فهرست مطالب saeed hesam

Heart failure (HF), as the final stage of cardiovascular disease, is a prevalent cause of mortality, disability, and recurrent hospitalization. Effective treatment of systolic HF is crucial for reducing patient disability and preventing repeated hospital admissions. In this context, we aimed to conduct a comparative study of spironolactone at doses of 25 mg and 50 mg in patients with systolic HF.

This randomized clinical trial was performed on 100 patients with systolic HF. The patients were randomly divided into two treatment groups receiving 25 and 50 mg of spironolactone. Subsequently, changes in ejection fraction, frequency of hospitalization, performance capacity, quality of life, and electrolyte disorders were examined.

There was no significant difference between the groups in terms of age, sex, cardiovascular risk factors, history of cerebrovascular accidents, readmission rate, and EF changes (P>0.05). At the end of the study, the mean scores of performance capacity and quality of life in patients receiving 50 mg of spironolactone were 204.3±28 and 32±3.1, respectively. These values were statistically higher than those reported in patients receiving 25 mg of spironolactone (178.9±30 and 36.7±3.3, respectively) (P<0.001). In patients who received 50 mg of spironolactone, the average levels of potassium and blood urea nitrogen were 0.68±0.08 and 6.1±1.4, respectively. These levels were significantly higher compared to those in patients receiving a 25mg dose, where the levels were 0.39±0.17 and 4.7±2.8, respectively (P<0.05). However, it is important to note that the maximum values observed did not exceed the normal range for these parameters.

Compared to the 25mg dose, the 50mg dose of spironolactone was observed to enhance both the quality of life and performance capacity in patients with systolic HF. Therefore, it can be prescribed as the initial daily dosage for managing patients with HF.

Reduced ability to control balance is one of the disorders affecting the qualityof life and daily activities of people with diabetic polyneuropathy (DPN), which can lead to dangerousconsequences such as falling. By identifying the causes of balance disorders, we can better understandthis condition to provide effective and evidence-based treatments for these patients. This study aimsto investigate and compare the use of motor strategies in people with and without impaired sensoryorganization suffering from DPN.

In this cross-sectional study, 40 people with DPN participated. Their demographicinformation were recorded and then underwent balance performance test using the sensory organizationtest. Based on the results, they were divided into two groups: Control group without impaired sensoryorganization (n=18) and Patient group with impaired sensory organization (n=22).

The prevalence of inappropriate use of motor strategies to restore balance in DPN patients withimpaired sensory organization was higher than in the control group. The adopted inappropriate strategywas mostly in using ankle strategy, where the somatosensory and visual perturbations were higher.

Patients with DPN use ankle strategy, instead of hip strategy, to restore balance. This non-useof hip strategy is more common in patients with impaired sensory organization.

Breast cancer is currently the most commonly diagnosed neoplasm in women worldwide. There is evidence that human papillomavirus (HPV) infection may play a key role in breast cancer aggressiveness, but results are conflicting across studies. The aim of this study was to investigate the presence of the HPV viral genome in benign and malignant breast tissue samples and its clinicopathological characteristics of cancer.

In this case-control study, 100 formalin-fixed paraffin-embedded (FFPE) of breast cancer and 100 blocks of non-cancerous breast tissue were selected as a control group from the pathology department of Imam Khomeini Hospital in Ahvaz from 2020-2022. The presence of HPV was detected using nested PCR including MY09/11 primers and sequencing were performed for virus genotyping.

The present study enrolled 100 subjects each in two cancer and control groups with a mean age of 52.81±13.23 and 35.77±11.65, respectively. The risk of cancer in HPV-infected patients is almost 5 times higher than in HPV-negative individuals, it is not statistically significant (OR =4.99, 95% CI 0.35 to 72.15, p=0.238). The prevalence of HPV in the cancer and control groups was 7% and 1%, respectively and HPVs detected in two groups were of the HPV 16 genotype. Although the chance of ER and PR expression, lymphvascular involvement, perineural invasion, and higher tumor grade was higher in HPV-positive subjects than in HPV-negative subjects, this was not statistically significant (OR>1, p>0.05).

