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Prevalence of acute kidney injury and its correlation with disease severity and outcomes in COVID-19 patients
Shima Heydari , Mohammad Nasrollahi, Mohammad Khodashenas Roudsari,
Volume 81, Issue 11 (February 2024)
Abstract
Background: Studies of viral pandemics in the past, as well as studies of patients with sepsis, have shown that there is a direct relationship between the occurrence of AKI with disease severity and mortality, prognosis and outcomes. Considering that the COVID-19 disease is a novel pandemic and there is not enough information on the occurrence of AKI with COVID outcomes and its consequences, especially in Iran, it is necessary to conduct research in this field.
Methods: This is a retrospective study on 310 Covid patients hospitalized in the internal medicine, critical care and infectious disease ward of Birjand Valiasr Hospital from 20 March 2020 until 20 March 2021. Data were collected from the hospital's health information unit. The information was collected including demographics, underlying diseases, vital signs, laboratory information, and imaging and type of respiratory support. Finally, data was analyzed by SPSS V.22.
Results: 310 patients with an average age of 51.9 ± 17.4 participated in this study, 58.4% of them were male. The prevalence of acute kidney injury in patients was 7.4%. There was a significant relationship between acute kidney injury and the COVID severity, so that the COVID severity increases with the occurrence of acute kidney injury. There was a significant relationship between COVID outcomes and acute kidney injury, so that a higher mortality rate was observed in patients with acute kidney injury. No significant relationship was found between the occurrence of acute kidney injury and the score of pulmonary involvement. Patients with hypertension were more tent to experience acute kidney injury. Also, patients with acute kidney injury have more leukocytosis compared to patients without acute kidney injury. In this study, no significant relationship was observed between lymphocyte count and acute kidney injury. This study showed that the level of serum CRP and BUN are significantly higher in patients with acute kidney injury.
Conclusion: Acute kidney injury in hospitalized patients with COVID-19 is not common but had a significant effect on disease severity and outcomes.

Evaluating the role of brain MRI in predicting clinical outcome of global developmental delay in children
Alireza Dehghan, Mahbube Abshirini, Hamid Nemati, Mahdi Saeedi-Moghadam ,
Volume 81, Issue 11 (February 2024)
Abstract
Background: Developmental disorders in children include a group of problems and limitations in learning and acquiring specific skills of each age group. The term global developmental delay is used to describe developmental disability in children under five years of age, which is in at least two areas of major development. Neuroradiological imaging such as brain MRI provides important information for physicians. The purpose of this study is to determine the role of brain MRI in predicting the clinical outcome of global developmental delay in children.
Methods: In this cross-sectional study, from 79 - from September 2013 to September 2018 at Motahari Clinic of Shiraz University of Medical Sciences, Shiraz Iran - eligible children with developmental disabilities, 37 patient who had brain MRI were selected as a sample and children scores in five ASQ clinical areas and MRI findings were reviewed and compared. Patients suffering from metabolic, genetic, trauma, infection and neoplasms problems and diseases were excluded from the study.
Results: Out of 37 patients studied, 23 were female and 14 were male with a dispersion of three 3 to 60 months of age. 31 of these children had at least one abnormal finding in brain MRI images and the other six were completely normal. In relation to the imaging findings, the highest frequency is related to abnormal head circumference with a prevalence of 54% and the lowest frequency is related to abnormal myelinization with a prevalence of 10.8%. Results of MRI findings correlation with developmental domains demonstrated that Children with white matter disorder on MRI show severe gross motor abnormality (P<0.049) and who had MRI finding of cortical problems suffer from developmental delay in fine motor area. (P<0.001).
Conclusion: Considering the mentioned findings; brain MRI can be a useful diagnostic tool in children with developmental delay and also focusing on the developmental area that is more likely to be affected, MRI can help with treatment and rehabilitation process of these children in the future.

