Comparative investigation of different chemicals on the germination of two aquatic microsporidia

Microsporidia are eukaryotic obligatory intracellular parasites that infect a wide range of vertebrates and invertebrate hosts. Spores infect target cells of the host by transferring their sporoplasm through a distinctive polar tube. This study investigated how selected chemicals influence the germination of two newly discovered microsporidia species from central-western Iran. Spores of Parathelohania iranica were extracted from infected larvae of Anopheles superpictus s.l. and purified by the Percoll discontinuous density gradient method. Because of the small number of spores per copepod, extraction and purification were not performed for spores of the microsporidium infecting Paracyclops chiltoni. Both spores were exposed to KCl, NaCl, KI, NaI, and H2O2 and the effects of concentration (0.5, 1.5, and 2.5 M), pH (7.0, 9.0, and 11.0), temperature (4 °C and 25 °C), and duration of exposure (10 and 30 min) on spore germination were investigated and compared. This study indicated that the type of the ionic nature of the surrounding environment of spores plays an important role in the release of polar tubes of both microsporidia. Additionally, anions played a more significant role than cations. This effect was directly related to concentration, temperature, and time. However, no specific pattern was recognized at different alkaline pH levels. Hydrogen peroxide was not effective in releasing the polar tubes of the spores of these microsporidia. This study demonstrated the comparative role of some chemicals and the associated factors in the release of the polar tube of two aquatic microsporidia. Future research should examine the practical value of these findings in the mass production of candidate microsporidia for the biological control of pest invertebrate hosts.

Effects of bromodomain and extra-terminal inhibitor JQ1 and interleukin-6 on breast cancer cells

BACKGROUND

Bromodomain and extra-terminal (BET) proteins are recognized acetylated lysine of histone 4 and act as scaffolds to recruit many other proteins to promoters and enhancers of active genes, especially at the super-enhancers of key genes, driving the transcription process and have been identified as potential therapeutic targets in breast cancer. However, the efficacy of BET inhibitors such as JQ1 in breast cancer therapy is impeded by interleukin-6 (IL-6) through an as-yet-defined mechanism.

METHODS AND RESULTS

We investigated the interplay between IL-6 and JQ1 in MCF-7 and MDA-MB-231 human breast cancer cells. The results demonstrate that the efficacy of JQ1 on the inhibition of cell growth and apoptosis was stronger in MDA-MB-231 cells than in MCF-7 cells. Further, MCF-7 cells, but not MDA-MB-231 cells, exhibited increased expression of CXCR4 following IL-6 treatment. JQ1 significantly reduced CXCR4 surface expression in both cell lines and diminished the effects of IL-6 pre-treatment on MCF-7 cells. While IL-6 suppressed the extension of breast cancer stem cells in MCF-7 cells, JQ1 impeded its inhibitory effect. In MCF-7 cells JQ1 increased the number of senescent cells in a time-dependent manner.

CONCLUSION

Analysis of gene expression indicated that JQ1 and IL-6 synergistically increase SNAIL expression and decrease c-MYC expression in MCF-7 cells. So, the BET proteins are promising, novel therapeutic targets in late-stage breast cancers. BET inhibitors similar to JQ1 show promise as therapeutic candidates for breast cancers, especially when triple-negative breast cancer cells are increased and/or tumor-promoting factors like IL-6 exist in the tumor microenvironment.

The effect of the supportive care program based on Bandura's self-efficacy on stress and participation of the mothers of the neonates admitted to neonatal intensive care unit

BACKGROUND

Maternal stress can affect both the neonate and the mother and deter them from participating in the care of preterm neonates. The purpose of the study was to determine the effect of the supportive care program (SCP) based on Bandura's self-efficacy on stress and participation of mothers of neonates admitted to the neonatal intensive care unit.

MATERIALS AND METHODS

This quasi-experimental study was performed in 2020 on 90 mothers of premature infants admitted to the NICU of Hajar Hospital in Shahrekord, Iran. First, the control group and then the experimental group were selected and a training package based on Bandura's self-efficacy theory was implemented for the intervention group. The research instruments in this study were the Heidari mothers stress questionnaire and Melnyk mother's participation questionnaire which was completed before and after the intervention. The analysis was performed based on SPSS (version 24) and Chi-square, independent t-test, and paired tests.

RESULTS

The results indicated that the demographic variables of mothers and neonatal characteristics of the two groups did not have significant differences except for the history of abortion and infertility in mothers and the weight of preterm neonates (P < 0.05). Mothers in the experimental group had less stress (t (88) = 29.50, P < 0.001) and more participation than the control group (t (88) = -27.18, P < 0.001) after the intervention.

CONCLUSIONS

Using self-efficacy-based SCP for maternal education besides routine education could positively affect the reduction of stress and the increase of maternal participation in caring for preterm neonates during hospitalization. Thus, using this supportive program is suggested for mothers with preterm neonates admitted to NICU.

