Beheshti Hospital Research Articles

Molecular typing of clinical and environmental isolates of Klebsiella pneumoniae producing ESBLs by PFGE.

Objective(s): Klebsiella pneumoniae is the common cause of pneumonia in hospitalized patients, particularly in intensive care units (ICU). The infection can transfer by medical equipment such as mechanical ventilators. This study aimed to investigate the molecular typing of the extended-spectrum beta-lactamase-producing K. pneumoniae isolates recovered from Beheshti Hospital, Kashan, Iran. Materials and Methods: K. pneumoniae isolates producing ESBLs have been collected from the samples obtained from Shahid Beheshti hospital, Kashan, Iran. Antimicrobial susceptibility was determined using the Kirby Bauer disk diffusion method. The presence of ESBLs was evaluated using CLSI for ESBL screening by the double-disk diffusion method. Molecular typing was conducted by pulsed-field gel electrophoresis (PFGE). In total, 89 K. pneumoniae isolates were recovered, of which 47.1% were ESBL producers.Results:Results showed that all of the clinical and environmental isolates were resistant to ceftriaxone, meropenem, cefazolin, cefotaxime, cephalothin, and piperacillin-tazobactam. All isolates were grouped under four clusters (A-D). The major cluster was related to the C cluster with 22 isolates (19 clinical and 3 environmental). Seventy-two percent of isolates were from the ICU ward. There was no correlation between antibiotic resistance patterns and PFGE clusters (P=0.2).Conclusion:We observed a common molecular signature among both clinical and environmental K. pneumoniae isolates, indicating a similar genotype and likely a common origin for ESBL producer isolates found in different hospital wards. Therefore, hospitals need to implement an effective infection control system to decrease the spreading of ESBL strains within the hospitals and subsequently the transmission of the infection to patients.

Study of Frequency of High Grade Cervical Intraepithelial Neoplasms (CIN 2, 3) in Patients Infected with Uncommon High Risk Human Papillomavirus

Introduction: Despite the significant relationship between human papillomavirus 16 and 18 subtypes and severe cases of cervical cancer, the assessing the frequency of high-grade cervical intraepithelial neoplasms in the patients infected with high-risk human papillomavirus other than 16 and 18 has been less studied in Iranian population. Methods: In this cross-sectional study, the patients referred to Oncology Clinic of Shahid Beheshti Hospital in Isfahan, Iran were selected by positive HPV-typing test through Cobas HPV test and high-risk papilloma virus in 2018 by convenience sampling method. Pap smear was first taken from the patients in the usual way, then they underwent colposcopy, and a biopsy was performed on the lesion during colposcopy. If colposcopy was normal, biopsies were randomly taken from 4 quadrants (12, 3, 9, 6 hours) and, if necessary, endocervical curettage was performed. Samplings were taken by the pathologist of the study center and the prevalence of CIN2 and CIN3 was reported. ANOVA test was performed to compare quantitative variables. Chi-square test was used to compare qualitative variables. SPSS version 17 software was used for statistical analysis of data. Significance level was considered less than 0.05. Results: In this study, 105 individuals with high-risk HPV other than 16 and 18 were evaluated. In the biopsy performed according to the standard diagnostic method, the prevalence of severe form of precancerous lesions (CIN 2, 3) was 9.6% and the most common types of HPV in the patients with CIN 2, 3 were 52 with a frequency of 40% and type 58 with a frequency 30%. Conclusion: Due to the significant prevalence of severe (precancerous) lesions in these patients, it is necessary to review the current protocols.

