Medical Journal of the Islamic Republic of Iran最新文献

Background: People with disabilities have greater unmet needs and need health care. These people are acknowledged as a global development priority. This study aimed to investigate the utilization of rehabilitation services by people with disabilities covered by the Iran Health Insurance Organization.

Methods: This was a cross-sectional descriptive study at the national level. A total of 3676 out of 315,626 insured people with disabilities covered by the Iran Health Insurance Organization were selected from all provinces of the country using a simple random sampling method proportional to the size of the insured population.

Results: A total of 53% of people reported needing rehabilitation services in 2021. Of those requiring rehabilitation services, 51% required physical therapy, 50% occupational therapy, 22% speech therapy, 19% optometry, 13% audiometry, and less than 1% orthotics and prosthetics. Also, only 41% of people who needed rehabilitation services received them. The main reasons for not receiving needed services were financial inability to pay for treatment (76%), physical inability to follow treatment (16%), and the spread of the coronavirus disease 2019 pandemic (8%).

Conclusion: The inability to pay fees emerged as the most significant barrier to receiving essential rehabilitation services. Enhancing the financial coverage provided by basic health insurance funds is crucial. Expanding coverage will enable more patients to utilize the rehabilitation services they need, ensuring that financial constraints do not hinder access to vital care. This policy adjustment could be key in increasing the utilization of rehabilitation services and improving overall health outcomes for those in need.

Background: According to the pyramid of evidence, systematic reviews hold the highest position among studies used in healthcare systems and policy-making. Avoiding systematic and methodological errors are demanding responsibility for authors. Clearly, erroneous studies can have irreparable consequences on health and treatment decisions. Therefore, this study aims to identify potential errors in systematic reviews within the field of health.

Methods: To systematically identify potential errors in systematic reviews, we conducted a comprehensive literature search using keywords such as "Bias," "Error," and "Systematic Reviews" across databases like PubMed, Web of Science, Scopus, Embase, Cochrane Library, and ProQuest without any time restrictions. This yielded 2333 articles and 11 books initially.After removing duplicates and unrelated sources based on predefined inclusion/exclusion criteria tailored for this study context (e.g., relevance to error identification in systematic reviews), we closely examined 88 relevant sources.

Results: Upon analyzing the full texts of these sources with strict adherence to our criteria, we identified 77 distinct types of errors that could occur either within or between studies. These findings highlight the complexity of maintaining accuracy in systematic review methodologies.

Conclusion: Given the critical role systemic reviews play in informing clinical decisions and health policies, ensuring their quality is paramount. Accurate methodology ensures validity; biased studies risk leading to suboptimal patient care outcomes. By pinpointing error sources-such as selection bias or information bias-and implementing strategies to mitigate them through rigorous methodologies like robust search protocols or transparent reporting standards (e.g., PRISMA guidelines), researchers can enhance review quality significantly.

Background: Coagulopathy is a significant risk factor for in-hospital mortality in patients with traumatic brain injury (TBI). Timely monitoring of coagulation biomarkers (CB) may be crucial for predicting TBI patient prognosis. The objective of this study was to assess the time-dependent accuracy of conventional CB in predicting TBI patient outcomes using an ROC curve based on a joint longitudinal and survival data analysis.

Methods: A retrospective cohort study was conducted on 132 out of 604 TBI patients admitted to Shohada-E-Tajrish Hospital in Tehran, Iran, between 2018 and 2020. CB (INR, PT, and aPTT) every 24 hours, and patient outcomes (death or survival) up to 10 days after admission were recorded. After choosing the best joint model longitudinal and survival data, the time-dependent ROC curve analysis was used, and the AUC, sensitivity, and specificity values were calculated in R 4.1.0.

Results: In this study, non-surviving TBI patients had significantly higher mean aPTT, PT, and INR values than survivors. In addition, aPTT demonstrated the strongest time-dependent predictive power (AUC>0.7) for up to the fourth day after admission, while PT and INR had AUC>0.7 for up to the third day after admission.

