Risk Factors of COVID-19 associated mucormycosis in Iranian patients: a multicenter study.

BACKGROUND: To evaluate the demographic, clinical, and prognostic characteristics of patients diagnosed with COVID-19-associated mucormycosis (CAM) in Iranian patients. METHODS: This prospective observational study was conducted in 8 tertiary referral ophthalmology centers in different provinces of Iran during the fifth wave of the COVID-19 pandemic. All patients were subjected to complete history taking and comprehensive ophthalmological examination and underwent standard accepted treatment strategy based on the disease stage. RESULTS: Two hundred seventy-four CAM patients (most were males (150, 54.7%)) with a mean age of 56.8 ± 12.44 years were enrolled. Patients with a history of cigarette smoking (Adjusted Odds Ratio (AOR) = 4.36), Intensive Care Unit admission (ICU) (AOR = 16.26), higher stage of CAM (AOR = 2.72), and receiving endoscopic debridement and transcutaneous retrobulbar amphotericin B (AOR = 3.30) had higher odds of mortality. History of taking systemic corticosteroids during COVID-19 was significantly associated with reduced odds of mortality (AOR = 0.16). Generalized Estimating Equations analysis showed that the visual acuity of deceased patients (LogMAR: 3.71, 95% CI: 3.04-4.38) was worse than that of patients who were discharged from the hospital (LogMAR: 2.42, 95% CI: 2.16-2.68) (P < 0.001). CONCLUSIONS: This study highlights significant risk factors for mortality in patients with CAM, such as cigarette smoking, ICU admission, advanced CAM stages, receiving transcutaneous retrobulbar amphotericin B and worser visual acuity. Conversely, a history of systemic corticosteroid use during COVID-19 was linked to reduced mortality. These findings underscore the critical need for early identification and targeted interventions for high-risk CAM patients to improve clinical outcomes.

Retinal and choroidal thickness in fuchs uveitis syndrome: a contralateral eye study.

BACKGROUND: To investigate the subfoveal retinal and choroidal thickness in patients with unilateral Fuchs Uveitis Syndrome (FUS). METHODS: This comparative contralateral study was performed in affected eyes with FUS versus fellow eyes. For each eye parameters such as subfoveal choroidal thickness (SCT), subfoveal choriocapillary thickness (SCCT), central macular thickness (CMT), and central macular volume (CMV) were measured; then the measured values of affected and fellow unaffected eye were compared. RESULTS: Thirty-seven patients (74 eyes) including 19 females (51.4%) with a mean age of 36.9 ± 7.6 years were enrolled. The mean SCT was lower in the affected eyes (344.51 ± 91.67) than in the fellow (375.59 ± 87.33) with adjusting for duration of disease and axial lengths (P < 0.001). The mean SCCT, CMT, and CMV were higher in eyes with FUS than in fellow eyes (P < 0.05). CONCLUSIONS: The result of our study demonstrated that affected eyes in patients with FUS tend to have thinner SCT and thicker SCCT and CMT compared to uninvolved fellow eyes.

A Comparison of 2 Exercise Protocols in Athletes With Primary Subacromial Impingement Syndrome: A Randomized Clinical Trial.

CONTEXT: To stabilize the humeral head within the glenoid fossa during arm elevation, the rotator cuff muscles may contribute through internal and external rotation. The main purpose of the current study was to compare the acromiohumeral distance between athletes with primary subacromial impingement syndrome who received progressive resistance exercises consisting of either shoulder internal or external rotation. DESIGN: A randomized and controlled clinical study. METHODS: Thirty athletes with primary subacromial impingement syndrome were enrolled and randomly divided into 2 experimental groups. The progressive resistance exercise protocol in experimental group I comprised shoulder internal rotation, while in experimental group II consisted of shoulder external rotation. The experimental groups worked out 3 days a week for 6 weeks. The experimental groups were compared with the control group consisting of 15 healthy athletes. The acromiohumeral distance was measured before and after the intervention using an ultrasound machine under the passive and active across no arm elevation and 45°of arm elevation. RESULTS: The acromiohumeral distance significantly increased in both experimental groups under the passive and active arm positions following the intervention (P < .001), with no significant differences detected between the experimental groups (P > .665). The paired comparisons of the acromiohumeral distance discrepancy indicated a significant difference between the control group and each experimental group under the active and passive arm positions (P < .001), while no significant difference was observed between the experimental groups (P > .999). CONCLUSIONS: The present study revealed, for the first time, that both progressive resistance exercise protocols involving either the shoulder internal or the external rotation increased the acromiohumeral distance in individuals with primary subacromial impingement syndrome and improved associated pain and disabilities.

