mohammad khademloo

Obesity is a common risk factor for lipid disorders, diabetes, and prediabetes, all of which are associated with adverse health outcomes and premature mortality. Considering the serious complications of hyperlipidemia and the lack of sufficient studies examining hyperlipidemia in prediabetic patients, timely identification of underlying factors, along with prevention and education, is critical in reducing the incidence of these conditions. The aim of this study was to investigate the relationship between obesity and lipid disorders in prediabetic individuals, as well as to evaluate the independent effect of prediabetes on lipid levels and the combined effect of obesity and prediabetes.

The present study is descriptive and analytical in nature. The statistical population consists of individuals over 30 years of age who visited health centers in Amol city. The centers were selected through simple random sampling, and the sample size was calculated to be 530 individuals. By reviewing health records, prediabetic individuals who were obese or had normal BMI were included in the study until the required sample size was reached.A person is considered obese if their BMI is equal to or higher than 30 kg/m². Information on blood sugar and lipid levels was extracted from patient files and recorded. The weight, height, and waist circumference of the subjects were measured, and BMI was calculated. Blood pressure was measured using a mercury sphygmomanometer. After data collection, data entry and analysis were performed using SPSS-23 software. The significance level was set at 0.05. Due to the normal distribution of the data, the Student’s t-test and ANOVA were used to compare quantitative variables, while multiple regression analysis was employed to evaluate the dependent variable against other independent variables. Pearson’s correlation coefficient was used to assess relationships between quantitative variables.

In total, 515 individuals met the inclusion and exclusion criteria, with 396 women and 119 men participating. The results indicated a significant relationship between abnormal waist circumference and dyslipidemia (P= 0.001), BMI and dyslipidemia (P= 0.001), and family history of obesity, family history of hyperlipidemia, and dyslipidemia (P= 0.001). However, no significant relationship was found between family history of diabetes and dyslipidemia (P= 0.05) or between dyslipidemia and age, occupation, sex, and smoking.The findings showed that for every increase in LDL, the likelihood of dyslipidemia increases by 1.5 times; for every increase in fasting blood sugar (FBS), it increases by 1.2 times; and for every increase in triglyceride levels, it increases by 1.1 times. The chance of dyslipidemia increases by 14.6 times in people with a family history of diabetes and by 0.02 times in those with a family history of hyperlipidemia.A significant relationship between BMI and dyslipidemia was observed (P= 0.001). With increasing BMI, the chance of dyslipidemia increases by 0.68 times. Additionally, a significant relationship was found between LDL and BMI (P= 0.000), and a significant inverse relationship was observed between HDL and BMI (P= 0.003). A significant relationship was also found between cholesterol (COL) and BMI (P= 0.000), triglycerides and BMI (P= 0.000), and waist circumference and BMI (P= 0.000).

This study demonstrates that BMI has a positive correlation with HDL, LDL, triglycerides, and cholesterol. As obesity increases, the likelihood of dyslipidemia rises as well. Moreover, increases in LDL, FBS, and triglycerides, along with a family history of diabetes and hyperlipidemia, are associated with an elevated risk of dyslipidemia.

After a diagnosis of ectopic pregnancy there are two choices for treatment: medical treatment with methotrexate and surgical treatment. It seems that medical treatment, has had acceptable success compared to surgery and lacks the complications of surgery. Nowadays, due to the progress achieved in the early diagnosis of ectopic pregnancy, a large number of patients are candidates for medical treatment. This study is conducted to evaluate the effective factors of medical treatment Response with methotrexate in ectopic pregnancies.

In this case-control study, the information related to patients who were diagnosed with ectopic pregnancy and were treated with methotrexate from March 2016 to March 2021 in Imam Khomeini Hospital in Sari was examined using hospital records by census method. In total, 160 patients out of 623 patients met the inclusion criteria and were studied. In the checklist prepared for each patient, the patient's age, number of gravity and parity and abortion, previous history of infertility, contraceptive method, presence of clinical symptoms (such as abdominal pain-vaginal bleeding-amenorrhea), History of using recent assisted reproductive methods, type of treatment regimen used (Single/Multiple Dose), serum beta human chorionic gonadotropin (BHCG) level before and after starting treatment, number of previous ectopic pregnancy, gestational age based on the last Menstruation, transvaginal ultrasound results(including the presence of the yolk sac & fetal heart rate & hematosalpinx - location and size of the ectopic mass-endometrial thickness) were recorded for each patient separately, The patients were divided into two categories: success and failure of treatment and the effect of different factors on the result of medical treatment with methotrexate was investigated. The collected data were entered into SPSS 26 software and qualitative variables were analyzed with the Chi-Square test. The normality of the distribution of quantitative variables was measured by the One-Sample Kolmogorov-Smirnov test, an independent t-test was used to examine quantitative variables with normal distribution, and the Mann-Whitney test was used for quantitative variables with non-normal distribution.

