Journal of Iranian Medical Council

After the Massacre of Innocent Children and Women in Gaza, Will the World Remain Silent against the Massacre of the People of Lebanon?

Shahin Akhondzadeh — 2024-11-24

The Article Abstract is not available.

Men’s Health in Disasters: A Systematic Scoping Review

Sanaz Sohrabizadeh — 2024-11-24

Background: Disasters affect men and women unequally. While both male and female populations have their own needs, capacities and vulnerabilities, little is known about the men’s health status in disasters. Thus, the present review is aimed to identify and explain the impacts of disasters on men’s health status in the world.

Methods: The current scoping review was conducted using PRISMA protocol 2020. Web of Sciences, PubMed, Scopus databases were searched using related keywords. Inclusion and exclusion criteria were used to select the relevant references. EndNote software, version 17, was applied to manage the citations. The data were analyzed using thematic analysis.

Results: A number of 13 references was selected for final analysis after screening process. Physical and sexual health were the most frequent aspects of men’s health which was studied by the gender and disaster researchers (23.1%). Men’s health aspects in disasters were categorized as physical health, mental health, social health and sexual health.

Conclusion: Men are visible as the capable group in disasters and their health needs (physical, mental, social, sexual and spiritual health) may likely not be considered post-disasters. Developing gender analysis tools for assessing the vulnerabilities, needs and health status of male population in disasters as well as establishing a sex-disaggregated database for effective decision-making regarding men’s health during disasters are highly suggested.

War Attacks on Medical Staff, Hospital and Healthcare System During 225 Days in Gaza: A Scoping Review and Efficiency Assessment of the International Humanitarian Law

Mohammadreza Salehi — 2024-11-24

During wars, hospitals, medical staff, and civilians are protected by International Humanitarian Law (IHL). However, this importance is not observed in some instances. We examined the killing of medical staff and attacks on medical facilities during the Gaza war. In this scoping review, we gathered data from primary and secondary sources, such as newspapers, peer-reviewed journals, open-source platforms, social networks, and Non-Governmental Organization (NGO) websites from October 27, 2023 to May 21, 2024. Additionally, we collected data from some organizations, such as Physicians for Human Rights (PHR), the World Health Organization (WHO), Palestine Ministry of Health, World Bank, and United Nations Children’s Fund (UNICEF).

According to different reports, between 400 to 800 incidents of violence against the healthcare services were documented in Gaza from the start of the war on October 27, 2023 until May 21, 2024. These incidents include obstruction of access to medical facilities, attack on ambulances, damage to hospital buildings, and targeting of medical staff and healthcare volunteers. Although the WHO issued warnings to stop the violence against medical staff and health facilities, these efforts were unsuccessful.

The results revealed that unprecedented tragedies are occurring in Gaza, where medical facilities and staff are being targeted and killed. However, the response of international organizations appears to be passive and not appropriate to the extent of the war crimes. Moving forward, the international community should consider developing more effective solutions to address criminal behavior within the healthcare sector.

Assessing the Psychometric Properties of a Reflective Practice Questionnaire Among Medical Sciences Students at Tabriz University of Medical Sciences

Leila Jahangiry — 2024-11-24

The Article Abstract is not available.

Beyond Aesthetic Enhancement: Unveiling the Impact of Nasal Plastic Surgery on Patient’s Quality of Life

Batool Naghavi — 2024-11-24

Background: In recent years, the desire to perform septorhinoplasty has increased in different societies, which can be due to the effect of this surgery on improving people’s sense of satisfaction with their appearance, and as a result, increasing self-confidence and increasing the quality of life in these people. On the other hand, in some people, despite the successful surgery from the surgeon’s point of view, the patient may not be satisfied enough with the new appearance of his/her nose. According to the conducted studies, several factors play a role in the patient’s satisfaction after surgery. In this study, it was tried to determine the presence sense of nasal obstruction before septorhinoplasty surgery and its effect on the patients’ satisfaction after surgery through three useful questionnaires in this field [1. black colour Rhinoplasty Outcome Evaluation (ROE) questionnaire that evaluates both satisfaction of cosmetic outcome and functional outcome, 2. Nasal Obstruction and Septoplasty Effectiveness Scale (NOSE) and 3.Visual Analogue Scale (VAS)].