Does application of honey improve surgical outcome in pilonidal cyst excision with secondary intention healing? A prospective randomized placebo-controlled clinical trial

BackgroundPilonidal sinus disease (PSD) is a common chronic inflammatory debilitating illness caused by ingrowth of hair into the skin. Excision and healing by secondary intention is one of the acceptable managements. The post-operative wound care needs frequent and time-consuming follow-ups. Honey is considered to be a traditional remedy for wound healing. The current study aimed at finding if application of honey could improve surgical outcome in pilonidal cyst excision with secondary intention healing.MethodsThis study was designed as a randomized placebo-controlled parallel assignment interventional (clinical trial) study conducted at the surgical ward of Shahid Beheshti Hospital affiliated to the Yasuj University of Medical sciences, Yasuj, Iran, and was consisted of the 48 patients who underwent surgical resection for PSD with secondary intention healing (24 patients in intervention and placebo-controlled groups). The main element of honey medicinal gel was the unheated natural honey of Dena Biosphere Reserve within the Zagros Mountains. Patients' wounds were visited by a surgeon and a nurse on the days 7, 15, 30, 45, 60, and 90 post-operation. The surgical outcomes including the time to complete wound healing, pain intensity, odor, discharge at the site of surgery, use of analgesics, the time of to return to the daily activities, and occurring of any side effects including infection, erythema, and bleeding were all recorded.ResultsIn intervention group, there was significantly lower wound healing time, the lower time to return to the daily activities, lower mean wound volume at the days of 30, 45, 60, and 90 of the follow-up, higher mean post-operative pain level at the days of 15, 30, 45, 60, and 90 of the follow-up, and more usage of analgesics at the days of 15, 30, 45, and 60 of the follow-up. There was no significant difference between intervention and placebo-controlled groups according to the foul smell and fluid discharge at the site of the operation. There were no side effects and complications in both groups of the study.ConclusionsApplication of honey after resection surgery with secondary wound healing is associated with a better surgical outcome and could eventually decrease healing time and reduce duration of return to normal activities, but could increase post-operation pain and analgesic consumption, and no effect on foul smell and discharge.Trial registrationThe project was found to be in accordance to the ethical principles and the national norms and standards for conducting research in Iran with the approval ID and date of IR.YUMS.REC.1399.088 and 2020.05.30 respectively, and is the result of a residency dissertation to get the specialty in general surgery, which has been registered with the research project number 960508 in the Vice Chancellor for Research and Technology Development of Yasuj University of Medical Sciences, Yasuj, Iran, URL: https://ethics.research.ac.ir/EthicsProposalViewEn.php?id=144742

Comparison of Ultrasound and Tumor Marker CA125 in Diagnosis of Adnexal Mass Malignancies.

Background:CA125 is the most used tumor marker for ovarian cancer monitoring and diagnosis. This study aimed to evaluate the capacity to predict malignancy in women with adnexal tumors using CA125 measurement and ultrasound criteria before the pathological examination.Materials and Methods:This observational diagnostic study was conducted on 300 patients with obvious diagnosis of adnexal mass consists of ovarian masses, fallopian tubes, and masses within the broad ligament referring to Alzahra and Beheshti Hospitals from 2018 to 2019. Ultrasound examinations were done before surgery and malignancy risk was investigated by the ADNEX criterion. Sensitivity, specificity, positive and negative likelihood ratio (likelihood ratio [LR]+ and LR−), and area under the curve (AUC) were calculated.Results:From 284 patients, 260 masses were categorized in benign, 18 were in borderline, and 18 masses were malignant. The mean age of patients with malignant tumors was significantly higher than the others (P = 0.01). Differences in the level of CA-125 were not statistically significant (P = 0.78). Furthermore, the proportion of ascites in the malignant group (16.3%) was significantly higher than the others (P = 0.003). The AUC in ADNEX model (cutoff ≥9%) for differentiation of benign and malignant tumors was 0.75 (95% confidence interval [CI]: 0.69–0.80) with a sensitivity of 0.63 (95% CI: 0.41–0.81) and a specificity of 0.80 (95% CI: 0.74–0.84). Receiver operating characteristic analysis for CA-125 revealed that this variable is not capable for discrimination between benign and malignant tumors as the AUCs of the aforementioned variable were 0.60, 0.60, and 0.52 for the whole patients, premenopause, and postmenopause categories.Conclusion:CA-125 marker, along with other ultrasound findings, can be more accurate in identifying the malignancy of the adnexa tumor.

