Medical Journal of the Islamic Republic of Iran最新文献

Background: Children with autism spectrum disorders (ASD) show prominent deficits in pragmatic aspects of language such as spoken narrative. Deficits in spoken narrative in school years lead to deficits in reading comprehension. Therefore, this randomized clinical trial research examined the influence of narrative intervention on spoken narrative and reading comprehension abilities in children with ASD.

Methods: In the current double-blind, randomized clinical trial study, 21 students with ASD from second to seventh grade participated in the study. Two intervention methods were provided three times a week and a total of 24 sessions of 45 minutes. The experimental group received the Supporting Knowledge in Language and Literacy (SKILL) program and the control group received Traditional Language Therapy (TLT). The score of macrostructures, microstructures, perspective-taking index, narrative complexity, Story knowledge index, and reading comprehension score were measured pre and post-intervention. ANCOVA was used for between- within-group comparisons analysis.

Results: The experimental group indicated significant improvement in macrostructure (P < 0.001, η² = 0.614), microstructure (P = 0.012, η² = 0.303), narrative complexity (P < 0.001, η² = 0.585), story knowledge index (P < 0.001, η² = 0.574) and perspective taking index (P < 0.001, η² = 0.553) compared to the control group. However, the difference between the two groups in reading comprehension skills was not significant in post-intervention (P = 0.457, η² = 0.031).

Conclusion: The results showed the efficacy of the three stages of the SKILL program compared to TLT in spoken narrative. Also, the results of the study showed that the SKILL program and TLT have the same effect on improving reading comprehension.

Background: No study was conducted to investigate the association between principal component (PCA) derived meal-based dietary patterns and odds of major depressive disorder. We aimed to explore the association between major dietary patterns at breakfast and oddsof major depressive disorder (MDD).

Methods: A total of 200 drug-free patients with MDD and 200 healthy individuals were enrolled in this age- and sex-matched case-control study. Dietary intake was assessed using 24-hour dietary recall. PCA was applied to identify meal-based dietary patterns. The Beck Depression Inventory-II questionnaire was used for screening depression in the control group. A trained interviewer documented socioeconomic status and anthropometric measurements using standardized procedures. Conditional logistic regression was performed to find the association between patterns and MDD odds.

Results: The mean age of the participants was 45.4 ± 10.7 years and 67.5% (270 participants) were women. We identified 3 major dietary patterns at breakfast including "healthy," "oil and egg," and " legumes and condiments" patterns. High adherence to healthy dietary patterns was associated with decreased odds of MDD (odds ratio (OR), 0.55 (95% CI, 0.32, 0.94); P = 0.030). Neither "oil and egg" nor "legumes and condiments" patterns were associated with MDD.

Conclusion: Healthy dietary patterns were associated with lower odds of MDD. However, no significant relationship was detected between the "oil and egg pattern" and "legumes and condiments pattern" and the odds of MDD. Recommendations for reducing the odds of MDD can be focused on increasing adherence to healthy dietary patterns at breakfast. It is recommended to conduct prospective design studies to confirm these findings.

Background: Compensatory errors are a conventional part of an articulation disorder identified by speech pathologists in patients with Cleft palate (CP). This study aimed to evaluate the effect of new mixed articulation therapy on the perceptual and acoustic features of these errors.

Methods: The single-case experimental design, ABA design, was used in this study. Five CP young children ages 3.9 to 5.4 months, received online multimodal articulation therapy for 5 weeks, 6 sessions per week, utilizing both standard and maximum opposition approaches. Patients underwent baseline and follow-up sessions before and after treatment for 3 weeks-1 session per week. The percentage of compensatory errors was calculated as a perceptual measure, and 2 acoustic measures-including the slope of the locus equation (LE slope) and the overall F2 Transition Frequency Extent (TFE)-were analyzed.

Results: Compensatory errors were eliminated in all 5 participants with the mixed articulation therapy (Percentage of nonoverlapping data [PND] ≥80%, percentage of Improvement Rate Difference [IRD] ≥73.33%), and this therapy effect was maintained for up to 3 weeks of follow-up. The acoustic measures showed a difference in the F2 changes during CV transition in compensatory error before and after therapy.

