JOURNAL OF MAZANDARAN UNIVERSITY OF MEDICAL SCIENCES
Year:2024 | Volume:34 | Issue:233|Papers Count:27

2Background and purpose: Cancer is considered one of the most common causes of mortality, in today’s world. A growing body of evidence has demonstrated that the global cancer burden is expected to rise significantly in the years to come. Cancer is characterized by the uncontrollable rate of cells growth, ultimately proving fatal if not treated. Both genetic and environmental contributing factors have proven critical in developing differential cancers. Chemotherapy is the most common form of treatment used for cancers all around the world. Despite a high efficiency in treating malignancies, toxicity and targeting of normal healthy tissues are considered the most common side effects of chemotherapeutic agents. Thus, reducing the aforementioned side effects with complementary treatments can prove critical through maximizing therapeutic efficiency while also minimizing unwanted side effects at the same time. Doxorubicin (DOX) is a common chemotherapy drug that, has limitations on its use due to severe side effects such as hepatotoxicity, nephrotoxicity, as well as cardiotoxicity. Metformin is one of the most common drugs originally used for the treatment of type II diabetes. Additionally, coenzyme Q10 is naturally produced by the body and can also be obtained from diet and supplements. Both metformin and coenzyme Q10 have demonstrated protective effects against toxicity and oxidative stress and are attractive candidates for the treatment of diseases with the basis of inflammation and oxidative stress as demonstrated by various studies investigating the effect of metformin as well as coenzyme Q10 against toxicities. This study investigates the protective effects of metformin and coenzyme Q10 alone and in combination against doxorubicin-induced oxidative damage in rats. Materials and methods: In this experiment, 36 male Wistar rats were divided into six groups (n=6). The groups consisted of a normal control group (distilled water), metformin and coenzyme Q10 control group: (metformin+coenzyme Q10), doxorubicin control group (doxorubicin), Metformin pre-treatment group (metformin+ doxorubicin), coenzyme Q10 pre-treatment group (coenzyme Q10+doxorubicin), as well as metformin and coenzyme Q10 pre-treatment group  (metformin + coenzyme Q10+doxorubicin). Metformin (200 mg/kg) and coenzyme Q10 (15 mg/kg) were administered orally daily for one week, and doxorubicin (25 mg/kg), was injected on the eighth day. 24 hours after the last injection, blood and liver tissue samples were collected to analyze liver enzymes (i.e. ALT, AST, ALP), oxidative stress parameters (i.e. malondialdehyde, total antioxidant capacity, catalase, superoxide dismutase, glutathione peroxidase), and histological changes. Results: The results showed that doxorubicin significantly elevates the activity of liver enzymes, concentration of malondialdehyde, and tissue damage and decreases total antioxidant capacity, catalase, superoxide dismutase, and glutathione peroxidase activity (P<0.001). Treatment with metformin, coenzyme Q10, and their combination significantly reduced liver enzymes' activity, improved antioxidant parameters, and significantly contributed to histomorphological amelioration compared to the doxorubicin control group. Conclusion: These findings showed that metformin and coenzyme Q10, alone or in combination, can significantly reduce and protect against the liver complications of doxorubicin injection in rats. This effect is likely, through mitigating oxidative stress and bolstering antioxidant defense mechanisms.

2Background and purpose: Accelerating the wound healing process is of paramount importance. Cutaneous wounds are associated with cellular damage and can impair the physiological function of the skin. Wound healing is a multifaceted process that involves cells, cytokines, and the vascular system. This process occurs in distinct phases: hemostasis, inflammation, proliferation, and remodeling of the skin's structure and architecture. The utilization of plant-derived products in wound healing has garnered significant interest among researchers due to their anti-inflammatory, antibacterial, and antioxidant properties. In Persian traditional medicine, there is evidence supporting the topical application of chamomile (Matricaria chamomilla L.), Echinacea purpurea, and Calendula officinalis individually; however, the synergistic effects of these two products on wound healing remain unclear. Therefore, this study aimed to compare the efficacy of chamomile cream and Calendite-E cream, a combination of marigold and Echinacea, on the healing process of surgical wounds. Materials and methods: 32 male rats were divided into four groups of 8: control, Kamil Cream, Calendit E, and Oserin. Wound area and histopathological findings were examined and compared on days 0, 3, 7, 21, and 7 and 21, respectively. Among the many properties of Matricaria chamomilla L in Persian traditional medicine, its anti-inflammatory, antibacterial, and antioxidant properties are confirmed. 32 male rats were divided into four groups (8 rats in each group) including the control, chamomilla cream containing 0.5% essential oil, and 5% chamomile extract, calendar-E and control were divided with Oserin base cream. The wound area was compared on days 0, 3, 7, and 21, and histopathological findings on 7 and 21 days, respectively. Results: There was no difference between the groups on the wound area on the third day, but on the 7th day, there was a significant difference (P=0.020). So the average wound area in the Calendit E group was significantly lower than the control group (P=0.008) and also compared to the Oserin group (P=0.019). Unlike other groups, wound healing was completely achieved on the 21st day in Calandit E and Kamil Cearm. In terms of histopathological indicators, on the seventh day, in the Kamil cream group, the restoration of the epithelial cells was better than the other groups (P=0.038) on the 21st day, in terms of regeneration of the lining cells and the process of fibroplasia of the Calendit-E group, and in terms of the extent of the fibrotic reaction, the amount of edema and swelling, and the assessment of both Calendit-E and Kamil cream bleeding, it had a significant effect (P<0.05). Conclusion: Calendite E and chamomilla Cream had positive effects on wound healing factors, and due to its availability and cheapness, it is recommended as an herbal product without complications, a suitable product for wound healing.

2Background and purpose: Although recent advances in cancer treatment have increased patient survival and improved quality of life, exposure to chemotherapy drugs leads to significant fertility problems in children with cancer. Etoposide is a chemotherapy drug that is widely used in the treatment of various types of cancer; However, it destroys healthy cells, especially male germ cells that are multiplying rapidly and continuously, and leads to infertility. In the present study, the antioxidant effect of pentoxifylline on the disorder caused by etoposide on the sperm parameters of adult male NMRI mice was investigated. Materials and methods: 24 adult male NMRI mice with an average weight of 35±2gr (n=6) were randomly allocated to the following groups (n=6): control, etoposide (1mg/kg), pentoxifylline (100mg/kg) and etoposide + pentoxifylline and treated with daily intraperitoneal injection for 35 days. At the end of the treatment period, mice were anesthetized with ketamine-xylazine solution, and the left caudal region of epididymis was transferred to a 3cm plate containing culture medium (HamsF10) in a 37°C incubator to examine sperm parameters including the number, motility, morphology, viability and tail length of the sperm. The denaturation of sperm DNA using acridine orange staining and the maturation rate of sperm nucleus using aniline blue staining method was measured. The left testicle was removed and used to calculate daily sperm production. After taking blood from the heart and preparing serum, total antioxidant capacity, and malondialdehyde level were also measured. The data were statistically analyzed with SPSS software, one-way ANOVA, and Tukey's test, and the difference in means was considered significant at the P<0.05 level. Results: A significant decrease in the mean percentage of progressive sperms and a significant increase in the mean percentage of in situ and immotile sperms were observed in the etoposide group compared to the control group (P<0.001). Also, a significant decrease in the mean count, viability, daily sperm production, tail length, and normal morphology of sperm was observed in the etoposide group compared to the control group (P<0.001). The total antioxidant capacity also decreased significantly in the etoposide group compared to the control group (P<0.001). The level of serum malondialdehyde showed a significant increase in the etoposide group compared to the control group (P<0.001). There was no significant difference in the mean percentage of sperm DNA damage and sperm nucleus maturation in the etoposide group compared to the control group (P<0.05). Simultaneous treatment of pentoxifylline with etoposide significantly improved the aforementioned parameters compared to the etoposide group. Conclusion: The results in the etoposide treatment group showed a significant decrease in sperm parameters and total antioxidant capacity, as well as a significant increase in malondialdehyde levels. The toxicity induced by etoposide through the induction of apoptosis, oxidative stress, and lipid peroxidation is considered the primary cause of the resulting damage, as evidenced by the study results. Pentoxifylline is believed to have mitigated the harmful effects of etoposide on sperm parameters and oxidative stress by leveraging its antioxidant properties to reduce oxidative stress.

