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Evaluation of the cerebrospinal fluid analysis parameters in children with febrile seizures
Reza Abbasi, Ahmad Mokhtari, Farnaz Sadat Javanmardi ,
Volume 81, Issue 2 (May 2023)
Abstract
Background: Febrile seizures are the most common cause of seizures in children under 5 years of age. Central nervous system infections are an important differential diagnosis of febrile seizures. Apart from infections, CSF characteristics are affected by many factors including the cause, type and duration of seizures. This study was designed to determine the cerebrospinal fluid (CSF) indices, including white blood cells (WBC), polymorphonuclear cells (PMN) count, and levels of protein and glucose in the CSF of children with fever-induced seizures.
Methods: The present study is a descriptive study that evaluated the results of CSF analysis in 56 children with febrile seizures admitted to Imam Sajjad Hospital in Yasouj from March 2012 to 2013. In the present study, CSF analysis was performed in children with a diagnosis of febrile seizures. In order to collect information from a pre-designed form that includes demographic information (age and gender), degree of fever, and information related to CSF indices including WBC, PMN and levels of protein and glucose in CSF, which have been extracted and recorded, statistical methods are used in this study to express descriptive statistics such as mean, standard deviation, number, percentage, etc.
Results: 56 children with a diagnosis of convulsive fever with a mean age of 21.4±14 months were evaluated. 37.5% (21 individuals) of the study population were females and 62.5% (53 individuals) were males. Among them, 33 individuals had low-grade fever and 23 individuals had high-grade fever. In 10.7%, the number of WBCs was more than 5. The amount of protein obtained was in the normal range, between 20 and 50 mg/dl, in 57.1% of cases. However, a significant percentage (39.3%) of CSF liquid protein was below 20 mg/dl. CSF fluid glucose levels were within the normal range at 91.1%.
Conclusion: Based on the results of this study, febrile seizures may be associated with low protein levels in the CSF. However, due to the limited sample size in our study, similar studies with higher sample sizes are recommended.

Effects of deep brain stimulation in a patient with chronic refractory pain: a case report
Sara Ranji, Mojtaba Shahbazi , Mahdi Shafiee Sabet , Abbas Tafakhori,
Volume 81, Issue 4 (July 2023)
Abstract
Background: Stroke is one of the most important causes of chronic pain. In patients with chronic pain medical therapy with analgesic drugs, anti-epileptic drugs, and serotonin receptor modulators is the first choice. However, for patients who are refractory to the usual medical treatments, different strategies have been proposed to treat these pains. One of these treatments involves the implantation of deep brain electrodes and deep brain stimulation in the thalamus nucleouses. In this article we are reviewing the first case done in Iran.
Case Presentation: A 51-year-old male presented with sudden-onset left side hemiparesis and impaired sensation on the left side of the body, eight years ago. He complained of gradually developing pain on the left side of the body, adding to his symptoms. In his examination, he had dysarthria and his left extremities were spastic and their forces were decreased. Despite numerous medical treatments with gabapentin, pregabalin, duloxetine, carbamazepine and the replacement of an intrathecal baclofen pump during the last few years, he didn't respond very well. This goes so far as to induce severe depression symptoms, which disturbed his daily routine and even induced suicidal ideas. Due to the debilitating symptoms which were resistant to medical treatment, the patient underwent deep brain electrode implantation and deep brain stimulation in the ventral posterior lateral/posterior medial nucleuses in April 2023 at Imam Khomeini Hospital. No remarkable adverse effects were observed after implantation. In the patient’s follow-up, he had a significant improvement in pain and some other symptoms.
Conclusion: Deep brain stimulation of the thalamus nucleus is a known treatment in patients with Parkinson's disease and dystonia. However, for patients with chronic refractory pain, deep brain stimulation is a controversial therapy and has been introduced recently as an effective alternative treatment. In our patient, who suffers from severe unilateral refractory pain after stroke, a deep brain electrode was implanted and after deep brain stimulation significant improvement in pain was seen.

