Iranian Journal of Medical Sciences最新文献

Background: Breast cancer is the most frequent malignancy among women. The COVID-19 pandemic significantly impacted healthcare systems, potentially affecting the management of this disease. Due to the critical importance of early diagnosis and treatment, and the limited data on the pandemic's specific effects, this study aimed to determine the correlation between the COVID-19 pandemic and various breast cancer parameters.

Methods: This retrospective study included patients with breast cancer in Shiraz, Iran. Patients were divided into two groups, including those diagnosed before and after the start of the COVID-19 pandemic (from September 2018 to March 2021). Variables included demographic, clinical, and management features. Continuous variables were reported as mean±SD, and the categorical data were reported as frequency and percentage. The significance level was set as P<0.05.

Results: The study documented 1,435 patients: 811 patients were diagnosed before the pandemic, and 624 patients were diagnosed after. The mean initial tumor size at the time of diagnosis was significantly larger in the post-pandemic group than the pre-pandemic group (2.29±1.44 vs. 2.11±1.39 cm, respectively; P=0.001). The distribution of cancer stages also differed significantly (P=0.001). While the prevalence of stage 1 disease was similar between groups (30.1% vs. 28.9%), the prevalence of stage 2 (14.8% vs. 8.5%) and stage 3 (10.1% vs. 7.0%) was significantly higher in the post-pandemic group (Stage 1: 30.1 vs. 28.9%, Stage 2: 8.5 vs. 14.8%, Stage 3: 7 vs. 10.1%; P=0.001).

Conclusion: Following the COVID-19 pandemic, patients presented with significantly larger breast tumors, increased axillary involvement, and more advanced stages after the COVID-19 pandemic.

None.

Background: Trigonella foenum-graecum, commonly known as fenugreek, is used both as a spice and a medicinal herb. While numerous studies investigated its therapeutic effects, this scoping review aimed to explore the reported adverse effects associated with fenugreek consumption in humans.

Methods: A systematic search of several scientific databases was conducted, including Google Scholar, Web of Science, PubMed/PMC-MEDLINE, Scopus, and Science Direct, from January 1990 to September 2024. The search utilized keywords such as "Fenugreek", "Adverse Effects", "Clinical Trial", and "Case Report", or "Case Series". References of retrieved articles were also screened.

Results: The review included 60 articles. Of these, 14 clinical trials reported adverse effects, 23 reported none, and 13 did not provide information on adverse effects. Additionally, 10 case reports or case series (reported in eight articles) detailed allergic reactions or hypersensitivity signs and symptoms. The most common adverse effect was mild gastrointestinal discomfort following oral consumption. Other reported effects included hypoglycemia, potential hypokalemia, allergic reactions, a maple syrup odor in the urine, sweat, or skin of infants and mothers, and interactions with certain medications.

Conclusion: Fenugreek is generally considered safe, with most reported side effects being mild and self-limiting. No fatalities have been attributed to its use. This evidence might be valuable for both the general public and healthcare professionals.

Background: In 2022, human immunodeficiency virus (HIV) affected 39 million globally, with Iran experiencing a concentrated epidemic. This study aimed to identify and prioritize critical HIV/AIDS research areas to address existing gaps in the Iranian context.

Methods: Researchers at Isfahan University of Medical Sciences employed a three-phase approach between May 2018 and March 2023. The first phase involved developing an HIV research matrix tailored to international guidelines and the Iranian context. In the second phase, a systematic review of HIV-related studies in Iran was conducted following the PRISMA protocol to assess quality and relevance. The third phase utilized a three-round Delphi method to collect expert feedback, which was used to prioritize research areas based on their importance and feasibility.

Results: A systematic review of 6,310 sources yielded 745 documents for full-text analysis. Key research domains identified included prevention, diagnosis, care and treatment, epidemiology, and co-infections. Quantitative analysis indicated that 23% of studies focused on co-infections, while ethical issues were addressed in only 0.04%. Qualitative assessment revealed that 54% of reviewed studies were of low quality. Subsequent expert consultation and multi-criteria decision analysis ranked laboratory research and co-infections as the highest priorities. Specific sub-areas identified included molecular epidemiology and interventions addressing stigma and discrimination. Despite being highly cost-effective and urgently needed, research on stigma-related interventions exhibited a significant gap.

Conclusion: The study identified 11 main research areas and 60 sub-areas as priorities for HIV/AIDS research in Iran, highlighting the need for strategic funding and research planning. Ethical considerations and laboratory improvements are essential for enhancing public health outcomes and addressing emerging challenges in the HIV epidemic.

Background: Alcohol, smoking, and substance use among medical students are significant health concerns that impact their well-being and their future roles as health advocates. This study aimed to investigate the prevalence of these behaviors and related risk factors among medical students in southern Iran.

Methods: This cross-sectional study was conducted among medical students in Shiraz, in southern Iran, in 2024. Data were collected using the World Health Organization's alcohol, smoking, and substance involvement screening test (ASSIST), supplemented with questions on demographic details, family and friend substance use, mental health, and major satisfaction. The sample was selected using the stratified random selection method. Logistic regression models were used to identify factors associated with substance use, controlling for potential confounders. P<0.05 was considered statistically significant. All analyses were performed using SPSS software (version 26, SPSS Inc., USA).

