Tehran University Medical Journal

Analysis of human electrocardiogram (ECG) signals using machine learning techniques

Fatemeh Rezaei

Background: An Electrocardiogram is a non-invasive method for receiving heart signals. Despite advances in imaging methods, the electrocardiogram still plays an important role remains a vital tool in the diagnosis of heart diseases. Analysis of electrocardiogram signals plays an important role in the early detection of heart diseases such as arrhythmias and heart attacks. Today, with the advancement of science and technology, computer methods have received more and more attention from doctors. In this study, machine learning methods were used to classify normal and abnormal heartbeats.
Methods: The data under study were extracted from a dataset called Heartbeat published on the Kaggle website. This dataset includes samples of audio ECG signals that are divided into healthy and unhealthy categories. First, the data were preprocessed and normalized to prepare them for input into the model. Then, temporal and frequency features were extracted from the signals. Next, a hybrid model consisting of one-dimensional convolutional layers was designed and trained. Also, by using the early stopping method, overfitting was prevented and the stability of the model was improved.
Results: In this study, it was shown that by using deep learning, especially using CNN and 1D Conv, an accuracy of 0.99% and a loss of 0.0350 for test data in detecting normal and abnormal heartbeats can be achieved. This model has the ability to analyze complex structures and temporal dynamics of ECG signals and is able to detect patterns related to cardiac disorders.
Conclusion: Today, the electrocardiogram has received more attention than ever before. Appropriate selection of the model, data standardization, and a qualitative range of data are among the factors of high accuracy in this study. This study can be an effective step in the development of intelligent systems for diagnosing cardiac disorders and can be used in medical applications, especially in the field of continuous patient monitoring.

Comparison of two methods prolene and ultralight prolene mesh in inguinal hernia repair: a double-blind randomized controlled clinical trial study

Mehrdad Sayadinia

Background: The use of mesh is considered one of the most effective methods and is considered the method of choice in hernia repair. However, the debate about the choice of mesh type still persists. Therefore, in the present study, the results of using ultra-light Prolene mesh with standard Prolene mesh in hernia repair surgery were compared.
Methods: The present study is a double-blind, randomized, controlled clinical trial that was conducted at Shahid Mohammadi Hospital in Bandar Abbas. Demographic information including age, sex, height, and weight were recorded in a checklist. Patients were randomly assigned to two groups. Each group used Prolene mesh in the first group and ultra-light Prolene mesh in the second group for repair. Hernia repair was performed by the surgeon using the Lebakhstein method.
Results: 119 patients were included in the study. 70 patients (57.4%) had direct hernia and 52 patients (42.6%) had indirect hernia. The mean age of the Prolene group was 43.8±7.49 and the ultra-light Prolene group was 44.32±8.91 years (P=.713). The mean BMI in the Prolene group was 29.94±3.43 and in the ultra-light Parwan group was 29.66±3.76 (P=.673). Wound infection was not observed in either group. Chronic pain was 14.5 in the Prolene group and 10.3 in the ultra-light Prolene group (P=.490). Administrative retention was 6.3 in the Prolene group and 8.5 in the ultra-light Prolene group (P=.738). The recurrence rate 3 months after surgery was 0 in the Prolene group and 1 case (1.7%) in the ultra-light Prolene group (P=.487). The recurrence rate 12 months after surgery was 2 cases (3.2%) in the Prolene group and 3 cases (5.2%) in the ultralight Prolene group (P=. 672). The time to complete recovery was 6.94±1.63 days in the Prolene group and 6.68±1.64 days in the ultralight Prolene group (P=. 368). There was no significant difference in pain intensity at 2, 6, and 24 hours after surgery between the two study groups.
Conclusion: Both Prolene and ultralight Prolene mesh have relatively similar efficacy in inguinal hernia repair. Although the advantages of ultralight Prolene mesh, such as pain intensity, chronic pain, and faster onset of motion, were slightly different in the ultralight Prolene group, the recurrence rate was slightly higher in the ultralight Prolene group.

