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Investigating lipopolymers based on polyethylenimine and nanoliposome for gene delivery to prostate cancer (PC3) cell line
Mohammad Hasan Jafari Najaf Abadi , Saeedeh Askarian, Reza Kazemi Oskuee , Bizhan Malaekeh-Nikouei, Mehdi Rezaee, Seyed Hamid Aghaee-Bakhtiari ,
Volume 78, Issue 5 (August 2020)
Abstract
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.
Results: The prepared lipopolyplex were 104 nm in size and all the lipopolyplexes were able to enhance transfection in the C/P=0.4 compared with its basic carriers (PEI and liposomes) alone, while showing less cytotoxicity than not manipulated liposomes. The results of this study suggest synthesized nanoparticles as nanocomposites for gene delivery purposes to different cells and in in-body studies.
Conclusion: The results of this study show that the lipopolyplex constructed from combination of PEI and liposomes can efficiently transfer the gene to the cell, while showing low cytotoxicity and appropriate size at the nano-scale. Therefore, this lipopolymer can be suggested for gene delivery purposes to different cells and in vivo targets.
 

Measuring medical errors and adverse events in a hospital using global trigger tool
Abolghasem Pourreza, Ali Mohammad Mosadeghrad , Masoumeh Parvizi-Shad ,
Volume 78, Issue 5 (August 2020)
Abstract
Background: Medical errors are those mistakes committed by healthcare professionals due to wrong execution of a planned healthcare action or execution of a wrong healthcare action plan whether or not it is harmful to the patient. Medical errors may cause patients to suffer and have huge financial costs for the healthcare system. Identifying and measuring medical errors and adverse events are essential for improving patient safety. The objectives of this research were to measure medical errors and adverse events rates, to identify their severity and also analyze their underlying causes in a general educational hospital in Tehran, Iran by using The Global Trigger Tool.
Methods: A descriptive, cross-sectional, and retrospective approach was used in this study. The medical records of 377 hospitalized patients between April 2015 and March 2016 were examined using simple random sampling method. Patient’s records were reviewed by a nurse using The Global Trigger Tool. Then, a physician authenticated the findings of the adverse events and rated their severity. The causes of adverse events were identified using brain storming and Ishikawa Cause And Effect Diagram.
Results:  A total of 205 triggers were detected, and 60 adverse events were identified. About 15.9 percent of patients experienced an adverse event. The rate of adverse events was 19.1 per 100 admissions and 5.7 per 100 Admission days or hospitalization days. Almost half of the adverse events were in the E and F categories (temporary harm). Bleeding, nosocomial infections, and patient fall were the leading adverse events. Employees and working processes were the underlying causes of the medical errors and adverse events. The Global Trigger Tool found 100 times more adverse events than the voluntary reporting method.
Conclusion: The adverse event rate of this study was high. Hospital managers should take appropriate actions to reduce medical errors and adverse events and enhance patient safety. The Global Trigger is a Powerful, reliable, strong tool for identifying adverse events and measuring their severity.

The effect of diabetes mellitus on coronary artery ectasia: brief report
Mostafa Bahremand, Ehsan Zereshki, Behzad Karami Matin, Samira Mohammadi,
Volume 78, Issue 5 (August 2020)
Abstract
Background: Coronary artery ectasia (CAE) is dilatation of an arterial segment to a diameter at least 1.5 times that of the adjacent normal coronary artery. The incidence of coronary artery ectasia is distinct in different countries that can be found in 1.2% to 5% of angiographic examinations.
Methods: This is a retrospective study that was conducted from September 2019 to February 2020 in Kermanshah University of Medical Sciences and the results were reported briefly. To obtain the desired articles, electronic searches were conducted in databases including the Scopus, PubMed, and Science Direct databases without time limited until October 2019. The keywords used were Coronary Artery Ectasia AND (Diabetes OR "Diabetes Mellitus"). This was done by two individuals separately and the final results were confirmed by a third person. Mixed method appraisal tool (MMAT) was used to evaluate the quality of studies. The structure of writing and the process of performing and reporting the study are based on the PRISMA checklist.
Results: Based on the search strategy carried out at PubMed, Scopus and Science Direct databases, 106 studies were found, which resulted in 24 articles being analyzed based on inclusion and exclusion criteria of which three were conducted in China, 18 in Turkey and one in Sweden, Egypt, and France. Finally, 24 articles were analyzed and the results showed a direct and effective relationship between diabetes mellitus and CAE (OR=1.19, CI: 0.94, 1.51).
Conclusion: Based on these results, the risk of CAE in subjects with diabetes mellitus was 19% higher than in subjects without diabetes mellitus.

