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Babak Vahdatpour, Mohammad Shirvani, Hamidreza Jahanbani-Ardakani , Omid Alizadehkhaiyat , Sadegh Baradaran Mahdavi ,
Volume 81, Issue 4 (July 2023)
Volume 81, Issue 4 (July 2023)
Abstract
Background: The objective of this study was the transcultural adaptation of the Rotator cuff quality of life (RC-QOL) questionnaire and the determination of the reliability and validity of the questionnaire in the Persian-speaking population with rotator cuff disease.
Methods: This study was conducted in Isfahan from April 2022 to February 2023. The participants consisted of 56 people with rotator cuff pathology. The process of adapting and translating the questionnaire was done with the methodology presented previously by Beaton et al. Content validity was first tested by a group of orthopedic and physical medicine and rehabilitation specialists and then through a pilot study consisting of 15 Persian-speaking patients with rotator cuff disease. Test-retest reliability was established with an intraclass correlation coefficient. Internal consistency was calculated using Cronbach's alpha. The measurement's error estimation was calculated with the standard error of the measurement. Reproducibility evaluation was measured with a 3-day interval between the completion of the test-retest questionnaire.
Methods: This study was conducted in Isfahan from April 2022 to February 2023. The participants consisted of 56 people with rotator cuff pathology. The process of adapting and translating the questionnaire was done with the methodology presented previously by Beaton et al. Content validity was first tested by a group of orthopedic and physical medicine and rehabilitation specialists and then through a pilot study consisting of 15 Persian-speaking patients with rotator cuff disease. Test-retest reliability was established with an intraclass correlation coefficient. Internal consistency was calculated using Cronbach's alpha. The measurement's error estimation was calculated with the standard error of the measurement. Reproducibility evaluation was measured with a 3-day interval between the completion of the test-retest questionnaire.
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Results: The age range of the participants was 34 to 68 years (55% men and 45% women). The mean (standard deviation) of the total score of the RC-QOL questionnaire was 44.33(10.81) and ranged from 17.35 to 70.88. Cronbach's alpha was 0.971, which showed high internal consistency. The intraclass correlation coefficient was 0.99, indicating high test-retest reliability. The mean values (standard deviations) of the DASH and SPADI questionnaires were equal to 77.66(13.69) and 66.66(18.25), respectively. The results of the study showed excellent and significant convergent validity of the RC-QOL questionnaire with both the DASH and SPADI questionnaires. The correlation value with the DASH and SPADI questionnaires was equal to 0.907 and 0.941, respectively.
Conclusion: The Persian version of the RC-QOL questionnaire is a valid and reliable tool to evaluate the quality of life in patients diagnosed with rotator cuff injuries. |
Hanieh Alimiri Dehbaghi , Karim Khoshgard, Hamid Sharini, Samira Jafari Khairabadi, Farhad Naleini,
Volume 81, Issue 5 (August 2023)
Volume 81, Issue 5 (August 2023)
Abstract
Background: The use of artificial intelligence algorithms to help with accurate diagnosis in medical images is one of the most important applications of this technology in the field of medical imaging. In this research, the possibility of replacing simple chest radiography instead of CT scan using machine learning models to detect pneumothorax was investigated in cases where CT is usually requested.
Methods: This study is analytical and was conducted from November 2022 to May 2023 at Kermanshah University of Medical Sciences. The data used in this research was extracted from the files of 350 patients suspected of pneumothorax. The collected images were pre-processed in MATLAB software. Then, three machine learning algorithms, including Logistic elastic net regression (LENR), Logistic lasso regression (LLR) and Adaptive Boosting (AdaBoost) were used. To evaluate the performance of these models, the criteria of precision, accuracy, sensitivity, specificity, area under the receiver operating characteristic curve (AUC), F1 score, and misclassification were used.
| Results: In the AdaBoost model, the accuracy value in radiographic and CT images was calculated as 98.89% and 98.63%, respectively, and the precision value was calculated as 99.17% and 98.27%, respectively. In radiographic images, the AUC value for AdaBoost model was calculated as 100% and in CT scan images as 96.96%. The F1 score for the same model in radiographic was 99% and in CT images was 98.68%. The specificity value for the AdaBoost model was calculated as 99.45% in radiographic images and 94.67% in CT scan images. In the LLR model, the AUC value for radiographic and CT scan images was 99.87% and 99.02%, respectively. Conclusion: According to the criteria evaluated in the present study, two LLR and AdaBoost models have similar performance in radiographic and CT images in terms of pneumothorax detection ability, so that this complication can also be diagnosed with high precision level using machine learning techniques on the radiographic images and thus receiving higher levels of radiation doses due to CT scan can be avoided in these patients. |
Hamidreza Ghasemi Basir , Mohammad Mahdi Majzoobi , Abbas Moradi, , Ali Saadatmand,
Volume 81, Issue 5 (August 2023)
Volume 81, Issue 5 (August 2023)
Abstract
Background: Brucellosis is one of the most common infectious diseases transmitted from animal to human. Different methods of blood culture, serology, PCR and ELISA are used to diagnose brucellosis. The aim of this study was to compare the diagnostic value of ELISA tests with Brucella serological tests in patients with brucellosis.
