Medical Journal of the Islamic Republic of Iran最新文献

Background: Surgical site infections (SSIs) cause morbidity, disabilities, and healthcare costs. This study aims to assess patient- and surgery-related factors influencing SSIs with standardized preoperative, operative, and postoperative care.

Methods: This prospective cohort study involved 140 patients undergoing elective or emergency surgeries at Al-Azhar University Hospitals, Egypt, from October 2020 to September 2021. Patients were stratified into two groups: emergency (Group A) and elective (Group B). Risk factors for SSIs were assessed through observational and analytical methods, focusing on adults aged 15 and older without prior infections. The chi-square test was utilized to assess the strength of associations for categorical variables. Statistical significance was determined at a p-value under 0.05, with a 95% confidence interval employed for all analyses. Data were tabulated using a spreadsheet and analyzed with IBM SPSS Statistics for Windows, Version 20.

Results: Among 140 patients, 25 developed SSIs (19 men, 6 women). Significant differences were found in wound type (P = 0.001, surgery type (P = 0.002), and operative time (P = 0.010). SSI risk was higher for dirty (45.8%), contaminated (31.3%), and clean-contaminated (12.9%) wounds. Prolonged operative times (≥60 minutes) increased SSI risk (57.9% vs. 40.6%, P = 0.010). Diabetic patients had a higher incidence. In emergency surgeries, E. coli, Staphylococcus aureus, and Pseudomonas aeruginosa predominated, while S. aureus and Citrobacter were more common in elective surgeries. Amikacin, metronidazole, azithromycin, and imipenem were effective antibiotics.

Conclusion: SSIs were more common in emergency surgeries. Risk factors included smoking, diabetes, wound contamination, and prolonged operative times. Effective antibiotic use and infection control measures can decrease SSI occurrence.

Background: Voice actors are a group of professional voice users who have heavy vocal demands in their profession and, as a result, experience a high percentage of vocal complaints. This study aimed to assess the impact of tele-practice compared to in-person voice therapy on various voice characteristics in voice actors.

Methods: A pilot clinical trial was carried out on 14 voice actors and actresses who were allocated to two groups. All participants received the same voice therapy interventions for 60 minutes per session, three sessions per week for 6 weeks. Sessions for one group were held in person, while the other group received therapy remotely. The acoustic measurements, aerodynamic measurements, auditory-perceptual judgment, and self-perceived measurements as outcome measures were assessed before treatment, post-treatment, and four weeks after the end of the treatment for each group. Repeated measure ANOVA was applied to within-groups comparisons, and the Kruskal-Wallis test was used to between-group comparisons.

Results: Shimmer, MPT, CAPE-V scores, VTD scores, and VHI scores improved significantly post-treatment and showed sustained improvement over time in both groups. Fundamental frequency, jitter, harmonic-to-noise ratio, and /s/ to /z/ ratio did not change significantly after treatment in both groups. None of the outcome measures had significant differences between groups in any assessment points. The power of the study was 80%.

Conclusion: Tele-practice can have the same effects as in-person voice therapy. In addition, providing vocal hygiene counseling alongside continuous warm-up and cool-down exercises, breathing exercises, and head and neck exercises can lead to improved voice condition and reduced voice complaints.

Background: Southeast areas of Iran, particularly Kerman province, are among the deprived areas of the country which have received less attention in research about cancer screening. This study focused on screening behaviors in a relatively deprived population of Jiroft and Rabor districts of Kerman province to determine the effective factors in women's common cancers screening.

Methods: In this cross-sectional study, we interviewed 970 women aged 20 to 69 years from urban and rural areas of two counties of Kerman province in Iran (Jiroft and Rabor counties), proportional to their population sizes. Participants were asked about their cancer screening history, knowledge, and attitude toward common cancers, as well as their health literacy, all measured on a scale from 0 to 100. Independent samples t-tests, ANOVA, and Pearson's correlation coefficient were utilized to examine the relationships between variables. Subsequently, a bivariate and multivariate linear regression model was used to investigate the relationship between the screening score and the other variables with 95% confidence intervals.

