This article reports a case of a medical error in the diagnosis and treatment of thyroid disease in a 29-year-old man hospitalized following a suicide attempt and diagnosed with severe depression. The patient had a history of hypothyroidism managed with levothyroxine. During his hospitalization, abnormal liver and kidney test results prompted an internal medicine consultation for further evaluation. The specialist mistakenly interpreted the patient’s TSH level as 0.2 mIU/L (instead of 2.0), diagnosed hyperthyroidism, and prescribed methimazole. Although the drug was not available in the hospital pharmacy, the patient received methimazole the day before discharge, which he took concurrently with levothyroxine. Upon review of the patient’s file, the ward pharmacist identified this drug interaction and contacted the patient to discontinue methimazole. This case clearly illustrates diagnostic and therapeutic errors caused by incorrect test interpretation, poor coordination in medication management, and insufficient clinical supervision. The study explores the possible causes of these errors, emphasizes the importance of clinical decision support systems, highlights the need for ongoing staff training in thyroid test interpretation, and underscores the crucial role of pharmacists in preventing medication errors.
Background and aims: Aggression and maladjustment in children can disrupt their development. Cognitive behavioral therapy (CBT) helps address these issues by modifying maladaptive thoughts and behaviors. This study aimed to evaluate the effects of group CBT on aggression, social adjustment, and peer interaction among elementary school boys. Methods: The study employed a semi-experimental design with pre-test and post-test measures and a control group. Thirty male students of 5th and 6th -grade from elementary schools in Fasa city, Iran were selected through convenience sampling and randomly assigned to either the experimental group (n=15) or the control group (n=15). Both groups completed questionnaires before the intervention. The experimental group then participated in 13 weekly CBT sessions, each lasting 60 minutes, while the control group received no intervention. After the intervention period, both groups completed the questionnaires again. Data were collected using Bell’s Emotional Adjustment Questionnaire, Hudson’s Peer Interaction Questionnaire, and Bass and Perry’s Aggression Questionnaire. Data analysis was performed using univariate analysis of covariance. Results: CBT had a significant effect on social adjustment (p<0.001), aggression (p<0.001), and peer relationships (p<0.001) in the experimental group at the post-test stage. Conclusion: The findings suggest that group CBT is effective in reducing aggressive behaviors, improving social adjustment, and enhancing communication skills with peers among boys in elementary school.
Background and aims: Nowadays, social support plays a crucial role in maintaining maternal health. This study aimed to design, implement, and evaluate an intervention to promote social support for mothers during the postpartum period. Methods: This multiphase mixed-methods study consisted of three stages. First, a qualitative study was conducted using conventional content analysis to explore mothers’ perceptions and experiences of social support during the postpartum period. In the second stage, a systematic review of existing interventions to enhance maternal social support in the postpartum period was performed. Following this, a nominal group technique session was held to prioritize interventions based on their importance and feasibility, informed by the qualitative findings and systematic review results. In the third stage, a randomized clinical trial was conducted with 100 pregnant women and their spouses to assess the effectiveness of the designed intervention. Results: The qualitative analysis identified three main categories: “support resources,” “support barriers,” and “support promotion strategies.” During the nominal group session, a group training intervention for husbands was designed based on these findings. The randomized trial showed that the intervention group had significantly higher social support scores immediately after (79.42 ± 7.15) and one month after the intervention (84.40 ± 5.91), compared to the control group scores (37.26 ± 7.99 and 37.14 ± 6.63, respectively) (p<0.001). Conclusion: The study demonstrated that group education for spouses effectively enhances social support for postpartum mothers. Therefore, this intervention is recommended for midwives and maternal healthcare providers.
