Search published articles


Showing 279 results for Ai
Evaluation of the success rate and quality of teaching of tracheal intubation to medical students by using video laryngoscope
Pejman Pourfakhr, Mohammad Amin Mirzaie , Farhad Etezadi , Reza Shariat Moharrari , Mohammad Reza Khajavi ,
Volume 79, Issue 12 (March 2022)
Abstract
Background: Training of airway management and tracheal intubation skill in emergencies for resuscitation of patients are basic skills for medical students. However, the success rate of beginners in this skill is low. Video laryngoscopes are new devices that can increase the success of endotracheal intubation training.
Methods: This clinical trial was conducted with 30 medical students who came to learn anesthesia care at Sina Hospital in 2020. After dividing the students into two groups (n=15) of glide scope and Macintosh, the glide scope group first performed laryngoscopy and tracheal intubation with a glide scope on the manikin 10 times. Then, in the operating room they were trained for endotracheal intubation on 5 patients by glide scope. The Macintosh group first got trained for intubation on the manikin, 10 times and then on five patients in the operating room with a Macintosh laryngoscope. Then all students in the operating room intubated two patients with a Macintosh laryngoscope and their performance was assessed and scored by an anesthesiologist. They evaluated the training course with a questionnaire. The duration of laryngeal access and the time spent for tracheal intubation were compared in the two groups.
Results: In the glide scope group, 76% of students were able to see the epiglottis and larynx in 20 seconds, but in the Macintosh group, 43% of students were able to see the larynx in 20 seconds. In terms of endotracheal intubation time, 72% of the students in the glide scope group were able to successfully perform endotracheal intubation within 40 seconds in their first attempt, but in the Macintosh group, 44% completed endotracheal intubation within 40 seconds (P=0.00). In the evaluation of the quality of skill, the average score of the students in the Macintosh group was 15.30±0.56, while the average score in the glide scope group was 17.20±0.83 (P=0.00). The scores and satisfaction of the students in the glide scope group were higher than the Macintosh.
Conclusion: The use of video laryngoscope in teaching of intubation in trainees will increase the speed, and accuracy of their training and satisfaction compared with the Macintosh laryngoscope.
 

Determining the effect of sun exposure and physical activity on the incidence of primary progressive multiple sclerosis
Hasan Asadi Gandomani , Abdorreza Naser Moghadasi , Mohammad Ali Sahraian , Sharareh Eskandarieh,
Volume 79, Issue 12 (March 2022)
Abstract
Background: The onset of primary progressive multiple sclerosis (PPMS) can be triggered by sun exposure and physical activity. The present study aimed to determine the risk of sun exposure and physical activity in PPMS development.
Methods: The case-control study recruited PPMS cases and healthy controls from the general population from September 2019 to September 2020 in Tehran, Iran. The selection of sex-matched controls from the same source population of cases was performed. Sun exposure was assessed in terms of exposure time in two age groups of 13-19 years and over 20 years in winter and summer.
Results: This study examined 146 PPMS cases and 294 controls. The sun exposure in summer in the age group 13-19 was negatively associated with the incidence of the disease (OR=0.68 (CI=0.57-0.82)). This relationship was also observed in the groups of men (OR=0.55 (CI=0.40-0.74)) and women (OR=0.70 (CI=0.53-0.91)). Exposure to sunlight in winter in the age group 13-19 was negatively associated with the incidence of the disease (OR=0.28 (CI=0.19-0.42)). In the group over 20 years, sun exposure was negatively associated with disease incidence in summer (OR=0.49 (CI=0.36-0.66)). Exposure to sunlight on average in winter in the age group over 20 years was negatively associated with the incidence of the disease (OR=0.14 (CI=0.07-0.28)) which in the male group OR=0.12 (0.04-0.32)) and women (OR=0.06 (CI=0.02-0.21)) were seen. Regarding physical activity, only physical activity above 4000 MET per week in the group of women was negatively associated with the incidence of the disease (OR=5.30 (CI=1.05-26.59), but in other groups, this negative relationship was not observed.
Conclusion: Exposure to sunlight in winter and summer had a negative relationship with the incidence of the disease. Physical activity was only negatively associated with the incidence of the disease in very high doses and women.
 

