Familial aggregation of traffic risky behaviours among pedestrians: a cross-sectional study in northwestern Iran.

OBJECTIVE: This study aims to assess the familial aggregation of traffic risky behaviours among pedestrians and describe the sociodemographic profile of pedestrians in northwestern Iran. METHODS: A cross-sectional study was conducted among 933 pedestrians in 2023. Participants were selected using stratified random sampling. Traffic risky behaviour was measured using a validated instrument among heads of households and their first relatives. The generalised estimating equations were computed to estimate the adjusted OR and 95% CI for familial aggregation of traffic risky behaviours. RESULTS: Of the total sample, 52.2% and 27.7% of the participants were male and aged 41-50, respectively. The majority of respondents were categorised in middle socioeconomic class (36.9%). The OR for familial aggregation of traffic risky behaviours was 1.42 (95% CI 1.07 to 1.89), indicating that the presence of traffic risky behaviours in at least one family member increased the likelihood of similar behaviour in other members. Fathers showing violation behaviours were associated by 1.98-fold increase in violation behaviours among their offspring. Similarly, the existence of violation behaviour in one sibling increased the odds of violation behaviour among other siblings (OR 1.99, 95% CI 1.18 to 3.73). CONCLUSIONS: This study revealed the familial aggregation of traffic risky behaviours of pedestrians, with father-offspring and sibling aggregations emerging as prominent components of familial aggregation. The findings suggested that family-based prevention programmes may yield greater effectiveness than individual-based approaches. As such, implementing targeted interventions focusing on family might have a substantial impact on reducing pedestrian traffic risky behaviours.

Development, Validation, and Cross Cultural Adoption of Persian Version of Behavioral Risk Factor Tool.

Background: One of the most crucial objectives of policymakers is to enhance the population's overall health. Establishing a surveillance system is a way to achieve this goal. The Behavioral Risk Factor Surveillance System (BRFSS) is a national system that collects data on the health-related behaviors of the United States residents using the Behavioral Risk Factor Questionnaire (BRFSSQ). This survey is aimed at reducing risk behaviors and their consequences. Regarding the fact that the cultural environment within each country may affect how behaviors are assessed, this study aimed to develop a Persian version, cross-cultural adaptation, and assess the validity and reliability of the PBRFSSQ. Methods: In this cross-sectional study, 250 individuals were enrolled using the stratified sampling method between August 2022 and April 2023. Six steps of translation and test method proposed by Sousa et al was used. Content and face validity were calculated. Also, the Cronbach's alpha and test-retest were computed. Results: Of all participants, 54.5% were male and aged 30 to 65 years old (69%). The Scale Content Validity Index was equal to 0.95. The Intra class Correlation Coefficient (ICC) was computed as 0.86, 0.88, and 0.87 for the core, optional, and total components, respectively. Furthermore, the Cronbach's alpha coefficient of 0.85 was obtained overall. Conclusion: This tool was highly valid and reliable for assessing risky behaviors among the Iranian general population.

Simultaneous rotary and linear displacement sensor based on soft pneumatic sensing chambers.

Specific industrial or research applications necessitate specialized displacement measurement conditions, thereby driving researchers to innovate sensors based on novel operating principles. One such challenging condition is the prevalence of strong electromagnetic waves, which precludes using any sensor with a metallic structure or one that operates on electrical measurement principles. Additionally, space constraints in applications requiring multidimensional displacement measurements mandate the development of sensors capable of measuring displacements simultaneously in multiple directions. This paper introduces a novel soft sensor designed to simultaneously measure linear and rotational displacements using Soft Pneumatic Sensing Chambers (SPSCs). This sensor is unique in its ability to measure both linear and rotational movements and, due to its Electro-Magnetic Compatibility (EMC) and compact size, is suitable for environments with significant electromagnetic interference and spatial constraints. Furthermore, its flexibility makes it appropriate for body-interacting applications. The Abaqus software was employed to optimize the operating parameters. Subsequently, a laboratory setup was assembled, and the sensor's performance was assessed using two calibration methods: mathematical modeling and machine learning. According to the machine learning method, the accuracy in the linear and rotational directions was 0.49 mm and 5.4°, while the Root Mean Square Error (RMSE) was 0.05mm and 0.48°, respectively.

