Analysis of polychlorinated biphenyls (PCBs) in dairy products by modified QuEChERS/GC-QqQ-MS/MS method: A risk assessment study.

Polychlorinated biphenyls (PCBs) are harmful chemicals that are persistent in the environment and can accumulate in the food chain. The purpose of the present research was to assess non-dioxin-like polychlorinated biphenyls (NDL-PCBs) in some dairy products (yogurt, doogh, and kashk) using modified QuEChERS (Quick, Easy, Cheap, Effective, Rugged, and Safe) technique and gas chromatography-triple-quadrupole mass spectrometry (GC-QqQ-MS/MS) method and risk assessment study. The LOQs (limit of quantifications), LODs (limit of detections), recovery, and RSD for the PCB analytes were 0.180-0.360, 0.06-0.12 ng/g fat, 97.45-102.63%, and 6.33-8.86%, respectively. The results revealed that the mean concentrations of Æ©6-NDL-PCBs in samples were 15.17 ± 3.44 ng/g fat, which was lower than the standard level established by European Union (EU, 40 ng/g fat). The maximum mean level was PCB 180 (9.98 ± 2.04 ng/g fat) and the minimum mean level of PCBs in samples was PCB 28 (0.09 ± 0.06 ng/g fat). Also, results showed that kashk samples had a maximum mean level of 6-NDL-PCBs (18.66 ± 2.42 ng/g fat) and doogh samples had a minimum mean level of 6-NDL-PCBs (12.21 ± 2.22 ng/g fat). The mean level of 6-NDL-PCBs in yogurt samples was 14.65 ± 2.02 ng/g fat. The heat map results showed the correlation between the spectral indices of 6-NDL-PCBs in different dairy products. According to the Monte Carlo method, risk assessment was done using calculating the Estimated Daily Intake (EDI) and Incremental Life Cancer Risk (ILCR). The EDI values of 6 NDL-PCBs based on the 95th percentile in yogurt, doogh, and kashk were 14.3, 1.49, and 0.5 ng/kg.day, respectively. Considering that the contaminant level in the samples is lower than the EU limit, it can be concluded that dietary exposure to 6 NDL-PCBs may not pose a risk to the health of consumers.

Probabilistic Health Risk Assessment of Trace Elements in Baby Food and Milk Powder Using ICP-OES Method.

This study was conducted to evaluate the concentration and health risk of trace elements in milk powder and baby food samples marketed in Iran using inductive couple plasma/optical emission spectroscopy (ICP-OES) method. The limit of detection (LOD) and limit of quantification (LOQ) were ranged from 1.80 × 10-5 to 2.17 × 10-3 and 6.00 × 10-5 to 7.22 × 10-3 mg/kg, respectively, with recoveries ranged from 92 to 105%. Zinc (Zn) was found in a high mean concentration (8.49 × 10-1 ± 3.93 × 10-2 mg/kg) in milk powder, and iron (Fe) was found in the highest mean concentration (2.04 ± 3.61 × 10-2 mg/kg) in baby food. The Monte Carlo simulation results for the infants revealed that the rank order of the hazard quotient (HQ) index was mercury (Hg) > nickel (Ni) > arsenic (As) > cadmium (Cd) > aluminum (Al). Further, the result of non-carcinogenic and probability of carcinogenic risk was lower than the limits of safe risk (HQ > 1 and cancer risk (CR) > 1 × 10-4). In conclusion, the toxic elements content in the tested products was sufficiently low, and all of the milk powder and baby food sold in Iran could be considered safe for infants and children.

Simultaneous and selective electrochemical sensing of methotrexate and folic acid in biological fluids and pharmaceutical samples using Fe3O4/ppy/Pd nanocomposite modified screen printed graphite electrode.

The purpose of this study was to fabricate an electrochemical sensor for the detection of methotrexate and folic acid based on a screen-printed graphite electrode (SPGE) modified with prepared iron oxide (Fe3O4)/polypyrrole (ppy)/Palladium (Pd) nanocomposite. Transmission electron microscopy (TEM), energy-dispersive X-ray spectroscopy (EDX), X-ray diffraction (XRD), and Fourier-transform infrared spectroscopy (FT-IR) techniques were employed to characterize the Fe3O4/ppy/Pd nanocomposite. The produced modifier was used to induce a remarkable electrocatalytic impact relative to the oxidation of methotrexate, which caused the potential peak shift to a less positive amount (from 800 mV to about 500 mV) and improved the peak current (from 5.3 µA to about 16 µA). Methotrexate peak current was linearly dependent on its concentration from 0.03100.0 µM and the limit of detection (LOD) was estimated at 7.0 nM. The methotrexate and folic acid were co-detected by the proposed sensor. The experimental results indicated that the oxidation peaks of methotrexate and folic acid were separated about 200 mV in phosphate buffer solution (PBS) at pH 7.0. Fe3O4/ppy/Pd/SPGE was successfully able to detect methotrexate and folic acid in pharmaceutical and biological samples with excellent recovery.

Metformin as a new option in the medical management of breast fibroadenoma; a randomized clinical trial.