The relationship between adherence to the Mediterranean dietary pattern during early pregnancy and behavioral, mood and cognitive development in children under 1 year of age: a prospective cohort study.

PURPOSE: To investigate the potential relationship between diet quality, represented by the Mediterranean diet score, during early pregnancy and behavioral, mood, and cognitive development in children under 1 year of age in a prospective cohort study in Iran. METHODS: 658 Iranian pregnant women and their infants participated in this prospective birth cohort study. The Mediterranean diet score was calculated by using data from a food frequency questionnaire during the first trimester of pregnancy. We assessed the children's development using the Ages and Stages Questionnaire (ASQ) at 6-month age. We used Cox proportional hazard model to calculate the hazard ratio (HR) and 95% confidence interval (CI) of ASQ domains across categories of the Mediterranean diet score. RESULTS: The mean age of the mothers was 28.8 ± 5.08 years old, and the average follow-up duration was 90 weeks. The mean BMI of the mothers before pregnancy was 25.1 ± 4.43 kg/m2. In the multivariable-adjusted model, those infants whose mothers were in the second (HR: 0.44; 95% CI: 0.19, 1.04; P = 0.06) and third (HR: 0.39; 95% CI: 0.17, 0.89; P = 0.03) tertiles of the Mediterranean diet score had a lower risk of communication impairment compared to those who were at the first tertile. There was no association between maternal adherence to the Mediterranean diet during early pregnancy and other domains of the ASQ. CONCLUSIONS: Greater adherence to the Mediterranean dietary pattern during the first trimester of pregnancy may be favorably associated with communication abilities at 6-month aged infants. More large-scale cohort studies are needed to confirm our findings.

Adherence to the Mediterranean diet and risk of gestational diabetes: a prospective cohort study.

BACKGROUND: Limited data is available on the association between adherence to the Mediterranean diet during early pregnancy and risk of gestational diabetes (GDM) in countries located in the Middle East, one of the regions with the highest prevalence of GDM. METHODS: A total of 647 pregnant mothers were included in the present prospective birth cohort study in Iran. Dietary intake was assessed by a 90-item food frequency questionnaire during the first trimester of pregnancy. Cases of GDM were ascertained by a two-step approach with a 50-g screen followed by a 100-g oral glucose tolerance for those who tested positive. Cox proportional hazard model was used to calculate the hazard ratio and 95%CI of GDM across tertiles of the Mediterranean diet score, while controlling for a wide range of potential confounders. RESULTS: A total of 647 pregnant mothers were included, of whom 77 mothers were diagnosed with GDM during their pregnancy. The average age of the mothers was 28.8 ± 5.1 years. In the multivariable analysis, being in the third tertile of the score of adherence to the Mediterranean diet was associated with a 41% lower risk of developing GDM as compared to those in the first tertile (adjusted hazard ratio: 0.59, 95%CI: 0.35, 0.99). CONCLUSIONS: Based on our findings, greater adherence to the Mediterranean diet during early pregnancy may be associated with a lower risk of developing GDM in Iranian women. Larger cohort studies are needed to confirm the findings.

A qualitative quantitative mixed methods study of domestic violence against women.