Methods: Seventy-two patients were evaluated before and 12 months after septorhinoplasty with validated ROE, NOSE and VAS questionnaires.

Results: The mean age of the patients was 28.59±5.74 years, of whom 69.2% were female and 20.8% were male. The ROE score improved significantly from 10.4±3.0 to 19.8±3.7 (p-value <0.001). The overall NOSE score was significantly lower (p-value: 0.002), and history of nasal obstruction was an independent factor for a significantly better NOSE score after surgery.

Conclusion: Septorhinoplasty can improve patient satisfaction with cosmetic and functional outcomes, especially in those who have more complaints about nasal obstruction before surgery.

The Flare-up of Rheumatic Autoimmune Diseases Following COVID-19 Vaccination

Maryam Sahebari — 2024-11-24

Background: Individuals with Autoimmune Rheumatic Disease (AIRD) are vulnerability to severe SARS-CoV-2 outcomes and vaccination. The present study aimed to determine the incidence of AIRDs flares following COVID-19 vaccination and its risk factors.

Methods: The study was retrospective cross-sectional focused on patients with AIRD who experienced a flare-up at least during 30 days after receiving the COVID-19 vaccine. These patients were seen at Rheumatology Clinics at Imam Reza and Ghaem Hospitals, affiliated with Mashhad University of Medical Sciences, as well as private clinics in Mashhad, Iran, over a period of 1 years.

Results: The rate of recurrence following COVID-19 vaccination was estimated to be 3.16%. Rheumatoid arthritis (18.9%), systemic lupus erythematosus (12.9%), and cutaneous vasculitis (10.6%) were the most frequent AIRDs among patients who experienced a flare-up following COVID-19 vaccination. More than 85% of patients who were vaccinated with AstraZeneca experienced a flare-up after the first dose of vaccination. In the majority of patients, the flare-up occurred after the first dosage of COVID-19 vaccination.

Conclusion: In Mashhad, Iran, the incidence of flare-ups in autoimmune and inflammatory rheumatic diseases following COVID-19 vaccination is estimated to be a mere 3%. Despite their rarity, flare-ups in autoimmune and inflammatory rheumatic diseases post-COVID-19 vaccination can still pose a public health issue, potentially undermining public confidence in vaccinations.

Clinical Features of Temporomandibular Disorders: Validity and Reliability of the Fonseca Anamnestic Index in Persian

Fahimeh Anbari — 2024-11-24

Background: Temporomandibular Disorders (TMDs) are a group of disorders associated with masticatory dysfunction. TMDs are usually diagnosed late which leads to complicated treatments. Early diagnosis and treatment of TMDs are essential.

Methods: A valid and reliable version of Fonseca’s Anamnestic Index (FAI) was prepared in Persian from the English version. It was used to assess TMD in 350 patients. Clinical signs of TMD were also recorded based on examination.

Results: FAI scores showed 161(46%) people had TMD. There was no significant difference between occlusion classes in terms of the frequency of TMD. There was no significant difference between the mean maximum mouth opening and severity of TMD.

Conclusion: In this study the validity and reliability of the FAI in Persian language, as a simple tool for TMD screening in health centers, was confirmed. Based on results, there is a relationship between clinical findings and the severity of TMD by using FAI and it can be used for screening TMD patients.

The Effect of Clinical Teammate Nurse Approach on the ICU Nurses’ Knowledge of Electrocardiogram (ECG) Interpretation of Cardiac Arrhythmia: A Pilot Study

Maedeh Tourdeh — 2024-11-24

Background: Using an effective method to enhance nurses’ knowledge of ECG interpretation is one of the most essential requirements for nursing managers. Self-directed learning approaches can help to introduce lifelong learning in learners, especially in clinical settings. This study purposed to detect the effect of the implementation of the clinical teammate nurse program on the critical care nurses’ knowledge of ECG interpretation on cardiac arrhythmia.