Artificial intelligence in cardiovascular medicine: An updated review of the literature.

Screening and early detection of cardiovascular disease (CVD) are crucial for managing progress and preventing related morbidity. In recent years, several studies have reported the important role of Artificial intelligence (AI) technology and its integration into various medical sectors. AI applications are able to deal with the massive amounts of data (medical records, ultrasounds, medications, and experimental results) generated in medicine and identify novel details that would otherwise be forgotten in the mass of healthcare data sets. Nowadays, AI algorithms are currently used to improve diagnosis of some CVDs including heart failure, atrial fibrillation, hypertrophic cardiomyopathy and pulmonary hypertension. This review summarized some AI concepts, critical execution requirements, obstacles, and new applications for CVDs.

Tailoring Release Profiles of BCS Class II Drugs Using Controlled Release Amorphous Solid Dispersion Beads with Membrane-Reservoir Design: Effect of Pore Former and Coating Levels.

Poor aqueous solubility is a major limiting factor during the development of BCS Class II drug candidates in a solid oral dosage form. Conventional amorphous solid dispersion (ASD) systems focus on maximizing the rate and extent of release by employing water-soluble polymeric crystallization inhibitors; however, they often encounter rapid supersaturation and solution-mediated phase transformation (SMPT). Therefore, in this work, a controlled release membrane was introduced onto ASD beads to mitigate the SMPT problem. A membrane-reservoir controlled release amorphous solid dispersion (CRASD) bead system was designed, and the effects of the coating thickness and pore former content on drug release profiles were investigated. CRASD beads were manufactured by spray-coating polyvinyl acetate with polyvinylpyrollidone (PVP) as a pore former onto sugar bead substrates layered with the ASD reservoir of celecoxib and PVP. Raising the pore former content and/or lowering the coating level imparted higher release rates and supersaturation levels. The extent of release, measured by the area under the curve, was greatest when an optimal balance between the release rate and peak concentration could be established, corresponding to a high pore former/high coating level combination. Attributed to a thicker membrane structure with a higher pore former, rapid initial release could be achieved, yet controlled gradually for several hours, avoiding the critical threshold where the onset of SMPT predominates. The greater membrane capacity to transiently immobilize drug molecules (i.e., preserve amorphicity) and gradually release drug over a prolonged duration may be key to balancing supersaturation on both sides of the membrane; hence coating variables should be tactfully selected to exploit this benefit.

Manufacturing of Dexamethasone-Poly(d,l-Lactide-co-Glycolide) Implants Using Hot-Melt Extrusion: Within- and Between-Batch Product Performance Comparisons.

Purpose: Reliable drug therapy with injectable intravitreal implants requires implants of consistent quality. The purpose of this study was to prepare dexamethasone-poly(d,l-lactide-co-glycolide) (PLGA) biodegradable implants and assess implant quality within and between batches for different polymer compositions. Methods: Implants containing 20% w/w dexamethasone with 3 theoretical rates of release (fast, intermediate, and slow) were manufactured with decreasing proportion of acid-terminated PLGA (50:50) and increasing proportion of ester-terminated PLGA (50:50) in a batch process using hot-melt extrusion. The implants were manufactured without and with in-process modification of extrusion/conveyor speed in the late phase of each batch. Implant samples collected at early, middle, and late phases of each batch were analyzed for diameter, drug loading, mechanical properties (strength and toughness), and drug release. Results: With a fixed process, unlike a modified process with an increase in extrusion speed and reduction of conveyor speed in the late phase, all implant formulations tended to decrease in diameter and mechanical properties in the late phase. Drug release profiles for the intermediate and slow release compositions were similar with or without process modification, unlike the fast release composition. Addition of ester-terminated PLGA resulted in a slower drug release. When all formulations are grouped together, the implant diameter exhibited a moderate correlation with mechanical properties, but no correlation was observed with drug release. Conclusions: Within a hot-melt extrusion batch process, the dexamethasone-PLGA implant diameter and hence toughness and strength tend to decline in the latter phase. In-process adjustment of extrusion and conveyor speeds can improve batch consistency and, potentially, implant integrity or performance during or after injection. Process changes did not affect drug release for 2 of the 3 implant compositions.