Based on studies reporting the existence of sequences of different high-risk HPV types (oncogenes) in breast cancer tissues, this study confirmed the hypothesis of a possible infectious cause in the development of breast cancer. So far, however, the results have been controversial and inconclusive. Further studies with large sample sizes are needed to demonstrate the link between HPV and breast cancer.

 Numerous equations are applied in order to estimate the glomerular filtration rate (GFR).

 This study aimed to spot the optimal equation that accurately estimates GFR and, therefore, the chronic kidney disease (CKD) stage in renal transplant patients.

 This cross-sectional study was conducted on 58 renal transplant patients. Their venous blood samples were obtained for serum creatinine and cystatin C determination used to calculate estimated GFR (eGFR). The average contrast of GFR in each equation was calculated using the Bland-Altman method. The correlation, bias, imprecision, and 10% and 30% accuracy were compared between the eGFR cystatin C and creatinine. Concordance between both equations for CKD staging was assessed. The classification of patients was also investigated.

 Bland-Altman plots and bias demonstrated that eGFR by the abbreviated modification of diet in renal disease (Ab-MDRD) was the most accurate compared with chronic kidney disease epidemiology collaboration (CKD-EPI) cystatin C, followed by CKD-EPI eGFR creatinine. With reference to CKD-EPI cystatin C, the imprecision of the equations was approximately similar to Ab-MDRD, and CKD-EPI creatinine is still better than the Cockcroft-gault (CG) formula. They also showed good 30% accuracy. Finally, our finding suggested that Ab-MDRD and CKD-EPI eGFR creatinine might be the best-performing equation in the classification of the CKD stages in a cutoff of 60 mL/min/1.73 m2.

 Due to the high cost and potential delay in measuring cystatin C, it would be much more appropriate to measure Ab-MDRD; after that, CKD-EPI eGFR creatinine as an alternative approach in order to facilitate rapid clinical decision in renal transplant patients.

One of the major challenges in intensive care unit (ICU) patients is sepsis. The incidence of sepsis in patients admitted to the ICU has been reported from 13.6-39.3%. Many factors affect patient mortality, including acute phase proteins such as albumin.

The present study was a retrospective study in which patients with a diagnosis of sepsis referred to Golestan Hospital in Ahvaz from March to August were collected. In the present study, patients with sepsis admitted to the ICU who did not show improvement for more than 7 days were evaluated for length of hospital stay, survival and the relationship with albumin levels. During the study, albumin was checked every 72 hours and its validation was done. Based on albumin levels less than 2.6, they were treated with albumin. The patients who did not have an increase in the level of albumin remained in the study.

124 patients including 64 women (51.6) and 60 men (48.4) with a mean age of 66.4±15.4 were included in the study. The mean duration of hospitalization was 31.4±18.9 days, in which 24 patients (19.4%) died and 100 patients (80.6%) were discharged. Age, albumin and protein levels were associated with disease prognosis (P<0.001). Also, the duration of hospitalization in the deceased patients was longer than the recovered patients (27.7±25 vs. 32±17.1) (P=0.04). After further investigations, it was found that there is no difference between the deceased people (66±15.7) and the recovered people (67.7±14.1) (P=0.7).

The results of the present study showed that albumin has a direct effect on the severity of sepsis and this issue affects older patients more. Therefore, it is recommended that albumin be considered as a risk factor and one of the influential factors in choosing the best treatment strategy, which is associated with a reduction in mortality, hospitalization and treatment costs.

Burnout is a psychological symptom characterized by emotional exhaustion, depersonalization, and lack of personal accomplishment. Several systematic reviews have examined the prevalence of burnout in some communities, including the communities of physicians, nurses, students, and teachers. Risk factors, consequences of burnout, and related interventions have also been evaluated in several systematic review studies. The purpose of this systematic review was to investigate the prevalence, risk factors, consequences, and interventions associated with burnout among military personnel in all types of studies.

Studies that quantitatively examined burnout in military personnel after 2000 were identified through systematic searches in PubMed, Scopus, Web of Knowledge, Embase, PsychInfo, and PsycArticles databases.

