Iranian Journal of Public Health
Volume:51 Issue: 10, Oct 2022

The association between congenital heart defects (CHDs) and selenium (Se) is still unclear. We aimed to systematically review and quantitative analyze the potential relationship between maternal Se exposure and CHDs in the offspring.

PubMed, Embase, Web of Science and Scopus databases were searched from inception up to August 2021 for relevant studies. Methodological quality of the studies was assessed through Newcastle-Ottawa scale. The Standard mean difference (SMD) and corresponding 95% confidence interval (CI) were calculated to compare maternal Se levels between CHDs groups and control groups using a random-effects model.

Four articles covering five studies were included in the systematic review, and three articles covering four studies were included in the meta-analysis. One study measured Se concentrations in maternal hair and found a positive correlation between high concentrations and increased risk of CHDs in offspring. However, one study on cord blood, and one on whole blood illustrated that Se exposure was associated with decreased risk of CHDs. There was no significant association found between serum Se levels and CHDs in two studies. Pooled results showed decreased Se levels in the circulation of mothers with CHDs offspring (SMD = -108.27, 95% CI: -192.72, -23.82), with statistically significant heterogeneity (I2 = 99.8%, P < 0.001) but not in hair, as compared with controls.

Low maternal Se status may be associated with increased risk of CHDs in offspring. However, further larger-scale studies with strict and consistent design methods are still required to investigate this issue.

Economic evaluation is used for the optimal allocation of resources in the health sector. While a large number of economic evaluation studies have been conducted, there is less critical review of these studies. We critically examined the economic evaluation studies of preventive health interventions.

The study was carried out using critical review method. Seven databases (i.e., PubMed, Cochrane Database of Systematic Reviews, Web of Science, Science Direct, Scopus, Springer Link, and Elsevier) were searched to find articles on economic evaluation of health interventions published from 1985 to 2018. In addition, the references of retrieved studies were hand screened for articles that were not indexed in these databases. Finally, 206 articles, including 33 cost- benefit analysis, 146 cost- effectiveness analysis, and 27 cost- utility analysis were included in this study. These studies were critically evaluated using a checklist of 11 criteria.

Only 20% of the studies met all the methodological criteria of health economic evaluation. The cost perspective, costs type, cost data source, and cost measurement were not explained and discussed in 17%, 20%, 5%, and 33% of studies respectively. Outcome data sources and outcome valuation method were only mentioned in 53% and 69% of studies. The sensitivity analysis and results’ generalizability were not reported in 16% and 46% of studies.

The quality of economic evaluation studies is low, and it can be misleading if resource allocation decisions are made using this evidence. Authors should use valid protocols to conduct and report economic evaluation studies, and journals’ editors should use valid checklists to evaluate these articles.

Dexmedetomidine (Dex), as a new and highly selective α2 adrenergic receptor agonist, has been widely used in mechanically ventilated patients. In the present study, we used meta-analysis to study the effect of Dex on the prognosis of mechanically ventilated patients with sepsis.

We searched PubMed, Cochrane clinical trial, EMBASE, Web of Science, and Chinese biomedical literature database to analyze relevant literature published from January 2000 to January 2021. We conducted the quality evaluation and data extraction for studies that met the inclusion criteria. RevMan 5.3 software was used to perform a meta-analysis of the 28-day mortality, hospital mortality, the length of ICU stay, and other adverse indicators.

Ten randomized controlled trials (RCTs) that met the inclusion criteria were finally included, including 9 RCTs in English and one in Chinese, with a total of 892 patients. Our meta-analysis results found that in mechanically ventilated patients with sepsis, Dex could significantly reduce the length of ICU stay (P=0.02), but did not reduce the patients' 28-day mortality (P=0.06), hospital mortality (P=0.17) and ventilator-free days (P=0.33). Furthermore, our meta-analysis results also found that Dex had no significant effect on the respiratory rate (P=0.53), heart rate (P=0.02), mean arterial pressure (P=0.63), the level of creatinine (P=0.82) and continuous renal replacement therapy (P=0.39) in mechanically ventilated patients with sepsis.

