Medical Journal of the Islamic Republic of Iran最新文献

Background: Hedging generally serves several important rhetorical and epistemic purposes in academic writing, allowing authors to qualify their claims, delay potential challenges, and preserve their credibility. This study aimed to identify the most frequently used types of hedging devices in basic science and clinical science research studies and to determine whether there was a significant difference in the use of hedging devices between these two types of research studies published in the Medical Journal of the Islamic Republic of Iran (MJIRI) in 2024.

Methods: This study employed a quantitative, corpus-based research design. Three PhD holders in applied linguistics examined the whole 150 published papers in 2024 in MJIRI and extracted the hedging devices manually from the conclusion sections of the papers. The frequency and type of the hedging devices were counted and recorded. The number and frequencies of the basic science and clinical science papers were recorded separately for later comparison. Hu and Cao's (2011) simplified taxonomy was used to classify the data. Descriptive statistics and Chi-Squared Tests were run using SPSS version 22 to answer the questions.

Results: In the clinical science papers, hedging were used 330 times, while the number was 154 for the basic science. In all four categories of the taxonomy, clinical studies enjoyed more hedging devices than basic science ones. The result of the inferential test showed that there was no statistically significant difference in using hedging devices between basic science and clinical science research studies (P=0.064).

Conclusion: Hedging is not limited to specific disciplines but is also influenced by journal standards and cultural factors. The findings underline the importance of balancing hedging with clarity, especially in medical writing where precise communication is essential.

Background: Rumination negatively affects emotional and psychological functioning in nonclinical populations and plays an essential role in psychological disorders as a transdiagnostic factor. This study examined factors that increase individuals' vulnerability to rumination, focusing on the relationship between emotional schemas and rumination, with emotional flexibility as a mediating variable.

Methods: This descriptive-correlational study used structural equation modeling (SEM). Participants were 578 Tehran residents (381 females and 197 males), recruited through a voluntary sampling method. Data were collected using the Ruminative Response Scale (RRS), the Persian version of the Emotional Schemas Scale (ESS-P), and the Emotional Flexibility Scale (EFS). SEM was employed for data analysis.

Results: Emotional schemas significantly predicted emotional flexibility (β = -0.25, P = 0.009) and rumination (β = 0.55, P = 0.001). Emotional flexibility also significantly predicted rumination (β = -0.26, P = 0.007). Furthermore, emotional flexibility significantly mediated the relationship between emotional schemas and rumination. Model fit indices for both the measurement model (χ²/df = 4.66, CFI = 0.95, NFI = 0.95, RMSEA = 0.064, GFI = 0.90, IFI = 0.95, SRMR = 0.052) and the structural model (χ²/df = 4.44, CFI = 0.94, NFI = 0.92, RMSEA = 0.069, GFI = 0.89, IFI = 0.94, SRMR = 0.056) indicated acceptable fit.

Conclusion: These findings suggest that emotional flexibility plays a crucial mediating role in the relationship between emotional schemas and rumination. Considering emotional flexibility in this context may provide a deeper understanding of the rumination process and inform management strategies.

Background: The principal mechanism underlying the development of ventilator-associated pneumonia (VAP) involves the aspiration of microorganisms from colonized oropharyngeal secretions past the endotracheal tube (ETT), followed by bacterial proliferation along the ETT surface. The Modified Clinical Pulmonary Infection Score (MCPIS) is commonly utilised to assist in the diagnosis and clinical evaluation of pneumonia. This instrument assesses various factors, including body temperature, leukocyte count, the volume and characteristics of tracheal secretions, oxygenation status, and results from chest imaging. Airway management through ETT intubation or tracheostomy plays a crucial role in ensuring airway patency, minimizing anatomical dead space, facilitating effective suctioning, and optimizing oxygen delivery.