The Efficacy of Ropivacaine 0.5% in Transversus Abdominis Plane Block to Relieve the Postoperative Pain of Female Laparoscopic Surgery Grade II.

Background:The aim of this study was determination of the effect of the transversus abdominis plane block (TAP block) with ropivacaine 0.5% in relieving postoperative pain after laparoscopic gynecologic surgery.Materials and Methods:The population of the double-blinded clinical trial study included 200 women candidates for elective laparoscopic gynecologic surgery who referred to Al-Zahra and Beheshti hospitals in Isfahan during 2016–2018. In the TAP block group in addition to standard general anesthesia, an anesthetic drug Ropivacaine (Naropin, 0.5%) was injected at a dose of 0.5 mg/kg between transverse abdominal muscle and internal oblique muscle facia. And in control group just received standard general anesthesia. Hence, the severity of pain and nausea and vomiting is recorded at the time of recovery, at 30 min, 2, 4, 6, 12, and 48 h after the surgery.Results:The results of this study showed that in all periods of time (30 min, 2, 4, 6, 12, 24, 36, and 48 h after the surgery), mean pain score in TAP block group was lower than control group (P < 0.001). Hence that, in the 48 h after the surgery, the pain score in the TAP block group with a mean of 0.46 ± 0.50 was significantly lower than the control group with a mean of 1.06 ± 0.68 (P < 0.001). Nausea and vomiting between the two groups were no significant differences. There was no decrease in narcotic use or length of stay among those who received the TAP block.Conclusions:TAP block with ropivacaine 0.5% had a significant role in reducing postoperative pain of laparoscopic surgery.

Comparison the Results of Hysterosalpangiography in Patients with Ectopic Pregnancy Treated by Laparoscopic Salpingostomy, Laparotomy, and Treated with Methotrexate.

Background:Ectopic pregnancy (EP) occurs in 1% of pregnancies, and may seriously effects on women's health and future fertility so this study aimed to compare the results of hysterosalpingography (HSG) after treatment of EP by laparoscopy, laparotomy, and methotrexate (MTX) therapy.Materials and Methods:This was a clinical trial study was done on 112 EP women with treatment indication referred to Isfahan Al-Zahran and Shahid Beheshti Hospitals from 2017 to 2018. They were divided into 33 populated groups of laparoscopic salpingostomy, laparotomy and MTX. Then patients of three groups underwent HSG 3 months after intervention. The factors such beta human chorionic gonadotropin (β–hCG) (mIU/mL), size of EP (mm), infection, hospital length of stay (LOS), and tubal patency were recorded and compared between the groups.Results:There were no significant differences between groups for age, body mass index, β–hCG, Size of EP, and hospital LOS (P > 0.05). The infection was more frequent in laparotomy group with no significant difference among three groups. The infection rates were 9%, 12%, and 6% for MTX, laparotomy, and laparoscopy arms, respectively. Between the three groups tubal patency as primary outcome had higher frequency than laparoscopy group, although, the difference was not statistically significant (P = 0.595).Conclusion:Although infection was more in laparotomy and that tubal patency was more within 3 months in laparoscopy and MTX, there were no statistically significant differences in the results of laparoscopy, laparotomy, and MTX in HSG results.

Prevalence and severity of lower-limb varicose and its related factors in nurses working in Shahid Beheshti Hospital, Kashan, Iran, 2020

Prevalence and severity of lower-limb varicose and its related factors in nurses working in Shahid Beheshti Hospital, Kashan, Iran, 2020

Use of Tranexamic Acid in Bleeding Control of Transabdominal and Transvaginal Hysterectomy.

