maryam montazeri

Background and

The occurrence of medical errors in healthcare centers is highly significant due to the sensitive nature of providing care and saving patients' lives. Failure to report such errors can result in both financial and moral harm to patients and have adverse effects on the healthcare system. Medical errors have significant clinical and economic consequences and can influence mortality rates. Despite the wide range of medical errors in healthcare delivery, the errors committed by medical staff—due to the close care relationship between them and the patient—are among the most complex issues in the management of treatment systems. Therefore, the purpose of this study was to explore the causes of non-reporting of medical errors in hospitals and methods of encouraging the reporting of such errors.

This qualitative study was conducted using semi-structured, in-depth individual interviews with a conventional content analysis approach. The goal was to identify the factors contributing to the non-reporting of medical errors in 1402 (Iranian calendar year). The study population included doctors, specialists, and providers actively involved in patient safety in the hospital. In other words, individuals with knowledge and valuable experience in this area were interviewed. Data collection was conducted using a semi-structured questionnaire, designed by reviewing the literature and with the assistance of expert professors for the interviews. Sampling was performed purposefully until data saturation was reached. Data saturation was achieved after interviewing 22 experts. After the interviews, items and sub-items were identified through content analysis.

Key factors contributing to the failure to report medical errors were identified in two themes, six categories, and 45 items. The extracted themes included organizational and management factors, as well as legal issues. Organizational and management factors encompassed organizational culture, communication, reporting, and monitoring, while legal factors involved the consequences of reporting and control mechanisms. In total, 38 solutions were proposed to encourage the reporting of medical errors. The experts' suggestions for strategies to promote error reporting were identified under two themes, six categories, and 38 items. The themes included organizational and management factors and legal issues. Organizational and management factors covered organizational culture, the reporting process, monitoring, and communication, while legal factors involved the consequences of reporting and control.

Errors in medical procedures may occur due to the inherent nature and sensitivity of these procedures. However, it is essential that medical staff consider themselves obligated to minimize errors and reduce harm to patients. Studying the causes of non-reporting of medical errors and understanding the underlying reasons are critical for improving patient safety and the quality of healthcare services. This knowledge can assist policymakers and healthcare practitioners in making informed decisions about error reporting and in delivering higher-quality services to the public. Additionally, it is important to train medical teams on the various types of errors and how to appropriately address them.

Sexual function significantly affects the quality of life in women with premature ovarian insufficiency (POI). This study aimed to identify predictors of sexual function considering psychological and socio-demographic factors.

The study was conducted in Tabriz, 2021, with 130 women who had POI. Data were collected using the female sexual function index (FSFI), perceived stress scale (PSS), Spielberger state-trait anxiety inventory (STAI), Rosenberg self-esteem scale (RSES), Beck depression scale (BDI), and socio-demographic characteristics questionnaire. The Pearson correlation test was used to determine the correlation between psychological variables and the total sexual function score. Additionally, the general linear model was used to identify the predictors of sexual function.

 The mean (SD) score of sexual function was 13.8 (6.7). There was a significant negative correlation between stress (r=-0.22, p=0.018), state anxiety (r =-0.13, p=0.153), trait anxiety (r=-0.26, p=0.005), depression (r=-0.39, p<0.001) with total sexual function score. On the other hand, self-esteem had a positive correlation (r= 0.34, p<0.001) with sexual function score. Moreover, variables such as desire to pregnancy and type of pregnancy were predictors of sexual function. Sexual function score was significantly higher in women who wanted to become pregnant than in ones who did not (p=0.012) and in women who became pregnant naturally than in women who became pregnant through assisted reproductive techniques (ART) (p=0.002).

The study findings indicate that the sexual function of women with POI is influenced not only by psychological factors but also by their desire to become pregnant and the type of pregnancy they have. Given the intricate interplay between psychological and physical factors and sexual function among infertile women, further research is warranted in this area.

Breast cancer is one of the common malignancies in women, for which doxorubicin (DOX) is widely used in its chemotherapy. Recently, it has been found that DOX affects the expression profile of oncogene genes and miRNAs. In this study, the impacts of DOX on the expressions of the STAT3 gene, miR-874-3p, and miR-337-3p were studied in the MCF-7 breast cancer cell line.

After exposure of MCF-7 cells with DOX, the MTT method was applied for evaluating the cell viability. Apoptosis and necrosis percentages were measured using flow cytometry. Also, the levels of ROS and NF-κB were measured in DOX-treated cells. Then, exosomes secreted from these cells were prepared. The shape of exosomes was studied by SEM. Finally, the expression of bax, bcl-2, p53, casp3, STAT3 gene, and miR-874-3p and miR-337-3p in MCF-7 cells as well as exosomes were evaluated using the RT-PCR technique. Data analysis was done by T-test in GraphPad Prism8 software.

