Bayesian estimation of the time-varying reproduction number for pulmonary tuberculosis in Iran: A registry-based study from 2018 to 2022 using new smear-positive cases.

Introduction: Tuberculosis (TB) is one of the most prevalent infectious diseases in the world, causing major public health problems in developing countries. The rate of TB incidence in Iran was estimated to be 13 per 100,000 in 2021. This study aimed to estimate the reproduction number and serial interval for pulmonary tuberculosis in Iran. Material and methods: The present national historical cohort study was conducted from March 2018 to March 2022 based on data from the National Tuberculosis and Leprosy Registration Center of Iran's Ministry of Health and Medical Education (MOHME). The study included 30,762 tuberculosis cases and 16,165 new smear-positive pulmonary tuberculosis patients in Iran. We estimated the reproduction number of pulmonary tuberculosis in a Bayesian framework, which can incorporate uncertainty in estimating it. Statistical analyses were accomplished in R software. Results: The mean age at diagnosis of patients was 52.3 ± 21.2 years, and most patients were in the 35-63 age group (37.1%). Among the data, 9121 (56.4%) cases were males, and 7044 (43.6%) were females. Among patients, 7459 (46.1%) had a delayed diagnosis between 1 and 3 months. Additionally, 3039 (18.8%) cases were non-Iranians, and 2978 (98%) were Afghans. The time-varying reproduction number for pulmonary tuberculosis disease was calculated at an average of 1.06 ± 0.05 (95% Crl 0.96-1.15). Conclusions: In this study, the incidence and the time-varying reproduction number of pulmonary tuberculosis showed the same pattern. The mean of the time-varying reproduction number indicated that each infected person is causing at least one new infection over time, and the chain of transmission is not being disrupted.

Comparison of the effects of burn assessment mission game with feedback lecture on nursing students' knowledge and skills in the burn patients' assessment: a randomized clinical trial.

BACKGROUND: Learning of burn patient assessment is very important, but heart-breaking for nursing students. This study aimed to compare the effects of feedback lecture method with a serious game (BAM Game) on nursing students' knowledge and skills in the assessment of burn patients. METHOD: In this randomized controlled clinical trial, 42 nursing students in their 5th semester at Mashhad University of Medical Sciences School of Nursing and Midwifery, were randomly assigned to intervention (BAM game, available for two weeks) and control (feedback lecture method presented in two 90-minute sessions) groups. Two weeks after the intervention, all students were evaluated for their knowledge (using knowledge assessment test) and skills (using an Objective Structured Clinical Examination). Statistical analysis involved independent t-test, Fisher's exact test, analysis of covariance (ANCOVA), and univariable and multivariable ordinal logistic regression models. RESULTS: Following the intervention, the skill scores were 16.4 (SD 2.2) for the intervention group and 11.8 (SD 3.8) for the control group. Similarly, the knowledge scores were 17.4 (SD 2.2) for the intervention group and 14.7 (SD 2.6) for the control group. Both differences were statistically significant (P < .001). These differences remained significant even after adjusting for various factors such as age, gender, marital status, residence, university entrance exam rank, and annual GPA (P < .05). Furthermore, the BAM game group showed significantly higher skills rank than the feedback lecture group across most stations (eight of ten) (P < .05) in the univariable analysis. Multivariable analysis also revealed a significantly higher skills score across most stations even after adjusting for the mentioned factors (P < .05). These results suggest that the BAM game group had higher skills scores over a range of 1.5 to 3.9 compared to the feedback lecture group. CONCLUSIONS: This study demonstrated that nursing students who participated in the BAM game group exhibited superior performance in knowledge acquisition and skill development, compared to those in the control group. These results underscore a significant enhancement in educational outcomes for students involved with the BAM game, confirming its utility as a potent and effective pedagogical instrument within the realm of nursing education. TRIAL REGISTRATION: Iranian Registry of Clinical Trials: IRCT20220410054483N1, Registration date: 18/04/2022.

Transitional Epidemiology of Human Papillomavirus Infection in Iran: A Cross-Sectional Study and National Review.

