Medical Journal of the Islamic Republic of Iran最新文献

Background: The frequency-following response (FFR) is an auditory electrophysiological response that reflects the spectrotemporal characteristics of an acoustic stimulus with high fidelity. Electrode montage has a significant impact on the recorded response, likely because it influences the neural generator contributions. However, the relationship between montage configuration, especially the location of the inverting electrode, and FFR parameters remains unclear. This study aimed to investigate the effect of cephalic versus noncephalic inverting electrode placements on FFR characteristics in adults. Clarifying this relationship can help optimize montage selection for improving the clinical and research application of FFR recordings.

Methods: In this cross-sectional study, FFRs were recorded from 38 healthy adults (11 men, 27 women; mean age = 21.8 ± 2.3 years). Five amplitude-modulated tones with modulation frequencies of 85, 100, 115, 130, and 145 Hz were used. The responses were recorded simultaneously with 2 electrode montages of the vertex to ipsilateral mastoid (cephalic) and the vertex to the seventh cervical vertebra (noncephalic), and their amplitudes, phase values, and residual noises were measured and compared using independent sample t tests and repeated measures analysis of variance.

Results: The results showed roughly similar amplitudes (85 Hz: P = 0.541, 100 Hz: P = 0.867, 115 Hz: P = 0.511, 130 Hz: P = 0.774, 145 Hz: P = 0.608), while significantly different noise (85 Hz: P = 0.526, 100 Hz: P = 0.244, 115 Hz: P = 0.022, 130 Hz: P = 0.003, 145 Hz: P = 0.071) and phase values (85 Hz: P = 0.720, 100 Hz: P = 0.002, 115 Hz: P = 0.001, 130 Hz: P = 0.001, 145 Hz: P = 0.704) were observed between the 2 electrode montages. Moreover, the noncephalic montage exhibited lower between-subject variability.

Conclusion: The results demonstrated that both electrode montages could be reliably used for recording FFR. However, noncephalic montage may offer practical advantages in clinical and research contexts due to reduced variability and improved response consistency, thus enhancing the diagnostic accuracy and efficiency of auditory assessments.

Background: Type 2 diabetes mellitus (T2DM) is a prevalent chronic condition associated with early vascular complications. Identifying relevant biomarkers early in the disease course may facilitate better risk stratification and management. This study aimed to assess serum levels of Growth Factor Receptor-Bound Protein-2 (GRB2), advanced glycation end-products (AGEs), and carotid intima-media thickness (CIMT) in patients with early versus established T2DM.

Methods: This retrospective study included 140 patients with T2DM (70 newly diagnosed and untreated, 70 with established disease, and 70 healthy controls). GRB2, AGEs, and CIMT were measured and correlated with demographic and biochemical data. The Statistical Package for Social Science for Windows, version 20 (IBM, Chicago, USA), was used to statistically analyze the collected data.

Results: GRB2, AGEs, and CIMT were significantly higher in both early and established T2DM compared to controls (P<0.001), and significantly higher in established compared to early T2DM (P<0.001). Mean GRB2 levels were 3.87±0.37 ng/dL (early), 4.33±0.57 ng/dL (established), and 3.01±0.46 ng/dL (controls). CIMT was 0.66±0.04 mm (early), 0.73±0.06 mm (established), and 0.60±0.05 mm (controls). GRB2 positively correlated with CIMT, AGEs, and glycemic indicators. Carboxymethyl-lysine (CML) ≤ 4.9 ng/mL yielded 100% sensitivity and specificity; methylglyoxal ≤ 3.5 ng/mL showed 88.57% sensitivity; CIMT ≤ 0.71 mm showed 85.71% sensitivity and 60.0% specificity; GRB2 ≤ 3.99 ng/dL had 71.43% sensitivity.

Conclusion: GRB2, AGEs, and CIMT levels increase with the progression of T2DM. These markers may aid in distinguishing early from established T2DM; however, further longitudinal studies are warranted to validate their prognostic and clinical relevance.

Background: Kawasaki Disease is a type of systemic vasculitis. Patients diagnosed with Kawasaki Disease require a regimen of aspirin and intravenous immunoglobulin (IVIG). Timely diagnosis and proactive treatment can prevent complications associated with Kawasaki Disease. Therefore, this study was conducted to investigate the levels of IgG in Kawasaki patients and its correlation with clinical outcomes at Taleghani Hospital in Gorgan in 2022.

