Designing and Launching Health Observatory Dashboard of Islamic Republic of Iran

Background: Health observatory dashboard can assist in promoting the quality of academic and governmental services by generator high-quality information. The aim of this research is to describe the stages of designing and launching the national public health dashboard. cMethods: This study was conducted with a qualitative approach and designing a web application using C#, ASP.NET and JQuery languages. The required data were gathered via 2 sources: (1) reviewing existing documents, and (2) gathering expert opinions. Results: The dashboard is developed in 3 sections, including a conceptual model of the indicators, a page for selecting the indicators, and metadata of each indicator. The indicators are demonstrated in 3 classes based on data sources (surveys and routine data collection), health effects (mortality, morbidity, risk factors, service coverage, social factors affecting health, health system functions, financial protection, population indicators, and macro indicators), as well as a plan, including the health reform plan. The page for selecting the indicators includes 190 major indicators encompassing the 3 mentioned areas. The metadata of each indicator includes the indicator name, its definition, its last figure, its source, the section for descriptive and comparative diagrams (the indicator's trend, provincial distribution, and international comparison of the indicator), and policy options. Conclusion: The Health Observatory System of Iran has been launched. The credibility of this system and user satisfaction depends on implementation of the health observatory calendar, qualitative control of the path of the recorded data, and national determination of policymakers. © 2022 Iran University of Medical Sciences. All Rights Reserved

Perforation as the First Manifestation of Marginal Ulcer Following One Anastomosis Gastric Bypass: a Multicenter Case Series and Review of Literature

One anastomosis gastric bypass (OAGB) has attracted increasing attention over the past decades due to its higher safety, simplicity, and efficacy over other bariatric techniques. Marginal ulcers (MUs) after OAGB are usually asymptomatic, potentially leading to life-threatening conditions, such as bleeding and perforation. However, the precise mechanisms and predisposing factors of perforation at the anastomotic site of OAGB remain unknown. In this study, we report six patients with a history of laparoscopic OAGB presenting with an acute abdomen and pneumoperitoneum. All patients underwent an open surgical intervention after the initial resuscitation. All patients underwent an exploratory laparotomy. Four patients were treated with omental patch repair. For one of them, Braun�s side-to-side jejunojejunostomy was also performed. One patient converted to Roux-en-Y gastric bypass (RYGB), and one patient converted to normal anatomy. Five out of six patients showed favorable outcomes after management. However, one of the patients, which presented with septic shock, expired 24 h after the emergent exploratory laparotomy. The mean interval between OAGB and MU perforation was 19 months, and the mean size of perforation was 2.08 cm. Perforation of an anastomotic ulcer after OAGB is rare and should be included in the differential diagnosis of patients presenting with an acute abdomen following OAGB; this may even occur years after OAGB. Patients can present with a perforated MU as the first manifestation. Adequate fluid resuscitation, along with administration of proton pump inhibitors (PPI) and antibiotics, should be considered in the primary management. Surgical options (oversewing, conversion to RYGB, and conversion to normal anatomy) vary according to the patient�s general condition, size and location of the perforation, and degree of contamination. © 2021, Association of Surgeons of India

Targeted delivery of galbanic acid to colon cancer cells by PLGA nanoparticles incorporated into human mesenchymal stem cells

Objective: The aim of this study was to investigate the efficacy of mesenchyme stem cells (MSCs) derived from human adipose tissue (hMSCs) as carriers for delivery of galbanic acid (GBA), a potential anticancer agent, loaded into poly (lactic-co-glycolic acid) (PLGA) nanoparticles (nano-engineered hMSCs) against tumor cells. Materials and Methods: GBA-loaded PLGA nanoparticles (PLGA/GBA) were prepared by single emulsion method and their physicochemical properties were evaluated. Then, PLGA/GBA nanoparticles were incorporated into hMSCs (hMSC/PLGA-GBA) and their migration ability and cytotoxicity against colon cancer cells were investigated. Results: The loading efficiency of PLGA/GBA nanoparticles with average size of 214±30.5 nm into hMSCs, was about 85 and 92 at GBA concentration of 20 and 40 μM, respectively. Nano-engineered hMSCs showed significant higher migration to cancer cells (C26) compared to normal cells (NIH/3T3). Furthermore, nano-engineered hMSCs could effectively induce cell death in C26 cells in comparison with non-engineered hMSCs. Conclusion: hMSCs could be implemented for efficient loading of PLGA/GBA nanoparticles to produce a targeted cellular carrier against cancer cells. Thus, according to minimal toxicity on normal cells, it deserves to be considered as a valuable platform for drug delivery in cancer therapy. © 2022 Mashhad University of Medical Sciences. All rights reserved

Comparison of outcomes and complications in conventional versus ultrasound-accelerated catheter directed thrombolysis for treatment of pulmonary embolism: A systematic review and meta-analysis

