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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 effect of carboxytherapy in the treatment of urinary stress incontinency and sexual dysfunction in patients referred to the clinics of Isfahan University of Medical Sciences
Zahra Allameh, Maryam Teimouri Jervekani , Minoo Movahedi , Maryam Hajihashemi ,
Volume 80, Issue 10 (January 2023)
Abstract
Background: The present study was performed to evaluate carboxytherapy as an outpatient and non-hormonal strategy for the treatment of a number of pelvic floor disorders.
Methods: This randomized block controlled clinical trial study was performed on 60 women aged 35-65 years in 1399-1400 to evaluate the effect of carboxytherapy on the treatment of stress urinary incontinence and sexual dysfunction in comparison with the control group. At the beginning of the study, vaginal examination, cough test and POP-Q test were performed for all patients. Eligible individuals were randomly assigned to either carboxytherapy or control groups. Stress urinary incontinence was assessed using the ICIQ-UI SF questionnaire and sexual dysfunction was assessed using the PISQ-12 questionnaire. In the intervention group, 30 cc of CO2 gas with a 90-degree angle was injected in three areas of the bladder neck with the help of a needle gauge 30 with a length of 12 mm, so that each person underwent carboxytherapy twice a week for one month. The control group received the same protocol but without CO2 injection. The results were assessed both at the beginning of the study and one month and three months after the intervention through physical examination and two questionnaires.
Results: The results of the present study showed that the mean of general sexual function index and also the mean index of sexual function of patients in the physical dimension and in the dimension related to sexual partner in the intervention group was significantly different during the two stages of measurement but no significant difference was observed in the control group. The overall score of urinary function, frequency of leakage and the effect of leakage on the quality of life of women in both control and intervention groups were significantly different between the three stages of measurement. While the rate of urine leakage in the intervention group was significantly different between times, no difference was observed in the control group.
Conclusion: Carboxytherapy is a safe, effective, acceptable, inexpensive, affordable, and accessible treatment option compared to other treatments for urinary incontinence, and better results can probably be achieved by increasing treatment sessions.

Success of gonadotropin replacement therapy in men with hypogonadotropin hypogonadism in urology and endocrinology clinics of Golestan Hospital in Ahvaz
Alireza Jahanshahi , Alireza Kheradmand, Mehrnoosh Zakerkish, Homeira Rashidi, Narges Goudarzian Khozani ,
Volume 80, Issue 10 (January 2023)
Abstract
Background: The treatment of male hypogonadotropic hypogonadism leading to infertility in men and caused by gonadotropin is the subject of the current thesis. In this research, particularly, the fertility rate has been noticed. However, changes in the secondary traits of testes size, induction of spermatogenesis, and hormonal activity have also been considered. this project is to investigate the effectiveness of the mentioned treatment in creating fertility in the spouses of patients and comparing it with other researches conducted in other centers of the world.
Methods: In this retrospective and descriptive-analytical study, men with isolated hypogonadotropic hypogonadism based on the normality of other pituitary axes who had a tendency to be fertile were studied. From November 2017 to February 2020, these patients had been referred to the doctor at the endocrinology and urology clinics of Ahvaz for fertility purposes. The initial test was based on clinical examinations and testosterone measurement and sperm count for the patients was recorded after the treatment. The treated patients simultaneously received HMG 75 units every other day (three times a week) and HCG 5000 units every other day. Hormonal evaluation and clinical examinations were assessed again.
Results: This research showed that the size of the testicles increased in 54.8% of these patients. Secondary characteristics (secondary hair growth) were developed in 88.9% of the patients. Spermatogenesis induction occurred in 36 patients, 29 of whom became fathers. Meanwhile, in 67.3% of patients, sexual desire and in 69.4% of them hormonal activity increased. In addition, it was observed that the response time to replacement therapy is more than 12 months in 47.5% of the patients. Moreover, 6.6% of the study samples had used assisted reproductive methods.
Conclusion: The results of this research indicate the timely initiation of treatment to improve infertility and treat hypogonadism among men.According to the results, it seems that the use of HMG and HCG in the treatment of hypogonadotropic hypogonadism disease is effective in creating secondary sexual characteristics and increasing hormonal activity and fertility.