160 patients were included in this study, 108 of patients (67.5%) were successfully treated and 52 patients (32.5%) faced treatment failure. In this study, the type of treatment regimen (P=0.001), Serum Beta Human Chorionic Gonadotropin (BHCG) level before treatment(P=0.000), BHCG level after treatment (P=0.000), the presence of fetal heart rate (P=0.002) and yolk sac (P=0.046) are factors affecting the response to methotrexate treatment in ectopic pregnancy. The presence of hematosalpinx, size of the ectopic mass, endometrial thickness, history of infertility and recent assisted reproductive procedures, presence of clinical symptoms, contraceptive method, gestational age, history of ectopic pregnancy, number of gravidity and parity, and abortion have no effect on the results of medical treatment with methotrexate.

Based on the results obtained, Single Dose regimen of methotrexate treatment is associated with greater treatment success than a multiple-dose regimen and also high serum BHCG levels before and after the treatment, the presence of fetal heart rate and yolk sac in transvaginal ultrasound are factors to increase the probability of failure of medical treatment of ectopic pregnancy with methotrexate

Severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) has emerged as a global concern. Since its outbreak in December 2019, researchers and authorities have made numerous efforts to identify the disease’s prognostic markers. Changes in the values of coagulation tests are common in these patients. This study aimed to study any possible association between coagulation parameters in COVID-19 patients with prognostic indicators and the disease severity.

This cross-sectional survey investigates the CBC, coagulation status, and plasma D-dimer level in confirmed cases of COVID-19 (RT-PCR and/or chest CT scan) admitted to Boo-Ali Sina and Imam Khomeini hospitals affiliated with Mazandaran University of Medical Sciences, in the north of Iran in the last three months of 2021. The tests were ordered at the beginning of hospitalization and discharge. The results included lung involvement percentage, intensive care unit (ICU) admission, and survival.

Of 140 COVID-19 patients (Mean±SD age: 55.73±16.821 years) evaluated in this study, 51.4% were male. Among comorbidities, diabetes and hypertension were the most common ones. The Mean±SD hospitalization length was 8.47±7.8 days. Also, 56(40.0%), 40(28.6%), and the rest of the patients showed <25%, 25%-50%, and >50% of lung involvement, respectively. In addition, the CURB-65 score for pneumonia severity was low, medium, and high risk for 84, 34, and 22 patients, respectively. The most frequent abnormality among the results was prothrombin time (PT) (17.9%), thrombocytopenia (25.7%), partial thromboplastin time (PTT) (32.9%), and elevated D-dimer level (62.9%). The results showed a significant relationship between abnormal D-dimer levels and poor outcomes, including higher CURB-65 score, higher lung involvement in CT scans, more ICU admissions, and even death. Meanwhile, PT, PTT, and platelet count on admission did not help predict the study population’s clinical course and general survival.

Disturbance of coagulation parameters in COVID-19 patients with no significant history can serve as an available and reliable prognostic marker in the patients’ outcomes and clinical course.

Septic arthritis is a serious orthopedic surgery and delayed management causes irreparable damages. The knee is the most common site involved in septic arthritis. The purpose of this study was to determine mortality rate, adverse joint outcome and prognostic factors in adult patients diagnosed with septic arthritis of the knee who had undergone debridement surgery.

This retrospective cohort study was carried out using the medical records of all adult patients admitted to Sari Imam Khomeini Hospital and Sari BuAliSina Hospital between 2009 and 2019 who were treated with either arthrotomy or arthroscopic irrigation for acute septic arthritis of the knee. Patients with prosthetic joints were excluded. The rate of mortality was determined. Clinical findings, laboratory evidence, knee radiographs, and the Knee injury and Osteoarthritis Outcome Scores (KOOS) were compared through statistical analysis to identify possible prognostic factors.  Radiographic severity was classified based on the Kellgren-Lawrence grading.

We included 31 patients and there were 41.9% female patients (mean age= 51.1±20.56). The most common underlying diseases were hypertension (29%) and diabetes mellitus (25.8%). Staphylococcus aureus was identified in 16.1% of synovial fluid cultures. The mortality rate was 22.6%. Factors influencing mortality included older age (P=0.003), diabetes mellitus (P=0.031), fever (P=0.038), length of hospital stay (P=0.019), high C-reactive protein levels (P=0.002), low creatinine clearance (P=0.003), and type of pathogenic microorganisms (P=0.028). Age was the only factor significantly associated with higher radiographic severity (P=0.014).

