A highly sensitive ion-selective chemiresistive sensor for online monitoring of lead ions in water.

Dissolved lead is a serious but common health hazard in drinking water, yet there is still no practical way to monitor its levels continuously in the distribution system or at the point of use. Here we propose using a lead-selective membrane on top of a chemiresistive device to continuously measure Pb2+ ion concentrations in real time. The detection limit was lowered by stabilizing the surface of the resistive film with sodium hydroxide and 15-crown-5 ether and optimizing the sensor geometry to maximize the effective surface area. The detection mechanism is based on the complexation of the Pb2+ ions by the lead ionophores within the membrane, thus modulating the interactions between the ionophores and the chemiresistive film. The limit of detection of the fabricated devices was reliably below 2 µg L-1, with concentrations up to 3 mg L-1 routinely quantifiable over several measurement cycles. The chemiresistive sensors can thus achieve lower detection limits than potentiometric devices while being more robust and simpler to fabricate by omitting the reference electrode. Ion-selective membrane-covered chemiresistors can therefore be deployed to continuously monitor drinking water sources and detect harmful levels of lead in real time.

The Effect of Hope Therapy on the Management of Hemodialysis Outcomes: A Review Article.

Hemodialysis can have specific adverse effects, so it's critical to minimize them by employing non-pharmacological techniques. This review's primary goal was to assess how hope therapy affected the treatment of hemodialysis patients. This review was conducted by analyzing the results of previous studies published between 1996 and 2023. We chose sixteen studies in consideration of the inclusion and exclusion criteria and by employing Medical Subject Headings (MeSH) terms to the literature discussed in international databases. The findings of the current study revealed that hope therapy can significantly reduce anxiety, stress, and depression and also considerably increase happiness, quality of life, and adherence to treatment in hemodialysis patients. In addition, effective interventions for improving hope in hemodialysis patients included spiritual counseling, spiritual therapy, stress management training, intervention based on disease perception, positive thinking training, and other similar methods. Based on the findings, we concluded that the caregivers of hemodialysis patients and their families must use other non-pharmacological methods, especially hope therapy, to reduce the adverse outcomes of hemodialysis.

Caregivers' concerns about the sexual and reproductive health of women with intellectual disability in Iran: a qualitative study.

BACKGROUND: Women with intellectual disability (ID) have many sexual and reproductive problems. This study was conducted to explain the sexual and reproductive health considerations of women with ID from the perspective of their caregivers in a qualitative approach. METHODS: This study was a qualitative research conducted with a content analysis approach in Iran. The sampling method used was targeted sampling with maximum possible variation, which was continued until data saturation. For data collection, in-depth and semi-structured interviews were conducted with 21 participants, including 8 mothers, 6 caregivers, and 7 specialist caregivers who had experience working with women with intellectual disabilities. Data analysis was conducted using the conventional content analysis method proposed by Zhang and Wildemuth. RESULTS: Two main themes, four categories and 12 subcategories emerged from the data analysis. The themes include "Reproductive health concerns" and" "Sexual health concerns". This means that this group of women has many problems with menstrual hygiene and vaginal infections. On the other hand, caregivers were concerned about the manifestations of unconventional sexual behaviors and difficulties in controlling sexual behaviors as well as the risk of sexual abuse. CONCLUSION: The results of the present study show that it is not only necessary to provide women with ID with practical instructions on menstrual hygiene and sexual self-care, but also that regular examinations of the reproductive system by obstetricians or midwives, especially in care centers, seem essential.

Women with intellectual disability, experience many sexual and reproductive problems. The results of previous studies have highlighted the problems related to menstrual hygiene, contraceptive choice, diagnosis and treatment of sexually transmitted diseases, and cancer screening among women with ID. women with intellectual disability are also more exposed to the risk of sexual abuse. In Iran, there are few studies on the sexual and reproductive health of this group, and there is little information in this regard. Therefore, we decided to conduct a study to investigate the sexual and reproductive problems of women with intellectual disability. For this purpose,we interviewed 21 mothers and caregivers who were directly responsible for the care of women with intellectual disability. The results of the study showed that women with intellectual disability have many problems related to menstrual hygiene and vaginal infections. Caregivers were also concerned about inappropriate sexual behaviors among women with intellectual disability and sexual abuse of these women. According to the caregivers, practical training of women with intellectual disability in menstrual hygiene and sexual self-care can help to reduce their sexual and reproductive problems. This training should be visual and repeated. To prevent vaginal infections, regular genital examinations by obstetricians or midwives are also important, especially in care centers.

