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The effect of ketorolac and naphazoline-antazoline eye drops on ocular complaints after cataract surgery
Nima Koosha, Hamidreza Shetabi, Ahmad Moradi,
Volume 80, Issue 1 (4-2022)
Abstract
Background: Cataracts are the leading diseases that cause blindness. Cataracts can be treated with surgery. Pain, itching, burning, and a foreign body sensation in the eye are common ocular complaints of patients in recovery. In this study, we compared the effect of Ketorolac eye drops and naphazoline antazoline eye drops on reducing complaints of surgery.
Methods: This randomized clinical trial study was performed from February 2016 to March 2017 on patients who were candidates for cataract surgery at Feyz University Hospital in Isfahan, Iran.  In this study, 54 patients were enrolled in two groups receiving Ketorolac eye drops and naphazoline antazoline (NA) eye drops. After the operation, patients' ocular complaints such as burning, itching, pain, and severity were evaluated every 15 minutes in recovery and every half hour in the ward until discharge from the hospital.
Results: In this study, 54 patients in two groups of 27 were studied. In the post-anesthesia care unit, the burning sensation in the naphazoline-antazoline group was significantly lower than in the ketorolac group (P=0.02). Patients in the NA group had less foreign body sensation in the eye in recovery (P=0.97) and the ward (P<0.001) than in the ketorolac group. Mean Pain intensity in the recovery unit (P=0.39) and ward unit in the ketorolac group were less than NA (P<0.001). In the recovery unit in the NA group, the eye-burning sensation was significantly lower than in the ketorolac group. The foreign body sensation in the NA group was less than the ketorolac group but there was no significant difference between the two groups. In the NA group, itching of the eyes was less than in the ketorolac group.
Conclusion: It can be concluded that ketorolac drops have been more effective in reducing post-operative eye pain than NA and NA drops have been more effective in reducing burning, itching and foreign body sensation in the eyes than Ketorolac.

Prevalence of beta group streptococcal colonization in rectovaginal discharge of pregnant women and comparison of maternal and neonatal complications in culture-treated individuals with those treated in risk factor at Arash Hospital.
Reihaneh Pirjani, Ali Akbari Sari, Mahbobeh Shirazi, Amin Nakhostin Ansari, Maryam Rabiei, Amene Abiri,
Volume 80, Issue 3 (6-2022)
Abstract
Background: Streptococcus beta group (GBS: Group B Streptococcus) is a gram-positive coccus that colonizes in the rectovaginal area. About 4.6% to 31.3% of women of childbearing age carry GBS infection. GBS colonization is a risk factor for subsequent infections in pregnant women that can be transmitted to the fetus through vertical transfer and aspiration of infected amniotic fluid. 2% of cases lead to an invasive infection in the baby. In most countries, treatment is done according to the CDC (Centers for Disease Control and Prevention) protocol which is based on culture results. According to studies conducted in our country, treatment is based on risk factors. Therefore, during this study, we decided to compare the results of treatment based on risk factors and treatment based on culture results and other maternal and neonatal complications in these two groups.
Methods: This case-control study was performed on 98 pregnant women aged 35 to 37 weeks who were referred to the perinatal clinic of Arash Hospital from April 2018 to the end of March 2020 and also 200 pregnant women with a GBS risk factor. Samples of rectovaginal discharge of 98 pregnant women were sent to a selected laboratory for culturing. In this group, treatment was performed based on the culture result. The control samples included 200 pregnant mothers who were treated based on risk factors without culture. Then the two groups were compared in terms of pregnancy outcomes.
Results: Out of 98 subjects, 24 (24.5%) had positive rectovaginal culture. Individuals treated with antibiotics based on positive culture results did not show a significant difference in terms of observed pregnancy outcomes compared with the control group.
Conclusion: The prevalence of GBS colonization was significantly higher in patients with a history of vaginal discharge than in those without a history. Due to the small number of studies conducted in Iran, it is recommended to conduct studies with a larger sample size in order to explain a more appropriate protocol in terms of effectiveness and economics.