Septic arthritis is an infectious orthopedic emergency that is associated with a high mortality rate even after joint surgery and debridement. Therefore, proper management and updating information about this disease and its treatment methods are necessary.

The Coronavirus Disease 2019 (COVID-19) pandemic, caused by severe respiratory syndrome coronavirus 2 (SARS-CoV-2) resulted in a worldwide emergency. Various studies show conflicting and diverse results on the role of inflammatory cytokines in predicting the severity and prognosis in patients with COVID-19. The aim of this study was to compare the serum levels of interleukin-6 (IL-6) and interleukin-8 (IL-8) in predicting the severity of COVID-19 and prognosis in patients admitted to Qaemshahr Razi Hospital.

In this cross-sectional prospective study, the serum levels of interleukin 8 and 6 were measured in 51 patients with COVID-19 and compared with 25 healthy individuals in Qaemshahr Razi Hospital, 2021. ELISA method was used to measure these cytokines and data analysis was performed in SPSS V25.

The serum levels of IL6 and IL8 in the patient group were about 4 times and 6 times higher than those of the control group, respectively. Average levels of IL-6 (P=0.004) and IL-8 (P<0.001) were significantly higher in patients with severe COVID-19 compared to moderate form and control group. There was no correlation between the duration of hospitalization and the level of IL-6 (P=0.1), while there was a significant correlation between the length of hospital stay and the level of IL-8 (P=0.012).

IL-6 and IL-8 serum levels in patients with COVID-19 can be helpful in predicting the severity of disease and prognosis of patients.

This study aims to evaluate the frequency of adjacent segment disease (ASD) and its risk factors following posterior decompression and fusion in lumbar degenerative disorders.

Methods and Materials/Patients: 

This retrospective cohort study was performed by reviewing the records of patients with spinal degeneration disorders who underwent lumbar fusion surgery and needed reoperation from 2013 to 2019. The participants were divided into two groups, including patients with ASD and non-ASD patients, and were compared in terms of age, sex, BMI, smoking, fusion level, surgical indications, follow-up times, laminectomy, cross-link device usage, imaging findings, fusion terminating in L1, L5 and S1, and reoperation.

Out of a total of 277 candidates, 181 met the inclusion criteria. In terms of gender distribution, 43.3% of the participants were male and 56.7% were female. The median age was 54 years in the ASD group and 48 years in the non-ASD group. The median follow-up of the patients was six years in the ASD group and five years in the non-ASD group. Forty patients (22.1%) developed ASD during this period. The final analysis showed a significant relationship between age, sex, indication for reoperation, repeated surgery, laminectomy, cross-link device use, imaging findings, and fusion terminating in L1.

High body mass index, aging, lumbar spinal canal stenosis, reoperation, laminectomy at the upper fusion unit, cross-link device use, lumbar canal stenosis in imaging, and fusion to L1 vertebrae are considered risk factors for ASD.

Pneumonia is the most common infectious cause of death. This study aimed at investigating the causative agent of pneumonia in nasopharyngeal secretions by PCR method.

This case-control study was carried out in patients (older than 19 years of age) suspected of pneumonia admitted to Qaemshahr Razi Hospital and Sari Imam Khomeini Hospital, Iran 2019. The control group included inpatient and outpatient cases with non-respiratory diseases. The case group included patients who met the clinical and radiological criteria. FTD respiratory pathogens 21 plus kit (Multiplex RT-PCR) was used which covers a significant number of microorganisms. Data were analyzed in SPSS V18.

The study included 60 patients with the mean age of 52.13±16.84 years (19-87 years old) and the mean age of the control group was 47.8±16.63 years (21-83 years old). Etiological agents were significantly different between the two groups (P<0.05). According to PCR results, the prevalence of viral and bacterial etiology was 56.7% and 26.7%, respectively, and in 16.7% the PCR was negative.

Multiplex RT-PCR is associated with great specificity and specificity and is easily performed.  The assay is not low cost but is of great benefit in detecting causative agents and avoiding inappropriate treatments and can reduce further bacterial resistance.

Iron deficiency anemia lead to a decrease in intelegence question (IQ) and a decrease in learning and mental and physical abilities. This study was done to determine the status of iron intake in infants aged 6 to 24 months under the cover of comprehensive health centers in Miandorood city, Mazandaran province, Iran during 2019.

This descriptive-analytical study was carried out on 400 infants aged 6-24 months who were enrolled in comprehensive health centers in Miandorood city, Mazandaran province, Iran during 2019. The status of iron drop consumption and mothers' awareness in this field were evaluated.