Comparison of diagnostic value of ELISA tests with Brucella serological tests in patients with brucellosis
Hamidreza Ghasemi Basir , Mohammad Mahdi Majzoobi , Abbas Moradi, , Ali Saadatmand,
Volume 81, Issue 5 (August 2023)
Abstract
Background: Brucellosis is one of the most common infectious diseases transmitted from animal to human. Different methods of blood culture, serology, PCR and ELISA are used to diagnose brucellosis. The aim of this study was to compare the diagnostic value of ELISA tests with Brucella serological tests in patients with brucellosis.
Methods: In this cross-sectional descriptive study that was conducted from the beginning of April 2018 to the end of March 2019, 231 patients referred to the Infectious Diseases Clinic of Sina Hospital in Hamadan with clinical symptoms and possible diagnosis of brucellosis were included in the study. 5 cc of blood was taken from the patients to prepare serum, at the same time as Wright, Combs Wright and 2ME serology tests, IgG and IgM ELISA tests were also performed using the ELISA kit of Pishtaz Teb Company (Made in Iran), which is designed with the cut-off method. Then the test results were analyzed with SPSS software, version 16 (SPSS Inc., Chicago, IL, USA).
Results: 231 patients suspected of brucellosis including 147(63.64%) men and 84(36.36%) women with an average age of 44.60±16.16 years and a minimum of 10 years and a maximum of 80 years were examined. IgG and IgM results were positive with brucellosis in 80.1% and 30.30%, respectively. The results of IgG and IgM were positive in 1/80 and 30.30%, respectively, and they were diagnosed with brucellosis. In comparison with 2ME, Wright and Coombs-Wright serology tests, the sensitivity of IgG was between 83.80% and 94.28% and its specificity was between 20 and 33.34%, the sensitivity of IgM was also between 34.78 and 40.0% and its specificity was between 78.67% and 89.47% at different cut points.
Conclusion: Compared to diagnostic serological tests for brucellosis, IgG is more sensitive and IgM is more specific. If serological tests are not available, ELISA can be used to diagnose brucellosis. But because of their lower diagnostic value, they cannot be replaced.

Investigating of the time and rate of occurrence of hematoma after angiography and its related factors in Mazandaran heart center
Samad Golshani, Zahra Azizi, Aliasghar Farsavian, Abbas Alipour,
Volume 81, Issue 5 (August 2023)
Abstract
Background: Coronary angiography is an elective method to confirm or rule out coronary artery disease and to decide on the treatment plan but it is an invasive method and it has some complications. The most important and common complication was hematoma. It could be the cause of mortality and morbidity. The present study was conducted with the aim of investigating the time of hematoma occurrence after angioplasty and investigating the effect of various factors (for example age, sex, BMI, BP, hematocrit, anticoagulant agent, etc.) on the occurrence of hematoma.
Methods: This was a prospective cohort study from March 2022 to March 2023 in Mazandaran heart center. The study population was patients who underwent angioplasty through the femoral artery. If the ACT is less than 150-180, sheet removal was done by applying pressure with the hand on the proximal puncture site for 15-20 minutes and ensuring sufficient hemostasis. Then, the ultrasound of the puncture site was performed before pulling the sheet/one hour and six hours after pulling the sheet, and after collecting the data, the data were analyzed to study the effect of BMI, BP, sex, hematocrit, hemoglobin, age, time of sheet removal, anticoagulant agent, etc. on prevalence of hematoma and it size.
Results: 200 patients were examined, of which 44(22%) had hematoma. Women had hematoma more than men (P<0.05). BMI and blood pressure in patients with hematoma decreased and increased, respectively (P<0.05). Older age, female gender, lower hematocrit, and longer duration of sheet retention were effective factors in increasing hematoma size (P<0.05). In the logistic regression model, with increasing BMI, the chance of hematoma occurrence decreased (P=0.029, OR=0.831).
Conclusion: Controlling blood pressure and preventing of decreasing the hematocrit, reduces the incidence of hematoma in patients after angiography. Also, preventing hematocrit drop and removal of sheet at the appropriate time, can prevent of increasing in size of hematoma. There is some difference between nursing report and sonography finding. Nursing report overestimated the hematoma size.