Background and aims: Chronic low back pain is a common musculoskeletal condition. This study aimed to investigate the effects of a sensorimotor exercise program on lumbar spine posture, pain, and proprioception in military personnel suffering from chronic non-specific low back pain. Methods: This interventional clinical trial involved 30 military personnel with chronic non-specific low back pain, divided equally into a sensorimotor exercise group and a control group. Lumbar spine posture, pain, and proprioception were assessed before and after the intervention using a flexible ruler, the Visual Analog Scale (VAS), and a goniometer, respectively. Data were analyzed using ANCOVA with a significance level set at 0.05. Results: Sensorimotor exercises significantly improved lumbar spine posture (p = 0.001) and reduced back pain (p = 0.001) in the military personnel. Additionally, proprioception showed a significant improvement following the exercise intervention (p = 0.001). Conclusion: Sensorimotor exercises that stimulate the proprioceptive system and enhance sensorimotor input can effectively improve spinal posture, reduce pain, and enhance proprioception in military personnel with chronic non-specific low back pain.
Background and aims: Given the nature of the firefighting profession and the necessity of optimal health and fitness for safe and effective performance, greater attention must be paid to firefighters’ physical fitness. This systematic review and and meta-analysis aimed to assess the impact of training interventions on firefighters' physical fitness levels. Methods: Primary data were collected from four databases: PubMed, SCOPUS, Cochrane Register of Controlled Trials, and Web of Science. The results were analyzed by calculating standardized mean differences (SMDs), weighted mean differences, and 95% confidence intervals (CIs) using either random- or fixed-effects models. After screening, 12 studies involving 474 participants were included in the review. Results: The meta-analysis showed that training interventions significantly improved multiple components of fitness: aerobic endurance, muscular endurance, muscular strength, power, flexibility, and agility (p = 0.001). Conclusion: These findings indicate that training interventions positively affect the physical fitness of firefighters. Consequently, coaches and professionals involved in firefighter performance enhancement should incorporate targeted exercise interventions into training programs. However, few studies have explored diverse exercise interventions, and only a limited range of variables has been assessed. Comparisons with alternative methods are also scarce, underscoring the need for further research.
Background and aims: Obesity in adolescents is frequently associated with low-grade systemic inflammation. This study aimed to examine the combined effects of aquatic aerobic exercise and royal jelly supplementation on body composition and interleukin-6 (IL-6) levels in obese adolescent girls. Methods: In this semi-experimental study, 60 obese girls aged 15 to 17 years were randomly assigned to four groups: exercise, supplement, combined (exercise + supplement), and control (n = 15 per group). The exercise protocol consisted of eight weeks of aquatic aerobic training, conducted three times per week at 50–70% of heart rate reserve. The supplement group received 1000 mg of royal jelly daily. Body mass index (BMI) and IL-6 levels were measured before and after the intervention. Intra-group and inter-group comparisons were performed using paired t-tests and covariance analysis. Results: A significant reduction in BMI was observed in the exercise and combined groups compared to the supplement and control groups (p < 0.05). Furthermore, IL-6 levels decreased significantly in all intervention groups compared to the control group, with the greatest reduction occurring in the combined group (p < 0.05). Conclusion: Aquatic aerobic training effectively improves body composition and reduces inflammation in obese adolescents. While royal jelly supplementation alone does not influence body composition, it significantly lowers inflammation. The combined intervention demonstrated superior efficacy in reducing IL-6 levels compared to supplementation alone.
Background and aims: Deaths caused by the coronavirus have complicated the grieving process, often leading to unexpressed or complicated grief with severe and long-lasting consequences. This study aimed to investigate the effectiveness of emotion-focused therapy on distress tolerance, fear of positive experience, and psychosomatic symptoms in individuals suffering bereavement related to COVID-19. Methods: This semi-experimental study employed a pre-test/post-test design with control group. The sample consisted of 20 individuals experiencing grief due to COVID-19, selected through convenience sampling. Participants were randomly assigned to either the emotion-focused therapy group (n = 10) or the control group (n = 10). Measures included Simmons and Gaher’s Distress Tolerance Questionnaire, a researcher-designed Fear of Positive Experience Questionnaire, and Lacourt’s Psychosomatic Symptoms Questionnaire. Following the pre-test, the experimental group underwent 10 sessions of emotion-focused therapy. Results: Findings indicated that emotion-focused therapy had a significant positive effect on distress tolerance, fear of positive experience, and psychosomatic symptoms (p<0.05). Conclusion: The results suggest that emotion-focused therapy can effectively enhance psychological well-being in individuals grieving losses caused by COVID-19. Such interventions may be beneficial in addressing the emotional and psychosomatic challenges associated with bereavement.