Long-Term Major Adverse Cardiovascular Events in Patients with Moderate and Severe COVID-19: A Focus on Early Statin Use and Previous CVD.

Background: Limited data exist regarding the status of long-term cardiovascular disease (CVD) outcomes of hospitalized COVID-19 patients. We aimed to examine the efficacy of early statin use after SARS-CoV-2 pneumonia and the impact of prior CVD on the incidence of cardiovascular events. Methods: A prospective cohort study was performed on hospitalized COVID-19 patients. The primary endpoint was major adverse cardiovascular events (MACE) as a composite of cardiovascular mortality, stroke, heart failure, venous thromboembolism (VTE), revascularization, and nonfatal myocardial infarction (MI). The secondary endpoints comprised MACE components, all-cause mortality, readmission for COVID-19, and impaired functional classes. Results: The mean age of the 858 participants was 55.52±13.97 years, and the median follow-up time was 13 months (11.5-15). Men comprised 63.9% of the patients. Overall, MACE occurred in 84 subjects (9.8%), and 98 patients (11.4%) received ventilation. A multivariate Cox regression model was employed to explore the association between statin use and outcomes, and the following hazard ratios were obtained: MACE (0.831 [0.529 to 0.981]; P=0.044), All-cause mortality (1.098 [0.935 to 1.294]; P=0.255), stroke (0.118 [0.029 to 0.48]; P=0.003), revascularization (0.103 [0.029 to 0.367]; P<0.0001), poor functional capacity (0.827 [0.673 to 1.018]; P=0.073), nonfatal MI (0.599 [0.257 to 1.394]; P=0.234), VTE (0.376 [0.119 to 1.190]; P=0.096), and decompensated heart failure (0.137 [0.040 to 0.472]; P=0.002). Prior CVD predicted MACE (2.953 [1.393 to 6.271]; P=0.005), all-cause death (1.170 [0.960 to 1.412]; P=0.102), and VTE (2.770 [0.957 to 8.955]; P=0.051). Conclusion: Previous CVD is a robust predictor of long-term MACE and VTE. Early statin use might decrease the incidence rates of MACE, ischemic stroke, revascularization, and readmission for heart failure.

An ion-selective chemiresistive platform as demonstrated for the detection of nitrogen species in water.

The use of ion-selective electrodes (ISE) is a well-established technique for the detection of ions in aqueous solutions but requires the use of a reference electrode. Here, we introduce a platform of ion-selective chemiresistors for the detection of nitrogen species in water as an alternative method without the need for reference electrodes. Chemiresistors have a sensitive surface that is prone to damage during operation in aqueous solutions. By applying a layer of ion-selective membrane to the surface of the chemiresistive device, the surface becomes protected and highly selective. We demonstrate both anion-selective (NO3-, NO2-) and cation-selective (NH4+) membranes. The nitrate sensors are able to measure nitrate ions in a range of 2.2-220 ppm with a detection limit of 0.3 ppm. The nitrite sensors respond between 67 ppb and 67 ppm of nitrite ions (64 ppb detection limit). The ammonium sensors can measure ammonium concentrations in a wide range from 10 ppb to 100 ppm (0.5 ppb detection limit). The fast responses to nitrate and nitrite are due to a mechanism involving electrostatic gating repulsion between negative charge carriers of the film and anions while ammonium detection arises from two mechanisms based on electrostatic gating repulsion and adsorption of ammonium ions at the surface of the p-doped chemiresistive film. The adsorption phenomenon slows down the recovery time of the ammonium sensor. This sensor design is a new platform to continuously monitor ions in industrial, domestic, and environmental water resources by robust chemiresistive devices.

PTEN promoter methylation and expression in endometrial cancer tissues.

