Evaluating CPR training: simulation vs. webinars for Iranian emergency medical technicians during COVID-19.

INTRODUCTION: The high prevalence of COVID-19 and the necessity for social distancing have impacted medical training. On the one hand, the high mortality rate following the disease led the American Heart Association (AHA) to issue guidelines in October 2020 for performing cardiopulmonary resuscitation on patients diagnosed or suspected of having COVID-19. Various methods exist for teaching these guidelines. However, the use of many of these methods is greatly challenged due to the high risk of disease transmission. Moreover, the published guidelines emphasize protection against COVID-19 infection. The present study aims to compare the impact of two educational methods, educational webinars and simulations, on the competence of performing cardiopulmonary resuscitation during the COVID-19 epidemic. METHODS: This semi-experimental study was conducted on 70 emergency medical technicians. A pre-test was administered to all participants, and then they were randomly assigned into two groups: an educational webinar group (35 people) and a simulation group (35 people). The educational webinar group received online training using Adobe Connect software version 2.6.9, while the simulation group received in-person training using a manikin simulator. The competence of performing cardiopulmonary resuscitation during the COVID-19 epidemic was compared between the two groups immediately after the training and again two months later. Data collection instruments utilized in this research included a demographic questionnaire and a competency questionnaire in performing CPR during the COVID-19 pandemic. The data were analyzed using SPSS software version 19 and statistical tests for comparison. RESULTS: The results indicated that in both the educational webinar and simulation groups, the average competence score for performing cardiopulmonary resuscitation (CPR) at the three stages under investigation showed significant differences (p < 0.001). Additionally, in both groups under study, the average competence score for performing CPR immediately and two months after training was significantly higher compared to before the training (p < 0.001); however, two months after training, it was significantly lower compared to immediately after the training (p < 0.001). CONCLUSIONS: Based on the results obtained from the current research, both educational methods (educational webinar and simulation) had a significant effect on the competence of performing CPR during the COVID-19 epidemic and were equally effective. Moreover, the recall test results (two months later) showed a decrease in the competence of performing CPR during the COVID-19 epidemic in both training methods (webinar and simulation), indicating the need for periodic CPR training.

Prevalence of thyroid dysfunction among Iranian older adults: a cross-sectional study.

There is limited data on the prevalence of thyroid dysfunction in the older population. This study aimed to determine the prevalence of thyroid dysfunction among a sample of Iranian older adults. A cross-sectional analysis of older adults who aged 60 years and over was conducted. A total of 363 subjects were randomly selected from Birjand longitudinal aging study (BLAS) cohort study. Serum thyroid-stimulating hormone (TSH) level, total thyroxine (T4) and total triiodothyronine (T3) were measured by the enzyme-linked immunosorbent assay (ELISA). Based on thyroid function tests and history of taking medicines used to treat thyroid disorders, participants were classified into the following groups: euthyroid, overt/subclinical hypothyroidism, and overt/subclinical hyperthyroidism. Subsequently, the crude and World Health Organization (WHO) age-standardized prevalence were estimated for different thyroid function categories. A total of 171 men and 192 women, aged 60-94 years, were randomly selected. The crude prevalence of total hypothyroidism was 22.31% (subclinical [18.46%], overt [3.86%]), and that of hyperthyroidism was 1.66% (subclinical [1.38%], overt [0.28%]). The crude prevalence of total thyroid dysfunction was, therefore, 23.97%. A female preponderance was noticed in both total (P-value = 0.035) and overt (P-value = 0.035) hypothyroidism. An increasing trend with age was noticed in the prevalence of total hypothyroidism (P-value = 0.049). Age-standardized prevalence of total hypothyroidism and hyperthyroidism was 26.63% (95% confidence interval [CI] 20.58-33.69%) and 1.11% (95% CI 0.49-2.51%), respectively. A considerable proportion of our study population demonstrated evidence of thyroid dysfunction, particularly subclinical hypothyroidism. Our findings highlight the importance of further investigation of thyroid disorders among older Iranian adults.

Impact of Continued Social Network-based Learning Based on Midwives Knowledge and Implementation of the Helping Babies Breathe Program.