BACKGROUND: Violence against women is one of the most widespread, persistent and detrimental violations of human rights in today's world, which has not been reported in most cases due to impunity, silence, stigma and shame, even in the age of social communication. Domestic violence against women harms individuals, families, and society. The objective of this study was to investigate the prevalence and experiences of domestic violence against women in Semnan. METHODS: This study was conducted as mixed research (cross-sectional descriptive and phenomenological qualitative methods) to investigate domestic violence against women, and some related factors (quantitative) and experiences of such violence (qualitative) simultaneously in Semnan. In quantitative study, cluster sampling was conducted based on the areas covered by health centers from married women living in Semnan since March 2021 to March 2022 using Domestic Violence Questionnaire. Then, the obtained data were analyzed by descriptive and inferential statistics. In qualitative study by phenomenological approach and purposive sampling until data saturation, 9 women were selected who had referred to the counseling units of Semnan health centers due to domestic violence, since March 2021 to March 2022 and in-depth and semi-structured interviews were conducted. The conducted interviews were analyzed using Colaizzi's 7-step method. RESULTS: In qualitative study, seven themes were found including "Facilitators", "Role failure", "Repressors", "Efforts to preserve the family", "Inappropriate solving of family conflicts", "Consequences", and "Inefficient supportive systems". In quantitative study, the variables of age, age difference and number of years of marriage had a positive and significant relationship, and the variable of the number of children had a negative and significant relationship with the total score and all fields of the questionnaire (p < 0.05). Also, increasing the level of female education and income both independently showed a significant relationship with increasing the score of violence. CONCLUSIONS: Some of the variables of violence against women are known and the need for prevention and plans to take action before their occurrence is well felt. Also, supportive mechanisms with objective and taboo-breaking results should be implemented to minimize harm to women, and their children and families seriously.

Aflatoxin reduction in nuts by roasting, irradiation and fumigation: a systematic review and meta-analysis.

The present study aimed to investigate the reduction of aflatoxins as a potent hazard for human health in nuts during roasting, irradiation, and fumigation processes. A systematic search was performed in PubMed, Scopus, and ISI Web of Science on 6 April 2020 to find interventional studies assessing the effects of roasting, fumigation, and irradiation methods on total and individual aflatoxins concentration in nuts. Study-specific results were pooled by using a random-effects model. A total of 19 trials were included in the analyses. In most studies, the influence of method on aflatoxin reduction was assessed on peanuts. The results showed that the roasting method significantly reduced aflatoxin B1, B2, G1, and G2 concentrations by 46.91%, 30.66%, 40.88%, and 26.19%, respectively. Such results for the fumigation method were 20.88% and 22.56% for aflatoxin B1 and aflatoxin total, respectively. There was a 58.60% reduction in aflatoxin B1 and a 74.97% reduction in aflatoxin total concentrations in nuts following the irradiation method. The findings indicated that the evaluated processes could be influential for reducing aflatoxin levels in nuts.

Effects of Valsalva Maneuver on Pain and Vasovagal Reaction During the Removing of Femoral Arterial Sheath After Percutaneous Coronary Intervention: A Randomized Controlled Trial.

PURPOSE: The objective of this study was to investigate the effects of the Valsalva maneuver on pain and vasovagal reactions during femoral arterial sheath removal in patients undergoing percutaneous coronary intervention. DESIGN: This study was a randomized controlled trial. METHODS: In this study, 60 patients undergoing elective coronary angioplasty were randomly assigned to the intervention and control groups. After angioplasty, the patients in the intervention group performed the Valsalva maneuver (20-30 mm Hg) for 10 seconds during the sheath removal. Conversely, in the control group, no inspiratory pressure was applied. Before and immediately after the sheath removal, the patients' pain, vital signs, and vasovagal reactions were measured. FINDINGS: The primary characteristics of the patients were similar in the two groups. The patients in the intervention group had significantly lower pain scores during femoral sheath removal compared to the control group (2.33 ± 1.56 vs 5.56 ± 3.08, P < .001). The Valsalva maneuver during femoral sheath removal decreased the patients' heart rate in the intervention group compared to the control group (78.26 ± 12.37 vs 85.46 ± 11.79, P < .001); however, blood pressure and vasovagal reactions were not significantly different. CONCLUSIONS: This study showed that the Valsalva maneuver during femoral arterial sheath removal can reduce the pain severity score, without increasing the incidence of vasovagal reactions.

H. pylori effects on ghrelin axis: Preliminary change in gastric pathogenesis.

Ghrelin and its receptors are present in the stomach, suggesting that the ghrelin axis plays an essential role in gastrointestinal complications. This investigation aimed to explore the effects of H. pylori infection and gastritis on serum ghrelin and ghrelin axis gene expression. In this study, we enrolled 68 adult ambulatory people referred for upper gastrointestinal endoscopy. The individuals were classified into three groups based on H. pylori infection and gastritis. Total serum ghrelin and tissue gene expression were tested with ELISA and quantitative RT-PCR, respectively. Serum ghrelin and mRNA expression were significantly lower in H. pylori-positive with gastritis subjects compared with both H. pylori-negative with and without gastritis. Growth hormone secretagogue receptor1a mRNA expression was not different between groups while GHSR1b expression was significantly higher in patients with H. pylori infection and gastritis. We propose the ghrelin axis intermediaries, such as GHSR1b, as a potential clinical target for gastric disorders.