Comparison of short-term outcomes of vasopressin and tranexamic acid in acute gastrointestinal bleeding
Seyed Arash Yazdanbakhsh, Simin Najafgholian, Arash Izadpanah , Mohammad Parohan, Azim Forozan, Amir Almasi Heshiani ,
Volume 81, Issue 11 (February 2024)
Abstract
Background: Acute gastrointestinal bleeding is one of the critical emergencies with good prognosis if properly managed. Combination of drug has had the best possible clinical results to stabilize the hemodynamic status of these patients. Therefore, in this study, the short-term consequences of simultaneous administration of vasopressin and tranexamic acid were compared.
Methods: In this double-blind clinical trial study that was conducted from November 2018 to November 2019 at Valiasr Hospital in Arak 120 eligible patients with acute gastrointestinal bleeding were included. Patients were divided into four groups of 30. In the first group (TXA) the common treatment with tranexamic acid was first infused at the rate of 10mg/kg as an initial dose over 20 minutes and then received to 1mg/kg per hour as a maintenance dose for up to four hours. The second group (VP group) received common treatment with infusion of 30 units per hour for six hours. The third group (R group) received only conventional treatments and the fourth group (TXA+VP group) received both tranexamic acid and vasopressin along with conventional treatment. The amount of light blood lose and vital signs including blood pressure and heart rate and Hg, BUN , CR , NA, K, BS, PT, PTT, INR were checked.
Results: In this study, the vasopressin group had a greater decrease in hemoglobin (p≤0.05), the increase in blood urea was less in the two groups that received vasopressin than the other two groups (p≤0.05). The group of tranexamic acid had much better conditions than the group of vasopressin, in terms of hematochezia or hematemesis interruption, need for blood transfusion, re-bleeding, need for endoscopy and emergency surgery, and adding vasopressin to tranexamic acid also led to improved outcomes (p≤0.05).
Conclusion: It seems that the concurrent use of tranexamic acid and vasopressin in upper gastrointestinal bleeding improves renal function and stops bleeding and reduces the risk of re-bleeding, the need for blood transfusion and endoscopic and surgical intervention. Its long-term results need further study.

Effect of mirror therapy on static and dynamic stability of children with hemiplegic cerebral palsy (between 5-12 years old)
Javad Alipour, Reihaneh Askary Kachoosangy , Zahra Ebrahimabadi , Yaghoub Shavehei, Mohammad Sadegh Malek ,
Volume 81, Issue 11 (February 2024)
Abstract
Background: Most hemiplegic children experience disorders related to lower limbs such as balance. Considering the importance of balance, in order to participate in activities of daily living, it is very important to use modern neuro-rehabilitation methods such as mirror therapy to improve balance. The purpose of the present study was to determine the effectiveness of mirror therapy on the static and dynamic balance of children with hemiplegic CP aged 5 to 12 years.
Methods: This study was conducted as a double-blind, randomized clinical trial on 20 children with spastic hemiplegia aged between 5-12 years old, from June 2021 to August 2022 in Tehran, Iran. Participating children were randomly allocated into test (n=10) and control (n=10) groups. The children in the treatment group underwent 20 treatment sessions during four weeks. Each session consisted of 30 minutes of routine treatment and 15 minutes of mirror therapy for lower limbs. In the control group, sham therapy was performed instead of mirror therapy. The exercises performed in a seated position were: (1) active flexion of hip, knee, and ankle joints, (2) active knee extension plus ankle dorsiflexion, and (3) knee flexion (> 90°). Both groups were measured by the Pediatric Balance Scale to assess static balance and the Timed Up and Go test to assess dynamic balance at entry and the end of the study. SPSS version 26 software was used for statistical analysis.
Results: Examining the results of the evaluations showed that before the treatment, the static and dynamic balance of the two groups did not differ significantly (p> 0/05), but the static and dynamic balance scores of the children in the treatment group after the four weeks mirror therapy period (five days per week) were statistically significant different from the control group (p<0/05).
Conclusion: According to the present study, it seems that mirror therapy as a complementary treatment can have a positive effect on improving balance (static and dynamic) in children with hemiplegic CP.

