An Adolescent Presenting With Mania and Catatonia Associated With Coronavirus Disease-2019 Encephalitis.

There is growing evidence that coronavirus disease-2019 (COVID-19) infection may have various neuropsychiatric manifestations and long-term outcomes. In this article, the authors report a rare case of a 16-year-old male with no previous history of psychiatric illness who presented with an acute manic episode, including laughing for no evident reason, talking to himself, isolation, irritability, sleeplessness, decreased appetite, prolonged staring episodes, having delusions about being harmed or controlled, and aggression. Despite initiating outpatient treatment with a mood stabilizer and antipsychotic for presumed bipolar disorder with psychotic features, his symptoms worsened, and he became catatonic with a decreased level of consciousness, leading to his hospitalization on day 10. Although he had not shown typical evidence of infection with COVID-19 in the days leading up to or during his hospitalization and his initial COVID-19 test was negative, his COVID-19 test was positive on day 14, and his chest X-ray showed infiltrations. His acute manic symptoms and catatonia were identified to be associated with COVID-19 encephalitis after excluding other causes. He responded well to treatment with lorazepam for catatonia and a course of intravenous immunoglobulin, methylprednisolone, and remdesivir for COVID-19 encephalitis. This case demonstrates the workup and treatment of a rare neuropsychiatric manifestation of COVID-19 encephalitis in an adolescent, which started with no past psychiatric history and no typical symptoms of COVID-19 infection.

Preclinical studies of chimeric antigen receptor-modified natural killer cells in cancer immunotherapy: a review.

INTRODUCTION: As one of the most efficacious methods of cancer immunotherapy, chimeric antigen receptor-modified immune cells have recently drawn enormous attention. After the great success achieved with CAR-T-cells in cancer treatment both in preclinical setting and in the clinic, other types of immune cells, including natural killer (NK)-cells and macrophages, have been evaluated for their anti-cancer effects along with their potential superiority against CAR-T-cells, especially in terms of safety. First introduced by Tran et al. almost 26 years ago, CAR-NK-cells are now being considered as efficient immunotherapeutic modalities in various types of cancers, not only in preclinical setting but also in numerous phase I and II clinical studies. AREAS COVERED: In this review, we aim to provide a comprehensive survey of the preclinical studies on CAR-NK-cells' development, with an evolutional approach on CAR structures and their associated signaling moieties. Current NK-cell sources and modes of gene transfer are also reviewed. EXPERT OPINION: CAR-NK-cells have appeared as safe and effective immunotherapeutic tools in preclinical settings; however, designing CAR structures with an eye on their specific biology, along with choosing the optimal cell source and gene transfer method require further investigation to support clinical studies.

The Effect of Peers Support on Fear of Hypoglycemia in Iranian Patients with Type 1 Diabetes: A Clinical Trial Study.

BACKGROUND: Fear of hypoglycemia is a medical emergency which leads to disrupt individuals' normal lives. Peers support is a hopeful approach to improve diabetes self-care behaviors. This study was conducted to assess the effect of peers support on the fear of hypoglycemia in patients with type 1 diabetes. MATERIALS AND METHODS: This randomized clinical trial study was performed among 60 patients with type 1 diabetes in Qazvin city from September 2019 to October 2020. Patients were assigned to control and intervention groups using a random method. The data collection tools included demographic characteristics and a standard questionnaire for Hypoglycemia Fear Survey (HFS). Patients in the intervention group were trained by skilled peers for 2 months, but those of the control group only received routine hospital training. The data were analyzed by SPSS version 16 and paired and independent t-test. RESULTS: The scores of the fear of hypoglycemia in diabetic patients in the two groups had no significant statistical difference before intervention (t53 = 0.93, p = 0.94). But after the intervention, the independent t-test showed that there was a significant difference between the scores of the fear of hypoglycemia in both groups (t53 = -2.13, p = 0.03). CONCLUSIONS: Considering the results of the current study, peer support for diabetic patients is an effective way to reduce the fear of hypoglycemia. Therefore, it is recommended using this training method to train diabetic patients.

