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Spontaneous rupture of splenic artery aneurysm in a pregnant woman: a case report
Mansoureh Baradaran, Mohammd Ashraf Azimi , Rasoul Nikdel, Seyed Hassan Seyed Sharifi ,
Volume 81, Issue 6 (September 2023)
Abstract
Background: Splenic artery aneurysm is seen in less than 0.1% of the population. Aneurysm of the splenic artery is more common in pregnant women. One of the life-threatening complications of splenic artery aneurysm is the spontaneous rupture of the aneurysm, which causes hemorrhagic shock. This complication is more common in pregnant women than other people in the society and has more mortality and morbidity. In this study, a pregnant patient with spontaneous rupture of splenic artery aneurysm is reported.
Case Presentation: The patient is an 18-year-old woman, 20 weeks pregnant, who came to the Emergency department of Bentolhoda Hospital in Bojnurd with diffuse  sudden onset of abdominal pain in the September of 2023. On examination, the patient's vital signs were unstable, which was due to the presence of hemorrhagic shock. In the examination of the patient's abdomen, or generalized tenderness and rebound tenderness? was evident, suggesting peritonitis. According to the ultrasound report, abundant free fluid and fluid containing blood was drained from the abdomen under ultrasound guidance. The patient underwent surgery with the diagnosis of hemorrhagic shock with a midline incision of the abdomen above and below the umbilicus. In the performed surgery, evidence of splenic artery aneurysm rupture was evident. For the patient, ligature and resection of splenic vessels (artery and vein) and splenectomy were performed. After surgery and stabilization of the patient's condition, fetal health ultrasound was performed, and the fetus had no heartbeat. Therefore, medical induction of abortion was performed, and after 48 hours, the fetus was completely expelled, and then mother was transferred to the ward. And four days after the surgery, she was discharged with general improvement. No remarkable adverse effects were observed after surgery.
Conclusion: One of the rare diseases is splenic artery aneurysm, which is difficult to diagnose due to its asymptomatic rupture and high mortality rate.

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 (October 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.

Comparison of the results of different types of vascular repair methods in penetrating trauma of the forearm
Shima Kashani, Seyed Masoud Moosavi , Iraj Nazari , Hossein Minaei,
Volume 81, Issue 7 (October 2023)
Abstract
Background: Vascular traumas are among the important traumas, most of which lead to significant complications due to the lack of correct and timely diagnosis, considering the frequency of penetrating vascular injuries, especially in our country and Khuzestan province, as well as the complications and mortality caused by injuries. This study was designed to investigate the effect of vascular surgery intervention on patients with arterial injury of forearm trauma.
Methods: In this descriptive-analytical study, all trauma patients suspected of penetrating forearm arterial injuries in terms of age, sex, type of trauma, location of trauma, type of intervention, location of arterial repair, angiographic and clinical findings including damaged arteries, type of injury Arterial fracture or dislocation. The proximity of vascular damage and the complications of surgical interventions are investigated.
Results: The results of this study showed that among the penetrating trauma patients requiring surgical intervention, 90.4% were men and only 6.9% were women. The average age of the patients was 32 years. The most frequent trauma requiring surgical intervention in this study was primary repair of a stab wound in the ulnar artery and the least was due to explosive. According to the obtained results, there was a statistically significant relationship between the amount of bleeding, the days of hospitalization and the duration of the operation with the type of trauma. The most damaged artery was ulnar artery 7.50% and the most type of arterial damage was arterial cut with active bleeding (7.39%).
Conclusion: According to the results of the present study, the most damage was in the ulnar artery caused by trauma with sharp objects (knives). The incidence of complications in primary repair surgery was higher than other types of surgical interventions, and there was a statistically significant relationship between the amount of bleeding, days of hospitalization, and duration of surgery with the type of trauma.