Frequency of causes of otalgia in patients referred to the ENT clinic: a brief report
Mohamad Ali Damghani , Ayeh Shamsadini , Elham Abbaszade,
Volume 81, Issue 6 (September 2023)
Abstract
Background: Otalgia is defined as pain localizing in the ear that can be primary or referred. By careful history and physical examination, all causes in this extensive differential diagnosis can be excluded. Given that otalgia is one of the most common causes for patients to visit the clinic and has a wide variety of differential diagnosis, the purpose of this study is to investigate the frequency of different etiologies of ear pain in patients referred to referral clinic.
Methods: This cross-sectional study was performed on patients presenting with otalgia. After entering the study, the patient underwent a thorough examination of the ear, nose, throat, head and neck, teeth and salivary glands by a resident under the supervision of a senior otologist, and based on the findings, relevant para clinical procedures such as x-ray, CT scan or stroboscopy were performed. Data collection was done based on a data log check list. Samples were collected during six months. SPSS software version 20 was used for analyses.
Results: The most common causes of otalgia were acute otitis media 29%, external otitis 17% and chronic otitis media 15%. Cerumen and referral ear pain were next in line (13.5%). There was significant relationship between otalgia with age groups (The age between 13 and 30 years were the most referred due to otalgia). There was no significant relationship between otalgia and gender, underlying disease, economic status, smoking and opium use.
Conclusion: Given that otalgia is a common complaint in patients referred to the clinic, knowing its causes and origin is useful in diagnosing, proper treating it and avoiding unnecessary para clinical procedures and empirical treatment. The most common causes of otalgia in this study were acute otitis media, otitis externa and chronic otitis media, respectively. Referral otalgia and cerumen impaction were the next causes. Among the age groups, the age between 13 and 30 years were the most referred due to otalgia, but there was no significant relationship with any of the variables of gender, economic status and smoking and opium use.

Performing Epidural blood patch through the caudal space in a patient with cerebrospinal fluid leakage: a case report
Farhad Tavakoli, Ebrahim Espahbodi, Abbas Ostad Alipour ,
Volume 81, Issue 9 (December 2023)
Abstract
Background: CSF fluid leakage due to damage to the dura mater layer is a rare complication of spine surgery. One of the methods to control symptoms in case of failure of supportive treatments is to inject the patient's blood into the epidural space at the levels adjacent to the leakage site
Case Presentation: The patient is a 56-year-old woman, who suffered a CSF leak after laminectomy of the fourth vertebra. Due to the presence of a surgical incision at the leak site, the lack of access to the epidural space from that location, and disturbing symptoms, caudal space was chosen. Method, In a prone position with vital signs monitoring, proper sedation, and local anesthetic injection, in completely sterile conditions, with the help of fluoroscopy, through the sacral hiatus  Tuohy 18G needle entered into the epidural space and contrast material was injected, the exact location of the needle in the AP-Lateral view ensured, the epidural catheter was measured from the skin to the approximate location of the L4 vertebra and about 20 cm of the catheter was shortened to facilitate blood injection then the catheter was inserted into the epidural space again, the contrast material was injected into the catheter and the diffusion of the contrast material was seen at the level of the fifth vertebra. Then, in the cubital vein, a 16G IV cannula was inserted under completely sterile conditions. Then 20 cc of blood was taken from the patient's peripheral vein and slowly injected into the catheter. After the injection of 17 cc, the patient felt heaviness and pain in the lower back, the blood injection was stopped and the catheter and needle were removed. The needle insertion site was bandaged and the patient with stable vital signs and full consciousness was transferred to the recovery room and then to the ward.
 Conclusion: when it is not possible to access the epidural space via the interlaminar approach, the caudal space by inserting a catheter can be a good alternative.

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

Investigating the causes and nature of medical errors in the voluntary reporting system in Firoozgar educational center
Maryam Ameri, Atieh Ansari, Abbas Aghabiklooei, Farrokh Taftachi , Leyla Abdolkarimi,
Volume 82, Issue 1 (April 2024)
Abstract
Background: Medical errors are one of the biggest problems of the health system in countries. Identifying the factors responsible for these errors is crucial to designing optimal strategies to reduce such occurrences. The aim of this study was to investigate the type and nature of medical errors.
Methods: In this cross-sectional descriptive study, all documented medical errors that occurred between March 2021 and February 2022 at Firoozgar Educational and Medical Center were thoroughly examined. The data collection involved reviewing records from various departments within the center to ensure a comprehensive analysis of error types. The extracted data were processed and analyzed using SPSS v.22 software, allowing for statistical evaluation and identification of potential patterns or trends in medical errors over the specified period.
Results: A total of 214 cases were reviewed. 45.3% of the recorded medical errors occurred in the morning shift, 20.6% in the evening shift and 34.1% in the night shift. The highest number of medical errors was reported by nurses (40.7%), followed by physicians (16.8%) and paramedics (11.7%). The etiology of most medical errors was systemic errors (63.6%) followed by pharmacological errors (15.4%) and technical errors (13.1%) and the most reported systemic errors were of insufficient supervision. Most of the patients who had medical errors were admitted to the inpatient wards (40.7%) and later to the surgical wards (17.3%) and ICU (12.6%). 62.1% of medical errors did not cause any specific complication and in 33.2% of cases, mild complication, 10.7% moderate complication and 3.3% severe complication occurred for patients. 62.1% of medical errors had no consequences for anyone, and in 36.9% of cases, the consequences of errors were to the patient and 1% of the consequences of errors were to the organization and employees.
Conclusion: Most of the reported medical errors were performed by nurses and were uncomplicated errors. Establishing transparent and accurate self-reporting systems is essential to identify medical errors of all employees.

