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Diagnostic value of the level of interleukins in cerebrospinal fluid in children meningitis
Behnam Soboti , Shima Javadinia , Samileh Noorbaksh , Ramin Asgarian , Nastaran Khosravi , Azardokht Tabatabaee ,
Volume 72, Issue 12 (March 2015)
Abstract
Background: Cerebrospinal Fluid (CSF) culture for distinction between aseptic and bacterial meningitis can be difficult and long-term, and other diagnostic methods are under studying. This study aimed to assess the diagnostic value for the levels of Interleukin 1 (IL-1), IL-6 and IL-8 of CSF in the children and adolescent with meningitis. Methods: Fifty-one patient with meningitis between one month and 18 year included in a Cross-Sectional Studies in the Rasul Hospital, Tehran, from 2012 to 2014. All of samples underwent aspiration of CSF. The routine tests performed that include culture coloring and biochemical of CSF. The concentrations of IL-1, IL-6 and IL-8 were determined by Enzyme-linked immunosorbant assay (ELISA) method and all of data were analyzed. Results: Frequency of bacterial and aseptic meningitis was equal (49%). 64.7% of samples were boys and gender had not different between two bacterial and aseptic group (P=0.7). Mean (±SD) of the age in total was 358.46±858.40, and bacterial group had a higher mean of age than aseptic group (P=0.047). The level of IL-1 was 10.87±37.04 pg/ml in bacterial and 0.55±1.64 pg/ml in aseptic group, that had not different (P=0.168). The level of IL-6 was 90.51±139.3 pg/ml in bacterial and 21.36±67.84 pg/ml in aseptic group, that had significant different (P=0.030). The level of IL-8 was 365.40±765.52 pg/ml in bacterial and 50.66±59.34 pg/ml in aseptic group, that had significant different (P=0.047). Diagnostic value of IL-1 was noted in the 80.77% of bacterial and 68.00% of aseptic group that had not different (P=0.349). Diagnostic value of IL-6 was noted in the 53.85% of bacterial and 64.00% of aseptic group that had not different (P=0.572). Diagnostic value of IL-8 was noted in the 80.77% of bacterial and 28.00% of aseptic group that had significant different (P=0.000). There was not different between two group of CSF variables include coloring degree, WBC and RBC index, glucose and protein. Conclusion: Although the concentration of IL-6 and IL-8 was higher in bacterial meningitis than in aseptic patients, only IL-8 had suitable diagnostic value for distinction between different types of meningitis.
Association between concentration of interleukin-6, 17 and 23 and Helicobacter pylori infection in otitis media with effusion
Mohammad Farhadi , Ahmad Daneshi , Shima Javadi-Nia, Mohammad Nabavi , Ramin Asgarian, Mahmood Faramarzi , Azardokh Tabatabaie ,
Volume 73, Issue 2 (May 2015)
Abstract
Background: Helicobacter pylori (H. pylori) cause various diseases especially gastrointestinal disorders. Clinical diagnosis of H. pylori infection can be done in different ways, and new diagnostic methods are under study .This study aimed to assess the levels of interleukin (IL) 6, 17 and 23 in the middle ear effusion of patients with otitis media, and the association between these levels with H. pylori infection. Methods: This cross-sectional study conducted in 40 patients who nominated for ventilation tube (VT) placement due to otitis media with effusion, and admitted to ear, nose, and throat (ENT) clinics of Tehran University of Medical Sciences from March 2012 to August 2013. All of patients underwent myringotomy with VT insertion, and then aspirated effusion sample was tested. H. pylori infection diagnosed by polymerase chain reaction (PCR) and bacterial culture. The concentration of IL-6, IL-17 and IL-23 measured by enzyme-linked immunosorbent assay (ELISA). The levels of each interleukins were compared between the two positive and negative PCR groups. Results: In all of samples, PCR test result was positive in 22.5%. The mean and standard deviation of IL-6 level was 10.11±2.95, IL-17 was 5.89±0.91 and IL-23 was 4.07±1.34. The mean±standard deviation (SD) of IL-6 level in patients with a positive PCR (H. pylori) was 22.29±6.40 and in patients with a negative PCR was 6.16±3.88 that difference was significant (P=0.01). The mean±SD of IL-17 level in patients with a positive PCR was 6.16±1.29 and in patients with a negative PCR was 5.81±1.13 that difference was not significant (P=0.42). The mean±SD of IL-23 level in patients with a positive PCR was 6.15±3.77 and in patients with a negative PCR was 3.42±1.33 that difference was not significant (P=0.27). Conclusion: According to finding, association between H. pylori infection and increased levels of IL-6 in the middle ear effusion was approved. It is recommended to conduct researches aimed to identify other cytokines as inflammatory markers.
Ultrasonic energy vs monopolar electrosurgery in laparoscopic cholecystectomy: a comparison of tissue damage
Mehdi Asgari , Nozar Dorestan , Neda Najibpour , Changiz Delavari , Mohammad Bahadoram ,
Volume 74, Issue 1 (April 2016)
Abstract

