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Application of bone cements based on ceramic and polymer in orthopedic surgeries: a review article
Naeemeh Kalali, Sogand Mirshah, Mohammad Hossein Ebrahimzadeh , Bibi Fatemeh Kalalinia, Ali Moradi, Azar Gharib, Nafiseh Jirofti ,
Volume 81, Issue 12 (March 2024)
Abstract
For over 50 years, bone cement has been used to strengthen artificial joints like hip, knee, shoulder, and elbow joints. The main purpose of bone cement is to fill the space between the prosthesis and the bone. This absorbs the forces on the joint by creating an elastic area. Besides ensuring the long-term stability of the artificial implant, it also improves the damaged bone. Polymeric bone cement consists of a polymer matrix known as polymethyl methacrylate (PMMA) and a liquid monomer called methyl methacrylate (MMA). When these two components are mixed, a free radical polymerization reaction occurs, leading to the cement's hardening at the place of use. The properties of bone cement, such as mechanical strength, biocompatibility, and handling characteristics, can be adjusted by combining the effective polymerization parameters. However, there are some challenges, such as heat generation during polymerization.
Ceramic bone cement is a composite material of ceramic particles dispersed in a polymer matrix, including calcium phosphate and calcium sulfate. The ceramic particles provide strength and bioactivity, while the polymer matrix enhances the transport properties of the cement. This combination results in a mechanically stable, bone-conductive, and biocompatible cement. Moreover, ceramic bone cement can be engineered to release therapeutic agents, such as antibiotics or growth factors, to prevent infection and foster bone regeneration. Ceramic bone cement is a promising alternative material for bone cement in joint replacement. However, more research and development are required to optimize the properties of bone cement and overcome the challenges associated with its use. With continued advancements in biomaterials, ceramic and polymer bone cement could revolutionize the field of orthopedic surgery and improve patient outcomes. Recent research has focused on developing new bone cement with improved properties like bioactivity, antibacterial activity, and drug delivery capabilities. These developments aim to enhance the performance of bone cement and remove the current limitations in orthopedic applications. In this review study, we will focus on the types of bone cement, their mechanical, biological, and structural properties, and how to optimize them.

Existential distress in palliative care of cancer patients at the end of life: a systematic review
Hossein Eskandari, Faramarz Sohrabi , Adeleh Rezagholizadeh Shirvan , Mohammad Asgari , Neda Shahvaroughi Farahani ,
Volume 81, Issue 12 (March 2024)
Abstract
Background: The experience of existential distress, along with other forms of distress, is one of the common experiences in end-of-life patients. Therefore, the purpose of this research is to review related studies and conceptualize existential distress in palliative care of cancer patients.
Methods: This study was a systematic review, which was conducted from May 1 to July 31, 1402 at Allameh Tabatabai University and search strategy was written and performed in MEDLINE, Web of Science/PubMed and Scopus databases from the beginning of 2003 to the end of 2022. The inclusion criteria included all quantitative, qualitative, mixed and review studies that focused on the experience of adult patients. Lack of access to the full text of the article and studies in non-English language, clinical trial (randomized and non-randomized), letter to the editor, case report and protocol were excluded from the list of studies. After removing duplicate articles, two research authors reviewed the studies independently according to the inclusion and exclusion criteria, and the differences between them were resolved by discussion.
Results: After searching, screening and selecting articles based on inclusion and exclusion criteria, finally 22 articles were included in the study, of which three were review articles, eight were quantitative and 11 were qualitative. Terminally cancer patients experience existential distress, and the data are significant for estimating the prevalence of these symptoms, especially in the severe category. In addition to examining the prevalence of this symptom, patients have described their experience of existential distress in several categories: Feelings of loneliness and isolation (or loss of support system), relationship concerns (concerns about family, changes in relationships, and conflictual relationships), loss of control/autonomy (physical control, cognitive and emotional control), burden on others, loss of sense of continuity (loss of roles, pleasurable activities and sense of self), uncompleted life tasks, hopelessness/helplessness, dissolving of the future, uncertainty and frightening ambiguity, feeling guilt/ regret about the past, lack of meaning, inevitable thoughts of death.
Conclusion: It seems that the themes raised beyond cultural differences show the universal human suffering, whose accurate conceptualization can help to develop effective therapeutic interventions to reduce existential distress.