Methods: In this cross-sectional descriptive study that was conducted from the beginning of April 2018 to the end of March 2019, 231 patients referred to the Infectious Diseases Clinic of Sina Hospital in Hamadan with clinical symptoms and possible diagnosis of brucellosis were included in the study. 5 cc of blood was taken from the patients to prepare serum, at the same time as Wright, Combs Wright and 2ME serology tests, IgG and IgM ELISA tests were also performed using the ELISA kit of Pishtaz Teb Company (Made in Iran), which is designed with the cut-off method. Then the test results were analyzed with SPSS software, version 16 (SPSS Inc., Chicago, IL, USA).
Methods: In this cross-sectional descriptive study that was conducted from the beginning of April 2018 to the end of March 2019, 231 patients referred to the Infectious Diseases Clinic of Sina Hospital in Hamadan with clinical symptoms and possible diagnosis of brucellosis were included in the study. 5 cc of blood was taken from the patients to prepare serum, at the same time as Wright, Combs Wright and 2ME serology tests, IgG and IgM ELISA tests were also performed using the ELISA kit of Pishtaz Teb Company (Made in Iran), which is designed with the cut-off method. Then the test results were analyzed with SPSS software, version 16 (SPSS Inc., Chicago, IL, USA).
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Results: 231 patients suspected of brucellosis including 147(63.64%) men and 84(36.36%) women with an average age of 44.60±16.16 years and a minimum of 10 years and a maximum of 80 years were examined. IgG and IgM results were positive with brucellosis in 80.1% and 30.30%, respectively. The results of IgG and IgM were positive in 1/80 and 30.30%, respectively, and they were diagnosed with brucellosis. In comparison with 2ME, Wright and Coombs-Wright serology tests, the sensitivity of IgG was between 83.80% and 94.28% and its specificity was between 20 and 33.34%, the sensitivity of IgM was also between 34.78 and 40.0% and its specificity was between 78.67% and 89.47% at different cut points.
Conclusion: Compared to diagnostic serological tests for brucellosis, IgG is more sensitive and IgM is more specific. If serological tests are not available, ELISA can be used to diagnose brucellosis. But because of their lower diagnostic value, they cannot be replaced. |
Hamidreza Shetabi, Mahsa Mohammadrezaei ,
Volume 81, Issue 7 (October 2023)
Volume 81, Issue 7 (October 2023)
Abstract
Background: This study was conducted to compare the effect of two doses of remifentanil infusion on the amount of bleeding, intraoperative hemodynamic changes, and complications after rhinoplasty surgery with general anesthesia.
Methods: This prospective randomized clinical trial study was conducted on 80 patients who were candidates for rhinoplasty from March 1401 to August 1402 in Al-Zahra Hospital, Isfahan, Iran. The participants were divided into two groups of 40 people using random allocation software. remifentanil infusion was adjusted in the first group with a dose of 0.15-0.25 mg/kg/min and in the second group with a dose of 0.25-0.35 mg/kg/min. The goal was to maintain mean arterial pressure (MAP) between 60 and 65 mmHg, to achieve this goal, reducing or increasing the rate of remifentanil infusion was used. During the operation, a heart rate of less than 50 beats per minute was considered bradycardia and was treated with atropine 0.015 mg/kg. In addition, the remifentanil infusion rate was reduced if MAP fell below 60 mmHg for more than 60 seconds. Patients were evaluated and compared during operation and recovery in terms of hemodynamic parameters, intraoperative bleeding and postoperative complications.
Methods: This prospective randomized clinical trial study was conducted on 80 patients who were candidates for rhinoplasty from March 1401 to August 1402 in Al-Zahra Hospital, Isfahan, Iran. The participants were divided into two groups of 40 people using random allocation software. remifentanil infusion was adjusted in the first group with a dose of 0.15-0.25 mg/kg/min and in the second group with a dose of 0.25-0.35 mg/kg/min. The goal was to maintain mean arterial pressure (MAP) between 60 and 65 mmHg, to achieve this goal, reducing or increasing the rate of remifentanil infusion was used. During the operation, a heart rate of less than 50 beats per minute was considered bradycardia and was treated with atropine 0.015 mg/kg. In addition, the remifentanil infusion rate was reduced if MAP fell below 60 mmHg for more than 60 seconds. Patients were evaluated and compared during operation and recovery in terms of hemodynamic parameters, intraoperative bleeding and postoperative complications.
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Results: There was no significant difference between the two groups in the changes of hemodynamic parameters during surgery and recovery (P>0.05). The average bleeding volume in the two groups receiving remifentanil 0.15-0.25 mcg/kg/min and 0.25-0.35 mcg/kg/min Remifentanil was 44.25±23.1 and 28.25±15.5 ml, respectively, and the difference between the two groups was significant (P<0.001). According to the surgeon's opinion, intraoperative bleeding in the 0.25-0.35 mcg/kg/min remifentanil group was significantly lower than 0.15-0.25 (P=0.001).
Conclusion: According to the findings of the present study, it seems that the use of 0.25-0.35 min/µg/kg dose of remifentanil compared to 0.15-0.25 min/µg/kg dose, is associated with a significant reduction in bleeding during rhinoplasty, and also the use of this dose is not associated with the occurrence of serious hemodynamic disorders, including bradycardia and severe drop in blood pressure. |
Ahmad Tahmasebi-Ghorrabi , Zahra Heydarifard, Behrouz Nemati, Majid Davari, Alireza Delavari, Hamideh Salimzadeh , Ali Akbari Sari ,
Volume 81, Issue 9 (December 2023)
Volume 81, Issue 9 (December 2023)
Abstract
Background: Screening is a cost-effective method for prevention, early detection of the disease and reducing the burden of the third deadliest cancer in the world, i.e. colorectal cancer. This study aimed to analyze the cost-effectiveness of colonoscopy screening compared to sigmoidoscopy for colorectal cancer in high-risk individuals in Iran.