Comparison of Ultrasonic Thickness of Masseter Muscle Between Individuals With and Without Severe Forward Head Posture: A Cross-Sectional Study.

OBJECTIVE: In this cross-sectional descriptive-analytical study, we sought to compare the ultrasonic thickness of the masseter muscle in people with severe forward head posture vs people without forward head posture, and to determine sex differences in muscle thickness. METHODS: Thirty-eight volunteers (19 with normal head postures and 19 with severe forward head postures), aged 18 to 35 years, entered the study. The severity of the forward head posture was measured by a plumb line and the craniovertebral angle drawn on the recorded images. Based on the recorded images, the masseter muscle thickness was also measured by a 7.5-MHz linear transducer using an ultrasound device in the seated position with 3 mouth positions (closed, half open, and fully open). RESULTS: The results showed that the head posture affects masseter thickness significantly (P = .01), with masseter thickness significantly lower in the participants without severe forward head postures compared to those with severe forward head postures in the closed, half-open, and fully open mouth positions (P < .05). Comparing the mean masseter thickness across sexes showed that the masseter muscle is significantly thicker in men compared to women (P = .01). CONCLUSION: Head posture and thickness of the masseter muscle are linked, as the masseter muscle was thicker in all 3 positions in the participants with severe forward head postures.

Health-related quality of life (HRQoL) in beta-thalassemia major (ß-TM) patients assessed by 36-item short form health survey (SF-36): a meta-analysis.

PURPOSE: The main purpose of this meta-analysis was to evaluate the impact of beta-thalassemia major (BTM) on the health-related quality of life as assessed by the medical outcomes short-form-36 questionnaire (SF-36). METHODS: A systematic literature search was performed on Cochrane library, Web of Science, Scopus, Science Direct, ProQues, Medline/PubMed, Scholar Google until March 17, 2017 to obtain eligible studies. A fixed effect model was applied to summarize the scores of each domain. The radar chart was used to compare the scores of BTM patients with other health conditions. Spearman's correlation analysis and meta-regression were used to explore the related factors. RESULTS: 26 studies were included in this study, which were all reliable to summarize the scores of the SF36. Pooled mean scores of the physical health domains ranged from 52.74 to 74.5, with the GH and PF domains being the lowest and the highest, respectively. Further, the pooled mean scores of the mental health domains varied between 59.6 and 71.11, with the (MH-VT) and SF domains being the maximum and the minimum, respectively. Patients with BTM had a substantially compromised HRQoL in comparison with the general population. CONCLUSION: BTM could adversely affect the HRQoL of patients. Measuring HRQoL should be considered as an essential part of the overall assessment of health status of BTM patients, which would provide valuable clues for improving the management of disease and making decisions on the treatment.

Effects of Virtual Reality Compared to Conventional Therapy on Balance Poststroke: A Systematic Review and Meta-Analysis.

OBJECTIVE: The objective of this study was to systematically review the effect of virtual reality on balance as compared to conventional therapy alone poststroke. METHODS: The databases of PubMed, Cochrane, and Ovid were searched using select keywords. The randomized controlled trials published between January 2000 and August 2017 in English language were included if they assessed the effect of virtual reality on balance ability compared to conventional therapy alone in adults' poststroke. The Physiotherapy Evidence Database scale was used to assess the methodological quality. RESULTS: Fourteen papers were included in this review. The experimental groups largely (n = 13) used virtual reality in combination with conventional therapy. Among the high quality studies, significant between-group improvement favoring virtual reality in combination with conventional therapy was found on Berg Balance Scale (n = 7) and Timed Up and Go Scale (n = 7) when compared to conventional therapy alone. The studies were limited by low powered, small sample sizes ranging from 14 to 40, and lack of blinding, concealed allocation, and reporting of missing data. Thirteen homogenous (n = 348, I2 = 37.6%, P = .083) studies were included in the meta-analysis using Berg Balance Scale. Significant improvement was observed in the experimental group compared to control group with a medium effect size of .64, confidence interval of .36-.92. CONCLUSIONS: The findings of this review indicate that virtual reality when combined with conventional therapy is moderately more effective in improving balance than conventional therapy alone in individuals' poststroke.

