, which was performed from November 2018 to February 2019 in the laboratory of the Faculty of Rehabilitation of Tehran University of Medical Sciences, 30 healthy men with hamstring tightness were randomly divided into two groups of dry needling (n=15) and sham needle (n=15). In both groups, dry needling and sham needle, three points of hamstring muscle were needled, each point for one minute during a single session. Outcome measures included flexibility based on passive knee extension test, H-reflex latency, and motor neuron excitability, which were measured three times: before the intervention, immediately after the intervention, and one week after the intervention.
Results: The results revealed that the mean of passive knee extension test (P=0.54), the mean delay time of H-reflex (P=0.84) and the mean of excitability of the motor neuron (P=0.41) didn’t have significant different between two groups after intervention.
Conclusion: The findings of this study showed that dry needling had no effect on hamstring flexibility and electrophysiological indices recorded in the soleus muscle of healthy individuals with hamstring tightness.

Background: Health insurance literacy is a nascent concept that has emerged mainly after the implementation of the law known as Obamacare in the United States. This study seeks to identify the themes of health insurance literacy in Iranian society.
Methods: The study approach is qualitative. Data were collected using nine semi-structured interviews, ten focal group meetings with the presence of 86 experts of an insurance organization and a specialized meeting with fifteen academic experts, from September to December 2018 at the organization's location. MAX QDA10 software was used to organize the data. Qualitative data analysis was performed using continuous comparison analysis and in the form of directional qualitative content analysis based on the conceptual model (Paez et al 2014). Coding was performed independently by two researchers and then collected. Results were reviewed by an external observer. Finally, in a specialized meeting with the participation of representatives of specialized (groups secretaries) and academic experts(participants in the initial interviews), the findings of the study were re-examined and confirmed

Background: Even after surgery, as the most effective treatment for colorectal cancer, about 30-40% of cases are recurring. Since growth inhibition is an important strategy in cancer treatment, many attempts are in the program to find new agents, so in this study, the cytotoxic and antimicrobial effects of Lactobacillus sakei on colon cancer cell line (HT-29) and some pathogenic microorganisms have been evaluated. Lactobacillus sakei is a probiotic that, when consumed affects the intestinal flora, causes beneficial effects on host health. Probiotics due to their anti-cancer effects, modulation of the differentiation process in tumor cells, changes in tumor gene expression and lack of immunological responses have attracted a lot of attention as a new and effective treatment for colorectal adenocarcinoma.