ACTA MEDICA IRANICA

Breathing Pattern Management Through Mental Imagery as Mental Health Rehabilitation After Dyspnea: A Narrative Review

Mahtab Roohi-Azizi — 2026-05-17

Dyspnea or air hunger is distressed breathing that is associated with mental awareness. Dyspnea in chronic respiratory often display anxiety or depressive symptoms. These emotional states cause a decline in the individual's quality of life and functional status. This category contributes to 1) the degree of disability related to dyspnea, and 2) the degree of impairment in lung function. In this study, we need to answer the question: Can mindfulness improve the condition of shortness of breath? Both mindfulness and shortness of breath are subjective sensations, but shortness of breath is multidimensional and multidisciplinary in nature. In this study, we conducted a scoping narrative review using three main online databases Google Scholar, PubMed, and Scopus on three main topics: respiratory system, mental imagery, and self- management (rehabilitation). We searched for observational studies and a limited number of systematic reviews and meta-analyses published up to 1968 to 2024. The specific keywords were dyspnea, oxygen, pulmonary rehabilitation, intensive care, and self-management. Dyspnea and mental imagery are the natural occurrence in most people's daily lives. Mental imagery as a cognitive ability is the motivational amplifier for promoting activities, potentially in representative outstanding emotional practices. This review emphasizes on managing the emotional distress caused by dyspnea by imagery in the brain through three different themes: 1) Attention and bodily sensations in the dyspnea, 2) Episodic memory and cognitive load in dyspnea, and 3) Managing dyspnea with mental imagery for health psychology process.

Ultrasound-Guided Peripheral Intravenous Catheterization in Patients With Difficult Venous Access: A Comparative Study of Antecubital Versus Saphenous Veins

Veins Babak Eslami — 2026-05-17

Establishing reliable intravenous access in patients with difficult peripheral veins is a common challenge in perioperative care. In such cases, central venous catheterization (CVC) is often used despite its invasive nature and associated risks. For short elective procedures, this may be excessive. Ultrasound-guided peripheral vein catheterization (US-PVC) has emerged as a safer, less invasive alternative that improves success rates. However, limited evidence exists comparing different anatomical sites for US-PVC in this population. This study aims to compare the efficacy and complication rates of ultrasound guided IV access in the antecubital versus saphenous regions in adult surgical patients with difficult venous access. This single-center, parallel-group, randomized clinical trial was conducted on adult patients undergoing elective surgery with difficult peripheral venous access. Patients were randomized to receive US-guided catheterization in either the antecubital (Group A) or saphenous (Group B) region. All procedures were performed by an anesthesiologist experienced in ultrasound-guided vascular access. Primary outcomes included first-attempt success rate and catheterization time; secondary outcomes included complication rates and patient-reported satisfaction. Follow-up assessments were conducted at 24 hours and 72 hours post-procedure. The saphenous group demonstrated significantly higher first-attempt success rates (53.1% vs. 44.9%, P=0.04) and greater catheter durability (89.8% vs. 75.6%, P=0.03). However, this group also reported significantly more procedural pain based on VAS scores (4.94 vs. 2.24, P<0.001), as well as greater increases in mean arterial pressure and heart rate. Although complication rates such as hematoma and thrombophlebitis were slightly higher in the antecubital group, the differences were not statistically significant. Patient satisfaction was significantly higher in the saphenous group (95.8% vs. 77.6%, P=0.001), while staff satisfaction did not differ meaningfully between groups. Ultrasound-guided IV catheterization in both antecubital and saphenous regions is effective in patients with difficult venous access. The saphenous site offers higher first-attempt success and catheter longevity but is associated with more discomfort. These findings may aid anesthesiologists in selecting optimal access sites based on clinical needs and patient tolerance. This study was approved by the Tehran University of Medical Sciences Ethics Committee (Ethics Code: IR.TUMS.IKHC.REC.1402.418, IRCT Id: IRCT20230130057273N2).