Evaluation of optic nerve sheath diameter in comparison with cerebrospinal fluid pressure in children with idiopathic intracranial hypertension.
Alireza Rezaie, Narges Gholami, Leila Bazhdan, Maryam Haghighi Morad , Narjes Jaafari,
Volume 80, Issue 3 (June 2022)
Abstract
Background: The purpose of this study is a non-invasive diagnosis of increasing the pressure of cerebrospinal fluid in patients involved in idiopathic intracranial hypertension (IIH) that is done with transbulbar sonography.
Methods: In this descriptive cross-sectional study all the non-toxic children under 18 who were referred to the neurology clinic of Loghman Hospital of Tehran from October 2017 to October 2018 with increased intracerebral pressure symptoms were studied. The increased intracerebral pressure symptoms were headache or vomiting or blurred vision or 6th nerve palsy and they had papillary edema. Also, if their diagnostic brain imaging measures were normal such as: Magnetic Resonance Imaging (MRI), Computed Tomography scan (CT scan) and in some cases Magnetic Resonance Venography (MRV), they were suspected to Idiopathic intracranial hypertension and were entered into the study consecutively. Their complete medical history and comorbidities and biographical information were recorded in the file. All patients were candidates for a lumbar puncture to measure cerebrospinal fluid pressure. After full explanation to the parents and obtaining written consent from them before performing a lumbar puncture, patients in coordination with the ultrasound unit without delay in performing a lumbar puncture, first underwent trans orbital ultrasound in supine position and were awakened with closed eyes. Opticians were implanted in both eyes by a skilled sonographer. And then sedated with sedatives (ketamine or midazolam) prescribed by an anesthesiologist. It was placed in a sterile position in a supine semi-flexion position and with lateral decubitus aligned with the body. Cerebrospinal fluid pressure to cm of water was recorded using a serum set in the lumber intervertebral space 4-5. Then a sample was sent for analysis and smear.
Results: Out of 10 patients (age 2.5–14 year, mean 9 years) 10% were girls, 90% were boys, and mean BMI was 22.5 kg/m2. Their symptoms included: 80% Headache, 40% Vomiting, 40% Diplopia, 20% Blurred vision, 10% 6th nerve palsy, and 10% Tinnitus when being reffered. In All patients, CSF pressure was more than 25 cm H2o (mean 40 cm H2o), right and left eyes optic nerve sheath diameter (ONSD) was more than the cutoff point (ONSD≤4.5 mm), the mean right ONSD was 6.31 mm and left eye was 6.64 mm.
Conclusion: According to the findings of this study, the measuring of optic nerve sheath diameter in patients suspected of increasing the pressure of idiopathic intracranial hypertension can be helpful as a non–invasive diagnosis method.

The effect of oral ibuprofen in doctus arteriosus closure in full- term neonates.
Manouchehr Soltani , Bahman Sadeghi Sedeh , Gholamali Fattahi Bayat , Parasto Mollai Tavana , Mojtaba Ahmadlou ,
Volume 80, Issue 3 (June 2022)
Abstract
Background: This study aimed to assess the efficacy and safety of the oral use of ibuprofen suspension in various doses in the treatment of PDA (Patent ductus arteriosus) in mature babies. Mature babies (37-42 weeks) aged more than 3 days who had been diagnosed with PDA were involved in this study. For the measurement of the ratio of left atrial to aortic root diameters (La/Ao) Color, pressure gradient and the internal ductal diameter, Doppler echocardiography (ECHO) was performed. This clinical trial was performed on 60 infants born born between August 2013 to August 2015.
Methods: This clinical trial study was performed on 60 infants were randomly born between August 2013 to August 2015 which Randomly divided into two groups: The first group, received oral ibuprofen in three doses (5, 5, 10 mg/kg at 24-hour intervals) and the second group received an early dose of OIS, in two doses of 10 mg/kg after 24 and 48 hours (totally 20 mg/kg). A follow-up ECHO was performed 48 hours and 2 weeks after treatment by the same pediatric cardiologist who was not aware of the study groups. Evaluation of changes in platelet count, blood urea nitrogen, creatinine and complications of thrombocytopenia, evaluation of elevated serum creatinine, and complications of gastrointestinal bleeding were compared between the two groups using statistical analysis.
Results: Seventy-three percent (73%) patients in the first group and seventy-six (76%) patients in the second group had successful PDA closure in the first 48 hrs. No statistically significant difference between the two groups (P=0.0001) was obtained and the highest response time was observed in the first 48 hours of treatment. After 2 weeks, the PDA closure in both groups was completely successful (100%). No specific side effects were observed between the two groups.
Conclusion: We conclude that higher doses of ibuprofen (20 and 2×510 mg/kg) do not show better results for PDA closure without renal or gastrointestinal complications.