Background: Laparoscopic cholecystectomy is a minimally invasive procedure whereby the gallbladder is removed using laparoscopic techniques. Monopolar electerosurgical energy is the method of dissection of gallbladder from liver bed. Ultrasonic energy causes less thermal damage and suggests an alternative to monopolar elevterocautery. Leptin is a tissue factor and C-reactive protein (CRP) is an acute phase protein that builds up in surgical damages. In laparoscopy, pneumoperitoneum and thermal damage cause this increase. In this study, after completion of surgery with both methods, plasma leptin and CPR were measured. Next, the complications and benefits of the two methods were compared.

Methods: This single blind randomized clinical trial was conducted on 78 patients who were candidate for laparoscopic cholecystectomy in surgery clinic of Razi Teaching Hospital in Ahvaz Jundishapur University of Medical Sciences from March 2013 to March 2015. Patients were divided randomly into two groups of ultrasonic and electerocautery. Then, leptin’s level and CRP’s level were measured at completion of surgery, 30 minutes after completion, 6 and 24 hours after completion of surgery in the two groups.

Results: This study shows that the average rate of leptin at completion of surgery, 30 minutes after completion, 6 and 24 hours after completion of surgery in ultrasonic group had less increase than electerocautery group and the difference was statistically significant (P= 0.0001). The average rate of CRP at completion of surgery, 30 minutes after completion, 6 and 24 hours after completion of surgery in ultrasonic group had less increase than electerocautery group and the difference was statistically significant (P= 0.0001).

Conclusion: The level of leptin and CRP shows that surgery with ultrasonic method will provoke the immune system less than electerocautery method.


Evaluation of chemical composition, antioxidant, antibacterial, cytotoxic and apoptotic effects of Aloysia citrodora extract on colon cancer cell line
Amir Mirzaie , Seyed Ataollah Sadat Shandiz, Hassan Noorbazargan , Elahe Ali Asgary,
Volume 74, Issue 3 (June 2016)
Abstract

Background: Aloysia citrodora belongs to the Verbenaceae family of plants, a well-known herbal medicine in Iran. The aim of the present study was to investigate the chemical composition, antioxidant, antibacterial, cytotoxic and apoptotic effect of A. citrodora extract against human colon cancer (HT29) cells by using real-time polymerase chain reaction and flow-cytometry methods.

Methods: This experimental study was carried out in Islamic Azad University, East Tehran Branch, from March to September of 2014. At first, the A. citrodora chemical constituents were analyzed by gas chromatography-mass spectrometry (GC-MS) technique. In addition, antioxidant assay, antibacterial and anti-cancer effect was performed using 1,1-diphenyl-2-picrylhydrazyl (DPPH), disk diffusion and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) methods, respectively. The half maximal inhibitory concentration (IC50) value was calculated. We extracted total RNA molecules by using RNX solution, after which cDNA was synthesized. Finally, the pro-apoptotic (Bax) and anti-apoptotic (Bcl2) gene expression was performed by real-time polymerase chain reaction and apoptotic effects were analyzed using Flow-cytometry method.

