The Efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS) versus Transcranial Direct-Current Stimulation (tDCS) on Migraine Headaches: A Randomized Clinical Trial.

Background: Non-pharmacologic prophylactic methods for chronic migraine have been developed, including the promising non-invasive techniques of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct-current stimulation (tDCS). This study aimed to compare the efficacy of rTMS and tDCS on pain intensity, the impact of headaches on daily life, anxiety, and depression in migraine headaches patients. Materials and Methods: This randomized clinical trial was conducted on 72 patients with migraine headaches, randomly allocated to the rTMS and tDCS groups. Participants received 3 and 12 sessions of stimulation over the left dorsolateral prefrontal cortex (DLPFC), respectively. Follow-up measurements, including pain intensity, anxiety, depression, and impact on daily life, were performed one month after the last sessions. Analyses were done by IBM SPSS statistics version 26 software. Results: Of 72 patients enrolled in the study, 19 were male (8 in the rTMS group and 11 in the tDCS group). There was no significant difference in baseline characteristics between groups. During the follow-up visit, both groups showed a decrease in anxiety levels (P values = 0.005 and 0.015), while only the rTMS group displayed a significant improvement in depression (P value = 0.01). However, no statistically significant difference was found among the groups regarding changes in pain intensity, anxiety, and the impact of headaches on daily life (P values >0.05). Conclusion: Our findings suggest that both rTMS and tDCS may be effective in reducing pain intensity and improving the impact of headaches on daily life and anxiety in patients with chronic migraine. However, significant improvement in depression was only observed in the rTMS group patients.

A cross-sectional study on the reasons for vaccine hesitancy in children under seven years of age in Isfahan, Iran.

Introduction: The diminution in vaccination coverage in recent years has contributed to the reappearance of infectious diseases, and vaccine hesitancy is one of the main causes. As a result, we investigated the causes of vaccine hesitancy in children. Materials and methods: This descriptive-analytical study was conducted cross-sectionally in 27 comprehensive health service centers in Isfahan City from June to October 2022. This study included Iranian families living in Isfahan who did not vaccinate their children by the due date. A researcher-made questionnaire collected data on children's vaccine hesitancy after verifying validity and reliability over the phone and in person by the researcher. The mothers completed informed consent. Independent T-tests, Pearson's correlation coefficient, analysis of variance, and a generalized linear model were used to analyze the data. Findings: Finally, 298 families participated in the study, 34.3% refused, and 65.7% delayed their child's vaccination. Vaccination was hesitant due to the child being sick at the time of injection (57.3%), believing that vaccination is not necessary to prevent uncommon diseases (49%), and being concerned about severe side effects caused by the vaccine (48.7%). Vaccine hesitancy among mothers with bachelor's degrees and families less than one kilometer from the health center was significantly less than among others. Additionally, Vaccines at birth, four, six, twelve, and eighteen months, and six-year-old vaccines were associated with vaccine hesitancy. Conclusion: Children's illness at the time of vaccination, the belief that vaccination is unnecessary to prevent uncommon diseases, and the worry about severe complications were among the most common reasons for vaccine hesitancy. Mother's education, distance to the health center, and vaccine type were associated with vaccine hesitancy.

Association between cognitive capacity and metabolic indices in patients with neuropsychiatric disorders.

BACKGROUND: Although previous studies suggested the relationship between metabolic indices and cognitive capacity, results have been conflicting. The prevalence of metabolic and cognitive disorders is high in patients with neuropsychiatric disorders. We aimed to assess the relationship between laboratory metabolic indices and specific areas of cognitive capacity. MATERIALS AND METHODS: This was a retrospective review of the medical records of 423 from 452 patients with neuropsychiatric disorders who were admitted to the neuropsychiatry unit, Ayatollah Kashani Hospital, Isfahan, Iran, from September 1, 2018, to September 30, 2022. We extracted demographic factors, laboratory metabolic indices, and scores of the Neuropsychiatry Unit Cognitive Assessment tool (NUCOG). We utilized a generalized linear model (GLM) to demonstrate the effect of metabolic indices on the risk of reduction in cognitive domains. Due to the presence of missing data in the metabolic indices, we used the multiple imputation method. RESULTS: The regression coefficient of NUCOG total score and subscale scores for metabolic indices using GLM after multiple imputation method demonstrated that among the metabolic indicators, fasting blood sugar (FBS) had the reverse relationship with the total score of NUCOG (ß = -.05). Among the NUCOG subscales, executive functioning had the strongest relationship with FBS (ß = -.01). Also, there was a negative relationship between patients' age and the total score of NUCOG (ß = -.38). Educational level had a positive relationship with the total NUCOG score (ß =10.2). CONCLUSIONS: The main metabolic factors that might reduce cognitive capacity were higher FBS.