Hysterectomy is one of the most common gynecology surgeries. This study aimed to compare perioperative bleeding in transabdominal and transvaginal hysterectomy. This prospective, double-blind, randomized, controlled clinical trial was performed on 80 patients undergoing hysterectomy referred to Shahid Beheshti Hospital, Isfahan, Iran. Patients were divided into two groups of 40; the first group (T) received 1 g intravenous tranexamic acid (TXA) for 20 min preoperatively. The second group (S) received 10 cc normal saline as placebo. Blood samples were taken before and 12 h after surgery for assessment of hemoglobin, hematocrit, and platelet count, the prothrombin time, activated partial thromboplastin time, and serum creatinine as well as volume of blood transfusion. There were no significant differences between the two groups in heart rate, diastolic blood pressure (BP), systolic BP, and mean arterial pressure before, during, and after surgery (P > 0.05). There was no significant difference in blood variables before and after surgery (P > 0.05) except the platelet count that was in the normal range in both groups after surgery (P = 0.022). The mean volume of blood transfused in the case group was significantly lower than the control group during surgery (P = 0.008) and 12 h after surgery (P = 0.01). The prophylactic administration of TXA results in a significant reduction in need for blood transfusion and the duration of surgery. Given the lower risks of using TXA compared to the other drugs, it is recommended in hysterectomy to control bleeding.

Inhibition of Renin-angiotensin System and Clinical Outcomes of COVID-19

Background and Aim: COVID-19 is an acute respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A few studies with conflicting results have been performed to evaluate the relationship between the use of angiotensin system inhibitors and COVID-19 outcomes. Therefore, this study was performed to compare the clinical and paraclinical characteristics of patients with COVID-19 in two groups of patients treated with angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) and the control group (no history of ACEIs/ARBs) in Kamkar and Shahid Beheshti hospitals in Qom City, Iran from March 14, 2019, to the end of September 21, 2020. Materials and Methods: This retrospective descriptive study was performed by reviewing the medical record of 359 patients with COVID-19, which was confirmed by a physician via lung scan or reverse transcription polymerase chain reaction (RT-PCR). We used the independent t test to compare quantitative variables and the Chi-square test to analyze qualitative variables. Results: The common clinical symptoms, number of hospitalization days, oxygen saturation, and lung involvement were not significantly different between the two groups. Weakness, nausea, and sweating were significantly reduced in the control group compared to the ACEIs/ARBs group (P&lt;0.05). Regarding the biochemical study, the patients’ hemoglobin levels and lymphocyte count on the first day of hospitalization in the ACEIs/ARBs group were significantly lower than the control (P&lt;0.05) Conclusion: These findings do not provide evidence of adverse or beneficial effects of angiotensin system inhibitors, so we require more detailed studies with a larger sample size.

Risk factors associated with positional plagiocephaly in healthy Iranian infants: a case-control study

Objectives Deformation of the skull by external forces in the absence of synostosis has been defined as positional plagiocephaly (PP). The aim of this investigation was to determine the risk factors of PP in healthy Iranian infants.Materials & Methods This case-control study was performed on 300 healthy Iranian infants aged 8-12 weeks who were referred to the pediatric neurology clinic at Shahid Beheshti Hospital of Kashan. Plagiocephaly evaluations were done using Argenta’s scale.Results Based on multivariate logistic regression analysis, there was a significant association between PP and male gender (OR=2.26; P=0.002), head circumference (OR=1.22; P=0.006), multiple pregnancy (OR=2.55; P=0.03), abnormal presentation in uterine (OR=2.18; P=0.02), primiparity (OR=2.43; P=0.003), and supine sleep position (OR=2.97; P<0.001). However, type of delivery, firmness of headrest, oligohydramnios, and prolonged labor were not correlated with PP.Conclusions The current investigation supports the idea that head circumference, male gender, primiparity, multiple pregnancy, supine sleep position, and abnormal presentation in the uterine are correlated with a greater incidence of PP. Further investigations should be undertaken to understand PP and its related risk factors fully.