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.

Survival Analysis of the Length of Hospital Stay of Suspected Stroke Patients Transferred by EMS to Ghaem Hospital in Mashhad
Razieh Yousefi , Payam Sasannejad, Eisa Nazar, Ali Hadianfar, Mohammad Taghi Shakeri., Zahra Jafari ,
Volume 81, Issue 11 (February 2024)
Abstract
Background: Identifying factors that influence the length of hospital stay for suspected stroke patients is crucial for optimizing the utilization of hospital resources. This study aimed to determine the factors associated with the length of hospital stay for suspected stroke patients transferred to Qaem Hospital in Mashhad through emergency services using survival analysis.
Methods: In this historical cohort study, general information was gathered for all suspected stroke patients who sought emergency services in Mashhad, the largest city in northeast Iran, from March 21, 2018, to March 20, 2019, and were then transferred to the Emergency Department of Qaem Hospital. Pre-hospital emergency data were integrated with hospital records using the mission ID. The primary outcome assessed in the study was the length of hospital stay, with model implementation carried out using the statistical software Stata.
Results: The median hospitalization time until patients' recovery was  seven days. Out of the 578 participants, 386 cases (66.8%) recovered, while the remaining 190 cases (33.2%) were censored (83 individuals had died during the study, and 107 individuals had exited the hospital for other reasons). The average age of patients at the time of hospitalization was 71.13±13.01 years. Statistical analysis employing Log-rank and Breslow tests identified a significant difference in hospitalization duration among patients receiving various levels of care and based on their insurance status. During multivariate analysis, the Cox regression model was considered unsuitable due to some variables not meeting the proportional hazards assumption, leading to the utilization of AFT models. Following the evaluation of AFT models, including Log-normal, Log-logistic, Exponential, and Weibull, the log-normal model emerged as the most suitable choice, exhibiting AIC and BIC values of 1273.909 and 1356.740, respectively. Significant variables influencing length of stay included patient admission priority, insurance status, season, and residency status.
Conclusion: The study suggests that parametric survival models are effective for analyzing lifetime data. Additionally, in light of the significant variables identified, enhancing facility readiness and resource allocation could facilitate more efficient planning and implementation.

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.

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.

Effect of strabismus surgery on emotional quotient in patients referring to Imam Khomeini Hospital, Ahvaz
Gholamreza Khataminia , Reza Papahn, Atefeh Mahdianrad , Soroush Karamirad, Samaneh Mohamadpour,
Volume 81, Issue 12 (March 2024)
Abstract
Background: Psychosocial improvements of successful strabismus surgery have been reported in previous studies. But the effect of strabismus surgery on the emotional intelligence of patients is unclear. The aim of this study was to evaluate the effect of strabismus surgery on emotional quotient in patients referring to Imam Khomeini Hospital, Ahvaz.
Methods: This prospective interventional study conducted on patients underwent strabismus surgery in Imam Khomeini Hospital, Ahvaz during May 2021 to March 2022. A total of 38 patients between 8-37 years were included. Patients with previous surgery were excluded. All subjects were evaluated before and three months after successful strabismus surgery. Three months post-surgery the improvement of emotional quotient, self-esteem, body image, social anxiety and social avoidance were evaluated and compared with previous surgery. All data were analyzed by SPSS (V25). P-Value less than 0.05 was considered as significant level.
Results: 38 subjects including 18 males (47.4%) and 20 females (52.6%) were included. The mean age of patients was 18.11±9.33 years old. Our results showed that compared with before surgery, significant improvements were noted after surgery, within the emotional quotient subscales including self-awareness (P=0.016), self-regulation (P<0.0001), self-motivation (P<0.0001), empathy (P<0.0001), social skills (P<0.0001) and emotional quotient total score (P<0.0001). Further analysis revealed statistically significant improvements in body image (P<0.0001), social anxiety (P=0.004) and social avoidance (P=0.002). The result showed that the improvement of emotional quotient after strabismus surgery was significantly higher in the age group of less than 12 years (P<0.0001). No significant difference was fund between two  genders for emotional quotient subscales (P>0.05).
Conclusion: The results of this study showed a significant improvement in the psychosocial factors including emotional quotient, body image, social anxiety and social avoidance after strabismus surgery. This result suggests that beyond functional and cosmetic improvements, successful strabismus surgery can result in improved emotional quotient and social anxiety, with the greatest effect noted in younger patients.

