Journal of Iranian Medical Council

From Neuroscience to Psychiatry: The Role of Drug Repositioning

Shahin Akhondzadeh — 2024-10-12

The Article Abstract is not available.

Non-Medical Treatments of Drooling by Speech and Language Pathologists in Cerebral Palsy Children: A Systematic Review

Sakineh Mohammad Zamani — 2024-10-12

Background: Drooling, commonly observed in cerebral palsy children, negatively impacts different aspects of their lives. There are several treatment options for drooling, with no consensus on a single method as the most effective one. The current systematic review provides an overview of the evidence of the different non-medical intervention methods used by speech and language pathologists to reduce drooling in cerebral palsy children.

Methods: A comprehensive and systematic search was conducted in the following electronic databases for publications from 2010-22: PubMed, Scopus, Science Direct, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. The National Health and Medical Research Council (NHMRC)and the Physiotherapy Evidence Database (PEDro-P) scale were respectively used to determine the level of evidence and the methodological quality of articles.

Results: Out of 2740 articles identified, 15 records met the inclusion criteria and were included in the study. The studies considered in this systematic review differed in the following criteria: design, participant characteristics, types of assessments and treatments, and follow-up periods. Non-medical interventions for drooling were found to be effective in alleviating the severity and decreasing the frequency of drooling.

Conclusion: The results showed the effectiveness of nonmedical interventions for drooling in cerebral palsy children. The treatments provided by SLPs can be classified into three categories: oromotor and sensory interventions, behavioral interventions, and the use of Kinesio-tape. Among these, the use of oromotor interventions and oral sensory interventions, alone or combined with other approaches, was the most widely used method.

The Prevalence and Predictors of Workplace Violence Among Hospital Staff

Vahid Ghavami — 2024-10-12

Background: Workplace violence has always been a serious chal-lenge in health care systems. It reduces employees’ satisfaction and productivity, and increases the potential for adverse medical events. This study aimed to determine the prevalence and predictors of workplace violence among hospital clinical staff.

Methods: This cross-sectional study was conducted on 140 hospital care staff including nurses and paramedics in 2022. The standard questionnaire of WHO on workplace violence in health sector was used to collect data. To describe the quantitative variables, the mean and standard deviations were utilized, and for analyzing the data, multiple logistic regression model was used. The analysis was performed using SPSS 26.

Results: The results showed that 47.9% of the participants ex-perienced verbal violence at least once in the past year, and 19.3% experienced sexual violence. Regarding the perpetrators of violence, except for physical violence, colleagues accounted for the highest. Most physical violence cases against the clinical staff were perpetrated by one of the patient’s family members. Gender, marital status, and years of work experience were determined as predictors of workplace violence. Married male employees with limited work experience were disproportionately at risk of workplace violence.

Conclusion: Hospital clinical staff were exposed to all kinds of violence, especially verbal violence. Training personnel on the management of workplace violence and enhancing their communication skills and determining the scope, and predictors of workplace violence can help healthcare managers reduce the violence and its complications.

The Severity of Wound Infection in Washing the Primary Prep Area with 70% Alcohol and Normal Saline in the Orthopedic Surgery Prepped with Povidone-Iodine: A Randomized Clinical Trial

Foad Rahimi — 2024-10-12

Background: Despite significant advances in patient treatment, infection remains a complication after surgery. The present study compared the incidence and severity of wound infection with two methods of washing the primary prep area with 70% alcohol and normal saline in patients who are candidates for orthopedic surgery in Kowsar Hospital of Sanandaj, Iran.

Methods: This single-blinded randomized clinical trial was conducted on 190 candidates for upper limb orthopedic surgery aged 18 to 65. Patients were randomly assigned to two alcohol and normal saline groups based on the table of random numbers. The primary outcome of this clinical trial was the incidence and severity of wound infection after surgery, which was measured by the standard scale of the Asepsis index. The results were analyzed using SPSS version 23, and statistical values less than 0.05 were considered significant.

Results: Patients’ hospitalization duration in the intervention group was (3.02±1.04 days) and in the control group (2.86±1.03 days) showed no significant statistical difference (p=0.297). The frequency of wound infection in the alcohol group was lower than in the normal saline group. this difference was statistically significant (p=0.023). Also, the severity of wound infection in the 70% alcohol group (Mean=5.12, SD=3.19) was lower than in the normal saline group (Mean=7.69, SD=4.12). This difference was statistically significant (p<0.001).