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

Effect of ten-week lower limb progressive resistance training on muscle quality of life and fatigue in adults with spinal muscular atrophy type III
Khadije Sohrabi, Abbas Ali Gaeini , Elham Shirzad , Shahram Khorshidi , Shahriar Nafissi, Hamid Reza Fateh,
Volume 82, Issue 4 (July 2024)
Abstract
Background: Spinal Muscular Atrophy (SMA) is a neurodegenerative disorder caused by a mutation in the survival motor neuron 1 (SMN1) gene. It is classified into five types (from type 0 to 4) based on the age of onset of symptoms and maximum motor function. This autosomal recessive mutation results in progressive weakness and atrophy of the proximal muscles. Due to the high cost of treatment, the critical timing of intervention, and the varied responses of patients, many individuals do not sufficiently benefit from current therapeutic methods. This study evaluates the impact of resistance training on the quality of life and fatigue in patients with SMA type III, considering the potential benefits of such training.
Methods: The present study was developmental and semi-experimental. Fourteen ambulatory patients with SMA type III were randomly assigned to exercise and control groups. The exercise group engaged in lower limb resistance training at an intensity of 6 to 8 on an adult resistance exercise scale for 10 weeks (25 sessions). During this period, the control group maintained their usual daily activities. Patients in the exercise group did not engage in any exercise activity other than the protocol of the present study. Patients' quality of life was measured with the Short Form 36 (SF-36) questionnaire, and fatigue severity was measured with the Fatigue Severity Scale (FSS), both evaluated pre- and post-intervention. The assessments and exercises were conducted in the occupational therapy department of Shariati Hospital, Tehran, from July 2023 to September 2023.
Results: Analysis of the results showed significant improvements (P<0.05) in the exercise group compared to the control group in the subscales of physical functioning and fatigue within the quality of life assessment. Additionally, notable differences were found between the groups on the fatigue intensity scale. However, No significant difference was observed in the patients' Body Mass Index (BMI) measurements.
Conclusion: Progressive resistance training of the lower limbs enhances the quality of life and reduces fatigue in patients with SMA type III.

Epidemiological investigation of emergency department visits in patients with cancer: a three-center study
Mohammad Masud Khubiari , Simin Najafgholian, Bahareh Abbasi, Ramin Parvizrad, Reza Aghbozorgi,
Volume 82, Issue 5 (August 2024)
Abstract
Background: Emergency Departments (EDs) visits reflect medical needs and demands or the only care available to patients. Many ED visits are potentially preventable with access to high-quality, community-based health care. Given the higher incidence of emergency conditions in patients with cancer the global increase in cancer will pose a challenge for emergency services. Therefore, this study was conducted with the aim of epidemiological investigation of emergency department visits by cancer patients in several centers.
Methods: In this cross-sectional study, the triage form and hospital file of known patients with various cancers, who visited in Eds of valiasr and Amir al Momenin hospitals in Arak, Hazrat Rasool Akram and Lolagar hospitals in Tehran, and Shahid Sadouqi and Shah vali hospitals in Yazd, From April to September 2017. To measure the urgency of ED visits, the emergency severity index and triage form were used, and the outcome of the emergency visit was extracted from the patient's file and recorded in the data collection checklist. Multivariate logistic regression analysis was used to examine the association of patient, hospital and potentially preventable factors.
Results: In this study, 1107 patients, 550 men (%49.7) and 577 women (%50.3) with cancer were were studied. Age 65 and older had the most emergency visits. The most common reason for patients to visit was: pain in different organs (18.2%), fever (8.7%), weakness and malaise (7.5%). A total of 617 (55.7%) visits were potentially preventable. Age 17 years and younger (OR, 3.172; 95% (CI), 2.409-4.021) and presence of more than 1 comorbidity (OR, 3.610; 95% (CI), 3.611-4.521) were positively associated with potentially preventable visits.
Conclusion: In this study, 50.7% of ED visits among patients with cancer were identified as potentially preventable, and the most common reason for patient visits was general and non-specific symptoms such as pain, weakness, and malaise. These findings highlight the need for palliative care and evidence-based interventions in outpatient settings.