Comparison of roux-en-y gastric bypass techniques with and without distal gastric plication in patients with morbid obesity
Mehdi Asgari, Ali Sanaee, Faramarz Pazyar,
Volume 80, Issue 5 (8-2022)
Abstract
Background: The vertical gastric plication technique leads to poor long-term outcomes and is associated with intolerable reflux, dysphagia, or weight gain in a high percentage of patients. Therefore, in this study, the therapeutic results of two methods with and without plication of the distal part of the stomach in gastric bypass surgery in patients with morbid obesity were compared.
Methods: In this clinical trial randomized single-blind study, 40 patients with morbid obesity who were referred to one of the hospitals affiliated with Jundishapur University of Medical Sciences in Ahvaz during March 2020-February 2021, were randomly divided into two groups: with plication of the distal part of the stomach (n=20) and without plication of the distal part of the stomach (n=20) in Roux-en-Y gastric bypass surgery. Weight loss rate, complications related to surgery, outcomes and satisfaction of patient were noted and followed up for one year.
Results: The mean percentage of weight loss at different times did not show a significant difference between the two groups (p>0.05). The length of hospitalization after surgery was significantly less in the distal gastric plication group (p=0.0001). During one year of follow-up, hypertension, diabetes, HLP, and reflux were well in the distal plication method but showed no significant difference (p>0.05). Satisfaction of the patients was more in the distal plication method and showed no significant difference (p>0.05). One year after the operation, the change of diet showed no significant difference in the two groups (p>0.05).
Conclusion: It looks that using the laparoscopic distal gastric plication method is an effective and safe method and is associated with early ideal weight loss, reduction of complications, and increase in satisfaction of patients with BMI>=35 kg/m2. No need to use a foreign body, stapler or bandage and the possibility of re-operation are the advantages of this technique.

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 (9-2022)
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.

Evaluation of severity, duration and complications of jaundice in infants of both sexes at Ghaem Hospital in Mashhad from 2014 to 2021
Hassan Boskabadi , Mahdie Mir, Maryam Zakerihamidi,
Volume 80, Issue 6 (9-2022)
Abstract
Background: The gender of the baby is one of the risk factors for neonatal jaundice, but the difference in the severity of jaundice and its prognosis between the two sexes is not clear. Therefore, in this study, we investigated the severity, duration and prognosis of jaundice in both sexes.
Methods: The present study is a cross-sectional study that was performed on 2847 icteric neonates over 35 weeks admitted to Ghaem Hospital in Mashhad from May 2014 to May 2021. This study is done by available sampling. After confirmation of jaundice in infants, data were recorded using a researcher-made checklist including maternal demographic information (maternal age, mode of delivery), complete infant characteristics (age, birth weight, age at onset of jaundice, jaundice recovery age) and laboratory findings (Bilirubin, Indirect Coombs, direct Coombs, G6PD), and neonatal development up to two years of age was performed based on the Denver 2 test. Then data analysis was performed by SPSS software using Chi-square test and Student’s t-test.
Results: 1642 infants (57.7%) were boys and 1205 infants (42.3%) were girls. Mean and standard deviation of bilirubin in values less than 20 mg/dl in boys was 17.20±2.48 mg/dl and in girls was 16.54±2.80 mg/dl (P=0.000), birth weight was 3.16±0.49 (kg) for boys and 3.07±0.45 for girls (P=0.000). In two groups of male and female infants, age (P=0.004), direct bilirubin (P=0.001), direct and indirect Coombs (P=0.000), and G6PD enzyme deficiency (P=0.000) had a significant difference. Acute kernicterus was reported in 25 (2.03%) boys and 4 (0.46%) girls (P<0.001). In the two-year follow-up, 23 boys (1.9%) and 11 girls (1.28%) had developmental delay (P<0.05).
Conclusion: The incidence of jaundice in male infants was higher than female infants, which is probably due to a higher prevalence of G6PD deficiency in boys. The severity of jaundice was higher in boys less than 20 mg/dl. Jaundice has a worse prognosis in male infants.