Conclusion: The present clinical trial showed that the incidence and severity of wound infection after surgery were lower in the group washing the skin of the surgical area with alcohol compared to the group washing with normal saline.

The Effect of Single-and Dual-Task Exercises on Functional Balance of Children with Autism Spectrum Disorder: A Randomized Clinical Trial

Maryam Yaghoubi — 2024-10-12

Background: Autism Spectrum Disorder (ASD) is a neurodevelop-mental disorder. According to the DSM-V, this condition has a variety of symptoms including impaired social relationships, and behavioral disorders. Various studies have shown that these children also have balance problems that are rarely investigated in this population. The purpose was to investigate the effect of single- and dual-task exercises on the functional balance of these children.

Methods: The study design was a clinical trial research. The participants were 40 children with ASD (9 to 14 years) who were randomly divided into two groups. The single-task exercise group only performed balance exercises, while the dual-task exercises group performed both balance exercises and cognitive tasks at the same time. The sessions consisted of 45-minute sessions (3 times a week for 4 weeks). The functional balance tests were performed before and after the intervention.

Results: There were no significant differences between two groups in the Timed Up and Go test, 10-meter walk test and Mini-BESTest endpoint of the study, but there was a significant difference in Pediatric Berg Balance Scale (p=0.01, effect size=0.82). Dual-task exercises could not cause significant improvements in the functional balance of the participants compared to the single-task group.

Conclusion: It seems that evidence that dual-task exercises cause significant improvements of functional balance of the participants compared to the single-task group is inconclusive.

Efficacy Evaluation of COVID-19 Vaccines in Patients with Autoimmune Rheumatic Diseases in Mashhad, Iran

Zahra Rezaieyazdi — 2024-10-12

vaccination. However, since the majority of studies in the related literature are focused on the efficacy of messenger RNA in rheumatic patients, the present study aimed to assess the efficiency of the inactivated whole virus vaccines and viral vector COVID-19 vaccines in rheumatic diseases in Mashhad, Iran.

Methods: This prospective cross-sectional study was conducted on ARDs patients who were referred to private clinics and rheumatologic clinics of Ghaem and Imam Reza Hospitals, Mashhad, Iran, during 2021-22. Anti-neutralizing antibodies have been considered to check antibodies of Sinopharm and Barkat vaccines, and an anti-spike antibody was considered to check Sputnik V and AstraZeneca vaccine antibodies. Humoral immunity was investigated using the anti-spike Enzyme-linked immunosorbent assay and anti-neutralizing antibodies.

Results: The obtained results showed that humoral immunity after COVID-19 vaccination was observed in 73.9% of the patients with ARDs. However, humoral immunity was lower in ARDs patients who took tacrolimus and higher in patients with a history of COVID-19 infection (χ²=5.84, p=0.01). The infection after the second COVID-19 vaccination was lower in patients with humoral immunity (χ²=5.69, p=0.01).

Conclusion: This study demonstrated that a homologous second dose of an inactivated whole viral vector SARS-CoV-2 vaccine was safe and provided a remarkable antibody response in ARDs patients.

Validity, Reliability and Psychometric Properties of the Exercise Dependence Questionnaire among Physically Active Young Adults

Sahar Khoshro — 2024-10-12

Background: Exercise Dependence (ED) is characterized by excessive and uncontrollable exercise behaviors leading to physiological and psychological symptoms. Valid assessment tools are crucial for identifying ED in understudied populations. The present study aimed to evaluate the validity and reliability of the Exercise Dependence Questionnaire (EDQ) among physically active young adults in Iran.

Methods: This psychometric validation study used a cross-sectional design with 200 participants aged 18-35 years (49% male, 51% female) recruited through clustered random sampling from sports clubs in Tabriz, Iran. The EDQ was administered between May-July, 2021. Validity was assessed through forward backward translation, content validity analysis, Exploratory Factor Analysis (EFA), and Confirmatory Factor Analysis (CFA). Reliability was evaluated using internal consistency (Cronbach’s alpha) and testretest (intraclass correlation, ICC) methods. Ceiling and floor effects, Standard Error of Measurement (SEM), and smallest detectable change (SDC) were also determined.