The mean age of the infants was 13.8±4.8 months. The range of the mother’s age was 28.8±5.6 years. Of these, 274 (68.5%) of infants used iron drops regularly, 106 case (26.5%) often, and 20 case (5.0%) never. The mother's knowledge score was significantly correlated with the type of iron intake, height percentile, and maternal education level (P<0.05). Evaluation of the possible causes of irregular iron intake shows that the most frequent cases were forgetting (28.8%), 9.5% for nausea and vomiting, and ‎‎9.0% for teeth color changing.‎

Mothers' awareness of iron drops consumption was good. The most important barriers to regular iron intake in the present study were forgetfulness, vomiting, and tooth discoloration.

Coronaviruses are a type of virus that can cause death due to pneumonia and respiratory problems. Pregnant women are at higher risk for developing COVID-19 and the disease has posed challenges to anesthesia in these patients. The aim of this study was to evaluate the consequences of general anesthesia and spinal anesthesia in expectant mothers with COVID-19 candidates for cesarean section.

This descriptive-analytical study was performed in 80 pregnant women with COVID-19 candidates for cesarean delivery in Sari Imam Khomeini Hospital and Qaemshahr Razi Hospital, 2021. The expectant mothers underwent general (n= 40) or spinal anesthesia (n= 40). A researcher-made checklist was completed before, during, and after the delivery. Data were analyzed applying Chi-square, Mann-Whitney, T-test, One-way analysis of variance, and repeated measure ANOVA.

No significant difference was found between the two groups in demographic characteristics (P> 0.05), but there was a significant difference between urgent surgery and the type of anesthesia (P <0.05). Significant differences were seen in heart rate and mean oxygen saturation between the two groups (P= 0.0001 and P< 0.05, respectively). Nausea and vomiting, and chills were observed to be more common during spinal anesthesia (P= 0.007 and P= 0.002). Changes in systolic and diastolic blood pressure occurred more in spinal anesthesia group than the general anesthesia group (P= 0.0001).

Both general anesthesia and spinal anesthesia in mothers with COVID-19 can be safe for both the mother and baby if carefully planned and performed by experienced anesthesiologists.

Recurrent implantation failure is one of the problems associated with in vitro fertilization cycles. The aim of this study was to evaluate the results of pregnancy using intralipid infusion in infertile women with history of two implantation failures.

A clinical trial was conducted in 80 infertile women in the infertility center in Sari Imam Khomeini Hospital, Iran 2020. In all samples, the level of peripheral blood natural killer (NK) cells was measured two weeks before the intervention using flow cytometry. The participants were divided into an intervention group (n=40) and a control group (n=40) by SAS statistical software. Two days before embryo transfer, patients in intervention group underwent intra lipid infusion (2 ml of 20% solution in 250 ml sterile saline) for two hours and the control group received normal saline (250 ml) infusion. Clinical pregnancy (detection of fetal heart rate by ultrasound) rate was compared between the two groups. Data were analyzed using Chi-square, Mann-whitney, and t-test.

Clinical pregnancy rate was higher in intervention group after intralipid infusion (30%) compared with the control group (10%) (P=0.025). There were no significant differences between the two groups in the level of NK cells and peripheral blood lymphocytes (P<0.05).

Intralipid infusion improved clinical pregnancy rate in women with history of recurrent implantation failure. However, further studies are required on the possible mechanism of immunological effects of interlaipid in NK cells.

Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention. Diagnostic tests with high accuracy could lead to immediate diagnosis and timely surgery could prevent further complications. This study was performed to assess the diagnostic value of serum fibrinogen level in diagnosis of acute appendicitis.

This cross-sectional diagnostic study was performed in patients (n=165) attending the emergency department in Sari Imam Khomeini Hospital with an initial diagnosis of appendicitis and available histopathologic examination results in 2016-2017. Fibrinogen levels were measured before surgery. Student's t test, Mann-Whitney test, and Chi-square were used to examine the relationship between fibrinogen level, demographic and clinical variables, acute appendicitis, and complicated/uncomplicated appendicitis. ROC Curve test was also performed and indicators associated with diagnostic accuracy were calculated.

The mean fibrinogen level in patients with normal appendices was 278.0±50.5, while it was 349.4 ± 68.7 in those with appendicitis (P<0.0001). The area under the curve was 0.794 (CI = 0.724-0.853). Moreover, at the optimal cut-point of fibrinogen level of 344 mg/dl, the sensitivity, specificity, negative predictive value, and positive predictive value were 51.7%, 90.4%, 94.4%, and 37.6%, respectively. Positive and negative likelihood ratios were 5.43 and 0.53, respectively.