Fractionated microneedle radiofrequency for treatment of primary axillary hyperhidrosis: A sham control study.

BACKGROUND/ OBJECTIVE: Primary axillary hyperhidrosis (PAH) creates social stress in patients. Although there are several options for treating PAH, only surgical modalities have conferred a permanent solution. This study evaluated the clinical effectiveness of fractionated microneedle radiofrequency (FMR) treatment for PAH. METHODS: This study is based on a single-blind, sham control comparative design. In all, 25 patients with severe PAH underwent three sessions of FMR at 3-week intervals. One side was treated with FMR while the other was sham controlled. Efficacy was evaluated using the hyperhidrosis disease severity scale (HDSS), sweating intensity visual analogue scale (VAS) and patient satisfaction at baseline, 3 weeks after each session and at 3 months after the last. Skin biopsies were obtained from two enrolled patients. RESULTS: The HDSS and VAS demonstrated significant improvement after treatment on the treated side in comparison with the control side. The mean ± SD of the HDSS after 21 weeks were 1.87 ± 0.61 and 3.38 ± 0.49 (P < 0.001) for the treated and the controlled side, respectively. The follow-up evaluation revealed that 79% of the patients showed a 1 or 2-score decrease in HDSS. In total, 80% of patients reported more than 50% satisfaction at the end of the study. Histopathological findings showed a decrease of the number of the sweat glands in the treated side, confirming the above findings. CONCLUSIONS: Treatment of PAH with FMR as a non-invasive modality can be a safe option with positive therapeutic effects on HDSS without any long-lasting side effects.

Is the sex hormone binding globulin related to preeclampsia independent of insulin resistance?

OBJECTIVE: To evaluate the association between Sex Hormone Binding Globulin and preeclampsia in Iranian women considering the probable confounding effect of insulin resistance. METHODS: The case-control study was conducted at the Semnan University of Medical Sciences, Iran, and comprised pregnant women who received prenatal care at Amiralmomenin Hospital in 2011. Cases represented patients admitted because of preeclampsia, while controls were randomly selected eligible pregnant women without hypertension and/or proteinuria. Fasting blood sugar and insulin were assessed for all participants as well as their blood concentration of Sex Hormone Binding Globulin. The Homeostasis Model Assessment of Insulin Resistance Score was used. The correlation between dependant and independent variables was reported by crude and adjusted odds ratio applying logistic regression models. SPSS 16.0 was used for statistical analysis. RESULTS: Of the 100 pregnant women in the study, 45 (45%) were cases. Insulin resistance was found to be significantly more frequent in the cases compared to the controls (adjusted odds ratio = 2.78; 95% Confidence Interval: 1.11, 6.90; p < 0.01). There was a significant reverse correlation between level of Sex Hormone Binding Globulin in blood and being a case of preeclampsia (adjusted odds ratio = 0.99; 95% Confidence Interval: 0.98, 1.00; p = 0.04). CONCLUSION: Independent of insulin resistance, every 1 nmol/l increase in Sex Hormone Binding Globulin, decreases the odds of preeclampsia by 1%, notifying Sex Hormone Binding Globulin as an important biomarker about its etiology and prediction.

The linear intra-articular motions of the temporomandibular joint in individuals with severe forward head posture: A cross-sectional study.

BACKGROUND: The cervical vertebrae and the temporomandibular joint (TMJ) may be linked through their common muscles. OBJECTIVES: The aim of the present study was to compare the linear intra-articular motions of the TMJ between individuals with the normal craniocervical posture (CCP) and severe forward head posture (FHP). DESIGN: Cross-sectional study. METHODS: Volunteers (N = 38) were equally assigned to either the severe FHP group or the normal CCP group according to their craniovertebral angle (CVA). The CVA angles greater than 49° were considered as the normal CCP while angles between 44 and 40° were regarded as the severe FHP. The TMJ was imaged at the closed, median, and maximum open positions of the mouth using an ultrasound machine with a 7.5 MHz linear transducer in the sitting position. The best-fitting curve in the contour registration method was employed to measure displacement of the mandibular condyle on the transverse and vertical axes. RESULTS: The forward displacement of the mandibular condyle in the severe FHP group was significantly (p-value = 0.037) reduced compared to the normal CCP group at maximum open position of the mouth, while no significant difference was revealed at closed (p-value = 0.937) or median open (p-value = 0.699) positions. The perpendicular displacement of the mandibular condyle exhibited no significant (p-value>0.107) difference between groups at any mouth position. DISCUSSION: The current study demonstrated, for the first time, that severe FHP may impact the intra-articular motion of the TMJ. This study presumed that individuals with severe FHP may encounter a force imbalance in the anterior-posterior direction.

