Razi Journal of Medical Sciences

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Background:
Strain Elastography (SE) is an emerging ultrasound-based imaging technique that allows the real-time assessment of tissue elasticity. By evaluating how tissues deform in response to applied mechanical stress, SE provides surgeons with a dynamic, intraoperative view of tissue consistency, offering critical insights into tumor and healthy tissue differentiation. This capability is particularly vital in neurosurgery, where the challenge of accurately delineating tumor margins is paramount for reducing the risk of residual tumor tissue and preserving healthy brain matter. In brain tumor resections, achieving a complete resection without damaging surrounding healthy tissue is essential, especially in high-grade tumors like glioblastomas, where recurrence rates are high if residual tumor remains. This study investigates using SE in the intraoperative setting to assist neurosurgeons in achieving more precise tumor resections. Specifically, the study evaluates SE's effectiveness in distinguishing between tumor and healthy brain tissues during surgery and its impact on postoperative outcomes, such as the rate of residual tumor tissue and the need for further surgical interventions.

Methods:
This study was conducted at Rasoul Akram Hospital of Iran University of Medical Sciences, focusing on 15 patients who underwent brain tumor resections. These patients were selected based on the following inclusion criteria: diagnosed brain tumors requiring surgical resection based on pre-operative MRI and CT scans and consent to the use of SE during their surgical procedures. The types of tumors are low-grade gliomas, high-grade glioblastomas, and metastasis. All patients ranged in age from 13 to 73, with 40% female and 60% male.
Before surgery, each patient underwent standard imaging protocols, including MRI with contrast and CT scans. These imaging modalities provided a detailed map of the brain lesions, including tumor location and involvement of critical structures. A multidisciplinary team, including neurosurgeons, neuroradiologists, and neurooncologists, reviewed these pre-operative images to develop a surgical plan to maximize tumor resection while preserving neurological function.
During the surgery, the surgeon evaluated the remaining tumor by examining tissue texture; afterward, the tumor residue was assessed using conventional B-mode ultrasound, followed by SE.

The key aspect of SE is its ability to visualize tissue deformation under stress, allowing surgeons to map out tumor boundaries more accurately. The elasticity contrast between tumor and healthy tissues was measured by applying gentle pressure with the ultrasound probe, causing the tissue to compress. SE captured the resultant deformation and produced a color-coded map indicating areas of differing elasticity. Firmer tissues, indicative of tumor presence, were displayed in cooler colors (blue), while more elastic tissues, corresponding to healthy brain matter, were displayed in warmer colors (red and green). If all assessments indicate a resectable tumor residue, the steps mentioned above are repeated until all the tumor is resected or unresectable residue remains. Following surgery, all patients underwent post-operative MRI within 48 hours to assess the extent of tumor resection and to identify any residual tumor tissue.
The primary outcome measure was the correlation between SE findings and post-operative MRI results regarding residual tumor presence, as well as the correlation between the Surgeon’s assessment and B-Mode Ultrasonography with each other and post-operative MRI has been calculated. Statistical analyses were performed using SPSS software, with a significance threshold set at p < 0.05. The Pearson correlation coefficient was used to evaluate the relationship between SE findings and residual tumor detection on postoperative MRI.

Results:
The study's results highlight the effectiveness of Strain Elastography (SE) as a valuable intraoperative tool for brain tumor resections. Out of the 15 patients evaluated, 53.3% (8 patients) achieved complete tumor resections, confirmed through post-operative MRI. SE demonstrated high sensitivity in detecting residual tumor tissue, successfully identifying areas of concern in 6 patients. Post-operative MRI confirmed these findings, illustrating SE's capability to provide accurate intraoperative feedback. SE missed residual tumor tissue in only one case, which underscores its generally strong correlation with post-operative MRI (0.87, p = 0.0043). This high correlation suggests that SE can significantly improve the precision of brain tumor resections by enabling surgeons to identify tumor margins more accurately.
The study also revealed a considerable disparity between SE and the other evaluation methods—B-mode ultrasound and surgeon assessment—regarding residual tumor detection. The surgeon's evaluation correlated less with post-operative MRI (0.53), and B-mode ultrasound showed an even weaker correlation (0.47), both falling below statistical significance. These findings emphasize the superior accuracy of SE in providing real-time assessments of brain tissue elasticity, especially in cases of high-grade tumors like glioblastomas, where tissue consistency plays a critical role in distinguishing tumor from healthy tissue. Moreover, the lack of correlation between tumor location and residual detection suggests that SE’s accuracy is consistent across different tumor sites.
Analyzing patient demographics, SE’s effectiveness remained consistent across various age groups and tumor types, demonstrating that this technology is reliable for a wide range of patients. While glioblastomas and other high-grade tumors present significant surgical challenges, SE’s color-coded elasticity mapping proved crucial in differentiating firmer tumor tissues from softer healthy tissues, contributing to more thorough resections.