Effect of health literacy among students on the adoption of osteoporosis-preventive behaviors in Iran.

BACKGROUND: In chronic diseases such as osteoporosis, understanding the factors that improve prevention, such as health literacy (HL), is essential in reducing the incidence of these diseases. This study aimed to determine the association between HL and adoption of osteoporosis-preventive behaviors among students in Qazvin. SUBJECTS AND METHODS: This is a cross-sectional study in which 375 female students (aged 15-18 years) at high schools (grades 10th, 11th, and 12th) in Qazvin city were selected, in 2019. Sampling method was multistage. To collect data, the standardized questionnaire for measuring HL in adolescents (health literacy measure in adolescents), in addition to another questionnaire for assessing osteoporosis-preventive behaviors, was used. Data were analyzed using SPSS 22 by descriptive statistics and logistic regression. The association considered significant when P < 0.05. RESULTS: The mean scores of adoption of osteoporosis-preventive behaviors and HL were 22.43 ± 5.60 and 70.84 ± 12.58, respectively. Logistic regression showed that there was a significant association between the adoption of osteoporosis-preventive behaviors and HL (P = 0.001). In addition, the association between the adoption of osteoporosis-preventive behaviors and age was also significant (P = 0.048 and odds ratio = 3.35). CONCLUSIONS: Young students and those of low HL showed less adoption of osteoporosis-preventive behaviors. Therefore, it is necessary to pay more attention to design educational programs that may raise the knowledge and awareness of those students about such these diseases, mainly prevention.

Social Determinants of Breast Cancer Screening among Married Women: A Cross-Sectional Study.

BACKGROUND: Regular cancer screening is the best way for early detection of breast cancer, but studies showed the low participation rates of screening in Iran. We aimed to determine breast cancer screening among married women and related factors in North of Iran. STUDY DESIGN: A cross-sectional study. METHODS: This cross-sectional study was carried out from Jan to Mar 2017 among 1472 married women in an urban population in Rasht City, North of Iran. Data were collected using a questionnaire included socio-demographic information and breast cancer screening behaviors. Descriptive statistics, chi-square and logistic regression were used for data analyzing with SPSS. RESULTS: The mean age of women was 35.1 ±6.5 years. Majority of women never performed clinical breast examination (70.7%) and regular monthly breast self-examination (52.2%). Only women over 40 yr performed mammography. Mammography performance was associated with health insurance (OR=4.99; 95% CI: 1.10, 22.53) and family history (OR=1.60; 95% CI: 1.19, 2.19), clinical breast examination was associated with age of women (OR=2.87; 95% CI: 1.90, 4.32) and breast self-examination was associated with age and occupation of women [OR=1.67; 95 % CI: 1.16, 2.39, OR=1.65; 95% CI: 1.19, 2.29) respectively]. CONCLUSION: The rate of breast cancer screening was low among married women. Therefore considering the structural and cultural barriers, effective health education is essential to reduce inequality and increase the efficiency of screening programs.

Zerumbone Suppresses Human Colorectal Cancer Invasion and Metastasis via Modulation of FAk/PI3k/NFκB-uPA Pathway.

The current study explored the basic molecular mechanisms of zerumbone (ZER), an herbal compound, in inhibiting the migration and invasion of colorectal cancer (CRC) cells in vitro. Two types of CRC cells, namely HCT-116 and SW48, were treated with various concentrations of ZER (8, 16, and 24 µM) for 24, 48, and 72 h, respectively. In vitro assays were performed to determine alterations in proliferation ability, mRNA expression and protein levels, and migration and invasion potential of CRC cells. An SYBR Green-based quantitative polymerase chain reaction (PCR) was utilized to detect the gene expression of focal adhesion kinase (FAK), nuclear factor (NF)-κB, and urokinase-type plasminogen activator (uPA) followed by the evaluation of the level of proteins by western blotting. Migration and invasion potentials of HCT-116 and SW48 cells treated by ZER were examined using migration and invasion assay kits, respectively. We compared the results of all experiments with control groups, including FAK inhibitor, ZER + FAK inhibitor-treated cells, NF-ß inhibitor, ZER + NF-ß inhibitor, and untreated cells. The data in the present study suggest that ZER may exert its antimetastatic effects through inhibition of FAk/PI3k/NF-κB-uPA signaling pathway, thereby possibly representing a novel class of FAK inhibitors.