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

Evaluation of the impact of blue light blocking filters on visual quality after PRK surgery
Saeed Rahmani, Aliakbar Shafiee, Abbas Riazi , Alireza Akbarzadeh Baghban , Alireza Jafari , Maryam Dashti,
Volume 82, Issue 6 (September 2024)
Abstract
Background: Problems related to blue light exposure are among the various issues experienced by individuals who have undergone Photorefractive Keratectomy (PRK).Given the growing concerns regarding blue light’s effects on visual health, this study aimed to thoroughly investigate the impacts of blue blocker filters on the improvement of vision in patients post-refractive surgery of the PRK type. The primary objective was to evaluate the overall effectiveness of these filters in enhancing visual quality and in reducing complications associated with the surgery, which can significantly affect a patient’s quality of life.
Methods: In a quasi-experimental study conducted from September 1, 2024, to the end of October 2024, individuals who had undergone PRK surgery were examined at the optometry clinic of Dr. Labbafi Nejad Hospital in Tehran. Participants were subjected to assessments both with and without the application of blue blocker filters. Key parameters, including visual acuity and contrast sensitivity among attendees, were meticulously measured under both conditions. The results were then systematically compared and analyzed to draw meaningful conclusions about the impact of blue blocker filters in this context.
Results: A total of thirty-four participants, comprising 73.5% females and 26.5% males, with an average age of 32.6 years, were incorporated into the study. Post-surgery, the average refraction measured in the right and left eyes was documented as   -0.42±0.16 D and -0.30±0.16 D, respectively. Notably, visual acuity in both eyes significantly improved with the use of the blue light blocking filter (P<0.005) Moreover, contrast sensitivity at varying spatial frequencies of 1.5, 6, and 18 cycles per degree (c/d) also exhibited significant enhancement (P<0.005).
Conclusion: The incorporation of blue blocker filters for individuals with a history of PRK surgery has led to noteworthy improvements in visual acuity and enhanced contrast sensitivity. These findings underscore the critical importance of integrating blue light protection in the post-operative care of patients, as it significantly elevates the overall visual experience and may contribute to better long-term outcomes following refractive surgery.

Evaluation of the accuracy of MAGIC polymer gel dosimeter in measuring dose in small electron fields in radiotherapy
Soraya Ahmadian Mask , Abbas Haghparast,
Volume 82, Issue 10 (January 2025)
Abstract
Background: Recent advances in modern radiotherapy techniques such as Intensity-Modulated Radiation Therapy (IMRT) and Stereotactic Radiosurgery (SRS) have significantly increased the need for accurate and reliable dosimetry in radiation therapy. Accurate dose delivery is particularly critical in small electron fields, which are increasingly used in targeted treatments. However, these fields pose unique challenges due to factors such as electron disequilibrium, increased lateral scatter, and steep dose gradients. These physical characteristics can introduce significant uncertainties in dose distribution, thereby reducing the effectiveness and safety of the treatment if not properly accounted for. Traditional dosimeters often struggle to maintain accuracy under such conditions. The aim of this study was to evaluate the performance of MAGIC polymer gel as a three-dimensional (3D) dosimeter in small electron fields and to compare its dosimetric characteristics with standard dosimeters including diode, semiflex, and pinpoint.
Methods: This experimental and applied study was conducted at the Radiotherapy Department of Imam Reza Hospital, Kermanshah, Iran, over a one-year period from December 2022 to December 2023. Five electron field sizes (2×2, 2.5×2.5, 3×3, 4×4, and 5×5 cm²) were generated using an Elekta linear accelerator at two electron beam energies of 6 and 9 MeV. MAGIC polymer gel phantoms were irradiated accordingly and scanned with a 1.5 Tesla MRI system to obtain three-dimensional dose distributions. These were compared to measurements obtained from diode, semiflex, and pinpoint dosimeters.
Results: The depth dose curves of MAGIC gel exhibited greater agreement with diode measurements compared to those from semiflex and pinpoint detectors. As field size decreased and beam energy increased, discrepancies in absorbed dose readings between different dosimeters became more apparent. These results underscore the importance of selecting appropriate dosimetric tools for accurate dose evaluation in small-field electron beams.
Conclusion: MAGIC polymer gel demonstrated strong potential as a reliable 3D dosimeter for small electron field dosimetry, showing the highest compatibility with the diode dosimeter.