The exposure of MCF-7 cells to doxorubicin led to a concentration-dependent decrease in cell viability and increases in apoptosis and necrosis. ROS and NF-κB activity were increased in DOX-treated cells. In DOX-treated cells, decreased expressions of bcl-2 and STAT3 genes and overexpression of bax, p53, casp3, miR-874-3p, and miR-337-3p were observed compared to untreated control cells.

One of the mechanisms of the anti-breast cancer effects of DOX is the induction of changes in the expression of oncogenic genes, mediating by downregulating of STAT3 gene and overexpressing miR-874-3p and miR-337-3p. More studies are needed in this field.

Developing potent therapeutic vaccines against human papillomaviruses (HPVs) is crucial for the effective management of various HPV-associated cancers. DNA-based vaccines are attractive due to their safety, stability, and capacity to elicit a targeted immune response against specific antigens. Heat shock proteins (HSPs) can enhance the efficacy of DNA vaccines when used as adjuvants. In this study, we created a recombinant DNA molecule by fusing the HPV16 e7 gene with either the hspB1 or hsp27 gene and assessed its expression in a eukaryotic cell line.

Initially, we constructed a recombinant eukaryotic expression vector by inserting the hsp27-e7 fusion gene into the pcDNA3.1 (-) vector. The concentration and purity of the sample were evaluated using NanoDrop spectrophotometry. We cultured human embryonic kidney 293T (HEK-293T) cells in RPMI 1640 medium and transfected them with the pcDNA3.1-hsp27-e7 construct using Lipofectamine 2000 transfection reagent. After 48 hours, we assessed the expression of the Hsp27-E7 fusion protein by western blotting using an anti-E7 monoclonal antibody.

We successfully subcloned the hsp27-e7 fusion gene into the pcDNA3.1 (-) vector, and enzymatic digestion confirmed a distinct ~975 bp band on an agarose gel. The concentration and purity of the recombinant DNA vector in a 10 mL culture were measured to be 210 ng/µL and 1.86, respectively. Furthermore, the expression of the Hsp27-E7 fusion protein in HEK-293T cells was confirmed by Western blot analysis, which detected a distinct band of approximately 38 kDa.

Our in vitro findings demonstrate successful expression of the DNA construct encoding the hsp27-e7 gene, which can be utilized as a DNA vaccine for future in vivo investigations.

Secondary hyperparathyroidism is prevalent among hemodialysis patients associated with vascular and skeletal complications. Thus, treatment is required, specially before kidney transplantation.

This study aimed to compare the efficacy of calcitriol and cinacalcet versus standard-dose calcitriol in treating severe secondary hyperparathyroidism in hemodialysis patients.

This randomized clinical trial was conducted on 70 hemodialysis patients with severe secondary hyperparathyroidism who were randomly allocated to two intervention groups. Group A received calcitriol 1mg PO every other night, and group B took calcitriol 1mg PO every other night and cinacalcet 30mg PO daily. The improvement of laboratory parameters was investigated 3 and 6 months after the intervention.

There was no significant difference between the two groups regarding age, sex, body mass index, and duration of dialysis (P > 0.05). In group A, serum levels of calcium (P < 0.001) and parathyroid hormone (PTH) (P < 0.001) were significantly reduced comparedto baseline. However, phosphorus (P=0.175)andalbumin (P=0.143)serumlevelsshowednosignificant changes. In group B, calcium (P = 0.001), PTH (P < 0.001), and serum phosphorus (P < 0.001) levels were significantly decreased after the intervention. Nevertheless, serum albumin levels showed no significant changes from baseline (P = 0.061). Changes in serum phosphorus (P < 0.001) and PTH levels (P < 0.001) were significantly different between the groups. However, changes in serum calcium (P = 0.062) and albumin levels (P = 0.773) were not significantly different (Wilcoxon signed-rank test).

The results of this study showed that treatment with cinacalcet and calcitriol was more effective than calcitriol alone without any side effects.

