Background: Dysphagia is an important complication that occurs in some patients with cancers and malignancies, such as esophageal and lung cancer, and can influence patients’ weight and serum albumin levels. The placement of Self-Expanding Metallic Stents (SEMS) and gastrostomy are common therapies for cancer-related dysphagia. The aim of the present study was to compare SEMS and gastrostomy in terms of changes in serum albumin level, changes in weight, three-, six-, nine- and twelve-month Overall Survival (OS) of patients and also the need for additional reintervention and incidence of aspiration pneumonia after the first procedure. Methods: This was a systematic review and meta-analysis study based on the PRISMA guidelines. Scopus, Web of Sciences, and PubMed databases were searched for studies, reporting out comes of interest mentioned above and compared both groups. The Egger bias test and funnel plot were used to detect and depict publication bias. Results: Five studies were eligible for inclusion in this study. SEMS group had a higher decrease in serum albumin level (SMD =-0.53, 95% CI: -0.92 to-0.15 mg/dl; p=0.006) and weight (SMD=-0.08, 95% CI: -0.38 to 0.21; p=0.57) and need for additional reintervention (OR=5.23, 95%CI: 1.27 to 21.48; p=0.02) compared to the gastrostomy group after the intervention, patients that underwent the SEMS placement had lower twelve-month OS (OR=0.24, 95%CI: 0.14 to 0.41; p<0.001). Conclusion: Patients of gastrostomy group have lower decrease in serum albumin level, need for additional intervention and better twelve-month OS.
Sialolithiasis is the most common pathology affecting the salivary glands. The submandibular gland is most commonly affected. Sialoliths typically causes pain and swelling in the affected gland. They usually range in size from 1 to 10 mm, while those larger than 15 mm are considered rare. The exact etiology of sialolith formation remains unknown. We report the case of a 62-year-old patient with submandibular gland sialolith, that was incidentally discovered during imaging performed for dental implant planning. Remarkably, the patient was completely asymptomatic, despite the stone being giant in all three dimensions. Cone-Beam Computed Tomography (CBCT) of the mandible revealed a radiopaque lesion posterior to the mandibular Body, measuring approximately 2.8×1.8×2 cm. The sialolith was successfully removed using a minimally invasive transoral sialolithotomy.
Background: Male circumcision is among the most common surgical procedures globally, yet limited data exist on maternal satisfaction, particularly where traditional and medical practices coexist. This study evaluated maternal satisfaction with circumcision outcomes and identified key influencing factors. Methods: This descriptive cross-sectional study included 350 mothers of male infants circumcised within the prior six months, recruited via random sampling from seven urban healthcare clinics (January-June 2024). Inclusion criteria were infants without penile abnormalities; maternal refusal or congenital anomalies (e.g., hypospadias) warranted exclusion. Data on demographics, procedure type, provider qualifications, complications, and satisfaction (overall and informational) were collected via structured interviews using validated Likert scales. Statistical analyses employed descriptive statistics, normality testing, t-tests, ANOVA, and nonparametric tests (significance: p<0.05). Results: Of respondents, 50.9% were younger than 30 years. Neonatal circumcisions (48.3%) and Plastibell procedures (92.8%) predominated. Circumcisions were performed by specialists (52.3%), general practitioners (24.9%), or non-medical providers (22.9%), mostly in hospitals (53.4%), outpatient clinics (36.6%), or traditional settings (10.0%). Overall mean satisfaction was 3.99±1.03, with low satisfaction regarding information (2.65±1.05). Satisfaction significantly differed by provider type (specialists highest: 4.42±0.91, non-medical lowest: 2.84±0.99; p<0.01) and setting (hospital highest: 4.43±0.80, traditional lowest: 2.77±1.06; p<0.01). Complications (4.0%; predominantly bleeding and meatal stenosis) primarily occurred with non-medical practitioners, significantly reducing satisfaction (p<0.01). Conclusion: Provider qualifications, setting, and complications significantly influence maternal satisfaction. Despite overall high satisfaction with hospital-based procedures, improved standardized counseling and regulatory oversight of non-medical practitioners are urgently required.
