Journal of Iranian Medical Council

What Do Faculty Do?

Shahin Akhondzadeh — 2025-01-27

The Article Abstract is not available.

Studies on Artificial Intelligence (AI) Techniques for Diabetes Diagnosis Using Facial Features

Mohammad Bagher Owlia — 2025-01-27

Diabetes Mellitus (DM) stands as one of the most widespread non-infectious diseases globally. Although diagnosis of diabetes is possible with the fasting plasma glucose test after 12-hour fast, once diabetes is diagnosed, it cannot be reversed. Therefore, it is crucial to identify early indicators for predicting diabetes.

Presently, DM can be discerned through various methods involving the analysis of human facial features. One method for facial recognition in diabetes relies on experimental evidence, with its accuracy contingent on the skill and expertise of the physician.

Another approach involves diagnosis based on facial morphological features. These morphological changes may be attributed to oxidative stress, damage of blood vessels and collagen, edema and craniofacial abnormalities stemming from hyperglycemia. While cephalometric analysis remains the gold standard for diagnosing skeletal craniofacial morphology, it is a costly and technique-sensitive procedure.

Facial recognition based on Artificial Intelligence (AI) has proven to be a valuable tool in the diagnosis and screening of diabetes. Its combination of simplicity, accuracy, and cost-effectiveness makes it a promising addition to the healthcare landscape, ultimately contributing to advancements in pre-clinical diagnosis and leading to enhanced patient outcomes.

Given the rapid global increase in diabetes, the importance of early detection of diabetes and the limited information about the role of facial recognition in this regard, this study assesses diabetes through facial features using AI approaches.

Monitoring Primary Health Care Experience: Validity and Reliability of a Patient-Centered Measure for Services Quality

Hojatolah Gharaee — 2025-01-27

Background: Due to the limited number of valid and reliable tools available to measure the opinions of service recipients regarding the quality of Primary Health Care (PHC), the aim of this study was to develop and validate a patient-centered questionnaire to measure the quality of PHC services.

Methods: The initial questionnaire was designed through literature review, and then, nine Focus Group Discussion (FGDs) sessions with 102 participants were held. To determine the content validity of the questionnaire, two qualitative (experts’ opinions and suggestions) and quantitative (CVR & CVI) methods were used. A total of 26 experts and 650 Service Recipients (SRs) participated in the validation process of the questionnaire. To measure reliability, test-retest methods and internal consistency were utilized.

Results: A total of 46 items in five dimensions were recognized as necessary, relevant and understandable by the experts. Content validity was confirmed by experts. According to the experts, the optimal model was explained in the form of five factors: “patient-centeredness”, “continuity of care”, “quality of facilities and basic amenities”, “access and availability” and “trust”. The fit of the extracted model was confirmed by confirmatory factor analysis at the desired level. The internal consistency of the constructs and all sub-constructs of the questionnaire was favorable (Cronbach’s alpha=0.942 and ICC=0.868). Also, the results of the test-retest in all constructs and all sub-constructs confirmed the reliability of the questionnaire.

Conclusion: In this study, a valid and reliable questionnaire was developed to measure the quality of PHC services from the perspective of service recipients. This measure could be applied for better management of PHC centers and improving the quality of services.

Patient-Centeredness of Hidden Curriculum in Medical Education

Lida Jarahi — 2025-01-27

Background: A significant gap exists between patient-centered health policies and medical graduates’ practice. Medical education is not restricted to the formal curriculum. The hidden curriculum has a powerful effect on students’ learning and behavior. This study measured the patient-centeredness of the hidden curriculum in Mashhad Medical School.

Methods: The participants were medical students at Mashhad Medical School who were about to graduate. The sample size was determined 100 students based on the Morgan table and selected in a convenient method. The validated Persian version of the Haidet instrument with three content areas of “role modeling, student’s experiences and support for students’ patient-centered actions” was used to evaluate the patient-centeredness of the hidden curriculum. Descriptive indexes and Independent samples T-Test were used for analysis.