2Background and purpose: Atrophy of the skeletal system caused by spinal cord injury (SCI) can cause secondary systemic metabolic dysfunction, such as glucose intolerance, type 2 diabetes, and insulin resistance. On the other hand, Sirtun1 (SIRT1) and Peroxisome Proliferator-Activated Receptor-Gamma Coactivator-1alpha (PGC-1α) are known factors and related proteins involved in skeletal muscle atrophy. Therefore, the present study aimed to investigate the effect of aerobic training with resveratrol consumption on SIRT1 and PGC-1α levels in the gastrocnemius muscles of rats after spinal cord injury. Materials and methods: 36 male Wistar rats aged eight weeks were randomly placed in 4 groups including control, resveratrol, training, and resveratrol+training (each group n=9). After anesthesia, an incision was made in the midline of the back and over the vertebral ridges. The muscles and lamina of the T9 vertebra were removed without damaging the dura mater, Spinal cord injury was caused by dropping a ten-gram weight from a height of 25 mm on the spinal cord in the T10 segment. After confirmation of SCI, a Resveratrol supplement with a dose of 10 mg/kg was injected intraperitoneally and daily (every morning for 4 weeks), and the rats of other groups were injected with the same amount of saline. The aerobic training was carried out with the help of the weight support system for 4 weeks, 5 sessions per week, each session was 58 minutes and the intensity was 20 m/min. 48 hours after the last training session, the gastrocnemius muscle of right leg of all rats was removed. The SIRT1 and PGC-1α levels in the gastrocnemius muscle were measured by the ELISA method. To analyze the data, one-way analysis of variance and LSD post hoc tests were used at the significance level of P<0.05. Results: SIRT1 levels in the gastrocnemius muscle of resveratrol and resveratrol+training groups were significantly higher than the control group (P-value respectively 0.023 and 0.007), but despite the increase in the level of this index in the training group compared to the control group, no significant difference was observed (P=0.399). SIRT1 levels in gastrocnemius muscle of resveratrol+training groups were significantly higher than training group (P=0.038). PGC-1α levels in gastrocnemius muscle of training and resveratrol+ training groups were significantly higher than control group (P-value respectively 0.024 and 0.007), but despite the increase in the level of this index in the resveratrol group compared to the control group, no significant difference was observed (P=0.449). PGC-1α levels in gastrocnemius muscle of resveratrol+training groups were significantly higher than reveratrol group (P=0.023). Conclusion: These results show the positive effect of resveratrol consumption, on SIRT1 level, as well as aerobic exercise on PGC-1α level of the biceps muscle in rats with SCI. It has been pointed out that the increase in SIRT1 expression and the subsequent increase in PGC-1α leads to an increase in the number of myonuclei, which improves the recovery process after injury and plays an active role in muscle hypertrophy by upregulating and reducing catabolic processes. herefore, it appears that a combination of aerobic training and resveratrol supplementation can mitigate muscle atrophy caused by spinal cord injury in muscles below the level of injury by influencing the levels of muscle SIRT1 and PGC-1α

2Background and purpose: One of the main complications of diabetes is psychological problems, such as reduced stamina and psychological well-being. The use of muscle relaxation is a simple, safe, and non-pharmacological method. Therefore, the present study was designed to investigate the effect of Jacobson's muscle relaxation technique on psychological well-being and resilience in patients with type 2 diabetes. Materials and methods: The current study is a two-group randomized clinical trial with a pre-test and post-test design conducted on 40 patients with type 2 diabetes at the Khayyam Diabetes Clinic in 2021. Eligibility criteria included minimum literacy, acceptable hearing, and speaking ability, age between 25 and 65 years, no history of relaxation training, type 2 diabetes for at least 6 months, no smoking and no alcohol, ability to use a computer, poor psychological well-being and resilience (psychological well-being score equal to or less than 63, resilience score equal to or less than 50), and no definite psychiatric disorders. Exclusion criteria included: special medical conditions (such as hospitalization or medical inability to continue treatment), withdrawal from the research, death, unwillingness to cooperate, incomplete completion of questionnaires by members, and failure to perform sedation for more than 4 sessions. The samples were selected using the available methods and then randomly allocated with permutation blocks to two intervention and two control groups. The relaxation technique was then practiced at home by the intervention group once a day for 8 weeks. Rif's psychological well-being questionnaire and Connor's resilience questionnaire were completed by the intervention and control groups at the beginning and end of the intervention. Data were analyzed using the Shapiro-Wilk test for normality, Fisher's exact test, chi-square, and analysis of covariance using SPSS 25 software. Results: The results of the research showed that the two groups were homogeneous in terms of gender, marriage, age, education, history of chronic diseases, history of neuro medications, insulin history, exercise history, peer history, dietary compliance, income, and occupation and there was a statistically significant difference. There was no difference in these variables between the two groups (P>0.05). The results of the covariance test show that the means of the experimental and control groups are the same in terms of patient resilience (P=0.49, eta=0.02). Therefore, it can be concluded that there is no significant difference between the experimental and control groups in terms of patient endurance, controlling for the effect of pre-test means. Also, the means of the experimental and control groups differ in psychological well-being (P=0.00, eta=0.44). Therefore, It can be concluded that there were statistically significant differences between the groups. More specifically, there was a significant difference between the experimental and control groups in terms of psychological well-being, controlling for the effect of pre-test means. Conclusion:  Results of the study showed that muscle relaxation training was an effective, practical, and inexpensive method of improving and preventing psychological problems in people with diabetes in the intervention group compared with the control group. (Clinical Trials Registry Number: IRCT20220110053682N1)

2Background and purpose: An unintended pregnancy denotes a conception that occurs without prior planning or intention by the couple involved. The repercussions of such pregnancies can be substantial for both the mother and the child, potentially resulting in inadvertent neglect of fetal health and influencing the quality of caregiving behaviors. These factors may contribute to adverse outcomes, such as low birth weight. This research aims to assess the impact of unintended pregnancy on newborn anthropometric parameters within the marginal neighborhoods of Bandar Abbas. Materials and methods: This study is a component of a prospective cohort project involving pregnant women residing in marginalized areas of Bandar Abbas City in 2015. A total of 1351 participants were enrolled in the cohort project, with 825 individuals included in this investigation. Among these, 132 were categorized into the exposure group representing unintended pregnancies, while 693 comprised the non-exposure (control) group, based on the proportion of unintended pregnancies in the original dataset. Our study delineates the associations between birth weight, height, head circumference, and the primary exposure variable of maternal unintended pregnancy. Data collection on unintended pregnancy and potential confounding factors was conducted through questionnaires and face-to-face interviews during the initial cohort visit, coinciding with the women's pregnancies. Confounding variables pertinent to each outcome were rigorously evaluated utilizing a causal analysis approach, facilitated by the dagitty software, with data management performed using SPSS version 24. Univariate analysis involved the utilization of Pearson's correlation coefficient, independent t-tests, and one-way analysis of variance to explore the relationships between anthropometric indices and individual characteristics. Meanwhile, multivariate analysis entailed the application of multiple linear regression techniques. Results: Among the total of 1351 pregnancies investigated, 219 (16.2%) were identified as unintended. The mean age of mothers experiencing unintended pregnancies was 29.23±6.49 years, compared to 26.98±5.31 years for those with intended pregnancies. For unintended pregnancies, the mean and standard deviation of birth weight, height, and head circumference were calculated as 3059.24±501.11 grams, 48.52±3.11 cm, and 33.80±2.22 cm, respectively. Conversely, for intended pregnancies, these measures were 3080±17.17 grams, 48.63±2.65 cm, and 33.82±1.92 cm, respectively. Statistically significant positive correlations were observed between birth weight and maternal age (P=0.041, r=0.056), paternal age (P=0.008, r=0.073), and maternal BMI (P<0.001, r=0.159). Additionally, Statistically significant positive correlations were noted between maternal BMI and infant height (P=0.022, r=0.062), as well as birth head circumference (P<0.001, r=0.102). Multiple linear regression analysis revealed no evidence of an association between unintended pregnancy and birth weight (95% CI: -91.3 to 58.3, b= -16.5), height (95% CI: -0.47 to 47.0, b= 0.01), or head circumference (95% CI: -0.32 to 0.34, b= 0.01). Conclusion: Our findings suggest a lack of substantial evidence supporting a correlation between unintended pregnancy and covariates including low birth weight, short height, and low head circumference. The outcomes of research in this domain exhibit inconsistencies, potentially attributed to variations in study design, methodologies for confounding variable management, demographic disparities among study populations, and other pertinent factors.

2Background and purpose: The prevalence of metabolic syndrome in societies is increasing. Metabolic syndrome is a cluster of medical conditions that include obesity, hypertension, dyslipidemia, and insulin resistance. Poor dental care is linked to numerous systemic disorders. Scientific research supports the presence of a relationship between oral hygiene and metabolic syndrome. Therefore, the present study was conducted to determine the relationship between oral hygiene based on DMFT (decayed, missing, filled teeth) and metabolic syndrome in the registration phase data of the Tabari cohort population. Materials and methods: This study was cross-sectional and analytical and included participants from the Tabari cohort population who had performed oral health and metabolic syndrome assessments during the registration phase. Throughout the registration period of the Tabari cohort study (TCS), data was gathered from 10255 individuals ranging from 35 to 70 years old. This data was obtained from both urban and mountainous parts of Sari, Mazandaran, Iran, during the years 2015 and 2017. Data regarding education level, occupation status, residential location, socio-economic status, marital status, mental health history, smoking or hookah habits, daily physical activity, dental hygiene practices (such as tooth brushing and flossing frequency), denture usage and care, mouthwash usage, and DMFT index were gathered during the implementation of TCS through interviews and oral examinations. Metabolic syndrome was diagnosed based on the criteria of the third adult treatment panel (ATP III). Ultimately, SPSS version 27 software was utilized to describe the data using mean, standard deviation, and percentage. The qualitative variables were compared with the metabolic syndrome using the chi-square test, while the quantitative variables were compared using the independent t-test in univariate analysis. Furthermore, the process of adjusting for confounding variables was carried out through the utilization of multivariate logistic regression. Results: 9,939 people were included in the final analysis. Independent T-test result showed that there was no significant relationship between metabolic syndrome and DMFT (P=0.156, T=4.59), so the average DMFT in the group with metabolic syndrome was 17.66±9.07, whereas in the non-affected group, it was 16.81±8.99. Based on chi-square test results, significant relationships with metabolic syndrome were found for the use of dentures (P<0.001), use of dental floss (P<0.001), age (P<0.001), gender (P<0.001), marital status (P=0.05), occupation (P<0.001), place of residence (P<0.001), psychiatric disorders (P<0.001), socio-economic status (P=0.005), smoking (P<0.001), BMI (P<0.001), MET (P<0.001), and education level (P<0.001). Upon adjustment of confounders in the multivariable logistic regression model, only the number of flossing twice a day was significantly associated with metabolic syndrome (OR 1.493 [95% CI 1.008–2.213], P=0.046). Conclusion: The findings of this study showed that there is no significant relationship between oral and dental hygiene measured by the DMFT index and the presence of metabolic syndrome in the population registration stage data of the Tabari cohort. There was a significant relationship identified alone between flossing twice daily and metabolic syndrome. Further studies are necessary to explore other potential factors that may contribute to the development of metabolic syndrome in this population.