Predisposing Factors and Clinical-Microbiological Profile of Neonatal Corneal Ulcer: A Systematic Review and Analysis.

OBJECTIVE: To provide a comprehensive overview of predisposing factors and clinical-microbiological profile of neonatal corneal ulcer. METHODS: The literature search was undertaken in PubMed, SCOPUS, Embase, Web of Science, and Google Scholar databases on published papers from inception to May 31, 2023. The included articles were independently assessed for methodological quality using a Joanna Briggs Institute checklist. Weighted analysis was utilized, assigning a weight of one to each case report and a weight equivalent to the sample size for the case series/original studies. RESULT: We included 34 relevant case reports/series and one original study. Seventy-four neonates were enrolled with a boy-to-girl ratio of 1.3:1 and a median age of 17 days (1-27 days). Prematurity and neonatal intensive care unit (NICU) care (21.6%), congenital horizontal tarsal kink (13.5%), neonatal herpes infection (13.5%), congenital entropion (5.4%), and jaundice (5.4%) were the most common potential risk factors and coexisting conditions. Microbiology evaluation showed positive results in 53.8% (21/39 cases). Viral and bacterial infections were the most common cause, followed by fungal infections. Herpes virus (18.9%), Pseudomonas aeruginosa (18.9%%) and Staphylococcus epidermidis (6.7%) were the most prevalent causative agents. Negative microbiology was significantly more common in neonates with structural abnormalities (14.9%) compared to others (6.8%) (p = 0.01). CONCLUSION: Based on the findings of reported studies, this systematic review has increased awareness of the risk factors and etiologies that lead to developing corneal ulcers in neonates.

Consumption of red and processed meat during early pregnancy and risk of gestational diabetes: a prospective birth cohort study.

To investigate the association of red and processed meat intake with the risk of gestational diabetes (GDM) in Iranian mothers. A total of 635 pregnant mothers were included. Dietary intake was assessed by a 90-item food frequency questionnaire during the first trimester of pregnancy. Intakes of total red meat, unprocessed red meat, and processed meat were calculated and then, Cox proportional hazard model was used to calculate the hazard ratios (HR) and 95%CIs of GDM across tertiles of red meat intake while controlling for age, occupation, pre-pregnancy body mass index, physical activities, history of cardiovascular disease, hypertension, hypothyroidism, hyperthyroidism, and pregnancy hypertension, order of pregnancy, nausea during current pregnancy, multivitamin use during current pregnancy, weight gain during current pregnancy and total energy intake. The average age of the mothers was 28.80 ± 5.09 years, the average pre-pregnancy body mass index was 25.13 ± 4.43 kg/m2, and the average weight gain during pregnancy was 13.50 ± 5.03 kg. The multivariable-adjusted HRs of GDM for the third tertiles of red and processed meat, red meat, and processed meat intake were, respectively, 1.92 (95% CI 1.06, 3.49), 1.52 (95% CI 0.85, 2.72) and 1.31 (95% CI 0.73, 2.34) when compared to the first tertiles. Our prospective cohort study suggested that there was a positive association between the consumption of red and processed meat and with risk of GDM in a small sample of Iranian mothers with low red meat intake. More large-scale cohort studies in the Iranian population are needed to present more robust evidence in this regard.

Incidence of cancer in Iranian sulfur mustard exposed veterans: a long-term follow-up cohort study.