 Functional electrical stimulation (FES) is a promising technique for rehabilitation and increasing the level of movement in paraplegic subjects. In this method, the movement in the hindlimbs can be restored by controlling the electrical current pulses and stimulating the intraspinal motor neurons or muscular fibers below the spinal lesion. In FES, functional control signals are received from a controller that creates a motor function for the paraplegic subject. By changing the pulse width or pulse amplitude of the current pulses (control input), the level of the contraction for generating the functional movement of the hindlimb joints can be altered. The electrodes are inserted into the spinal cord to stimulate the desired movement by stimulating the flexor and extensor muscles and motor neurons connected to the desired joint. Therefore, the superposition of torque in flexor and extensor muscles is applied to the musculoskeletal system and joint moves.

 In FES, a model of the musculoskeletal system that acts on simultaneous movement of the hip and knee joints (multi–joint) is used as the virtual patient. In general, the skeletal segment of the model consists of a planar swinging pendulum model of a two–link rigid robotic manipulator with nonlinear constraints on the hip and knee joint movements. A biarticular model of six muscles is used to generate the torques of the skeletal part of the model. Four muscles are considered for flexing and extending the hip and knee joints (one for flexing the joint and one for extending), and two biarticular muscles work on flexing the hip (knee) joint and extending the knee (hip) joint synergically. On the other hand, excellent tracking performance can be obtained with high precision, and the controllers can automatically switch between control inputs and the muscles by regulating the stimulation pulse width. The stimulation pulse width of muscles is continuous, nonsingular, with low chattering. The model dynamics can be assumed unknown and identified online without the controller's requirement for offline calibration. The controller robustly and rapidly switched the activation between the muscles to track the desired trajectory of the knee and hip joint. Various control methods, such as combining fuzzy adaptive or neural networks with classic sliding mode control, have generated FES control signals. Such hybrid methods have led to the chattering phenomenon, the control signal's singularity, and the controller's low speed outside and on the sliding surface.

 Rehabilitation movement in paralyzed limbs of paraplegic subjects based on FES in their muscles is associated with problems such as reflection in the spinal cord and unwanted movements, joint disturbances, fatigue, etc.

 The controller could automatically regulate the stimulation pulse width without considering the effect of the applied ground reaction force so that, by switching between muscles synergically, excellent tracking results were obtained in the presence of external unit step disturbance and muscle fatigue. The major challenges for developing an appropriate control method for stimulating paralyzed limbs include high–order nonlinear and time–varying properties of the neuromusculoskeletal system, spasms, and muscle fatigue. These drawbacks limit using prespecified stimulation patterns and open–loop control systems in the FES application.

The pharmacological approach of abortion is a safe and effective alternative to surgical procedures that is associated with a high level of patient's satisfaction. The present study was performed with aim to evaluate the effect of misoprostol with and without letrozole in the treatment of successful medical abortion and its relationship with BHCG titration level and cervical length.

This two-group randomized clinical trial study was performed in 2021 on 168 pregnant women under 18 weeks of gestation who were candidates for termination of pregnancy. The patients were randomly divided into two groups: A (misoprostol and letrozole) and B (misoprostol and placebo). Initial tests, βHCG titration, ultrasound and cervical length were performed for all patients on the first day of hospitalization. After receiving the drug, all patients underwent ultrasound on the fifth day to evaluate complete abortion and removal of pregnancy residues. Data were analyzed by SPSS software (version 22) and Chi-square, independent t and logistic regression tests. P<0.05 was considered statistically significant.

The results showed that misoprostol + letrozole had a more successful abortion rate than misoprostol + placebo (88.1% vs. 59.5%). Increased cervical length was associated with a higher probability of miscarriage (P <0.001), while BHCG titration did not show a predictive role in induction of abortion (p>0.05).

Adding letrozole to misoprostol for inducing abortion leads to an increase in the percentage of successful abortion and a reduction in the use of curettage.

Nursing is a care profession and nurses, due to their professional nature, need moral courage to provide safe and professional care to clients. On the other hand, one of the needs of nursing education is to improve the professional ethics skills of nurses in order to provide nursing care based on professional standards and ultimately to ensure proper clinical care. Therefore, this study was conducted to investigate the relationship between clinical competence and moral courage of nurses working in the intensive care units' hospitals of Tehran University of Medical Sciences at 2020.

This multicenter Cross-sectional Study was conducted on 350 nurses working in the intensive care units' hospitals of Tehran hospitals who were selected by quota method. The data collection tools of the study included demographic questionnaire, clinical competency questionnaire of intensive care unit nurses and moral courage questionnaire of Sekerka et al.

The mean scores of total moral courage and clinical competence in intensive care unit nurses were 74.24±12.22 and 155.10±23.37, respectively. There is a strong and significant direct relationship between moral courage and clinical competence of nurses (r=0.81 and p=0.001). Clinical competence in nurses with more work experience, older, working in the morning and day shifts and with formal and contract employment status was significantly higher than other nurses (p<0.001). Also, moral courage in male nurses, married, with more work experience, older, working in the morning and day shifts and with formal and contract employment status was significantly higher than other nurses (p<0.001).

