Payavard Salamat

Investigation of the Antifungal Effects of Carvacrol on Clinical Isolates of Trichophyton Rubrum

Mahin Tavakoli

Background and Aim: Trichophyton rubrum is among the most frequently detected species that cause dermatophyte infections, especially chronic infections, so it requires early diagnosis and appropriate antifungal treatment. Due to the increasing resistance of different species of dermatophytes to antifungals, the use of herbal compounds with antifungal properties can be used as adjuvant therapy or even an alternative therapy. Carvacrol has a wide range of biological activities, including antifungal, antiviral, antibacterial, insecticidal, and antioxidant properties. Accordingly, we aimed to determine the antifungal effect of carvacrol on 12 strains of Trichophyton rubrum in comparison to the antifungal drug terbinafine in vitro.
Materials and Methods: This investigation was conducted on Trichophyton rubrum isolates that had been previously identified morphologically and molecularly. The protocol used to perform in vitro susceptibility testing was the A38-M-CLSI standard using the Broth Microdilution method. The obtained results were analyzed using SPSS software, and the MIC50, MIC90, and GM of this compound against Trichophyton rubrum isolates were estimated compared to terbinafine.
Results: The minimum inhibitory concentration (MIC) was determined using different concentrations of carvacrol (in the concentration range of 0.25 to 2 μg/mL) and terbinafine (in the concentration range of 0.0625 to 0. 5 μg/mL). The MIC50 and MIC90 values for Carvacrol were determined to be 0. 5 and 2 μg/mL, respectively. Whereas, the corresponding values for terbinafine were calculated at 0.0625 and 0. 5 μg/mL. The GM values were 0.5 for cavacrol and 0.1 for terbinafine. Similar to terbinafine, the antifungal efficacy of the studied compound displayed significant differences against Trichophyton rubrum isolates (P-value<0.05).
Conclusion: Although the MIC values for carvacrol were higher than those for terbinafine in vitro, it demonstrated significant antifungal activity against Trichophyton rubrum isolates. Therefore, this natural compound seems to be a good option for adjuvant therapy along with antifungals in dermatophyte infections, although the realization of this matter requires further investigation on the combined effect of carvacrol and terbinafine, determining the toxicity of carvacrol, and also examining this compound in vivo.

Investigating Occupational Conditions and Socioeconomic Support of Patients with Neuromyelitis Optica in Iran

Sharareh Eskandarieh

Background and Aim: Noncommunicable diseases are one of the most important public health challenges in the 21st century. Neuromyelitis optica (NMO) is a rare autoimmune disease that affects the central nervous system and can lead to permanent disability in young people. This disease is important due to its economic impact and reduced quality of life, and it is essential to understand its economic and social factors on these subjects.
Materials and Methods: This study is a cross-sectional study based on the population of Iranian NMO patients. The instrument of this study was a researcher-made questionnaire in English from Harvard University, USA, which was translated into Persian and re-translated into English (translate- retranslate technique). The samples included NMO patients registered in the Iranian National NMO Registry System at Sina Hospital in Tehran, who completed information about their employment, income, and socioeconomic status via telephone interviews. The data were analyzed by SPSS software.
Results: The total number of samples was 70, with a mean age of 41.40 years with a standard deviation of 10.91 years. The majority of patients were women, with 71.4% (50 of 70) of patients being female and 28.6% (20 of 70) being male. Sixty-one-point four percent of patients (43 of 70) had lost their jobs due to NMO and 70% (49 of 70) had reduced their working hours. Also, 47.1% of patients (33 of 70) reported a decrease in their annual income. Thirty-two-point eight percent (23 of 70) had lost between 51% and 100% of their annual income due to this disease and 10% (7 of 70) of patients had no annual income. Eighteen point five percent (13 of 70) of patients no longer work outside home due to the occurrence of NMO disease. Overall, the effects of NMO on the reduction of employment, working hours and income of patients were significantly high.
Conclusion: The results showed that NMO has serious effects on the employment and income status of these patients in Iran and they need more economic and social support. Considering the physical disabilities caused by this disease and the reduced ability to work, NMO patients should receive special social and economic support from government.

