Medical Journal of the Islamic Republic of Iran最新文献

Background: It seems that the prevalence of intimate partner violence increased during the COVID-19 pandemic. To investigate the prevalence of different types of IPV and its contributing factors on a global scale during the COVID-19 pandemic.

Methods: This is a systematic review and meta-analysis study. This study followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist. All original studies, written in English that reported the overall prevalence of IPV or at least one type of IPV against women during the COVID-19 pandemic were included in this study. PubMed, Embase, Scopus, and Web of Science databases were searched in July 2023. Our general keywords included "Intimate Partner Violence", "Spouse Abuse", "Domestic Violence", "COVID-19", and "SARS-CoV-2". We used the Joanna Briggs Institute Checklist to assess the quality of all included studies. We conducted a random effect model for meta-analysis using the Mantel-Haenszel method in comprehensive meta-analysis software Version 3. Each type of IPV is calculated as an event rate with a 95% CI for each variable. The I2 statistic test was used to assess the Heterogeneity.

Results: Forty-one studies encompassing 14,615 participants met our eligibility criteria and were included in our study. The overall prevalence of IPV was 31% (95% CI: [24.2, 38.8], P < 0.001). Based on type, the highest rate of IPV in the included studies was reported for psychological type (33%, 95% CI: [23.4, 44.3], P = 0.004). The rates of IPV for economic, physical, and sexual types were 19.1% (95% CI: [12.2, 28.6], P < 0.001), 9.5% (95% CI: [6.8, 13.1], P < 0.001), and 8.5% (95% CI: [6.2, 11.7], P < 0.001), respectively. Age, education level, being pregnant, and marital duration were among the most frequent influencing factors.

Conclusion: About one-third of women experienced IPV during the COVID-19 pandemic. Psychological IPV emerged as the most prevalent type in the included studies. The most important factors were environmental, social, economic, cultural, and political factors. Age, education level, marital duration, being pregnant, and marital duration were among the most frequent influencing factors.

Background: One of the most important causes of mortality in the world is acute myocardial infarction. There are two general treatments including thrombolytic drugs and percutaneous coronary interventions. But, monitoring outpatient AMI treatment from a remote or rural location has emerged as a successful telemedicine technique. So, the present study aimed to review the economic evaluation studies of telemedicine in patients with acute myocardial infarction.

Methods: This study was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist (PRISMA is a 27-item checklist used to improve transparency in systematic reviews) guidelines in 2022. PubMed, Scopus, Web of Science, Proquest, Iranian databases (SID, Magiran), and Google Scholar were searched with the keywords of telemedicine and myocardial infarction from 2000 to 2022. After eliminating duplicates, titles and abstracts were screened based on inclusion and exclusion criteria, details, and the most important results of eligible studies were recorded in the data collection form.

Results: 904 records were identified in this search, of which 147 were duplicates. Finally, 6 records were included in this study. Among these studies, 4 were cost-effectiveness, one was cost analysis, and one was cost-utility. The willingness to pay threshold was between 20,000 and 100,000, and the outcomes were measured with QALY (Quality-adjusted life-years). The reviewed studies showed that telemedicine can improve outcomes such as quality of life and reduce disease costs.

Conclusion: The results showed that telemedicine interventions for acute myocardial infarction can be helpful, and cost-effective. However in some cases, it can cause increased costs and may not have a significant difference in effectiveness with other methods because of the condition and stage of the disease.

Background: Limb loss can negatively affect the psychological and physical well-being, mobility, and social life of people with lower limb amputation. Participating in physical activities is of great importance for these people. This study aimed to explore factors affecting the physical activity of Iraqi lower-limb amputees.

Methods: In this cross-sectional study, the participants were asked to fill out the Oswestry disability index (ODI) questionnaire, the 12-item short-form health survey (SF-12), the Trinity Amputation and Prosthesis Experience Scales (TAPES), and the International Physical Activity Questionnaire (IPAQ). The performance-based Timed Up and Go (TUG) test was also assessed. We used a hierarchical regression model to estimate the effect of some parameters on physical activity considering age, sex, and level of amputation.

Results: A total of 376 lower limb amputees, aged 20 to 67 years old, completed the tests. The TUG time (beta = 0.406; P < 0.001), mental component score of the SF-12 (beta = 0.214; P < 0.001), ODI (beta = -0.201; P < 0.001), and physical activity component of SF-12 (beta = 0.131; P = 0.002) had significant associations with physical activity.