Results: The mean±SD score of patient-centeredness of the hidden curriculum was 54.9±9.4, slightly more than half of the total questionnaire score. The area of "support for students' patient-centered actions" received a higher mean±SD score (62.1±16.5) compared to role modeling (53.9±12.3) and student experiences (53.6±9.4). Additionally, medical students emphasized the professor's role in acquiring patient-centered care.

Conclusion: Despite the formal education for patient-centeredness, students learn mainly from the practical environment and their educators’ behaviors. There was a relative dissonance between the formal and implicit curriculum regarding patient-centeredness associated with the medical student. The medical students’ experiences regarding patient-centered manners and giving encouraging feedback are two chief points for improving patient-centeredness.

The Association between Planetary Health Diet Index with the Odds of Breast Cancer: A Case-Control Study

Fateme Souni — 2025-01-30

Background: Breast cancer is the most common cancer among women worldwide. Diet is recognized as an important factor in the prevention of cancer. No research has evaluated the association between the Planetary Health Diet Index (PHDI) and breast cancer risk in the Iranian population. Therefore, the association between PHDI and breast cancer odds in Iranian women was examined in this study.

Methods: The present case-control study (n=134 cases, n=267 controls) was conducted in two hospitals in Tehran, Iran. Women aged 30 or older diagnosed with breast cancer through biopsy were included. In the current study, the participants’ food consumption was assessed using a food frequency questionnaire, a reliable and valid tool.

Results: A lower odds of breast cancer was observed in the last tertile of the PHDI compared to the first tertile in both crude and adjusted models [adjusted model: Odds Ratio (OR)=0.54; 95% Confidence Interval (CI): 0.31-0.95]. In the subgroup analysis, based on the menopausal status, in the fully adjusted model, lower odds of breast cancer were found in the last tertiles of PHDI compared to the first tertile in the post-menopausal group (OR=0.38; 95% CI: 0.17-0.84).

Conclusion: The findings suggest an inverse association between higher PHDI scores and breast cancer risk. An inverse association between PHDI and breast cancer risk was also evident, particularly among post-menopausal women.

Economic Burden of COVID-19 in West Azerbaijan, Iran: A Societal Perspective

Soheila Norouzi — 2025-01-30

Background: The COVID-19 pandemic has resulted in massive loss of life and an unprecedented economic crisis, with far-reaching social impacts. This study aimed to estimate the economic burden of Coronavirus from a societal perspective in Iran.

Methods: This cross-sectional study was conducted between March 20, 2020 to March 19, 2021. To calculate the direct cost associated with COVID-19, a bottom-up approach was used with a record of 264 on the prevalence-based method and using the human capital approach. All the costs hospitalized patients. Indirect costs related to COVID-19 patients were estimated based were reported as US Dollars, using the exchange rate ($US 1=172,430 Rials) in 2020 and a 3% discount rate.

Results: From March 20, 2020 to March 19, 2021, this study included 467,883 patients with COVID-19 and 5,806 deaths in West Azerbaijan. Due to the economic burden, COVID-19 was approximately estimated at $647.37 million ($1,384 per patient), of which $425.32 million was caused by lost productivity and $222.05 million by direct costs. The results show that the mean cost of direct medical services was $1415 in the ICU ward and $426 in the general ward.

Conclusion: The findings of this study underscore the substantial economic impact of the COVID-19 pandemic, particularly in developing countries. Notably, the economic burden primarily arises from indirect costs, such as lost productivity due to premature mortality and morbidity. This investigation revealed that medicine and consumables account for 50% of the direct medical costs associated with COVID-19.