The effect of high-intensity interval training on cardiac mitochondria PGC1α and some oxidative stress indices in mice with liver damage
Maryam Mokhtari, Seyyed Reza Attarzadeh Hosseini, Nahid Bijeh, Mohammad Mosaferi Ziaaldini ,
Volume 81, Issue 12 (March 2024)
Abstract
Background: Fatty liver disease is the most common cause of chronic liver diseases in the world, which can cause cardiovascular diseases, so this research aims to scrutiny a period of intense intermittent sports activity and growth hormone perfuse on cardiac mitochondrial PGC1α and some indicators of oxidative stress in mice with liver damage.
Methods: The present research was conducted from September 2022 to March 2023 in the specialized physical training laboratory of Ferdowsi University of Mashhad. The statistical population was twenty one adult male Syrian mice with an average weight of twenty three grams. The sports activity protocol was adopted for fifty-six days using the special video recorder for rodents. The intense interval training program was carried out in the form of ten one-minute repetitions and two-minute active rest, so that the total daily training time for each person was thirty minutes.The vaccination protocol includes the daily vaccination of somatropin injected intraperitoneally.
Results: The PGC1α levels were significantly higher in both the HIIT (P=0.02) and H- GH (P=0.03) groups collationed to the witness team. Moreover, the levels of SOD were considerably increased, in both the HIIT (P=0.05) and H-GH (P=0.005) team s compared to the witness team. Moreover, the levels of MDA were considerably decreased, in both the HIIT (P=0.007) and H-GH (P=0.04) teams compared to the witness team. The decrease in insulin resistance was significant only in the HIIT (P=0.05) team compared to the witness team and slightly increased in the H-GH (P=0.36) team but was not considered. The difference between HIIT and H-GH team (P=0.03) was also significant.The proportion of ALT/AST in both HIIT (P=0.02) and H-GH (P=0.03) teams had a significant decrease compared to the witness team. LDL/HDL proportion evidenced considered decrement at just in the HIIT team (P=0.01).
Conclusion: Intense intermittent sports activity was able to produce a more optimal response compared to GH peptide in improving NAFLD-related indices. Injection of this hormone single may have adverse outcomes on some indexes of this abnormality.

Effect of strabismus surgery on emotional quotient in patients referring to Imam Khomeini Hospital, Ahvaz
Gholamreza Khataminia , Reza Papahn, Atefeh Mahdianrad , Soroush Karamirad, Samaneh Mohamadpour,
Volume 81, Issue 12 (March 2024)
Abstract
Background: Psychosocial improvements of successful strabismus surgery have been reported in previous studies. But the effect of strabismus surgery on the emotional intelligence of patients is unclear. The aim of this study was to evaluate the effect of strabismus surgery on emotional quotient in patients referring to Imam Khomeini Hospital, Ahvaz.
Methods: This prospective interventional study conducted on patients underwent strabismus surgery in Imam Khomeini Hospital, Ahvaz during May 2021 to March 2022. A total of 38 patients between 8-37 years were included. Patients with previous surgery were excluded. All subjects were evaluated before and three months after successful strabismus surgery. Three months post-surgery the improvement of emotional quotient, self-esteem, body image, social anxiety and social avoidance were evaluated and compared with previous surgery. All data were analyzed by SPSS (V25). P-Value less than 0.05 was considered as significant level.
Results: 38 subjects including 18 males (47.4%) and 20 females (52.6%) were included. The mean age of patients was 18.11±9.33 years old. Our results showed that compared with before surgery, significant improvements were noted after surgery, within the emotional quotient subscales including self-awareness (P=0.016), self-regulation (P<0.0001), self-motivation (P<0.0001), empathy (P<0.0001), social skills (P<0.0001) and emotional quotient total score (P<0.0001). Further analysis revealed statistically significant improvements in body image (P<0.0001), social anxiety (P=0.004) and social avoidance (P=0.002). The result showed that the improvement of emotional quotient after strabismus surgery was significantly higher in the age group of less than 12 years (P<0.0001). No significant difference was fund between two  genders for emotional quotient subscales (P>0.05).
Conclusion: The results of this study showed a significant improvement in the psychosocial factors including emotional quotient, body image, social anxiety and social avoidance after strabismus surgery. This result suggests that beyond functional and cosmetic improvements, successful strabismus surgery can result in improved emotional quotient and social anxiety, with the greatest effect noted in younger patients.

The effectiveness of intermittent Nordic exercises with and without VR on body composition and cardiorespiratory fitness in boys with internet addiction
Nima Nejati Boushehri , Valiollah Dabidi Roshan ,
Volume 81, Issue 12 (March 2024)
Abstract
Background: Being sedentary due to internet addiction is a common public health problem that causes overweight and obesity. Novel methods are needed for weight control behaviors. This study aimed to determine effects of short-term (two weeks) and moderate-term (four weeks) of virtual reality (VR) exercise program with and without interval Nordic walking (INW) in adolescent boys on novel body composition and maximal oxygen uptake (VO2max) parameters; body adiposity index (BAI), abdominal volume index (AVI), conicity index (CI), waist-to-height ratio (WHtR), and a body shape index (ABSI).
Methods: In a semi-experimental trial during July to December 2023, 70 adolescent boys (age 14.8 years, body mass index (BMI)=24.4 kg/m2 and VO2max 38 ml/kg/min) with the Young IA tests score ranging over five, were selected from the city of Karaj and randomly was classified to VR, INW, VR+INW and control groups. Individual and combined exercise programs of VR and INW were performed (three session in week for 30 min) for two and or four weeks. The parameters were evaluated at the baseline and the follow up phases (two and four weeks after the interventions period) with a repeated measure ANOVA.
Results: According to Young's internet addiction test scores at the beginning of the study, there was no significant difference between the control and intervention groups (P≥0.05). It has been observed that internet addiction negatively affects cardiorespiratory fitness. When a 2-week intervention of VR exercises was implemented along with INW, the improvement in cardiorespiratory fitness (VO2max) was better than when VR exercises alone lasted for four weeks (P≤0.05). After four weeks of INW intervention, separately and in combination with VR, a significant improvement was observed in VO2max, WHtR and BAI values compared to the control group (P≤0.01).
Conclusion: Although improvement in cardiorespiratory fitness of boys with IA can be achieved by doing short and medium term INW, VR and INW+VR exercises, longer interventions, i.e., four weeks or more, cause more significant changes in the novel body composition.