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

Determining the impact of stoic resilience training on operating room staff
Elmira Hajizade, Hossein Karimi Moonaghi , Jamshid Jamali, Haniye Mastour ,
Volume 81, Issue 10 (January 2024)
Abstract
Background: In health care, the well-being and flexibility of the operating room staff are of great importance due to the hard and stressful nature of their work. Therefore, this study was conducted to determine the effect of Stoic resilience training on the resilience of operating room staff.
Methods: The present study was a semi-experimental pre-test-post-test intervention study with a control group. A study was conducted among 67 people operating room staff working in Imam Ali and Imam Hassan hospitals in Bojnord city in September 2023 In this research, the demographic check list and the Connor and Davidson standard resilience questionnaire were used to collect information. The educational intervention was also implemented using the “SeRenE” Stoic education package. This training package includes 4 exercises, which were used only 3 exercises per day and for 6 consecutive days (45 minutes per day) due to the resilience variable. Statistical analysis was done using SPSS version 24 and at a significance level of 0.05.
Results: Based on the results, the total resilience score increased after the Stoic training (72.03±8.31) and showed a statistically significant difference with the control group (65.03±11.16) (P>0.05). The results showed that after Stoic training, mean of subscales of competence, trust in one’s instincts, tolerance of negative affect, positive acceptance of change and secure relationships, control as well as the total score of resilience increased in the training group. Although the mean score of spiritual influences dimension increased after the training, this increase was not statistically significant (P=0.097).
Conclusion: The findings show that Stoic training had a positive effect on various aspects of resilience among operating room staff, whose effects are more obvious in some subscales such as trusting individual instincts, tolerance of negative emotions, and positive acceptance of change. In general, the results showed that people's resilience increased after Stoic training. It is recommended to include Stoic training programs in the training of health personnel and caregivers.

Investigation of epidemiological and histopathological features of central nervous system tumors in the samples referred to the pathology department of a referral hospital in the east of iran in a 10-year period
Yasser Hasanzadeh, Zahra Sagheb Movafagh , Atena Sahrabeygi , Hamid Heidarian Miri , Masoumeh Gharib ,
Volume 81, Issue 10 (January 2024)
Abstract
Background: Identifying the epidemiological aspects of central nervous system (CNS) tumors is the first step in implementing management protocols to control the condition of these tumors. We aimed to examine the epidemiology and histopathology of both benign and malignant tumors of the CNS in one of the referral and university centers in the east of Iran.
Methods: This cross-sectional study was conducted on all files of patients admitted to Qaem Hospital in Mashhad City, Iran, in a period of 10 years from March 2009 to February 2018 with a definitive diagnosis of benign or malignant tumors of the CNS, including tumors of the brain, cerebellum, spinal cord, or meningeal membranes. Information sources included the patients' physical files and the hospital information system (HIS). The statistical software SPSS version 28.0 for Windows (IBM SPSS, Armonk, New York, USA) was used for the statistical analysis.
Results: In total, 775 patients with benign and 771 patients with malignant CNS tumors were included in the study. Regarding epidemiological aspects of benign tumors, the incidence rate of women was almost twice that of men (68.47% versus 31.53%), with an overall average age of 45.31±19.81 years. The most common benign tumors were meningioma (72.77%), followed by schwannoma (13.67%). Regarding malignant brain tumors, the mean age of affected patients was 36.64±19.67 years, with males accounting for 53.04% of cases and females for 46.96%. The most frequent type of tumor was glioblastoma (32.68%), followed by diffuse astrocytoma (16.47%). Both benign and malignant CNS tumors were associated with significant hospital mortality; in-hospital mortality rates for benign and malignant tumors were 10.1% and 17.5%, respectively. Tumor type and its grade were the main determinants of early death in malignant CNS tumors.
Conclusion: The epidemiological characteristics of benign and malignant tumors in our study community were similar to the reports presented in other communities. Knowledge of these characteristics provides the possibility of managing patients and reducing morbidity and mortality related to these tumors.

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 (February 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.