Point-of-care ultrasound and auscultation versus fiberoptic bronchoscope in determining the position of double-lumen tube
Behzad Nazemroaya, Fatemeh Kazemi Goraji , Azim Honarmand, Mohammad Saleh Jafarpisheh ,
Volume 80, Issue 11 (February 2023)
Abstract
Background: Double lumen tube (DLT) is used in lung surgeries. Classically, the patient should undergo fiberoptic bronchoscopy (FOB) to confirm the location of the DLT and its proper function. However, the sensitivity of ultrasound and clinical methods in diagnosing the correct position of DLT has not yet been definitively determined. This study was designed to assess the accuracy of point-of-care ultrasound and auscultation versus Fiberoptic Bronchoscope in determining the position of the Double-Lumen Tube.
Methods: This cross-sectional study of diagnostic value measurement type was conducted on patients who were candidates for double lumen implantation. After induction of anesthesia, DLT with the appropriate size was implanted, and then the position of DLT was evaluated. In the first step, the lungs were examined by auscultation, then the ultrasound was performed, and two signs of lung pulse sign and lung sliding sign were examined as signs of normal lung and ventilated lung. FOB was performed by an anesthesiologist. At the end, by opening the chest after surgery, the surgeon's opinion about the quality of lung collapse was recorded.
Results: In our study, the correct placement of the tube was correct in 37 cases and wrong in 3 cases, which were checked and corrected by FOB. Vital signs of the patients were stable before and during the operation. There were no problems with anesthesia during the surgery. Diagnostic sensitivity of lung auscultation clinical examination was 64.9% and chest ultrasound was 91.9%. The sensitivity of ultrasound compared to auscultation was not significant (P=0.242), but there was a clinically significant difference in the positive predictive value of the two, so that the positive predictive value of lung auscultation was 88.9% and lung ultrasound was 91.9%. In terms of surgeon satisfaction level, 22 cases (59.5%) had excellent satisfaction and 15 cases (40.5%) had moderate satisfaction. The sensitivity of ultrasound was not significant in comparison with the surgeon's satisfaction.
Conclusion: Ultrasound can be a good substitute for FOB. Although ultrasound cannot have all the functions of FOB, but having advantages such as lower cost, speed of operation, and non-invasiveness, makes it more practical than FOB.

Sporadic pulmonary lymphangioliomyomatosis (LAM) in a 24-year-old female: a case report
Shahram Seyfi, Nazli Farnoosh, Kayvan Latifi, Parviz Amri Male , Hamed Mehdinezhad Gorji , Asadollah Shakeri, Khadijeh Ezoji ,
Volume 80, Issue 11 (February 2023)
Abstract
Background: Sporadic lymphangioleiomyomatosis (S-LAM) is a rare disease that generally affects young women and involves the abnormal proliferation of smooth muscle cells (LAM cells) in the lungs (pulmonary LAM). There are two types of LAM, sporadic and LAM with tuberous sclerosis, which is an autosomal dominant genetic disease caused by mutations in the Tsc1 and Tsc2 genes. The most common manifestation of this disease is pneumothorax due to cyst rupture. Median transplant-free survival for pulmonary LAM is 23 years from diagnosis. Factors associated with a poor prognosis are often those associated with a more rapid decline in lung function.
Case Presentation: The patient was a 24-year-old woman who presented with pneumothorax and multiple bullae in both lungs. The patient had no family history of respiratory disease, and the patient herself had no symptoms other than mild shortness of breath following activity from a year ago. A lung CT scan was performed for the patient and multiple bullae were evident in both lungs, which confirmed the diagnosis. There was no evidence of involvement of other organs but the lung. For the patient in the ICU with the diagnosis of left pneumothorax, a chest tube was inserted and she underwent mechanical ventilation. Finally, after 24 days of hospitalization, oxygen therapy of the patient was performed with a normal mask, and she underwent left lung pleurodesis with talcum powder, and a few days later, right lung pleurodesis was performed on the patient. On the 36th day of hospitalization, her general condition improved and she was discharged from the ICU. The patient was discharged in good general condition and had no problem on her four months follow-up.
Conclusion: Fortunately, with the diagnosis of LAM for the patient according to the CT scan of the patient's lung, she was treated with insertion of a chest tube and by performing pleurodesis, the recurrence of pneumothorax was prevented. In a young woman with spontaneous pneumothorax, sporadic LAM is one of the differential diagnoses.