Investigating the Relationship Between Orthodontic Index and Body Dysmorphic Disorder in Females under Orthodontic Treatments: A Case-Control Study

Ali Talaei — 2025-01-30

Background: The demand for orthodontic treatment to correct malocclusion has increased worldwide. A main cause of applying for orthodontics treatment may arise from mental disorders, such as Body Dysmorphic Disorder (BDD). This study aimed to investigate the relationship between BDD, the real need for orthodontic treatment based on the ICON index, and inquiry about orthodontics treatment in women.

Methods: In a case-control study, 414 women from the public outpatient dental clinic of Mashhad University of Medical Sciences, completed a demographic questionnaire, Beck Depression Inventory (BDI II), Beck Anxiety Inventory (BAI), and Yale-Brown Obsessive-Compulsive Scale Modified for BDD (BDD-YBOCS). A specialist also determined the ICON index for each participant.

Results: Among 414 subjects, 52 patients (31 in the orthodontics and 21 in the control group) (p=0.182) had a BDD-YBOCS score of 20 or above. The frequency of BDD, based on a definite diagnosis by an interview with a psychiatric specialist, was 6.28% among the orthodontic patients, which was significantly more than that of other dental patients (p<0.05). The mean ICON index score was found to have a significant difference between the orthodontic patients and the controls (p<0.001). No correlation was found between the severity of ICON and BDD-YBOCS scores in all the participants (p=0.804), in the cases (p=0.655), or the controls (p=0.403).

Conclusion: The current study found no correlation between ICON and BDD score. However, a significantly higher rate of BDD subjects receiving orthodontic procedures suggests using the BDD-YBOCS survey in dental clinics to screen patients suspected of having BDD for further psychological management.

Association between Serum Bilirubin Levels and Acute Exacerbation in Patients with Chronic Obstructive Pulmonary Disease

Maryam Najafpour — 2025-01-30

Background: The literature on the potential protective role of serum bilirubin levels in the development of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) has produced conflicting findings. This study aimed to investigate the potential relationship between serum total and direct bilirubin levels and the risk of acute exacerbation in COPD.

Methods: Over a period of 18 months, a total of 99 patients were recruited from two major hospitals in Mashhad, Iran, comprising 49 individuals with stable COPD and 50 with AECOPD. After obtaining informed consent and conducting a comprehensive medical history and physical examination, both groups underwent an assessment of various laboratory indices, such as total and direct bilirubin levels. Appropriate statistical analysis was applied to assess the potential associations between bilirubin concentrations and the risk of AECOPD.

Results: The study population had a mean age of 64.97±10.12 years, and there was no significant difference in gender distribution (p=0.546). The majority of subjects (55.6%) were male. The serum levels of AST and ALT were significantly higher in the AECOPD group (p<0.001). Additionally, although there were no significant differences in total bilirubin levels between the two groups (p=0.323), there was a significantly higher level of direct bilirubin in the AECOP group (p<0.001).

Conclusion: Serum direct bilirubin levels were higher in COPD patients with acute exacerbation. It may be an independent biomarker for screening the COPD patients with and without acute exacerbation. Further studies are required to validate the findings.

Predictors of Unfavorable Treatment Outcome Among Multidrug-Resistant Tuberculosis Enrollees in Osun State, Nigeria

Sunday Olakunle Olarewaju — 2025-01-30

Background: Multidrug-Resistant Tuberculosis (MDR-TB) poses a significant challenge to Nigeria’s efforts in tuberculosis prevention and control, as well as the achievement of Sustainable Development Goal 3 (Good health and well-being). Identifying the predictors of successful MDR-TB treatment outcomes is crucial for guiding health policy implementation and containing the spread of the disease. This study aims to identify the predictors of unfavorable treatment outcomes among patients with multidrug-resistant tuberculosis in Osun State, Nigeria.

Methods: This was a retrospective study that included 181 TB patients from all chest clinics in Osun state’s 30 LGAs. Data were collected using a proforma, and analysis was conducted using SPSS version 26. Univariate and bivariate analyses were performed, with the chi-square test used to determine the associations between the categorical variables. The significance level was set at 0.05.