Conclusion: This study highlights that conventional coagulation biomarkers (aPTT, PT, and INR) demonstrate significant time-dependent efficacy in predicting in-hospital mortality in comatose TBI patients within the first three days of admission. Early recognition and proper management of coagulopathy are essential to improve outcomes and reduce morbidity and mortality in these patients during three days of admission.

Background: One effective strategy for enhancing the social health of the elderly is the development of leisure activities. The aim of this study was to determine the relationship between leisure activities and social health among elderly residents of Tehran.

Methods: This descriptive-analytical study was conducted in 2018 on 413 elderly individuals aged 60 and above in Tehran. Cluster random sampling was employed from five districts of Tehran, maintaining the gender ratio. Data collection instruments included a demographic questionnaire, a 20-item Keyes Social Health Questionnaire, and a 44-item researcher-made Leisure Activities Questionnaire. Data were analyzed using SPSS version 23, employing descriptive and analytical statistics, Spearman correlation coefficient, and multiple linear regression analysis.

Results: Among the eight subdomains of leisure activities (recreation, sports, social interactions, rest, arts, cultural, media, and religious duties), the media category scored the highest mean (84.01%±23.6). The lowest mean score was related to the cultural activities category (21.6%±0.74). Women significantly participated less than men in recreation (P=0.025), sports (P=0.003), cultural (P=0.006), and media activities (P=0.008). With increasing age, elderly participation in recreation (P=0.000), sports (P=0.005), social interactions (P=0.008), and artistic activities (0.010) significantly decreased. The results of multiple linear regression analysis indicated that recreation category (B=0.057 and P=0.001) and religious duties (B=0.023 and P=0.043) had the strongest effects on social health.

Conclusion: Leisure activities, especially recreation and religious duties, are significantly linked to the social health of the elderly. Age-related decline and gender disparities in participation highlight the need for targeted planning to improve access and involvement, particularly for women and older seniors. Promoting such activities can effectively enhance their quality of life and social well-being.

Background: Considering low-quality evidence regarding the impact of laparoscopic surgery on in vitro fertilization (IVF) success rates in women with endometriosis, our research aimed to evaluate IVF success rates and their influential factors in women with endometriosis-related infertility who underwent laparoscopic surgery.

Methods: In a retrospective cohort study, we included women aged 15 to 40 years diagnosed with endometriosis-related infertility who underwent laparoscopic surgery in a university hospital. Women with severe male factor infertility, adenomyosis, uterine myomas, premature ovarian insufficiency, incomplete information, or inaccessible data from infertility centers were excluded. Data were collected from the Endometriosis Data Registry approved by the Iran University of Medical Sciences under code number 1400-2-65-21233, including age, body mass index, infertility duration, endometriosis severity, and Anti-Müllerian hormone levels before IVF. IVF success was considered by an embryonic heartbeat identification during an ultrasound exam, that is, a clinical pregnancy. Independent sample t test, Mann-Whitney, and chi-square tests were applied for single-variable analysis, and logistic regression was used for multivariable analysis.

Results: Of 55 eligible patients, IVF was successful in 23 (41.81%). The mean age of participants was 34.98 years, with a standard deviation of 5.93 years. Endometriomas were observed in 42 (76%) of the participants; unilateral endometriomas were more common than bilateral (25 [45.5%] vs 17 [30.9%]). No significant differences were identified between the IVF-positive and IVF-negative groups regarding clinical and demographic characteristics.

Conclusion: Laparoscopic surgery in women with deep infiltrating endometriosis enhances IVF success and increases pregnancy rate.

Background: Myofascial tissues are interconnected, and fascia connects them to forming a web of myofascial chains. This research investigated whether incorporating myofascial release along the superficial backline offers additional benefits compared to a localized gastrocnemius release in managing clinical symptoms and plantar fascia thickness in individuals with chronic plantar fasciitis.