Methods: A pilot study was performed by a quasi-experimental design with a nonequivalent control group. The participants were 32 critical care nurses divided into two groups: the clinical teammate nurse program and control groups. The data were collected by a knowledge assessment questionnaire that measured nurses’ knowledge of ECG interpretation of cardiac arrhythmia. The nurses’ knowledge was measured three times: initial study, one month, and six months later. Results: The mean and standard deviation of age of participants was 32.38±7.03 years. There was a significant difference between three scores of repeated measurement of nurses’ knowledge (p<0.001), as the nurses’ knowledge one month after the study was significantly higher than in the initial test six months later. Also, pairwise comparisons showed that nurses in the clinical teammate program had higher knowledge scores than the control group (p<0.001).

Conclusion: The clinical teammate nurse program can be used as an easy and economical way to improve nurses’ knowledge in interpreting ECG. This method can also be an excellent alternative to formal and traditional methods such as lecturing programs in continuing education programs.

The Prevalence of Stunting in Indonesia: An Examination of the Health, Socioeconomic Status, and Environmental Determinants

Andi Kustanto — 2024-11-24

Background: Stunting is a significant public health concern in Indonesia. It represents a form of chronic malnutrition that manifests not only as a short stature for one’s age, but also as a profound challenge affecting children’s physical and cognitive development. This study aims to provide more research basis for the government to formulate stunting policies by exploring the ecological factors associated with stunting, consistent with the goal of reducing stunting according to Sustainable Development Goals (SDGs) targets by 2030.

Methods: Data were collected on stunting and ecological factors from 34 provinces in Indonesia from 2015-18, sourced from Statistics Indonesia and the Ministry of Health. A framework of ecological factors that influence stunting, consisting of health, socioeconomic status, and the environment was developed. A panel data model to test the influence of each ecological factor on stunting was created.

Results: Among the 27 independent variables of health, economic status, and environment, the results of this study show that malnutrition, diarrhea, dependency ratio, and hygiene significantly affect the risk of stunting. Meanwhile, antenatal care, nurses, and sanitation have an effect on reducing the risk of stunting.

Conclusion: To achieve the SDGs targets associated with malnutrition by 2030, addressing stunting in Indonesia requires a comprehensive and multisectoral approach that addresses the fundamental causes of stunting, including health, socioeconomic status, and environmental factors. Addressing stunting is crucial for Indonesia, not only to improve the health and well-being of its children, but also for the long-term benefits of enhancing educational outcomes and economic productivity.

The Effect of Exercise on Improving Respiratory Function and Physical Activity in Hospitalized Patients with COVID-19

Maryam Sadat Mirenayat — 2024-11-24

Background: The outbreak of COVID-19 has been associated with various physical and psychological effects. The role of exercise in strengthening the immune system and reducing inflammation has already been proven. Moderate levels of exercise can enhance overall immunity. Exercise can improve intracellular metabolism and increase cell defense activity by improving inflammatory cytokines, immature B cells, and cytotoxic T cells. Therefore, exercise is known as a defense strategy against respiratory infections. Here the role of exercise in improving respiratory function and physical activity in hospitalized patients with COVID-19 was evaluated.

Methods: The present study was performed as a randomized clinical trial on 90 hospitalized patients with COVID-19. Both groups received all routine treatments (medication, invasive or non-invasive ventilation, physiotherapy). Then, in the experimental group, standard exercises were provided to improve the patients’ physical condition and exercise capacity. After two weeks and one month later, all indices were measured again in two groups.

Results: The results of the present study showed that exercise causes significant changes in indicators such as 6-Minute Walk Test (6MWT) (p=0.001), balance score (p=0.02), and Sf1 score (p=0.05) in two time periods before and after rehabilitation in two groups.

Conclusion: Performing standard and defined exercise exercises for patients with the new coronavirus improves the physical activity and respiratory function of patients.

Prevalence of Post-Traumatic Stress Disorder among COVID-19 Survivors: A 6-Month Follow-up Study in a Few Referral Hospitals of Tehran, Iran

Sayedeh Elham Sharafi — 2024-11-24

Background: COVID-19 has significantly impacted individuals globally, leading to heightened levels of stress and psychological distress. COVID-19 hospitalized patients experience social exclusion, physical pain, and survival anxiety. This study aims to screen recovered COVID-19 patients for Post-Traumatic Stress Disorder (PTSD) and assess its correlation with psychosocial factors for six months.

