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Foregut cysts are various congenital lesions originated from emberyonic foregut. Bronchogenic, enterogenous and neuroenteric cysts are the most frequent forms of foregut cysts. They create different clinical symptoms based on their location. Enterogenous cysts comprise 4-5 percent of posterior mediastinal cysts and include esophageal, gastric and enteric cysts. A 61 year old woman referred to surgical clinic with dysphasia and regurgitation 6 months ago whose illness aggravared over the last 3 months. In physical examination, a lesion was seen in the right site of posterior mediastinum. Surgical excision was done and a ciliated columnar epithelium with two thin muscular layers were reported in pathology. In reality, the distinction between esophageal and bronchogenic cysts is not always clear. Both cysts present in mediastinum and their epithelial tissues are non-specific, however presence or lack of muscle layer in cyst-wall, proximity to gastrointestinal tract or tracheobronchial tree, adaption of clinical symptoms with paraclinic results and observations during surgical procedure can reveal certain diagnosis.

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Background and purpose: Fear of negative evaluation consists of anxiousness about other people’s evaluation of oneself, worries resulting from these negative evaluations, and the expectations from others, that they would develop only negative evaluations of one. The purpose of the present study was to determine the effect of metacognitive therapy (MÇT) on symptoms of fear of negative evaluation in social phobia disorder patients.
Materials and methods: This study was carried out as a controlled clinical trial. Participants were referred from clinics in the city of Shiraz, Ïran, and 19 patients were selected. They were randomly assigned to either the experimental or the control group. Âfter running the pretest, which was done using the fears of negative evaluation scale (FNË) and social phobia symptoms assessment questionnaire (SPSÂQ), the experimental group received 8 weekly metacognitive intervention sessions, while the control group received no intervention. Post-test and follow-up (after 3 months) were performed using the same tools.
Results: The results of analysis of multivariate covariance showed that MÇT had a significant effect on alleviating the symptoms of fear of negative evaluation (p<0.05).
Çonclusion: This intervention emphasizes on the promotion of efficient adaptive and flexible skills through metacognitive processes and their effect on a decrease in fear of negative evaluation in patients suffering social phobia disorder.

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Background and purpose: Harmane, norharmane and harmine are -carboline members of the family of Harmalas alkaloids (Peganum harmala, Zygophillaceae). The -carboline alkaloids bind to benzodiazepine site of the γ-aminobutyric acid type A (GABAA) receptors as inverse agonists. This finding suggests that the harmane, norharmane and harmine might attenuate the hot-plate and formalin-induced nociceptions in mice. This study assessed the antinociceptive effects of harmane, norharmane and harmine in the mice used in hot-plate and formalin tests. Materials and methods: The experiment was carried out on male BALB/C mice (20-25 g). In the hot-plate test, antinociceptive effects of drugs were assessed using a hot plate apparatus (Harvard, UK). The hot-plate temperature was thermostatically set at 52.5 ±5 °C. The latency to licking or kicking of the fore or hind paws was recorded at various times after drug injection. To avoid tissue damage a cut-off time of 45 seconds was imposed. In the formalin test, total time spent licking injected paw was recorded in 5 min intervals from 0-5 min (as early phase) and 15-50 min (as late phase) after injection of formalin. A decrease in the duration of the time spent licking indicated an antinociceptive response. Results: In the hot-plate test i.p. injection of harmane (5-20 mg/kg, seven mice per group), norharmane (5-15 mg/kg, seven mice per group) and harmine (10 and 15 mg/kg, seven mice per group), led to a significant antinociceptive effect. The antinociceptive effects of harmane, norharmane and harmine were antagonized by flumazenil (2 mg/kg, i.p.) and naloxone (5mg/kg, i.p.). In the formalin test, i.p. injection of the doses of 2.5-5-10 mg/kg, harmane, norharmane and harmine resulted in a significant antinociceptive effect. The antinociceptive effects of harmane, norharmane and harmine were antagonized by flumazenil (5 mg/kg, i.p.). Conclusion: The results suggest that the antinociceptive effects of harmane, norharmane and harmine may be mediated through an inverse agonistic mechanism located in the benzodiazepine receptors.