Comparison of the effectiveness of intranasal ketamine compared with intravenous ketamine in controlling pain during cataract surgery
Hamidreza Shetabi , Khosro Naghibi, Alireza Peyman, Hamed Norouzi,
Volume 80, Issue 8 (11-2022)
Abstract
Background: To improve the quality of sedation in procedures, different medications are used alone or in combination with each other, but so far, no administration method that is agreed upon by anesthesiologists has been presented. This study aimed to investigate the effectiveness and safety of intranasal ketamine in comparison with intravenous ketamine in cataract surgery.
Methods: This clinical trial was performed from December 2016 to March 2017 in Feyz Hospital, Isfahan. Ninety patients over the age of 18 who were candidates for cataracts surgery were randomly assigned to receive 1 mg/kg ketamine through the nasal route (INk) or intravenously (IVK). Ten minutes before the surgery, ketamine was administered in the INK group and intranasal saline in the IVK group. Two minutes before the start of surgery, normal saline was administered in the INK group and ketamine was administered intravenously in the IVK group. Patients received intravenous midazolam 0.04 mg/kg during prep and drape. The quality of sedation and analgesia, vital signs, patient and doctor satisfaction, and side effects were recorded during the study period. Data were analyzed using of SPSS software, version 23 (IBM SPSS, Armonk, NY, USA).
Results: In this study, 90 people were included in the study, 53 of whom (58.9%) were men. The mean age of the patients was 61.5±10.6. Two groups had a significant difference in terms of gender (P=0.696), age (P=0.960), weight (P=0.212), height (P=0.632), underlying disease (P=0.094), and type of disease (P=0.090). Two groups were not significantly different in terms of mean heart rate (P=0.77), mean arterial blood pressure (P=0.13), mean blood oxygen saturation (P=0.58), patient satisfaction (P=0.470) and surgeon satisfaction (P=0.115), pain intensity (P=0.506), level of sedation level (P=0.477) and side effects (P=0.221).
Conclusion: Intranasal administration of ketamine provides similar sedation and cardiovascular response compared to intravenous administration of ketamine. Administering ketamine intranasally is a non-invasive, safe and effective method with easy application and can be a suitable alternative to intravenous administration.

Association between sonographic features of thyroid nodules and cellular examination obtained by fine needle aspiration
Soudeh Hamedi , Marzieh Hadavi , Farhad Mohammadi , Somayeh Behzadi, Kourosh Sayehmiri,
Volume 80, Issue 9 (12-2022)
Abstract
Background: As we know, thyroid nodules are common, but many of them are benign, and this shows that sampling of nodules is not necessary to diagnose benignity.The aim of this article was to determine the diagnostic accuracy of ultrasound features for diagnosing malignant thyroid nodules in patients referred to Fajr infirmary in Ilam.
Methods: This descriptive-cross-sectional study was conducted on 122 patients referred to Fajr Ilam Clinic in October 2015 to January 2018.Clinical characteristics such as age, gender, BMI and history of underlying thyroid diseases and Hashimoto's thyroiditis were collected with the help of a questionnaire.The dependence of ultrasound characteristics with thyroid malignancy was determined using a multivariate analysis test. This ultrasound feature was compared with the results of fine needle aspiration cytology and the diagnostic accuracy indices were calculated for each ultrasound feature.This article was conducted using statistical tests, chi-square, independent t-test, Mann-Whitney test, and bivariate logistic regression using Spss software.
Results: The study sample included of 30(24.6%) malignant and 92(75.4%) benign nodules. Hypoechogenicity and microcalcification showed statistically significant positive associations with thyroid malignancy (P<0.05).Also, according to Fisher's exact test, 7% and 20% of men had benign and malignant nodules, and 86% and 80% of women had benign and malignant nodules, respectively. But there was no statistically significant difference between the two groups (P>0.05). Hypoechogenicity had 63.3% sensitivity and 67.04% specificity, microcalcification had 60% sensitivity and 65.93% specificity. Having at least one good sonographic feature resulted in the highest sensitivity (86.67%), while the presence of both features had almost perfect specificity (91.3%) and the highest positive likelihood ratio (4.21).
Conclusion: According to the results of this article, the presence of Microcalcification variables and Hypoechogenicity are the most important criteria in predicting thyroid malignancy, and they are Locate in the TI-RADS grading. Therefore, nodules larger than 1 cm in size with the characteristics of microcalcification and homogeneity ultrasound should be the main focus of diagnostic evaluations.

Deep learning approach for motor imagery EEG signal classification
Faezeh Moghadas, Zahra Amini, Rahele Kafieh,
Volume 80, Issue 10 (1-2023)
Abstract
Background: Brain-computer interface systems provide the possibility of communicating with the outside world without using physiological mediators for people with physical disabilities through brain signals. A popular type of BCIs is the motor imagery-based systems and one of the most important parts in the design of these systems is the classification of brain signals into different motor imagery classes in order to transform them into control commands. In this paper, a new method of brain signal classifying based on deep learning methods is presented.
Methods: This cross-sectional study was conducted at Isfahan University of Medical Sciences, School of Advanced Technologies in Medicine, from February 2020 to June 2022. In the pre-processing block, segmentation of brain signals, selection of suitable channels and filtering by Butterworth filter have been done; then data has transformed to the time-frequency domain by three different kinds of mother wavelets including Cmor, Mexicanhat, and Cgaus. In the classification step, two types of convolutional neural networks (one-dimensional and two-dimensional) were applied whereas each one of them was utilized in two different architectures. Finally, the performance of the networks has been investigated by each one of these three types of input data.
Results: Three channels were selected as the best ones for nine subjects. To separate 8-30 Hz, a 5th degree Butterworth filter was used. After finding the optimal parameters in the proposed networks, wavelet transform with Cgauss mother wavelet has the highest percentage in the both proposed architectures. Two-dimensional convolutional neural network has higher convergence speed, higher accuracy and more complexity of calculations. In terms of accuracy, precision, sensitivity and F1-score, two-dimensional convolutional neural network has performed better than one-dimensional convolutional neural network. The accuracy of 92.53%, which is obtained from the second architecture, as the best result, is reported.
Conclusion: The results obtained from the proposed network indicate that suitable, and well-designed deep learning networks can be utilized as an accurate tool for data classification in application of motion perception.

