Medical Journal of the Islamic Republic of Iran最新文献

Background: With the advancements in fertility preservation technology, such as egg freezing, women could now preserve their gametes for potential future parenthood. It is important to explore how the needs of women are addressed and supported throughout the egg-freezing process. By investigating the experiences of research participants, we aimed to identify how reproductive rights are interpreted for egg-freezing applicants in Iranian infertility centers.

Methods: In this qualitative study, 16 service providers and 5 egg-freezing applicants in infertility treatment centers in Iran were interviewed. Data were collected through semi-structured interviews. All interviews were recorded and after transcription, conventional qualitative content analysis was used for data analysis.

Results: Issues related to specific requirements for evaluating the reproductive rights of egg-freezing applicants included the following: the right to preserve fertility, the right to access psychological support services,the right to decide the fate of the oocyte, the right to trust and privacy, and the right to one's own body.

Conclusion: Women had the right to decide the fate of their eggs and choose to preserve them for future uses. Service providers played a role by offering comprehensive information about the egg-freezing process, considering applicants' requests, and offering psychological support to those interested. It seemed, trusting and using this emerging technology, users can protect their reproductive rights by preventing infertility in the future.

Background: The coronavirus disease 2019 (COVID-19) outbreak has caused significant health and social impacts worldwide. Severe acute respiratory syndrome coronavirus 2, the virus responsible for COVID-19, can lead to neurological symptoms, including Guillain-Barré syndrome (GBS). This study aimed to compare the clinical manifestations, electrophysiological characteristics, degree of disability, and treatment outcomes of GBS patients with COVID-19 (COVID-19-related GBS) with GBS patients without COVID-19.

Methods: This retrospective cross-sectional multicenter study investigated the clinical characteristics and outcomes of GBS patients with a history of COVID-19. A total of 60 patients with GBS and a history of COVID-19 were included in the COVID-19 group, while 56 patients with GBS without COVID-19 were included in the control group. Demographic, clinical, therapeutic, and prognostic data were compared between the 2 groups.

Results: The COVID-19 patients were older (56.2 ± 16.8 vs 47.46 ± 19.25; P = 0.01), and there was no sex difference between the 2 groups. The most frequent electrophysiological type was acute inflammatory demyelinating polyradiculoneuropathy (55% and 41%) in both groups. Although almost half of the patients in both groups were admitted to the intensive care unit (ICU), the group of COVID-19 patients required mechanical ventilation more (16.6% vs 0%; P < 0.001). Also, the COVID-19 group had more length of ICU stay (P < 0.001). Although some electrophysiological differences were found (acute motor axonal neuropathy was more frequent in the non-COVID-19 group), The analysis did not show any difference in the response to treatment scores based on Phenotype, type of treatment, or electrophysiological pattern between the 2 groups of patients.

Conclusion: GBS in COVID-19 patients may have different manifestations and electrophysiological patterns, but the response to treatment and in-hospital prognosis were not different compared with GBS in non-COVID-19 patients.

Background: Several studies have evaluated RNFL thickness in PD, with only a few on other Parkinsonian syndromes. There is insufficient information on the pattern of changes in these patients who have dementia. Therefore, the present study examined the RNFL thickness in Parkinsonism patients with and without dementia.

Methods: In this cross-sectional study, all patients diagnosed with PD, MSA, and PSP from March 2017 to February 2019 were evaluated. The severity of the disease and the presence of dementia were determined using the UPDRS and MMSE tests, respectively. The thickness of the RNFL was measured in the superior, inferior, nasal, and temporal quadrants using the 3D-OCT 1000 Mark II. Statistical methods, including the independent t-test, one-way analysis of variance (ANOVA), and the Pearson correlation coefficient, were used to analyze the data at a significance level of 0.05 using SPSS statistical software.

Results: Fifty-three patients were examined. The mean age and mean UPDRS showed a significant difference between the groups, while gender and disease duration did not show. The mean RNFL thickness in the nasal sector had a significant difference among the three groups, with a thinner thickness in patients with MSA (P<0.05). Patients with PD, PSP, and MSA with dementia showed a significantly greater reduction in RNFL thickness in the upper and temporal quadrants, nasal quadrant, and upper and temporal quadrants compared to PD, PSP, and MSA without dementia, respectively (P<0.05).

Conclusion: Evaluating RNFL can be useful in predicting ocular involvement. Once validated in further studies, OCT may serve as a biomarker for predicting the presence or progression of movement disorders. OCT may also assist in predicting the presence of dementia in these patients by reflecting a more significant reduction in RNFL thickness compared to patients without dementia.

Background: Diabetic ulceration leads to amputation in up to 85% of cases. Managing a diabetic ulcer requires an expert team to prevent wound progression and apply proper supportive procedures, decreasing the risk of amputation. This study aimed to compare the clinical efficacy of toe-sparing surgery and toe amputation in patients with diabetic foot ulcers.