Background: The Helping Babies Breathe (HBB) program is a simple neonatal resuscitation protocol implemented in low-resource clinical systems. Therefore, it is necessary to train midwives on the implementation of this program and ensure the sustainability of the learned materials. The present study aimed to assess the impact of continued social network-based learning based on midwives knowledge and implementation of the HBB program. Materials and Methods: This randomized controlled field trial was performed on 50 midwives who were selected by the available sampling method. All midwives attended the HBB workshop; thereafter, in the intervention group, the learned materials were reinforced for 3 months using WhatsApp messenger. Data were collected using Objective Structured Clinical Examination (OSCE), which was administered before the HBB program and 3 months later (HBB guide; 2th Ed, 2018). The data were analyzed in SPSS software (version 19) using independent and paired t-tests. Results: Based on the results, the mean knowledge score was not significantly different in both groups (control and intervention) immediately after the workshop. The mean scores of knowledge and skill variations did not decrease significantly in the WhatsApp group during the 3 months; nonetheless, a marked decrease was observed in the control group (t21 = 16.68, p < 0.05). Conclusions: The results of this study pointed out that continued social network-based education promoted the knowledge and skills of health care providers, highlighting the importance of social networks in education.

Serum Vitamin D Status and Cognitive Function in Iranian Older Adults: Evidence from the Birjand Longitudinal Aging Study.

BACKGROUND: There is evidence of the role of vitamin D deficiency in cognitive decline. However, the results of studies regarding the relationship between the reduction of vitamin D concentrations and cognitive impairment are heterogeneous. OBJECTIVES: We aimed to answer the question of whether vitamin D deficiency is associated with cognitive decline in older adults. METHODS: In this cross-sectional study, the baseline data of the Birjand Longitudinal Aging Study (BLAS) were analyzed. Of 1420 participants in the BLAS, 1219 participants aged ≥60 y old were included in the present study. Serum concentrations of 25-hydroxyvitamin D [25(OH)D] were measured by the enzyme-linked immunosorbent assay method. The 6-item Cognitive Impairment Test (6-CIT), Mini-Mental State Examination (MMSE), Category Fluency Test (CFT), and Abbreviated Mental Test Score (AMTS) were used to assess cognitive function. Multiple logistic regression analysis, adjusted for potential confounders, was employed to estimate the association between cognitive function and 25(OH)D concentrations. RESULTS: Among study participants, 905 (74.24%) had sufficient vitamin D concentrations (≥20 ng/ml), 209 (17.15%) had insufficient vitamin D concentrations (12-20 ng/ml), and 105 (8.61%) had vitamin D deficiency (<12 ng/ml). There was no significant correlation between serum 25(OH)D concentrations and scores of 6-CIT (P = 0.279), AMTS (P = 0.181), MMSE (P = 0.118), and CFT (P = 0.259). Also, the prevalence of cognitive impairment had no significant relationship with vitamin D status. Finally, in the multiple logistic regression analysis, there was no association between the insufficient or deficient concentrations of 25(OH)D and impaired cognitive function both before and after adjustment for various cofounders. CONCLUSIONS: The present study found no significant association between vitamin D status and cognitive impairment.

The molecular evaluation of thioredoxin (TXN1 & TXN2), thioredoxin reductase 1 (TXNRd1), and oxidative stress markers in a binary rat model of hypo- and hyperthyroidism after treatment with gallic acid.

Oxidative stress plays an important role in the pathology of thyroid disorders. This study examined the effect of gallic acid (GA) on the oxidative status and expression of liver antioxidant genes including thioredoxin (TXN1 & TXN2) and thioredoxin reductase1 (TXNRd1) in hypo- and hyperthyroid rat models. Forty-nine male Wistar rats were randomly assigned into seven groups as follows: control group, hypothyroid and hyperthyroid groups respectively induced by propylthiouracil and levothyroxine, hypo- and hyper thyroid-treated groups (where the groups were separately treated with 50 and 100 mg/kg of GA daily, orally). The levels of thyroid hormones and serum oxidative stress markers were evaluated after 5 weeks. The relative expression of TXN1,2 and TXNRd1 genes was measured via real-time qRT-PCR. The mean level of total antioxidant capacity (TAC), malondialdehyde, and uric acid index diminished in the hypothyroid group. Increased TAC reached almost the level of control in hypothyroid groups treated with GA. Elevation of thiol index in the hypothyroid group was observed (p < 0.01), which diminished to the control level after GA treatment. The relative expression of TXN1, TXNRd1, and TXN2 genes in the hypothyroid and hyperthyroid groups significantly increased compared to the control group (p ≥ 0.05), but in the groups treated with GA, the expression of these genes declined significantly (p ≥ 0.05). Our results indicated GA can affect the expression of TXN system genes in the rat liver. Also, the results suggest GA has a more positive effect on modulating serum oxidative parameters in hypothyroid rat models than in hyperthyroid.

The effect of educational intervention based on self-efficacy theory on pregnancy anxiety and childbirth outcomes among Iranian primiparous women.