Results: Clinically, majority of the patients had pulmonary MDR-TB (181, 100.0%), were newly diagnosed with DRTB (Drug-resistant TB) (75, 41.4%), and were underweight (89, 49.2%). Regarding the laboratory profiles, nearly all the patients (92.8%) were anemic. More than four-fifths of respondents (156, 86.2%) experienced favorable treatment outcomes (cured or treatment completed), while 25 (13.8%) had unfavorable treatment outcomes. Associations were observed between drug intake (second-line drugs) and treatment outcome (p=0.001, X2=10.53), as well as hemoglobin status (p=0.045, X2=2.245).

Conclusion: Successful treatment was found to be influenced by drug adherence and hemoglobin status. Therefore, there is a need to enhance adherence counseling and ensure early commencement of treatment among patients with MDR-TB.

The Effectiveness of Volleyball Exercises on Cognitive Function and Daily Living Skills in Patients with Schizophrenia: A Randomized Clinical Trial

Maryam Khazaei Poul — 2025-01-30

Background: This study aimed to investigate the effectiveness of volleyball exercises on executive function and daily living skills in schizophrenia.

Methods: In this randomized study, 28 individuals with schizophrenia participated. The intervention was volleyball exercises for two months. The Functional Independence Measure, The Lawton instrumental activities of daily living scale‏, and Loewenstein Occupational Therapy Cognitive Assessment battery tests were used in this study. Repeated measures and effect size were utilized for analysis.

Results: Volleyball exercises improve cognitive function and Activities of Daily Living (ADLs) in the intervention group in the following: group effect, time effect, and group and time interaction. They were significant respectively (p-value¹=0.041, p-value²=0.001, p-value³=0.001, Cohen’s d=1.267,1.266), (p-value¹=0.001, p-value²=0.001, p-value³= 0.001, Cohen’s d=3.967,3.749). With this intervention, no significant difference was observed between the control and intervention groups in instrumental activities of daily Living.

Conclusion: Volleyball exercises improve executive function and ADLs in individuals with schizophrenia.

Comparative Risk of Gastrointestinal Major Bleeding with Rivaroxaban and Warfarin

Sahar Ravanshad — 2025-01-30

Background: Warfarin has been the primary anticoagulant medication for a long period. However, its efficacy presents clinical challenges, particularly due to the increased risk of bleeding. The introduction of NOACs, such as rivaroxaban, has revolutionized anticoagulation therapy. Nevertheless, evidence regarding their potential side effects has been conflicting. This study aimed to compare the incidence of major bleeding between rivaroxaban and warfarin.

Methods: This cohort study was conducted at Ghaem Hospital’s emergency department, involving patients admitted between December 2019 and September 2021 for any reasons. To qualify, the participants were required to have a recorded history of taking warfarin or rivaroxaban for at least one year. The data on major bleeding incidents within the first year of medication usage were collected and then the outcomes were compared between rivaroxaban and warfarin users.

Results: A cohort of 402 patients were enrolled in this study, with 203 patients on warfarin and 199 on rivaroxaban. During a one-year follow-up, there were four cases of bleeding in the rivaroxaban group and six in the warfarin group. Upper gastrointestinal bleeding occurred in four patients taking warfarin and one patient taking rivaroxaban, while lower gastrointestinal bleeding was reported in two warfarin users and three rivaroxaban users. Despite these differences, they were not statistically significant (p=0.370), and no patient experienced cerebral hemorrhage.

Conclusion: Recommending rivaroxaban might help lower complications and offer a safer treatment option for patients with a history of atrial fibrillation, pulmonary embolism, deep vein thrombosis, or ischemic cerebrovascular accident.

Prevalence of Biopsy-Proven Clinically Significant Prostate Cancer in Patients with PI-RADS 3 on MRI and Factors Associated with It

Farhood Khaleghimehr — 2025-01-30

Background: To assess prevalence of prostate cancer and clinically significant prostate cancer in patients with PI-RADS 3 on bpMRI and factors associated with them.