Removal of Natural Organic Matter (NOM) from Aqueous Solutions by Multi-Walled Carbon Nanotube Modification with Magnetic Fe3O4 Nanoparticles

Backgroundand Aim. Natural organic matter (NOM) has become one of the most serious environmental problems due to its persistence in aqueous solutions and the risk of carcinogenesis. In this study, the removal efficiencies of real and synthetic humic acid (HA) by multi-walled carbon nanotubes (MWCNTs) coated with iron oxide were evaluated. Materials and Methods. The MWCNs were synthesized and coated with iron oxide. In addition, the effects of pH, contact time, mixing speed, and adsorbent dose on the removal efficiency of NOM by MWCNTs-Fe3O4 were studied. Then, the removal efficiency of NOM from real samples was investigated at optimal conditions. The MWCNT-Fe3O4 was characterized by scanning electron microscopy (SEM) test and X-ray diffraction (XRD), respectively. Data analysis was performed using Minitab software based on the Taguchi method. Results. The results showed that MWCNTs were coated with Fe3O4. The SEM test shows particle (MWCNTs-Fe3O4) size in the range of 48–143 nm, and the particles have uniform spherical shapes. Enix software was used to identify the phase in this sample. The conditions including $\mathrm{p}\mathrm{H}=3$ , mixing speed = 120 rpm, adsorbent dosage = 1.5 g·L−1, and contact time = 90 minutes were selected as optimal for NOM adsorption. The mean removal efficiencies of NOM in synthetic samples at 5, 10, and 20 mg·L−1 concentrations were 86.6%, 84.87%, and 95.41%, respectively. In addition, the mean removal efficiency of NOM in Choghakhor Wetland was 77%. Conclusion. Our findings demonstrated that the MWCNTs-Fe3O4 can be potentially used as an adsorbent for removing natural organic matter (HA) from aqueous solutions.

Promoting Health Literacy and Perceived Self-Efficacy in People with Chronic Obstructive Pulmonary Disease

Background

Chronic Obstructive Pulmonary Disease (COPD) is an irreversible condition and it is of great importance for the patients to practice self-care. Given the impact of inadequate health literacy on people's self-efficacy in a self-care program, the aim of this study was to improve health literacy and self-efficacy in people with COPD.

Materials and Methods

The present quasi-experimental study was conducted on 70 patients with COPD admitted to Shahrekord educational hospitals in 2019. Using random allocation software, the samples were randomly divided into intervention and control groups. Data collection tools included three questionnaires including demographic, health literacy, and perceived self-efficacy questionnaires. A training program, with three weekly sessions of theoretical and practical trainings, was conducted for the intervention group in classes in the hospital. The time of each session was 40 min. Data were collected three times i.e., before, immediately after, and three months after the trainings. Data were analyzed by means of SPSS 21 statistical software using descriptive and inferential statistics.

Results

Before the intervention, the mean scores of perceived self-efficacy and health literacy did not differ significantly between the two groups, but after the intervention, the scores of the members in the intervention group increased significantly (f = 62.15, p < 0.05).

Conclusions

The results of the study indicated an increase in the scores of perceived self-efficacy and health literacy in people with COPD. The use of targeted educational interventions can have a positive effect on the treatment and control of the disease.

Evaluation of chemical oxygen demand and color removal from leachate using coagulation/flocculation combined with advanced oxidation process

Background:

One of the basic practices in the field of waste management is the collection and treatment of leachate. Leachate from municipal waste due to high chemical oxygen demand (COD) and dark color is a potential pollutant of the environment, which causes a lot of problems in the absence of treatment and direct discharge to the environment. This study aimed to determine the efficiency of ultrasonic process in combination with coagulation and flocculation process using sodium ferrate in COD and color reduction.

Materials and Methods:

In this experimental study, all experiments were performed in batch conditions and with changing process variables such as pH and sonication time, and the effect of three parameters, including ultrasonic reaction time (15, 30, and 45 min), pH (2, 4, 5/5, and 7), and coagulant dosage (from 1 to 150 g/l) on the COD reduction and color removal, was evaluated. Coagulant concentration and then the removal efficiency of COD and color were analyzed by ANOVA using SPSS 18.

Results:

The COD reduction and color removal were 87.05% and 88.6% in optimal condition (using 120 g/L of sodium ferrate at pH 5.5), with coagulation/flocculation, after ultrasound (15 min). Ultrasound (15 min) + sodium ferrate (without coagulation/flocculation) achieved 46.25% of COD reduction and 90.35% of color elimination, whereas the ultrasonic process alone allowed removing the COD and color in the leachate by less than 50%.

Conclusion:

The results indicate that C–F followed by ultrasonic can be used to efficiently reduce the organic matter and color from municipal waste leachate, and it would be an ideal option for leachate treatment.