Predicting the Performance of Faculty Members of Medical Universities in Providing Virtual Learning in the Covid-19 Pandemic in terms of Problem-Solving Methods and Their Individual Social Characteristics: A Data Mining Study
Mohammad Sattari, Rahele Samouei,
Volume 80, Issue 12 (3-2023)
Abstract
Background: In the Covid-19 Pandemic, virtual education in universities became essential and came with some challenges, especially for professors who had the role of presenters. In this regard, the study was conducted to predict the performance of professors in providing virtual training in Covid-19 in terms of problem-solving methods and their demographics.
Methods: A descriptive-analytical study was performed on 252 professors of Iranian universities of medical sciences from 2021 April to 2021. Also, demographic characteristics such as gender, field of study, position, job rank and work experience were asked. The faculty members' performance questionnaire in providing virtual training (α=0.89) and the problem-solving methods questionnaire (α=0.75) was administered virtually and the data were analyzed by Random forest, CHAID and ID3 techniques.
Results: Based on used data mining methods findings, factors related to teachers' satisfaction with their performance in providing virtual education were "the possibility of monitoring the performance of homework", "establishing order and regulations", "preparing standard educational content", "using multimedia content", "Mastery of software, educational systems, and multimedia content", and "possibility of examining the quality and quantity of students' learning". Also, interpersonal problem-solving methods, such as "believing in the role of personality traits of people in their behavior", "solving problems with effort and follow-up", "notifying people's mistakes in interpersonal interactions", "giving people the opportunity to check their behavior", "proposing solutions to solve problems for the benefit of both parties", and "dividing big problems into smaller parts" have played a big role in professors' satisfaction about their teaching methods. These characteristics are related to more basic areas such as self-regulation, pursuit and challenge, agreeableness, and realism.
Conclusion: The results of the study showed that the performance of teachers in providing virtual education is influenced by some behavioral factors and individual situational abilities. However, despite the virtual training implementation difficulties, it is a productive opportunity that can be used in the days of returning for conditions (after-covid 19 condition) without physical distance along with face-to-face training.

Evaluation and comparison of statistical models of hemodialysis adequacy in hemodialysis patients in two groups (fistula and permanent catheter) in Arak dialysis center
Kowsar Sadat Ashrafi, Nasser Saeedi, Parvin Soltani, Ali Sadough Abbasian , Mohammad Rafiei, Fereshteh Nejati, Mahdieh Gholamzadeh, Mojtaba Ahmadlou,
Volume 80, Issue 12 (3-2023)
Abstract
Background: Adequacy of dialysis is a very important issue in dialysis patients, so comparing the adequacy of dialysis in different dialysis methods is very important. Therefore, due to the fact that the number of people undergoing dialysis  through fistulas and catheters varies in different centers, and depending on different centers, there is a possibility of decreasing or increasing the adequacy of dialysis, so we decided to do this comparison in Arak support center.
Methods: In this analytical-cross-sectional study, the dialysis patients of Hami Arak Center from April 2019 to September 2019 were divided into two groups (the first group with permanent catheter, the second group with arteriovenous fistula) based on vascular access. The both groups were matched in terms of age, sex, weight, pump speed, filter size and also the duration of dialysis. All patients were dialyzed with the same type of dialysis machine, and the duration of hemodialysis for all samples was 4 hours in each session. To confirm the reliability of the device, it was calibrated before each use and the same setting was used for all samples. The blood samples were taken from the arterial route before dialysis and starting the dilution with heparin or normal saline. Statistical models of dialysis adequacy of patients in two groups were measured using the Kt/V criterion, SPSS and AMOS data analysis was performed.
Results: In the analysis of covariance of BUN before dialysis, there is a statistically significant difference in the studied groups (P<0.05), also in the UF and URR variables, dialysis time and the number of times of dialysis in three consecutive repetitions, there is a statistically significant difference in the studied groups. (dime fistula and catheter) are not present (P<0.05).
Conclusion: In this study, during repeated repetitions, 22% of the dialysis adequacy in the two groups did not have good adequacy, and 78% of the patients in the two groups had appropriate dialysis adequacy.

