ACTA MEDICA IRANICA

Management of Pediatric Candida Endocarditis: A Mini Review on Available Literature Between 2010-2022

Mohamad Rafie Khurgami — 2025-09-20

There has been a notable rise in cases of Candida Endocarditis (CE). Even with surgical procedures and antifungal treatments, the worldwide impact of Candida on health, including morbidity and mortality, has escalated. This narrative review was carried out through the PubMed and Scopus databases, where the search terms “Candida” and “Endocarditis” were used. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, reviews, and case reports. The search was restricted to articles written in the English language from 2010 to Dec 30, 2022. Moreover, duplicate articles and non-available full-text articles were excluded. The extracted data of the search results were retrieved in this study. A background involving central venous catheters (CVC), congenital heart conditions and persistent debilitating illnesses heightens the chances of infection. Early initiation of antifungal treatment is crucial when considering Candida species and associated risk factors. The majority of research has concentrated on adult populations, leaving a gap in studies concerning pediatric patients. Presents manuscript review pediatric CE, including recent advances in management.

Determination Infertility-Related Stress Among Women Attending an Infertility Center: A Cross-Sectional Study

Lina Sheehan Rasein — 2025-09-20

Infertility is a difficult experience that can greatly impact a woman's mental, emotional, and thus, physical wellbeing. The study aimed to assess the infertility-related stress among women attending an infertility center and the associated socio-demographic characteristics. A cross-sectional descriptive study was conducted at Kamal Al-Samarrai Hospital for Fertility and Infertility in Baghdad from November 2023 to November 2024 to investigate infertility-related stress among 385 women diagnosed with infertility. Data were collected through interviews using the modified infertility-related stress questionnaire, and validity and reliability were established through expert ratings and a pilot study. Statistical analysis was performed using IBM SPSS 20.0, employing techniques such as Pearson correlation, Regression, and Kruskal-Wallis assessments. The results indicate that the majority (97.1%) reported moderate infertility-related stress, with an average stress rating of 92.96. An inverse relationship was observed between age and infertility-related stress, indicating that stress tends to decrease with age (r= -0.151, P=0.003). Additionally, a statistical analysis showed that infertility-related stress levels differed significantly based on education level (P=0.010) and monthly income (P=0.016). The study found mild stress among women with infertility, especially younger, less educated, and lower-income women. The study recommends less expensive counseling, advanced fertility resources, and public awareness to reduce stigma and help affected women improve their health.

Economic Inflation and Occupational Stress: Understanding Psychological Distress Among Healthcare Workers

Mohsen Arabi — 2025-09-20

Economic Inflation has placed a unique burden on healthcare workers, increasing psychological distress and changing their professional experiences. This study assesses levels of stress and anxiety in healthcare workers, namely medical interns, nurses, and paramedics, before and after the economic crisis, while exploring factors that influence their mental health. A cross-sectional study was conducted among 180 healthcare workers in a hospital in Tehran, Iran. They completed a questionnaire containing the Kessler Psychological Distress Scale (K10) about their stress before and after the crisis, which coincided with the COVID-19 pandemic situation. Some demographic characteristics, such as occupation title, marital status, gender, and age, have been explored in order to find their possible relation to the variation of anxiety state. The study exposed different responses to stress among professional groups. Medical interns showed the highest increase in stress level (55.4%), while paramedics (16%) and nurses showed comparatively stable levels (8.9%). Marital status significantly influenced anxiety; married respondents exhibited a higher increase in stress level (40%) compared with singles (26%, P=0.04). No significant associations were found between changes in stress level and age (P=0.12) or sex (P=0.07). 35.5% of participants showed an improvement in stress levels, while 30% experienced a worsening, and 34.5% did not change significantly. These findings underline the huge psychological impact of the financial instability on healthcare workers, hence the need to emphasize targeted mental health interventions. Programs focusing on stress management, resilience building, and professional support are crucial for enhancing the well-being of healthcare professionals during economic crises.