Available and future of digital health solutions for body weight management in diabetic patients
Marziyeh Najafi, Sima Marzban, Roya Rajaee, Behrooz Pouragha,
Volume 81, Issue 12 (March 2024)
Abstract
Managing overweight and obesity is associated with lower risks of chronic diseases like diabetes. Digital health, particularly smartphones or m-health, effectively manages body weight. Technologies such as telemedicine services, mobile health (mHealth) or the use of mobile phones or portable digital devices in healthcare services and wearable devices can be used in this field. Therefore, this study was conducted to understand the impact of digital health technologies on weight management in diabetic patients.
Methods: The present study is a systematic review study that was initially searched using a systematic review of published studies in the field of digital health for weight management in diabetic patients from October 1401 to October 1402. Our study was conducted in two rigorous steps. Firstly, we performed a systematic review by searching for publications on Digital Health Solutions for Body Weight Management in Diabetic Patients until 12 October 2022. We meticulously combed through two comprehensive databases, PubMed and Web of Science, using a set of specific and relevant keywords. After a thorough screening and full-text assessment, we handpicked eight documents for this study. We cross-referenced with the companies' websites producing the identified applications to enrich our findings further.
Results: In the initial search, 223 documents were identified and after screening and qualitative evaluation, eight documents were selected for this study. Our research uncovered a range of mHealth apps that have shown promise in weight management for diabetic patients. These apps have demonstrated potential efficacy, high acceptability, and favorable user experiences. Importantly, they have also improved diabetes management and quality of life for the users.
Conclusion: Our review of digital health solutions has not only illuminated their potential in weight management for diabetic patients but also opened up new avenues for a more personalized, engaging, and practical approach to this issue. As technology continues to advance, these interventions hold the potential to revolutionize diabetes self-management, significantly enhance the quality of life, and contribute to better health outcomes for individuals living with diabetes.

Relationship between maternal early pregnancy body mass index (BMI) and weight gain during pregnancy with pregnancy outcomes: a cross-sectional study
Lida Saeed, Niusha Bahmanpoor, Robabe Hosseinisadat, Fatemeh Karami Robati ,
Volume 81, Issue 12 (March 2024)
Abstract
Background: One of the factors affecting the outcome of pregnancy is the primary body mass index (BMI) and the amount of weight gain during pregnancy. This study aimed to check the relationship between mother's initial body mass index and weight gain in pregnancy with pregnancy outcomes.
Methods: This cross-sectional study was conducted on 455 pregnant women referred to Afzalipour Hospital in Kerman, Iran, from August 2021 to August 2022. These pregnant women were included in the study through easy and accessible sampling. The mother's initial weight was recorded through the mother's health card. The height of the mother was measured using a standard meter and the final weight of the mother before delivery was measured using a standard scale available in the department. Other information of the mothers was extracted from their records. Weight gain during pregnancy and initial body mass index were calculated and divided into four categories, less than normal, normal, overweight and obese. Maternal-fetal complications were included in the information registration form. Descriptive and analytical statistical methods and SPSS version 24 software were used to analyze the data.
Results: The average age of women was 27.56±6.82 years. Body mass index of more than 40% of them (44.4%) was normal (19.8-26) and more than 45% of them were overweight 11.5-16 (45.5%). There was a significant relationship between initial body mass index and weight gain during pregnancy (P=0.001), gestational diabetes (P=0.001) and newborn weight (P=0.019). There was also a significant relationship between weight gain during pregnancy with premature birth (P=0.001), vaginal delivery (P=0.001), gestational diabetes (P=0.001) and newborn Apgar (P=0.001).
Conclusion: High body mass index of the mother and weight gain during pregnancy can cause complications in the mother and the fetus. Therefore, prenatal care should be done more carefully and health care providers should place mothers who have abnormal body mass index and inappropriate weight gain in pregnancy in the high-risk group and under special care to minimize maternal and fetal complications.