Methods: In this descriptive-analytical cohort study, 401 patients aged 18-80 years were hospitalized in hospitals related to Tehran University of Medical Sciences due to COVID-19 from March 1 to May 31, 2021, and were followed for six months. Recovered patients completed electronic PCL-5 and demographic questionnaires to be screened for PTSD and other psychiatric comorbidities. The data were analyzed utilizing multivariate logistic regression models.

Results: Based on the PCL-5, PTSD was diagnosed in 6.4% of the samples. 10.2% of the samples received a subthreshold PTSD diagnosis. 46.2% of the samples with a PTSD diagnosis had a positive past psychiatric history. Results demonstrated that a previous positive psychiatric diagnosis has a statistically significant relationship with PTSD (p<0.05). This research did not reveal any significant association between PTSD symptoms and demographic features.

Conclusion: PTSD and subthreshold PTSD rates in COVID-19 patients after hospital discharge are significant. A positive past psychiatric history was recognized as a contributing factor contributing to the onset of PTSD. COVID-19 survivors should be screened for PTSD during follow-up examinations.

Predicting ICU Admission for Hospitalized COVID-19 Patients by Artificial Neural Network Combined with Elastic Net

Parvin Sarbakhsh — 2024-11-24

Background: Machine learning models could assist physicians in identifying high-risk COVID-19 patients. This study aimed to predict the Intensive Care Unit (ICU) admission in COVID-19 hospitalized patients by the Artificial Neural Network (ANN) model combined with Elastic Net algorithm.

Methods: In this prospective study, the data of 139 COVID-19 patients admitted to Imam Reza Hospital in Tabriz between 20 March and 5 April 2020, were analyzed. The Elastic Net method was used to choose features with high importance. The chosen variables were standardized and ANN was fitted to the data with one hidden layer based on the descending gradient algorithm. To validate the model, the training and test group method with a ratio of 70 to 30 was used. The model’s predictive power was reported by calculating the overall accuracy, sensitivity, specificity, and Area Under the ROC curve (AUC).

Results: According to the results of the Elastic Net, the ANN model was constructed based on age, sex, body mass index, diabetes mellitus status, history of heart disease, and vital signs including systolic and diastolic blood pressure, saturated oxygen level, pulse rate, respiration rate, and body temperature. The overall accuracy of this model was 93.15%, sensitivity 80%, specificity 95.8%, and AUC 0.90. Saturated oxygen level, pulse rate, and age were the most important and predictive variables.

Conclusion: In the investigated sample of patients admitted with COVID-19, the fitted ANN model had acceptable performance to predict the ICU admission. This finding could be useful for physicians and policy makers.

Investigation of the Accompaniment of Cancer in Rheumatic Diseases in Mashhad, Iran, from 2007-2018: A Retrospective, Descriptive, Cross-Sectional Study

Maryam Sahebari — 2024-11-24

Background: The present study aimed to investigate the association between rheumatic diseases and cancer in patients referred to two medical-training centers and private clinics over 10 years in Mashhad, Iran.

Methods: This study, which was retrospective, descriptive, and cross-sectional in nature, involved 1,036 rheumatic patients who were referred to Imam Reza and Ghaem Hospitals, as well as rheumatology clinics in Mashhad, Iran, between 2007 and 2018. For each patient, data was collected on demographics, laboratory results, type of rheumatic disease, duration of the disease, frequency of malignancy among rheumatic patients, type of malignancy, and the drug treatments administered up until the final diagnosis of malignancy. The study concluded with a comparison between rheumatic patients with malignancy and those without.

Results: The incidence of malignancy was found to be higher in women (p=0.005) and in older age groups (p=0.005). Furthermore, patients with malignancy were observed to use biological drugs (p=0.001), Adalimumab (p=0.02), and Infliximab (p=0.01) less frequently. Upon examination of laboratory data, it was noted that the Erythrocyte Sedimentation Rate (ESR) was higher in cases of malignancy (p<0.005), while the serum hemoglobin level was lower in such cases (p=0.009).