Background: Following car accidents, falls, and interpersonal violence, burn injuries rank fourth among the most common types of trauma worldwide. The incidence of burn injuries is significantly higher in developing countries compared to developed low- and middle- income countries. Therefore, it is crucial to identify the contributing factors, that lead to increased mortality and morbidity among burn patients. According to the literature, age, inhalation injury, Total Body Surface Area (TBSA), and sex significantly influence the morbidity and mortality of burn patients. However, there are limited studies extensively evaluating the association between laboratory tests and mortality. Methods: A comprehensive understanding of the characteristics of burn injuries and the factors predisposing patients to a higher risk of death can help clinicians identify high-risk patients and make informed decisions to minimize morbidity and mortality rates. Results: This study identifies key predictors and factors influencing mortality among burn patients, providing clinicians with a deeper understanding of burn cases. The findings are based on data collected from a referral center specializing in burns and plastic surgery. Additionally, the Volume Index is introduced for the first time as a predictive factor for mortality. Conclusion: Volume index and thrombocytopenia are novel and effective indices of poor prognosis among burned patients.
Background: Identification of the risk factors of potential Drug-Drug Interactions (DDI) and investigation of their adverse outcomes. Methods: The cross-sectional study was a retrospective analysis of a patient cohort treated at the COVID-19 ward of the Imam Khomeini hospital in Ardabil, northwest of Iran. The study included a randomized selection of patients who were admitted to the ward over three months in 2020. The demographic, medical data and drug-drug interactions of 150 randomly selected patients during three months in the COVID-19 ward of the Imam Khomeini hospital in Ardabil, northwest of Iran was analyzed. Results: At least one potential DDI was identified in 96% of patients. The number of drugs was the only risk factor for the occurrence of DDI. In addition to the number of drugs and prescribers, all types of interactions (except type X) were associated with an increased risk of mortality and duration of hospitalization. Conclusion: DDI are highly prevalent in the COVID-19 ward. A reduction in potential adverse effects and unwanted outcomes of pharmacotherapy is possible by reducing the number of prescribed drugs and preventing drug-drug interactions.
Background: Periodontal disease and diabetes are two prevalent chronic conditions that have shown significant bidirectional relationships. The current study investigated the periodontal indices of diabetic patients, comparing those with normal weight to those with overweight or obesity. Method: This cross-sectional study was conducted on 48 patients with Type 2 Diabetes (T2D). Data of age, gender, Body Mass Index (BMI), and Waist-to-Hip Ratio (WHR) of the patients were recorded. All individuals underwent periodontal examinations and data of Plaque Index (PI), Bleeding on Probing (BOP), Probing Pocket Depth (PPD), and Clinical Attachment Loss (CAL). The data were analyzed using SPSS version 24 with a significant level <0.05. Results: The mean age of participants was 40.5 years and most participants were over 40, with about 50% classified as overweight or obese. Most patients had low (35.4%) to moderate (37.5%) PI levels. The mean BMI was 26.47±4.78 kg/m², and the mean WHR was 0.95±0.11 cm. Obese participants had significantly higher mean BOP, PPD, and CAL compared to those with normal weight (p=0.001). Significant associations were found between BMI and PI levels, with higher PI observed in overweight and obese individuals, and between WHR and PI, of which high WHR correlated with more severe PI levels (p=0.001). Conclusion: The findings showed that overweight and obese individuals with diabetes had poorer periodontal health, with higher plaque levels and worse PPD and CAL, compared to those with normal weight. Both BMI and WHR were significantly associated with increased plaque accumulation.