2Background and purpose: Kidney transplantation is still the most important and main treatment for advanced kidney failure. However, some patients reject the transplant through an immune system reaction. Improvement of immunosuppression with drugs such as rituximab and bortezomib allows these patients to be eligible for transplantation. This study aims to determine the cost-effectiveness of rituximab versus bortezomib in kidney transplant patients at Farhikhtegan Hospital, Tehran. Materials and methods: The target statistical population in this research was inpatients receiving rituximab and bortezomib in 2022 in Farhikhtegan Hospital. Rituximab with a minimum dose of 375 mg/m2 was administered one day before transplantation. Bortezomib was administered at a dose of 1.3 mg/m2 on four occasions (usually days 1, 4, 8, and 11). The indicators related to the calculation of the cost of the disease and the parameters indicating the effectiveness were determined through library studies and interviews with experts, and finally, the aforementioned information was collected through the examination of the patient's records (hospital database). Cost indicators include the cost of a physician visit (first day, second day, general practitioner, emergency department, discharge day), medicine (main medicine, complementary medicine), hospital hoteling (nursing services, consumables, bed, radiology, ECG, critical care, physiotherapy, preparation of nutrition formulary, examination, and burial permit) and tests (all tests necessary to evaluate and monitor the patient). Efficacy indices included IgG class I, IgG class II, IgM class I, and IgM class II. The data analysis was conducted by SPSS software. Results: 77 kidney transplant patients including 53 treated with bortezomib and 24 receiving rituximab with an average age of 41.01±8.50 years were studied. Our findings showed that the average cost of the bortezomib group was 19,548,230.86 tomans. Before taking bortezomib, the average level of class I and class II IgG was 68.16±6.34 and 67.11±4.96, respectively, which significantly decreased to 17.28±15.73 and 18.13±16.75 after treatment with bortezomib (P=0.000). The average IgM class I and class II before taking medicine were 5.69±1.30 and 5.54±0.95, respectively, which reached 5.43±0.79 and 5.13±0.39 after taking Bortezomib, respectively. This decrease was significant for IgM class II (P=0.000), but not significant for IgM class I (P=0.223). In patients receiving rituximab, before taking the drug, the average level of class I and class II IgG was 71.66±7.86 and 67.83±4.53, respectively, which significantly decreased to 13.95±13.82 and 15.83±14.15 after treatment with rituximab (P=0.000). The average IgM class I and class II before taking rituximab was 5.70±1.23 and 5.45±0.97, respectively, after taking the drug, it decreased to 5.41±0.65 and 5.16±0.38, respectively, and this decrease was not statistically significant (P>0.05). The average cost of the rituximab group was 28,261,539.29 Tomans and caused a significant decrease in the average level of IgG class I and II. The incremental cost-effectiveness rate (ICER) was 1770997.65, which was lower than the threshold defined by WHO. Conclusion: The results of our study showed that rituximab is cost-effective compared to bortezomib

2Background and purpose: Pseudoexfoliation syndrome (PEX) is a common age-related disorder, characterized by the secretion of fibrillar material from intraocular components, particularly along the anterior segment structures. This condition leads to obstruction of the trabecular meshwork impairing aqueous humor outflow and subsequently increasing intraocular pressure (IOP). These factors contribute to an increased risk of developing glaucoma, damage to the internal ocular structures, and irreversible vision loss. Therefore, screening and evaluating individuals with this syndrome may allow timely identification of glaucoma risk and implementation of appropriate preventive or therapeutic measures. Consequently, it is crucial to screen for PEX syndrome to assess glaucoma risk and take necessary actions to preserve vision and ocular health. This study aims to determine the prevalence of glaucoma in patients with PEX syndrome to accurately assess the risk of developing glaucoma. This assessment may include monitoring of intraocular pressure, preventive measures, and specific treatments. Materials and methods: This cross-sectional study was conducted on patients over 40 years old diagnosed with pseudoexfoliation (PEX) syndrome referred to the ophthalmology department of Bu-Ali Sina Hospital in Sari from February 2019 to March 2020. Initially, comprehensive ophthalmic examinations, including autorefraction with a Topcon autorefractometer, visual acuity determination with Snellen E charts, slit lamp examination, and fundoscopy with a 90D lens, were performed for all patients. Subsequently, intraocular pressure (IOP) was measured using a Goldmann tonometer. In individuals suspected of glaucoma, an angle examination using a three-mirror goniolens to assess the trabecular meshwork, and cup/disc ratio using Cirrus HD-NFL OCT (Carl Zeiss Meditec, Inc.) was performed. Based on clinical findings, patients were categorized into glaucoma and non-glaucoma groups. The data were analyzed using SPSS version 22 software. Descriptive statistics, including mean, standard deviation, frequency, and percentage, were used to describe the data. For comparing the means of quantitative variables, the t-test was utilized, while the chi-square test was used for comparing the means of qualitative variables between the glaucoma and non-glaucoma groups. A statistically significant level of P<0.05 was considered. Results: Among of the 100 patients (180 eyes), 27.77% were diagnosed with glaucoma, with bilateral involvement noted in 90% of glaucoma cases. 54% of glaucoma patients were male with a mean age of 73.88±7.03 years. Glaucoma patients exhibited higher intraocular pressure (IOP) and cup/disc ratio compared to non-glaucoma cases (P<0.001). Within the glaucoma group, the left eyes demonstrated higher IOP (29.12±4.75 versus 28.86±5.65, P<0.001) and a higher cup/disc ratio (0.53±0.12 versus 0.51±0.15; P<0.001) compared to the right eyes. Conclusion: Pseudoexfoliation syndrome (PEX) is associated with a significant prevalence of glaucoma, particularly with bilateral involvement in most cases. This syndrome may be an important risk factor for the development of glaucoma and the onset of elevated intraocular pressure, especially in elderly men. These findings provide valuable insights for future research and improve our understanding of the relationship between ocular PEX syndrome and glaucoma, which may have an impact on improving patient outcomes and clinical management strategies.

2Background and purpose: The classification of prostate cancer patients based on the criteria of the European Urology Association, based on the level of a prostate-specific antigen, digital rectal examination, and Gleason score, is one of the golden criteria for the prognosis of the disease. On the other hand, it seems that in aggressive forms of the disease, cancer cells can spread along nerve cells, which is called perineurial invasion. The relationship between prostate cancer classification criteria and disease recurrence or survival is well known, but the importance of perineurial invasion in the prognosis of the disease is less discussed and investigated, so this study aims to compare two groups of positive and negative perineurial invasion. It is based on the EAU risk classification to investigate the difference between the two groups in terms of disease prognosis. Materials and methods: This retrospective study was conducted on 200 prostate cancer patients who underwent radical prostatectomy in Babol University of Medical Sciences affiliated hospitals between 1396 and 1400. Inclusion criteria included prostate cancer and, the presence of clinical and pathology test results. The exclusion criterion was the patient suffering from all types of prostate cancer, other than adenocarcinoma. All the demographic, paraclinical, clinical, and pathology data of the patients were obtained using the data recorded in the patient's pathology file as well as the hospital's archive department. Patients' information was extracted from patient files using a checklist including age, results of PSA, DRE, TNM, and Gleason scores, as well as the patient's condition in terms of peripheral nerve invasion. Gleason score is the standard criterion for histological differentiation of prostate cancer, which is graded from 2 to 10 points. A score less than 7 indicates better differentiation, a score of 7 indicates moderate differentiation, and a Gleason score of 8, 9, or 10 indicates poor differentiation of prostate cells. The study data were analyzed using SPSS version 20 software. was analyzed. Chi2 and Fisher Exact tests were used to analyze the data, and independent t-test (to compare two groups) and ANOVA (to compare more than two groups) were used to compare the mean of quantitative variables. Results: The average age of the subjects under study was 67.13±5.91. By classifying patients according to EAU risk groups, and comparing the risk class between patients with positive and negative perineurial invasion based on PSA, DRE, TNM, and Gleason score statistically significant differences were seen between the two groups. In almost all classifications based on clinicopathological scales, patients with positive perineurial invasion were at higher risk in terms of EAU criteria than patients with negative perineurial invasion. Conclusion: The results of the study showed that positive perineurial invasion in prostate cancer patients can be considered as a poor prognosis of the disease. The presence of cancer cells in the perineurial space can be an early sign of cancer progression