A review of neural network detection methods for breast cancer: review article
Homayoon Yektaei, Mohammad Manthouri,
Volume 78, Issue 6 (September 2020)
Abstract
Breast cancer is the most common cancer among women and the earlier it is diagnosed, the easier it is to treat. The most common way to diagnose breast cancer is mammography. Mammography is a simple chest x-ray and a tool for early detection of non-palpable breast cancers and tumors. However, due to some limitations of this method such as low sensitivity especially in dense breasts, other methods such as 3d mammography, ultrasound and magnetic resonance imaging are often suggested to obtain additional useful information. Recently, computer-aided diagnostic or intelligent diagnostic have been developed to assist radiologists to improve diagnostic accuracy. In general, a computer system consists of four steps: pre-processing, dividing areas of interest, extracting and selecting features, and finally classification. Nowadays, the use of imaging techniques in the identification of patterns for diagnosis and automatic determination of breast cancer by mammography and even digital pathology (which is one of the emerging trends in modern medicine) reduces human errors and speeds up the diagnosis. In this article, We reviewed recent findings and their disadvantages and benefits in the diagnosis of breast cancer by neural networks, especially the artificial neural network, which is widely used in the diagnosis of cancers and intelligent breast cancers. This literature review shows that hybrid algorithms have been better at improving classification and detection accuracy. Providing a convenient way to diagnose tumors in the breast by computer-assisted diagnosis systems will be of great help to the physicians. Much work has been done in recent years to diagnose breast cancer, and many advances have been made in improving and diagnosing breast cancer by computer. All methods have a significant error percentage and are different depending on the type of breast, but compared to other types of neural networks, convolution and combining methods with convo have better results. Another advantage of the convoluted network is the automatic extraction of desirable features. Today, the best percentages of accuracy in detecting benign or malignant cancerous mass are achieved by convolution.
Relationship between neutrophil to lymphocyte ratio and mortality and morbidity of dialysis patients in Birjand, a one-year old follow-up: brief report
Zeinab Saremi, Mohammad Khodashenas Roudsari, Zahra Tanaki,
Volume 78, Issue 6 (September 2020)
Abstract
Background: Chronic kidney disease is considered as one of the most common health problems in the world. High mortality and morbidity in these patients, are due to cardiovascular disease and infections. Neutrophil to lymphocyte ratio is recently known as an inflammatory marker. This study aimed to determine the ratio of neutrophil to lymphocyte count in hemodialysis patients in Birjand Special Disease Center, and its role in mortality and morbidity during one-year follow-up.
Methods: This is an analytical descriptive study that was performed on 59 End-Stage Renal disease patients referred to the dialysis department of Special Disease Center, Birjand University of Medical Sciences Birjand, Iran. The levels of neutrophil to lymphocyte ratio, erythrocyte sedimentation rate, and C reactive protein were measured and cases divided into 4 groups according to the NLR: less than 1, 1-1.5, 1.5-2.5, 2.5-3.5, and>3.5. All patients were followed up for one year to determine rate of mortality, cardiovascular and infectious events.
Results: The mean NLR was 2.89±1.38. There was no significant difference in mortality rate between groups according to NLR with P=0.052, also no remarkable difference in infectious and cardiovascular morbidity events in groups with P=0.09 and P=0.21, respectively. The mean NLR in patients with cardiovascular or infectious events was 4.2 and 3.75 respectively, which were notably higher than patients without cardiovascular (NLR:2.49) and infectious (NLR:2.68) events, P=0.02 and P=0.03 respectively. In the bivariate correlation analysis, NLR was positively correlated with CRP in hemodialysis patients.
Conclusion: ESRD patients with NLR>2.5 have higher cardiovascular and infectious events than patients with NLR<2.5 but there was no difference in mortality rate between them.