Introduction: Some gene expression regulation in cancers can be controlled by epigenetic change like methylation. PTEN promoter methylation and expression were evaluated in endometrial cancer. Methods: The study was run on 39 tumor tissues of endometrial cancer patients and 41 normal endometrial tissues. After total RNA extraction, cDNA synthesis was done by reverse transcription of the total (real-time PCR) using SYBER Green master mix. DNA extraction and bisulfite treatment were conducted and methylation was semiquantified by the methylation-sensitive high-resolution melting method. Finally, promoter methylation quantification of the total number of 25 tumors and 22 non-neoplastic tissues was done. Results: PTEN gene expression showed a significant decrease in endometrial cancer tissues. Promoter methylation was significantly lower in the non-neoplastic group (7.2; p < 0.001). In addition, PTEN promoter methylation was observed in 52.0% of tumor tissues compared with 13.6% in the non-neoplastic group (p = 0.06). There were no significant correlations between PTEN expression and methylation and clinicopathological features in endometrial cancer patients (p > 0.05). Conclusion: PTEN gene expression in endometrial cancer tissues decreased because of its promoter hypermethylation.

Abortion services during the COVID-19 pandemic: a systematic review.

Evidence suggests that COVID-19 may impair access to sexual and reproductive health services and safe abortion. The purpose of this systematic review was investigating the changes of abortion services in the COVID-19 pandemic era. We searched PubMed, Web of Science and Scopus for relevant studies published as of August 2021, using relevant keywords. RCT and non-original studies were excluded from the analysis and 17 studies of 151 included in our review. Requests to access medication abortion by telemedicine and demand for self-managed abortion were the main findings of identified studies. Women requested an abortion earlier in their pregnancy, and were satisfied with tele-abortion care due to its flexibility, and ongoing telephone support. Presenting telemedicine services without ultrasound has also been reported. Visits to clinics were reduced based on the severity of the restrictions, and abortion clinics had less revenue, more costs, and more changes in the work style of their healthcare providers. Telemedicine was reported safe, effective, acceptable, and empowering for women. Reasons for using tele-abortion were privacy, secrecy, comfort, using modern contraception, employing of women, distance from clinics, travel restrictions, lockdowns, fear of COVID-19, and political reasons (abortion prohibition). Complications of women using tele-abortion were pain, lack of psychological support, bleeding, and need to blood transfusions. The results of this study showed that using telemedicine and teleconsultations for medical abortion in the pandemic conditions may be extended after pandemic. Findings can be used by reproductive healthcare providers and policy makers to address the complications of abortion services.Trail registration This study is registered in PROSPERO with number CRD42021279042.

COVID-19 pandemic shocks the international community, especially health policymakers around the world. The most important consequence of this outbreak has been direct and indirect impacts on health service provisions in all parts of the health system, including sexual and reproductive health services. We reviewed numerous studies investigating healthcare related to abortion in the pandemic era that showed women had more requests to access medical abortion, more than surgical. They preferred self-managed abortion process by telemedicine. Presenting telemedicine services without ultrasound has also been reported. Visits to clinics were reduced, and this decrease was reported based on the severity of the restrictions. Abortion clinics had reduced revenue, increased costs, and changed work style of their healthcare providers. Reasons for using telemedicine were fear of COVID-19, travel restrictions, lockdowns, more privacy, secrecy, and comfort. Telemedicine was reported safe, effective, acceptable, satisfying, and empowering for women. Maternal complications using tele-abortion were pain, bleeding, and need to blood transfusions. These findings can be used by policy makers and reproductive healthcare providers to address the complications of abortion management.

Piperonylbutoxide as a Dubious Cause of Cardiac Manifestations in Pyrethroid Insecticide Poisoning; a Letter to Editor.

There is little evidence regarding pyrethroid poisoning manifesting with cardiac problems in the literature. Many authors, however, adopted that pyrethroids have a direct effect on heart tissue and can cause cardiotoxicity. Interestingly, no experimental studies have yet determined its mechanism of toxicity on cardiac muscle cells. This letter aims to describe the probable cause of clinical manifestations attributed to piperonylbutoxide, an ignored ingredient in pesticide poisoning, which is added to many pesticide products to increase their insecticidal potency. We think that cardiac manifestations in some cases of pyrethroid poisoning are due to the concomitant piperonylbutoxide toxicity and its possible effect on norepinephrine release from adrenal gland, which might explain changes in cardiac findings. Thus, it is necessary for all clinical toxicologists to determine suspicious ingredients when they are facing a doubtful manifestation.