Comparison of Liver stiffness Prevalence in Diabetics and Prediabetics
Elena Lak , Eskandar Hajiani, Jalal Sayyah , Zeynab Hosseinpour , Alireza Sedaghat,
Volume 81, Issue 11 (February 2024)
Abstract
Background: Diabetes is known to be linked with a high risk of liver stiffness in non-alcoholic fatty liver patients. Previous studies have faced challenges in examining the association between prediabetes and liver stiffness. This study aimed to compare liver fibrosis in diabetes and prediabetes patients.
Methods: This cross-sectional descriptive study was conducted on patients with diabetes and prediabetes who were referred to Imam Khomeini Hospital in Ahvaz from March 2022 to March 2023. The study aimed to clear the relationship between liver stiffness and age, gender, BMI, AST, ALT, ALKP, Bilirubin, and the type of treatment. The normality of quantitative variables was checked using the Kolmogorov-Smirnov test. The chi-square test examined two qualitative variables with more than two levels.
Results: Out of the total participants, 53 people (63.9%) had diabetes, while 30 people (36.1%) had prediabetes. There was a significant difference between the mean severity of liver fibrosis in diabetic and pre-diabetic patients (P=0.014). The frequency of liver stiffness in all levels except in the group with mild or no fibrosis (F0-F1) was higher in diabetic than pre-diabetic patients. In both diabetes and prediabetes groups, there was no significant relationship between gender, age, BMI, ALT, and ALKP with liver fibrosis. However, there was a significant direct relationship between HbA1C% and liver fibrosis (P≥0.003) in both groups. In diabetic patients, a significant relationship between FBS and liver fibrosis was observed (P=0.001). In pre-diabetic patients, significant direct relationship was seen between the severity of liver fibrosis and AST levels (P=0.026).
Conclusion: Diabetic patients showed a higher severity of liver fibrosis compared to pre-diabetic patients. No statistically significant relationship was seen between liver fibrosis and age, sex, body mass index, ALT, and ALKP in both groups. Additionally, both diabetes and prediabetes groups showed significant relationship between liver fibrosis and HbA1C (P≥0.003). Prediabetes was also found to be associated with an elevated risk of liver fibrosis.

Evaluation of obstacles to receive tissue plasminogen activator in patients with acute ischemic stroke in Imam Khomeini Hospital of Urmia
Hamidreza Mehryar, Payman Atabaki, Abass Riyahi, Mohammad Reza Amiri Nikpour,
Volume 81, Issue 11 (February 2024)
Abstract
Background: The emergence of thrombolytic drugs has opened new horizons in the treatment of patients with acute ischemic stroke, and this study was conducted with the aim of evaluating the barriers of receiving tissue plasminogen activator in patients with acute ischemic stroke in Imam Khomeini Hospital of Urmia.
Methods: This descriptive-analytical, cross-sectional study was conducted from April 21, 2015 to March 19, 2016 on patients with acute ischemic stroke referred to the emergency department of Imam Khomeini Hospital in Urmia using census sampling method. To collect data, a checklist containing demographic information was used. After collecting the data, it was entered into SPSS 18 and analyzed with the help of descriptive statistics.
Results: In this study, the results showed that out of 100 patients, most of the participants were male (58%)58 and the rest were female, and the average age was 63.71±17.3 years, and 86% were in the age range of 18-80 years, which was the appropriate age to receive or thrombolytics. and the rest were over 80 years old. The fastest visit time was 25 minutes and the latest was 10080 minutes (168 hours). Among these 40 people, only four people (40%) were in the golden time period of thrombolytic drug, i.e. Three hours from the onset of symptoms to the final evaluation. Among the four people who were placed in the golden time, in 50% of the cases there was a history of taking anticoagulants, in 25% a history of head injury, in 50% of the blood sugar less than 50 and finally 1 person (25% of the people placed in the golden time) that is, 1% of all patients were eligible to receive rtPA. About 24% of patients had NIHSS<4 and 2% had NIHSS>25, and the average number obtained was 10.
Conclusion: The most important obstacle in the timely initiation of thrombolytic therapy is the delay in visiting the emergency room. Therefore, public education in order to improve the level of general awareness of the society can be effective in reducing this time delay.