Conclusion: This study supports the hypothesis that online mixed articulation therapy in children with CP can eliminate compensatory errors. The results of this study can also help extend the knowledge about F2 changes during CV transition in compensatory error before and after speech therapy to create objective and visual diagnostic documentation for patients with CP and prediction of some coarticulation models.

Background: Nephrolithiasis is a common condition that has been linked to various systemic diseases. Recent studies have suggested that young patients with nephrolithiasis are at increased risk of developing premature atherosclerosis. This study aims to investigate the relationship between nephrolithiasis and systemic disease by examining the association between aortic calcification and the severity of kidney stone disease.

Methods: This study employed a matched case-control design involving 144 patients with kidney stones and 144 non-stone formers. All participants underwent non-contrast abdominal and pelvic CT scans. The Agatston score was used to quantify the severity of aortic calcification. The data were analyzed and compared between the two groups. Quantitative data were analyzed using Pearson's chi-square test. Non-parametric data were analyzed using the Mann-Whitney test.

Results: The Agatston score was measured in both case and control groups, with mean values of 316±734 and 231±706, respectively. However, the difference between the two groups was not statistically significant (P = 0.122). Notably, a significant correlation was observed between Agatston score and stone size (P = 0.014). The value of the correlation coefficient is 0.23, which shows the increase in severity of aortic calcification with increasing stone size. A comparison of the Agatston score between male kidney stone formers patients aged 45 years or younger and controls revealed a statistically significant difference, with a p-value of 0.049, indicating more pronounced aortic calcification in the patient group.

Conclusion: These results suggest that there may be a shared pathophysiological mechanism underlying both nephrolithiasis and atherosclerosis.

Background: Falls are considered one of the leading causes of accidental deaths and nonfatal accidental injuries in older adults. Previous research indicates a 1-in-5 yearly fall incidence among Iranian older adults. To examine specific risk factors within this population, our study aimed to evaluate fall risk factors such as obesity, sarcopenia, functional mobility, and activities of daily living (ADL) scores.

Methods: This cross-sectional study used data from the first wave of the Ardakan Cohort Study on Aging (ACSA), involving participants ˃50 years who lived in Ardakan, Iran. The primary outcome was fall history in the past 12 months. The main biomechanical variables included body mass index (BMI), muscle strength, gait speed, static balance, and mobility-assisting devices. Sarcopenia was assessed based on the ratio of hand grip strength to BMI. Multiple logistic regressions assessed associations by odds ratio (OR) and 95% confidence interval.

Results: The final analysis included 4983 participants, 994 of whom reported at least 1 fall. Participants had a mean age of 62.21 ± 4.47 years (50-86 years), with a 48% male distribution. The results of multivariable logistic regression indicated that obesity (OR, 1.02 [95% CI, 0.70- 1.47]; P = 0.910), waist-to-hip ratio (OR, 1.02 [95% CI, 0.74-1.40]; P = 0.903), hand grip strength (OR, 1.20 [95% CI, 0.87-1.66]; P = 0.255), and sarcopenia (OR, 1.11 [95% CI, 0.82- 1.51]; P = 0.474) did not have significant associations with falls. However, impaired standing balance test (OR: 1.64 [95% CI, 1.09-2.47]; P = 0.017) and dependency on ADL (OR, 1.94 [95% CI, 1.05-3.56]; P = 0.032) increased falling.

Conclusion: Impaired balance tests and dependency on ADL increase the risk of falls in older adults. However, obesity indicators, sarcopenia, and gait speed were not associated with the risk of falls.

Background: Aging is an inseparable part of life, accompanied by mild to severe cognitive disorders. This study aimed to investigate the influence of balance-based interventions on cognitive function in older adults, encompassing both healthy individuals and those with mild cognitive impairment (MCI).