2Background and purpose: Diabetic neuropathy (DN) is one of the most common complications of diabetes which causes disability and mortality. Nearly half of patients with diabetes develop DN. A few studies have been conducted to evaluate the prevalence of DN in children. More than 90% of diabetic children have type 1 diabetes mellitus (T1DM). The most accurate way to diagnose neuropathy is NCV. Accordingly, the present study investigates the prevalence of DN in children with T1DM by clinical symptoms, neurological examinations, and NCV. Materials and methods: This cross-sectional study was conducted between 2021 and 2023 after approval. Patients (younger than 18 years old) with T1DM, diagnosed for at least 5 years, and not suffering from other diseases such as hypothyroidism and neuromuscular diseases were included. Children who were not willing to undergo NCV were excluded from the study. Demographic data of patients (age, gender, weight, height, body mass index (BMI), and duration of diabetes) were collected. Neurological symptoms were evaluated using the neuropathy symptom score (NSS). Patients were asked about tingling, burning, numbness, fatigue, cramping, and pain in the lower extremities. The clinical history of the patients, including HbA1c levels, blood pressure, retinopathy, lipodystrophy, nephropathy, history of diabetic ketoacidosis, and daily insulin dosage, was evaluated. The Achilles reflex was evaluated using the case reflex hammer and peripheral nerve function through 10g monofilament in patients. Patients who met the inclusion criteria of the study underwent NCV. NCV was performed by a specialist in physical medicine and rehabilitation. In NCV, peroneal, tibial, and sural sensory and motor nerves were performed in both lower limbs, and median and ulnar sensory and motor nerves in both upper limbs. Results: In the present study, 32 patients with T1DM met the study criteria. The mean age was (14.16±2.55 years), height (154.28±8.96 cm), weight (44.88±12.32 kg), and BMI (18.55±3.787) of the patients. The mean duration of diabetes in the studied patients was 7.1±2.428 years. The mean HbA1c was 9.54%±1.941. The mean NSS was 2.94±2.862. The NSS results showed that 18.75% (score: 3 or 4), 31.25% (score: 5 or 6), and 6.25% of patients had mild, moderate, and severe symptoms (score: 7 to 9), respectively. The blood pressure of the examined patients was in the normal range. The most common complications of type 1 diabetes mellitus in patients were lipodystrophy (21.87%), nephropathy (12.5%), and retinopathy (3.12%). The results of Achilles reflex evaluation revealed no disorder in any of the patients. Only one (3.12%) of the studied patients was diagnosed with peripheral nerve disorder in the evaluation by monofilament. However, the NCV results of this patient showed that the patient did not have peripheral neuropathy. Conclusion: We found that the prevalence of DN in children and adolescents with T1DM is very low. Our results, similar to those of other studies, showed that a mere clinical evaluation and having DN symptoms are not sensitive enough to diagnose DN. Further investigation through a standard test (NCV) is needed in this regard. Based on the results of the present study, NCV is not recommended for T1DM patients under 18 years of age, whose 10g monofilament results were also negative. A limited number of patients were evaluated in the present study and it is necessary to conduct studies with a larger population. Background and purpose: Diabetic neuropathy (DN) is one of the most common complications of diabetes which causes disability and mortality. Nearly half of patients with diabetes develop DN. A few studies have been conducted to evaluate the prevalence of DN in children. More than 90% of diabetic children have type 1 diabetes mellitus (T1DM). The most accurate way to diagnose neuropathy is NCV. Accordingly, the present study investigates the prevalence of DN in children with T1DM by clinical symptoms, neurological examinations, and NCV. Materials and methods: This cross-sectional study was conducted between 2021 and 2023 after approval. Patients (younger than 18 years old) with T1DM, diagnosed for at least 5 years, and not suffering from other diseases such as hypothyroidism and neuromuscular diseases were included. Children who were not willing to undergo NCV were excluded from the study. Demographic data of patients (age, gender, weight, height, body mass index (BMI), and duration of diabetes) were collected. Neurological symptoms were evaluated using the neuropathy symptom score (NSS). Patients were asked about tingling, burning, numbness, fatigue, cramping, and pain in the lower extremities. The clinical history of the patients, including HbA1c levels, blood pressure, retinopathy, lipodystrophy, nephropathy, history of diabetic ketoacidosis, and daily insulin dosage, was evaluated. The Achilles reflex was evaluated using the case reflex hammer and peripheral nerve function through 10g monofilament in patients. Patients who met the inclusion criteria of the study underwent NCV. NCV was performed by a specialist in physical medicine and rehabilitation. In NCV, peroneal, tibial, and sural sensory and motor nerves were performed in both lower limbs, and median and ulnar sensory and motor nerves in both upper limbs. Results: In the present study, 32 patients with T1DM met the study criteria. The mean age was (14.16±2.55 years), height (154.28±8.96 cm), weight (44.88±12.32 kg), and BMI (18.55±3.787) of the patients. The mean duration of diabetes in the studied patients was 7.1±2.428 years. The mean HbA1c was 9.54%±1.941. The mean NSS was 2.94±2.862. The NSS results showed that 18.75% (score: 3 or 4), 31.25% (score: 5 or 6), and 6.25% of patients had mild, moderate, and severe symptoms (score: 7 to 9), respectively. The blood pressure of the examined patients was in the normal range. The most common complications of type 1 diabetes mellitus in patients were lipodystrophy (21.87%), nephropathy (12.5%), and retinopathy (3.12%). The results of Achilles reflex evaluation revealed no disorder in any of the patients. Only one (3.12%) of the studied patients was diagnosed with peripheral nerve disorder in the evaluation by monofilament. However, the NCV results of this patient showed that the patient did not have peripheral neuropathy. Conclusion: We found that the prevalence of DN in children and adolescents with T1DM is very low. Our results, similar to those of other studies, showed that a mere clinical evaluation and having DN symptoms are not sensitive enough to diagnose DN. Further investigation through a standard test (NCV) is needed in this regard. Based on the results of the present study, NCV is not recommended for T1DM patients under 18 years of age, whose 10g monofilament results were also negative. A limited number of patients were evaluated in the present study and it is necessary to conduct studies with a larger population.

2Background and purpose: Stress is a behavioral process that helps humans to increase survival. Stress refers to any biological response to an internal or external stimulator. Stress is difficult to study because of its widespread effect on different parts of the body. A good diet is essential for maintaining mental and physical health. During stress time, eating habits are greatly disrupted and this can cause nutritional deficiencies that may lead to more stress on the body. In stressful situations, the body uses more nutrients than usual. So a good diet is required, as a poor diet causes deficiencies that lead to more stress and health problems. Since 2004, many scientific studies have proven the functional and health-promoting properties of non-living probiotics. In recent years, research has been conducted on the consumption of deactivated cells of probiotics (paraprobiotics) whose positive effects have been proven in some studies. In the current research, lactobacillus plantarum paraprobiotic cells have been used in Shahani grape drinks to reduce stress in master's degree students. Materials and methods: The production of paraprobiotics is done in different ways, including heating, applying ultrasound, ultraviolet radiation, infrared radiation, ionizing rays, applying high hydrostatic pressure, and using some chemical compounds. Each of these inactivation methods cause changes in the structure and functional characteristics of non-living probiotic cells. High-power ultrasound was used for deactivation. the suspension containing parapsychobiotic was evaluated for the amount of the active ingredient gamma-aminobutyric acid using a high- performance liquid chromatography. Inactivated cells were added to the reconstituted Shahani grape juice. 32 healthy students consumed a control drink and a drink containing paraprobiotics daily for 10 weeks during the end-of-semester exams. Results: The use of paraprobiotics obtained from inactivation methods is useful when the health-giving compounds and metabolites are not completely reduced or destroyed under the influence of the inactivation method. Gamma-aminobutyric acid (GABA) is the most important inhibitory neurotransmitter in the central nervous system and plays an important role in coordinating brain function and reducing anxiety and stress. The results showed that the amount of gamma-aminobutyric acid in the suspension of parapsychobiotics was higher than in the suspension of live bacteria. Subjects who consumed a grape juice drink containing parapsychobiotics had higher general health scores than the control group during exams. The use of paraprobiotics in drinks improved the quality of sleep. At the end of the test, the amount of cortisol in the saliva of the control group was higher than the parapsychobiotic treated group. Conclusion: The results of this research showed that Lactobacillus plantarum paraprobiotic has potential benefits for improving mental health. Based on the results of this research, paraprobiotics, by affecting the human brain axis, reduce the secretion of stress hormones such as cortisol and, as a result, increase mental stability during the final semester exams of students. (Clinical Trials Registry Number: IRCT20240128060833N1)

2Background and purpose: Health tourism is one of the dimensions of sustainable development to help Mazandarn’s economic dynamic. A strong agreement is doubted in identifying factors influencing the attraction of health tourists. This study was implemented to design a questionnaire to measure the factors influencing the attraction of healthy tourists and investigate its psychometric properties. Materials and methods: This study was done with a combinatorial approach in three steps, including relevant literature and the opinions of experts as long as health tourists' opinions of Mazandaran province were applied to the development of the item pool. Then, content validity, face validity, construct validity, and reliability of the questionnaire were assessed for the psychometric properties of the questionnaire. The final questionnaire was approved after performing 17 interviews and applying professional expertise in the qualitative part. In the first stage of the quantitative part content validity was studied by 10 people from an expert panel, and its face validity, the questionnaire was completed by 10 participants. Finally, the construct validity of the designed instrument was calculated using exploratory factor analysis using SPSS 24 software and confirmatory factor analysis using AMOS 24 software by asking 300 people familiar with health tourism in Mazandaran province. The internal and external validity were determined using Cronbach's alpha and test-retest in 25 people. Results: The results of the literature review and interviews with experts in the first and second stages of the study led to the design of 76 items. In the next step, the changes in the qualitative stage 15 questions did not receive favorite points in Content validity ratio (CVR) and content validity index (CVI) calculation in the quantitative part of content validity. Then face validity was applied and the item effect index for 8 items was lower than 1.5 in the quantitative stage of face validity. Then the questionnaire with 53 items was entered into construct validity. In the exploratory factor analysis, the value of KMO was equal to 0.778. Furthermore, the value of Bartlett's test of significance was less than 5%. Based on the rotated matrix of components, eight factors with positive values were obtained. The results of exploratory factor analysis showed that 7 items had a factor loading of less than 0.4, which were removed from the questionnaire, and finally, 46 items remained. In the confirmatory factor analysis stage, the factor load of all dimensions was in good condition and the P-value was in the acceptable range. Cronbach alpha rate was calculated as 0.831. The external reliability was lower than 0.05 (ICC= 0.90, P<0.001). Conclusion: The designed questionnaire, due to the low number of questions, the simplicity of the sentences, as well as the acceptable validity and reliability, can be used to identify and investigate the factors affecting the attraction of health tourists. Normalization of the questionnaire in other cultures is suggested. It is hoped that the findings of this study will be utilized by researchers, healthcare and tourism system managers, and other stakeholders to inform the planning of interventions aimed at increasing medical tourism. Additionally, it is hoped that the results of this study will serve as a springboard for future research in this area.