Dexamethasone Degradation in Aqueous Medium and Implications for Correction of In Vitro Release from Sustained Release Delivery Systems.

The in vitro drug release in an aqueous medium is a critical performance metric for a sustained release drug product. During long-term release studies, drugs may degrade in the release medium, and such degradation can lead to errors in drug release quantitation. Using dexamethasone as a model drug and LC-MS/MS methods employing dexamethasone-d4 as an internal standard, this study identified that dexamethasone can degrade into 13 major degradation products in phosphate buffered saline (PBS) as a function of time, temperature (25, 37, and 45°C), and light exposure. A putative scheme for dexamethasone degradation pathways in PBS has been proposed. In proof-of-concept studies, the analytical method was used to quantitate dexamethasone and its degradation products during in vitro release studies with sustained release dexamethasone-poly(D,L-lactide-co-glycolide) (PLGA) implants incubated in phosphate buffer saline (PBS). Further, mathematical approaches were developed to estimate drug release from implants after accounting for drug degradation in PBS. The LC-MS/MS analytical method and the mathematical approaches developed could be used for assessing the stability and/or release of dexamethasone during manufacturing, storage, and use of various dosage forms.

Development of controlled release amorphous solid dispersions (CRASD) using polyvinyl acetate-based release retarding materials: Effect of dosage form design.

The amorphous solid dispersion (ASD) technique has been employed to formulate poorly-soluble drugs, however, development of solid dosage forms with ASD is challenging due to the high propensity of amorphous drug to precipitate upon dissolution. Thus this work aimed to explore the potential of controlled release amorphous solid dispersion (CRASD) systems using polyvinyl acetate (PVAc) as a release-retarding excipient to mitigate the drug precipitation during dissolution of poorly water-soluble drugs. A number of solid oral CRASD dosage forms in different shapes and structures were prepared to contain spray-dried SD powders of a model BCS Class II drug, celecoxib (CEL), polyvinylpyrrolidone (PVP) and polyvinyl acetate (PVAc) which was incorporated in varying ways. In vitro dissolution tests were performed to investigate the effect of dosage form design on the dissolution/recrystallization profiles. The results indicated that despite nearly identical formulation compositions, the dissolution/recrystallization profiles could be tailored by changing the dosage form design. Matrix-form granules demonstrated greatest improvement of solubility appropriate for rapid drug release, while membrane-coated beads appeared to have the greatest potential for sustained release and thereby the least possibility of precipitation during dissolution. These results suggest that appropriate dosage form design of CRASD systems is of potential to reduce the problem of precipitation during dissolution of poorly soluble drugs.

Single Layer Extended Release Two-in-One Guaifenesin Matrix Tablet: Formulation Method, Optimization, Release Kinetics Evaluation and Its Comparison with Mucinex® Using Box-Behnken Design.

