Journal of Iranian Medical Council

Campaign No to Road Traffic Accidents: A Collective Effort to Save Lives in Iran

Shahin Akhondzadeh — Wed, 28 May 2025 06:44:00 +0000

The Article Abstract is not available.

Ethical Considerations in the Application of Artificial Intelligence in Health Systems: A Narrative Review

Wed, 28 May 2025 06:53:17 +0000

Artificial Intelligence (AI) has emerged as a transformative technology in healthcare, enabling the management of vast data volumes and predictive analysis of the future of issues to support decision-making. This narrative review examines ethical dimensions of AI integration in health systems, drawing from articles published from January 1, 2000 to November 30, 2023, across seven databases—Cochrane Library, PubMed, SCOPUS, Science Direct, BMJ Journals, ProQuest, and SAGE. Using Boolean operators such as “AI” paired with “health”, “health system”, or “hygiene”, the study identifies critical ethical concerns including the preservation of human dignity, confidentiality, informed consent, and the dual principles of beneficence and nonmaleficence. It further highlights systemic challenges like algorithmic bias, transparency gaps in decision-making processes, and disruptions to social justice, alongside legal complexities surrounding accountability for errors, fraud, and compensatory mechanisms. To address these challenges, the study advocates for multilayered solutions. These include establishing ethical audits, formulating policies to ensure equitable global access to AI benefits, and enforcing robust data protection frameworks. Designers are urged to develop comprehensive systems safeguarding patient confidentiality and extending privacy protections to healthcare personnel and affiliated individuals. International regulatory standards must align with social and ethical norms rooted in human dignity, while frameworks for error identification and damage compensation should be prioritized. Continuous adaptation of AI capabilities to evolving medical expertise, coupled with strict adherence to ethical guidelines, is emphasized as essential for sustainable integration of AI in healthcare systems.

Investigating the Motivations of Mothers to Volunteer for Gestational Surrogacy: A Systematic Review Study

Zohreh Radmehr, Fatemeh Ghodrati — Wed, 28 May 2025 07:28:45 +0000

A surrogate mother is a woman who becomes pregnant and gives birth to a child with the intention of donating the child to another person or couple. Surrogacy has become a new ethical challenge. Various factors such as economic issues, social stigma, consequences of pregnancy and the commercialization of this issue play a big role in the acceptance of surrogacy. The aim of the study was to investigate the motivations effective in accepting surrogacy by volunteer women. The keywords of “surrogate, motivation, volunteer, gestational, infertility” were searched for in studies published between 1970 and 2023 in reliable databases, resulting in 130 articles, of which 58 articles were reviewed. This review article searched for studies published by researchers from 1970 to 2023 in Scopus, PubMed, ScienceDirect, Google Scholar, as well as other jurisprudential texts using alternative keywords. Financial need and independence, social factors, the process of psychological compensation and restorative motives, resolving loneliness due to previous failures, resolving the internal psychological conflicts and compensatory movement, unresolved unconscious feelings, interest in experiencing a different type of motherhood (attachment or curiosity), empathy, altruism and spiritualism (commitment and care) are among the effective factors in surrogacy volunteering. The lack of supporting regulations for surrogate mothers and biological parents causes the profiteering of middlemen and commercial agencies. It is necessary to review the relevant laws in order to preserve human dignity and prevent the vulnerability of the surrogate.

Impact of Instrument-Assisted Soft-Tissue Mobilization (IASTM) on the Functional Status of Myofascial Structures: Scoping Literature Review

Wed, 28 May 2025 07:41:20 +0000

Background: Instrument-Assisted Soft-Tissue Mobilization (IA-STM) is a non-invasive technique using specialized tools to treat soft tissue dysfunctions and enhance myofascial function. It improves joint range of motion through mechanical stimulation. Comparable to manual therapies like deep friction massage, IASTM may offer advantages by applying greater force, reducing both treatment time and physical strain on the practitioner.

Methods: In this scoping literature review, a thorough search was performed across PubMed, Cochrane, and Google Scholar. The articles were screened according to specific inclusion criteria, ultimately identifying 14 studies: 12 randomized controlled trials and 2 quasi-experimental studies. These studies were selected for their relevance to myofascial conditions and IASTM interventions, while excluding those that were irrelevant or did not focus on IASTM.

Results: The findings reveal that both IASTM and stretching effectively improved ankle dorsiflexion ROM. However, neither intervention significantly altered pain sensitivity or muscle stiffness.