Background and aims: Cancer patients often experience severe pain due to both the disease and its treatment. This study aimed to investigate the effectiveness of Acceptance and Commitment Therapy (ACT) in reducing pain catastrophizing and pain anxiety while enhancing resilience among cancer patients. Methods: This study employed a quasi-experimental design with pre-test and post-test assessments, including a control group. The statistical population consisted of cancer patients referred to the pathology department of Imam Khomeini Hospital in Behshahr city, during 2023. Totally, 40 participants were selected based on the study's inclusion and exclusion criteria (20 for each group). Data were collected using three validated questionnaires incuding Pain Catastrophizing Scale (PCS) by Sullivan, Bishop, and Pivik (1995), Pain Anxiety Symptoms Scale (PASS) by McCracken and Dhingra (2002), Connor-Davidson Resilience Scale (CD-RISC) by Conner and Davidson (2003). Data were analyzed using analysis of covariance (ANCOVA). Results: The findings revealed significant improvements in the experimental group including pain catastrophizing (decreased from 52.6 ± 4.8 to 32.3 ± 3.5), pain anxiety (decreased from 35.7 ± 4.2 to 21.0 ± 3.9), and resilience (increased from 54.4 ± 16.2 to 60.3 ± 18.1). All changes were statistically significant (p< 0.001) whereas no significant differences were observed in the control group. The effect sizes were 0.58, 0.53, and 0.64 for pain catastrophizing, pain anxiety, and resilience, respectively. Conclusion: The results demonstrate that ACT is effective in reducing pain catastrophizing and pain anxiety while improving resilience in cancer patients. Therefore, ACT is recommended as a therapeutic intervention to alleviate these psychological challenges in this population.
Background and aims: Excessive mobile phone use increases strain on the neck, leading to muscle weakness and imbalance in the neck and shoulder girdle. This study examined the effects of corrective exercises on neck muscle length, endurance, and strength in female students with text neck syndrome. Methods: In this quasi-experimental pretest-posttest study, 70 female students aged 12–14 with text neck syndrome from Hamedan were purposefully selected and randomly divided into experimental and control groups (35 each). The experimental group underwent an eight-week corrective exercise program, while the control group received no intervention. Pectoralis minor muscle length, neck flexor and extensor strength, and endurance were measured before and after the intervention. Data were analyzed using repeated measures ANOVA and paired-sample t-tests. Results: Significant time × group interactions and paired differences were observed for pectoralis minor length, neck flexor and extensor strength, and endurance, indicating improvements in the experimental group compared to the control (p < 0.05). Conclusion: Corrective exercises enhance pectoralis minor length and neck muscle strength and endurance, mitigating forward head posture and neck pain. These exercises are recommended for students with frequent mobile phone use to improve muscular balance and alleviate symptoms of text neck syndrome.
Background and aims: Anaerobic capacity is a key factor in the performance of wrestlers, particularly in their ability to produce energy under oxygen-deficient conditions. This study aimed to predict lower-body anaerobic capacity in elite young wrestlers using a field-based test involving repeated double-leg takedowns from both the left and right sides in the Japanese stance position. Methods: This semi-experimental study included 42 elite wrestlers from Razavi Khorasan Province who participated voluntarily. Lower-body anaerobic capacity was assessed using two methods: the 30-second Wingate anaerobic test and a 30-second field test involving left and right double-leg takedowns. Heart rate and blood lactate levels were measured before the test, immediately after, and at 5 and 10 minutes post-exercise. Data were analyzed using Pearson correlation, the Intraclass Correlation Coefficient (ICC), the Bland-Altman agreement test, and linear regression. Results: The results revealed a significant positive correlation between the Wingate anaerobic test and the double-leg takedown field test (r = 0.482, p = 0.015). Strong correlations were observed for peak anaerobic power (r = 0.714, p = 0.001), mean power (r = 0.931, p = 0.001), and minimum power (r = 0.771, p = 0.002). Additionally, significant correlations were found between heart rate immediately post-test (r = 0.427, p = 0.033), at 5 minutes (r = 0.613, p = 0.001), and 10 minutes post-test (r = 0.448, p = 0.025). However, changes in blood lactate levels at 5 and 10 minutes post-test were not statistically significant. Conclusion: The double-leg takedown field test in the Japanese stance effectively predicted lower-body anaerobic capacity in elite young wrestlers and could serve as a suitable alternative to the Wingate anaerobic test for athlete evaluation.