Oxytocin plus foley catheter versus misoprostol plus foley catheter on cervical preparation in prolonged pregnancies
Masoume Mirteimouri, Seyyedeh Azam Poorhosseini , Maliheh Rakhshanifar, Seyede Houra Mousavi Vahed , Fedyeh Haghollahi,
Volume 81, Issue 3 (6-2023)
Abstract
Background: The success of labor induction depends on the condition of the cervix at the time of delivery. This study examines the effect of labor induction with an intra-cervical Foley catheter and oxytocin compared to a Foley catheter and misoprostol on cervical preparation and delivery rate in the first 24 hours after induction.
Methods: In a randomized clinical study, pregnant women with a singleton pregnancy and a gestational age of more than 40 weeks, with a Bishop score less than 4 and an intact amniotic sac referred to Umm al-Binin Hospital in Mashhad from 2017 to 2018 were included in the study. They were randomly divided into two groups of Foley catheter and oxytocin (1) or Foley catheter and misoprostol (2). In the first group, immediately after placing the Foley catheter; Oxytocin was started with a dose of 2 milliunits per minute, and every 20 minutes, 2 milliunits were added to reach the maximum dose of 30 milliunits per minute (induction method with a low dose). In the second group, after Foley catheter insertion, sublingual misoprostol was prescribed at a dose of 25 micrograms every 4 hours up to a maximum of 6 doses.
Results: 74 pregnant women were randomly evaluated in two groups of 37 people. There is no statistically significant difference in the demographic variables in the two groups. There was a significant difference in the labor rate in the first 24 hours, and it was higher in the oxytocin group (P=0.009). Bishop's score after 24 hours of induction was not significantly different in the two groups. Reaching the active phase was significantly shorter in the oxytocin group. (P=0.01). The time of catheter removal in both groups and the rate of cesarean section and the occurrence of complications were the same in both groups.
Conclusion: The use of oxytocin with a Foley catheter inside the cervix can accelerate the preparation of the cervix and increase the chance of labor in the first 24 hours, but it does not affect labor complications.

Effects of intravenous infusion of lidocaine and dexmedetomidine on immediate complications after tonsillectomy surgery in children
Behzad Nazemroaya, Azim Honarmand, Shima Shams,
Volume 81, Issue 4 (7-2023)
Abstract
Background: Tonsils are lymphoid tissues of the body's defense system that surround the pharynx and prevent the entry of microbes through inhalation. Tonsillectomy is the final treatment for enlarged tonsils and is one of the most common procedures in the ear, throat and nose. To prevent and improve postoperative complications, various methods are used, including lidocaine and dexmedetomidine injections. The aim of this study was to compare the effects of intravenous infusions of lidocaine and dexmedetomidine on the rate and severity of immediate complications after tonsillectomy surgery.
Methods: This study was conducted as a prospective, triple-blind, randomized clinical trial on 96 patients who were candidates for tonsillectomy under general anesthesia at Al-Zahra Hospital, Isfahan, Iran. The patients had informed consents and met the conditions to enter the study. 30 minutes before induction of anesthesia, patients were randomly assigned to one of three groups receiving lidocaine, dexmedetomidine, or placebo. All patients were examined for intraoperative bleeding, laryngospasm in the first 2 hours after the operation, and laryngitis in the first 24 hours after the operation. SPSS version 26 software was used for statistical analysis.
Results: The findings of this research indicated that at 45, 75 and, 90 minutes after recovery, the mean score of pain and at 15-90 minutes in terms of anxiety was significantly different from the rest in at least one of the three groups (P<0.05). Systolic blood pressure (SBP) and arterial oxygen blood pressure in minutes 30 to 90, as well as Diastolic blood pressure (DBP) in minutes 60, 75 and 90, showed a significant difference between the three studied groups (P<0.05). There was no significant difference between the incidences of laryngospasm in the groups. However, there was a significant difference between the incidences of bronchospasm in all three groups. In terms of factors such as cough and nausea, no significant differences were observed in the studied groups. However, the average amount of bleeding in surgery, the recovery time and, the first time to tolerate liquids and solids in at least one group were significantly different from the others.
Conclusion: Overall, both dexmedetomidine and lidocaine are effective in reducing heart rate, SBP, Per Os (PO), and bleeding, and also increase arterial oxygen pressure, while respiratory rate, laryngospasm, bronchospasm, cough, nausea and extubation time were not significantly different between the three study groups.

