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Showing 135 results for Type of Study: Review Article
Evaluation of nodule incidence as findings of lung involvement in Covid-19 infection and its comparison in three CT scan centers of Shiraz
Razieh Behzadmehr, Ariana Rasekhi , Banafsheh Zeinali-Rafsanjani , Alireza Rasekhi,
Volume 81, Issue 5 (8-2023)
Abstract
Background: Several typical and atypical findings have been observed in Covid-19 high-resolution computer tomography (HRCT). To our knowledge, there is no study investigating the relationship between the presence of nodules in Covid-19 patients and the patient's condition. Therefore, the present study assessed the frequency of pulmonary nodules in Covid-19 patients according to their condition.
Methods: This cross-sectional study assessed the medical images of the patients referred to three university-affiliated centers (Nemazi, Ali Asghar and Shahid Faghihi Hospital) to perform Covid-19 HRCT from April to September 2020. The centers have been named H1, H2, and H3. Patients who were referred to these centers had good, poor, and fair conditions, respectively. The history of patients was assessed carefully. Patients' demographic information, nodule shape, number, size, location, presence of cavitation, and GGO around the nodule were assessed and recorded.
Results: Overall, 20576 patients (mean age=46.75±16.64 years old) were included in the study. Only 2.1% of cases had solid nodules. Most of them (96.76%) were accompanied by a GGO (halo sign), and only 10.42% were associated with a cavity. The good condition, patients showed significantly more solid nodules (3.46%) than others. In size of the nodules in good-condition patients (1.8 cm) is significantly larger than in fair-condition (1.22 cm) or poor condition patients (1.15 cm). 79.86%, 12.5%, and 7.64% of nodules were multiple, dual/triple, and single, respectively.
Conclusion: The frequency of nodules in the HRCTs of good-condition patients was significantly higher than in fair- or poor-conditionpatients; they also had more multiple and larger-sized nodules. The Pearson-coefficient test also revealed a small negative correlation between the presence of nodules and the patient's condition. It seems the presence of nodules indicates higher immunity to viral infections. In the follow-up, it was revealed that people who had nodules were not hospitalized in the ICU. Further study is needed to prove this point.

Response to treatment of osteoid osteoma after radio frequency ablation and a comparison between drilling and curettage techniques before radio frequency ablation
Alireza Rasekhi, Ali Vatankhah , Saeed Solouki-Mootab , Banafsheh Zeinali-Rafsanjani ,
Volume 81, Issue 5 (8-2023)
Abstract
Background: Osteoid osteoma is a painful benign osteoblastic lesion occurring mainly in the long bones. On the one hand, some studies have declared that post-treatment CT cannot determine the success or failure of radiofrequency ablation, on the other hand, some studies have stated that imaging follow-up can be helpful or even mandatory in some cases. The present study aims to evaluate Osteoid Osteoma's imaging features before or after radiofrequency ablation with or without curettage and during the follow-up period.
Methods: In this retrospective and cross-sectional study, we reviewed twenty seven Osteoid Osteoma patients with radiofrequency ablation who were assessed via drilling with or without curettage from March 2015 to December 2019 at Nemazi Hospital, Shiraz University of Medical Sciences.
Results: Radiofrequency ablation with drilling was used in 22(81.5%) patients, and for the rest 5(18.5%), radiofrequency ablation with curettage and drilling was performed as a treatment procedure. The overall clinical success rate was 92.6%(25/27), with a low complication rate (7.4%). The mean diameter of nidus in pre/pos treatment was 3.46±2.02 and 2.22±1.75 mm, respectively. Femur 12(44.4%) was the most common bone in the patients. Significant differences between pre/post treatment follow up examinations in nidus size (P=0.03), nidus diameter (P=0.02), bone and calcification size (P=0.005) were detected. Additionally, it depicts that the mean values of tumor size and cortical thickening decreased after treatment.
Conclusion: It is noteworthy that the present study had some limitations, including the small sample size and the relatively short follow-up period. There is no significant difference between radiofrequency ablation after drilling and curettage in treating Osteoid Osteoma. It is concluded that although there was a significant difference in pre/post-treatment imaging, there is no need for continuous imaging follow-up in treated patients without clinical complications such as pain to mitigate radiation dose risks and healthcare expenses.

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.