Results: The EDQ demonstrated good content validity (CVI=0.88, CVR=0.73). EFA yielded a 7-factor model explaining 59.45% of variance. Key factors were withdrawal symptoms, exercise for health/social reasons, positive reward, interference with life, insight into problems, and stereotyped behavior. CFA showed moderate fit. Internal consistency was adequate overall (α=0.8) but lower for some subscales. The ICC confirmed good test-retest reliability (0.80, 95% CI 0.76-0.84). No ceiling and floor effects were detected. SEM and SDC were 0.52 and 1.03, respectively.

Conclusion: The results indicated that the Persian version of the EDQ is a valid and reliable scale for assessing ED.

Gender-Based Driving Behavior Patterns in the Context of Iran: A Qualitative Study

Sanaz Sohrabizadeh — 2024-10-12

Background: Road traffic injuries are the eighth leading cause of deaths in all ages. Considering the fact that driving is a social context with different rules and behaviours, the present study was aimed to explore the patterns of gender-based driving behaviours focusing on women driving in the context of Iran.

Methods: Through a conventional content analysis, overall, 30 participants with different social and educational levels were recruited. A purposeful sampling method was used in which 7 males and 23 females were included because of sample triangulation. Data were collected using in-depth semi-structured interviews and analysed through inductive content analysis.

Results: Overall, three main categories and 10 subcategories were extracted from the data including unsafe risky behaviours against female drivers (subcategories of scary behaviours, aggression and violence against female drivers, ignoring women and revenge-based behaviours), protective and friendly behaviours (helping and caring for women drivers, respecting women drivers, being patient for women driving subcategories) and specific driving behaviours of women (preventive and cautious behaviours, driving based on traffic rules and cultural characteristics subcategories).

Conclusion: Different patterns of driving behaviors focused on female drivers were found in the present research. Reducing the aggressive gender-based driving behaviors against female drivers and strengthening the protective behaviors for women can be achieved through establishing appropriate rules and public education. Further research is required to explore the process of gender-based driving behaviours, as well as identifying different consequences of such behaviours on communities.

The Status and Expectations of the Relatives of Surgery Patients in the Waiting Area of Guilan Academic Hospitals

Bahram Naderi Nabi — 2024-10-12

Background: The situation of the relatives of surgery patients in waiting areas is an important issue, which has not been investigated in Guilan province, so this study was planned.

Methods: This cross-sectional descriptive study was conducted in Guilan academic hospitals (Razi-Poorsina-Heshmat-Alzahra–Amir al Momenin) from Feb 2022 to Dec 2022. Relatives of patients who underwent elective surgeries enrolled the survey. A questionnaire containing two parts of demographic data and 12 items assessing relative’s conditions in waiting area was filled out via a direct interview.

Results: 318 relatives enrolled the survey. 93.2% of patients’ relatives were first-degree relatives.76.7% had information about the surgery. 41.5% were informed of their patient’s status in operating room. Fear of not emergence from anesthesia 109(34.3%) and death 105(33.0%) were the main causes of anxiety which was reported as 8.23±28.2 from 10 and only 6(1.9%) had financial concern. 86.8% of the responders declared that being informed from their patient’s condition in operating room, was the most effective approach to reduce their anxiety. A positive and highly significant association was observed between the level of education and receiving explanation from surgeon, anesthesiologist and being informed from patients’ status in waiting area (p=0.001).

Conclusion: It was found that relatives of surgery patients suffered from high degrees of anxiety mainly due to fear of death and not emergence from anesthesia. They stated that being informed from their patient’s conditions was the most powerful factor in reducing their anxiety.

The Association Between Mental Health Literacy of Parents and Referral of Children and Adolescents to Mental Health Service Centers

Zahra Mashayekhi Asl — 2024-10-12

Background: Mental health literacy refers to an individual’s knowledge and beliefs about mental health, which can aid in the detection, management, and prevention of mental illnesses. Prompt diagnosis of mental disorders is crucial for timely intervention and treatment. This study aims to investigate the mental health literacy and help-seeking behaviors of parents with children and adolescents under the age of 18.

Methods: In this descriptive-analytical study, a cross-sectional design was utilized, and a surveying method was employed. A total of 134 parents of children and adolescents under 18, who were referred to the mental health service centers at Iran University of Medical Sciences and private psychiatric clinics in 2019 and 2020, participated in the study through convenient sampling. Two psychiatrists evaluated the psychiatric disorders of the children, and the parents completed the General Health Questionnaire-28 (GHQ-28) and the Mental Health Literacy Questionnaire. The collected data were analyzed using SPSS version 24.

Results: The results of the one-way analysis of variance indicated that the total score of mental health literacy significantly differed among groups with varying levels of maternal education (p=0.001).

