Journal of Iranian Medical Council (JIMC) is a free access, peer-reviewed and refereed international journal published by Islamic Republic of Iran Medical Council (IRIMC). The main objective of JIMC is to provide an intellectual platform for the international scholars and medical practitioners. JIMC aims to promote interdisciplinary studies which are of interest to medical societies and are within the range of the responsibilities and activities of Islamic Republic of Iran Medical Council (IRIMC). This includes all professional, scientific, legal and ethical topics. All the manuscripts should be submitted through the Journal Primary Website at http://www.jimc.ir/contacts?_action=loginForm
Islamic Republic of Iran Medical Council
The Public Health Impact of Armed Conflict on Mental Health
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The Role of ceRNA Networks in the Development and Progression of Gastric Cancer
MicroRNAs or miRNAs bind to miRNA Response Elements (MREs), a location on target transcripts, causing either transcript destruction or translational inhibition. NcRNAs with MREs can compete with mRNA as a miRNA sponge and are involved in a complex regulatory network that regulates the transcription of mRNAs through miRNAs competitive binding. According to the ceRNA hypothesis, ncRNAs, including lncRNAs, circRNAs, and pseudogenes, contend against mRNAs in binding to miRNAs via miRNAs’ MRE. MicroRNA is the most important part of the ceRNA network and ncRNAs and mRNAs are other components of the ceRNA network. LncRNAs, circRNAs, and pseudogenes have been demonstrated to play a key role in cellular processes like cell proliferation, cell growth, apoptosis, and differentiation. CeRNA networks are involved in many cancers, including liver, breast, lung, and Gastric Cancer (GC). Therefore, the study of the ceRNA network in GC will help to understand how the disease develops and progresses, as well as identify new therapeutic approaches.
The Role of Artificial Intelligence in Palliative Care: A Scoping Review
Palliative care is a holistic, multidisciplinary approach aimed at improving the quality of life for patients with life-limiting illnesses and their families. Despite the global need for these services, many patients—especially in low-income countries—lack adequate access. Artificial Intelligence (AI) has emerged as a promising tool to enhance palliative care delivery by supporting early identification of patient needs, optimizing clinical decision-making, and improving patient outcomes. This scoping review examined the applications of AI in palliative care. A systematic search was conducted in PubMed, Scopus, and Web of Science up to June 2025, ultimately identifying 8 empirical studies that met the inclusion criteria. These studies were carried out across 5 countries and involved diverse patient populations, including advanced cancer, organ failure, dementia, and traumatic brain injury. AI applications were categorized into five main areas: (1) evaluating chatbot responses (e.g., ChatGPT, Gemini, Copilot), which revealed inadequate readability and quality; (2) identifying communication silences in patient-provider conversations using machine learning; (3) supporting clinical documentation and decision-making to reduce clinician workload; (4) analyzing inequalities in access to palliative care through predictive algorithms; and (5) predicting disease progression and patient status using longitudinal symptom data. The findings indicate that AI holds significant potential to improve symptom management, support clinical decisions, and enable data-driven interventions in palliative care. However, several challenges must be addressed for sustainable and effective implementation, including poor readability of AI-generated content, ethical concerns, patient privacy issues, and disparities in access to technology. Future research should focus on broader and more diverse populations, integrate survival prediction models, and carefully consider the ethical, regulatory, and organizational dimensions of AI integration into palliative care practice.