Methods: Patients suspicious for prostate cancer following serum Prostate Specific Antigen (PSA) screening, who had PI-RADS 3 on bpMRI, were included. All patients underwent systemic plus MRI targeted biopsy of prostate. Gleason score 3+3 was considered positive for prostate cancer but clinically non-significant one. Higher scores were pertained to as clinically significant prostate cancer. The relationship between patient age, PSA level, PSA density, number of core biopsies, and number of PI-RADS 3 lesions on bpMRI with presence of prostate cancer per se and presence of clinically significant prostate cancer in our patients is assessed.

Results: 244 patients were enrolled. 101 patients had prostate cancer (41.4%). Out of these 101 patients, 34 (13.9% of total) had clinically significant prostate cancer. Among different factors, only PSA density was associated with both prostate cancer (OR=1.05, p=0.001) and clinically significant prostate cancer (OR=1.03, p=0.001). According to receiver operating characteristic curve analysis, best cut off value of PSA density which has highest association with clinically significant prostate cancer in PI-RADS 3 patients would be 0.36; with a sensitivity of 0.38 and specificity of 0.93.

Conclusion: Considering PSA density with threshold of 0.36 for performing biopsy in patients with PI-RADS 3 on bpMRI might lower the rate of unnecessary biopsies.

The Optimism Effect: How Core Self-Evaluation Shapes Well-Being in Punjab’s Nursing Students

Mohammad Saleem — 2025-01-30

Background: The current study investigates the intricate relationship between dispositional optimism, core self-evaluation, and mental well-being among nursing students. The present research aims to understand the mediating role of core self-evaluation on nursing students’ well-being and dispositional optimism.

Methods: The present study was cross-sectional in nature and included a purposively selected sample of 286 (112 females, 172 males) nursing students from Punjab (India). Students completed a measure of a short version of the Warwick–Edinburgh Mental Well-being Scale, The Revised Life Orientation Test (LOT-R), and the Core Self-evaluations Scale. The collected data was analyzed using correlational and multiple regression analysis. Moreover, the mediational analysis was analyzed using the Hayes PROCESS macro.

Results: The results indicated that core self-evaluation (β=0.606, p<0.01) and dispositional optimism (β=0.394, p<0.01) are significant predictors of nursing students’ mental well-being. Mediation analysis showed that core self-evaluation completely mediated the relationship between dispositional optimism and mental well-being. Furthermore, it was found that the measures of t-value of dispositional optimism (t=-1.536), and mental well-being (t=-1.594) were non-significant at the 0.05 level, while significant differences were found in core self-evaluation (t=-2.223).

Conclusion: The results of the present study demonstrated the predictive role of dispositional optimism and core self-evaluation in the mental well-being of nursing students. Moreover, the current study highlighted the underlying mechanism through which dispositional optimism influences nursing students’ mental well-being.

Comparative Opinion of Dental Clinicians and Patients Regarding Dental Appearance and the Need for Cosmetic Dental Procedures

Narges Panahandeh — 2025-01-30

Background: This study compared the opinion of dental clinicians and patients regarding dental appearance and the need for cosmetic dental procedures. This information can serve as a basis for efficient treatment planning.

Methods: This cross-sectional study was conducted on 200 dental patients, 5 general dentists, and 5 restorative dentists. A standardized questionnaire with 17 questions was used to collect information regarding the opinion of patients about the appearance of their anterior teeth and the need for cosmetic dental procedures. Tooth shade, overjet, and overbite were also recorded, and three photographs were obtained from their teeth and assessed by dental clinicians. Data were analyzed by the Spearman, independent t, Mann-Whitney, and Bonferroni tests and ANOVA (alpha=0.05).