Conclusion:
The study concludes that SE substantially enhances the precision of brain tumor resections by offering real-time, intraoperative insights into tissue elasticity. SE’s high correlation with post-operative MRI findings underscores its potential as an essential tool for neurosurgeons, particularly in the resection of high-grade tumors such as glioblastomas. Its ability to differentiate between tumor and healthy brain tissue reduces the risk of residual tumor tissue, which could otherwise lead to tumor recurrence and the need for additional surgeries.
SE outperformed traditional methods such as surgeon assessment and B-mode ultrasound, demonstrating superior sensitivity in identifying residual tumors. These findings suggest that integrating SE into neurosurgical procedures could lead to improved patient outcomes by reducing the incidence of incomplete tumor resections and associated complications.
The study highlights the need for further research to standardize SE protocols and expand their applicability to a broader range of brain lesions. Future research should also focus on larger patient populations and long-term outcomes, including survival rates and recurrence. As SE becomes more accessible, it is expected to play a pivotal role in improving the precision of brain surgeries, ultimately contributing to better patient prognosis.
 

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 Wresting is one of the most involve sports in sport injuries. Because of Increasing number of wrestlers in Iran as the native sports, and lack of a precise study about the cervical root lesion and associated peripheral nerve lesion, we decided to study prevalence, type, involved root of probable cervical radiculopathy and also associated predisposing factor in 40 wrestlers, age range of 36-63 year and minimum 10 years of wrestling in Tehran.

  These groups were examined clinically, then by electrodiagnostic study and finally were referred for MRI study of cervical spins. Following results were obtained by electrodiagnostic studies in 40 persons and MRI in 21 persons. About 45% of patients studied by electrodiagnosis had cervical Radiculopathy. All of patients studied by MRI were reported by radiologist to have one type of cervical spine involvement as follows: degenerative changes: 61%, disc protrusion: 28%, cervical canal stenosis: 19%, and disc extrusion: 9%.

  The most common involved root in electrodiagnostic study was bilatrally C6 root lesion. The most common involved level in MRI was C5-C6 disc disease. There was no statistically significant correlation between root lesion and previous nerve Injury, age and years of wrestling.

  Based on this concept that electrodiagnostic is the most specefic test, MRI was calcuated to have 41.6% specifity and 100% sensitivity in evaluation of cervical root lesion. Twenty seven percent of cases had associated peripheral nerve lesion of upper limb, among these bilatrally capral tunnel “15%” , tardy ulnar palsy “12.5%” were most prominent. There was high statistical correlation between ulnar nerve lesion and previous elbow injury. Fifty four percent of patients had concomittant peripheral nerve injury and cervical root lesion “Double crush syndrome”.

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In this case report, we present a 40-year-old man with the history of flank pain and weight loss in recent months. A left adrenal mass was the sonographic finding supported by CT-Scan. After light microscopic and immunohistochemistry examination and based on “ pheochromocytoma of adrenal gland scaled score(PASS)” the diagnosis was “Histologic malignant pheochromocytoma”.

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Primitive Neuroectodermal Tumors(PNETs) are common tumors in children and are mainly intracranial in location. They frequently disseminate throughout the central nervous system via CSF(cerebrospinal fluid) and may rarely have metastasis outside the neuraxis. Rare cases of primary intraspinal PNETs have been reported so far and most of which are located intradurally in cauda equina. In the present case report, the clinical, radiological and pathological features of a primary intraspinal PNET are presented which all occurred intraspinally in T9 nerve root and radiologically resembled a nerve sheath tumor.

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    Fibro-Osseous lesions are numerous and heterogeneous group of tumors of the jaws which pose difficulties on classification, diagnosis and treatment. The present study was undertaken to evaluate fibrous dysplasia and the diagnostic value of histologic examination for its workup. Fifteen patients with cranio-facial bone lesion, who had previous pathologic diagnosis of fibrous dysplasia, were evaluated during 4 years (1998-2002) in Hazrat Fatemeh Hospital. Male-female ratio was 9/6 and patients’ range of age was between 16-38 years with mean age of 20 years. There were 12 patients with monostotic and 3 patients with multiple lesions of both jaws and skull. The maxilla bone was the most frequent site of the lesion. Clinicopathologic diagnostic correlation was 46.6%. There was one patient with malignant transformation of the lesion to osteogenic sarcoma. In microscopic view, 10 cases were classic fibrous dysplasia with evenly distributed islands of woven bone without osteoblastic rimming in a fibroblastic stroma, 5 cases showed variation in histologic pattern, 3 cases had focal or diffused osteoblastic rimming(ossifying fibroma) and 2 cases had rounded bodies regarded as a form of cementum both contained cellular stroma exhibiting mitotic activity named as cemento-ossifying fibroma. These two lesions showed more local aggressiveness and bone deformity in clinical and radiologic study than in classic fibrous dysplasia.

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    Background & Aim: Therapeutic drug monitoring(TDM) is a very important function of a modern clinical laboratory. Chromatographic techniques have been the gold standard method for quantitative monitoring of drugs from the long time ago. Immunoassay methods are very useful today due to their ability to be installed on automation systems, their high speed and independence from expert personnel. The present study was undertaken to compare high performance liquid chromatography(HPLC) method with fluorescent polarization immunoassay(FPIA) for analysis of carbamazepine(CBZ) and phenobarbital (PHE) level in human blood. Patients & Methods: In this cross-sectional research 100 patients on PHE and 103 patients on CBZ regimen admitted to TDM center of Iran Reference Laboratories were sampled. Levels of drug in blood were measured. Data were recorded and then analysed by statistical tests of Pearson correlation coefficent(r), linear regression analysis and T-Test. Results: For PHE and CBZ, r was respectively 0.971 and 0.953, which indicated a good correlation between two methods. Linear analysis of regression and T-Test showed that data sets of FPIA method are a little higher than HPLC. Conclusion: Both HPLC and FPIA may be applied to determine PHE & CBZ in TDM. HPLC can be more useful in special cases who need high precision and TDM related research.