Methods: This cross-sectional study was conducted on 36 Kawasaki patients admitted to Taleghani Hospital in Gorgan in 2022. Patients were categorized into two groups based on Kawasaki criteria: complete and incomplete. Levels of IgG and primary disease characteristics, laboratory findings, and echocardiographic results were measured and recorded. Data was collected using a researcher-made checklist through observation, examination, and interview. Data were analyzed using an independent t-test and a Chi-square test at the 0.05 level, as determined by SPSS version 23.

Results: The results showed that the average age of the children was 26.43 ± 21.88 months, with 63.9% of the samples aged between 1 and 5 years. 89.2% did not have coronary involvement, and 91.7% responded to treatment. Leukopenia was present in 2.8% of children, leukocytosis in 75%, and 36% were in the acute phase. Inflammatory factors ESR and CRP were positive in 72.2% of children. The average IgG level in female children was higher than in males, but this difference was not significant. The frequency of laboratory diagnosis was less in boys than in girls, but this difference was also not significant.

Conclusion: Timely diagnosis and proactive treatment (IVIG) can prevent complications associated with Kawasaki Disease. Paraclinical findings play a significant role in determining the response to treatment and clinical outcomes.

Background: Decompressive craniectomy is a widely accepted life-saving therapeutic approach for treating refractory raised intracranial pressure in traumatic brain injury. Research on the optimal size for craniectomy has yielded mixed results, and currently, there is no consensus on the appropriate size. The present study aims to investigate the effect of craniectomy size on the outcome of traumatic brain injury patients.

Methods: In this cross-sectional retrospective analysis, all patients who underwent decompressive craniectomy for the management of refractory raised intracranial pressure following traumatic brain injury from March 2019 to 2022 were surveyed. For craniectomy size assessment, the first postoperative CT scan was evaluated, recording the largest superior-inferior and anterior-posterior diameters of the craniectomy. The primary outcome of interest was hospital discharge status or mortality, while the secondary outcome focused on GOS scores three months post-discharge. The collected data were analyzed using SPSS software and using Fisher's Exact and T-tests, and Pearson's correlation coefficient with a significance threshold set at P<0.05.

Results: One hundred twenty-two patients were analyzed. The most common underlying cause of head trauma was a motor vehicle accident (72% of patients). The mean age of patients was 27.44 ± 12.42 years, and more than 70% of the patients were younger than 25 years of age. 79.9% of the patients were male. Thirty-two patients (26.22%) died during hospitalization. The mean GCS of patients at admission was 8.58 ± 4.08, and in patients who died, GCS was lower than in surviving patients (P<0.0001). The largest craniectomy size was 80.40 ± 18.95 mm in the superior-inferior direction and 95.57 ± 23.67 mm in the anterior-posterior direction. The craniectomy size of patients was significantly different in surviving and deceased patients. Moreover, in patients who died, the craniectomy size was smaller than in patients who survived. No significant correlation was observed between the largest anteroposterior size (r=0.024, P=0.858) and the largest superior-inferior diameter (P=0.217 and P=0.065) with GOS.

Conclusion: Larger sizes of craniectomy and bilateral surgery are associated with a greater reduction of intracranial pressure and a reduction in patient death, and the death rate of patients with a low GCS is also higher.

Background: Artificial intelligence (AI) is transforming healthcare with applications that can surpass human performance in prevention, detection, and treatment. This systematic review aimed to collect and assess the impact and success of AI technologies across various healthcare domains.

Methods: A systematic search of major databases (including PubMed, Scopus, and ISI) was conducted for articles published up to 2023. Keywords related to AI-driven disease detection, classification, and prognosis were used. Non-English articles or those with inaccessible full texts were excluded. Data was extracted by two researchers, and the quality of selected articles was evaluated based on the strengths and limitations stated by the authors.

Results: In total, 123 articles were included. AI contributions were categorized into three areas. For disease detection (n=75), Coronavirus disease 2019 (COVID-19) was the most frequent topic (n=18), followed by oncology. Chest X-rays were the most common input (n=15). In disease classification (n=23), oncology (especially breast cancer) was the most researched field (n=7), primarily using breast imaging. For prediction and prevention (n=25), oncology was again the most studied category, with clinical and laboratory parameters being the most utilized input (n=12).

Conclusion: AI-driven clinical decision support systems (CDSS) exhibit strong diagnostic and prognostic accuracy in imaging and laboratory settings. However, many models function as "black boxes," which limits interpretability and clinician trust. Data bias and challenges in integrating AI tools into practice also persist. The findings suggest that future work should focus on explainable AI and rigorous real-world validation to safely implement these tools in healthcare.