BACKGROUND: Fibroadenoma (FA) is the most common benign solid breast mass in women, with no definite method of management. Because fibroadenoma is dependent on female sex hormones and comprises hypertrophic changes at cellular levels, we investigated the effects of metformin (MF), a safe hypoglycemic agent with anti-estrogenic and anti-proliferative properties, in the management of fibroadenoma. METHODS: In this randomized clinical trial study, eligible women with fibroadenomas were assigned randomly to the metformin (1000 mg daily for six months) or the placebo group. Breast physical and ultrasound exam was performed before and after the intervention, and the changes in the size of fibroadenomas were compared in the two groups. RESULTS: Overall, 83 patients in the treatment, and 92 in the placebo group completed the study. A statistically significant difference in changing size between the two groups was observed only in the smallest mass. In the largest FAs, the rate of size reduction was higher in the treatment group (60.2 % vs. 43.5 %); while a higher rate of enlargement was observed in the placebo group (38 % vs. 20.5 %). In the smallest FAs, the rate of the masses that got smaller or remained stable was about 90 % in the treatment group and 50 % in the placebo group. We categorized size changes of FAs into < 20 % enlargement and ≥ 20 % enlargement. The odds ratio (OR) for an elargemnt less than 20% was 1.48 (95 % CI = 1.10-1.99) in the treatment group in comparison with the placebo group; the odds for an enlargement less than 20% was higher in women with multiples fibroadenomas (OR = 4.67, 95 % CI: 1.34-16.28). In our study, no serious adverse effect was recorded, and the medicine was well-tolerated by all users. CONCLUSIONS: This is the first study that evaluates the effect of MF on the management of fibroadenoma, and the results suggest a favorable effect. Larger studies using higher doses of MF and including a separate design for patients with single or multiple FAs are suggested in order to confirm this effect. TRIAL REGISTRATION: This trial (IRCT20100706004329N7) was retrospectively registered on 2018-10-07.

Monitoring of polycyclic aromatic hydrocarbons and probabilistic health risk assessment in yogurt and butter in Iran.

This study was conducted to determine the polycyclic aromatic hydrocarbons (PAHs) levels and health risk of yogurt and butter samples collected from Tehran using MSPE/GC-MS (magnetic solid-phase extraction/gas chromatography-mass spectrometry). The results revealed that the limit of detection (LOD) and limit of quantification (LOQ) were ranged from 0.040 to 0.060 and 0.121 to 0.181 µg/kg, respectively; with recoveries ranged from 86.1% to 100.3%. The highest mean of total PAHs was higher in butter (6.87 ± 1.21 µg/kg) than in yogurt (3.82 ± 0.54 µg/kg). The level of benzo (a)pyrene in all samples was lower than of standard levels of the European Union (EU). The highest value of all PAHs in samples was recorded in the winter season and also in the expiration date. The percentile 95% of the total hazard quotient (THQ) due to the consumption of yogurt and butter recorded 1.33E-02 and 3.69E-04 in adults and 6.12E-02 and 1.75E-03 in children, respectively. The percentile of 95% incremental lifetime of cancer risk (ILCR) due to the ingestion of yogurt and butter recorded 1.17E-06 and 2.02E-08 for adults and 5.51E-06 and 9.46E-08 for children, respectively. The rank order of 7 PAHs in adult and children based on P95% Hazard Quotient (HQ) in all samples was benzo(a)anthracene (BaA) > pyrene (P) > fluorene (F) > fluoranthene (Fl) > acenaphthylene (Ace) > anthracene (A) > naphthalene (NA). According to the Monte Carlo Simulation (MCS) method, health-risk assessment showed that children and adults are not at significant health risk.

Predicting Inpatient Length of Stay in Iranian Hospital: Conceptualization and Validation.

OBJECTIVE: The length of stay is an important indicator of hospital performance and efficiency. Regarding the importance of the length of stay, this study aimed to design a structural model of the inpatients' length of stay in the educational and therapeutic health care facilities of Iran in order to identify the influencing dimensions. METHODS: The present study was an analytical and applied study. The face validity of the data gathering tool was investigated by the expert judgment and the construct validity was examined by using the exploratory factor analysis. In order to verify the reliability of the tool, the internal consistency was also trialed by using the Cronbach's alpha. For ranking the influencing dimensions and factors and also in order to examine the causal relationships between the variables in a coherent manner and presenting the final model, the structural equation modeling technique was used in AMOS software at a significant level of 0.05. RESULTS: The mentioned structural model consists of 4 dimensions and 29 factors influencing the length of stay of hospitalized patients. The independent variables are based on priority and importance as follows: patients' conditions, the underlying factors, the clinical staff performance, and hospitals' service delivery, which were examined by second-order factor analysis in order to study the relationship between them and the inpatients' length of stay. CONCLUSION: Considering the importance of each one of the proposed dimensions from the point of view of service providers in some therapeutic centers of the country by paying attention to the role of each one of them in preventing prolonged hospitalization can be essential in the effectiveness of the treatment and cost reduction.
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Effect of Occupational Exposure to Radar Radiation on Cancer Risk: A Systematic Review and Meta-Analysis.