A total of 43 studies met the criteria for inclusion in this systematic review. Of these, 34 were cross-sectional, 7 were longitudinal, 1 was case-control and 1 was experimental. Half of the studies had more than 350 samples. The studies were from 17 different countries, among which the United States had the largest number with 17 studies. 33 studies were measured with one version of Maslach Burnout Inventory (MBI). Totally, only 10 studies reported a prevalence of burnout and/or its subscales. The prevalence of high emotional exhaustion ranged from 0% to 49.7% (median 19%), the prevalence of high depersonalization ranged from 0% to 59.6% (median 14%) and the prevalence of low personal accomplishment ranged from 0% to 60% (median 6.4%). In this systematic review, work environment factors (such as workload, shift work), psychological factors (anxiety, depression, stress), and duration and quality of sleep were shown as risk factors of burnout or its subscales. Also, psychological distress was observed as the consequence of burnout in more than one study.

The studies investigated in this systematic review showed a relatively moderate prevalence of burnout. In fact, burnout was associated with work environment factors and psychological variables.

Mothers with autistic children suffer a lot of psychological and physical pressures that can affect their quality of life, emotional states, and judgment about medical services. This study aimed to evaluate the quality of life, anxiety, and satisfaction with rehabilitation services for mothers of children with autism spectrum disorders and of non-autistic children in Ahvaz-Iran.

In this cross-sectional descriptive-analytical study, 128 mothers with autistic children and 30 mothers with non-autistic children needing rehabilitation interventions were selected from Ahvaz rehabilitation centers. All participants were asked to complete Quality of Life (WHOQOL-BREIF) questionnaire, 14-item Perceived Stress Scale as well as Satisfaction Questionnaire. Data analysis was performed using a multivariate three-way ANOVA test.

It was found that mothers of autistic children had a significantly lower quality of life score than those without autistic children (P<0.001). However, the two groups had no significant difference in anxiety score (P=0.114) and satisfaction (P=0.079). Factors such as age, education, and occupation of mothers significantly affected the results (P<0.05). Moreover, mothers whose autistic children received rehabilitation services under one month had lower quality of life (P=0.003) and a higher level of anxiety (P=0.025) than those who received rehabilitation over six months.

Middle-aged housewives with autistic children had the lowest mean quality of life score among all mothers studied. Mothers with a university education reported a lower level of satisfaction compared to mothers without a university education, indicating a higher level of expectations for their rehabilitation outcome.

Research findings can be applied in managing rehabilitation services for autistic children and their families.

The insertion of central venous catheters in patients with chronic renal failure and poisoning is a vital step for these patients. Therefore, it is necessary to know the complications and clinical applications of these catheters. The aim of this study was to identify catheter complications in patients with Shaldone dialysis catheter and the choice of the best method for preventing the occurrence of these complications in patients. The study population consisted of all patients, who were admitted in the ICU poisoning for dialysis and used Shaldon's catheter. Information including age, sex, cause of admission, duration of admission, duration of catheterization, the type of complication, and the use of Shaldon's catheter were extracted from patients' files and special forms. Among the 80 patients, who had Shaldone's catheter, 59 were uncomplicated and 21 were complicated. The most common complication was catheter site infection (8.8%). There were 5% of patients with pneumothorax, 5% with bleeding, 2.5% with thrombosis, 1.3% hemothorax, 1.3% hematoma, 1.3 % pneumothorax plus hemothorax, and 1.3% catheter site infection along with thrombosis. According to the pertinent literature, if the experienced patients practice catheterization, the internal jugular catheter is a more appropriate and feasible approach than femoral. It is recommended to conduct catheterization by experienced individuals with the introduction of a catheter and under the guise of ultrasound to minimize the occurrence of some complications

Diabetes mellitus (DM) is one of the mostcommonchronic non-communicable diseases (NCD).

The present study aimed to investigate the relationship between demographic and clinical data with balance impairments in people with diabetic peripheral neuropathy (DPN), considering the importance of early detection of balance impairments in this population.

Forty-three patients with DPN were evaluated in this cross-sectional study. Age, disease duration, height, weight, and physical activity, along with blood sugar samples and neuropathy disability scores were collected to explore correlations with the balance evaluation system test (BESTest) inthis population.