Acceptance and commitment: An intervention for improving family function and emotional problems in informal caregivers of people with severe traumatic brain injury: A randomized clinical trial

Background and Objectives: Traumatic brain injury (TBI) is one of the main causes of disability. Since individuals with TBI experience many problems in their daily life, they must be highly supported. Regarding the nature of their problems, their caregivers suffer from many psychological problems. The current study aimed to investigate the effect of group acceptance and commitment therapy (ACT) on the family function, experiential avoidance, and anxiety of the TBI patients' caregivers. Methods: The current study was a randomized clinical trial with waiting list and intervention groups. Forty caregivers of TBI patients who referred to Kashan's Shahid Beheshti Hospital, Iran, since 2017 until 2019 were randomly assigned to the experimental (n = 20) and the waiting list control (n = 20) groups. Both the groups completed a demographic information questionnaire, the Family Assessment Device, the Experiential Avoidance in Caregiving Questionnaire, and the anxiety subscale of the Depression, Anxiety, and Stress Scale in pretest, posttest, 3-month follow-up, and 6-month follow-up. Results: The results of repeated measures analysis of variance showed that ACT program can significantly decrease the anxiety, experiential avoidance, and most of the dimensions of the family functions (P < 0.005). Conclusion: ACT could be utilized to improve the family functions and reduce the experiential avoidance and the anxiety of the TBI patients' caregivers. This trial is registered with the Registry of Clinical Trials: “IRCT20190704044100N1.”

Study of outcomes of delay in referral of patients with acute myocardial infarction

BACKGROUND:Delay in seeking medical help in patients with acute myocardial infarction (AMI) challenges the patients in terms of diagnosis and treatment. This study aimed to evaluate the outcomes of delay referral (≥12 h) in patients with AMI.MATERIALS AND METHODS:In this retrospective cohort study, the medical records of 252 patients with AMI (2017–2019) admitted to Shahid Beheshti Hospital, Qom, Iran, was reviewed. Data collection tool was a researcher-made data sheet that included demographic characteristics, times, hospitalization costs, risk factors, history of heart disease, results of paraclinical tests, clinical information at the time of admission, and outcomes of delayed referral. Data were analyzed using t-test, Chi-square, Kaplan–Meier estimator, log-rank test, Cox regression by STATA, and SPSS (version 25).RESULTS:The levels of troponin, creatine phosphokinase, lactate dehydrogenase were significantly higher in the delayed referral group (P < 0.05). After treatment, the cardiac ejection fraction was significantly different in the nondelayed referral (41.56 ± 9.16) and the delayed referral group (38.39 ± 11.01) (P < 0.001). There was no significant difference in the percentage of hospital deaths in the groups (P = 0.078).CONCLUSION:Delayed referral of patients with AMI is associated with decreased physiological cardiac function, which complicates recovery for these patients.

Evaluating Musculoskeletal Disorders and Their Ergonomic Risk Factors among Office Workers of a Large Public Hospital in Iran

Aims: Musculoskeletal disorders (MSDs) are injuries in the musculoskeletal system which is also named as “repetitive stress injury” or “overuse injury”. Inattention to the principles of ergonomics at work is associated with different MSDs. This study evaluated MSDs and their ergonomic risk factors among office workers in a large public hospital in Iran. Materials and Methods: This cross-sectional study was conducted in 2019. Participants were 111 office workers of Shahid Beheshti Hospital, Kashan, Iran. Data were collected using the Cornell Musculoskeletal Discomfort Questionnaire and the Rapid Office Strain Assessment. The SPSS software (v. 20) and the STATA software were used for data analysis, using t-test and linear regression. Results: Most participants were female (55.9%) and had experienced MSDs during the past week (76%). Subject analysis revealed significant differences in vertebral column's MSDs versus limbs and right-sided limbs versus left ones (P < 0.001). The most common MSDs among participants were in the neck (67.6%), lower back (59.5%), and upper back (55%). MSDs among females were significantly more than males (P < 0.05). MSDs in the lower back among overweight and obese participants were significantly more than others (P < 0.05). Respecting the chair-related ergonomic risk factors for MSDs, 24% of participants were at high risk and 75% of them were at moderate risk. Conclusion: Office workers were at moderate risk for MSDs. Providing education about the principles of ergonomics can reduce their MSDs.