The effect of situation, background, assessment, recommendation-based safety program on patient safety culture in intensive care unit nurses

BACKGROUND

Patient safety culture is an integral part of patient care standards and a prerequisite for safe care. SBAR is an acronym for Situation, Background, Assessment, Recommendation; this communication model has gained popularity in health-care settings, especially among professions such as nursing. However, there is little evidence that nursing professional education can enhance patient safety culture. The aim of this study was to investigate the effect of a SBAR-based training program on patient safety culture in intensive care unit (ICU) nurses.

MATERIALS AND METHODS

The quasi-experimental study was carried out in 2018-2019 at areas covered by Shahrekord University of Medical Sciences, Iran. This study was performed on 60 nurses working in ICU. The participants were randomly assigned to two experimental and control groups of 30 each. For the experimental group, five workshop sessions of SBAR-based program were held. For the control group, the patient delivery process was performed according to the ward routine. Data were collected using patient safety culture questionnaires before and 1 month after the intervention, and were analyzed using descriptive and analytical tests such as paired t-test, independent t-test, and Chi-square test by SPSS 22.

RESULTS

The mean score of safety culture was 31 ± 23.5 and 55.2 ± 28.6 in frequency of reporting events, 32.8 ± 17.8 and 54.3 ± 19 in overall perception of patient safety, 23 ± 20.1 and 52.9 ± 26 in communication channel openness, and 35.2 ± 19.8 and 52.4 ± 18.8 in information exchange and conveyance before and after training intervention, respectively, so that they improved from poor level to neutral-moderate level. There was no strength in any dimensions of safety culture; however, the implementation of the SBAR-based program was significantly associated with patient safety culture (P < 0.001).

CONCLUSIONS

Improving patient safety culture requires attention to patient safety models such as SBAR approach that provides an appropriate and reliable structure for quality improvement. SBAR-based program training is effective in promoting patient safety culture; therefore, it is recommended that managers use this technique to promote patient safety culture.

Decolorization mechanism, identification of an FMN-dependent NADH-azoreductase from a moderately halotolerant Staphylococcus sp. MEH038S, and toxicity assessment of biotransformed metabolites

The application of halotolerant microorganisms capable of decolorizing is attractive. Decolorization mechanism, the effect of different parameters on the decolorization percentage, and toxicity analysis of Reactive Black 5 before and after decolorization were investigated in the present study. The decolorization percentage for live cells of Staphylococcus sp. strain MEH038S was more than dead cells, which demonstrated that Reactive Black 5 was decolorized through the degradation process. The results confirmed that an FMN-dependent NADH-azoreductase gene was responsible for the decolorization and then was identified as Staphylococcus sp. EFS01 azoreductase from a moderately halotolerant Staphylococcus strain for the first time. The maximal decolorization of 98.15% was observed at pH 6.5 and 35 ^° C for 50 mg/L of Reactive Black 5. In addition, more than 90% decolorization was achieved with 5-40 g/L of NaCl. The results of Gas chromatography-mass spectrometry and Fourier transform infrared spectroscopy showed that Reactive Black 5 was broken to the lower molecular weight compounds without any chromophoric azo groups. Phytotoxicity and fish toxicity proved that the biotransformed metabolites of Reactive Black 5 degradation were more toxic than the original dye. The moderate halotolerant strain exhibited a remarkable decolorization capability and can be applied for textile wastewater treatment. PRACTITIONER POINTS: An azoreductase gene from a moderately halotolerant Staphylococcus was identified. More than 90% decolorization efficiency was observed under high-salt conditions. Biotransformed metabolites of RB5 degradation were identified. Toxicity analysis of biotransformed metabolites was investigated.

The effects of a self-management program based on 5 A`s model on the quality of life and self-efficacy in the myocardial infarction patients

INTRODUCTION AND OBJECTIVES

The myocardial infarction is the most severe manifestation of coronary artery disease. The promotion of self-efficacy in these patients can be effective in the improvement of their quality of life. The aim of this study was to investigate the effects of a self-management program based on 5 A`s model on the quality of life and self-efficacy of the patients with myocardial infarction.

METHODS

The current study was a clinical trial that was conducted in Ayatollah Kashani and Hajar hospitals in Shahr-e Kord (Iran) with the participation of 96 patients with myocardial infarction. The research units were blocked randomly into two 48-patient intervention and control groups. The training content was provided to the intervention group in five stages and they were asked to implement in three months. The demographic information questionnaire, the Ferrans and Powers Quality of Life questionnaire, and Sullivan Self-Efficacy questionnaire were the data collection instruments. The mean scores of pre and post-intervention were compared by the use of SPSS, version 16, software, paired t-test, single t-test, chi-square, and Fisher's Exact Test.

FINDINGS

The results showed that the mean squares of quality of life and self-efficacy in pre and postintervention had a significant difference and the intervention group had a higher quality of life and self-efficacy levels compared to the control group (P<0.001).

CONCLUSION

According to the results of the study, it is suggested to use this model for empowerment and caring of patients besides the medicinal treatments, so that it would not lead to inability, reduction about the medical centers, frequent hospitalization, and ultimately, reduction in medical costs, and promotion of the society's health.

