ACTA MEDICA IRANICA

Assessment of the Heparin and Enoxaparin Prophylaxis Protocol in Patients Receiving Care at Sina Hospital in Tabriz

2025-11-16T09:52:05+00:00

Abstract- Venous thromboembolism (VTE) poses a significant risk to hospitalized patients, accounting for approximately 10% of morbidity cases among this population. However, preventive measures such as heparin and low molecular weight heparin (LMWH), along with mechanical interventions like graduated compression stockings (GCS), can effectively mitigate this risk. The aim of this study was to investigate the rational use of DVT prophylaxis regimen in hospitalized patients. A prospective and descriptive study was conducted randomly in various wards of the hospital throughout 2017. 335 participants were randomly assessed using an already designed questionnaire containing demographic information (age, weight, height, etc.), medical history, type of prophylaxis administered, laboratory tests, prescribed medications, the Geneva score for thrombosis risk evaluation (low risk: 0-2, high risk: ≥3), and bleeding risk assessment tool (low risk: 0-7, high risk: ≥7). Randomly, the medical records of 335 patients admitted to Sina Hospital and who received VTE prophylaxis with heparin (87.8%), enoxaparin (12.54%), and GCS (1.79%), were carefully reviewed over a period of 12 months. According to the guidelines, only 235 patients (70.1%) required anticoagulant prophylaxis, while the remaining 100 patients (29.8%) were not eligible for such prophylaxis. Additionally, out of the 335 patients studied, only 6 received GCS, although only one patient actually necessitated this intervention. Consequently, the total cost of inappropriate anticoagulant prophylaxis was estimated to be 68,270,500 Rials. The appropriate utilization rate of VTE prophylaxis was 70.1%, with heparin being the most commonly prescribed medication. Further, the study highlights the cost implications of inappropriate prescription practices. To address these issues, educational programs and the implementation of clinical practice guidelines within general Hospitals are highly recommended.

Sexual Satisfaction and Self-Concept of Women With Mayer-Rokitansky-Küster-Hauser (MRKH) After Vaginoplasty Surgery: A Case Control Study

2025-11-16T09:52:04+00:00

Women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome do not have proper performance and sexual satisfaction because of physical problems. MRKH syndrome leads to psychological and identity problems and has a negative effect on self-concept. This study aimed to compare the sexual satisfaction and self-concept of women with MRKH syndrome before and after vaginoplasty with normal women. The current study was a case study with a pre-test, post-test design and a control group. Fifteen people were selected using the purposeful sampling method, and 15 normal newly married women were also selected as a control sample group. In both groups, sexual satisfaction and self-concept questionnaires were administered; after the relevant vaginoplasty surgery, only in the test group, and after six months, both groups completed the sexual satisfaction and self-concept questionnaires as a post-test. Hudson's sexual satisfaction questionnaire and Rogers' self-concept questionnaire were used to collect the data. Data were analyzed using multivariate covariance analysis. The results indicated that the average levels of sexual satisfaction and self-concept in women with MRKH syndrome significantly increased after vaginoplasty in comparison to their preoperative scores; but compared to the women of the control group, it is lower. To increase sexual satisfaction and improve the self-concept of women with MRKH syndrome, vaginoplasty surgery can be used as an effective treatment and an efficient program.

Evaluation of Factors Affecting Intraventricular Hemorrhage in Term Neonates in Tehran Vali-e-Asr Hospital, 2016-2018

2025-11-16T09:52:02+00:00

Intraventricular hemorrhage can be associated with various complications that ultimately lead to brain damage. This study aimed to investigate the factors affecting intraventricular hemorrhage in term neonates. This case-control study compared 58 full-term neonates with an IVH diagnosis and 100 healthy full-term neonates. Information on exposure to maternal and prenatal risk factors was collected from Vali-e-Asr Hospital's neonatal information system between 2016 and 2018. Data were collected and analyzed in SPSS software. In this study, risk factors significantly associated with IVH included male gender, respiratory distress, pneumothorax, hydrocephalus, thrombocytopenia, anemia, vitamin K deficiency, asphyxia, hypoglycemia, the need for resuscitation at birth, the requirement for mechanical ventilation, and low weight for gestational age. The mean Apgar score of the first and fifth minutes was significantly lower in the IVH group. The results of this study will determine the risk factors affecting intraventricular hemorrhage to predict and manage brain injury in term neonates.