Results: GC-MS analysis of Aloysia citrodora extract was shown 37 major components and the most frequent component was belonged to Spathulenol (17.57%) and Caryophyllene oxide (15.15%) The antioxidant activity of the extract was IC50= 0.6±0.03 mg/ml. The maximum and minimum antibacterial effects of extract were belonged to gram-negative and gram-positive bacteria, respectively. Cytotoxic results revealed that the A.citrodora extract have IC50= 20.1±0.78 mg/ml against colon cancer (HT29) cell line and real-time polymerase chain reaction results showed the expression level of Bax and Bcl2 was increased and decreased respectively in colon cancer cell line (3.470±0.72 (P< 0.05), 0.43±0.35 (P< 0.05)). In addition, the flow-cytometry results indicated the 38.66% apoptosis in colon cancer cell line.

Conclusion: According to the results, it seems that A. citrodora extract has potential antioxidant, antibacterial and anticancer effects and it suggested that further studies were performed for A. citrodora pharmaceutical importance.


Diabetes bus: benefits and difficulties: letters to the editor
Maryam Asgari, Masoud Mohammadi,
Volume 75, Issue 11 (February 2018)
Abstract

The studying of people died under 18 old referred to forensic medicine organization in Tehran, from 2014 to 2015: brief report
Khadije Saravani , Mohammad Hossien Kamaloddini , Mahboobe Asgari ,
Volume 77, Issue 7 (October 2019)
Abstract
Background: Determination of mortality causes precisely, is very important in developing countries. Mortality rate is a helpful index for evaluating the quality of health in every society. However, recording of life events as well as mortality rates are difficult and conducted only in a few developing countries which account for a large percentage of the world’s mortality. Thus, it was attempted to conduct a study on mortality cases of under 18 year’s old corpses referred to the dissection laboratory of forensic medicine in Tehran from 2014 to 2015.
Methods: In this cross-sectional descriptive study, all cases of accidental deaths less than 18 years old which were referred to forensic medicine in Tehran have examined. All mortality data between April 2014 and April 2015 was completed by a questionnaire. This data were classified by age, sex, cause of referral, type of death, underlying disease, and cause of death based on autopsy results and positive findings of autopsy, pathology, and toxicology.
Results: In 2014 and 2015, 495 and 508 cases of under 18 years old were sent to the dissection laboratory of forensic medicine in Tehran, consequently. The mortality rate of 520 males and 483 females was recorded and it has risen from 2014 to 2015. The most common mortality causes are accidents, suspicious death, suicide, and car accidents.
Conclusion: The results showed that the mortality rate in males was higher than females, which is in line with the global findings. This may be due to cultural issues or the vulnerability of males. Study on causes of deaths, which recorded over two years showed that deaths in Tehran province are due to accidents, falls, strangulation, life-threatening poisoning and electrocution, birth disorders and suicides, which requires more studies on these subjects.