Background and aims: Upper Crossed Syndrome (UCS) is a postural imbalance that leads to abnormal patterns in joints and soft tissues. This study aimed to compare neck and shoulder pain, as well as scapulohumeral rhythm, in female students with and without UCS. Methods: In this causal-comparative study, 60 female students aged 10-12 years from Khalkhal city, during the academic year 2022-2023, were selected as the research sample and screened using a posture assessment grid. Based on quantitative physical assessments, participants were divided into two groups: healthy (n=30) and UCS (n=30). Forward head and shoulder angles were evaluated using photographic analysis, kyphosis angle was measured with the Goniometer-pro app, pain index by Visual Analog Scale (VAS), and scapulohumeral rhythm was assessed using the Lateral Scapular Slide Test (LSST). Results: The findings revealed significant differences in neck pain, shoulder pain, and scapulohumeral rhythm between students with UCS and healthy subjects (p < 0.05). Conclusion: UCS is associated with increased neck and shoulder pain and disrupted scapulohumeral rhythm. Therefore, implementing corrective interventions and preventive programs is recommended for students at risk of postural abnormalities and impaired musculoskeletal function.
Background and aims: Chronic pain from knee osteoarthritis (KOA) induces adverse changes in the central and peripheral nervous systems, negatively impacting patients’ cognitive function and diminishing their psychological and physical well-being. This study aimed to investigate the effects of neuromuscular exercises combined with motivational interviewing and mindfulness on pain, balance, kinesiophobia, quality of life (QOL), and gait patterns in patients with KOA. Methods: Sixty patients with KOA were randomly assigned to three groups: Motivational Interviewing (n=20), Mindfulness (n=20), and a control group (n=20). All groups performed neuromuscular exercises. Outcomes were assessed before and after six weeks and included pain (primary outcome) measured by the Visual Analog Scale, QOL assessed by the SF-36, kinesiophobia evaluated using the Tampa Scale, balance measured by the Berg Balance Scale, and gait analyzed with a plantar pressure measurement device (secondary outcomes). Results: All groups showed significant improvements in pain, balance, kinesiophobia, and gait patterns after six weeks (p < 0.05). After adjusting for baseline scores, inter-group comparisons revealed that the Motivational Interviewing group experienced significantly greater improvements in pain (p = 0.0001), kinesiophobia (p = 0.02), balance (p = 0.002), and QOL (p = 0.02) compared to the Mindfulness group. Conclusion: This study indicates that integrating psychological interventions - especially motivational Interviewing - with the physical benefits of neuromuscular exercises can more effectively reduce pain severity in KOA patients.
Background and aims: The lack of distress tolerance and resilience in type 2 diabetic patients can lead to serious harm to themselves and those around them. Therefore, this study aimed to investigate the effectiveness of intensive short-term dynamic psychotherapy (ISTDP) on distress tolerance and resilience in these patients. Methods: This research employed a semi-experimental design with a pre-test-post-test approach and a control group. The statistical population consisted of 30 type 2 diabetic patients from medical centers and hospitals in Qom city, Iran, during the second half of 1403 (Sep 2024 - Mar 2025). Participants were selected through targeted and available sampling and randomly assigned to either the experimental group (n=15) or the control group (n=15). The experimental group underwent ISTDP sessions, totaling eight 90minute sessions. Data were collected using the Distress Tolerance Questionnaire (Simmons & Gaher, 2005) and the Resilience Scale (Conner & Davidson, 2003). The data were analyzed using the analysis of covariance (ANCOVA) method. Results: The results indicated that ISTDP significantly improved distress tolerance and resilience in type 2 diabetic patients (p < 0.001). Conclusion: ISTDP has been shown to produce significant improvements in distress tolerance and resilience among patients with type 2 diabetes. As a result, it can serve as an effective intervention to enhance distress tolerance and foster resilience in this patient population.
