Tetralogy of Fallot is the most prevalent cyanotic CHD. With the advent of advanced surgical methods, the majority of tetralogy of Fallot patients reach adulthood. However, many need re-intervention for the residual anomalies including residual right ventricular outflow obstruction, pulmonary regurgitation, residual ventricular septal defects, and progressive aortic dilatation. Aortic dilation could lead to aortic regurgitation or dissection requiring surgical correction. In the current study, we aimed to determine the prevalence and outcomes of aortic root dilatation in adults with repaired tetralogy of Fallot in our tertiary care centre.

In this retrospective study, 730 consecutive patients with history of repaired tetralogy of Fallot were included. Aortic diameter at the level of annulus, the sinus of Valsalva, sinotubular junction, and the ascending aorta as measured by echocardiography were evaluated. Prevalence of outcomes necessitating re-intervention including aortic regurgitation and dissection were recorded.

The mean size of annulus, sinus of Valsalva, sinotubular-junction, and ascending aorta in the latest available echocardiography of patients were 2.4+/-0.4 cm, 3.3+/-0.5 cm, 2.9+/-0.5cm, and 3.2+/-0.5cm, respectively. Prevalence of dilatation of sinus of Valsalva, dilation of Ascending aorta, sinotubular-junction, and aortic annulus was 28.7%, 21%, 8.3%, and 1 %, respectively. Five patients had severe aortic regurgitation (0.6%) and underwent surgical repair. One of these patients presented with acute aortic dissection.

Aortic dilation is common in tetralogy of Fallot but prevalence of redo surgery for aortic dilation, regurgitation, and adverse events including acute dissection is low.

The cardioprotective effects of nuts are well established. However, the positive impacts of nuts in preventing CVD at a younger age, a condition known as premature coronary artery disease (PCAD), is still debated. Therefore, we aim to determine the association between nuts and PCAD occurrence and its severity in different Iranian ethnicities.

This case–control study was conducted within the framework of the Iran-premature coronary artery disease (I-PAD) study, an ongoing multi-centric study on Iranian patients of different ethnicities.

This multi-centric case–control study was conducted in among 3253 persons under the age of 70 years in women and 60 years in men from different ethnicities in Iran.

Information on nut consumption was collected using a validated FFQ. Subjects were selected from among the candidates for angiography. Cases were those whose coronary angiography showed stenosis of more than 75 % in at least one vessel or more than 50 % of the left main artery, while the control group participants had normal angiography results.

In the crude model, compared to the first quartile, the highest quartile of nut consumption was significantly associated with a lower risk of PCAD (OR = 0·26, 95 % CI (0·21, 0·32); Pfor trend = 0·001). In the top quartile of nut intake, a substantial decrease in PCAD was observed after controlling for putative confounders (OR = 0·32; 95 % CI (0·24, 0·43); Pfor trend = 0·001). Additionally, a 75 % decrease in the risk of severe PCAD was observed in the participants in the highest quartile of nut intake.

A significant inverse association was observed between nut intake and the risk and severity of PCAD in the Iranian population. Large-scale clinical trials are required to confirm these findings.

Benefit has been shown from testosterone therapy given to postmenopausal women experiencing reduced sexual desire. Specifically, an increased frequency of satisfying sexual encounters and intensity of sexual desire and better sexual response has been shown with testosterone therapy in a number of studies spanning more than 35 years. Androgen therapy has been related to improvement in energy, mood, well-being, self-perception, and some parameters of sexuality (libido, activity, sexual arousal, excitability and satisfaction.

In a group of 10 menopausal women applying Testogel 16.2mg/g at the dose of 20.25 mg every 3-4 days as part of their usual care together with oestrogen +/- progestogen HRT, we measured serum testosterone and free androgen index (FAI) pre-application of Testogel and 24 hours after its application. Testosterone was measured by mass spectrometry. The Female Sexual functioning Index (FSFI) was completed by the women.

The range of duration of treatment with testosterone was 6 months-23 years. All women subjectively reported an improvement in sexual function with testosterone administered most recently as Testogel.

Female Sexual functioning Index (FSFI) median score was 24.5/36 (25-75% interquartile range 18-28) with highest domain scores for sexual satisfaction and arousal (4.2/6) and moderate scores for orgasm and desire (3.6/6) with lowest domain score for lubrication (2.4/6) and no reported issues re pain on intercourse, All women subjectively reported an improvement in sexual function with testosterone supplementation.

Mean pre-Testogel administration testosterone level (corresponding to a trough level) was 0.85: 0.6-1.2 nmol/L (median: 25-75% interquartile range) rising at 24 hours post Testogel to 3.6: 1.9-4.8 nmol/L (median: 25-75% interquartile range) (Reference range for testosterone is women is up to1.4 nmol/L).

The rise in serum testosterone was not associated with any untoward effects in terms of hirsutism/acne.

All the women in our case series experienced benefit with testosterone gel in terms of sexual function. FSFI score indicated reasonable sexual function in this group of women treated with Testogel for HSDD.

The increase in serum testosterone level and FAI at 24 hours after application of Testogel was not associated with untoward reported / manifest consequences.

Testosterone supplementation is not approved for treatment of hypoactive sexual desire disorder (HSDD) in the UK / other parts of Europe. This matter needs to be addressed as a priority by all stakeholders so that this medication can be made more freely available.

Considering that coronavirus disease 2019 (COVID-19) is an emerging disease and results in very different outcomes, from complete recovery to death, it is important to determine the factors affecting the survival of patients. Given the lack of knowledge about effective factors and the existence of differences in the outcome of individuals with similar values of the observed covariates, this study aimed to investigate the factors affecting the survival of patients with COVID-19 by the parametric survival model with the frailty approach.