Methods: This was an add-on design a single-blind randomized clinical trial that was conducted with 30 chronic plantar fasciitis patients. Subjects were randomized into two groups: the Gastrocnemius Myofascial Release (G-MFR) group and the Chain Myofascial Release (C-MFR) group. Each participant underwent four MFR sessions over two weeks. Outcome measures included the Numeric Pain Rating Scale (NPRS), the Foot Function Index (FFI), and ultrasound-based evaluations of plantar fascia thickness. Due to the non-normal distribution of change scores, between-group comparisons were performed using the Mann-Whitney test with the Hodges-Lehmann estimator, and effect sizes were reported using r values.

Results: Both groups exhibited significant improvements in NPRS and FFI scores post-intervention (P<0.001), with the C-MFR group showing greater reductions in both measures (for NPRS: P=0.004, r=0.686 and for FFI: P=0.004, r=0.518). However, while plantar fascia thickness decreased significantly in the C-MFR group (P=0.001, r=0.829), no significant change was observed in the G-MFR group (P=0.422, r=0.206). The reduction in thickness for C-MFR compared to G-MFR was not statistically significant (P=0.233, r=0.222).

Conclusion: This study suggests that myofascial release in the superficial backline chain is more effective than isolated gastrocnemius release for improving NPRS and FFI scores in chronic plantar fasciitis. Future studies with longer follow-ups may clarify the long-term effects of these interventions on plantar fascia thickness.

Background: Gastric cancer in Kazakhstan shows low survival rates due to late diagnosis. This study aimed to explore apoptosis biomarkers to improve early detection and diagnostic accuracy. By investigating biomarkers like p53, RAS, miRNAs, and inflammation markers, the study sought to identify potential indicators for better prognosis and survival outcomes.

Methods: This systematic review was conducted using the keywords "apoptosis biomarkers" OR "gastric cancer" AND "Kazakhstan" OR "Kazakhstani" in the PubMed and Google Scholar databases, yielding 2,025 records. After filtering, 24 studies were selected for analysis. Quality was assessed using the Newcastle-Ottawa Scale, and data were extracted and synthesized for critical findings.

Results: This systematic review on apoptosis biomarkers in gastric cancer diagnosis in Kazakhstan highlights key findings across diverse studies. Biomarkers with the strongest diagnostic potential include p53, RAS, miRNAs (e.g., miR-21, miR-34a), and inflammation markers like NLR (neutrophil-to-lymphocyte ratio), PLR (platelet-to-lymphocyte ratio), and SII (systemic immune-inflammation index). Cytokines, including IL-2 and TNF, were linked to prognosis. DNA repair markers such as γ-H2AX and 53BP1 correlated with improved survival rates. Male predominance was consistent, with 63.1% to 66.4% of participants being male. Key environmental risk factors include Helicobacter pylori infection and heavy metal contamination. Survival rates ranged from 7.3% (Stage IV) to 50.5% (Stage I). The study also observed a statistically significant reduction in mortality rates from 14.0 to 8.9 per 100,000 (p<0.001), reflecting improvements in cancer management and diagnostic interventions.

Conclusion: This review underscores the pivotal role of apoptosis biomarkers in gastric cancer diagnosis in Kazakhstan. Biomarkers such as p53, RAS, and inflammation indices are integral to prognosis. Personalized diagnostic approaches, early detection, and targeted treatments can significantly improve survival outcomes and cancer management in this population.

Background: Arnebia euchroma (Ae) in traditional Persian medicine is used for wound treatment. This study assessed the efficacy of Ae liniment on pressure ulcer (PU) remedy in patients with Spinal Cord Injury.

Methods: In this triple-blind, randomized clinical trial, grade 2 and 3 wounds were randomly assigned to receive either Ae liniment or Phenytoin Cream 1% twice a day for 5 weeks. Recovery was measured by the wound size, exudate, and tissue type by the "Pressure Ulcer Scale for Healing" (PUSH) tool on days 0, 7, 14, 21, 28, and 35. PUSH score between groups was compared with the Mann-Whitney U test, and also within each group by Friedman test.

