The use of antibiotics has been associated with the sizeable cutback of infectious disease mortality. Antibiotics also tremendously support the treatment of cancer, transplantation and many other surgeries. Currently, the development of new antibiotics has been slow down. Besides, there is a rapid process of antimicrobial resistance (AMR) against almost all available antibiotics. Moreover, there is quick progress of microbial development with multiple antibiotic resistant which adds more fatality. An independent search was performed from inception until January 2019 using electronic databases, including Medline, Scopus, Web of Science and PubMed for published articles. Seventeen articles were included; six among the medical professionals and students and 11 among the general public across the country. The quality of the included studies was deemed average. Medical, pharmacy and other university subjects' students' knowledge level were low to average. Often, medical and pharmacy students' knowledge level was better than others. One study clearly denoted that there is a gap between theoretical and practical input regarding antibiotic prescribing. Although medical officers and general physician knowledge level was good, but actual real-life attitude and practice cannot be assessed because of the study design. Common people had a lot of misunderstanding regarding antibiotic use and AMR. All these studies incorporated suggested that further educational intervention is warranted to promote prudent use of antibiotic and prevent AMR. This review similarly advocates educational interventions among all stakeholders of healthcare with a special emphasis on antibiotics stewardship and regulatory enforcement programme to promote rational use of antimicrobial and to prevent AMR.

Background: Preterm premature rupture of the membranes (PPROM) is a condition that can occur in pregnancy as well as causes one-third of all preterm births. The aim of our study was to assess the perinatal outcome in PPROM after 34 weeks' gestation. Materials and Methods: This historical cohort study was conducted by 602 pregnant participants, including 300 women with PPROM and 302 women without PPROM between 34 and 37 weeks who were admitted at Qom's Izadi Hospitals during April 2013 and March 2015, Iran. Data were extracted from the patient's dossier and entered in checklist. Then were analysed by the t-test and Chi-squared and Fisher's exact tests in SPSS software. Results: The mean maternal age of the participants was 28.8 years (range: 16–51 years). The independent t-test showed that the mean of infant weight (P = 0.002) and Apgar score in the 5^th min (P = 0.044) after delivery was statistically significant between no-PPROM and PPROM groups. There was a significant difference regarding receiving corticosteroid (odds ratio [OR] = 0.2.05), lower birth weight 2500 g (OR = 1.44), girls gender of baby (OR = 1.24), respiratory distress syndrome (RDS) (OR = 1.81), unhealthy infant (OR = 4.44), sepsis (OR = 1.60), tachypnoea (OR = 2.03) and other neonatal complications (OR = 1.702). Conclusion: RDS, sepsis, tachypnoea and other perinatal outcomes are more common in women with PPROM. Hence, in view of the unfavourable outcome, preventive measures and control of PPROM are essential.

Introduction: Dengue, an arthropod-borne disease caused due to dengue virus belonging to Flaviviridae, is a serious health problem globally. Currently, there is no licensed vaccine for prophylaxis of the infection or an effective drug regimen for treatment. The virus genome codes for three structural and seven non-structural proteins. Envelope protein is required for the attachment and binding of the virus to the host cells, viral replication and hence, it can act as a good antiviral target. Method: We intend to evaluate the antiviral activity of compounds from both natural and synthetic sources by using tools of bioinformatics and computational biology. The favourable sites for drug binding, ligand interaction were analysed by various modules of Schrodinger software (2016-1). Results: Results indicated the amino acids – cysteine 3, arginine 2, threonine 155, tyrosine 132 and asparagine 194 show major interactions such as van der Waals and hydrophobic interaction with the different functional groups of the drug molecules. Conclusion: We observed the natural compounds such as rutin, gallic acid and ellagic acid showed better binding affinity in comparison to the synthetic antiviral drugs such as acyclovir, tenofovir and oseltamivir on different sites of the envelope protein suggesting the plausible anti-dengue viral property.

