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Mohsen Sadat Shahabi , Ahmad Shalbaf ,
Volume 82, Issue 2 (May 2024)
Abstract
Background: Major Depressive Disorder (MDD) is one of the most prevalent and disabling mental disorders in the world. Due to the life quality decline caused by this disease and its growing nature, timely detection and treatment is of paramount importance. In the present study Electroencephalogram (EEG) signal utilized for the precise detection of MDD using Artificial Intelligence (AI) Methods.
Methods: In this analytic study, which is done in Shahid Beheshti University of medical Sciences in 2023, fifty eight subjects were investigated using an experienced psychiatrist that 30 subjects diagnosed as MDD and 28 determined to be healthy. Nineteen channels EEG signals in resting state with eyes closed situation acquired for five minutes from all of the participants including 36 men and 22 women with the average age of 39.3 years. The EEG signals were preprocessed to remove contaminating signals from brain-originated signals. The EEGLAB package in MATLAB utilized to re-reference channels to the average reference, apply a band-pass filter between 1 and 40 Hz and to remove non-brain components of the signal using Independent Component Analysis (ICA). The cleaned data segmented to the three seconds windows with 50 percent overlapping. These segments were used as the input to the AI models. Deep Learning (DL) models utilized in the present study were EEGNet, ShallowConvNet and DeepConvNet which were developed based on the deep convolutional models for the classification of healthy and MDD brain signals. The main difference between these models laid in the number of specific convolutional layers and the model complexity.
Results: MDD and Healthy signals classification has been done using EEGNet, ShallowConvNet and DeepConvNet models and accuracy of 92.3%, 83.2% and 92.2% were achieved, respectively. Also EEGNet acquired the highest sensitivity of 98.9% and specificity of 79.1%.
Conclusion: The detection of MDD patients using EEG signals with high accuracy and generalizability is possible and proposed AI models can be utilized in the clinical settings as assistant tools.

Survey of pregnancy outcome in preterm premature rupture of membranes
Azam Zafarbakhsh, Elham Fateminia, Anahita Babak, Somayeh Khanjani, Mamak Shariat, Fedyeh Haghollahi,
Volume 82, Issue 2 (May 2024)
Abstract
Background: Preterm premature rupture of membranes (PPROM) significantly impacts perinatal mortality and maternal-fetal outcomes. The purpose of this study is to investigate the frequency of maternal risk factors, maternal and fetal outcomes and the role of care in the occurrence of outcomes.
Methods: This retrospective cross-sectional study involved 317 pregnant women with premature rupture of membranes (PPROM) at Shahid Beheshti Hospital in Isfahan, between April 2020 and April 2022. Data were collected from medical records, including demographic information, risk factors, and maternal and neonatal outcomes. Patients were categorized into two groups: those receiving care (24-34 weeks of gestation) and those undergoing pregnancy termination (less than 24 weeks or more than 34 weeks). The chi-square test was used for qualitative variables, while the T-student test was applied for quantitative variables.
Results: In this study, the average age of patients was 29.42±6.56 years. The most common risk factors for PPROM were 20.2% for abortion records, 20.2% for urinary infections, 18% for cervical insufficiency, and 13.6% for gestational diabetes. Comparing maternal outcomes between the two groups revealed that chorioamnionitis occurred more frequently in the care group (18% vs. 2%, P=0.0001), as did emergency cesarean sections (37% vs. 4.5%, P=0.0001) and NICU hospitalization (71% vs. 17%, P=0.001). In the next stage, a regression test identified the independent effects of variables on maternal and newborn outcomes without intervention or confounding factors. The analysis indicated that mothers in the care group experienced significantly more complications than those in the pregnancy termination group, and their babies also faced significantly more complications.
Conclusion: The study results indicate that a history of abortion, urinary infections, cervical insufficiency, and gestational diabetes are significant risk factors for PPROM. Expectant management of PPROM is associated with more neonatal and maternal complications than pregnancy termination. Thus, timely identification of these risk factors allows healthcare providers to educate mothers and potentially prevent and manage them, significantly reducing the incidence of PPROM and its complications.