Vagus nerve stimulation in the treatment of nervous system disease: a review article
Somayeh Nazari , Raheleh Rafaiee, Hamed Ghazvini , Elmira Beirami , Sara Chavoshinezhad , Seyedeh Masoumeh Seyedhosseini Tamijani ,
Volume 80, Issue 4 (July 2022)
Abstract
The vagus nerve (VN), the longest cranial nerve and an essential part of the parasympathetic system, connects the central nervous system to respiratory, cardiovascular, immune, gastrointestinal, and endocrine systems and is involved in the maintenance of homeostasis by controlling these systems. Vagus nerve stimulation (VNS) is related to any method that would stimulate the vagal nerve via electrical stimulation. VNS is a Food and Drug Administration (FDA)-approved treatment for medication-resistant depression, drug-resistant epilepsy, and migraine. However, VNS has also been studied for various other conditions, such as Alzheimer's disease and tinnitus, by targeting the VN in the neck and ear. Currently, there are two methods for VNS: a) invasive-VNS (iVNS), which requires surgical implantation of a pulse generator under the anterior chest wall, that is linked through a wire to an electrode cuff that wraps around a cervical vagus nerve, b) non-invasive transcutaneous VNS which is separated into cervical transcutaneous vagal nerve stimulation (ctVNS) and auricular transcutaneous vagal nerve stimulation (atVNS). The non-invasive transcutaneous VNS techniques are well tolerated and have no significant side effects, making them effective in clinical research for brain diseases. Because with these newer methods, the electrical stimulation is carried out through the skin.
The results of this study were collected using the advanced search in Scientific Information Database (SID), Google Scholar, PubMed, and Scopus between 2011 to 2021. Out of 671 articles surveyed, we used 53 articles in the study after the evaluation. Medical Subject Headings (MeSH) and Keyword Searching was carried out through the MeSH database. VNS has been shown to alter neural activity in multiple areas of the brain related to the regulation of the affective states. However, the precise mechanism of VNS action on the clinical consequences is still unknown. This study aimed to review the therapeutic effect of both methods of VNS in neuropsychiatric and neurological disorders such as depression, migraine, seizure, tinnitus and Alzheimer's disease and discuss several hypotheses on the mechanism of VNS, as a new approach, in the treatment of such disorders. It considers that a brain-mapping approach is needed to discover the therapeutic mechanisms of VNS in brain diseases.

Assessing the status of medical ethics Unit education in Tehran University of Medical Sciences and deterrent factors on its effectiveness
Sepehr Sahraian , Alireza Parsapour, Amir Ahmad Shojaee ,
Volume 80, Issue 6 (September 2022)
Abstract
Background: Medical ethics is an applied branch of ethics that deals with ethical challenges in medical and health environments, and its related topics have a long history, but its education as an academic subject in universities has received a lot of attention in the last 40 years. In recent years, medical universities have made extensive efforts to expand medical ethics education, which has been accompanied by significant progress, but given that the modern medical ethics education system is a growing and nascent structure, more research is needed. Therefore, this study aims to assess the status of the medical ethics education system at Tehran University of Medical Sciences to identify its gaps so that the current situation can be improved with proper planning.
Methods: The type of this research is descriptive quantitative-qualitative and it was collected from December 2018 to September 2019 at Tehran University of Medical Sciences. First, the educational curriculum of 165 educational levels at Tehran University of Medical Sciences was reviewed and described in terms of the existence of a medical or professional ethics course in the educational curriculum. Then, a semi-structured interview was conducted with the 13 professors in charge of teaching this course in all faculties, and content analysis was performed to describe and identify the obstacles in its effectiveness.
Results: The results showed that in 53% of the educational levels, there was no separate medical or professional ethics course in the educational curriculum and the most educational coverage of this course took place in the faculties of medicine, dentistry, nursing and midwifery. The obstacles in the effectiveness of teaching this unit were categorized into five main themes of educational curriculum, hidden curriculum, teaching methods, teachers and education management.
Conclusion: The results show that the content of curricula needs to be revised and education should be inclusive. Creating a coherent educational organization and monitoring the hidden curriculum are other issues that should be considered to increase the effectiveness of this education.