Conclusion: IASTM was safe and effective in reducing joint stiffness, but its impact on muscle properties was limited. The study highlights the need for further research to explore additional outcome measures, refine intervention protocols, and investigate tool designs to optimize therapeutic effectiveness. Limitations include variability in methodologies and small sample sizes, which may affect the result’ consistency and generalizability.

Review of the Possible Role of the Stomach in the Gut–Joint Axis in Osteoarthritis: Avicenna’s Perspective Versus Modern Medicine

Sat, 31 May 2025 08:46:03 +0000

Osteoarthritis (OA) is the most common debilitating chronic joint disorder with no definitive treatment. Avicenna considers a strong relation between the Gastrointestinal Tract (GIT), with other body organs, including the joints. Specifically, he regards disorders of the stomach as the most important underlying cause of arthritis. The present review study aims to collect the available scientific evidence on the role of the stomach in OA in order to provide a new insight of the gut-joint axis based on Persian Medicine (PM) theory. In this narrative review, the term “vajae-al-mafasel” was searched (the equivalent term for arthritis) in Avicenna’s medical masterpiece, Canon of Medicine. Additionally, PubMed, Web of Science and Google Scholar databases were queried with keywords including OA, gut, stomach, PM, and systems biology. After gathering data, they were classified, coded, analyzed, and compared. Mechanisms that play a role in the GUT-OA axis include: 1) Gut Microbiota (GM) dysbiosis; 2) contribution of GM metabolites; 3) leaky gut syndrome; 4) bacteria transfer phenomenon; and 5) Metabolism disturbance. Growing evidence shows the pivotal role of the stomach, as part of the GIT, in the balance of metabolic functions and gut-joint axis. the role of the stomach is discussed in OA in the four sections: maintaining the metabolic balance by stomach, bone metabolism and gastric acid, controlling cartilage homeostasis by gastric hormones, gastric microbiota dysbiosis and OA.

An Analogy between Gray Values of Cone Beam Computed Tomography and Hounsfield Units of CT: A Systematic Review and Meta-Analysis

Harini Kumaravel, Harsha Vardhan B.G, Poongodi V, Saraswathi Gopal.K — Sat, 31 May 2025 09:01:37 +0000

Background: This study was conducted to determine and compare the efficacy of Hounsfield Units (HU) of Computed Tomography (CT) and Gray Values (GV) of Cone Beam Computed Tomography (CBCT) in assessing bone Mineral density.

Methods: Literature search was carried out using electronic databases including PubMed, Google scholar, Scopus. In vivo, in vitro and animal studies that analyzed the comparison between the GV of CBCT and HU of CT were included. This review adheres to the Prisma guidelines, and QUADAS-2 tool for risk of bias assessment was performed.

Results: A Total of 4760 studies were roped in for this systematic review, of which 22 articles were included and 8 articles were selected for the meta-analysis. The odds ratio of 8 included articles showed a strong positive correlation between CT and CBCT and the overall classification of 89.86% was obtained. 19 studies had low risk of bias and 4 studies had high risk. Some of the included studies indicated quite low and limited reliability, advocating the need for clinical studies with diagnostic capacity to support the use.

Conclusion: The existing evidence suggests that GVs of CBCT and HUs of CT had a strong positive correlation and the standard formula for the conversion between the two parameters (Gray values and Hounsfield units) need to be derived in future studies with clinical correlation.

National Research Institute of Tuberculosis and Lung Disease (NRITLD) Implementation Protocol of an Exercise Training Program in Pulmonary Rehabilitation of Patients with COPD

Sat, 31 May 2025 09:04:21 +0000

Pulmonary rehabilitation is an effective method to improve the clinical conditions of patients with Chronic Obstructive Pulmonary Disease (COPD), which includes providing a supervised exercise program at home or in a treatment center according to the patient’s conditions and abilities. Despite the many benefits of pulmonary rehabilitation, it has not received much attention in different countries. Pulmonary rehabilitation is done according to international general guidelines, but it is very important to develop center-based programs according to existing facilities and conditions. Currently, very few pulmonary rehabilitation centers are active in Iran. Considering the limitations in access to patients, and the importance of pulmonary rehabilitation in the treatment process of patients with COPD, in the present study, the pulmonary rehabilitation protocol, localized by National Research Institute of Tuberculosis and Lung Disease (NRITLD) in Tehran, Iran, has been presented.