The effectiveness of intermittent Nordic exercises with and without VR on body composition and cardiorespiratory fitness in boys with internet addiction
Nima Nejati Boushehri , Valiollah Dabidi Roshan ,
Volume 81, Issue 12 (March 2024)
Abstract
Background: Being sedentary due to internet addiction is a common public health problem that causes overweight and obesity. Novel methods are needed for weight control behaviors. This study aimed to determine effects of short-term (two weeks) and moderate-term (four weeks) of virtual reality (VR) exercise program with and without interval Nordic walking (INW) in adolescent boys on novel body composition and maximal oxygen uptake (VO2max) parameters; body adiposity index (BAI), abdominal volume index (AVI), conicity index (CI), waist-to-height ratio (WHtR), and a body shape index (ABSI).
Methods: In a semi-experimental trial during July to December 2023, 70 adolescent boys (age 14.8 years, body mass index (BMI)=24.4 kg/m2 and VO2max 38 ml/kg/min) with the Young IA tests score ranging over five, were selected from the city of Karaj and randomly was classified to VR, INW, VR+INW and control groups. Individual and combined exercise programs of VR and INW were performed (three session in week for 30 min) for two and or four weeks. The parameters were evaluated at the baseline and the follow up phases (two and four weeks after the interventions period) with a repeated measure ANOVA.
Results: According to Young's internet addiction test scores at the beginning of the study, there was no significant difference between the control and intervention groups (P≥0.05). It has been observed that internet addiction negatively affects cardiorespiratory fitness. When a 2-week intervention of VR exercises was implemented along with INW, the improvement in cardiorespiratory fitness (VO2max) was better than when VR exercises alone lasted for four weeks (P≤0.05). After four weeks of INW intervention, separately and in combination with VR, a significant improvement was observed in VO2max, WHtR and BAI values compared to the control group (P≤0.01).
Conclusion: Although improvement in cardiorespiratory fitness of boys with IA can be achieved by doing short and medium term INW, VR and INW+VR exercises, longer interventions, i.e., four weeks or more, cause more significant changes in the novel body composition.

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.