BACKGROUND: Pregnancy anxiety is associated with a diverse birth outcomes. Mothers' education could have a critical role in increasing their self-efficacy to defeat their anxiety and improve pregnancy and child birth outcomes. The study was conducted to examine the effect of intervention based on self-efficacy theory on pregnancy anxiety and child birth outcomes. MATERIALS AND METHODS: The study was conducted as a quasi-experimental design on 60primiparous women (26-28 weeks) in Birjand (East Iranian province) from May to September 2017, who were randomly divided into intervention and control groups. The intervention group received 8 sessions of 90-min educational intervention based on self-efficacy theory strategies besides the routine prenatal care. Vanden Bergh's pregnancy anxiety questionnaire and checklist of pregnancy and delivery outcomes were used for data collection. RESULTS: The level of pregnancy anxiety was similar in both groups before the intervention, but immediately and 1 month after the intervention, the mean score of pregnancy anxiety significantly reduced in the intervention group and significantly increased in the control group (P < 0.001). There was a significant difference in mean neonatal weight (P < 0.001) between the two groups. Emergency and elective cesarean section were significantly lower in the intervention group compared to the control group (P < 0.001), but there were no significant differences in the frequency of preterm delivery between two groups (P < 0.05). CONCLUSION: The results provide support for the effectiveness of intervention based on self-efficacy theory in reducing pregnancy anxiety and enhancing positive pregnancy outcomes. Hence, theory-based educational interventions may serve as a cost-effective and noninvasive approach to reduce pregnancy anxiety in Iran.

The effect of educational intervention based on theory of planned behavior and self-regulatory strategies on the social vitality of women employee.

BACKGROUND: Social vitality is one of the most important social indicators to develop a sense of public satisfaction. The aim of this study was to investigate the effect of educational intervention based on theory of planned behavior (TPB) and self-regulatory strategies on the social vitality of women employee. MATERIALS AND METHODS: In this randomized controlled field trial study, 66 women employees of Birjand University of Medical Sciences (Iran) were selected including intervention (n = 31) and control (n = 35). Data were collected by standard Oxford Happiness Questionnaire and a researcher-made questionnaire based on TPB which its the validity and reliability were confirmed. The educational intervention consisted of 5 sessions based on the constructs of the TPB and self-regulatory strategies which were to the interventional group. Data analysis was performed using the Chi-square, Fisher's exact test, independent t-test, repeated measures ANOVA, and Bonferroni post hoc test at a significance level of <0.05. RESULTS: The mean age of women in the intervention and control group was 37.1 ± 9.3 and 36.2 ± 7.6 years (P = 0.67). Model constructs and happiness scores were homogeneous (P > 0.05) before the intervention, in two group of study, but after attitude (P = 0.016), subjective norm (P = 0.029), perceived behavior control (P = 0.01), intention (P = 0.006), and happiness score (P < 0.001) had a significant increase in the intervention group. In the control group, only a significant difference occurred over time in the happiness rate (P = 0.031). CONCLUSIONS: The results of the present study showed the effectiveness of educational intervention on the social vitality of women employees. Therefore, TPB is recommended to use in interventions to promote social vitality.

Evaluation of Diuretic and Antioxidant Properties in Aqueous Bark and Fruit Extracts of Pine.

OBJECTIVE: The present study has been carried out to evaluate the diuretic and antioxidant properties of pine herb in an animal model. MATERIALS AND METHODS: 45 adult male rats were randomly divided into nine groups including: groups I (the negative control), groups II (positive control, furosemide 10 mg/kg), groups III to VIII (treatment groups received 100, 200, 400 mg/kg of the aqueous extracts of bark and fruit) and group IX received the combination of aqueous extract of bark (100 mg/kg) and the fruit (100 mg/kg). The urine output, glomerular filtration rate (GFR), electrolytes, urea, and creatinine levels were evaluated. Furthermore, the phenolic content and antioxidant activity of both extracts were also assessed using 2, 2-diphenyl-1-picrylhydrazyl (DPPH), ferric reducing antioxidant power (FRAP) and Folin-Ciocalteu methods. RESULTS: The aqueous extracts of the pine bark and fruit increased the urinary output in a dosedependent manner. The combination of the two extracts compared to the other extracts alone significantly increased the serum potassium level. This study also showed each extract increase creatinine clearance in a dose-dependent manner (p<0.01 and p<0.05). The increase of GFR in the combination group was not significant. The current data showed a significant increase in the total phenolic content in pine bark extract in compared with the fruit extract. CONCLUSION: The pine bark and fruit can be useful in the prevention and treatment of kidney stones due to the high diuretic properties and antioxidant activity.