Health Professionals’ Responses to Patient Gift-Giving
Background: Healthcare professionals› acceptance of gifts poses ethical dilemmas, potentially biasing clinical decisions and eroding public trust. The aim of this study is to investigate the prevalence, motivations, and responses to gift-giving among healthcare staff. Methods: An analytical cross-sectional study was conducted at Razi Hospital, Rasht, from January to June 2024. Convenience sampling was used to recruit physicians, nurses, and residents. A valid questionnaire was used to collect data. The validity was ensured through expert panel review and pilot testing, and reliability was confirmed by calculating Cronbach’s alpha which showed acceptable internal consistency. After obtaining informed consent, participants completed questionnaires detailing gift types, timing, motivations, and responses to gift offers. Results: This study involved 97 healthcare workers, with 53.6% being male and an average age of 43.6 years. The majority were nurses (67%). The most common type of gift received was goods (45.6%), usually given before hospitalization (67%). Gifts were refused mainly due to rules against accepting them (42.3%), lack of personal need (5.2%), or fear of potential consequences (6.1%). Among the 45 participants (46.39%) who accepted gifts, 53.3% received cash, 24.4% goods, 17.8% services, and 4.5% influence. Most gift recipients were nurses (71.2%), with the remainder being other medical staff (28.8%), all indicating gratitude as the primary reason for acceptance. Conclusion: Many healthcare staff accept gifts, often cash, driven by patient gratitude. These findings underscore the need for clear policies and ethical training to mitigate conflicts of interest and maintain public trust in healthcare
Servant Leadership in Public Health Services: Examining Influential Factors and Key Drivers
Background: This study examines the relationships between servant leadership and its influence on burnout prevention, employee empowerment, happiness, eudaimonic well-being, and motivation to retain employment among public health service staff. Methods: A cross-sectional survey was conducted from March to June 2024 at the Samarinda City Public Health Office, Indonesia. A total of 188 were selected via stratified random sampling. Data were collected using a validated Likert-scale questionnaire covering five constructs. Spearman’s rank correlation was applied to assess the strength of bivariate associations between servant leadership and each construct, while multiple regression was used to evaluate their unique and combined contributions after controlling for overlap. Results: Correlation analysis showed that all five predictors were positively associated with servant leadership. Spearman’s rho values were 0.381 for burnout prevention, 0.562 for empowerment, 0.642 for happiness, 0.442 for eudaimonic well-being, and 0.296 for motivation to retain employment (all p<0.05). In the regression model (R²=0.550, adjusted R²=0.495, p<0.001), eudaimonic well-being (β=0.408, p=0.001) and motivation to retain employment (β=0.338, p=0.001) were the strongest predictors, followed by burnout prevention (β=0.302, p=0.003), empowerment (β=0.214, p=0.031), and happiness (β=0.189, p=0.042). Conclusion: Servant leadership was positively associated with employee well-being and motivation, indicating its potential to strengthen Indonesia’s public health workforce. Policymakers should consider integrating its principles into training and management to reduce burnout, improve retention, and enhance service quality. Longitudinal studies are needed to confirm causal effects and inform broader implementation.
Old Age Priorities and Needs Related to Men Living with HIV: A Qualitative Study Among Referred Patients to a Big Referral Hospital in Tehran
Background: People living with HIV often live for decades after the detection of the virus, leading to a rise in the number of middle-aged and elderly people living with HIV. In fact, as the lives of HIV positive patients return to normal if they fully adhere to HIV treatment, the issue of care and treatment of other diseases, especially non-communicable diseases, becomes more important. Therefore, a study was conducted with the aim of investigating the old age priorities and needs related to men living with HIV. Methods: This study a qualitative content analysis. Seven male individuals older than 60 years old living with HIV were invited to a Focus Group Discussion session. Data were collected in this study by gathering the opinions of participants regarding questions aligned with the study’s purpose, which the researchers posed. Dialogues were recorded and documented digitally. The data were transferred to the OPEN CODE software for classification and qualitative analysis. Results: Analysis of data revealed health issues participants encountered related to cardiovascular, respiratory, gastrointestinal, musculoskeletal, dermatologic, and psychological health. Nevertheless, participants’ assessments of the impact of HIV on various aspects of their health differed. The remainder of the analysis examined the challenges faced, while managing HIV and other aspects of health simultaneously; these included financial burden, fatigue due to chronic disease, managing medication side effects, time-consuming physician visits, and the frequency of such visits. Conclusion: This study shows that older males living with HIV encounter various physical, mental, and social problems, whereas the quality of patient care delivered by medical staff was not desirable from their point of view.