Methods: This prospective cohort study included individuals diagnosed with non-traumatic brain damage, selected using successive sampling according to established inclusion and exclusion criteria. The sample size was established at a 90% confidence level and a precision of 20%, with statistical significance defined at p < 0.05. The research was carried out at Wahidin Sudirohusodo Hospital in Makassar, from March 2024 to April 2025, and involved evaluating the MCPIS both before and after tracheostomy, as well as in patients who did not undergo the procedure. Data analysis was conducted using SPSS version 25, applying the Wilcoxon Signed-Rank test to assess statistical differences.

Results: A total of 50 samples were included (25 with tracheostomy and 25 without). When the average MCPIS scores were analyzed, the tracheostomy group's score dropped from 4.92 to 3.20 (P=0.001), a statistically significant drop. On the other hand, MCPIS scores in the non-tracheostomy group increased from 5.04 to 5.60, although this difference was not statistically significant (P=0.158). Within the tracheostomy cohort, significant improvements were noted in the subcomponents of body temperature (P=0.009), tracheal secretion characteristics (P=0.003), and oxygenation status (P= 0.046). However, no meaningful changes were detected in the parameters of leukocyte count (P=0.564) and chest radiographic findings (P=0.222).

Conclusion: Tracheostomy was associated with improved MCPIS outcomes compared to non-tracheostomy, particularly in the components of temperature, tracheal secretion, and oxygenation.

Background: Although various factors have been proposed in connection with the recurrence of chronic subdural hematoma (cSDH), the results obtained in previous studies have not been consistent. This study was conducted to describe the risk factors for cSDH recurrence, drawing upon the current literature, and to provide an integrative framework that links these factors with underlying biological mechanisms.

Methods: In December 2024, a systematic literature search was performed using the Scopus, Web of Science, PubMed, and Embase electronic databases. The retrieved records were screened against eligibility criteria and selected in 2 stages. The Newcastle-Ottawa Scale (NOS) was utilized for bias assessment, and the PRISMA (Preferred Reporting Items for Systematic Reviews) checklist was employed to assess the methodological rigor and reliability of the selected studies and their findings.

Results: After applying the inclusion and exclusion criteria, 61 studies were retained for the systematic review. The principal risk factors associated with the recurrence of cSDH were elucidated and correlated with underlying pathophysiological processes. Lower Glasgow Coma Scale (GCS) scores and elevated postoperative neutrophil counts indicate increased inflammation. The use of antiplatelet and anticoagulant agents reflects coagulation dysfunction, which raises the risk of rebleeding. Additional factors such as male sex, older age, larger hematoma size, and shorter drainage duration relate to anatomical and clinical vulnerability. Radiological signs, such as high hematoma density and midline shift, support the role of structural brain changes. Comorbidities, including diabetes and hypertension, exacerbate vascular fragility, increasing recurrence risk. Early detection, effective postoperative drainage, and higher serum HDL levels contribute to a reduced risk of recurrence.

Conclusion: cSDH recurrence results from the complex interplay of biological processes, including inflammation, coagulation dysfunction, and structural brain changes, with clinical risk factors. Recognizing and targeting these integrated pathways is crucial for improving prevention and management strategies.

Background: Obstructive sleep apnea (OSA), a worldwide prevalent sleep-related breathing disorder, is associated with an increased rate of cardiovascular disease (CVD) incidence and higher all-cause mortality. Evidence demonstrates that OSA can contribute to subclinical cardiac damage and lead to a significantly higher risk of future heart failure. Speckle tracking echocardiography (STE) is a new technique that is useful for detecting subclinical dysfunction in patients without clinical manifestations of cardiac problems and who have normal conventional echocardiography. This review examines the application of STE for the early detection of subclinical dysfunction in all four heart chambers of individuals with OSA.

Methods: To provide an in-depth overview of the current evidence in this review study, we conducted a broad literature search across 4 major databases-PubMed, Scopus, Embase, and Web of Science-in July 2025. Keywords and combinations related to "speckle tracking echocardiography," "global longitudinal strain," "left atrium," "left ventricle," "right atrium," "right ventricle," and "obstructive sleep apnea" were used to identify relevant studies. We aimed to explore studies examining subtle functional alterations in cardiac chambers among patients with OSA using STE. Systematic reviews, meta-analyses, case reports, abstracts, letters, conference proceedings, and non-English publications were excluded to maintain focus on original research and clinical insights.