A survey on the effect of recording rates and causes of surgery cancellation on the incidence of rates in candidates for surgery: a brief report
Arash Heroabadi, Mahsa Zargaran , Alireza Khajehnasiri, Reza Atef Yekta ,
Volume 81, Issue 5 (8-2023)
Abstract
Background: Preventing the cancellation of surgeries is an important and devastating challenge in operating room management. Cancellation of pre-scheduled surgeries at the last moment in the operation room leads to increased length of stay, patient dissatisfaction, human resource consumption and financial burden for patients and the health care system. In this study, we have investigated the effect of recording the causes of surgery cancellations in the operation room on the incidence of surgery cancellations in patients who have been candidates for non-emergent surgeries.
Methods: A total of 545 surgeries which had been canceled in different types of surgery between March 2014 and March 2015 were recorded according to the reasons for cancellation in predetermined forms and the information was analyzed. The most common reasons for cancellation included changing the plan of treatment from surgery, a high-risk comorbidity with a high probability of mortality, patient’s refusal from surgery, an unanticipated duration of previous surgery longer than anticipated, the unavailability of an ICU bed in the hospital, requested laboratory data not being ready, failing to prepare requested packed RBCs and other hospital or patient-related problems.
Results: The percentage of surgery cancellations in most groups including orthopedics, urology, cardiac surgery, general surgery, gynecology and maxillofacial surgery, decreased during the course of this study. According to our findings the most relevant cause of non-emergent surgery cancellation was the unpredictable increased duration of previous surgery. The maxillofacial surgery group reached the highest surgery cancellation reduction rate and the cardiovascular surgery group experienced the lowest cancellation reduction rate. Also, the percentage of surgery cancellations in the field of neurosurgery increased during the study period.
Conclusion: Recording the reasons mentioned by the surgical team as the reason for canceling surgeries and reducing the rate of their occurrence during the study and providing appropriate feedback and dialogue in this case had a positive effect on reducing the rate of cancellation of the surgeries and reducing the mentioned reasons.

Considerations of in-vivo breast tissue assessment using raman spectroscopy: a review article
Sadaf Alipour, Zohreh Dehghani-Bidgoli ,
Volume 81, Issue 6 (9-2023)
Abstract
Raman spectroscopy, as an emerging and promising molecular assessment tool, has attracted the attention of researchers, especially for disease diagnosis in human organs such as the breast. Although most of the Raman studies on the breast have dealt with ex-vivo examination of either intact or processed excised tissue specimens, there are some in-vivo studies, including intraoperative tumor margin assessment and a few non-invasive studies. Since the non-invasive or minimally invasive Raman assessment technique is an essential need for translation to clinical approaches, in the present article, the most recent and relevant studies in this regard have been reviewed to find and introduce the most proper Raman spectroscopy system’s specifications for in-vivo assessment of breast tissue.
Scholarly documents, including articles, books, and dissertations related to Raman assessment of breast tissue or in-vivo Raman assessment of other human organs, were perused in search of the most relevant technical details of Raman systems employed so far. On the one hand, the present study has covered Raman instrumentation aspects of diverse types of Raman spectroscopy, different types of laser source and their specifications, optical elements used in the delivery and collection of light to and from the tissue such as lenses and fibers, detectors and even calibration settings. On the other hand, the main Raman features corresponding to different breast pathologies have been studied, speculating their variations in a non-invasive setting. Having studied all, we tried to find the best feasible configuration for a Raman system in terms of the ability to meet the needs of a non-invasive, in vivo clinical examination of the breast. 
In terms of the Raman spectroscopy modality and laser source, SORS/TRS and 785nm laser diode, were selected for in vivo examination of the breast respectively. The pertinent parameters of the spectrograph, detector, and fiber optic probe were introduced as well.
In the present study, detailed specifications of a non-invasive, in vivo Raman apparatus for examination of breast tissue have been studied and specified.

Efficacy of filgrastim and Lenograstim drug treatment in patients with neutropenia: a systematic review
Sogol Shirzad, Zeinab Karimi, Mehdi Mohsen Zadeh , Masoud Mohammadi,
Volume 81, Issue 7 (10-2023)
Abstract
Background: Neutropenia refers to a decrease in the absolute number of neutrophils in the blood circulation, certain drugs are used in connection with the treatment of neutropenia. Therefore, the aim of this study is to investigate and compare the efficacy of filgrastim and lenograstim drug treatment in patients with neutropenia in a systematic review.
Methods: This study is a systematic review study conducted in connection with the comparison of the effectiveness of filgrastim and lenograstim in neutropenic patients based on the search in Google scholar, PubMed, ScienceDirect, Irandoc, SID, Magiran databases in the time range of January 2000 to August 2023. This systematic review was based on the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, including systematic search of databases, organization of documents for review, selection of studies, information extraction and finally presentation of the final report. The keywords used for searching in this study were selected based on published primary studies and MESH, and after a detailed examination of the study questions, they were selected according to the PECO criteria.
Results: 1099 articles were identified in the review of the investigated databases, and after removing duplicate articles, unrelated articles, as well as articles that did not have access to their full text or did not have the required information, eight studies were the final phase, and were checked. Out of the eight selected articles, three articles declared the effectiveness of lenograstim more than filgrastim. Two articles mentioned the greater effect of filgrastim and three articles published in recent years declared the effect of two drugs to be the same. Among these articles, the studies that considered the drug dosage to be the same in the investigated groups and the studies that had a larger statistical population in order to generalize to the society are more important.
Conclusion: According to studies conducted in recent years, both filgrastim and lenograstim recombinant drugs have the same effectiveness in the treatment of neutropenia.