Background: The high prevalence of cervical cancer in developing countries, despite its preventive nature, makes the disease a principal matter of concern for scientific studies. Providing global availability of primary and secondary preventive methods based on the high-risk human papillomavirus (HPV), which is the well-known pathogenesis in most malignant cervical lesions, has become the World Health Organization's (WHO's) critical target for 2030. Considering the demographic diversity and manufacturing of the internal vaccine in Iran, there is need for more study on the cost-effectiveness of these strategies. Materials and Methods: This study intends to assess female HPV prevalence at the time in Iran provinces, especially in the capital province, Khorasan Razavi, in the north to establish a scientific rationale for conducting further studies on arguments for and against national HPV prevention strategies in line with the WHO. In this population-based study, the HPV prevalence was evaluated in 900 cervical samples accumulated between 2012 and 2015. The data were later compared with recently published data in the same province, in the north of Iran. Result: Based on the results of our cross-sectional study, the estimated prevalence of HPV infection in the northern female population was 4.1% in 2015 and significantly increased to 35% in 2021. Conclusion: The hypothesis of the impact of behavioral and cultural changes in addition to population aging on general health indicates the need for national health promotion strategies. Additionally, it emphasizes the critical significance of conducting further investigational studies to obtain the actual and updated prevalence of HPV in Iran.

The Effect of Telenursing on Disease Outcomes in People with Type 2 Diabetes Mellitus: A Narrative Review.

Method: A comprehensive search of online databases, including PubMed, Scopus, Cochrane Library, and Google Scholar, was performed using the following MeSH keywords: telenursing, telephone follow-up, diabetes mellitus, disease management, glycemic, self-care, treatment adherence, and quality of life, up to September 2023. Two reviewers independently screened pertinent studies based on the prespecified outcomes (treatment adherence, self-care, glycemic control, and quality of life) and extracted data from all eligible studies. Results: Of all retrieved records, 23 studies including 5 quasiexperimental (21%) and 18 randomized controlled trials (RCTs) (79%) from five continents met the inclusion criteria. Both male and female patients were considered in the included studies, with mean age of 56.2 years old and a follow-up range of 12 weeks to 18 months. Findings showed that telenursing or nurse telephone follow-up significantly increased mean self-care efficacy score, improved adherence to the treatment regimen, decreased glycosylated hemoglobin and plasma glucose levels (but not lipid profile and body mass index), and improved quality of life compared to the routine care in people with T2DM. Conclusion: Telenursing can effectively supplement healthcare professionals to manage PWT2D. Increasing patients' knowledge about their drugs, insulin administration, and diabetes complications improves self-care behaviors and medical adherence. Consistently, improved self-care and regular use of treatment result in improved metabolic indicators and decreased rate of complications, which is associated with a better quality of life.

Assessment of the Performances of Adaptive Neuro-Fuzzy Inference System and Two Statistical Methods for Diagnosing Coronary Artery Disease.

Background: The accurate diagnosis of cardiac disease is vital in managing patients' health. Data mining and machine learning techniques play an important role in the diagnosis of heart disease. We aimed to examine the diagnostic performances of an adaptive neuro-fuzzy inference system (ANFIS) for predicting coronary artery disease and compare this with two statistical methods: flexible discriminant analysis (FDA) and logistic regression (LR). Methods: The data of this study is the result of descriptive-analytical research from the study of Mashhad. We used ANFIS, LR, and FDA to predict coronary artery disease. A total of 7385 subjects were recruited as part of the Mashhad Stroke and Heart Atherosclerotic Disorders (MASHAD) cohort study. The data set contained demographic, serum biochemical parameters, anthropometric, and many other variables. To evaluate the ability of trained ANFIS, LR, and FDA models to diagnose coronary artery disease, we used the Hold-Out method.For analyzing data, we used SPSS v25, R 4.0.4, and MATLAB 2018 software. Results: The accuracy, sensitivity, specificity, Mean squared error (MSE) , and area under the roc curve (AUC) for ANFIS were 83.4%, 80%, 86%, 0.166 and 83.4%. The corresponding values based on the LR method were 72.4%, 74%, 70% , 0.175 and 81.5% and for the FDA method, these measurements were 77.7%, 74%, 81%, 0.223, and 77.6%, respectively. Conclusion: There was a significant difference between the accuracy of these three methods. The present findings showed that ANFIS was the most accurate method for diagnosing coronary artery disease compared with LR and FDA methods. Thus, it could be a helpful tool to aid medical decision-making for the diagnosis of coronary artery disease.