Evaluating the effect of Matricaria chamomilla and Melissa officinalis on pain intensity and satisfaction with pain management in patients after orthopedic surgery

Introduction: The most important compliant of post-operative orthopedic patients is severe and intolerable pain. This pain has negative impacts on patient’s satisfaction with pain management and bone healing after surgery. This study was conducted with the aim of evaluating the effects of Melissa officinalis (Melissa) tea and Matricaria chamomilla (Chamomile) tea on pain intensity and satisfaction with pain management in patients after lower limb orthopedic surgery. Methods: This was a randomized controlled trial conducted on 96 patients after lower limb orthopedic surgery in Ayatollah Kashani hospital of Shahrekord city, Iran. Patients were randomized to M. officinalis, Chamomile and control groups with blocking randomization method. For M. officinalis group, 1 g of Melissa tea, for Chamomile group 1 g chamomile tea and for control group black tea was prescribed 3 times a day. Study variables were evaluated before and 30 min after each stage of intervention and then the mean changes of pain intensity and satisfaction before interventions and after each step of intervention were compared between groups. Significance level was considered as P<0.05. Results: Before intervention, the mean scores of pain intensity and satisfaction with pain management had no significance difference between groups. The mean changes of pain intensity and satisfaction with pain management (after first 3 steps of intervention) in M. officinalis and M. chamomilla groups were significantly greater than the ones in control group (P<0.05). Conclusion: Prescription of M. officinalis tea or Chamomile tea might be used as effective remedy for reducing pain and increasing satisfaction with pain management after orthopedic surgery.

The effect of empowerment program based on the social cognitive theory on the activity of daily living in patients with chronic obstructive pulmonary disease

OBJECTIVE AND AIM

Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases. The patient's fear and anxiety of shortness of breath and coughing during exercise may lead to a decrease in patients' daily activities. Therefore, the present study aimed to determine the effect of empowerment program based on the social cognitive theory (SCT) on the daily activity of patients with COPD.

METHODS

This quasi-experimental study was performed on 70 patients with COPD referred to Kashani and Hajar centers in 2019. Samples were randomly divided into two groups of experimental and control. Data collection tools included demographic information questionnaire and activity of daily living questionnaire, specific for COPD, and a researcher-made questionnaire for measuring SCT constructs. For the experimental group, the training program consisted of four theoretical and practical sessions of 40 min/week. The data were collected at three time points, before, immediately and 3 months after the training are 3 time. The data were analyzed by SPSS software using descriptive and inferential statistics.

RESULTS

The difference between the mean scores of behavioral ability, self-efficacy, and empowerment in the three stages was significant only in the experimental group (P < 0.001). The mean daily activity score of patients before, immediately, and 3 months after intervention showed a statistically significant difference between the two groups (52.46 ± 21.98, 63.36 ± 21.95, and 71.34 ± 19.02), respectively, in the intervention group, and (51.79 ± 19.29, 53.70 ± 19.28, and 53.82 ± 19.26), respectively, in the control group (P < 0.001).

CONCLUSION

The results of this study showed that empowerment of patients through interventions based on SCT can increase the daily activity of patients with COPD. Because nurses play an important role in patient education and improvement, it is hoped that the findings of this study will be used as a strategy to increase the daily activity and ultimately improve the quality of life in these patients.

A Comparative Analysis of Patients' Quality of Life, Body Image and Self-confidence Before and After Aesthetic Rhinoplasty Surgery

OBJECTIVE

Having desired facial features creates a better mental image, results in increased self-confidence and boosts social activities to a more acceptable level. The goal of the current study is to investigate how rhinoplasty surgery affects patients admitted to Shahrekord surgical clinic.

METHODS

The study was conducted on 100 patients randomly selected and referring for rhinoplasty surgery. The required information was collected through demographic questionnaires of rhinoplasty outcomes F 36 and Rosenberg's self-esteem scale. The questionnaires were filled out by patients before surgery and 3 months after surgery. The data were analyzed using SPSS and data mining software.

FINDINGS

Out of the hundred participants, 63% were female and 37% were male. The number of individuals in the studied groups decreased in older age groups so that most of the participants were in the 20-24-year group followed by 25-30 y/o group. Patients from other age groups were less frequent. In terms of educational attainment, the highest frequency was associated with a BSc and the lowest with a diploma. In terms of employment status, the highest frequency was among students and the unemployed and employees and the self-employed followed. Body image and self-esteem were significantly improved after surgery (p < 0.005). Although not statistically significant, quality of life was improved too after surgery.

CONCLUSION

According to the results of this study, physicians and patients should measure the pros and cons of the surgery before making a treatment decision. It also showed that rhinoplasty leads to an increase in quality of life and self-esteem. Prior to surgery, specialist consultation should be performed, and rhinoplasty should be performed if a specialist physician allows it.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the Online Instructions to Authors www.springer.com/00266.