Grade five liver laceration following cardiopulmonary resuscitation: a case report
Mohammad Ashraf Azimi , Rasul Nikdel, Seyed Hassan Seyed Sharifi ,
Volume 82, Issue 2 (May 2024)
Abstract
Background: Cardiopulmonary resuscitation (CPR) is a potentially life-saving treatment for cardiac arrest but puts the subject at risk for iatrogenic skeletal and soft tissue injuries including the liver. In this study, an elderly patient with grade 5 liver rupture after cardiopulmonary resuscitation following laparotomy is reported.
Case Presentation: A 76-year-old female patient with diffuse abdominal pain that started a week ago and worsened since 2 days ago in the winter of 2024, referred to the emergency room of Imam Ali Bojnurd Hospital. In the examination, the patient met the criteria for shock. Abdominal examination revealed peritonitis. After initial resuscitation and stabilization of the patient's condition, an X-ray was performed for the patient. According to the Standing chest x-ray, pneumoperitoneum report, the patient underwent surgery with midline incision. In the performed surgery, evidence of gangrene and perforated was evident in a part of the small intestine, and The patient is a candidate for resection of the gangrenous and perforated intestinal segment, and then the two proximal and distal ends of the resected area were removed as an ileostomy from the right side of the abdomen. At the end of surgery, before closing the abdominal wall, the patient suffered a cardiac arrest, and CPR was started for the patient in operation room. After starting the chest massage, the patient suffered a grade 5 liver tear, the bleeding of the liver was stopped by packing with four Large Abdominal pads and CPR continued for 45 min, but unfortunately the patient died.
Conclusion: One of the rare complications of cardiopulmonary resuscitation and chest massage is visceral damage, including liver rupture. Considering that its symptoms are similar to cardiac arrest, it is difficult to diagnose in case of rupture and has a high mortality rate. According to the reports of liver and visceral damage after CPR, some studies have recommended the use of Focused Assessment with Sonography for Trauma (FAST) to detect visceral damage after CPR.

Primary pyogenic spinal infection: a review article
Seyed Hasan Emami Razavi , Mohammadreza Salehi, Hooshang Saberi , Mohammad Zarei, Babak Mirzashahi, Pegah Afarinesh, Sepideh Khodaparast,
Volume 82, Issue 3 (June 2024)
Abstract
Primary pyogenic spinal infection, also known as spondylodiscitis or vertebral osteomyelitis, is a serious and potentially debilitating condition involving a bacterial or fungal infection of the intervertebral disc space and adjacent vertebral bodies. While relatively uncommon, with an estimated incidence of 2.4 per 100,000 population per year, it is a medical emergency that requires prompt diagnosis and treatment to prevent permanent spinal damage and neurological complications. The most common causative organisms are Staphylococcus aureus, which accounts for up to 50% of cases, followed by Gram-negative bacteria such as Escherichia coli, and mycobacterial infections like Mycobacterium tuberculosis. Risk factors for developing primary pyogenic spinal infection include intravenous drug use, a weakened immune system, recent spinal surgery or instrumentation, and contiguous spread from an infection elsewhere in the body, such as a urinary tract infection or endocarditis. Patients typically present with severe, localized back pain, fever, and general malaise, which can easily be mistaken for more common spinal conditions. Prompt diagnosis is critical and involves a thorough medical history, physical examination, laboratory testing, and advanced imaging studies such as magnetic resonance imaging (MRI). Blood cultures and, in some cases, image-guided biopsy may be necessary to identify the causative organism and guide appropriate antimicrobial therapy. The mainstay of treatment is the prompt initiation of targeted antibiotic or antifungal therapy, often requiring intravenous administration for several weeks. Surgical intervention may be necessary in some cases, such as to drain an abscess or provide spinal stabilization. A multidisciplinary approach involving infectious disease specialists, spine surgeons, and rehabilitation providers is essential for optimal management and outcomes. Despite advances in diagnosis and treatment, primary pyogenic spinal infection remains a challenging condition. Delays in diagnosis and treatment can lead to devastating complications, including permanent spinal deformity, paralysis, and even death. With timely and appropriate management, however, most patients are able to achieve a good clinical outcome, though some may experience residual pain or neurological deficits.

Effect of ten-week lower limb progressive resistance training on muscle quality of life and fatigue in adults with spinal muscular atrophy type III
Khadije Sohrabi, Abbas Ali Gaeini , Elham Shirzad , Shahram Khorshidi , Shahriar Nafissi, Hamid Reza Fateh,
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.