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Background and purpose: Health related quality of life (HRQOL) is a main outcome in irritable bowel syndrome (IBS). Several psychological factors are mentioned as effective factors in determining HRQOL in IBS patients. The aim of this study is to determine the association between patient’s illness perceptions and HRQOL in IBS sufferers. Materials and methods: In this cross-sectional study 160 patients with IBS who were referred to psycho-somatic clinic (related to Noor hospital of Isfahan) were participated. Patients’ illness perceptions and HRQOL were assessed by Brief Illness Perception Questionnaire (Brief-IPQ) and IBS specific quality of life questionnaire (IBS-QOL-34). Information gathered from questionnaires was finally analyzed by descriptive statistic methods, Pearson correlation and Canonical correlation method. Results: Results of analysis performed by canonical correlation method showed significant association between patient’s illness perception and HRQOL in IBS sufferers (Canonical correlations: 0.84, P<0.001). Among illness perception subscales, Emotions (P<0.001, r=0.69), Consequence (P<0.001, r=0.67), Identity (P<0.001, r=52), Concern (P<0.001, 0.51), Timeline (P<0.001, r=49) and Personal Control (P<0.001, r=0.19), respectively, had the most significant correlation with HRQOL, and there was no relation found between Illness Comprehensibility or treatment control and HRQOL. Conclusion: Patient’s illness perceptions seem to play a role in determining HRQOL in IBS sufferers. Therefor [psychological interventions based on patients’ Illness perceptions are recommended for these patients.

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Background and purpose: Air pollution is one of the most important environmental factors threatening human health that cause short and long term health effects and various diseases. The present study aimed at investigating and quantifying the health consequences associated with exposure to O3, NO2, and SO2 in ambient air in Tehran, 2014, using the air quality (Air Q) model.

Materials and methods: A descriptive–analytic study was performed in which hourly data of pollutants were taken from Tehran environmental protection agency and Air Quality Control Company. Data was validated according to the WHO guidelines. Statistical parameters were calculated for quantifying health effects. Then, processed data was converted for Air Q model.  

Results: The highest cumulative cases of mortality was due to NO₂ (n= 1274, attributable proportion= 2.51). Also, cumulative cases of hospital admission due to chronic obstructive pulmonary disease were attributed to O₃ (n= 240 cases, attributable proportion= 2.54). The number of heart attack cases due to SO₂ was 225.

Conclusion: According to the growing trend of air pollution, resultant mortality rate, and adverse effects more efficient solutions are required to control and reduce air pollution in Tehran.

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Premature ejaculation is likely the most common sexual dysfunction in men with a worldwide prevalence of approximately 30%. Epidemiological studies, accurate diagnosis, appropriate treatment and evaluation of clinical trials need a universally acknowledged definition that is also capable of operationalization. Studies have defined premature ejaculation differently. The most widely used definition is the DSM-IV-TR definition. However, the majority of these definitions are authority-based rather than evidence-based, and has no support from clinical and/or epidemiological studies. In this article, 41 articles were examined, various definitions of premature ejaculation were reviewed, definition criteria of it were discussed and classification of this dysfunction was mentioned. The results showed that multidimensional classifications and definitions using various diagnostic criteria, especially objective criteria like IELT are the most appropriate ones.

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Background and purpose: Nitrobenzene (NB) as the main material of synthetic fuels, cleaners, rubber and explosives is discharged into the environment and groundwater in large-scale. This compound is considered as a persistent organic pollutant with high toxicity and stable chemical structure which can cause serious risks for human health and ecosystem even in low concentrations. Therefore, the aim of present study was to synthesize polyaniline/zero-valent iron composite nano-fiber (CNFs) and its ability in degradation of nitrobenzene from aqueous solution.