The prevalence of trichomonas vaginalis in iranian women: a systematic review and meta-analysis

Masoud Mohammadi

Background: Trichomonas vaginalis is one of the main causes of vaginitis and cervical inflammation worldwide. Almost half of sexually transmitted and curable diseases worldwide can be assessed through the examination of this disease, so the aim of this study is to determine the prevalence of trichomoniasis in Iranian women.
Methods: This study is a review of the SID, PubMed, Science Direct, and Google Scholar databases, conducted up to September 2023. The extracted data were analyzed using CMA software (version 2). A search of articles in Science Direct, SID, PubMed, and Google Scholar databases was conducted in accordance with the PRISMA statement criteria, including systematic search, screening of articles, and selection of appropriate studies. The words used for the search and final review in this systematic review were determined based on MESH Terms in the PubMed database. These keywords that were used and selected in this study were in English and Persian. The final information obtained from the studies was reviewed and analyzed using the Comprehensive Meta-analysis (CMA, Version 2) software, and finally the heterogeneity of the studies was examined with the I² test.
Results: Based on the search for studies and their screening, 22 studies were finally included in the meta-analysis. This study included a sample size of 49,990 Iranian women who were included in the study. In the heterogeneity analysis based on the studies obtained, the heterogeneity was 99.7. Due to the heterogeneity of the studies, the random effects method was used for the final analysis. The prevalence of Trichomonas vaginalis in Iranian women was reported to be 9.3 (95% CI: 4.6-18) based on the 22 final studies and meta-analysis. The publication bias analysis indicated the absence of bias in the studies (p: 0.175).
Conclusion: Based on the prevalence report in the meta-analysis, a relatively high prevalence was reported in Iranian women, and this situation requires more awareness raising through health centers to families, as well as care and screening of women in these centers and also in obstetric centers.

Comparison of weight loss and short-term outcomes of endoscopic botulinum neurotoxin intragastric injection with sleeve gastrectomy surgery

Hamidreza Norouzi

Background: In this study, Botox method is compared with sleeve gastrectomy as one of the endoscopic methods in the treatment of obesity for patients who are not effective in lifestyle and drug modification methods and do not have the interest or necessary conditions for bariatric surgery.
Methods: This Cross-sectional study was conducted in eligible patients who were outpatients at the gastroenterology clinics of Amir al-Momenin Hospital, Arak, in June 2014 for one year in the gastroenterology clinic after obtaining informed consent, demographic information, and anthropometric measurements. After 12 weeks, patients in both groups were visited again. In patients in group A (Botox group), endoscopy was performed by an experienced gastroenterologist under sedation after a 10-hour fast, and in patients in group B (sleeve gastrectomy) under general anesthesia, a partial and longitudinal gastrectomy was performed. The BAROS questionnaire was used to assess the quality of life of patients.
Results: The mean age of the subjects in the endoscopic botulinum neurotoxin group was 30.88±11.89 years and the sleeve gastrectomy group was 29.88±11.06 years. In this study, 12 subjects (24.0%) were male and 38 subjects (76%) were female. There was a significant difference in the mean body mass index and weight at four measurements in the two study groups (endoscopic botulinum neurotoxin and sleeve gastrectomy). There was no statistically significant difference in the mean blood pressure, laboratory results, and mean quality of life in the study groups.
Conclusion: Endoscopic botulinum injection in the stomach is an effective and safe method for short-term weight loss, but its long-term effect on weight and the occurrence of complications or metabolic effects requires long-term follow-up.

Prophylactic intravenous ondansetron for prevention of hypotension following spinal anesthesia in lower limb orthopedic surgery patients