Background: To evaluate the results of Radiofrequency Ablation (RFA) treatment for patients with inoperable Non-Small Cell Lung Cancer (NSCLC) at Nghe An Provincial Oncology Hospital. Methods: An uncontrolled clinical intervention study, comparing before-and-after results on 63 inoperable NSCLC patients who were treated with radiofrequency ablation at Nghe An Provincial Oncology Hospital from January 2014 to August 2022. Results: In the 63 patients studied, the average age was 64.8±7.9 yrs. Men accounted for 82.5%. The average tumor size was 4.45±1.86 cm. The group of tumors with a size of 5 cm accounted for 39.7%, from 3 cm to less than 5 cm, and tumors <3 cm all had a rate of 30.2%. There were 34 cases of partial response (54.0%), 31.7% of intact disease, and 14.3% of progressive disease. There was no complete response. The results of multivariate Cox regression analysis showed that tumor size <3 cm (HR=0.258; 95%CI:0.094-0.703), mild disease stage (Stage I/II/III) (HR=0.263; 95%CI: 0.099-0.696) and having a treatment response after RFA (HR=0.332; 95%CI: 0.160-0.690) were factors that affect the patient’s overall survival time. Conclusion: RFA is a minimally invasive treatment method that is effective in local tumor control and survival time.
Background: Physiological changes during pregnancy occur in all organs, including the cardiovascular system. Since these changes may mimic the symptoms associated with diseases, awareness of them is very important to manage the condition. The present study was conducted with the aim of investigating and comparing Trans Thoracic Echocardiography (TTE) and ECG findings in pregnant women <35 and ≥35 years old. Methods: The present descriptive-cross-sectional study was conducted in a comparative manner on 200 pregnant women referring to Imam Ali Clinic and Hajar Shahrekord Hospital. The data of the study was collected using a researcher-made checklist including demographic information and information related to pregnancy, TTE and ECG findings. SPSS version 24 software was used for data analysis. Results: TTE and ECG indices have been evaluated in both groups. Based on the results, it was shown that the average indices of QRS axis, LAD, AO, LVDD, PAP, RVDD, IVSD and PW were lower in the <35 group of patients compared to the ≥35 group. The difference in the average indices between the two groups was statistically significant (p<0.05). On the other hand, it was shown that the average indices of LVEF, LVSD, and TAPSE in patients of the ≥35 group were significantly lower compared to the <35 group of patients (p<0.05). Conclusion: With the increase in the gestational age of women, the rate of changes in heart parameters increases, which indicates that age as a risk factor can affect the function of the heart.
Background: Psychiatric comorbidity and substance use disorders were major risk factors for suicide. In Iran, although suicide rates are rising, there is limited research in this regard, therefore, this study aims to investigate the relationship between psychiatric comorbidity and substance use disorder in these patients through a retrospective review of medical records. Methods: This retrospective study analyzed 413 medical records of patients with substance use disorder who had attempted suicide and were hospitalized at Shahid Beheshti Hospital, Taft, Iran from 2014 to 2023. Diagnosis of poisoning was done under the supervision of a clinical toxicology and poisoning fellowship. Psychiatric diagnoses were established based on DSM-5 criteria through clinical interviews. Chi-Square test and logistic regression analysis were used for analysis. Results: Among the patients, Major Depressive Disorder (MDD) was the most common comorbidity (53%). Methadone was the most frequent substance use disorder (20.1%). Significant associations were found between MDD and factors such as age, education, employment status, and methadone and benzodiazepine use. Logistic regression analysis indicated strong positive associations between opioid, cannabis, and methamphetamine use and the likelihood of having bipolar disorder [Odds Ratios (OR): 8.96, 13.59, and 8.22, respectively; p<0.01]. Methamphetamine use was also significantly associated with increased odds of personality disorders (OR=3.002; 95%CI: 1.195–7.545; p=0.019). Conclusion: MDD was the most prevalent psychiatric disorder among patients with substance use disorder after a suicide attempt, with higher prevalence observed in younger, less educated, and unemployed individuals. Methamphetamine use was significantly associated with increased odds of developing personality disorders. Additionally, opioid, cannabis, and methamphetamine use were linked to a higher likelihood of developing bipolar disorder.