In mechanically ventilated patients with sepsis, Dex can reduce the length of ICU stay, but which cannot reduce the 28-day mortality, hospital mortality, and ventilator-free days.

Horizontal transmission of hepatitis B virus (HBV) is a significant transmission route in households, among contact sport athletes and institutionalized individuals. Children often are infected by non-sexual close contacts with an increased tendency to become chronic carriers. Hence, the awareness about various high-risk behaviours leading to horizontal transmission in the community is essential. A systematic review and meta-analysis was carried out to assess quantitatively the pooled prevalence of horizontally transmitted HBV infection globally.

The study was started after ruling out registered or ongoing systematic reviews related to this topic in the PROSPERO database. The study protocol was documented in PROSPERO with a registration number CRD42021235165. We searched electronic databases for published articles in English between 1981 and April 2021 reporting horizontal modes of hepatitis B transmission among unvaccinated contacts. Meta-analysis was carried out in STATA version 13.0 (College Station, Texas 77,845 USA). The forest plots were constructed using metaprop package in STATA.

Forty-one studies were systematically reviewed and 15 studies were qualified for the meta-analysis, including 1619 hepatitis B cases and 4869 contacts. The overall pooled prevalence of horizontally transmitted HBV infection among the contacts was 38% (95% CI 30%-46%). The pooled prevalence among 3,912 household contacts from nine qualified studies was estimated as 44% (95% CI 35%-54%). The pooled prevalence rates among institutionalized individuals and contact sport athletes were 30% (95% CI 23%-37%) and 18% (95% CI 5%-32%), respectively. 

The likelihood of horizontal transmission of HBV is greater among household contacts of chronic carriers of HBV and institutionalized individuals.

Hematuria is one of the most common symptoms in nephrology and urology. Due to the lack of extensive meta-analysis studies on the epidemiology of hematuria in Iran, this study was conducted to determine the epidemiological status of hematuria in Iran.

In Sep 2020, researchers studied six international databases such as PubMed, ISI/WOS, ProQuest, Embase, Scopus, and Google Scholar for English papers and Iranian databases (SID and MagIran) for Persian papers. Joanna Briggs Institute (JBI) checklist was used to review and control the quality of articles. Heterogeneity between studies was assessed by Cochran's test and its composition using I2 statistics.

After several screening phase, the number of 25 article included to the final analysis. The prevalence of hematuria in the general population and children, in Iran were estimated at 16.4% (95% CI, - 0.05-37.9) and 1.6% (95% CI, 0.9-2.3) respectively. The odds ratio (OR) of women to men in the prevalence of hematuria in the general population 1.74, 95% CI: 1.20-2.52, P=0.003, patients with beta-thalassemia major 2.02, 95% CI: 1.11-3.65, P=0.020, children 2.61, 95% CI: 1.19-5.71, P=0.016, the elderly 1.50, 95% CI: 1.15-1.94, P=0.002, and taxi drivers 3.73, 95% CI: 2.58-5.38, P<0.001 was obtained.

The prevalence of hematuria in the general population is relatively high. Hematuria is a good predictor for detecting of bladder cancer and Idiopathic hypercalciuria and the physician should attention to microscopic hematuria.

Liver transplantation is one of the most effective treatments for acute liver failure, chronic liver cirrhosis, and hepatocellular carcinoma. This study was implemented to evaluate the survival rate of liver transplant in Asia.

Studies that investigated the survival rate of liver transplant were selected using a systematic search strategy in the following databases: Medline, Embase, Scopus, ProQuest, ISI Web of Science, and Cochrane to November 30th, 2020. The extracted data were entered into the Excel software. Then, stata 16.0 was used for analysis. The search identified 3046 articles of which, 713 were duplicates and 2156 deemed as irrelevant after reading titles and abstracts. Also, 51 articles were excluded as they were not original (i.e. letter, commentary, review) or did not meet the inclusion criteria. As such, 117 studies, involving 406,646 participants, were included in this meta-analysis.

In this study one, 2, 3, 5, and 10-year survival rates of liver transplant were estimated to be 85%, 80%, 75%, 73%, and 71%, respectively.