Methods: This economic evaluation study was conducted using the cost-effectiveness method between July 2016 and February 2017. Evaluation of the effectiveness of screening methods was done using a systematic review. Cost evaluation was also done using the costs obtained from the tariff approved by the Iranian Ministry of Health in 2015 for colonoscopy and sigmoidoscopy. Finally, the combined model of decision tree and Markov was used to evaluate the cost effectiveness. Incremental Cost Effectiveness Ratio (ICER) formula was used for cost effectiveness analysis considering the final outcome of 5-year survival of high-risk individuals. Excel and TreeAge software were used for data analysis.
Methods: This economic evaluation study was conducted using the cost-effectiveness method between July 2016 and February 2017. Evaluation of the effectiveness of screening methods was done using a systematic review. Cost evaluation was also done using the costs obtained from the tariff approved by the Iranian Ministry of Health in 2015 for colonoscopy and sigmoidoscopy. Finally, the combined model of decision tree and Markov was used to evaluate the cost effectiveness. Incremental Cost Effectiveness Ratio (ICER) formula was used for cost effectiveness analysis considering the final outcome of 5-year survival of high-risk individuals. Excel and TreeAge software were used for data analysis.
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Results: The effectiveness of sigmoidoscopy and colonoscopy in increasing 5-year survival is 11 and 15.7%, respectively, and colonoscopy screening is 4.7% more than sigmoidoscopy. The cost of colonoscopy and sigmoidoscopy screening was calculated as 1000 and 19920 billion Rials, respectively. Based on cost-effectiveness analysis, the cost of treating patients in the case of screening with colonoscopy and sigmoidoscopy is lower than without screening. The ICER ratio of colonoscopy and sigmoidoscopy compared to no screening was -4/441/389/160 and -4/757/954/940 Rials respectively, and colonoscopy compared to sigmoidoscopy was -3/699/785/880 Rials, respectively. Finally, the use of colonoscopy leads to spending 3/699/785/880 Rials less in exchange for obtaining 4722 additional survivals with the prevention of colorectal cancer compared to sigmoidoscopy.
Conclusion: Screening by colonoscopy and sigmoidoscopy methods are effective in reducing the incidence and death of colorectal cancer compared to no screening. Screening by colonoscopy is a dominant option for the high-risk population in Iran. Colonoscopy screening is more cost effective compared to sigmoidoscopy. However, decisions about colorectal cancer screening and screening methods depend on local resources and personal preferences. |
Hamid Reza Choobdari , Mohammad Ali Gharaat ,
Volume 81, Issue 10 (January 2024)
Volume 81, Issue 10 (January 2024)
Abstract
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Stroke is a medical condition in which occluded blood flow to the brain causes cell necrosis. The main types of stroke are ischemic (due to lack of blood flow with much higher prevalence) and hemorrhagic (due to bleeding with low prevalence). Ischemic stroke is caused by the reduction of blood to the brain tissue or complete occlusion of brain vessels by a blood clot following arterial plaques rapture of cerebral arteries due to atherosclerosis, cerebral myocardial infarction and small vascular lesion infarction. Inflammatory reactions, increased oxidative stress, cell death and autophagy are the most aggravating factors in this condition. Instead, hemorrhagic stroke is caused by spontaneous intracranial hemorrhage and subarachnoid hemorrhage, highly common in men. To prevent the possible causes of stroke, investigators attempted to study about the ways that may decrease the risk factors such as trauma, high arterial hypertension, alcohol, low-density lipoprotein and glycerides, tobacco and drugs. Physical activity is a potent inhibitory factor which reported to be effective in prevention of stroke and post-stroke rehabilitation. Aerobic, combined or strenuous activities protect brain tissue by balancing apoptotic and anti-apoptotic pathways, stimulating angiogenesis, reducing oxidative stress, increasing antioxidant activity, optimizing Integrity and preservation of the blood-brain barrier, improving nerve functions and preventing neuronal death. The mechanisms involved in rehabilitation after ischemic stroke with physical activity mostly refer to improved dendrites and synapses, synaptic flexibility, regulation of inotropic receptors with glutamate, increased BDNF, GAP43 and insulin-like growth factor. In patients with cognitive impairments following acute ischemic stroke, high intensity exercise improves processing timing and attention allocation, self-independence, walking ability, aerobic power and reduces memory degradation. Moreover, early start of physical activity after ischemic stroke inhibits the initial physiological response to stroke and prevents optimal recovery. In contrary, reports show positive effects of onset of physical exercise a day after stroke. In hemorrhagic stroke, exercise reduces systolic blood pressure, moderates resting blood pressure via parasympathetic regulations and triggers angiogenesis in the nervous system. Light to moderate or long-term physical training is recommended in comparison to short-term high-intensity training. In addition, early onset of physical activity during recovery after stroke may be beneficial.