Results: The scores for screening, knowledge, and attitude were 14.6, 58.1, and 54, respectively, while health literacy was 18.6. The correlation coefficients between screening and health literacy, awareness, attitude, and knowledge ranged from 0.2 to 0.33. Screening history was lower among older women, those with less education, housekeepers, and divorced women. There was a significant relationship between knowledge about risk factors, attitude, and health literacy.

Conclusion: Although studied women had relatively acceptable scores in knowledge and attitude, cancer screening rates were relatively low. This suggests that a comprehensive approach to health promotion, beyond just health education, is needed to improve cancer screening practices among women in studied areas.

Background: With the increase in life expectancy and the rising number of total hip arthroplasty (THA) cases, the rate of complications is also expected to increase. One of the most challenging complications is dislocation, which is the leading cause of revision surgery within the first year after THA. This study aimed to assess hip instability rates in high-risk patients who underwent dual mobility cup (DMC) implantation.

Methods: This retrospective study reviewed all patients who underwent THA with DMC at Rasul-e-Akram Hospital between 2014 and 2021. DMC was used in high-risk patients for dislocation, including those with neuromuscular diseases (e.g., Parkinson's disease, poliomyelitis) and intracapsular femoral neck fractures (FNF), instead of the standard cup. Clinical outcomes, instability, and other complications were recorded. All data was analyzed using SPSS software version 27.0.1. The chi-squared test was used to compare binary variables, and the student's t-test was used to compare numerical variables after checking for normal distribution.

Results: A total of 163 patients (168 hips) underwent THA with DMC, with a mean age of 58 ± 5.3 years. Five patients had bilateral total hip surgery. The average follow-up time was 48 ± 5.8 months. The average BMI of patients was 28.3 ± 3.1. The preoperative Harris Hip Score (HHS) was 49 ± 8.5, while the postoperative HHS at the four-year follow-up was 89 ± 2.4. None of the patients experienced a dislocation requiring revision, and One case of severe wear on the polyethylene's inner surface and intraprosthetic dislocation, without a dislocated metal head, was identified and revised. No cases of component loosening or significant osteolysis were observed.

Conclusion: The use of DMC can significantly reduce the dislocation rate in patients with risk factors such as femoral neck fractures while improving patient satisfaction and restoring near-normal function. We recommend greater consideration of this cup in patients at risk of dislocation.

Background: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in women that may be associated with an increased risk of various cancers. This meta-analysis aims to evaluate the relationship between PCOS and the risk of breast, ovarian, and endometrial cancers.

Methods: We performed a comprehensive search of databases, including PubMed (Medline), Scopus, Web of Science, and Embase (Elsevier), covering the period from 1983 to November 2023. The review included cohort studies (both retrospective and prospective) and case-control studies. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) for nonrandomized studies. Data analysis was conducted with Stata 17.

Results: Our meta-analysis reviewed 13 studies on the association between Polycystic Ovary Syndrome (PCOS) and endometrial cancer, revealing a combined Relative Risk (RR) of 2.91 (95% CI: 2.29 - 3.70; I²: 61.97%; P < 0.001), indicating a significantly increased risk of endometrial cancer among women with PCOS. For breast cancer, the pooled RR from the studies was 1.09 (95% CI: 0.97-1.22; I²: 55.81%; P = 0.012), suggesting a modestly elevated risk. In the case of ovarian cancer, seven studies contributed to the analysis, resulting in a combined RR of 1.52 (95% CI: 1.17-1.97; I²: 49.22%; P = 0.072). This finding indicates a moderate increase in risk for ovarian cancer in women with PCOS. These results collectively point to an elevated risk of endometrial, breast, and ovarian cancers in women with PCOS, although the magnitude of risk varies among different types of cancer.

Conclusion: This meta-analysis supports an elevated risk of endometrial, breast, and ovarian cancers in women with PCOS. These findings highlight the need for increased surveillance and preventive measures for women with PCOS to mitigate their cancer risk. Further research with larger sample sizes is needed to confirm these associations and explore underlying mechanisms.