Psychometric properties of the of the Persian version of the Coping Assessment for Bereavement and Loss Experiences (CABLE).

BACKGROUND AND AIM: The loss of a loved one through death is practically an inevitable part of the human experience. However, not all grieving people cope with this blow in the same way. One of the factors that may differentiate the grieving reactions of mourners in the face of this lesion is the strategies that the person uses in this situation to adapt and manage the situation. A valid and reliable tool is also needed to measure and evaluate coping strategies. The aim of this study was to translate and determine the characteristics of psychological tools for measuring coping with experiences of grief and loss (28 items) in people living in Tehran. MATERIALS AND METHODS: This is a methodological study with a descriptive cross-sectional design that after obtaining written permission from the original developer and according to the WHO protocol, the Persian version of the questionnaire was completed by 480 people who experienced mourn in Tehran in February 2021 to October 2021. Then, the Face validity, Content validity and Construct validity of questionnaire were assessed. Cronbach's alpha coefficient, McDonald's omega and Test-retest were used to determine the reliability. RESULTS: Cronbach's alpha for all items was 0.91 and intra-class correlation coefficient was 0.86, both of which indicate the reliability of the Persian version of the CABLE tool. Based on exploratory factor analysis, maximum likelihood (n = 260) and confirmatory factor analysis (n = 220) six factors were identified. Factors can explain 50% of the total variance observed. The model had an acceptable fit: GFI: 0.88, CFI: 0.96, IFI: 0.96, NFI: 0.92, PNFI: 0.82, RAMSEA: 0.058, CMIN / DF: 2.37 RMR: 0.056. Internal consistency and construct validity of the questionnaire were confirmed. CONCLUSION: The findings of the present study indicate that the Persian version of CABLE has the appropriate validity and reliability to assess the compliance with the experiences of grief and loss in Persian population.

USP7 and SET9 Expression in The Oligospermic Human Semen: A Case-Control Study.

BACKGROUND: Oligospermia is defined as a less than 15 million per milliliter sperm in each ejaculation of semen. Proper and complete spermatogenesis requires the expression of a large number of genes. As a result, stopping the expression of any of them may lead to disrupt the process of spermatogenesis. In order to understand the disorders of spermatogenesis, it is necessary to study expression of effective genes in the spermatogenesis process. Therefore, in the present study, USP7 and SET9 (SETD7) gene expression was examined in the healthy and oligospermic men. MATERIALS AND METHODS: In this case-control study, semen samples of individuals with normal sperm and oligospermia were collected from men who referred to the Roya Clinic (Qom, Iran) according to World Health Organization (WHO) parameters after obtaining consent. Then the expression of USP7 and SET9 genes in two groups was analyzed using quantitative polymerase chain reaction (qPCR). RESULTS: There was no difference forage between the healthy and oligospermic individuals (P=0.889). The data showed that, USP7 gene expression in the patients was 3.99 times higher than the control group (P<0.001). The expression of SET9 gene in the patient was 1.28 times less than the control group, which was not significant (P=0.231). The results indicated that USP7 gene expression was increased in the 84% of oligospermic individuals. CONCLUSION: The USP7 gene can be considered as one of the molecular markers in the development of oligospermia.

Comparison of Three-Month HIIT and CMT Effects on Left Ventricle Echocardiography Observations in Male Employees.