Comparison of airway assessment tests for prediction of difficult intubation in obese patients: importance of thyromental height and upper lip bite test.

BACKGROUND: Prediction of difficult intubation (DI) has remained challenging for anesthesiologists and validity of airway assessment tests has not been fully investigated. This study aims to compare predictive values of these tests for prediction of DI in obese patients. METHODS: One hundred ninety-six patients with Body Mass Index (BMI) ≥30 kg/m2 were included in this prospective study. Variables including intubation Difficulty Scale (IDS), thyromental height (TMH), hyomental distance (HMD) in extent and neutral neck position, HMD ratio (HMDR), sternomental distance (SMD), thyromental distance (TMD), ratio of height to TMD (RHTMD), width of mouth opening (MO), mandibular length (ML), Cormack-lehane (C-L) grade, upper lip bite test (ULBT), history of snoring, and obstructive sleep apnea were collected. Multiple logistic regression and receiver operating characteristic (ROC) curve analysis were used to determine independent predictors of DI (defined as IDS≥5) and their cut off points. RESULTS: DI and difficult laryngoscopy (defined as C-L grade ≥3) were observed in 23% and 24.5% of the study population, respectively. Multiple logistic regression identified TMH (Odds ratio (OR):0.28, 95% confidence interval (CI):0.14-0.58, P=0.001), BMI (OR:1.18, 95% CI: 1.11-1.26, P<0.001), HMDR (OR:0.45, 95% CI:0.36-0.56, P<0.001) and ULBT (OR: 3.91, 95% CI: 2.14-7.14, P<0.001) as independent predictors of DI. Sensitivity of TMH<4.8 cm, BMI>34.9 kg/m2, HMDR<1.4 and ULBT class ≥2 were determined as 75.1%, 73.3%,62.3% and 93.3% respectively. CONCLUSIONS: TMH and ULBT had the highest sensitivity for prediction of DI in obese patients in this study and it is recommended to be considered as part of airway assessment in this patient population.

The association of maternal plant-based diets and the growth of breastfed infants.

Background: Studies are needed to further understand how different plant-based dietary patterns of mothers relate to infant growth. Thus, we investigated the association between maternal plant-based diets and infant growth in breastfed infants during the first 4 months of life. Methods: This cross-sectional study included 290 Iranian mothers and infants. Maternal dietary intake was assessed using a 168-question validated semi-quantitative food frequency questionnaire (FFQ). Three plant-based diet indices (PDIs) were then created to evaluate dietary intakes. Eighteen food groups were classified in three main categories by scoring method: wholeplant diet, healthy plant diet, and animal and unhealthy plant diet. Results: Participants in the top tertile of unhealthy PDI (uPDI) had a lower intake of potassium,phosphorus, zinc, magnesium, calcium, folate and vitamin C, B1, B2, and B3. The upper tertileof uPDI was associated with stunting at 4-month in infants (uPDI: odds ratio [OR] = 3.27, 95%CI= 1.32, 8.10). There were no significant associations between plant-based diet scores and anthropometric indices, including weight, weight status and head circumference (P > 0.05). Conclusion: In conclusion, higher adherence to uPDI may be associated with stuntingamong Iranian infants. Other PDIs were not associated with anthropometric measures. Future studies are needed to further understand the association between plant-based diets and infant growth.

Citalopram and metacognitive therapy for depressive symptoms and cognitive emotion regulation in patients with major depressive disorder: A randomized controlled trial.