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    Background and Aim: The accurate determination of HER-2 in invasive breast cancer has become a critical issue, particularly in context of the results of Herceptin adjuvant therapy. The aim of this study was to evaluate inter- and intraobserver reproducibility of assessment of HER2/neu immunostaining in invasive breast cancer

Materials and Methods: This study was cross sectional and the convenience sampling method was applied. IHC for HER2/neu was performed on 107 archival invasive breast carcinoma tissues. Protein overexpression was scored independently by 4 pathologists using the criteria recommended by DAKO (0 to 3+ reflecting the intensity and pattern of the immunohistochemical signal present in 10% or more of tumor cells.). After a session in order to train for better evaluation and standardization of the scoring criteria, the samples were evaluated for the second time. A minimum of two months elapsed between the two examinations. The discrepancies in scoring results were reviewed by the 4 observers using a multihead microscope to obtain consensus. The inter- and intraobserver agreements were calculated by kappa statistics.

Results: Complete agreement was achieved in 33 (31%) and 40 (37%) of 107 cases in the first and second examinations, respectively. Generally, interobserver agreement was moderate (Kappa=0.44 in the first examination and 0.51 in the second one), with intermediate categories (1+, 2+) showing fair agreement and extreme categories (0, 3+) showing moderate agreement. Intraobserver agreement was also moderate (from the minimum kappa=0.55 to the maximum of 0.60). Considering three groups as negative (0/1+), weakly positive (2+) and strongly positive (3+), interobserver agreement improved but still staying in the moderate level (kappa=0.54 and 0.60 in the first and second time, respectively) with score 2+ group showing the least level of agreement. However, with dividing the cases into two groups as negative (0/1+) and positive (2+/3+), interobserver agreement improved to substantial level (kappa=0.68 and 0.75 in the first and second time, respectively).Also, with this consideration, intraobserver agreement improved to substantial level (0.71 to 0.84). By consensus there were 42 cases (39.2%) that were scored 0, 19 cases (17.8%) scored 1+, 27 cases (25.2%) scored 2+, and 11 cases (10.3%) scored 3+. For 8 cases (7.5%) no consensus was achieved in 6 of them the problem was placing them into 2+ or 3+ category  and in 2 cases the problem was placing them into 0 or 1+ category.

Conclusion: Our study showed that reproducibility (interobserver agreement) is moderate for evaluation of HER2 status in invasive breast carcinoma by IHC using DAKO criteria. However, for discrimination between negative and positive state, reproducibility (that is in substantial level) is better.

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Background: With the advancement in technology, internet addiction has become an issue which adversely affects the healthy life style. The aim of this study was to investigate the relations between internet addiction and health promoting lifestyle of the students and determine the effects of internet addiction on the health of students and to collect basic data to plan for preventing internet addiction and to improve students’ life style.

 

Methods: This descriptive and analytical study was done on 250 cases (140 females and 110 males) living in the dormitories of Tehran University of Medical Sciences in 2012. Stratified Random Sampling was used for selecting students, participation in the study was voluntary, tools of collecting data for this study was self-reported questionnaire consisting of three parts, the first part contained demographic information including age, sex, marital status, employment status, educational level, and educational status (grade point average) the second part was health promoting lifestyle (HPLP) questionnaire (52 questions) of Walker and colleagues and the third section of the questionnaire was “Young's Internet Addiction”. In order to analyze the data SPSS V.19 was used and results at the level of p<0/05 was considered significant.

 

Results: According to the findings of the study there is a significant relationship between internet addiction and promoting healthy lifestyles (p<0/001), and addicts to the internet are in adverse situation as compared to the internet users in terms of promoting healthy lifestyles. People addicted to the internet received significantly lower scores in spiritual growth (p<0/001), health responsibility (p<0/001), interpersonal relationships (p<0/001), stress management (p<0/001), physical activity (p<0/001), and nutrition (p<0/001) compared to ordinary users.

 

Conclusions: This study shows that internet addicts gain lower score in health promoting lifestyle and reveals necessity of interventions to correct methods of internet using and training students to improve their lifestyle.

 

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Background: Musculoskeletal disorders are one of the main causes of morbidity worldwide with different impacts on mental health characters of employees. There are some evidence that show adverse impacts of mental health impairment on worker and their work tasks. Present study was performed for assessment of association between mental health and musculoskeletal disorders among employees of Fars ABFA Company.

Methods: Employees of ABFA Company consisted participants of present cross sectional study which was performed at 2014. Nordic and general health questionnaires were used for data gathering.

Results: Mean of total GHQ score and somatic, depression and anxiety subscales were significantly higher in workers with low back pain compared with other workers. General health status in workers with low back pain was poorer than other workers.

Conclusion: Findings of our study showed that general health status in workers with low back pain was lower than other workers. Knowing about psychosocial factors which had impact on low back pain can be useful in controlling and preventing the complication among working and decreasing their disability risks.