Methods: This cohort evaluated 54 consecutive patients with Diabetes Mellitus and chronic ulcers in the lower extremities. The patients were treated by bone resection with preserving toe and soft tissue or complete toe amputation. They were followed up for one year. We evaluated the relative risk for re-ulceration of the same toe, ulcers in other parts, increased levels of hemoglobin A1c (HbA1c), and infection between the two groups.

Results: The re-ulceration rate at the same toe was 12.9% in the toe amputation and 39.1% in the toe-sparing group (P < 0.001). The prevalence of other amputations in the toe amputation and toe-sparing surgery groups was 29.0% and 17.4%, respectively (P < 0.001). However, the infection rate was lower in the toe-sparing group (P < 0.001).

Conclusion: The re-ulceration rate was lower after toe amputation, and the infection rate was higher in the toe amputation group.

Background: Drug addiction is a serious public health concern. Tramadol addiction and dependence have been documented in recent years, most commonly in young adults, making tramadol use a significant health concern. The study investigated the long-term effects of tramadol intoxication on the γ-aminobutyric acid (GABA) system and tricarboxylic acid cycle enzymes in the brains of rats, focusing on regions with a high number of GABAergic neurons.

Methods: In this animal study, three treatment groups of adult male rats were considered. Rats were divided into three treatment groups: control no tramadol was given, Gp 25 mg/Kg tramadol was given 25 mg/kg for one month by oral gavage, and Gp 50 mg/Kg tramadol was given 50 mg/kg for one month by oral gavage for one month, and the enzyme activities for GABA transaminase (GABA-T), succinic semialdehyde dehydrogenase (SSA-DH), succinate dehydrogenase (SDH), and isocitrate dehydrogenase (IDH) were measured using ELISA kits, on brain tissue samples from the cerebellum, brain stem, cerebral cortex, thalamus, and hypothalamus. Histopathological analysis of the cerebral cortex was conducted using hematoxylin-eosin and Nauta silver staining. Statistical analysis for GABA shunt enzymes and tricarboxylic acid cycle enzymes was conducted using one-way ANOVA followed by Tukey's multiple means comparisons.

Results: Tramadol significantly (P < 0.05) reduced the levels of GABA-T, SSA-DH, and IDH enzymes across various brain regions, with the most pronounced reductions observed in the brain stem and hypothalamus. In contrast, SDH enzyme levels remained largely unchanged in most regions. Additionally, structural changes in the brain were noted, including vascular congestion, neuronal degeneration, and disruption of cortical layers. These alterations were more severe in the high-dose group, suggesting that higher doses of Tramadol may lead to more extensive brain damage.

Conclusion: Tramadol exposure was found to cause biochemical and histopathological alterations in the nervous tissue through impairment of GABA metabolism.

Background: The effectiveness of integrating a self-help training application with cognitive behavioral therapy (CBT) for treating maladaptive perfectionism remains unclear. This study evaluated the impact of combining CBT with a web-based program versus CBT alone on psychological outcomes in college students with maladaptive perfectionism.

Methods: This study involved 52 participants randomized to a 10-week intervention of either CBT or CBT combined with a web-based application. Outcomes assessed included perfectionism, depression, anxiety, stress, psychological well-being, procrastination, and life satisfaction, measured through self-reporting at baseline, posttreatment, and 3 follow-ups. Data analyses utilized independent t tests, chi-square tests for preintervention differences, and repeated mixed analysis of variance (ANOVA) to evaluate intervention effects over time, with effect sizes calculated using η².

Results: Participants had a mean age of 27.85 years (SD, 4.94), were predominantly female (n = 34; 74%), mostly single (n = 29; 73.9%), and held a master's degree (n = 20; 43.5%). Overall, 52 participants were randomized into 2 groups, with 26 participants in each group. Of these, 23 participants from each group completed the treatment and follow-up periods. The CBT combined with an App group demonstrated superior effectiveness in addressing perfectionism and improving interpersonal sensitivity, striving for excellence, and high standards for others compared with CBT alone. In addition, this combined treatment was significantly better than CBT in reducing stress, increasing psychological well-being, and improving life satisfaction.

Conclusion: Integrating a web-based self-help application with CBT effectively reduces maladaptive perfectionism and associated psychopathology, highlighting the potential benefits of combining digital tools with traditional therapeutic approaches.

Background: Language teachers in the classroom face a common challenge: students' lack of engagement in oral communication and limited problem-solving abilities. This study aimed to determine whether students who displayed a greater willingness to communicate also possessed critical thinking abilities.