Investigating the reproducibility of radiomics features extracted from ultrasound images as diagnostic biomarkers in patients with hepatocellular carcinoma
Yunus Soleymani, Amir Reza Jahanshahi, Hamed Rezaeejam, Davood Khezerloo,
Volume 80, Issue 12 (March 2023)
Abstract
Background: Radiomics is a noninvasive method that reveals information from medical images that are not recognizable by the naked eye. Radiomics has shown a high potential in the accurate diagnosis and prognosis of liver lesions in ultrasound images. Despite this high potential, changes in imaging parameters affect the reproducibility of ultrasound radiomics results. Therefore, the present study aims to investigate the reproducibility of the radiomics features extracted from the images of patients with hepatocellular carcinoma under changes in ultrasound scan parameters.
Methods: This was a cross-sectional study conducted from July 2020 to July 2021 in the radiology department of Tabriz Paramedical Faculty. The images of 20 patients with hepatocellular carcinoma were obtained from the Cancer Imaging Archive database. These images were taken under different imaging conditions and parameters. The areas related to the lesion were manually extracted from the images with software tools. Then, in order to radiomics analysis, different radiomics features, including 24 gray level co-occurrence matrix (GLCM) and 16 gray level run length matrix (GLRLM), were extracted from the images. Then, using the coefficient of variation (CV%) and intraclass correlation coefficient (ICC) statistical tests, the reproducibility of radiomics features under changes in scan parameters was investigated. The values of ICC≥0.90 and CV<20% were considered reproducible in this study.
Results: Among the 40 features extracted from ultrasound images, eight showed high reproducibility in both CV% and ICC tests. These features were joint entropy, Idmn, Imc2, correlation, MCC, sum entropy, gray level non-uniformity normalized, and run entropy in which the two features, Idmn and gray level non-uniformity normalized, showed the highest (CV%=0.24) and the lowest (CV%=14.90) stability against the changes of ultrasound scan parameters, respectively. The average ICC value of these features was obtained at 0.977.
Conclusion: Despite the high potential of radiomics in diagnosing liver lesions, changes in imaging parameters directly affect the reproducibility of results. However, some radiomics features still show high stability and reproducibility under changes in imaging parameters.

The role of rectal sparing devices in post-prostatectomy radiotherapy: a review article
Arezoo Mehrabian, Hamed Ghaffari, Soheila Refahi , Mohammad Haghparast , Abolhasan Rezaeyan,
Volume 80, Issue 12 (March 2023)
Abstract

                                                                
Adjuvant or salvage radiotherapy can control biochemical relapse after radical prostatectomy and reduce the risk of distant metastases. Dose-escalated radiotherapy after radical prostatectomy can lead to improved biochemical relapse-free survival. Over the last decades, despite the technological advancements in prostate radiotherapy, radiation-induced rectal toxicity is still the main limiting factor for dose escalation owing to the anatomical proximity of the prostate gland to the rectum. To this end, several rectal sparing devices, including Endorectal balloons (ERBs), prostate-rectum spacers (e.g. SpaceOAR hydrogel), and rectal retractor have been explored to increase the distance between the prostate and the rectum to reduce rectal radiation doses and toxicities. Over the last decade, several studies applied these devices during post-prostatectomy radiotherapy setting. Therefore, the purpose of this review is to evaluate the impact of rectal sparing devices on dose-volume parameters of anorectal, radiation-induced rectal toxicity, and prostate bed motion during post-prostatectomy radiotherapy. The results showed that although using ERBs can lead to stability in the target volume position, it cannot reduce rectal radiation doses, in particular dose to the anterior rectal wall. The application of ERBs can reduce the received dose of the anal wall and increase the geometric reproducibility of the clinical target volume (CTV) position. However, the role of ERBs in reducing the received dose of the rectal wall is still controversial, which can be associated with the displacement of the anterior rectal wall towards the prostate bed (high radiation dose area). The use of SpaceOAR hydrogel can significantly increase the distance between the rectum and the prostate bed and ultimately reduce the dose received by the rectal wall. Also, the use of rectal retractor remarkably reduces rectal radiation doses. The dosimetric and clinical results of the use of SpaceOAR hydrogel and rectal retractor are very promising, and these devices can be used for patients after the necessary evaluations by radiation oncologist in post-prostatectomy radiotherapy. However, further studies will be required to elucidate the efficacy of SpaceOAR hydrogel and rectal retractor in reducing radiotherapy-induced rectal toxicity following post-prostatectomy radiotherapy.

Keywords: prostatectomy, prostate cancer, radiotherapy, rectum.