Enhancing bioterrorism defense, leveraging animal models for viral drug and vaccine development: a review article
Hadi Lotfi, Morteza Izadi, Ehsan Lutfi , Hadi Esmaeili Gouvarchin Ghaleh,
Volume 81, Issue 7 (10-2023)
Abstract
Deliberate or threatening use of viruses, bacteria, toxins, or poisonous substances prepared from living organisms to cause death or disease in humans, animals, and plants is called bioterrorism. These agents can be spread by spraying them in the air, causing infection in animals, transferring this infection to humans, or contaminating water and food sources. Defense measures, such as emergency responses to this type of terrorism, are unfamiliar and unknown. The general state of helplessness caused by the lack of complete preparation and the lack of anti-pollution strategies complicates the issue. The ability and widespread interest of civilian personnel to participate in the development of chemical and biological weapons is directly related to easy access to academic excellence around the world. Another factor is the tempting misuse of freely available electronic data and knowledge about the production of antibiotics, vaccines, and conventional weapons with their various complex details. The use of animals in laboratory research to better understand the mechanisms of disease and treatment and to overcome the limitations of clinical trials has a long history. For many viruses, laboratory diagnostic methods and reagents must be continuously modified to account for genetic variations and variants. Unlike bacterial diseases, many of which can be treated with antimicrobial drugs, there are fewer medical countermeasures to combat viral infections. Many of these pathogens are lethal or cause debilitating diseases in humans, making it ethically inappropriate to test the effectiveness of these countermeasures on human volunteers. Researchers must have a correct understanding of various animal models so that they can make the correct choice, gain a better understanding of the clinical symptoms of viral diseases, and provide possible options for treatment and vaccine development. It should be noted that decision-making when faced with a biological attack should be done away from too much fear, and this requires researchers to have prior knowledge of facing these threats. Despite all these checks and measures taken in advance, the international preparedness against these attacks is weak, which can be attributed to the lack of global plans to deal with the epidemic.

An overview of future developments of exosomes in cell-free therapies: a review article
Seyed Khalil Pestehei, Mahdieh Ghiasi, Seyed-Hassan Emami-Razavi ,
Volume 81, Issue 7 (10-2023)
Abstract
Human mesenchymal stromal cells are multipotent cells capable of differentiating into the mesenchymal lineage that can be isolated from bone marrow and adipose tissue or from umbilical cord blood and fetal tissues. Among the widely characterized in vitro properties, MSCs show strong anti-proliferative and anti-inflammatory effects on immune responses Exosomes derived from mesenchymal stem cells derived from different tissues are promising cell-free treatments for tissue damage repair. Exosomes serve as a potential portal for cell-free drug delivery systems, as these drugs possess the properties of the parent cell from which they are derived. Extracellular vesicles (EVs) play key roles in cell biology and may provide new clinical diagnostics and therapies. Exosomes, called extracellular vesicles (EcVs), are present in almost all cells, tissues, and body fluids. They contribute to intercellular signaling and maintain tissue homeostasis. The biogenesis of exosomes starts in the endosomal system. Researchers have identified 9769 proteins, 2838 miRNAs, 3408 and 1116 lipids present in exosome of mRNA cargo. Isolation of exosomes from cells, tissues and body fluids follows a different pattern. Exosomes interact with receptor cells through their surface receptor molecules and ligands and are internalized into receptor cells through micropinocytosis and phagocytosis. This varies depending on the origin of the EV, its physiological and pathological state, and even the exact site of cellular release. The composition of the protein inside can also indicate the presence of disease pathologies such as cancer or inflammatory diseases; However, exosomes also contain a number of common proteins as well as proteins involved in vesicle formation. Advanced technologies in regenerative medicine have caused researchers to use exosomes isolated from mesenchymal stem cells (MSCs) with high regeneration ability in diseases. Exosome cargo plays a key role in diagnosis and treatment by controlling the disease process. Various studies in laboratory conditions have shown the effectiveness and therapeutic potential of exosomes in cancer, neurodegenerative, cardiovascular and orthopedic diseases. This article describes the therapeutic role and potential of exosomes derived from mesenchymal stem cells, as well as the necessary precautions for their processing.