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Yasser Hasanzadeh, Zahra Sagheb Movafagh , Atena Sahrabeygi , Hamid Heidarian Miri , Masoumeh Gharib ,
Volume 81, Issue 10 (January 2024)
Volume 81, Issue 10 (January 2024)
Abstract
Background: Identifying the epidemiological aspects of central nervous system (CNS) tumors is the first step in implementing management protocols to control the condition of these tumors. We aimed to examine the epidemiology and histopathology of both benign and malignant tumors of the CNS in one of the referral and university centers in the east of Iran.
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Methods: This cross-sectional study was conducted on all files of patients admitted to Qaem Hospital in Mashhad City, Iran, in a period of 10 years from March 2009 to February 2018 with a definitive diagnosis of benign or malignant tumors of the CNS, including tumors of the brain, cerebellum, spinal cord, or meningeal membranes. Information sources included the patients' physical files and the hospital information system (HIS). The statistical software SPSS version 28.0 for Windows (IBM SPSS, Armonk, New York, USA) was used for the statistical analysis.
Results: In total, 775 patients with benign and 771 patients with malignant CNS tumors were included in the study. Regarding epidemiological aspects of benign tumors, the incidence rate of women was almost twice that of men (68.47% versus 31.53%), with an overall average age of 45.31±19.81 years. The most common benign tumors were meningioma (72.77%), followed by schwannoma (13.67%). Regarding malignant brain tumors, the mean age of affected patients was 36.64±19.67 years, with males accounting for 53.04% of cases and females for 46.96%. The most frequent type of tumor was glioblastoma (32.68%), followed by diffuse astrocytoma (16.47%). Both benign and malignant CNS tumors were associated with significant hospital mortality; in-hospital mortality rates for benign and malignant tumors were 10.1% and 17.5%, respectively. Tumor type and its grade were the main determinants of early death in malignant CNS tumors. Conclusion: The epidemiological characteristics of benign and malignant tumors in our study community were similar to the reports presented in other communities. Knowledge of these characteristics provides the possibility of managing patients and reducing morbidity and mortality related to these tumors. |
Alireza Dehghan, Mahbube Abshirini, Hamid Nemati, Mahdi Saeedi-Moghadam ,
Volume 81, Issue 11 (February 2024)
Volume 81, Issue 11 (February 2024)
Abstract
Background: Developmental disorders in children include a group of problems and limitations in learning and acquiring specific skills of each age group. The term global developmental delay is used to describe developmental disability in children under five years of age, which is in at least two areas of major development. Neuroradiological imaging such as brain MRI provides important information for physicians. The purpose of this study is to determine the role of brain MRI in predicting the clinical outcome of global developmental delay in children.
Methods: In this cross-sectional study, from 79 - from September 2013 to September 2018 at Motahari Clinic of Shiraz University of Medical Sciences, Shiraz Iran - eligible children with developmental disabilities, 37 patient who had brain MRI were selected as a sample and children scores in five ASQ clinical areas and MRI findings were reviewed and compared. Patients suffering from metabolic, genetic, trauma, infection and neoplasms problems and diseases were excluded from the study.
Methods: In this cross-sectional study, from 79 - from September 2013 to September 2018 at Motahari Clinic of Shiraz University of Medical Sciences, Shiraz Iran - eligible children with developmental disabilities, 37 patient who had brain MRI were selected as a sample and children scores in five ASQ clinical areas and MRI findings were reviewed and compared. Patients suffering from metabolic, genetic, trauma, infection and neoplasms problems and diseases were excluded from the study.
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Results: Out of 37 patients studied, 23 were female and 14 were male with a dispersion of three 3 to 60 months of age. 31 of these children had at least one abnormal finding in brain MRI images and the other six were completely normal. In relation to the imaging findings, the highest frequency is related to abnormal head circumference with a prevalence of 54% and the lowest frequency is related to abnormal myelinization with a prevalence of 10.8%. Results of MRI findings correlation with developmental domains demonstrated that Children with white matter disorder on MRI show severe gross motor abnormality (P<0.049) and who had MRI finding of cortical problems suffer from developmental delay in fine motor area. (P<0.001).
Conclusion: Considering the mentioned findings; brain MRI can be a useful diagnostic tool in children with developmental delay and also focusing on the developmental area that is more likely to be affected, MRI can help with treatment and rehabilitation process of these children in the future. |
Hamidreza Mehryar, Payman Atabaki, Abass Riyahi, Mohammad Reza Amiri Nikpour,
Volume 81, Issue 11 (February 2024)
Volume 81, Issue 11 (February 2024)
Abstract
Background: The emergence of thrombolytic drugs has opened new horizons in the treatment of patients with acute ischemic stroke, and this study was conducted with the aim of evaluating the barriers of receiving tissue plasminogen activator in patients with acute ischemic stroke in Imam Khomeini Hospital of Urmia.