Methods: A systematic review was conducted by searching multiple databases up to April 2023, and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist was followed for reporting. Sixteen studies, comprising 1148 participants aged 43 to 89 years, were analyzed. Balance exercises were administered 1 to 3 times per week, lasting 30 to 60 minutes per session. Methodological quality was assessed using the Downs and Black checklist. A meta-analysis was conducted for executive functions (Stroop Test) and complex attention (Trail-Making Test, TMT A&B), while other outcomes underwent qualitative analysis.

Results: Qualitative analysis revealed positive effects on specific executive functions and complex attention aspects. However, the meta-analysis did not show significant differences in scores between balance training and control groups, which included healthy adults receiving nonbalance interventions or no intervention.

Conclusion: Limited research and methodological constraints hinder conclusive findings on balance-based interventions for older adults' cognitive functions. Yet, these interventions show the potential to enhance executive function and complex attention, emphasizing the need for further research in disability and rehabilitation.

Background: Treatment of hypertrophic burn scars is challenging. Intralesional injection of corticosteroids has been the first line of treatment. Triamcinolone Acetonide (TA) and Bleomycin (BLE) are standard therapeutic options. We conducted a comparative study to measure the effects of BLE and TA on hypertrophic burn scars.

Methods: In this clinical trial, we enrolled 25 patients with hypertrophic burn scars in this study. In each patient, two adjacent affected areas on the body were randomly selected for intralesional injection of TA and BLE. The size of the burn scars was between 10 and 40 cm2 (square centimeter). The injections were repeated at intervals of four weeks for three periods. Follow-up of patients continued until the end of the fourth month of treatment. We used the Vancouver Scar Scale and Patient and Observer Scar Assessment Scale system to compare the recovery of each lesion. Means, standard deviation, and p-values comparing the treatment of lesions with BLE and TA using two different scales were reported. Independent samples t-test and paired sample t-test were used to find out a statistically significant difference between BLE and TA treated lesions.

Results: The results showed that the hypertrophic scar scores in BLE and TA lesions were statistically significant from the perspective of patients and physicians (P = 0.035). The mean score of hypertrophic scars in the BLE and TA groups was also statistically significant (P = 0.023). The proportion of individuals who had no side effects after taking BLE and TA was much higher than those who experienced skin pain or hypopigmentation.

Conclusion: Intralesional BLE injection is more effective than TA in treating hypertrophic scars. Further studies with larger sample sizes are needed to approve these results.

Background: Brain ischemia is one of the leading causes of morbidity and mortality in infants. Currently, many factors influence the degree of development of ischemia and the consequences affecting the child's body. The purpose of this study was to find the characteristics of the physical and psychomotor development of children with brain ischemia.

Methods: Based on empirical data, physical (centile tables were used) and psychomotor development (Griffiths scale was used) were studied in 246 full-term children who suffered mild and moderate brain ischemia (ICD-10 codes: 91.1-91.4). There was a frequency of physical disharmony and psychomotor dysfunction, association with each other and the modeling of prognostic characteristics. The following methods were used for the analysis: Pearson chi-square calculation, Kaplan-Meier method and logistic regression.

Results: The prevalence of physical disharmony in the studied population of children who had cerebral ischemia is 19.5%, and that of psychomotor dysfunction is 35.0%. The results of the analysis indicate the presence of an association between physical development and psychomotor development of children with cerebral ischemia (P ≤ 0.001; %95 CI OR 1.961-7.270). The disharmony of physical development in children with cerebral ischemia is higher in female children (OR = 2.061, CI = 1.002-4.236), and it grows with an increase in the childbearing age of the mother (OR = 1.090, 95% CI = 1.018-4.236) and decreases with a decrease in the birth weight of the child (OR = 0.189, 95% CI = 0.104-0.345). The probability of occurrence of psychomotor dysfunction is higher in children whose mothers had a complicated birth (OR = 2.065, 95% CI = 1.209-3.527).

Conclusion: In children who have suffered brain ischemia, 1/5 of cases develop physical disharmony, and 1/3 of cases develop psychomotor dysfunction. These long-term consequences studied are interrelated with such prognostic characteristics as childbearing age and complicated childbirth in the mother, as well as the sex and weight of the child. The incidence of a combination of physical disharmony and psychomotor dysfunction in children who have suffered cerebral ischemia is 11.8%.