Ethnic Disparities in Allogeneic Hematopoietic Cell Transplantation: A Secondary CIBMTR Study

Sat, 31 May 2025 09:07:48 +0000

Background: Allogeneic Hematopoietic Cell Transplantation (allo-HCT) is a necessary therapeutic option for patients with Acute Myeloid Leukemia (AML) and Acute Lymphoblastic Leukemia (ALL). This study aims to evaluate the effects of race on the outcomes of allo-HCT.

Methods: This secondary data analysis utilized the Center for International Blood and Marrow Transplant Research (CIBMTR) data repository for allo-HCT cases in the United States from 2008 to 2018. The eligible patients were aged 18 or older, undergoing initial allo-HCT for AML or ALL from an HLA-identical sibling or 8/8 matched unrelated donor. Recipient, disease, and transplant variables were assessed. A Cox proportional hazards model was employed for multivariable analysis.

Results: The dataset included 4,783 cases, with 4,310 White, 211 Black, 230 Asian, 12 Native Hawaiian/Pacific Islander, and 26 American Indian/Alaska Native individuals. Asians had a significantly higher mortality rate when receiving transplants from HLA-identical siblings compared to well-matched unrelated donors (76.56 vs. 41.91%, p=0.001). The median survival times did not differ significantly among the racial and ethnic groups. White (39.08 months), Black or African American (25.16 months), Asian (62.27 months), Native Hawaiian or other Pacific Islanders (25.33 months), and the overall estimated median survival across all groups was 39.14 months (log rank test p=0.870). After adjusting for age, disease type, and donor type, Black or African American individuals had a 25.2% higher risk of death compared to White individuals (HR: 1.252 95%CI: (1.043, 1.503) p=0.016).

Conclusion: This study reveals significant disparities in outcomes among different racial and ethnic groups

Investigating the Relationship between Fetal DNA Fraction in Cell-Free DNA Test and Adverse Pregnancy Outcomes in Pregnant Women Referring to Perinatology Clinics

Shabnam Vazifekhah, Ali Wahhabi, Mahsa Rouhi Gharehbagh — Sat, 31 May 2025 09:09:21 +0000

Background: Screening is done by examining the Fetal Fraction (FF) in cell-free DNA to find fetal aneuploidy. In this study, the relationship between FF obtained in weeks 10–20 of pregnancy and adverse pregnancy outcomes, as well as demographic variables of mothers were investigated.

Methods: This study included pregnant women (n=685) referred to perinatology clinics in West Azerbaijan from April 2018 to March 2021 who underwent cell-free DNA (cfDNA) screening in weeks 10 to 22 of pregnancy. The demographic variables of the mothers were extracted and recorded at the time of sample collection and the pregnancy outcomes at the time of delivery from their records.

Results: Two patients had cervical insufficiency, 10 participants had preterm Premature Rupture of Membranes (PPROM), and the frequency of NICU Hospitalization was 0.9% (6 person). The distribution estimates FF less than the 25^th percentile as less than normal, with 197 (29.5%) individuals having FF less than 4.36. Body Mass Index (BMI) had an opposite relationship with FF (p-value=0.001 and B=0.296). Only the prevalence of Gestational Diabetes Mellitus (GDM) patients was different between the two groups (p=0.032). The area under the diagram was significant for the outcomes of preterm delivery (0.503), pregnancy-related high blood pressure (0.599), and GDM (0.609, according to the ROC diagram).

Conclusion: Based on the present study, FF assessment at 10–20 weeks of pregnancy can predict the possibility of gestational diabetes, pregnancy-induced blood pressure, and premature delivery during pregnancy to a weak to moderate extent.

Comparison of Mental Health Status in Infertile Women with or without Polycystic Ovary Syndrome

Sat, 31 May 2025 09:11:37 +0000

Background: The aim of this study was to evaluate mental health disorders in infertile women with Polycystic Ovary Syndrome (PCOS) compared to the infertile women without PCOS.

Methods: These two parallel case series studies were conducted during a 12-months period from June 2020 to march 2022 at Arash Hospital affiliated to Tehran University of Medical Sciences (TUMS). A total of 69 PCOS and 69 non-PCOS women diagnosed with infertility were recruited into the study. The Symptom Checklist-90 (SCL-90) containing of nine main domains: somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid and psychoticism was filled out by the participants. The independent t-tests and logistic regression analysis were implemented for comparative analysis.

Results: The prevalence of depression was approximately 34% among the infertile women with PCOS which did not significantly differ from non PCOS group (32%). It was shown that phobic anxiety even after adjusting for age was significantly lower in infertile group with PCOS than non-PCOS group. After entering phobic anxiety as independent variable in the model, the odds of having any psychiatric morbidities were significantly lower in infertile women with PCOS than non-PCOS group.