Modeling the Number of Attacks in Multiple Sclerosis Patients Using Zero-Inflated Negative Binomial Model

Background and aims: Multiple sclerosis (MS) is an inflammatory disease of the central nervous system. The impact of the number of attacks on the disease is undeniable. The aim of this study was to analyze the number of attacks in these patients. Methods: In this descriptive-analytical study, the registered data of 1840 MS patients referred to the MS clinic of Ayatollah Kashani hospital in Isfahan were used. The number of attacks during the treatment period was defined as the response variable, age at diagnosis, sex, employment, level of education, marital status, family history, course of disease, and expanded disability as the explanatory variables. The analysis was performed using zero-inflated negative binomial model via Bayesian framework in OpenBUGS software. Results: Age at diagnosis (CI: -0.04, -0.20), marital status (CI: -0.56, 0.002), level of education (CI: -0.81, -0.26), Job (CIHousewives vs Employee=[0.04, 0.64], CIUnemployee vs Employee=[-1.10,0.008])), and course of disease (CI: -0.51, -0.08) had a significant effect on the number of attacks. In relapsing-remitting patients, the number of attacks was partial significantly affected by expanded disability status scale (EDSS) (CI: -0.019, 0.16). Conclusion: Aging, being single (never married), high education, and not having a job decrease the number of attacks; therefore, lower age, being married, primary education, and being a housewife increase the number of attacks. An interventional or educational program is suggested in order to prevent the occurrence of further attacks in high-risk groups of patients and to increase their chances of recovery.

The association between fever and pyuria in children older than one month

Introduction: Some assumptions have been made on the probable association between fever and pyuria. Objectives: The present study aimed to investigate the association between fever and pyuria. Patients and Methods: In this case-control study, 90 febrile and 90 non-febrile children aged more than one month who were admitted to the pediatric ward were included. Urine specimens of children less than 2 years of age were collected by urine bag. Midstream urine samples were collected and immediately sent to the laboratory for complete urinalysis and urine culture. Results: Overall, 6.7% in febrile children and 2.2% in control group had pyuria however there was no significant association between fever and pyuria (P>0.05). Additionally, no association between the presence of pyuria and type of disease was detected (P>0.40). Conclusion: The present study could not reveal any association between fever and pyuria in children older than one month.

The protocol of a population-based prospective cohort study in southwest of Iran to analyze common non-communicable diseases: Shahrekord cohort study

Background

Prospective cohort studies are considered ideal choices to study multiple outcomes and risk factors for Non-communicable diseases (NCDs). Our aim is to set-up the protocol and analyze risk factors, incidence rates, prevalence, trends, and the models of environmental and genetic determinants of NCDs and their outcomes as well as interaction among such determinants.

Methods

Shahrekord cohort study (SCS) that is a population-based prospective, study on a cohort consisting of people aged 35-70 years started in November 2015 in Iran. The sample size of the original cohort is at least 10,000 people. Annual follow-ups (200,000 person-year) of the cohort were designed to be conducted up to 2036. Exposures (a detailed demographic, socioeconomic, general health, quality of life, physical activity, anthropometric indexes, stress, health literacy, social capital, nutrition and eating habits, lifestyle, occupational history, living place, blindness, deafness, electrocardiography, lung capacities, blood pressure, sleep, smoking and alcohol, contact to animals, physical examinations and medical history, dental health, used drugs and supplements, glucose and lipid profiles) were measured by relevant standard methods and questionnaires. Incidence of common NCDs (cardiovascular diseases, cancer, gastrointestinal, respiratory, renal, hepatic, accidents, injury and neurological diseases), trend of risk factors, hospitalization, disability, and death were considered the outcomes of the cohort. The definition of disease was determined based on the International Classification of Diseases 10th version (ICD-10). Routine hematologic and biochemical tests were conducted and an all-inclusive biobank (blood, hair, nail, and urine specimens) of the cohort was stored for future studies. All steps of data collection and examinations are directly monitored by the quality control team.

Discussion

The SCS is a unique study conducted in southwest of Iran that is a notable work given the climate conditions and ethnicity population (especially in Bakhtiari) of this region. By providing high quality the protocol and introduce it, the SCS can serve as a solid foundation for management and researchers in southwest of Iran. The SCS provides prerequisites for collaboration and regional, national, and international studies on NCDs. Data are available at the modeling in health research center, Shahrekord University of Medical Sciences, Shahrekord, Iran, for any collaboration.

Artificial Neural Network to Modeling Zero-inflated Count Data: Application to Predicting Number of Return to Blood Donation

Background: Traditional statistical models often are based on certain presuppositions and limitations that may not presence in actual data and lead to turbulence in estimation or prediction. In these situations, artificial neural networks (ANNs) could be suitable alternative rather than classical statistical methods.

Study design: A prospective cohort study.