The Relationship between Pelvic Organ Prolapse Stage and Urinary Incontinence
Background: Pelvic Organ Prolapse (POP) and Urinary Incontinence (UI) are common pelvic floor disorders and significant healthcare concerns that significantly affect womens quality of life. Urinary incontinence is classified into several types: Urgency Urinary Incontinence (UUI), Stress Urinary Incontinence (SUI), and Mixed Urinary Incontinence (MUI), which involves features of both types. Prevalence of UI increases with age, affecting multiple aspects of patients’ lives. Given the frequent coexistence of POP different stages and UI, this study aimed to evaluate their relationship. Method: This study included 99 women with UI, divided into three groups: those with UUI, SUI, and MUI. Demographic information was collected, and clinical assessments included the UDI-6 questionnaire, cough stress test and POP staging using the POP-Q system performed. Statistical analyses were applied to examine correlations by using SPSS version 26. This study analyzed the relationship between UI and POP stage, along with factors such as age, Body Mass Index (BMI), number of pregnancies, delivery history, delivery method, menopausal age. Results: No statistically association was found between type of urinary incontinence and pelvic organ prolapse stage (p<0.05). Also no statistical associations were observed between incontinence type and age, number of deliveries, number of pregnancies, delivery method, BMI, and age at menopause. However, menopausal status was significantly associated with UI type (p=0.009). Subgroup analysis revealed that in women under 50 years and nonmenopausal women, posterior compartment prolapse was significantly correlated with UI type, especially UUI and MUI (p<0.016). Logistic regression analysis did not identify any independent predictors. Conclusion: Overall, POP stage was not associated with UI type. Nonetheless, posterior prolapse was significantly related to UI in younger and nonmenopausal women, highlighting the importance of subgroup-specific evaluation and the need for larger-scale studies
Factors Influencing the Timing of Enteral Nutrition Tolerance in Pediatric Patients Following Open-Heart Surgery: A Retrospective Study in a Referral Center in Iran
Background: Congenital Heart Disease (CHD) is a leading cause of morbidity and mortality in children, with open-heart surgery being a critical intervention. Early initiation of Enteral Nutrition (EN) after surgery is essential for recovery; however, few studies have explored the factors that influence the timing of EN tolerance. This study aimed to identify the factors affecting the timing of EN tolerance in pediatric patients following open-heart surgery. Methods: A retrospective study was conducted on pediatric patients who underwent open-heart surgery at Children’s Medical Center, Tehran, between July 2018 and March 2019. Medical records were reviewed to assess factors such as patient characteristics, duration of mechanical ventilation, sternum status, and the day EN was tolerated. The statistical analysis was performed in SPSS version 24 using Pearson correlation, independent t-test, One-way analysis of variance (ANOVA), and multiple linear regression analysis. The significance level was set at 0.05. Results: The medical records of 109 patients were analyzed. EN was tolerated at an average of 8.67 days post-surgery. Univariate analysis showed significant associations between late EN tolerance and lower weight (p=0.03), longer mechanical ventilation duration (p<0.001), and open sternum status (p=0.02). However, multiple linear regression identified duration of mechanical ventilation as the sole significant predictor of EN tolerance time (p<0.001). Conclusion: The results identified prolonged mechanical ventilation as the primary predictor of late EN tolerance in pediatric cardiac surgery patients. Further studies are needed to validate this finding and to explore additional factors influencing EN tolerance.
Study in Iodine-Deficient Areas: What Factors Influence Motor Development in Children Under Two Years old?
Background: Iodine deficiency areas usually occur in highlands above 600 meters above sea level. Iodine is an essential material for thyroid hormones, which plays a role in metabolic stability and organ function. Iodine deficiency is the main cause of Iodine Deficiency Disorders (IDD), which affect children’s growth and development issues that affect the motor development of children under two years old in iodine-deficient areas. Methods: 46 respondents participated in a cross-sectional study with iodine deficiency in Magelang Regency. In this study, five independent variables were examined: wasting, stunting, underweight, age, mother knowledge, mother’s education, mother’s occupation, gender, and parenting styles. Meanwhile, the dependent variable is motoric development. The author uses a logistic regression test at the final stage. Results: Bivariate analysis showed that gender, underweight, and stunting were significantly related to the motoric development of children under two years old with a p-value <0.05. Multivariate analysis showed that iodine deficiency in under two years old who experienced underweight and stunting, had a significant effect on child motoric development. Conclusion: Stunting, underweight, and gender are factors that affect the motor development of children under two years old in iodine deficient areas. Children under two years old who are underweight have a risk of delayed motoric development of 14,222 times compared to those who are not underweight, and children under two years old who are stunted have a risk of 16,915 times compared to those who are not stunted.