Evaluation of etiologic findings in patients with surgery of cubital tunnel syndrome
Mohammadreza Emamhadi , Ashkan Asgari-Gashtroudkhani , Roxana Emamhadi , Samaneh Ghorbani-Shirkouhi , Sasan Andalib,
Volume 78, Issue 2 (May 2020)
Abstract
Background: Cubital tunnel syndrome, a neuropathy of ulnar nerve, is the second most common entrapping syndrome in the upper limb surpassing carpal tunnel syndrome. This syndrome arises from a high pressure decompressing the nerve for a long time. Patients with cubital tunnel syndrome show numbness in the ring and small fingers. The aim of this study was to evaluate the etiology of cubital tunnel syndrome in patients who underwent surgery for treatment of the syndrome.
Methods: In this retrospective study, medical records of 100 patients who underwent surgery for treatment of cubital tunnel syndrome at Department of Neurosurgery, Poursina Hospital, Rasht, Iran from March 2008 to March 2017, were checked. The etiology of cubital tunnel syndrome including inflammatory, tumoral, vascular, orthopedic causes and anomalies in nerve site and information about age, gender, job, and weight were collected and analyzed.
Results: In this study, the mean±SD of age was 33.8±11.5 years. Females and males constituted 21% and 79% of the cases, respectively. Idiopathic and orthopedic etiologies were seen in 84% and 13% of the operated cases, respectively. Vascular, tumoral, and inflammatory causes were found in 1% of the cases. Regarding location of nerve involvement, 57% of the cases had the ulnar nerve entrapment between MCL (medial collateral ligament) and Osborne ligaments; and in 22% of the cases, the cubital tunnel was involved. Arcade of Struthers and medial epicondyle and medial intermuscular septum were involved in 8%, 8%, and 5% of the patients, respectively. Forty-five percent of the cases performed a repetitive manual task by hand and 1.9% of cases were vibrator workers. Moreover, 12.4% of cases had a history of cubitus valgus or cubitus varus. Finally, 20.9% and 18% of the cases suffered from obesity (BMI>30) and diabetes mellitus, respectively. Furthermore, one patient had a history of head injury with contractions of upper limb flexion and one patient had arthritis of medial epicondylitis.
Conclusion: The evidence from the present study indicates that the idiopathic cubital tunnel syndrome constituted the bulk of involvement on ulnar nerve in the patients. Job, obesity, and diabetes were the most important accompanying factors with cubital tunnel syndrome.

The role of MMP9 C-1562T and MMP2 G1575A genetic variants in male infertility: review article
Rezvan Asgari, Mitra Bakhtiari,
Volume 78, Issue 6 (September 2020)
Abstract
Infertility as a vital process in human reproduction involves many couples worldwide. Although many genetic causes of infertility are known, the genetic basis of infertility in men is largely unknown. Therefore, the identification of genetic biomarkers in this field is important and genetic polymorphisms in key genes of the spermatogenesis pathway can be valuable biomarkers in this field. Gene's polymorphisms with specific genetic background and/or environmental factors can lead to the dysfunction in testicular function or the process of sperm production. Matrix metalloproteinases (MMPs) are a family of zinc-dependent enzymes that play an important role in extracellular matrix remodeling by activating gelatinases, collagenases, and proteolytic enzymes. These enzymes are essential for the regulation of cellular connections in the testis. Extracellular matrix degradation and connective tissue remodeling are important structural changes in germ cell migration that are controlled through important genes, including MMPs and their biological inhibitors. Given the important role of MMPs in the structural and functional characteristics of reproductive organs, genetic polymorphisms in MMP genes are significant because they can influence gene transcription and the biological function of proteins. Studies have shown that matrix metalloproteinases are involved in the degradation of extracellular matrix and play an important role in the process of spermatogenesis and sperm quality. This review article aims to evaluate the role of two common, functional MMP2 G1575A and MMP9 C-1562T polymorphisms in male infertility. The findings indicate that polymorphisms of MMP2 G1575A and MMP9 C-1562T can affect gene transcription, protein level, and enzymatic activity, and also, these variants can be as one of the genetic causes in male infertility among different ethnic populations. Therefore, identifying these molecular changes can help to adopt appropriates therapeutic and diagnostic measures as well as guide therapeutic approaches to intelligent therapies. To achieve a definitive conclusion and confirm the association of these polymorphisms with male infertility, evaluations of gene-gene and gene-environment interactions can be important for larger sample sizes of different ethnicities.
Association between alcohol consumption and pancreatic cancer: a systematic review of cohort studies
Zohreh Ghoreishi, Ali Esfahani, Shima Asgarzad, Laleh Payahoo, Fatemeh Hajizadeh-Sharafabad ,
Volume 79, Issue 10 (January 2022)
Abstract
Background: Among all types of cancers, pancreatic cancer has poor prognosis with 5-year survival below 10%. In theory, alcohol intake may be a modifiable risk factor for pancreatic cancer due to its role in multiple carcinogenic and metabolic signaling pathways. In addition, alcohol consumption may lead to chronic pancreatitis which is underlying cause of pancreatic cancer. However, little is known about whether this factor is associated with pancreatic cancer. This study aimed to systematically review the cohort studies investigating the possible link between alcohol consumption and the morbidity or mortality of pancreatic cancer.
Methods: This study was carried out based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). All of cohort studies that assessed the association between alcohol intake and the risk of pancreatic cancer or death were included in this systematic review without a language restriction. Electronic databases including PubMed, Web of science, Scopus, and Google scholar were searched using the keywords "pancreatic cancer" and "alcohol" and similar words from 1990 to April 2021 to find the cohort studies.
Results: 858 articles were identified, of which 806 were excluded and the full-text of 52 papers were evaluated for the eligibility. Eventually, 22 articles were eligible and were included in this study. Many of the articles assessed the impacts of low to moderate alcohol intake. A comprehensive review of these studies showed that low to moderate alcohol consumption had a non-significant correlation with pancreatic cancer, while high alcohol consumption was significantly associated with the risk of pancreatic cancer or death. The results also revealed that high liquor consumption was associated with higher risk of pancreatic cancer. Nevertheless, the follow-up durations in most of these studies were shorter than that to lead to pancreatic cancer.
Conclusion: Long-term heavy alcohol drinking can increase the morbidity or mortality of pancreatic cancer. Regarding that several genetic and environmental variations involve in the pathogenesis of this cancer, simultaneous control of these differences should be addressed to determine the net effect of alcohol drinking on pancreatic cancer.
 

