Background: Dynamic knee valgus (DKV) is a well-established contributor to knee injuries, with women at higher risk. Traditional rehabilitation often emphasizes proximal muscle strengthening, but growing research suggests that foot and ankle dysfunction may play a critical role in DKV development. This study aimed to investigate the effects of a 6-week short foot exercise (SFE) program on the DKV angle, navicular drop, ankle dorsiflexion range of motion (DFROM), and proprioceptive acuity at the knee and ankle in women with DKV.
Methods: This quasi-experimental study involved 28 female university students (aged 20-30 years) with DKV and excessive navicular drop, assigned to either an SFE group or a control group. The intervention group performed supervised SFE sessions 3 times per week for 6 weeks. Measurements taken before and after the intervention included DKV angle, navicular drop, ankle DFROM, and proprioceptive acuity at the knee and ankle. Appropriate parametric and nonparametric statistical tests (t-tests, analysis of covariance, Mann-Whitney U, and Wilcoxon test) were used based on data distribution.
Results: After the intervention, the SFE group demonstrated significant improvements compared to the control group in DKV angle (adjusted mean difference = -4.0°, 95% CI: -6.0° to -2.1°, p = 0.001, d = 2.04), navicular drop (-4.2 mm, 95% CI: -5.4 to -2.9 mm, P<0.001, d=2.08), and ankle DFROM (+6.9°, 95% CI: 5.2° to 8.7°, P<0.001, d=2.89). Knee joint proprioception error decreased by -1.2° (95% CI: -1.8° to -0.7°, P<0.001, d=1.47), and ankle proprioception error (dorsiflexion) improved by -1.4° (95% CI: -2.5° to -0.6°, P=0.002, r=0.60). The control group showed no significant changes in any outcome (all P>0.05).
Conclusion: A structured 6-week SFE program effectively enhances foot posture, ankle mobility, and proprioceptive control, leading to reduced knee valgus in young women. These findings support the inclusion of distal kinetic chain exercises in rehabilitation programs aimed at correcting lower limb dysfunction and preventing knee injuries.
Background: Reliable estimates of key affected populations (KAPs), including people who inject drugs (PWID) and people who use drugs (PWUD), are essential for effective human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and harm reduction programming. This study compares how 3 methodological adjustments collectively modify PWID/PWUD size estimates across 4 Iranian cities.
Methods: Using data from mapping exercises in 4 Iranian cities (Ahvaz, Sari, Yazd, and Tehran), we applied 3 methodological adjustments: (1) frequency adjustment (correcting for infrequent hotspot attendance); (2) duplication adjustment (accounting for multihotspot visitors); and (3) hidden population adjustment (incorporating KAPs avoiding mappable sites). Input parameters were derived from field surveys and national studies, including the Iranian Mental Health Survey.
Results: Frequency adjustment increased initial PWID estimates (eg, Ahvaz: from 843 to 2104), while duplication adjustment reduced them by 29% to 37%. Hidden population adjustment (assuming 76% of PWID avoid hotspots) yielded final estimates of 1966 (Ahvaz), 854 (Sari), 663 (Yazd), and 28 (Tehran). PWUD estimates followed similar trends, although hidden population adjustments were limited by data gaps.
Conclusion: Standard hotspot mapping significantly underestimates KAP sizes if methodological biases are unaddressed. Our 3-step adjustment framework enhances accuracy but highlights limitations, including reliance on mobility assumptions and accuracy of the available national survey data. These findings advocate for integrating correction factors into KAP surveillance systems to optimize resource allocation for harm reduction.
Background: Despite observing all precautions, complications are not uncommon during transthoracic needle biopsy (TTNB). We aimed to evaluate the complications associated with TTNB in patients with lung masses from 1 center in southern Iran.
Methods: In this retrospective cohort study, data on complication rates, types, and potential risk factors from 87 biopsies were collected. Complications were assessed through immediate post-biopsy computed tomography (CT) scans and follow-up chest X-rays, and their correlations were evaluated with patient demographics, lesion characteristics, and procedural factors. Chi-square and Wilcoxon rank-sum tests were used for univariable analysis, and multivariable binary logistic regression analyses were conducted to control for potential confounders.