Management of left ventricular thrombus: diagnostic and therapeutic methods: a review article
Maryam Mehrpooya, Zahra Sadeghi,
Volume 81, Issue 8 (11-2023)
Abstract
Left ventricular thrombosis (LVT) is a very serious condition and life-threatening complication that usually occurs after acute occlusion of the left anterior descending (LAD) coronary artery followed by acute myocardial infarction with ST-segment elevation (STEMI), which leads to significant regional wall motion abnormality (RWMA). It should be noted that its diagnosis, treatment, and management are challenging now and depend on various factors such as the type of thrombus, time of percutaneous coronary intervention (PCI), and underlying disease. The preferred diagnostic method is cardiovascular magnetic resonance imaging (CMR), but transthoracic echocardiography (TTE) is routinely used for diagnostic and screening purposes also follow-up of response to treatment. It is worth mentioning that when the diagnosis of left ventricular thrombus is not clear with conventional echocardiography, contrast echocardiography is used for more resolution and detailed information. Left ventricular thrombosis can appear in both acute and chronic forms and lead to significant complications, the most important of them are stroke and systemic arterial embolism (SE). According to previous studies, vitamin K antagonist (warfarin) by keeping INR within the therapeutic range currently used to treat left ventricular thrombosis. Although the use of direct oral anticoagulants (DOAC) has brought excellent outcomes, but due to the lack of large clinical trials, the routine use of these agents is controversial, and only in case of warfarin intolerance or contraindications, DOACs can be used as an alternative. Generally, the best way to prevent left ventricular thrombosis is primary percutaneous coronary angioplasty (primary PCI) which preserves left ventricular function. Depending on the sensitivity of the diagnostic method, thrombus will likely resolve in >50% of patients by six months after the MI. On the other hand, in rare cases, surgery is indicated if a thrombosis remains despite the medical treatment especially if it is accompanied by a left ventricular aneurysm. The purpose of this narrative review is to evaluate the latest evidence in the field of left ventricular thrombosis management and to adopt the best approach for these patients.

Preventable risk factors of hospital readmission in stroke patients: an integrative review
Mohammad Rajabpour, Abbas Heidary , Kavian Ghandehari , Amir Mirhaghi,
Volume 81, Issue 10 (1-2024)
Abstract
Background: Despite advances in medical treatments, readmission of stroke patients remains high and has been reported between 31% and 56.1% during the first year after discharge. The difference between the risk factors of readmission and the risk factors of stroke is not clear. The purpose of this study is: 1) to determine the preventable risk factors associated with stroke readmission and 2) to provide a conceptual model for preventable factors that effective in the readmission of stroke patients.
Methods: This integrated review was performed according to Whittemore and Knafl (2005) method in five stages including problem identification, literature search, data evaluation, data analysis, and presentation. In order to find relevant articles, PubMed, Web of Science, CINAHL, Scopus databases and Google Scholar search engine were searched. The search was conducted using the keywords "stroke," "readmission," "recurrence," "re-hospitalization," "review," and "systematic review," for the period between January 2023 and September 2023, following the PRISMA guidelines. In addition to providing a qualitative synthesis of readmission factors categorized into categories, a conceptual model of these factors was also presented.
Results: Out of a total of 3785 article titles, 38 articles were included in the study for the final analysis after screening and removing duplicates. The most important risk factors for readmission in four categories: (1) knowledge deficit about the comorbidities (such as hypertension, atrial fibrillation, diabetes), (2) unhealthy diet and medicine, (3) high-risk behaviors (smoking, alcohol consumption, and tobacco use disorder), and (4) psychological distress (depression and worry about the future). In addition, the conceptual model showed that the most important preventable factor in readmission of stroke patients is of knowledge deficit about comorbidities (especially hypertension). 
Conclusion: The most important preventable risk factors that are effective in the readmission of stroke patients are knowledge deficit regarding clinical risk factors, especially high blood pressure, high-risk behaviors and unhealthy diet and medicine. Therefore, more detailed care and follow-up programs should be designed for stroke patients after discharge.

The relationship between stroke and physical activity: effects of exercise on prevention and rehabilitation: a review article
Hamid Reza Choobdari , Mohammad Ali Gharaat ,
Volume 81, Issue 10 (1-2024)
Abstract
Stroke is a medical condition in which occluded blood flow to the brain causes cell necrosis. The main types of stroke are ischemic (due to lack of blood flow with much higher prevalence) and hemorrhagic (due to bleeding with low prevalence). Ischemic stroke is caused by the reduction of blood to the brain tissue or complete occlusion of brain vessels by a blood clot following arterial plaques rapture of cerebral arteries due to atherosclerosis, cerebral myocardial infarction and small vascular lesion infarction. Inflammatory reactions, increased oxidative stress, cell death and autophagy are the most aggravating factors in this condition. Instead, hemorrhagic stroke is caused by spontaneous intracranial hemorrhage and subarachnoid hemorrhage, highly common in men. To prevent the possible causes of stroke, investigators attempted to study about the ways that may decrease the risk factors such as trauma, high arterial hypertension, alcohol, low-density lipoprotein and glycerides, tobacco and drugs. Physical activity is a potent inhibitory factor which reported to be effective in prevention of stroke and post-stroke rehabilitation. Aerobic, combined or strenuous activities protect brain tissue by balancing apoptotic and anti-apoptotic pathways, stimulating angiogenesis, reducing oxidative stress, increasing antioxidant activity, optimizing Integrity and preservation of the blood-brain barrier, improving nerve functions and preventing neuronal death. The mechanisms involved in rehabilitation after ischemic stroke with physical activity mostly refer to improved dendrites and synapses, synaptic flexibility, regulation of inotropic receptors with glutamate, increased BDNF, GAP43 and insulin-like growth factor. In patients with cognitive impairments following acute ischemic stroke, high intensity exercise improves processing timing and attention allocation, self-independence, walking ability, aerobic power and reduces memory degradation. Moreover, early start of physical activity after ischemic stroke inhibits the initial physiological response to stroke and prevents optimal recovery. In contrary, reports show positive effects of onset of physical exercise a day after stroke. In hemorrhagic stroke, exercise reduces systolic blood pressure, moderates resting blood pressure via parasympathetic regulations and triggers angiogenesis in the nervous system. Light to moderate or long-term physical training is recommended in comparison to short-term high-intensity training. In addition, early onset of physical activity during recovery after stroke may be beneficial.