The effect of threshold inspiratory muscle training on the duration of weaning in intensive care unit-admitted patients: A randomized clinical trial.

Background: The purpose of this study was to evaluate the effect of threshold inspiratory muscle training (IMT) on the duration of weaning in intensive care unit (ICU)-admitted patients. Materials and Methods: This randomized clinical trial enrolled 79 ICU-admitted, mechanically ventilated patients in 2020-2021 in Imam Reza Hospital, Mashhad. Patients were randomly divided into intervention (n = 40) and control (n = 39) groups. The intervention group received threshold IMT and conventional chest physiotherapy, while the control group only received conventional chest physiotherapy once a day. Before and after the end of the intervention, the strength of inspiratory muscles and the duration of weaning were measured in both the groups. Results: The duration of weaning was shorter in the intervention group (8.4 ± 1.1 days) versus the control group (11.2 ± 0.6 days) (P < 0.001). The rapid shallow breathing index decreased by 46.5% in the intervention group and by 27.3% in the control group after the intervention (both P < 0.001), and the between-group comparison showed a significantly higher reduction in the intervention group than control group (P < 0.001). The patients' compliance after the intervention compared to the 1st day increased to 16.2 ± 6.6 in the intervention group and 9.6 ± 6.8 in the control group (both P < 0.001), and the between-group comparison showed a significantly higher increase in the intervention group than control group. The maximum inspiratory pressure increased by 13.7 ± 6.1 in the intervention group and by 9.1 ± 6.0 in the control group (P < 0.001). Furthermore, the weaning success was 54% more probable in the intervention group than control group (P < 0.05). Conclusion: The results of this study showed the positive effect of IMT with threshold IMT trainer on increased strength of respiratory muscles and reduced weaning duration.

The effect of couple supportive counseling on self-efficacy in women with insulin-treated gestational diabetes: A randomized clinical trial.

BACKGROUND: Gestational diabetes is the most common medical complication and a common metabolic disorder during pregnancy. Increasing people's self-efficacy is one of the best ways to control this disease. As there is a lag of intervention in this regard, the purpose of this study was to determine the effect of couple supportive counseling on self-efficacy in women with insulin-treated gestational diabetes. MATERIALS AND METHODS: In this randomized clinical trial, 64 women with gestational diabetes who referred to diabetes clinic of Mashhad Ommolbanin Hospital were divided into intervention and control groups through block randomization during 2019. Their gestational age was in 26-30 weeks. For the couples in the intervention group, three couple supportive counseling session was held. Each session lasted 1 h and was held one time per week. The instruments were diabetes self-efficacy questionnaire, fasting and 2-h postprandial checklist and Cassidy social support, which were assessed before and 4 weeks after intervention in both groups. Data was analyzed by SPSS software version 25 through Mann-Whitney and Wilcoxon test. P values of < 0.05 were reported to be significant. RESULTS: In the preintervention, the diabetes self-efficacy score had no significant difference in the intervention (30/6 ± 38/50) and control groups (09/8 ± 56/51) (P = 515/0). However, in the postintervention, the diabetes self-efficacy score was significantly higher in the intervention group (58/6 ± 41/71) compared to the control group (15/7 ± 31/51) (P < 001/0). Also, before the intervention, there was no significant difference between the intervention (30/2 ± 72/10) and control group (87/1 ± 63/11) (P = 137/0) regarding social support. However, after the intervention, there was a significant difference between the intervention and control groups (879/0 ± 53/13, 03/2 ± 41/11, P < 0/001 respectively). Also, data analysis showed a significant correlation between self-efficacy and social support (r = 0.451, P < 0.001), self-efficacy and fasting blood sugar (P < 0.001, r = -0.577), and 2 h post prandial (r = -0.778, P < 0.001). CONCLUSION: Couple supportive counseling leads to increased self-efficacy and social support in pregnant women with gestational diabetes. Therefore, it is recommended to use this counseling as an effective method in the management of diabetic pregnant women during their prenatal care to have a healthier pregnancy.

Seroprevalence of Herpes Simplex Viruses Types 1 and 2 in a Population, Age 15-35 Years, of Mashhad City.