Changes in Lactobacillus and Bifidobacterium Load in a Population of Iranian People with Papillary Thyroid Cancer: The Effect of Radioactive Iodine therapy
Background: To investigate the changes in Lactobacillus and Bifidobacterium load in a population of Iranian people with Papillary Thyroid Carcinoma (PTC) before and following Radioactive Iodine (RAI) therapy. Methods: This longitudinal cohort study included 28 healthy individuals and 30 PTC patients referred for RAI therapy. A total of 90 stool samples from the same 30 patients with PTC were collected one day before RAI therapy, two weeks and two months following RAI therapy. As a control group, 28 stool samples were collected from 28 healthy age-sex matched individuals. Stool microbiotas were detected using 16S rRNA gene sequencing. Results: Lactobacillus load was significantly lower in patients with PTC compared to the healthy individuals before (2.56 vs. 4.47 copies/gr stool, p=0.01) and two weeks after RAI therapy (3.51 vs. 4.47 copies/gr stool, p=0.02). Two months after RAI therapy, there was no significant difference in the load of Lactobacillus between the two groups (5.21 vs. 4.47 copies/gr stool, p=0.69). Moreover, the load of Lactobacillus increased significantly from 2.42 copies/gr stool before RAI therapy to 3.80 copies/gr stool at two weeks, and 5.27 copies/gr stool after two months of RAI therapy (p=0.01). On the other hand, there was no difference in the abundance of Bifidobacterium between the PTC and healthy individuals at different time points. Conclusion: This study indicated the difference in the load of Lactobacillus in PTC patients compared to healthy individuals. Moreover, it highlighted a significant increase in the load of Lactobacillus in PTC patients following RAI therapy. These results highlight the potential for microbiota modulations as an adjuvant therapy in PTC management
Relationship of the Parenting Style with Parental Acceptance of the Behavioral Management Techniques
Background: This study assessed the relationship of the parenting style with parental acceptance of the behavioral management techniques for pediatric dental patients. Methods: This cross-sectional study was conducted on parents of 64 children between 3-6 years at their first dental visit. Parenting style was assessed using the Parenting Styles and Dimensions Questionnaire (PSDQ). Parents then watched a video of behavioral management techniques, and their acceptance of each technique was assessed using a 5-point Likert scale. Data were analyzed with Spearman’s correlation test (alpha=0.05). Results: Of all, 60.9% had authoritative, 23.5% authoritarian, and 15.6% permissive parenting style. Positive reinforcement was the most accepted technique by the parents for cooperative children (75% totally agreed, p=0.01), while general anesthesia was the most accepted technique for non-cooperative children (54.7% totally agreed, p=0.01). Authoritative parenting style showed significant positive correlation with Tell-Show-Do (TSD) (p=0.004) and parent separation (p=0.003), and inverse correlation with general anesthesia (p=0.01) and Nitrous Oxide (N2O) sedation (p=0.003). Authoritarian parenting style correlated positively with voice control (p<0.001), active restraint (p<0.001), passive restraint (p<0.001), and general anesthesia (p=0.03), and inversely with TSD (p=0.001) and parent separation (p<0.001). Permissive parenting style correlated positively with TSD (p=0.002), positive reinforcement (p=0.01), and parent separation (p<0.001), and inversely with voice control (p=0.04), active (p<0.001) and passive restraint (p<0.001). Conclusion: Parenting style significantly affected parental acceptance of behavioral management techniques and should be considered in choosing techniques for pediatric dental patients.
Appendicular Pathologies in Ovarian Mucinous Adenocarcinoma and Borderline Tumor: A Retrospective Analysis
Background: The role of appendectomy in the control of mucinous adenocarcinoma of the ovary has become a controversial issue, and its effectiveness in increasing the 5-year survival rate of patients is not well known. Mucinous carcinoma account for 3-4% of primary ovarian cancer. Nearly all mucinous carcinoma of the ovary presents with early-stage disease stage 1. Therefore, in this study, the aim was to examine simultaneous appendectomy in ovarian mucinous adenocarcinoma surgery and its reported pathologies. Methods: This review is a retrospective study. The participants in this study included patients with mucinous ovarian mass with borderline mucinous pathology (n=101) or mucinous adenocarcinoma (n=69). These patients were selected from among the patients referred to Mahdia and Imam Hossein (AS) Hospitals who underwent surgery for mucinous adenocarcinoma of the ovary between 2017 and 2022. Results: In terms of the pathology of the appendix, the results showed that the percentage of ACA was higher in the borderline mucinous group compared to the other group, however, there was no significant relationship between the two groups (p=0.60). In terms of the appearance of the appendix, the results showed that the nodular, thickened and normal state was more in the borderline mucinous group compared to the other group, which was statistically significant (p=0.04). In terms of disease stage, it was also found that there was no statistically significant relationship between the two groups (p=0.65). Conclusion: It can be said that the appearance of the appendix can play an important role in distinguishing the two groups.
A Mathematical Model to Predict the Angle of Z-plasty and Rotation with Trigonometric Relationships
Background: Burns contractions restrict limb movement. Z-plasty is a widely used technique for repairing contractures resulting from burns. Methods: Equations were derived utilizing trigonometric relationships that enable surgeons to estimate the angle and rotation of the Z-plasty based on the degree of lengthening required for the contracted area. Results: This study introduces a mathematical model designed to assist surgeons in selecting a Z-plasty with the appropriate angle and rotation. Numerical results were presented for various lengths of contracture in non-classical Z-plasties. Conclusion: This model aims to enhance surgical precision and facilitate the development of standardized procedures.