Exercise training and cardiovascular health in postmenopausal women with breast cancer: physiological perspectives, clinical evidence, and practical challenges
Babak Hooshmand-Moghadam , Abbas Ali Gaeini,
Volume 82, Issue 12 (March 2025)
Abstract
Background: As survival rates among breast cancer patients improve, cardiovascular disease (CVD) has emerged as a leading cause of long-term morbidity and mortality in postmenopausal survivors. This epidemiological transition from oncologic risk to cardiometabolic vulnerability reveals a critical yet underexplored dimension of survivorship care. Structured exercise training represents a promising intervention, and this narrative review-grounded in a systematic literature search investigates the effects of aerobic, resistance, and combined training modalities on cardiovascular health in postmenopausal women with breast cancer. The review synthesizes evidence across physiological mechanisms, clinical outcomes, and implementation challenges to provide a comprehensive perspective on exercise oncology in this underserved population.
Methods: A systematic search of reputable international databases including PubMed, Scopus, Web of Science, Embase, and Google Scholar as well as Persian databases SID and Magiran was conducted to identify relevant human studies, clinical trials, and randomized controlled trials published between January 2000 and April 2025. Screening, selection, and synthesis of the studies were performed in Iran between October 2024 and January 2025.
Results: Accumulating evidence supports that structured exercise especially combined aerobic and resistance training exerts substantial cardioprotective effects through multiple mechanisms, including reductions in systemic inflammation, improvements in body composition, regulation of blood pressure, enhancement of cardiorespiratory fitness, and improved left ventricular function. Combined interventions consistently outperformed single-modality programs, underscoring the importance of integrative approaches in oncologic rehabilitation. Despite this promise, persistent barriers such as limited access to trained personnel, lack of individualized protocols, and weak institutional support impede translation into routine practice. Notably, few existing reviews have bridged mechanistic, clinical, and operational domains in this population, highlighting a significant gap in the literature.
Conclusion: Exercise training is not merely an adjunct to care it is a clinically potent, physiologically grounded, and policy-relevant strategy for mitigating cardiovascular risk in postmenopausal breast cancer survivors. Given the increasing burden of CVD in this group, integrating personalized, evidence-based exercise into oncologic care pathways is both urgent and essential for advancing survivorship standards and informing future clinical guidelines.

 
The challenging management of hyperparathyroidism in a 9-year-old boy: a case report
Reza Tavakolizadeh , Abbas Alibakhshi, Sevil Abdolmohamadian ,
Volume 82, Issue 12 (March 2025)
Abstract
Background: Primary hyperparathyroidism is a rare but significant endocrine disorder in pediatric patients; although uncommon, parathyroid adenomas are the most frequently identified cause of primary hyperparathyroidism in this population. Diagnosis and treatment of primary hyperparathyroidism in children, especially in cases caused by parathyroid adenoma, demand careful assessment and require a coordinated and multidisciplinary approach involving endocrinologists, pediatric surgeons, radiologists, and other specialists. Early diagnosis is often delayed due to the rarity of the disease and the nonspecific nature of presenting symptoms.
Case Presentation: This case report describes the complex clinical management of a 9-year-old boy who presented with gradual onset of bone pain and visible deformities of the upper and lower extremities, which prompted further evaluation and later led to a diagnosis of hyperparathyroidism secondary to a parathyroid adenoma. The diagnosis was confirmed by elevated parathyroid hormone levels, hypercalcemia, and imaging studies revealing a parathyroid adenoma. Despite a comprehensive preoperative planning and surgical intervention, adenoma resection was not successful during the first two surgeries, leading to persistent hyperparathyroidism and subsequent surgical complications such as postoperative thyroid tissue damage and resultant iatrogenic hypothyroidism. Ultimately, the third surgical attempt successfully removed the adenoma, leading to a marked resolution of hyperparathyroidism and gradual return to normal calcium and parathyroid hormone levels. The patient’s bone pain and deformities showed improvement during follow-up.
Conclusion: This case highlights the numerous challenges in managing hyperparathyroidism in pediatric patients. In particular, it illustrates the potential complications that can arise when the disease is resistant to initial treatment efforts. This report underscores the importance of having a multidisciplinary approach, carefully planned and executed surgical intervention and vigilant postoperative care in pediatric patients with hyperparathyroidism. Early recognition, accurate localization of the adenoma, and coordination among specialists are essential for favorable outcomes in complex pediatric cases such as this. Continued follow-up is essential to monitor for recurrence and to manage any long-term complications.