BACKGROUND: Metacognitive therapy (MCT) is a new psychotherapy for depression. This study was conducted to compare the effectiveness of citalopram and MCT on major depressive disorders (MDDs). MATERIALS AND METHODS: A total of 36 patients with MDD were randomly assigned into three groups of citalopram (n = 12), MCT (n = 16), and control (n = 8). MCT group received ten sessions of metacognition therapy. Citalopram group received 20-40 mg citalopram, and the control group did not receive any interventions. Outcomes were measured using the Beck Depression Inventory-II, Metacognition Questionnaire-30, and Cognitive-Emotion Regulation (CER) Questionnaire. Data were analyzed with ANCOVA using SPSS version 18. RESULTS: Depression score reduction was significant in both citalopram and metacognitive groups (P < 0.05). However, there was only a statistically significant difference between MCT and control group in CER and metacognition. CONCLUSION: MCT and citalopram both are effective in symptom reduction in MDD. Furthermore, MCT could lead to more improvement in metacognition, depression symptoms, and CER than citalopram, when treating MDDs.

Can Couples With MCV≥80, MCH<26, HbA2<3.2, HbF<3 be Classified as Low-risk ß-Thalassemia Group?

BACKGROUND AND AIM: Thalassemia screening instructions in Iran categorizes couples with mean corpuscular volume (MCV)=75 to 80, mean corpuscular hemoglobin (MCH)=26 to 27, hemoglobin A2 (HbA2)<3.5, and hemoglobin fetal (HbF)<3 indices as low-risk couples, and therefore further genetic testing is not obligatory. This study examined the possibility of classifying couples with MCH<26 and MCV≥80 indices in the low-risk group when their HbF was <3 and HbA2 was <3.2. METHODOLOGY: This was a cross-sectional study. The data included results from cell blood count and HbA2 prenatal diagnosis (PND) and HbF tests taken by 22 health care centers in Esfahan province, central Iran, throughout the years 2012-2016. The inclusion criterion was the registering of MCV, MCH, and PND results of the participants. From the 5804 participants, 5624 individuals were included in the study. RESULTS: The sensitivity and specificity of the screening program were 99.7 and 53.12, respectively. Ten cases (0.18%) with thalassemia trait had indices MCV≥80 and MCH≥26 including 3 cases (0.05%) with concurrent α and ß-thalassemia mutations and 7 cases (0.12%) with HbS mutations. Altogether, 553 subjects (9.83%) had MCV≥80 and MCH<26 indices, and only 1 case (0.018%) was found with ß-thalassemia mutations (codon8 (-AA)/WT genotype). CONCLUSIONS: Subjects with MCV≥80, MCH<26, HbA2<3.2, and HbF<3 cell blood count indices could be grouped as low-risk couples if normal HbA2 and HbF values are considered. The results of this study also indicate that there is a chance of missing concurrent α and ß-thalassemia or HbS hemoglobinopathies in the current screening program given the fact that genetic testing is not considered for couples with MCV and MCH in the low-risk range. HbF testing could be conducted to prevent these missing cases.

Preparedness of community-based organisations in biohazard: reliability and validity of an assessment tool.

The purpose of this study was to develop a tool for community-based health organisations (CBHOs) to evaluate the preparedness in biohazards concerning epidemics or bioterrorism. We searched concepts on partnerships of CBHOs with health systems in guidelines of the Centers for Disease Control and Prevention and literature. Then, we validated the researcher-made tool by face validity, content validity, exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and criterion validity. Data were collected by sending the tool to 620 CBHOs serving under supervision of Iran's ministry of health. Opinions of health professionals and stakeholders in CBHOs were used to assess face and content validity. Factor loads in EFA were based on three-factor structure that verified by CFA. We used SPSS V.18 and Mplus7 software for statistical analysis. About 105 health-based CBHOs participated. After conducting face validity and calculating content validity ratio and content validity index, we reached 54 items in the field of planning, training and infrastructure. We conducted construct validity using 105 CBHOs. Three items exchanged between the fields according to factor loads in EFA, and CFA verified the model fit as Comparative Fit Index, Tucker-Lewis index and root mean square error of approximation were 0.921, 0918 and 0.052, respectively. The Cronbach's of the whole tool was 0.944. Spearman correlation coefficient confirmed criterion validity as coefficient was 0.736. Planning, training and infrastructure fields are the most important aspects of preparedness in health-based CBHOs. Applying the new assessment tool in future studies will show the weaknesses and capabilities of health-based CBHOs in biohazard and clear necessary intervention actions for health authorities.