The success of simultaneous balloon dacryoplasty and stenting in failed congenital nasolacrimal duct intubations and its indications
Mansooreh Jamshidian Tehrani , Haniyeh Zeidabadinejad, Fereshteh Tayebi, Mohammad Reza Khalili, Bita Momenaei ,
Volume 80, Issue 12 (March 2023)
Abstract
Background: Congenital nasolacrimal duct obstruction (CNLDO) is one of the most prevalent orbital diseases in children and treatment of recalcitrant cases is always challenging. The purpose of this study is to identify the effectiveness of balloon dacryoplasty and stenting in persistent congenital nasolacrimal duct obstruction following previous intubation of nasolacrimal duct.
Methods: Our study was an interventional study from January 2015 to January 2018 on 16 lacrimal systems of 11 patients (5 males and 6 females) with congenital obstruction of the lacrimal duct (CNLDO) and a history of unsuccessful probing and stenting, in Farabi Hospital of Tehran (affiliated to Tehran University of Medical Sciences). Children who presented to our hospital and had previously been probed with or without intubation by another surgeon first underwent reprobing and re-intubation with a Crawford tube. Endoscopy of the nasolacrimal system was performed in suspected cases of false stent passage or in the presence of a history indicating nasal pathology. Crawford's Monoka tube was removed after two months. Balloon dacryoplasty with intubation was performed as the third surgery in cases who did not respond to probing and stenting after 3-6 months. The success after six months was evaluated using fluorescein dye disappearance test (FDDT) and also the resolution of the patients' symptoms.

Results: The age of the patients was 67±35.01 months (range: 26-121). The site of the canalicular stenosis in our patients was in the common canaliculi or within 2-3 mm from it. After 6 months, surgery was successfully performed in 13 lacrimal systems (81.25%). One patient with congenital lacrimal duct obstruction and Down syndrome and two other patients did not respond to balloon dacryoplasty and stenting and subsequently underwent dacryocystorhinostomy (DCR).
Conclusion: Balloon dacryoplasty combined with Monocrawford intubation is an effective surgical procedure that should be considered in cases of congenital nasolacrimal duct obstruction who have not responded to the probing and stenting of the lacrimal system.

 

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.

A rare complication of covid-19 infection in a 14-month-old infant: a case report
Asra Moradkhani, Mobin Azami, Massomeh Abedini ,
Volume 80, Issue 12 (March 2023)
Abstract
Background: Sever Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in some patients leads to cytokine storm and causes hemophagocytic lymphohistiocytosis (HLH) secondary to this viral agent. HLH is a rare and aggressive disease that increases in children, and is caused by changes in the immune system that associated with high mortality. Consideing the current pandemic, early diagnosis and treatment is important. Herein, we report a case of a 14-month-old infant presented with COVID-19 and prolonged fever who was eventually treated with the diagnosis of HLH. The study has been done in Sanandaj in January 2020.
Case Presentation: A 14-month-old female infant with Covid-19, in November 2019 with prolonged fever lasting for 12 days, weakness and lethargy was admitted to Sanandaj Social Security Hospital, in November 2019. The infant did not have any history of illness, drug or allergy and had received vaccination according to the country's protocol. Later she was transferred to Besat Hospital in Sanandaj due to persistent fever and elevated liver enzymes. The patient had severe leukocytosis and hepatosplenomegaly in the second center. During the diagnostic measures for the patient and the rule out of other possible causes through imaging and laboratory investigations and also the evaluation of relevant criteria, HLH was suggested and treated with antibiotics (ceftriaxone, meropenem), IVIg, dexamethasone and pantoprazole. After that the fever decreased, then oral prednisolone was prescribed and a follow-up was recommended. She was discharged in good general condition.
Conclusion: The current Covid-19 pandemic causes infection of children and may lead to occurrence of secondary HLH disease. therefore, assessment of children with liver manifestations and resistant fever should be considered by performing a PCR test to avoid complications and consequences as much as possible by timely treatment. more studies should be done in the field of its various dimensions.