Microbiota and probiotics, a new approach in the prevention and treatment of breast cancer: a review article
Saeedeh Keyvani-Ghamsari , Kiana Nouri, Ali Khaleseh Nejad , Shokoufeh Hassani,
Volume 81, Issue 11 (2-2024)
Abstract
Today, despite vast advances in cancer diagnosis and treatment, breast cancer is still the leading cause of cancer-related deaths in women. Various factors such as race, age, family history, mutation in the BRCA1/2 gene, diet, inactivity, alcohol consumption, and estrogen levels have been identified as risk factors for breast cancer. In recent years, microbiota has also been recognized as a new risk factor in breast cancer. In fact, the change in the microbial balance that occurs due to many environmental and internal factors of the body can be effective in the spread of cancer by affecting the intracellular pathways and signals. Studies have shown that intestinal dysbiosis affects the spread of breast cancer by affecting the metabolism and production of estrogen, or mechanisms unrelated to estrogen, such as the production of microbial metabolites that affect the immune system and lead to chronic inflammation. In addition, it has been proven that the breast tissue also has its microbiota, the types of which are different in healthy people, patients, even in different stages of breast cancer, and its subgroups. In such a way that a large amount of Proteobacteria, Firmicutes, Lactobacillus, and Actinobacteria are observed in healthy breasts, while their ratio changes in cancerous tissues. Considering the relationship between microbiota and breast cancer, maintaining a healthy microbiota is a new and significant approach to reducing the risk of developing, spreading, and managing this cancer. In this regard, compounds such as probiotics that can affect the balance of intestinal microbiota are considered as an effective approach to prevent and treat breast cancer. Probiotics can stimulate the growth of beneficial bacteria and inhibit the growth of harmful bacteria by causing physicochemical changes and affecting the metabolism of the intestinal microbiota. Furthermore, the consumption of probiotics can prevent the proliferation of cancer cells and reduce the tumor size by balancing the immune system, reducing inflammation, and inducing apoptosis in the cancer cells. This study describes the importance of microbiota in breast cancer, the difference between microbiota in a healthy person and a sick person, and the role of probiotics in the treatment of breast cancer.

Existential distress in palliative care of cancer patients at the end of life: a systematic review
Hossein Eskandari, Faramarz Sohrabi , Adeleh Rezagholizadeh Shirvan , Mohammad Asgari , Neda Shahvaroughi Farahani ,
Volume 81, Issue 12 (3-2024)
Abstract
Background: The experience of existential distress, along with other forms of distress, is one of the common experiences in end-of-life patients. Therefore, the purpose of this research is to review related studies and conceptualize existential distress in palliative care of cancer patients.
Methods: This study was a systematic review, which was conducted from May 1 to July 31, 1402 at Allameh Tabatabai University and search strategy was written and performed in MEDLINE, Web of Science/PubMed and Scopus databases from the beginning of 2003 to the end of 2022. The inclusion criteria included all quantitative, qualitative, mixed and review studies that focused on the experience of adult patients. Lack of access to the full text of the article and studies in non-English language, clinical trial (randomized and non-randomized), letter to the editor, case report and protocol were excluded from the list of studies. After removing duplicate articles, two research authors reviewed the studies independently according to the inclusion and exclusion criteria, and the differences between them were resolved by discussion.
Results: After searching, screening and selecting articles based on inclusion and exclusion criteria, finally 22 articles were included in the study, of which three were review articles, eight were quantitative and 11 were qualitative. Terminally cancer patients experience existential distress, and the data are significant for estimating the prevalence of these symptoms, especially in the severe category. In addition to examining the prevalence of this symptom, patients have described their experience of existential distress in several categories: Feelings of loneliness and isolation (or loss of support system), relationship concerns (concerns about family, changes in relationships, and conflictual relationships), loss of control/autonomy (physical control, cognitive and emotional control), burden on others, loss of sense of continuity (loss of roles, pleasurable activities and sense of self), uncompleted life tasks, hopelessness/helplessness, dissolving of the future, uncertainty and frightening ambiguity, feeling guilt/ regret about the past, lack of meaning, inevitable thoughts of death.
Conclusion: It seems that the themes raised beyond cultural differences show the universal human suffering, whose accurate conceptualization can help to develop effective therapeutic interventions to reduce existential distress.