This study showed that measuring serum fibrinogen levels, as an acute phase reactant, is useful for diagnostic screening of acute appendicitis and for predicting complicated appendicitis.

Evaluation of protease inhibitors (PIs) is important in terms of prescribing an effective regimen for reducing mortality and hospitalization in Covid-19. Therefore, follow- up of patients better determines the characteristics of existing regimens.

We retrospectively evaluated the demographic, co-morbidities, gastrointestinal (GI) and liver complications of patients at two teaching hospitals from the first of March to the end of July 2020. All patients received one of two recommended regimens including hydroxychloroquine (HCQ) (400 mg BD on the first day and then 200 mg BD) plus atazanavir/ritonavir (ATV) (300/100 mg daily) or HCQ with the same dose plus lopinavir/ritonavir (Kaletra) (400/100 mg BD) for 5-7 days.

We chose 170 cases that received 2 different regimens. In group one, 85(57.6% males) patients received Kaletra and HCQ and group two, 85 (55.3% males) patients received ATV and HCQ. The study of hospitalization in both groups showed no difference in more or less than 5 days hospitalization. (P=0.757) Comparison of mortality rates has not shown a significant difference including 19 (22.4%) deaths in group 1 and 15(17.6%) deaths in group 2 (P=0.443). Nausea followed by diarrhea was the most common side effects in group 1. But no side effects were reported in group 2 (P=0.000). Abnormal liver function tests (LFTs) were seen in both groups.

Comparison of hospitalization and mortality were not statistically significant. It seems that a respect to similar effect on mortality and hospitalization. ATV regimen is superior to Kaletra especially for better GI tolerance and less daily pills.

One of the problems of in vitro fertilization (IVF) cycles is recurrent failure of implantation. The present study aimed to investigate the effect of intrauterine saline infusion in luteal phase of previous menstrual cycle on occurrence of pregnancy in infertile patients undergoing frozen-thawed embryo transfer.

This clinical trial was conducted in 70 infertile women attending the infertility center in Sari Imam Khomeini Hospital who were undergoing frozen-thawed embryo transfer in 2020. The participants were randomly divided into an intervention group and a control group (n= 35 per group) using random number table. In intervention group, intrauterine injection of saline with ultrasound guidance was performed on day 21 of previous menstrual cycle, while the control group received no intervention. Pregnancy outcomes were compared between the two groups. Data analysis was performed using Chi-square and t-test.

The intervention group and control group were found to be significantly different in rate of clinical pregnancy (6.5%, 28.1%) (P=0.003) and live birth (6.5%, 28.1%), respectively (P=0.02).

In this study, saline infusion sonohysterography did not have positive effect on clinical pregnancy and live birth, which could be due to small sample size, performing the procedure on day 21 of cycle, or ineffectiveness of this method in causing inflammation following scratches compared to conventional methods. Further molecular and cellular studies are needed to compare the effect of these methods on increasing the level of inflammatory factors.

Osteoporosis is a general skeletal disease characterized by decreased bone mass over the years, bone fractures, decreased bone strength, and consequently increased bone fragility and fracture susceptibility. There is paucity of information about the effect of calcitonin on osteoporosis in Iran. The current study aimed at investigating the relationship between serum calcitonin levels and osteoporosis in women aged 40-70 years old.

This cross-sectional study was carried out in women with osteoporosis (n=29) attending Sari Imam Khomeini Hospital who were selected by census sampling in 2019.  Written consent was obtained and the participants entered the study based on bone densitometry. They were divided into three groups of normal (n=8), osteopenic (n=10), and osteoprotic (n=11). Mean serum levels of calcium, phosphorus, and calcitonin were measured in all patients. Data analysis was conducted in SPSS V23.

The mean serum levels of calcium, phosphorus, and calcitonin were 0.43±1.58, 0.64±2.04, and 1.08±3.59, respectively indicating no significant relationship between their concentrations and osteoporosis (P> 0.05).  

The study showed no relationship between the three groups of patients in serum calcium and phosphorus levels, which means that the body maintains normal serum levels of these salts even with severe osteoporosis. Serum calcium and phosphorus tests can not be used to comment on bone density.

Type of anesthesia during elective cesarean is very important and is chosen according to the decision of the specialist as well as the mother’s desire. This study aimed to determine the rate and associated factors of choosing general or regional (spinal and epidural) anesthesia among pregnant women who underwent elective cesarean in hospitals of Northern Iran in 2017.