OBJECTIVE: Microwave radiation is one of the most growing environmental workplace factors that exposes too many workers in the various workplaces. Regard to concerns about cancer incidence in these workers and lack of systematic or meta-analytic studies about this object, so, we conducted a meta-analysis to acquire an understanding of the association between cancer risk and occupational exposure to radar radiation. METHODS: A systematic search was carried out on case-control, cohort and clinical control trial studies that published in the Cochrane Library, PubMed, ISI Web of Science, Scopus and Google scholar databases that accomplished from March 2017 to March 2018 and updated on 30 September, 2018 in English and Persian articles without time limit in publication date. Keywords were selected based on PICO principle and collected from MeSH database. After removal of duplicated studied, taking into inclusion and exclusion criteria, the process of screening was carried out and data were extracted after preparation of the full text of included articles. Article collection was completed by manually searching for a reference list of eligible studies. For quality assessment of included studies, Newcastle-Ottawa scale was used. RESULTS: a total of 533 studies was found in the first step of literature search, only 6 were included with 53,008 sample size according to inclusion and exclusion criteria. Estimated pooled random effects size analysis showed no significant increasing effect of occupational exposure to radar radiation on mortality rate (MR=0.81, 95%CI: 0.78, 0.83) and relative risk (RR=0.87, 95%CI: 0.75, 0.99, P <0.0001) of cancer with a significant heterogeneity between the selected studies. CONCLUSIONS: In conclusion, the results of this meta-analysis study have shown no significant increase in overall mortality ratio and cancer risk ratio from occupational exposure to the radar frequency of workers. But, these results are not conclusive. As regards to some limitation such as fewer numbers of included studies, lack of data about exposure characterizations and demographic characterizations in this meta-analysis, this result is not certain and conclusive. It is recommended to conduct future studies.

Interaction of Safety Climate and Safety Culture: A Model for Cancer Treatment Centers

Background: In health care institutions, safety culture is defined as the integrity of individual and group efforts to reduce the harms for the patients. This is possible through interactions, attitudes, and understanding of safety matters. On the other hand, one of the indicators of the safety culture is the safety climate. Objective: The aim of this study is to investigate the interaction between safety climate and safety culture using structural equation modeling in personnel of cancer treatment centers in Iran. Methods: In this study, 680 personnel of Iran's hospitals were chosen in a random manner. Demographic (9 questions), safety culture (42 questions) and safety climate (37 questions) questionnaires were filled. The data were inserted in SPSS 20 software. Descriptive statistics method and Pearson's correlation coefficient were used to describe the data and evaluate the relation between the variables, respectively. Structural equations model was developed using AMOS 22 software and fitness of the model was tested by χ2, RMSEA, GFI and NFI statistics. Results: The scores of safety climate and safety culture were 3.61 and 3.30, respectively, which imply that they are suiTable. The overall fitness of the model was accepTable. In this model, χ2 = 8637.17, df = 2964, χ2/df = 2.914, RMSEA = 0.058, NFI = 0.912, GFI=0.907, and CFI=0.875. In the regression analysis, there were positive significant relationships between safety climate and safety culture, safety climate and any of its components, and safety culture and any of the components. Conclusion: It was found that the safety climate and the safety culture had a positive impact on each other; so that with increasing safety climate, the safety culture also increases, and vice versa. Also, the level of education has a positive impact on safety culture and safety climate. So appropriate training can promote both variables in cancer treatment hospitals.

Effectiveness of Integrating Simulation with Art-Based Teaching Strategies on Oncology Fellows' Performance Regarding Breaking Bad News.

The task of breaking bad news (BBN) may be improved by incorporating simulation with art-based teaching methods. The aim of the present study was to assess the effect of an integrating simulation with art-based teaching strategies, on fellows' performance regarding BBN, in Iran. The study was carried out using quasi-experimental methods, interrupted time series. The participants were selected from medical oncology fellows at two teaching hospitals of Tehran University of Medical Sciences (TUMS), Iran. Participants were trained through workshop, followed by engaging participants with different types of art-based teaching methods. In order to assess the effectiveness of the integrating model, fellows' performance was rated by two independent raters (standardized patients (SPs) and faculty members) using the BBN assessment checklist. This assessment tool measured seven different domains of BBN skill. Segmented regression was used to analyze the results of study. Performance of all oncology fellows (n = 19) was assessed for 228 time points during the study, by rating three time points before and three time points after the intervention by two raters. Based on SP ratings, fellows' performance scores in post-training showed significant level changes in three domains of BBN checklist (B = 1.126, F = 3.221, G = 2.241; p < 0.05). Similarly, the significant level change in fellows' score rated by faculty members in post-training was B = 1.091, F = 3.273, G = 1.724; p < 0.05. There was no significant change in trend of fellows' performance after the intervention. Our results showed that using an integrating simulation with art-based teaching strategies may help oncology fellows to improve their communication skills in different facets of BBN performance. Iranian Registry of Clinical Trials ID: IRCT2016011626039N1.