Background: Approximately 80% of all malignant brain tumors and the most common cause of death that occur as a result of primary brain tumors belong to glioma. Hence, identifying effective biomarkers for early diagnosis and prognosis can have a significant impact on patient treatment. Recent years have witnessed a significant increase in the use of machine learning (ML) to analyze RNAseq data to identify new cancer biomarkers. In this study, diagnostic and prognostic biomarkers for Glioma were identified through the collection of patient data from the TCGA database and analysis using ML algorithms and bioinformatics.

Methods: The study used ML to analyze ribonucleic acid (RNA) expression profiles from Glioma patients (GBMLGG) to identify differentially expressed genes (DEGs). In general, the sample of 1012 patients and 35 controls, which included 613 men and 434 women, was used in this study. Biomarkers of prognosis have been identified using the Kaplan-Meier analysis of survival curves. The coexpression of DEGs, protein-protein interactions (PPIs), and the correlation between DEGs and clinical data were also examined. The receiver operating characteristic (ROC) curve analysis was used to determine diagnostic markers.

Results: After normalization and filtering, we identified 3172 DEGs with a log fold change |FC| ≥ 1 and P < 0.0.05. According to a survival analysis, 15 upregulated genes (GRAPL, LOC339240, LOC723809, NODAL, SILV, SPINK8, TAC4, ANG, CD209, F2RL2, LYZ, SLAMF7, psiTPTE22, SFRP4 and DKFZP) and 9 downregulated genes (PCDHGC5, CES8, CHD5, DNAJC6, DNM1, KIRREL3, NCOA7, RASAL1, SNCA) were associated with overall survival (OS). In addition, the ML algorithm identified 20 genes, among which PSD, TUBA4A, and PCDHGC5 were identified as candidates with high correlation coefficients.

Conclusion: Generally, our results showed that immune-related genes play a crucial role in the development, progression, and pathogenesis of gliomas. Five immune-related genes-including SLAMF7, CD209, TAC4, HLA-DRB68, and LYZ-were found to be diagnostic and prognostic biomarkers of the disease.

Background: Type 2 diabetes mellitus (T2DM) is associated with chronic inflammation, reflected by elevated markers like Interleukin-6 (IL-6), Neutrophil Lymphocyte Ratio (NLR), and Platelet Lymphocyte Ratio (PLR).These inflammatory markers contribute to increased risk of complications related to poor glycemic control in T2DM. Understanding the interplay of metabolic and inflammatory factors in T2DM is crucial for improving prevention, diagnosis, and management strategies. This study was aimed to conduct a comparative analysis of NLR, PLR, IL-6, and HbA1c levels in individuals with type 2 diabetes mellitus versus healthy controls within the Kashmiri population.

Methods: A Comparative study was conducted with 600 subjects, comprising 300 T2DM patients and 300 age- and sex-matched healthy controls. Biochemical markers including IL-6, NLR, PLR, and HbA1c were measured using standard methods. The association between these markers and glycemic control, obesity, and hematological parameters was assessed.

Results: T2DM patients exhibited significantly higher levels of IL-6, NLR, and PLR compared to controls (P=0.001). Obese diabetic patients had markedly elevated inflammatory markers compared to non-obese diabetic patients. Higher HbA1c levels strongly correlated with increased IL-6, NLR, and PLR (P=0.001). IL-6 also showed significant associations with WBC count, hemoglobin, and hematocrit, indicating a link between chronic inflammation and hematological disturbances in T2DM.

Conclusion: The study concludes that the elevated inflammatory markers in T2DM patients, particularly among obese individuals are closely associated with poor glycemic control reflecting the chronic inflammation in T2DM. These findings underscore the need for a comprehensive management approach in T2DM. Regular monitoring of these inflammatory markers may help predict complications and guide therapeutic interventions.