Comparing intensity of pain due to intravenous injection of sodium thiopental, propofol, diazepam, and etomidate during induction of general anesthesia.

The aim of the present study was to compare the pain intensity due to intravenous injection of sodium thiopental, propofol, diazepam, and etomidate during the induction of general anesthesia. This was a non-controlled quasi-experimental double-blinded study performed on eligible patients referred to the operating room of Shahid Beheshti Hospital in Yasouj. A total of 200 patients were randomly selected by convenience sampling and based on a table of random numbers generated on a computer. They were then randomly divided into four intervention groups based on random blocks (sodium thiopental, propofol, etomidate, and diazepam). Finally, the collected data were analyzed using descriptive as well as analytical statistical tests such as Chi-square, analysis of covariance (ANCOVA), and Bonferroni post hoc test were analyzed in SPSS ver. 24. The results of the present study showed that the diazepam group experienced the highest pain intensity (8.42) compared to other groups, which was statistically significant (P = 0.001). Also, the sodium thiopental group experienced the highest pain (6.92) after the diazepam group, which was also statistically significant as compared to the other remaining two groups (P = 0.001). Propofol and etomidate groups experienced the lowest pain intensity (3.30 and 3.26, respectively). The present study revealed that the use of diazepam and sodium thiopental as anesthetic drugs was generally associated with greater pain intensity during injection and less hemodynamic stability. The results of the present study indicated that propofol and etomidate are preferred over diazepam and sodium thiopental in abdominal and gastrointestinal surgeries, considering their less pain intensity and fewer hemodynamic changes.

Genetic Diversity, Antimicrobial Resistance Pattern, and Biofilm Formation in Klebsiella pneumoniae Isolated from Patients with Coronavirus Disease 2019 (COVID-19) and Ventilator-Associated Pneumonia.

Introduction Patients with acute respiratory distress syndrome caused by coronavirus disease 2019 (COVID-19) are at risk for superadded infections, especially infections caused by multidrug resistant (MDR) pathogens. Before the COVID-19 pandemic, the prevalence of MDR infections, including infections caused by MDR Klebsiella pneumoniae (K. pneumoniae), was very high in Iran. This study is aimed at assessing the genetic diversity, antimicrobial resistance pattern, and biofilm formation in K. pneumoniae isolates obtained from patients with COVID-19 and ventilator-associated pneumonia (VAP) hospitalized in an intensive care unit (ICU) in Iran. Methods In this cross-sectional study, seventy K. pneumoniae isolates were obtained from seventy patients with COVID-19 hospitalized in the ICU of Shahid Beheshti hospital, Kashan, Iran, from May to September, 2020. K. pneumoniae was detected through the ureD gene. Antimicrobial susceptibility testing was done using the Kirby-Bauer disc diffusion method, and biofilm was detected using the microtiter plate assay method. Genetic diversity was also analyzed through polymerase chain reaction based on enterobacterial repetitive intergenic consensus (ERIC-PCR). The BioNumerics software (v. 8.0, Applied Maths, Belgium) was used for analyzing the data and drawing dendrogram and minimum spanning tree. Findings. K. pneumoniae isolates had varying levels of resistance to antibiotics meropenem (80.4%), cefepime-aztreonam-piperacillin/tazobactam (70%), tobramycin (61.4%), ciprofloxacin (57.7%), gentamicin (55.7%), and imipenem (50%). Around 77.14% of isolates were MDR, and 42.8% of them formed biofilm. Genetic diversity analysis revealed 28 genotypes (E1–E28) and 74.28% of isolates were grouped into ten clusters (i.e., clusters A–J). Clusters were further categorized into three major clusters, i.e., clusters E, H, and J. Antimicrobial resistance to meropenem, tobramycin, gentamicin, and ciprofloxacin in cluster J was significantly higher than cluster H, denoting significant relationship between ERIC clusters and antimicrobial resistance. However, there was no significant difference among major clusters E, H, and J respecting biofilm formation. Conclusion K. pneumoniae isolates obtained from patients with COVID-19 have high antimicrobial resistance, and 44.2% of them have genetic similarity and can be clustered in three major clusters. There is a significant difference among clusters respecting antimicrobial resistance.