Familial adenomatous polyposis, diagnosis and surveillance strategies: review article
Sima Sedighi, Maliheh Moradzadeh, Mehrdad Aghaei, Ashraf Mohamadkhani, Mohammad Hassan Jokar,
Volume 78, Issue 7 (October 2020)
Abstract
Familial adenomatous polyposis is characterized by over 100 colorectal adenomas in the colorectum. The disease equally affects both sexes, with an incidence estimated at 1.14025-1.8300. The disease is premature in people with familial adenomatous polyposis. Patients suffering from familial adenomatous polyposis have a range of extra-intestinal diseases such as papillae, gastric, small intestine, and duodenal polyps; cutaneous wounds (lipomas, fibromas, and epidermoid cysts); desmoid tumors; osteomas; nephroderma retinal pigment epithelium, including hepatoblastoma and thyroid cancers; and pancreas, biliary system, and brain cancer. Familial adenomatous polyposis is characterized by >100 polyps in the colon that are often observed on the left side of the colon and rectum. A germline mutation in the adenomatous polyposis coli gene that can be clinically and genetically diagnosed is responsible for this disease. Several methods are available for testing the adenomatous polyposis gene. Whole-gene sequencing of all adenomatous polyposis coli exons and exon-intron boundaries with maximum sensitivity for determining adenomatous polyposis coli mutations is not affordable. Another method, the protein shortening assay, correctly identifies 80% of the mutations in families who show familial adenomatous polyposis and is less expensive than complete gene sequencing. The application of a COX-2 inhibitor for chemical prevention is limited in patients showing familial adenomatous polyposis because of cardiovascular toxicity. Aspirin does not negatively impact cardiovascular diseases and is even used as primary pharmacotherapy in patients who demonstrate cardiovascular risk factors.   After 55.7 months of the diagnosis in hereditary CRC carriers, the incidence of cancer can be decreased by a dose of 600 mg/day aspirin for 25 months. After diagnosis, patients should undergo prophylactic proctocolectomy or ileoanal pouch. Undiagnosed patients having a family history of FAP must be referred to a genetic counselor and enrolled in optimal genetic and clinical surveillance programs. Recent advancements in endoscopic technology, e.g. high-resolution endoscopy, double-balloon endoscopy, and capsule endoscopy have enabled the comprehensive study of the gastrointestinal tract. Despite the limited evidence, more studies on these novel endoscopic technologies may modify the surveillance strategies for FAP patients.

The effect of prenatal preparation classes on the choice of the delivery method
Zahra Shahraki, Tayebeh Shahraki, Mahin Badakhsh, Khadijeh Saravani, Ghasem Shahraki, Abdolghani Abdollahi Mohammad ,
Volume 78, Issue 7 (October 2020)
Abstract
Background: Childbirth is a natural phenomenon without the medical intervention but someone a cesarean section is necessary when a vaginal delivery might put mother and baby at risk. Given the increased rate of cesarean section and post-operative complications, prolonged recovery, high cost of labor through surgery, Childbirth education classes can prepare parents for normal or complicated labor and delivery. This study aimed to investigate the effect of delivery preparation classes on choosing a delivery method.
Methods: This study compared the experimental and control groups of pregnant women who were referred to Zabol health centers and it was performed from May 2017 to November 2017. The statistical population included 70 pregnant women of which 35 cases were selected as the experimental group and 35 cases as the control group. For the experimental group, 8 sessions of counseling and training for natural childbirth were held. Data in two stages were collected. Up until the end of pregnancy, both groups were followed and the method of delivery was evaluated. Data was analyzed by using descriptive statistics and Chi-square test in SPSS software, version 23 (SPSS Inc., Chicago, IL, USA).
Results: Based on the obtained data, it was observed that out of the participants in the training classes, 5 cases (14.3%) had cesarean section and  and 30 cases (85.7%) had a normal delivery. 18 cases (51.4%) of the control group had the natural method and 17 cases (48.6%) were delivered by cesarean section. It was observed that there was a significant difference between the control and intervention groups in the type of delivery method, therefore, 85.7% of the intervention groups had a normal delivery (P=0.002).
Conclusion: The results of this study showed that participation in childbirth preparation classes were influenced for the choice of delivery.
 