Assessment of STIR and contrast-enhanced MRI sequences in detection of diabetic foot osteomyelitis
Somayeh Zamani, Mohammad Reza Sasani , Mahdi Saeedi-Moghadam ,
Volume 81, Issue 4 (7-2023)
Abstract
Background: MRI is the imaging modality of choice for the detection of diabetic pedal osteomyelitis. The aim of this study is to compare the STIR sequence, as the most important fluid-sensitive sequence, with contrast-enhanced images for diagnosing diabetic pedal osteomyelitis.
Methods: Medical images were compared. Moreover, the effect of adding T1W image findings to the STIR sequence was evaluated. This cross sectional study was collected and analyzed at Namazi Hospital, Shiraz University of Medical Sciences, from 20 March 2016 to 22 September 2017.
Results: The final diagnosis of osteomyelitis was confirmed for 47 bones (78%). 13 bones (22%) didn't have osteomyelitis. The specificity of contrast-enhanced and STIR sequences was 92.3% and 53.8%, respectively; whereas the sensitivity of the two sequences was similar (100%). Records of 48 diabetic patients suspected of having pedal osteomyelitis referred to one of the university hospitals, who underwent foot MRI with and without contrast injection, were assessed. Overall, 48 Patient MRIs and 60 separate bony parts were evaluated. Diagnoses were confirmed by clinical correlation. Finally, sensitivity, specificity and diagnostic accuracy of STIR sequence and contrast-enhanced images were compared. Moreover, the effect of addition of T1W image findings to STIR sequence was evaluated.
Conclusion: This study was performed to suggest a pulse sequence that doesn’t need contrast media injection for diagnosing diabetic pedal osteomyelitis since the previous studies showed that gadolinium-based contrast media shouldn’t be applied in patients with renal failure (glomerular filtration rate<30 ml/min/1.73m2. According to the results STIR images had the same sensitivity as T1 post-contrast images; therefore, it can be concluded that contrast media injection can be avoided using this pulse sequence. The specificity of the STIR pulse sequence was lower than that of post-contrast images which was due to the lower ability of this pulse sequence to detect secondary symptoms of osteomyelitis such as cortex disruption, sinus path, and abscess. Using the T1 pre-contrast images, specificity and diagnostic accuracy increased. Finally, it can be concluded that MRI without contrast including STIR and pre-contrast T1W images is a reliable modality for the detection of osteomyelitis in suspected diabetic patients who are more prone to renal disorders.

Approach and management of congenital cataract: A review article
Parisa Abdi, Zakieh Vahedian, Atefeh Dehghani, Mona Safizadeh, Elias Khalilipour ,
Volume 81, Issue 5 (8-2023)
Abstract
Congenital cataract refers to the presence of any opacity in the lens at birth or during early childhood. Cataracts in children can manifest as unilateral or bilateral, congenital or acquired, with specific inheritance patterns or occurring sporadically. Additionally, the condition can be stable or progressive. Congenital cataracts can be associated with certain systemic diseases, or they may occur in the eye of an otherwise healthy child in isolation. Congenital cataract is one of the main causes of blindness in childhood. According to the report of the World Health Organization in 2001, congenital cataract is responsible for about 5 to 20 percent of cases of childhood blindness in the world based on different geographical regions. Untreated cataract in children leads to a tremendous social, economic and emotional burden for the child, family and society. Common complaints associated with congenital cataracts often include leukocoria (white pupil), reduced vision, a child's inability to track objects up close, light sensitivity leading to eye closure, squinting, the presence of either small eyes (microphthalmos) or large eyes (buphthalmos), strabismus (eye deviation), and abnormal eye movements such as nystagmus. Childhood cataract-related blindness can be cured with early detection and appropriate management. Managing pediatric cataracts is a challenge. Increased intraoperative complications compared to adults, tendency to increase postoperative inflammation, associated with complications such as aphakic glaucoma and persistent fetal vasculature, change in refractive status of the eye, and tendency to develop amblyopia, all complicate the achievement of good vision. Congenital cataract has a good prognosis if it is diagnosed early and surgery is performed before 6 weeks. Factors that may adversely affect the outcome, include the presence of unilateral cataract, presence of nystagmus, strabismus, or any ocular defect such as microphthalmos and PFV. Pediatric cataract surgery has evolved over the years, and with improved knowledge about myopic shift and axial growth, outcomes for these patients have become more predictable. Optimal results depend not only on effective surgery, but also on careful postoperative care and visual rehabilitation. Hence, it is the combined effort of parents, surgeons, anesthesiologists, pediatricians and optometrists that can make the difference.