Methods: This descriptive-analytical, cross-sectional study was conducted from April 21, 2015 to March 19, 2016 on patients with acute ischemic stroke referred to the emergency department of Imam Khomeini Hospital in Urmia using census sampling method. To collect data, a checklist containing demographic information was used. After collecting the data, it was entered into SPSS 18 and analyzed with the help of descriptive statistics.
| Results: In this study, the results showed that out of 100 patients, most of the participants were male (58%)58 and the rest were female, and the average age was 63.71±17.3 years, and 86% were in the age range of 18-80 years, which was the appropriate age to receive or thrombolytics. and the rest were over 80 years old. The fastest visit time was 25 minutes and the latest was 10080 minutes (168 hours). Among these 40 people, only four people (40%) were in the golden time period of thrombolytic drug, i.e. Three hours from the onset of symptoms to the final evaluation. Among the four people who were placed in the golden time, in 50% of the cases there was a history of taking anticoagulants, in 25% a history of head injury, in 50% of the blood sugar less than 50 and finally 1 person (25% of the people placed in the golden time) that is, 1% of all patients were eligible to receive rtPA. About 24% of patients had NIHSS<4 and 2% had NIHSS>25, and the average number obtained was 10. Conclusion: The most important obstacle in the timely initiation of thrombolytic therapy is the delay in visiting the emergency room. Therefore, public education in order to improve the level of general awareness of the society can be effective in reducing this time delay. |
Hamidreza Mehryar, Mohammad Rafiei,
Volume 81, Issue 12 (March 2024)
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.
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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. |
Hamidreza Mehryar , Sahil Farakh,
Volume 82, Issue 2 (May 2024)
Volume 82, Issue 2 (May 2024)
Abstract
Background: Medicines that are used to prevent and cure disease may affect patients if used incorrectly, and this study was conducted with the aim of evaluating the frequency of drug interactions in patients admitted to the emergency department of Imam Khomeini Hospital in Urmia.
Methods: This study is descriptive-analytical in a cross-sectional way, From March 20, 2020 to September 21, 2020, a census was conducted on patients admitted to the emergency department of Imam Khomeini Hospital in Urmia, who were 1901 people. The data was collected using a checklist that included information (age, sex, type of drug and severity of interference and type of interference). After collecting the data, it was entered into SPSS software, version 18 (IBM SPSS, Armonk, NY, USA) and analyzed with the help of descriptive and analytical statistics.
Methods: This study is descriptive-analytical in a cross-sectional way, From March 20, 2020 to September 21, 2020, a census was conducted on patients admitted to the emergency department of Imam Khomeini Hospital in Urmia, who were 1901 people. The data was collected using a checklist that included information (age, sex, type of drug and severity of interference and type of interference). After collecting the data, it was entered into SPSS software, version 18 (IBM SPSS, Armonk, NY, USA) and analyzed with the help of descriptive and analytical statistics.
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Results: In this study, the results showed that out of 1901 studied patients, 1101(57.9) were male and the rest were female 801(42.1), And the average age of the patients was 61.67±17.13 years, and 1160(60.9) patients did not have drug interactions and 724(39.01) had drug interactions, and the most common type of drug interaction was the moderate type, which was present in 75.1% of cases; And the final clinical outcome of the patients was 1088(57.2) discharge, 296(15.5) personal consent discharge and 506(26.6) death. Also, the most common drug interactions were serotide/salbutamol, azithromycin/ondansetron, and aspirin/nitroglycerin, respectively. And there was no significant relationship between the occurrence of drug interactions and the gender of patients (P=0.27) and finally, the average age of patients with drug interactions was 17.7±61.2 years and in patients without drug interactions was 16.7±61.9 years. Conclusion: The overall incidence of drug interactions in the studied patients was equal to 39.01, and the most common drug interactions in patients were of moderate and mild type; and there was no statistically significant relationship between the age of the patients and the gender of the patients and the incidence of drug interactions.
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Khadije Sohrabi, Abbas Ali Gaeini , Elham Shirzad , Shahram Khorshidi , Shahriar Nafissi, Hamid Reza Fateh,
Volume 82, Issue 4 (July 2024)
Volume 82, Issue 4 (July 2024)
Abstract
Background: Spinal Muscular Atrophy (SMA) is a neurodegenerative disorder caused by a mutation in the survival motor neuron 1 (SMN1) gene. It is classified into five types (from type 0 to 4) based on the age of onset of symptoms and maximum motor function. This autosomal recessive mutation results in progressive weakness and atrophy of the proximal muscles. Due to the high cost of treatment, the critical timing of intervention, and the varied responses of patients, many individuals do not sufficiently benefit from current therapeutic methods. This study evaluates the impact of resistance training on the quality of life and fatigue in patients with SMA type III, considering the potential benefits of such training.
Methods: The present study was developmental and semi-experimental. Fourteen ambulatory patients with SMA type III were randomly assigned to exercise and control groups. The exercise group engaged in lower limb resistance training at an intensity of 6 to 8 on an adult resistance exercise scale for 10 weeks (25 sessions). During this period, the control group maintained their usual daily activities. Patients in the exercise group did not engage in any exercise activity other than the protocol of the present study. Patients' quality of life was measured with the Short Form 36 (SF-36) questionnaire, and fatigue severity was measured with the Fatigue Severity Scale (FSS), both evaluated pre- and post-intervention. The assessments and exercises were conducted in the occupational therapy department of Shariati Hospital, Tehran, from July 2023 to September 2023.
| Results: Analysis of the results showed significant improvements (P<0.05) in the exercise group compared to the control group in the subscales of physical functioning and fatigue within the quality of life assessment. Additionally, notable differences were found between the groups on the fatigue intensity scale. However, No significant difference was observed in the patients' Body Mass Index (BMI) measurements. Conclusion: Progressive resistance training of the lower limbs enhances the quality of life and reduces fatigue in patients with SMA type III. |
Hamid Reza Mehryar, Mohammad Reza Hosseini Azar , Afshin Ebrahimi , Omid Garkaz,
Volume 82, Issue 4 (July 2024)
Volume 82, Issue 4 (July 2024)
Abstract
Background: Although the respiratory system is the main element involved in the disease of COVID-19, nevertheless, there are reports of the involvement of other organs and their lesser symptoms. This study was conducted with the aim of investigating the frequency of gastrointestinal symptoms in patients with COVID-19.