Comparing scientific production of prioritized health areas of Iran's comprehensive scientific map with outlook horizon 1404 countries, a scientometric study: brief report
Mohammadreza Cheshmyazdan, Mousa Bamir, Reza Dehnavieh, Ali Masoud, Amir Hossein Setayesh, Ali Karamoozian,
Volume 78, Issue 7 (October 2020)
Abstract
Background: Studying and evolution of medical sciences is so important to draw up the future path with a view to per capita of science production. The purpose of this study was to clarify the status and position of Iran in science production and compare it with four competitor countries of the region for 2025.
Methods: This research is conducted using the scientometric method our ranked citations and ranked document data collection source is the SCImago database. The statistical population is the priority fields of Iran health program, which has 25 field names In three categories: infrastructure, survival, perfection, compared with the four competitor countries in the Middle East. The evaluated time period is examined are from 2010 to 2017. Data analysis is performed using Excel software.
Results: In three groups of infrastructure, survival, and perfection, the results are as below respectively. The highest rate of progress in terms of the ranked document in the groups of infrastructure, family physician area with 314% growth belongs to Iran, in the groups of survival, Nanosciences with 269% growth belongs to Saudi Arabia and in the groups of perfection, nursing with 193% growth belong to Iran again. But in terms of ranked citations, in the groups of infrastructure, health information management with 193% growth belongs to Saudi Arabia and in the groups of survival, Nano sciences with 247% growth belongs to Saudi Arabia and in the groups of perfection, nursing with 166% growth belongs to Egypt.
Conclusion: In terms of ranked citations and ranked document, Iran has achieved the first rank of the region in the majority of subject areas in 2017. Iran and Saudi Arabia in the majority of thematic areas have had an ascending rate and Israel and Turkey have had a descending rate in the ratio of variation in two periods. Iran has also the highest rank in three thematic areas in terms of citations per document comparing to the competitors.

Rethinking Health reforms in Iran: letter to the editor
Ali Mohammad Mosadeghrad,
Volume 78, Issue 7 (October 2020)
Abstract
No
Cystic fibrosis from genotype to phenotype: review article
Mohammad Sadra Modaresi , Arta Amir Jamshidi , Mohammad Reza Modaresi ,
Volume 78, Issue 8 (November 2020)
Abstract
Cystic fibrosis (CF) is the most common autosomal recessive genetic disease, which is caused by defection in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene. CFTR gene codes chloride channels to modulate the homeostasis of epithelial environments. Defective CFTR affects various organs such as the lungs, pancreas, intestine, liver and skin; however, lung impairment is the main reason for mortality in these patients. About 2000 mutations in this gene have been discovered, but nearly 150 mutations lead to serious symptoms. CFTR mutations are classified into six major classes based on phenotypic manifestations such as structural instability of channels, defective processing, malfunctioning chloride-ion transfers and decreased number of chloride channels in the cell membranes. These cause various symptoms such as respiratory infection, intestinal obstruction, pancreatic exocrine insufficiency and malabsorption. Significant improvements in diagnostic tools and methods such as newborn screening, chloride sweat test and gene sequencing have increased the incidence and the prevalence of CF. Enormous studies have also been done on CF recognition and treatment procedures, which have resulted in 30 years of growth in the life expectancy of the patients. Despite the recent achievements, due to the high complexity of this disease and the involvement of various organs, the available treatments are nonpermanent. In the past few years, new combinatorial drugs have been introduced which potentiate and correct CFTR and ameliorate the CF symptoms. Recently, novel genetic engineering methods like CRISPR/Cas9 and TALEN have been utilized to correct the mutated CFTR gene with high accuracy and eradicate the symptoms. Studying this disease at its distinct levels from subcellular to organs could help to find new treatments. Systematic research in finding common attributes between different states of the disease is very beneficial. Interdisciplinary research groups with various expertise in mathematics, biology and engineering could have a great impact on describing the full picture of the disease and development of new treatment strategies. The main part of this article provides a comprehensive overview of cystic fibrosis with emphasis on the key studies on genetics and their effects on cellular and physiological levels. In this work, conventional and new treatment methods have also been discussed.