Background: It is essential to have a test that creates the best competitive conditions for evaluating meaning perception. Therefore, this study aimed to investigate the psychometric properties of the Word-In-Noise Perception test (WINP) using Homotonic-Monosyllabic Words (HMWs) and Spectrum Speech Noise (SSN) for Persian speakers aged 18 to 22 years. Method: This study was a test-development type that was conducted in a cross-sectional-comparative way. Assessments included 110 young Persian speakers. The evaluations included checking the state of general health, sleep and mental states, basic audiological evaluations, dichotic digit test and WINP. Mann-Whitney and Friedman tests were used to compare group scores. Results: The validity and reliability of WINP using HMWs and SSN were determined. The mean Conversion Rate (CVR) and mean Content Validity Index (CVI) of the HMWs were 0.99 and 0.95, respectively. The minimum acceptable reliability (ICC) was also calculated for single and mean measurements. The results showed that the obtained scores are stable and without measurement errors. Normal values of WINP were obtained using HMWs and SSN. Gender was not an effective factor in causing differences in mean WINP scores. There was no significant difference between WINP mean scores in Signal-to-Noise Ratios (SNR) in different noises between the right and left ears. Also, there was a significant difference between mean scores of WINP in SNRs from -5 to +15 for left and right ears. Conclusion: The psychometric properties of the WINP using HMWs and SNN have been confirmed for Persian speaking adults.
Evaluating the Association of Pregnancy-Related Plasma Protein A with Pregnancy Outcome: A Single-Center Retrospective Study
Background: Pregnancy-Associated Plasma Protein (PAPP-A) is a type of metalloproteinase that stimulates cell growth and plays a role in regulating the biological activity of Insulin-like Growth Factors (IGF). This enzyme plays an important role in the development of the fetus and placenta. Therefore, in this study, the relationship between the serum PAPP-A level and Maternal-fetal obstetrics abnormalities and aneuploidies disorders were examined. Methods: Available data were used in this retrospective cohort study. The research population was made up of women with a history of pregnancy referring to Tajrish Martyrs’ Hospital in 2018, which was approximately 15,000 people. All the prenatal aneuploidy screening tests of these patients were done in Nilou Medical Laboratory a referral Laboratory in Tehran, Iran. The data was collected using a checklist that was prepared in advance. Based on this, the demographic data of the patients was collected. Results: The results show that most of the patients with chromosomal abnormalities had a PAPP-A level of <0.27 (p<0.001). It was found that the group of patients whose PAPP-A level was > or =3 had the highest structural anomaly (p=0.021). On the other hand, the highest maternal adverse outcomes [such as Premature Rupture of Membranes (PROM), pre-eclampsia, abortion, polyhydramnios, oligohydramnios, amniotic leakage, bleeding, and blood spotting] were in patients whose PAPP-A level was <0.27 (p<0.001). No significant difference in adverse fetal outcomes was observed in the above three groups (p=0.61). Conclusion: In general, it can be said that the decrease in PAPP-A serum levels in pregnant mothers can be associated with maternal and fetal adverse outcomes. The occurrence of these complications can increase the risk of T18 and T21 in patients.
Investigating the Correlation between Cognitive Errors and Stress, Anxiety, and Depression in the Procrastination of Yazd Medical Students
Background: Procrastination is common among students and has been associated with anxiety, depression, and cognitive errors. Recent studies suggest that such patterns may emerge in nonclinical populations as well as clinical ones. This study examines the relationship between cognitive errors and procrastination in university students to identify cognitive markers that may aid in early detection and intervention. Methods: This observational, descriptive, and cross-sectional study was conducted between 21 March 2022 and 22 October 2023 including 170 Yazd University of Medical Sciences medical students. Participants completed three standard questionnaires: Solomon and Rothblom Procrastination Scale, Depression, Anxiety, and Stress Scale (DASS), and the Cognitive Errors Questionnaire. The sample included both native and non-native students, with non-native students defined as individuals studying outside their region of origin. Results: No significant differences were observed in procrastination scores based on gender, marital status, place of birth, or level of education. However, 47% of students showed high levels of academic procrastination. DASS results indicated high levels of stress (42%), anxiety (38%), and depression (35%). The results showed a direct relationship between procrastination and anxiety, stress, and depression, with higher levels of these symptoms corresponding to greater procrastination (r=0.41 for anxiety, r=0.39 for stress, r=0.36 for depression). “Exaggeration or minimization” was more prevalent among clinical students and single students, while “overgeneralization” was more frequent among non-native and married students. Conclusion: The results show that there is a direct relationship between procrastination and anxiety, stress, and depression, with higher levels of these symptoms corresponding to greater procrastination.