This descriptive-analytic study included the pregnant women referred to the hospitals in Sari with indications for both kinds of anesthesia. The reasons for choosing the type of anesthesia were asked and collected in a researcher-made checklist. The collected data were described and analyzed using SPSS software (version 24) through the Chi-square or Fisherchr('39')s exact tests and Logistic regression. A p-value less than 0.05 was considered statistically significant.

Out of 384 pregnant women who participated in the study, 60% and 40% of the cases chose general and regional anesthesia, respectively. Fear of spinal cord damage (64.3%) and fear of observing and hearing in the operation room (53.3%) were the most reasons for the rejection of the regional methods of anesthesia. However, the fear of not waking up (54.3%) and being interested in seeing the baby during childbirth (40.7%) were the main reasons for choosing spinal anesthesia. Most of the women who had experienced regional anesthesia selected this procedure in the current operation (53%), while general anesthesia was chosen by women without previous history of regional anesthesia (62%).

Although most of the pregnant women selected general anesthesia, the reasons for rejecting the spinal method were mainly non-scientific and could be managed with maternal education.

Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder that can be time-consuming and cause considerable disruption to routine activities, occupational functioning, social activities, and relationships with others. This study aimed to determine the prevalence of obsessive-compulsive disorder among high school girl students.

This descriptive cross-sectional study was done on 342 high school female students in Amol city, northern Iran in the academic year of 2018-19. Cluster random sampling mehod was applied in this study. The Maudsley OCD Questionnaire was used for screening and the Yale-Brown Obsessive-Compulsive Questionnaire was used to confirm obsessive-compulsive disorder.

98 students (28.7 %) had positive symptoms. The highest frequency was related to slowness and repetition (37 cases), followed by doubting (36 cases), repetitive checking (35 cases), cleaning (31 cases), and finally rumination (12 cases). Among the 98 screened individuals, 67 were positive based on the Yale-Brown questionnaire. Severity of the obsessive compulsive disorder was mild in 37 cases (55.2 %), moderate in 21 cases (31.34%) and severe in 9 cases (13.43%).

The prevalence of obsessive-compulsive disorder observed in one-third of high school students in the area.

Coronavirus Disease-2019) COVID-19) is a respiratory infection which was recognized as a pandemic by the world health organization on march 11, 2020. This study aimed to evaluate new treatment modalities therapy in management of COVID-19.

A descriptive-analytical, retrospective study was performed in patients over 17 years of age with suspected COVID-19 admitted to Qaemshahar Razi Hospital in March and April 2020. The case group included patients treated with methylprednisolone, intravenous immunoglobulin (IVIg), Beta Interferon, Ribavirin, Arbidol, Remdesivir, Favipiravir and Hydroxychloroquine and lopinavir/ritonavir. The control group was selected from hospitalized cases who were treated only with lopinavir/ritonavir and Hydroxychloroquine. This study evaluated the efficacy of these drugs. Data was analyzed in SPSS V18.

The mean ages of case group (n=217) and control group were 54.23±16.64 (17-88) years and 53.8±16.23 (19-80) years, respectively. The need for ICU admission and mechanical ventilation were significantly different between the two groups (P<0.05) but no significant difference was seen on mortality rate (P>0.05).

Using anti-inflammatory and anti-viral drugs in hospitalized patients seems reasonable until widespread vaccination and development of effective drug.

There are various factors affecting mother’s feelings, pain, and excitement during pregnancy which play significant roles in making decision about terminating pregnancy and reducing its outcomes. This study aimed to systematically review the effect of hypnosis on pregnancy and childbirth outcomes.

In this systematic review, we thoroughly searched Google Scholar, PubMed, Web of Science, Scientific Information Database (SID), Cochrane Library, Scopus, Magiran, Registry of Clinical Trial (IRCT), and ProQuest with no time limitations. After removing unrelated studies, 21 English articles were included. The quality of these articles was determined by Jadad Scale. Finally, 13 studies entered into our meta-analysis. To assess the heterogeneity, Q and I2 tests were used and STATA 11 was used for data analysis.

According to the findings, the effects of hypnosis on pregnancy and delivery outcomes were classified into six categories as the following: hypnosis decreases the consumption of pain relief medicines (OR=0.21, CI95%: 0.12- 0.38, P<0.001), it does not decrease the consumption of oxytocin (P=0.880), it does not decrease the rate of Cesarean section (P=0.082), it leads to higher rates of natural vaginal delivery (OR=3.06, CI95%:1.75-5.32, P<0.001), it does not decrease the rate of preterm labor (P=0.051), and it does not increase neonatal Apgar score (P=0.27). 

Hypnosis interventions can reduce the consumption of pain relief medicines, and also increase the rate of normal vaginal delivery.