Background: Acute submassive a massive pulmonary embolism are known as leading causes of cardiovascular morbidity and mortality in emergency departments. Choosing the optimal type of catheter directed thrombolysis (CDT) for treatment of pulmonary embolism presents a quandary to the practitioners. To the best of our knowledge, there is no meta-analysis comparing superiority of conventional CDT and ultrasound-accelerated catheter directed thrombolysis (USACDT). Therefore, in this meta-analysis, we aimed to compare conventional CDT with USACDT regarding clinical outcomes and safety profile. Methods: A systematic literature search of previous published studies comparing conventional CDT with USACDT regarding clinical outcomes and safety profile was carried out in the electronic databases including MEDLINE, Scopus, EBSCO, Google Scholar, Web of Science, and Cochrane from inception to December 2021. Data were analyzed by comprehensive meta-analysis software (CMA, version 3). Results: The meta-analysis included nine studies with a total of 705 patients. Our meta-analysis showed that there is no significant difference between two groups with respect to pulmonary arterial systolic pressure (SMD: �0.084; 95 CI: �0.287 to 0.12; p: 0.41), RV/LV (SMD: �0.003; 95 CI: �0.277 to 0.270; p: 0.98), and Miller score (SMD: �0.345; 95 CI: �1.376 to 0.686; p: 0.51). Similarly, we found no statistically significant differences between two groups regarding major and minor bleeding (p >.05). Conclusion: Our meta-analysis showed that when compared with USACDT, conventional CDT provides similar clinical and hemodynamic outcomes or safety for treatment of pulmonary embolism without the need for very expensive technologies. However, randomized clinical trials are required to further investigate cost-effectiveness of USACDT in comparison with conventional CDT. © The Author(s) 2022

Features of Pathobiology and Clinical Translation of Approved Treatments for Coronavirus Disease 2019

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is currently the most important etiological agent of acute respiratory distress syndrome (ARDS) with millions of infections and deaths in the last 2 years worldwide. Several reasons and parameters are responsible for the difficult management of coronavirus disease-2019 (COVID-19) patients; the first is virus behavioral factors such as high transmission rate, and the different molecular and cellular mechanisms of pathogenesis remain a matter of controversy, which is another factor. Summary: In the present review, we attempted to explain about features of SARS-COV-2, particularly focusing on the various aspects of pathogenesis and treatment strategies. Key Messages: We note evidence for the understanding of the precise molecular and cellular mechanisms of SARS-CoV-2 pathogenesis, which can help design the appropriate drug or vaccine. Additionally, and importantly, we reported the updated issues associated with the history and development of treatment strategies such as, drugs, vaccines, and other medications that have been approved or under consideration in clinics and markets worldwide. © 202

Minor lobulation of the testis, mimicking polyorchidism when inflammed, discussion of a rare case: A case report

Introduction: Bilobed testis is an uncommon congenital malformation with only eight cases reported up to now. It seems that bilobed testicle is a form of polyorchidism which is not yet thoroughly divided. This report could provide information about diagnosing minor lobulation on ultrasound and MRI for the first time. Presentation of case: In this report, a 13-year-old boy presented with extreme Epididymo-orchitis on the right testis, without any history, which showed itself on ultrasound as type A3 polyorchidism or bilobed testis. Clinical discussion: Recent studies have not shown an apparent association between bilobed testis with testicular torsion and malignancy. In our case, because the minor lobulation is small, it probably has no association with torsion. The bilobed testis seems benign, so there is no requirement to check tumor markers. An inflamed testicular appendix and epididymitis can appear similar to a major lobulation which must be accurately found and evaluated on ultrasound as separate entities. Conclusion: Inflamed minor lobulation of the testicle can demonstrate itself as polyorchidism or bilobed testicles; thus, Ultrasound and MRI can assist in diagnosing minor lobulation. Serial examination and imaging are recommended for managing minor lobulation. © 2022 The Author

Assessing related factors to fasting blood sugar and glycosylated hemoglobin in patients with type 2 diabetes simultaneously by a multivariate longitudinal marginal model

The multivariate marginal model can be used to simultaneously examine the factors affecting both FBS and HbA1c using longitudinal data. The model fitted to multivariate longitudinal data should prevent redundant parameter estimation in order to have greater efficiency. In this study, a multivariate marginal model is used to simultaneously investigate the factors affecting both FBS and HbA1c with longitudinal data for patients with type 2 diabetes in Northern Iran. The present research is a retrospective cohort study. Overall, 500 medical records with complete information were reviewed. The multivariate marginal model is used to determine the factors associated with FBS and HbA1c using longitudinal data. Data have been analyzed in R-3.4.0 using �mmm2� package. Given that the coefficients for the interactions of rtype with the intercept, time, family history of diabetes, history of hypertension, history of smoking, insulin therapy, systolic/diastolic blood pressure and duration of disease at first visit are significantly different from zero (P 0.05), indicating that their effect on the two response variables is similar and only one coefficient should be used for each. We examined the similarity of coefficients when fitting the longitudinal multivariate model for the relationship between FBS/HbA1c and sex, age, history of high blood cholesterol, and body weight. If an independent variable has similar effects on both responses, only one coefficient should be estimated, which will increase the efficiency of the model and the reliability of the results. © 2022, The Author(s)

Molecular docking evaluation of celecoxib on the boron nitride nanostructures for alleviation of cardiovascular risk and inflammatory