Methods: This cross-sectional descriptive study was conducted on all patients diagnosed with COVID-19 hospitalized in Imam Khomeini Hospital from April to September 2021 by census method. The data was collected using a checklist that included demographic information. After the data was collected, it was entered into SPSS software, version 18 (IBM SPSS, Armonk, NY, USA) and analyzed with the help of descriptive statistics.
Methods: This cross-sectional descriptive study was conducted on all patients diagnosed with COVID-19 hospitalized in Imam Khomeini Hospital from April to September 2021 by census method. The data was collected using a checklist that included demographic information. After the data was collected, it was entered into SPSS software, version 18 (IBM SPSS, Armonk, NY, USA) and analyzed with the help of descriptive statistics.
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Results: In this study, the results showed that out of 2580 hospitalized patients, 54% were women and 46% were men. And the average age of the patients was 58.67±17.68. The highest frequency of people was in the age range of 40-59 years (925 people). 64% of patients had at least one gastrointestinal symptom, Each of the symptoms had a different prevalence, Anorexia 40% with a preference for men (57%) and the highest frequency in the age range of 40-59 years (430 people), gastrointestinal bleeding 10% with a preference for men (80%), And the highest frequency in the age range of 60-79 years (112 people), abdominal pain 8% with preference for women (65%) with preference for frequency in the age range of 40-59 years (65 people), vomiting 3% with preference for women (51%) with abundance in the age range of 80-99 years (58 people), diarrhea 1.5% with preference in men (51%) with abundance in the age range of 60-79 years (18 people) and constipation in 0.2% with preference Women (67%), all of whom were over 60 years old.
Conclusion: The findings of this study showed that the COVID-19 disease can not only involve the respiratory system but also the digestive system in the course or beginning of the disease. |
Fateme Sadat Zendehdel, Seyyed Abdolhamid Angaji , Behnaz Beikzadeh, Behzad Narouie , Mahdi Mohammadi,
Volume 82, Issue 6 (September 2024)
Volume 82, Issue 6 (September 2024)
Abstract
Background: Clear renal cell carcinoma (ccRCC) is the most common malignant kidney tumor and has a high mortality rate. The pathogenesis of this cancer is complex and efficient biomarkers for its diagnosis and prediction are limited. This study aimed to identify predictive genes in ccRCC through analysis and laboratory validation ccRCC is the most common malignant kidney tumor and has a high mortality rate.
Methods: The present study was a case-control study in which samples were taken from patients and healthy individuals from Labafi Nejad Hospital in Tehran between October 2012 and April 2014, and laboratory tests were performed on the samples.
First, genes with differential expression in ccRCC patients were identified by bioinformatics using gene expression profile data from the Gene Expression Omnibus (GEO) database with accession number GSE213324. Data analysis was performed using Galaxy web server, protein-protein interactions were checked using Cytoscape and STRING app software, and finally two genes were selected for real-time PCR testing.
Methods: The present study was a case-control study in which samples were taken from patients and healthy individuals from Labafi Nejad Hospital in Tehran between October 2012 and April 2014, and laboratory tests were performed on the samples.
First, genes with differential expression in ccRCC patients were identified by bioinformatics using gene expression profile data from the Gene Expression Omnibus (GEO) database with accession number GSE213324. Data analysis was performed using Galaxy web server, protein-protein interactions were checked using Cytoscape and STRING app software, and finally two genes were selected for real-time PCR testing.
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Results: Analysis identified 4,065 genes with differential expression in RCC tissues compared to healthy tissues. These genes are involved in immune responses and renal disease pathways, suggesting their potential role in disease development. After constructing the protein-protein interaction network and identifying differentially expressed genes in kidney tissue and blood, two genes, MTTP and CALCA, were selected for further investigation. In the Mann-Whitney U test, the expression of the CALCA gene decreased significantly in the patient group (P<0.05). On the other hand, the MTTP gene showed a decrease in expression, but not significantly. The AUC calculated to evaluate the diagnostic accuracy for the CALCA gene was 0.64 and significant (P<0.05), demonstrating its potential as a useful biomarker for ccRCC diagnosis. However, the AUC for the MTTP gene was not significant.
Conclusion: The reduction in CALCA expression could serve as a useful biomarker for diagnosing ccRCC. |
Mohammad Gholami , Alireza Mahmoudabadi, Maryam Moradi , Hossein Nezami, Hamideh Mohammadzadeh ,
Volume 82, Issue 7 (October 2024)
Volume 82, Issue 7 (October 2024)
Abstract
Background: Androgenetic alopecia is the most common cause of hair loss, and its prevalence increases with age. Different studies have reported different results regarding the association of cardiovascular diseases with androgenetic alopecia. The present study aimed to The present study aimed to Investigating the relationship between androgenetic alopecia and the thickness of the intima media of the carotid artery in the referrals to the specialized skin and hair clinic of Allameh Bohlool Gonabadi Hospital.