Outcomes of AstraZeneca vaccine for relapse and Covid-19 infection in people with multiple sclerosis
Nazanin Razazian, Mohammad-Ali Sahraian, Sharareh Eskandarieh, Nooshin Jafari, Mansour Rezaei, Negin Fakhri,
Volume 80, Issue 6 (September 2022)
Abstract
Background: People with chronic diseases of the immune system, such as multiple sclerosis (MS), are at risk for Covid-19 disease. However, more research is needed with long-term follow-up. The aim of the study was to follow up people with MS (PwMS) for up to three months after AstraZeneca vaccination for the recurrence of MS and Covid-19 infection.
Methods: This study was a case study (descriptive-analytical) of follow-up type. The study population was PwMS over 18 years of age in Kermanshah province who received both doses of the AstraZeneca vaccine. This study was conducted from August to November 2021. Sampling was done with existing methods based on the National MS Registry of Iran (NMSRI). Demographic information of patients was extracted from NMSRI. A researcher-made form was used to collect information by telephone three months after vaccination about clinical characteristics, Covid-19 infection, and recurrence of MS. Data were analyzed using SPSS-25 software.
Results: Study participants were 40 MS patients with a mean (SD) age of 39.27 (8.8) years, including 32 (80.0%) women. A mean of 9.39 (4.6) years had passed since The patients were diagnosed with MS, and 29 (76.4%) had RR type MS. Four patients (10%) relapsed between the second dose and three months later, of whom two (50%) had sensory symptoms, one (25%) had optic nerve involvement, and one (25%) had motor symptoms and pyramidal pathway involvement. The symptoms of Covid-19 were mild in three patients (10%), while severe symptoms developed in one patient (10%) who received rituximab. Among the patients, no cases of thrombosis were observed. Infusion therapy, a leg fracture, and kidney stones were the only hospitalized cases.
Conclusion: Covid-19 and MS relapse prevalence did not differ significantly in the three months before and after vaccination. There is a need for further studies with a longer follow-up period.

Investigating factors affecting the response to treatment in patients with ITP
Seyed Kamal Eshagh Hossaini , Javad Hakimelahi, Mohammad Aghaali, Zahra Mehrabi, Rasool Karimi Matlob , Saeed Karimi Matlob,
Volume 80, Issue 10 (January 2023)
Abstract
Background: Idiopathic thrombocytopenic purpura (autoimmune), the most common cause of acute onset of thrombocytopenia in children who are otherwise healthy. This study was conducted with the aim of investigating the factors affecting the response to treatment in hospitalized children.
Methods: This retrospective study was conducted by examining the files of patients hospitalized due to ITP in Hazrat Masoumeh (S) Hospital from April 2009 to March 2019. The criteria for inclusion in the study included confirming the diagnosis of ITP and the age of 1 month to 14 years, and the exclusion criteria included cases of discharge with personal consent and not completing the patient's treatment course, the presence of pancytopenia or bicytopenia, the presence of moderate or severe splenomegaly or severe in clinical examinations, BMA based on the presence of a diagnosis other than ITP, not receiving any of the ITP treatment protocols, and patients whose first visit with the diagnosis of ITP was in another center or city. The information about age, sex, clinical symptoms on arrival, initial platelets and the platelets of days 3, 5, 14 and 180 were extracted from the patients' files. The type of treatment protocol, the need to repeat the treatment, the recurrence of the disease and the major complications of the treatment were extracted from the patients' files and finally the data were analyzed with SPSS software.
Results: The response to the treatment on different days was unrelated to the age, gender, and initial platelets (except for one exception) (P>0.05). In relation to clinical symptoms, the response to treatment on days three and five was related to the clinical symptoms at the time of presentation and on days 14 and 180 it was unrelated. Response to treatment on days 3 and 5 in different treatment protocols had a significant relationship (P<0.05), but there was no significant difference on days 14 and 180.
Conclusion: The best response was in the combined treatment group with methylprednisolone and IVIg, and the lowest response to treatment was observed in those receiving methylprednisolone alone.