Background: Considering the high prevalence and clinical importance of herpes simplex virus (HSV) infection worldwide, we aimed to evaluate the seroprevalence of HSV-1 and HSV-2 in a population aged between 15 and 35 years in Mashhad, Iran. Methods: This cross-sectional study was conducted on 916 cases composed of 288 (31.4%) men and 628 (68.6%) women. Using ELISA method, the presence of IgM and IgG antibodies against HSV-1 and HSV-2 was assessed. Results: Among the population studied, 681 (74.3%) cases were positive for anti-HSV antibodies, while 235 (25.7%) cases were negative. Moreover, no IgMs were found and all positive subjects had IgG antibodies. Age (p < 0.001), occupation (p < 0.001), education (p = 0.006), smoking (p = 0.029), and BMI (p = 0.004) demonstrated a significant association with HSV-1 and HSV-2 infection. Conclusion: Our study indicates a high seroprevalence of HSV infection; however, there was no cases positive for IgM antibodies, suggesting the high prevalence of latent infection.

Analyzing the relationship between tissue color observed in VELscope examination and histopathological factors in OSCC patients.

OBJECTIVE: Early detection of OSCC is a crucial step towards improving OSCC prognosis. In recent years, novel diagnostic aids such as light-based detection systems have been introduced for early diagnosis. VELscope is one such light-based device which is used to examine tissue fluorescence. Based on different studies, VELscope has a sensitivity of 90% in the diagnosis of oral premalignant and malignant lesions. Tumor depth of invasion and invasive front have recently been proposed as influential factors in OSCC prognosis. Therefore, the aim of this study was to assess the relationship between tissue color seen through this device and tumor depth of invasion. METHODS & MATERIALS: 20 histopathologically approved OSCCs were included in this study. Conventional oral examination was carried out followed by an assessment of the lesion using VELscope. The H&E slides prepared following the final OSCC surgeries were then examined by an oral pathologist to assess tumor depth of invasion (interpreted as low-risk/high-risk), invasivefront (low-risk/high-risk) and perivascular and perineural invasions. Data was transferred to SPSS 16 software. The association between color changes and histopathological factors was analyzed using the fisher's exact and chi-square tests. RESULTS: The mean age of the patients was 51/5+/-16/74, 60% of which were men. Most lesions were exophytic and the most common color seen during VELscope examination was red. 55% and 50% of the OSCCs showed high-risk tumor depths and high-risk invasive fronts respectively. Perivascular and perineural invasion was seen in 55% and 35% of the samples respectively. Statistical analysis showed that 72/2% of the lesions with high tumor depths and 70% with high-risk invasive fronts were seen as red, although these associations were not significant (P>0/05). Tumor depth was significantly correlated with invasive front (P<0/05). CONCLUSION: There was no significant relationship between the type of color seen through VELscope and tumor depth of invasion, however most cases with high-risk depth of invasions were red.

A Spatial Variation Analysis of In-Hospital Stroke Mortality Based on Integrated Pre-Hospital and Hospital Data in Mashhad, Iran.

BACKGROUND: Despite significant advances in the quality and delivery of specialized stroke care, there still persist remarkable spatial variations in emergency medical services (EMS) transport delays, stroke incidence, and its outcomes. Therefore, it is very important to investigate the possible geographical variations of in-hospital stroke mortality and to identify its associated factors. METHODS: This historical cohort study included suspected stroke cases transferred to Ghaem Hospital of Mashhad by the EMS from March 2018 to March 2019. Using emergency mission IDs, the pre-hospital emergency data were integrated with the patient medical records in the hospital. We used the Bayesian approach for estimating the model parameters. RESULTS: Out of 301 patients (142 (47.2%) females vs. 159 (52.8%) males) with a final diagnosis of stroke, 61 (20.3%) cases had in-hospital mortality. Results from Bayesian spatial log-logistic proportional odds (PO) model showed that age (PO=1.07), access rate to EMS (PO=0.78), arrival time (evening shift vs. day shift, PO=0.09), and sequelae variables (PO=9.20) had a significant association with the odds of in-hospital stroke mortality (P<0.05). Furthermore, the odds of in-hospital stroke mortality were higher in central urban areas compared to suburban areas. CONCLUSION: Marked regional variations were found in the odds of in-hospital stroke mortality in Mashhad. There was a direct association between age and odds of in-hospital stroke mortality. Hence, the prognosis of in-hospital stroke mortality could be improved by better control of hypertension, prevention of the occurrence of sequelae, increasing the access rate to EMS, and optimizing shift work schedule.