Conclusion: The study’s findings suggest a higher incidence of malignancy was observed in women and older age groups. Additionally, patients with malignancy were less likely to use biological drugs, including Adalimumab and Infliximab. These insights could potentially guide future research and therapeutic strategies in the management of rheumatic diseases.

Investigation of the Radiation Protection Effect of Metformin Against Complications Caused by Radiation Therapy in Patients with Prostate Cancer: Randomized Clinical Trial

Sasan Razmjoo — 2024-11-24

Background: External-Beam Radiation Therapy (EBRT) is one of the most important treatments for prostate cancer. Metformin is a multifunctional drug that can control complications following radiotherapy.

Methods: This double-blind, randomized clinical trial was conducted on patients with prostate cancer candidates for EBRT. Patients were randomly assigned to two groups receiving oral Metformin (n=20) or placebo (n=20). The incidence of acute complications was investigated using radiation therapy oncology group acute complications criteria.

Results: There was no significant change in the number of blood cells before and after treatment in the two groups (p<0.05). The micronuclei number in both groups showed a significant increase during radiotherapy, immediately and one month later (p<0.001). There was no significant difference in number of micronuclei between the two groups (p<0.05). The frequency of urinary complications ≥ grade 2 in the metformin group was lower (p=0.005). There was no significant difference in the incidence of gastrointestinal complications ≥ grade 2 between the metformin and placebo groups (p=0.5).

Conclusion: It is recommended that further studies on Metformin as a radioprotective agent in prostate cancer patients who are candidates for radiotherapy be carried out. This research project was registered in the clinical trial center (IRCT: IRCT20211213053377N1).

One Public Health Crisis into Many Others: The Impact of COVID-19 on Upstaging of Gastric Cancer

Amirmohsen Jalaeefar — 2024-11-24

Background: This study aimed to investigate how COVID-19 affects patients with Gastric Cancer (GC) and what should be expected to happen in post-CVOID-19 era.

Methods: A retrospective study of GC patients referring to Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences in two parallel time periods of February 25^th to December 25^thof 2020 and the same period in 2019 was conducted.

Results: Twenty-six patients during COVID-19 pandemic and 54 patients during pre-COVID-19 time were recruited. Mean age, gender, tumor location and T status distribution did not show statistically significant difference between study groups (all p-values >0.05). Regarding N status, distributions of N0, N1, N2 and N3 in pre-COVID group were as follows: 2(3%), 21(39%), 25(48%) and 6(10%). In COVID-19 period, group N0 was not reported and N1, N2 and N3 were 7(27%), 7(27%) and 13(46%), respectively (p-value <0.05). Among pre-COVID patients, 6(11%) patients had gross metastasis in Staging Laparoscopy (SL) and 10(18.5%) patients had positive malignant cytology. In COVID-19 group positive SL and positive cytology were found in 9(35%) and 11(42%) patients, respectively (all p-values <0.05).

Conclusion: Health care systems should adopt reasonable approaches to cancer management, otherwise we might face the upcoming pandemic of locally advanced and metastatic cancers.

HTLV1 Infection in Patients with Common Endogenous Dermatitis

Pouran Layegh — 2024-11-24

Background: Human T-cell Lymphotropic Virus type I (HTLV1) infection has been reported in patients with a variety of skin lesions in some parts of the world, especially in endemic areas. Infective Dermatitis associated with HTLV-1 (IDH) is the prototypic dermatologic manifestation of infection. However, to the best of our knowledge, it has not been reported in Iran as an endemic area yet. It is aimed to investigate the prevalence of HTLV1 infection among patients with common endogenous dermatitis.

Methods: During a cross-sectional study, blood samples of 100 patients with both clinical and pathological diagnoses of common endogenous dermatitis including atopic, seborrheic, and nummular dermatitis who were referred to the Dermatology Clinic of Ghaem and Imam Reza Hospitals, Mashhad, Iran were obtained and evaluated for the presence of anti –HTLV-1 antibody using the ELISA method. The Polymerase Chain Reaction (PCR) for HTLV-1 was conducted in cases where the anti-HTLV1 antibody was positive. Statistical analysis was performed using SPSS version 16, Chicago, IL, USA.