Conclusion: This study underscores the impact of maternal education on mental health literacy among parents. Notably, parents with higher levels of education exhibited greater mental health literacy. It is essential to consider these findings in developing targeted interventions to improve mental health literacy among parents from diverse educational backgrounds. Further research should explore effective strategies for increasing awareness and knowledge about mental health in communities with varying levels of education.

Effectiveness of Cabergoline in Comparison with Control in Women with Fibroids Uterus: A Randomized Clinical trial

Marzieh Vahid Dastjerdi — 2024-10-12

Background: Uterine fibroids are one of the most common benign tumors that cause abnormal bleeding and pain in women of reproductive age. One of the objectives of this study is to evaluate the effect of cabergoline drug on the size and volume of uterine bleeding as well as menopausal symptoms in women with uterine myomas.

Methods: This double-blind clinical trial was conducted among 80 women with fibroid myomas and Abnormal Uterine Bleeding (AUB). The participants were allocated to two groups after random allocation. Group I received Cabergoline, 1 tablet (0.5 mg/w) orally once a week for 3 months. Group II obtained a placebo tablet (0.5 mg/w), taken at the same time.

Results: 80 patients were included in the study (40 patients in the control group and 40 patients in the cabergoline treatment group). No statistically significant difference was observed between the two groups in terms of age, number of pregnancies, number of births, body mass index, uterine myoma characteristics, myoma type, myoma volume, and myoma number. A 37% decrease in myoma size was observed in the cabergoline recipients, as well as a 25% decrease in the placebo group, which is not statistically significant (p-value >0.05).

Conclusion: Cabergoline drug reduces the volume of bleeding and the number of uterine myomas, but this reduction is not statistically significant and requires more studies in this field.

Oral Manifestations in Asthmatic Patients Using Metered Dose Inhaler and Dry Powder Inhaler

Hedieh Amin Moghadassi — 2024-10-12

Background: The prevalence of asthma indicates the importance of studying oral manifestations of inhalers as one of the indications of asthma. This study compares two methods of using inhalers, Metered Dose Inhaler (MDI) and Dry Powder Inhaler (DPI) in asthmatic patients.

Methods: 100 asthmatic patients (50 MDI-treated, 50 DPI-treated) and 50 healthy individuals were selected by convincing sampling. The three sampled groups were gender- and age-matched. We performed a clinical examination, recorded the information, and analyzed the data by SPSS21 software using a t-test and one-way ANOVA for quantitative and Pearson’s chi-square test for qualitative indicators.

Results: DMFT index (p-value 0.001), fissured tongue (p-value 0.005), xerostomia (p-value 0.001), and dental erosion (p-value: 0.011) in MDI-treated patients were significantly higher than the other two groups, while the geographic tongue (p-value 0.008) was significantly higher in DPI-treated patients than in the other two groups. It showed that periodontal disease and median rhomboid glossitis had no significant difference between the three groups.

Conclusion: Due to the higher incidence of manifestations in MDI, it is expected that physicians give more attention to prescribing inhalers and give them the necessary training to maintain oral and dental hygiene.

The Effectiveness of an Intervention Based on the Information, Motivation, and Behavioral Skills Model on Treatment Adherence and Self-Efficacy in Patients with Coronary Artery Diseases: An Explanatory Mixed Method Study

Zahra Khademian — 2024-10-12

Background: Promoting adherence to treatment and self-efficacy in patients with coronary artery diseases helps to improve patient outcomes. The present study was conducted to explain the effectiveness of interventions based on information, motivation, and behavioral skills model on treatment adherence and self-efficacy in patients with coronary artery diseases.

Methods: This explanatory-sequential study was conducted on patients with coronary artery diseases in Shiraz, Iran. First, a quasi-experimental study was conducted on 112 patients who were randomly assigned to two intervention and control groups. The intervention consisted of ten motivational training sessions that were designed based on Information, Motivation, and Behavioral Skills (IMBS) model and continued with six months of telephone follow-up and counseling. Data were collected before, three months, and six months after the end of the intervention. Then, in the second phase, a qualitative study including 20 in-depth interviews with 18 participants from the intervention group was conducted. The data were analyzed by deductive and inductive qualitative content analysis. Finally, quantitative findings were explained with the help of qualitative findings.