INTRODUCTION: It is estimated that during the Iraq-Iran war of the 1980s, over 100,000 Iranians (military or civilian) were exposed to sulfur mustard (SM), and a considerable proportion of them are still suffering with long-term consequences of exposure. The aim of the present article is to address carcinogenesis of SM following these acute exposures. METHODS: Using a cohort study, we estimated and compared the incidence rates of malignant disorders in 7,570 veterans exposed to SM and 7,595 unexposed comrades in a 25-year follow-up period. We also determined the hazard ratio of cancer occurrence for SM exposure during the follow-up period. RESULTS: Cancer incidence was significantly increased with exposure to SM. The incidence rate ratio of cancer for SM exposure was 1.81 (95 % CI 1.27-2.56), and the age-adjusted incidence rate ratio was 1.64 (95 % CI 1.15-2.34).The hazard ratio of cancer was 2.02 (95 % CI 1.41-2.88). CONCLUSION: Present study suggests carcinogenesis of SM following acute exposure during war. With respect to this finding, it is reasonable to improve care programs such as routine screening schemes for exposed veterans.

Depression and Suicidal Ideation among Patients Receiving Opioid Maintenance Treatments Considering Cognitive Flexibility.

Objective: Cognitive flexibility is associated with psychiatric disorders. Drug addicts experience more psychiatric disorders. This research aimed to examine depression and suicidal ideation among those receiving opioid maintenance treatment (OMT), taking into account the mediating role of cognitive flexibility. Method : This cross-sectional research was conducted on patients who were enrolled in the OMT program in Semnan in 2021 and abstained from opioid use for at least one year. 126 participants (115 males and 11 females) were randomly selected from among patients in three therapeutic groups (42 from each of the methadone, buprenorphine, and opium tincture groups). The main data collection tools were the Beck Scale for Suicide Ideation (BSSI), Cognitive Flexibility Inventory (CFI), and Beck Depression Scale (BDI-II). Data analysis was done through logistic regression models. Results: Correlation analysis between depression scores, suicidal ideation, and cognitive flexibility showed a significant correlation between each of them. Adjusting for the type of treatment, the increase in cognitive flexibility was associated with a decreasing chance of depression (odds ratio [OR] = 0.87; 95% CI [0.82, 0.92]), and the use of buprenorphine (OR = 15.1) and opium tincture (OR = 9.3), compared to methadone, were associated with a depression increase. Yet, multivariate analysis did not show an independent and significant association between cognitive flexibility and the risk of suicide. Conclusion: Based on the results, patients receiving maintenance treatments are in different conditions in terms of depression and suicide, and psychological flexibility is in correlation with depression and suicidal thinking and behavior in them. This suggests that these patients seem to benefit from cognitive training, at least in reducing their depression.

Adjuvant Treatment with Oral Dydrogesterone in the Prevention of Preterm Labor: A Randomized, Double-Blinded, Placebo-Controlled Trial.

We conducted a double-blind, randomized, placebo-controlled clinical trial to evaluate the efficacy of oral dydrogesterone (DG) on maternal and neonatal consequences in the treatment of preterm labor. We included 100 nulliparous mothers (24-34 weeks) with normal pregnancy who had preterm labor pain. Participants who received magnesium sulfate were randomly assigned to the investigation group (DG 30 mg/day) or placebo group. Maternal and neonatal outcomes were compared between the two groups. Recurrent uterine contraction (UC) rates (92% vs. 88%, P = 0.862) and the incidence of preterm delivery (66% vs. 58%, P = 0.834) were not different in the DG and placebo groups. No significant differences were observed in terms of gestational age at delivery (33.5 ± 3.5 vs. 34.2 ± 3.2, P = 0.281), latency period (5.53 ± 2.29 days vs. 5.59 ± 2.57 days, P = 0.622), cervical dilation (1.82 ± 0.26 cm vs. 1.84 ± 0.29 cm, P = 0.281), and effacement (53 ± 4.47% vs. 57.21 ± 6.27%, P = 0.622) between the placebo and DG groups. The percentage of neonates with a 1-min Apgar score < 7 was higher in the placebo group compared with that of the DG group (12% vs. 0%, P = 0.0001). However, both groups were similar in the frequency of a 5-min Apgar score < 7. No differences in the term of adverse effects of medications were recorded. Our results showed that DG adjuvant to magnesium sulfate could not be effective in improving the incidence of preterm labor, rate of recurrent UC, latency period, pregnancy outcomes, and maternal and neonatal outcomes when compared with the placebo group.