Results: Of 100 male and 100 female patients participating in this study, 73% were satisfied with the appearance of their teeth, which was higher than the satisfaction rate reported by general dentists (65%) and restorative dentists (48%). The difference in opinion was not significant between the patients and general dentists (p=0.325). The satisfaction level of the restorative dentists was significantly lower than the patients (p<0.001) and general dentists (p<0.001). The patients were mostly dissatisfied with the color of their teeth (60%), and 88.5% were interested in cosmetic procedures (mostly bleaching). The opinion of the three groups was not significantly different regarding the need for cosmetic procedures (p=0.414).

Conclusion: Restorative dentists had a significantly lower satisfaction with dental appearance of the patients, compared with general dentists and patients themselves. However, the opinion of the three groups was not significantly different regarding the need for cosmetic procedures.

Association between Serum Vitamin D Levels and Diabetic Retinopathy: A Cross-Sectional Study

Faeze Poshtchaman — 2025-01-30

Background: Diabetic retinopathy is a common vascular complication of diabetes. Vitamin D has been found to play a role in the development and progression of diabetic retinopathy. The aim of this study is to investigate the relationship between vitamin D levels and proliferative and non-proliferative retinopathy in diabetic patients.

Methods: The present study is a cross-sectional analytical study. This study was conducted at Hafiz Sabzevar Diabetes Clinic and involved diabetic patients. A total of 80 diabetic patients were categorized into three groups: patients without retinopathy, patients with proliferative diabetic retinopathy, and patients with non-proliferative retinopathy. Patients’ information was collected through a demographic questionnaire and a researcher-made checklist. The data were analyzed using SPSS 28, with descriptive statistical tests, Chi-square, ANOVA, and Bonferroni’s post hoc test.

Results: The results of the study showed a significant difference in vitamin D and creatinine levels among the three groups (p<0.001). The post hoc test was used to accurately determine this significant difference. The data revealed that both retinopathy groups had lower levels of vitamin D and higher creatinine compared to the non-retinopathy group, and this difference was statistically significant (p<0.001). However, there was no significant difference between the groups in terms of HDL (p=0.23), LDL (p=0.52), and total cholesterol (p=0.95).

Conclusion: Vitamin D deficiency increases the risk of developing diabetic retinopathy, both proliferative and non-proliferative. Therefore, it is recommended to consider taking vitamin D supplements in diabetic patients to maintain normal vitamin D levels, since it has positive effects in preventing the occurrence of diabetic retinopathy

The Role of Cultural Capital in Food Choice Patterns: The Mediatory Role of Educational Inequalities

Elaheh Foroumandi — 2025-01-30

Background: Cultural capital can interestingly mediate what a person prefers to eat and, thus, may be effective in dietary choice. The objectives of this study were to compare the distribution of cultural capital components within the different educational levels and also compare food consumption patterns across the different educational levels; and examine cultural capital’s role in the educational inequalities in food consumption among healthy women.

Methods: The data was obtained in the form of a cross-sectional design with face-to-face interviews with 527 women who had visited shopping centers and parks in Tabriz from September to November 2021, using convenient sampling. Food recall as well as cultural capital questionnaire were completed for the participants, and anthropometric indices were measured. The level of education of the participants was considered as an indicator of socio-economic status.

Results: Family institutionalized cultural capital, objectivized cultural capital, and most of the incorporated cultural capital’s indicators were significantly differed by educational inequalities. Daily frequency scores of unhealthy food consumption in the participants with primary education was higher than other educational groups (p<0.001). The high-educated individuals’ intakes healthier foods were compared to unhealthy foods, and participants with low total cultural capital score were in adherence of a low overall healthy food consumption (PR: 1.49, 95%CI: 1.23-1.68).

Conclusion: Education levels are significantly associated with cultural capital, and participants with high levels of cultural capital choose healthier foods more often than participants with low cultural capital.