According to the results of the present study, moral courage increases with increasing the clinical competence of nurses. Therefore, it requires the attention of as many officials as possible in this regard.

Aortic arch calcification (AAC) is very common in hemodialysis patients and is associated with cardiovascular events and the incidence of arteriovenous fistula (AVF) failure. In order to predict the prognosis of patients, a study was conducted to determine the annual failure rate of AVF and its related factors.

This cross-sectional study was performed on 145 patients with end-stage renal disease (ESRD) who were AVF candidates, visiting a referral center in Golestan province of Iran. After the insertion of intravenous arterial fistulas, posterior-anterior chest x-rays were captured, and the grafts were classified by a radiologist. Patients were followed for one year, and the rates of fistula failure (FF) and cardiovascular mortality were recorded. Finally, the data were entered into SPSS 19 software and analyzed by the Chi-square test.

Of 112 patients followed up for one year, 56.2% were men. During the one-year follow-up period, 5.3% of the patients developed arteriovenous FF, and this event was more common in men, but the difference was not statistically significant. The majority of the AVF candidates had a history of diabetes and hypertension, but no association was found between the one-year FF rate and these two diseases. Nearly 7.7% of the patients had grade III calcification, but no significant relationship was observed between the AAC grade and AVF failure rate.

The rate of one-year FF was higher among ESRD patients with a history of chronic kidney diseases. Our results also demonstrated that the mortality rate is higher in patients with a high degree of AAC and patients with medical history (cardiovascular disease and diabetes).

Diabetes mellitus, like any other chronic and debilitating illness, causes the person with the disease, especially children and adolescents, to experience problems that affect all aspects of the daily life of the individual. This study aimed to evaluate the effectiveness of cognitive-behavioral therapy on insulin induced anxiety in children and adolescents with type 1 diabetes. The research design was quasi-experimental with a pre-test-post-test design with the control group and a follow-up stage of 1.5 months. The statistical population of the study included all children and adolescents aged 8 to 13 years with type 1 diabetes in Isfahan province. Twenty-five subjects was selected by purposive sampling method and randomly divided into experimental (10) and control (15) groups. The case group received cognitive-behavioral therapy during the eight sessions of 45 minutes, and the control group did not receive any specific treatment during this period. Elliott et al.'s (1987) Observational Scale of Behavioral Distress Questionnaire was completed by mothers of children and adolescents in three stages: pre-test, post-test, and follow-up. Data were analyzed using repeated measure analysis. A significant reduction of insulin-induced anxiety in the case group compared to the control group was observed in the post-test phase. (P <0.01). The results of follow-up also showed that the effect of treatment lasted over time. Therefore, Cognitive-behavioral therapy was considered an effective intervention in reducing insulin-induced anxiety in children with type 1 diabetes mellitus. So, it is recommended that endocrinologists and diabetes associations include psychological interventions, including cognitive-behavioral therapy, in the care program of children with diabetes.

Diabetes is a metabolic disease that disrupts metabolism of sugars and fats in the body. The aim of present study was to investigate the effect of isatin-schiff base derivatives on blood glucose and lipid levels in streptozotocin-induced type II diabetic rats.

Drugs (insulin, glibenclamide, Schiff base I and Schiff base II) were injected intraperitoneally for 14 days. After 14 days, blood samples were taken from all groups and blood glucose and lipid profiles were measured.

Streptozotocin injection significantly increased blood sugar, triglyceride, cholesterol and LDL, but significantly decreased blood HDL compared to the control group. Also, injection of insulin, glibenclamide, Schiff base I and different doses of Schiff base II (for 14 days) in the diabetic group significantly reduced blood sugar, triglycerides, cholesterol and LDL, but significantly increased blood HDL compared to the sham diabetic group. Injection of the lowest dose of Schiff base II (25 mg/kg) with glibenclamide (5 mg/kg) significantly reduced blood sugar compared to the control or glibenclamide group, but had no significant effect on triglyceride, cholesterol, HDL and LDL compared to the control, insulin or glibenclamide groups.

These results indicate that the derivatives of E)) - 3- (H1-imidazole-4-yl) -2 - ((2-oxindolin-3-ylidine) amino) propanoic acid may be effective in the treatment of diabetes. The effect of Schiff base I and Schiff base II are probably due to the presence of isatin or imidazole ring and their antioxidant properties.