Comparison of postoperative morbidity between conventional cold dissection and bipolar electrocautery tonsillectomy: which technique is better? / Comparação da morbidade pós-operatória entre tonsilectomia por dissecção a friotradicional e por eletrocautério bipolar: qual técnica é a melhor?

Abstract Introduction Tonsillectomy is one of the most common surgeries in the head and neck worldwide. This operation is carried out by different methods, the most frequent of which are the cold dissection and bipolar electrocautery techniques. Objective This study was conducted to assess and compare postoperative morbidity between cold dissection and bipolar electrocautery. Methods This prospective randomized clinical trial was performed on 534 patients who underwent tonsillectomy in Vali-e-Asr Hospital of Birjand, east of Iran from October, 2013 to October, 2015. The patients were systematically selected for cold dissection technique or bipolar electrocautery technique groups. Time of surgery, amount of intraoperative blood loss, postoperative hemorrhage, the intensity of local pain 4 and 24 hours after operation and nausea and/or vomiting were recorded and compared in the two groups to decide which technique is better. The data were analyzed in SPSS software (ver-22). The p-value less than 0.5 was considered significant. Results In this study, 51.7% of the cold dissection technique patients and 50.6% of the bipolar electrocautery technique participants were male. Compared to the cold dissection technique, the average intraoperative blood loss was significantly lower (p < 0.001) in the bipolar electrocautery technique group, while the intensity of local pain 4 and 24 hours after the operation was significantly higher (p < 0.001). Other variables showed no significant differences between the two groups. Conclusion Based on the findings of the present investigation, the bipolar electrocautery technique is suggested for tonsillectomy in children, while the cold dissection technique is preferred for adult patients.

Resumo Introdução A tonsilectomia é uma das cirurgias mais comuns de cabeça e pescoço em todo o mundo. Essa cirurgia é feita por diferentes métodos, os mais frequentes são a dissecção a frio e por eletrocauterização bipolar. Objetivo Este estudo foi feito para avaliar e comparar a morbidade pós-operatória na dissecção a frio e eletrocauterização bipolar. Método Este ensaio clínico prospectivo e randomizado foi feito em 534 pacientes submetidos a tonsilectomia no Vali-e-Asr Hospital de Birjand, no leste do Irã, de outubro de 2013 a outubro de 2015. Os pacientes foram selecionados de forma sistemática para o grupo submetido à técnica de dissecção a frio ou para o grupo com uso da técnica de eletrocauterização bipolar. Para a avaliação acerca da melhor técnica, os seguintes parâmetros foram registrados e comparados entre os dois grupos: tempo de cirurgia, quantidade de perda sanguínea intraoperatória, hemorragia pós-operatória, intensidade da dor local 4 e 24 horas após a cirurgia e ocorrência de náuseas e/ou vômitos. Os dados foram analisados no software SPSS (versão 22). O valor de p inferior a 0,5 foi considerado significante. Resultados Neste estudo, 51,7% dos participantes do grupo técnica de dissecção a frio e 50,6% do grupo técnica de eletrocauterização bipolar eram do sexo masculino. No grupo operado pela técnica de eletrocauterização bipolar a média de perda sanguínea intraoperatória foi significantemente menor (p < 0,001) em comparação à técnica de dissecção a frio, enquanto a intensidade da dor local 4 e 24 horas após a cirurgia foi significativamente maior (p < 0,001). As outras variáveis não apresentaram diferenças significantes entre os dois grupos. Conclusão Com base nos achados da presente investigação, para a tonsilectomia em crianças sugere-se o uso da técnica de eletrocauterização bipolar, enquanto a técnica de dissecção a frio é recomendada para pacientes adultos.

Evaluation of gum health status in hemophilia patients in Birjand (a case-control study).

BACKGROUND: Gum bleeding in the absence of trauma or injury in adults with haemophilia is often reported. So hemophilic patients require special care and attention in various dentistry practices. The purpose of this study was to evaluate the gingival health status in patients with hemophilia in Birjand in 2018-2019. METHODS: Sampling was used in this case-control study to recruit cases (89 patients with hemophilia) and 89 individuals as control group recruited randomly from the general population, which were matched with cases based on gender, age and place of residence. Clinical examinations included dental health and salivary assessments. After taking informed consent from cases who had the inclusion criteria for the study, information including demographic characterizes, family history, viral infections, coagulation history, and the time of onset treatment was recorded. Oral examination was done by catheter and dental mirror. MGI (Modified gingival index) and Periodontal Index (PI) were determined for each subject. RESULTS: In this study, 84.3% of the hemophilia patients were males and 76.4% of them had a family history of hemophilia. The results show that difference between the mean of MGI and PI in hemophilic patients and healthy subjects is not statistically significant (P>0.05) while, it is higher in hemophilic patients than healthy subjects, but this difference is not statistically significant (P>0.05). Also, with increasing age, MGI and PI showed a significant increase (P<0.05). CONCLUSION: Although the higher MGI and PI index in hemophilia patients, attention to oral health and frequent control in hemophiliac is necessary. Also, to prevent dental problems and further bleeding play an important role.