2Background and purpose: An organization's safety culture is the product of its values, attitudes, beliefs, and behavioral patterns that define the organization's commitment and framework for managing safety and health. The purpose of evaluating the safety culture is to identify the current state of the safety culture raise the awareness of the employees in this field evaluate the interventions related to safety and track the changes that have been made. The present study was conducted to analyze the status of patient safety culture among the employees of hospitals covered by Mazandaran University of Medical Sciences in 2022. Materials and methods: The current descriptive, analytical, and cross-sectional study was conducted in 1401 on 440 employees of medical and educational hospitals covered by Mazandaran University of Medical Sciences. The sample size was calculated using Cochran's formula and the sampling method was simply random. The tool used in the Standard Patient Safety Culture Questionnaire (HSOPSC) The questionnaire had 42 questions, and 12 dimensions of the patient safety culture including dimensions of general understanding of the patient, organizational learning and continuous improvement, discipline within hospital departments, non-punitive policy in cases of errors, issues Work related to staff, manager/supervisor expectations and actions to promote patient safety, open communication channels, feedback and exchange of information about errors, hospital management support, teamwork among hospital departments, hospital handovers and transfers, and frequency of incident reporting. Unwantedness was measured based on a five-point Likert scale. The average score of less than 2.5 indicates a low patient safety culture, between 2.5 and 3.75 an acceptable state of safety culture, and 3.75 and above indicates the patient safety culture is a strength of the hospital. The study was conducted with IR.TUMS.SPH.REC.1400.289 code of ethics. Analysis was done using Spss 24 software and independent t-tests, one-way analysis of variance, and Friedman. Results: Most of the participants (47%) were 30 to 40 years old and had work experience of 1 to 10 years (44.6%). Also, most of the studied people (59%) were on rotating shifts. The overall status of patient safety culture in hospitals covered by Mazandaran University of Medical Sciences was 64.4% with an average of 3.22±0.43, so 86.1% of the participating employees considered the patient safety status as an average. Among the dimensions of patient safety culture, the highest and lowest scores are respectively related to the dimensions of "teamwork within hospital departments" with a mean and standard deviation of 3.90±0.79 (78 percent) and "hospital delivery and transfers" with a mean, and the standard deviation was 2.75±0.92 (55%). According to the single-sample independent parametric T-test, the score obtained from the status of patient safety culture in covered hospitals was higher than the average standard score of 3 (P<0.05). Patient safety culture in people with higher service experience had a better condition than people with less experience (P<0.05). No significant difference was observed in the status of patient safety culture in different work shifts of the participants (P<0.05). Also, teaching hospitals had a better average patient safety culture than non-teaching hospitals (P<0.05). Conclusion: Based on the findings, hospital transfers were identified as one of the weakest areas. The implementation of appropriate training courses, such as workshops and in-service training, for correct patient transfer and handover is recommended. Additionally, empowering staff to freely question and critique decisions and actions of senior personnel regarding patient safety concerns is crucial.

2Background and purpose: Pesticides are well-known for their carcinogenic, mutagenic, and teratogenic properties, and they exhibit resistance to environmental degradation. Organophosphorus compounds represent one of the largest and most diverse groups of pesticides globally. Diazinon, an organophosphorus pesticide widely used in agriculture, was selected as the target pollutant for the present study. Materials and methods: The co-precipitation method was employed to synthesize zinc oxide nanocomposites coated on polyethylene terephthalate (PET). Subsequently, the nanoparticle structure was analyzed using XRD, FT-IR, SEM, and EDX analyses. The efficiency of diazinon sonocatalytic removal by zinc oxide nanocomposites coated on PET was investigated, and the impact of various parameters, including pH (3-11), nanocomposite dosage (0.2-2.5 g/L), initial diazinon concentration (5-50 mg/L), contact time (5-60 min), hydrogen peroxide concentration (2-50 mM), different gases (oxygen and nitrogen gas (2 L/min)), organic compounds (folic acid, citric acid, humic acid, EDTA, oxalate acid, phenol), radical scavengers (ammonium oxalate as h+ scavenger, benzoquinone as scavenger, tert-butyl alcohol as •OH scavengers), various processes (PET, US, PET/US, ZnO, ZnO-PET, ZnO/US, ZnO-PET/US), and recycled experiment, was evaluated. Firstly, the pH optimum was acquired to be 5, with changing pH and constant nanocatalyst dosage and initial diazinon concentration. The effects of different parameters on the removal of diazinon were investigated at the constant value of pH. Diazinon residual concentration was measured by a spectrophotometer (UV/VIS, DR5000) at a wavelength of 295 nm. Results: FT-IR and XRD analyses confirmed the coating of ZnO nanorods onto PET. Under optimal conditions, initial diazinon concentration of 20 mg/L, pH of 5, and nanocomposite dosage of 2.5 g/L for 60 minutes the sonocatalytic removal efficiency of diazinon reached 99.81%. The removal efficiency decreased from 100 to 40.15% as the diazinon concentration increased from 5 to 100 mg/L. The first-order rate constant (kobs) decreased from 0.123 to 0.0086 min-1, while R2 decreased from 0.985 to 0.9152, and electrical energy per order (EEo) increased from 181.073 to 2589.77 kWh.m-3 with increasing diazinon concentration. The sonocatalytic removal of diazinon increased with rising H2O2 concentration up to 5 mM. However, the addition of organic compounds and nitrogen gas led to a decrease in diazinon removal efficiency. The effectiveness of processes for pesticide removal from drinking water decreased due to anions scavenger activity. Examination of radical scavengers revealed that •OH radicals were the most active in diazinon removal. Notably, proper sonocatalytic activity in diazinon removal was observed even after six successive cycles. Intermediate products identified by GC-MS in the sonocatalytic removal process included diazoxon, IMP, hydroxy-diazinon, and diazinon-methyl-ketone. Conclusion: The findings suggest that zinc oxide coated on polyethylene terephthalate, as an affordable, practical, and environmentally friendly material, exhibits satisfactory efficiency for the sonocatalytic removal of diazinon from water environments.

2Background and purpose: Students often express confusion and dissatisfaction with the current internship structure for their master's degree in geriatric health. They feel the lack of clear evaluation criteria and a portfolio system to track their progress. Additionally, the field is relatively new, and traditional teaching methods may not be optimal. This study aimed to design and implement a portfolio based on problem-based learning (PBL) for the geriatric health master's internship program. We also evaluated student satisfaction with this approach. Materials and methods: This semi-experimental quantitative study was conducted in 2024. The stages of conducting the research included designing, implementing, and evaluating the level of satisfaction of students from the portfolio and comparing it with the traditional method. In this way, after designing and compiling the portfolio in problem-based learning, during the implementation phase of the internship program, all the students in the internship unit in the field of elderly health, who were ten people, were randomly divided into two groups: control (five people) and test (five people) were divided and during 12 weeks they passed the training course using the traditional method (control group) and the portfolio method (test group) It was implemented and the internship scores were announced for the students of each group. In the third step, to measure the level of satisfaction of students, the two mentioned methods of a two-part questionnaire including demographic information and questions related to the level of satisfaction of students were used. After collecting the research data, they were entered into SPSS-26 software, and independent t-tests and Fisher's exact test were used to compare the level of satisfaction of the two groups due to the normality of the data. Results: The average age (standard deviation) of the control and test groups was 35.4 (8.56) and 33.6 (8.08) years, respectively. There were no significant differences between the groups in terms of age, grade point average, gender distribution, or marital status. The mean (standard deviation) of overall satisfaction scores for the control and test groups was 26.8 (8.1) and 35.8 (2.28), respectively. The independent t-test revealed a statistically significant difference in overall satisfaction between the two groups (t=2.38, p ≤ 0.05). Conclusion: This study suggests that geriatric health master's students find the PBL portfolio method more satisfying than the traditional internship approach. Students in the PBL group reported higher motivation and felt a stronger connection between theoretical knowledge and clinical practice. Therefore, incorporating the PBL portfolio method into geriatric health and other medical science internship programs is recommended. Notably, this is the first study to explore this method with geriatric health students. A limitation is the small sample size. Future research should involve a larger and more diverse student population across multiple universities.