Effect of cell therapy compared to renin-angiotensin-aldosterone system blocking agent in chronic kidney disease in cat-animal model
Nahid Askari, Ali Ali Shafieipour , Soudeh Khanamani Falahati-Pour,
Volume 81, Issue 5 (8-2023)
Abstract
Background: Mesenchymal stem cell (MSC) transplantation is a promising therapy for kidney repair. This study compared the regenerative effects of feline MSCs (fMSCs) and telmisartan, a renin-angiotensin blocker (RAB), in a feline model of chronic kidney disease (CKD).
Methods: The fMSCs were obtained from 35 Persian cats with CKD and characterized by CD44, CD90, and CD105 markers by using real-time RT-qPCR. The cats were randomly allocated to four groups, fMSCs injection (first group), telmisartan administration (second group), no treatment (third group), and healthy controls (fourth group). The study was conducted in Kerman province from December 2018 to December 2019. The factors that may affect the risk of CKD, such as age, weight, and history of kidney diseases, were considered as independent variables. The presence or absence of CKD was the dependent variable. The cats were followed up for 120 days and evaluated by physical examination, glomerular filtration rate (GFR), blood urea nitrogen (BUN), serum creatinine (SCr), serum urea, alanine transaminase (ALT), urine specific gravity (SG), and kidney histopathology. Statistical analysis was performed using SPSS software (version 20) with two-way ANOVA and Tukey test. P<0.05 was considered statistically significant.
Results: The fMSCs group showed significant improvement in GFR, BUN, SCr, serum urea, SG, and kidney histology compared to the other groups. The fMSCs group also showed increased expression of CD44, CD90, and CD105 genes in the kidney tissue, indicating enhanced stem cell activity. The telmisartan group showed modest improvement in blood pressure and proteinuria, but no significant effect on other parameters. fMSCs transplantation can restore the kidney function and structure in cats with CKD by modulating the apoptosis and proliferation of renal cells. The telmisartan  patients benefited from the anti-hypertensive and anti-proteinuric effects of the drug, but not from its anti-fibrotic or anti-inflammatory effects.
Conclusion: fMSCs transplantation was more effective than telmisartan in improving kidney function and reducing kidney damage in cats with CKD. fMSCs may be a potential therapeutic option for CKD patients.

Available and future of digital health solutions for body weight management in diabetic patients
Marziyeh Najafi, Sima Marzban, Roya Rajaee, Behrooz Pouragha,
Volume 81, Issue 12 (2-2024)
Abstract
Managing overweight and obesity is associated with lower risks of chronic diseases like diabetes. Digital health, particularly smartphones or m-health, effectively manages body weight. Technologies such as telemedicine services, mobile health (mHealth) or the use of mobile phones or portable digital devices in healthcare services and wearable devices can be used in this field. Therefore, this study was conducted to understand the impact of digital health technologies on weight management in diabetic patients.
Methods: The present study is a systematic review study that was initially searched using a systematic review of published studies in the field of digital health for weight management in diabetic patients from October 1401 to October 1402. Our study was conducted in two rigorous steps. Firstly, we performed a systematic review by searching for publications on Digital Health Solutions for Body Weight Management in Diabetic Patients until 12 October 2022. We meticulously combed through two comprehensive databases, PubMed and Web of Science, using a set of specific and relevant keywords. After a thorough screening and full-text assessment, we handpicked eight documents for this study. We cross-referenced with the companies' websites producing the identified applications to enrich our findings further.
Results: In the initial search, 223 documents were identified and after screening and qualitative evaluation, eight documents were selected for this study. Our research uncovered a range of mHealth apps that have shown promise in weight management for diabetic patients. These apps have demonstrated potential efficacy, high acceptability, and favorable user experiences. Importantly, they have also improved diabetes management and quality of life for the users.
Conclusion: Our review of digital health solutions has not only illuminated their potential in weight management for diabetic patients but also opened up new avenues for a more personalized, engaging, and practical approach to this issue. As technology continues to advance, these interventions hold the potential to revolutionize diabetes self-management, significantly enhance the quality of life, and contribute to better health outcomes for individuals living with diabetes.