Materials and methods: Characterization of CNFs was determined using scanning electron microscopy, transmission electron microscopy, X-ray diffraction and vibrating sample magnetometer. The effect of operational parameters such as pH, NB concentration and nanocomposite dosage on nitrobenzene degradation were analyzed by response surface methodology. Box Behnken model was used to investigate the interaction among variables. Analysis of variance was considered as statistical method for responses analyzes.

Results: ANOVA test showed a significant relationship between statistical model and test data. The observations also revealed that the distribution of residuals were normal and parameters i.e. pH, NB concentration, nanocamposite dosage and interaction of nano-composite and NB concentration had significant effect on removal of NB. The degradation efficiency was over 98% in optimized conditions (pH=2, NB concentration= 40 mg/l, and nanocomposite dosage= 0.88 g/l) that was achieved in 45 minutes. Limit of Detection (LOD) and Limit of Quantification (LOQ) were calculated as 1.5 and 5 mg/l, respectively.

Conclusion: According to the results, polyaniline nanofiber composite/zero-valent iron has a good efficiency in NB degradation. NB kinetic studies showed that the NB degradation process by nanocomposite followed the one order kinetic model. In addition, the nano-composite separation is simple due to its magnetism properties that it can improve its application.

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Background and purpose: Human health and disease are as old as human history. Today, the concept of health is tied to the components of social capital which can act as a shield against stress, depression, anxiety, accident, aging, and various diseases. The present study aimed to review the effect of social capital on women's health.
Materials and methods: A scoping review was carried out in five stages: 1-Designing a research question, 2- Searching and extracting research-dependent studies, 3- Selecting related studies, 4- Organizing and summarizing information and data, and 5. Reporting the results. Data collection was done in electronic databases, including MagIran, SID, Iran Doc, IranMedex, Scopus, Google scholar, PubMed, Science Direct, and Embase. The search keywords were women, female, feminine, lady, wife, Iran, Persian, Social capital, health, physical health, mental health, and social health in both Persian and English.
Results: Overall, 15 related articles were included in this review study. These studies were reviewed to organize the findings into three categories: the relationship between social capital with physical health, mental health, and social health.
Conclusion: According to current findings, women's health improves by increasing their social capital which is also increased by more health and education facilities, social participation, trust, and communication with family and friends.
 

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 Background and purpose: The Coronavirus Disease 2019 (COVID-19) was first observed in December 2019 and caused a global pandemic. The aim of this study was to evaluate the clinical features and paraclinical findings in patients who died of COVID-19 in Sari Imam Khomeini Hospital, February 2020- May 2020.
Materials and methods: A cross-sectional descriptive and retrospective study was done by reviewing the medical records of 149 patients who died of Covid-19 whose diagnosis was confirmed by chest CT scan or PCR-RT. Independent sample t test was used to compare quantitative variables and Chi-square test was used for analyzing qualitative variables.
Results: The mean age of death from Covid-19 was 63.36±15.26 years and 58.1% were male. The most common clinical complaints were cough, fever, and dyspnea. The most common manifestation of chest CT scan was bilateral involvement. Among the dead cases of COVID-19, 13.5% had myocarditis and 4.7% developed respiratory complications (such as pneumothorax). According to findings, 54.1% died of cardiac arrest and 44.6% died due to respiratory arrest.
Conclusion: Many ambiguities of SARS-CoV-2 still remain that require extensive studies and research in various aspects. Evaluation of demographic, radiological, clinical complications, and laboratory features can help physicians in finding ways to reduce mortality, perform more effective treatments, and use predictive tools.