The effect of hypnosis on perceived stress in women with preeclampsia.

BACKGROUND: Perceived stress is one of the causes of preeclampsia; one of the ways to manage mental stress is hypnosis. The aim of this study was to determine the effect of hypnosis on perceived stress in women with preeclampsia. MATERIALS AND METHODS: This randomized clinical trial was performed on 80 (40 people in each group) pregnant women 28-32 weeks with preeclampsia and hospitalized in two public hospitals in Mashhad in 2020. The Cohen Perceived Stress Questionnaire was first completed in two groups. Then, in the intervention group, three half-hour sessions of hypnosis were performed with an interval of 3 days (hypnosis consists of three sessions: each session is held for three consecutive nights). After each session, the intervention package, which included recording the dialogs of each session for posthypnotic suggestion, was delivered to the mothers on a CD to listen to every night before bed. The control group received routine care. Then, 2 weeks after the intervention, the Perceived Stress Questionnaire was completed by both groups. The results were analyzed by independent t-test, paired t-test, Mann-Whitney, Chi-square, Friedman and covariance tests, and by SPSS 16. RESULTS: At the beginning of the study, there was no statistically significant difference between demographic characteristics and the perceived stress score before the intervention between the two groups (P > 0.05). However, after the intervention, the mean perceived stress score was a statistically significant difference between the intervention and control groups (P = 0.005). Perceived stress after the intervention was significantly reduced in the intervention group, which was significant between the two groups. CONCLUSION: Perceived stress in mothers with preeclampsia is reduced by hypnosis.

Application of the Truncated Zero-Inflated Double Poisson for Determining of the Effecting Factors on the Number of Coronary Artery Stenosis.

BACKGROUND: Risk factors of coronary heart disease have been discussed in the literature; however, conventional statistical models are not appropriate when the outcome of interest is number of vessels with obstructive coronary artery disease. In this paper, a novel statistical model is discussed to investigate the risk factors of number of vessels with obstructive coronary artery disease. METHODS: This cross-sectional study was conducted on 633 elderly cardiovascular patients at Ghaem Hospital, Mashhad, Iran from September 2011 to May 2013. Clinical outcome is number of vessels with obstructive coronary artery disease (=0, 1, 2, 3), and predictor variables are baseline demographics and clinical features. A right-truncated zero-inflated double Poisson regression model is performed which can accommodate both underdispersion and excess zeros in the outcome. The goodness-of-fit of the proposed model is compared with conventional regression models. RESULTS: Out of 633 cardiovascular patients, 327 were male (51.7%). Mean age was ~65 ± 7 years (for individuals with zero, one ,and two coronary artery stenosis) and ~66 ± 7 years (for individuals with three coronary artery stenosis). BMI (0.04 ± 0.01, p = 0.011) and female gender (0.19 ± 0.09, p = 0.032) were significant associated with the count part of the model, and only BMI (-0.47 ± 0.2, p = 0.011) was significantly predictive of logit part of the model. The goodness-of-fit measurements indicate that the proposed model outperforms the conventional regression models. CONCLUSION: The proposal regression model shows a better fit compared to the standard regression analysis in modeling number of vessels with obstructive coronary artery disease. Hence, using truncated zero-inflated double Poisson regression model-as an alternative model-is advised to study the risk factors of number of involved vessels of coronary artery stenosis.

Effects of government policies and the Nowruz holidays on confirmed COVID-19 cases in Iran: An intervention time series analysis.

BACKGROUND: Public health policies with varying degrees of restriction have been imposed around the world to prevent the spread of coronavirus disease 2019 (COVID-19). In this study, we aimed to evaluate the effects of the implementation of government policies and the Nowruz holidays on the containment of the COVID-19 pandemic in Iran, using an intervention time series analysis. METHODS: Daily data on COVID-19 cases registered between February 19 and May 2, 2020 were collected from the World Health Organization (WHO)'s website. Using an intervention time series modeling, the effect of two government policies on the number of confirmed cases were evaluated, namely the closing of schools and universities, and the implementation of social distancing measures. Furthermore, the effect of the Nowruz holidays as a non-intervention factor for the spread of COVID-19 was also analyzed. RESULTS: The results showed that, after the implementation of the first intervention, i.e., the closing of universities and schools, no statistically significant change was found in the number of new confirmed cases. The Nowruz holidays was followed by a significant increase in new cases (1,872.20; 95% CI, 1,257.60 to 2,476.79; p<0.001)), while the implementation of social distancing measures was followed by a significant decrease in such cases (2,182.80; 95% CI, 1,556.56 to 2,809.04; p<0.001). CONCLUSION: The Nowruz holidays and the implementation of social distancing measures in Iran were related to a significant increase and decrease in COVID-19 cases, respectively. These results highlight the necessity of measuring the effect of health and social interventions for their future implementations.