Investigating the effectiveness of Sodae herbal capsule on migraine headaches and comparing it with sodium valproate
Daryoush Afshari, Mansour Rezaei, Mojtaba Khazaei, Negin Fakhri ,
Volume 81, Issue 12 (March 2024)
Abstract
Background: One of the first-line treatments to prevent migraine attacks is Sodium Valproate. "Booali Daroo" pharmaceutical company has made a herbal capsule called Sodae based on traditional Iranian medicine. The aim of this study is to compare the effect of Sodae and Sodium Valproate on migraine headaches.
Methods: This two-center, double-blind, randomized clinical trial was conducted between December 2021 and July 2022 in the cities of Kermanshah and Hamadan. In this study, 76 migraine patients were randomly divided into two groups. One group received routine medication with Soda capsules and the other group received routine medication with Valproate capsules. Tow group were examined and followed up for three months. Data related to demographic and clinical information of patients were collected and entered into SPSS software version 25. Data analysis was done with a significance level of 0.05.
Results: Overall, 76 patients assessed (36 in the Sodae group and 40 in the Valproate group). The reduction of headache indicators was not significant between the two groups; in such a way that: the frequency (7.49±6.1 vs. 5.75±4.5, P=0.183), the severity (5.66±1.6 vs. 6.34±1.8, P=0.089), the duration of attacks (23.48±30.5 vs. 32.35±32.6, P=0.069), and the Migraine Disability Assessment Score (53.94±77.3 vs. 95.94±104.2, P=0.061) respectively in Valproate and Sodae. Examining different classes of MIDAS score showed that at the end of the study compared to the beginning of the study, the number of people with severe disability decreased significantly and their disability changed from severe disability to lower degrees of disability (P<0.05). The frequency of side effects was not significantly different between the two groups (12 patients (35%) in Sodae versus 21 patients (55%) in Valproate, P=0.090).
Conclusion: In terms of frequency, intensity and duration of migraine headaches as well as side effects, there was no significant difference between Sodium Valproate and Sodae groups.

Investigation of the relationship between the dietary inflammation index and the dietary phytochemical index with non-alcoholic fatty liver diseases
Parastoo Beknejadi, Davoud Vahabzadeh, Esmaeil Yousefi Rad , Somayeh Saboori , Koroush Ghanadi , Mehdi Birjandi,
Volume 81, Issue 12 (March 2024)
Abstract
Background: The increasing prevalence of non-alcoholic fatty liver disease (NAFLD) in recent years has raised concerns about its significant risks for public health. According to previous studies, a diet with low phytochemicals and high inflammatory index is related to non-alcoholic fatty liver disease. In this study, we intend to investigate the relationship between inflammatory diet and phytochemical diet with NAFLD.
Methods: In this case control study, 112 newly diagnosed patients with NAFLD referred to the Shahid Rahimi Hospital clinic in Khorramabad between January 1400 and April 1401 and 112 healthy individuals without NAFLD and any other chronic diseases as the control group, with the range 23-59 years old were selected. General information, demographics, physical activity level and food intake were collected using general information questionnaire, physical activity questionnaire and valid semi-quantitative food frequency questionnaire (FFQ). The energy received between the people of the two groups was adjusted. People's diet was divided into two anti-inflammatory and pro-inflammatory groups based on the DII index based on the score quartiles.
Results: The results showed a significant relationship between DII score and NAFLD in the crude model (OR: 2.22, 95% CI: 1.04 -4.73), model I (adjusted for energy and age classification) (OR: 2.4, 95% CI:1.07-5.58), model II (adjusted for model I+physical activity, sex, education) (OR:2.77, 95% CI:1.14-6.77) and model III (model II+BMI) (OR: 2.16, 95% CI: 0.81-5.71) and DPI score and NAFLD the crude model (OR: 0.69, 95% CI: 0.32-1.47), model I (adjusted for energy and age classification) (OR: 0.56, 95% CI: 1.29-5.58), model II (adjusted for model I+physical activity, sex, education) (OR:0.58, 95% CI: 0.23-1.44) and model III (model II+BMI) (OR: 0.65, 95% CI: 0.24-1.75).
Conclusion: The results obtained from this study showed an inverse relationship between following an anti-inflammatory diet and the risk of NAFLD. However, there was no correlation between receiving a diet with a high phytochemical index and NAFLD.

Evaluation of emergency department crowding of Imam Khomeini hospital in Urmia based on EDWIN index in 2020
Hamidreza Mehryar, Mohammad Rafiei,
Volume 81, Issue 12 (March 2024)
Abstract
Background: Overcrowding in the emergency department is considered as a problem of the public health system, and the present study was conducted with the aim of evaluating the overcrowding in the emergency department of Imam Khomeini Hospital in Urmia based on the EDWIN index.
Methods: This descriptive-analytical study was carried out cross-sectionally from March 21, 2019 to March 19, 2020, using a simple random sampling method in patients referred to the emergency department of Imam Khomeini Hospital in Urmia. Which was used to collect information from the demographic information checklist and the EDWIN index was calculated. Then the information was entered into SPSS18 software and analyzed with the help of descriptive and analytical statistics.
Results: In this study, the results showed that in terms of the frequency of triage level, 5.4% was level one, 65.6% was level two, 26.3% was level three, 2.7% was level four and there was no disease in level five. In terms of shift, 22.5% visited the hospital in the morning shift, 27.6% in the evening shift and 49.9% in the night shift. The average EDWIN index was 2.7±0.75 on holidays and 5.9±4.6 on non-holiday days. Although emergency room congestion was more on non-holiday days, this difference was not statistically significant (P=0.15). Also, the average of EDWIN in the morning shift was 2.5±2.3, in the evening shift it was 0.71±2.16 and in the night shift it was 9.7±5.8 and even though the average of EDWIN in the night shift was higher than in the evening and night shifts, this difference was not statistically significant (P=0.06).
Conclusion: The results of the present study indicated that on most of the investigated days, the emergency room was evaluated as crowded based on the EDWIN criteria. Also, there is no significant difference between the busyness of the emergency room according to the holiday or working day, as well as the morning, evening and night shift.