Challenges of Disaster Management in the Earthquake-Prone and High-Risk Region of Kuhbanan, Kerman

Mohammad Hossein Mehrolhassani

Background and Aim: Identifying and transferring lessons learned from past disasters can significantly improve future disaster management performance. Although the general principles of disaster management are similar across events such as earthquakes, context-specific factors, including geographical location, scale and severity of the event, timing, and local characteristics, can shape distinct challenges and, consequently, different management approaches. Therefore, conducting case-based studies that account for the unique conditions of each disaster is essential for effective learning. This study focuses on the Kuhbanan earthquake and aims to identify management challenges arising from the specific characteristics of this region.
Materials and Methods: This study employed a qualitative design using a directed content analysis approach. The study population consisted of experts, decision-makers, and frontline practitioners directly involved in managing the Kuhbanan earthquake. Using purposive sampling with maximum variation, 15 participants were selected from key organizations, including the University of Medical Sciences, the Iranian Red Crescent Society, the Provincial Crisis Management Center, and non-governmental organizations active in rescue and relief operations. Data were collected through in-depth semi-structured interviews, with questions developed based on the dimensions of the STEEPV framework (Social, Technological, Economic, Environmental, Political, and Values). Interviews continued until data saturation was achieved. Data analysis was conducted using MAXQDA software.
Results: Data analysis led to the identification of 42 initial codes, 14 subcategories, and six categories aligned with the STEEPV framework. In the social dimension, key challenges included deficiencies in public and professional training systems (3 codes), weak intersectoral communication and coordination (6 codes), and inadequate responsiveness to community health needs (4 codes). In the technological domain, major limitations were observed in information management (2 codes) and the capacity of technological infrastructure (2 codes). From an economic perspective, financial constraints (5 codes) and welfare-related barriers (3 codes) were identified as influential factors. In the environmental dimension, specific geographical and climatic conditions including mountain topography, fault proximity, and mining operations (4 codes), along with unsuitable physical spaces for disaster management (3 codes), posed major challenges. In the political sphere, a noticeable gap between the government and the public (2 codes) and weak performance of some executive institutions (2 codes) were evident. Cultural and values-related challenges included specific local beliefs (1 code), inappropriate behaviors among communities and relief teams (2 codes), and insufficient consideration of regional culture in rescue and relief operations (3 codes).
Conclusion: This study demonstrated that despite the relatively small scale of the Kuhbanan earthquake, many structural and managerial challenges previously observed in larger disasters were repeated. This finding highlights a chronic weakness in institutional learning and process improvement within the disaster management system. The application of comprehensive analytical frameworks such as STEEPV can assist managers and planners in understanding the complexity and interconnections of different crisis dimensions, moving beyond fragmented and reactive approaches toward more informed decision-making, enhanced stakeholder coordination, and ultimately greater community resilience. It is recommended that the findings of this study be used as a roadmap for revising national disaster management policies and for designing an integrated disaster lesson-learning system.

Assessment of Hospital Information System’s Compliance with Physical and Technical Safeguards for Health Data: A Study at Birjand University of Medical Sciences in 2024

Razieh Farrahi

Background and Aim: With the digitalization of healthcare, hospital information systems handle vast amounts of sensitive data, making their protection crucial. This study aimed to assess the compliance of these systems in hospitals affiliated with Birjand University of Medical Sciences with the physical and technical safeguard standards of Health Insurance Portability and Accountability Act (HIPAA) in 2024.
Materials and Methods: This cross-sectional descriptive study was conducted in 15 hospitals affiliated with Birjand University of Medical Sciences. The study population consisted of Information Technology (IT) unit managers, who were selected using a census method (15 individuals). The research instrument was a researcher-developed checklist consisting of 56 items based on the physical and technical standards of HIPAA. The face validity of the checklist was confirmed by five experts in Health Information Management, Medical Informatics, and Health Policy, and its reliability was verified with a Cronbach’s alpha coefficient of 0.84. Data were analyzed using SPSS software and descriptive statistics, including frequency, percentage, mean, and standard deviation.
Results: A total of 15 information technology managers (14 men and 1 woman) from 15 hospitals, including 8 teaching and 7 non-teaching hospitals, participated in the study. The findings showed that the hospital information systems of Birjand University of Medical Sciences complied with the HIPAA physical and technical safeguard standards at rates of 81.7% and 86.7%, respectively. In the domain of physical safeguards, the workstation security standard demonstrated the highest level of compliance, with a mean score of 89.3%. Full compliance (100%) was observed for certain indicators, including emergency access procedures for facilities and physical access control procedures. In contrast, the lowest compliance in this domain was related to the device and media controls standard, with a mean score of 74.9%, particularly in the identification and tracking of hardware and electronic media. In the domain of technical safeguards, the overall mean compliance rate was 86.7%. Among these standards, person or entity authentication achieved the highest level of compliance, with all hospitals demonstrating full compliance (100%). In addition, access control (93.3%), audit controls (86.7%), and transmission security (85.3%) were all at desirable levels. However, the lowest compliance was observed for the integrity standard (50%), highlighting the need to strengthen technical infrastructure and implement more advanced electronic mechanisms to ensure data accuracy and integrity.
Conclusion: Although the overall level of compliance in the hospitals under study is satisfactory, significant gaps remain, particularly in device and media control and data integrity. These deficiencies may lead to breaches of patient privacy and undermine public trust in the healthcare system. It is recommended that senior hospital managers and health policymakers address these deficiencies by developing and implementing clear internal guidelines, investing in appropriate supportive technologies, and conducting continuous, targeted training programs for all personnel. In addition, periodic compliance monitoring is essential to ensure continuous improvement.