Investigation of the relationship between the dietary inflammation index and the dietary phytochemical index with non-alcoholic fatty liver diseases
Parastoo Beknejadi, Davoud Vahabzadeh, Esmaeil Yousefi Rad , Somayeh Saboori , Koroush Ghanadi , Mehdi Birjandi,
Volume 81, Issue 12 (March 2024)
Abstract
Background: The increasing prevalence of non-alcoholic fatty liver disease (NAFLD) in recent years has raised concerns about its significant risks for public health. According to previous studies, a diet with low phytochemicals and high inflammatory index is related to non-alcoholic fatty liver disease. In this study, we intend to investigate the relationship between inflammatory diet and phytochemical diet with NAFLD.
Methods: In this case control study, 112 newly diagnosed patients with NAFLD referred to the Shahid Rahimi Hospital clinic in Khorramabad between January 1400 and April 1401 and 112 healthy individuals without NAFLD and any other chronic diseases as the control group, with the range 23-59 years old were selected. General information, demographics, physical activity level and food intake were collected using general information questionnaire, physical activity questionnaire and valid semi-quantitative food frequency questionnaire (FFQ). The energy received between the people of the two groups was adjusted. People's diet was divided into two anti-inflammatory and pro-inflammatory groups based on the DII index based on the score quartiles.
Results: The results showed a significant relationship between DII score and NAFLD in the crude model (OR: 2.22, 95% CI: 1.04 -4.73), model I (adjusted for energy and age classification) (OR: 2.4, 95% CI:1.07-5.58), model II (adjusted for model I+physical activity, sex, education) (OR:2.77, 95% CI:1.14-6.77) and model III (model II+BMI) (OR: 2.16, 95% CI: 0.81-5.71) and DPI score and NAFLD the crude model (OR: 0.69, 95% CI: 0.32-1.47), model I (adjusted for energy and age classification) (OR: 0.56, 95% CI: 1.29-5.58), model II (adjusted for model I+physical activity, sex, education) (OR:0.58, 95% CI: 0.23-1.44) and model III (model II+BMI) (OR: 0.65, 95% CI: 0.24-1.75).
Conclusion: The results obtained from this study showed an inverse relationship between following an anti-inflammatory diet and the risk of NAFLD. However, there was no correlation between receiving a diet with a high phytochemical index and NAFLD.