Conclusion: The results demonstrated that some mental health disturbances can be observed among infertile women regardless of the etiology of their infertility. Hence, physicians should pay more attention in early diagnosing and managing of psychiatric disorders in these patients.

Foreign Body Ingestion in Children: Distribution and Complications in a Tertiary Center of Pediatrics

Parisa Rahmani, Ramin Shayan-moghadam, Rozhin Dariush — Sat, 31 May 2025 09:19:25 +0000

Background: Foreign body ingestion is a common event in pediatric population. Children swallow different object including, coins, toys, batteries, etc. Most instances of foreign body ingestion are uncomplicated and the foreign body is excreted spontaneously. In some cases, the foreign body is lodged in the gastrointestinal tract and leads to complications. This study investigated the distribution of foreign body ingestion, and associated complications in a tertiary center of pediatrics.

Methods: In this retrospective study, electronic records of patients with diagnosis of foreign body ingestion in two consecutive years in a tertiary center were reviewed. The associated data were extracted and analyzed.

Results: 1125 cases were identified. 633(56.3%) patients were male. Median age was 3.7 years. The most common swallowed objects were batteries, followed by coins, and sharp objects. The most common location of foreign body was the esophagus. The median time interval between ingestion and presentation was 4 hr. In patients with disk battery ingestion, there was a significant statistical relationship between time interval and presence of complications. Most patients (84.4%) needed no intervention. 14.9% were managed by a non-surgical intervention, and 0.6% needed surgery. No mortalities were recorded. Two cases of peritonitis were documented, following ingestion of magnets. Eight cases of esophageal burn, and one case of mediastinitis were documented following disk battery ingestion.

Conclusion: Foreign body ingestion is a common occurrence in children under 5 years of age. In this study, batteries were the most common swallowed objects. Most serious complications were following batteries, or magnet ingestion. Preventive measures focusing on batteries and high-powered magnets could decrease the incidence of these complications.

Investigating the Central Auditory Processing Damage Caused by Industrial Noise

Seyede Faranak Emami, Elnaz Shariatpanahi, Seyed Mohammad Mahdi Shahtaheri — Sat, 31 May 2025 09:21:19 +0000

Background: The Word-In-Noise Perception test (WINP) is a new assessment that assesses the auditory brain function by recognizing speech consonants. The Dichotic Digits Test (DDT) measures the directional superiority of the temporal cortex and brainstem function based on the ability to recognize the tonality of words. So far, the performance of the central auditory processing of industrial personnel has not been investigated by referring to the WINP test. The aim was investigating Central Auditory Processing Damage (CAPD) caused by industrial noise.

Methods: This case-control study was conducted in a cross-sectional-comparative way on 69 industrial personnel aged 25-40. The case (n=39) and the control (n=30) groups were evaluated by audiological tests, WINP and DDT.

Results: The participants were divided into three groups based on their hearing status: 60 normal ears in the control group, 37 normal ears and 41 abnormal ears in the case group. Mean scores of WINP and DDT in three groups were significantly different from each other (right ear: p’WINP=0.01, p’DDT=0.02 and left ear: p’WINP=0.01, p’DDT= 0.01). The mean scores of WINP and DDT in the abnormal ears of the case group were significant compared to the normal ears of the control group (right ear: p’WINP <0.001, p’DDT <0.001 and left ear: p’WINP =0.02, p’DDT=0.02).

Conclusion: In industrial personnel with a history of continuous exposure to noise pollution, there is a possibility of damage to the brainstem and auditory brain functions.

Evaluation of Clinical and Radiological Outcomes after Cross Pinning and Transverse Pinning Methods in Metaphysis Distal Radius Fractures in Children

Ali Mousapour, Mohammad Reza Anvar, Maziar Malekzade, Ghobad Ramezani — Sat, 31 May 2025 09:23:52 +0000

Background: Distal radius fractures are among the most common and important fractures in children. Among surgical techniques, percutaneous pinning is a widely used and relatively simple method for treatment. This study aims to compare the outcomes of parallel versus transverse pinning in such fractures.

Methods: In this cross-sectional study, children aged 5 to 10 years with distal radius fractures who were referred to Ayatollah Taleghani Hospital during 2021–2022 were included. After taking a detailed history and performing clinical examination, patients were treated using either parallel or transverse pinning techniques.