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Background: Air pollution is one of the disadvantages of unsustainable development cause to short and long term sanitary effects without consideration of environment in addition to destruction of environment. Therefore, the present research was conducted with the purpose of quantifying and estimating of health endpoints related to SO2 pollutants in six cities (Tehran, Mashhad, Isfahan, Shiraz and Tabriz) by using AirQ model during 1390.

Methods: At first, the raw data related to SO2 pollutant was received from environmental organizations of the under review cities. Then, according to WHO criterion and programming in Excel software, required parameter in AirQ tool was calculated and finally results are presented in tables for death.

Results: the results showed that, annual average concentration of SO2 in Tehran, Mashhad, Shiraz, Isfahan, Tabriz and Urmia are 49, 31, 11, 12, 21 and 76 mg/m3 respectively. The maximum and minimum of accumulative cases of cardiovascular mortality attributed to SO2 is related to Urmia and Tabriz cities that were 89 cases with 5.64 attributable proportion and 32 cases with 0.91 attributable proportions respectively.

Conclusion: The rate of air pollution in large cities of Iran is increased and become more intense day to day. Thus, this issue needs to pay more attention of officials and specialists for air pollution control.

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Background: Injuries to ACL can be seen with meniscus tear, chondral lesions, and other ligament injuries. This study assesses the epidemiology of ACL injury and concomitant injuries in an athletic population.
Methods: From January 2001 to December 2011, athletes with ACL injuries were enrolled in this study. Ultimately, 227 patients, 220 males (96.92%) and 7 females (3.08%), were studied.
Results: Median interval from accident to surgery was 18 months, and the mean of this interval was 21.85 months. Mean age of patients was 25.6 years. 75% of patients had some type of meniscus injury (medial meniscus injury in 52.15%). The most common site of meniscus injury was posterior horn in both medial and lateral meniscus. Chondral lesions were seen in 13.4% of patients, and the highest risk was 4 years after injury. Most chondral lesions (65.5%) occurred in the medial compartment. The ligament most commonly injured in association with an ACL injury was the medial collateral ligament (6.9%). Noncontact sports, especially soccer, were the most common cause of ACL injury (50%).
Conclusion: In this study, we concluded that concomitant injuries with ACL tear will increase with time. Further studies are needed to evaluate the role of early operation (ACL reconstruction) to decrease concomitant injuries.
 

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Background: Development and psychometric properties of an instrument in general health should be methodologically strong and follow standard procedures. An important factor of mental health is praying. The purpose of this study was to develop a questionnaire for assessing students' attitude towards prayer.
Methods: This cross-sectional study was conducted on 500 students in the Jan. 2017 at the University of Welfare and Rehabilitation Sciences (USWRS). The first draft of the prayer questionnaire (68 items) was based on literature review. To ensure content validity and face validity, the research panel team examined the questionnaire and the items were reduced to 33. Thereafter the questionnaire was tested by 9 students and also an expert panel team (10 persons) examined face and content validity. Then construct validity, internal consistency, and test- retest reliability of were assessed. Finally, Receiver Operating Characteristic (ROC) curve was used to assess the predictive ability of the attitude questionnaire and to inform the choice of a cut-off point. Data analysis was carried out using SPSS 21 software.
Results: 18 items were omitted based on the content validity ratio (CVR<0.6) and 11 items were  added by the expert panel. For this questionnaire, the average content validity index of relevance, simplicity, and clarity were 0.879, 0.976 and 0.958, respectively. Scale- Level content validity index was calculated 0.937. Cronbach's alpha coefficient (0.95) confirms the high internal consistency and test-retest coefficient (0.903) confirms stability of this questionnaire. Factor analysis identified four factors, based on 22 items, which explained a total of 68% of the total variance. The cut-off point score by using the ROC curve analysis was calculated 53.5.
Conclusion: Our finding showed that the students’ attitude questionnaire with 22 items provided a reliable and valid tool to detect attitude of students towards praying. This questionnaire can be used in other universities in Iran.
 
 

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Background: Myonectin is one of the well-known myokines and similar to insulin-like growth factor-1 (IGF-1) involves in cellular signaling pathways. The aim of this study was to survey the effect of resistance training length on serum levels of myonectin and IGF-1 and their relationship in sedentary young men.
Methods: Fourteen volunteer non-physical education students (age 26.50±0.94, BMI 23.70±2.34) were randomly selected to participate in this semi-experimental study. For 6 weeks, the participants performed resistance training. The protocol consisted of 3 sessions per week and included 6 exercises (bench press, barbell curl, leg press, leg extension, leg curl, wide grip lat pull down), with 3 sets of 8-10-12 repetitions in each exercise and the intensity of 60 -70- 80 percent of one repetition maximum (respectively for first, second and third two weeks). Rest time between sets and exercises were determined two and three minutes, respectively. Blood samples were collected 24 hours before and 48 hours after four and six weeks of resistance training. The data were analyzed at significance level of p≤ 0.05, using 23th version of SPSS software.
Results: According to the results, there were no significant difference in serum levels of myonectin and IGF-1 after four weeks of resistance training (p=0.202, p=0.337 respectively). However, serum levels of myonectin and IGF-1 increased significantly after six weeks of resistance training (p=0.001, p=0.029 respectively). It should be noted that Pearson correlation coefficient did not show any significant relationship between myonectin and IGF-1 (p= 0.74: fourth week, p= 0.71: sixth week).
Conclusion: The results showed four weeks of resistance training could not significantly change serum levels of myonectin and IGF-1 in sedentary young men, and to do that, at least 6 weeks of resistance training is required.
 