The present study aimed to identify changes in echocardiographic parameters before and after three-month high-intensity interval training (HIIT) and continuous moderate-intensity training (CMT) in male employees. For this purpose, using a convenience sampling method, 33 male employees of the Islamic Republic of Iran Army (office workers with a sedentary lifestyle) aged 30 through 40 were selected. Participants were divided into three groups of HIIT, CMT, and control (11 for each group) including all anthropometric data (body fat percentage, body mass index, height, weight, and VO2 max) with no history of chronic diseases, metabolic syndrome, confirmed heart disease or congenital heart defect, and hospitalization due to chronic diseases or consumption of medication affecting cardiovascular indicators. A one-way ANOVA was conducted to compare the groups. The results demonstrated that the end-systolic volumes (ESVs) (p < 0.01) and relative wall thickness (RWT) in the CMT group (p < 0.01) and the end-diastolic volumes (EDVs) (p < 0.01), stroke volumes (SVs) (p < 0.01), end-systolic and diastolic diameters (ESD, EDD) (p < 0.01), as well as the RWT and left ventricle diastolic function (E/A ratio) in the HIIT group (p < 0.05) were significantly different before and after the 12-week training (Bonferroni correction was used for pairwise comparisons). The results revealed a significant increase in the end-systolic diameters (ESDs) of the HIIT group, whereas no such increase was observed in the ESDs of the CMT group (p < 0.51). Moreover, a significant increase was observed in left ventricular (LV) RWT and aerobic power of both training groups. The significant decrease of ESVs and the significant increase in E/A ratio, ESDs, EDDs following HIIT (two to three sessions per week) may indicate beneficial and optimal LV structural adaptations and improved LV function in nonathletes (even with a sedentary lifestyle).

Patient safety friendly hospital standards and customer orientation among Iranian nurses during the COVID-19 pandemic.

BACKGROUND: The quality of health services is determined on the basis of meeting customers' needs and expectations. Due to the COVID-19 pandemic, health systems have faced high degrees of uncertainty as well as a variety of challenges. Thus, this study aimed to investigate the relationship between patient safety friendly hospital standards and customer orientation among Iranian nurses during the COVID-19 pandemic. METHODS: This cross-sectional, descriptive-analytical study was conducted on 266 nurses working in Imam Khomeini Hospital, Tehran, Iran selected via stratified sampling in 2020. The study data were collected using a questionnaire including demographic information, patient safety friendly hospital initiatives, and Kim's customer orientation scale. Then, the data were entered into the SPSS V.16 software and were analysed using descriptive statistics, dispersion indices and correlation tests. RESULTS: The mean age and mean duration of working as a nurse were 38.60+7.94 and 13.87+7.41 years, respectively. From the nurses' perspective, the means of patient safety friendly hospital standards and customer orientation were 97.35±16.59 and 16.40±2.62, respectively, both of which were at the moderate level. In addition, patient safety friendly hospital standards and all its dimensions were positively correlated to customer orientation (p<0.001). CONCLUSION: From the nurses' viewpoint, the patient safety friendly hospital standards and customer orientation were both at the moderate level during the COVID-19 pandemic. In addition, patient safety friendly hospital standards and all its dimensions were significantly associated with customer orientation. In other words, increase in the patient safety friendly hospital standards was accompanied by an increase in the nurses' customer orientation. These results can provide the organisations delivering health services with the opportunity for management on the basis of multicriteria decision making so as to adapt with the patient safety friendly hospital standards and to internalise customer orientation among nurses.

Development and psychometric evaluation of Sexual and Reproductive Health Assessment Scale for women with educable intellectual disability (SRH-WIDS): a sequential exploratory mixed-method study.

BACKGROUND: Women with Intellectual disability have many problems in their sexual and reproductive health due to their special mental and physical conditions caused by disability. This study aimed to develop and evaluate the psychometric properties of Sexual and Reproductive Health Scale for Women with Educable Intellectual disability. METHODS: This sequential exploratory mixed-method study was conducted at two qualitative and quantitative stages in Tehran, from 2018 to 2020. At the qualitative stage, in-depth and semi-structured interviews were conducted with 21 parents and caregivers of women with intellectual disability to explain the concepts and to generate items. Thereafter, the item pool was formed based on the concepts and themes extracted from the qualitative phase as well as the review of literature. At the second stage, psychometric properties of the scale were assessed. Finally, responsiveness, interpretability, and feasibility of the scale were determined. RESULTS: An item pool containing 95 items was produced at the first stage. At the second stage, the final version of scale was developed. The psychometric properties of this final version were then assessed and the results showed that the instrument has good validity and reliability. The results of exploratory factory analysis showed that the instrument contains seven factors. Accordingly, these factors explained 53% of the total variance of the instrument variables. CONCLUSIONS: The results show that the SRH-WIDS with 25 items has sufficient validity and reliability, so it could be easily used by caregivers to assess the sexual and reproductive health of Women with Educable Intellectual disability. Ethical code: IRI.TUMS.VCR.REC 1397.340.