Results: The findings showed that the mean score of treatment adherence, medication adherence, and self-efficacy in the intervention group was significantly higher than the control group 3 and 6 months after the intervention (p<0.001). The results of the qualitative phase of the study also showed that the four main categories include receiving targeted information, encouragement to care, gained self-efficacy/doubt in care, and improvement/non-improvement of treatment adherence behaviors can explain quantitative phase results.

Conclusion: The results showed that receiving training with effective methods, strengthening the support system, self-confidence and positive attitudes about care, and promoting self-management and proper management of emotional distress contributed to the effectiveness of the interventions. However, receiving conflicting information, limited financial resources, and the inability to face challenges were among the obstacles to strengthening self-efficacy and adherence to treatment.

Comparing the Effect of Granisetron with Meperidine on Post-Shivering in Elective Cesarean Section under Spinal Anesthesia

Tohid Karami — 2024-10-12

Background: Post-operative shivering after spinal anesthesia is a common issue in women undergoing cesarean section, then its management is necessary to increase patients’ satisfaction. Therefore, the current study aimed to compare the prophylactic effect of Granisetron and meperidine on post-spinal shivering in elective cesarean section.

Methods: In this double-blinded clinical trial study, 100 women under elective cesarean section using block randomization were divided into two groups. The spinal anesthesia was performed in all women with 10 mg hyperbaric bupivacaine 0.5 %. Then, after the birth of the baby, the patients received 0.04 mg/kg Granisetron or 0.4 mg/kg meperidine intravenously. Mean Arterial Pressure (MAP), Heart Rate (HR), and percentage of arterial blood oxygen saturation (SpO₂) were measured before intervention and 60 minutes after surgery using a standard monitoring device. Shivering was evaluated 30 minutes after the surgery in the recovery room according to the clinical examinations.

Results: The changes in hemodynamics parameters were similar between the two groups. There was a statistically significant difference in the rate of shivering between the two groups. The rate of shivering in the Granisetron group was higher than in the meperidine group. Thus, 13 patients (26%) and 5 patients (10%) had shivering in the Granisetron and meperidine groups, respectively (p=0.037).

Conclusion: Granisetron was not more effective than meperidine as routine treatment in preventing shivering after spinal anesthesia in women under elective cesarean section.

Daily Versus Conventional Dialysis for COVID-19 Patients: A Randomized Controlled Trial

Fatemeh Yassari — 2024-10-12

Background: Hemodialysis patients have high mortality and morbidity in COVID-19 due to different causes, thus the current study evaluates the difference between the effect of conventional and daily hemodialysis on mortality in End-Stage Renal Disease (ESRD) patients with COVID-19.

Methods: This study was designed as a single-center, parallel, randomized and un-blinded clinical trial that chronic hemodialysis patients with confirmed COVID-19 infection enrolled. The study group was dialyzed daily for a week and the control group was on three sessions per week of dialysis. The primary outcome was estimation of mortality rate and secondary outcome was considered as ICU admission rate during hospitalization.

Results: A total of 47 patients with the diagnosis of ESRD were included. The mean age of the included patients was 57.1±14.2 years in daily hemodialysis and 58.8±17.4 years in the conventional hemodialysis, and 36(76.6%) were male. From the 47 included patients, 18(38.3%) were admitted to the ICU, and 12(25.5%) were deceased during their hospital stay. The prevalence of the two main outcomes of the study, ICU admission and mortality, was not different between the two groups of the study.

Conclusion: In this study, daily hemodialysis was beneficial in reducing mortality in COVID-19 infected patients, but this difference was not statistically significant. Studies with higher sample sizes may show this difference significantly.

Prediction of Illness Attitude Based on Early Maladaptive Schemas and Intolerance of Uncertainty in Patients with Multiple Sclerosis

Zohreh Ghasemloo — 2024-10-12

Background: The present study was conducted to predict attitudes towards illness based on early maladaptive schemas and intolerance of uncertainty in individuals with Multiple Sclerosis (MS).

Methods: This was a cross-sectional study conducted on 62 patients with MS (72% of them were female). They were selected based on availability and voluntary participation. Data were collected through three questionnaires: the Illness Attitudes Scale, the Intolerance of Uncertainty scale, and the Yang Schema Questionnaire.