Identifying Indicators of Change Management in Medical Education With a Focus on Third-Generation Universities

Elahe Bahrami — 2026-05-17

Transforming universities into third-generation universities is a prerequisite for future development. Therefore, awareness of the factors, structures, and practices that exist in higher education institutions and affect the potential emergence of entrepreneurship enables managers to plan to achieve specific results. It seems that the first step in managing this change is to identify the indicators that medical education and medical universities should have in the future. This study was conducted with the aim of identifying the indicators necessary to manage the change in medical education, Shahid Beheshti University of Medical Sciences, on the path to transition to third-generation universities. This study was conducted using a qualitative method and the two-stage Delphi method was used to conduct the research. The research tool was a questionnaire derived from literature on the concepts and components of third-generation universities, which was conducted with the participation of 15 key informants from Shahid Beheshti University of Medical Sciences regarding the research topic in 1403. The results showed that the university's support index for staff and student exchanges between the university and industry and organizations outside the university scored the highest with a score of 52, followed by entrepreneurship as a major part of the university's strategy with a score of 50, and internationalization as an important part of the university's entrepreneurial strategy with a score of 30. The lowest score was obtained. Medical universities are forced to move towards third-generation universities for their survival, and in this direction, it is necessary to change their functions and structures, therefore, awareness of activities and changes in this direction is necessary and essential, both to change and improve the structure and in order to improve performance. It should be noted that creating entrepreneurial universities is not easy and "entrepreneurship and innovation" is complex, chaotic and lacks any linear concept. Universities can start working based on their conditions by changing several indicators and move in this direction and continue until the indicators are fully established.

The Validity of Doppler-Ultrasound in Distinguishing of Malignant and Benign Masses in Ovaries Using Cutoff Values

Rana Hatem Matrood Alkhazraji — 2026-05-17

Some studies have concluded that PI and RI play an inadequate role in distinguishing benign tumors from malignant ones; however, later studies have reported different results, showing that Doppler ultrasound is effective in differentiating malignant from non‑malignant ovarian masses by using specific threshold values for both RI and PI. The presence of such conflicting data justifies our study. The purpose of this project was to use color Doppler and ultrasound imaging to differentiate between malignant and benign ovarian tumors and to verify the findings by comparing them with histopathology. Over the course of two years, 86 patients with ovarian masses were evaluated for morphologic features, pulsatility indices (PI), and resistance indices (RI) using Doppler ultrasound. Histopathologic confirmation served as the basis for the final diagnosis. The cutoff value for RI was ≤0.39 and for PI was ≤1.1, as shown in figures 1 and 2 and table 1. The sensitivity, specificity, and positive and negative predictive values were all 100%. Doppler ultrasound provides effective tools, including resistive and pulsatility indices, that can be used to differentiate between benign and malignant ovarian masses.

Melatonin vs. Clobazam for Preventing Recurrent Simple Febrile Seizures: A Randomized Clinical Trial

Nahideh Khosroshahi — 2026-05-17

Febrile seizures are the most common neurologic disorder in infants and young children. Febrile seizures generally have a good prognosis, but approximately one-third of patients may experience a second attack. This study was conducted to assess the effectiveness of melatonin in preventing the recurrence of subsequent seizures. In this prospective randomized clinical trial study, 60 children with febrile seizures were enrolled in two groups of 30. Clobazam was administered to the control group, while melatonin was given to the intervention group for prophylaxis. Over a 12-month telephone follow-up, the number of febrile illnesses and seizure attacks, as well as drug side effects, was recorded of the 60 children included in this study, 56.7% were boys. The mean age of the participants was 30.22±11.69 months. Seven patients experienced febrile seizures after receiving prophylactic medication, including three patients in the melatonin group and four in the clobazam group. This difference was not statistically significant (P=1.00). Additionally, only two patients in the control group experienced sleepiness. Melatonin may be effective in preventing recurrent febrile seizure episodes without any serious side effects. Iranian Registry of Clinical Trial (IRCT20221102056380N1).