Application of bone cements based on ceramic and polymer in orthopedic surgeries: a review article
Naeemeh Kalali, Sogand Mirshah, Mohammad Hossein Ebrahimzadeh , Bibi Fatemeh Kalalinia, Ali Moradi, Azar Gharib, Nafiseh Jirofti ,
Volume 81, Issue 12 (3-2024)
Abstract
For over 50 years, bone cement has been used to strengthen artificial joints like hip, knee, shoulder, and elbow joints. The main purpose of bone cement is to fill the space between the prosthesis and the bone. This absorbs the forces on the joint by creating an elastic area. Besides ensuring the long-term stability of the artificial implant, it also improves the damaged bone. Polymeric bone cement consists of a polymer matrix known as polymethyl methacrylate (PMMA) and a liquid monomer called methyl methacrylate (MMA). When these two components are mixed, a free radical polymerization reaction occurs, leading to the cement's hardening at the place of use. The properties of bone cement, such as mechanical strength, biocompatibility, and handling characteristics, can be adjusted by combining the effective polymerization parameters. However, there are some challenges, such as heat generation during polymerization.
Ceramic bone cement is a composite material of ceramic particles dispersed in a polymer matrix, including calcium phosphate and calcium sulfate. The ceramic particles provide strength and bioactivity, while the polymer matrix enhances the transport properties of the cement. This combination results in a mechanically stable, bone-conductive, and biocompatible cement. Moreover, ceramic bone cement can be engineered to release therapeutic agents, such as antibiotics or growth factors, to prevent infection and foster bone regeneration. Ceramic bone cement is a promising alternative material for bone cement in joint replacement. However, more research and development are required to optimize the properties of bone cement and overcome the challenges associated with its use. With continued advancements in biomaterials, ceramic and polymer bone cement could revolutionize the field of orthopedic surgery and improve patient outcomes. Recent research has focused on developing new bone cement with improved properties like bioactivity, antibacterial activity, and drug delivery capabilities. These developments aim to enhance the performance of bone cement and remove the current limitations in orthopedic applications. In this review study, we will focus on the types of bone cement, their mechanical, biological, and structural properties, and how to optimize them.

Challenges and solutions of integration in the health service delivery: a scoping review
Aida Asghari, Abbas Vosoogh Moghaddam , Ali Mohammad Mosadeghrad , Ebrahim Jaafaripooyan,
Volume 82, Issue 2 (5-2024)
Abstract
Background: Communication and cooperation among health care organizations have become nowadays crucial for improving the quality and equity in providing health services, and integration has been expressed as a solution by the World Health Organization. The purpose of this review was to identify the challenges and solutions of integration in health services.
Methods: This research was carried out from September 2023 to April 2024. All articles on the challenges and solutions of integration in health, using scoping review, were identified and used in the PubMed, Scopus, Web of Science and Google Scholar search engines in the period from 2000 to 2024. The total number of English articles found was 4996, of which 662 were removed due to repetition. Among the remaining 4334 articles, 4249 articles whose titles and abstracts were not related to the research topic were removed, left a total of 85 articles, and after reviewing the full text of the articles, 27 articles entered the data extraction phase, which were finally analyzed using the framework analysis method.
Results: Finally, 27 articles were selected from which, 46 challenges and 26 solutions were extracted as to the integration in health services and categorized based on the framework of WHO six building blocks in five areas of governance and leadership, financing, human resources, information system and service delivery. The most important challenges of integration include; weakness in planning, imbalance of power between organizations, differences in geographical and spatial boundaries of organizations, weakness in maintaining data security, workforce resistance and the lack of laws and regulations, needs assessment from patients, related knowledge, financial resources, suitable payment models, integrated communication and information systems and interoperability between technologies. 
Conclusion: Integration of health service endures a series of challenges such mainly as the lack of rules and regulations for collaborative processes and resistance from providers and employees requiring innovative solutions. Addressing issues such as stakeholder power-benefit analysis, interoperability and data sharing among the providers could be essential for successful integration.