Results: Among 100 samples, two cases including erythrodermic dermatitis and atopic dermatitis were positive according to the ELISA method (2.0%). The dermatitis in HTLV1-positive patients was erythematous, scaly, with a generalized distribution and a recurrent nature, but did not complete the Infective Dermatitis (ID) criterion.

Conclusion: In Iran as an endemic area, HTLV1-associated dermatitis may be present as recurrent generalized erythematous and scaly rash instead of known typical features of infective dermatitis.

Investigating Complaints Filed against the Medical Staff in Kerman Healthcare Organization before and after the COVID-19 Epidemic during 2018-19

Mohammad amin Ahmadinejad — 2024-11-24

Background: Patients’ complaints against hospital staff reflect dissatisfaction with care and service, indicating gaps in the healthcare delivery system. This study investigates the causes of complaints against medical staff referred to the Kerman healthcare organization before and after the COVID-19 epidemic.

Methods: This cross-sectional study examined claims filed against medical staff during two years—2018 (before COVID-19) and 2019 (after COVID-19). The data, collected from 154 forensic medical cases (120 in 2018, 34 in 2019), included the year of complaint, complaint outcome, reasons, and defendant’s education level.

Results: Indictments were issued for 31.2% (48 cases), prohibition of prosecution for 63.6% (98 cases), and suspension of prosecution for 8.2% (8 cases). Complaints due to complications were 61% (94 cases), mostly before COVID-19 (74 cases). Complaints due to patient death increased post-COVID-19 (8.4%, 13 cases). After the epidemic, most complaints were against physicians (70.5%) and dentists (20.6%) (p=0.001). Before COVID-19, complaints were highest among gynecologists and obstetricians (18.3%), surgical specialists (14.2%), and general practitioners (9.2%). Post-COVID-19, the highest complaints were against surgical specialists (20.6%), dentists (20.6%), and orthopedic specialists (17.6%).

Conclusion: Complaints against medical staff decreased post-COVID-19 compared to the previous year. The highest complaints were against gynecologists and obstetricians, surgical specialists, dentists, and orthopedic specialists. Common causes included death, complications due to lack of skill, and carelessness. Monitoring the performance of specialties with the highest complaints is necessary.

The Outcome and Hospital Discharge Rate after Pediatric in Hospital CPR During Nights and Weekends

Mustafa Ali Mohamed Ahmed — 2024-11-24

Background: Cardiopulmonary Resuscitation (CPR) is considered as the most important skill for physicians. The practice of effective CPR depends on the quality of the CPR training, team work skills and hospital management. Because of complexity and several variables involved, the outcome of CPR may vary in the different times of day and different days of the week.

Methods: This study is a cross sectional and the data were provided from the medical records. All the patients who underwent CPR from July 2021 to Feb 2022 in the Children’s Medical Center Hospital were included. The ward, disease, gender and age, the time of the day and the day of the week in which CPR event happened and the Survival to Discharge from Hospital (SDH), had been registered. We compared The SDH rate of CPRs between different days of the week (working days and weekends) and also different working shifts (morning, afternoon and night) were compared.

Results: The rate of SDH of the patients who underwent CPR was to 21.2%. There wasn’t a significant difference between SDH during working days and weekends and during the morning, afternoon and night shifts.

Conclusion: The SDH rate was lower in the night shifts and during the weekends but the difference wasn’t significant. It is recommended to improve the medical team CPR skills in all shifts specially in the evening and night shifts. Also, an appropriate dissemination of health care staff in working shifts should be done to increase the success rate of CPR procedure.

Dietary Acid Load and Glomerular Filtration Rate in Chronic Kidney Patients: A Study From South West of Iran

Behrooz Ebrahimzadeh koor — 2024-11-24

Background: Kidney diseases are prevalencing rapidly and -nutri tional transition has increased the Dietary Acid Load (DAL) of diet and thus exacerbating the metabolic disorders. The goal of the study was to determine the association the DAL of the diet with certain renal function indices in Chronic Kidney Disease (CKD) patients.