Introduction: Pentoxifylline (PEN) is a xanthine derivative used as a drug to inhibit the inflammatory factors activity, reduce blood viscosity and improve peripheral blood flow. Proteins play the most important role in reproductive parameters. The aim of the present investigation is to evaluate the effects of PEN against high-protein diet (HPD)-induced damage to the reproductive parameter of male rats. Materials and Methods: In this experimental study, 48 male rats were randomly divided to 8 groups: sham (normal protein diet) and HPD (35% protein) groups; PEN groups (25, 50 and 100 mg/kg) and HPD + PEN groups (25, 50 and 100 mg/kg). Animals of the HPD group have fed with high protein daily for 10 months. Daily PEN treatment was injected intraperitoneally. The sperm parameters, spermatogenesis index, total antioxidant capacity, testosterone level and seminiferous tubule diameter were analysed. Results: The values of all reproductive parameters reduced significantly in the HPD group compared to the sham group (P < 0.01). The whole doses of PEN and PEN + HPD groups increased all parameters significantly compared to the HPD group (P < 0.01). Conclusions: No significant modifications were observed in PEN groups in all doses compared to the sham group. PEN relieved the effects of HPD on reproductive parameters.

Background: Dietary intake of Vitamin D is an effective public health strategy to improve the current low Vitamin D status of populations. This research aimed to identify subpopulations at greater risk for Vitamin D deficiency. We studied the sociodemographic factors that are potentially associated with dietary intake of Vitamin D in the Iranian population. To do so, we used a marginalised two-part (MTP) model to control for the substantial proportion of zero Vitamin D intake. Methods: Data from 180 cross-sectional random samples were recorded. Dietary intake of Vitamin D was assessed using a 168-item validated food frequency questionnaire. Sociodemographic factors associated with intake of Vitamin D were explored using MTP-Weibull. Results: Mean (standard deviation) daily dietary Vitamin D intake was 0.54 (0.70) μg/day which was below the standard recommended level for all participants. The 'fish, milk and eggs' food group contributed 50% of total dietary intake of Vitamin D. Higher intake was associated with higher levels of education (P = 0.003). Furthermore, the odds of Vitamin D intake was associated with smoking status (odds ratio = 0.613, confidence interval: 0.407–0.914); where smoking decreases the chance of having a non-zero Vitamin D intake by 38.7%. Conclusion: Dietary intake of Vitamin D is below the recommended levels in our study in Iran, a developing country. We identified that education level and smoking status are associated with low intake. This result could lead to the straightforward recommendation for smokers and less-educated individuals to increase their intake of Vitamin D-rich foods.

Introduction: Oxidative stress is largely implicated in a molecular mechanism involving initiation, development and progression of leukaemogenesis. Trévo^® supplement is a multiherbal formula produced from various phytonutrients with antioxidant potential. We investigated the antioxidant activities of Trèvo^® supplement as a prospect for leukaemia treatment. Materials and Methods: The study was carried out on 36 Wistar rats weighing between 140 g and 160g. They were randomly divided into six groups. Group 1 (positive controls) were induced with 0.2 ml benzene chromosolv solution 48 hourly for 4 consecutive weeks and fed with rat pellets without Trévo^® supplement. Group 2 (negative controls) received only rat pellets. Group 3 received only normal dose of Trévo^® supplement with rat pellets. Groups 4, 5 and 6 were induced for 4 weeks followed with low-, moderate- and high-dose Trévo^® supplement for 3 weeks with rat pellets, respectively. Glutathione (GSH), catalase (CAT), malondialdehyde (MDA), total protein (TP) and gamma-glutamyltransferase (GGT) plasma concentrations were assayed simultaneously. Results: Induction of leukaemia was evidenced in positive controls by elevated total white blood cell counts (marked with lymphocytosis) and mild anaemia with reduced haemoglobin counts. Furthermore, GSH, CAT and TP levels for graded dosages of Trévo^®-treated groups (following benzene induction) showed statistically significant elevations (P < 0.05) compared to the benzene-induced positive controls, whereas MDA and GGT levels with high-dose Trévo^® treatment showed statistically significant reductions (P < 0.05) compared to the positive controls. Conclusions: Trévo^® supplement exhibited profound antioxidant potential indicated by improvement from leukaemia after oral administration. This amelioration is believed to be associated with the nutritional supplement in a dose-dependent manner.