Effects of Dietary Flaxseed and Atorvastatin on Blood Hematology and Renal Health Metrics in Rats Fed High-Fat Diet

Zahra Eslami — 2026-05-17

Flaxseed is rich in omega-3 fatty acids and dietary fiber, both of which contribute to reduced inflammation and oxidative stress in the kidneys. Moreover, atorvastatin appears to enhance the activity of important antioxidant enzymes, potentially reducing the risk of chronic kidney disease and hematological disorders. Eighty male Wistar rats were divided randomly into ten groups: 1) ND (normal diet) 2) HFD (high-fat diet), 3) HFD+ ATO 10, 4) HFD+ ATO 20, 5) HFD+ FO (flaxseed oil), 6) HFD+ F (flaxseed), 7) HFD + ATO 10 + FO, 8) HFD + ATO 20 + FO, 9) HFD + ATO 10 + F, and 10) HFD + ATO 10 + F. Atorvastatin 10 and 20 mg/kg, FO 40 mg/kg, and flaxseed 40 g/kg were administrated for 8 weeks. After 23 weeks, serum level of kidney markers and CBC parameters were evaluated. ATO 20 led to reduce WBC, RBC, and HCT. Furthermore, ATO 20 + FO decreased WBC and ATO 20 + F reduced PLT, RBC and HCT. Administration of ATO 10 cause to increase creatinine (Cr) levels but other interventions had better effect on Cr, however these effects weren’t notable. There weren’t significant differences in Hb, MCV, MCH, MCHC, and urea between groups. F/FO therapies with ATO seems to have synergistic effects to improved dyslipidemia-associated kidney injuries and hematological indices. Although high dose of ATO can be more efficient than low dose.

Knowledge, Attitude, and Practice of Dental Students Regarding Electronic Cigarettes and Associated Factors

Fatima Adnan Abdulkareem — 2026-05-17

The use of electronic cigarettes (e-cigarettes) has surged globally and is frequently marketed as a safer alternative to traditional tobacco smoking. Nonetheless, the health implications of e-cigarettes remain debated, and their increasing popularity among youth and medical students raises concerns, particularly in countries with limited local research. This study aims to assess the knowledge, attitudes, and practices (KAP) regarding e-cigarettes among dental students at Ashur University in Iraq, while also examining correlations with demographic factors and smoking behavior. A cross-sectional study was conducted from January to March 2025 involving 104 dental students in their fourth and fifth years. The research team developed a structured, self-administered questionnaire based on previous studies to assess demographic data, smoking status, and knowledge (17 items), attitudes (13 items), and practices related to e-cigarettes. Data analysis utilized descriptive statistics and chi-square tests, with a P of ≤0.05 considered statistically significant. Of the 100 valid responses, 50% of participants were male, 69% were aged 20 years or younger, and 91% were unmarried. Nearly half (47%) reported being current smokers, with dual use being the most common pattern at 20%. Knowledge levels regarding e-cigarettes were generally high: 88% acknowledged their harmfulness, 69% recognized their addictive potential, and 50% associated them with cancer risk. In contrast, attitudes were more permissive, with 49% believing that e-cigarettes are less harmful than traditional tobacco, 65% considering them a better option for patients, and 61% supporting a ban on their use. Initiation of e-cigarette use was significantly linked to the smoking habits of peers and family (P<0.001). Social media was identified as the primary source of information, cited by 51% of respondents. No significant associations were found between knowledge or attitudes and demographic factors such as age, gender, or income. Dental students at Ashur University demonstrated a solid understanding of e-cigarettes but held permissive attitudes toward their use, indicating misconceptions about their safety. To address these gaps and enhance preventive measures, awareness programs and integration of this topic into the curriculum are essential.

One-Year Clinical and Patient-Reported Outcomes After Endovenous Radiofrequency Ablation for Varicose Veins: A Prospective Cohort Study