This study suggests that the survival rate of liver transplant in Asia is comparable with the corresponding rate reported in the United States and Europe. This study provides a better and more clear view of the efficiency of medical cares, regarding liver transplantation.

We aimed to confirm the effect of interpersonal service worker protection system on workplace violence and depression and to determine the relationship among the protection system, workplace violence, and depression.

Self-reporting survey was conducted for approximately a month beginning on 2 March 2020, among members selected using the convenience sampling method from seven labor unions in South Korea to which interpersonal service workers belonged. The questionnaire consisted of questions regarding the subjects’ general characteristics, worker protection system, workplace violence, and depression. Overall, 1,541 workers participated in this study.

The basic model was used to test the relationship between the protection system and depression, with a mediating effect of workplace violence. Three of the hypothesized paths were significant (P<.001), but the basic model did not fit the data. In the revised model, the direct path from the protection system to depression was deleted. Path coefficient of the direct effect of the protection system on violence was -0.05, the direct effect of the violence on depression was 0.77, and the indirect effect of the protection system on depression was -0.04. The fit of this model was acceptable.

Organizational interventions have an indirect effect on reducing depression by preventing workplace violence; however, there was no direct effect on reducing the depression of the workers. These results justify the need to invest in strengthening workplace protection systems for the interpersonal service workers.

The RAD51 recombinase is involved in homologous recombination and DNA repair. However, the association of RAD51 with the prognosis of adenocarcinoma at the gastroesophageal junction (ACGEJ) is not clear. We aimed to investigate the association of RAD51 with ACGEJ prognosis.

The difference in the expression level of RAD51 between ACGEJ tumors and control tissues in the microarray datasets (GSE159721, GSE74553, and GSE96669) were compared. The online Kaplan-Meier plotter survival analysis and meta-analysis were used to analyze the association of RAD51 with overall survival in pan-cancers. MiRNAs targeting RAD51 were identified and their expression profiles in ACGEJ tumors were analyzed. Functional enrichment analysis was performed for miRNAs of RAD51.

RAD51 was upregulated in ACGEJ tumors compared with control tissues (P < 0.05). High RAD51 level was correlated with a poor prognosis in stomach adenocarcinoma and esophageal cancer. The meta-analysis showed that high RAD51 level was correlated with a poor prognosis in TCGA pan-cancers (P = 0.03). Six regulatory miRNAs of RAD51, including hsa-miR-182, hsa-miR-221, and hsa-miR-34a, were downregulated in ACGEJ tumor tissues and were associated with pathways including “fatty acid biosynthesis” and “viral carcinogenesis”.

RAD51 is a potent prognostic biomarker in ACGEJ. MiRNAs including hsa-miR-182, hsa-miR-221, and hsa-miR-34a might play crucial roles in ACGEJ by regulating the RAD51 gene.

Falls have been one of the leading causes of injury-related deaths among the elderly, having an increasing trend in many countries. We investigated trends of fall-related mortality among people aged ≥65 yr in Serbia.

Based on official data, we calculated unintentional fall-related mortality rate (MR) from 1998 to 2017, using join point regression analysis to determine annual percentage changes (APC). Starting from 2005, doctors from Serbian Public Health Institute have been controlling the quality of death certificates.

  In the 1998-2004 period, MR decreased in men and women aged 65-74 and men aged ≥85 (by -12.4; -13.0; and -15.1% yearly) followed by an upward trend in men and women aged 65-74 (by 76.3 vs.40.2%yearly) from 2004 to 2007 and men aged ≥85 (by 13.7% yearly) from 2004 to 2017. MR decreased among women aged ≥85 (by-9.8% yearly) from 1998 to 2008 and then increased (by 9.0% yearly) from 2008 to 2017. In men and women aged 75-84, an increase of MR (by 7.4 vs.3.1%) was observed during the entire study period. In all age groups, except women aged ≥85, significant negative correlation was found between fall-related deaths and ill-defined and unknown causes of deaths.