Investigating the effects of swimming exercise training on xidative stress induced by chronic morphine administration
Mehdi Sadegh, Mohammad Hassan Sakhaie ,
Volume 80, Issue 12 (March 2023)
Abstract
Background: Morphine as a strong analgesic compound is widely prescribed in clinic to control medium to severe pain, they are also may cause drug abuse. Recent studies have shown chronic morphine consumption and it could induce oxidative stress and cause cell damage. In this study, the effects of daily swimming exercise investigated on oxidative stress indices in the hippocampus and plasma of morphine dependent rats.
Methods: In this study, 48 adult male wistar rats were randomly divided to four groups. Experiments were done during January to March 2022 at Arak University of Medical Sciences. Morphine was self-administrated for 4 weeks, as dissolved (0.4 mg/ml) in the daily drinking water. Exercise training was included 15 minutes daily continuous swimming in a swimming pool. Swimming occurred during all days of morphine consumption. At the end, 6 rats were randomly selected from each group and withdrawal signs were evaluated by naloxone injection, to confirm morphine dependency. Then, hippocampus and plasma were collected from the 8 remaining rats of each group and were used for GSH, GSSG, MDA, irisin and BDNF assessment.
Results: All rats in morphine consumed groups showed withdrawal signs in naloxone text, which means morphine dependency successfully were induced. However swimming exercise significantly reduced the consumption size of morphine. GSH was significantly decreased, while GSSG and MDA were significantly increased in the plasma and hippocampus of morphine groups in compare with control. Morphine consumption had no effect on plasma levels of irisin, while significantly decreased hippocampus level of BDNF. Daily swimming exercise in the morphine consumed group significantly repaired morphine effects on plasma and hippocampus levels of GSH, GSSG, MDA and hippocampus levels of BDNF.
Conclusion: Daily swimming exercise during the morphine consumption is able to repair at least some parts of the oxidative stress induced by morphine. This effect might help to reduce cellular and molecular damages raised by chronic morphine consumption.

Efficacy of treatment in children and adolescents with vasovagal syncope in the long term: an 8-year follow-up study
Mohammad Reza Sabri, Bahar Dehghan, Mahsa Rafiee Alhossaini ,
Volume 81, Issue 1 (April 2023)
Abstract
Background: Syncope is a temporary loss of consciousness with a loss of postural tone. Medicinal treatment of reflex syncope has shown to have no significant effect in reducing the recurrence of syncope. A 36-month follow-up of our pilot cohort showed that non-pharmacological treatments alone were effective in reducing relapse rates. The purpose of this study is to investigate long-term results and 8-year follow-up of previous patients.
Methods: The current study is a continuation of a prospective pilot cohort which was done between August 2013 and 2014 in two academic hospitals in Isfahan (Dr. Chamran heart center and Imam Hossein children hospitals). This current study examines the 8-year follow-up results of children with reflex syncope who were treated with non-pharmacological treatments alone or with drugs. Therefore, the patients who participated in the pilot study were enrolled (30 patients in the pharmacologic group and 40 patients non-pharmacological group). Finally, on 26 patients in the pharmacologic group and 31 patients in the non-pharmacological group (after applying the exclusion criteria), the incidence of syncope and pre-syncope attacks was compared between these two groups of patients using the Chi-square test.
Results: Our study showed that within 5 years after the last follow-up, the incidence of syncope and pre-syncope in patients with a history of vasovagal syncope who did not continue the diet or tilt exercises was different between the two groups of patients (without medication and drug recipient) was not significantly different, even the incidence of presyncope increased significantly again in both groups. The incidence of syncope in the period of 5 years after the last follow-up from the previous study was slightly increased in the group of patients without medication compared to the previous periods, but in the group of patients receiving medication, this incidence decreased slightly.
Conclusion: In order to prevent recurrence, the use of non-pharmacological methods is effective, but for the stability of this recovery, follow-up and continuation of these methods is necessary.