Introduction:

 There is a mutual relationship between hypertension and renal failure, so that hypertension can be considered as a common finding in patients with end-stage renal disorders. Patients with persistent hypertension despite multiple medications are at high risk for adverse cardiovascular and kidney events. Some studies suggest that there is a correlation between RI and renal function in kidney diseases. Therefore, we conducted a study to investigate the relationship between renal arterial resistive index (RRI) and renal outcomes in patients with resistant hypertension.

Methods:

 This 2-years cross-sectional study was performed on patients with resistant hypertension. All patients undergo GFR, serum Cr and urine Alb tests. Then Doppler ultrasound was performed by a radiologist to measure RRI and was evaluated for the relationship between RRI and renal function.

 Among 133 patients with resistant hypertension, 57.5% were male and the rest were female. Average age of participants and average RI were 48.26 ± 16.90 and 0.63 ± 0.80, respectively. There was no significant relationship between RI and gender (P > .05). Relationship between RI index with age, GFR, serum creatinine level, and albuminuria was significant in all cases (P < .05). Patients were divided into two groups with RI ≥ 0.7 and RI less than 0.7. Results showed a significant increase in serum creatinine and urinary albumin excretion in group with RI ≥ 0.7 (P < .05), while age, protein exertion level, and GFR in the two groups were not statistically significant (P > .05), despite the difference in the mean. Results of analysis of difference in the mean RI in 3 groups (macro-, micro-, normo- albuminuria) showed no significant difference between them (P > .05).

Conclusion:

These data demonstrate the clinical importance of renal Doppler that may be an effective way to evaluate the prognosis of renal involvement in resistant hypertension.

Silica Nanoparticles (MCM41) are silica mesopores (MSNs), which have large pores and relatively low density. The purpose of this study was to load Econazole onto silica nanoparticles (MCM41-NH2 and MCM41) And release of econazole in human skin (Ex-Vivo) then the antifungal effect of loaded econazole on silica nanoparticles was investigated.

In this study, MCM41 was prepared, then MCM41-NH2 nanoparticles were provided by using amine cetyltrimethylammonium bromide and finally, the drug econazole was loaded on it. The morphology of the nanoparticles was determined by SEM and drug loading by FT-IR. Francescell and UV-Vis were used to measure the release. The release cream from the skin containing 1/1 drug and nanoparticles was prepared. Finally, the anti-fungal effect of ECO/MSNs was investigated in three ways. Francescell device was also used to check skin release.

Silica nanoparticles were prepared about 300 nanometers Release of the drug into the skin showed that during the first 8 hours 80% release and then up to 24 hours of continuous drug release. Antifungal effect by disk diffusion method showed that ECO/MCM41 had a larger inhibitory effect and also minimal inhibition of fungal growth (MIC) 75 mg/ml. Antifungal tests showed that no fungus grew after 72 hours.the antifungal effect as well as ECO / MCM41 (MIC) was greater in methanol.

The antifungal effect of the newest agar method was not suitable for this drug. Therefore, as a suitable drug in the cream, a drug loaded with methanol is recommended.

Cystic Fibrosis (CF) is a systemic autosomal disorder and themost important chronic lung disease in children. Oxalate is the end product of vitamin C metabolism, which increases the risk of kidney stones, urinary bladder stones, and calcium deposits in CF patients.

Considering the increased mineral excretion and the rate of stone formation in the urinary tract, examining the excretion of minerals will greatly help resolve clinical problems.

This descriptive-analytical study was performed on CF and healthy children in Gorgan in 2018 - 19. In this study, 40 CF children and 40 healthy children were randomly selected. After obtaining informed consent from the parents of the children, a random urine sample was collected to evaluate urine minerals. Children with abnormal urinary mineral excretion underwent ultrasonography. The data were analyzed by SPSS 18 using descriptive indices (mean ± SD, frequency, and percentage) and statistical tests (independent t-test, chi-square test, and nonparametric tests).

Out of 80 CF and healthy children, 34 were girls, and the rest was boys. The mean age of the patients was 4.34 ± 3.38. The age difference was not significant between the groups (P > 0.05). The mean urinary levels of phosphorus, uric acid, magnesium, and citrate were 0.87 ± 1.01, 1.16 ± 0.68, 0.23 ± 0.18, 2.37 ± 3.13 mg/mg of creatinine. In the pediatric patient group, respectively (P < 0.001). The mean urinary calcium level in CF patients was 0.28 ± 0.39, which was lower than that in the healthy group. The mean urinary oxalate level was 0.13 ± 0.20 in CF patients, which was higher than that in the healthy group (P > 0.05). Hyperoxaluria, hyperuricosuria, hypomagnesiuria, and hypocitraturia occurred in 35, 30, 62, and 7.5% of the CF patients, respectively. Among the urinary minerals studied, hyperoxaluria was found to be a major determinant of stone formation risk in CF. No correlation was observed between the formation of stones and the rate of excretion of minerals (P > 0.05).