A significant weak to moderatecorrelations was found between physical activity (p-value=0.046/ CC= 0.286),severity of neuropathy (p-value=0.025/ CC= -0.317), and gender (p-value=0.032/ CC= -0.311) with BESTest, using multivariate linear regression analysis.

It is recommended that diabetic patients with a sedentary lifestyle, more severe scores on neuropathy screening instruments, and female patients be referred for early screening of balance disorders regardless of age and disease duration. Also, increasing physical activity to prevent balance impairments in the future can be recommended.

Acknowledging the key role of hardiness, importance of health and its various dimensions, the present study aimed to investigate the simultaneous relationship between hardiness components and spiritual health, burnout, and general health, among Baqiyatallah University of Medical Sciences staff.

307 Baqiyatallah University of Medical Sciences’ staff in Tehran with at least five years work experience participated in this cross-sectional study using simple random sampling. Four questionnaires were used to evaluate the participants: the 28-item General Health Questionnaire (GHQ) to assess general mental problems with four subscales, 22-item Maslach Burnout Inventory (MBI) with two aspects (frequency and intensity) and three subscales of emotional exhaustion, depersonalization and personal accomplishment, the 20-item Spiritual Well Being Scale (SWBS) Questionnaire with two subscales of religious well-being and existential well-being and the 50-item Kobasa Hardiness Questionnaire to measure psychological hardiness with three subscales of control, commitment and challenge. At the end, two conceptual models which have shown effect of hardiness and its subscales on general health, Spiritual health and burnout were evaluated by path analysis.

According to the path analysis results, it was found that hardiness and its subscales, which were approved by univariable and multivariable analyses, had significant relationship with general health (direct effect: -0.525, P < 0.001), spiritual health (direct effect: 0.555, P < 0.001) and burnout (direct effect of frequency aspect: -0.523, P < 0.001). Thus, by increasing hardiness and its subscales, spiritual health increases while symptoms of illness and burnout decrease.

Spiritual health increases as hardiness and its subscales increase as well; therefore, symptoms of illness and burnout decrease as hardiness and its subscales increase.

Job analysis, detecting hazards, and measuring their relationship with risk perception in workers are efficient ways of preventing accidents. Therefore, the present study is an attempt to identify and assess the risk of job accidents in steel industry in the south of Iran in 2020 using job safety analysis and the William Fine method. The results are also compared with the workers' perception of risk.

The study population consisted of workers in the supplementary section of the studied steel industry(N=169). All the collected data were analyzed in SPSS using frequency and percentage for description and simple/multivariate logistic regression for analysis with sig. equal to 0.05.  To determine the risks, JSA was used. Risk assessment was also performed using William Fine method, and then risk scores were obtained. Afterwards, Risk Perception Questionnaire was used to collect information about risk perception in the workers.

In total, 265 job activities along with 2684 risks were identified and evaluated in 7 units of sections in the steel industry.

The results of risk assessment and risk perception in this study indicate that when safety risk is properly perceived by workers, the chance of observing safety codes and better detection of risks increases. Therefore, in the face of an unsafe condition at work, workers will be abed to make the right decision and control the risk and prevent work accidents by taking corrective measures and making safe and efficient decisions.

Alteplase is a thrombolytic drug that is produced by recombinant DNA technology. Tissue plasminogen activator enzymewhich converts plasminogen to the active form of plasmin is also produced by the same technology; it causes fibrinolysis and clot dissolution. This study aimed to compare the efficacy and complications of Alteplase injection in patients with acute ischemicstroke (AIS(during the first 3hours and 3-4.5hours after the onset of symptoms.

In this study, patients with AIS who were referred to Golestan Hospital of Ahvaz city during 2018-2019 were selected. Information was collected by a checklist.

The results showed that the mean Modified Rankin Scale(mRS)for 3 months and 6 months (p-value: 0.91 for 3months and p-value: 0.80 for 6months) and National Institutes of Health Stroke Scale(NIHSS)(p-value: 0.21) were not significantly different between both groups; statistically, no significant relationship was observed between them. The incidence of complications after treatment was almost similar, in both groups.