Assessing the Effects of Electrical Muscle Stimulation and Resistance Training on Regulation of HbA1c and Plasma Glucose in Individuals with Type 2 Diabetes Mellitus: An Experimental Study
Background: Type 2 diabetes mellitus (T2DM) is a common metabolic condition that places a major health and financial burden on individuals and healthcare systems worldwide. Maintaining good glycemic control, particularly through measures such as HbA1c and blood glucose levels, is essential for reducing the risk of long-term complications. Although resistance training is widely recommended for diabetes management, it may not be suitable for people with limited mobility or multiple comorbidities. This study compared the effects of Electrical Muscle Stimulation (EMS) and Resistance Training (RT) on glycemic outcomes in individuals with T2DM. Methods: Sixty-six participants with T2DM were randomly allocated to one of three groups: EMS, RT, or control, with 22 participants in each group. The EMS group received 30-minute stimulation sessions three times per week for 12 weeks. The RT group completed supervised progressive resistance exercises targeting the major lower-limb muscles on the same schedule. The control group received education on diet, exercise, and blood glucose management. HbA1c, fasting blood glucose, and postprandial glucose were measured at baseline, after 12 weeks, and again at 3-month follow-up. Results: Both intervention groups showed significant improvements in glycemic control compared with the control group. HbA1c fell from 8.77 to 7.59 in the EMS group and from 8.73 to 8.05 in the RT group, while it increased from 8.91 to 9.41 in controls. Fasting and postprandial glucose levels also improved significantly in both intervention groups. Conclusion: Both EMS and RT were effective, with EMS showing stronger and more sustained benefits in this study.
Validity and Internal Consistency of the Persian Version of the Copenhagen Hip and Groin Outcome Score for Evaluation of Hip and Groin Pain among Iranian Athletes
Background: Copenhagen Hip and Groin Outcome Score (HAGOS) was previously translated to Persian. In this study, the construct validity, discriminative validity, and internal consistency of HAGOS among Iranian athletes were evaluated. Methods: This study was cross-sectional conducted between 2014 and 2015 at the physiotherapy clinics and sport clubs of Tehran. One hundred athletes with hip and groin pain and 50 healthy athletes were included. Participants completed the Persian version of HAGOS, and the Visual Analog Scale (VAS) was used to assess the severity of their hip and groin pain. The construct validity, discriminative validity, and internal consistency of the HAGOS were assessed. Results: In total, 100 athletes with hip and groin pain (mean age= 25.5 yr, SD=3.3) and 50 healthy athletes (mean age= 24.7 yr, SD= 3.5) participated in the study. The mean total HAGOS score and all its subscale scores were significantly lower in athletes with pain compared to healthy athletes (p<0.001), indicating the discriminative validity of the Persian version of HAGOS. HAGOS’ total score had a strong correlation with VAS score (coefficient -0.75, p<0.001), and all its subscales had moderate negative correlations with the VAS score (p<0.001), confirming the construct validity. The total HAGOS score had a Cronbach’s alpha of 0.87, indicating acceptable internal consistency. Conclusion: The present study demonstrated the internal consistency, discriminative validity, and construct validity of the Persian version of HAGOS for assessing hip and groin pain and function among Iranian athletes. This tool can be considered as a useful tool for both clinical practice and research involving Iranian athletes with hip and groin pain.
Comprehensive Study on Patients with Molar Pregnancy Referred to Mahdieh Hospital in Tehran: A Descriptive and Retrospective Research
Background: Hydatidiform mole is a rare but clinically significant pregnancy abnormality. This study was undertaken to improve understanding of molar pregnancy risk factors in the Iranian population and to develop strategies for early detection and management. It also aimed to evaluate the impact of Methotrexate (MTX) chemoprophylaxis on progression to Gestational Trophoblastic Neoplasia (GTN). Methods: This single-center, retrospective descriptive study was conducted at Mahdieh Hospital in Tehran between 2011 and 2023. A total of 449 patients with histopathologically confirmed molar pregnancies were included. Detailed clinical and laboratory data were collected and analyzed using SPSS (version 26), with significance set at p<0.05. GTN was diagnosed according to FIGO criteria, based on serial β-hCG monitoring (rising or plateauing levels) and confirmed by histopathological examination. Results: The incidence was 6.75 per 1,000 pregnancies. Anemia and vaginal bleeding were the most common presenting symptoms. Complete moles accounted for 66.6% of cases. Among 18 patients who received MTX prophylaxis, elevated β-hCG levels and larger uterine size were significantly associated with MTX administration (p<0.001). However, MTX prophylaxis did not significantly prevent progression to GTN (p=0.365). During follow-up, 11 patients developed GTN. Conclusion: Molar pregnancies in Iran exhibited a higher incidence compared to developed countries. The limited benefit of prophylactic MTX in this small subgroup support the need for larger, multicenter studies to refine treatment protocols.