Navid Kalani

Background: Spinal anesthesia is an effective method for providing analgesia in surgery and a safe alternative to general analgesia; But despite its benefits, in many cases it is not free of side effects, including unwanted cardiovascular events such as hypotension and bradycardia. Ondansetron effectively reduces the incidence of nausea, vomiting, and bradycardia associated with spinal anesthesia Thus, the present study aimed to assess intravenous ondansetron's efficacy in preventing post-spinal hypotension among patients scheduled for lower extremity orthopedic surgery at Peymanieh Hospital in Jahrom, Iran.
Methods: This randomized double-blind clinical trial included 60 patients undergoing lower limb orthopedic surgery at Peymanieh Hospital, Jahrom, Iran, from March 2021 to February 2022. Patients were randomly allocated into two groups: the intervention group (receiving 8 mg intravenous ondansetron) and the control group (receiving distilled water). Systolic and diastolic blood pressure (SBP, DBP) and heart rate (HR) were measured before pre-spinal anesthesia, after spinal anesthesia and then every two minutes for the first ten minutes and at 15, 30, 45, 60 and 90 minutes after surgery. After spinal anesthesia, the patient was asked about pruritus every 10 minutes. Nausea and vomiting during surgery in case of incidence, recording and nausea after spinal anesthesia, the patient was asked every 10 minutes.
Results: The chi-square test indicated no significant differences between the study groups regarding age and sex distribution(P>0.05). Time before anesthesia, immediately after anesthesia, 10 minutes, 15 minutes, 30 minutes, 45 minutes, 60 minutes, 75 minutes, and 90 minutes after anesthesia, significant difference between ondansetron and placebo groups from There was no mean SBP and DBP and HR (P <0.05). No significant difference between ondansetron and placebo groups in the incidence of pruritus and nausea and vomiting at different times (p <0.05).
Conclusion: Dose of 8 mg of ondansetron in lower limb orthopedic surgery has no significant effect on hemodynamic symptoms as well as the prevention of postoperative nausea, vomiting and pruritus in these patients. Therefore, to achieve more results regarding the transient effect of this drug, it can be compared with other drugs in the class of HT3-5 receptor antagonists.

A comparative study of egfr changes in patients with type 2 diabetes mellitus with and without albuminuria

Mahboobeh Hemmatabadi

Background: Patients with type 2 diabetes mellitus (T2DM) are diagnosed with a wide range of renal damage, usually presenting with albuminuria and decreased estimated Glomerular Filtration Rate (eGFR). Some patients have only albuminuria and normal eGFR, while others have normoalbuminuria even in advanced stages of chronic kidney disease. This study investigated and followed the course of diabetic nephropathy in patients with T2DM.
Methods: 1107 patients with T2DM were enrolled in the study. This historical cohort was conducted between the years 2017 and 2022. Patients with confirmed type 2 DM, referred to the diabetes clinic of Vali-Asr Hospital, affiliated with the Tehran University of Medical Science. Complete medical history, blood pressure, and laboratory data were obtained in the first and follow-up visits. Follow-up was every 3 to 6 months for 30 months. Every year, 24-hour urinary albumin was measured, and eGFR was estimated based on the Cockcroft-Gault formula.
Results: Male sex, age, disease duration, weight, systolic blood pressure, 2 hours postprandial (2hpp) glucose, serum triglyceride, and uric acid significantly correlated with albuminuria. At the initiation of the study, the highest eGFR values occurred in microalbuminuric patients, followed by a sharp decrease. No significant correlation was found between eGFR and albuminuria in most patients, and more than half of them with eGFR of less than 60 ml/min/m2 still had normal albuminuria
Conclusion: This study showed that patients with microalbuminuria and normoalbuminuria had the highest eGFR values followed by macroalbuminuria, but patients with normoalbuminuria and microalbuminuria had an initial increase and then a decrease, and the macroalbuminuria group showed the sustained and greatest decrease during the follow-up period. Serial surveillance of both albuminuria and GFR is crucial in T2DM.

Study of the frequency of osteonecrosis of the jaw in cancer patients receiving denosumab

Tina Vosoughi

Background: Osteonecrosis of the jaw has recently been reported in patients receiving denosumab for cancer treatment. Accordingly, the present study aimed to determine the frequency of osteonecrosis of the jaw in cancer patients receiving denosumab.
Methods: In the present descriptive-analytical study, 62 cancer patients receiving denosumab who referred to the oncology clinic of Golestan and Shafa Hospitals in Ahvaz in 1403 were studied. The prevalence of osteonecrosis of the jaw among the studied patients was investigated and its relationship with predisposing factors, including gender, type of cancer, comorbidity, and dental caries status, was recorded and analyzed in a checklist.
Results: The prevalence of osteonecrosis of the jaw was 1.6%. There was no significant association between the incidence of osteonecrosis of the jaw and gender and comorbidities (P<0.05), but females showed a 38% higher probability of developing osteonecrosis of the jaw (95% confidence interval; 1.62-1.18, r=1.386). Breast cancer was the most common type of cancer among the study participants (61.3%), but no significant association was found between the incidence of osteonecrosis of the jaw and the incidence of the cancers studied (P-value=0.986). No significant association was found between the incidence of osteonecrosis of the jaw and dental caries (P-value=0.741). The odds of developing osteonecrosis of the jaw in patients with or without dental caries risk were reported to be 1.1 (95% confidence interval; 1.205-1.021, r=1.109).
Conclusion: Despite the lack of a significant association between the incidence of osteonecrosis of the jaw and various factors such as gender, type of cancer, comorbidities, and dental caries, there was evidence of a relative increase in the risk of osteonecrosis of the jaw in women with cancer treated with denosumab, which highlights the need for further investigation.