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Background and purpose: One of the problems of in vitro fertilization (IVF) cycles is recurrent failure of implantation. The present study aimed to investigate the effect of intrauterine saline infusion in luteal phase of previous menstrual cycle on occurrence of pregnancy in infertile patients undergoing frozen-thawed embryo transfer.
Materials and methods: This clinical trial was conducted in 70 infertile women attending the infertility center in Sari Imam Khomeini Hospital who were undergoing frozen-thawed embryo transfer in 2020. The participants were randomly divided into an intervention group and a control group (n= 35 per group) using random number table. In intervention group, intrauterine injection of saline with ultrasound guidance was performed on day 21 of previous menstrual cycle, while the control group received no intervention. Pregnancy outcomes were compared between the two groups. Data analysis was performed using Chi-square and t-test.
Results: The intervention group and control group were found to be significantly different in rate of clinical pregnancy (6.5%, 28.1%) (P=0.003) and live birth (6.5%, 28.1%), respectively (P=0.02).
Conclusion: In this study, saline infusion sonohysterography did not have positive effect on clinical pregnancy and live birth, which could be due to small sample size, performing the procedure on day 21 of cycle, or ineffectiveness of this method in causing inflammation following scratches compared to conventional methods. Further molecular and cellular studies are needed to compare the effect of these methods on increasing the level of inflammatory factors.
 
(Clinical Trials Registry Number: IRCT20160815029374N8)

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 Background and purpose: Infants with persistent pulmonary hypertension (PPHN) are readmitted to hospital three times more than other infants or die after discharge. The disease imposes a high cost on families and health systems. In this study, for the first time, the prevalence of PPHN and associated factors were investigated in mature neonates born in southeast of Iran.
Materials and methods: In this cross-sectional study, the clinical records of 1859 infants born in Kerman Afzalipour Hospital, 2020 were reviewed. Infants hospitalized from delivery, congenital heart disease, other differential diagnoses of PPHN, and evidence of genetic diseases were excluded from the study. Then, mature infants with clinical evidence of PPHN underwent Doppler echocardiography to confirm the final diagnosis. Information about pregnancy, childbirth, infant gender, birth, 1-minute and 5-minute Apgar scores, and advanced respiratory support were also obtained. Data were analyzed by SPSS V25.
Results: Out of 229 neonates meeting the inclusion criteria, 31 (11.9%) had PPHN. Signification relationship was observed between frequency of PPHN and cesarean delivery and 5-minute minute Apgar score (P<0.05). But, no significant association was found between developing PPHN and other maternal or neonatal factors (P>0.05). The mean parameters of PPHN, including tricuspid annular plane systolic excursion (TAPSE), tricuspid regurgitation rate, mean pulmonary artery pressure, and pulmonary artery diameter were significantly higher in infants delivered by cesarean section than those born by normal vaginal delivery group (P<0.05).
Conclusion: Further multicenter studies with larger sample size over a longer period of time are suggested in southeast of Iran to elicit clear explanations on the association between PPHN and maternal, fetal, and neonatal factors.
 

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Background and purpose: Hyperdontia is defined as supernumerary teeth (ST) in deciduous or permanent dentitions which can cause a variety of dental, occlusion, and cosmetic problems. This study aimed to evaluate the prevalence and location of ST in different classes of malocclusion in a population of orthodontic patients attending a private orthodontic clinic in Sari, North of Iran between 2006 and 2021.
Materials and methods: In this cross-sectional study, the records of 4873 patients were reviewed. ST characteristics and malocclusion classes were studied using panoramic radiography, lateral cephalometry, and intraoral photographs. Data analysis was performed in SPSS ver.26 applying Chi-square, Mann-Whitney, Kruskal-Wallis, and Fisher's exact test.
Results: Out of 4873 records, 36 (0.74%) patients had ST. These included 21 (58.3%) women and 15 (41.7%) men with a mean age of 23.39±10.76 years. The prevalence of ST was not significantly associated with sex, classes of malocclusion, and the type of teeth (P= 0.317, 0.02, and 0.18, respectively). However, significant correlations were found between the incidence of ST and the direction (unilateral or bilateral), malocclusion, and type (maxilla or mandible) and direction (left or right) of the jaw (P<0.001).
Conclusion: Distribution of ST is significantly associated with the direction, malocclusion, and left or right jaw. Nevertheless, additional studies are required in order to offer the best treatment.
 