  Control of death certificates by physicians from the Institute of Public Health led to the better reporting of the increasing trend of fall-related mortality among the elderly. Policy makers must investigate risk factors for fall and then adopt national guidelines for prevention and treatment of fall-related injury.

The study aimed to discuss the influences of 24-form Tai Chi on cardio-pulmonary functions, exercise performances, and cognitive functions of the aged.

Forty old people in Pingdingshan of China were selected through convenient sampling method from 2020 to 2021. They were randomly divided into the observation group (n=20) and the control group (n=20). The observation group exercised 24-form Tai Chi for 8 weeks, three times per week, 45 min per session. The respondents were evaluated by cardiopulmonary exercise testing, sitting-standing test, 6-min walking test, and the Berg balance scale. The P300 test was performed to evaluate the cognitive functions of respondents.

After the intervention, the observation group was significantly (P<0.05) superior to the control group concerning maximal oxygen consumption, anaerobic threshold, vital capacity, stroke volume (SV), cardiac output (CO), left ventricular end-diastolic diameter (LVEDD), left end-diastolic velocity (EDV), sitting-standing test, 6-min walking test, and the Breg balance function scores, showing statistically significant differences (P<0.05). The content of body fat and body mass index (BMI) of the observation group decreased significantly, whereas muscle mass and fat-free mass increased dramatically, which were however significantly lower than those of the controlled group (P<0.05). Moreover, the P3b amplitude of the observation group increased significantly (P<0.05) and was significantly higher than that of the control group (P<0.05).

The 24-form Tai Chi not only improves cardio-pulmonary functions and exercise performances of the aged but also increases cognitive functions of the aged.

The lack of physical activity because of restrictions from the pandemic has increased interest in the deterioration of mental and physical health. This is the first study in Korea to investigate how participation in physical activity is correlated with subjective well-being among Koreans in the early stages of the COVID-19 pandemic.

The survey was conducted among those aged >13 years, from August 24 to September 7, 2020. The process included self-reported surveys, telephone surveys, and face-to-face household interviews; 11,604 people (men=7,758 and women=3,846) participated. Frequency, correlation, and one-way analysis of variance were performed to identify differences between age and sex groups according to the physical activity level, while post-hoc Scheffe tests to examine between-group differences when significant results were observed.

Statistically significant correlations were observed between life satisfaction, living environment satisfaction, and levels of happiness and anxiety based on sex and age (P<0.05). There were significant differences between frequency and time spent on physical activity and subjective well-being according to sex and age (P<0.05).

The study results are highly generalizable considering the analysis of a large-scale sample within a big area in Korea. The findings emphasize that subjective well-being is influenced by sex, age, frequency, and time spent engaged in physical activity. Such basic data can be helpful for establishing policies related to physical activity.

Cirrhosis due to alcohol-related liver disease (ALD cirrhosis) is a significant burden to health systems worldwide. We aimed to determine the trends in hospitalization frequency due to ALD cirrhosis and to analyze their characteristics.

This cross-sectional study used data from the Institute of Public Health of Belgrade database, and included all hospitalization reports which contained code K70.3 (Cirrhosis hepatis alcoholica) as the primary diagnosis, including re-hospitalizations, on the territory of Belgrade, between January 2009 and December 2018.

A total of 4644 patients with ALD cirrhosis were hospitalized (male: 4154, 89.45%), with a mean age of 58.83±10.02 years. During the 2009-2018 decade, no difference in the number of ALD cirrhosis hospitalizations in subsequent years was observed. Men more commonly developed esophageal and gastric varices with bleeding compared to women (P=0.037), while women developed acute-on-chronic liver failure (ACLF) almost two-times more often compared to men (P<0.001). Patients with hepatocellular carcinoma were significantly older (P<0.001), while those who developed ascites and splenomegaly were significantly younger compared to those who did not (P<0.001 and P=0.04, respectively). Altogether, complications of portal hypertension were registered and reported with very low frequency, and therefore do not represent actual frequencies of these conditions. The median duration of hospital stay was 9 days (range 0-243). Patients in whom lethal outcome occurred during the hospitalization were significantly older, and more commonly developed chronic renal failure.