Comparison of Vitamin D Deficiency in Patients with Bladder Cancer and Healthy Individuals Referring to Shahid Beheshti Hospital in Hamadan, Iran, from 2018 to 2019

Background and Objective: Bladder cancer is one of the most common cancers in the world. In some studies, vitamin D deficiency has been reported in patients with bladder cancer. Vitamin D deficiency may increase the risk of bladder cancer by disrupting the responses of bladder wall cells to abnormal cells. Materials and Methods: This case-control study included 226 patients with gross hematuria who were referred to the urology clinic of Shahid Beheshti Hospital in Hamadan. The patients were divided into two groups of patients (n=76) with bladder cancer (case group) and those (n=150) without bladder cancer (Control group). The data were analyzed using SPSS software (Version 16) and at a confidence level of 95%. Results: The mean serum level of vitamin D in the case and control groups was obtained at 23.78 and 27.20 ng /mL, respectively (P=0.69). In total, 50% and 34% of patients had moderate and severe vitamin D deficiency in the case and control groups, respectively (P=0.020). The mean tumor size was 2.66 cm and 4 cm in moderate and severe cases of vitamin D deficiency, respectively (P=0.007). Conclusion: Vitamin D deficiency is also associated with increased tumor size in patients with bladder cancer, other than increasing the chance of developing bladder cancer.

The Relationship Between Serum Level of Interleukin-33 and Allergic Rhinitis and Its Severity in Children

Background: T helper type 2 (Th2) cells are critical cellular elements in allergic rhinitis. Interleukin-33 (IL-33) produces Th2-related cytokines and binds to the ST2 receptors. This is expressed strongly in mastocytes and discerningly in Th2 cells. Through Th2 cells, IL-33 may also have partly involved in immune responses. Objectives: This study aimed to measure the IL-33 serum levels in children suffering from allergic rhinitis and investigate its relationship with the disease. Methods: This case-control study was conducted on a population with the age range of 7-18 years, who referred to the Pediatric Clinic of the Shahid Beheshti Hospital in Kashan, Iran, in 2017. The study sample encompassed 57 patients with allergic rhinitis (case group) and 57 subjects with no allergic rhinitis (control group). The ELISA assay was used to measure the serum level of IL-33 in the case and control groups. Allergic rhinitis was diagnosed by a pediatric immunologist considering the patient’s history and the guidelines set out by the Allergic Rhinitis and its Impact on Asthma (ARIA). All study data were analyzed with SPSS software version 22. Results: There were significant differences between the two groups in terms of age (P = 0.001), gender (P = 0.0144), family history of atopy (P &lt; 0.001), symptoms duration (P &lt; 0.001), and comorbidities (e.g., atopic dermatitis and asthma) (P &lt; 0.001). Furthermore, compared to the control group, the case group exhibited significantly higher IL-33 serum levels (P &lt; 0.001). Conclusions: The high serum levels of IL-33 exhibited in patients with allergic rhinitis indicate its involvement in the pathogenesis of the concerned disease.

The effect of sexual counseling on depression, anxiety, stress, sexual knowledge and sexual quality of life in men who have undergone invasive coronary interventions: An RCT.