Results: A total of 47 patients were evaluated, including 35 boys (74.5%) and 12 girls (25.5%) with a mean age of 7.5±1.7 years. In both surgical groups, the DASH and MAYO scores showed significant improvement compared to preoperative status. This reflects improved function, reduced symptoms and pain, higher patient satisfaction, and better hand performance. However, no statistically significant difference was found between the two groups in postoperative DASH and MAYO scores.

Conclusion: The results indicate that both parallel and transverse pinning methods yield similar clinical outcomes and complication rates. Therefore, either technique can be considered safe and effective for managing distal radius fractures in children.

Effect of Irrigation Fluid Temperature on Hypothermia and Complications in TURP Patients Under Spinal Anesthesia: A Randomized Clinical Trial

Sat, 31 May 2025 09:27:17 +0000

Background: Hypothermia during surgical procedures increases the risk of complications. This study aimed to compare the effects of Irrigation Fluid (IF) temperature on hypothermia, hemodynamic changes, and complications in patients undergoing Transurethral Resection of the Prostate (TURP) surgery under Spinal Anesthesia (SA).

Methods: In this double-blind clinical trial, 76 patients scheduled for TURP surgery were randomly assigned to two groups. The first group received warm IF heated to 37°C, while the second group received IF at room temperature. Body temperature and hemodynamic parameters were measured at five time points: upon entering the operating room (T0), after spinal anesthesia (T1), at the start of surgery (T2), at the end of surgery (T3), and during recovery (T4).

Results: In evaluating the trend of core mean body temperature changes, there was a statistically significant difference over the study period (T0-T4) in each group (p<0.001). A significant difference in mean body temperature between the two groups was observed at T2 and T3 (p<0.05), indicating higher body temperatures in group one. Additionally, there was a statistically significant difference between the two groups in terms of shivering, the need for pethidine injection, and blood product transfusion. However, no statistically significant difference was found between the groups in terms of the trends of changes in hemodynamic parameters over the study period (T0-T4).

Conclusion: Using IF heated to body temperature was associated with a lower incidence of hypothermia, reduced shivering, and fewer blood transfusions compared to room temperature IF during TURP surgery.

Relationship between Health-Promoting Lifestyle and Quality of Life in Urolithiasis Patients

Sat, 31 May 2025 09:33:36 +0000

Background: Urolithiasis is one of the most common urological diagnoses. It represents a significant clinical and economic challenge for health care systems and affects a patient’s Quality of Life (QOL). Lifestyle is a unique configuration of everyday behavior, which largely depends on the QOL available. As QOL should be an important outcome of urolithiasis management and there are few studies about that in these patients, this study was aimed at investigating the relationship between the health-promoting lifestyle and the QOL in urolithiasis patients.

Methods: This cross-sectional study was conducted in Rasht hospitals. 300 patients with urinary tract stones participated in this study. The questionnaire included three parts of demographic variables, the SF-12 QOL questionnaire and the health-promotion lifestyle profile. The collected data were analyzed using T-test, ANOVA, Pearson and linear regression. In all the variables, the significance level was considered p<0.05.

Results: The overall QOL score was 36.96±15.10 and the overall score for health-promoting lifestyle was 2.57±0.47 There was a significant relationship between the QOL and health-promoting lifestyle. Multivariate linear regression showed that health-promotion lifestyle, age and level of education were the predictors of QOL.

Conclusion: The present study demonstrated that a better lifestyle and a higher level of education can improve the QOL, therefore, to manage and prevent the recurrence of the disease, improving the lifestyle and increasing awareness regarding the disease is necessary

Determining the Association of Cardiometabolic Parameters with Liver Fibrosis in Non-Diabetic Patients with Nonalcoholic Fatty Liver

Sat, 31 May 2025 09:36:23 +0000

Background: There is an association between Cardiometabolic Parameters (CPs) and liver fibrosis in Non-Alcoholic Fatty Liver Disease (NAFLD). This study investigated the relationship between CPs with liver fibrosis and steatosis in NAFLD.

Methods: Fatty liver severity, fibrosis, and steatosis were determined by elastography in patients with NAFLD. CPs, including the Atherogenic Index of Plasma (AIP), Lipid Accumulation Product (LAP), Cardiometabolic Index (CMI), and Lipoprotein Combination Index (LCI), were calculated.