An Analysis of the Areas Occupied by Vessels in the Ocular Surface of Diabetic Patients: An Application of a Nonparametric Tilted Additive Model.

(1) Background: As diabetes melllitus (DM) can affect the microvasculature, this study evaluates different clinical parameters and the vascular density of ocular surface microvasculature in diabetic patients. (2) Methods: In this cross-sectional study, red-free conjunctival photographs of diabetic individuals aged 30-60 were taken under defined conditions and analyzed using a Radon transform-based algorithm for vascular segmentation. The Areas Occupied by Vessels (AOV) images of different diameters were calculated. To establish the sum of AOV of different sized vessels. We adopt a novel approach to investigate the association between clinical characteristics as the predictors and AOV as the outcome, that is Tilted Additive Model (TAM). We use a tilted nonparametric regression estimator to estimate the nonlinear effect of predictors on the outcome in the additive setting for the first time. (3) Results: The results show Age (p-value = 0.019) and Mean Arterial Pressure (MAP) have a significant linear effect on AOV (p-value = 0.034). We also find a nonlinear association between Body Mass Index (BMI), daily Urinary Protein Excretion (UPE), Hemoglobin A1C, and Blood Urea Nitrogen (BUN) with AOV. (4) Conclusions: As many predictors do not have a linear relationship with the outcome, we conclude that the TAM will help better elucidate the effect of the different predictors. The highest level of AOV can be seen at Hemoglobin A1C of 9% and AOV increases when the daily UPE exceeds 600 mg. These effects need to be considered in future studies of ocular surface vessels of diabetic patients.

Assessing Heavy Metal Burden Among Cigarette Smokers and Non-smoking Individuals in Iran: Cluster Analysis and Principal Component Analysis.

Smoking is one of the major causes of mortality and numerous diseases, both directly and indirectly. The role of smoking as a significant risk factor is already known in several human diseases such as cardiovascular diseases, lung cancer, and chronic obstructive pulmonary disease. We aimed to compare the toxicity of heavy metal levels in the two groups of cigarette smokers and non-smokers in Birjand during 2018. In this case-control study, 70 smokers were enrolled as the case group and 70 individuals with no history of smoking as control group. The cases were selected from among those who smoked 10 cigarettes per day without a drug use history. Heavy metal concentrations were collected in participants' serum samples. Cluster analysis and principal components analysis were employed to compare heavy metal toxicity between the groups. The duration of smoking and the number of cigarettes consumed per day were 14.36 ± 12.75 years and 11.32 ± 7.23, respectively. The concentration of thallium (Ti), arsenic (As), manganese (Mn), and copper (Cu) was significantly higher in the smoker group than that in the non-smoker group (p < 0.05). Lead (Pb), cadmium (Cd), and cobalt (Co) are among the most important metals accumulated in smokers' blood, and 21.6% of our study's total data was associated with them. Cluster analysis in the smoker group, including A1 (Cd), A2 (Co, Pb), B1 (Ti), B2 (mercury (Hg), As, chromium (Cr), iron (Fe), nickel (Ni), and zinc (Zn)) and C (Mn and Cu). In our study, cluster analysis showed a different grouping of elements in patient and control groups. Lead, cadmium, and cobalt were the most critical metals accumulated in the blood of cigarette smokers.

Evaluation of the salivary glutaredoxin-1 levels in oral lichen planus and oral squamous cell carcinoma.