Financial Protection Analysis in the Health System: Assessing Out-of-Pocket Payments and Catastrophic Health Expenditures Indicators among The Insured People in Tehran

Sanaz Zargar Balaye Jame

Background and Aim: Fair protection against financial risks is considered one of the main goals of health systems, and lack of financial protection in health is regarded as a disease in health systems. Protecting citizens from the financial consequences of illness and fair access to health services is a challenge for governments and policymakers. Therefore, this study was conducted to investigate the indicators of out-of-pocket payments (OOP), catastrophic health expenditures (CHE), and Impoverishing Health Expenditures in hospitals in Tehran.
Materials and Methods: This descriptive-analytical study was conducted cross-sectionally in 2023. The research population was all the households covered by one of the country’s insurance organizations in Tehran and 298 households participated in this study. A simple random sampling method was performed in five selected general hospitals in Tehran. The World Health Organization questionnaire was used to collect data. An interview was conducted with the head of the household or an informed person of the family. The back-breaking expenses were calculated based on the household’s payment capacity and the poverty line based on the household’s food expenses. Data were analyzed using Excel and SPSS software.
Results: The results showed that 39.9% of households spent less than 10% of their total household expenditures on OOP health payments. However, 62.1% and 24.2% of participants experienced CHE and impoverishing health expenditures, respectively. Additionally, 36.9% reported borrowing money from friends or family, while 17.4% borrowed from non-relatives to cover health expenses. Furthermore, 5.4% of participants were forced to sell household assets, such as furniture, carpets, or jewelry, to finance their healthcare costs. Dental services, with an average cost of 1369000 tomans (±3,626,000), and medications with an average cost of 1,210,000 tomans (±2,104,000), imposed the highest expenses on households. Statistical analyses showed that the prevalence of CHE among participants differed significantly according to age (P=0.001), employment status (P=0.004), presence of a disabled or care-dependent individual in the household (P=0.002), and education level (P=0.021).
Conclusion: According to the results of the study, over 62% of households face CHE, particularly among older adults and retirees, indicating weak financial protection in the health system. This highlights the urgent need to reform health financing policies and expand targeted insurance coverage for high-risk groups. It is recommended to design special insurance packages for individuals aged 60 and above, covering chronic, specialized, and preventive services.

Self-Care in War-Injured Patients Immediately after Injury: A Narrative Review

Afzzal Shamsi

Background and Aim: War is an inseparable part of human history that brings many problems. Self-care plays a major role in reducing complications and mortality. The purpose of this study is to “familiarize war casualties with self-care immediately after injury.”
Materials and Methods: In this study, a narrative review of library resources and searching of internal and external databases related to the purpose of the study was used. Then, articles, books, dissertations, and other scientific resources related to the subject were examined.
Results: In wartime conditions, a set of clinical problems leads to the deterioration of casualties’ conditions. One of the most important factors influencing self-care during wars is having sufficient awareness and knowledge in first aid, which requires the development of integrated approaches for first aid content. Other factors include identifying and eliminating threatening factors; quickly stopping the damaging agent; immediate contact with rescuers; maintaining an open airway; general self-assessment and temporary control of external bleeding; more thorough examination to identify signs of injury and life-threatening conditions; monitoring status (consciousness, breathing, circulation) and psychological self-support; and ambulance transfer to medical centers.
Conclusion: To have a successful and effective self-care program for war casualties, first aid training specific to war crises should be provided to members of the community. Control of extensive bleeding, airway protection, wound dressing, pain control, and psychological self-support should be included in self-care programs. Accordingly, basic planning by relevant authorities, especially the health system, is recommended to increase the level of awareness and knowledge of self-care among members of the community in war crises.