Results: 170 subjects with NAFLD were included. No associations between CMI (p=0.456), AIP (p=0.44), LCI (p=0.822), and LAP (p=0.599) with fibrosis were found. Also, no associations were found between CMI (p=0.429), AIP (p=0.398), LCI (p=0.095), and LAP (p=0.788) with steatosis. The 0.52 cutoff of AIP index has 0.6 area under curve (AUC) for F3 and F4 diagnosis (95%CI:0.574-0.722) (p=0.010). 2.16 cutoff of CMI has 0.6 AUC for F3 and F4 diagnosis (95%CI: 0.56-0.709) (p=0.02). The CMI (p=0.023), AIP (p=0.011), and LAP (p=0.035) were significantly higher in men. Multivariant analysis revealed that patients with waist circumference (W.C)≥90 (OR=3.07, 95%CI (1.38, 6.83) (p=0.006), waist-to-hip Ratio (WHR)>0.88 in males and >0.83 in females OR=3.96, 95% CI (1.48, 10.61) (p=0.006), waist-to-height ratio (WHtR)>0.5 OR=2.79, 95%CI (1.08, 7.21)(p=0.034) have higher odds for fibrosis development.

Conclusion: Our data demonstrated there is no association between CPs with steatosis and fibrosis. CMI and AIP have favorable predictive value in high-grade fibrosis. Our data also revealed that W.C≥90, WHR>0.88 or 0.83, and WHtR>0.5 are associated with fibrosis.

Adherence to Nursing Ethical Principles: Perspectives of Nurses and Patients in Dialysis Departments of Ahvaz: A Cross-Sectional Study

Khojasteh Hoseinynejad, Maryam Radan, Shokouh Shayanpour, Hossein Behbahani — Sat, 31 May 2025 09:41:05 +0000

Background: The critical nursing care for hemodialysis patients is one of the most effective factors to achieve promising results. Therefore, the aim of the current study was to comparison the perspectives of nurses and patients in dialysis departments.

Methods: A total of 225 participants were involved, comprising 80 nurses working in hemodialysis wards and 145 patients receiving hemodialysis treatment. Data collection was carried out through a questionnaire, and ANOVA was used for data analysis through SPSS.

Results: The demographic analysis indicated that the predominant patients were male individuals aged between 20 and 70, with the majority holding a diploma as their highest level of education. In contrast, the nursing staff was primarily female, and their educational qualifications were notably significant. The average score and standard deviation for the total consideration of nursing ethical principles among the hemodialysis patients and nurses were recorded at 5.32 and 0.25, respectively, compared to 6.04 and 0.31 for the nurses. Furthermore, both groups exhibited significantly higher scores in the areas of professional skill and respect when in comparison to other evaluated items.

Conclusion: According to the obtained results, consideration of the nursing ethical principles is necessary to improve the patients’ health condition in critical care wards. Additional investigations are required to develop and standardize assessment tools for evaluating nurses’ professional ethical practices in alignment with the ethical codes applicable to nurses in Iran.

Evaluating Physical Access to Primary Health Care Services: A Case Study of Mashhad City

Sat, 31 May 2025 09:44:02 +0000

Background: Ensuring equitable access to health services is a primary objective of health systems. This study aimed to evaluate the physical accessibility of Primary Health Care (PHC) facilities in Mashhad city, Iran, in 2022.

Methods: This cross-sectional study utilized geo-spatial analysis, specifically the Two-step Floating Catchment Area (2SFCA) method. The population within a 4 km radius of each of the 83 PHC facilities was calculated using ArcMap software. A checklist for weighting the components of service production in the facility was designed that included three main components (manpower, materials, equipment and space) and 17 sub-components. The differences between geographical areas of the studied city in terms of Accessibility Index were determined using cluster analysis.

Results: All areas of the city were covered by the 4 km buffer zones of PHC facilities and there was no area out of the 4 km buffer zones. In addition, the eastern regions of the studied city, which had lower socio-economic status, enjoyed higher capacity density and access indices. Considering capacity and access indices, physical access to PHC facility across the areas of the city was not equal. In areas with lower socio-economic status, there was better access to services than areas with higher status.

Conclusion: Totally, at least in some areas covered by a PHC system contrary to the popular idea, having good financial situation may prevent a person from accessing some PHC and cause the creation of areas we called them “deprived affluent areas” in this study.

I-Gel as an Alternative to Endotracheal Tube in Gynecologic Laparoscopic Surgeries: A Comparative Study

Sat, 31 May 2025 09:48:08 +0000

Background: Endotracheal Tube (ETT) intubation with rigid laryngoscopy evokes significant hemodynamic changes. Therefore, it is crucial to find an alternative for specific conditions like an irritative airway. For this purpose, the safety and efficacy of I-gel in gynecologic laparoscopic surgeries was examined.