Tuning the Chemical and Mechanical Properties of Conductive MoS2 Thin Films by Surface Modification with Aryl Diazonium Salts.

Molybdenum disulfide (MoS2) is a promising material for applications in sensors, energy storage, energy conversion devices, solar cells, and fuel cells. Because many of those applications require conductive materials, we recently developed a method for preparing a conductive form of MoS2 (c-MoS2) using dilute aqueous hydrogen peroxide in a simple and safe way. Here, we investigate modulating the chemical and mechanical surface properties of c-MoS2 thin films using diazonium chemistry. In addition to a direct passivation strategy of c-MoS2 with diazonium salts for electron-withdrawing groups, we also propose a novel in situ synthetic pathway for modification with electron-donating groups. The obtained results are examined by Raman spectroscopy and X-ray photoelectron spectroscopy. The degree of surface passivation of pristine and functionalized c-MoS2 films was tested by exposing them to aqueous solutions of different metal cations (Fe2+, Zn2+, Cu2+, and Co2+) and detecting the chemiresistive response. While pristine films were found to interact with several of the cations, modified films did not. We propose that a surface charge transfer mechanism is responsible for the chemiresistive response of the pristine films, while both modification routes succeeded at complete surface passivation. Functionalization was also found to lower the coefficient of friction for semiconducting 2H-MoS2, while all conductive materials (modified or not) also had lower coefficients of friction. This opens up a pathway to a palette of dry lubricant materials with improved chemical stability and tunable conductivity. Thus, both in situ and direct diazonium chemistries are powerful tools for tuning chemical and mechanical properties of conductive MoS2 for new devices and lubricants based on conductive MoS2.

Experiences of health care providers on pregnancy and childbirth care during the COVID-19 pandemic in Iran: a phenomenological study.

BACKGROUND: Coronavirus currently cause a lot of pressure on the health system. Accordingly, many changes occurred in the way of providing health care, including pregnancy and childbirth care. To our knowledge, no studies on experiences of maternity care Providers during the COVID-19 Pandemic have been published in Iran. We aimed to discover their experiences on pregnancy and childbirth care during the current COVID-19 pandemic. METHODS: This study was a qualitative research performed with a descriptive phenomenological approach. The used sampling method was purposive sampling by taking the maximum variation possible into account, which continued until data saturation. Accordingly, in-depth and semi-structured interviews were conducted by including 12 participants, as 4 gynecologists, 6 midwives working in the hospitals and private offices, and 2 midwives working in the health centers. Data were analyzed using Colaizzi's seven stage method with MAXQDA10 software. RESULTS: Data analysis led to the extraction of 3 themes, 9 categories, and 25 subcategories. The themes were as follows: "Fear of Disease", "Burnout", and "Lessons Learned from the COVID-19 Pandemic", respectively. CONCLUSIONS: Maternal health care providers experience emotional and psychological stress and work challenges during the current COVID-19 pandemic. Therefore, comprehensive support should be provided for the protection of their physical and mental health statuses. By working as a team, utilizing the capacity of telemedicine to care and follow up mothers, and providing maternity care at home, some emerged challenges to maternal care services can be overcome.

Investigation of TGF-ß1 gene variant and expression in a group of Iranian women with endometriosis.

PURPOSE: Endometriosis is defined as a common gynecologic and inflammatory disease. Transforming growth factor-beta 1 (TGF-ß1) gene and its protein level might play a role in the pathogenesis of endometriosis. The present study aimed for the first time to assess the associations between endometriosis risk and - 509 C/T (rs1800469) variant of the TGF-ß1 gene as well as TGF-ß1 mRNA expression in eutopic endometrium tissue of patients with and without endometriosis among a group of Iranian women. METHODS: Genotyping was carried out in 100 endometriosis patients (cases) with confirmed histological diagnosis of endometriosis and 197 non-endometriosis subjects (controls). The expression level of TGF-ß1 mRNA was determined using Real-Time PCR assay in 15 eutopic endometrium tissue of women with endometriosis and 15 healthy controls. RESULTS: There was a significant association for allele and genotype frequencies of rs1800469 variant and endometriosis. No significant difference for TGF-ß1 expression was observed between eutopic endometrium of patients and healthy group. Also, evaluation of TGF-ß1expression across the menstrual cycle showed the same level of TGF-ß1 among case and control subjects. CONCLUSION: Our investigations indicated enough evidence for the effect of TGF-ß1 genetic variant on endometriosis risk in an Iranian population. Furthermore, we could not find any relations between TGF-ß1 mRNA expression and susceptibility to endometriosis.