Introduction: Invasive cervix cancer is one of the most common causes of female genital cancer and accounts for 30% of cancers in developing countries and 5% in developed countries. Economic, social and sexual differences are associated with an increased risk of the cancer in women. Methods: This is a descriptive–analytic study based on incidence and mortality data extracted from the World Cancer Bank. The incidence and mortality rates and cervix uteri cancer distribution maps were drawn for world countries. To analyse data, correlation test and regression tests were used to evaluate the correlation between the incidence and mortality with Human Development Index (HDI). The statistical analysis was carried out by Stata-14, and the significance level was estimated at the level of 0.05. Results: The results showed a significant negative correlation between cervix cancer incidence rate (r = −0.570,P < 0.001) and mortality (r = −0.699,P < 0.001) with the HDI index. Negative and significant correlation was found between the incidence rate with the gross national income (GNI) (r = −0.37,P < 0.0001), Mean years of schooling (MYS) (r = −42,P < 0.0001), Life expectancy at birth (LEB) (r = −0.64,P < 0.0001) and Expected years of schooling (EYS) (r = −0.41,P < 0.0001). There was a significant negative correlation between the mortality rate and GNI (r = −0.42,P < 0.0001), MYS (r = −0.57,P < 0.0001), LEB (r = −0.73,P < 0.0001) and EYS (r = −0.56,P < 0.0001). The linear regression model showed that the increase of HDI (B = 91.8, confidence interval [CI] 95%: [−146.6, −37]) and LEB (B = −0.86, CI 95% [−1.3, −0.3]) decreased and increased MYS (B = 1.31, CI 95% [0.05, 2.5]) and EYS (B = 2.9, CI 95% [1.5.4.4]) significantly increased the incidence of cervix uteri (P < 0.05). Linear regression model showed that the increase of HDI [B = 91.8, CI95%: (-146.6, -37)] and LEB [B = -0.86, CI95% (-1.3, -0.3)] decreased the incidence and increase of MYS [B = 1.31, CI95% (0.05, 2.5)] and EYS [B = 2.9, CI95% (1.5.4.4)] significantly increased the incidence of cervical uteri (P <0.05). And increased HDI [B = 89.3, CI95% (-124.9, -53.8)] and [B = -0.3, CI95% (-0.6, -0.04)] reduced mortality and increased GNI [B = 0.009, CI95% ( 0.001, 0.1)], MYS [B = 0.8, CI95% (1.1.2.9)] and EYS [B = 2.04, CI95% (1.1.4.9)] significantly increased mortality of cervical cancer (P <0.05). Conclusion: Women in moderate to low HDI societies face poor socioeconomic conditions and should be considered as target groups for the prevention of cervix cancer. Moreover, prevention interventions should be focused on this group to ultimately bring about a positive change in the level of morbidity and mortality caused by cervix cancer.

Background: Workers have to spend a substantial proportion of their income on foods and despite the high prevalence of stress among them, little is known about the association of dietary patterns and mental health disorders in this group. We examined whether dietary patterns are associated with depression and anxiety risk in the Iranian workers of steel mill company. Materials and Methods: We conducted a cross-sectional study among 3060 workers (2803 males and 260 females) in 2015. Dietary intake was assessed using a validated semiquantitative food frequency questionnaire during the preceding year, and depression and anxiety were evaluated using a Persian-validated Hospital Anxiety and Depression Scale. Major dietary patterns were determined using exploratory factor analysis and the risk of depression and anxiety was assessed across the tertiles of dietary patterns using logistic regression. Results: Three dietary patterns were identified: healthy (loaded by fruit, vegetables and skim dairy products), Western (loaded by processed foods, butter and sweets), and Iranian traditional diet (loaded by refined grains, red meat, poultry and legumes). After adjustment for various confounders, individuals in the highest tertile of healthy diet had lower risk of depression (odds ratio [OR]: 0.47; 95% confidence interval [CI]: 0.32, 0.68) and anxiety (OR: 0.71; 95% CI: 0.52, 0.99) compared with those in the first tertile, whilst greater adherence to the Iranian traditional diet was associated with increased risk of depression (OR: 1.82; 95% CI: 1.24, 2.67) and anxiety (OR: 1.50; 95% CI: 1.08, 2.09). The Western-style diet was marginally associated with increased risk of depression, but not anxiety. Conclusion: Overall, we found healthy diet might be associated with decreased risk of depression and anxiety, but the Iranian traditional diet might be associated with increased risk of depression and anxiety. Therefore, to improve public health, Iranian traditional diet should be adjusted according to the healthy diet recommendations.