Birjand longitudinal aging study (BLAS): the objectives, study protocol and design (wave I: baseline data gathering).

OBJECTIVES: The pace of population aging is growing rapidly around the world. Aging is associated with the emergence of different health status including geriatric syndrome such as frailty, diabetes, cardiovascular diseases, and dementia. These conditions are the most prominent challenges for health care systems and also elderly people. Therefore, understanding these changes can help scientists to prevent and treat significant health issues and also improve the functional ability of older adults. METHODS: This is a protocol of the first wave of Birjand Longitudinal Aging Study that is an ongoing community-based prospective cohort study with a following up at least 10 years. This study carries out on aged population ≥ 60 years which were residents in Birjand County (urban and rural older subjects). The selection of the participants of this study in urban areas is based on an age group weighted multistage stratified random sample while in the rural region the sample was selected from all ten rural regions of Birjand County by simple random sampling. The rural region sampling was based on the list of the aged population which were under the coverage of the rural health center. Sociodemographic, past medical history, lifestyle, sleep, activities of daily living, cognitive function, quality of life, and social capital were evaluated by interviewing with the participants and one of the informants. Anthropometric measures, electrocardiography, and interpretation of ophthalmologic examination were carried out by experts. Fasting Blood samples were collected and bio-banked in - 80 °C. then finally biochemical and hematologic markers were measured. RESULTS: This is the protocol of stage one baseline of Birjand Longitudinal Aging Study (BLAS). The BLAS is an enjoining study, the first phase of its baseline was carried out on a community- dwelling aged population sample ≥ 60 years who were residents in urban and rural regions of Birjand County. This is a community based prospective cohort study with at least 10 years follow up of participants. The data for 65% of older subjects (response rate = 65%) that lived in clusters were collected. CONCLUSIONS: This study can help scientists to recognize some risk factors related to the aging process and also aware policymakers about the necessity to create heath care services at regional and even national levels.

Efficacy of zinc sulfate on indirect hyperbilirubinemia in premature infants admitted to neonatal intensive care unit: a double-blind, randomized clinical trial.

BACKGROUND: Hyperbilirubinemia is a common neonatal problem. Studies conducted on the effectiveness of zinc salts on serum indirect bilirubin levels in newborns have yielded different results, all calling for further research. This study aimed to determine the effect of oral zinc sulfate on indirect hyperbilirubinemia in preterm infants admitted to the neonatal intensive care unit. METHODS: A randomized double-blind clinical trial was performed in the neonatal intensive care unit of Vali-e-Asr Hospital in Birjand, Iran. The study population comprised neonates aged between 31 and 36 gestational weeks, who required phototherapy in the neonatal intensive care unit. A total of 60 neonates were selected by census and allocated into an experimental group and a control group. In addition to phototherapy, the experimental group received 1 cc/Kg zinc sulfate syrup (containing 5 mg/5 cc zinc sulfate; Merck Company, Germany), and the control group received a placebo syrup (containing 1 cc/kg sucrose). Data were analyzed in SPSS-21 software using the independent t-test, repeated-measures ANOVA, Bonferroni post-hoc test, and Mann-Whitney test. P-values smaller than 0.05 were considered significant. RESULTS: Bilirubin level changes in the experimental and control groups six hours after intervention were - 1.45 ± 3.23 and - 0.49 ± 0.37 (p = 0.024), respectively. The changes 24 and 48 h after intervention were-3.26 ± 2.78 and - 1.89 ± 1.20 (p = 0.017) in the experimental group and - 4.89 ± 2.76 and - 3.98 ± 2.32 (p = 0.23) in the control group, respectively. There was no significant difference in the phototherapy duration between the two groups (p = 0.24). CONCLUSIONS: The results of this study showed that the use of zinc sulfate syrup in preterm infants with indirect hyperbilirubinemia significantly reduced bilirubin levels within 48 h of treatment. TRIAL REGISTRATION: Trial registration: IRCT, IRCT2015120825439N1. Registered 21 February 2016, http://irct.ir/trial/21277.