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Background: Pulmonary hypertension (PH) was defined for the first time in 1951 as primary pulmonary hypertension (PPH). Some studies emphasized on the role of genetics in the development of pulmonary hypertension in family members of affected patients. So, in this study we evaluated the prevalence of pulmonary hypertension in first degree family of patients with documented PPH.
Methods: In this cross-sectional analytic study 51 subjects (first relatives of patients with PPH, including parents, sisters, brothers and children were enrolled. Echocardiography and EST was done and the pulmonary artery pressure (PAP) before and after the test was compared.
Results: A total of 27 subjects, 17 women and the 10 men were evaluated in 3 groups and based on PAP before exercise, 22 (81.5%) of participants had normal PAP and 5 (18.5%) were in intermediate group. After the exercise test 55.5% were in normal group, 33.3% in intermediate group and 11.1% had high PAP.
Conclusion: We recommend to screen and evaluate the first degree relatives of these patients as high risk group.

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Background: Cancer is one of the most important health-related issue in Iran and worldwide; and fatigue is one of the most common problems related to it. Cancer-related fatigue significantly affects the physical, psychological, social and spiritual health of the patient and is associated with reduced survival and increased mortality rates in patients. Considering the significant effect of fatigue on the quality of life of patients with cancer as well as the lack of knowledge on this topic, the present study aimed to examine the frequency and severity of fatigue and its correlation with demographic and clinical characteristics in patients with cancer.
Methods: In this cross-sectional descriptive study, 290 patients with cancer were included through convenience sampling. Data was collected by a self-report questionnaire and demographic and clinical characteristics questionnaire. The results were analyzed by Pearson and Spearman correlation, ANOVA and T-test (P<0.05).
Results: Mean score of fatigue of patients were calculated 12.6±5.896, 7.4±3.186, and 5.2 ±3.658 for the sub-scales of physical, emotional, and cognitive fatigue and 25.1±9.285 for the total scale. Results revealed that fatigue severity has a significant negative correlation with the level of education and family income. Moreover, a direct and significant correlation was found between metastasis and fatigue severity (P<0.05).
Conclusion: Fatigue is experienced by patients with cancer and is correlated with demographic and clinical factors. Therefore nurses, as key members of the healthcare team, must pay attention to fatigue and the role of demographic and clinical factors in order to provide effective holistic care.
 

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Background: Acinetobacter baumannii has emerged as an opportunistic nosocomial pathogen that causes ventilator-associated pneumonia, bacteraemia, endocarditis, wound infections, meningitis and urinary tract infections in patients with serious underlying disease and immunocompromised patients, and in those undergoing prolonged hospitalization and surgical procedures involving long-term antimicrobial therapy. The majority of nosocomial A. baumannii isolates are resistant to different classes of antibiotic including cephalosporin's, penicillin's, carbapenem's, fluoroquinolones and aminoglycosides. Multidrug-resistant (MDR) A. baumannii isolates are a serious problem in healthcare settings worldwide, especially in Europe, Asia, Latin America and other areas. The majority of MDR strains have been isolated from adults attending intensive healthcare units and are associated with increased patient mortality and persistence of isolates in the hospital environment. Horizontal transfer of antibiotic resistance genes is thought to play a major role in the emergence and development of MDR strains. Treatment of infections caused by highly resistant isolates, especially MDR, XDR (extensively drug resistant) and PDR (pan drug resistant), can be difficult. Currently, beta-lactams are used as a selective drug in the treatment of multi-drug resistant Acinetobacter spp., although resistance to these agents is increasing. Metalo-beta-lactamases have different types that are often plasmid and among them bla_VIM and bla_NDM are the most prominent. The aim of this study was to evaluate the drug resistance and the frequency of bla_VIM and bla_NDM genes in isolated isolates from Isfahan and Shahrekord cities by molecular methods.
Methods: This cross-sectional study was performed on 500 clinical specimens including blood, ulcer, urine and respiratory tract collected from 3 hospitals in Isfahan (Alzahra and Kashani) and Shahrekord (Kashani) during one year from April 2018 to April 2019. After assembling samples, biochemical methods of Acinetobacter spp were identified. Susceptibility of isolates to the following antibiotics was examined using the disk diffusion method according to the Clinical and Laboratory Standards Institute guidelines. Multidrug resistance (MDR) was defined as resistance to at least one agent in three or more antimicrobial categories. The antimicrobial susceptibility test of the isolated organisms was completed by the disc diffusion method using the Kirby–Bauer technique. According to the recommendation of CLSI, all tests were performed on Mueller Hinton agar. The surface was lightly and uniformly inoculated by a cotton swab. Prior to inoculation, the swab stick was dipped into a bacterial suspension having visually equivalent turbidity to 0.5 McFarland standards. The swab stick was then taken out and squeezed on the wall of the test tube to discard extra suspension. Inoculated plates were incubated at 35°C for 24 h. On the next day, plates were read by taking measurements of zone of inhibition. Finally, DNA extraction from overnight cultures of A. baumannii isolates was performed according to the protocol provided with the QIAGEN DNA Mini kit (QIAGEN Inc., Valencia, CA). PCR primers were used to determine the frequency of bla_VIM and bla_NDM genes. The data were analyzed with SPSS version 17.0 software (SPSS, Inc., Chicago, IL). A chi-square test was used to determine the statistical significance of the data. A p<0.05 was considered significant.
Results: Antibiotic resistance in 100 isolates of A. baumannii was related to antibiotics: Cefimoimide (97%), Ceftriaxone (95%), Amikacin (95%), Imipenem (76%), Piperacillin-tazobactam (70%), Meropenem (69%), Gentamicin (63%), Tobramycin (56%), Tetracycline (51%), and Ampicillin-Sulbactam (49%) and lowest resistance to Poly-Mixin B were obtained. The PCR results showed 17 and 20%, of strains carrying blaVIM and blaNDM genes, respectively.
The prevalence rate of blaNDM in this study was 20%, which is contrary to studies conducted by Tognim et al. In 2011 (55%) which show that the prevalence rate of blaNDM has been decreasing over time. This decrease can be seen in the prevalence of blaVIM.
Conclusion: Increase in the incidence of A. baumannii in hospital points to the need to design protective programs such as controlling infections in the intensive care unit. Also, using molecular methods, these bacteria can be identified and their antibiotic resistance characteristics are determined and appropriate antibiotics are prescribed.