These data offer an important insight into the ALD cirrhosis-related hospitalizations while drawing attention to inadequate coding as an important public health issue at the same time.

LncRNA FGD5-AS1 regulates the pathogenesis of many human diseases. We aimed to elucidate the function of lncRNA FGD5-AS1 and the regulatory mechanism of lncRNA FGD5-AS1/miR-129-5p in myocardial ischemia-reperfusion (I/R) injury.

Myocardial I/R injury mice model and H/R treated H9c2 cells were established. RT-qPCR and Western blot analysis were used to detect the mRNA and protein expression. Cell viability was detected by MTT assay. Dual luciferase reporter assay was applied to confirm the relationship between lncRNA FGD5-AS1 and miR-129-5p.

LncRNA FGD5-AS1 was upregulated in myocardial I/R injury mice models and H/R treated H9c2 cells. Functionally, knockdown of lncRNA FGD5-AS1 promoted cell viability and inhibited apoptosis in H/R treated H9c2 cells. In addition, lncRNA FGD5-AS1 directly targets miR-129-5p. Upregulation of lncRNA FGD5-AS1 weakened the protective effect of miR-129-5p on myocardial I/R injury.

LncRNA FGD5-AS1 aggravates myocardial I/R injury by downregulating miR-129-5p.

Effective care of any trauma is a priority in all health care systems. If a patient gets adequate treatment within "golden hour" from the injury the prognosis is better, but not as the only factor. The objective was focused on the influence of time and spacial distance of the hospital from the accident as determinant factors of survival, all in the aim Public Health System of Montenegro reorganisation for better accessibility for traumatized persons from 2011-2020.

Among 334 subjects, three groups were defined according to the type of injury: bleeding, ashpyxiations, and cranio-cerebral injuries. In every group lethal and non-lethal subjects were analyzed.

Cut-off values are given by ROC curves following proximity and transportation time to hospital specific for injury sustained, as well as for nearest hospital, showed significant differences for proximity of any hospital for bleeding and asphyxiation injuries, and for proximity of any hospital and transportation time to the hospital specific for the sustained cranio-cerebral injury.

Most of the seriously injured patients with bleeding or asphyxiation could be taken care of in any hospital while for cranio-cerebral injuries the specific hospital is crucial. How it is very often about, different organ systems are usualy injured in single patient, so the forming of easily available trauma centers net is the best solution for Montenegro, which is necessary for better survival rates.

We aimed to explore the ole and mechanism of lactate receptor (HCAR1) in the angiogenesis of leptomeningeal fibroblast-like cells.

Human brain fibroblast-like cells were selected and some cells were deactivated, analyzed and compared with HCAR1 mRNA and protein expressions in deactivated/normal cells. HCAR1-/- mice and wild type (WT) mice were selected and divided into WT, WT exercise, HCAE1 KO and HCAE1 KO exercise groups, with 10 mice for each group. HCAR1mRNA and expression levels of proteins in fibroblast-like cells, mRNA and expression levels of proteins in Collagen IV, phosphatidylinositol trihydroxykinase (PI3K), serine threonine kinase (AKT) and extracellular signal-regulated kinases 1 and 2 (ERK1/2) in hippocampus were compared, and the microvessel density (MVD) and diameter were calculated.

mRNA and expression levels of proteins in Collagen IV, PI3K, AKT, ERK1/2 and MVD in hippocampus were significantly higher in the WT exercise group than those in the WT group, microvessel diameter was significantly lower than that in the WT group (P<0.05). mRNA and expression levels of proteins in Collagen IV, PI3K, AKT, ERK1/2 and MVD in hippocampus in the HCAR1 KO and HCAR1 KO exercise groups were significantly lower than those in the WT group, microvessel diameter was higher than that in the WT group (P<0.05). Compared with the HCAR1 KO exercise group, the changes of mRNA in Collagen IV, PI3K, AKT, ERK1/2 and microvascular were not significant.

Exercise can promote cerebral angiogenesis through the activation of the lactate receptor HCAR1 and the ERK1/2-PI3K/Akt signaling pathways.

The study conducted a component analysis of the dynamics of the incidence of breast cancer (BC) in Karaganda region.