Results: After screening by title/abstract and full-text review, from a total of 145 studies, 29 were included based on the best match with our inclusion criteria. Our key finding in this systematic review were as follows: (1) left atrium (LA) subclinical systolic and early diastolic strain/strain rate decrease before alteration in conventional echocardiography indexes; (2) left ventricle (LV) early detectable strain/strain rate decrease in all its 3 contracting directions (longitudinal, circumferential, and radial); (3) subtle changes in LV myocardial work index (MWI); (4) valuable information about early strain changes in different directions of RV wall contraction despite its complex geometry.

Conclusion: Our study highlighted available studies describing subclinical strain and strain rate alterations in each cardiac chamber through speckle tracking echocardiography and addresses this method's feasibility to detect early changes in myocardium as a result of OSA.

Background: Patient education plays a pivotal role in improving health outcomes and enhancing the quality of care. With the evolution of educational approaches and the rise of new technologies, there is a growing need to comprehensively examine the current methods used within Iran's healthcare system. This scoping review aims to identify and map the various techniques, tools, and outcomes of patient education in Iran from January 20, 2011, to April 20, 2025.

Methods: A scoping review was conducted based on Arksey and O'Malley's framework. A systematic search was carried out across national databases, including SID, Magiran, IranMedex, Google Scholar, Scopus, and PubMed, using keywords related to patient education. A total of 200 articles were retrieved in the initial search, of which 29 met the inclusion criteria and were analyzed using a structured data extraction form.

Results: The review identified multiple approaches to patient education in Iran, including patient-centered, family-centered, technology-based, interactive, empowerment-focused, and learning-style-oriented methods. Reported outcomes included reduced anxiety, enhanced awareness, improved self-care capabilities, and increased patient satisfaction.

Conclusion: Patient education in Iran is evolving from traditional models toward modern, technology-enhanced, and individualized approaches. The study underscores the need for comprehensive national strategies and policies to support and institutionalize effective patient education practices.

Background: Paxlovid, an investigational oral therapeutic comprising Nirmatrelvir (NMV) and Ritonavir, is being developed to treat SARS-CoV-2 infections and reduce the risk of severe disease, hospitalization, and mortality. This study evaluates the effects of Paxlovid on the skeletal morphogenesis of rat fetuses at doses up to 1000 mg/kg/day, adhering to the International Council for Harmonisation guidelines for embryo-fetal development studies.

Methods: In this morphological study of the morphogenesis of the skeletal system, Pregnant rats were allocated into four groups (one control and three subjected to varying treatment levels). fetal weight, crown-rump length (CRL), and abdominal circumference (AC) were measured. Skeletal abnormalities were assessed using double staining with Alizarin red S and Alcian blue. Data were evaluated using Microsoft Excel. One-way analysis of variance (ANOVA) was performed to compare fetal weight, CRL, and AC among the experimental groups and the control group. When significant differences were detected, Tukey's Honestly Significant Difference (HSD) test was used for post hoc comparisons. Statistical analysis was conducted using XLSTAT 2016 software, and a p-value of < 0.05 was considered statistically significant.

Results: Results indicated that mothers in the Paxlovid treatment groups experienced less weight gain compared to controls (252 ± 19.84 g, 224.1 ± 14.1 g, 232.1 ± 15.5 g, 246.2 ± 12.8 g, respectively, on GD21). On GD (gestational day) 21, fetuses from treatment groups exhibited reduced weight (3.5 ± 0.6 g, 1.7 ± 0.8 g, 1.8 ± 0.8 g, 2.5 ± 0.3 g, respectively), CRL (35 ± 3.8 mm, 25.9 ± 6.5 mm, 26.36 ± 6.2 mm, 31.58 ± 2.2 mm, respectively), and AC (12.2± 1.2 mm, 9.9 ± 1.4 mm, 9.8 ± 1.6 mm, 11 ± 1 mm, respectively) compared to controls; however, no skeletal abnormalities were detected through staining methods.