BackgroundSexual dysfunctions are common in men with ischemic heart disease, especially in men undergoing therapeutic interventions.ObjectiveThis study intended to assess the effect of counseling on depression, anxiety, stress, sexual knowledge and sexual quality of life in men after invasive coronary interventions in the post catheterization department of Kashan Shahid Beheshti Hospital during 2018.Materials and MethodsThe study population consisted of 54 male participants who had undergone an invasive coronary intervention. The intervention group received counseling and the control group underwent the standard ward routine. Data were collected using the depression anxiety stress scales, Abraham's sexual quality of life, and the Yi-Hung Sexual Knowledge questionnaires before discharge and also two months later.ResultsWithin two months, the intervention group's mean score of sexual knowledge significantly increased, compared with the control group, from 12.37 to 14.81 (p 0.001). The intervention group's mean score of sexual quality of life also significantly increased, compared with the control group, from 48.2 to 60.7 (p 0.001). Moreover, the mean anxiety score changed in the intervention group from 11.18 to 5.25, again a significant difference compared with the control group (p = 0.01). But, the differences in the depression and stress scores were not significant.ConclusionOur findings suggest that sexual counseling may improve sexual knowledge, sexual quality of life and anxiety in men following invasive coronary intervention, but might not reduce their stress or depression. Further studies are needed to confirm these findings.

Effects of Lifestyle and Environmental Factors on the Risk of Acute Myeloid Leukemia: Result of a Hospital-based Case-Control Study

Background: Acute myeloid leukemia (AML) is a common malignancy in adults. A vast variety of environmental and lifestyle factors play a role in AML incidence. This study aimed to assess the factors related to AML. Study design: A case-control study. Methods: This case-control study was performed on 137 AML cases during 2018-2021 at Beheshti Hospital in Hamadan, Iran, and 137 gender/age-matched controls. A questionnaire including 12 items was used to obtain information about lifestyle and environmental factors. A univariate and multiple variate logistic regression was used to estimate the odds ratios (OR), and a 95% confidence interval (CI) was used to investigate the relationship between the studied variables and the incidence of AML. Results: Based on findings, 62 (45.3%) out of the 137 leukemic cases were male and 75 (4.7%) were females. A statistically significant increased risk for AML was found with regard to prior usage of cytotoxic agents (OR: 8.00, 95% CI 1.01, 63.9, P =0.050), family history of malignancies (OR: 3.62, 95% CI: 1.65, 7.92, P =0.001), exposure to electrical power (OR: 3.22, 95% CI: 1.52, 6.81, P =0.002), and history of mental diseases (OR: 8.50, 95% CI: 3.64, 19.80, P =0.001). It was found that the AML incidence had no association with age, gender, radiation therapy, cigarette smoking, prior chemotherapy, congenital disorders, exposure to chemical agents, history of infectious mononucleosis, exercise, and blood transfusion ( P >0.05). Conclusion: The current results suggested that cytotoxic agents, family history of malignancy, mental disorders, and exposure to electrical power could play a role in AML incidence.

Relationship between D-dimer Levels and the Glomerular Filtration Rate in Patients with Chronic Kidney Disease

Background: Given the high sensitivity of the D-dimer assessment when ruling out pulmonary embolism, the present study was conducted to investigate the D-dimer levels in patients with CKD based on their related GFR. Methods: The present cross-sectional study included 98 patients with CKD who presented to the nephrology clinic of the Shahid Beheshti Hospital in Hamadan, Iran. The patients gave informed consent before enrollment. The data of each patient was recorded in the form of a checklist. The data analysis was performed using the SPSS software at a significance level of 0.05%. Results: There was found to be a negative correlation between GFR and D-dimer levels in the study participants. However, there was no evidence of thromboembolic events during the 1-year follow-up. Moreover, we found a direct relationship between patient age and the serum levels of the D-dimer, in that the D-dimer levels were higher in the participants who were older. Conclusion: We concluded that serum D-dimer level has a positive correlation with age, while it has a negative correlation with GFR in CKD patients. However, no evidence of thromboembolic events was found. &nbsp;