Primary data were for registered patients with BC (ICD 10–C50) in Kazakhstan, Karaganda region the period of 2009-2018. Evaluation of changes in BC incidence in the population of Karaganda was performed using component analysis according to the methodological recommendations.

Overall, 4,391 new cases of BC and 1,202 deaths were recorded. The incidence rate increased from 44.4 (2009) to 72.7 in 2018 and the overall growth was 28.37 per 100,000 population of female, including due to the age structure – ∑ΔA=3.13, due to the risk of acquiring illness – ∑ΔR=22.69 and their combined effect – ∑ΔRA=2.56. The component analysis revealed that the increase in the number of patients with BC was mainly due to the growth of the population (ΔP=+3.7%), changes in its age structure (ΔA=+10.3%) and changes associated with the risk of acquiring illness (ΔR=+75.0%). The mortality rate in the region changed from 18.6 (2009) to 10.9 (2018) and tended to decrease.

The role of the influence of demographic factors and the risk of acquiring illness on the formation of the number of patients and the incidence of BC was evaluated. In this region, these indicators were the highest. The implementation of the results of this study is recommended in management of anticancer activities for BC.

We aimed to compare the clinical effects of continuous renal replacement therapy (CRRT) with different hemofilters in patients with septic shock and acute kidney injury (AKI).

Thirty patients with septic shock complicated with AKI admitted to The Fourth Affiliated Hospital of Anhui Medical University from 2018-2020 were selected and divided into the control and observation groups. The control group was treated with CRRT using the conventional ST-100 hemofilter. The observation group was treated with CRRT using the oXiris hemofilter for 48 hours, followed by CRRT with the conventional ST-100 hemofilter. Infection indexes, sepsis-related organ failure assessment (SOFA), changes in corresponding organ function indexes, duration of each treatment, and death were compared between the two groups during CRRT.

The white blood cells (WBC) count, high-sensitivity C-reactive protein (hs-CRP), and procalcitonin (PCT) levels were significantly decreased in the oXiris group 48 hours after CRRT (P= 0.048, 0.036, 0.031, respectively). After 48 hours of CRRT, SOFA score, serum lactic acid, and norepinephrine dose in the oXiris group were significantly lower than those in the control group (P= 0.039, 0.002, 0.021, respectively). The use time of vasoactive drugs and the treatment time of CRRT in the oXiris group was significantly shortened (P= 0.031 and 0.029, respectively). However, there were no significant differences in mechanical ventilation duration, intensive care unit (ICU) hospitalization time, total hospitalization time, ICU mortality, and in-hospital mortality.

For patients with septic shock complicated by AKI, CRRT treatment with the oXiris hemofilter could effectively clear inflammatory cytokine levels and quickly correct hemodynamic disorders, thus accelerating the recovery of organ function.

Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system characterized by infiltration of inflammatory leukocytes to the CNS followed by oligodendrocyte cell death, myelin sheath destruction, and axonal injury. A logical incidence occurring after demyelination is remyelination. G-protein coupled receptors (GPCRs) activate internal signal transduction cascades through binding to different ligands. This family of receptors are targeted by more than 40% of currently marketed drugs. GPCRs can be successfully targeted for induction of remyelination. GPCRs highly enriched in oligodendrocyte progenitor cells compared to oligodendrocytes are proposed to hamper oligodendrocyte differentiation and therefore their inhibition might induce remyelination. This study aimed to investigate the expression of GPCRs in silico and in vitro.

We performed gene expression analysis using DAVID and Panther websites on a RNA-seq dataset (GSE52564 accession number). Primary embryonic neural stem/progenitor cell isolation and culture were performed and subsequently NSPCs were characterized by Immunocytochemistry with Anti-Nestin antibody. Expression of GPR37L1, EDNRB, PDGFRα, CNPase and GFAP were assessed using real-time PCR. All the experiments were conducted at Shiraz University of Medical Sciences (SUMS), Shiraz, Iran, in the year 2018.

The 14 most highly expressed GPCRs in oligodendrocyte progenitor cells (OPCs) compared to Oligodendrocytes were presented in our study.