Associations Between Dietary Energy Density in Mothers and Growth of Breastfeeding Infants During the First 4 Months of Life.

Objectives: Despite the overwhelming impact of dietary energy density on the quality of the entire diet, no research has investigated dietary energy density among lactating mothers. Hence, the present study was undertaken to assess the influence of maternal dietary energy density during lactation on infant growth.Method: Three hundred healthy lactating mother-infant pairs were enrolled in the study. Detailed demographic information and dietary intake data were collected from the lactating mothers. Anthropometric features such as infant weight, height, and head circumference at birth and 2 and 4 months and mother's pregnancy and postpartum weight and height were derived from health center records. Data on physical activity were reported using the International Physical Activity Questionnaire.Results: After adjusting for confounding variables, infant weight, length, weight-for-height, and head circumference at birth, 2 months, and 4 months did not show significant differences among four dietary energy density categories (all p values > 0.01).Conclusions: Our study showed no association among quartiles of dietary energy density among lactating mothers and infant weight, length, weight-for-height, and head circumference growth by 2 and 4 months of age.

Altered Th17/Treg Ratio in Recurrent Miscarriage after Treatment with Paternal Lymphocytes and Vitamin D3: a Double-Blind Placebo-Controlled Study.

BACKGROUND: Recurrent miscarriage (RM) affects 2-5% of pregnant women. Paternal lymphocyte immunotherapy is a common treatment for RM patients but the outcome has not been consistent. Therefore, combined therapy with other immunosuppressive drugs such as 1a, 25-dihydroxy-vitamin-D3 (vitamin D3) may improve the outcome. OBJECTIVES: To investigate the effect of vitamin D3 on the balance of two essential T cells subsets, T helper (Th) 17 and T regulatory (Treg) cells, which contribute to the immune tolerance during pregnancy. METHODS: The expression levels of CD4 and forkhead box protein 3 (FOXP3) in Treg cells, and the expression levels of CD4 and IL-17 in Th17 cells, were evaluated pre- and 3 months post-immunotherapy in RM patients treated with a combination of paternal lymphocytes and vitamin D3 compared with RM patients receiving lymphocyte immunotherapy alone. RESULTS: Vitamin D3 therapy decreased the frequency of Th17 cells in addition to reducing the Th17/Treg ratio in peripheral blood of RM patients compared with the control group (p<0.05). CONCLUSION: Considering that RM patients have a higher Th17/Treg ratio in peripheral blood, vitamin D3 may be a candidate therapeutic approach in this disease.

Effects of Soy Flour Fortified Bread Consumption on Cardiovascular Risk Factors According to APOE Genotypes in Overweight and Obese Adult Women: A Cross-over Randomized Controlled Clinical Trial.

Recent studies suggest that inclusion of soy product in the diet may have favorable effects on relief of cardiovascular diseases (CVDs) and risk factors. These effects might be associated with the presence of specific polymorphism in gene. The aim of this study was to examine the effects of consumption of soy flour fortified bread on cardiovascular risk factors in overweight and obese women according to APOE genotype. In a randomized cross-over clinical trial 30 overweight and obese women received a mild weight loss diet and assigned to a regular diet and a soy bread diet, each for 6 weeks and a washout period for 20 days. Subjects in the soy bread diet were asked to replace 120 grams of their daily usual bread intake with equal amount of soy bread. No significant effects of soy bread on serum lipid, systolic blood pressure and anthropometric indices were observed compared to the regular diet (p > 0.05). For diastolic blood pressure (DBP), comparison of mean differences between two groups showed a marginally significant effect of soy bread (p = 0.06). Compared to regular diet, soy bread had a significant effect on DBP in E2 genotype group (ε2/ε2) (p = 0.03). Having ε2 allele may influences responses of CVD risk factor to soy bread consumption. However more nutrigenetic studies are required.