2Background and purpose: User interface environments of databases should be designed in such a way that, in addition to facilitating users' information-seeking behavior, they can provide appropriate strategies to solve their problems in the shortest possible time. The user interface allows users to get a proper understanding of the information base and they can take advantage of it. The closer the design of the user interface is to the mental patterns and information-seeking behavior of the users, the more effective and useful it is and the less the user's efforts. Despite the development of medical information technology in the field of user interface design, most medical information systems have not been able to meet users' expectations mainly due to: a lack of awareness of information needs, information behavior of users, and lack of understanding of its nature. This research aims to present a new model for effective information retrieval and increasing the desirability in the design of user interface environments of information databases. Materials and methods: This study is a mixed type with a quantitative and qualitative approach which has been done with the design of combined exploratory methods. In the qualitative part, the research community included expert professors and specialists, and in the quantitative part, specialized and research-oriented PhD students of the basic science fields of Mazandaran University of Medical Sciences. In the qualitative part, 12 people were included in the study with the purposeful sampling method, and with this number of interviews, information saturation occurred. In the quantitative part, stratified random sampling was used and 100 people were included in the study. The required data was collected through content analysis and researcher-developed questionnaires. The data was then analyzed using SPSS software version 22 and inferential statistics (Kolmogorov-Smirnov, Wilcoxon, Mann-Whitney, and structural analysis). Results: According to the IPMA analysis, the findings of the research showed that among the variables that explain the desirable information-seeking behavior in terms of importance, the highest rank in desirable information-seeking behaviors is related to the dimension of users' position with an emphasis on ability (with a significance coefficient of 0.437 and the lowest is related to the ease of access component (with a significance coefficient of 0.048) and in terms of performance, the highest rating is related to the user interface design dimension with an emphasis on the database efficiency variable (with a performance factor of 57.191) and the lowest was related to the ease component (with a performance factor of 40.793). Also, the proposed model was able to obtain the necessary validity and reliability. Conclusion: The presented model helps users of database user interface environments so that they can use the basic elements as much as possible to speed up work and save time. Also, the proposed model can provide the necessary ideas to the designers of database environments so that they can implement the appropriate features for better interaction with the databases to facilitate and understand as easily as possible for more users. considering that the proposed model has obtained the necessary validity and reliability, it can be claimed that this model will not only be able to answer the issues raised in the field of searching and retrieving information, but it can be used, criticized, and perfected in future researches as a basis for designing and implementing user interface environments.

2Background and purpose: The Convolvulus genus (Convolvulaceae) is one of the medicinally and economically important genera, including about 250 species broadly distributed worldwide. Many researchers have paid attention to this genus because of its important phytochemical composition, biological activities, and safety. The Convolvulus genus contains various chemical profiles such as flavonoids, phenolic acids, coumarins, tannins, and essential oils. All the parts of these plants possess pharmacological activities such as antimicrobial, anticancer, and antioxidant activities. This investigation was designed to study the antioxidant and antihypoxic activities of C. fructicodus. Materials and methods: The aerial parts were extracted by maceration with methanol as a solvent. In this experimental study, antioxidant activities were evaluated by four methods, DPPH and nitric oxide radical scavenging activities, iron chelatory capacity, and reducing power. Total phenolic and flavonoid contents were also investigated. High-performance liquid chromatography was used for the determination of phenolic compounds. The protective effects of extract at 62.5-250 mg/kg were evaluated against hypoxia-induced lethality in mice by three experimental models of hypoxia, i.e. asphyctic, haemic, and circulatory. The time it took for the mice to die (latency for death) was recorded in minutes. The Institutional Animal Ethical Committee of Mazandaran University of Medical Sciences approved the experimental protocol. In the asphyctic hypoxic model, phenytoin (50 mg/kg, i.p.) and in the next two tests, propranolol (20 mg/kg, i.p.) were used as the positive control. Normal saline (0.5 ml, i.p.) was used as the negative control. Analysis of variance was performed followed by Newman-Keuls multiple comparisons (by GraphPad Prism 8) to determine the differences in means. The extract did not show any metal-chelating activity in the chelating test. Results: Total phenolic and flavonoid contents of the extract were 113.37 GAE and 20.32 QE, respectively. IC50 of extract for DPPH radical-scavenging activity and nitric oxide-scavenging were 85.28 and 177.40 µg/ml, respectively. The extract showed a good effect in reducing the power test and there was no significant difference between extract and standard in higher concentrations (p>0.05). In the haemic model, the extract showed a good and dose-dependent effect in all tested doses. The extract at 62.5 mg/kg increased the survival time by about 2 minutes (P<0.01). At 250 mg/kg, the extract showed a similar effect to propranolol. In the circulatory model, it showed very good completely dose-dependent effects. At 62.5 mg/kg, the extract increased the survival time by more than 2 minutes (P<0.01). The extract at 250 mg/kg increased the survival time by about 8 minutes (P<0.0001). The effect of the extract at 62.5 mg/kg was similar to propranolol. In the asphyctic model, the extract did not show activity in any of the tested doses. Conclusion: The presence of phenolic compounds in the extract can be responsible for the antioxidant activity observed in the plant extract. By conducting anti-hypoxia tests in two models of haemic and circulatory models, the extract was able to show good protective effects in increasing the survival time of mice. The good antioxidant activity of this extract can be a possible mechanism for the anti-hypoxia activity.

2Background and purpose: Breast cancer is the 1st most common cancer in the female population and the third leading cause of cancer mortality in Ladies. Given the importance of early detection of cancer, it is necessary to find biomarkers related to this disease that are essential for the prognosis and early diagnosis of breast cancer. The estrogen receptor gene for beta, whose full name is Estrogen Receptor-β (ESRβ). Our main aim in this study was to investigate the expression changes of this gene in cancer tissue tumor samples compared to normal tissue samples to obtain a biomarker to predict the risk of cancer. Materials and methods: In this research, in 2023 samples were obtained from 30 patients diagnosed with breast cancer who underwent surgery at Omid Hospital in Mashhad. Both tumor tissue and adjacent healthy tissue were collected from each patient. The diagnosis of breast cancer was confirmed by a specialist doctor, and none of the patients had received any prior treatment such as chemotherapy or radiation therapy. Tissue samples were collected immediately after surgery and stored at -70°C. RNA extraction and synthesis were performed, followed by analysis of the expression of the ESR gene along with the GAPDH gene as an internal control, using real-time PCR. Results: In this study, 30 cancer patients were examined, with ages ranging from 32 to 62 years old and a mean age of 47.5 ± 9.38. Among them, one person had tumor grade 1, 16 had grade 2 tumors, and 8 had grade 3 tumors. Metastasis was observed in 11 patients (36.7%), while 19 patients (63.3%) had no metastasis. Regarding tumor size distribution, 5 patients (16.7%) had tumors smaller than 1 cm, and 25 patients (83.3%) had tumors sized between 1 and 2 cm. The study focused on changes in the expression of the ESRβ gene in both tumor and adjacent healthy tissues of breast cancer patients. It was found that the gene expression was higher in tumor samples compared to the adjacent healthy tissues. Using SPSS software, the analysis revealed a significant relationship between gene expression intensity and tumor grade across all three groups. Additionally, a significant difference was observed between patients with and without tumor metastasis. Conclusion: Overall, the findings of this study indicate a significant correlation between gene expression intensity and tumor grade across all three groups. Moreover, there is a significant distinction between patients with and without tumor metastasis. Notably, a considerable expression difference was observed between healthy and tumor samples. Hence, this gene could serve as a potential biomarker for cancer diagnosis.

2Background and purpose: Acinetobacter baumannii is an opportunistic pathogen that causes serious infections in hospitalized patients. It is particularly concerning due to its increasing resistance to antibiotics, making it difficult to treat. This bacterium can survive on hospital surfaces for extended periods due to its high resistance to environmental conditions. It can colonize ventilators, form biofilms, and cause pneumonia. A. baumannii with its ability to form biofilm is very important in causing treatment-resistant nosocomial infections. Csu A/BABCDE pilus system, outer membrane proteins, the chrome sensing system, and the pga ABCD operon are virulence factors of Acinetobacter baumanii. Biofilm formation by Acinetobacter baumanii plays a crucial role in the development of hospital-acquired infections. Expression of the CSU operon, which plays a significant role in pilus assembly, the adhesion of bacteria to surfaces, and biofilm formation, is of great importance. This study aimed to investigate the presence of csu operon genes in carbapenem-resistant clinical isolates of A. baumannii and their ability to form biofilms. Materials and methods: A total of 97 carbapenem-resistant clinical isolates of A. baumannii were examined for the presence of csu operon genes (csuA, B, C, D, E, and A/B) using PCR. Isolates were cultured in BHI broth until turbidity reached a McFarland standard of 0.5. 200 μL of each bacterial suspension was transferred into individual wells of a 96-well microtiter plate. The microtiter plate was incubated at 37°C for 24 hours. The biofilm formation assay was conducted using the microtiter plate method. The optical density of the samples was measured at 650 nm using a microplate reader. The biofilm-forming ability of the isolates was compared to that of a negative control (sterile broth) and a positive control (Pseudomonas aeruginosa PA01). The results were analyzed using SPSS software and Pearson's chi-squared test. Results: The results of biochemical and differential tests for 97 carbapenem-resistant Acinetobacter baumanii isolates were summarized. Out of 97 carbapenem-resistant A. baumannii isolates, 62 (63.9%) harbored the csuA gene, 51 (52.6%) harbored the csuB gene, 81 (83.5%) harbored the csuC gene, 29 (29.9%) harbored the csuD gene, 57 (58.8%) harbored the csuE gene, and 54 (55.7%) harbored the csuA/B genes. The presence of the csuC gene was higher compared to other genes, while the presence of the csuD gene was lower. Additionally, 29 isolates (29.9%) exhibited strong biofilm production, 30 (30.9%) exhibited moderate biofilm production, and 38 (39.2%) exhibited weak biofilm production. Conclusion: The results of this study suggest that the csuD gene may play a lesser role in biofilm formation in A. baumannii, as its expression was lower in isolates with strong and moderate biofilm formation compared to other csu operon genes, while the expression pattern of other csu genes in isolates with strong and moderate biofilm formation was relatively similar