Strategies for prevention, diagnosis and treatment of Post Covid-19 Fungal Infections in Immunocompromised Patients: A systematic review
Abdolahad Nabiolahi , Najmeh Khammari, Nasser Keikha,
Volume 82, Issue 1 (April 2024)
Abstract
Background: Nowadays, understanding healthy treatment strategies is crucial in the post-COVID era where immunocompromised patients are more likely to get exposure to fungal infections. The aim of the research was to investigate studies of fungal infections after COVID-19.
Methods: The systematic review study was conducted from 11 July 2023 to 04 February 2024 in Zahedan, Iran. To extract articles on fungal infections, the vocabulary of selected Medical Subjects Headings (Mesh), other specialized literature was determined and a search strategy was formulated in three databases, Web Science, Scopus, and PubMed, without any time limitation. In addition, the articles were analyzed according to the research objectives, types of fungal infections encountered in immunocompromised patients, their incidence in different immunocompromised patient groups, diagnostic and detection strategies, treatment methods and other background information.
Results: A 15 number of related articles were included. The most common type of study was case report. From the lens of Aspergillus and mucormycosis fungal infections, they were given more attention, and in terms of the type of immunodeficiency, patients with a history of diabetes, including groups of diabetic patients, cancer groups, AIDS patients, and some groups with genetic disorders, were investigated in the studies. Appropriate treatment methods; particularly the use of corticosteroid drugs such as methylprednisolone as intravenous injection, systemic antifungal drugs such as liposomal amphotericin B, Antifungal treatment using high-dose amphotericin B, the use of prophylactic drugs, and isolation of the damaged tissue are recommended as the best treatment strategies. In order to prevent fungal infections in groups of Immunocompromised Patients, it is recommended to use simple hygiene Recommendations.
Conclusion: Analyzing the conditions of cocvid-19 patients and recognizing effective treatment strategies is inevitable, especially in the post- COVID era. A review of the literature showed that prevention and control of fungal infections after covid-19 was critical among immunodeficiency patients and the use of the recommended treatment method for their lifecycle continuity should be more considered by health care providers, health system managers and health policy makers.

The effect of Early Mobilization on the length of intensive care unit stay in pediatrics under ventilator: A Pilot study
Jamalodin Begjani , Bahareh Yaghmaei, Azam Mahmoudi , Mohammad Mehdi Rajabi ,
Volume 82, Issue 1 (April 2024)
Abstract
Background: Prolonged stay in intensive care unit (ICU) can worsen the patient's prognosis and represents a significant economic burden. Previous studies have reported the effectiveness of early mobilization in reducing length of stay in ICUs for adult patients; However, conflicting results have been reported regarding its effects on pediatric patients. Therefore, this research aimed to investigate the impact of early mobilization on the length of stay in the pediatric intensive care unit (PICU) in ventilated children.
Methods: This pilot quasi-experimental study was conducted on 60 children admitted to the Children's Medical Center hospital from March 2020 to June 2021. For the control group, routine care (standard physiotherapy) was started on the second day of intubation and continued until discharge from the intensive care unit. In this study, we used an early mobilization protocol including active and passive exercises. The intervention was implemented by Pediatric intensive care unit nurses under supervision of a pediatric critical care fellowship physician. In the intervention group, passive exercises were started on the second day of intubation. At each shift, the nurses check the level of sedation and presence of delirium in the patients using the Richmond Agitation-Sedation Scale and the Cornell Assessment of Pediatric Delirium questionnaire. If the results showed that the sedation was not deep and delirium was not present, then active exercises were initiated. If the child did not achieve an adequate score indicating the absence of deep sedation and delirium, the patient remained in the passive exercise phase. The length of stay was recorded based on the patients' records. Descriptive and inferential statistics were used for data analysis using SPSS version 23.
Results:  The results showed that there was no significant difference in the length of stay in the pediatric intensive care unit (PICU) between the control (23.20±6.34 days) and intervention (22.60±6.18 days) groups (P=0.77).
Conclusion: The implementation of early mobilization did not significantly reduce the length of PICU stay for pediatric. The researchers are advised to identify and evaluate evidence-based guidelines for implementing early mobilization in children with different diagnoses.