A guide for conducting exploratory factor analysis in medical science research using SPSS: a brief report
Jafar Hassanzadeh, Haleh Ghaem Maralani , Fatemeh Jafari , Aboubakr Jafarnezhad,
Volume 81, Issue 11 (February 2024)
Abstract
Background: It is necessary to examine different dimensions of psychometrics in different sciences, and paying attention to the accuracy and precision of the results can lead to the construction of reliable and valid tools; In this article, exploratory factor analysis has been done using SPSS software, version 26.
Methods: This research was a brief report that was conducted between 30 January 2023 to 10 October 2023. Reliability means reproducibility and continuity of results in the same conditions, and validity means matching the test with the purpose for which it was designed. Validity includes face, content, criterion and construct validity. To determine construct validity, various methods are used including: convergent validity, divergent validity, internal consistency and factor analysis. Factor analysis is a method that aims to simplify a complex set of data and allows researchers to find a specific pattern among many variables and complex relationships between them which includes exploratory factor analysis and confirmatory factor analysis. Exploratory factor analysis is a statistical technique that is used to estimate hidden factors or variables and reduce the large number of variables.
Results: exploratory factor analysis is a statistical method that is used by reducing the number of variables and exploring the underlying structure of a large set of variables with the aim of discovering factors or hidden variables, and its basic assumption is that any variable may be related to any factor. It tries to use factor loadings to discover the factorial structure of the data and by identifying the basic structures, grouping the factors by considering the common meaning of the variables.
Conclusion: Reliability means repeatability and validity of the degree of accuracy of the results which are measured through different methods. Exploratory factor analysis uses construct validity measurement methods to simplify the data and provide more reliable and valid tools, so it is very important to pay attention to the accurate and correct measurement of the results in the validation of health system tools.

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 (March 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.

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 (March 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.

The effect of high-intensity interval training on cardiac mitochondria PGC1α and some oxidative stress indices in mice with liver damage
Maryam Mokhtari, Seyyed Reza Attarzadeh Hosseini, Nahid Bijeh, Mohammad Mosaferi Ziaaldini ,
Volume 81, Issue 12 (March 2024)
Abstract
Background: Fatty liver disease is the most common cause of chronic liver diseases in the world, which can cause cardiovascular diseases, so this research aims to scrutiny a period of intense intermittent sports activity and growth hormone perfuse on cardiac mitochondrial PGC1α and some indicators of oxidative stress in mice with liver damage.
Methods: The present research was conducted from September 2022 to March 2023 in the specialized physical training laboratory of Ferdowsi University of Mashhad. The statistical population was twenty one adult male Syrian mice with an average weight of twenty three grams. The sports activity protocol was adopted for fifty-six days using the special video recorder for rodents. The intense interval training program was carried out in the form of ten one-minute repetitions and two-minute active rest, so that the total daily training time for each person was thirty minutes.The vaccination protocol includes the daily vaccination of somatropin injected intraperitoneally.
Results: The PGC1α levels were significantly higher in both the HIIT (P=0.02) and H- GH (P=0.03) groups collationed to the witness team. Moreover, the levels of SOD were considerably increased, in both the HIIT (P=0.05) and H-GH (P=0.005) team s compared to the witness team. Moreover, the levels of MDA were considerably decreased, in both the HIIT (P=0.007) and H-GH (P=0.04) teams compared to the witness team. The decrease in insulin resistance was significant only in the HIIT (P=0.05) team compared to the witness team and slightly increased in the H-GH (P=0.36) team but was not considered. The difference between HIIT and H-GH team (P=0.03) was also significant.The proportion of ALT/AST in both HIIT (P=0.02) and H-GH (P=0.03) teams had a significant decrease compared to the witness team. LDL/HDL proportion evidenced considered decrement at just in the HIIT team (P=0.01).
Conclusion: Intense intermittent sports activity was able to produce a more optimal response compared to GH peptide in improving NAFLD-related indices. Injection of this hormone single may have adverse outcomes on some indexes of this abnormality.