The effect of laughter therapy on promoting the health of women with breast cancer: a systematic review
Shohre Behrouz, Alireza Ebrahimi , Ehsanmoosa Farkhani,
Volume 82, Issue 2 (5-2024)
Abstract
Background: Breast cancer is one of the most important cancers in women. Considering the importance of design for improving physical and mental health, quality of life of vulnerable women, the present study aims to design of humor and laughter programs in women with breast cancer and its effects in promoting their health.
Methods: In this systematic review, in order to access relevant articles used from Persian and English databases SID, Magiran, Cochrane Library, MEDLINE/PubMed, Scopus and Science direct, and the key words "Humor therapy", "Laughter therapy", "Breast Cancer", "Wit and Humor as Topic" and "Breast Neoplasms" using logical operators (AND, OR, NOT) were used. All articles were evaluated between January 2008 and January 2023. To assess the quality of the articles, the "Jadad" scale was used.
Results: Among the 975 articles in the initial search, 525 articles are due to the repetition of the title and 442 articles due to other reasons such as not assigning humor therapy in breast cancer, not implementing the joke and laughter intervention program, the language of the article not being related to English or Farsi, and not Conducting clinical trials were excluded, and finally eight articles that scored higher than 3 were included in the systematic review. The results of the studies showed that laughter therapy had an effective role in improving the quality of life, improving various aspects of mental health, reducing negative emotions such as anxiety, stress, depression, pain intensity, fatigue and strengthening positive emotions such as self-esteem, mood. while There has been a non-significant decrease in the dermatitis caused by radiotherapy and the activity of immune cells and the serum level of cortisol.
Conclusion: Considering the positive effect of laughter therapy in reducing the negative emotions of patients, it is recommended that nursing managers and psychologists use this easy, fun, uncomplicated and accessible intervention to improve the physical, mental and emotional health of women with breast cancer.

Primary pyogenic spinal infection: a review article
Seyed Hasan Emami Razavi , Mohammadreza Salehi, Hooshang Saberi , Mohammad Zarei, Babak Mirzashahi, Pegah Afarinesh, Sepideh Khodaparast,
Volume 82, Issue 3 (6-2024)
Abstract
Primary pyogenic spinal infection, also known as spondylodiscitis or vertebral osteomyelitis, is a serious and potentially debilitating condition involving a bacterial or fungal infection of the intervertebral disc space and adjacent vertebral bodies. While relatively uncommon, with an estimated incidence of 2.4 per 100,000 population per year, it is a medical emergency that requires prompt diagnosis and treatment to prevent permanent spinal damage and neurological complications. The most common causative organisms are Staphylococcus aureus, which accounts for up to 50% of cases, followed by Gram-negative bacteria such as Escherichia coli, and mycobacterial infections like Mycobacterium tuberculosis. Risk factors for developing primary pyogenic spinal infection include intravenous drug use, a weakened immune system, recent spinal surgery or instrumentation, and contiguous spread from an infection elsewhere in the body, such as a urinary tract infection or endocarditis. Patients typically present with severe, localized back pain, fever, and general malaise, which can easily be mistaken for more common spinal conditions. Prompt diagnosis is critical and involves a thorough medical history, physical examination, laboratory testing, and advanced imaging studies such as magnetic resonance imaging (MRI). Blood cultures and, in some cases, image-guided biopsy may be necessary to identify the causative organism and guide appropriate antimicrobial therapy. The mainstay of treatment is the prompt initiation of targeted antibiotic or antifungal therapy, often requiring intravenous administration for several weeks. Surgical intervention may be necessary in some cases, such as to drain an abscess or provide spinal stabilization. A multidisciplinary approach involving infectious disease specialists, spine surgeons, and rehabilitation providers is essential for optimal management and outcomes. Despite advances in diagnosis and treatment, primary pyogenic spinal infection remains a challenging condition. Delays in diagnosis and treatment can lead to devastating complications, including permanent spinal deformity, paralysis, and even death. With timely and appropriate management, however, most patients are able to achieve a good clinical outcome, though some may experience residual pain or neurological deficits.

Assessment of studies on the use of platelet-rich plasma in shoulder tendinopathy: a review article
Nima Bagheri, Mahdieh Ghiasi, Khalil Pestehei,
Volume 82, Issue 4 (7-2024)
Abstract
Tendon ruptures may occur as a result of acute injuries or degenerative changes in the tendons caused by aging, excessive and long-term use of the shoulders, and sudden wear and tear. This tear may be partial or completely separate the tendon from its attachment to the bone. Rotator cuff tendinopathy of the shoulder is one of the common causes in patients that affect the daily performance and quality of life. Tendinopathy problems are one of the most common problems of people who refer to medical centers, and in some people, improvement is very important because of their job position. Platelet-rich plasma has received attention due to having growth factors involved in tissue repair in tendinopathy patients. This review study examined the clinical effect of platelet-rich plasma injection in rotator cuff tendinopathy, as well as other studies comparing it with corticosteroids. A literature search was conducted in various scientific databases to obtain articles up to 2022 examining the clinical effects of PRP injection on tendinopathy. Platelet-rich plasma (PRP) is one of the products derived from blood that contains a greater number of physiological platelets. PRP contains a large amount of growth factors such as TGF-β, platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF) and epidermal growth factor (EGF), which play an important role in cell proliferation, cell differentiation, chemotaxis and angiogenesis. These growth factors are significantly upregulated following tendon injury and are active at different stages of the healing process. Platelet-rich plasma is an autologous source of growth factors and has been shown to be beneficial in the treatment of tendinopathy and osteoarthritis. PRP injection can be recommended as a suitable and desirable method in tendinopathy and rotator cuff tear patients, especially in adults, and can be substituted for corticosteroids. PRP is a minimally invasive treatment method that is used to treat muscle diseases and tendon injuries. In this method, blood is taken from the person, and after that, the components of the blood are separated during a process, and the platelet-enriched plasma is re-injected into the muscles and tendons of the shoulder.