Background: Breastfeeding, as a healthy and effective method of infant feeding, contributes to enhanced short- and long-term health outcomes for both women and infants. However, there is growing concern about the decline in breastfeeding rates, particularly in low- and middle-income countries. In Iran, despite some progress, the incidence of early breastfeeding cessation has increased. Many factors affect the quality of breastfeeding, including breastfeeding self-efficacy and stress, which have been identified as two critical factors influencing this issue. Methods: This analytical-descriptive study was conducted in 2023 on 147 lactating women who attended comprehensive health centers in Khalkhal city. Data were collected using standardized questionnaires, including the Breastfeeding Self-Efficacy Scale and the Perceived Stress Scale (PSS-10), along with a demographic questionnaire. Results: The results indicated a statistically significant negative correlation between breastfeeding self-efficacy and stress (r=-0.206, p=0.012). Additionally, breastfeeding self-efficacy was significantly associated with several demographic variables, including education (r=0.168, p=0.041), duration of marriage (r=0.255, p=0.002), infant gender (r=0.246, p=0.003), and birth interval (r=0.264, p=0.001). Conclusion: The findings highlight the critical role of self-efficacy and stress in breastfeeding outcomes. Enhancing breastfeeding self-efficacy among lactating women may contribute to higher rates of exclusive breastfeeding. Educational and supportive interventions targeting these factors can play a pivotal role in improving breastfeeding practices.
Background: Timely diagnosis of Bloodstream Infections (BSIs) is crucial for effective sepsis management. Conventional culture methods, though considered the gold standard, exhibit limitations. This study aimed to evaluate the efficacy of multiplex Polymerase Chain Reaction (PCR) for rapid and accurate detection of bloodstream pathogens in suspected sepsis patients. Methods: The study was conducted between March 2021 and March 2022 at Valiasr Hospital, Zanjan, Iran. One hundred patients with suspected sepsis were recruited, and blood samples were collected for both methods. Demographic and clinical data were collected, and genomic DNA was extracted for PCR. Data were analyzed using SPSS software. Results: Most patients were elderly (>60 years), and Multiplex-PCR demonstrated higher detection rates than culture. Age, antibiotic history, and infection site were associated with bacterial frequency. A significant relationship existed between bacterial frequency and patient outcome. Pulmonary infections were most common, with specific imaging patterns observed. Conclusion: Multiplex PCR is a rapid and sensitive tool for diagnosing sepsis, offering superior sensitivity compared to culture. Further research is needed to validate its broader clinical application.
Background: Pediatric Emergency Departments (EDs) play a vital role in identifying and managing life-threatening conditions in children. Despite global reductions in under-five mortality, pediatric mortality remains a significant public health concern, particularly in Low- and Middle-Income Countries (LMICs). Localized studies on mortality patterns in pediatric EDs are essential for developing targeted interventions. This study aimed to investigate the incidence of pediatric mortality in the emergency department of the Children’s Medical Center, a national referral hospital in Iran, from 2019 to 2022. Methods: A retrospective study was conducted on children under 18 years of age who died in the ED during the study period. Data were collected from medical records, including demographic information, causes of death, and time of death. Descriptive statistics were used for analysis. Results: Among 76187 pediatric admissions, 155 deaths occurred, yielding a mortality rate of 2.03 per 1000 admissions. The mean age of the deceased was 43.58±6.1 months, with a slight male predominance (52.9%). Infants had the highest mortality rate (32.3%), while neonates had the lowest (5.8%). Neurological disorders (36.1%) were the most common cause of death, followed by infectious diseases (29.0%), cardiological conditions (20%), and hematological disorders (12.3%). A significant proportion of deaths (40%) occurred within one hr before or two hours after shift changes. Conclusion: The findings highlight the need to enhance neurocritical care and infection management in EDs. The high proportion of deaths near shift changes underscores the importance of effective handover protocols to improve patient safety.