Background :

The most common type of feeding for infants is breastfeeding. Since breastfeeding mothers have low levels of breastfeeding knowledge, proper Health workers' support can play an effective role in raising mother's awareness and enhancing exclusive nutrition. This study aimed to evaluate the effect of telephone counseling during the postpartum period on exclusive breastfeeding. 

This quasi-experimental study was conducted on 170 breastfed women referred to the 2 selected health centers of Mazandaran University of Medical Sciences in 2018. The participants were randomly allocated into two equal groups (75 individuals each). The participants in the intervention group received telephone counseling by one midwifery expert. The control group received routine care. Data were collected using a questionnaire including demographic characteristics and a breastfeeding check-list. Exclusive breastfeeding rates were recorded two and six months after childbirth in both groups. Data were analyzed using SPSS software version 24.0.

A total of 165 mothers participants in this study. Based on the results, exclusive breastfeeding rate was 61% in treatment group and 39.8% in control group which was statistically significant (p=0.006). In addition, 24 neonates (28.9%) of the newborns in the control group and 19 (23.2%) in the intervention group were fed to the breastfeeding. This difference was statistically significant and indicates that the intervention Telephone counseling in postpartum period has a positive effect on exclusive breastfeeding (p = 0.027). Conclusion Based on the results, using a counseling program in this study led to an increase in exclusive breastfeeding in newborns. Pre and postpartum and lactation care for both mother and infant can increase health and exclusive breastfeeding.

 The parieto-frontal integration theory of intelligence revealed a novel scope of investigation examining how performance networks are related to structural networks in the brain.

 These investigations highlighted the role of brain commissures, but no evaluation has been performed examining the anterior commissure (AC) in determining the level of intelligence.
Patients and

 A total of 100 healthy volunteers were selected, and their brain MRIs were acquired. Measurements were performed for the AC and the corpus callosum (CC) on MRI. Intelligence quotient (IQ) was calculated using the Wechsler Adult Intelligence Scale-R (WAIS-R). P < 0.05 was considered significant.

 The average age of men was 32.58 ± 8.84 years, and the average age of women was 32.88 ± 7.83 years. The average IQ of volunteers in the study was 103.57 ± 4.178. Partitioning the subjects by gender did not lead to significant results. No significant correlation was determined between the dimensions of AC and IQ. The height of the CC had a positive correlation with IQ. However, the thickness of the genu, body, and splenium of the CC demonstrated no significant relation to IQ.

 The AC had no clear relationship with IQ, although it may have a role in women. The height parameter of the CC had a significant correlation with IQ, suggesting the interference between the anterior and posterior parts of the brain in the human intelligence process.

Distal radius fracture (DRF) is one of the most common upper limb fractures, which is associated with osteoporosis and vitamin D deficiency, especially in old adults.

The aimof this studywas to evaluate the effectof supplementary vitaminDongrip strength, pinchpower, painintensity, and DASH score in post-menopausal females after distal radius fractures.

Fifty-two post-menopausal women with distal radius fractures were enrolled in a randomized single-blinded multicenter trial from January 2015 to January 2016 (IRCT registration number: IRCT20160830029603N7). Patients with pre-operative serum vitamin D level of 30 to 100 ng/mL were enrolled in the study. Patients were divided into two randomized groups including groups with and without supplementation of vitamin D [25 women in intervention group (50,000 IU supplementary vitamin D, every 4 weeks for 6 months) and 27 women in placebo group]. Grip strength, pinch power, pain intensity, and DASH score pre-operatively and at three and six months after the surgery were measured; the obtained data were analyzed using SPSS version 16.

The subjects’ mean age in vitamin D supplemented and placebo group was 57.98 ± 7.15 and 59.15 ± 8.03, respectively. The mean grip strength of patients in vitamin D supplemented group was significantly higher than the placebo group on both the third and sixth months (P = 0.011 and P = 0.003, respectively). The pinch power was significantly increased on the sixth month compared to the third month in patients with revised vitamin D supplementation (1.32 ± 2.14 and 0.67 ± 0.96 respectively, P = 0.0001). There was no statistically significant difference between the two groups in terms of mean VAS and DASH scores at the end of the study (P = 241, P = 0.665, respectively).

Vitamin D supplementation was significantly helpful in improving grip strength recovery in post-menopausal women after distal radius fracture, however, no significant differences were observed in supplementation of vitamin D on pinchpower and pain intensity after distal radius fractures.