The Impact of Metformin Treatment on Serum Level of AMH and on Ovulation and Pregnancy Outcome in Women With PCOS

2025-11-16T09:52:01+00:00

Anti-Müllerian Hormone (AMH) AMH inhibits follicle recruitment and may reduce FSH action, contributing to ovulatory issues in females. PCOS patients often receive metformin treatment. This study aimed to investigate metformin's effect on serum AMH levels in PCOS women and its impact on ovulation and pregnancy rates. This interventional study was performed between June 2023 and June 2024. 100 PCOS women attending the infertility departments of Maternity Teaching Hospital in Adiwniyah province, Iraq, were invited to participate in the study. PCOS was diagnosed based on the Rotterdam consensus statements criteria. Metformin was given to 50 women (study group) and 50 women received placebo o serve as a control group. After 3 months, comparison of mean serum AMH between study groups revealed significant variation (P=0.020) and this significant variation became more pronounced 6 months later (P<0.001). In case of placebo group, comparison of baseline mean serum AMH to those after 3 months and after 6 months revealed minimal no significant changes (P>0.05); whereas the use of metformin resulted in significant reduction of mean serum AMH 3 months later (P=0.006) and the reduction was more significant 6 months later (P<0.001). The rate of ovulation and the rate of positive pregnancy test were reported to be higher significantly in metformin group in contrast to placebo group (P=0.001 and 0.016, respectively). Metformin treatment is efficient and safe in reducing serum AMH in women with PCOS, thus indicating reduction in antral follicle count and changes in overall hormonal status that can improve ovulation and pregnancy in those women.

Blood Indoxyl Sulfate and TGF-β1 Protein and mRNA Levels in Chronic Kidney Disease: Updated Insights

2025-11-16T09:52:00+00:00

Chronic kidney disease (CKD) is characterized by systemic inflammation and the accumulation of uremic toxins such as indoxyl sulfate (IS), which induces fibrogenic signaling via transforming growth factor-beta 1 (TGF-β1). Forty CKD patients and ten healthy controls were enrolled. IS was measured by HPLC, TGF-β1 protein by ELISA, and TGF-β1 mRNA by RT-qPCR in PBMCs. IS and TGF-β1 mRNA levels increased significantly with CKD stage, particularly in stages 3 and 4. TGF-β1 mRNA correlated with IS levels (R=0.4, P<0.01), while TGF-β1 protein levels were associated with platelet count (R=0.817, P<0.001). TGF-β1 mRNA in PBMCs may serve as an early biomarker of CKD-related fibrosis. IS is a key uremic toxin influencing fibrogenic gene expression.

Effects of Lower Extremity and Core Muscles Fatigue Protocols on Landing Mechanics and Performance in Female Athletes

2025-11-16T09:52:06+00:00

Fatigue decreases muscle strength and functional capacity, disrupting neuromuscular coordination by impairing load control. This negatively impacts the kinetics and kinematics of the ankle, knee, and hip joints, resulting in reduced performance and an increased risk of injury, particularly to the anterior cruciate ligament (ACL). This study aimed to compare the effects of fatigue protocols for lower extremity and core muscles on landing mechanics and performance of female athletes. This study used a cross-sectional, comparative, pretest-posttest design with a control group. A total of 105 female athletes, aged 11 to 49, were selected via convenience and purposive sampling. Participants were divided into three groups: core muscle fatigue, lower extremity muscle fatigue, and a control group. Data were gathered using the Landing Error Scoring System (LESS), Y-Balance, and 45-degree trunk flexion tests. Data were analyzed using descriptive statistics, Shapiro-Wilk test, Levene's test, one-way ANCOVA, and the Bonferroni post hoc test. A P of 0.05 or lower was considered statistically significant. ANCOVA results showed significant differences among the groups for the LESS (P=0.001) and 45 ° trunk flexion test (P=0.001). There was no significant difference between the two experimental groups regarding the LESS (P=1.00). However, a significant difference was observed between the two experimental groups in the trunk flexion test (P=0.001). Fatigue had a greater effect size on landing mechanics (ηp²=0.209) than on the trunk flexion test (ηp²=0.143). However, no significant difference was observed between the groups regarding the Y-Balance Test (P=0.996). The study revealed that fatigue protocols targeting lower extremity and core muscles had a negative impact on kinematic parameters associated with ACL injuries during jump-landing in female athletes. Additionally, core muscle fatigue significantly impacted the 45º trunk flexion test, while lower extremity muscle fatigue had no significant effect on it.