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 Malignant neoplasms that affect the lymphatic system are called lymphoma and include a wide range of diseases that originate from B cells. Lymphoma is the second common neoplasm of the head and neck and includes Hodgkin's lymphoma and non-Hodgkin's lymphoma. This article reports the case of a primary non-Hodgkin's lymphoma in the oral cavity. He attended Sari Maxillofacial Surgery Clinic because of a gradual growth of a mass in the posterior region of the maxilla. The patient was primarily diagnosed with periodontal abscess but misdiagnosis led to treatment failure and disease progression. After attending our clinic, immunohistochemical examination was performed which revealed a diffuse large B-cell lymphoma. The patient underwent surgery and treatment with CHOP regimen (cyclophosphamide, daunorubicin, vincristine, and prednisolone). The development of lymphoma in the oral cavity is very rare and its symptoms such as pain, swollen gums, and loose teeth are similar to other dental problems and may lead to diagnostic problems. The present report draws attention to non-Hodgkin's lymphoma in differential diagnosis of soft and hard tissues of the oral lesions that can lead to appropriate treatment and better prognosis.
 

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Background and purpose: Post-traumatic stress disorder (PTSD), a type of psychiatric disorder that occurs after exposure to traumatic events, is associated with anxiety and abnormality in the activity of hypothalamic-pituitary-adrenal axis and cognitive functions. Physical activity can improve symptoms of somatic and neuropsychiatric disorders; however, appropriate exercise intensity and duration are still in question. In the present study, the effects of high-intensity exercise on anxiety-like behaviors, fear extinction, serum insulin-like growth factor (IGF-1), brain-derived neurotrophic factor (BDNF), and expression of apoptosis-related genes were investigated in the prefrontal cortex of the rat PTSD model.
Materials and methods: In this experimental study, single prolonged stress (SPS) was used to induce PTSD in adult male Wistar rats. After 10 days, the animals in the exercise groups were subjected to high-intensity treadmill exercise (20 m/min, 5 days/week) for four weeks. Next, anxiety-like behaviors and fear extinction were examined using open field and shuttle box tests, respectively. Thereafter, serum IGF-1 and brain BDNF were measured by ELISA kits; and expression of Bax, Bcl-2, and caspase-3 in the prefrontal cortex were measured by real-time PCR.
Results: SPS rats showed increased anxiety and decreased fear extinction, serum IGF-1, and prefrontal BDNF compared to the control animals. In addition, SPS induced apoptosis by an increase in Bax and caspase-3 and a decrease in Bcl-2. High-intensity exercise reduced apoptosis and increased serum IGF-1 significantly (P<0.05).
Conclusion: High-intensity exercise decreases anxiety-like behaviors by increasing serum IGF-1 and inhibiting apoptosis in the prefrontal cortex of PTSD rats.
 