Relationship between maternal early pregnancy body mass index (BMI) and weight gain during pregnancy with pregnancy outcomes: a cross-sectional study
Lida Saeed, Niusha Bahmanpoor, Robabe Hosseinisadat, Fatemeh Karami Robati ,
Volume 81, Issue 12 (2-2024)
Abstract
Background: One of the factors affecting the outcome of pregnancy is the primary body mass index (BMI) and the amount of weight gain during pregnancy. This study aimed to check the relationship between mother's initial body mass index and weight gain in pregnancy with pregnancy outcomes.
Methods: This cross-sectional study was conducted on 455 pregnant women referred to Afzalipour Hospital in Kerman, Iran, from August 2021 to August 2022. These pregnant women were included in the study through easy and accessible sampling. The mother's initial weight was recorded through the mother's health card. The height of the mother was measured using a standard meter and the final weight of the mother before delivery was measured using a standard scale available in the department. Other information of the mothers was extracted from their records. Weight gain during pregnancy and initial body mass index were calculated and divided into four categories, less than normal, normal, overweight and obese. Maternal-fetal complications were included in the information registration form. Descriptive and analytical statistical methods and SPSS version 24 software were used to analyze the data.
Results: The average age of women was 27.56±6.82 years. Body mass index of more than 40% of them (44.4%) was normal (19.8-26) and more than 45% of them were overweight 11.5-16 (45.5%). There was a significant relationship between initial body mass index and weight gain during pregnancy (P=0.001), gestational diabetes (P=0.001) and newborn weight (P=0.019). There was also a significant relationship between weight gain during pregnancy with premature birth (P=0.001), vaginal delivery (P=0.001), gestational diabetes (P=0.001) and newborn Apgar (P=0.001).
Conclusion: High body mass index of the mother and weight gain during pregnancy can cause complications in the mother and the fetus. Therefore, prenatal care should be done more carefully and health care providers should place mothers who have abnormal body mass index and inappropriate weight gain in pregnancy in the high-risk group and under special care to minimize maternal and fetal complications.

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 (3-2024)
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.

Investigating the relationship between the type of delivery and neonatal and maternal outcomes in public and private hospitals in Yazd
Morad Ali Zareipour, Shahla Mohammad Khani , Behjat Khorsandi , Faezeh Afkhami Aghda , Fateme Moshirenia, Mahdieh Hardani Naeemzadeh ,
Volume 82, Issue 1 (3-2024)
Abstract

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

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

Evaluation of maternal and neonatal out come in twin or multiple births in Imam Khomeini Hospital of Ahwaz
Fatemeh Beitsayah, Najmieh Saadati , Mojgan Barati ,
Volume 82, Issue 1 (3-2024)
Abstract
Background: Maternal and neonatal complications in twin and multiple pregnancies are higher than in singleton pregnancies. The purpose of this study is to investigate maternal and neonatal outcomes in twin or multiple births.
Methods: In this descriptive and analytical study, 266 pregnant women with twins and multiples were selected in a goal-based manner who had medical records in Imam Khomeini Hospital in Ahwaz from March 2020 to March 2022. This study is based on the purpose of selection and then the required information was extracted from the archive department of Imam Khomeini Hospital in Ahwaz. A two-part checklist was used to collect data, and then the collected information was analyzed by descriptive and analytical statistical tests.
Results:  The observations of this study show that the highest frequency of the total number of births is from March 2020 to March 2021 (6729 people), while the highest ratio of the number of twin or multiple births to the total number of births is from March 2021 to March 2022 (4.63 percent). The frequency of stillbirths is the highest from March 2021 to March 2022 (62.96 percent). There is a significant difference in fetal complications of twin and multiple births, premature birth, low birth weight and intrauterine growth delay between twin and multiple births (P-value<0.05) and for fetal anomaly and death from March 2021 to March 2022. Comparison of the two years under study shows no significant difference was observed between twin and multiple births (P-value>0.05). Pre-eclampsia was observed in 7.8 percent for twin births and 6 percent for multiple births, which statistically has no significant difference between them (P-value=0.331) and for diabetes, placental abruption and placenta Previa. There is a significant difference between twin and multiple births (P-value<0.05).
Conclusion: The frequency of multiple pregnancy shows an increase compared to previous studies in Iran, and prevention of premature birth and careful monitoring of the fetus can improve the outcome of twin or multiple births.

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