Prevalence of Musculoskeletal Disorders among Dentists in Iran: A Systematic Review.

INTRODUCTION: Musculoskeletal disorders (MSD) have become significant problems for all health care workers especially dentists. This systematic review provides prevalence of MSD in dentists of Iran. MATERIAL AND METHODS: In this study all published literatures about MSD in Iranian dentists were selected without any time limits or other restrictions. However, it was found that the studies about MSD among Iranian dentist are very low. RESULTS: The results of literatures investigations show that the prevalence was between 0.5% and 70%. The prevalence of pain in different regions includes; neck pain (0.7- 0.15), back pain (0.08 - 0.55), wrist pain (0.005-0.48), shoulder pain (0.08-0.5), knee pain (0.03- 0.25) and elbow pain (0.01- 0.2). The gender has no influence on the prevalence. Compare the results with other similar studies shows that the prevalence of MSD is an important issue in other area too. CONCLUSION: Results show that the prevalence of musculoskeletal problems is high in Iran. Therefore it is necessary conduct reliable and comprehensive epidemiological studies in this field to determine the causes of the problem more consciously; and propose appropriate solutions.

Occupational Disease Registries-Characteristics and Experiences.

INTRODUCTION: Due to growth of occupational diseases and also increase of public awareness about their consequences, attention to various aspects of diseases and improve occupational health and safety has found great importance. Therefore, there is the need for appropriate information management tools such as registries in order to recognitions of diseases patterns and then making decision about prevention, early detection and treatment of them. These registries have different characteristics in various countries according to their occupational health priorities. AIM: Aim of this study is evaluate dimensions of occupational diseases registries including objectives, data sources, responsible institutions, minimum data set, classification systems and process of registration in different countries. MATERIAL AND METHODS: In this study, the papers were searched using the MEDLINE (PubMed) Google scholar, Scopus, ProQuest and Google. The search was done based on keyword in English for all motor engines including "occupational disease", "work related disease", "surveillance", "reporting", "registration system" and "registry" combined with name of the countries including all subheadings. After categorizing search findings in tables, results were compared with each other. RESULTS: Important aspects of the registries studied in ten countries including Finland, France, United Kingdom, Australia, Czech Republic, Malaysia, United States, Singapore, Russia and Turkey. The results show that surveyed countries have statistical, treatment and prevention objectives. Data sources in almost the rest of registries were physicians and employers. The minimum data sets in most of them consist of information about patient, disease, occupation and employer. Some of countries have special occupational related classification systems for themselves and some of them apply international classification systems such as ICD-10. Finally, the process of registration system was different in countries. CONCLUSION: Because occupational diseases are often preventable, but not curable, it is necessary to all countries, to consider prevention and early detection of occupational diseases as the objectives of their registry systems. Also it is recommended that all countries reach an agreement about global characteristics of occupational disease registries. This enables country to compare their data at international levels.

Prevalence of Low Back Pain in Health Care Workers and Comparison with Other Occupational Categories in Iran: A Systematic Review.