2Background and purpose: Yarrow is a member of the Asteraceae family, utilized extensively in the field of medical sciences. Among the medicinal plants, one may encounter few specimens like the aforementioned plant, which enjoys widespread distribution across various regions of the globe and boasts a diverse array of uses that contribute to its renown. The aim of the present study was the synthesis of Yarrow extract evaluation of its antibacterial effects on a group of intestinal bacteria and comparing its antibacterial properties with phenol. Materials and methods: In this experimental study, Yarrow plant extract was extracted with the hydroalcoholic method. The aerial parts of Achillea ageratum plant with herbarium number 1753 were prepared from the slopes of Ardabil mountains and after determining the identity, the extract of this plant was extracted by hydroalcoholic method. In this method, after preparing the plant and drying the aerial parts of the plant, 10 g of it was crushed in a sterile mortar, then it was poured into an Erlenmeyer flask, and 50 mL of 100% ethanol was added to it. After 24 hours of mixing in a magnetic stirrer using a Buchner funnel with Whatman filter paper and a vacuum pump, the remaining components of the plant were separated. Then, a certain amount of distilled water (20 ml) was added to the desired solution and placed again in the magnetic stirrer whose temperature was set at 80 degrees Celsius, so that the alcohol was completely removed from the reactor. The Antibacterial effect of yarrow extract was performed by disc diffusion method and micro broth dilution on standard species of Enterobacteriaceae families including the standard bacterial strains of Klebsiella pneumoniae (ATCC:10031), Escherichia coli (ATCC:23591), Shigella dysentery (ATCC:25922) and Enterobacter aerogenes (ATCC:13048). All experiments were performed according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: In the present study, the growth rate of bacteria decreased by increasing the concentration of yarrow extract. The MIC of Yarrow plant extract for Klebsiella pneumonia and Enterobacter aerogenes was obtained in %6.25 and for Shigella dysentery and Escherichia coli was obtained in %12.5 and %25, respectively. Also, the MBC of extract for Shigella dysentery, Klebsiella pneumonia, and Enterobacter aerogenes bacteria was obtained in 25%, and for Escherichia coli it was obtained in 50%. The results of MIC and MBC show that the most sensitive bacteria to yarrow extract among the studied bacteria is Enterobacter aerogenes and the most resistant is Escherichia coli. The diameter of the inhibition zone for Shigella dysentery, Escherichia coli, Klebsiella pneumoniae, and Enterobacter aerogenes bacteria was obtained at 19, 18, 20, and 23 mm, respectively. In this experiment, Enterobacter aerogenes bacteria were the most sensitive and Escherichia coli was the most resistant among the investigated bacteria. Comparative investigation of the antibacterial properties of yarrow extract with phenol, showed that yarrow extract had a lower killing effect than phenol at 5, 10, and 15-minute contact time. In this test, the most resistant bacteria are Shigella dysentery and the most sensitive bacteria are Escherichia coli and Enterobacter aerogenes. The reason that the type of resistant and sensitive bacteria was slightly different in the method of comparing the antibacterial effect of yarrow extract with phenol with the results of MIC, MBC, and non-growth halo diameter is related to the reduction of contact time of the extract with bacteria. Conclusion: The results of the present research show that the hydroalcoholic extract of the yarrow plant is very effective in the removal of gram-negative intestinal bacteria. Also, the hydroalcoholic extract of the yarrow plant is more effective in removing gram-negative bacteria than phenol

2Background and purpose: In December 2019, a series of pneumonia cases of unknown origin were reported in Wuhan, China, named by the World Health Organization as COVID-19. The risk factors for developing the disease of COVID-19 are still not well known, but evidence shows that some factors, including respiratory diseases such as tuberculosis, are important risk factors in the disease of COVID-19. It should be noted that tuberculosis, like SARS-COV-2, is mainly transmitted through breathing and affects the lungs. Also, some studies show that infection with Mycobacterium tuberculosis causes more rapid and severe pneumonia symptoms in COVID-19 and is the main cause of death due to severe disease. Considering that the disease of COVID-19 is a newly emerging pandemic and the risk factors related to its incidence and severity are still being investigated and considering that tuberculosis is a curable infectious disease that can affect other respiratory diseases. This study was conducted to investigate the probable and definite frequency of COVID-19 (COVID-19) in the first and second peaks of the coronavirus pandemic among patients with a history of tuberculosis. Materials and methods: This study was descriptive-cross-sectional and the study population included patients with a history of tuberculosis whose diagnosis date was between 2015 and 2020. The number of these samples was equal to 1532. The sampling method was census. The time of investigation in terms of contracting COVID-19 was after the first peak and during and after the second peak of Corona (from the second half of May 2019 to November 2019). The data collection tool included a checklist containing demographic variables and clinical symptoms related to COVID-19. The method of collecting information was in the form of telephone interviews and document review. Data collection was done by trained interviewers. For this purpose, the questioners were first given the necessary training on how to complete the checklist. Data entry was done in Excel software and transferred to SPSS V.16 software for analysis. The description of the variables is presented in terms of number, percentage, mean, standard deviation, and median. A chi-square test was conducted to compare the grouped variables. Results: In this study, the prevalence of probable and definite cases of COVID-19 among patients with a history of tuberculosis was reported as 5.5% (85 people), and suspected, probable and definite cases were reported as 15.6% (239 people). Also, there was no correlation between age groups, gender, place of residence, type of tuberculosis, marriage, diabetes, kidney disease dialysis, immunodeficiency,, and liver disease with the prevalence of COVID-19 among patients with a history of tuberculosis. It should be noted that in this group of patients, heart disease, lung disease, cancer, chemotherapy, high blood pressure, and brain and nerve diseases were related to the spread of COVID-19. Also, the highest frequency of suspected, probable, and definite COVID among patients with a history of tuberculosis was diagnosed respectively in 2019 with 38.5% (25 out of 65 cases with a history of tuberculosis), in 2014 with 26.7% (63 out of 236 cases with a history of tuberculosis) and 20.8% (58 people out of 279 cases with a history of tuberculosis) in 2018. Conclusion: Due to the significant difference in the prevalence of Covid 19 in patients who have not received the flu vaccine, it is necessary to inject the flu vaccine in these patients. Advice to quit smoking in these patients should be a priority. Because no independent study on Covid disease was observed in patients with tuberculosis, further studies in this field are necessary.

2Background and purpose: After a diagnosis of ectopic pregnancy there are two choices for treatment: medical treatment with methotrexate and surgical treatment. It seems that medical treatment, has had acceptable success compared to surgery and lacks the complications of surgery. Nowadays, due to the progress achieved in the early diagnosis of ectopic pregnancy, a large number of patients are candidates for medical treatment. This study is conducted to evaluate the effective factors of medical treatment Response with methotrexate in ectopic pregnancies. Materials and methods: In this case-control study, the information related to patients who were diagnosed with ectopic pregnancy and were treated with methotrexate from March 2016 to March 2021 in Imam Khomeini Hospital in Sari was examined using hospital records by census method. In total, 160 patients out of 623 patients met the inclusion criteria and were studied. In the checklist prepared for each patient, the patient's age, number of gravity and parity and abortion, previous history of infertility, contraceptive method, presence of clinical symptoms (such as abdominal pain-vaginal bleeding-amenorrhea), History of using recent assisted reproductive methods, type of treatment regimen used (Single/Multiple Dose), serum beta human chorionic gonadotropin (BHCG) level before and after starting treatment, number of previous ectopic pregnancy, gestational age based on the last Menstruation, transvaginal ultrasound results(including the presence of the yolk sac & fetal heart rate & hematosalpinx - location and size of the ectopic mass-endometrial thickness) were recorded for each patient separately, The patients were divided into two categories: success and failure of treatment and the effect of different factors on the result of medical treatment with methotrexate was investigated. The collected data were entered into SPSS 26 software and qualitative variables were analyzed with the Chi-Square test. The normality of the distribution of quantitative variables was measured by the One-Sample Kolmogorov-Smirnov test, an independent t-test was used to examine quantitative variables with normal distribution, and the Mann-Whitney test was used for quantitative variables with non-normal distribution. Results: 160 patients were included in this study, 108 of patients (67.5%) were successfully treated and 52 patients (32.5%) faced treatment failure. In this study, the type of treatment regimen (P=0.001), Serum Beta Human Chorionic Gonadotropin (BHCG) level before treatment(P=0.000), BHCG level after treatment (P=0.000), the presence of fetal heart rate (P=0.002) and yolk sac (P=0.046) are factors affecting the response to methotrexate treatment in ectopic pregnancy. The presence of hematosalpinx, size of the ectopic mass, endometrial thickness, history of infertility and recent assisted reproductive procedures, presence of clinical symptoms, contraceptive method, gestational age, history of ectopic pregnancy, number of gravidity and parity, and abortion have no effect on the results of medical treatment with methotrexate. Conclusion: Based on the results obtained, Single Dose regimen of methotrexate treatment is associated with greater treatment success than a multiple-dose regimen and also high serum BHCG levels before and after the treatment, the presence of fetal heart rate and yolk sac in transvaginal ultrasound are factors to increase the probability of failure of medical treatment of ectopic pregnancy with methotrexate