Results: The mean age (±SD) of the participants and duration of diagnosis was 36.10±7.05 yr, and 4.21±3.78 yr, respectively. The results showed that 18 early maladaptive schemas, together with intolerance of uncertainty, can predict up to 8.9% of illness attitude in patients with MS. Among the early maladaptive schemas, schemas of emotional deprivation, social isolation-alienation, abandonment-instability, failure, dependence-underdeveloped self, vulnerability, trapped-victim, emotional inhibition, stubborn/fault-finding standards, self-control disciplinary, seeking attention-seeking approval, and negativity/pessimism had a significant relationship with attitudes towards illness (p<0.05). Additionally, there was a significant relationship between intolerance of uncertainty and all its dimensions with attitudes towards illness (p<0.05).

Conclusion: Early maladaptive schemas and intolerance of uncertainty can predict illness attitudes in patients with MS. Patients with MS who have high intolerance of uncertainty are more likely to interpret ambiguous information as threatening. Therefore, effective interventions in the field of uncertainty intolerance for these patients can likely be effective in improving their attitudes towards illness and preventing the exacerbation of their symptoms.

Demographic and Clinical Characteristics of Pre-Malignant Oral Lesions and their Related Factors in an Iranian Population: A Registry-Based Study

Somayeh Rahmani — 2024-10-12

Background: Oral Potentially Malignant Disorders (OPMDs) can lead to Oral Squamous Cell Carcinoma (OSCC). The sixth most common cancer in the world is OSCC. This study aimed to describe the demographical and clinical characteristics of OPMD patients and their risk factors registered at the Oral Medicine Department of Shahid Beheshti Dental School in 2019-2021.

Methods: The observational-analytical study was conducted using the dental records of 96 consecutive patients using a web-based registration software (OPMDs registry). Information including demographics and clinical features, the type of OPMD, and risk factors were extracted. Data were analyzed using the Chi-square test, T-test, and Fisher’s exact test with SPSS version 21.

Results: In this study, 96 patients (average age: 52.41±14.87) including 52 women and 44 men, participated. The most common OPMDs comprised 69 Oral Lichen Planus (OLP) and 15 leukoplakia. The most common location of lesions was the buccal mucosa (74%) with erosions and plaques being the most common morphology types. Most patients with leukoplakia were male, however, majority of the patients with OLP were female (p=0.001). In patients with leukoplakia, 66.5% were smokers; hence, a significant relationship between smoking and OPMD was observed (p=0.001). Patients with OLP commonly presented with burning symptoms, while patients with leukoplakia were mostly asymptomatic (p=0.004).

Conclusion: A significant relationship was observed between gender, clinical symptoms, location of lesions, morphology, and type of OPMDs. Most patients with OPMDs were women with OLP in their buccal mucosa, suffering from burning sensation.

Does Topiramate Add-On Enhance the Response to the MATRIX Program in Individuals with Methamphetamine Use Disorder? A Double-Blinded Randomized Placebo-Controlled Trial

Hamidreza Ahmadkhaniha — 2024-10-12

Background: Methamphetamine dependence significantly impacts individuals and society. Treating methamphetamine use disorder is challenging due to limited evidence on effective pharmacotherapies and their interaction with nonpharmacologic interventions. This study evaluated the efficacy of topiramate compared to placebo in treating methamphetamine use disorder among participants in a Matrix program.

Methods: Participants were recruited from the Addiction Center of Iran Psychiatric Hospital between January 2020 and June 2023 and randomly assigned to receive either topiramate or a placebo for 12 weeks, alongside Matrix program sessions. Blinding was maintained for participants, personnel, outcome assessors, and statisticians. Main outcomes included craving, desire to use, positive urine amphetamine toxicology rates, and depression severity. Craving was assessed using the Visual Analog Scale (VAS) and the Substance Craving Questionnaire–brief (SCQ-B). The desire to use was evaluated with the Addiction Severity Index (ASI), while depression severity was measured using the Beck Depression Inventory. Data analysis utilized IBM SPSS Statistics® 20.0, employing various statistical tests for comparison.

Results: Both groups exhibited improvement in craving as per VAS scores (p=0.007), with greater reduction in the topiramate group; however, no significant difference was found between groups (p=0.06). The negative urine toxicology rates showed no significant difference (Hazard ratio=1.15, 95% CI: 0.75, 1.78). Depression scores decreased in both groups without significant between-group differences (p=0.78).

Conclusion: The findings do not support the efficacy of topiramate in enhancing outcomes within a Matrix program for individuals with methamphetamine use disorder.