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Methods: This case-control study was conducted from October 2021 to June 2022 on 100 patients referred to the Skin and Hair Clinic of Allameh Bahloul Hospital in two groups of 50 cases and controls, aged less than 40 years. The subjects were matched in terms of age and gender. Patients with alopecia were classified into three categories: mild, moderate, and severe based on the diagnosis of the treating physician. The thickness of the intima-media layer of the carotid artery was measured using ultrasound.
Results: There were 37 males and 13 females in both the case and control groups. The mean age in the case group was 29.50 and 30.28 years, respectively. In addition, the duration of alopecia in the case group was 6.9 years. Although the results indicated that the carotid artery intima-media thickness was higher in patients with androgenetic alopecia, no statistically significant relationship was found between androgenetic alopecia and carotid artery intima-media thickness (P=0.66). There was also a statistical relationship between the carotid artery intima-media thickness and the duration of alopecia (P=0.03). Conclusion: Considering the relationship between the thickness of the intima media of the carotid artery and the duration of alopecia, it can be said that there is a possible relationship between alopecia and atherosclerosis, but to prove it, studies with a larger sample size are needed. |
Zakieh Vahedian Ardakani , Mehran Zarei-Ghanavati , Hamid Riazi-Esfahani , Seyed Mehdi Tabatabaei , Mohammad Reza Mehrabi Bahar, Sadegh Ghafarian, Ahmad Masoomi,
Volume 83, Issue 1 (April 2025)
Volume 83, Issue 1 (April 2025)
Abstract
Artificial intelligence (AI) has emerged as a transformative force in modern medicine, with ophthalmology standing at the forefront of its clinical integration. Among ophthalmic disorders, glaucoma—a leading cause of irreversible blindness worldwide—presents unique opportunities and challenges for AI-based solutions due to its chronic, progressive nature and reliance on multimodal data, including structural and functional assessments. This review article offers a comprehensive synthesis of the current and emerging roles of AI in the detection, monitoring, and management of glaucoma. AI algorithms, particularly deep learning and machine learning models, have demonstrated exceptional capabilities in interpreting fundus photographs, optical coherence tomography (OCT) images, and visual field data to identify glaucomatous damage. These systems often approach or even exceed the diagnostic performance of human experts. Moreover, AI has shown significant promise in facilitating large-scale population-based screening, improving early detection rates, and addressing disparities in access to subspecialty care, particularly in low-resource and remote settings. In the monitoring of disease progression, AI tools are being developed to detect subtle structural or functional changes over time, predict future visual outcomes, and support more precise and individualized treatment decisions. Despite these advancements, the widespread clinical adoption of AI in glaucoma care faces several critical barriers. Key limitations include poor generalizability of models across diverse populations, imaging devices, and clinical settings; scarcity of well-annotated, high-quality, and demographically representative datasets; and a lack of transparency and interpretability in algorithmic decision-making—commonly referred to as the “black box” problem. Ethical concerns, regulatory uncertainty, integration challenges within existing healthcare infrastructures, and medico-legal accountability also require thoughtful resolution before AI can be reliably deployed in clinical practice. This review critically evaluates the strengths, limitations, and real-world potential of AI technologies in glaucoma. It provides clinicians, researchers, and healthcare policymakers with a balanced and up-to-date perspective, highlighting promising avenues for future research, including explainable AI, federated learning, multi-modal data integration, and longitudinal validation studies. By fostering a deeper understanding of both the opportunities and challenges associated with AI, this article aims to guide the responsible, equitable, and evidence-based integration of AI into comprehensive glaucoma care.
Saeed Kafrashi, Hamidreza Norouzi, Malihe Safari,
Volume 83, Issue 3 (June 2025)
Volume 83, Issue 3 (June 2025)
Abstract
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.
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.
Hamidreza Abdolsamadi , Pardies Mahmoudvand, Zahra Pourgholi Takrami , Elahe Alipour,
Volume 83, Issue 3 (June 2025)
Volume 83, Issue 3 (June 2025)
Abstract
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.
Ehsan Nasirai, Mehdi Bakhshaee, Bashir Rasoulian, Daryoush Hamidi Alamdari, Kiana Ketabi, Imaneh Roshanzamir,
Volume 83, Issue 5 (August 2025)
Volume 83, Issue 5 (August 2025)
Abstract
Background: To improve hemostasis and optimize the healing process, autologous fibrin sealant (FS) has been introduced in selected cases. However, the clinical benefits of FS in sinonasal surgery remain controversial and require further evaluation. This study aimed to investigate the effects of autologous FS on hemostasis, mucosal healing, postoperative clinical outcomes, and recurrence in patients undergoing bilateral FESS, compared with normal saline as the control.
Methods: This randomized clinical trial included 32 patients who underwent bilateral FESS at Ghaem and Imam Reza University Hospitals in Mashhad, Iran, between 2019 and 2021. For each patient, autologous FS was applied to one nasal cavity, while the contralateral cavity received normal saline. Postoperative outcomes including bleeding, crusting, adhesion formation, and infection were assessed at 1 week, 1 month, and 3 months after surgery. In addition, sinonasal symptom burden and endoscopic findings were evaluated using the Sinonasal Outcome Test (SNOT-22) and the Lund-Kennedy endoscopic score, respectively, both recorded preoperatively and three months postoperatively.