Studying the educational satisfaction of obstetrics and gynecology residents of Tehran University of Medical Sciences with the residency training program
Mahroo Rezaieenejad , Fedyeh Haghollahi, Nasim Eshraghi, Hossein Gholamzadeh , Marjan Ghaemi, Zinat Ghanbari,
Volume 82, Issue 1 (April 2024)
Abstract
Background: Given the significance of patient care in obstetrics and gynecology, we aimed to assess the satisfaction of Tehran University of Medical Sciences residents with their training program in this field.
Methods: In this cross-sectional descriptive study, 77 obstetrics and gynecology residents from the first to fourth year at Tehran University of Medical Sciences participated with informed consent, adhering to ethical principles, from April to October 2023 across four teaching hospitals: Imam Khomeini, Shariati, Mohib Yas, and Arash.The researcher developed a questionnaire consisting of 62 online questions, including 15 demographic questions and 47 related to satisfaction. Most of the questions are statements with five response options: strongly agree, agree no opinion, disagree, and strongly disagree. Each criterion was assessed and classified on a scale from one to five. The assistants' satisfaction levels were assessed in various areas, yielding an overall score of 47-235. Scores above 70% indicate high satisfaction, 50-69% reflects average satisfaction, and below 50% signifies dissatisfaction. It's important to clarify that the areas include clinics, with specific focus on rotation shifts for assistants in gynecology, oncology, prenatal care, and infertility. Data analysis was conducted using SPSS software, Version 22. Descriptive statistics included the median and range for continuous variables (number of surgeries and satisfaction scores) and frequency and percentage for nominal variables (quality of satisfaction) across three defined levels of desirability: appropriate, relatively appropriate, and unfavorable.
Results: Satisfaction with the number of surgeries and educational quality at Imam Khomeini Hospital was higher than at other hospitals (P=0.07). Significant differences were noted in the gynecology and pelvic surgery departments, with residents at both Imam Khomeini and Arash hospitals reporting greater satisfaction in gynecology (P=0.018) and pelvic surgery (P=0.036). Additionally, regarding the conference program and educational mornings, Shariati Hospital reported a higher level of satisfaction in this area (P=0.47).
Conclusion: The satisfaction scores in various areas indicate that 64.5% of assistants at Imam Khomeini Hospital rated their educational status as appropriate, while 60% at Arash Hospital rated it as relatively good, and 25% at Yas Hospital found it unfavorable.

Evaluating the Correlation between Liver Size and Fatty Liver Progression in Patients with Non-Alcoholic Fatty Liver Disease
Maryam Behmaram, Mohammad Ghasem Hanafi, Ahmad Fakhri Zadeh , Mahsa Akhavan Sabagh , Elham Farhadi,
Volume 82, Issue 1 (April 2024)
Abstract


Background: Increasing the prevalence of non-contagious and chronic disorders such as Non-alcoholic fatty liver disease (NAFLD) takes the attention of researchers. NAFLD recognized by abnormal accumulation in the liver tissue. The aim of present study is investigating the association between liver size liver enzymes and degree of fatty liver in patients with NAFLD.
Methods: Based on the inclusion criteria, 100 Patients were selected from those referred to the radiology and ultrasonography clinic in Golestan Hospital, Ahvaz, for fatty liver evaluation. The study was carried out during May 2022 to April 2023. Liver enzymes, including alanine aminotransaminase (ALT) and Aspartate aminotransferase (AST), were measured. Based on the ultrasonography results, patients were divided into four groups: healthy, mild fatty liver, moderate fatty liver, and severe fatty liver. Ultrasonography was carried out by an experienced expert. All demographic information of patients was collected. Data were analyzed by SPSS (V25).
Results: According to ultrasonography results, the mean of span was 148.4 ± 14.7 cm, which was significantly higher in patients with grade II of NAFLD (P<0.001). Further analysis revealed the highest difference between grades I and II (P<0.001). Also, a significant difference between grades II and III and grades III and I were found  (P<0.001). Our data showed a significant relationship between body mass index (BMI) and NAFLD grades (P<0.001). The mean of BMI in grade I was significantly lower than in grades II and III (P<0.05). Our findings demonstrated that the mean of ALT in grade I was significantly lower than in grades II and III (P<0.05). In this line, the highest AST level was seen in grade III (P<0.001).
Conclusion: Our study showed that as NAFLD progresses, the enzymes and size of the liver increase. Based on ultrasound findings, the increasing liver size suggests NAFLD grade II, while the rise in AST and BMI suggests NAFLD grade II -III and progression of cirrhosis.