Methods: In this cross-sectional study, 90 CKD patients were recruited. The DAL index, including the Potential Renal Acid Load (PRAL), Net Endogenous Acid Production (NEAP), and Net Acid Excretion (NAE) was calculated using data from a Food Frequency Questionnaire (FFQ) and adjusted for energy variables. Ultimately, their correlation with anthropometric and biochemical indices, such as Glomerular Filtration Rate (GFR) and Creatinine (Cre) was estimated.

Results: Median and Interquartile range (IQR) of DAL for participants was 13.9(8.9-20.9), 47.1(39.3-52.12) and 55.8(50.16-61.9) mEq/day for PRAL, NEAP, and NAE, respectively, with a strong correlation (p<0.001) among them. Age (p<0.05), total daily energy intake (p<0.05), percentage of protein and carbohydrates from energy (p<0.05), and GFR (p<0.05) were significantly higher in the third tertile compared to the T1 group of DAL indexes. However, Blood Urea Nitrogen (BUN) (p<0.05) and Cre (p<0.05) were lower.

After adjustment in the General Linear Model, the Mean difference (MD) of GFR and Cre became nonsignificant. Nevertheless, in the crude model, the MD of GFR and Cre were significant (p<0.05).

Conclusion: By adjusting the effect of confounding variables, DAL indics of CKD patient did not show significant correlation with renal function. Long-term studies involving larger populations and consideration of confounding factors are recommended.

Which is More Accurate? Urologist or STONE Nomogram: An Original Study

Behnam Shakiba — 2024-11-24

Background: Comparing and determining the accuracy of -urolo gists and STONE nomogram prediction about the Percutaneous Nephrolithotomy (PCNL) outcomes in urolithiasis patients.

Methods: This retrospective cohort study was performed on 70 patients who underwent PCNL in Firoozgar Hospital (Tehran, Iran) from March 2019 to April 2020. Two expert urologists, who were not informed about the actual result of the procedure and did not have access to the post-operative data, were asked to predict the success rate of PCNL based on pre-operative imaging. The remaining stone size of less than 4 mm was considered as stone-free in PCNL. On the other hand, the STONE nomogram calculated the stone-free rate, and if the predicted success rate was over 60%, PCNL was considered successful based on the STONE nomogram.

Results: The accuracy of the urologist’s prediction was 76.42%. The STONE nomogram correctly predicted the PCNL result in 59 cases (84.28%). There was a significant correlation between the actual success rate of the PCNL and the nomogram’s prediction (p-value= 1.013×10^-5). There was no significant difference between the surgeons and the nomogram’s prediction (p-value=0.336). The number of stones did not significantly affect the correct prediction of surgical results (p-value<0.05). Upper calyx stones caused a significant difference between correct prediction of surgical results by surgeons and nomograms (p-value<0.05).

Conclusion: No significant difference was found between surgeons’ prediction and STONE nomogram, but only in patients with kidney stones in the upper calyx; the nomogram’s prediction accuracy was higher.

Morphologic Evaluation of Lingual Concavity in Posterior Region of Mandible: A Cone Beam Computerized Tomography Study

Abdolaziz Haghnegahdar — 2024-11-24

Background: The present study aimed to assess the frequency, Lingual Concavity Angle (LCA) and the different types of lingual concavity in the posterior mandible.

Methods: In this study Cone Beam Computerized Tomography (CBCT) images of 670 mandibular bodies in the molar areas were evaluated. Cross-sectional images of the mandible were reconstructed at furcation points of first molar area. The LCA was measured. The subjects with LCA smaller than 85° were considered as concave. Then, the concave subjects were classified into three groups: angle less than 40°, angle between 40-60°, and angle between 60-85° were designated as extremely deep, deep, and mild deep, respectively.