Comparison of serum vitamin D levels in children with nephrolithiasis and healthy children: a cross-sectional study
Navid Qaraei, Mohammad Ali Jafari, Maedeh Jafari , Fatemeh Karami Robati , Saeedeh Parvaresh,
Volume 82, Issue 4 (July 2024)
Abstract
Background: Nephrolithiasis is one of the oldest known systemic diseases of kidney and urinary tract in children. This study aimed to compare the serum level of vitamin D in children with nephrolithiasis and healthy children.
Methods: The present descriptive-cross-sectional study was conducted from October 2017 to September 2019. 74 children with kidney stones and 63 healthy children referring to Afzalipour Hospital in Kerman were selected by simple sampling method. Healthy children who were considered as the control group were matched with the case group in terms of age and gender. All patients underwent kidney and urinary tract ultrasound. The diagnosis of kidney stones was based on the radiologist's opinion. Demographic characteristics of patients (age and sex) were recorded. Patients' blood tests were checked for vitamin D and calcium. Descriptive and analytical methods and SPSS software version 21 were used to analyze the data.
Results: The average age of children with kidney stones and healthy children was 5.41±1.8 and 10.06±0.41 years old, respectively (P=0.971). The most number of patients were boys (58.1%). 29.7% of patients and 15.9% of healthy children had a family history of kidney stones (P=0.056). 71.6% of patients had unilateral kidney stones and 28% had bilateral kidney stones. The mean serum level of vitamin D was higher in healthy children (P=0.021). The average calcium was higher in children with kidney stones (P=0.001). The average calcium was higher in children with kidney stones who had a family history of kidney stones (P=0.018). Average calcium was higher in children with bilateral kidney stones (11.4±1.1) (P=0.033). The mean calcium was higher in children with kidney stones with vitamin D deficiency (P=0.001) and sufficient vitamin D levels (P=0.037).
Conclusion: The average level of vitamin D serum in healthy children was significantly higher than that of children with kidney stones, and the average level of calcium in children with kidney stones was significantly higher than that of healthy children. Larger studies with more patients are needed to investigate these relationships.

The effect of adding two doses of epinephrine along with intrathecal bupivacaine and fentanyl on hemodynamic in lower extremity orthopedic surgery: a double-blind randomized clinical trial study
Navid Kalani , Hasan Zabetian, Shahram Shafa, Erfaneh Alirezai, Fatemeh Eftekharian, Reza Sahraei ,
Volume 82, Issue 4 (July 2024)
Abstract
Background: Recently, epinephrine is used to increase the depth and duration of local anesthetic pain, and it is widely used topically to reduce local anesthetic release and reduce bleeding caused by surgery.
Methods: This study was a randomized, double-blind clinical trial on 30 patients aged 18 to 85 years undergoing lower limb orthopedic surgery referred to Peymaniyeh Hospital in Jahrom from September to December 2022. Patients were randomly assigned to two groups, A (epinephrine+fentanyl+bupivacaine) and B (bupivacaine+fentanyl). Systolic blood pressure, diastolic pressure, mean arterial pressure, arterial blood oxygen saturation percentage, and pulse rate were measured and recorded before drug administration, before spinal anesthesia, after anesthesia, and then every half hour until the end of surgery (15, 45, 30, 60, 75, 90, 120) and during recovery. Data analysis was performed using SPSS version 21 software and descriptive (mean, standard deviation) and inferential statistics (t-test, chi-square, Mann-Whitney, Friedman) at a significance level of P<0.05.
Results: Thirty patients aged 18 to 85 years (in two groups of 15) with anesthesia class I and II undergoing lower limb orthopedic surgery were evaluated. The study groups are matched in terms of age and gender variables. There was no significant difference in mean systolic, diastolic, mean arterial blood pressure, and heart rate before and after anesthesia, 15, 45, 30, 60, 75, 90, and 120 minutes after drug injection, and at entry and exit from recovery between the Epinephrine+Fentanyl+Bupivacaine and Fentanyl+Bupivacaine groups. There was a significant difference in mean O2SAT before anesthesia, 15, 30, and 75 minutes after drug injection between the epinephrine+fentanyl+bupivacaine and fentanyl+ bupivacaine groups (P<0.05).
Conclusion: The use of the combination of epinephrine+fentanyl+intrathecal bupivacaine compared to the combination of fentanyl+bupivacaine did not have a significant difference in the studied variables of patients' vital signs.

Examining the prevalence of gastrointestinal symptoms in patients with COVID-19 admitted to Imam Khomeini Hospital in Urmia in the first half of 2021
Hamid Reza Mehryar, Mohammad Reza Hosseini Azar , Afshin Ebrahimi , Omid Garkaz,
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.
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.