BACKGROUND: Glutaredoxin-1, as a component of antioxidant system, plays a crucial role in pathogenesis of some cancers and pre-malignant lesions. The aim of this study is to assess salivary levels of glutaredoxin-1 in oral lichen planus (OLP) and oral squamous cell carcinoma (OSCC) patients compared with healthy controls. METHODS & MATERIALS: This cross-sectional study was conducted on 28 OLP patients, 20 OSCC cases, and 40 healthy subjects. Their salivary glutaredoxin-1 was assessed by the enzyme-linked immunosorbent assay (ELISA). RESULTS: Regarding the glutaredoxin-1 level, there was no significant difference between the three studied groups (p=0.073); however, the salivary glutaredoxin-1levels were higher in the healthy subjects than the OLP and OSCC patients. Among OSCC patients, the salivary glutaredoxin-1 levels were significantly higher in the males (p=0.03). According to glutaredoxin-1 levels, the difference between keratotic and non-keratotic OLP lesions were not significant (p=0.98). Furthermore, there was no significant difference between various clinical manifestations and grades of OSCC, (p=0.08, p=0.56, respectively). CONCLUSION: Salivary glutaredoxin-1 levels were lower in OLP and OSCC patients compared to the normal volunteers; therefore the role of glutaredoxin-1 in the pathogenesis of these diseases could be proposed.

Assessment of salivary thioredoxin levels in oral lichen planus and oral squamous cell carcinoma.

OBJECTIVE: Oral lichen planus (OLP) is a chronic mucocutaneous inflammatory disease, which is considered as a potentially malignant condition and could transformed into oral squamous cell carcinoma (OSCC). Squamous cell carcinmoma is the most common oral cancer. This study aimed to compare salivary thioredoxin levels as an antioxidant protein among patients with OSSC, OLP and healthy subjects. MATERIALS AND METHODS: Twenty-eight patients with OLP, 20 patients with OSCC and 40 healthy people enrolled in this observational study. Saliva samples were collected from all subjects and salivary thioredoxin levels were evaluated by Elisa test. The data were recorded in the check lists and analyzed using SPSS (ver.17). RESULTS: Thioredoxin levels of healthy controls were insignificantly higher than OLP and SCC patients (p = 0.135). There was a statistically remarkable indirect relationship between thioredoxin levels and severity of the lesions determined by Thongprasom criteria among OLP patients. The thioredoxin concentration was significantly higher in the keratotic OLP. Among the OSCC patients, the highest levels of thioredoxin were found among patients aged more than 65 years. Salivary thioredoxin levels based on other variables were not significantly different between the studied groups. CONCLUSION: In this study, there was not any significant difference between salivary thioredoxin levels in the OLP and OSCC patients, though it was unremarkable higher in the healthy group compared to the patients; therefore, the role of thioredoxin in the cellular oxidation-reduction status could be suggested; however, further studies are recommended.

Evaluation of Tissue and Serum Expression Levels of Lactate Dehydrogenase Isoenzymes in Patients with Head and Neck Squamous Cell Carcinoma.

BACKGROUND: Head and Neck Squamous Cell Carcinoma (HNSCC) is a common malignancy that is associated with high morbidity and mortality all over the world. We explored the role of mRNA expression of both subunits of LDH in the early diagnosis of HNSCC. MATERIALS AND METHODS: This was a case-control study on 62 healthy individuals and 62 patients with HNSCC. The expression of LDH in tumors and healthy tissue margins, and in the serum of both HNSCC patients and healthy individuals was evaluated using a quantitative real-time PCR method. Analysis of LDH-A and LDH-B expression and sensitivity-specificity analysis were carried out using SPSS software. RESULTS: mRNA expression levels of LDH-A (4.18±1.29) and LDH-B (2.85±1.07) isoenzymes in tumor tissues were significantly higher than the expressions in the corresponding healthy tissue margins (1.85±0.56 and 1.61±0.56 for LDH-A and LDH-B, respectively). A comparison of LDH-B expression between histological grade I tumor tissue (2.74±0.19) and marginal tissue (1.62±0.90) showed a significant difference (P=0.016). Patients with a positive history of alcohol consumption and cigarette smoking had significantly higher mRNA expression of LDH-A (P=0.024) and LDH-B (P=0.03) in the marginal tissue and blood, respectively. The highest sensitivity and specificity values pertained to the mRNA expression of LDH-A (90.9%) and LDH-B (85.5%) in the blood. CONCLUSION: This is the first study reporting LDH gene expression as a biomarker in blood and tumoral tissue of HNSCC patients. Given the highest sensitivity and specificity values for LDH-A and LDH-B in blood, we recommend the simultaneous evaluation of both LDH isoenzymes in blood samples as a potential diagnostic method.