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

Strategies for prevention, diagnosis and treatment of Post Covid-19 Fungal Infections in Immunocompromised Patients: A systematic review
Abdolahad Nabiolahi , Najmeh Khammari, Nasser Keikha,
Volume 82, Issue 1 (April 2024)
Abstract
Background: Nowadays, understanding healthy treatment strategies is crucial in the post-COVID era where immunocompromised patients are more likely to get exposure to fungal infections. The aim of the research was to investigate studies of fungal infections after COVID-19.
Methods: The systematic review study was conducted from 11 July 2023 to 04 February 2024 in Zahedan, Iran. To extract articles on fungal infections, the vocabulary of selected Medical Subjects Headings (Mesh), other specialized literature was determined and a search strategy was formulated in three databases, Web Science, Scopus, and PubMed, without any time limitation. In addition, the articles were analyzed according to the research objectives, types of fungal infections encountered in immunocompromised patients, their incidence in different immunocompromised patient groups, diagnostic and detection strategies, treatment methods and other background information.
Results: A 15 number of related articles were included. The most common type of study was case report. From the lens of Aspergillus and mucormycosis fungal infections, they were given more attention, and in terms of the type of immunodeficiency, patients with a history of diabetes, including groups of diabetic patients, cancer groups, AIDS patients, and some groups with genetic disorders, were investigated in the studies. Appropriate treatment methods; particularly the use of corticosteroid drugs such as methylprednisolone as intravenous injection, systemic antifungal drugs such as liposomal amphotericin B, Antifungal treatment using high-dose amphotericin B, the use of prophylactic drugs, and isolation of the damaged tissue are recommended as the best treatment strategies. In order to prevent fungal infections in groups of Immunocompromised Patients, it is recommended to use simple hygiene Recommendations.
Conclusion: Analyzing the conditions of cocvid-19 patients and recognizing effective treatment strategies is inevitable, especially in the post- COVID era. A review of the literature showed that prevention and control of fungal infections after covid-19 was critical among immunodeficiency patients and the use of the recommended treatment method for their lifecycle continuity should be more considered by health care providers, health system managers and health policy makers.

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

Effects of EN12791-based surgical scrub with tgsept al plus on normal flora of hands among operating room staff in Hazrat Fatemeh Hospital of Tehran
Vahid Malekzadeh, Shadi Sheikhizadeh , Mohadeseh Taklo, Hossein Jamalifar, Younes Ghaseminezhad Koshali , Hassan Khorramian, Hossein Naseri ,
Volume 82, Issue 2 (May 2024)
Abstract
Background: Considering the emergence of new diseases, increased prevalence of nosocomial infections, and microbial resistance in recent years, it is necessary to disinfect the hands with a suitable hand sanitizer, as instructed by the Center for Disease Control (CDC). This is because hand hygiene is the most important way to control infections. Surgical hand antisepsis protocols emphasize the importance of both mechanical cleaning and antimicrobial action to effectively eliminate microbial contamination. Recommendations from organizations such as the Association of Perioperative Registered Nurses (AORN), the World Health Organization (WHO), and the Association for Professionals in Infection Control and Epidemiology (APIC) underscore this principle. While routine handwashing removes visible debris and transient microbes, surgical hand antisepsis requires additional steps and the use of antimicrobial agents. This may involve a surgical scrub with an antimicrobial soap or the application of an alcohol-based hand rub (ABHR). The latter approach has demonstrated greater efficacy in reducing microbial contamination compared to soap and water alone. Since a few compressive studies in Iran have dealt with global standards for disinfectants, this study investigated the effects of surgical scrub based on the European standards with TGSept AL Plus, produced by the research team of Tajhiz Gostar Sharif , on normal flora of hands in a group of the operating room medical staff in Hazrat Fatemeh Plastic Surgery and Repair Hospital of Tehran, in 2023.
Methods: This study evaluated the short-term durability and effectiveness of this solution according to the EN12791 standard on microorganisms and microbial contamination reduction. To this end, 30 members of the surgical team were randomly selected. The bacterial sampling was performed three times: after washing the hands with common detergents, after hand scrubbing with the studied disinfectant (about 90 seconds), and three hours after surgery. The samples were immediately transferred to a laboratory for swap culture and pour plate test.
Results: Then bacterial colonies were counted, contamination reduction was measured, and the shelf life of the solution was determined according to the standards.  Results showed that a 60-to-90-second scrub with an alcohol-based disinfectant is the best way to reduce hand contamination and, thereby, nosocomial infections.
Conclusion: Based on the study findings, alcohol-based solutions can be recommended for surgical scrubs, according to WHO guidelines.