Comparison of duration and survival rate of burn patients above 90% in the burn unit isolation room and BICU
Najibeh Mohseni Moalem Kolae , Abdolreza Jafarirad, Mohammadhossein Hesamirostami , Khadije Moeiltabaghdehi , Mojtaba Ghorbani , Abolfazl Hosseinnattaj,
Volume 82, Issue 4 (July 2024)
Abstract
Background: Death is one of the serious consequences of burns, which usually occurs as a result of hospital infections. This study was conducted with the aim of investigating the existing disagreement regarding the admission of more than 90% patients in the burn intensive care unit with the isolation room of the burn unit.
Methods: This retrospective descriptive-analytical study was conducted based on case review. The statistical population included the files of patients hospitalized in the burn wards and burn intensive care unit of Zare'e Sari Burn and Psychiatric Center from 2011 to 2023 who died. All these patients were included in the study as a census. The data was extracted through a checklist prepared by the researcher. Descriptive and inferential analysis of the data was performed using SPSS version 21 software. The variables studied included gender, age, burn percentage, burn factor, and duration of hospitalization, and determining the relationship between burn percentage and survival time in the two burn intensive care units and the isolation room of the burn unit was the main variable. The mean and standard deviation were used to describe quantitative data, and the frequency and percentage were used to describe qualitative data.
Results: Among 882 cases, 226 patients had burns above 90%. 143 cases were related to men (63.3%). Most patients were in the age group of 19 to 40 years (61.9%). The cause of the burn (54.9%) was flame. Among the patients (83.2%) were hospitalized in the isolation room of the burn ward. Although the average days of hospitalization of patients above 90% in the burn intensive care unit was 13.71±11.82 days and the burn isolation room was 8.66±9.11 days, the Mann-Whitney test showed that the average survival time of these patients in the burn isolation room of the burn ward was significantly different from the intensive care unit. (sig.=0.001).
Conclusion: Although the average survival time in the two groups showed a significant difference, ultimately all patients in the two groups died within a few days of each other.

Epidemiological investigation of emergency department visits in patients with cancer: a three-center study
Mohammad Masud Khubiari , Simin Najafgholian, Bahareh Abbasi, Ramin Parvizrad, Reza Aghbozorgi,
Volume 82, Issue 5 (August 2024)
Abstract
Background: Emergency Departments (EDs) visits reflect medical needs and demands or the only care available to patients. Many ED visits are potentially preventable with access to high-quality, community-based health care. Given the higher incidence of emergency conditions in patients with cancer the global increase in cancer will pose a challenge for emergency services. Therefore, this study was conducted with the aim of epidemiological investigation of emergency department visits by cancer patients in several centers.
Methods: In this cross-sectional study, the triage form and hospital file of known patients with various cancers, who visited in Eds of valiasr and Amir al Momenin hospitals in Arak, Hazrat Rasool Akram and Lolagar hospitals in Tehran, and Shahid Sadouqi and Shah vali hospitals in Yazd, From April to September 2017. To measure the urgency of ED visits, the emergency severity index and triage form were used, and the outcome of the emergency visit was extracted from the patient's file and recorded in the data collection checklist. Multivariate logistic regression analysis was used to examine the association of patient, hospital and potentially preventable factors.
Results: In this study, 1107 patients, 550 men (%49.7) and 577 women (%50.3) with cancer were were studied. Age 65 and older had the most emergency visits. The most common reason for patients to visit was: pain in different organs (18.2%), fever (8.7%), weakness and malaise (7.5%). A total of 617 (55.7%) visits were potentially preventable. Age 17 years and younger (OR, 3.172; 95% (CI), 2.409-4.021) and presence of more than 1 comorbidity (OR, 3.610; 95% (CI), 3.611-4.521) were positively associated with potentially preventable visits.
Conclusion: In this study, 50.7% of ED visits among patients with cancer were identified as potentially preventable, and the most common reason for patient visits was general and non-specific symptoms such as pain, weakness, and malaise. These findings highlight the need for palliative care and evidence-based interventions in outpatient settings.