Assessing the role of enema in improving outcomes and complications of benign gynecological laparoscopy: a randomized clinical trial
Zahra Asgari, Azam Barkhordarinasab, Reihaneh Hosseini , Alireza Hadizadeh, Venus Chegini, Sara Farzadi,
Volume 79, Issue 11 (February 2022)
Abstract
Background: mechanical bowel preparation (MBP) is a common practice before laparoscopic gynecologic surgeries but the role and efficacy of preparation have been questioned. this study assesses visualization and bowel handling in a group of patients who receive MBP and the control group and thereafter; compares the results.
Methods: We designed and conducted this randomized, single-blinded and controlled trial on patients who underwent advanced gynecologic laparoscopic surgeries. This clinical trial was carried out between July 2020 and January 2021. The patients were enrolled from l the laparoscopic office. 120 women aged 18-65 years undergoing level 2 and 3 benign gynecologic laparoscopic surgeries were randomized to bowel preparation with a normal saline enema (n=60) or non-bowel preparation (n=60) groups. Our patients underwent level 2 and 3 of benign laparoscopic gynecologic surgeries with or without MBP. The visualization and bowel handling were assessed by the primary surgical team and a questionnaire was later obtained. The outcomes included intraoperative surgical view and bowel handling, preoperative and post-operative patient signs and symptoms. The patients were also assessed in respect to discomfort prior and after the surgery, this assessment was obtained using a questionnaire. The gathered data was analyzed using IBM’s SPSS v26 software.
Results: there was no difference in intraoperative visualization and bowel handling between the two groups. We also found no clinical improvements in respect to discomfort and symptoms. MBP even increased the distention rate amongst patients (P-value=0/04). We tried to evaluate whether MBP had any effects on haemorrhage and blood loss during the surgery and to assess this we compared hemoglobin levels before and after the surgery. We compared the subtracted values between the two groups and found no significant difference (T-test=1.135, P=0/259) (see table 4). However, hospitalization duration was about 5 hours longer in the group who received MBP.
Conclusion: MBP with normal saline enema does not improve intraoperative visualization and bowel handling. And it also does not reduce patient complication rates and post-operative symptoms either. MBP also increases hospitalization duration and puts extra pressure on the healthcare system. Therefore, a normal saline enema is not recommended before benign gynecologic laparoscopic surgeries.
 