Comparison of national and personal identity between person with internet addiction disorder and normal internet users.

BACKGROUNDS: The present study was carried out in order to compare national and personal identity and their subscales in internet addicts and nonaddicts. MATERIALS AND METHODS: This study was a descriptive-analytical research, and was carried out on 384 student internet users in different universities in the city of Isfahan who were selected using quota sampling. Subjects completed the questionnaires, then, subscales of personal and national identity questionnaires in internet addict and nonaddict were analyzed via SPSS16 software. RESULTS: Results indicated a significant difference between the scores of national identity and personal identity as well as all subscales in internet addicts and nonaddicts, except for national heritage and homeland defence factors. In addition, there was a negative and significant relationship between addiction to internet and personal and national identity, except for the fourth and fifth factors of national identity (viewpoints of others considering the national group and homeland defence). Moreover, after controlling for the sex variable, internet addiction had an effect on personal and national identity. CONCLUSION: The findings of this research indicate that an excess of internet use and overinvolvement in cyberspace and the addiction to them, could be associated with defects in some aspects of national and personal identity.

Prevalence and risk factors of hepatitis B and C viruses among hemodialysis patients in Isfahan, Iran.

BACKGROUND: The aim of this study was to assess the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) and their associated risk factors among hemodialysis patients in Isfahan, Iran in 2011. MATERIALS AND METHODS: In this cross-sectional study, a total of 499 chronic hemodialysis patients from eight governmental hemodialysis centers were tested. Demographic information, time duration on hemodialysis, history of blood transfusion, and the number of transfused blood units as risk factors to HBV and HCV infections were calculated. The status of HBsAg and anti-HCV was assessed by serological testing. RESULTS: The overall prevalence of HBV-positive and HCV-positive among study population was 1.2% and 5.2%, respectively. Age, sex, and time duration on hemodialysis were not statistically significant in HBV- and HCV-patients compared with other hemodialysis patients (P > 0.05). History of blood transfusion and the number of transfused blood units in HBV infected patients were similar to other patients (P > 0.05). The main risk factors in hemodialysis patients infected by HCV were history of blood transfusion and the number of transfused blood units (P < 0.0001). CONCLUSION: In conclusion, the prevalence of HBV and HCV infections in hemodialysis centers in Isfahan is lower than in some other cities of Iran. History of blood transfusion and the number of blood units transfused might be a risk factor for HCV gaining. However, further studies are needed to assess the role of other demographic and clinical risk factors in these patients.

Cardiac strain comparison between workers with normal weight and overweight in the hot humid weather of the Persian Gulf region.

BACKGROUND: In the hot weather, overweight and obesity are considered as significant risk factors for the incidence of cardiac strain in workers. This study is aimed at comparing the cardiac strain among overweight and normal-weighted workers, in the hot, humid conditions of the south of Iran. MATERIALS AND METHODS: This cross-sectional study was conducted on 71 workers in the south of Iran, in the summer of 2010. The heart rate was measured at rest and at actual work. Cardiac strain based on the working heart rate (WHR), the relative cardiac cost (RCC), the net cardiac cost (NCC), the load relative cardiovascular (CVL), and heart rate reduction were analyzed in 35 normal weight people (BMI <25) and 36 people who were overweight (BMI >25), using descriptive statistics and t- tests. RESULTS: In 42% of the total workers, the body mass index was more than 25. The average temperature of the two groups was not significantly different. The mean WHR in these two groups was 101 ± 20.3 and 112 ± 18.9, respectively (P = 0.026). Percentages that exceeded the acceptable limits in parameters of NCC, RCC, WHR, CVL, and the Brouha index, were significantly higher in overweight people than those in people with normal weight. CONCLUSIONS: Based on the study results, the severity of cardiac strain was higher in overweight workers when compared with normal weight workers. Hence, in order to decrease the cardiac strain, selecting overweight individuals for these jobs should be avoided, as also some vital intervention for losing weight, such as, nutrition education and encouraging them to increase their physical activity, should be implemented.