Methods: This clinical trial was conducted at Al-Zahra Hospital affiliated with Guilan University of Medical Sciences (GUMS) from July 2023 to May 2024. Eligible women, aged 18 to 55 years, ASA class I and II, were randomly divided into two groups of I-gel and ETT. Hemodynamic status, ease of device placement, ventilation parameters and complications were compared between the two groups.

Results: Finally, the data from 92 women were analyzed. In terms of patients’ demographic data (p>0.05), surgery duration (p=0.730), surgeons’ satisfaction (p=0.655), airway pressure (p=0.804), leak volume (p=0.430), ETCO₂values (p=0.957) and side effects (p< 0.05), the results showed no significant difference between the two groups. Easy insertion was observed among 80.4% of the patients in I-gel group and in 93.5% in ETT group (p=0.063). Regarding the hemodynamic parameters, including Heart Rate (HR) and Mean Arterial Pressure (MAP) values, the difference was not significant in any of the measurement times (p< 0.05).

Conclusion: I-gel could be suggested as a safe alternative to ETT in special conditions in laparoscopic surgeries.

Postoperative Outcomes after Inguinal Hernia Repair Performing Modified Lichtenstein Procedure

Sat, 31 May 2025 09:51:21 +0000

Background: Repairing the inguinal hernia with mesh using the Lichtenstein method is safe, with a high success rate and low recurrence. Still, there is a potential risk of damage and entrapment of the ilioinguinal and iliohypogastric sensory nerves. This study aimed to investigate the outcomes of the patients after modified Lichtenstein hernia repair surgery.

Methods: This cross-sectional study was conducted on 35 male patients referred to Poursina Hospital with complaints of inguinal hernia who underwent a modified Lichtenstein hernia repair procedure. The demographical data, clinical characteristics, and the outcomes of the patients were recorded. A visual Analog Scale (VAS) evaluated pain scores after surgery, and the data was analyzed using SPSS version 24.

Results: The mean age of the patients was 50.65±14.44 years. Surgery duration averaged 41.17±14.97 minutes, and most patients had indirect hernias (71.4%), with a 57.2% occurrence on the right side. No intraoperative complications occurred, and only one patient experienced postoperative complications. No hernia relapses were reported, and the mean pain score was 0.38±0.07, according to the VAS. Patients returned to work in an average of 2.90±0.98 days, with 45.7% returning after three days.

Conclusion: Findings illustrated that the modified Lichtenstein surgery procedure can treat inguinal hernia due to its fewer postoperative complications.

Comparison of Dental Age in Patients with and without Cleft Lip and Palate: A CBCT Study

Maryam Paknahad, Maedeh Ommani, Majid Paknahad, Faezeh Ghaderi — Sat, 31 May 2025 09:54:30 +0000

Background: This study was designed to estimate the dental age of patients with Cleft Lip and Palate (CLP) and compare it with the control group using the Demirjian’s method based on Cone Beam Computed Tomography (CBCT) technique.

Methods: The CBCT images of 46 patients with CLP aged 5–16 years and 46 age-gender matched patients without CLP were evaluated. The dental age was determined using Demirjian’s method compared between the two groups (control, experimental) using independent t-test. Significant level was considered at p<0.05.

Results: The dental age was overestimated in relation to the chronological age in both groups p < 0.001. The mean of dental age in patients with CLP was lower in comparison to control group; however, no statistically significant difference was found (p=0.706).

Conclusion: The findings revealed that both groups exhibited a significantly higher mean dental age compared to their chronological age, indicating advanced dental development relative to their actual age. However, no significant difference was observed between the CLP and control groups regarding this advancement in dental age, suggesting that CLP may not have a substantial impact on the overall timing of dental development. These results suggest that while dental age may advance beyond chronological age in children with and without CLP, CLP itself is not a determining factor in this developmental difference.

Prevalence of Postpartum Readmission in University Hospitals of Ahvaz, Southwest of Iran in 2020-2022

Zainab Zamanpour, Mozhgan Barati, Elham Kargarzadeh, Sana Yektania — Sat, 31 May 2025 09:58:24 +0000

Background: The postpartum period, which includes the 12 weeks after delivery, is considered the fourth trimester. During this period, postpartum complications such as febrile morbidities, thromboembolic events, preeclampsia, etc. can lead to readmission and morbidity in mothers. Therefore, this study investigated the prevalence of post-partum patient readmission in university hospitals of Ahvaz, southwest of Iran during 2020-22.

Methods: This retrospective cross-sectional descriptive study was conducted in university hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences during 2020-22. All pregnant mothers who were re-admitted to hospital during their postpartum period were examined.