Conclusion: The TUG time was the most critical factor in predicting physical activity. The mental score component of the SF-12 ranked second, showing the importance of family and social support for amputees in their physical activity and emphasizing the importance of including mental and psychosocial plans in the rehabilitation program of lower limb amputees. Low back pain should be taken seriously in lower limb amputees because of its prevalence and the effect of its related disability on the physical activity of amputees. Residual limb pain was also very prevalent. Although it did not contribute to our model, its negative effect on physical activity should not be underestimated.

Background: COVID-19 and influenza are both contagious respiratory diseases. Influenza virus can increase the severity of COVID-19 infection in the cold months of the year through damage to respiratory ciliated cells, which may cause an increase in hospitalization, disease symptoms and mortality rate. Therefore, the purpose of this study was to ascertain the frequency of co-infection with the influenza virus and SARS-CoV-2, as well as the impact of co-infection on clinical outcomes in hospitalized patients suffering from respiratory problems within Semnan City, Iran.

Methods: In this cross-sectional descriptive study, we investigated 1267 hospitalized patients with respiratory problems between September 2021 and March 2022. Two nasopharyngeal and oropharyngeal throat swab samples were collected from each patient and tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza A, and influenza B viruses using real-time reverse-transcriptase- polymerase-chain-reaction (RT-PCR). The collected data were analyzed with χ² test, ANOVA, paired Student's t-test, and Pearson's correlation coefficient test in different groups. Analyzes were done with SPSS 26.0 software.

Results: In total, 29.6% (n = 375) of patients had confirmed positive results for SARS-CoV-2, and their median age was 55.4 ± 24.63 years. It was found that 1.9% (n = 7) and 0.5% (n = 2) of COVID-19 patients had co-infections with influenza viruses A and B, respectively. In 2.4% of the cases, co-infection with COVID-19 and influenza was found. 8 out of 9 patients (88.8%) recovered, while one patient (11.1%) died. Co-infection did not significantly correlate with cancer (P = 0.588), diabetes (P = 0.202), hypertension (P = 0.530), or any other illness. Also, Associations of death and co-infection with diabetes, cardiovascular disease, or CKD showed that a statistically significant correlation was present only between diabetes and death. Based on the ANOVA test to look at associations of death and co-infection with diabetes, cardiovascular disease, or CKD, it showed that there was no significant association of co-infection with diabetes (P = 0.202), hypertension (P = 0.530), cancer (P = 0.588), and other diseases.

Conclusion: Although a low proportion of COVID-19 patients have influenza co-infection, the importance of such co-infection, especially in high-risk individuals and the elderly, cannot be ignored. Given the prevalence of influenza co-infection, increased coverage of flu vaccination is encouraged to mitigate the transmission of the influenza virus during the ongoing COVID-19 pandemic and reduce the risk of severe outcomes and mortality.

Background: The role of histamine H3 receptors (H3Rs) in gastric protection and anti-inflammatory function is controversial. In this study, we investigated the gastroprotective effect of a histamine H3 receptor antagonist drug, betahistine, on cytokine-induced neutrophil chemoattractant (CINC) gene expression in a rat model of indomethacin-induced gastric mucosal injury.

Methods: In this experiment, rats were divided into four groups; the control group received no treatment, group 2 was treated with indomethacin at a dose of 25 mg/kg, group 3 pre-treated with famotidine at a dose of 50 mg/kg, and group 4 pre-treated with betahistine (as a reference drug) at a dose of 50 mg/kg. The last two groups were followed by indomethacin administration (25 mg/kg), three days later. The obtained values were expressed as the mean and standard error of the mean (mean ± SEM). The level of statistical significance was set at α = 0.05.

Results: Indomethacin treatment resulted in large ulcerative lesions with a mean ulcer index of 29± 13.63 mm. However, ulcerative indices were significantly improved in groups pre-treated with famotidine (15.5 ± 8.68 mm; P < 0.05) and betahistine (11±5.66 mm, P < 0.01), compared to the indomethacin-treated group. The expression levels of gastric CINC-2ɑ were significantly elevated in indomethacin-induced groups by 0.028±0.05 in the indomethacin group, 0.005±0.01 in indomethacin + famotidine, and 0.012±0.03 in indomethacin + betahistine groups, compared to the control group (P < 0.05). Besides, pre-treatment with betahistine significantly reduced the expression of CINC-2ɑ induced by indomethacin administration (P < 0.05).