Gargled ketamine versus magnesium for prevention of postoperative sore throat: a randomized clinical trial
Zahra Azizi Farsani , Mehrdad Faizi, Arash Tafrisinejad , Mona Khoramjouy, Hamidreza Azizi Farsani ,
Volume 81, Issue 2 (May 2023)
Abstract
Background: Sore throat after surgery is the second most common cause of complications in recovery. It causes decreased patient satisfaction, and it affects patients’ well-being after surgery. The aim of this study was to compare the effects of ketamine and magnesium sulfate gargle on sore throat after laminectomy.
Methods: In this randomized clinical trial, 69 candidates for laminectomy patients in Shohade-Tajrish hospital from June 2021 to December 2022 were randomly assigned to three groups of ketamine (n=25), magnesium (n=23) and control (n=21). The Magnesium group received magnesium sulfate gargle (30 mg/kg in a total of 30 ml 5% Dextrose water), Ketamine gargle (0.5 mg/kg in a total of 30 ml 5% Dextrose water), and the control group received 30 ml 5% Dextrose water gargle. Standard similar anesthesia protocols were applied for all patients. In PACU (0) and 2, 4, 24 hours afterward sore throat was assessed using a visual analog scale (VAS) scoring.
Results: The study showed that the incidence of sore throat in the magnesium group was lower than ketamine. Comparison of the three groups at the time of recovery (0), 2, 4, and 24 hours after surgery showed that the differences between the three groups were significant in terms of sore throat. Also, the difference in the incidence of sore throat within each group in the four times in all three groups was statistically significant (P=0.001). There was no statistically significant difference between age, gender, body mass index, heart rate, blood pressure, duration of intubation, duration of surgery and anesthesia, size of laryngoscopy insertion and Cormack and Lehane score in the three studied groups. A drop in systolic blood pressure was observed in the both groups half an hour after the operation, which was statistically significant. Changes in diastolic blood pressure were significant only in the magnesium group.
Conclusion: The preventive effect of "magnesium sulfate gargle" on sore throat after laminectomy is much better than "ketamine" or "placebo" gargle.
 
Investigating the factors affecting post-laparoscopic cholecystectomy pain in patients referred to mashhad medical sciences of islamic azad university hospitals in 2021-2022
Yasamin Kaheni, Ali Mirsadeghi, Mohammad Ali Raisolsadat , Mohammad Javad Ghamari , Mohammad Barhemmat , Tooraj Zandbaf,
Volume 81, Issue 4 (July 2023)
Abstract
Background: Due to the prevalence of laparoscopic cholecystectomy, controlling common problems after this surgery is essential. This study aimed to determine the factors affecting pain after laparoscopic cholecystectomy.
Methods: In this cross-sectional study, 222 patients over 18 years old with symptomatic gallstones who underwent laparoscopic cholecystectomy from March 2021 to February 2022 in Mashhad Medical Sciences of Islamic Azad University Hospitals, were included. The amount of analgesic received after surgery was the same for all patients (Acetaminophen 1 gram intravenously every 8 hours and diclofenac 100 mg rectal every 8 hours). Demographic information of patients, body mass index, history of abdominal surgery, duration of surgery, carbon dioxide pressure, type of surgery (elective or emergency), number of surgical incisions, and pain intensity six and 24 hours after surgery (using a visual analog scale) were collected, and finally, the findings were statistically analyzed by SPSS version 26.
Results: Out of 222 patients, 179 cases were women (80.6%), and their average age and body mass index were 44.68±12.27 years and 27.08±4.7 kg/m2, respectively. In our study, 110 people (49.5%) had a history of abdominal surgery, of which cesarean section was the most common delete. Pain six and 24 hours after the operation was more common in women than in men, and surgery with three incisions was more painful than surgery with four incisions (P<0.05). In patients with a history of surgery, the pain was greater in six hours after surgery (P<0.05). Pain 24 hours after the operation in patients with gas pressure less than or equal to 14mmHg was greater than in patients with gas pressure greater than 14 mmHg (P<0.05). Pain six and 24 hours after surgery according to age, body mass index, type of surgery (emergency or elective), and duration of surgery had no statistically significant difference (P>0.05).
Conclusion: In our study, female gender, use of three incisions for surgery, and history of previous surgery were associated with more pain after laparoscopic cholecystectomy.