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Background & Aims: The coach is considered as the strongest factor of socialization in the physical realm. Effective coaches significantly affect athletes' performance, behavior, and motivational and emotional aspects. Research on the conceptual model of coaching effectiveness has also grown exponentially over the years. Effective rye significantly affects athletes' performance, behavior, and motivational and emotional aspects. Given the effective role of coaching effectiveness in advancing the goals of club management and the multiplicity of related factors, researchers seek to identify the variables that are associated with this important factor. One of the cases in which the effect of other variables has been studied in recent research is individual creativity. At the level of championship and professional sports, experience shows that coaches who are technically and coaching efficient have played a more effective role in the success of their teams and in providing better work and player satisfaction. Recognizing the factors affecting the mental and physical condition of athletes in coaching and training sports skills, especially in national level athletes, can be very decisive in their success. For this reason, and considering the importance of the role of coaching behaviors on the psychological processes and performance of athletes, sports psychologists became interested in studying the consequences of different coaching styles. These studies can help increase the effectiveness of coaches, create a suitable sports environment, and improve the performance of athletes. Given that so far few studies have been conducted on the characteristics of effective trainers and their relationship with other variables, especially individual creativity, the present study may be one of the few studies in this field in the country and on the other hand, due to the needs of the institute. Sports clubs to obtain comprehensive information on the employment of effective coaches, the present study aims to study the relationship between the effectiveness of coaches and the individual creativity of the country's zurkhaneh athletes, and in this regard, the main question in this way raises whether the effectiveness of coaches is related to the individual creativity of Zurkhaneh athletes?
Methods: The research method was a descriptive correlation which was performed using structural equations. The statistical population of the research, based on the information obtained through the Federation of Zurkhaneh Sports and Wrestling, is 1573 people, which includes all athletes in all age groups of juniors, teenagers, adults, and veterans in all national championships. In 2019, they competed. Thus, 550 questionnaires were distributed among the statistical sample of the research, of which 396 questionnaires, which were completely completed, were returned by the athletes. In order to collect information, three questionnaires were used as follows.
A personal information questionnaire that measured the variables of age, marital status, level of education, history of sports activity, championship history, and type of team presence.
The coach effectiveness questionnaire has 24 questions and four subscales of motivation (7 questions), the effectiveness of game or competition strategies (7 questions), training and education (6 questions), and development of personality traits (4 questions). The alpha coefficient for all questions is 0.95 and internal consistency for motivation effect subscale is 0.92, game or competition strategies subscale is 0.88, training and education subscale is 0.87 and personality traits development subscale is 0.86 and reliability is Questionnaire was calculated 0.87.
Abedi Individual Creativity Assessment Questionnaire 1984, which had 60 three-choice questions and four subscales, which are: fluidity, expansion, initiative, and flexibility. The higher your score on this questionnaire, the more creative you are. These data were analyzed using descriptive and inferential statistical methods such as elongation test and path analysis (structural equation modeling) using SPSS and lisrel software.
Results: The results showed that the effectiveness of coaches, in general, did not affect athletes' sports creativity. Also, among the components of coaches' effectiveness, only the component of the effectiveness of competition strategies affects athletes' sports creativity, and the three components of competition strategy, training and training, and development of personality traits do not affect athletes' sports creativity.
Conclusion: Based on the results of the research, it is suggested that coaches working in zurkhaneh sports promote the effectiveness of coaches and athletes' creativity by using appropriate decision-making methods, which in this way and considering that in zurkhaneh sports Moral virtues have a high status, they can bring more success. This research, like all researches, had limitations, which are: Answering the questions of the questionnaire depending on the judgment of the subjects, so their tendencies, prejudices, insights, and experiences may have influenced the results of the research. Another limitation of the present study was the problems related to data collection, which may be due to insufficient motivation of the studied samples or low cooperation of their loved ones.
 