Methods: The study was conducted in Shahrekord Blood Transfusion Center, Shahrekord, central Iran, on blood donors from 2008-2009. The accuracy of the proposed model to prediction of number of return to blood donations was compared with classical statistical models. A number of 864 donors who had a first-time successful donation were followed for five years. Number of return for blood donation was considered as response variable. Poisson regression (PR), negative binomial regression (NBR), zero-inflated Poisson regression (ZIPR) and zero-inflated negative binomial regression (ZINBR) as well as ANN model were fitted to data. MSE criterion was used to compare models. To fitting the models, STATISTICA 10 and, R 3.2.2 was used

Results: The MSE of PR, NBR, ZIPR, ZINBR and ANN models was obtained 2.71, 1.01, 1.54, 0.094 and 0.056 for the training and 4.05, 9.89, 3.99, 2.53 and 0.27 for the test data, respectively.

Conclusions: The ANN model had the least MSE in both training, and test data set and has a better performance than classic models. ANN could be a suitable alternative for modeling such data because of fewer restrictions.

Artificial Neural Network to Modeling Zero-inflated Count Data: Application to Predicting Number of Return to Blood Donation

BACKGROUND

Traditional statistical models often are based on certain presuppositions and limitations that may not presence in actual data and lead to turbulence in estimation or prediction. In these situations, artificial neural networks (ANNs) could be suitable alternative rather than classical statistical methods.

STUDY DESIGN

 A prospective cohort study.

METHODS

The study was conducted in Shahrekord Blood Transfusion Center, Shahrekord, central Iran, on blood donors from 2008-2009. The accuracy of the proposed model to prediction of number of return to blood donations was compared with classical statistical models. A number of 864 donors who had a first-time successful donation were followed for five years. Number of return for blood donation was considered as response variable. Poisson regression (PR), negative binomial regression (NBR), zero-inflated Poisson regression (ZIPR) and zero-inflated negative binomial regression (ZINBR) as well as ANN model were fitted to data. MSE criterion was used to compare models. To fitting the models, STATISTICA 10 and, R 3.2.2 was used RESULTS: The MSE of PR, NBR, ZIPR, ZINBR and ANN models was obtained 2.71, 1.01, 1.54, 0.094 and 0.056 for the training and 4.05, 9.89, 3.99, 2.53 and 0.27 for the test data, respectively.

CONCLUSIONS

The ANN model had the least MSE in both training, and test data set and has a better performance than classic models. ANN could be a suitable alternative for modeling such data because of fewer restrictions.

Phytotherapy with Hordeum Vulgare: A Randomized Controlled Trial on Infants with Jaundice

INTRODUCTION

Jaundice is one of the most common causes of admission to hospital in newborns which is often associated with several complications.

AIM

The present study was conducted to evaluate the effect of H. vulgare in reducing jaundice.

MATERIALS AND METHODS

In this double-blind, randomized controlled trials 70 term infants hospitalized due to jaundice in 2014 were enrolled. Control group was treated with full-time phototherapy alone using LED except when the infants were breastfed and case group with phototherapy, as per the protocol in the control group, along with and topical H. vulgare seed flour three times a day. Data were analysed using and analysis of covariance (ANCOVA) and paired t-test in SPSS version 16.0.

RESULTS

There was a significant difference in mean indirect bilirubin level between the two groups p<0.05, such that the mean indirect bilirubin level was higher in the control group. Furthermore, no significant difference was seen in direct bilirubin level between the two groups at discharge p>0.05.

CONCLUSION

H. vulgare flour can cause decrease in indirect bilirubin. Because the rate of decrease in indirect bilirubin can be effective in preventing severe complications due to bilirubinemia, H. vulgare can be used as a complementary therapy to treat jaundice.

A Hybrid ANN-GA Model to Prediction of Bivariate Binary Responses: Application to Joint Prediction of Occurrence of Heart Block and Death in Patients with Myocardial Infarction

BACKGROUND

In medical studies, when the joint prediction about occurrence of two events should be anticipated, a statistical bivariate model is used. Due to the limitations of usual statistical models, other methods such as Artificial Neural Network (ANN) and hybrid models could be used. In this paper, we propose a hybrid Artificial Neural Network-Genetic Algorithm (ANN-GA) model to prediction the occurrence of heart block and death in myocardial infarction (MI) patients simultaneously.

METHODS

For fitting and comparing the models, 263 new patients with definite diagnosis of MI hospitalized in Cardiology Ward of Hajar Hospital, Shahrekord, Iran, from March, 2014 to March, 2016 were enrolled. Occurrence of heart block and death were employed as bivariate binary outcomes. Bivariate Logistic Regression (BLR), ANN and hybrid ANN-GA models were fitted to data. Prediction accuracy was used to compare the models. The codes were written in Matlab 2013a and Zelig package in R3.2.2.

RESULTS

The prediction accuracy of BLR, ANN and hybrid ANN-GA models was obtained 77.7%, 83.69% and 93.85% for the training and 78.48%, 84.81% and 96.2% for the test data, respectively. In both training and test data set, hybrid ANN-GA model had better accuracy.