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Background and purpose: Unpredictable stressors cause changes in behavioral parameters such as motor and exploratory behaviors, feeding, and sexual and anxiety behaviors. Stress leads to the release of corticosteroids and, as a result, causes dysfunction in different parts of the nervous system. A decrease in the synaptic levels of serotonin or norepinephrine in different parts of the brain such as the prefrontal cortex and a decrease in BDNF production in the hippocampus may also contribute to stress-related complications. Posttraumatic stress disorder occurs in some people after facing a severe stressful event. In PTSD, the activity and function of many physiological systems are disturbed. Fluoxetine, or Prozac, is used to treat neurological disorders such as depression and anxiety and inhibits the reuptake of serotonin by the serotonin transporter (SERT) in neurons. Some studies have shown that females respond better to SSRI antidepressants than males, which may be due to the interaction between estrogenic and serotonergic pathways. BDNF is a member of the neurotrophin family and is expressed in several tissues and cells such as the brain and blood. Its role in several mental disorders, such as depression, anxiety, eating disorders, and PTSD, has been identified. SPS (single prolonged stress) as an animal model of PTSD decreases the mRNA expression of BDNF in hippocampus rats and causes anxiety-like behaviors. The role of gender differences in the effect of antidepressants and clinical interventions in psychotic diseases is also discussed. Sex hormones in women affect the pharmacokinetics and efficacy of antidepressants. Women respond better to fluoxetine than men during reproductive years. Considering the different results regarding the effectiveness of effective drugs in the treatment of psychotic diseases in both sexes, in this study, we aim to investigate the response of male and female rats exposed to stress to the trial of fluoxetine.
Materials and methods: In this experimental study, Wistar male and female rats with an average weight of 200-250 grams were used (56 animals, 8 groups of 7). The selection of the number of animals was based on previous studies in this field. After the drug intervention period, and fear and anxiety suppression test, the animals were killed under deep anesthesia, and a blood sample was collected to prepare serum to measure BDNF and corticosterone levels (using the Eliza kit of Germany Zelbio Company and according to the kit protocol). All experiments were performed according to the laboratory animal protocol of Mazandaran University of Medical Sciences.
The work steps are as follows: 1. Creation of PTSD through SPS was done in three stages, 2. Drug intervention: the drug dose for all groups is 10 mg/kg/day for 4 weeks dissolved in drinking water, 3. Evaluation of anxiety-like behaviors with the light-dark box (L/D BOX), 4. Evaluation of the ability to forget painful memories with the fear silence test, 5. Measurement of BDNF and corticosterone in serum by Eliza method.
Results: In this study, it was observed that male and female rats that were exposed to single prolonged stress showed a decrease in fear extinction an increase in anxiety-like behaviors in the dark-light box test, and an increase in serum corticosterone. Fluoxetine led to an increase in the percentage of fear extinction, a decrease in the Entrance Latency in the light area, the Time in the Light Compartment, the number of rearing, and a decrease in serum corticosterone significantly in both sexes(P<0.05). The change in serum BDNF levels in both sexes before and after stress was not significant.
Conclusion: The results of the study showed that exposure to stress leads to behavioral and biochemical damage in male and female rats. The use of fluoxetine 10 mg/kg for 4 weeks improved the damage caused by stress, but there was a significant difference in Response of both genders to the above treatment was not observed.
 

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Background and purpose: Ethical decision-making is a fundamental aspect of management and a vital competency for healthcare professionals, enabling them to handle complex responsibilities effectively. Surgical technology students, as one of the key groups involved in bedside care, train and work in a complex environment. Due to their close interaction with patients and their presence in the high-risk environment of the operating room, this group experiences higher levels of stress and must make proper ethical decisions in response to ethical dilemmas encountered at the bedside. This study aims to explore the experiences of ethical decision-making among surgical technology trainees.
Materials and methods: This qualitative study was conducted in 2023 at Golestan University of Medical Sciences. Using a purposive sampling method, 15 eighth-semester surgical technology students voluntarily participated in the study. Data were collected through semi-structured, interactive, face-to-face interviews with open-ended questions focusing on students' experiences of ethical decision-making during clinical training. For data analysis, MAXQDA software (version 24) and the conventional content analysis approach proposed by Graneheim and Lundman were employed.
Results: Data analysis yielded a total of 283 meaning units, categorized into three main themes: "Violation of Patient Rights," with four subcategories; "Violation of Student Rights," with five subcategories; and "Educational Shortcomings in Students", with two subcategories.
Conclusion: This study highlights the crucial need for ethical decision-making skills among surgical technology students and underscores the importance of addressing educational shortcomings to better prepare them for the challenges of the operating room environment