In summary, CF patients are at an increased risk of developing citrate and calcium stones compared to the healthy group, which is associated with hyperuricosuria, hypocitraturia, and hyperoxaluria.

As one of the most enjoyable life experiences, pregnancy may be accompanied by many physiological and psychological changes that make women susceptible to developing mental disorders such as anxiety. Non-pharmacological methods such as writing therapy are among the ways to deal with anxiety.

The present study aimed to determine the effect of writing therapy on anxiety in women during pregnancy.

This randomized controlled trial was conducted on 70 pregnant women with a gestational age between 28 - 31 weeks. The participants were assigned to an intervention group and a control group using a randomized block design. The intervention group received three in-person writing therapy-based counseling sessions and two telephone calls between the sessions, while the control group received routine pregnancy care. The Beck anxiety inventory was completed before and six weeks after the intervention. Independent t-test and ANCOVA were used for data analysis.

There was no significant difference between the two groups in terms of socio-demographic variables and baseline anxiety scores. Based on ANCOVA with baseline score adjustment, the mean score of anxiety was significantly lower in the intervention group than in the control group after the intervention (adjusted mean difference = -6.8; 95%CI = -4.5 to -9.1; P < 0.001).

According to the results, writing therapy can reduce anxiety in pregnant women; however, further studies are needed before a definitive conclusion. 

Chronic diseases, such as diabetes mellitus, are among the healthcare issues in new communities. Diabetes, like any other chronic and debilitating diseases, poses some problems for the patients, especially the children, thereby affecting all aspects of their daily life. The purpose of this study was to evaluate the effectiveness of cognitive-behavioral therapy in social anxiety among children with type I diabetes mellitus.

The present quasi-experimental study was conducted using a pretest-posttest design with a control group and follow-up. The study population corresponded to a group of 25 children aged 8 to 13 years with type I diabetes as diagnosed by an endocrinologist. The participants were selected using purposive sampling technique and then randomly assigned into control and intervention groups. The intervention group received 8 cognitive-behavioral therapy sessions of 45 min within 2 months. On the other hand, the control group was placed on the waiting list. The subjects completed the Social Anxiety Scale for Children-Revised (La Greca & Stone, 1993) at the pre-test and post-test stages, as well as after 45 days of follow-up. The data were analyzed using repeated measures ANOVA.

The results of this study showed a significant difference among the mean scores of social anxiety obtained at the pre-test, post-test, and follow-up (P<0.01). In addition, there was a significant difference between the intervention and control groups regarding the mean scores of social anxiety dimensions (P <0.05).

As the results of this study indicated, cognitive-behavioral therapy was considered an effective intervention in reducing social anxiety in children with type I diabetes mellitus, and the treatment effects were maintained until follow-up.

Context: Breath-holding spells (BHSs) are episodes of brief, involuntary cessation of breathing that occur in children in response to stimuli such as anger, frustration, fear, or injury. It occurs in about 0.1%–4.6% of healthy children. Although the etiology is not known, autonomic dysfunction and increased vagal tonus leading to cardiac arrest and cerebral anoxia are considered to play a role. Increase of QT dispersion increases the risk of sudden death. Because of this, children are always referred to cardiac clinics.

Our aim was to evaluate According to these problems, our aim was the evaluation of ECG and Echocardiography findings in children diagnosed with BHSs in Taleghani Hospital in Gorgan. Settings and Design/ Methods and Material: All patients diagnosed with BHSs were enrolled in this study. In the first step, demographic characteristics and echocardiography and electrocardiogram (ECG) findings were obtained from the patients. Statistical Analysis Used: For statistical analysis, the demographic variables and ECG and echocardiography information of the patients were analyzed using frequency, percentage, and statistical tests such as Chi-square.

Sixty-three (9%) children were male and 36 (1%) children were female. Thirty-eight (9%) children were aged between 1 and 2 years, and this group was the most common age group. The most common type of attack was cyanotic (68/5%); 24 (1%) children had a positive family history, 78 (8%) had incomplete or absent iron supplementation, and 68% of children had anemia. Five (6%) children had long QT in ECG and five (6%) had abnormal echocardiography. There was a significant correlation between echocardiography findings and age, whereas there was no significant relationship between ECG findings with age, echocardiography findings with sex, and type of attack with age and sex.