Results: Between 2020 and 2022, a total of 21,498 births took place in Ahvaz University Hospitals. Of these, 8,071 were Vaginal Deliveries (VDs) and 13,427 were Cesarean Section (CS). The prevalence of readmission was 1.39%. The most common cause of readmission was febrile complications, with pelvic abscess (17.7%) and metritis (27%) being the most frequent. Pelvic abscess occurred only in women with cesarean delivery. Wound dehiscence rates were 3.3% for episiotomy and 4.7% for cesarean. Blood transfusion was required in 35.5% of cases, with 7.0% related to VD and 26.5% to CS.

Conclusion: This study showed that in patients undergoing CS, there were greater rates of postpartum readmission and morbidity and longer length of hospital stay. The most common cause of hospitalization was febrile morbidity followed by delayed postpartum hemorrhage, Abscess, Episiotomy, Hospitals, University, Iran

A Rare Case of Non-Ossifying Fibroma in a 32-Year-Old Man: Case Report and Review of Literature

Sat, 31 May 2025 10:00:17 +0000

Background: Non-ossifying fibroma is a benign fibrohistiocytic bone tumor and occurs mostly in the metaphysis of long bones. Non-ossifying fibroma of the rib is extremely rare.

Case presentation: Herein, a case of a 32-year-old man who was referred for a prolonged cough after an accident was presented. CT scan revealed a well-defined expansile lesion in the right 11^th rib. Due to the uncertainty of the diagnosis, a core needle biopsy was taken from

the lesion. The biopsy showed proliferated bland fibroblasts admixed with multinucleated giant cells and hemosiderin deposition. Based on the imaging findings and H&E studies, non-ossifying fibroma of the rib was confirmed.

Conclusion: Although the most common sites of non-ossifying fibroma are metaphysis of long bones, they can occur in any bone. The diagnosis of non-ossifying fibroma is based on radiological findings, and the correct diagnosis in imaging studies reduces invasive procedures

Unravelling Drug-Induced Arrhythmias: A Case Series Analysis

Varun A, Kirubhakaran K, Ranga Bashyam SR — Sat, 31 May 2025 10:01:49 +0000

Background: Drug-induced arrhythmias pose a significant clinical challenge, with potential life-threatening complications such as cardiac arrest and sudden cardiac death. Understanding the epidemiology, implicated drugs, and clinical characteristics of drug-induced arrhythmias is crucial for optimizing patient care and improving outcomes.

Methods: A retrospective cohort study involving 500 arrhythmia-diagnosed patients was conducted. Drug-induced cases were identified through meticulous medication histories. Various demographic and clinical variables were collected, and statistical analyses, including logistic regression, explored the association between drug exposure and arrhythmia development.

Results: Among the 500 patients diagnosed with arrhythmias, 115 cases (23%) were attributed to pharmacological agents. Notably, amiodarone was significantly associated with arrhythmia development (p<0.001, OR=2.5, 95% CI 1.8–3.4), as were ciprofloxacin (p=0.006, OR=1.8, 95% CI 1.2–2.7), sertraline (p=0.014, OR=1.6, 95% CI 1.1–2.3), and amitriptyline (p<0.05, OR=1.6, 95% CI 1.1–2.3). Advanced age (>65 years) was significantly associated with a higher risk of drug-induced arrhythmias (OR=2.5, p<0.001), similar to a history of cardiovascular disease (OR=3.1, p<0.001). Polypharmacy (OR=2.8, p =0.002) also emerged as an independent risk factor.

Conclusion: Understanding the complexity of drug-induced arrhythmias is crucial for patient care. Tailored risk assessment and management strategies are imperative to mitigate adverse outcomes associated with these arrhythmias, especially in high-risk patient populations. Incorporating personalized approaches into clinical practice can enhance patient safety and improve outcomes in individuals prone to drug-induced arrhythmias.

Vitamin D Deficiency: A Major Issue for Patients Undergoing Hemodialysis

Nader Aghakhani, Roya Naderi — Sat, 31 May 2025 10:03:11 +0000

The Article Abstract is not available.

Extended Reality Technologies in Respiratory Care

Babak Daneshfard, Arda Kiani — Sat, 31 May 2025 10:04:31 +0000

The Article Abstract is no available.

The Importance of Psychological First Aid for the People of Gaza: Necessities and Challenges

Zahra Saboohi — Sat, 31 May 2025 10:05:42 +0000

The Article Abstract is no available.