Evaluation of the impact of blue light blocking filters on visual quality after PRK surgery
Saeed Rahmani, Aliakbar Shafiee, Abbas Riazi , Alireza Akbarzadeh Baghban , Alireza Jafari , Maryam Dashti,
Volume 82, Issue 6 (September 2024)
Abstract
Background: Problems related to blue light exposure are among the various issues experienced by individuals who have undergone Photorefractive Keratectomy (PRK).Given the growing concerns regarding blue light’s effects on visual health, this study aimed to thoroughly investigate the impacts of blue blocker filters on the improvement of vision in patients post-refractive surgery of the PRK type. The primary objective was to evaluate the overall effectiveness of these filters in enhancing visual quality and in reducing complications associated with the surgery, which can significantly affect a patient’s quality of life.
Methods: In a quasi-experimental study conducted from September 1, 2024, to the end of October 2024, individuals who had undergone PRK surgery were examined at the optometry clinic of Dr. Labbafi Nejad Hospital in Tehran. Participants were subjected to assessments both with and without the application of blue blocker filters. Key parameters, including visual acuity and contrast sensitivity among attendees, were meticulously measured under both conditions. The results were then systematically compared and analyzed to draw meaningful conclusions about the impact of blue blocker filters in this context.
Results: A total of thirty-four participants, comprising 73.5% females and 26.5% males, with an average age of 32.6 years, were incorporated into the study. Post-surgery, the average refraction measured in the right and left eyes was documented as   -0.42±0.16 D and -0.30±0.16 D, respectively. Notably, visual acuity in both eyes significantly improved with the use of the blue light blocking filter (P<0.005) Moreover, contrast sensitivity at varying spatial frequencies of 1.5, 6, and 18 cycles per degree (c/d) also exhibited significant enhancement (P<0.005).
Conclusion: The incorporation of blue blocker filters for individuals with a history of PRK surgery has led to noteworthy improvements in visual acuity and enhanced contrast sensitivity. These findings underscore the critical importance of integrating blue light protection in the post-operative care of patients, as it significantly elevates the overall visual experience and may contribute to better long-term outcomes following refractive surgery.

Evaluation of frequency and factors associated to cerebrospinal fluid circulation disorder after decompressive craniectomy
Majid Jahanshahi , Morteza Taheri , Seyyed Abdollahadi Daneshi , Mostafa Haji Rezaei ,
Volume 82, Issue 6 (September 2024)
Abstract
Background: Decompressive craniectomy (DC) is a therapeutic approach for patients with raised intracranial pressure and cerebral edema. Although DC is not a complicated procedure, it is associated with significant complications and morbidities that significantly affect clinical outcomes. This study investigates the frequency of cerebrospinal fluid (CSF) circulation disorders after DC and evaluates related factors.
Methods: This cross-sectional analytical study was conducted on 79 patients who underwent DC at Shohadaye Haftome Tir Hospital, one of the main trauma centers in Tehran. The patients' files and the Picture Archiving and Communication System (PACS) were reviewed to collect demographic, clinical, and radiologic data. After identifying patients with post-operative (after DC) CSF circulation disorders, the relevant factors were determined using multivariate logistic regression.
Results: Overall, seventy-nine patients were studied. The mean age of patients was 40.56±12.64 years and 82.3% were male. Forty-seven patients (59.5%) underwent DC due to traumatic causes and thirty-two patients (40.5%) due to vascular pathologies. In total, 36.7% (nineteen) of patients were affected by some degree of subdural hygromas of which 13 patients (44.8%) progressed to clinical and radiologic hydrocephalus. 19% (fifteen patients) developed hydrocephalus within the first six months after surgery. Considering the clinical variables, the GCS of patients was the only one that showed a significant relationship with CSF circulation disorders. Regarding radiological variables, the presence of intraventricular hemorrhage (IVH) was the only relevant factor. In addition, from the surgical perspective, performing duraplasty (autograft or allograft) and reoperation demonstrated significant relationships with CSF circulation disorders. The results of multivariate logistic regression showed that having intraventricular hemorrhage (OR, 6.15-6.9414: CI95%, P=0.003) and reoperation (75.91: OR, 3.88-3.6, 1485/43: CI95%, P=0.004) were two independent factors associated with hydrocephalus in DC patients.
Conclusion: In patients who have undergone decompressive craniectomy, intraventricular hemorrhage (IVH) and reoperation can be independent risk factors for CSF circulation disorders. Although the incidence and presence of IVH cannot be controlled, careful and meticulous surgical technique and skill can significantly improve the outcome of decompressive craniectomy by reducing the need for reoperation