Background and aims: Knee osteoarthritis is a prevalent chronic musculoskeletal condition among elderly women, significantly impairing their quality of life. Exercise interventions have demonstrated efficacy in alleviating symptoms associated with this condition. Nordic walking, a recently introduced exercise modality, has shown promise in addressing age-related disabilities. This study aims to evaluate the effects of a Nordic walking program on pain, motor function, and related disabilities in middle-aged women with knee osteoarthritis. Methods: This randomized controlled clinical trial employs a parallel-group design. Forty-five middle-aged women (aged 45–65 years) diagnosed with knee osteoarthritis, meeting inclusion criteria and confirmed by a rheumatologist, will participate. Following baseline assessments, participants will be randomly allocated to one of three groups: Nordic walking (n=15), simple walking (n=15), or a control group (n=15). The experimental groups will undergo a 6-week walking intervention, consisting of three one-hour sessions per week, while the control group will receive Nordic walking training post-study. Intra-group and inter-group comparisons will be analyzed using a mixed-model repeated-measures ANOVA. Conclusion: This research protocol aims to establish a standardized walking intervention to mitigate symptoms of knee osteoarthritis, including pain, motor dysfunction, and diminished quality of life, in affected individuals.
Background and aims: Growing evidence suggests that resistance training and cognitive games, such as Sudoku, may enhance cognitive performance and memory. This study aimed to investigate the effects of a six-week intervention combining resistance training and Sudoku mental exercises on serum levels of BDNF, IGF-1, and working memory in female students at Ilam University. Methods: A total of 40 female students were recruited through purposive sampling of available volunteers and randomly assigned to four experimental groups (n=10 each): 1) Resistance training alone, 2) Sudoku alone, 3) Combined (training + Sudoku), and 4) control group. The interventions were conducted three times per week for six weeks. Blood samples and working memory tests were administered before and after the training protocols. Results: The results revealed a statistically significant increase in serum BDNF and IGF-1 levels across all intervention groups (training, Sudoku, and combined) (p< 0.001). Working memory performance improved significantly only in the Sudoku group and the combined intervention group compared to baseline measurements (p< 0.05). Between-group comparisons showed that the combined intervention yielded significantly greater improvements in serum BDNF levels (p< 0.05), IGF-1 concentrations (p< 0.01), and working memory performance (p< 0.001) relative to the control group. Conclusion: Combining resistance training with Sudoku cognitive exercise produces synergistic effects on serum neurotrophic factor levels and working memory performance, surpassing the benefits of either intervention alone. The results underscore the clinical relevance of integrated physical-cognitive interventions as an effective strategy for enhancing brain health and cognitive function in young adults.
Background and aims: Hypothyroidism leads to a reduction in muscle volume and mass. Meanwhile, the myostatin and follistatin genes play a pivotal role in regulating muscle growth, homeostasis, and preventing atrophy. This study investigated the expression of these genes in response to a moderate-intensity exercise program in rats with hypothyroidism. Methods: In this controlled experimental study, 21 male Wistar rats (8 weeks old, weighing 210 ± 15 g) were induced with hypothyroidism (150 mg/kg) and randomly divided into three groups: healthy, hypothyroidism control, and hypothyroidism + endurance training. The intervention group underwent a 6-week endurance training program (speed: 10–20 m/min, duration: 20–40 min). After training and anesthesia, tissue samples were collected, and gene expression was measured using Real-Time PCR. Data were analyzed using a one-way ANOVA test (significance level: p < 0.05) and GraphPad software. Results: Hypothyroidism induction significantly increased myostatin levels (p < 0.0001) and also decreased follistatin levels (p = 0.353) in rats. However, endurance training significantly reduced myostatin (p < 0.0001) and increased follistatin levels (p = 0.01) in hypothyroid rats. Conclusion: Endurance training appears to counteract muscle atrophy and wasting in hypothyroid rats by inducing beneficial changes in the expression of the studied genes.