Risk assessment of carcinogenic and non-carcinogenic effets of exposure to heavy metals in hookah smoke using the monte carlo simulation technique
Taibe Ruenifard, Ali Oghazyan, Mohammad Hossien Saghi , Mahdi Ghorbanian , Ayoob Rastegar, Shahram Nazari ,
Volume 81, Issue 4 (July 2023)
Abstract
Background: This study aimed to evaluate the carcinogenic and non-carcinogenic health risks of heavy metals in seven types of tobacco widely consumed in the east of the country through inhalation exposure.
Methods: This descriptive-analytical study was conducted from April 2022 to October 2022 in the city of Bojnord, Iran on sook of seven popular tobacco brands. Metal concentrations in sook of tobacco were determined using inductively coupled plasma-optical emission spectroscopy. In order to analyze the data and ensure the accuracy of the results, the amount of metals in the samples was repeated three times, and their average was analyzed. Monte Carlo software was used to assess possible risks.
Results: The results of this study showed heavy metal concentrations in sook tobaccos were, respectively, Fe>Zn>Mn>Ba>Pb>Ni>Cu>Mo>Cr>As>Cd. The concentration of heavy metals such as arsenic, cadmium and molybdenum in Alrah brand tobacco was higher than other types of tobacco. So that the amounts of heavy metals including arsenic, cadmium and molybdenum for this brand were 14.2±0.05, 10.4±0.06 and 11.6±0.04 micrograms per gram, respectively. The hazard index (HI) values for different types of tobacco, including Al-Rah, Amordadsub, Al-Fakher, Al-Rubi, Mazaya, traditional flavorless, and Nakhle, were 2.64, 2.41, 2.05, 1.7, 1.49, 1.46, and 1.44, respectively. The lifetime cancer risk (ILCR) for Amordadsub, Al-Rah, Nakhla, Mazaya, Al-Rubi, Al-Fakher, and traditional flavorless tobaccos was 2.8×10-3, 2.43×10-3, 1.72×10-3, 1.58×10-3, 1.43×10-3, 9.58×10-4, and 8.08×10-4, respectively. Lead in Alrah tobacco sook had the highest non-carcinogenic risk value with a value of 1.59.
Conclusion: According to the obtained results, Alrah tobacco sook has a higher cancer and non-cancer risk than regular tobacco and can cause non-carcinogenic and carcinogenic risks for consumers. Thus, it is necessary to regularly monitor the quality of prevalent tobacco to reduce delete human health risks.

Evaluation of the validity and reliability of the persian version of the rotator cuff quality of life (RC-QOL) questionnaire in patients with rotator cuff injuries: a brief report
Babak Vahdatpour, Mohammad Shirvani, Hamidreza Jahanbani-Ardakani , Omid Alizadehkhaiyat , Sadegh Baradaran Mahdavi ,
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.
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.

Diagnosis of pneumothorax using machine learning algorithms and radiomics: Investigating the possibility of replacing simple chest radiography instead of CT scan in order to reduce the radiation dose
Hanieh Alimiri Dehbaghi , Karim Khoshgard, Hamid Sharini, Samira Jafari Khairabadi, Farhad Naleini,
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.

Evaluating the guidelines adherence in the management of NSTE-ACS referred to shahid chamran hospital within six-month period in 2021: a brief report
Mohammad Mahdi Gholamian , Mehrnoush Dianatkhah, Mohammad Kermani-Alghoraishi, Ehsan Shirvani,
Volume 81, Issue 8 (November 2023)
Abstract
Background: The purpose of this study was to evaluate the adherence to the ESC 2020 guideline for the management of NSTE-ACS patients admitted to Shahid Chamran Cardiology Hospital affiliated to Isfahan University of Medical Sciences in 2021.
Methods: In this retrospective study which was done during April 2021 to September 2021 we reviewed the hospital documents of 239 NSTE-ACS patients, in regard to prescribed medication during the admission period in Shahid Chamran Heart Center. Guideline-adherence was evaluated according to ESC2020 guideline. Totally 18 items were evaluated including Antiplatelet (Clopidogrel, Ticagrelor, and Prasugrel) Anticoagulant (Heparin or Enoxaparin), PPI, Statin, Beta blocker, and RAAS blockers (including ACEI/ARB or MRA). In each section the selected drug and the administered dose were compared with the guideline and the guideline adherence for each part was expressed as percent.
Results: Almost complete guideline adherence was described for 12 out of 18 reviewed items (77%). However, guideline adherence in relation to the type of medicine chosen as an antiplatelet was reported to be very low, and only 1.2% of the cases received ticagrelor or prasugrel which are the guideline recommended antiplatelet agent. Additionally, most of the administered GP2b3a antagonist agents such as eptifibatide were not in accordance with the guideline (Guideline adherence 39.74%). Also, the choice of the anticoagulant agent was among the items with low guideline adherence (29.76%) and the cross-over between anticoagulants (changing heparin to enoxaparin or vice versa) which has been inhibited by the guideline was seen with high incidence in this center (78 cases).
Conclusion: The present study showed relatively high guideline adherence in the most aspects of medical management. However, compliance was reported to be low in relation to the antiplatelet selection, the choice of the anticoagulant agent, and the indication for GP2b3a antagonist use, which maybe due to the higher cost of recommended agents, and shortage of some medications and dosage forms in Iran.