The Role of Peer Groups in HIV Case Finding, Diagnosis, Care, and Treatment: A Qualitative Study

2025-11-16T09:51:59+00:00

People living with HIV increasingly participate as community health workers in supporting the HIV care continuum. Evidence suggests that peer interventions can reduce risky behaviors related to HIV transmission, provide relevant HIV education, and promote healthier lifestyles. In addition to HIV knowledge, peer supporters must be trained on their professional roles within clinical teams, appropriate boundaries, confidentiality practices, referral procedures, and self-care strategies in workplace settings. Conducting such studies in regions where peer interventions are underexplored can generate valuable insights and contribute to more precise reporting at both regional and international levels. A group of HIV-positive individuals, serving as peer supporters-non-clinical health advocates from within the affected community-were recruited after providing written informed consent and assurances of confidentiality. Eligibility required affirmative responses to two screening questions: "Are you willing to participate in this study?" and "Have you been serving as a peer supporter for more than six months?" A baseline survey was conducted to gather socio-demographic information (age, race/ethnicity, gender, education, prior work experience), assess HIV-related knowledge and understanding of peer roles, and document the specific activities peers perform. Additionally, data were collected on HIV self-care behaviors, including healthcare utilization, medication adherence, and risk-reduction practices. Knowledge domains included questions on viral life cycle, antiretroviral therapy and resistance, harm reduction strategies, and treatment adherence. Peer roles were assessed across various domains, including workplace expectations, boundaries, confidentiality, counselling, healthcare navigation, teamwork, communication with healthcare providers, peer readiness, and self-care. Communication skills were further evaluated based on stages of change, active listening, open-ended questioning, cultural awareness, and non-judgmental behaviors. A total of 7 participants (2 women [28.57%] and five men [71.42%]) were enrolled, with a mean age of 47.14 years. The mean duration since HIV diagnosis was approximately 12.19 years. Participants had an average peer work experience of about 9 months. All participants (100%) confirmed that peer supporters' involvement played a positive, essential role in patient diagnosis, support, and follow-up in HIV care. The findings of this study suggest that peer group involvement has a positive and significant impact on the process of HIV diagnosis, treatment, and follow-up care.

Investigating the Analgesic Effect of Sublingual Glycerol Trinitrate (GTN) Spray as an Alternative Treatment in Renal Colic Pain: A Triple-Blinded Randomized Controlled Trial

2025-11-16T09:51:58+00:00

Renal colic, a severe pain caused by renal and urethral calculi, causes millions of patients to visit the emergency department (ED) worldwide each year. Based on international guidelines, NSAIDs are the first-line analgesics of choice for renal colic management. The second most preferred analgesic is opioids. NSAIDs and opioids have several complications and contraindications that limit their administration and necessitate the search for alternative treatments for renal colic pain. The present study aimed to assess the effect of sublingual Glycerol Trinitrate (GTN) spray, a smooth muscle-relaxing agent, on renal colic pain as an alternative treatment. In this triple-blinded randomized controlled trial, 94 patients with renal colic who visited the emergency department (ED) were included. The drug group included 48 patients who were administered sublingual GTN spray, and the placebo group consisted of 46 patients. After diagnosis, the patients' pain was assessed based on the Numeric Rating Scale (NRS), a 30-milligram dose of ketorolac was administered to all patients, and sublingual GTN/placebo spray was administrated. The pain was also recorded 5 min after spray administration. Again, 30 min after spray administration, the NRS was reassessed. 94 patients enrolled in this study, the mean age of the participants was 39.22±11.72, and 82 (87.23%) of them were male. Five minutes after GTN/placebo administration, The NRS in both groups decreased significantly compared with the NRS upon arrival (P<0.01). Furthermore, in both groups, the NRS measured at 30 minutes also decreased significantly from the NRS measured at 5 minutes (P<0.01). Nevertheless, the reduction in the NRS score between the drug and placebo groups was not significantly different (P=0.365). Our results showed no significant pain reduction with sublingual GTN spray in comparison with placebo; thus, sublingual GTN spray might not have considerable analgesic effects in patients with renal colic referred to the ED.

Brain Tumor Presenting Mania Symptoms: A Case Report

2025-11-16T09:51:56+00:00

Brain tumors manifest with neurological symptoms as a result of mass effects. Occasionally, brain tumors may manifest with an initial psychiatric presentation in the absence of neurological deficits or symptoms. We present a case of a 54-year-old woman who showed increased energy, elevated mood, delusions, and headache. Symptoms of psychosis and mania began about two months ago and have worsened over the past month. Neurological examinations are normal. MRI of the brain confirmed the tumor on the left frontal lobe. A craniotomy and tumor resection were performed and the final diagnosis was meningioma (meningotheliomatous, WHO grade I). However, manic symptoms have been documented to occur more frequently in right frontal tumors. Early neuroimaging and a high index of suspicion are crucial to avoid misdiagnosis and ensure timely treatment of brain tumors with psychiatric symptoms