Background: This study was conducted with the aim of determining the diagnostic accuracy of a magnetic resonance imaging (MRI) scan before surgery in evaluating the tear of the subscapularis tendon in comparison with the actual results obtained from arthroscopy. Materials and Methods: This retrospective study was conducted on medical records of 85 patients who underwent shoulder arthroscopic surgery suspected to subscapularis tendon tears which referred to the Besat Hospital (Hamadan, Iran) during 2012–2013. In the present study, the MRI was considered as a screening method and arthroscopy results were considered as the gold standard, and sensitivity, specificity, positive predictive value and negative predictive value were computed for MRI compared arthroscopy. Results: The sensitivity, specificity, positive predictive value and negative predictive value of MRI for the identification of incomplete tear were 28.57%, 100%, 100% and 63.77%, respectively, whereas had perfect sensitivity, specificity and positive and negative predictive value for detecting complete tear. In overall, sensitivity, specificity, positive and negative predictive values of MRI for detecting all types of ruptures were 39.02%, 100%, 100% and 63.77%, respectively. Conclusion: According to this study, MR images are a highly specific method with high positive and negative predictive values for the diagnosis of complete subscapularis tendon tear. However, the sensitivity for the incomplete tear of subscapularis tendon is not such high.

Background: Labour pain is the most severe pain experienced by a mother during her lifetime. This study aims to encourage normal delivery, reduce caesarean section, and morbidity by comparing two fentanyl–bupivacaine and sufentanil–bupivacaine combination as spinal anaesthetics of the mothers who referred to Ayatollah Mousavi Hospital in Zanjan in the active phase of delivery. Materials and Methods: This study was performed on 90 pregnant women with active phase of labour who were divided into three groups. The first group received 50 μg fentanyl and 2.5 mg bupivacaine and the second group received 5 μg sufentanil and 2.5 μg bupivacaine by spinal injection and the third group received no intervention. The severity of analgesia and maternal and neonatal outcomes were recorded. To compare the data, ANOVA, t-test and Chi-square test were used. Results: Our study showed that the duration, the first and second stage of labour, did not show significant difference between three groups (P > 0.05). Sufentanil has a faster return pain duration (P = 0.37). Patients in Group A had more severe pain (3.93 vs. 4.73,P = 0.001). Return the sense was significantly longer for fentanyl (P = 0.001). In sufentanil group, 40% were in T8–T10 level, while in fentanyl use group, 20% were categorized in this range. Conclusion: The present study reported that the use of fentanyl or sufentanil in combination with bupivacaine for spinal analgesia as a low-risk method for controlling labour pain, although it seems that the combination of sufentanil–bupivacaine is more effective.

Background: Prostate cancer is one of the most common cancers in men and is the second leading cause of death, especially in developed countries. Therefore, the aim of this study was to investigate the incidence and mortality of prostate cancer and its relationship with the human development index (HDI). Materials and Methods: This is an ecological review of the incidence of prostate cancer and its relation with HDI and its components in 2018. Data about the incidence and mortality rate of breast cancer for the year 2018 were obtained from the global cancer project for 185 countries. To analyse data, correlation test and regression tests were used to evaluate the correlation between the incidence and mortality with HDI. The statistical analysis was carried out by Stata-14, and the significance level was estimated at the level of 0.05. Results: The result showed that there is a positive and significant correlation between the incidence (R = 0.531,P < 0.001) and mortality (R = −0.219,P < 0.001) of prostate cancer with HDI. The linear regression model showed that the increase in HDI, mean years of schooling (MYS), expected years of schooling (EYS), life expectancy at birth (LBE) and gross national income was associated with an increase in the incidence of prostate cancer in men, but it was statistically significant only in MYS (B = 3.6,P < 0.05) and EYS (B = 4.8,P < 0.05). Furthermore, the increase in life expectancy at birth (B = −0.45,P < 0.05) significantly decreased mortality. Conclusion: By increasing the HDI the incidence of prostate cancer increases, but the mortality rate decreases. Therefore, HDI can be used to provide a clear picture of the distribution of this cancer. Having a comprehensive picture of the epidemiological features and changes of prostate cancer has a significant role to play in preventing, diagnosing and treating early, and reducing mortality.