BACKGROUND: There are few research studies evaluating the significance of low back pain (LBP) in Iran, even though the majority of locally published surveys are written in the Persian language. In the present review study, we aimed at appraising published articles related to the burden of LBP and its divergence among different jobs. METHODS: A comprehensive search was conducted in all accessible national and international electronic databases from 1948 to mid-2012. The international electronic databases were MEDLINE (PubMed), Web of Sciences, Google Scholar, Scopus, CINAHL, and the Iranian equivalents were SID, IRANDOC, IranMedex, and Magiran. The main search terms were musculoskeletal disorders, musculoskeletal symptoms, low back pain, back pain, and Iran. All keywords were searched electronically by three Boolean operators. The inclusion criteria were age ≥10 years, study focus on LBP prevalence, inclusion of both genders, and no limitation to the study design. A dedicated STROBE questionnaire was developed as a critical appraisal tool and the quality of the identified literature was examined according to the 5-point Linker scale. Articles scoring ≥3 on the Linker scale were appraised. Each literature was screened by four reviewers independently and possible disagreements were streamlined in a joint review meeting. The extracted data were entered into a dedicated table using Microsoft Office Excel program. Data were analyzed for homogeneity using the STATA software (version 11). RESULTS: Of the 51 articles that were included in the present review study, 35 articles reported 1-year LBP with Nordic questionnaire and 3 articles reported point prevalence of LBP. The calculated global prevalence of 1-year LBP in workers was 25% and LBP was the most prevalent issue among health care workers. There was no association between the prevalence of LBP and job classification among workers. CONCLUSION: LBP is the most common issue among health care workers. It is recommended that future research should focus on this job category for investigating LBP prevalence. This allows parameters that increase the frequency of LBP to be assessed and subsequently permits the reduction or elimination of such factors.

Allocating operating room block time using historical caseload variability.

Operating room (OR) allocation and planning is one of the most important strategic decisions that OR managers face. The number of ORs that a hospital opens depends on the number of blocks that are allocated to the surgical groups, services, or individual surgeons, combined with the amount of open posting time (i.e., first come, first serve posting) that the hospital wants to provide. By allocating too few ORs, a hospital may turn away surgery demand whereas opening too many ORs could prove to be a costly decision. The traditional method of determining block frequency and size considers the average historical surgery demand for each group. However, given that there are penalties to the system for having too much or too little OR time allocated to a group, demand variability should play a role in determining the real OR requirement. In this paper we present an algorithm that allocates block time based on this demand variability, specifically accounting for both over-utilized time (time used beyond the block) and under-utilized time (time unused within the block). This algorithm provides a solution to the situation in which total caseload demand can be accommodated by the total OR resource set, in other words not in a capacity-constrained situation. We have found this scenario to be common among several regional healthcare providers with large OR suites and excess capacity. This algorithm could be used to adjust existing blocks or to assign new blocks to surgeons that did not previously have a block. We also have studied the effect of turnover time on the number of ORs that needs to be allocated. Numerical experiments based on real data from a large health-care provider indicate the opportunity to achieve over 2,900 hours of OR time savings through improved block allocations.

Increased carotid intima-media thickness in scuba divers.

BACKGROUND: Scuba divers work in high pressure conditions which may cause some changes in physiological status to adapt to this situation. In this study, the carotid intima-media thickness (CIMT) was assessed in divers as a risk factor of cerebrovascular and cardiovascular disorders. METHODS: This historical cohort study was performed on 16 male professional scuba divers as case group and 30 healthy people as controls with age range of 26-66 years. CIMT of both carotids of supine participants was measured by a 10 MHz linear ultrasonic probe quantitatively. Relationship between experience of diving and carotid IMT was evaluated. RESULTS: All the participants were males (mean age 42.9 ± 10.58. and for the control group was (47.05 ± 12.31 years). The mean right CIMT in divers and control group was 524.31 ± 149.40 and 443.66 ± 59.62 micrometer, respectively. Furthermore, the mean left CIMT in divers and control group was 624.57 ± 116.15 and 458.44 ± 49.56 micrometer, respectively. CONCLUSION: The findings demonstrated that long-term occupational diving leads to increased intima-media thickness in scuba divers.

Effect of scuba-diving on optic nerve and sheath diameters.