A randomized double-blind, placebo-controlled study of therapeutic effects of silymarin in ß-thalassemia major patients receiving desferrioxamine.

OBJECTIVE: Thalassemia is one of the most common genetic disorders worldwide. Chronic blood transfusions treat the underlying anemia but may lead to iron toxicity. Effective iron chelation remains one of the main targets of clinical management of thalassemia major. In this study, iron-chelating activity of silymarin, a flavonolignan isolated from silybum marianum, was examined in ß-thalassemia major. METHODS: Patients were treated with the combination of desferrioxamine and silymarin (Legalon(®) ; n = 49) or desferrioxamine plus placebo (n = 48) for 9 months. The serum levels of ferritin, iron, total iron-binding capacity (TIBC), soluble transferrin receptor, and hepcidin were determined at the baseline and after 9-month therapy. Liver function test was performed before and after treatment in both groups. RESULTS: Serum ferritin levels decreased significantly from the beginning to the end of silymarin treatment (3028.8 ± 2002.6 vs. 1972.2 ± 1250.6 ng/mL); however, no significant change in serum ferritin was observed in the patients receiving placebo (2249.0 ± 1304.2 vs. 2015.6 ± 1146.8). Moreover, serum iron and TIBC levels were significantly reduced in silymarin group compared with placebo. Patients on silymarin therapy also exhibited a significant decrease in serum levels of hepcidin and soluble transferrin receptor after 9-month treatment period. A significant improvement in liver function test was observed in silymarin group in comparison with placebo. CONCLUSION: This study shows that silymarin is effective at reducing iron overload in patients when used in conjunction with desferrioxamine. Therapeutic effects of silymarin on a background of desferrioxamine suggest the potential effectiveness of silymarin alone in reducing body iron burden.

The Direct Medical Costs of Colorectal Cancer in Iran; Analyzing the Patient's Level Data from a Cancer Specific Hospital in Isfahan.

BACKGROUND: The Immense cost of cancer treatment is one of the main challenges of health care systems all over the world including Iran. The aim of this study was to analyze the direct treatment costs of colorectal cancer patients in Isfahan, Iran. METHODS: In this cross sectional study, the medical records of colorectal cancer (CRC) patients admitted to the Seyyed-al-Shohada Hospital "SSH" from 2005-2010 were reviewed. The profiles of 452 patients were examined. However based on inclusion, exclusion criteria a total number of 432 profiles were analyzed. All records including age, sex, treatment processes and treatment costs were extracted from the patients' profiles and analyzed using Kruskal-Wallis test. FINDINGS: The results showed that 56.1% of CRC patients were male. The mean age of patients suffering from CRC was 56 ± 13.4. More than Thirty-six percent of the patients were in stages 1-3 of CRC and more than half of them (64.4%) were in the 4(th) stage. The higher the stage of the cancer the higher the percentage of treatments used. 5-Fluorouracil and Leucovorin (5FU/LV) was the most common used chemical treatment protocol. The mean treatment cost for stage one was 10715 (±4927), for stage two 15920 (±3440), stage three 16452 (±2828) and for stage four was 16723 (±2555) US Dollars. The cost of drug treatment was the first cost driven between the medical services. CONCLUSION: CRC in Iranian population starts in younger age than people in western countries. This imposed considerable direct and indirect economic cost to the society. The direct medical cost of colorectal cancer in Iran is very higher than 38 million $. Screening programs could reduce the economic cost of CRC significantly.

Development and validation of a postpartum depression risk score in delivered women, Iran.