Conclusion: Betahistine for five days before administrating indomethacin reduced the ulcer index and downregulated the expression of CINC-2α significantly. Overall, pre-treatment with betahistine protects against the gastric damage induced by indomethacin by lowering the expression of CINC-2ɑ.

Background: The COVID-19 pandemic brought significant challenges for oncology centers and cancer patients, necessitating the implementation of various preventive and restrictive protocols and postponing elective surgeries. We aimed to assess and compare tumor characteristics, including the size, metastasis, and duration of hospitalizations between the periods before and during COVID-19 in patients with thyroid cancer.

Methods: The present cross-sectional study was performed at The Institute of Cancer, Tehran University of Medical Sciences, with 143 patients observed 2 years before the pandemic and 92 during March 2020 and March 2022. Clinical and pathological tumor characteristics were compared between the 2 groups, including surgical details, hospitalization and intensive care unit (ICU) admission durations, time intervals between diagnoses and surgeries, and various metastatic factors. All data were analyzed using SPSS software 21. The chi-square test was used for the statistical analysis of qualitative data, and the t test was used for the statistical analysis of continuous data. P < 0.05 was considered statistically significant.

Results: The most frequent tumor type was papillary thyroid cancer (134 [93.7%] and 82 [89.13%]; P = 0.209). The right lobe was the most prevalent tumor site both before and during COVID-19, respectively (55 [38.5%] and 29 [31.5%]; P = 0.278). Central (64 [50.8%] and 62 [49.2%]; P < 0.001), and lateral (45 [34.5%] and 45 [48.9 %]; P = 0.045) lymph node metastasis in the first surgery and recurrence (P = 0.006 and P = 0.022, respectively) were significantly higher in patients admitted during the COVID-19 pandemic, respectively. The mean interval between the first surgery and subsequent surgery due to recurrence (P < 0.001), duration of ICU admission (P = 0.010), and hospitalization after the second operation were significantly lower during the pandemic (P = 0.006).

Conclusion: During the COVID-19 pandemic, patients exhibited larger tumors, increased lymph node metastasis, and shorter intervals between surgeries. This underscores the need for healthcare decision-makers to implement effective thyroid cancer management strategies in future outbreaks. Our study stands out by analyzing hospitalization and ICU admissions and duration for each patient, unlike any other study. Moreover, we extended our observation period beyond the typical duration found in most of the literature.

Background: St-elevation myocardial infarction (STEMI) is a serious condition that occurs when the blood flow to one or more coronary arteries is blocked, leading to damage or death of the heart muscle (myocardial injury or necrosis). The present study aimed to compare QTc and QTd intervals in patients with STEMI before and 90 minutes after treatment in Booali Sina Hospital, Qazvin, Iran.

Methods: The present study is an analytical cross-sectional study. Between March 2021 and 2022, 107 patients administered to Booali Sina Hospital, Qazvin, Iran, due to STEMI who underwent primary PCI were enrolled in the study. Data including age, sex, height and weight, disease history, QTc interval before and 90 minutes after treatment, QTd before and 90 minutes after treatment and Ejection fraction values were extracted from the patient's files. Then, the relationship between change in QT and QTd after treatment with response to treatment based on ST Resolution was evaluated. SPSS 20.0 statistical program was used for the statistical analysis. All values are given as mean± standard deviation (SD). A p-value of less than 0.05 was considered as significant.

Results: The observed mean difference in investigated variables of patients, including age, height, weight, and BMI, was not statistically significant between the two groups (response to treatment and non-response to treatment (P > 0.05). Findings demonstrated that the mean QTd 1 in the response to the treatment group was higher compared to the non-response to the treatment group, and this difference was not statistically significant (P = 0.337). It is remarkable that the mean QTd 2 in the response to treatment group was statistically significantly lower than the non-response to treatment group (P = 0.002).

Conclusion: We showed that QTd in the studied patients after primary angioplasty reduced significantly compared to the QTd before the treatment, so the QTd can be considered as a noninvasive measure of the response to the treatment in patients with STEMI.

Background: There is limited research on the sonographic view of people with skeletal malocclusions. Therefore, this study aimed to evaluate the sonographic findings of the masseter muscle in patients with skeletal malocclusions.