Results: The overall complication rate was 37.9% (95% CI, 27.6%-48.3%), with pneumothorax being the most common, occurring in 26.4% (95% CI, 17.3%-35.6%) of cases, followed by perilesional hemorrhage (17.2%) (95% CI, 10.3%-25.3%), hemoptysis (3.3%), and pleural effusion (1.1%). All pneumothorax cases were identified via immediate post-biopsy CT, and only 1 patient required chest tube insertion. No significant correlations were found between age, sex, presence of emphysema, lesion size, location, and depth, or needle path and the incidence of pneumothorax. However, a significantly higher perilesional hemorrhage incidence was observed for smaller lesion size (26 mm [interquartile range, IQR], 13,40 vs 43 mm [IQR, 24,73]; P = 0.019), deeper lesion (10 mm [IQR, 0.17] vs 0 mm [IQR, 0.10]; P = 0.041), and longer needle path (17 mm [IQR, 9.29] vs 0 mm [IQR, 0.7]; P < 0.001). Furthermore, 47.8% of pneumothorax cases identified on postbiopsy CT showed no signs on follow-up chest X-ray 3 hours later.
Conclusion: TTNB is generally safe, with a manageable complication profile. Early detection and appropriate follow-up are crucial, particularly for pneumothorax, which often resolves spontaneously. The findings underscore the importance of considering lesion characteristics to minimize complications during biopsy procedures.
Background: The widespread use of generic drugs (GDs) represents a key strategy for reducing medication costs for patients and the healthcare sector. Promoting the rational use of GDs requires a clear understanding of physicians' knowledge and attitudes, assessed through reliable and culturally validated instruments. This study aimed to adapt and validate the Kazakh and Russian versions of a standardized questionnaire designed to evaluate physicians' knowledge and attitudes toward GDs. The validated tool is intended to support future research, educational programs, and policy efforts aimed at enhancing the rational prescription and utilization of GD in the Republic of Kazakhstan.
Methods: The questionnaire underwent a standardized forward-backward translation process in accordance with internationally accepted guidelines for cross-cultural adaptation of survey instruments. A pilot study was subsequently conducted among physicians in Shymkent, Republic of Kazakhstan, to evaluate its clarity and applicability in real-world conditions. To examine the psychometric properties of the Kazakh and Russian versions, Confirmatory Factor Analysis (CFA) was carried out using the Structural Equation Modeling (SEM) module in Jamovi software. In addition, descriptive statistics, standardized factor loadings, factor covariances, and model fit indices were calculated to assess the validity and internal structure of the instrument.
Results: Confirmatory Factor Analysis (CFA) supported the hypothesized two-factor model comprising the latent constructs "Information" and "Attitude" in both the Kazakh and Russian versions of the questionnaire. The majority of items demonstrated statistically significant standardized factor loadings, with several exceeding the recommended threshold of 0.70, indicating strong associations with their respective latent variables. The estimated correlation between the two factors was moderate in the Kazakh version (r = 0.599) and strong in the Russian version (r = 0.780), suggesting a meaningful conceptual relationship between physicians' knowledge and attitudes toward generic drugs.
Conclusion: The psychometric evaluation confirmed that the questionnaire has an adequate internal structure, with most items showing significant factor loadings and acceptable model fit. These findings support its use as a reliable tool for assessing physicians' awareness and attitudes toward generic medicines in Kazakhstan.
Background: Endoscopic ultrasound (EUS)-guided drainage using lumen-apposing metal stents (LAMS) is the first line choice for treatment of pancreatic fluid collections (PFCs). This study evaluated the technical success, clinical success, and adverse events (AE) associated with the Hot AXIOS electrocautery-enhanced LAMS for pancreatic pseudocysts (PPs).
Methods: This retrospective cohort study included 45 patients with PPs undergoing Hot AXIOS stent placement between 2019 and 2021. Clinical and technical success were assessed. AEs were graded based on severity and timing. Survival analysis and the Kaplan-Meier curve were used in the study.
Results: Technical success was achieved in 97.78% (44/45) cases and clinical success in 95.56% (43/45). Patients with a previous history of PP intervention were significantly more likely to experience moderate to severe AE (P = 0.009). Removal time of stent was significantly longer in patients with moderate or severe AE (median 70 vs 34.5 days, P = 0.005). Transition of PP to walled-off necrosis was associated with moderate or severe AE in comparison with mild or no AE (P < 0.001).
Conclusion: Hot AXIOS stents demonstrated high clinical and technical success rates for PP drainage. Patients with a history of prior interventions for PPs were at significantly higher risk of AE. Closer monitoring is recommended in patients with delayed removal. Future studies should incorporate a multicenter design and control groups with standardized success rates and AE definitions.