Turnover Intention Among Nurses: The Role of Burnout Dimensions and Interprofessional Relationships With Physicians

Nima Faghirpou — 2025-09-20

Job burnout and the professional relationship between nurses and physicians affect the nurses’ intention to leave their profession and ultimately the quality of care. In this study, we determine the prevalence of turnover intention among nurses and its relationship with personal and occupational characteristics, as well as burnout domains and the professional relationship between nurses and physicians. In this cross-sectional study, 296 nurses from hospitals affiliated with Tehran University of Medical Sciences were selected using a multi-stage sampling method. Burnout is assessed via the Maslach Burnout Inventory. The physician-nurse professional relationship and intention turnover were evaluated using the Shokri and Cammann questionnaires, respectively. SPSS 26 software was applied for data analysis. The rate of turnover intention among nurses was 61.5%. A significant negative relationship was found between the nurse's age, work experience, and number of children and their intention to leave the job. (P<0.01). The turnover intention was higher among nurses with rotating shifts compared to those with fixed shifts (P=0.04). The results of the Pearson correlation analysis revealed a significant positive relationship between the burnout dimensions of emotional exhaustion and depersonalization, and turnover intention (P<0.01), as well as a negative relationship between the dimension of personal achievement and the nurse’s abandonment tendency (P<0.01). Additionally, there was a significant negative relationship between the doctor-nurse professional relationship and nurses’ intention to quit (P<0.01). Our findings indicate that emotional exhaustion and a positive nurse-physician professional relationship significantly increase turnover intention among nurses, while personal accomplishment decreases it. Depersonalization did not have a significant impact on turnover intention. These results highlight the importance of addressing burnout factors and fostering collaborative interprofessional relationships to reduce turnover intention and enhance retention in healthcare settings.

Estimation of Some Biomarkers in Type 2 Diabetic Patients for Detection Early Incidence of Diabetic Nephropathy

Alyaa Kadhim Hliel — 2025-09-20

Diabetic Nephropathy (DN), is the major microvascular complications of diabetes, affecting 40% of type 2 diabetic patients, is the leading cause of end-stage renal failure. Microalbuminuria has a limited diagnostic role in early-stage diabetic nephropathy, because renal damage usually occurs before proteinuria. Therefore, more sensitive and specific biomarkers are needed for early detection of Diabetic Nephropathy. A Case-control study involved 180 participants aged 40-≥70 year, 60 individuals are healthy, 120 person with type 2 diabetes mellitus (T2DM), they were divided in three groups by urinary albumin/ creatinine ratio (ACR). Group 1:40 patients with normo albuminuria (ACR<30 mg/g). Group 2: 40 patients with micro albuminuria (ACR 30-300 mg/g). Group 3: 40 patients with macro albuminuria (ACR˃300 mg/g). Nephrin, transforming growth factor-β (TGF-β) and Wnt inducible signaling pathway protein1 (WISP1) was estimated in serum by an enzyme-linked immunosorbent assay (ELISA); also fasting blood sugar, glycated hemoglobin, blood urea and serum creatinine was determined by enzymatic method, urine albumin/creatinine ratio determined by measurements of albumin and creatinine in urine sample. There was a significant elevation for all parameters in the patients compared to healthy control but eGFR decrease. The prevalence of diabetic nephropathy was found in male more than female and the majority of patients were in age group 60-≥70 years. A significant difference in mean±SD of age, Body Mass Index (BMI), and duration of diabetes, macro albuminuria, microalbuminuria, and normoalbuminuria groups show a statistically higher S. Nephrin, TGF-β and WISP1 in comparison to control. Nephrin and TGF- β have a strong association with blood urea, serum creatinine and an inverse association with glomerular filtration rate in all diabetic groups. While there were significant positive correlations between the WISP1 with urea. In contrast there was positive correlations with creatinine only in micro- and macro albuminuria groups, while no correlation with eGFR. In Receiver operating characteristic (ROC) curve analysis, nephrin, WISP1 and TGF- β showed high sensitivity and specificity. Elevated levels of Nephrin, WISP1 and TGF-β in type 2 diabetic patients have been reported in the current study. These findings proposed that nephrin, WISP1 and TGF- β could be an early diagnostic marker for DN detection.