The effect of planned behavior theory-based education on computer game dependence in high school male students.

BACKGROUND: Teenagers are increasingly interested in computer games, and the adverse effects of these games are dependent on the execution of these games. The theory of planned behavior (TPB) is one of the most important theories in behavior change. This study aimed to determine the effect of educational planning based on TPB on the level of dependence on computer games in high school male students in Gonabad, Iran. MATERIALS AND METHODS: This was a randomized controlled trial. The study population was students of computer games in Gonabad. Sixty-four students were selected by a multistage random sampling method and were randomly divided into intervention (n = 32) and control (n = 32) groups. Data-gathering tool was the standard questionnaire of computer game dependency and researcher-made questionnaire according to TPB constructs that were completed before, immediately, and 3 months after the intervention. The intervention consisted of eight 90-min training sessions. Data were analyzed using the Chi-square test, Fisher's, t-test, repeated measures ANOVA, and Bonferroni post hoc test. RESULTS: Before the intervention, the intervention and control groups were matched for the mean score of model constructs. However, after the intervention, the mean score of computer game addiction significantly decreased (≤0.001). However, the mean score of knowledge, attitude, perceived behavioral control, and behavioral intention increased, which was statistically significant. Furthermore, the mean changes of model structures were statistically significant (P < 0.05). CONCLUSION: The findings revealed that TPB can be used as a good theoretical framework for designing and implementing educational programs to reduce the dependency of computer games on students.

Comparison of postoperative morbidity between conventional cold dissection and bipolar electrocautery tonsillectomy: which technique is better?

INTRODUCTION: Tonsillectomy is one of the most common surgeries in the head and neck worldwide. This operation is carried out by different methods, the most frequent of which are the cold dissection and bipolar electrocautery techniques. OBJECTIVE: This study was conducted to assess and compare postoperative morbidity between cold dissection and bipolar electrocautery. METHODS: This prospective randomized clinical trial was performed on 534 patients who underwent tonsillectomy in Vali-e-Asr Hospital of Birjand, east of Iran from October, 2013 to October, 2015. The patients were systematically selected for cold dissection technique or bipolar electrocautery technique groups. Time of surgery, amount of intraoperative blood loss, postoperative hemorrhage, the intensity of local pain 4 and 24hours after operation and nausea and/or vomiting were recorded and compared in the two groups to decide which technique is better. The data were analyzed in SPSS software (ver-22). The p-value less than 0.5 was considered significant. RESULTS: In this study, 51.7% of the cold dissection technique patients and 50.6% of the bipolar electrocautery technique participants were male. Compared to the cold dissection technique, the average intraoperative blood loss was significantly lower (p<0.001) in the bipolar electrocautery technique group, while the intensity of local pain 4 and 24hours after the operation was significantly higher (p<0.001). Other variables showed no significant differences between the two groups. CONCLUSION: Based on the findings of the present investigation, the bipolar electrocautery technique is suggested for tonsillectomy in children, while the cold dissection technique is preferred for adult patients.

In vitro cytotoxicity of polyphenols from Datura innoxia aqueous leaf-extract on human leukemia K562 cells: DNA and nuclear proteins as targets.

Leukemia is a malignant hematological disease and chemotherapy remains the most important tool for its treatment. As chemotherapy has many side effects and could lead to resistance in cancer cells, plant-based medication is being considered as a new strategy in cancer treatment. Datura innoxia from the Solanaceae family is used in traditional medicine. The present study investigated the effect of an aqueous extract of D. innoxia aqueous leaf-extract on human chronic myeloid leukemia cells (K562 cell line) and human B lymphoblastoid cells (FS-2 cells) as the noncancerous cell line. The interaction of the D. innoxia extract with double-stranded DNA and histones was studied using multiple spectroscopic techniques. The total phenolic and flavonoid contents were determined through colorimetric analysis and the major polyphenols were quantified by HPLC-DAD analysis. The results demonstrated that the D. innoxia extract inhibited proliferation of the K562 cell line in a dose- and time-dependent manner (IC50 = 0.6 mg/ml), but had a slightly toxic effect on human B lymphoblastoid cells. The spectroscopy results suggest that the D. innoxia extract interacted with both DNA and histones in solution and that D. innoxia could be suggested as an anticancer drug.

Prevalence of Hepatitis B and C among Drug-Abusing Male Prisoners in Birjand, South Khorasan, Iran.