A systematic review on the effect of brachytherapy in the treatment of prostate cancer
Mostafa Kazemi , Mohammad Hossain Dadkhah Tehrani , Ali Asghar Khaleghi, Masoud Mohammadi ,
Volume 81, Issue 9 (December 2023)
Abstract
Background: Prostate cancer is one of the most common cancers in the world, which is associated with a high prevalence, especially in the elderly male population. Treatment options for non-metastatic prostate cancer usually include active surveillance, radiotherapy and surgery, so the aim of the present study is a systematic review of brachytherapy in the treatment of prostate cancer.
Methods: The study conducted is a systematic review article in which a review of the treatment of prostate cancer with brachytherapy has been done. The information used is taken from articles published in Persian and English in Google scholar, SID and PubMed databases from 2000 to 2022. The selected keywords in this article included Brachy therapy, Prostate cancer, Radio therapy, Prostate neoplasms, High dose rate, Low dose rate and External beam radio therapy. Selection of studies was done according to PRISMA guidelines.
Results: Brachytherapy can be classified into 2 types of permanent implantation and temporary implantation based on the length of the treatment period. In permanent brachytherapy implants for prostate cancer, iodine (125I) or palladium (103Pd) are used as radioactive sources for low dose rate cases and for high dose rate brachytherapy. Iridium (192Ir) is used. Brachytherapy is usually used in two ways, either as a monotherapy in which LDR and HDR are used to treat some low-risk patients, or as a booster treatment after other treatments such as EBRT, which here may be part of the treatment process before, after, or during treatment. In contrast to brachytherapy alone, brachytherapy plus EBRT is an appropriate approach in patients with intermediate-risk and high-risk disease. In high-risk patients, the combined use of EBRT and HDR-BT can lead to better results than EBRT alone. Brachytherapy treatment is not suitable for every disease.
Conclusion: One of the main advantages of this treatment method is the ability to administer a high dose of radiation while minimizing radiation exposure to adjacent healthy organs. Since optimal dose distribution occurs in the treatment, quality treatment can be ensured. The results obtained from both forms of brachytherapy are generally suitable and comparable to other treatment methods with fewer side effects.

Awareness, attitude and behavior toward using microwave in health care workers of shahid beheshti university
Zainab Moradi, Tayebeh Marashi, Ali Ramezankhani,
Volume 81, Issue 10 (January 2024)
Abstract
Background: In the last decade, the use of microwave ovens throughout the world, including Iran, has increased significantly. Therefore, it is important to understand the knowledge, attitude, and behavior of microwave oven use among employees of the Eastern Health Center to promote safe and responsible practices in the workplace. Assessing their familiarity and attitudes with microwave ovens, this study aims to identify potential areas for improvement and training. This, in turn, can create a safer and more efficient work environment for all involved.
Methods: In this cross-sectional study in 2022, the study population was all employees working in the health center and comprehensive health service centers affiliated with the East of Shahid Beheshti University of Medical Sciences, numbering 162 people. The research tool was a questionnaire adapted from Nadiri's thesis (2015). After collecting the questionnaires, the data was obtained by SPSS 26 software and were analyzed using Pearson's correlation coefficient, multiple regression, independent t-test, and one-way ANOVA.
Results: Although the attitude (36.35±3.579) and the behavior (61.16±6.402) towards using microwave ovens are favorable, there is still room for improvement of knowledge and awareness. Knowledge has a positive and significant effect on behavior (P=0.002, B=0.245) and attitude (P=0.001, B=0.263), which shows that improving knowledge about the safe and responsible use of microwave devices can lead to behavior. and a more favorable attitude among employees. In addition, the attitude has a strong positive and significant effect on behavior (P=0.001, B=0.417), and promoting a positive attitude toward using microwave devices can also lead to more favorable behavior. However, the relatively weak effect of awareness on attitude indicates that other factors may also play a role in determining the attitude toward using microwave devices.
Conclusion: These findings highlight the importance of educational and awareness campaigns to promote the safe and responsible use of microwave devices among healthcare workers.

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

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

Page 13 from 14     

© 2024 , Tehran University of Medical Sciences, CC BY-NC 4.0

Designed & Developed by : Yektaweb