CONCLUSIONS

ANN model could be a suitable alternative for modeling and predicting bivariate binary responses when the presuppositions of statistical models are not met in actual data. In addition, using optimization methods, such as hybrid ANN-GA model, could improve precision of ANN model.

Effect of folic acid on homocysteine and insulin resistance of overweight and obese children and adolescents

Background:

Considering the increasing trend of childhood obesity and subsequent burden of the disease in Iran and other countries and importance of early life intervention for achieving sustained effect on health of children and adolescents, this study aimed to investigate the effect of two different dose of folic acid on homocysteine (Hcy) level and insulin resistance of obese children.

Materials and Methods:

In this randomized, double-blind controlled clinical trial study, 60 obese and overweight children aged 5–12 years were enrolled. Selected obese children randomly allocated in two interventional (1 mg/day folic acid and 5 mg/day folic acid, for 8 weeks) and one control groups. Biochemical measurements including folic acid, Hcy, insulin and insulin resistance were measured between and within groups before and after trial.

Results:

In each group, 20 obese children were studied. The three groups were age and sex matched. After folic acid administration, mean of Hcy, insulin resistance and insulin decreased significantly in two groups which folic acid administrated with two different doses (P < 0.05). The reduction in studied biochemical variables was similar in two interventional groups (1 and 5 mg folic acid daily) (P > 0.05). Mean differences for Hcy, insulin resistance and insulin, in two intervention groups were significantly higher than the control group (P < 0.0001). Mean differences of Hcy, insulin resistance and insulin, in two intervention groups were not different significantly (P > 0.05).

Conclusion:

The findings of current trial showed that folic acid in two studied doses could be a safe and effective supplement for obese children to reduce Hcy level and insulin resistance, which consequently could prevent obesity-related complications including cardiovascular and metabolic disorders.

Association between common carotid artery intima-media thickness and proteinuria in type 2 diabetic patients

INTRODUCTION

Proteinuria is the most reliable marker of diabetic nephropathy and an index of atherosclerosis and cardiovascular mortality in diabetic patients. In addition, common carotid artery intima-media thickness (CIMT) is a sensitive marker of early atherosclerosis and cardiovascular risk. The aim of this study was to evaluate the association between proteinuria and CIMT in type 2 diabetic patients.

MATERIALS AND METHODS

In a cross-sectional study, 154 patients with type 2 diabetes mellitus were enrolled. The CIMT was measured for all of the patients by one researcher. The 24-hour urine protein was measured using trichloroacetic acid method.

RESULTS

A total of 154 type 2 diabetic patients were enrolled with a mean diabetes mellitus duration of 8.91 ± 6.99 years (95 women and 55 men). The mean urinary protein in the patients was 294.70 ± 525.85 mg/24 h. The mean CIMT in all of the patients was 0.84 ± 0.19 mm, and it was greater in the men than in the women (P = .03). The CIMT significantly correlated with patients' age (P < .001), systolic blood pressure (P < .001), and urinary protein excretion (P = .001). There was a marginal positive correlation between diabetes mellitus duration and the CIMT (P = .049).

CONCLUSIONS

This study showed a significant association between CIMT, as a sensitive marker of macrovascular complication of diabetes mellitus, and proteinuria as an important index of microvascular complication of the disease.

Association of retinopathy and intima media thickness of common carotid artery in type 2 diabetic patients

BACKGROUND

This study was carried out in order to evaluate the relationship between retinopathy and carotid intima-media thickness (CIMT).

MATERIALS AND METHODS

In a cross-sectional study, 154 diabetic patients who had a history of diabetic disease were evaluated in two equal groups of 77 patients with and without retinopathy, respectively. CIMT was evaluated in all of the patients.

RESULTS

Mean age of the patients was 59.65 ± 9.37 years. Mean CIMT of all patients was 0.84 ± 0.18. CIMT of patients with retinopathy was significantly greater than patients without retinopathy (P < 0.001). CIMT also correlated with age, duration of diabetes, systolic blood pressure, blood urea nitrogen, and serum creatinine.

CONCLUSION

CIMT may be used as a simple, available and noninvasive method for screening of macro and microvascular complication of diabetic patients.

Long-term pulmonary functional status following coronary artery bypass grafting surgery

BACKGROUND

The present study aimed to describe the long-term alterations of pulmonary function and also to describe its association with post-operative pain after coronary artery bypass grafting (CABG) surgery.

METHODS

In this prospective study, thirty non-smoker male patients undergoing isolated on-pump CABG were consecutively included in this study. Pulmonary function measurements were performed, in a sitting position, preoperatively, a week postoperatively, and 6 months after the surgery using a Medical Graphics PF/Dx pulmonary function system. Pain was determined by using visual analog scale (VAS) pain scores with a standardized questionnaire's.