A survey of awareness, knowledge and attitudes regarding stem cell donation among different people in the community: a systematic review study
Behjat Kalantari Khandani , Fatemeh Irannejad Parizi , Sedigheh Sadat Mousavi, Pouria Salajegheh,
Volume 81, Issue 1 (April 2023)
Abstract
Background: Stem cells play an important role in tissue regeneration and treatment of diseases. This study aimed to investigate the awareness, knowledge and attitudes regarding stem cell donation among different people in the community.
Methods: In this systematic review study, Persian keywords and English keywords such as awareness, knowledge, stem cells, embryonic stem cells, adult stem cells, cord blood stem cells and donation were selected according to MeSH database and then these selected keywords have been searched in the academic databases such as PubMed, Scopus, OVID, Science Direct, Iran Medex and SID. In addition, these selected keywords have been searched in the search engines such as Google Scholar, between January 2010 to December 2021.
Results: The results of this study found a total of twenty-five articles related to the awareness, knowledge and attitudes regarding stem cell donation among different people in the community. They were selected. In this study there were 10 cross-sectional studies, 2 descriptive-cross-sectional studies, 5 descriptive studies, 1 mixed method study, 1 semi-experimental study, 1 intervention study, 1 survey study, 1 review study, and the study type was not mentioned in three studies. Most of the studies were conducted in countries such as India, Saudi Arabia, and then United States (USA) and Turkey. Only one article was found in Iran. The results of studies have shown that the level of awareness and attitude of the majority of different people in the community towards the donation and use of stem cells is medium and low. However, most people have a good and positive attitude towards the donation and use of stem cells and mention the use of stem cells as an effective way to treat diseases.
Conclusion: Considering the importance and application of stem cells, it is suggested that managers and planners provide the necessary conditions to implement educational programs to raise the level of awareness and attitude of different people in the community towards stem cell donation.

Antioxidant effects of adipose derived stem cells conditioned media against high glucose-induced injuries in cultured of C28I2 chondrocytes
Sedigheh Safari, Akram Eidi, Mehrnaz Mehrabani, Mohammad Javad Fatemi , Ali Mohammad Sharifi ,
Volume 81, Issue 1 (April 2023)
Abstract
Background: Osteoarthritis (OA) is the most common form of arthritis characterized by progressive loss of articular cartilage, causing pain and loss of articular function. High glucose is a crucial inflammatory factor playing a pivotal role in the pathogenesis of OA that induces ROS production. Since most of the current therapies for OA are short-term benefits, hence, there is high demand for finding novel therapeutic agents for OA treatment. Recent studies have demonstrated that mesenchymal stem cells secrete important therapeutic factors that protect chondrocytes. In the current study, we investigated the protective potential of Adipose-derived stem cell conditioned medium (CM-ADSC) as an alternative to cell therapy in high glucose-mediated oxidative stress in C28I2 human chondrocytes.
Methods: This experimental study was performed in the Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran from May 2018 to August 2020. Adipose-derived stem cells were cultured until they reached 90% confluence then washed with PBS and cultured in a FBS-free medium for 48 hours. The conditioned medium was collected and centrifuged. The protective effect of the concentration of conditioned medium on high glucose (75mM)-induced oxidative stress in C28I2 cell viability was evaluated by WST-1 assay. Total RNA was isolated from the treated and untreated cells with TRIzol reagent. The mRNA expression of antioxidant enzymes including, glutathione S-transferase-P1 (GSTP1), catalase (CAT), and superoxide dismutase1 (SOD1) was evaluated by reverse transcription-polymerase chain reaction in treatment and non-treatment groups.
Results: Adipose-derived stem cell conditioned medium pretreatment remarkably protected C28I2 cells against high glucose. The expression of mRNA of CAT, GSTP1, and SOD1 significantly increased following treatment with the conditioned medium (50%) for 24 hours in high glucose-exposed cells as compared to the control.
Conclusion: Present study indicates that the Adipose-derived stem cell conditioned medium can reduce oxidative stress. It seems that the conditioned medium may protect cartilage in the progression of osteoarthritis.