Background: The escalating prevalence of moral harassment in the high-stress environment of the intensive care unit is impacting the overall health of nurses, ultimately putting patient health, safety, and even lives at risk. This issue is becoming increasingly significant. One common form of moral harassment is the misuse of authority within the treatment system. This study aims to determine the relationship between resilience and moral and power harassment in critical care nurses. Methods: This cross-sectional study was conducted in 2022-23. The study included a sample size of 106 critical care nurses in hospitals affiliated with Tehran University of Medical Sciences in Tehran, Iran. Sampling was carried out using a stratified random method. Data collection involved demographic, moral harassment, power harassment and resilience questionnaires. Analysis was performed using SPSS software version 19, with descriptive statistics and the Pearson correlation test. Results: The study revealed that the mean±SD resilience score for nurses overall was 89.01±19.50, with mean±SD for moral harassment at 16.99±14.54 and power harassment at 66.9±9.31. Spearman’s correlation coefficient test showed a significant and poor relationship between power harassment and moral harassment among nurses (p<0.001, r=0.647), as well as a significant and negative relationship between power harassment and resilience (p<0.001, r=-0.357), and moral harassment and resilience (p<0.001, r=- 0.387). Conclusion: Resilience plays a crucial role in mitigating the negative effects of power and moral harassment in the workplace, impacting the perceived health of individuals. Resilience helps explain the distress caused by power harassment and moral harassment in the workplace.
Postural stability is critical for preventing falls in the elderly, a population particularly vulnerable to injury, morbidity, and mortality from falls. Electromyography (EMG) biofeedback training has emerged as a potential intervention, offering real-time muscle activity feedback to improve neuromuscular control, proprioception, and muscle activation patterns. Despite promising results in various clinical populations, the application of EMG biofeedback for enhancing postural stability in the elderly remains underexplored. This scoping review aims to explore the impact of EMG biofeedback training on postural stability among older adults, evaluating its effectiveness, underlying mechanisms, and clinical implications for fall prevention. A scoping review methodology was employed to comprehensively analyze peer-reviewed literature published from 2010 to 2024. Studies were sourced from PubMed, CINAHL, Cochrane Library, Scopus, and Web of Science. The review focused on randomized controlled trials, quasi-experimental, and observational studies examining the use of EMG biofeedback to enhance postural stability in elderly populations. Key variables such as intervention protocols, participant demographics, and outcomes were extracted and synthesized thematically. The review identified significant improvements in static and dynamic balance through EMG biofeedback training, with studies demonstrating enhanced muscle activation, reduced postural sway, and improved functional mobility. Notably, personalized biofeedback protocols showed superior outcomes, suggesting tailored interventions could optimize therapeutic effectiveness. While short-term benefits were evident, further research is needed to evaluate the long-term sustainability of these effects. Overall, EMG biofeedback presents a promising tool for improving postural stability and reducing fall risk in older adults.
Background: The present study explored patient outcomes and factors possibly associated with these outcomes among patients hospitalized with severe COVID-19 during the Omicron variant’s surge in a tertiary care center in Tehran, Iran. Methods: The study design was a retrospective observational study conducted on adults hospitalized with severe COVID-19 in a tertiary care center in Iran, from 22 December 2021 to 22 April 2022. Patients with major comorbidities were excluded. Demographics, Cycle threshold (Ct) value at diagnosis, and outcomes (length of stay, ICU admission, and mortality) were obtained from hospital archives. Vaccination status was retrieved from a national registry. The relationship between proposed prognostic factors and patient outcomes was analyzed. Results: Data from 212 in-patients with severe COVID-19 was analyzed. Patients were aged 54.7±18.6 years old. 11.3% of patients were admitted to the ICU, and overall mortality was 14.1%. Average length of stay was 6.27 days. 70.8% of patients were fully vaccinated, and 11.3% had received a booster dose. Vaccination was associated with significantly less hospital stay (p=0.006), ICU admissions (p=0.018), and mortality (p=0.024). Higher viral burden was associated with mortality (p=0.01), but not ICU admission or longer stay. Conclusion: The present study findings restate the protective role of vaccines against adverse outcomes of COVID-19 infection. However, an alarming rate of poor outcomes during the peak circulation of the Omicron variant was found – warranting further consideration.