The effect of eight weeks of physical activity with vitamin D supplementation on endothelial indices in hypertensive patients
Mozaffar Jan Faza, Mohammad Rahman Rahimi ,
Volume 82, Issue 7 (October 2024)
Abstract
Background: The aim of our study was to evaluate the effect of 8 weeks of aerobic exercise with vitamin D supplementation on indulin-1 and nitric oxide in patients with hypertension aged 30 to 50 years.
Methods: This study was conducted as a semi-experimental pre-test and post-test design, and was conducted from June 1401 at Seyyed Shohada Hospital in Urmia. 40 eligible men and women were randomly divided into four groups (supplement group, placebo + exercise group, a supplement + exercise group, and a control group). The training program of the experimental groups included eight weeks of aerobic exercise running on a treadmill (3 sessions/8 weeks). Blood sampling to evaluate biochemical variables was performed 48 hours before and after the intervention in a fasting state with a volume of 10 cc.
Results: The results of the study show that after 8 weeks of aerobic exercise, vitamin D, BMI, NO, ET-1 and weight were significantly affected (P < 0.05) and systolic blood pressure in the supplement, supplement + exercise and exercise + placebo groups changed compared to the control group(P < 0.05).
Conclusion: Based on the results of the present study, the results showed that taking eight weeks of vitamin D supplements along with aerobic activity reduced blood pressure indices in the subjects. Also, taking vitamin D supplements along with physical activity reduced BMI and increased NO, reduced ET-1 and body weight in the subjects in the study.

Investigation of the causes of legal abortion in women referring to Amir al-Momenin Ali (AS) Hospital Zabol
Khadijeh Rezaei Kahkhaei , Soha Shokri, Tayebeh Azarmehr, Mehdi Afshari , Maryam Nakhaee Moghadam , Kolsoum Rezaie Kahkhaie , Leili Rezaei Kahkhaei ,
Volume 82, Issue 7 (October 2024)
Abstract
Background: Abortion is the termination of pregnancy before the 20th week of pregnancy, which may be spontaneous or induced. In general, therapeutic abortion is defined as the termination of pregnancy before the 20th week of pregnancy in order to save the mother's life and prevent birth defects. The purpose of this study is to investigate the causes of legal abortion in women referring to Amir al-Mominin Ali hospital in Zabol city.
Methods: This study is a descriptive-cross-sectional study. The studied population included women who had a legal abortion on March 1, 2022 to September 1, 2022 at Amir al-Mominin Ali Zabol Hospital (Zabol-Iran). The tool used was a checklist made by the researcher and approved by the faculty members of Zabol University of Medical Sciences. The researchers collected the necessary information, including demographic information, obstetrics and mother's illness, fetal disorders, test results, ultrasound screenings, pathology results of patients and other conditions that led to the issuance of an abortion license.
Results: In the specified period of time, there were 100 abortion cases that were investigated, and 78 (78%) of these abortions had maternal causes and 22% had fetal causes. The most common maternal causes of abortion were cardiovascular problems (7%) and mothers' age. Also, the most fetal causes were cerebrospinal causes (23%). Mothers who had abortions of maternal origin were significantly older than mothers with abortions of fetal origin (p=0.009).
Conclusion: The present study showed that in Sistan region, most cases of legal abortion depended on fetal reasons and mothers' age.

بهینه‌سازی بازتوانی برای بازسازی رباط صلیبی قدامی: نامه‌ای به سردبیر
Ebrahim Piri, Amirali Jafarnezhadgero, Anders Stålman,
Volume 82, Issue 7 (October 2024)
Abstract

Evaluation of results of vascular intervention on arterial blunt trauma of distal of lower extremity (below trifurcation) in Golestan Hospital Ahvaz Vascular Trauma Center.
Iraj Nazari, Seyed Masood Mousavi, Ali Asghar Dastyar , Shaghayegh Sherafatmand , Ali Saeidi,
Volume 82, Issue 8 (November 2024)
Abstract
Background: Vascular trauma is a life-threatening emergency and the third leading cause of death worldwide. Due to the frequency and importance of distal lower extremity artery injury in lower extremity trauma, the present study aimed to investigate the outcomes of vascular surgical interventions in patients with non-penetrating arterial trauma of the distal lower extremity (sub-trifurcation).
Methods: In this retrospective study, trauma patients with suspected non-penetrating injuries of the lower extremity arteries (sub-trifurcation) who referred to the Vascular Surgery Center of Golestan Hospital, Ahvaz, between September 2021 to September 2023 were evaluated. Data included demographic information, duration of surgery, length of hospitalization, and side effects of surgery.
Results: Of the total of 86 patients, 76 patients (88.4%) were treated with open surgery. 83.7% of patients (72) were male and in the age range of 30-35 years. The most common surgical method used was bi-artery repair (92.3%). The most complications were in the bi-artery bypass repair method, but only the results of nerve involvement and limb preservation in the Ligation repair or bypass two artery intervention showed a statistically significant difference in the first week after surgery (P=0.05). Among patients, only two cases of mortality were observed one week after surgery, which was in the bi-artery repair group. (5.1%). The bi-artery repair intervention method was the best and least complicated surgical method among patients with vascular injury under blunt trauma.
Conclusion: According to the results of this study, the bi-artery repair intervention method had the lowest rate of other complications and was the best and least complicated surgical method among patients with vascular injury under blunt trauma.