An overview on hyperthyroidism: pathogenesis, diagnosis ,management, complications and prognosis: a review article
Sahar Karimpour Reyhan , Mahsa Abbaszadeh, Alireza Esteghamati ,
Volume 83, Issue 1 (April 2025)
Abstract
Hyperthyroidism is one of the most important endocrine disorders, characterized by increased activity of the thyroid gland and excessive production of thyroid hormones. These hormones play a key role in regulating the body’s metabolism; therefore, their excess leads to a wide range of clinical manifestations. The most common symptoms include anxiety, restlessness, weight loss despite normal or even increased appetite, palpitations, excessive sweating, fine tremors of the hands, sleep disturbances, and heat intolerance. Some patients may also experience mood changes such as irritability and nervousness. On physical examination, rapid tendon reflexes, tachycardia, moist and thin skin, and in many cases the presence of goiter (thyroid enlargement) may be observed. The condition is more common in women than men and is most frequently seen between the ages of 20 and 50 years. Once hyperthyroidism is confirmed, the underlying cause of thyrotoxicosis must be determined. The most common cause is Graves’ disease, an autoimmune disorder that leads to diffuse thyroid enlargement and overproduction of hormones. Toxic multinodular goiter and solitary toxic adenoma are other important causes. For definitive diagnosis, blood tests measuring TSH, T3, and T4 are essential. In hyperthyroidism, TSH is typically suppressed while T3 and T4 are elevated. In addition to laboratory testing, thyroid ultrasound can help evaluate the structure of the gland, and a thyroid radioactive iodine uptake scan can further differentiate between different causes and determine disease activity. Several treatment options are available for managing hyperthyroidism. Antithyroid drugs such as methimazole or propylthiouracil inhibit the synthesis of thyroid hormones. Beta-blockers are often prescribed to control cardiovascular symptoms and reduce palpitations. Radioactive iodine therapy is a common and effective method that destroys the overactive thyroid tissue. In rare cases, or when other treatments fail, thyroidectomy (surgical removal of part or all of the thyroid gland) may be required. Overall, hyperthyroidism is a manageable condition, but it requires accurate diagnosis, careful selection of therapy, and close follow-up with a specialist. Patient cooperation and adherence to treatment play a crucial role in controlling symptoms and preventing long-term complications. This review will focus on describing the symptoms, causes, diagnostic methods, and treatment options.

A 5-year follow-up study of renal status in children with posterior urethral valve dysfunction
Mastaneh Moghtaderi, Hossein Amirzargar, Behnaz Bazargani , Arash Abbasi, Daryoush Fahimi, Fahime Asgarian,
Volume 83, Issue 1 (April 2025)
Abstract
Background: Posterior urethral valve (PUV) is recognized as one of the most frequent causes of obstructive uropathy in the pediatric population, particularly in male infants. This congenital anomaly leads to variable degrees of urinary outflow obstruction, which may result in progressive renal damage and deterioration of kidney function over time. Despite advances in diagnostic modalities and surgical interventions, infants and children affected by PUV continue to demonstrate suboptimal long term renal outcomes, with a considerable proportion developing chronic kidney disease (CKD). Understanding early predictors of adverse renal prognosis is essential to guide timely interventions and optimize follow up strategies. The present study aimed to assess the long term renal outcomes, over a minimum of five years, of patients with PUV treated at the Children’s Medical Center, and to investigate the role of preoperative serum creatinine levels as a predictor of future CKD in this patient group.
Methods: A cross sectional and retrospective study design was employed. The medical records of patients diagnosed with PUV between March 2011 and March 2016 who had at least five years of documented follow up were reviewed at the Children’s Medical Center in 2021. Data extracted included demographic characteristics, laboratory tests—particularly pre and post operative serum creatinine—ultrasound imaging results, surgical details, and follow up findings throughout the study period.
Results:  Eighty one patients met the inclusion criteria, with a mean age at diagnosis of 105 days. At the five year follow up, the overall prevalence of CKD among these patients was estimated at approximately 9.9%. During the follow up period, one patient died due to kidney disease, one underwent kidney transplantation, and three required maintenance dialysis. Statistical analysis demonstrated that a preoperative creatinine level exceeding 1.15 mg/dL was strongly associated with the future development of CKD, showing 100% sensitivity and 75% specificity in predicting adverse long term renal outcomes.
Conclusion: This study underscores the persistent risk of CKD in children with PUV, even after surgical intervention. Regular and comprehensive monitoring of renal function remains vital in this high risk group. Preoperative serum creatinine may serve as a reliable, accessible, and clinically useful prognostic marker to identify patients who may benefit from closer follow up and proactive management strategies.
 