Management of cosmetic surgery in iran: challenges and solutions
Maryam Tajvar, Parisa Pourfarokh, Najmeh Bahmanziari, Ebrahim Jaafaripooyan, Maryam Nazari , Haniye Sadat Sajadi ,
Volume 81, Issue 1 (April 2023)
Abstract
Background: Nowadays, beauty practices have attracted the attention of people following the change in lifestyle and social values. Therefore, the present study was conducted with the aim of examining the opinion of experts regarding the challenges and management solutions of the aforementioned practices in Iran.
Methods: This qualitative study was conducted through interviews with 26 policymakers and cosmetic surgery service providers in Tehran from April to September 2022. Sampling was purposeful and snowball. The interviews were semi-structured and thematic analysis was used to analyze the data obtained from the interviews. The inclusion criteria for the interviewees' entry were knowledge and experience in the subject and willingness to participate.
Results: Challenges under the four categories of service providers (improper education, non-specialist providers, moral hazards, deficiencies in the way laws are written, and the ineffectiveness of the complaint handling process), service receivers (being influenced by deceptive advertisements, low level of public health literacy and lack of mental health), the place of providing services (performing surgeries in non-standard places and non-integrated information system) and medicines, products and medical equipment (insufficient control over supply, distribution and use and price fluctuations) were categorized. Experts considered the major part of the challenges to be related to the service providers. In the category of service recipients, "being influenced by deceptive advertisements" was the main problem mentioned by the experts. Performing surgeries in non-standard places, including limited surgery centers, non-sterile places, and unauthorized places, is among the unsolved problems regarding the place of providing services. In relation to medicines, products, and medical equipment, the main problem was insufficient supply, distribution, and use supervision.
Conclusion: The main effective measure to solve the challenges is to strengthen the supervision of the health system administrator with internal and external coordination and cooperation. In this regard, it is recommended to develop educational, ethical, and legal frameworks, regulate regulatory laws, public awareness, clinical interviews and psychological counseling, especially before cosmetic surgery, and the establishment of an integrated electronic health record system.

The satisfaction of infertile patients with the quality of medical services in Tehran university of medical sciences hospitals during the year 2020-2021
Batool Hossein Rashidi, Maryam Bagheri., Ashraf Aleyasin, Ladan Kashani, Fatemeh Davari Tanha , Elham Feizabad , Fedyeh Haghollahi,
Volume 81, Issue 1 (April 2023)
Abstract
Background: Patient satisfaction is considered as one of the most important elements of the evaluation of healthcare centers. In this research, the level of satisfaction of infertile patients was evaluated.
Methods: This study is a cross-sectional descriptive study. The research population is infertile patients who referred to the infertility clinic (at least 4 visits) and hospitalized in four hospitals affiliated with the Tehran University of Medical Sciences. The satisfaction questionnaire was valid researcher-made which included 56 questions in 9 areas, and were collected from May 2021 to September 2022. In order to comply with the ethical principles in research, hospitals were named 1-4.The results were analyzed using the chi-square test or Fisher's exact test for qualitative variables and analysis of variance for quantitative variables in SPSS software, version 24 (SPSS Inc., Chicago, IL, US).
Results Three hundred–four infertile women in four hospitals were studied. The mean age of the participants was 33.8 years, with a standard deviation of 5.8 years. The average satisfaction with admission and discharge services, medical services, nutrition, accounting, and insurance services in the number-1 Hospital had the highest score, and the average satisfaction with nursing or midwifery services, diagnostic and therapeutic services (radiology/laboratory), hospital services, charter patient rights, management services, paid expenses in Hospital 4 received the most points. The mean score of satisfaction was the highest among those who visited the infertility clinic of Hospital 3 (161.54±21.41). Average satisfaction with admission and discharge services, medical services, nutrition, accounting, and insurance services in Hospital No. 1 had the highest score, and average satisfaction with nursing or midwifery services, medical diagnostic services (radiology/laboratory), hospital services, respecting the patient's rights, management services, paid expenses in hospital number 4 got the most points. The average of nursing or midwifery services, respecting the patient's rights, and hotelling in all hospitals received the highest score, respectively, and nutrition services and paid expenses received the lowest points (most dissatisfaction) (P<0.05).
Conclusion: The level of satisfaction of women referring to the infertility clinic in 35.9% of cases was considered to be at an appropriate and exceptional level, in 49.3% of cases it was at a partially appropriate level, and in 14.8% at an inappropriate level.