Results: The study included 360 medical students, of whom 51.9% were men, with a mean age of 22.62±3.02 years. The lifetime prevalence was 27.5% for alcoholic beverages, 26.7% for tobacco products, 14.4% for sedatives or sleeping pills, and 15.8% for electronic cigarettes and vapes. Logistic regressions analysis revealed that having a family member who uses substances (OR=1.8, 95% CI: 1.01-3.5), having a friend who uses substances (OR=3.9, 95% CI: 2.0-7.8), being male (OR=1.8, 95% CI: 1.03-3.2), and having a recent history of mental illnesses (OR=2.8, 95% CI: 1.1-7.1) were positively associated with lifetime cigarette use.

Conclusion: The prevalence of alcohol, smoking, and substance use among medical students in southern Iran is concerning. These findings emphasized the significance of targeted interventions to reduce and prevent use within this population.

Background: Retrosternal burning is often linked to gastroesophageal reflux disease. However, it can also indicate other gastrointestinal disorders. This study aimed to compare and assess upper gastrointestinal (UGI) endoscopic findings in patients with and without retrosternal burning to determine its clinical significance.

Methods: This cross-sectional study analyzed data from 5,561 patients who underwent UGI endoscopy in Khorramabad, Iran (2018-2023). Required data, such as demographics, clinical symptoms, and endoscopic diagnoses, including the grade and severity of esophagitis and sliding hiatal hernia, were collected and compared. Statistical significance was set at P<0.05.

Results: Of the patients, 57.08% were women. The most common indications for endoscopy were dyspepsia and retrosternal burning. Sliding hiatal hernia (49.73%), esophagitis (60.04%), and antral gastropathy (76.53%) were the most frequent endoscopic findings. Grade 2 was the most prevalent type in patients with hernias (74.80%), and among patients with esophagitis, Grade A was predominant (87.36%). Retrosternal burning showed a significant positive association with sliding hiatal hernia, esophagitis, gastric antral gastropathy, and inlet patches (P<0.001). In contrast, the absence of retrosternal burning was associated with gastric ulcers, gastric and esophageal masses (P<0.001), duodenal ulcers (P=0.037), and bulb deformities (P=0.015). A significant association was found between retrosternal burning and the severity of both sliding hiatal hernia and esophagitis (P<0.001).

Conclusion: Retrosternal burning was frequently observed in patients with certain UGI structural abnormalities, such as sliding hiatal hernia and esophagitis, suggesting a possible association. Based on the findings of the present study, a more comprehensive diagnostic approach might be warranted for patients presenting with retrosternal burning to evaluate them for potential structural abnormalities.

Background: Idiopathic oligoasthenoteratozoospermia (iOAT) treatment still poses significant challenges. This study aims to compare the therapeutic efficacy of probiotics on sperm parameters of iOAT patients with placebo and antioxidants.

Methods: In this triple-blind, randomized controlled trial, 110 men with iOAT were assigned to receive either a probiotic (Familact^®), an antioxidant (Sperigen^®), or a placebo daily for 3 months, in two academic centers in Iran (Isfahan and Yazd). The study was conducted from July 2021 to April 2022. Sperm parameters were analyzed using computer-assisted semen analysis. The main measured outcomes included semen volume and sperm features, including motility, morphology, and concentration. Changes in semen parameters were assessed using linear mixed-effects models with fixed effects for time, group, and their interaction. Estimated marginal means were compared across groups using Bonferroni-adjusted pairwise tests.

Results: Overall, 110 men (mean age of 34.3±4.5 years) were included in the final analysis. Significant Time×Group interactions were found for sperm concentration (P=0.003), motility (P<0.001), and morphology (P<0.001), but not for semen volume (P=0.71). After 3 months, the probiotic group showed significantly greater improvements in sperm concentration (10.42±1.11×10⁶/mL, P=0.007), motility (46.65±3.73%, P=0.001), and morphology (4.31±0.21%, P<0.001) compared to the placebo group. Additionally, probiotics outperformed antioxidants in morphology (P<0.001) and motility (P=0.009).

Conclusion: This study is the first to directly compare probiotics and antioxidants in treating iOAT. Probiotics showed superior performance in sperm motility and morphology compared to antioxidants, although drawing a strong conclusion requires further robust studiesTrial Registration Number: IRCT20150420021869N5.

Spastic paraplegia 50 (SPG50) is a rare autosomal recessive disorder caused by mutations in the AP4M1 gene (OMIM 602296). It is characterized by spasticity, severe intellectual disability, and delayed or absent speech. The present study reported a case from consanguineous parents, where the affected child presented with intellectual disability, seizures, muscle weakness, and deep white matter hyperintensity. Whole exome sequencing (WES) of the proband identified a novel, homozygous frameshift variant, c.258delG:p.A87Pfs*44, in the AP4M1 gene, which was confirmed by Sanger sequencing. This variant is predicted to cause a large truncation of the protein, leading to a loss of function. Molecular modeling and docking analyses further revealed that the loss of a substantial protein segment disrupts proper intramolecular interactions. A review of the literature on Iranian families with SPG50 yielded few reports, consistent with the disease's rarity. This study expanded the knowledge of the clinical and genetic features of SPG50 and underscored the importance of this variant for genetic diagnosis and counseling in affected families.