Ahmed Ali Al Mashhadani — 2026-05-17

Endo-Venous Radio-Frequency Ablation (EVRF) is widely used for treating varicose veins, offering a minimally invasive alternative to traditional surgery. However, the trajectory of postoperative symptoms, recurrence patterns, and patient-centered outcomes remains variable across populations. To evaluate postoperative symptom changes, vein occlusion patterns, recurrence, cutaneous effects, patient satisfaction, and quality of life in patients undergoing EVRF over a one-year follow-up period. A prospective observational study was conducted on 125 patients treated with EVRF at Dijlah Private Hospital, Maysan, Iraq. Clinical outcomes—including paresthesia, thrombophlebitis, ecchymosis, redness and skin changes, cellulitis, recurrence, occlusion rate, patient satisfaction, and quality of life—were assessed using a standardized four-point scoring system. Evaluations were performed at week one, 30 days, and one year. Paired t-tests were applied to compare temporal changes. Significant early improvements were observed across most clinical indicators. Paresthesia decreased from 1.3462 at week one to 1.0692 at 30 days (P<0.001). Redness, skin changes, thrombophlebitis, and ecchymosis demonstrated similar reductions. Recurrence improved significantly from 0.9846 to 0.6769 at one year (P<0.001). In contrast, occlusion scores declined from 2.8846 at week one to 1.9231 at one year (P<0.001), suggesting partial recanalization. Quality-of-life scores improved significantly from 3.6154 to 2.4154 (P<0.001). Despite these objective improvements, patient satisfaction decreased from 2.8154 to 1.8538 over the same period (P<0.001). Cellulitis showed no significant change (P=0.074). EVRF provides substantial early postoperative benefits and long-term improvements in quality of life, with low complication rates. However, reduced occlusion durability and declining patient satisfaction highlight the importance of standardized imaging follow-up and enhanced patient counseling to optimize long-term outcomes.

Clinical and Anatomical Predictors of AVF Success: Multivariate Evaluation of Distal Radiocephalic and Antecubital Brachiocephalic Access

Roozbeh Cheraghali — 2026-05-17

The survival of arterio-venous (AV) fistula and the high rate of hospitalization of these patients (about 20% of the hospitalizations of these patients) are one of the most important challenges of the health system in the management of ESRD patients all over the world. Since AVF failure increases the mortality of patients and causes an increase in treatment costs, determining the optimal site (distal radiocephalic vs. antecubital brachiocephalic) as well as patient factors influencing functional success is crucial. This observational study was conducted on ESRD candidates for hemodialysis who underwent fistula bypass surgery in a tertiary center. Medical records of fifty patients who underwent distal radiocephalic fistula (DRF) creation and fifty who received antecubital brachiocephalic fistulas (ACBF) were reviewed. Demographic characteristics of the patients, such as age, gender, history of diabetes, high blood pressure, and smoking, were recorded. The primary outcome was AVF maturation at 120 days (functional vs. failed). A secondary outcome was early failure, defined as the absence of bruit or thrill within 30 days. 100 patients were examined in two groups (according to the location of the fistula), and the average age was reported as 52.4±12.5. AVF failure was reported in 38% of patients, of which 26% occurred within the first 30 days and 12% occurred within 30 to 120 days. The AVF failure rate was similar between DRF and ACBF groups (P:1.00). No statistically significant difference was seen for the failure rate of fistulas based on gender (P value: 0.715). In adjusted analysis, each additional year of age increased the odds of maturation by 4.3% (OR 1.043, 95% CI 1.004–1.083; P=0.029), and hypertension was independently associated with higher maturation odds (OR 2.747, 95% CI 1.119–6.746; P=0.027). For early failure (<30 days), female patients had 4.7-fold higher odds of failure than males (OR 4.676, 95% CI 1.556–14.048; P=0.006), while other covariates showed no significant associations. This study examined the factors that contribute to the failure of arteriovenous fistulas in ESRD patients who are eligible for hemodialysis. The findings demonstrated that various factors, including age and history of hypertension, can affect its success rate. These results are congruent with previous articles and emphasize the importance of choosing the correct type of fistula and careful management of risk factors in improving treatment.

Soft Tissue Mass as Primary Manifestation of IgG4 Related Disease

Fariba Abbasi — 2026-05-18

IgG4- related disease is a systemic fibroinflammatory syndrome characterized by tumefactive enlargement of affected organ , diffuse lymphoplasma cells infiltration with a large number of IgG4 producing plasma cells and sclerotic changes. The most commonly involved organs are pancreas, lacrimal and salivary glands. Patients show good response to glucocorticoid therapy and despite its relapsing and remitting course, patients have good prognosis. We report an unusual presentation of IgG4- related disease manifested as isolated soft tissue mass of hand which is an extremely rare manifestation of this disorder.