In Vitro Evidences for Renal-Protective Properties of Phloretin in Nephrotoxicity Induced by Bisphenol-A via Mediation of VCAM-1/ICAM-1 Genes Expression
Background: Oxidative stress is a major contributor to kidney dysfunction. Phloretin, a dietary flavonoid, exhibits antioxidant and anti-inflammatory activity. This study evaluated the protective effects of Phloretin against Bisphenol-A (BPA)-induced oxidative stress in human renal tubular epithelial (HK-2) cells. Methods: HK-2 cells were exposed to BPA (1000 μM) for 24 hr with or without Phloretin (50, 100, 200 μM). Cell viability, oxidative stress markers Reactive Oxygen Species (ROS), Malondialdehyde (MDA), Total Antioxidant Capacity (TAC), cytokines (IL-6, IL-10), and VCAM-1/ICAM-1 expression were assessed. Results: BPA markedly decreased cell viability and TAC while elevating ROS, MDA, IL-6, and VCAM-1/ICAM-1 expression (all p<0.001). Phloretin significantly reversed these effects in a dose-dependent manner. At 200 μM, Phloretin increased cell viability by ~35–40% (p<0.001), reduced ROS and MDA by ~35–40% (p<0.001), and restored TAC by ~40–45% (p<0.001) compared to BPA. Inflammatory markers were also modulated: IL-6 was reduced by ~35–40% (p<0.001), while IL-10 was elevated by ~40–45% (p<0.001). Moreover, Phloretin suppressed VCAM-1 and ICAM-1 expression by ~45–50% (p<0.001). Conclusion: Phloretin significantly attenuates BPA-induced oxidative stress and inflammation in renal tubular cells, suggesting its potential as a natural nephroprotective agent.
Knowledge and Attitudes Toward Electroconvulsive Therapy Among Companions of Psychiatric Patients: A Cross-Sectional Study from Northern Iran, Rasht
Background: Electroconvulsive Therapy (ECT) is a highly effective treatment for psychiatric disorders, particularly in emergency cases, pregnancy, and when pharmacological treatments are contraindicated. However, misconceptions and negative attitudes among patients’ companions can hinder its acceptance and adherence. This study aimed to evaluate the knowledge and attitudes of companions of ECT recipients at Shafa Hospital in 2024. Methods: A cross-sectional descriptive study was conducted among companions of psychiatric patients referred to Shafa Hospital in Rasht, Iran during 2024. The data collection tool is a questionnaire measuring knowledge and attitudes related to ECT. The variables analyzed using mean, standard deviation (SD), frequency and a significance level of p<0.05 also 95% confidence interval. Results: Of the 361 participants, 52.4% were male, and 47.6% were female, with a mean age of 47.91±12.02 years. Most companions (48.5%) received information about ECT from healthcare providers, while 22.7% relied on the internet. Concerns included memory loss (30.7%), brain damage (25.4%), and fear of anesthesia (22.5%). Despite these concerns, 69.3% believed ECT was beneficial for their patients. Companions with higher education levels or prior ECT experience exhibited more positive attitudes and greater knowledge. Conclusion: The findings of this study reveal significant misconceptions and negative attitudes toward ECT among patients’ companions, which are characterized primarily by unfounded fears of memory loss and brain damage. Companions with higher education levels or prior ECT exposure demonstrated markedly more positive attitudes and greater knowledge. These findings underscore the necessity of structured educational interventions by healthcare providers to address misconceptions and to enhance ECT acceptance and treatment outcomes.
Comparison of Bone Fracture Healing in Patients with Delayed Union of the Diaphyseal Femur and Tibia Shaft, with and without the Administration of Teriparatide
Background: This study investigates the effect of teriparatide on the healing of long bone fractures in the lower limbs of patients with delayed union. Fractures are a major global health issue, leading to increased mortality and economic costs. Methods: This retrospective observational study with a one-year follow-up examined patients with delayed union of long bone fractures in the lower limbs who were treated with Teriparatide. The study followed these patients for one year to assess the effects and side effects of this treatment. Patient data, including age, gender, fracture type, and medical history were extracted from hospital archives using a standard checklist. Data analysis was conducted using SPSS version 22, and patients with incomplete records were excluded from the study. Results: The present study showed that the average age of patients receiving Teriparatide administration was 42.37±13.63 years, whereas the average age of patients in the group without Teriparatide administration was 32.95±14.84 years. The results indicated no statistically significant difference in fracture healing between patients treated with teriparatide and those without the drug (p>0.05). Conclusion: Radiographic evaluations in this study did not demonstrate a significant acceleration in fracture healing with the administration of Teriparatide. No adverse effects were reported among patients receiving the drug, supporting its favorable safety profile. While the study design and sample size limit the findings, they may contribute to informing future treatment strategies for managing delayed fracture healing.