Background: The involvement of inflammation in the start and advancement of atherosclerotic plaques in acute coronary syndrome has been clarified. White blood cell count and its differential are key inflammatory markers in cardiovascular disease, with the neutrophil-to-lymphocyte ratio (NLR) emerging as a marker of inflammation and a predictor of mortality in patients with acute coronary syndrome. The study aims to investigate the utility of neutrophil to lymphocyte ratio and other complete blood count parameters as a risk stratification tool and independent predictor of Global Registry for Acute Coronary Events (GRACE) risk score in Non-ST segment elevation acute coronary syndrome (NSTE-ACS).

Methods: This was a cross-sectional retrospective single-center study conducted in Baghdad Teaching Hospital. A total of 110 patients diagnosed with NSTE-ACS were enrolled in this study. Demographic data and components that determine the GRACE risk score were recorded at admission to the emergency department alongside risk factors for coronary artery disease. Venous blood for relevant laboratory analysis was obtained from all patients. Patients were categorized into three risk groups according to the GRACE risk score. The study results were statistically analyzed using the one-way Analysis of Variance (ANOVA) test and the Kruskal Wallis test. Spearman test and multiple linear regression analysis were used for correlation and identification of independent predictors respectively.

Results: The mean age of patients was 59.4 years with a standard deviation of 21.1 years. The majority of them were males (61.8%). The predominant portion (102) had non-ST elevation myocardial infarction (NSTEMI). The mean total white blood cell count, absolute neutrophil count, absolute lymphocyte count, and neutrophil to lymphocyte ratio of the patients were 11.1 ×103/ml, 8.7 ×103/ml, 1.7 ×103/ml, and 5.9 respectively. The mean admission left ventricle ejection fraction (LV EF) of the patients was 52.5 % with a standard deviation of 9.6 %. There is a significant positive correlation between NLR and GRACE risk score (r = 0.339, P < 0.001) and a statistically significant negative correlation between NLR and LV EF (r = -0.385, P = 0.005).

Conclusion: This study showed a statistically significant association and positive correlation between neutrophil-to-lymphocyte ratio (NLR) and Global Registry of Acute Coronary Events (GRACE) risk score, so neutrophil-to-lymphocyte ratio (NLR) is a valuable marker for risk stratification and prognosis in NSTE-ACS patients, serving as an independent predictor of the GRACE risk score.

Background: The narrative review aims to explore CRC pathogenesis by deciphering genetic-environmental interactions, analyzing the tumor microenvironment's role, and assessing treatment responses. These objectives seek to enhance clinical decision-making and improve CRC patient care through a comprehensive understanding of the disease.

Methods: A narrative review from 2019 to 2024 on colorectal cancer (CRC) pathogenesis and treatment strategies was conducted. Systematic literature searches were performed on PubMed, using CRC-related keywords ("Colorectal Neoplasms"[Mesh]) AND "Tumor Microenvironment"[Mesh]. Screening yielded 233 eligible studies, with 14 highly relevant ones included. PRISMA guidelines were followed for transparency and reproducibility.

Results: This narrative review spanning 2019-2024 shows diverse study designs (5 clinical studies, 4 randomized controlled trials, 2 cohort studies, and 3 systematic literature reviews) with varied sample sizes (from 14 to 4000 participants). Genetic mutations like KRAS and BRAF are significant in colorectal cancer pathogenesis, with 8% exhibiting MMR proficiency. Immune cells and paracrine signaling are influential, and therapeutic responses vary, with limited efficacy reported in certain combinations.

Conclusion: This narrative review highlights CRC's multifactorial nature and complex tumor dynamics. Integrating genetic, environmental, and immune factors, personalized therapies are pivotal for efficacy. Continued research is crucial for optimizing treatments and improving patient outcomes, emphasizing the need for multifaceted, patient-tailored approaches in CRC management.