Impact of viral oncoproteins on human genome methylation: a review article
Farzane Hayati, Esma’il Akade, Negar Dinarvand, Gholam Abbas Kaydani , Shahram Jalilian,
Volume 82, Issue 6 (9-2024)
Abstract
Epstein-Barr virus (EBV), human herpesvirus 8 (HHV-8), hepatitis B virus (HBV), human papilloma virus (HPV), Merkel cell polyomavirus (MCPyV), human lymphotropic virus type 1 (HTLV-1) and Hepatitis C virus (HCV) are among the most important viruses that cause cancer in humans. These viruses are collectively known as oncoviruses due to their potential to induce malignant transformations in host cells. Oncoviruses exert their cancer-causing effects by utilizing various viral oncoproteins and non-coding RNAs, which can drive host cells toward malignancy through multiple pathways. One critical strategy these viruses employ involves altering the host cell's regulatory mechanisms, particularly by influencing DNA methylation processes.
DNA methylation is a crucial modification that occurs on the promoter regions of genes, effectively reducing their expression levels. Under normal cellular conditions, a delicate balance of methylation and demethylation is maintained by a specific set of enzymes. Key players in this process include DNA methyltransferases (DNMTs) and TET methylcytosine dioxygenases (TETs), which are pivotal in regulating gene expression through methylation. These enzymes are prime targets for oncoviruses because, by altering their activity, viruses can hijack the host cell's regulatory machinery. Viral oncoproteins, though diverse in structure and function, often converge on disrupting the expression of these enzymes. By doing so, they induce widespread changes in DNA methylation patterns, effectively reprogramming the gene expression landscape of the host cell. This reprogramming is not random; rather, it is a calculated mechanism through which oncoviruses can manipulate the cell cycle, promoting uncontrolled cellular proliferation and progression towards cancer. By suppressing or activating specific genes, these viruses can push cells past normal checkpoints, eventually leading to tumor formation. Despite the critical role of DNA methylation in cancer development, the precise mechanisms by which oncoviruses modulate these methylation processes are not fully understood. Researchers have made significant progress in exploring the connection between viral infections and cancer, but many of the detailed pathways through which oncoviruses control methylation remain to be elucidated. As a result, this area remains a fertile ground for further research, offering potential avenues for therapeutic intervention in virus-induced cancers.

An overview of the types of neural networks used in the examination of panoramic radiographic images: a narrative review
Mahdieh Soltani , Seyyede Zohreh Seyyedsalehi, Reyhane Mahdavi,
Volume 82, Issue 9 (12-2024)
Abstract
With the rapid expansion of artificial intelligence across clinical disciplines, a variety of artificial neural networks (ANNs) have become indispensable tools for endowing computer systems with advanced analytical power. Dentistry, as an information‑rich branch of medicine, routinely generates and must interpret large, complex datasets from imaging and diagnostic records. Consequently, researchers have increasingly directed their attention toward intelligent, automated techniques for analyzing dental data. This study therefore surveys and synthesizes the methods that have been applied to the intelligent and automated analysis of such data, highlighting the prevailing trends in current literature.The majority of the examined investigations relied on panoramic radiographic images of the teeth orthopantomograms (OPG) as their primary source material. Three overarching technical objectives repeatedly emerged: first, tooth diagnosis, meaning the reliable separation and identification of each individual tooth from its neighbors; second, sample segmentation, that is, the piece‑by‑piece analysis of visual information within the image; and third, semantic segmentation, namely, the contextual interpretation of information extracted from the radiograph. Depending upon which of these objectives was pursued, researchers selected different neural‑network architectures and configurations. Across the reviewed corpus, input images were typically subjected to preprocessing steps such as normalization, noise reduction, and contrast enhancement before being supplied to a neural network for training, thereby preparing the data for subsequent machine interpretation. In several instances, the raw output produced by the neural network underwent additional post‑processing, a stage designed to refine the preliminary results and enhance overall accuracy. The comparative analysis presented here concentrates on how effectively the various neural‑network models fulfilled the three technical objectives described above. The surveyed articles reveal two dominant analytical approaches. In the intelligent problem‑solving paradigm, convolutional neural networks (CNNs) overwhelmingly predominate. Conversely, in the automated paradigm, investigators favor classical, non‑learning algorithmic techniques. Work employing ANNs consistently emphasizes image comprehension, segmentation, feature extraction, feature classification, network modeling, and careful variable tuning to promote effective learning that aligns with each study’s stated objectives.

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