2Background and purpose: Knee joint disorders are divided into two general categories of traumatic and non-traumatic injuries, including skeletal deformities such as genu valgum (knocked knee) and genu varum (bowed legs). Genu valgum and genu varum are two of the most common deformities of the knee joint. These deformities can directly affect the quality of people's social lives. Considering the importance of determining its rate in the youth community, this study aims to determine the relationship between genu valgum and genu varum with anthropometric indices in elementary school students of Dezful City in 2022. Materials and methods: The current research was cross-sectional-analytical, which was conducted in 2022 at the level of elementary schools in Dezful City on 400 students of girls' and boys' schools between 7 and 11 years old. Patient demographic information, including age, gender, height, weight, family history, and hip joint width, was gathered using a questionnaire. To evaluate the deformation of the lower limb, the participants must stand in a way that the knee is in full extension and the ankles of both legs should be close together so that the patella bones on both sides are facing forward. In this position, deformation of the knee joint (genu valgum and genu varum) was determined by measuring the distances between the medial condyles of the femur and the medial malleolus of the ankle, and its relationship with demographic information was evaluated. Results: The frequency distribution showed that 2.5% of the studied subjects had genu valgum, and 11.5% of them did not have genu varum. These results showed the existence of skeletal disorders in knee joints at the rate of 14% in the studied population. Also, the results of this study showed that only 2.2% of the studied population had a family history of musculoskeletal disorders such as genu valgum and genu varum, and 97.5% of them had no family history, which indicated the absence of a significant relationship between the occurrence of disorders and family history (P=0.187). Results showed that there was a significant relationship between the average age and the observation of genu varum and genu valgum disorder (P<0.001). Also, a significant relationship was observed between height and weight and genu varum and genu valgum (P=0.001). It is noteworthy that a significant relationship was observed between the width of the hip joint with these abnormalities (P<0.05). Conclusion: Although the rate of disorders in the sample population was not very impressive, investigations in this study have confirmed a significant relationship between demographic indicators and knee joint disorders. The existence of a relationship between height, weight, age, and other important anatomical indicators, such as the distance between the hip joint and genu varum and genu valgum, probably indicates the increasing trend of observing these disorders in society with growth and changes in the skeletal framework, which requires further evaluation. The findings of this research can be utilized by health policy institutions to mitigate the prevalence of this condition, particularly among the younger population, through implementing suitable plans and strategies.

2Background and purpose: Musculoskeletal disorders (MSDs) are becoming increasingly prevalent as a source of occupational disability injuries. Musculoskeletal disorders in midwives are a major concern, as midwifery is one of the professions with a high risk of occupational diseases, in addition to risk factors such as awkward posture, repetition of movements, heavy workload, fatigue, and stress, are also dependent on individual-organizational factors, which can be caused by occupational tensions and may lower the quality of care provided to mothers and newborns. Because there is little research in this field, the current study aimed to determine the prevalence of musculoskeletal disorders among midwives working in public and private hospitals in Sari City, as well as the influence of related risk factors on it. Materials and methods: This descriptive-analytical cross-sectional study was conducted in 2023 (summer) among midwives working in public and private hospitals in Sari City as a census. 193 workers in maternity wards were chosen, with having more than one year of experiencea nd the exclusion being a history of musculoskeletal disorders. The data collection tool included a demographic and organizational information collection form, the Cornell musculoskeletal disorders questionnaire. This questionnaire looks at 12 body areas and the frequency, severity, and impact of discomfort on work abilities throughout the previous working week. Data analysis was done by SPSS statistical software, descriptive statistics, chi-square, and independent t-tests at a significance level of 0.05. Results: The mean and standard deviation of the age and work history of the studied subjects were 35.60±7.74 and 10.42±6.84, respectively. Analysis of the frequency of musculoskeletal problems revealed that the most commonly affected areas were the wrists, shoulders, lower back, and neck. Meanwhile, 79.4% of people have experienced discomfort in at least one of the various organs. In terms of the amount of pain, the highest average pain sensation among participants was reported the highest average pain intensity at night (40.7%). Based on the results, the highest prevalence of MSDs was found in the neck region (58.4%), followed by the lower back (57.6%), shoulder (53.9%), and then one or both wrists (51%). Also, the average age and history of midwives with MSDs had a significant relationship (P<0.05). Conclusion: The current study found that the majority of midwives felt pain and discomfort in at least one part of the musculoskeletal system. Also, the highest rate of musculoskeletal disorders was in the neck, waist, and shoulder, respectively, which indicates the high prevalence of disorders in the upper limbs. The study's analytical investigations revealed an effective relationship between the prevalence of musculoskeletal disorders and demographic and work-related variables. As a result, to improve working conditions and reduce musculoskeletal disorders in midwives, specialized ergonomics

2Background and purpose: Environmental pollution, is one of the main causes of increasing cognitive-neurological disorders. All pollutants, whether biodegradable or non-biodegradable, contribute to various neurological issues, including cognitive disorders, and affect human life, particularly in the early stages of development. Given the growing concern about the impact that air pollutants may have on children's learning and neural development, the current research aims to determine the relationship between exposure to pollution and neural development skills in children, in the early stages of education and schooling. Materials and methods: The present systematic review was conducted following international standards and according to the PRISMA checklist. English-language articles were searched from PubMed, Scopus, and Web of Science, Science Direct, and Google Scholar databases until September 2023. Eligible articles were screened by reading titles and abstracts by the researcher. Then, the full text of relevant articles was evaluated, and discrepancies were resolved before making the final decision. The studies reviewed in this research included air and soil pollution, one of the cognitive and learning disorders such as attention, memory, intelligence, thinking, neural development, etc., preschool, and elementary school. In the present study, articles were fully reviewed, and research that did not fall within the age range of preschool and elementary school was excluded from the review; such as articles related to air pollution during the fetal period or children over the age of 12 years. Articles that simultaneously included children within and outside the age range of the study were only reviewed for the relevant age groups, and review articles were also used to find studies related to the research topic. Results: The search strategy resulted in the identification of 528 studies related to the article’s topic. Based on the screening of inclusion and exclusion criteria, eventually 37 articles were selected that matched the objectives of this research. The results indicated a wide heterogeneity in neuropsychological assessment tools, geographical regions, and sample sizes recorded. Also, many findings reported significant detrimental effects of air pollutants on cognitive functions and sensory-motor abilities (reported a significant difference in terms of brain white matter volume and motor abilities among children exposed to pollution, indicating that living in a polluted area is a risk factor for disruption in sensory-motor functions), increased risk of ADHD, reduced intelligence and cognitive performance, reduced memory, reduced attention; and reduced learning power and perception, most of which examined the effects of several pollutants on cognitive changes in children in preschool and elementary stages. In two of the articles reviewed in this research, the relationship was analyzed based on gender. In these studies, boys were at greater risk in terms of active memory. Also, in the quality assessment of articles, most articles scored 15 or higher, indicating the desirable status of most of the selected articles. Conclusion: The exposure to pollution with problems in cognitive skills; it is particularly associated with intellectual functions, attention, learning, comprehension, and memory skills. However, the association of pollution with specific neurodevelopmental skills in preschool and elementary school children is less clear and requires more research.

2Knowledge translation is the sharing of knowledge obtained from research with knowledge users, including community members, organizations, and policymakers, to use it to improve systems and improve the provision of services and products. The implementation of the knowledge translation process in the health field is facing challenges in our country, which is partly because of insufficient knowledge about the concept of knowledge translation and how to implement the knowledge translation process. In the present study, the definition of knowledge translation, and how the process and tools of knowledge translation were discussed, and then, while reviewing the status of knowledge translation in Iranian universities of medical sciences, solutions for the implementation of knowledge translation were presented. Some of the mentioned knowledge translation tools in this study are podcasts, three-minute thesis presentations, webinars, infographics, research news from research results, press releases, journal clubs, policy briefs, and clinical guidelines. The situation of knowledge translation has been reported as inappropriate and incomplete in medical sciences universities of Iran. In these studies, the evaluation was done using the evaluation tool of knowledge translation, which included the four areas of audience needs assessment, knowledge production, knowledge transfer, and evidence application. According to the current situation of knowledge translation, the implementation solutions of knowledge translation in each field have been presented separately. Appropriate networking between knowledge producers and knowledge users, as well as holding regular meetings with representatives of executive organizations and industry owners to determine research priorities, are among the solutions presented in the audience needs assessment section. Creating the infrastructure to carry out research projects based on the needs of the audience, allocating the necessary resources for the implementation of research projects, active participation of representatives of executive organizations in the process of conducting research, creating an internal network between academic researchers to advance research priorities as much as possible, and also pay attention to the quality of knowledge production to gain the trust of the audience are the solutions provided in the knowledge production sector. Acquainting researchers with the field of knowledge transfer and its importance, allocating resources to implement the knowledge transfer process, using appropriate and up-to-date tools for knowledge transfer by researchers, and creating rules to support researchers who, before publishing their research findings in reputable journals, publish them through other means of knowledge transfer, institutionalizing the mechanisms of benefiting from the research achievements in the general education program, and also considering the incentive plans for the transfer of the produced knowledge are among the solutions presented in the knowledge transfer section. Producing valid and reliable evidence, placing produced evidence at the disposal of policymakers, building trust in the audience by researchers, policymakers, and relevant officials to use produced evidence, informing the audience about the need to use production evidence, creating appropriate communication between knowledge producers and knowledge users through the use of knowledge brokers, the existence of resources and financial support for the use of evidence by policymakers as well as target audiences are some of the solutions provided in the use of evidence section