Evaluation of the impact of colored filters on visual quality of visually impaired people
Ali-Akbar Shafiei , Saeed Rahmani , Abbas Riazi, Alireza Akbarzadeh Baghan ,
Volume 83, Issue 4 (July 2025)
Abstract
Background: This study investigates the use of color filters, which represent a scientific and standardized approach to assist individuals with visual impairment. Although there is no fixed protocol for prescribing color filters, these filters, which are often prescribed by ocular care providers in a trial-and-error manner today, help improve visual performance, control glare, and enhance motor skills in affected individuals. Given the absence of formal guidelines and standardized protocols in this area, this study tested common diseases leading to visual impairment against various color filters.
Methods: The study population consisted of patients visiting the Optometry Clinic of Labbafi Nejad Hospital. Participants were voluntarily referred from retinal and corneal departments to this clinic. This quasi-experimental study evaluated acuity at distance and near and contrast sensitivity function with and without color filters, and compared the results. After analysis, filter(s) suitable for each participant were identified and applied clinically, with one-month monitoring and re-evaluation.
Results: A total of 99 participants (54 male, 45 female) with a mean age of 32.19±15.41 years were included. The results showed that after using color filters, distance visual acuity (BCVA) improved significantly in most diseases (P<0.001). However, in albinism and diabetic retinopathy patients, there was no significant improvement in distance vision. At near distance, there was generally a significant improvement in near vision in most diseases after applying the filters (P=0.001). Exceptions included albinism and glaucoma, where no significant difference was observed (P=0.073). For contrast sensitivity (CSF), most patients showed improvement and increased contrast sensitivity (P<0.001), but this increase was not significant in albinism and glaucoma (P=0.483).
Conclusion: The study suggests that the use of certain color filters in visually impaired patients leads to significant improvements in both distance and near acuity and contrast sensitivity function, potentially enhancing quality of life. Based on the quantitative results, selecting the appropriate filter should be disease-specific and done with greater precision. However, the diversity and severity of diseases, the degree of vision loss, and genetic differences among individuals require greater attention to practical experiences and statements from this patient group. Additionally, patients with more than one ocular condition often changed the type and color of the filter.

Analysis of parameters of patients undergoing pulmonary angiography with the possibility of pulmonary embolism in the emergency department
Maryam Safari, Abbas Ghaisouri, Shokofeh Mohammadi,
Volume 83, Issue 5 (August 2025)
Abstract
Background: Shortness of breath is a common disorder and means difficulty in breathing and shortness and shallow breathing that the patient feels unpleasant, difficulty and shallow breathing. The main purpose of this study was to analyze patients undergoing pulmonary angiography with a prognosis of pulmonary embolism in the emergency department.
Methods: This descriptive-analytical study was performed in the adult emergency department of Shahid Mostafa Hospital in Ilam in March2018-March2020 after receiving permission from the ethics committee. This study evaluated patients over 18 years of age who underwent CTPA with a pre-diagnosis of PE.
Results: The highest frequency was reported in CT findings of 31.9% normal, 27.6% PE. In our study based on CT results, 30.2% of patients suffered from PE. The highest frequency was reported in CT findings of 31.9% normal, 27.6% PE. In the present study, 65.5% of patients presented with shortness of breath, of which CT results showed 28.9% (PE), 38.2% (Non PE) and 98% (Normal). Other complaints of patients with shortness of breath were reported with CP (7.8%), lower edema (6%), respiratory distress (8.6%), CP and fever (5.2%) and hemotypy (1.7%).
Conclusion: Based on the above study, we conclude that the criterion for selecting patients for CT angiography to rule out PTE is the most important criterion for clinical examination and the Welsh Criteria score. As we can see, the results showed that patients with a Wales score above 8-12 had 80% PTE and patients with a Wales score of 3-6 had 23.5% PTE and the rest had a negative answer, so the Wells criteria were good criteria which unfortunately Due to some conditions, the diagnosis of a general practitioner or carelessness in examinations are not taken into account and causes a large percentage of patients with complaints of shortness of breath to undergo CT angiography while not having the necessary criteria based on Wells scores and clinical examination. CT angiography is either normal or another condition that does not require CT angiography and radiation.

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