Background: COVID-19 can affect multiple organs, including the lungs and liver. Elevated liver enzymes are often observed in these patients, and a chest CT scan is typically used to assess the extent of lung involvement.The aim of this study was to determine the frequency of liver enzyme elevation in children infected with COVID-19 and evaluate the type and severity of lung involvement based on chest CT scan findings. Additionally, the study aimed to identify any relationship between hepatic enzyme abnormalities and the severity of lung involvement based on imaging findings.

Methods: A cross-sectional study was conducted on all patients under 18 years of age who were admitted to Hazrat Ali Asghar Children's Hospital from March 2020 to September 2022 with a confirmed COVID-19 infection by PCR test. Normal laboratory values for aspartate transaminase (AST) and alanine transaminase (ALT) were 8-33 U/L and 10-40 U/L, respectively. Mild, moderate, and severe increases in ALT were defined as 40-200 U/L, 200-800 U/L, and more than 800 U/L respectively. Similarly, mild, moderate, and severe increases in AST were defined as 33-165 U/L, 165-660 U/L, and more than 660 U/L, respectively. Continuous data between two groups were compared using an independent t-test, while comparisons across multiple groups were analyzed via one-way ANOVA. Associations between categorical variables were assessed using the Chi-square or Fisher's exact test.

Results: The present study included 320 patients, with 186 (58.12%) male and 134 (41.88%) female cases. No cases of clinical hepatitis were observed during the study. In terms of ALT values, 264 (82.5%) patients had normal levels, while 56 (17.5%) had subclinical hepatitis. Specifically, 51 (16%)cases were classified as mild, 4 (1.2%) as moderate, and 1 (0.3%) as severe in terms of increased ALT levels. It is important to note that all patients showed improvement in AST and ALT levels during the course of treatment. A chest CT scan was performed in 192 cases, accounting for 60% of the total. Out of these, 110 patients (57.3%) had a normal CT scan, while 49 (25.5 %), 23 (12%), and 10 (5.2%) cases showed mild, moderate, and severe pulmonary involvement, respectively. Additionally, 4 (2%) cases had pleural effusion. Regarding the type of involvement, 27 (14%), 37 (19.3%), and 18 (9.4%) cases presented with typical, indeterminate, and atypical findings on the chest CT scan. No significant relationship was found between liver enzyme abnormalities and the severity of lung involvement based on imaging findings.

Conclusion: Liver enzyme values do not appear to predict the severity of lung involvement in pediatric COVID-19 patients.

Background: Nursing service providers play an important role in disaster response teams. However, their ability to deal with disasters is less than desirable. This situation can lead to poor performance in caring for victims. On the other hand, trained and empowered volunteers can play a valuable role in achieving the goals of disaster management at all stages, from mitigation to recovery. Therefore, this systematic review was conducted to investigate the dimensions and key components of empowering nursing service providers in responding to disasters.

Methods: In this study, an electronic search of the PubMed, Scopus, Web of Science, Embase, and ProQuest databases and gray literature was performed. The searches were conducted on October 14, 2023. Other search resources, such as organizational websites and key journals, were manually searched. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) checklist was used to select the studies. The findings were analyzed via thematic content analysis using MAXQDA2020 software. The Joanna Briggs Institute checklists were used to evaluate the quality of studies.

Results: A total of 16 studies out of 8067 studies were included in this analysis. The selected studies included 3 studies from the United States, 1 from Turkey, 1 from Saudi Arabia, 2 from Iran, 3 from Republic of Korea, 2 from China, 2 from Switzerland, and 2 from Brazil. Two main themes, including individual elements and organizational elements, as well as 6 categories and 27 subcategories, were extracted. The categories included management and leadership abilities, professional and knowledge-based capabilities, personality and behavioral abilities, professional and organizational empowerment, organizational support packages, and capacity building.

Conclusion: The results of this study emphasized that the volunteers providing nursing services should have certain characteristics and capabilities. These characteristics may include strong communication skills, the ability to work under pressure, empathy, and sufficient technical knowledge in the field of healthcare. Policymakers and managers should also have the necessary support for the nurses and play an effective role in empowering them by creating innovative and continuous training programs. Such training programs help improve the professional skills of volunteers and facilitate their empowerment to provide better quality services.

Background: Coronary slow flow syndrome or phenomenon (CSFP) is a coronary artery disease that may cause cardiac ischemia, symptoms, and related complications. This study, conducted as a randomized controlled trial, assessed and compared the effects of a treatment plan comprising aspirin, statin, nitrate, and Nicorandil on the quality of life of patients with CSFP.