Although BHS among children with LQTS are relatively rare and occur at similar frequency as the general population, they can be the presenting symptom for a heart rhythm disorder.

Type 1 diabetes is one of the most common metabolic abnormalities in childhood, with one in every 400 to 600 children affected by the disease. The aim of study was to evaluate the effectiveness of cognitive-behavioral therapy on emotional regulation of children with type 1 diabetes. The research design was a quasi-experimental design with pre-test, post-test and follow-up and control group. The sample of 25 children aged 8 to 13 years with type 1 diabetes was diagnosed by endocrinologist. They were randomly assigned control (n = 15) and experimental (n = 10) groups. Subjects completed an cognitive emotion regulation questionnaire (Garnefski et al., 2007) in a pre-test, post-test, and one month and a half follow-up. Data were analyzed using repeated measure analysis of variances. The results of this study showed that there was a significant difference between the mean scores of emotional regulation in pre-test, post-test and follow-up (P <0.01). Also, there was a significant difference between emotional regulation in the experimental and control groups (P <0.05). Cognitive-behavioral therapy can be considered as an effective intervention to regulate the excitement of children with diabetes.

Liver is the largest and most vital organ in human body and able to detoxify several chemical compounds. Acute liver failure (ALF) is a rare devastating process that can leads to urgent liver transplantation. In this study we introduce 3 children of a family with an accidental intoxication of Cassia Floribunda which causes ALF. The first case is a four-year-old girl with an icter's complaints and drowsiness after eaten plant in the garden while playing with her sister and friend 3 days ago. At the beginning her GCS was 10, vital signs were normal, sclera was icteric and pupil has normal size and was reactive to the light. Initial tests showed leukopenia, anemia, thrombocytopenia, increase of liver enzymes , coagulopathy , hypoglycemia. With diagnosis, fulminant liver deficiency and hepatic encephalopathy, the patient transferred to PICU and GCS reduced. her general appearance became better ,consciousness increased, lab test findings improvedand and discharged after 11 days.Second and third cases presented to emergency with similar complaints without icteric, vital signs and other examinations were normal . Initial tests reported reduced platelets, increase liver enzymes , Without hypoglycemia. treatment was started for patient by intravenous ranitidine and monitored in emergency . Two days after discharged. But in third case platelets increased.ALF in children is a serious problem that can lead to death or need to liver transplantation. When evaluate the causes of ALF, poisoning due to plants should be kept in.

Topography of the human insula has occasionally been studied in different populations. The purpose of this study was to evaluate the morphology of human insula in Iranian population and its relationship with sex, age, and handedness via magnetic resonance imaging.
Methods and Materials/Patients: In our study, 380 normal magnetic resonance imaging were enrolled. The number of short and long insular gyri, as well as their relationship with sex, age, hemispheres and handedness were assessed.
No significant differences were seen in number of insular gyri among right and left hemispheres, and males and females, but gyri number of left insula in right handers were significantly more than that in left handers. Maximum anterior – posterior distance of base of insula was longer in male and left insula compared to female and right insula, respectively. Younger individuals had more gyri than the older ones. The middle short insular gyrus can be absent more frequently than anterior and posterior short gyri.
The sagittal magnetic resonance imagings in our study can be appropriate for numbering the insular gyri and help to understand the complicated anatomical structures of insula. The findings of this study demonstrate an insular gyri pattern of handedness and age-related morphology in Iranian population, with similar gyri pattern in both males and females.

Despite the good results of anticancer activities by curcumin, there are some hurdles that limit the use of curcumin as an anticancer agent. Many methods were examined to overcome this defect like the use of the dendrosomal curcumin (DNC). There is increasing evidence that miRNAs play important roles in biological processes. In this study, we focus on the roles of microRNA-21 in the anti-cancer effects of DNC in breast cancer.
Also, we have used different methods such as MTT, apoptosis, cell cycle analysis, transwell migration assay and RT-PCR to find out more.
We observed that miR-21 decreased apoptotic cells in both cells (from 6.35% to 0.34 % and from 7.72% to 1.32% orderly) and DNC increased it. As well as, our findings indicated that cell migration capacity was increased by miR-21 over expression and was decreased by DNC. The combination of miR-21 vector transfection and DNC treatment showed lower percentage of apoptotic cells or a higher level of penetration through the membrane compared with DNC treatment alone. Furthermore, DNC induced a marked increase in the number of cells in sub G1/G1 phase and a decrease in G2/M phase of the cell cycle in both; but, we observed reverse results compared it, after transfection with miR-21 vector.
We observed that miR-21 suppress many aspects of anti-cancer effects of DNC in breast cancer cells, it seems that co-treatment with DNC and mir-21 down-regulation may provide a clinically useful tool for drug-resistance breast cancer cells.