The data of 139 patients with COVID-19 hospitalized in Imam Reza Hospital in Tabriz were analyzed by the Gompertz survival model with gamma frailty effect. At first, variables with P < 0.1 in univariable analysis were included in the multivariable analysis, and then the stepwise method was used for variable selection.

Diabetes mellitus was significantly related to the survival of hospitalized patients (P = 0.021). The rest of the investigated variables were not significant. The frailty effect was significant (P = 0.019).

In the investigated sample of patients with COVID-19, diabetes was an important variable related to patient survival. Also, the significant frailty effect indicates the existence of unobserved heterogeneity that causes individuals with a similar value of the observed covariates to have different survival distributions.

Iran is facing a big challenge controlling the coronavirus disease 2019 (COVID-19) outbreak, and it is unclear to how individuals are engaging in preventive behaviors. This study aimed to investigate changes in preventive behaviors during the first 3 mo of the COVID-19 outbreak in Iran.

This cross-sectional survey was conducted on 1477 adults aged 18 y and older in 31 provinces of Iran. Data were collected by an anonymous online questionnaire.

Overall, engagement in preventive behaviors was relatively acceptable, and more than 45% of subjects always carried out all preventive behaviors. Engaging in all preventive behaviors had a peak in the second month and obviously declined during third month. Engagement in some preventive behaviors, such as “wearing a face mask” and “keeping a safe distance from others,” was observed less than other behaviors. There was a statistically significant difference in the engagement in preventive behaviors by gender and occupation (P < 0.001).

Although engagement in preventive behaviors was relatively acceptable for the first 2 mo of the outbreak, it has declined gradually. This is a warning for public health decision makers. COVID-19 is still a crucial issue in Iran, and it is necessary that government decision be based on the fact that Iranian people must live with a coronavirus for months, with full caution and compliance toward all preventive care protocols.

Identity disturbance is one of the DSM- IV criteria for borderline personality disorder, but there has been little attention to its nature. Four subset of identity disturbance (role absorption, painful incoherence, inconsistency, lack of commitment) have been assessed.

Assess the role of these subsets in patients with borderline personality disorder and examine the relation between identity disturbances with substance- dependency.

This case- control study was conducted on 40 patients with borderline personality disorder referring to Beheshti Hospital in Kerman during 2007-2008; and 40 healthy people who were matched with case group in term of gender, and educational level. Data gathering was done with three questionnaire including a demographic- related questionnaire, disturbance questionnaire (included 35 items), and a questionnaire related to substance- dependency and its related factors. Data analysis was performed using SPSS software (version 11) by mean calculation and t-test and ANOVA.

Mean score of 33 items of identity disturbance questionnaire were greater with significant difference in case group (p < 0.05). Means differences in two groups in all subsets were statistically significant except for role absorption (p < 0.05). Means differences in all subsets in substance- dependent subjects and substance- independent people in both groups were not statistically significant.

Identity disturbance is one of the major criteria for borderline personality disorder, but in different societies the role of its subsets are different. Assessing subsets of identity disturbance has no value in assessing substance- dependency in patients with borderline personality disorder.

Atypical antipsychotic use in youth has increased. Adverse metabolic effects on weight, lipids, and glucose are evident in adults, but inadequately studied in youth. This report focuses on the metabolic effects of these agents in psychiatrically hospitalized youth.

Inpatient subjects were assessed at admission, 3 weeks, and discharge. Weight, body mass index, blood pressure, fasting glucose levels, high and low density lipoproteins (HDL and LDL, respectively), and triglycerides were measured.

N=112 subjects, diagnosed as: Affective Disorders (26.4%), Disruptive Behavior Disorders (32.6%), Pervasive Development Disorders (9.3%), Psychotic Disorders (5.4%), and Others (26.3%). Ages ranged from 4-17 years. Patients received: risperidone (N=41), olanzapine (N=13), quetiapine (N= 15), aripiprazole (N=22), while 34 patients received no medication. Average length of hospital stay (LOS) was 55.9 days (1-289). For the sample as a whole, trends of statistical differences were noted in weight at the time of discharge (+3.79 lbs). Weight gain at discharge was significantly correlated with only olanzapine (r=.553, p<0.0001), multiple regression analysis controlling for LOS is also significant (Beta .558, p < 0.0001) for olanzapine. For the medication treated group, statistically significant increases in HDL are noted at three weeks (+ 5 mgs/dl, p = 0.023); at discharge the difference was not significant. A similar trend was observed for glucose. There was a statistical trend for decrease in triglycerides at 3 weeks (15 mg/dl, p = 0.054), discharge difference was non-significant (-9 mg/dl).

Certain agents may carry greater propensity for inducing certain metabolic changes, but further study is required.

Psychotic disorder due to industrial drug, such as methamphetamine addiction, is one of the important causes for referral to psychiatric hospital. Psychotic symptoms in these patients are varied. A group of researchers believe that methamphetamine-induced psychosis is completely similar to schizophrenia. Others believe that at least some cases of permanent psychotic clinical manifestation due to methamphetamine abuse are different from schizophrenia. In the present study, the existence of differences between psychotic symptoms caused by methamphetamine addiction and schizophrenia is investigated.

This study was a qualitative study. Patients with psychosis due to methamphetamine addiction were selected from among patients who were hospitalized in hospitals of the Kerman University of Medical Sciences, Iran. All patients were interviewed using unstructured interview based on self- reporting. Interviews were recorded and reviewed later.

Based on clinical observations, some of the patients with psychotic disorder due to methamphetamine showed rare symptoms that had been mostly reported in psychosis due to organic disorders and some of them showed symptoms that had not been reported before. Conclusion: This study showed that in a group of patients with methamphetamine-induced psychosis, clinical manifestation is different from schizophrenia.