BACKGROUND: To estimate the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) and the associated risk factors among drug-abusing prisoners in Birjand correctional facility. METHODS: This is a cross-sectional study on 300 drug-abusing prisoners in 2016. Data were collected through questionnaires and interviews. HBV infection and HCV exposure status of the participants were determined by HBsAg, HBcAb, and HCVAb blood tests using third-generation enzyme immune assays (ELISA). The chi-square test was used to investigate the associations between risk factors and status of HBV infection and HCV exposure. All data were analyzed with SPSS software and P<0.05 was considered as significant difference. RESULTS: The mean age of participants was 37.4 ± 9.4 years with a range of 20-78 years. The prevalence rates of HBV exposure (total HBcAb) and infection (HBsAg) were 20.7 and 3.3% respectively, and the prevalence of HCV exposure (HCV Ab) was 8%. No co-infection was observed. Seroprevalence results for injecting drug users (IDUs) was 13 (18.8%) for total HBcAb, 1 (1.4%) for HBsAg, and 13 (18.8%) for HCVAb. There was no significant difference between the IDUs and non-IDUs in terms of HBsAg and total HBcAb positive rate, but the prevalence of HCV was significantly higher in the IDUs (P < 0.001). In logistic regression analysis, the main risk factors for HCV exposure in the entire samples was injecting drug use and having tattoos (OR = 4.08, 95% CI: 1.64-10.17, P = 0.003). CONCLUSION: We found a high rate of HBV and HCV infection in drug-using prison inmates compared to the general population of this area. The main risk factors associated with HCV infection in the prison populations with history of drug abuse were injecting drug use and having tattoo.

Comparison of the sonographic findings in laparoscopic cholecystostomy with and without hemostatic agent on 45-day follow-up of patients attending hospital.

INTRODUCTION: Cholelithiasis is one of the most prevalent pathological conditions, and elective laparoscopic cholecystostomy with and without hemostatic agent (HA) is the therapeutic approach to its treatment. This research study aimed to compare the sonographic findings of patients who underwent cholecystostomy with and without HA use. MATERIALS AND METHODS: This cross-sectional, descriptive-analysis study was conducted by available nonprobability sampling technique, and according to Cochran Formula, 144 patients, who underwent laparoscopic cholecystostomy, were recruited and divided into two groups including a group of 85 patients with HA use and a group of 59 patients without HA use. Patients in each group had sonography on discharge date and 15, 30, and 45 days after the surgery. Data were collected and entered in SPSS-24 software; meanwhile, descriptive statistics was used to analyze Chi-square test, Fisher's exact test, and Friedman and Wilcoxon nonparametric test. FINDINGS: The results of the study showed that the presence of echogenic mass with reverberation artifact (abscess mucosa) on 15- and 30-day follow-up sonography of patients, who underwent laparoscopic cholecystostomy, were significantly higher in patients with HA than in the group without HA (P < 0.05), and on 45-day follow-up sonography, there was no significant correlation regarding the presence of echogenic mass with reverberation artifact (abscess mucosa) and fluid in the two groups (P > 0.05). Besides, HA density significantly decreases in individuals over time (P < 0.05); however, there was no significant differences between HA reduction rate and gender (P > 0.05). CONCLUSION: These findings might be the indication of HA agents' effect on surgical operations and their resemblance to abscess. Due to the possibility of temporary immune responses to HA, as an external object, it is necessary, in vital pathologies, to pay close attention to what differentiates the normal imaging appearance in follow-up sonography.

Assessment of carbon monoxide concentration in indoor/outdoor air of Sarayan city, Khorasan Province of Iran.

Nowadays, air pollution by humans is considered a serious problem. One of the main sources of air pollution is carbon monoxide which is called the silent killer. With the increasing rate of population growth in Iran and subsequent acceleration of vehicle and fossil fuel usage, the mortality rate of carbon monoxide has increased. The aim of this study is assessment of the concentration of carbon monoxide in indoor and outdoor air of Sarayan city, Khorasan Province of Iran. In this descriptive-analytic study, the air condition of a residential area and outdoor environment of Sarayan city has been monitored for determining the carbon monoxide concentration during a 3-month period from January to March 2017. Overall, 25 stations with uniform distribution were located in the city. Fifty samples were taken monthly and by considering 3-month period, a total of 150 samples were gathered. The samples were taken in kitchens between 11 a.m. and 3 p.m., and by considering the respiratory height of the human body, the carbon monoxide meters (TES model, Taiwan) were placed at a height of 75-150 cm. The descriptive statistics were presented after entering data into SPSS-16, and, by applying Mann-Whitney and Kruskal-Wallis tests in the case of α = 0.05, the data were analyzed. The average concentrations of carbon monoxide in indoor and outdoor environments were 0.84 ± 3.21 ppm and 0.27 ± 0.92 ppm, respectively. The maximum carbon monoxide concentration in February in an outdoor environment was 6 ppm (station no. 4) and the least one was 0 ppm. In March, for an indoor area, the maximum carbon monoxide concentration was 41 pm for station no. 11. The indoor-to-outdoor (I-to-O) ratio in March was higher than other months, and in January, was less than others. The study reveals that the indoor and outdoor carbon monoxide indices of Sarayan city are at acceptable levels.