The Effectiveness of Anemia Treatment with Injectable Iron within 48 to 72 Hours before Coronary Artery Bypass Surgery on Cardiac Function and Postoperative Outcome: A Randomized Clinical Trial

Mohammad Jebelli — 2024-10-12

Background: Anemia is considered as one of the risk factors affecting the outcomes after cardiac surgery. Accordingly, the improvement of iron deficiency anemia through injection or oral may be associated with the improvement of post-procedure results, especially the improvement of cardiovascular function. This study was aimed at investigating the effectiveness of iron treatment shortly before surgery in reducing the need for blood transfusion and improving myocardial performance parameters (left ventricular ejection fraction) in coronary bypass surgery patients.

Methods: This study was a single-blind randomized clinical trial. In total, 60 candidates for coronary bypass surgery having iron deficiency anemia before the operation were randomly divided into two groups treated with injectable iron supplement (iron sucrose at a dose of 200 mg/200 ml of normal saline injected in 30 minutes) 48 to 72 hours before surgery or without therapeutic intervention. The patients were examined during and after the operation in terms of surgical outcomes.

Results: Treatment with injectable iron before surgery was associated with improvement in serum hemoglobin level after surgery and a significant reduction in the need for intraoperative and postoperative transfusions. Preoperative treatment of iron deficiency was associated with a reduction in the length of hospitalization of the patients after surgery.

Conclusion: Treatment of iron deficiency anemia within 48 to 72 hours before surgery will improve the condition of patients’ anemia and compensate serum hemoglobin, reduce the need for blood transfusion during surgery and the length of hospitalization of the patients after surgery.

Determining the Optimal Morphometry of Pedicle Screws in Lumbar and Thoracic Spine in the Iranian Population

Reza Ajudani — 2024-10-12

Background: The improper length and direction of pedicle screw may also cause it to penetrate the adjacent organs. Unknowing the safe zone of dimensions and directions of the pedicles is essential to proper screw placement.

Methods: The present study is a cross-sectional morphometric study on patients with spinal trauma referred to the neurosurgical department in 2021. The MARCO PACS software scale measured the CT scan images and included the vertebral left pedicle diameter, pedicle body distance, body aorta distance, pedicle diameter, height, and area. The entry point and direction of the pedicle screw were made with the “free-hand” method.

Results: 301 patients were included, consisting of 113 females (37.5%) and 188 males (62.5%). The mean age of the participants was 42.87±12.3 years. “Among all T12 vertebra parameters, just body aorta distance was not significant between genders (p-value=0.311). The pedicle height and body aorta distance were lowest among 18-35 years patients (p-value=0.001) (p-value=0.003), respectively. Post-hoc analysis revealed a significant difference between 18-35 and 51-70 years for body aorta distance in the L1 vertebra (p-value=0.002).

Conclusion: The present investigation has shown significant differences between genders for optimal left pedicle screw parameters, which should be considered before surgery.

Double Ovarian Stimulation Versus Using Antagonist with a High Dose of Gonadotropin in Women with Poor Ovarian Response: A Randomized Clinical Trial Study

Farnaz Montazeri — 2024-10-12

Background: Poor Ovarian Response (POR) to ovarian stimulation is a challenging factor in Assisted Reproduction Technology (ART). This study aimed to compare the efficacy of a conventional antagonist with high doses of gonadotropin protocol with double stimulation protocol in females with POR.

Methods: This randomized clinical trial study was conducted on 60 women aged >35 with PORS at the Avicenna Infertility Center, Tehran, Iran. The participants were randomly divided into 2 groups (n=30 /each). In group 1, from the second day of the menstrual cycle, gonadotropin started at a dose of 450-600 units. In group 2, the second day of the menstrual period began with Letrozole 5 mg every night and an oral tablet of Clomiphene citrate 50 mg every day, and from the fourth day started 150 units of gonadotrophin (Triptorelin, 0.2 mg).

Results: In this study, at the end of the follicular phase, there was a significant correlation between protocol type and the number of Germinal Vesicles (GV) (p=0.04). The mean number of oocytes retrieved was 2.76±1.9 in the conventional method and 3.23±2.1 in the double stimulation group (p=0.90). The number of fertilized oocytes was 31 in the conventional protocol and 25 in the double stimulation protocol. The mean number of pregnancies that led to the fetus was 1.38±1.3 in the conventional protocol and 0.96±0.9 in the double stimulation group (p=0.018).

Conclusion: The results of this study show that the embryos in the double-stimulation group were more capable of completing the pregnancy, and the double-stimulation group had a higher live birth rate.