Investigating the results of breastfeeding counseling in mothers referred to the breastfeeding counseling clinic of the health centers
Zeinab Khazaeeshir , Kobra Mirzakhani, Golnaz Sadat Ahmadinezhad, Fatemeh Sadat Naderi, Nahid Jahani Shoorab ,
Volume 81, Issue 1 (April 2023)
Abstract
Background: The rate of exclusive breastfeeding in Iran at the ages of 3 and 6 months is estimated to be 44% and 27%, respectively, which is still far from the optimal index of the World Health Organization until 2030 (70% in the first six months). In order to monitor breastfeeding counseling centers, which have been set up with the aim of promoting breastfeeding and supporting mothers who have problems with breastfeeding.
Methods: This is a descriptive-retrospective study and all the mothers who were referred to the Health and Treatment Center No. 2 in Mashhad between April 2019 and March 2019 were examined. This health center has two active counseling clinics and the collection of information is based on documents registered in offices and computers. The inclusion criteria for study were not having breast diseases, having an infant child, being able to read and write and living in Mashhad city. The exclusion criteria were also the unwillingness to participate in the study and the newborn suffering from diseases that are incompatible with breastfeeding. Therefore, census sampling was done. The data were analyzed using SPSS 16 software and the significance level was less than 0.05.
Results: In 42.8% of cases, mothers had started feeding combined formula with breast milk before visiting, and in 28.1% of cases, when referring to counseling milk clinics, it was reported that the baby was fed only with formula. After breastfeeding consultations and follow-ups at the end of six months, the rate of exclusive breastfeeding is 34.1% (12% increase compared to the initial reference) and combined formula feeding with breastmilk is 27.8% (a 22% decrease compared to the first visit). And feeding with powdered milk alone was calculated to be 36.5% (an increase of 8.4% compared to the first visit).
Conclusion: The positive role of breastfeeding counseling center in reducing the cases of artificial feeding is clear, and it is recommended to prepare written instructions based on the challenges in breastfeeding for breastfeeding counseling in the first month after delivery.

Evaluations of vascular incasion, perineural invasion and serosal involvement in pathology slides of colorectal cancer
Maryam Motamer, Maryam Kadivar,
Volume 81, Issue 2 (May 2023)
Abstract
Background: Colorectal cancer (CRC) is one important cause of mortality in the world. In the common staging systems of CRC, many biological behaviors of the tumor that determine the prognosis are not defined. Risk stratification is becoming increasingly important in low-stage CRC, because these patients do not undergo adjuvant therapy unless poor prognostic factors such as vascular invasion (VI), perineural invasion (PI) and serosal involvement (SI) are present. Accurate evaluation of these factors in CRC specimens is still challenging.
Methods: In this study, we evaluated the detection rate of VI, PI and SI in 180 patients of CRC who underwent surgical resection based on basic pathology reports, review of hematoxylin and eosin (H&E) slides with considering morphologic clues such as “protruding tongue” and “orphan artery” signs, and elastin stain for detection of VI. In addition, the stage of the disease, pT stage, tumor location, tumor type and grade were categorized, separately. We used the Fisher’s exact test for comparing variables between the two groups. P<0.05 was considered significant. All data analyzed using SPSS version 26.
Results: Overall, the detection rate of VI was significantly increased in review of H&E slides with considering morphologic clues (P=0.019) and also using elastin stain (P<0.05) than basic pathology reports, but no significant differences observed in PI (P=0.118) and SI (P=1.00) between the first basic pathology reports and review of H&E slides. Also, significant differences observed in VI, PI and SI based on AJCC stage, pT stage and grade of tumor (P<0.05).
Conclusion: Considering the prognostic importance of VI detection in the treatment of patients of CRC, Slide review with attention to the morphologic clues such as “protruding tongue” and “orphan artery” signs and elastin staining could be used for better detection of VI in patients of CRC in routine surgical specimens.

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.
 
Comparison of the effect of entonox gas and Sufentanil epidural anesthesia in labor pain on the umbilical cord blood gas analysis and neonatal apgar score
Ali Mazouri, Majid Aklamli, Mahdis Mohammadian Amiri , Pegah Taheri Fard , Danesh Aminpanah , Mahaan Memarian,
Volume 81, Issue 2 (May 2023)
Abstract
Background: Today, the health of mothers and babies is of particular importance in health systems. So far, various interventions have been implemented to improve the health of pregnant mothers. The present study aimed to compare the effect of Entonox gas and Sufentanil epidural anesthesia in labor pain on the umbilical cord blood gas analysis and neonatal Apgar score.
Methods: The present study is a clinical trial on 800 pregnant women It was done in April 2020 to January 2022 at Shahid Akbarabadi Hospital. Mothers were divided into two groups: spinal anesthesia and the group receiving Entonox gas. To measure the effectiveness, Apgar scores were measured at 1 and 5 minutes along with BE, HCO3, and PCO2 parameters. Two independent sample t-tests and ANOVA were used in SPSS version 22 software to analyze the data.
Results: The results of the study showed that the average age of mothers participating in the study was 27 years, and the average Apgar score of 1 and 5 minutes in the group of mothers receiving Entonox gas and spinal anesthesia was 9.9 and 8.6, respectively. Also, the average Apgar score at minutes 1 and 5 in the group of mothers with spinal anesthesia was 9.8 and 8.2, respectively. The results of the analysis and comparison of the parameters obtained from the arterial gases of the umbilical cord of newborns were not significantly different between both groups of mothers. Also, no significant difference was found in Apgar scores between both groups of mothers.
Conclusion: There is no significant difference between the effectiveness of using Entonox gas with spinal analgesia in the painless delivery of mothers; Therefore, considering the cost of each intervention along with their effect may cause a difference in the two interventions. This means that although both of the interventions have the same clinical and diagnostic effects, the one which costs less, will be more preferable from the point of view of the health system.