Cardiovascular Events occur at different ages for different reasons, One of the uncommon causes of sudden cardiac arrest that can be fatal in humans, is Brugada syndrome. The victims are often young men Appearance quite healthy. Its prevalence is high in Southeast Asia.The best treatment method in patients with ECG recognize But without a history of sudden cardiac death, Is that prognosis of clinical variables And ECG in patients with ECG Compatible with Brugada syndrome without previous history of cardiac arrest Effectively be analyzed.
The patient is a young man who in the early morning after waking up from sleep with Syncope and decreased level of consciousness And was brought to hospital emergency. On initial examination, patient had no pulse rate and electrocardiogram showed a straight line And bilateral pupillary dilation And had no reaction to light immediately (CPR) started after about 40 minutes rhythm of the patient was converted to sine and was transferred to the ICU . After transfer to the ICU and perform E.C.G characteristic changes Brugada syndrome was observed. In about a month hospitalization in ICU , and after tracheotomy and insertion(N.G Tube) patient was discharged and transferred to home and through a gastric tube feeding for a long time, he continued, And then with the help of those around him began oral feeding. Currently the patient is not able to mobility and activities and with the help of others continue to vegetative state life.

This paper presents a control approach to the fuzzy-adaptive control scheme for rigid manipulators with unknown parameters. Lagrange’s method is employed for computing robot motion dynamics. Stability analysis guaranteed through Lyapunov’s theory using some suitable adaptive rules that make sure all signals in the closed-loop system are bounded and tracking error ones asymptotically reaches to zero. Compared with other controllers، there are some numerical simulations that verify effectiveness of the proposed method. Also، simulation results verify that the proposed controller can deal with uncertainties in the system.

Huntington disease (HD) is a dominantly inherited, neurodegenerative disease characterized by choreiform movement disturbances and dementia. The onset age of this disease is varied but usually is between the ages 40-50. Huntington''s disease is caused by a triplet-repeat expansion in the IT15 gene (also known as huntingtin or HD) which is located on chromosome 4p3.1. Since many clinical picture of HD are indistinguishable from other distinct genetic disorders molecular test such as PCR is the only way to confirm the disease. The aim of this study was to introduce a new and fast technique for the diagnosis of Huntington disease. Blood specimens were collected from individuals suspected for Huntington disease and also people with no symptoms and family history of this disease. DNAs were extracted according to standard protocol. Using conventional PCR, patient positive for Huntington disease were diagnosed. Then employing real time PCR on the basis of difference between melting temperature (Tm) a new and fast diagnostic method was introduced. Among 29 patients suspected to be HD only 8 HD patients were confirmed using PCR and real time PCR. The numbers of CAG repeat were between 42-50 and melting temperatures were between 89-92. The concept of using melting temperature in real time PCR protocol presented in here could be employed for the rapid diagnosis of the diseases caused by the increased in triple repeat sequences. It is fast, robust and has the potential use for the prenatal diagnosis.

The findings of incidence or prevalence studies can help managers and policy makers evaluate the degree of changes and its relation with the performed interventions. This study aimed to determine the frequency of hypertensive disorders during pregnancy in maternal deaths that occurred during 2006-10 in Isfahan Province, Iran. This descriptive, cross-sectional study assessed all maternal deaths that occurred during 2006-10 in Isfahan. Data was collected by reviewing available documents using a checklist whose validity has been approved by experts. Data was analyzed by descriptive statistics and chi-square and Fisher''s exact tests in SPSS12. In total, 58 women who had died due to complications of pregnancy and childbirth were studied. The mean age of the subjects was 30.2 ± 6.5 years (range: 17-45 years). From 22.4% of maternal deaths which were due to gestational hypertension, 92.3% were preeclampsia and eclampsia. One case of chronic hypertension (7.7%) was also observed. Other types of hypertension in pregnancy were not detected. The first direct cause of maternal death was hypertension disorders. Underlying diseases (36.2%) and bleeding (18.9%) were the other major causes of death. The number of deaths caused by blood pressure disorders, as a direct and important factor in maternal deaths, reduced during the 5-year course of study. In order to improve pregnancy outcomes, measures should be taken for early detection and diagnosis of these disorders.