Finally, it was concluded that complications and efficacy of rt-PA (Alteplase) injection were not statistically different, between the two groups under study.

Studies have shown that syllable speech technique (SST) can be a useful and practical way to achieve stutter-free speech for children with stuttering (CWS). In this preliminary study, the use of SST in Persian-speaking school-age CWS was investigated.

Ten 8- to 11-year-old students with stuttering were entered in the single-group pretest-posttest study as participants. Their speech fluency has been enhanced using SST accompanied by verbal encouragement for stutter-free speech. The percentage of stuttered syllables, stuttering severity, and communication attitude as outcome measures were evaluated in three time points: before the intervention (T0), after the intervention (T1), and one month after the intervention (T2).

The children showed significantly better scores on all outcome measures at T1 (P≤0.004) and T2 (P≤0.005) compared with T0. There was no significant difference between T1 and T2 (P≥0.026).

The reported benefits of SST in stuttering reduction and speech-related anxiety-relieving of Persian-speaking school-age CWS confirms the feasibility and usefulness of this technique.

 Cardiopulmonary resuscitation (CPR) has been a frequently performed medical intervention that increases the chance of survival of a person stricken by cardiac arrest, and there is an excellent value of diversity in the rate of successful rehabilitation in societies.

 A retrospective observational study was carried out. The medical records of all in-hospital and out-hospital cardiac arrest patients who underwent CPR were collected. A total of 587 people with who underwent CPR during two years between January 2017 and June 2018, using a designed form were enrolled. Demographic information, the ward which CPR was committed, hospitalization, the delay before the onset of CPR and time of the day were recorded.

 The overall success rate of CPR in this study was 25.89%. There was no significant difference in the success rate of CPR between men and women. A comparison of age groups revealed a difference between the success rates of CPR in 14 - 64 years group compared with the group above 64. Analysis of the data revealed no difference between CPR success rates in various seasons. Investigating the occurrence of cardiac arrest and its success rate at the hospital shifting showed a significant difference between the success rate of CPR in the morning shift with the evening shift and night. The dual comparison revealed a significant difference in the success rate of CPR only between the emergency department and intensive care units.

 The current study revealed a significant difference in age group and location, and did not show any significant success rate of CPR in the presence of witnesses, location of cardiac arrest, season and gender.

Although the antioxidant properties of ginger have been revealed, there is little available information on the effectiveness of ginger on inflammatory disorders such as atherosclerosis. This study was carried out to examine the effect of ginger on improving the complication of atherosclerosis.

This study was a double-blind, placebo-controlled, randomized clinical trial conducted on patients with atherosclerosis. Participants in the ginger and control groups received 1600 mg of powdered ginger or placebo (wheat flour) in capsules daily for 8 weeks. Weight, body mass index (BMI), fasting blood sugar (FBS), cholesterol, triglyceride (TG), low-density lipoprotein (LDL), very-low-density lipoprotein (VLDL), high-density lipoprotein (HDL), lipoprotein (a) [Lp(a)], high-sensitivity C-reactive protein (hs-CRP), and total anti-oxidant capacity (TAC) were assessed before and after the intervention.

Ginger consumption in the intervention group significantly reduced serum Lp(a) level (27.25 ± 1.30 ng/ml vs. 23.57 ± 0.97 ng/ml) (P = 0.040) and also the level of hs-CRP in the intervention group was 1.90 ± 0.33 µg/ml and 1.24 ± 0.15 µg/ml (P = 0.010) before and after intervention, respectively, but the levels of Lp(a) and hs-CRP were not decreased significantly in the placebo group. The level of TAC in the ginger group was 0.71 ± 0.05 mM and after the trial was 0.57 ± 0.04 mM (P = 0.050); no significant differences were seen in TAC when ginger was administered at 1600 mg/daily for 60 days. Also the level of Lp(a) and hs-CRP but not TAC reduced significantly in ginger group compared to placebo group after intervention.

This study showed that ginger had anti-atherosclerosis and anti-glycemic properties associated through a significant decreased Lp(a) and FBS in patients with atherosclerosis supplemented with ginger.