Guaifenesin, a highly water-soluble active (50 mg/mL), classified as a BCS class I drug. Owing to its poor flowability and compressibility, formulating tablets especially high-dose one, may be a challenge. Direct compression may not be feasible. Bilayer tablet technology applied to Mucinex®, endures challenges to deliver a robust formulation. To overcome challenges involved in bilayer-tablet manufacturing and powder compressibility, an optimized single layer tablet prepared by a binary mixture (Two-in-one), mimicking the dual drug release character of Mucinex® was purposed. A 3-factor, 3-level Box-Behnken design was applied to optimize seven considered dependent variables (Release "%" in 1, 2, 4, 6, 8, 10 and 12 h) regarding different levels of independent one (X1: Cetyl alcohol, X2: Starch 1500®, X3: HPMC K100M amounts). Two granule portions were prepared using melt and wet granulations, blended together prior to compression. An optimum formulation was obtained (X1: 37.10, X2: 2, X3: 42.49 mg). Desirability function was 0.616. F2 and f1 between release profiles of Mucinex® and the optimum formulation were 74 and 3, respectively. An n-value of about 0.5 for both optimum and Mucinex® formulations showed diffusion (Fickian) control mechanism. However, HPMC K100M rise in 70 mg accompanied cetyl alcohol rise in 60 mg led to first order kinetic (n = 0.6962). The K values of 1.56 represented an identical burst drug releases. Cetyl alcohol and starch 1500® modulated guaifenesin release from HPMC K100M matrices, while due to their binding properties, improved its poor flowability and compressibility, too.

Complications and Carcinogenic Effects of Mustard Gas--a Systematic Review and Meta-Analysis in Iran.

BACKGROUND: Catastrophic effects of mustard gas as a chemical warfare agent have always been a major problem for those exposed to this agent. In this meta-analysis it was tried to evaluate carcinogenesis, ocular, cutaneous and respiratory complications of mustard gas exposure among Iranians who had been exposed to this agent during the Iran-Iraq war. MATERIALS AND METHODS: In this meta-analysis, the required data were collected using keywords "mustard gas", "sulfur mustard", "cancer", "neoplasm", "respiratory complications", "ocular complications" , "lung disease", "chronic complication", "eye", "skin", "cutaneous complication", "carcinogenesis" and their combination with keywords "Iran", "Iranian", "prevalence", "mortality" and their Farsi equivalent terms from the databases of SID, Iranmedex, Magiran, Pubmed, Science Direct, Google Search engine, Gray Literature and Reference of References. To determine the prevalence of each complication and perform meta-analysis, CMA: 2 (Comprehensive Meta-Analysis) software with a randomized model was used. RESULTS: Of the 542 articles found, 7 national articles, consistent with the aims of this study were selected. Meta- analysis of seven papers revealed that cancer risk, especially cancer of the respiratory system was elevated, so that the relative risk (RR) of cancer role of mustard gas was inconsistent from 2/1 to 4 in this survey. Also prevalence of delayed skin disorders due to sulfur mustard was 94.6%, pulmonary complications 94.5% and ocular complications 89.9%. The incidence of various cancers in victims exposed to mustard gas was 1.7% worldwide where the rate was 2.2% in Iranian victims of the Iraq-Iran war. CONCLUSIONS: Based on present study the prevalence of delayed mustard gas related cutaneous, pulmonary and ocular complications is above 90% and risk of carcinogenesis is higher in comparison to worldwide statistics. This may suggest need for long-term and persistent follow-up and rehabilitation procedures for populations exposed to this agent.

Ki-67/MIB-1 as a Prognostic Marker in Cervical Cancer - a Systematic Review with Meta-Analysis.

BACKGROUND: In cervical cancer patients it has been reported that there in a significant Ki-67/MIB-1 expression is correlated with survival in cervical cancer patients. However, the prognostic value is still not well understood. MATERIALS AND METHODS: In the present meta-analysis the prognostic value of Ki-67/MIB-1 with regard to overall survival (OS) and disease-free survival (DFS) in cervical cancer was investigated. The databases of PubMed, ISI Web of Science, Cochrane Central Register of Controlled Trials, EMBASE, Science Direct and Wiley Online Library were used to identify appropriate literature. RESULTS: In order to explore the relationship between Ki-67/ MIB-1 and cervical cancer, we have included 13 studies covering 894 patients in the current meta-analysis. The effect of Ki-67/MIB-1 on OS for pooled random effects HR estimate was 1.63 (95%confidence interval (CI) 1.09- 2.45; P<0.05). The pooled HR for DFS was 1.26 (95%CI 0.58-2.73; P>0.05) and the subgroup analysis indicated Ki-67/MIB1 was associated with DFS (HR=3.67, 95%CI 2.65-5.09) in Asians. CONCLUSIONS: According to this meta-analysis, Ki-67/MIB-1 has prognostic value for OS in patients suffering from cervical cancer. For better evaluation of the prognostic role of Ki-67/MIB-1 on DFS, studies with larger numbers of patients are needed to validate present findings in the future.