The relationship between Tonic-Clonic sizures in children and increased time of ventricular repolarization
Mohammad Radgoodarzi, Sepideh Ammooeian, Hassan Esmaeili, Shima Salehi, Mohammad Nikoocar,
Volume 78, Issue 8 (November 2020)
Abstract
Background: Long QT syndrome (LQTS) is a disorder in which electrical cardiac ventricular repolarization is impaired. It results in an increased risk of an irregular heartbeat which can result in palpitations, fainting, drowning, or sudden death. Long QT Syndrome may present as tonic-clonic seizure or a seizure-like disorder. By taking a superficial electrocardiogram (ECG) and proper diagnosis, Sudden death, one of the most important complications of Long QT syndrome can be easily prevented.
Methods: This is a prospective case-control study that was conducted in the emergency department of Taleghani Children's Hospital of Gorgan University during 2017.
Four hundred and eighty subjects in three groups (two cases and one control groups), were included in this study. These comprised as patients with afebrile convulsion (n: 160), patients with seizures associated with fever (n: 160), and the control group (patients who have been hospitalized for any reason other than seizure (n: 160)). Those with severe cerebral palsy, acute meningitis, prolonged loss of consciousness, severe disturbances of electrolytes and those who were taking drugs that affect the QT interval were excluded. Once admitted with a primary diagnosis of seizure, a 12 leads superficial ECG was performed.
Results:  In the group of patients with febrile convulsion, 123 children were Low probability Long QT syndrome, 33 cases were Intermediate and 4 were high probability Long QT syndrome. Probability of Long QT syndrome in children with afebrile seizures showed that 112 children were in Low probability Long QT syndrome, 42 children in Intermediate and 6 children in High probability Long QT syndrome group. Comparison of Probability of Long QT syndrome among the three evaluated groups showed that children with afebrile seizure (48 children) and subsequently children with febrile seizure (37 children) were more in Intermediate and High categories than others. Only 11 children in the control group were in the Intermediate and High groups. Chi-square test results showed a significant difference with P<0.001.
Conclusion:  The results of this study show that in patients who present with seizure as the initial symptom, it is always mandatory to account Long QT syndrome into differential diagnosis. Doing a simple electrocardiogram makes it easy to distinguish two issues and prevent sudden death.

Evaluation of the effect of intratracheal ketamine on sore throat after intubation in patients undergoing strabismus surgery
Mehdi Sanatkar, Mehrdad Goudarzi, Mostafa Mohammadi, Ebrahim Espahbodi,
Volume 78, Issue 8 (November 2020)
Abstract
Background: Sore throat after endotracheal intubation during general anesthesia is a common complaint of patients especially in children. Strabismus surgery in one of the common procedures in child patients. The present study investigates the use of intratracheal ketamine administration in reducing sore throat after strabismus surgery.
Methods: This study was performed on 60 patients undergoing elective strabismus surgery under general anesthesia from December 2019 to February 2020 in Farabi eye hospital, Tehran University of medical sciences, Tehran, Iran. These cases were referred to our center for strabismus operation from other centers of our country. Patients were randomly divided into two equal groups. After sufficient depth of anesthesia with sevoflurane and injection of fentanyl, endotracheal intubation was performed. In the control group, the endotracheal tube was inserted and 2 ml of ketamine solution at a concentration of 5 mg/ml were administered in endotracheal tube. The severity of sore throat, length of stay in recovery, incidence of delirium in recovery, satisfaction of recovery nurses and their parents and other complications were compared between the two groups.
Results: Mean age, sex and weight were not significantly different between the two groups and were comparable. The mean duration of stay in recovery was higher in the case group than in the control group. The mean postoperative sore throat was significantly higher in the control group. Moreover, the mean incidence of delirium in the postoperative phase was higher in the case group. Besides, the rate of nurse satisfaction in the control group was higher than the case group. The incidence of bronchospasm, laryngospasm, and postoperative nausea and vomiting was not significantly different between the two groups.
Conclusion: Intratracheal ketamine can reduce postoperative sore throat and the need for postoperative analgesic medications. Postoperative complications were not increased with this strategy, but the length of recovery stay increased in these patients.

Overview of aseptic meningitis after MMR vaccination in a group of Iranian infants in Children’s Medical Center
Parisa Rahmani, Mohammad Roshanghalb, Hosein Alimadadi, Behnaz Bazargani, Nasir Fakhar, Reihaneh Mohsenipour,
Volume 78, Issue 8 (November 2020)
Abstract
Background: CNS infection can be focal or generalized. Meningitis, besides other etiologies, can occur after a viral infection or viral vaccine. Although meningitis can occur in at any age but it is more common in children less than five years old. Aseptic meningitis and meningoencephalitis are two of the most common complications of mumps (wild type or vaccine). As a result of their serious complication, we decided to obtain more information about clinical manifestations and laboratory findings after the injection of the Hoshino MMR vaccine in a group of children in an Iranian referral hospital.
Methods: In this cross-sectional study, performed from March 2013 to February 2015 on 73 children with meningochemical symptoms of meningitis, children who have been diagnosed with aseptic meningitis followed by an MMR vaccine in an infectious ward or emergency department of the Children’s Medical Center were enrolled in the study and their information was recorded from their files. A questionnaire was provided for children with diagnostic criteria of aseptic meningitis and their data were collected.
Results: The gender ratio of patients was 46 males to 27 females. After collecting the symptoms of meningitis, the frequency of symptoms in these patients was as below: fever 66%, headache 49.3%, nausea and vomiting 74%, parotid swelling 0%, seizure 21.9% and meningeal symptoms 37%. Their laboratory data showed that 8.2% of patients had normal WBC and 76.7% had Abnormal results in their CSF (Cerebrospinal fluid) analysis. Mumps PCR (Polymerase chain reaction) was positive in 85% of samples.
Conclusion: our study revealed that nausea and vomiting were the most frequent symptom after MMR vaccination in children and fever was in second grade in aseptic meningitis. There was no relation between clinical symptoms together, therefore we should take care of children after MMR vaccination to avoid complications when they become symptomatic.