Investigating the causes and nature of medical errors in the voluntary reporting system in Firoozgar educational center
Maryam Ameri, Atieh Ansari, Abbas Aghabiklooei, Farrokh Taftachi , Leyla Abdolkarimi,
Volume 82, Issue 1 (April 2024)
Abstract
Background: Medical errors are one of the biggest problems of the health system in countries. Identifying the factors responsible for these errors is crucial to designing optimal strategies to reduce such occurrences. The aim of this study was to investigate the type and nature of medical errors.
Methods: In this cross-sectional descriptive study, all documented medical errors that occurred between March 2021 and February 2022 at Firoozgar Educational and Medical Center were thoroughly examined. The data collection involved reviewing records from various departments within the center to ensure a comprehensive analysis of error types. The extracted data were processed and analyzed using SPSS v.22 software, allowing for statistical evaluation and identification of potential patterns or trends in medical errors over the specified period.
Results: A total of 214 cases were reviewed. 45.3% of the recorded medical errors occurred in the morning shift, 20.6% in the evening shift and 34.1% in the night shift. The highest number of medical errors was reported by nurses (40.7%), followed by physicians (16.8%) and paramedics (11.7%). The etiology of most medical errors was systemic errors (63.6%) followed by pharmacological errors (15.4%) and technical errors (13.1%) and the most reported systemic errors were of insufficient supervision. Most of the patients who had medical errors were admitted to the inpatient wards (40.7%) and later to the surgical wards (17.3%) and ICU (12.6%). 62.1% of medical errors did not cause any specific complication and in 33.2% of cases, mild complication, 10.7% moderate complication and 3.3% severe complication occurred for patients. 62.1% of medical errors had no consequences for anyone, and in 36.9% of cases, the consequences of errors were to the patient and 1% of the consequences of errors were to the organization and employees.
Conclusion: Most of the reported medical errors were performed by nurses and were uncomplicated errors. Establishing transparent and accurate self-reporting systems is essential to identify medical errors of all employees.

Comparison of the effects of Althaea officinalis and eucalyptus nebulizers on the severity of cough in patients with Covid-19: Clinical trial
Fatemeh Najafi, Masoumeh Amiri Delui, Maryam Moradi , Parastoo Sarkhosh, Zahra Rezaian, Farnoosh Sharifymood, Fateme Kameli ,
Volume 82, Issue 1 (April 2024)
Abstract
Background: one of the most common and important complications of COVID-19 is cough. The present study was designed with the aim of comparing the effect of althaea officinalis and eucalyptus nebulizer on the severity of cough in COVID-19 patients.
Methods: in this randomized clinical trial, from January 2022 to June 2022, 36 patients with COVID-19 were selected and randomly divided into three groups. Next, the severity of cough was recorded two hours before the intervention based on the visual analogue (VAS) in both groups until the patient was admitted to the hospital, then, one cc aqueous extract of althaea officinalis with five cc Normal Saline for the althaea officinalis group and four cc aqueous extract eucalyptus whit five cc Normal Saline for the eucalyptus group, were nebulized once a day for 15 minutes. Two hours after the intervention, the intensity of cough was again recorded in two groups. This intervention continued until the hospitalization of the patients. No intervention was done for the control group. The data was analyzed with Spss software at a significance level of less than 0.05.
Results: In this study before the intervention, there was no statistically significant difference between the three groups in terms of cough intensity (p>0.05), but after the intervention on the second and third days, there was a statistically significant difference between the three groups in terms of cough intensity. The rate of reduction in cough severity in althaea officinalis group was higher than the other two groups (p<0.05).  Also, the results of Friedman's test indicated that althaea officinalis and eucalyptus nebulizers incense improved the severity of cough in patients over time.
Conclusion: the use of althaea officinalis and eucalyptus nebulizer improved the severity of cough in patients with COVID-19, but althaea officinalis nebulizer had a greater effect on cough severity compared to eucalyptus. It is suggested to use althaea officinalis nebulizer as well as eucalyptus as a treatment method along with other treatment methods.

Investigating the relationship between the type of delivery and neonatal and maternal outcomes in public and private hospitals in Yazd
Morad Ali Zareipour, Shahla Mohammad Khani , Behjat Khorsandi , Faezeh Afkhami Aghda , Fateme Moshirenia, Mahdieh Hardani Naeemzadeh ,
Volume 82, Issue 1 (April 2024)
Abstract

Background: The type of delivery significantly affects a woman's life and her newborn's health. Various factors, including medical conditions, personal preferences, and cultural influences, shape this decision. Increasing cesarean delivery rates have raised concerns about associated risks. This study examines the health impacts of different delivery types on mothers and newborns in Yazd hospitals, with a focus on maternal and neonatal outcomes.
Methods: This cross-sectional analytical study involved a substantial cohort of 69,321 mothers who delivered in Yazd between March 21, 2018 to March 20, 2022. Comprehensive data were collected from Iman Hospital and relevant online patient records. To analyze the relationship between delivery type and health outcomes, independent samples t test and chi-square test were utilized. Additionally, odds ratios were calculated to assess relative risks concerning various maternal and neonatal outcomes. SPSS 26 software was employed for all analyses, with a significance level set at 5% to ensure robustness in the findings.

Results: The average age of participants in the study was 34.45±6.44 years, highlighting a mature population of mothers. Neonatal outcomes indicated that babies delivered naturally were more likely to have unfavorable Apgar scores (ranging from four to six) when compared to infants delivered via cesarean section (CI=0.99-1.55, P=0.05, OR=1.24). Furthermore, naturally delivered infants showed a significantly higher likelihood of having Apgar scores below six (CI=0.90-1.03, P=0.001). Alarmingly, the odds of neonatal death were found to be 1.22 times higher for cesarean births (CI=1.19-1.25, P<0.001). Additionally, mothers who underwent cesarean deliveries exhibited nearly a 4.9 times higher likelihood of requiring intensive care after delivery (CI=4.71-5.12, P<0.001, OR=4.9) and were 14.3 times more likely to be hospitalized postoperatively compared to those who had natural deliveries (CI=3.53-1.31, P<0.001, OR=14.33).
Conclusion: This study indicates that cesarean delivery is associated with higher complications for both mothers and newborns, highlighting the need to promote natural childbirth for better health outcomes.