Results: The most common type of lingual concavity was mild deep, followed by deep, and extremely deep. There was a significant positive correlation between the LCA and the age of participants (p<0.001). There was also significant relationship between the age of participants and the type of lingual concavity (p<0.001). The subjects in mild deep group were significantly older than deep group (p=0.032). Also, the non-concave subjects were significantly older than deep and mild deep subjects. (p=0.001 and 0.040, respectively). The LCA was significantly higher in males than females (p=0.020). The LCA was significantly larger on the left side (p<0.001).

Conclusion: The presence of deep lingual concavity was common (95%.). Also, mandibular lingual concavity types were found to vary by age, and laterality. Moreover, the LCA was significantly different according to patient age, sex, and laterality.

Determinants of Maternity Care Across Continuum of Care Among Women Aged 15-49 Years in Pakistan: A Stratified Comparative Cross-sectional Study

Omid Dadras — 2024-11-24

Background: While numerous studies have explored sociodemo- graphic disparities in accessing maternity care in Pakistan, there remains a paucity of knowledge regarding the continuum of maternity care and the unequal access between urban and rural areas in the country. Thus, this study aimed to bridge this gap.

Methods: We performed a secondary analysis using data from the Pakistan Demographic Health Survey (2017-18), stratifying by urban and rural residents. Poisson regression was employed to discern the sociodemographic factors associated with three crucial aspects of maternity care: adequate antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC), as well as the completion of the continuum of care (CoC). Additionally, path analysis estimated the relationship between adequate ANC, SBA, and PNC along the pathway of ongoing maternity care.

Results: The results indicated higher education, wealth, living in ICT region, mobile phone ownership, internet use, TV viewership, and newspaper reading increased the likelihood of receiving ANC, SBA, PNC, and completing CoC. Conversely, higher parity, living in Baluchistan/FATA regions decreased the likelihood of receiving ANC, SBA, PNC, and completing CoC. Adequate ANC increased the likelihood of SBA, PNC, and completing CoC. However, SBA did not impact PNC along the care pathway.

Conclusion: Regardless of place of residence, higher levels of education and wealth, as well as access to mass media, were found to be the most significant determinants of receiving adequate ANC, SBA, PNC, and completing CoC and should be prioritized in future policy making in Pakistan to enhance the maternal and child health.

Diagnosis of Cowden Syndrome as an Example of Dentist-Physician Communication: Report of a Case

Maryam Baharvand — 2024-11-24

Background: The mouth is the mirror of the body and can manifest signs of underlying health issues. The oral soft and hard tissues are physically linked to the rest of the body. Therefore, the role of dentists is much greater than the dental setup. Many physicians consider dentistry as a purely practical occupation and not scientific. In recent years, the relationship between oral and systemic disease has become a leading research issue. Interventional studies focused on the relationship between dental treatment and its effect on certain systemic condition. In this regard, the aim of this study is to introduce a case of Cowden Syndrome (CS) which was first diagnosed according to their oral manifestations by a dentist.

Case report: A 37-year-old woman was referred to the Department of Oral Medicine, Shahid Beheshti University of Medical Sciences complaining of aesthetic problems. Intra-oral examinations showed grooves and papillomatosis. Examination of the oral cavity showed a high- arched palate, hypoplasia of the maxilla and jaw. According to the patient’s oral presentation, we asked for a consultation with gastroenterologist, gynecologist and endocrinologist. Finally, based on clinical and paraclinical findings, the clinicians put the final diagnosis of CS.

Discussion: According to the review of literature, less than 500 cases have been reported worldwide, many of which have been diagnosed by dental surgeons, or oral pathology and medicine specialists by recognition of mucocutaneous lesions. There is a close association of CS with the development of several malignant neoplasms. This point emphasizes the importance of the early recognition of these lesions, which facilitates an early diagnosis of CS. Oral lesions can be the first sign of the disease, because they develop in 90 to 99% of cases. The diagnosis of CS in this case was made based on criteria proposed by the International Cowden Syndrome Consortium.

Conclusion: Since the patients can have a variety of clinical manifestations, the diagnosis can be mistaken and delayed. Therefore, it seems that there is a need for awareness of this entity in the dental community.

Echocardiography Findings Among Hospitalized Psychiatric Patients in Iran

Shiva Soraya — 2024-11-24

The Article Abstract is not available.