A knee MRI study to investigate the correlation between patellofemoral alignment and knee joint cartilage defects
Parvin Taghavinejad, Mohammad Ghasem Hanafi , Ahmad Fakhrizadeh ,
Volume 82, Issue 8 (November 2024)
Abstract
Background: This cross-sectional study aims to evaluate the association between patellofemoral joint alignment measurements and patellofemoral cartilage defects using MRI images.
Methods: A retrospective and cross-sectional study was conducted on 530 knee MRI images from Golestan and Imam Khomeini hospitals in Ahvaz, Khuzestan, Iran. The images were obtained from individuals experiencing non-traumatic knee pain and were selected based on their age, with subjects over 30 years of age being included in the study. This survey was conducted over the period from March 2023 to March 2024. The parameters of femoral groove angle (SA), femoral groove depth (SD), lateral patellofemoral angle (LPFA), tibial-trochlear tubercle groove distance (TT-TG), lateral patellar displacement (LPD), patellar inclination angle, and patellar height were evaluated. In addition, the Caton-Deschamps index and the degree of focal cartilage defect (from 0 to III) in the knee joint were evaluated.
Results: Regarding body mass index, 15.7% of the patients studied were underweight, 42.3% were of normal weight, 31.1% were overweight, 10.4% were obese, and 0.6% were extremely obese. There was a significant relationship between body mass index and patellar-lateral articular cartilage defects in the lateral tibia and lateral femur. There was a significant relationship between age and patellar-lateral articular cartilage defects in the lateral femur. There was a significant relationship between lateral patellar articular cartilage defects and lateral patellar dislocation, lateral patellofemoral angle, tibial prominence-skeletal groove distance, and patellar inclination angle. In addition, there was a significant relationship between medial patellar articular cartilage defects and knee groove angle.
Conclusion: Patellofemoral misalignment is multivariately associated with knee articular cartilage defect. The results of this study will be of use to medical professionals, and the early diagnosis of knee osteoarthritis can prevent the development of the condition. It is recommended that similar studies and surveys be conducted in other provinces of Iran so that the statistical population is highly vulnerable.

Evaluation of the epidemiological, clinical, paraclinical characteristics, and clinical outcomes of hospitalized patients with positive blood cultures for Brucella
Maedeh Afshar, Mahboubeh Haddad , Aliakbar Heydari, Majid Khadem Rezaiyan ,
Volume 82, Issue 8 (November 2024)
Abstract

Background: Brucellosis is the most frequently encountered zoonosis and one of the most important health challenges, especially in developing countries. This disease can be accompanied by bacteremia and may result in severe complications. A definitive diagnosis may be made by culture of the organism from blood, body fluids or tissues, although serum agglutination test is often recognized as the reference test. While bacteremic brucellosis is not uncommon, research on this topic remains limited. The present study was conducted to determine the epidemiological, clinical, and para-clinical characteristics of patients hospitalized with bacteremic brucellosis.
Methods: This retrospective cross-sectional study evaluated the epidemiological, clinical, and para-clinical characteristics, and clinical outcomes of patients hospitalized with bacteremic brucellosis from March 2011 to February 2021 at Imam Reza and Ghaem hospitals in Mashhad, Iran. A list of adult patients with confirmed brucellosis was assembled from microbiology laboratory records. The inclusion criterion was a positive blood culture for Brucella, regardless of the Brucella serology results. According to the laboratory report, the BACTEC culture medium was used to identify the organism, and the reported results did not specify the Brucella species. Demographic data, clinical presentations, paraclinical findings (including Wright, 2ME Wright, and Coombs Wright), and clinical outcomes were extracted from archived medical records.

Results: The mean age was 38.8±18 years, and 17 patients (53.1%) were male. Cardiac diseases were the most common underlying disease, and 15.7% of patients were immunocompromised. Fever and mono-arthritis were the most common symptoms and signs, respectively. Serologic investigations were negative in 12 patients (37.5%). 84.4% of patients had anemia. There was no mortality among patients.
Conclusion: A significant property of patients with positive blood culture for Brucella may not be identified with serologic assays, so if there is strong clinical suspicion of brucellosis, blood culture should also be considered. According to this study, bacteremic brucellosis is not accompanied by mortality, and the patients respond well to common antibiotic regimens.