Comparative study of the effect of neurotec vs gabapentin on sensory symptoms of patients with diabetic neuropathy
Hadi Gharebaghian, Mehri Amiri, Sepideh Seydi,
Volume 81, Issue 3 (June 2023)
Abstract
Background: Diabetes is the most common cause of peripheral neuropathy throughout the world and has negative impact on patient's quality of life. There is no cure and to date several drugs have been used for its symptomatic treatment, including antidepressants and antiepileptics. Neurotec is a herbal medicine (combination of wild star anise, nettle and tansy) that can be potentially effective in the treatment of this disorder. Proposed mechanisms include its effects on increasing nerve conduction velocity and repairing peripheral nerves.
Methods: In a single-blind randomized clinical trial from April to September 2018 in Kermanshah of patients referred to Taleghani Hospital Clinic, 100 diabetic patients with sensory complaints, were randomly divided into two groups. The first group received 100 to 300 mg gabapentin (a well-known effective antiepileptic drug) daily and the second group received 100 mg Neurotec daily. At the beginning of the study and at the weeks of 6 and 12, patients were evaluated with DN4 questionnaire and the visual analog scale (VAS) for severity of sensory symptoms including paresthesia and numbness and the results were compared and analyzed. In each serial visit, possible drug side effects were asked from patients and recorded.
Results: Neurotec reduced the feeling of coldness, pain, paresthesia and numbness VAS and DN4 scores (P of 0.01,0.05, 0.05, 0.05, 0.001, 0.05 respectively). Neurotec showed a significant advantage over gabapentin in reducing pain intensity and in other parameters the difference between the two groups was not significant. The only significant complication of Neurotec was dyspepsia that could be minimal in patients who receive the drug after a meal. Conversely in the gabapentin group, dizziness, drowsiness, and vertigo were significantly more common (P>0.05).
Conclusion: Neurotec can be useful for sensory symptoms of diabetic neuropathy. Its effect on symptomatic therapy is comparable to gabapentin or even better for painful diabetic neuropathies. Its proposed mechanism in neuronal repair needs to be evaluated and can be a potential advantage over symptomatic therapies. Neurotic has no serious side effects.

The effectiveness of tDCS on insomnia and mood of female with insomnia
Tahereh Motevalizadeh, Fatemeh Rezaei, Khosro Sadegh Niat Haghighi , Mohammad Ali Sepahvandi ,
Volume 81, Issue 3 (June 2023)
Abstract
Background: Insomnia is the most common sleep disorder that is associated with cortical hyperexcitability. Potentially transcranial direct current stimulation (tDCS) modifies the cortical state related to insomnia. Therefore, we hypothesized that by using tDCS the intensity of insomnia can be reduced, followed by improvement of the mood symptoms.
Methods: This study was an experimental design with a pre-test and post-test with a control group. The statistical sample included 32 females with chronic insomnia that were randomly divided into an experimental group (active stimulation) and a control group (sham stimulation). Transcranial direct current with an intensity of 2 mA was applied for 30 minutes during 12 sessions (three times in the week) in the active stimulation group. In this protocol, anodal stimulation of left Superior temporal gyrus (STG) and cathodal stimulation of right dorsolateral prefrontal cortex (DLPFC) and left secondary motor cortex (SMA). In the control group, sham stimulation was performed for 30 minutes during 12 sessions (three times in the week). The participants were evaluated before and after of the intervention using the Insomnia Severity Index (ISI) and Positive and Negative Affect Scale (PANAS).
Results: The findings of this research showed that the application of transcranial direct current stimulation was effective in reducing the severity of insomnia and improving positive and negative affect (P<0.001, F=19.87). The value of this effect (eta2) in the severity of insomnia, negative mood and positive mood is 0.64, 0.34 and 0.6 respectively.
Conclusion: The results of the present study showed that the implementation of our designed tDCS protocol for the treatment of insomnia, significantly reduced the intensity of insomnia in women with chronic insomnia and improved their mood symptoms.

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