Effect of Using a Simulation Device for Ostomy Self-care Teaching in Iran: A Pilot, Randomized Clinical Trial.

The appearance of a stoma and the potential for contact with stool may negatively affect postoperative teaching effectiveness, especially for patients with cultural and religious backgrounds that consider stool untouchable. Instruction that involves the use of a physical stoma simulator for practice may help address this problem. PURPOSE: The aim of this pilot study was to determine the effects of simulation in ostomy self-care training on self-efficacy and adjustment. METHODS: A randomized clinical trial was conducted among patients at 2 public medical center surgical units in eastern Iran from April 2015 to December 2015 using consecutive sampling. Patients who spoke Persian, were 18 to 65 years of age, had a temporary or permanent intestinal stoma, and did not have comorbidities that might interfere with self-care teaching were invited to participate and randomly allocated to the simulation (SG) or the control group (CG). Both groups were provided 4 training sessions; the first and fourth session was the same for each group, but in sessions 2 and 3, the SG group used a wearable stoma simulator, whereas the CG group used the demonstration-return method. Demographic and stoma variables were collected, and the Stoma Self-Efficacy Scale (SSES) and Ostomy Adjustment Inventory-23 (OAI-23) were administered at baseline (following surgery), after 4 instructional sessions, and 45 days following the last education session. Descriptive statistics and chi-squared, Fisher's exact, Mann-Whitney U, repeated measure, and least significant difference tests were used to analyze the data. RESULTS: Of the 53 patients enrolled, 46 (23 in each group) completed the study. Mean age for SG and CG patients was 45.91 ± 10.40 and 53.78 ± 9.15, respectively (P = .009). The majority of patients were female (SG: 11 [47.8%]; CG: 14 [60.9%]), married (SG: 20 [87.0%]; CG: 19 [82.6%]), and had a diagnosis of cancer (SG: 20 [87.0%]; CG: 21 [91.3%]). The mean SSES score for stoma self-efficacy was 103.82 ± 15.81 in the SG and 89.91 ± 13.41 in the CG after the fourth session. Results indicated an improvement in self-efficacy in both groups from baseline to final follow-up visit (P <.0001). SSES in the SG was significantly different from baseline to final follow-up visit during the study (F = 3.183, P = .008). Mean OAI-23 scores were 51.04 ± 13.37 in the SG and 50.82 ± 13.84 in the CG at baseline and after the intervention (fourth session) were 60.56 ± 16.41 in the SG and 53.95 ± 13.22 in the CG group. The repeated measure test results indicated significant increases in adjustment scores from baseline to final follow-up visit in both groups (P = .000). CONCLUSION: The results of this pilot study suggest that using simulation to teach ostomy self-care improves self-efficacy after 3 and 9 weeks. Further randomized controlled trials that expand the sample size and demographic should be conducted.

Overexpression of Lactate Dehydrogenase in the Saliva and Tissues of Patients with Head and Neck Squamous Cell Carcinoma.

BACKGROUND: Head and neck squamous cell carcinoma (HNSCC) is the sixth most common malignancy that is associated with high morbidity and mortality. Salivary lactate dehydrogenase (LDH concentration), as an expression of cellular necrosis, may be a special marker of lesions that occur with changes in the integrity of the oral mucosa. This study was performed to determine the accuracy of salivary LDH as a clinical marker for HNSCC detection and to investigate the relationship between salivary LDH levels and tissue tumor detection. METHODS: The case group consisted of 44 HNSCC patients and the control group consisted of 44 healthy subjects. The stage and grade of HNSCC were determined, and the LDH levels in collected saliva samples were measured in all subjects. The expression of LDH in tumors and healthy tissue margins was evaluated via immunohistochemistry. RESULTS: The expression of LDH in the saliva of patients with HNSCC is significantly higher than that in the saliva of the healthy control group. The expression of salivary LDH in patients with oral squamous cell carcinoma (OSCC) is significantly higher than that in the other patients and healthy individuals in the control group. The levels of salivary LDH in patients with SCC of the tongue and lower oral cavity were significantly higher than those in other patients affected with SCC in other parts of the head and neck (P<0.01). CONCLUSION: As this enzyme increases simultaneously in both tumoral tissues and saliva, it can serve as a useful diagnostic marker for the early diagnosis and prediction of HNSCC.