Conclusion: The findings suggest that while there are observable effects on maternal weight and fetal growth parameters, the administration of Paxlovid did not result in skeletal system abnormalities in the embryos. This research indicates a minimal risk of fetal harm associated with Paxlovid use, reinforcing its safety profile regarding fetal development. These results contribute to the understanding of Paxlovid's implications for pregnant individuals and support its potential therapeutic use against SARS-CoV-2.

Background: Ankle sprains are common injuries in sports involving jumping and rapid directional changes. This study aimed to assess the incidence of ankle sprains among nonprofessional athletes in futsal, volleyball, and basketball and to identify associated risk factors-including sport type, previous ankle injuries, and leg dominance.

Methods: This cross-sectional study included 72 nonprofessional university athletes, with 24 participants each from futsal, volleyball, and basketball teams. Participants were selected using simple random sampling. Data collected included demographic information, ankle sprain incidence, history of previous injuries, and leg dominance. Logistic regression and odds ratios (OR) were utilized to analyze relationships between variables.

Results: The overall incidence of ankle sprains was 43%, with lateral sprains being the most common type. A previous history of ankle injuries was reported by 54% of participants. Basketball players had the highest incidence (58%), followed by volleyball (37.5%) and futsal (33.3%). No significant association was found between sport type and ankle sprain occurrence in either crude or adjusted analyses (crude P = 0.171; adjusted P = 0.181-0.201). However, a history of previous ankle injuries was a strong predictor of future sprains (crude OR = 33; P < 0.001; adjusted OR = 25; P = 0.002). Leg dominance showed a limited effect, with only 23% of injuries occurring on the dominant side (crude P = 0.462; adjusted P = 0.601).

Conclusion: The findings indicate that sport type does not significantly influence ankle sprain occurrence; however, a previous history of ankle sprains is a strong predictor of future injuries.

Background: Economic sanction is a planned action by one or more governments to limit economic, commercial, and/or financial relations to exert pressure on the target country. Information about the impact of sanctions on social capital within Iranian society is scarce. Therefore, this study investigated how an economic crisis affects social capital in medical education.

Methods: This qualitative study involved conventional content analysis. Faculty members or employees with notable work experience in education in universities of medical sciences constituted the population of this study. Participants were purposefully selected and invited to be interviewed. Semi-structured, in-depth interviews were used to collect the data. Eleven interviews were conducted in person, while 2 were conducted remotely via WhatsApp. Data were analyzed using the Graneheim and Lundman method.

Results: Out of a total of 13 interviews analyzed, 161 initial codes were extracted. After removing similar codes and merging the remaining codes, 17 codes remained. Continuous comparison of these 17 codes led to the emergence of 3 subcategories: (1) Damage to ethics, human dignity, human values, and human principles; (2) Reduction of the genetic resources of intelligence and genius; and (3) Damage to human resources and human infrastructure. Finally, we merged these subcategories into 1 category, which we called Damage to Social Capital.

Conclusion: Economic crises or sanctions will unavoidably damage medical science universities' social capital. Creating an ethical charter and using it as the basis for human resource training is advised.

Background: Polycystic ovary syndrome is a prevalent endocrine disorder and a major cause of infertility. Although lifestyle modification is emphasized in both Persian and modern medicine, the role of sleep is often overlooked. This review investigates the role of sleep in different patterns of PCOS management from both perspectives.

Methods: The study is a narrative review. Literature from both Persian and modern sources was analyzed regarding the impact of various factors on PCOS, with a focus on the impact of sleep. Modern databases were searched with defined keywords and criteria.

Results: Modern studies often describe sleep disorders as consequences of PCOS. However, Persian medicine considers poor sleep a potential cause of the disease, highlighting the need for personalized sleep recommendations.

Conclusion: It is recommended that sleep, like diet and exercise, be included in the lifestyle management of PCOS. For this purpose, more clinical studies are needed to prove the connection between improving sleep and reducing disease outcomes.