The investigation of the most highly expressed GPCRs in OPCs compared to oligodendrocyte in silico and in vitro presents the significant role of GPCRs in remyelination induction. Among the 14 GPCRs mentioned in this study, GPR37L1 is a potential remyelinating drug target and is suggested for further studies.

Multi-drug resistant (MDR) Klebsiella pneumoniae strains cause the majority of community acquired and life-threatening infections. We aimed to detect the gyrA mutations in the clinical strains of nalidixic acid and ciprofloxacin resistant K. pneumoniae isolated from the patients with urinary tract infections.

Bacterial strains were isolated from the patients with urinary tract infections admitted to a major hospital in Tehran, Iran (2017-2018). Bacterial identification was done according to standard microbiological tests. Antimicrobial susceptibility testing for quinolones and fluoroquinolone antibiotics was done using both disc diffusion and minimal inhibitory concentrations (MICs) methods. PCR-RFLP was used to detect the probable mutation in the gyrA gene in nalidixic acid and ciprofloxacin resistant strains. Finally sequencing was performed to detect point mutations in isolated K. pneumoniae strains.

One hundred K. pneumonia isolates were recovered from the urine samples of the clinical cases. Antibiotic resistance testing showed that among all K. pneumoniae isolates, 26% and 19% of the strains were resistant to nalidixic acid and ciprofloxacin respectively. MIC value was ≥4 µg/ml for ciprofloxacin resistant isolates. The results of RFLP on gyrA PCR amplicons using HinfI restriction enzyme showed point mutation in this gene in 46% of nalidixic acid and ciprofloxacin resistant K. pneumonia. The data obtained from the sequencing confirmed the RFLP results and indicated the presence of point mutations in codons 83 and 87 in the gyrA gene which leads to the substitution of different amino acids in gyrA protein.

Our findings indicated a relative increased rate of resistance against quinolones and fluoroquinolone antibiotics that raised a concern about extensive dissemination of clinical strains of nalidixic acid and ciprofloxacin resistant K. pneumonia. Point mutation of gyrA gene was responsible for the resistance in our strains however to gain more insight into the molecular characterization of quinolone-resistant isolates, other possible mechanisms of the resistance should also be investigated.

Research on the role of social problem-solving in the relationship between autistic traits and depression is still in its nascent stage and more detailed research is required.

We aimed to investigate the mediating role of problem-solving in the relationship between autistic traits and depression. A sample of 376 university students were assessed on depression, problem-solving and autism-spectrum quotient in 2019 at Shahed University, Tehran, Iran.

Social problem-solving played the role of a partial mediator in the relationship between autistic traits and depression. Positive problem orientation and negative problem-solving style fully mediated the effects of autistic traits on depression.

Since people with autistic traits have deficits in problem-solving strategies, they may be vulnerable to symptoms of depression. Increasing the ability of positive problem-solving and decreasing negative problem orientation may serve as a buffer against depression in people with autistic traits.

Self-rated health (SRH) indicator is widely used and recommended in health research as a standard indicator for measuring health in different populations. This paper reports SRH of employees at Tehran University of Medical Sciences (TUMS), Tehran, Iran; and its related factors.

We used the TUMS Employee's Cohort Study (TEC) data, collected from September 2017 to August 2019. SRH of 2158 employees were assessed using a single question. Univariate and multivariate logistic regression were performed to determine factors associated with sub-optimal SRH.

Overall, 14.9% (n = 321) of respondents rated their health as sub-optimal. Differences were observed with subgroups. Women, lower socioeconomic status (SES), experiences of more economic fluctuation conditions and lower reading scores could predict sub-optimal SRH variations in crude and adjusted regression analyses. The age, social capital, work experience and employment status could predict sub-optimal SRH variations only in crude regression analyses (P<0.05).

Differences in SRH report reflected differences in socioeconomic conditions. The biggest gap was observed between people of different SES (five times). Considering that SRH reflected socioeconomic characteristics of individuals, it may be considered as a quick, non-expensive, and simple way of identifying groups in need of addressing their social determinants of health.