Creation of the suitable natural human kidney scaffold: comparison of 2 decellularization methods
Samira Shahraki , Mahmoud Tavakkoli, Abolfazl Khajavirad, Maryam Moghadam Matin , Mohammad Aslzare ,
Volume 82, Issue 1 (April 2024)
Abstract
Background: A range of diseases can result in end-stage renal disease (ESRD), characterized by a gradual decline in kidney function and associated with significant morbidity and mortality. Currently, renal transplantation as the most effective treatment for managing ESRD. Tissue engineering presents a considerable opportunity to expand the available supply of donor organs for kidney transplants. The aim of this research was to develop a suitable technique for preparing decellularized kidney scaffolds from human tissues.
Methods: The present study was carried out from April 2019 to August 2019 in Mashhad University of Medical Sciences. In this study, two decellularization protocols were compared using sections of human kidney tissue. Therefore, two human kidneys which collected from Ghaem and Imam Reza hospitals were used. In the first protocol, detergents such as 1% Triton X-100 (1A) and 1% SDS (Sodium Dodecyl Sulfate) (1B) were employed, followed by the application of DNase I. The second protocol utilized 0.5% SDS (2A) and 1% SDS (2B). The effectiveness of these techniques was evaluated using hematoxylin and eosin (H&E) staining, 4',6-diamidino-2-phenylindole (DAPI), DNA quantification, and immunohistochemistry (IHC).
Results:  Based on H&E staining results, comparison of the decellularized and native human kidney tissues showed a successful elimination of cell nuclei and the ameliorate extracellular matrix preservation in triton-treated scaffolds (1A) in comparison with the SDS-treated scaffolds (1B) at all times protocols. Furthermore, DNA quantification illustrated triton X-100 in removing DNA was more effective in eliminating DNA from kidney tissues compared to other protocols in renal tissues. In addition, IHC staining demonstrated that the expression of collagen IV and laminin was preserved throughout the decellularization process with Triton X-100 on day fifth. Also, IHC staining indicated human leukocyte antigen (HLA) was completely eliminated in the cortex-medulla of human scaffolds treated with Triton X-100 within day fifth.
Conclusion: Our results demonstrated that triton X-100 outperformed SDS as a detergent for decellularizing human kidneys. Meanwhile these results indicate suitable method for decellularization of human kidneys to produce functional kidneys.

 
Comparative clinical and epidemiological analysis of waves during the corona epidemic based on a university surveillance system
Erfan Dehghani, Pezhman Bagheri, Zahra Montaseri , Niloofar Sohrabi , Mehdi Sharafi ,
Volume 82, Issue 1 (April 2024)
Abstract
Background: COVID-19 is one of the most recent known human infections that has resulted in a global pandemic, causing high rates of morbidity and mortality worldwide. This study evaluated the clinical and epidemiological characteristics of the waves of the corona epidemic within a university surveillance system in southern Iran.
Methods: This cross-sectional study analyzed data from 24,132 individuals with Covid-19 in the registered waves from the beginning of the Corona epidemic from March 2020 to March 2021 in one of the southern universities of Iran. Information on age, gender, number of infections, severity, hospitalization, recovery rate, dominant strain, and compliance with protocols separately for each wave from 2020 to 2021 was collected from the University's databases. After calculating the cumulative incidence rate, mean and standard deviation and drawing graphs, chi-square, Mann-Whitney and one-way ANOVA were used in SPSS26 at a significance level of 5%.
Results: The cumulative incidence of the disease was 11.36%, with a relative frequency of hospitalization at 11.7% and an average hospital stay of Seven days. The highest percentage of protocol compliance was applied in the initial waves. The highest frequency of infection was in the third wave, where men were more infected than women in all waves except the 4th and 5th waves. High blood pressure was the most common underlying disease in patients and the most lung involvement was observed in the fifth wave. Most of the patients have recovered, and the highest rate of recovery was observed in the sixth wave. Significant associations were found between hospitalization duration, underlying conditions, and clinical symptoms across different waves (P<0.001). Systemic symptoms were the most common, and there was a notable difference in radiological findings between waves (P<0.001).
Conclusion: The findings of this study emphasize the significant impact of underlying diseases and the severity of clinical symptoms on hospitalization outcomes. They also highlight the need for appropriate evidence-based management strategies and consideration of clinical changes and radiological patterns when evaluating diseases in different groups.

Effect of maternal death on number of childbirths in the only hospital of a city: a letter to editor
Nasrin Changizi, Arash Shirdel, Amin Daemi ,
Volume 82, Issue 1 (April 2024)
Abstract

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