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Background & Aims: One of the important goals of development programs in any country is to reduce social harms, and achieving this goal requires recognizing the effective factors that cause it in society. Nowadays, researchers consider social capital as one of the underlying and effective factors in social health and reducing risk in society .Students in a society constitute a large segment of the active population of a country, which various factors such as internal stimuli and external stressors, can endanger their social and mental health and are exposed to various social harms. And put at risk . Many efforts have been made in countries around the world to identify environmental and individual factors that predispose to risk. Among these efforts, attention to the social dimension is possible. Social capital is the result of the "social capital" of health, which is the study of phenomena such as mutual trust, social interaction, social groups, a sense of collective identity, a sense of a shared vision of the future and teamwork with effective interpersonal and group interactions. It can provide risk prevention and many social harms such as violence, drug use, alcohol and high-risk sexual behaviors. Studies have shown that youth and adolescents' access to social capital can reduce social and behavioral problems, so by providing the basis for social interaction, social skills and teamwork can reduce the rate of social harm and risk. They provided opportunities for academic advancement and health promotion. The purpose of this study was to present a model of social capital communication model and high-risk behaviors of social identity in students of Kermanshah University of Medical Sciences.
Methods: The present study is descriptive-correlational in terms of applied purpose and in terms of data collection method. n terms of applied purpose, the present study is descriptive-correlational in terms of data collection method because no manipulation has been done on variables and factors and based on the research approach, it is small. The statistical population of the present study will be selected from all students studying medicine in Kermanshah (2000 people in total) in the academic year 1399-1398 using Morgan table and available sampling method of 322 people to compensate for the possibility of falling sample size. 350 people were considered who will eventually be removed after completing the questionnaires by the volunteers of the distorted questionnaire and the relevant data of 322 people were analyzed. To measure high-risk behaviors, the High-Risk Behaviors Scale (YRBSS) was used. The adaptation of the High Disease Behavior Questionnaire of the US Centers for Disease Control and Prevention (CDC) was designed and developed in 2010 (15). The reliability of the high-risk behaviors questionnaire by Brenner et al. (2002, quoted by Mohammadi, Refahi and Samani, 2013) was evaluated through a test-retest and the results of the items ranged from 14.5 to 91.1 kappa. (1998) has three structural, communication and cognitive dimensions that examine the seven subscales of networks, trust, cooperation, mutual understanding, relationships, values, and commitment, and are arranged in 28 items based on a five-scale scale. Likert (I strongly agree = 5, I agree = 4, I have no opinion = 3, I disagree = 2 and I strongly disagree = 1). The reliability coefficient of this questionnaire in Sardari, Silavio Silavi (2016) research was 0.89 (16) and the Ethical Identity Questionnaire is a self-report scale that was developed and validated by Ako Bino and Reid (2002) and has two subscales of internalization from questions 1 to 5. (The degree to which moral identity is centralized in the individual's self-concept) and symbolism from questions 6 to 10 (the degree to which each subject shows moral identity in their appearance) (17). The answer to this questionnaire is in the range of 1 (strongly agree) to 5 (strongly agree) in each of the questions. The scoring of two items 4 and 7 is done in reverse. First, the person is asked to pay attention to the moral traits written at the top of the questionnaire, and then 10 questions about these traits are asked of the subjects to determine the extent to which these traits are important to the person. Cronbach reported these two dimensions as 0.77 and 0.76, respectively.
Results: In order to analyze the data, descriptive statistics indicators (frequency, mean, standard deviation, graphs) and inferential statistics were used. In order to determine the validity and reliability of the research instrument, Cronbach's alpha statistical methods and confirmatory factor analysis were used to evaluate the normality of data distribution, skewness and elongation indices, and path analysis was used to examine the relationships between variables. SPSS and Smart PLS software were used to perform these tests.The results of the present study showed that moral identity and social capital have a significant effect on high-risk behaviors of students of Kermanshah University of Medical Sciences.
Conclusion: Laying the groundwork for improving and increasing the social capital of young people both at the family level and at the community level by increasing the sense of social trust, social solidarity, social awareness, providing the necessary social support and youth participation in social and cultural affairs. It seems that according to the theories and backgrounds and the results of the present study, the existence of a significant amount of social capital facilitates social actions and paves the way for achieving certain goals and Subsequently, it can act as a shield against social problems and harms, such as the occurrence of risky behaviors of young people.Universities and institutions of higher education should design and implement special training courses or classes in the form of extracurricular activities in order to educate and familiarize students with the field of social identity and social capital and high-risk behaviors with its constituent components.