RESULTS

Regarding functional class, all patients had New York Heart Association (NYHA) Class II to III. A week after operation, a severe restrictive pulmonary impairment was revealed with a mean decrease in VC to 60.9 ± 9.2% and in forced expiratory volume in one second (FEV1) to 64.6 ± 12.2% of pre-operative values (P < 0.001). Regarding sternotomy related pain, the mean pain VAS score was preoperatively 3.3 ± 1.5 that reached to 6.2 ± 2.5 and 4.8 ± 2.2 1 week and 6 months after the operation (P < 0.001). The trend of the changes in pain score within 6 months of operation was significantly similar to the trend of the changes in some pulmonary function indices such as FEV% and residual volume (RV).

CONCLUSION

A significant reduction is expected in most pulmonary functional parameters following CABG despite normal pulmonary function state preoperatively. Severe pain originated from sternotomy may be an important factor related to pulmonary dysfunction following CABG.

Association of Corrected QT and QT Dispersion with Echocardiographic and Laboratory Findings in Uremic Patients under Chronic Hemodialysis

Introduction:

Cardiovascular disease is the most common cause of mortality in dialysis patients. Chronic renal failure and hemodialysis (HD) patients may have longer corrected QT (QTc) interval compared with the normal population. Long QTc interval may be a predictor of ventricular arrhythmia and cardiovascular mortality in these patients and hence the aim of this study was the evaluation of the relationship between QTc interval and some echocardiographic findings and laboratory exam results in HD patients.

Materials and Methods:

In a cross-sectional study, 60 HD patients with age >18 years and the dialysis duration >3 months were enrolled. Blood samples were taken, and electrocardiography and echocardiography were done before the dialysis session in the patients.

Results:

Mean age of the patients was 56.15 ± 14.6 years. QTc interval of the patients was 0.441 ± 0.056 s and QT dispersion (QTd) was 64.17 ± 25.93 ms. There was no statistically significant relationship between QTc interval and QTd with duration of dialysis, body mass index, age, and gender (P > 0.05). There was also no significant relationship between QTc interval and QTd with mitral regurgitation, tricuspid regurgitation and aortic insufficiency (P > 0.05). In addition, QTc interval and QTd of the patients had not any correlation with serum parathormon and serum Ca, K, HCO₃ (P > 0.05).

Conclusion:

Based on our results, in HD patients, QTc interval and QTd were not correlated with echocardiographic findings or laboratory exam results. Therefore, it can be concluded that QTc interval prolongation probably has not any correlation with cardiac mortality of the HD patients.

Analysis of the Factors Affecting the Interval between Blood Donations Using Log-Normal Hazard Model with Gamma Correlated Frailties

BACKGROUND

Time to donating blood plays a major role in a regular donor to becoming continues one. The aim of this study was to determine the effective factors on the interval between the blood donations.

METHODS

In a longitudinal study in 2008, 864 samples of first-time donors in Shahrekord Blood Transfusion Center,  capital city of Chaharmahal and Bakhtiari Province, Iran were selected by a systematic sampling and were followed up for five years. Among these samples, a subset of 424 donors who had at least two successful blood donations were chosen for this study and the time intervals between their donations were measured as response variable. Sex, body weight, age, marital status, education, stay and job were recorded as independent variables. Data analysis was performed based on log-normal hazard model with gamma correlated frailty. In this model, the frailties are sum of two independent components assumed a gamma distribution. The analysis was done via Bayesian approach using Markov Chain Monte Carlo algorithm by OpenBUGS. Convergence was checked via Gelman-Rubin criteria using BOA program in R.

RESULTS

Age, job and education were significant on chance to donate blood (P<0.05). The chances of blood donation for the higher-aged donors, clericals, workers, free job, students and educated donors were higher and in return, time intervals between their blood donations were shorter.

CONCLUSIONS

Due to the significance effect of some variables in the log-normal correlated frailty model, it is necessary to plan educational and cultural program to encourage the people with longer inter-donation intervals to donate more frequently.

Evaluation of chemical quality in 17 brands of Iranian bottled drinking waters

BACKGROUND

The purpose of study was to evaluate and compare chemical quality of Iranian bottled drinking water reported on manufacturer's labeling and standards.

METHODS

This study was a cross-sectional descriptive study and done during July to December 2008. The bottled mineral water collected from shops randomly were analyzed for all parameters address on manufacturer's labeling and the results were compared with the manufacturer's labeling data, WHO Guideline Values, USEPA Maximum Contaminant Levels and the maximum contaminant levels of drinking water imposed by the Iranian legislation. Statistical analysis on data was done with the Kolmogorov-Smirnov test for normal distribution, the paired t-test to compare the data with manufacturer's labeling and the one-sample t-test to compare with standard and MCL values at P 0.05). In addition, pH and calcium values were significantly higher than their proposed values indicated by Iranian National Legislation and international MCLs (P< 0.05).

CONCLUSION

Our results are extremely important for the health supervisory agencies such as Ministry of Health and Institute of Standards & Industrial Research of Iran to have more effective controls on bottled water industries, and to improve periodical the proposed standard values.