Epidemiology, risk factors, and molecular characterization of occult hepatitis B infection among anti-hepatitis B core antigen alone subjects.

OBJECTIVES: Features of occult hepatitis B virus (HBV) infection among the anti-hepatitis B core antigen (anti-HBc) positives have yet to be described in more details. This study aimed to determine the molecular prevalence of occult HBV infection (OBI), and association to risk factors among seropositives for anti-HBc. METHODS: This was part of a community-based screening project that included 5234 cases. All participants completed a questionnaire on demographic and socio-epidemiological information. Then, the blood samples were collected and tested for anti-HBc and HBsAg using ELISA method. To identify OBI, nested-polymerase chain reaction (PCR) assays were performed for HBV-S and X genes, and viral load was determined using an in-house real-time PCR. Sequencing and phylogenetic analysis have been implemented for genotyping. RESULTS: Overall, 596 cases, positive only for anti-HBc were included in the study. OBI was detected among 61 cases (10.2%). The genotype and subgenotype of HBV among all of them was D1, except one that was D4. Most of them had low viral loads ranged from 1.2 × 102 to 1.34 × 10 3 copies/mL; 19.6% had undetectable viral loads. Important mutations in surface protein and reverse transcriptase were sI92T, sQ129H, rtL80I, rtS85F, rtL91I. The prevalence of OBI was related to some risk factors, such as tattooing (P = 0.02), sexual activities (P = 0.009), and diabetes (P = 0.031). CONCLUSION: Our study suggests that OBI should be considered among anti-HBc seropositive subjects. This form of HBV infection was accompanied with some mutations, risk factors, and diseases. However, further investigations are needed to determine virological importance of documented mutations.

Marshall and Rotterdam Computed Tomography scores in predicting early deaths after brain trauma.

Trauma is one of the most important issues of most healthcare systems accompanying with head trauma in the most cases. We sought to determine the scoring system and initial Computed Tomography (CT) findings predicting the death at hospital discharge (early death) in patients with traumatic brain injury based on Marshall and Rotterdam CT scores. This is a cross sectional study on traumatic neurosurgical patients with mild-to-severe traumatic brain injury admitted to the emergency department of Emam Reza Hospital, Birjand University of Medical Sciences. Patients≥18 years old with TBI during last 24 hours with GCS≤13 were included and exclusion criteria were multiple trauma, penetrating injuries, previous history of anticoagulant therapy, pregnancy, not willingness for participation. Their initial CT and status at hospital discharge, one and three months (dead or alive) were reviewed, and both CT scores were calculated. We examined whether each score is related to death using SPSS11 by The Mann-Whitney U at the level of p≤0.05. Overall, 98 patients were included. Mean age was 43.52±21.29. Most patients were male (63.3%). Mean Marshall and Rotterdam CT scores were 3.2±1.3 and 2.5±1. The mortality at two weeks, one moth and three months were 19.4%, 20.4%, and 20.4%. Rotterdam CT score was significantly different based on type of hematoma. Median GCS score in alive and dead patients on 2 weeks were 10 and 4 (p=0.0001), at one month were 10 and 4 (p=0.0001), and at three months were 10 and 4 (p=0.0001). The median Marshall CT score on 2 weeks were 2 and 4 (p=0.0001), at one month were 2 and 4 (p=0.0001), and at three months were 2 and 4 (p=0.0001). The median Rotterdam CT score on 2 weeks were 2 and 4 (p=0.0001), at one month were 2 and 3 (p=0.001), and at three months were 2 and 3 (p=0.001). The Rotterdam CT score was significantly correlated with mortality at two weeks, one month and three months (p=0.004, p=0.001, and p=0.001, respectively). The Marshall CT score was not significantly correlated with mortality at any time. The Rotterdam CT score was more accurate for prediction of mortality on 2 weeks (ROC80.9), at one month (ROC80.7), and at three months were (ROC80.7) than The Rotterdam CT score (ROC 76, 74.1, and 74.1, respectively). This study concluded that The Marshall CT score was more accurate for prediction of mortality on 2 weeks, at one month, and at three months were than The Marshall CT score with higher ROC. The correlation of the Rotterdam CT score with mortality was significant.