 

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Background & Aims: Alopecia areata is a complex genetic disease with an immune system that targets anagen hair follicles (1). The prevalence of mental disorders, especially mood and anxiety disorders in these patients is significantly higher than other people (2). The etiology of alopecia areata is not completely known But this disorder is an autoimmune disease caused by a combination of genetics and environmental factors (3). Among the environmental factors that have the highest abundance in the initiation of alopecia areata, It is psychological stress (4). Recent studies have shown that 74% of the examined patients with alopecia areata had at least one psychiatric diagnosis during their lifetime (6). The psycho-physical origin of skin diseases has also been emphasized and stress factors have been mentioned as the most important factors that initiate or aggravate the disease process (10). The stress factor plays a dual role in this: either it occurs before the appearance of skin disease and the person suffers from skin discomfort after dealing with many stressful factors, or the appearance of skin problems and manifestations It causes stress in the person, which in turn aggravates the problem (11). There is a relationship between the amount of blood cortisol (stress hormone) and the duration of skin diseases and the severity of the disease symptoms (15). Considering the problems of life in the modern world, one of the reasons for causing alopecia is the problem in the functioning of the adrenal gland and the secretion of adrenaline and cortisol, which is necessary to deal with stressful situations, especially in the modern world, for many reasons, including (heavy traffic, noise a lot, emergencies and time constraints, air pollution) or greater damages such as illness or The death of loved ones is secreted, which all causes wear and tear and disturb the balance of these hormones (16). The positive effect of psychological interventions in reducing symptoms and improving psychosomatic disorders is not hidden from anyone (17). Metacognitive treatments and cognitive therapy based on mindfulness work directly on modulating these positive and negative emotions (19). With the development and evolution of psychological treatments, metacognitive therapy (MCT) was also proposed by Adrian Wells (20). Metacognition tries to change the place of the two categories of reasoning and emotion in the brain during the stages of treatment (recovery) through exercises and applications. This means that before any behavior (in which emotion usually plays a more prominent role), we should reason first (21). Another approach that can improve and improve the psycho-emotional performance of people with skin disorders is mindfulness-based cognitive therapy (MBCT). This treatment was first introduced by Segal et al. in 2002 to prevent the recurrence of depression and anxiety. Mindfulness includes a receptive and judgment-free awareness of current events (22). Therefore, this study was conducted with the aim of comparing the effectiveness of metacognitive therapy and cognitive therapy based on mindfulness on depression and blood cortisol levels in patients with alopecia areata.
Methods: This was a semi-experimental study with a pre-test, post-test and control group design with a three-month follow-up. The statistical population included all patients with alopecia areata who referred to specialized skin and hair clinics in Tehran and Iranian Alopecia Society in 1401, which was done with the purposeful sampling method at a time interval of 2 months and with the help of the treatment staff in these centers. Among the mentioned patients, 63 patients who were eligible to participate in the study were selected. First, the self-report tool used in the research was distributed among them; In the next step, according to the cooperation and complete completion of the research tool and reconsidering the inclusion criteria, 49 people were selected, and finally 46 people remained in the study until the end. These people were replaced by a simple random method,  in 3 groups, including two experimental groups and one control group. Then, for the people of the experimental groups, therapeutic interventions were carried out online and during different days of the week by a therapist with experience in the relevant treatment method and at the personal expense of the researcher in one of the rooms of the relevant treatment center, but the people of the control group received conventional treatment in the field. received skin and hair and did not receive psychological interventions during this period. At the end of the intervention sessions, the post-test was taken again with the same self-report tools from the three groups. At the end of the intervention, in order to comply with the ethical principles, one of the aforementioned interventional methods, i.e., metacognitive therapy, was implemented free of charge for the control group. To collect information, in addition to the demographic information checklist-researcher-made form, Beck's depression questionnaire and clinical tests of blood cortisol were used. Therapeutic interventions were applied to the experimental groups during 9 sessions of 90 minutes. The data was analyzed by SPSS statistical software and analysis of variance with repeated measurements.
Results: In the present study, 46 patients with alopecia areata were divided into three groups: metacognitive therapy (7 women and 9 men), cognitive therapy based on mindfulness (9 women and 6 men), and control (8 women and 7 men) they got. In the metacognitive therapy group, the average and standard deviation of the age of the participants were 31.88 and 6.82 years, respectively, in the mindfulness-based cognitive therapy group, 30.93 and 5.95 years, respectively, and in the control group, respectively It was 29.73 and 7.07 years. In the metacognitive therapy group, the level of education of 3 participants was diploma, 3 were post-graduate, 8 were bachelor's and 2 were post-graduate and above. In the group of cognitive therapy based on mindfulness, the level of education of 2 participants was diploma, 2 were post-graduate, 8 were bachelor's and 3 were post-graduate and above. In the control group, the level of education of 4 participants was diploma, 3 were post-graduate, 6 were bachelor's and 2 were post-graduate and above. In this research, the assumption of normality of data distribution was investigated using the evaluation of Shapiro-Wilk values, and the results showed that the distribution of data related to both dependent variables in three groups and in three implementation stages is normal. The findings showed that metacognitive therapy and cognitive therapy based on mindfulness decreased the mean depression(p=0/001) scores and blood cortisol levels(p=0/012) in patients with alopecia areata (P<0.05). The changes caused by metacognitive therapy and cognitive therapy based on mindfulness on depression and blood cortisol were still maintained after three months of intervention. The difference in the effect of two treatment methods on depression was significant (p=0.031), so that metacognitive therapy reduced depression more compared to cognitive therapy based on mindfulness; But the effect of two treatments on blood cortisol levels was not significant.
Conclusion: Based on the results of the present study, it can be said that metacognitive therapy and cognitive therapy based on mindfulness are effective for reducing depression and blood cortisol levels in patients with alopecia areata, along with medical and pharmaceutical teams and treatments.
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