Results: 74 patients (37 in each group) participated and completed the study. Mean±SD of PUSH Scores at baseline, and 1,2,3,4,5 week after the treatment in Ae group were 9.73±2.65, 9.92±3.08, 8.24±3.86, 7±4.08, 5.22±4.3, 3.41±3.85 and in Phenytoin group were 10.05±1.85, 9.97±1.9, 9.59±2.08, 9.22±2.09, 8.54±2.72, 7.57±3.26. PUSH Score decrease in the Ae group was70.33 ± 32.25% , and in group 2 was 27.67± 26.8% (P < 0.001), which indicates that in comparison of the PUSH Score decrease between the two groups, this reduction was significantly higher in the Ae group. During the study, complete wound healing was observed in 16 patients (43.2%) in the Ae group and in the Phenytoin group in 3 wounds (8.1%) (P = 0.010). No side effects were reported in either group.

Conclusion: PU healing was significantly better in the Ae group than phenytoin cream. It may be considered as a potential option in the treatment of PU in patients with Spinal Cord Injury.

Background: Degenerative disorders of the lumbar spine are a common cause of chronic pain and disability, particularly in older adults. They involve the progressive degeneration of intervertebral discs, which leads to symptoms such as lower back pain, nerve compression, and neurological deficits. While traditional MRIs are a widely used and effective tool for diagnosing many spinal conditions, including degenerative disorders of the lumbar spine, they do have limitations when it comes to detecting early microstructural changes in the intervertebral discs and other spinal components. This limitation can delay diagnosis and intervention in the early stages of degeneration, which is critical for preventing progression. The scoping review aims to sensitize the current evidence on the diagnostic performance of Diffusion Kurtosis Imaging (DKI) in detecting and characterizing degenerative changes in the lumbar spine.

Methods: Using the Arksey and O'Malley framework, we performed an extensive literature search across Scopus, Embase, and PubMed to identify relevant studies published between January 2010 and 2024. The selection criteria included 3T MRI studies utilizing DKI techniques aimed at evaluating degenerative changes in the lumbar spine.

Results: The total number of studies included in this study was 3 out of 355, where our preliminary findings indicate that the DKI parameters demonstrated an early detection of microstructural changes within the degenerative lumbar spine as compared to the healthy controls. Accordingly, these changes are highly correlated with clinical symptoms and the extent of degeneration observed on conventional MRI, suggesting that DKI is more sensitive to detecting early microstructural changes.

Conclusion: MR Diffusion Kurtosis Imaging offers a substantial potential for detecting subtle microstructural changes in the lumbar spine degeneration at an early stage, that is crucial for earlier diagnosis and intervention. The integration of DKI sequence into clinical practice could result in an increase in diagnostic accuracy and patient outcomes.

Background: Dental caries, caused by bacterial activity leading to tooth decay, has a profound impact on children's quality of life. This study aimed to investigate factors associated with dental caries in 3-year-old Iranian children.

Methods: A cross-sectional study was conducted involving 815 three-year-old children who were referred to healthcare centers in the southern region of Tehran Province, Iran. Truncated random forest, traditional random forest, and a log-linear model were employed, utilizing the number of dental caries (including excess zeros) as the outcome variable. Predictors included sex, tooth brushing, dental flossing, sweet consumption, dental visits, and parental education level.

Results: The log-linear model's rate ratio (RR) indicated that boys were more likely to have at least 1 decayed tooth compared to girls (RR, 1.11). Dental floss usage significantly reduced childhood dental caries (RR, 2.74). Variable importance analysis from 2 random forests identified dental floss usage, dental visits, and the father's educational level as the most impactful factors on childhood caries. Results based on mean squared error (MSE) demonstrated that the truncated random forest (MSE, 0.002) outperformed the log-linear model (MSE, 0.959) and exhibited similar performance to the traditional random forest model (MSE, 0.006).

Conclusion: The truncated random forest model demonstrated superior performance compared to traditional random forest and log-linear models. From a clinical perspective, promoting knowledge and practices related to good oral health habits in parents and their children emerges as a crucial strategy for reducing the risk of childhood caries.