Cardiopulmonary resuscitation (CPR) has been a frequently performed medical intervention that increases the chance of survival of a person stricken by cardiac arrest, and there is an excellent value of diversity in the rate of successful rehabilitation in societies.

A retrospective observational study was carried out. The medical records of all in-hospital and out-hospital cardiac arrest patients who underwent CPR were collected. A total of 587 people with who underwent CPR during two years between January 2017 and June 2018, using a designed form were enrolled. Demographic information, the ward which CPR was committed, hospitalization, the delay before the onset of CPR and time of the day were recorded.

The overall success rate of CPR in this study was 25.89%. There was no significant difference in the success rate of CPR between men and women. A comparison of age groups revealed a difference between the success rates of CPR in 14 - 64 years group compared with the group above 64. Analysis of the data revealed no difference between CPR success rates in various seasons. Investigating the occurrence of cardiac arrest and its success rate at the hospital shifting showed a significant difference between the success rate of CPR in the morning shift with the evening shift and night. The dual comparison revealed a significant difference in the success rate of CPR only between the emergency department and intensive care units.

The current study revealed a significant difference in age group and location, and did not show any significant success rate of CPR in the presence of witnesses, location of cardiac arrest, season and gender.

Lumbar disc hernia recurrence is the most common complication after a primary open-ended discectomy that has a poor prognosis.

To assess the risk factors for re-operational need in patients with lumbar discs referred to Golestan Hospital, Ahvaz from 2011 to 2015.

In this retrospective and epidemiological study, 35 patients with recurrence (group 1) and 70 patients without recurrence after surgery (group 2) were evaluated to investigate the potential risk factors for recurrence of lumbar disc herniation. They were randomly selected from the patients who underwent lumbar disc (discectomy) from Golestan Hospital between, Ahvaz 2011 to 2015. Clinically, the herniated disk recurrence is a ruptured disc that causes foot pain and has symptoms in radiography (MRI) and is defined by the disk material at the same side and the level of the surgical index that causes impingement, compression, or deviation of the nerve tissue (which is reported by the presence of a radiologist).

The results of this study showed that height, gender (male), weight gain, education lower than diploma, heavyweight and jobs could predict lumbar disc herniated recurrence. However, there was no significant difference in terms of age, body mass index, diabetes mellitus, smoking, alcohol consumption, marital status, ethnicity, and family history of both groups.

The variables of height, gender (male), weight gain, lower-diploma education, and heavyweight jobs can predict the recurrence of lumbar herniated disc.

 Comparison of midazolam and propofol has been done hoping to reduce the incidence rates of emergence agitation (EA) after anesthesia. Both drugs however, are still under inspection as for their effect on EA after using Isoflurane for maintenance of anesthesia.

 This study was designed for measuring the effect of either propofol or midazolam near the end of tonsillectomy operation on incidence of EA during the recovery phase.

 In this randomized, double-blind study, 90 children, aged 5 to 15, undergoing anesthesia with Isoflurane were randomly assigned to three groups receiving either propofol (group P), midazolam (group M) or saline (group S) near the end of anesthesia. Severity and incidence of EA were then calculated using the pediatric anesthesia emergence delirium (PAED) scale.

 The mean PAED score in group P was (2.87 ± 2.69) and (1.90 ± 2.55) in group M. Both were significantly lower than group S (7.60 ± 3.78) (P < 0.05). However, there was no statistical difference in the duration of post-anesthesia care unit (PACU) stay between groups P (42.50 ± 12.58) and M (48.33 ± 24.26), groups P and S (52.00 ± 10.64) and between groups M and S (P > 0.05). No significant difference was found between all groups for apnea and laryngospasm (P > 0.05).

 Administration of either midazolam or propofol near the end of operation may result in reduction of EA in children undergoing tonsillectomy after Isoflurane anesthesia.

Central blood pressure is an important index in central hemodynamic stress andmaybe associated with an increased risk of cardiovascular diseases.

This study evaluated the central blood pressure indices in coronary artery disease (CAD) subjects and their association with the number of diseased vessels involved in CAD.