Background: Cognitive impairment, which is one of the debilitating consequences of traumatic brain injury (TBI), leads to long-term adverse outcomes that disrupt an individual's participation in daily activities. This study aimed to investigate the effects of combining occupational therapy with transcranial direct current stimulation (tDCS)-a non-invasive and safe electrical method for targeting specific areas of the brain-on the cognitive function of individuals with TBI.
Methods: This semi-experimental study utilized convenience sampling, resulting in the inclusion of 24 patients with moderate to severe TBI. We then randomly assigned them to one of two groups: an experimental group (n = 12) or a control group (n = 12). Both groups underwent 10 sessions of daily occupational therapy, but the experimental group also received 20 minutes of tDCS during their occupational therapy sessions. Cognitive functions, such as working memory, divided attention, problem solving, and planning, were assessed using computer-based versions of the Wisconsin Card Sorting Test (WCST), Tower of London, N-back, and Stroop tests at the baseline and the day after the intervention's conclusion. To implement the data analysis phase, we used SPSS Version 27. Depending on the normality of data distribution, either independent samples t-tests or Mann-Whitney U tests were used to compare the outcomes between the experimental and control groups.
Results: After the 10-session intervention, executive functions improved in both groups (P < 0.05). When comparing the groups, the experimental group demonstrated significant improvements in working memory (P = 0.002), planning (P = 0.002), and problem-solving (P = 0.001); however, no significant difference was observed in selective attention (P = 0.310).
Conclusion: The findings suggest that employing tDCS techniques plays a pivotal role in enhancing specific executive functions, such as working memory, problem-solving, and planning, in patients with traumatic brain injuries. tDCS can be considered a complementary treatment option in the rehabilitation of TBI patients.According to the findings, the use of tDCS can improve executive functions, including working memory, problem-solving, and planning, in TBI patients. As a complementary treatment, tDCS can be utilized in the rehabilitation of TBI patients.
Pediatric emergency medicine (PEM) emerged as a subspecialty of both emergency medicine and pediatrics to address the specific needs of children requiring urgent care. Originating in the United States (US) in the late 20th century, PEM was formally recognized following collaborative efforts by pediatricians, notably Dr. Foster Jerry, and the establishment of fellowships and certification boards. Since its inception, the subspecialty has significantly advanced pediatric emergency services, with over 29 fellowship programs active in the US by 2021. In Iran, the need for specialized pediatric emergency care led to the first formal request to develop PEM in 2021. Following approval from the Medical Education and Specialization Council and endorsement, Iran University of Medical Sciences initiated the implementation of this vital subspecialty. This article explores the global and national development of PEM and outlines the rationale, progress, and institutional efforts toward its establishment in Iran.
Background: Approximately a third of patients with SARS-CoV-2 have shown changes in respiratory function, impaired diffusion capacity for carbon monoxide, and persistent lung damage, one year after discharge. In severe COVID-19, patients may have a restrictive or obstructive defect in spirometry during and after recovery. One hypothesis is that respiratory symptoms in survivors might be attributable to pulmonary fibrosis. In this context, we evaluate spirometry and chest computed tomography (CT), 3 and 6 months after discharge, to further investigate the improvement of respiratory function in discharged patients with COVID-19.
Methods: This cohort study was conducted on 260 Iranian COVID-19 patients with a COVID-19 PCR-positive pneumonia. A chest CT scan was done at admission and 6 months after discharge. Also, a spirometry test was done 3 and 6 months after discharge. We used the Chi-Square test, t-test, Pearson's coefficient, and linear regression multivariate analysis by SPSS version 26.0 to analyze the data.
Results: We identified that the most common chest CT scan abnormalities at presentation were ground glass opacities (GGO) (206 (79.23%)) and consolidation (183 (70.4%)). However, these sequelae were improved retrospectively 6 months after discharge to 17 (6.53%) and 16 (6.2%). The present study revealed abnormal spirometry in 81 (30.8%) cases in the 3rd month and 61 (23.9%) cases in the 6th month after acute COVID-19 pneumonia. There was a negative correlation between GGO score and spirometry parameters in both follow-ups (P values were < 0.016).
Conclusion: In summary, our study indicated that abnormal spirometry in the post-COVID-19 recovery phase is associated with a higher risk of long-term parenchymal lung disease, characterized by fibrotic-like changes in chest CT scans and smoking status, hypertension, and chronic kidney disease.
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