Assessment the health-related quality of life in women with polycystic ovary syndrome
Farideh Zafari Zangeneh, Mohammad Mehdi Naghizadeh , Masomeh Masomi, Marzieh Mohebbi,
Volume 78, Issue 8 (November 2020)
Abstract
Background: Polycystic ovary syndrome is the most common disorder in the endocrine system. Hyperandrogenism, hyperinsulinemia, chronic ovulation, and infertility are important Complications of PCOS. Health-related quality-of-life (HRQoL) has a significant reduction in women with polycystic ovary syndrome (PCOS). This reduction can be due to many disorders including: menstrual and sleep disorders, hirsutism, marital issues, infertility, and emotional/psychosocial problems. The purpose of current study was to investigate the role of sleeping and other environmental factors affecting the quality of life in patients with polycystic ovary syndrome. 
Methods: This case/control study was conducted in 2017 in two groups: control and study (PCOS). The inclusion criteria were women aged 20-40 with a body mass index (BMI)<28. Exclusion criteria included no disease and no medication for all women. The participants were 180 women who were referred to the infertility center of Imam Khomeini Hospital in Tehran. Four questionnaires including Demographics (40 questions), sleep quality (PSQI) (19 items 0-3), quality of life (GHQ) (28 items) and psychometric (DASS-42) with their consent form were filled out. Student’s t-test and Chi-square were used to compare the variables between two groups and the Pearson correlation coefficient to examine the relationship between lifestyle dimensions.
Results: The mean weight and BMI (P=0.002), hirsutism and irregular menstruation cycle in the study group were greater than the control (P<0.001). In the study group the mean score of the sleep questionnaire in three dimensions: sleep problems (P=0.024), drug use (P=0.048), and the sufficiency of sleep (P=0.049) were higher than control.
Regression analysis showed that there is a significant relationship between quality of life and menstruation cycle (P=0.046), as well as the three dimensions of negative affecting situations with family income (respectively, 0.015, 0.016 and P=0.035).
Conclusion: The environmental factors can easily affect the quality of life in PCO women. Sleep patterns were not favorable, and the effect of menstruation on mood and low family income caused negative emotions in women with PCOS.

Laryngeal tuberculosis with hoarseness: case report
Mohammad Ali Damghani , Mandana Saberi, Soheil Motamed,
Volume 78, Issue 9 (December 2020)
Abstract
Background: Laryngeal tuberculosis (TB) is one of the most common complications of pulmonary tuberculosis, which increased for various reasons such as more prevalence of immune system suppression diseases, increasing the survival of the elderly, immigrants from high-risk areas and the appearance of atypical or resistant organisms over the past two decades, and its clinical pattern changed compared to the past. In contrast to the past that patients complained about dyspnea, coughing and other symptoms, today, the main complaints of these patients are hoarseness and Odynophagia. In reality, the prevalence of laryngeal TB without pulmonary manifestation was increased these days. The purpose of this study was to evaluate these symptoms in laryngeal TB.
Case Presentation: In this case report study, we examined a 77-year-old man who was admitted to the otorhinolaryngology department of Shafa hospital of Kerman (an academic hospital of Kerman University of Medical Sciences), Iran in April 2019 due to hoarseness since 6 months before admission and the results of evaluation confirmed the presence of laryngeal tuberculosis in this patient. The patient treated with Anti-TB drugs (Isoniazid, Rifampicin, Pyrizinamide, and Ethambutol) according to standard protocol and responded appropriately to this medication regimen.
Conclusion: Although laryngeal tuberculosis is a rare disease, it still occurs. Therefore, by increasing the incidence of tuberculosis, changes in the clinical pattern and its spreading mechanism, physicians should always be aware of the unusual clinical features of laryngeal tuberculosis and the possibility of developing it for early diagnosis and treatment. It should be considered as a differential diagnosis in all laryngeal diseases to prevent the complications of the disease and decrease the risk of transferring it to other people.