Evaluation and comparison of dose homogeneity index, sacrum bone dose and maximum rectal dose in endometrial and cervical cancer patients with two energies of 6 and 15 MV

Zahra Momeni

Background: Radiotherapy is one modalities for common cancers like cervical and endometrial. Although radiation therapy has side effects such as digestive problems and radiation-induced changes in the sacrum. At the current article, the factors that evaluate the side effects of radiation therapy for two energies of 6 and 15 megavoltage were compared.
Methods: For this study, the data of 50 female patients with an average age of 58.5 years with cervical and endometrial cancers were used. For each patient, the BOX treatment plan was carried out with Eclipse software for two energies, 6 and 15 MV, with total prescribed dose of 50 Gy. Along with factors such as dose homogeneity, sacrum bone dose, and maximum rectal dose were compared.
Results: The comparison reveals that the maximum rectal dose for 6 MV energy was significantly (Pvalue=0.001) more than those planed with 15 MV.
For the volume of the sacrum that receives a dose of 40 Gy (V_40), it was seen that for 6MV (99.86±0.42) energy, were significantly more than the treatment plan with 15 MV energy (99.83±0.48) (Pvalue=0.026). According to the homogeneity index for this study, a statistically significant difference was seen for the value obtained from HI2 and HI3 for 6 MV compared to 15 MV Pvalue<0.001, PValue=0.008 respectively which the treatment plans performed with 15 MV energy were more homogeneous than MV 6 energy.
Conclusion: In this article, it was observed that the use of low energies for the treatment of pelvic cancers, enhances the percentage of the maximum dose reached to healthy organs, which causes patients to suffer complications Therefore, it is recommended to use high energy, such as 15 MV, to reduce the side effects of radiotherapy, and also it has been suggested that patients should be followed up for 3 to 5 years in order to obtain more reliable information about the sacrum dose.

Mandibular osteosarcoma presenting as a peripheral tumoral mass: a case report

Pardies Mahmoudvand

Background: Although osteosarcoma in the head and neck region is relatively rare accounting for 2.1% of all malignant oral and maxillofacial tumors it is nevertheless regarded as the most common primary malignant bone tumor in children and young adults. In the craniofacial skeleton its overall occurrence remains uncommon, and that rarity contributes to diagnostic difficulty and occasional delay. The neoplasm is recognized simultaneously for its infrequency and its malignant character, and these features together can obscure recognition when early symptoms are muted or resemble more benign oral conditions. Because presentations may be subtle, careful clinical attention to patient-reported sensations and visible mucosal or submucosal changes is advisable. Early complaints may initially involve tingling paresthesia or awareness of a focal oral mass. Vigilance matters in everyday oral and maxillofacial practice.
Case Presentation: The patient was a 38-year-old married man from Asadabad County, Hamedan Province, who presented to the Department of Oral and Maxillofacial Diseases at the School of Dentistry, Hamedan, during February March 2025. He reported a tingling, electric-shock like sensation together with a lesion on the floor of the mouth. The persistence of the sensation and the presence of a visible lesion prompted evaluation in a specialized academic clinic. The demographic context, the anatomic location in the floor of the mouth, and the clear time frame are central features of the presentation. The chief complaint centered on the peculiar sensation and the discernible lesion, which together motivated clinical assessment in an oral and maxillofacial setting.
Conclusion: This report highlights the importance of considering mandibular osteosarcoma in the differential diagnosis of peripheral tumoral lesions. Reporting such cases can improve understanding of unusual clinical presentations and assist in more accurate clinical decision-making. The central message is unchanged: clinicians should include mandibular osteosarcoma among diagnostic possibilities when encountering peripheral lesions so that evaluation proceeds thoughtfully.

Sanctions effects on health system: a letter to the editor

Ali Mohammad Mosadeghrad