Factors affecting the interest of specialized assistants to continue studying in subspecialized fields: a brief report
Ghazal Mansouri, Fatemeh Nouri Koohbanani , Fatemeh Karami Robati , Robabe Hosseinisadat,
Volume 82, Issue 2 (May 2024)
Abstract
Background: Choosing a specialty in medicine is an important decision for the individual. It is also important decision for the health system. This study aimed to investigate the factors affecting the interest of specialized assistants to continue studying in subspecialized fields.
Methods: This descriptive cross-sectional study investigated the factors affecting the interest of 261 specialized assistants to continue their studies in subspecialized fields from March 2021 to March 2022. All the specialized assistants of Kerman University of Medical Sciences (KMU), whose assistantship continued until the end of March 2022, were included in the study by census method. The data collection tool was a 4-part questionnaire. 1) demographic information including 13 questions (age, gender, marital status, city where the family lives, place of residence to complete the residency course, specialized field, level of education, grade point average, parents' education, parents' occupation and having first-degree relatives with subspecialized degrees), 2) the willingness or unwillingness to continue studying in subspecialized fields and the field of interest, 3) the reasons for the assistants' interest in continuing their education, included 14 questions, and 4) the reasons for the assistants' lack of interest in continuing their education, included 14 questions.
Results: The average age of the assistants was 31.53±3.90 years old. Most of the assistants were women (57.9%). 57.5 percent of the assistants were interested in continuing their studies in subspecialized fields. The most important reason for residents' interest in continuing their studies was "increasing practical-clinical knowledge" (80.1%). The most interest in continuing education was observed in internal assistants (17.33%). The assistant's age, specialist field and having first-degree relatives with a subspecialist degree had a significant relationship with the interest of the assistants to continue studying in subspecialist fields.
Conclusion: The results showed that a significant percentage of assistants were interested in continuing their studies in subspecialized fields. Age, the assistant's specialty and having first-degree relatives with a subspecialist degree had a significant effect on this interest.

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

The effect of dexamethasone on controlling nausea and vomiting after cesarean surgery
Seyedeh Fatemeh Hosseini Nejad , Mahshid Vaziri, Ahmad Reza Mohtadi, Elham Kargar Zadeh , Mohammad Pakzadi,
Volume 82, Issue 3 (June 2024)
Abstract
Background: Postoperative nausea and vomiting (PONV) is a common challenge in cesarean surgeries, on the other hand, the use of dexamethasone has been proposed as an effective prophylaxis in the management of these complications. This study evaluated the effect of dexamethasone in reducing PONV.
Methods: This study was conducted as a randomized and double-blind clinical trial from April 2022 to September 2023 at Razi Hospital of Jundishapur University of Medical Sciences, Ahvaz. Elective cesarean section patients under spinal anesthesia were divided into two groups of 30 people. In this research, there were two groups: a group that received 0.1 mg/kg dexamethasone (Iran company) and a placebo group that received normal saline. The injections were done before the start of anesthesia, and both groups had received 500 cc of normal saline serum before drug injection. During the surgery and after that at specific time intervals, parameters such as blood pressure, heart rate, and the occurrence of nausea and vomiting were recorded through the V&N scoring table and shivering through the shivering scoring table. Recorded 1/2/4/6/12 after surgery.
Results: In this study the investigated variable is postoperative nausea and vomiting (PONV), since the investigated variable is a qualitative/nominal variable, to calculate the sample size from the formula P1- P2 ∕√P(1-P) used. The significance level of the tests is considered to be less than 0.05 and data analysis was done with SPSS type 23 software. Although no significant difference was observed between dexamethasone and placebo in the first hour after the operation, in the following hours, dexamethasone significantly reduced nausea and vomiting, on the other hand, heart rate and blood pressure decreased faster in the groups receiving dexamethasone.
Conclusion: Dexamethasone is significantly effective in reducing nausea and vomiting after cesarean surgery. It also has a positive role in reducing the heart rate and blood pressure and This drug is particularly effective in controlling complications after spinal anesthesia after the operation.

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