BACKGROUND: There is not any data available about the effect of high bar pressure condition on intracranial pressure. In this study, the effect of diving on the optic nerve and sheath diameters as non-invasive markers of intracranial pressure has been investigated. METHODS: Twenty professional male divers from twenty one volunteers were chosen for this cross-sectional study. Only one person who had a history of barotraumas was excluded. Each diver then completed a questionnaire on demographic data, medical and diving history. Nineteen other volunteers were selected to represent a control group. A 10-MHz linear ultrasonic probe was used to measure the optic nerve sheath diameters of both eyes in closed and supine position and its relationship with diving history of divers was determined. RESULTS: It was found that divers have a higher mean optic nerve sheath diameter compared to the normal population as previously reported by other studies. The mean diameter of the left and right optic nerve sheaths were 6.4±0.7, 6.5±0.9 mm respectively and a significant relationship between optic nerve sheath diameter and diving history was found. CONCLUSION: RESULTS showed that divers have a higher optic nerve diameter than the general population. However, our result cannot yet be considered as a marker of intracranial pressure in divers as it was conducted on an limited number of subjects and so a bigger study should be undertaken for this purpose.

Effect of obesity and clinical factors on pre-incision time: study of operating room workflow.

As the obese population is increasing rapidly worldwide, there is more interest to study the different aspects of obesity and its impact especially on healthcare outcomes and health related issues. Targeting non-surgical times in the operating room (OR), this study focuses on the effect of obesity along with clinical factors on pre-incision times in OR. Specifically, both the individual and combined effect of clinical factors with obesity on pre-incision times is studied. Results show that with the confidence of 95%, pre-incision time in the OR of obese patients is significantly higher than those for non-obese patients by approximately five percent. Findings also show that more complex cases do not exhibit significant differences between these patient subgroups.

The (dubious?) benefits of second chances in batterer intervention programs.

In batterer intervention programs, there are conflicting recommendations about best practices for responding to client dropout. Risk management philosophies emphasize the importance of swift and sure sanctions for failure to comply with program attendance requirements. In contrast, change theory emphasizes the importance of providing clients with multiple opportunities to engage in treatment. To clarify the implications of each of these philosophies, the current study examined rates of program dropout, reinstatement, and completion in a consecutive sample of 294 probation-mandated clients referred to a large batterer intervention program. Just over half (53.7%) of men completed intervention on their first attempt. Over the 2-year follow-up study period, 73 clients were reinstated once by the intervention program, 23 clients were reinstated twice, and 5 clients reinstated three (or more) times. Reinstated clients were, in general, more similar to men who failed to complete than those who completed on their first attempt. Although rates of dropout at each reentry point were quite high (56% to 80%), 32 of the 73 (43.7%) reinstated clients eventually completed. There were significant costs associated with providing clients with additional chances to complete the program, with successful reinstatement requiring an average of 7.55 phone calls to clients, 3.82 phone calls to referral agents, one letter, and 0.73 in-person meetings. Results are discussed in terms of practice and policy implications of risk management and change theory approaches to dropout.

Effect of Air Pollutant Markers on Multiple Sclerosis Relapses.

BACKGROUND: Multiple Sclerosis (MS) is one of the autoimmune diseases with an unknown cause. The aim of this study was to explore the link between air quality and MS relapses in patients who suffer from MS. METHODS: This time-series study was conducted on patients registered at the Iranian Multiple Sclerosis Society in 2011-2012. They were randomly selected from patients lived in Tehran in the last five years, and had at least one relapse in the last three years. The link between monthly mean air pollutant levels and the relapses of MS in the participants was studied. RESULTS: Among the registered 160 participants, at least 150 had one attack during 2009 and 2012. Most air pollutants such as NO2, NO and CO are in high levels in the rainy season. Others like Pm10 and Nox are in high levels in the dry season. The correlation between NO2 levels of all markers of air quality and MS relapses (P=0.03, r=0.27) is weak. Best ARIMA model (p,d,q; 1,0,1) was determined between number of monthly relapses and living place, although this model was not significant (P=0.3) (AR; P=0.000, MA;P=0.4). CONCLUSIONS: Air pollutants might be regarded as a risk factor for MS relapse.

Health related quality of life and pain characteristics among Iranian patients suffering non-malignant chronic pain.