Methods: Out of 963 patients who underwent coronary angiography at Booalisina University Hospital in Qazvin, 52 individuals diagnosed with primary CSFP were enrolled in the study. They were randomly divided into two groups, with one receiving a three-drug treatment with 80 mg of aspirin, 20 mg of atorvastatin daily, and 2.6 mg of nitroglycerin every 12 hours (26 patients) and in the second group plus nicorandil 10 mg every 12 hours (26 patients). After two months, the patient's QOL was evaluated and compared using McNew's quality of life questionnaire. The SPSS version 16 software was used for data analysis.

Results: In both groups, after two months, the QOL scores in physical, emotional, social, and overall (P<0.001) were significantly improved compared to the baseline (before the treatment). The comparison between the two groups revealed no statistically significant differences in emotional, social, or overall quality of life scores, but the physical dimension of the quality of life in the group who received nicorandil showed more improvement than the other group (P=0.032).

Conclusion: A combination therapy of aspirin, atorvastatin, and nitrates has been demonstrated to significantly improve the quality of life in patients with Coronary Slow Flow Phenomenon (CSFP). However, the addition of nicorandil to this regimen does not provide significant further improvement, according to present findings.

Background: Respiratory muscle dysfunction, particularly of the diaphragm, is common after stroke and limits physical performance. Targeted diaphragmatic exercises may enhance respiratory efficiency and recovery. To evaluate the effect of diaphragmatic breathing exercises on diaphragmatic motion and functional performance in patients with chronic hemiplegia.

Methods: In this single-blind randomized controlled trial, 70 chronic hemiplegic patients were randomly assigned to two equal groups (n=35 each): a control group (traditional exercise) and an intervention group (traditional plus diaphragmatic breathing exercises). Over eight weeks, outcomes including diaphragmatic excursion (DE) (assessed via M-mode ultrasonography), six-minute walk distance (6MWD), modified Medical Research Council (mMRC) dyspnea scale, and Berg Balance Scale (BBS) were evaluated. Data were analyzed using SPSS version 25.0. Statistical methods included descriptive statistics, independent samples t-tests, paired samples t-tests, Chi-square tests, and analysis of covariance (ANCOVA) to compare post-intervention outcomes while adjusting for baseline values. A p-value < 0.05 was considered statistically significant.

Results: There were no statistically significant differences between the two groups in baseline characteristics (age, sex, BMI, smoking history) or in baseline assessments of 6MWD, BBS, or mMRC scores (P>0.05). After eight weeks, the intervention group showed significantly greater improvements in functional capacity, balance, dyspnea, and diaphragmatic function (6MWD, BBS, and mMRC scores) compared to the control group (P<0.05). DE improved significantly in the intervention group during tidal (P=0.005), deep (P=0.009), and sniff breathing (P<0.001), while the control group showed a significant change only in tidal excursion (P=0.027). ANCOVA confirmed these findings after baseline adjustment (P<0.05), with moderate to large effect sizes.

Conclusion: Diaphragmatic breathing exercises significantly enhance diaphragmatic movement, physical performance, and quality of life in chronic hemiplegic patients. These findings support incorporating targeted pulmonary rehabilitation in stroke management, with ultrasonography as a valuable non-invasive bedside monitoring tool.

Background: Systematic reviews and meta-analyses are essential for evidence-based urology practice. Despite their importance, no comprehensive assessment of their evolution exists, limiting understanding of research priorities. This bibliometric analysis examines systematic reviews and meta-analyses in urology, analyzing publication trends, influential works, and collaboration networks to guide future research.

Methods: In this bibliometric study, a comprehensive search of the Scopus database was conducted until January 2024, focusing on English-language systematic reviews and meta-analyses in urology. Bibliometric data were analyzed using Excel, VOSviewer, and Scimago Graphica to examine publication trends, citations, collaborations, and research themes.

Results: Analysis of 9006 publications (55.4% open access) showed exponential growth from 1987 (n = 1) to 2024 (n = 1025). The top 50 cited papers focused mainly on urological oncology (uro-oncology), surgical outcomes, and diagnostic imaging. European Urology emerged as the leading journal, showing strong bibliographic coupling with other specialty urological journals. Term co-occurrence analysis revealed 5 major clusters: (1) drug efficacy in prostatic hyperplasia; (2) cancer risk and genetic studies; (3) treatment modalities in urological cancers; (4) surgical complications; and (5) diagnostic accuracy in prostate cancer. The United States, Italy, and the United Kingdom demonstrated the strongest international collaboration networks, with European countries showing robust research partnerships.

Conclusion: Urological evidence synthesis shows particular emphasis on uro-oncology, surgical outcomes, and diagnostic imaging, reflecting the evolution of evidence-based urological practice. Future research should focus on expanding international collaborations, addressing emerging diagnostic technologies, and developing standardized methodologies for evidence synthesis in urological practice.