Patient safety is one of the most important indicators of primary healthcare settings. There is a direct association between patient safety culture and improvement in healthcare outcomes. Also, identifying the factors that enhance client satisfaction could be of great help in improving quality of care. This research was done to investigate patient safety culture in health centers in Amol, Iran and evaluating patient satisfaction attending these centers. A descriptive study was carried out in 422 individuals including healthcare staff (n=211) and patients (n=211) selected from health centers in Amol, Iran between March and June 2018. The Medical Office Survey on Patient Safety Culture (MOSPSC) was administered among the healthcare staff. The scale measures 12 dimensions of patient safety culture. The patients responded to service quality (SERVQUAL) scale which evaluates the quality of services received. Statistical analysis was performed in SPSS V22. Positive attitude in all dimensions was 82% among the staff. The highest rate of positive attitudes were seen towards patient follow up (85%) and the lowest rate was found towards total quality assessment and safety (59%). Total patient satisfaction was 79%. The highest level of satisfaction was in dimension of trust (88%) and the lowest was found to be in accessing to the physician (18%). Adequate number of staff and providing them with standard working conditions alongside allocating sufficient resources to improve quality and care could be of great benefit in improving safety culture in healthcare settings. Moreover, managers could adopt collaborative approaches and recognize client perceptions and expectations to enhance their satisfaction.

"Health Assistant Plan" is one of the health system designs whose effectiveness has been less considered.The aim of this study is to determine the correlation between social accountability and quality of service delivery in "Health Assistant Plan" of Imam Hossein Medical Education Center, Tehran.

In this descriptive-correlational study, 384 patients referred to Imam Hossein Medical Education Center of Tehran participated by convenience sampling method. Data were collected using “Health Assistant Plan Evaluation Questionnaire” which developed in this study. Validity of the questionnaire was confirmed by content, face and construct validity through factor analysis. The reliability of the questionnaire was confirmed by internal consistency and Cronbach alpha. Data was analyzed by SPSS. 16.

There was a significant and positive correlation between social accountability and the quality of service delivery (r = 0.562, P = 0.001). The mean scores for the dimensions of human of dignity, autonomy, quality of facilities, access to support, communication clarity and behavioral aspects were less than average. The mean scores dimensions of privacy and confidentiality, the choice of therapist, equipment and physical facilities, environmental health, access and care were more than average.

There was a correlation between social accountability and the quality of services delivery at Imam Hossein Hospital. It is suggested that health planners and health officials consider the two main principles of social accountability and quality of service delivery.

Physiological changes in pregnancy can affect the tissues of the mouth and gums and can increase the severity of problems such as inflammation, bleeding and swelling of the gum. Periodontal diseases can play a role as a focal point Infections in the body. According to the above, the purpose of this study is to investigate the effects of maternal periodontal disease on pregnancy outcomes.
In this review article, articles related to the key words (periodontal disease, pregnancy outcomes, preterm delivery, premature infants) from prestigious internal databases (SID, Irandoc, Iranmedex) and With keywords (Periodontal disease, Consequences of Pregnancy, Preterm Delivery, Premature infants) (Confirmed in Mesh) from foreign authoritative databases (Google Scholar, Scopus, Pubmed, Medline) were found between 2008 and 2017 and Articles published in this field were reviewed.
In this study, 48 papers were collected, of which 30 papers were analyzed. 18 other articles were omitted due to repeatability, non-relevance to the title and keywords from the review process. The results of the research showed that periodontal diseases are infections that can affect cytokines production, causing early birth pain, tearing of fetal screens and early delivery. Preterm infant births also increase infant mortality. Studies have shown that periodontal disease of pregnant mothers is associated with the birth of a low birth weight baby. Also, periodontal disease is associated with an increase in inflammatory factors as a risk factor for gestational diabetes mellitus.
The findings indicated that periodontal disease was associated with gestational diabetes, and pregnant women with periodontal disease were 5/7 times more likely to have gestational diabetes than non-periodontal patients.
Regarding the role of periodontal condition of pregnant mothers in the health of their future children, the need for an appropriate planning to increase the awareness of women and improve their oral health is becoming more and more evident. With the prevention and treatment of periodontal diseases in pregnant women, these complications can be decreased. Confirmation of periodontal health of women by the dentist can be very effective before going to pregnancy in this direction.

In the article published in Volume 27, issue 158, 2017, the Results section in English Abstract have been published incorrectly. The correct Results is given below:
The most frequent sizes of mass were 2-4 cm (n=33, 54%) and 4-5 cm (n=23, 38%). Among the patients, 35 (67.3%) had one tumor before, in 11.5% renew tumor happened, and 65.4% had one tumor after treatment. Liver tumors were controlled in 76.9% in case group which was statistically higher than that in control group (P