Methods: In this descriptive study, 48 patients aged 15-20 years with skeletal class I, II, and III malocclusions (n = 16) who were referred to Mashhad Dental School for treatment were selected. The masseter muscle was evaluated by ultrasound, including transverse and longitudinal scans on both sides of the face in resting and contraction states. The age, gender, muscle thickness, muscle pattern (Malocclusion were classified based on A-point, nasion, B-point (ANB): 0< ANB <4 as class I, ANB > 4 as class II, ANB < 0 as class III), side of chewing, and body mass index (BMI) parameters were measured for each patient. Paired t-tests compared masseter muscle states; ANOVA assessed differences among malocclusion groups.

Results: The most commonly observed pattern in the masseter muscle of patients with class III skeletal malocclusions was type II, and in people with class II malocclusions was type I. There was a positive and significant correlation between the thickness of masseter muscle and BMI in each group separately (P < 0.001). However, the masseter muscle pattern did not show a significant correlation with BMI, gender, and age. A significant difference was observed between the thickness of the masseter muscle in the resting and contracted states in each group (P < 0.001).

Conclusion: This study showed that skeletal malocclusions can affect the pattern and internal structure of the masseter muscle in the anterior-posterior dimension of the face. Ultrasound can be a suitable diagnostic tool for these patients.

Background: Managerialism and leaderism were introduced in response to the challenges in public service management, aiming to improve the management of public service organizations. These ap-proaches both have their own strengths and challenges. The purpose of this study was to examine the current and desired state of the Iranian health system and to find whether these approaches can be integrated to leverage their strengths and address some of the management and leadership challenges of the country's health system.

Methods: In this qualitative study, semi-structured interviews were conducted with 43 senior managers of the health system, employees of three medical universities in Tehran, and experts in public management. The participants were selected using purposive sampling, and the snowball technique was used to increase the number of interviewees. The data were analyzed using the framework method in MAXQDA 18.

Results: Structural changes, realization of managerialism, establishment of evidence-based in-formation systems, readiness of managers and employees, creating a climate of trust, identifica-tion, and recruitment of competent individuals, specialized training, delegation of sufficient au-thority to managers, building a culture conducive to an integrated approach, communication and cooperation, and benchmarking were identified as the prerequisites for complementing Manageri-alism Ideology with Leaderism Discourse.

Conclusion: Complementing managerialism ideology with leaderism discourse can help solve some of the management and leadership challenges faced by the country's health system. But more important are the prerequisites that need to be satisfied in order to prepare the ground for integrating these approaches and capitalizing on their advantages.

Background: Pectus excavatum is the most frequent congenital defect of the chest wall. Surgical treatment with modified Ravitch-type repair is recommended in patients with cosmetic dissatisfaction or considerable cardiopulmonary symptoms. We aimed to analyze the surgical, aesthetic, cardiopulmonary functions and patient satisfaction outcomes of modified Ravitch repair pre and postoperatively.

Methods: This was a prospective analysis of 13 pectus excavatum patients undergoing repair by modified Ravitch using a permanent titanium plate fixed with a screw from September 2021 to August 2023. Patients were included to relieve pressure on the heart and lungs if complaining of exercise intolerance, cosmetic impairment, shortness of breathing, chest pain, or psychological disturbance with an age range from 10 years to 30 years old. While patients who had received conservative or surgical treatment previously or patients with scoliosis, Marfan syndrome or bronchial asthma were excluded. At the 6-month postoperative visit, a postoperative satisfaction survey was conducted.

Results: The means of the age of patients (16.4 ± 2.36 years); operative duration (120 minutes); blood loss (200± 15.47 mL) and Haller index was (3.8± 0.35) preoperatively compared with less than 3.0 (2.7± 0.08 postoperatively; hospital stay (7 days). The most frequent complications were seroma in one patient (7.69%), postoperative bleeding in one patient (7.69%) and skin infection in one patient (7.69%) of patients. No recorded infection of the sternal plate or required operative re-exploration for infection. All patients were subjectively satisfied with the excellent surgical results. Exercise intolerance despite increased exercise performance was observed following surgery, including less sensation of dyspnea.

Conclusion: Modified Ravitch-type repair is a secure and reliable method for treating pectus excavatum with better relief of preoperative symptoms.