Inflammatory Features of Low Back Pain with Modic Changes on MRI

Sina Owlia — 2025-01-30

Background: Recent evidence suggests a potential association between Modic Changes (MC) and inflammation in nonspecific low back pain patients. Inflammation, characterized by the activation of immune cells and the release of pro-inflammatory molecules, is known to play. This research aims to investigate the clinical and laboratory features suggestive of inflammation in patients with MC on lumbar MRI.

Methods: A retrospective analysis was conducted on 169 patients with MC identified on lumbar Magnetic Resonance Imaging (MRI). Laboratory investigations were also obtained, including Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) levels. The MC were categorized based on their MRI signal patterns. The presence of inflammatory markers and their association with clinical features was assessed using appropriate statistical methods.

Results: The majority of patients exhibited type 2 MC (n=139, 82.4%), followed by type 1 MC (n=28, 16.5%) and type 3 MC (n=2, 1.1%). Among the clinical features, patients with type 1 MC had a significantly higher prevalence of nocturnal low back pain (OR=6.76 [95%CI: 2.25-20.24], p<0.001) and morning low back stiffness (OR= 4.27 [95%CI: 1.42-12.85], p=0.006). Additionally, patients with type 1 MC were more likely to have elevated CRP levels (OR=2.61 [95%CI: 1.18-5.78]).

Conclusion: Although the majority of patients had type 2 MC (82.4%), type 1 MC was strongly associated with higher CRP levels, morning stiffness, and nocturnal pain. These associations suggest that type 1 MC may represent a more inflammatory and clinically severe form of the condition, emphasizing the importance of recognizing it in clinical practice.

Investigating and Comparing the Relationship between the SYNTAX Score and Short-Term and Long-Term Consequences of Patients with STEMI under Thrombolytic Treatment and then Angiography in the Years 2018-2020

Saeid Jodi — 2025-01-30

Background: The SYNTAX score is a strong predictor of adverse cardiovascular events such as cardiac death, myocardial infarction, and lesions with revascularization. This rating was also confirmed for patients with left ventricular problems and all the patients referred for percutaneous coronary interventions Percutaneous Coronary Interventions (PCI).

Methods: This study was conducted on 107 patients with ST-Elevation Myocardial Infarction (STEMI) who underwent thrombolytic treatment and then angiography. SYNTAX score was calculated in all the patients. Finally, the short-term and long-term prognoses were examined. Finally, the STR values were compared in two groups of people with high syntax and low syntax.

Results: Eighteen patients (16.8%) suffered Congestive Heart Failure (CHF), one (0.9%) experienced GI bleeding, and one (0.9%) suffered ReMI. The patients’ mean±standard deviation, maximum, and minimum SYNTAX scores were 12.82±7.19, 35, and 3, respectively. Twelve patients (11.2%) had SYNTAX scores higher than 22 (high risk), and 95 (88.8%) had scores lower than 22 (low risk).

Conclusion: Results of the present study indicated that patients with SYNTEX scores >22 had STR lower than 50. CHF incidence rate in patients with SYNTAX scores higher than 22 (high risk) was higher. There was also a significant relationship between the patients’ prognosis and SYNTAX scores.

Effects of 810 and 970 nm Diode Laser on Microtensile Bond Strength of Universal Adhesives to Tooth Dentin

Mohsen Rezaee — 2025-01-30

Background: Some previous studies have suggested that laser irradiation improves the bond strength of composite to dentin. This study aimed to assess the effect of 810 and 970 nm diode laser on microtensile Bond Strength (µTBS) of universal adhesives to dentin.

Methods: In this in vitro, experimental study, the occlusal third of 54 extracted third molars was cut, and they were randomly divided into 9 groups (n=18). In groups 1-3, Tetric N-Bond Universal (TNB), G-Premio Bond (GPB), and Single Bond Universal (SBU) adhesives were applied, respectively and the teeth were built-up by applying three 1-mm thick composite increments. The same was performed for groups 4-6 and 7-9 with the difference that they underwent 810 and 970 nm diode laser irradiation (0.8 W, 20 s), respectively, prior to light curing. All the teeth were then sectioned into 1×1 mm blocks and their µTBS was measured. Data were analyzed by two-way ANOVA and Tukey test.