Celecoxib (CXB) is a nonsteroidal anti-inflammatory drug (NSAID) that can be used to treat rheumatoid arthritis and ischemic heart disease. In this research, density functional theory (DFT) and molecular docking simulations were performed to study the interaction of boron nitride nanotube (BNNT) and boron nitride nanosheet (BNNS) with CXB and its inhibitor effect on pro-inflammatory cytokines. The calculated adsorption energies of CXB with the BNNT were determined in aqueous phase. The results revealed that adsorption of CXB molecule via its SO2 group on BNNT is thermodynamically favored than the NH2 and CF3 groups in the solvent environment. Adsorption of CXB on BN nanomaterials are weak physisorption in nature. This can be attributed to the fact that both phenyl groups in CXB are not on the same plane and require significant activation energies for conformational changes to obtain greater H-� interaction. Both BNNT and BNNS materials had huge sensitivity in electronic change and short recovery time during CXB interaction, thus having potential as molecular sensor and biomedical carrier for the delivery of CXB drug. IL-1A and TNF-α were implicated as vital cytokines in diverse diseases, and they have been a validated therapeutic target to manage cardiovascular risk in patients with inflammatory bowel disease. A molecular docking simulation confirms that the BNNT loaded CXB could inhibit more pro-inflammatory cytokines including IL-1A and TNF-α receptors as compared to BNNS loaded to CXB. © 2021 The Author(s

Usefulness of Doppler ultrasound for the early diagnosis of diabetic nephropathy in type 1 diabetes mellitus

Purpose: Early diagnosis and management of diabetic nephropathy (DN) might prevent or delay its progression to end-stage renal disease. The purpose of this study was to investigate whether changes in the duplex Doppler resistivity index (RI) are useful for the early identification of renal involvement in children and adolescents with insulin-dependent diabetes mellitus and associated conditions. Materials and methods: A total of 49 diabetic patients (two groups: 21 with DN and 28 without DN) were included in this study. DN was defined as 30�300 mg/l of albumin excretion in a random urine sample. The RI of the main renal arteries and their intrarenal branches (arcuate, interlobar) were evaluated with duplex Doppler ultrasound and correlated with age, renal length, duration of diabetes, and laboratory examinations. Results: The mean age did not significantly differ between the two groups. The patients with DN had a significantly longer duration of type 1 diabetes (p = 0.02). The majority of patients (90.5) had mild renal involvement with microalbuminuria and normal renal function. The mean RI was normal in both groups of patients, with no significant difference between the two groups. Conclusion: The RI did not increase in the early clinical stage of DN and was not a reliable marker for the screening of DN in patients with type 1 diabetes mellitus. © 2021, Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB)

Psychometric Properties of the 'Patients' Perspective of the Quality of Palliative Care Scale'

Objectives: Palliative care is a basic human right for all patients suffering from progressive and excruciating pain, limitations in daily activities as well as requiring constant care. The development of palliative care is always associated with the physical, psychological, social and spiritual care quality level and requires continuous evaluation by the care-receiving patients. This study aimed to determine the psychometric properties of the patients' perspective of the quality of palliative care scale. Materials and Methods: This methodological study was conducted on 500 patients with chronic diseases admitted to the hospitals affiliated in Golestan University of Medical Sciences, between 2019 and 2020. Participants were selected through stratified sampling through proportional allocation as well as considering the bed occupancy rate in the two referral hospitals of the university. According to Wild approach, we translated the original version of the scale the patients' perspectives of the quality of the palliative care scale with 35 items and eight subscales. Using exploratory and confirmatory factor analysis, the psychometric properties of the scale (i.e., initial reliability and face, content, convergent and construct validities) were assessed. The reliability of the scale was calculated by applying Cronbach's alpha coefficient, McDonald's omega coefficient and the Intraclass correlation coefficient (ICC). SPSS- 16 and AMOS-24 software programs were used to analyse the data. Results: Three items were omitted after assessing the initial reliability of the translated version of the perspectives of the quality of the palliative care scale using adjusted Cronbach's alpha. The qualitative face validity and impact score of the remaining items of the scale were confirmed by the target group. Meanwhile, a panel of experts confirmed the content validity ratio and content validity index. Convergent validity was approved by calculating the average variance extracted >0.5. Performing EFA led to the extraction of 7 subscales with 32 items. CFA and goodness of fit indices such as GFI = 0.98, CFI = 0.91, RMSEA = 0.048 and GFI = 0.97 confirmed the construct model by omitting three items. Hence, the Persian version of the patient's perspective of the quality of palliative care scale was finalised, including seven subscales with 29 items. ICC of >0.7 represented good reliability. Moreover, Cronbach's alpha and McDonald's omega coefficient confirmed the internal consistency of the scale. Conclusion: Based on the findings of this study, the Persian version of the patients' perspective of the quality of palliative care scale is introduced as a valid and reliable scale. It can accurately indicate and predict the meticulous quality of such care in hospitalised patients and can be used in the cure and care assessments in the health system. © 2022 Wolters Kluwer Medknow Publications. All rights reserved