Atorvastatin and Hesperidin: A Study into Their Effect on the Liver

Tabarek Falih Chichan — 2025-09-20

The liver is a vital organ responsible for metabolism, immune support, and detoxification, making it vulnerable to drug-induced injuries that can lead to severe complications. Among commonly prescribed medications, atorvastatin is effective in lowering cholesterol levels and reducing cardiovascular disease risk but can also cause hepatotoxicity. This study aims to investigate the potential hepatoprotective effects of hesperidin, a flavonoid known for its antioxidant properties, against liver damage caused by atorvastatin. By examining changes in liver enzyme levels, particularly ALT and AST, the research seeks to elucidate hesperidin's role in mitigating statin-induced liver injury. This study utilized thirty healthy male Wistar rats, aged 10 to 12 weeks and weighing approximately 230 grams, housed under standardized conditions at Mustansiriyah University. The rats had unlimited access to tap water and pellet food, with all care methods approved by the university's ethical committee. Atorvastatin and hesperidin were sourced from AstraZeneca (Germany) and a supplier in China, respectively, and dissolved in DMSO for administration. The rats were randomly divided into five groups, with varying treatments over twenty days, including a negative control group receiving saline and groups receiving atorvastatin alone or in combination with different doses of hesperidin. Blood samples were collected for liver enzyme analysis (ALT and AST) following ethical guidelines. Data was analyzed using SPSS software, with significance determined at a P less than 0.05. The results indicated significant differences in liver enzyme levels among the experimental groups (P<0.05). Group 2, which received 80 mg/kg atorvastatin, exhibited markedly elevated ALT and AST levels compared to the negative control group. In contrast, groups receiving hesperidin in combination with atorvastatin showed significant declines in both ALT and AST levels. Notably, Group 3 (80 mg/kg atorvastatin plus 50 mg/kg hesperidin) demonstrated a significant reduction in ALT compared to Group 2, while Group 5 (200 mg/kg hesperidin plus atorvastatin) exhibited the lowest ALT and AST levels overall. These findings suggest that hesperidin effectively mitigates atorvastatin-induced hepatotoxicity. Thus, incorporating hesperidin may offer a protective strategy against liver damage associated with statin therapy, warranting further investigation into its clinical applications.

Decision Making in Skin Paddle Design of Pedicled Radial Forearm Flap

Ali Yavari — 2025-09-20

The Elbow is one of the functional big joints that is at risk of trauma, especially during traffic accidents. Although the reconstruction ladder is the priority, regional flaps have some advantages, including pliable tissues, being far from the danger zone of trauma, and having sufficient tissue. A 32-year-old man who suffered severe injury to the upper limb was referred for reconstruction. The fractured elbow had a plate that should be covered with sufficient soft tissue and skin. Proximally based fascio-cutaneous forearm flap, designed and harvested preserving perforators, and transferred safely. There are small septocutaneous perforators from the radial artery to the wrist skin. Fine microscopic dissection should be done to preserve this perforator to achieve a small skin paddle for harvest on the distal part of the wrist. The radial forearm flap should be considered in elbow skin defects. This proximally based flap has robust nourishment and can be harvested safely.

Crafting a Solution: An Impromptu Approach to Intubation in a Patient With Treacher-Collins Syndrome, Utilizing Video-Laryngoscopy and a Custom J-Shape Stylet

Babak Eslami — 2025-09-20

Treacher-Collins syndrome (TCS) is a rare congenital disease known to be associated with a difficult airway and is challenging for anesthesiologists practicing pediatric anesthesia. Many features of the syndrome are predictors of a difficult airway, including limited mouth opening, mandibular hypoplasia, relative macroglossia, glossoptosis, and obstructive sleep apnea. In this report, we share our experience with a TCS patient who presented for adenotonsillectomy and underwent successful intubation using video laryngoscopy with a revised J-shaped stylet.