Iran's Bushehr Earthquake at a Glance.

On 9 April 2013, an earthquake of 6.1 magnitude hit southwestern Iran near the city of Khvormuj and the towns of Kaki and Shonbeh in Bushehr province. The official disaster mitigation committee took immediate actions to coordinate rescue teams equipped with 24-hour medical air assistance. Overall, 160 victims were transferred to and treated in the Khvormuj hospital, while 139 survivors were transferred to the hospitals in Bushehr for specialized care. The survivors have been settled in temporary shelters with adequate primary supplies. Considering the hot climate of the area, immediate measures should be taken in order to avoid any further casualties particularly heatstroke, dehydration, diarrheal and vector-borne diseases.

Spinal injuries in the 2012 twin earthquakes, northwest iran.

On 11 August 2012, twin earthquakes measured 6.3 and 6.4 on the Richter scale hit three towns (Ahar, Varzaqan, and Heris) in East Azerbaijan Province, Iran resulting in tragic loss of three hundred lives and leaving thousands of injured. The aim of the present study was to report the spinal injuries during recent earthquake in northwest Iran, its consequences and management. Of the 923 hospitalized patients, 26 (2.8%) had neurosurgical complications. The imaging and clinical data of the patients were retrospectively studied regarding the anatomical location of the injury, the severity of spinal injury and associated neurological deficit. To further analyze the findings, Magerl (AO) and Frankel's classifications were used. The injuries without any fracture were considered as minor spinal injuries. The mean age of the patients was 44.54±22.52 (range: 5-88) years. We detected a total of 38 vertebral injuries including 24 major (63.15%) and 14 minor injuries (36.85%). The most common injuries were observed in the lumbar spine (19 injuries, 50%). The 24 major injuries chiefly included Magerl type A (14 injuries, 58.3%). According to the Frankel's classification, majority of the patients (88.46%) had no neurological deficit. In this study, three patients had nerve injuries. In conclusion, the number and proportion of spinal fractures patients in the recent twin earthquakes, northwest Iran was limited and caused less nerve injuries compared to the previous similar disasters. This might be due to the milder earthquake consequences since the incident happened in the middle of the day when men were working their fields. Potential complications in patients traumatized in earthquake incidents should be monitored for and early assessment of the neurological function is required to prioritize care for the victims.

Effect of pirfenidone on pulmonary fibrosis due to paraquat poisoning in rats.

BACKGROUND: This study investigated the effectiveness of pirfenidone compared with antioxidants, in the prevention of pulmonary fibrosis and increasing the survival in acutely paraquat poisoned rats. METHODS: Five groups of ten rats were included in this study. Three groups were poisoned with intraperitoneal injection of 15 mg/kg paraquat. Among these poisoned groups, one group was treated with vitamin C (500 mg/kg, intraperitoneal), vitamin E (200 mg/kg, intraperitoneal) and N-acetylcysteine (250 mg/kg, intravenous); two others were treated with either normal saline or pirfenidone (200 mg/kg, intravenous); two groups were not poisoned and received normal saline or pirfenidone (200 mg/kg, intravenous). All injections except paraquat were repeated in four consecutive days. On the 15th day of study a semi-quantitative determination of lung fibrosis was done using Ashcroft staging criteria on the lung sections. RESULTS: Pirfenidone decreased paraquat induced lung fibrosis (p < 0.001) while antioxidants did not decrease the lung fibrosis (p = 0.413). Life expectancy decreased in paraquat + normal saline (11 days, 95% CI 7.94-14.05) and paraquat + antioxidant (11 days, 95% CI 7.77-14.23) groups. The increase in the survival of rats in paraquat/pirfenidone group was insignificant (13.4 days, 95% CI 11.13-15.67). CONCLUSION: This study showed that pirfenidone is able to decrease pulmonary fibrosis following paraquat poisoning in a rat model.