Identification of Conflict-of-Interest Management Strategies in Iranian Healthcare System Comparing with Selected Countries: A Scoping Review

Hossein Dargahi

Background and Aim: The occurrence of conflict of interest in the Iranian health system has a negative impact on the provision of efficient and effective health care and services to patients, the training and education of students in medical sciences. Despite the efforts made in the country’s health system to manage conflict of interest, this phenomenon is currently observed through various factors, including the inefficiency of the financial structure, lack of transparency, and the lack of an integrated health information system in Iran.
Materials and Methods: The present scoping review study that aimed to identify and determine conflict of interest management strategies in the Iranian health system in comparison with selected countries and to select appropriate strategies in 2024-2025 using the Arksey and O’Malley guidelines. All relevant articles and resources from 2007 to 2024 were extracted from national and international databases by observing the entry and exit criteria and by selecting Persian and English keywords. After screening steps using Prisma flowchart, 23 studies in English and Persian language from international and national databases, were analyzed.
Results: Findings from 17 international studies—most of which were conducted in the United States—along with 6 domestic articles, showed main strategies of Iranian conflict of interest which included participation, transparency, legal oversight, processes reform, restructuring and reorganization. Although, using collective campaigns for correction of process behaviors and decisions, definition of ethical ethic codes, and standardization may help implementation of these strategies. Also, the most common cause of conflict of interest in the health system is individual rather than organizational, which requires regulation, the use of legislative levers, and the transparency of financial relations in the health system.
Conclusion: Accurate identification of potential examples of conflict of interests among the agents of health care system by implementing information clarification, and using modern procedures may decrease the challenges in formulating and implementing strategies of conflict of interests among Iranian health care system. Although benchmarking from successful countries will be helpful in these countries. The implementation of these recommendations may face challenges within Iranian society, including resistance from certain professional groups, a lack of financial and technical resources, and the complexity and specific conditions of the health system. Therefore, a step-by-step approach to implementing policy recommendations for managing conflicts of interest in the health system should be considered.

Case-Based Reasoning: An Applied Technique for Designing Intelligent System for the Differential Diagnosis of Oral Diseases

Hamideh Ehtesham

Background and Aim: Artificial intelligence-based systems can facilitate data management and interpretation in various dental specialties and can be used as auxiliary tools in diagnosis and education. Case-based reasoning is a promising artificial intelligence method for implementing decision support systems in medical sciences. In the current research, this technique has been used to design an intelligent system for the differential diagnosis of oral diseases.
Materials and Methods: This research is a developmental study and is applied in terms of results. To create a database of cases, patient data was collected by referring to the specialized polyclinic of the Faculty of Dentistry at Tehran University of Medical Sciences and through clinical interviews. The [feature-value] collection was used to display the cases. The weight of the features was determined through a specialized Delphi survey conducted at the national level and as an online study. The determined weights were stored in the case database and used as similarity evaluation parameters. Then, the similarity index was calculated for each case.
Results: The intelligent system designed in this research has been developed based on web technologies. Problem-solving in the case-based reasoning method is done in a cycle and includes four main stages: recovery, reuse, review, and maintenance. The input parameters of the system include clinical indicators, paraclinical indicators, historical data, and management data affecting the diagnosis process. The system provides a prioritized list of differential diagnoses of oral diseases across six main axes as output including Ulcerative, vesicular, and bullous lesions, Red and white lesions of the oral mucosa, Pigmented lesions of the oral mucosa, Benign lesions of the oral cavity, Oral cancer, Salivary gland diseases.
Conclusion: The development of the system utilizing case-based reasoning techniques and clinical data processing has the potential to assist dentists in achieving differential diagnosis across six main areas of oral diseases.