Mid-term (up to 12 years) clinical and echocardiographic outcomes of percutaneous transvenous mitral commissurotomy in patients with rheumatic mitral stenosis.

BACKGROUND: Rheumatic heart disease (RHD) is still a concerning issue in developing countries. Among delayed RHD presentations, rheumatic mitral valve stenosis (MS) remains a prevalent finding. Percutaneous transvenous mitral commissurotomy (PTMC) is the intervention of choice for severe mitral stenosis (MS). We aimed to assess the mid-term outcome of PTMC in patients with immediate success. METHODS: In this retrospective cohort study, out of 220 patients who had undergone successful PTMC between 2006 and 2018, the clinical course of 186 patients could be successfully followed. Cardiac-related death, undergoing a second PTMC or mitral valve replacement (MVR) were considered adverse cardiac events for the purpose of this study. In order to find significant factors related to adverse cardiac outcomes, peri-procedural data for the studied patients were collected.The patients were also contacted to find out their current clinical status and whether they had continued secondary antibiotic prophylaxis regimen or not. Those who had not suffered from the adverse cardiac events were additionally asked to undergo echocardiographic imaging, in order to assess the prevalence of mitral valve restenosis, defined as mitral valve area (MVA) < 1.5 cm2 and loss of ≥ 50% of initial area gain. RESULTS: During the mean follow-up time of 5.69 ± 3.24 years, 31 patients (16.6% of patients) had suffered from adverse cardiac events. Atrial fibrillation rhythm (p = 0.003, HR = 3.659), Wilkins echocardiographic score > 8 (p = 0.028, HR = 2.320) and higher pre-procedural systolic pulmonary arterial pressure (p = 0.021, HR = 1.031) were three independent predictors of adverse events and immediate post-PTMC mitral valve area (IMVA) ≥ 2 cm2 (p < 0.001, HR = 0.06) was the significant predictor of event-free outcome. Additionally, follow-up echocardiographic imaging detected mitral restenosis in 44 patients (23.6% of all patients). The only statistically significant protective factor against restenosis was again IMVA ≥ 2 cm2 (p = 0.001, OR = 0.240). CONCLUSION: The mid-term results of PTMC are multifactorial and may be influenced by heterogeneous peri-procedural determinants. IMVA had a great impact on the long-term success of this procedure. Continuing secondary antibiotic prophylaxis was not a protective factor against adverse cardiac events in this study. (clinicaltrial.gov registration: NCT04112108).

The Effect of Vitamin D Deficiency on Overgrowth of Uterine Fibroids: A Blinded Randomized Clinical Trial.

BACKGROUND: To evaluate the effects of vitamin D (vitD) supplement on uterine fibroid growth. MATERIALS AND METHODS: A randomized blinded clinical trial was conducted at a tertiary university-based hospital from August 2017 to September 2018. Totally, 204 women were enrolled into the study. They had at least one uterine fibroid >10 mm on transvaginal ultrasound and their vitD level was insufficient (i.e. 20-30 ng/ml). The intervention group was treated with vitD 50000 U supplements for two months. After 2 months, ultrasound screening and vitD level measurement was done in both groups. RESULTS: At first, the mean serum vitD levels in intervention and control group were 23.62 and 23.20 ng/ml, respectively. After 8 weeks, the mean serum vitD levels in the control and intervention group were 22.72 and 28.56 ng/ml respectively (P<0.05). Also, mean fibroma diameter in the intervention group before and after 8 weeks of vitD supplementation was 43 ± 4.68 and 42.6 ± 1.31 mm, respectively. Mean uterine fibroid diameter in the control group which did not receive vitD supplements, before and after 8 weeks was 41.98 ± 5.25 and 47.81 ± 3.42 mm, respectively. The variation in the mean size of the uterine fibroid between the control and intervention group which was respectively about 5.83 mm increase and 0.48 mm decrease, was significant (P<0.001). CONCLUSION: Our results showed that vitD supplementation prevents fibroid growth. It seems that vitD supplement is a simple, safe and inexpensive modality for leiomyoma growth prevention (Registration number: IRCT201703122576N15).