Methods: This cross-sectional descriptive study was conducted in 2023 at the School of Health Management and Information. A total of 22 PhD students specializing in health services management were recruited. Data collection tools included McCroskey and Baer's and Baghaei's questionnaires measuring willingness to communicate, Honey's questionnaire assessing critical thinking, and an interview. Data were analyzed using SPSS Version 23. Pearson's Correlation Coefficient and t-statistic were employed to calculate the correlation between the 2 variables and the associated P values. For the interview, content analysis was utilized to identify factors influencing students' willingness to communicate in English.

Results: The students achieved high scores on 3 questionnaires independently. However, the correlation analysis revealed no statistically significant relationship between the students' willingness to communicate and their critical thinking abilities. Specifically, the correlation between McCroskey and Honey's questionnaires was r = 0.307, while the correlation between Baghaei and Honey's questionnaires was r = 0.003.

Conclusion: Given the importance of health tourism, it is crucial for PhD students, as future healthcare managers, to effectively communicate with medical tourists and make informed decisions in challenging situations. Therefore, it is recommended to create a conducive classroom environment that encourages students to participate in discussions, raise critical issues, and develop problem-solving skills.

Background: Evaluating the performance of a brace in the treatment of adolescents with idiopathic scoliosis, without considering the process of brace compliance, is not comprehensive and valuable. This study aimed to evaluate the multifaceted and complex modality of brace compliance by drawing a comprehensive model with a qualitative approach.

Methods: This study employed the grounded theory methodology to systematically explore and interpret factors affecting brace compliance, uncovering patterns and themes that influence treatment success. Data collection involved nonrandom convenience sampling of individuals from local clinics specializing in orthotic management of scoliosis. A semi-structured interview guide was utilized to explore participants' experiences, challenges, and perceptions related to brace compliance and orthotic treatment. We engaged in constant comparison analysis as data were collected until we reached saturation, where no new themes emerged from additional data.

Results: A total of 133 codes about the experiences of patients, parents, and specialists were extracted from the transcripts and categorized into 42 subthemes. The study identified 8 interconnected themes-including extensive lifestyle changes, visible improvements, supervision dynamics, result maintenance, a sense of difference, long-term commitment, monotony, and hope for a definitive treatment without surgery.

Conclusion: This comprehensive analysis provides valuable insights into the multifaceted nature of compliance with braces and the dynamic interplay between patients, their families, and the treatment process.

Background: The coronavirus disease 2019 (COVID-19) pandemic has heightened interest in using medicinal plants (MPs) for disease management. Considering regional, socioeconomic, and demographic differences, this study explores the determinants and consumption patterns of MPs among Iranian households before and after the pandemic.

Methods: This descriptive and analytical study was conducted using survey data from the the Iranian Statistics Center (ISC). from 2018-2019 (prepandemic) and 2020-2021 (postpandemic) to compare MPs consumption. Logistic regression analysis examined the impact of independent variables, and COVID-19 on MPs consumption. The outcome variable was household MPs consumption (yes: 1, no: 0), with explanatory variables including the sex, age, and marital status of the household head, education level, number of educated household members, place of residence (rural/urban), income quintile, and province.

Results: MPs consumption in Iran increased from 15.8% before the COVID-19 pandemic to 18.8% after.After COVID-19, the provinces with the highest MPs consumption were Markazi (43.7%), Guilan (39.2%), and Qom (34.3%). In contrast, the lowest consumption rates were observed in Lorestan (5.6%), Chaharmahal and Bakhtiari (5.6%), and Sistan and Baluchistan (6.1%). Overall, MPs consumption increased across all provinces and socioeconomic groups after the pandemic. Households led by women were more likely to consume MPs, with an adjusted odds ratio (aOR) of 1.280 (95% CI, 1.083-1.516, P = 0.010). Similarly, married heads had a higher likelihood of MPs consumption (aOR, 1.630 [95% CI, 1.161-2.297]; P = 0.010). Households with more educated members also showed increased odds (aOR, 1.380 [95% CI, 1.163-1.629]; P < 0.001). Rural residents had lower odds compared to urban residents (aOR, 0.830 [95% CI, 0.781-0.876]; P < 0.001). Higher-income quintiles were associated with increased MPs consumption, particularly in the fifth quintile (aOR, 1.800 [95% CI, 1.592-2.025]; P < 0.001). Additionally, COVID-19 significantly raised MPs consumption compared to prepandemic levels (aOR, 1.290 [95% CI, 1.212-1.367]; P < 0.001).

Conclusion: MPs consumption in Iranian households increased significantly during the COVID-19 pandemic, but these increases were not uniform across all socioeconomic and demographic groups. Health policymakers must address the quality, safety, and efficacy of MPs, their interactions with conventional pharmaceutical treatments, and the potential economic consequences associated with increased utilization.