Results: Application of autologous FS significantly reduced immediate postoperative bleeding, and no further bleeding events were noted during follow-up. Pain severity was comparable between the two sides. No statistically significant differences were observed in crust formation, adhesion, infection, recurrence, or changes in Lund-Kennedy scores between the FS and control sides (p=0.08, p=0.8, p=0.17, and p=0.14, respectively).
Conclusion: Autologous fibrin sealant reduced early postoperative bleeding without adversely affecting pain control, mucosal healing, or recurrence after FESS. Larger randomized trials with extended follow-up are recommended to determine its definitive clinical value and potential for routine use in surgical practice.
Methods: This randomized clinical trial included 32 patients who underwent bilateral FESS at Ghaem and Imam Reza University Hospitals in Mashhad, Iran, between 2019 and 2021. For each patient, autologous FS was applied to one nasal cavity, while the contralateral cavity received normal saline. Postoperative outcomes including bleeding, crusting, adhesion formation, and infection were assessed at 1 week, 1 month, and 3 months after surgery. In addition, sinonasal symptom burden and endoscopic findings were evaluated using the Sinonasal Outcome Test (SNOT-22) and the Lund-Kennedy endoscopic score, respectively, both recorded preoperatively and three months postoperatively.
Results: Application of autologous FS significantly reduced immediate postoperative bleeding, and no further bleeding events were noted during follow-up. Pain severity was comparable between the two sides. No statistically significant differences were observed in crust formation, adhesion, infection, recurrence, or changes in Lund-Kennedy scores between the FS and control sides (p=0.08, p=0.8, p=0.17, and p=0.14, respectively).
Conclusion: Autologous fibrin sealant reduced early postoperative bleeding without adversely affecting pain control, mucosal healing, or recurrence after FESS. Larger randomized trials with extended follow-up are recommended to determine its definitive clinical value and potential for routine use in surgical practice.
Mobina Zamanifard, Hamid Reza Norouzi, Fazilat Jokar Darzi , Malihe Safari,
Volume 83, Issue 5 (August 2025)
Volume 83, Issue 5 (August 2025)
Abstract
Background: Helicobacter pylori (H. pylori) is a human gastrointestinal pathogen that infects more than half of the world's population and leads to chronic gastritis and its role in the development of gastric ulcers, gastric cancer and gastric lymphomas is considered. However, eradication of this bacterium with triple therapy fails in more than 30% of cases. Therefore, efforts to find new treatment methods are increasing. As a result, this study was conducted to evaluate the effectiveness and tolerability of several drug regimens compared to the standard regimen.
Methods: This study is a randomized clinical trial in which patients with Helicobacter pylori infection were randomly selected in the endoscopy department of Amiralmomenin Hospital and the Gastroenterology Clinic of Professor Ghavamzadeh Clinic, Arak from October 2024 to March 2025 and were divided into three groups, including a control group and two intervention groups, with three different drug regimens. Four weeks after treatment, the rate of bacterial eradication in all three evaluation groups was assessed using fecal antigen testing and the treatment results were compared using appropriate statistical analyses.
Results: The frequency of negative test results in intervention group 2 was higher than in control and intervention group 1. (P<0.001) and the rate of Helicobacter pylori eradication was in intervention group 2 (94%), in control group (54%), and in intervention group 1 (20%). The chance of H.P eradication in intervention group 1 decreased by 84% compared to the control group and increased by 10.77 times in intervention group 2 compared to the control group. Also, a significant proportion of H.P eradication success was observed in people without diabetes (p-value = 0.022, Phi = -0.188, n = 150) and the rate of drug side effects was higher in intervention group 2 compared to the other two groups.
Conclusion: This study showed that compared to the standard regimen, a 2-week regimen of amoxicillin, omeprazole, and clarithromycin plus bismuth is a good, potent, and more cost-effective regimen for eradicating Helicobacter pylori.
Methods: This study is a randomized clinical trial in which patients with Helicobacter pylori infection were randomly selected in the endoscopy department of Amiralmomenin Hospital and the Gastroenterology Clinic of Professor Ghavamzadeh Clinic, Arak from October 2024 to March 2025 and were divided into three groups, including a control group and two intervention groups, with three different drug regimens. Four weeks after treatment, the rate of bacterial eradication in all three evaluation groups was assessed using fecal antigen testing and the treatment results were compared using appropriate statistical analyses.
Results: The frequency of negative test results in intervention group 2 was higher than in control and intervention group 1. (P<0.001) and the rate of Helicobacter pylori eradication was in intervention group 2 (94%), in control group (54%), and in intervention group 1 (20%). The chance of H.P eradication in intervention group 1 decreased by 84% compared to the control group and increased by 10.77 times in intervention group 2 compared to the control group. Also, a significant proportion of H.P eradication success was observed in people without diabetes (p-value = 0.022, Phi = -0.188, n = 150) and the rate of drug side effects was higher in intervention group 2 compared to the other two groups.
Conclusion: This study showed that compared to the standard regimen, a 2-week regimen of amoxicillin, omeprazole, and clarithromycin plus bismuth is a good, potent, and more cost-effective regimen for eradicating Helicobacter pylori.
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