Investigating the association of matrix metalloproteinase-2 gene variants with endometriosis in an Iranian population.

OBJECTIVES: matrix metalloproteinases including matrix metalloproteinase-2 play a key role in endometrial extra cellular matrix breakdown in endometriosis. Aberrant expression of matrix metalloproteinase-2 has been reported in eutopic and ectopic endometrial tissue of endometriosis patients so altered expression of matrix metalloproteinase-2 due to polymorphisms may lead to establishment and progression of endometriosis. In this study the association between -735 C/T (rs2285053) and -1575 G/A (rs243866) variants of matrix metalloproteinase-2 gene with presence of endometriosis in an Iranian population were investigated for the first time. STUDY DESIGN: A case-control association study was conducted to investigate the role of MMP-2-735 C/T and _1575 G/A variants in development of endometriosis. Polymerase chain reaction-restriction fragment length polymorphism method was used to determine genotype frequencies of these variants in 100 endometriosis patients and 200 normal samples. Total genomic DNA was extracted from blood samples and single-nucleotide polymorphism flanking regions were amplified using designed specific primers. Enzymatic digestion was performed using Pag I and Hinf I restriction enzymes for rs2285053 and rs243866 variants, respectively. Statistical analysis was ascertained using statistical package for social science version 16 and "SHEsis" software. RESULTS: There were no significant differences in genotype frequencies of rs2285035 (-735C/T) variant between case and control groups (CC + CT vs. TT p = 0.40; OR = 0.50, 95 % CI 0.100-2.551). There were also no significant differences for C allele frequencies in both case and control groups (p = 0.9). For variant rs243866 (-1575 G/A) the differences in genotype frequencies between case and controls group were determined to be significant (GG + GA vs. AA p = 0.041; OR = 6.46, 95 % CI 0.82-50.43). The frequency of G allele was significantly different in case and control groups (p = 0.037). CONCLUSION: In conclusion, existence of rs243866 variant in promoter region of matrix metalloproteinase-2 gene can increase the risk of endometriosis in Iranian women.

Alendronate slows down aortic stenosis progression in osteoporotic patients: An observational prospective study.

BACKGROUND: Aortic stenosis (AS) is the most common primary valvular disease. Currently, there is no pharmacological approach for the medical management of AS. We investigated the effect of osteoporosis therapy with alendronate on hemodynamic progression in patients concurrently affected by AS and osteoporosis. MATERIALS AND METHODS: In this observational prospective study, we enrolled 37 women more than 60 years old with diagnosis of AS and concurrent osteoporosis from August 2017 to December 2019. These patients were treated with alendronate 70 mg every week added to their routine treatment for AS, and their outcomes were compared with 33 patients only affected by AS. Echocardiographic changes and N-terminal-prohormone of brain natriuretic peptide (NT-pro-BNP) level were evaluated during about 2 years of follow-up. RESULTS: The mean follow-up time for the treated and nontreated groups was 20.89 ± 2.73 and 20.84 ± 2.76 months, respectively. Mean gradient (P = 0.02) and peak gradient (P = 0.04) of aortic valve were significantly different between the groups after follow-up. Aortic valve area was decreased 0.09 cm2 in the treated group by alendronate and 0.23 cm2 in the other group (P = 0.001). Furthermore, NT-pro-BNP was significantly decreased in patients treated by alendronate (P = 0.01), but it was increased in nontreated patients (P = 0.04). CONCLUSION: Treatment with alendronate in patients with AS and concurrent osteoporosis slows down the progression of stenosis and improves their prognosis. This study could open a new pathway for the treatment of AS. Further studies, particularly randomized controlled clinical trial, should be done for providing more evidence.