Prediction of the Iranians self-care in terms of communication pattern of their individual and social characteristics in face of Covid-19 pandemic-2020
Mahmoud Keyvanara, Mohammad Satari, Majid Jangi, Nasrin Sharbafchizadeh, Rahele Rahele,
Volume 78, Issue 9 (December 2020)
Abstract
Background: Infectious diseases in the pandemic stage have significant life-threatening, psychological and social effects. Identifying the characteristics associated with people's cooperation in self-care leads to greater immunity for themselves and others. Therefore, this study was conducted to predict the self-care of the Iranian people according to their individual and social characteristics in face of the Covid-19 pandemic.
Methods: A survey study was conducted on 1056 adults aged 18 and over in different provinces of Iran through a form of answering online researcher-made questions (n=40, α=0.9) in social networks in four days. This paper studies the level of self-care of people against Covid 19 pandemic which was conducted with the support of Isfahan University of Medical Sciences in April 2016. Data were analyzed using Student t-test and variance. Moreover, "decision tree technique" was used to identify communication patterns.
Results: The findings showed that the average self-care score in women, the most educated, married women, women aged 41 to 55, housewives and some other occupations was very high. However, the average self-care score of single men with a diploma was average. In general, the mean score of women's self-care was higher than men (P<0.0001) and the educated were more than the less educated literate (P=0.007). There was no significant difference between the self-care scores of the respondents in terms of their marital status and employment.
Conclusion: The results showed that the average scores of self-care in women, more educated people, married women, women in the age group of 41 to 55 years, housewives and some other occupations were reported to be very high; While the average self-care score reported in single men with a diploma was average. Overall, the mean score of self-care reported in women was higher than men (P<0.0001) and people with doctoral education reported more self-care than illiterate people (P=0.007). Besides, there was no significant difference between the self-care scores of the respondents in terms of their marital status (single and married) and their employment status (employed and non-employed).

Health insurance literacy for the Iranian community, a qualitative study: brief report
Jalal Saeidpour, Mohammad Javad Kabir, Amrollah Roozbehi, Mehran Pozesh, Moslem Sharifi,
Volume 78, Issue 9 (December 2020)
Abstract
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
Results: By reviewing the collected texts, 264 initial codes, 21 components, 10 sub-themes, and five themes were extracted. Based on the conceptual model of the study, the data were organized in three axes. In the knowledge axis, the themes of health insurance knowledge (including health insurance knowledge and attitude toward health insurance) and awareness of insured rights and assignments (including insured assignments and insured rights), in the axis of skill, themes of information search and services (including information acquisition and service search) and utilization of insurance coverage (including receiving insurance coverage and benefiting from benefits), and in the axis of self-confidence, the theme of self-efficacy (including Timely decision making and environmental awareness) have been identified.
Conclusion: Health insurance literacy for Iranian society, instead of being able to choose the type of insurance, focuses on its application in improving decision-making behavior and seeking insured treatment in the health market.

Sarcopenia and planning to management: review article
Hamed Behrad, Mahdi Zareei , Zeinab Borjian Boroujeni , Seyed Saeed Asadi, Zeinab Tabanejad , Mohammad Panji, Masoud Asgharpour-Arshad ,
Volume 78, Issue 10 (January 2021)
Abstract
Life expectancy has increased throughout the world and, as a result, the population of the elderly is also rising. From the age of 30 years old, the human body mass loses about 0.1 to 0.5% of its skeletal muscle mass annually, which is accelerated after the age of 65 years old. Aging is characterized by a decrease in the progression of musculoskeletal and physical activity known as sarcopenia. Sarcopenia has a complex molecular pathogenesis that includes age-related changes in muscles’ neuromuscular activity, muscle protein replacement, the hormone levels and the related sensitivity of human body to these mentioned factors. The pathogenic conditions and other disorders in sarcopenia are the chronic inflammatory states that include oxidative stress and changes in behavioral factors, especially in nutritional status and physical activity. By definition of the European Working Group on Sarcopenia in Older People (EWGSOP), the diagnosis of sarcopenia is determined by the presence of two main factors which are low muscle mass and low muscle function. Besides, specific sarcopenia-related biomarkers have been identified for early diagnosis and accurate identification of the main pathophysiology mechanisms involved in the development of the disease. Since sarcopenia has adverse outcomes on public health in terms of behavioral factors, frailty, hospitalization and mortality of people, it is an important necessity for the social health system to plan some therapeutic approaches to prevention. The main and more important of these therapeutic approaches have known as exercises, nutritional supplements and hormonal therapies. Also, other new therapeutic strategies are under investigation to be introduced in the future. However, currently, it has been shown that only physical exercise has a positive effect on the controlling and prevention of sarcopenia and its adverse effects on human and public health. However, the role of appropriate nutrition is also effective. Therefore, carefully designed studies in terms of better utilization of physical activity are needed to achieve useful therapeutic results for sarcopenia management. Thus, this survey aims to review the other considerable studies on the pathogenesis, appropriate evaluation of the disease and treatment options for sarcopenia.