Objective: Tuberculosis (TB) is a global health concern and is one of the main reasons responsible for the death of people by infectious diseases. We conducted this study to investigate the effect of human development index (HDI) on the incidence of TB in Asia. Methods: This ecological study was conducted in Asia to evaluate the correlation between the incidence of TB and HDI (life expectancy at birth, years of education mean and gross national income per capita). Data on TB from 2000 to 2016 were obtained from the World Bank Institution. The bivariate method and regression test were used to evaluate the correlation between incidence and mortality with HDI. Statistical analysis was conducted using Stata-14, and the significance level was considered 0.05. Results: In the recent years, the most occurrence of this disease in Eastern Asia is reported in Democratic Republic of Korea (513 persons/100,000), South-Eastern Asia in Philippines (520–590 persons/100,000), Cambodia (345–575 persons/100,000) and Timor-Leste (498 persons/100,000). A significant negative correlation was found between the incidence of TB and the HDI index in South Eastern (R = −0.609,P < 0.05) and South Central Asia (R = −0.793,P < 0.05). The results of regression analysis indicated that the increase in life expectancy at birth (LBE) (B = −11.45,P < 0.05) and MYS (B = −9.6,P < 0.05) caused a statistically significant decrease in the incidence of TB as well. Conclusion: The incidence of TB has a correlation with the human development index (HDI) in several Asian countries. Therefore, to reduce the incidence of the disease and prevent from it, the human development index should be considered as an effective factor in the occurrence of the disease, particularly in developing countries.

Introduction: Restoring Class II lesions in deciduous molars has always been a nightmare for the dentist. This survey was designed to understand the perception of dentists regarding the treatment choice. Aim: The aim of this study is to determine the choice of material and influencing factors for the treatment of proximal lesions in primary molars. Materials and Methods: The cross-sectional web-based survey enclosing nine closed-ended questions was conducted among 180 paediatric dentists and post-graduates of Gujarat. Data were obtained and evaluated at the statistical significance level ofP < 0.05. Results: For 65% of respondents' stainless steel crowns (SSCs) was preferred material for the treatment of cavitated Class II lesions followed by composite and for non-cavitated incipient proximal lesions silver diamine fluoride was preferred by 71% of respondents. Childs age and child's behaviour were the most influencing factors affecting the choice of material (P < 0.001). Conclusion: Different clinical situation requires a different choice of material. The present study enlightens current perception and preference regarding the material of choice in a different situation while restoring Class II lesions in primary molars. We concluded that SSC was the most suitable material of choice amongst a wide range of materials by paediatric. The older concept 'excavation for prevention' is still applied as compared to newer minimal invasive strategies. Many factors contribute to the treatment and material choice for restoring Class II lesions; thus, one ultimate material cannot be selected for all kinds of situations. Thus, it highlights the current trends followed among paediatric dentist.

Tumour lysis syndrome (TLS) is a potentially life-threatening complication of the tumour. This syndrome consists of laboratory parameters such as hyperuricaemia, hyperkalaemia, hyperphosphataemia and hypocalcaemia and clinical complications such as acidosis, seizures, acute renal failure, cardiac arrhythmias and ultimately even death. TLS is especially standard in patients with haematological malignancies with rapid cellular turnover rates such as acute lymphocytic leukaemia, Burkitt lymphoma and diffuse large cell lymphoma, but is very rare in patients with solid tumours. T-cell acute lymphoblastic leukaemia is aggressive leukaemia, a subtype of acute lymphoblastic leukaemia accounts for 15% of children and 25% of adult acute lymphoblastic leukaemia. Diagnostic confirmation of T-cell acute lymphoblastic leukaemia (T-ALL) in this case done through utilising flow cytometry which is one of the best diagnostic tools for acute leukaemia, further diagnosed with a cortical T-ALL, a subtype of T-ALL, initially responded well in pre-phase induction chemotherapy (oral prednisolone 40 mg for 7 days). TLS developed after the 2^nd day of 40 mg oral prednisolone with hyperkalaemia and hyperphosphataemia. The prevention of TLS now considered more effective than the treatment and identification of the high-risk patient and taking preventive support is a crucial research area. Herein, this manuscript discusses a case of the TLS the acute management.