BACKGROUND: Investigators describe a dramatic increase in the incidence of mood disorder after childbirth, with the largest risk in the 90 days after delivery. This study is designed to develop a relatively simple screening tool and validate it from the significant variables associated with postpartum depression (PPD) to detect delivered women at high risk of having PPD. MATERIALS AND METHODS: In the cross-sectional study, 6,627 from a total of 7,300 delivered women, 2-12 months after delivery were recruited and screened for PPD. Split-half validation was used to develop the risk score. The training data set was used to develop the model, and the validation data set was used to validate the developed the risk factors of postpartum depression risk score using multiple logistic regression analysis to compute the ß coefficients and odds ratio (OR) for the dependent variables associated with possible PPD in this study. Calibration was checked using the Hosmer and Lemeshow test. A score for independent variables contributing to PPD was calculated. Cutoff points using a trade-off between the sensitivity and specificity of risk scores derived from PPD model using the Receiver Operating Characteristic (ROC) curve. RESULTS: The predicted and observed PPD were not different (P value = 0.885). The aROC with area under the curve (S.E.) of 0.611 (0.008) for predicting PPD using the suggested cut-off point of -0.702, the proportion of participants screening positive for PPD was 70.9% (sensitivity) (CI 95%; 69.5, 72.3) while the proportion screening negative was 60.1% (specificity) (CI 95%; 58.2, 62.1). CONCLUSION: Despite of the relatively low sensitivity and specificity in this study, it could be a simple, practical and useful screening tool to identify individual at high risk for PPD in the target population.

Evaluation of wet bulb globe temperature index for estimation of heat strain in hot/humid conditions in the Persian Gulf.

BACKGROUND: Heat exposure among construction workers in the Persian Gulf region is a serious hazard for health. The aim of this study was to evaluate the performance of wet bulb globe temperature (WBGT) Index for estimation of heat strain in hot/humid conditions by the use of Physiological Strain Index (PSI) as the gold standard. MATERIAL AND METHODS: This cross-sectional study was carried out on 71 workers of two Petrochemical Companies in South of Iran in 2010 summer. The WBGT index, heart rate, and aural temperature were measured by Heat Stress Monitor (Casella Microtherm WBGT), Heart Rate Monitor (Polar RS100), and Personal Heat Strain Monitor (Questemp II), respectively. The obtained data were analyzed with descriptive statistics and Pearson correlation analysis. RESULTS: The mean (SD) of WBGT values was 33.1 (2.7). The WBGT values exceed from American Conference of Governmental Industrial Hygienists (ACGIH) standard (30°C) in 96% work stations, whereas the PSI values were more than 5.0 (moderate strain) in 11% of workstations. The correlation between WBGT and PSI values was 0.61 (P = 0.001). When WBGT values were less and more than 34°C, the mean of PSI was 2.6 (low strain) and 5.2 (moderate strain), respectively. CONCLUSION: In the Persian Gulf weather, especially hot and humid in the summer months, due to the WBGT values exceeding 30°C (in 96% of cases) and weak correlation between WBGT and PSI, the work/rest cycles of WBGT Index is not suitable for heat stress management. Therefore, in Persian Gulf weather, heat stress evaluation based on physiologic variables may have higher validity than WBGT index.

The expression of Th1- and Th2-related chemokine receptors in women with recurrent miscarriage: the impact of lymphocyte immunotherapy.

PROBLEM: Recurrent miscarriage (RM) is defined as three or more consecutive pregnancy losses prior to the 20th week of gestation. The aim of this study was to investigate the expression of T helper (Th)1- and Th2-related chemokine receptors on CD4(+) T helper and CD8(+) T cytotoxic (Tc) cells in RM and control subjects. The effects of lymphocyte immunotherapy on the balance of Th1/Th2 and Tc1/Tc2 chemokine receptors were further evaluated in RM women. METHOD OF STUDY: The expression of Th1-related (CCR5 and CXCR3) and Th2-related (CCR3 and CCR4) chemokine receptors on CD4(+) or CD8(+) T cells from RM women were analyzed and compared with controls using flow cytometry. The expression of chemokine receptors in RM women was also compared before and after lymphocyte immunotherapy. RESULTS: The ratios of Th1/Th2 and Tc1/Tc2 chemokine receptors were higher in RM women compared to controls. The ratio of Th1/Th2 chemokine receptors was decreased in RM women after immunotherapy, while no significant change was identified in the Tc1/Tc2 after immunotherapy. CONCLUSION: This study indicates the Th1 dominant immune responses in circulation of RM women compared to controls. Moreover, lymphocyte immunotherapy might influence pregnancy outcome via a shift in the balance of the Th1/Th2 chemokine receptors.