Cytotoxic and antimicrobial effects of lactobacillus sakei on human colorectal adenocarcinoma cell line (HT29) and some pathogenic microorganisms
Mohammad Saber Malaki , Leila Rouhi, Khalil Khashei Varnamkhasti ,
Volume 78, Issue 10 (January 2021)
Abstract
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.
Methods: In the present study, which was conducted experimentally from May to September 2018 in bacteriology and Cellular and Developmental Research Centers of Islamic Azad University, Shahrekord branch, the antimicrobial activity of supernatant of Lactobacillus sakei was assessed by Well Diffusion Agar (WDA) method against some pathogenic bacteria. HT-29 Colorectal adenocarcinoma cancer cells were cultured in DMEM medium with 10% bovine serum. The cells were treated in 5, 15, 10 and 20 mg/ml concentrations of sakei metabolites and incubated at 24, 48 and 72 hours. Cell growth was analyzed by celltiter 96® aqueous one solution cell proliferation assay kit to the manufacturer's protocol in all three incubation times.
Results: The results of this study indicate that sakei was able to produce antimicrobial metabolites against pathogenic bacteria. Besides, the results of the celltiter 96® aqueous one solution cell proliferation assay showed that the bioavailability of HT-29 cell lines decreased at all concentrations of sakei metabolites in a dose and time-dependent manner.
Conclusion: Since lactic acid probiotic bacteria can alter the metabolic activities of the intestinal microflora, attach to carcinogens and destroy them, prevent carcinogenesis such as ammonia and secondary bile acids, producing anti-cancer substances and creating an acidic state to inhibit the growth and proliferation of carcinogenic bacteria, It seems that there is a good research field for the use of bioactive compounds produced by Lactobacillus sakei in the control of bacterial pathogens and treatment of human colorectal adenocarcinoma (HT-29).

Nasopharyngeal tube placement in emergency intubated patients with decreased consciousness with a new guidewire: a prospective randomized controlled trial
Alireza Baratlou, Mojtaba Mokhlesian, Mohammadreza Khajavi, Alireza Behseresht,
Volume 78, Issue 10 (January 2021)
Abstract
Background: There is some demand for nasogastric tube insertion in unconscious or ICU patients. Nasogastric tubes are generally made of flexible plastic materials, prone to twisting and deviation by the tracheal tube, when passing through the pharynx and esophageal opening, making it difficult to insert the NG-tube properly. We hypothesized that NG-tube insertion with help of guidewire can significantly increase a successful first-try insertion rate in contrast with the conventional "neck flexing" technique in unconscious intubated patients.
Methods: One hundred adult intubated patients, in the emergency ward at Sina Hospital, Tehran University of Medical Sciences were enrolled in this prospective clinical trial study from February 2020 to July 2020. These patients were randomly divided into two groups, with and without use of the guidewire insertion technique. Parameters such as successful NG tube insertion average time, first and second try failure, total failure and occurrence of complications such as kinking, twisting, sticking, moderate hemorrhage and traumatic injuries to the nasopharynx pathway were studied.
Results: One hundred patients were enrolled in this study. The median age of patients was 55.4±10.8 years (12-75 yr). First-try insertion success was 98% in the guidewire group and 74% in the control group (P=0.001). First, the try insertion failure percentage was 2% in the guidewire group and 26% in the control group (P=0.001). The time needed for NG tube insertion was significantly lower in the guidewire group, as 38.3±4.8 seconds in the guidewire group vs 61.5±6.2 seconds in the control group (P=0.001). A significantly lower number of complications like twisting, sticking, hemorrhage and traumatization were seen in the guidewire group.  Remarkably, that no case of absolute insertion failure was seen in the guidewire group but there were three such cases in the control group.
Conclusion: The incidence of a successful first-try NG tube insertion has been significantly improved by the use of Steel Wire rope against the conventional neck flexing technique, in unconscious intubated patients, and causes less traumatization and complications as well.

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