Association of Triglyceride-Glucose Index with Fibrosis Index Based on Four Factors in Patients with Diabetes Mellitus Type II
Background: This research examined the relationship between the triglyceride-glucose (TyG) index and the Fibrosis Index Based on four factors (FIB-4) in patients with type 2 Diabetes Mellitus (T2DM). Methods: During 2023-24, this prospective cross-sectional research was done at the Endocrine Research Center in Tehran, Iran, and 292 individuals with T2DM were recruited by random sampling. Correlation and linear regression were used as the inferential tools. Results: The sample had a mean (SD) age of 59.4 years (12.2 yr) and included 166 females (56.9%). Spearman correlation analysis revealed the following associations: FIB-4 and the Triglyceride-Glucose Index (TyG) index had a correlation coefficient of -0.18, FIB-4 showed an inverse association of -0.19 with Fasting Blood Glucose (FBG), and the TyG index had a direct correlation of 0.48 with HbA1c. Regression models indicated a 0.004 (95% CI: 0.001, 0.007) increase in the TyG index per a 1-mmHg increase in Systolic Blood Pressure (SBP) and a 0.8% (95% CI: 0.2, 1.3%) decrease in FIB-4 due to a 1-mg/dL increase of High-Density Lipoprotein cholesterol (HDL-C). Moreover, a 2.4% (95% CI: 7.8,32.9%) decrease in FIB-4 per a 0.1 unit increase in the TyG index was demonstrated. Conclusion: A weak association was observed between FIB-4 and the TyG index in diabetic patients. Additionally, FBG and HDL-C were inversely associated with FIB-4, while HbA1c and SBP were positively associated with the TyG index.
Test–Retest Reliability of the Persian Version of the Self-Determination Student Scale in Adolescents with Autism Spectrum Disorder
Background: Adolescents with Autism Spectrum Disorder (ASD) may experience difficulties in social participation, executive functioning, independence, and transition to adulthood. Self-determination is an important construct for supporting autonomy and goal-directed behavior; however, the test–retest reliability of the Persian Self-Determination Student Scale (SDSS) has not been examined in adolescents with ASD. Methods: This methodological reliability study included 19 Persian-speaking adolescents aged 13–18 years with Level 1 ASD recruited by convenience sampling from three rehabilitation and occupational therapy centers in Tehran. Participants completed the revised 88-item Persian SDSS twice with a 14-day interval. Test–retest reliability was assessed using single-measures Intraclass Correlation Coefficient (ICC) based on a two-way mixed-effects absolute-agreement model. Results: All participants completed both administrations, and no missing responses were recorded. Scores ranged from 37 to 126 at the first administration and from 38 to 124 at retest. Mean SDSS scores were 101.26±23.00 and 100.84±22.87, respectively. The single-measures ICC was 0.998, with a 95% confidence interval of 0.996–1.000 (p<0.001). Conclusion: The revised Persian SDSS showed preliminary evidence of excellent test–retest reliability over a 14-day interval in this small sample of Persian-speaking adolescents with Level 1 ASD. Further studies with larger and more diverse samples are needed to examine additional psychometric properties.
Ophthalmic and Neurological Manifestations of Otitic Hydrocephalus: A Pediatric Case Report
Pediatric Otitis Media (OM) can result in rare intracranial complications such as otitic hydrocephalus. This case report describes a 6-year-old girl with acute OM, right esotropia, and bilateral papilledema. Imaging revealed mastoiditis and intracranial complications, which required mastoidectomy, ventilation tube insertion, tympanomastoidectomy, and lumbar puncture. Early recognition of ophthalmic signs is crucial for prompt diagnosis and intervention.
Don’t be Afraid of me, I’m Just a Dentist!!
Night Shifts and Lost Moments: Behavioral Disorders as an Overlooked Consequence in Children of Nursing Mothers that Must be Addressed
Improving Quality of Life for Patients Undergoing Maintenance Hemodialysis: The Benefits of Guided Imagery as an Effective Physiological Approach
Establishing Positive Clubs to Provide HIV-Related Care to People Living with HIV (PLWH): Two Decades of Iranian Experience
It’s Time to Act More Rigorously: Zero-Tolerance Policies in Medical Education
Informed Consent in Dermatology: Protecting Patients or Regulatory Obstacle?