A random sample of 300 Iranian subjects who underwent coronary angiography (mean age 58.08  10.62 years) was studied. Coronary lesionsweredefinedas luminal stenosis 50% andthenumberof diseased vesselsandthe central aortic pressure were taken. The probability of central blood pressure indices with the number of diseased vessels was also determined by using cutoff points, based on the sensitivity, specificity, positive predictive value, and negative predictive value.

The central blood pressure indices (fractional pulse pressure (FPP), systolic pressure (FSP), diastolic pressure (FDP) and FSP/FDP) were statistically significant in CAD patients with an increase in the number of diseased vessels (P < 0.001). There was a significant association between central blood pressure indices and CAD (P < 0.001) as well as with the increase in the number of diseased vessels (P < 0.001). Both odds ratio (11.84; 95% CI: 6.11 - 22.95; P < 0.001) and ROC analysis (AUC: 0.909; 95% CI: 0.870 - 0.939; P < 0.001) showed FSP as the strongest predictor of CAD. Furthermore, cut-off points of the FSP ( 1.373), FDP (0.811), FPP ( 0.559) and FSP/FDP ( 1.688) were determined for CAD for the first time based on 92% sensitivity, and 74% specificity.

FDP, FSP, and FSP, in particular, could be the effective predictors of CAD in Iranian populations. Therefore, the quality of life may be improved by the management of central blood pressure and using CAD cut-off points.

Todays one of the most common anorectal problems is hemorrhoid. Minor symptom of disease can be treated by medical treatment but at high grade disease we should consider surgery. Although conventional surgery is standard operation for hemorrhoid, it is associated with some complication. Many techniques were designed to overcome these problems. One of these procedures stapled hemorrhoidopexy that this study was done to compare it with conventional hemorrhoidectomy. Subjects and This is a clinical trial study was conducted on 40 patients with hemorrhoids in Ahvaz Razi Hospital. Patients were randomly divided into two groups. Group A (n=20) was treated with stapled hemorrhoidopexy and Group B (n=20) was treated with conventional hemoroidectomy method. Sphincter tone, resting and pressing before and after surgery was measured and compared between two groups. . Data analysis showed that there was no significant differences in tone sphincter resting and pressing before and after surgery in stapled hemorrhoidopexy group and conventional hemoroidectomy group (P-value=0.32). Also, there was no significant difference between the mean scores of pain in groups (P-value=0.32). However, the loss of blood, the need for analgesic drugs and return to work in stapled hemorrhoidopexy group was significantly lower than that of conventional surgery group (P-value<0.001). Findings of study showed that stapled hemorrhoidopexy is an alternative and effective treatment that can be used in adult age groups to reduce pain, side effects, duration of hospitalization and time to return to work.

 The chest pain is a very common complaint among patients with acute coronary syndrome (ACS). The local thermotherapy can reduce or relieve the heart pain by suppressing metabolites as pain mediators.  This study aimed to determine the effect of local thermotherapy on the chest pain in patients with ACS.  This clinical trial was conducted on 78 patients with ACS hospitalized in the ICU of Golestan Hospital of Ahvaz in 2016. Based on the sample size and inclusion criteria, and by a convenience sampling, the eligible patients were enrolled and randomized into two equal-sized groups, namely control and intervention, each containing 39 participants. During the local thermotherapy sessions, the patients received local heat by using a hot pack warmed to 50°C for five days. The control group only received the routine treatment. Data collection instruments included a demographic questionnaire and the Numerical Rating Scale (NRS). The NRS was completed by the participants before the intervention and five days after it. Data were analyzed using the descriptive tests, correlation coefficient, independent t-test, Chi-square, and logistic regression in SPSS 20.  The mean pain severity in the case group before the intervention was 3.22 ± 0.86 and after the intervention, it decreased to 2.61 ± 0.7, indicating the effect of local thermotherapy. However, it was not statistically significant (P > 0.05). There was no significant relationship between age, gender, diabetes, hypertension, and hyperlipidemia, and the pain severity in this study (P > 0.05). Logistic regression analysis showed that women experienced more pain than men did.  This study suggested the slight effectiveness of local thermotherapy in reducing the severity of pain in these patients. As a result, further studies are recommended.