Correlation of Tongue Dimensions and Posture with Lower Central Incisor Inclination and Alveolar Bone Thickness in Skeletal Class I and II Malocclusion: A CBCT Study

Kazem Dalaie — 2024-10-12

Background: In this study, Cone-Beam Computed Tomography (CBCT) was used to assess the dimension and posture of the tongue, as well as Alveolar Bone Thickness (ABT) and labiolingual inclination of mandibular central incisors in order to look for any correlations.

Methods: A total of 200 CBCT images of skeletal Class I and II individuals were studied. Each group of malocclusion was divided into three subgroups: low-angle, normal-angle, and high-angle. Buccal and lingual alveolar bone thickness (BT & LT), and the Inclination of Mandibular Plane Angle (IMPA) were measured and compared by using T-test. The spearman rank correlations test analyzed the correlations between dental variables and tongue measurements (p<0.05).

Results: Significant weak correlations were identified between dental variables and tongue measurements. In Cl I malocclusion, IMPA and Tongue Length (TGL) were found to be significantly correlated with a correlation value of 0.324 (p=0.001). In Cl II malocclusion, there was a significant correlation between BT3 and TGH. About BT3, there was a significant correlation with D4’ and a negative correlation with D5’. Further comparison among vertical subgroups revealed the same results.

Conclusion: Class I patients with superior tongue posture may have thicker lingual alveolar bone around mandibular incisors and Class II patients showed that thicker labial alveolar bone of lower incisor and thinner alveolar bone at the lingual side may be associated with a superior position of the posterior portion of the tongue.

The Prevalence of Various Stages of Heart Failure in Individuals Over 40 Years Old: The Findings from Yazd Health Study

Elahe Zare — 2024-10-12

identification and prevention of HF. Therefore, this study aims to evaluate the prevalence of various stages of HF in individuals over 40 years old within a large population of Iranian adults.

Methods: In this descriptive cross-sectional study, a random sub sample of Yazd Health Study (YaHS) participants aged 40-70 years was evaluated. History and clinical examination of the patients was conducted by a cardiologist and then, the participants underwent echocardiography to determine the stages of heart failure.

Results: Among 410 Yazd population -the representative sample with mean age 58.0±9.2 years, 183 patients (44.6%) were in stage 0, 121 (29.5%) in stage A, 77(18.8%) in stage B, and 29 (7.1%) in stage C heart failure. No individuals were in stage D. There was a significant difference between the frequency of individuals with different stages of HF in terms of diabetes, hypertension, obesity, and history of ischemic heart disease (p<0.05). In addition, the frequency of HF increased in the age group >60 years and the obesity group (p<0.05).

Conclusion: According to these, about half of the patients with HF were in stage A and B. Therefore, appropriate measures are needed to identify these groups of patients, especially individuals with risk factors of diabetes, hypertension, obesity and those over 60 years to prevent the progression of the disease to higher stages which lead to poorer outcome.

Impact of Advanced High-Power Pain Threshold Static Ultrasound and Muscle Energy Technique on Pain Thresholds and Functional Improvement in Myofascial Trigger Points

Anand Kumar Singh — 2024-10-12

bands and hypersensitive Trigger Points (TrPs), contributing to musculoskeletal pain. The objective of this study is to investigate and assess the effectiveness of Advanced High-Power Pain Threshold Static Ultrasound (AHPPTSU) and Muscle Energy Technique (MET) in altering pain thresholds and enhancing functional outcomes in individuals with myofascial trigger points.

Methods: In this randomized clinical trial involving 86 individuals with TrPs in the upper trapezius muscle, the participants were divided into experimental and control groups. 33 males and 53 females, underwent six sessions of treatment over two weeks. A repeated measure Analysis of variance was used to compare baseline values and altered values at 1 and 2 weeks.

Results: The study demonstrated that the Pressure Pain Threshold (PPT) and the Neck Pain Disability Index (NPDI) score, showed a significant improvements in participants receiving AHPPTUS in experimental group compared to the other group. Experimental group showed a significantly greater improvement in PPT (p=0.001) and both groups experienced a significant enhancement in function. However, when comparing the two groups, experimental group showed a significantly greater improvement (p=0.001). Importantly, no adverse effects were reported in either group.

Conclusion: In the treatment of myofascial trigger point, AHPPTSU can be considered as an alternative therapy method, which is more effective than previously used High-Power Pain Threshold Static Ultrasound (HPPTSU) therapy and it also shortens the total treatment protocol to 2 weeks.