BACKGROUND: Chronic pain is a frequent disability that negatively affects patient's quality of life. Understanding of the possible relation between sociodemographic and medical variables with Health Related Quality of Life (HRQL) may help identifying the multidimensionality of pain and risk factors that limit physical and psychological adjustment of the patients. The present study was done to find these possible relationships, based on using Medical Outcomes Survey-Short Form (SF-36). METHODS: Among the patients who were referred to pain clinic of Iranian Pain Society, 101 consecutive outpatients were select based on the defined inclusion and exclusion criteria. All the participants in this study orally satisfied and were fully informed by a check list and SF-36 questionnaire. The possible impact of demographic variables, characteristics, diagnosis, analgesic use, smoking and opium addiction were collected as the first part of a routine pretreatment evaluation. RESULTS: Our findings showed significant relation between HRQL and gender (P < 0.05), the rate of chronic pain in female was higher than male, and same results found for elderly patients compared to younger ones. Our findings also showed significant relation between employment and intensity of pain (p = 0.001) as, employed patients showed less physical and psychotic problems than unemployed ones. The mean average of intensity of pain in these patients was 7.5±2.2; few patients used alcohol (4%), opium (1%) and cigarette (10%). Large number of participants used analgesic (%78.2). No significant difference between sociodemographic features with pain duration and quality of life was found. In contrast our data showed significant difference between pain intensity and quality of life (p < 0.001). CONCLUSION: Based on our findings it could be concluded that chronic pain in Iranian patients certainly leads to poor HRQL, the state is more serious in the elderly and female patients. Thus, in order to re-socialize the patients suffering chronic pain and decrease the impact of their pain on their life, these findings should be considered in any kind of pain relief therapy.

Helicobacter pylori in patients suffering from pulmonary disease.

BACKGROUND: Recently, research of indirect evidence suggested a possible association between Helicobacter pylori and pulmonary disease. This study aimed to determine if H. pylori could be detected in endobronchial specimens collected from patients undergoing bronchoscopy. MATERIALS AND METHODS: This prospective study was conducted on 34 consecutive patients with any type of lung disease undergoing bronchoscopy in which biopsy was required for their diagnosis. A written informed consent was obtained from all participants. Three bronchial mucosa biopsy samples were obtained using fenestrated biopsy forceps. One sample was used to determine urease activity, the second one for histopathological examination, and the third one for diagnosis. All subjects were fully informed regarding the gastroesophageal reflux disorder (GERD) Questionnaire. RESULTS: There were 34 patients with pulmonary diseases (12 males and 22 females, mean age 58.2±18.2 years) out of which, 11 (32.4%) had GERD. No significant difference was found between the histopathological assay and GERD. CONCLUSION: Our study found no direct evidence supporting the theory that H. pylori may cause pulmonary disease and no relation with GERD was detected. However, a possible indirect role could not be excluded. Further studies in patients with GERD and lung disease may reveal a potential pathogenic link between H. pylori and pulmonary disease.

Effectiveness of diabetes educational interventions in Iran: a systematic review.

BACKGROUND: Education of patients with diabetes is considered a fundamental aspect of diabetes care and aims to empower patients by improving knowledge and skills. The aim of this study was to conduct a systematic review of reports published about educational interventions on Iranian patients with diabetes. METHODS: All published articles in Iranian and international journals and those presented in relevant congresses were reviewed using standard key words. Studies published from April 2002 to December 2008 that met the eligibility criteria were included for this systematic review. RESULTS: A total of 18 discrete studies were identified. These studies were heterogeneous with respect to patient population, educational intervention, outcomes assessed, study quality, and generalizability. However, positive effects of self-management training on knowledge, frequency, and accuracy of self-monitoring of blood glucose and glycemic control were demonstrated in studies with short follow-up (less than 6 months). Effects of interventions on lipids, nutritional diet, weight, blood pressure, and quality of life were variable. CONCLUSIONS: There are insufficient and conflicting findings to obtain any firm conclusions regarding diabetes education in Iran. However, the appropriate diabetes health education appears to have short-term effects on glycemic control and knowledge of diabetes. The heterogeneity of studies made subgroup comparisons difficult to interpret with confidence. There is a need for long-term, more rigorous methodology. It is also highly recommended to health policy makers in Iran that a special course for training diabetes educators be designed because it would enable them to tailor appropriate education intervention for people with diabetes.