Effect of age on semen parameters in infertile men after varicocelectomy.

BACKGROUND: The effectiveness of varicocelectomy in restoration of fertility and improvement of semen parameters is still controversial. The purpose of this study was to determine the effect of age on semen parameters following varicocelectomy in a group of infertile men. METHODS: Improvements in sperm count, morphology, and motility were studied in 67 infertile patients 4-10 months after varicocelectomy. RESULTS: The mean age of the patients was 30.48 ± 7.49 years. Significant improvements in total sperm count, percentage normal morphology, and motility were noted in all age groups (P < 0.05). Patients aged <25 years demonstrated the greatest increase in sperm counts, normal morphology, and motility following varicocelectomy. There was a significant negative correlation between age and sperm count, sperm morphology, and sperm motility (P < 0.05). CONCLUSION: The effect of age on improvement in sperm parameters after varicocelectomy is inconsistent with some reports in the literature, and could be attributable to the duration of infertility prior to surgery; in the long term, varicoceles are known to have deleterious effects on testis biology.

Lepromatous leprosy in a kidney transplant recipient: a case report.

Leprosy is a chronic granulomatous disease of the skin and peripheral nerves caused by Mycobacterium leprae. Among mycobacterial infections, leprosy is rare in renal transplant recipients. Here, we report the manifestations of lepromatous leprosy in a 41-year-old renal transplant recipient. Before the renal transplant, the patient had recurrent bullous lesions on his extremities with no systemic complaints. He was on an immunosuppressive regimen that included prednisolone (1 mg/kg/d), cyclosporine (6 mg/kg), and mycophenolate mofetil (2000 mg/d), and had 2 serologically confirmed acute episodes of cytomegalovirus infection that responded favorably to intravenous ganciclovir. The density of his bullous skin lesions decreased after renal transplant. During his regular posttransplant visits, we noticed a decrease in his eyebrow hairs on their lateral margins bilaterally. Later, he developed generalized, symmetric, erythematous papules. With a positive acid-fast bacilli with Fite staining, the results of a skin biopsy showed diffuse foamy histiocyte infiltration in the dermis. These findings are compatible with lepromatous leprosy. After antileprosy therapy, no deterioration of renal allograft function or lepra reactions was noted in a 4-month follow-up. Clinicians should consider leprosy in the differential diagnosis of skin lesions in immunocompromised hosts, and in particular, solid organ transplant recipients in endemic areas.

Generalized peritonitis requiring re-operation after leakage of omental patch repair of perforated peptic ulcer.

BACKGROUND/AIM: Peptic ulcer perforations are a common emergency, but available literature is silent on the exact definition, incidence, management, and complications of peritonitis due to omental patch leakage. PATIENTS AND METHODS: Retrospective data were collected on 422 patients who underwent omental patch repair of perforated peptic ulcer between March 20, 1999 and March 20, 2006. The definitive diagnosis of perforated peptic ulcer and omental patch leakage was obtained at surgery. RESULTS: Seventeen (4%) patients experienced generalized peritonitis due to omental patch leakage. Mean age was 60.6 years. Mortality rate was 29.4%, and the mean hospital stay was 23.6 days. Delay in surgical approach, shock on admission, and age were all significantly associated with increased mortality. CONCLUSIONS: Peritonitis due to omental patch leakage can result in significant morbidity and mortality. The most common causes of omental patch leakage and operative procedures were unknown and reinsertion of omentum, respectively. Factors such as shock on admission or delayed surgery, have significantly contributed to fatal outcomes and need careful attention.