Background: Multiple Sclerosis (MS) is an autoimmune disorder that affects the nervous system affecting all aspects of patients’ lives. Researchers found effects of acupuncture on different aspects of MS related complications such as fatigue, spasticity, pain, and overall quality of life. This systematic review was conducted to assess the impact of acupuncture on different complication of MS as well as quality of life. Methods: An independent and systematic search across PubMed, Scopus, EMBASE, and Web of Science was carried out. Additionally, the gray literature, including references from the selected studies and conference abstracts published up until October were examined. Results: The literature search identified 1,877 articles, and after removing duplicates, 1,062 remained. Finally, a total of 18 studies were included in the systematic review. The studies included were published between 1974-2023 and the sample size ranged between 1-108. Four of six studied including Randomized Controlled Trial (RCTs) found that acupuncture in cases who completed the study was effective in pain management, symptomatic relief for spasticity, MS-related fatigue and enhanced patients’ quality of life. Conclusion: Acupuncture can be effective in treating some MS related complications such as fatigue, disability and quality of life.
Background: The production of alloantibodies as an immunological reaction to blood cell transfusion is a therapeutic challenge in patients with beta-thalassemia. Determining the rate of this event and its related factors is very important in managing blood transfusion. This study aimed to assess the prevalence rate and main determinants of red-cell alloimmunization in Iran’s selected sample of patients with beta-thalassemia. Methods: This cross-sectional study was performed on 265 beta-thalassemia patients scheduled for regular blood transfusions in Imam Khomeini Complex Hospital and Children’s Medical Center as tertiary hospitals in 2021 and 2022. Along with baseline characteristics, special laboratory techniques also tracked the types of alloantibodies to red cell antigens. Results: The overall rate of alloantibody positivity in thalassemia patients was 17.4%. The most common alloantibodies were anti-K in 10.6%, anti-E type in 4.5%, and anti-C in 2.3%. Conclusion: Overall, 17.4% of beta-thalassemia patients in our population may face red-cell alloimmunization. Phenotyping and blood matching for K, E, and C antigens in patients with transfusion-dependent thalassemia could reduce the rate of RBC alloimmunization.
Social media, particularly Instagram, plays an integral role in contemporary dentistry. It has significantly transformed the dental field by facilitating visual communication, marketing strategies, peer networking, patient education, and clinical training. However, significant risks exist, including violations of patient confidentiality, dissemination of inaccurate dental information, potential promotion of unnecessary cosmetic dental procedures, and increased psychological stress among practitioners due to unrealistic treatment expectations. Additionally, issues such as plagiarism of clinical content further compromise professional integrity. To address these challenges, establishing a dental-specific regulatory body to monitor Instagram content is recommended, ensuring accuracy, ethical standards, and safeguarding the interests of both dental professionals and patients.
Background: The coronavirus pandemic led to significant moral distress among nurses, diminishing care quality and increasing their intention to leave the profession. Since the intention to leave the profession can predict future career abandonment, this study was conducted in 2022 to investigate the relationship between the intention to leave the profession and the moral distress of novice nurses working in the COVID-19 wards. Methods: In this descriptive correlational study, 181 novice nurses working in the COVID-19 wards were recruited using the census method. Data were collected using Corley’s moral distress and intention to leave the profession questionnaires and analyzed using SPSS26. Results: The results of the data analysis showed that the mean score of novice nurses’ intention to leave the profession was 40.70±8.02 and at a moderate level, and their mean moral distress was 71.03±35.60 and at a low level. Moreover, the results indicated a positive and significant relationship between the intention to leave the profession and moral distress (p<0.001, r=0.61). No significant relationship was observed between these nurses’ demographic variables, their intention to leave the profession, and moral distress (p>0.05). Conclusion: This level of intention to leave the profession, the moral distress experienced by novice nurses working in the COVID-19 wards, and the positive and significant relationship between them is a warning for health policymakers. Therefore, holding training courses to manage moral distress in the workplace can be considered a solution.