Caring limbo for nurses, caring for patients with delirium: a letter to the editor
Reza Abdollahi , Yaser Moradi,
Volume 81, Issue 12 (March 2024)
Abstract
سردبیر محترم
دلیریوم (Delirium) یک سندرم روانی- عصبی شناخته شده است که با اختلال در سطح هوشیاری و توجه بیمار مشخص می‌گردد. علایم آن در مدت زمان کوتاهی بروز کرده و معمولاً با نوسان علایم در طول شبانه‌روز همراه است. این اختلال از جمله دلایل اصلی ایجادگیجی در بیماران بستری در بیمارستان می‌باشد که می‌تواند به‌صورت حالاتی از کم‌تحرکی، بیش‌فعالی و یا ترکیبی از هر دو، در بیماران دیده شود.1
پرستاران در تعیین و کنترل دلیریوم در جایگاه مهمی قرار دارند. با توجه به اینکه آنها از مراقبین اصلی بیماران به‌شمار می‌آیند، مشاهدات منظم و به‌موقع آنان باعث تشخیص سریع علایم اصلی دلیریوم از جمله عدم توجه و نوسانات سطح هوشیاری در بیماران می شود.2
با این وجود دلیریوم اغلب اوقات به‌دلیل کمبود دانش و سطح آگاهی پرستاران تشخیص داده نشده و یا نادیده گرفته می‌شود. ماهیت متغیر دلیریوم، همپوشانی علایم آن با علایم بیماری فراموشی، کمبود پروتکل‌های ارزیابی و تشخیصی در بیمارستان‌ها و ضعف کارکنـان تـیم درمـان در نحوه استفاده از ابزارهای شناسایی دلیریوم، از جمله دلایل نقص در تعیین ایـن اختلال محسوب می‌شود.3
علیرغم آگاهی پرستاران از وجود دستورالعمل‌های تدوین شده برای کنترل دلیریوم، پرستاران به دلایلی همچون بار زیاد کاری، عدم آشنایی با پروتکل‌های مراقبتی و نبود انگیزه از اصول مراقبتی و دستورالعمل‌ها به‌صورت کامل تبعیت نمی‌کنند.4
از سوی دیگر، مراقبت پرستاران از بیماران مبتلا به دلیریوم تحت تاثیر ساختار آموزش پرستاران و فرهنگ مراقبت در سیستم درمانی حاک بر سازمان انجام می‌شود. لذا ضعف پرستاران در تشخیص و مراقبت‌های پرستاری موثر و با کیفیت از دلیریوم می‌تواند ریشه در نقص پیشینه سیستم آموزش داشته باشد.5 ماهیت ویژه و منحصر به فرد دلیریوم و عوامل متعدد تاثیرگذار بر آن، پرستاران را در تشخیص و به‌خصوص مراقبت از این بیماران با چالش‌های فروانی روبه‌رو کرده است که از جمله آنها می‌توان به موارد زیر اشاره کرد:
1- بروز رفتار لجام گسیخته در بیمار مبتلا به دلیریوم که باعث بی‌قراری در بیمار شده و به‌دلیل بروز رفتارهای پرخاشگرانه احتمال صدمه و آسیب به بیمار و پرستار بیشتر می‌گردد.6
2- غفلت اعضای خانواده بیمار در بروز و یا تشدید دلیریوم، تغییر ناگهانی شرایط جسمی و روحی بیمار مبتلا به دلیریوم و همچنین نمایش رفتارهای غیرمعمول در بیمار باعث می‌شود تا اعضای خانواده بیمار نتوانند شیوه صحیحی را برای ایجاد آرامش در بیمار خود انتخاب نمایند.7
3- عدم آگاهی اعضای خانواده در مورد ارایه مراقبت‌هایی مطلوب و رفع نیازهای پایه مانند غذا دادن، اجابت مزاج و غیره عاملی برای بروز دلیریوم می‌باشد. تنهایی بیمار در بیمارستان و یا همراهی افراد غیرآشنا در کنار بیمار می‌تواند زمینه بروز دلیریوم را بیشتر کند.8
4- ارتباط ناکارآمد نیز می‌تواند سبب بروز دلیریوم شود. در صورت برقراری ارتباط درست با بیماران می‌توان نیازهای بیماران          را ارزیابی کرد و عوامل مسبب دلیریوم ر ا برطرف نمود. براساس منابع علمی، یکی از مهمترین عوامل مربوط به کیفیت مراقبت          و ایمنی بیمار، مهارت‌های ارتباطی بین پرستاران و بیمارانشان می‌باشد.9
5- ترس از ناشناخته‌ها در قالب تـرس بیمار از محیط درمانی، پرسنل و فرایندهای درمانی نیز می‌تواند به‌عنوان ریشه‌های ظهور دلیریوم شناخته شوند.
6- بی‌ثباتی محیط در بروز دلیریوم نقش دارد. دلیریوم در محیط آرام و بی‌سر و صدا مانند بخش CCU بیشتر بروز می‌کند، بروز دلیریوم در بیماران بستری در بخش‌های پر سر و صدا، شلوغ و پر رفت و آمد را نیز می‌توانند مورد انتظار باشد.10
باتوجه به چالش‌های ذکر شده، به‌دلیل ماهیت چند بعدی و پیچیده دلیریوم، مراقبت از این بیماران را برای پرستاران می‌توان به برزخ مراقبتی تشبیه کرد که با نوعی ابهام و سردرگمی همراه است.  لذا می‌توان با اقداماتی همچون برگزاری دوره‌های آموزشی ویژه‌ای بـرای پرستاران در مورد دلیریوم، ابزارهای تشخیصی آن و روش‌های کنترل و پیشگیری آن، این مشکل را تعدیل کرد. از سوی دیگر با توجه به نقش پرستاران در پیشگیری و کنتـرل دلیریـوم، ضروری اســت گایدلاین‌ها و برنامه‌های پیشگیرانه از دلیریوم مطابق با گایدلاین‌های بین‌المللی تدوین و مورد استفاده پرستاران قرار گیرد.

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.