Background: Early detection of vesicoureteral reflux (VUR) is crucial to prevent potential complications such as recurrent urinary tract infections and kidney damage. Noninvasive diagnostic alternatives to voiding cystourethrography (VCUG), such as ultrasound (US) and 99mTc-DMSA scan, offer effective and safe methods for identifying VUR without exposing children to ionizing radiation. This investigation aimed to evaluate the efficacy of US and 99mTc-DMSA scan in detecting VUR compared with VCUG among children with urinary tract infection (UTI).

Methods: In this observational study, we included 540 hospitalized children with UTI in Aliasghar Children`s Hospital between April 2017 and May 2019. US and VCUG were performed on all patients, with 99mTc-DMSA administered to some to detect VUR. Sensitivity, specificity, positive and negative predictive values, overall accuracy, and kappa agreement were calculated to evaluate ultrasound efficacy in predicting VUR based on VCUG-confirmed existence or nonexistence of VUR.

Results: Out of 540 patients, VCUG identified VUR in 143 cases, with 90 (63%) classified as grades III to V. US results were abnormal in 97 of the 143 patients (67.8%) confirmed to have VUR via VCUG, while the 99mTc-DMSA scan showed abnormalities in 41 out of 69 (59%) cases detected by VCUG. The sensitivity and negative predictive value (NPV) of the 99mTc-DMSA scan for diagnosing VUR were recorded at 59.42% and 46.59%, respectively. For ultrasound, the overall accuracy was 61.30%, with sensitivity at 67.83%, specificity at 58.94%, NPV at 37.31%, and positive predictive value (PPV) at 83.57%. In children with high-grade VUR (grades III-V) as determined by VCUG, the sensitivity, specificity, and NPV for ultrasound were found to be 80%, 58.2%, and 93.60%, respectively. However, when both US and 99mTc-DMSA scan results were utilized for detecting high-grade VUR, the sensitivity, specificity, and NPV were calculated to be 92%, 42.30%, and 93.20%, respectively.

Conclusion: While both US and the 99mTcDMSA scan are not fully reliable in detecting all grades of VUR individually, integration of US and ^99mTc-DMSA scan demonstrates reliable sensitivity and NPV for effectively excluding high-grade VUR. These findings suggest that in children with normal results from both US and ^99mTc-DMSA scans, there may be no need for VCUG. This approach could significantly reduce unnecessary VCUG procedures, minimizing patient exposure to radiation and enhancing overall diagnostic efficiency in pediatric care.

Background: Osteoarthritis (OA), as one of the most common chronic joint diseases, significantly contributes to the global burden of disability and imposes considerable financial costs on patients and healthcare systems. The prevalence of this disease is increasing rapidly across various countries. This study aimed to examine and compare national policies on the prevention and management of OA in four high-income countries and Iran.

Methods: A comparative review was conducted by searching PubMed, Scopus, Web of Science, Google Scholar, Google, and the websites of the World Bank, the Organization for Economic Co-operation and Development (OECD), and the Ministry of Health of the selected countries from 2000 to 2024. This study utilizes the "Policy Analysis Triangle" framework by Walt and Gilson to analyze OA prevention and management policies in the selected countries. Expert interviews and document analysis were used to collect information in Iran. In the data analysis of this section, framework analysis and content analysis were also used through the software MAXQDA-10.

Results: This study examined the policies and measures of 5 countries (the United States, Canada, Australia, the United Kingdom, and Iran) concerning OA prevention and management. In the United States, the focus is on physical activity, weight management, and healthy diets, supported by the Centers for Disease Control programs and the Arthritis Foundation. Canada implements educational programs and national policies through extensive collaboration between government and nongovernmental organizations. Australia emphasizes improving access to healthcare services and care through the cooperation of various organizations. In the UK, the focus is on prevention and public education, alongside strengthening access to health services. Iran primarily focuses on treatment and pain management, facing challenges such as limited financial resources and public awareness.

Conclusion: Although there are similarities between OA prevention and management policies in Iran and high-income countries, Iran continues to face significant challenges in primary prevention, policy evaluation, and resource access. By leveraging the experiences of high-income countries and adopting strategies based on assessment and prevention, Iran could significantly improve its policies and reduce the long-term burden of OA.