Effect of ursobil on prevention of gallstone formation in patients following bariatric surgery
Meisam Rezaei, Mehdi Asgari , Amir Ashrafi, Elham Farhadi ,
Volume 82, Issue 9 (December 2024)
Abstract
Background: Gallstones are a common gastrointestinal complication following bariatric surgery, potentially resulting in cholecystitis, cholangitis, and pancreatitis. These complications arise due to biliary homeostasis alterations and rapid postoperative weight loss. Ursodeoxycholic acid (UDCA) has been shown to reduce biliary cholesterol saturation, thereby preventing gallstone formation. This study aimed to evaluate the effectiveness of Ursobil (UDCA) in preventing gallstones in patients undergoing bariatric surgery.
Methods: This case-control study was conducted study was conducted at Golestan Hospital in Ahvaz, Iran, from October 2022 to March 2023. Ethical approval was obtained from the institutional review board. Patients aged 18 to 65 years with a BMI between 35 and 65 kg/m² were eligible. Exclusion criteria included a history of gallstones, previous bariatric or cholecystectomy surgery, inflammatory bowel disease, recent UDCA use, or bleeding disorders. Participants were divided into two groups: the case group received 600 mg of UDCA daily for six months postoperatively, while the control group received no UDCA. Abdominal ultrasonography was performed before surgery and six months afterward. Outcome measures included gallstone formation, weight loss, need for cholecystectomy, and health-related quality of life, assessed using the WHOQOL-BREF questionnaire.
Results: The two groups were comparable in terms of age, gender distribution, and baseline BMI. The mean weight loss was similar between groups after six months. Gallstone formation occurred in 1.7% (n=1) of the UDCA group compared to 15% (n=9) of the control group (P=0.012). None of the patients in the intervention group required cholecystectomy, whereas 11.7% (n=7) in the control group underwent the procedure (P=0.011). Quality of life scores were higher in the UDCA group, though not statistically significant.
Conclusion: Oral administration of UDCA effectively and significantly reduces the risk of gallstone formation and the need for cholecystectomy in post-bariatric surgery patients. Routine use of UDCA during rapid weight loss phases may improve clinical outcomes and reduce gallstone-related complications. Preventive use of UDCA may effectively and significantly reduce gallstone-related morbidity in patients undergoing rapid weight loss.
 

An evaluation of treatment volume coverage and dose delivered to vital organs in the management of low-grade brain gliomas using three-dimensional conformal radiotherapy (3DCRT) compared to intensity-modulated radiation therapy (IMRT)
Reza Ghalehtaki, Mahdieh Razmkhah, Ali Kazemian, Mostafa Farzin, Samaneh Salarvand, Kasra Kolahdouzan, Ehsan Saraee,
Volume 82, Issue 10 (January 2025)
Abstract
Background: Gliomas are the most common primary brain tumors in adults, with low-grade gliomas making up 15% of cases. These slow-growing tumors often occur in young adults. Radiotherapy is one of the treatment options. New radiotherapy techniques like IMRT may reduce complications by sparing normal tissue. The study aims to determine which tumors benefit most from IMRT based on tumor location and size.
Methods: Patients diagnosed with low-grade glioma who were referred for treatment at the Cancer Institute of Imam Khomeini Hospital between September 2017 and September 2020 were included in this study. All patients underwent CT simulation with a thermoplastic mask for immobilization. A diagnostic MRI (performed within two weeks prior) was fused with the planning CT to define the target volume (GTV/CTV), with contours verified by a neuroradiologist. A doctor outlines the treatment volume and critical organs for both 3D and IMRT techniques. Radiotherapy physics experts design treatment plans using both techniques, which are then approved by a radiation oncologist. The treatment volume coverage and doses to critical organs are compared between the two techniques.
Results: Among 25 patients, 14 patients (56%) with single-lobe involvement, 7 (28%) with two lobes, and 4 (16%) with multifocal disease. Right-side brain involvement was seen in 32%, with the frontal lobe most affected. IMRT significantly reduced the mean and maximum cochlear dose on the treatment side in all patients. It also lowered the mean chiasma dose in those with both lobes involved and reduced cochlear dose on the opposite side in frontal lobe cases. No significant difference was found between the techniques for patients with multiple lobe involvement.
Conclusion: According to our study on 25 patients with low-grade glioma, it was shown that there is no clear difference between the two techniques. Given the young age and long survival of LGG patients, IMRT may be preferred when hearing preservation is a priority. Further studies with larger cohorts are needed to confirm these findings.

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