The effect of Early Mobilization on the length of intensive care unit stay in pediatrics under ventilator: A Pilot study
Jamalodin Begjani , Bahareh Yaghmaei, Azam Mahmoudi , Mohammad Mehdi Rajabi ,
Volume 82, Issue 1 (April 2024)
Abstract
Background: Prolonged stay in intensive care unit (ICU) can worsen the patient's prognosis and represents a significant economic burden. Previous studies have reported the effectiveness of early mobilization in reducing length of stay in ICUs for adult patients; However, conflicting results have been reported regarding its effects on pediatric patients. Therefore, this research aimed to investigate the impact of early mobilization on the length of stay in the pediatric intensive care unit (PICU) in ventilated children.
Methods: This pilot quasi-experimental study was conducted on 60 children admitted to the Children's Medical Center hospital from March 2020 to June 2021. For the control group, routine care (standard physiotherapy) was started on the second day of intubation and continued until discharge from the intensive care unit. In this study, we used an early mobilization protocol including active and passive exercises. The intervention was implemented by Pediatric intensive care unit nurses under supervision of a pediatric critical care fellowship physician. In the intervention group, passive exercises were started on the second day of intubation. At each shift, the nurses check the level of sedation and presence of delirium in the patients using the Richmond Agitation-Sedation Scale and the Cornell Assessment of Pediatric Delirium questionnaire. If the results showed that the sedation was not deep and delirium was not present, then active exercises were initiated. If the child did not achieve an adequate score indicating the absence of deep sedation and delirium, the patient remained in the passive exercise phase. The length of stay was recorded based on the patients' records. Descriptive and inferential statistics were used for data analysis using SPSS version 23.
Results:  The results showed that there was no significant difference in the length of stay in the pediatric intensive care unit (PICU) between the control (23.20±6.34 days) and intervention (22.60±6.18 days) groups (P=0.77).
Conclusion: The implementation of early mobilization did not significantly reduce the length of PICU stay for pediatric. The researchers are advised to identify and evaluate evidence-based guidelines for implementing early mobilization in children with different diagnoses.

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.

Evaluating the Correlation between Liver Size and Fatty Liver Progression in Patients with Non-Alcoholic Fatty Liver Disease
Maryam Behmaram, Mohammad Ghasem Hanafi, Ahmad Fakhri Zadeh , Mahsa Akhavan Sabagh , Elham Farhadi,
Volume 82, Issue 1 (April 2024)
Abstract


Background: Increasing the prevalence of non-contagious and chronic disorders such as Non-alcoholic fatty liver disease (NAFLD) takes the attention of researchers. NAFLD recognized by abnormal accumulation in the liver tissue. The aim of present study is investigating the association between liver size liver enzymes and degree of fatty liver in patients with NAFLD.
Methods: Based on the inclusion criteria, 100 Patients were selected from those referred to the radiology and ultrasonography clinic in Golestan Hospital, Ahvaz, for fatty liver evaluation. The study was carried out during May 2022 to April 2023. Liver enzymes, including alanine aminotransaminase (ALT) and Aspartate aminotransferase (AST), were measured. Based on the ultrasonography results, patients were divided into four groups: healthy, mild fatty liver, moderate fatty liver, and severe fatty liver. Ultrasonography was carried out by an experienced expert. All demographic information of patients was collected. Data were analyzed by SPSS (V25).
Results: According to ultrasonography results, the mean of span was 148.4 ± 14.7 cm, which was significantly higher in patients with grade II of NAFLD (P<0.001). Further analysis revealed the highest difference between grades I and II (P<0.001). Also, a significant difference between grades II and III and grades III and I were found  (P<0.001). Our data showed a significant relationship between body mass index (BMI) and NAFLD grades (P<0.001). The mean of BMI in grade I was significantly lower than in grades II and III (P<0.05). Our findings demonstrated that the mean of ALT in grade I was significantly lower than in grades II and III (P<0.05). In this line, the highest AST level was seen in grade III (P<0.001).
Conclusion: Our study showed that as NAFLD progresses, the enzymes and size of the liver increase. Based on ultrasound findings, the increasing liver size suggests NAFLD grade II, while the rise in AST and BMI suggests NAFLD grade II -III and progression of cirrhosis.

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

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