Results: The interaction effect of type of bonding agent and laser irradiation on µTBS was not significant (p=0.79). There was a statistical difference between the bond strength of the adhesive systems used (p=0.009).

Conclusion: Laser irradiation of universal adhesives applied by the etch and rinse (E&R) technique using 810 and 970 nm diode laser (0.8 W, 20 s) prior to their polymerization did not increase their µTBS to dentin.

Surgery Cancellation on the Day of Surgery: A Report from an Academic Center in Northern Iran

Mohammad Reza Habibi — 2025-01-30

Background: Cancellations of elective scheduled surgeries on the intended day is a major problem for healthcare organizations with significant negative outcomes for patients and hospitals. This study aimed to investigate the rate and the reasons for day of surgery cancellations at an academic center in the north of Iran.

Methods: This retrospective single center study was conducted at Amir-al-Momenin Hospital, a referral and academic center in Guilan, Iran, during 2018-2022. A detailed review of a total of 187 cases canceled was performed. A responsible medical student filled out a checklist including type of surgery, patients’ age, ASA class and the cause of cancelation.

Results: From 41900 cases, 187 surgeries were canceled representing a cancelation rate of 0.46%. The most common reason for cancellation was “change in the patient’s clinical condition” by 59.1%. The other reasons were ‘patient refusal’ 8%, ‘lack of correct timing for elective surgeries’ 7%, and ‘Technical problems in operating room facilities and equipment and unavailability of surgeon/surgeon’s opinion’ 5.3%. ‘Insufficient paraclinical tests’ and ‘lack of anesthesia pre-operative visits’ 0.5% had the least frequency among the reasons of cancelations.

Conclusion: The rate of day of surgery cancelation was low (0.46%). The majority of causes of cancelations were due to patient-related issues, particularly changes in patients’ clinical condition on the scheduled day of the operation. Process improvements need to be considered continuously to further decrease in cancelation rate.

Complete Embedment of a Stainless-Steel Crown in the Alveolar Soft Tissue: The First Case Report

Hamed Mortazavi — 2025-01-31

Background: Reports of foreign bodies in oral tissues are available in the literature; however, this is the first report of complete embedment of a Stainless-Steel Crown (SSC) in the alveolar soft tissue.

Case Report: Upon radiographic evaluation of a 19-year-old male patient seeking orthodontic treatment with several missing teeth, an SSC of the primary right mandibular second molar entirely encompassed by soft tissue was observed. The patient had no pain or discomfort in the region. The overlying mucosa had no sign of inflammation except for a slight pallor, and adjacent teeth had tilted into the space of the corresponding absent tooth. The crown was removed with a crestal incision under the local anesthesia.

Conclusion: Infraocclusion of deciduous teeth, especially those covered with SSCs, should be strictly monitored clinically and radiographically as they can embed in soft tissue, cause severe bone defects, and complicate future treatments.

Spontaneous Extraperitoneal Bladder Wall Rupture Due to Emphysematous Cystitis: A Case Report and Literature Review

Mahdi Ramezani-Binabaj — 2025-01-31

Emphysematous cystitis is a rare condition that can have fatal complications if left untreated. A timely diagnosis and proper treatment are crucial to achieving appropriate outcomes. Patients with this condition should be evaluated, and if necessary, conservative treatment or surgery should be provided. This case report describes a 73-year-old male patient with emphysematous cystitis who underwent conservative treatment for bladder rupture and reviews the existing literature on this topic. The gold standard for diagnosis of EC is a computerized tomographic scan. This condition should be evaluated, and if necessary, conservative treatment or surgery should be provided.

The Forgotten Right of Nurses and Patients in Iran’s Islamic Penal Code

Shahram Molavynejad — 2025-01-31

The Article Abstract is not available.