Human amniotic membrane (HAM) is used as a supporter for limbal stem cell (LSC) expansion and corneal surgery. The aim of study is to use HAM extracts from healthy donors to enhance proliferation of LSCs in vitro and in vivo.
In this interventional experimental study, the effective and cytotoxic doses of the amniotic membrane extract eye drops (AMEED) was assessed by adding different concentrations of AMEED (0-2.0 mg/ml) to LSC cultures for 14 days. Subsequently, the expression levels of ATP-binding cassette sub-family G member 2 (ABCG2, a putative stem cell marker), cytokeratin 3 (K3, corneal maker), K12 and K19 (corneal-conjunctival cell makers) were assessed by real-time polymerase chain reaction (PCR). In the second step, the corneal epithelium of 10 rabbits was mechanically removed, and the right eye of each rabbit was treated with 1 mg/ml AMEED [every 2 hours (group 1) or every 6 hours (group 2)]. The left eyes only received an antibiotic. The corneal healing process, conjunctival infection, degree of eyelid oedema, degree of photophobia, and discharge scores were evaluated during daily assessments. Finally, corneal tissues were biopsied for pathologic evidences.
In comparison to the positive control [10% foetal bovine serum (FBS)], 0.1-1 mg/ml AMEED induced LSC proliferation, upregulated ABCG2, and downregulated K3. There were no remarkable differences in the expression levels of K12 and K19 (P>0.05). Interestingly, in the rabbits treated with AMEED, the epithelium healing duration decreased from 4 days in the control group to 3 days in the two AMEED groups, with lower mean degrees of eyelid oedema, chemosis, and infection compared to the control group. No pathologic abnormalities were observed in either of the AMEED groups.
AMEED increases LSCs proliferation ex vivo and accelerates corneal epithelium healing in vivo without any adverse effects. It could be used as a supplement for LSC expansion in cell therapy.

Optic neuritis is an inflammation of the optic nerve. Because of importance of vision for human, management of optic neuritis is an important issue in neurology.
This study aimed at assessing the effect of oral steroid treatment after intravenous (IV) methylprednisolone therapy on demyelinating optic neuritis.
60 Patients with first episode of acute demyelinating optic neuritis who referred to a neurology clinic in an academic hospital in south-west of Iran in 2015-2016 included in this randomized double-blind clinical trial study (No: IRCT2015102724735N1). They were divided into two groups with (A) and without (B) tapering oral steroid treatment after IV methylprednisolone. Visual acuity and color vision were measured before treatment, before oral tapering, 1 and 3 months after treatment. Independent t-test in SPSS software version 20 was used to analyze the data. P Visual acuity in two groups did not have any significant difference in any time point of assessment (P>0.05).Frequency of color vision abnormality in groups A and B were at baseline (53.3% vs. 56.6%) (P=0.796), before oral tapering (43.3% vs. 30%, P=0.284), 1 month after treatment (23.3% vs. 30%, P=0.559), 3 months after treatment (0% vs. 23%, P=0.011).
Oral steroid treatment after IV methylprednisolone pulse therapy improves color vision after 3 months in patients with demyelinating optic neuritis but has no effect on visual acuity.

We aimed to compare the effect of accelerated and conventional corneal collagen cross-linking (CXL) on visual, refractive, and topographic parameters in patients with progressive keratoconus. Between December 2014 and February 2016, at Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Iran, we compared 37 eyes of 21 patients treated by conventional CXL (CCXL; 3 mW/cm2 in 30 minutes) with 34 eyes of 18 patients treated by accelerated CXL (ACXL; 18 mW/cm2 in 5 minutes) based on generalizing estimation equation analysis in terms of corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), corneal endothelial cell indices, and topographic parameters before and at 3, 6 and 12 months after the operation. The mean UDVA and spherical equivalent changes were similar in the two groups, but an improvement in CDVA was only observed in the CCXL group (P = 0.003). Keratometry (minimum and maximum) was significantly decreased in the CCXL group (P = 0.043 and P = 0.008, respectively). Indices of keratoconus progression—surface asymmetry index (SAI), keratoconus prediction index (KPI), and keratoconus index (KCI)—were significantly lower in the CCXL group than in the ACXL group (P = 0.002, P