Evaluation of the relationship between blood group and intubation and mortality rate in COVID 19patients.
Faranak Behnaz, Azita Chegini, Sogol Asgari,
Volume 80, Issue 3 (June 2022)
Abstract
Background: Coronavirus (COVID-19) represents a global public health crisis that is causing significant deaths and affecting health systems around the world. There are several risk factors for the severity of infection, complications and mortality of COVID-19. One of them is blood group. The aim of this study was to investigate the relationship between blood group and rate of covid 19 disease.
Methods: A cross sectional study was performed on 130 patients over 18 years of age admitted in ICU of Shohada Tajrish Hospital between August 2020 and April 2021.The positive COVID-19 diagnosis was confirmed by polymerase chain reaction (PCR) test. Blood groups were determined and then, we monitored and followed up the patients' outcome during staying in ICU, the need for intubation, recovery and death. Data were collected using a questionnaire and analyzed by Pearson correlation coefficient and stepwise multiple regression analysis. Results were determined based on Fisher’s exact test. P<0.05 was considered significant.
Results: 60 (46.1%) patients had blood type A, (20%) 26 patients blood type AB, 12 (9.2%) patients’ blood type B and (24.7%) 32 patients blood type O. Blood group A was significantly higher in these patients. 55 patients (42.3%) were female and 75 patients (57.7%) were male. Their mean age was 43.19±19.05. Totally, 43.1% of hospitalized patients were intubated regardless of blood type. The number of cases requiring intubation was higher in people with positive blood type A. The lowest need for intubation was seen in blood type B negative. Blood group A positive (39.6%) and then AB negative (33.3%) had the highest mortality rate. Death was not observed in blood group A negative, B negative, B positive and O negative.
Conclusion: The number of patients with COVID-19 with blood type A was significantly higher (46.1%). The most common blood group in these patients was A and the lowest was blood group B. The number of cases requiring intubation was higher in people with positive blood type A.

Comparison of roux-en-y gastric bypass techniques with and without distal gastric plication in patients with morbid obesity
Mehdi Asgari, Ali Sanaee, Faramarz Pazyar,
Volume 80, Issue 5 (August 2022)
Abstract
Background: The vertical gastric plication technique leads to poor long-term outcomes and is associated with intolerable reflux, dysphagia, or weight gain in a high percentage of patients. Therefore, in this study, the therapeutic results of two methods with and without plication of the distal part of the stomach in gastric bypass surgery in patients with morbid obesity were compared.
Methods: In this clinical trial randomized single-blind study, 40 patients with morbid obesity who were referred to one of the hospitals affiliated with Jundishapur University of Medical Sciences in Ahvaz during March 2020-February 2021, were randomly divided into two groups: with plication of the distal part of the stomach (n=20) and without plication of the distal part of the stomach (n=20) in Roux-en-Y gastric bypass surgery. Weight loss rate, complications related to surgery, outcomes and satisfaction of patient were noted and followed up for one year.
Results: The mean percentage of weight loss at different times did not show a significant difference between the two groups (p>0.05). The length of hospitalization after surgery was significantly less in the distal gastric plication group (p=0.0001). During one year of follow-up, hypertension, diabetes, HLP, and reflux were well in the distal plication method but showed no significant difference (p>0.05). Satisfaction of the patients was more in the distal plication method and showed no significant difference (p>0.05). One year after the operation, the change of diet showed no significant difference in the two groups (p>0.05).
Conclusion: It looks that using the laparoscopic distal gastric plication method is an effective and safe method and is associated with early ideal weight loss, reduction of complications, and increase in satisfaction of patients with BMI>=35 kg/m2. No need to use a foreign body, stapler or bandage and the possibility of re-operation are the advantages of this technique.

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.

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