مجله علوم پزشکی صدرا
سال دهم شماره 1 (زمستان 1400)

Scoliosis is a musculoskeletal disorder in which a person's spine bends sideways and rotates along its vertical axis. Cobb-angle (CA) is a common index to evaluate, determine, and track the progression of scoliosis; however, measuring this index manually depends on the operator’s experience and image quality, which may lead to errors, dispersion of obtained values, and variability. This study aimed to resolve this issue by developing an algorithm for measuring CA.

In this analytical study, we developed software using image processing, data modeling, and analytical geometry tools for measuring CA.  A given x-ray image was processed to highlight the spinal cord. Then, the spinal cord curvature was extracted by manually segmenting the spinal cord in the given image and fitting a polynomial function to the data points in the identified region.  Finally, CA was estimated by calculating the angle between the two normal lines that pass through the inflection points of the fitted curve. Thirty X-ray images having CA values obtained by an expert were used to evaluate the accuracy of the developed algorithm.

There is no statistically significant difference between the average CA values measured by the expert (53.95º ± 20.3º) and those estimated using the developed software (56.41º ± 19.95º). There is a significant correlation between the values estimated using the developed algorithm and the reference values, (r=0.93) and (P<10-8).

The obtained results are promising and show that the developed algorithm might be used to measure cobb-angle. Nevertheless, its accuracy and reliability should be further evaluated using a large data set.

Environmental and structural factors have a significant effect on the concentration of bioaerosols in the indoor air; however, this issue has not received enough attention in research. . Therefore, this study aimed to determine the distribution of bioaerosols and environmental factors affecting the concentration of bioaerosols by using an artificial neural network.

In this study, the concentration of bioaerosols was determined using the inactive method for one hour in the human respiratory tract. The teypticas soy agar and sabouroud dextrose agar were used to culture bacteria and fungi; then, they were incubated at 15, 25, and 37° C. The independent variable includes three categories of structural variables (number of ward beds, room dimensions, and window dimensions), hospital management and management variables (ward air change per hour), and analytical variables (incubation temperature and type of culture medium). The effect of these variables was modeled by an artificial neural network with Levenberg–Marquardt algorithm.

This study showed that the distribution of bioaerosols in dialysis and surgery wards was higher than in other wards. Also, the artificial neural network can predict the effect of environmental and structural factors of the hospital on bioaerosols, especially fungi because the maximum and minimum concentrations of bacteria and fungi in the actual data were similar to the data predicted by the artificial neural network. In addition, the correlation coefficient for the fungi was 0.95, and the correlation rate between the actual data and the data predicted by the artificial neural network was higher than 0.92.

ANN could be a desirable and reliable method for detecting bioaerosol in hospitals based on the environmental and structural parameters.

Drug abuse is a major concern, leading to inappropriate control of pain, agitation, and delirium. In the current study, we aimed to evaluate the effect of implementing Pain, Agitation, and Delirium (PAD) control protocol on the outcomes of critically ill patients with a history of drug abuse in the intensive care unit (ICU).

In this experimental study, 44 opioid-dependent patients (18 years and older) were included. The pain was assessed by the Behavioral Pain Scale (BPS) per hour, the level of sedation was evaluated by the Richmond Agitation Sedation (RASS) per hour, and Delirium was measured every 8 hours by the Confusion Assessment Method (CAM-ICU). Based on the type and dose of the consumed drug and the way it was used, the dose of methadone was calculated. In addition, possible symptoms of withdrawal syndrome and excessive use were assessed every hour by the intensive care unit nurse.

The ICU stay length was 17 days in the control group and seven days in the intervention group. Patients in the intervention group received lower doses of Methadone and Propofol compared to the control group during 72 hours and lower doses of fentanyl after 48 and 72 hours (p<0.05). In addition, patients with acceptable limits of pain and sedation were significantly more in quantity in the intervention group compared to the control group (p=0.001 and p=0.05, respectively).

Implementing PAD protocol, along with appropriate medical therapy, can greatly help improve the medical care provided by the ICU team.

Many women with breast cancer suffer from the psychological problems associated with cancer, and the patients' psychological well-being is deteriorating daily. This study aimed to compare cognitive avoidance, intolerance of uncertainty, and emotion regulation in women with and without breast cancer.

The research method was causal-comparative. The statistical population of this study was all patients with non-metastatic breast cancer referred to the Shahid Motahari clinic, selected by the convenience sampling method (n=100). Also, all women referring to primary schools in District 2 of Shiraz during the same two-month period were selected as cancer-free and healthy women (n=100) for comparison with the group of women with breast cancer. The data were collected by Sexton and Dougas’s Cognitive Avoidance Questionnaire, Freestone, Ryuma, Retarte, Dogas, and Ladosaur’s Intolerance and Ambiguity Questionnaire, and Garnfski and Craig’s short questionnaire of Cognitive Emotion Regulation. Data were analyzed using (MANOVA).

The results showed a significant difference between women with breast cancer and without cancer in the components of cognitive avoidance (P<0/029), intolerance of uncertainty (P<0/0001), and emotion regulation (P<0/046).

 Findings showed a difference between cognitive avoidance variables, intolerance of uncertainty, and emotion regulation in women with breast cancer and those without cancer. Therefore, identifying psychological factors and their role in women with breast cancer help reduce the problems of women with breast cancer.

The education process of Health and Medical Network Staff and its improvement provides human resources an ever-changing work environment compatibility. Education is a tool that aids managers in managing organizations in different ways. This research was done with the goal of presenting a model for enhancing the quality of education for health and medical network staff, using Structural Equations Modeling.

It is an exploratory study. Population in this research was 150 staff at Fars Province working in numerous health branches selected through random cluster sampling. The sample size (108 people) was determined using Cochran's formula. The completed questionnaire included demographic information and questions related to the research hypothesis. Confirmatory Factor Analysis was used to check the validity of the questionnaire and Structural Equation Modeling and Smart PLS 3 software were applied to analyze the data.

Out of 108 participants, 40.7 percent were males (44 in total) and 59.3 were females (64 in total). Out of 108 participants, 21.3 percent (23 in total) were single and 78.7 percent (85 in total) were married. All factor load ratios were more than 0.4, which show the use of proper modeling. Cronbach's alpha for all structures was 0.7, which indicates high reliability. All components and effective factors on the quality of education of Health and Medical Network staff were identified and validated.

The findings showed the mechanisms used to improve the education quality of health and medical network staff were adequate, and the current status of the quality of education for health and medical network staff is approximately medium to high. Education holds an undeniable place in the prosperity of an organization. Therefore, planning for staff education will result in better service and satisfaction of the clients.

Psychological state of multiple sclerosis patients is very important due to its strong influence on incidence, progression, prognosis, and treatment of this disease. The present study compared the effectiveness of gestalt therapy, behavioral activation and placebo on cognitive emotion regulation in Multiple Sclerosis patients.

This study was a quasi-experimental pretest-posttest design with a control group and three months follow-up in which sixty patients with multiple sclerosis referred to the MS Clinic of Rasoul Hospital in Tehran were selected. Using four blocks, the authors randomly assigned participants to four groups of 15 people, including three intervention groups and a control group. Members of psychotherapy groups were treated once a week for eight 90-minute sessions. In the placebo group, capsules containing rice flour were used once a day for 8 weeks.  The people in the control group received no intervention during this period. The research instrument was Garnefski's (2006) Cognitive Emotion Regulation Questionnaire. SPSS (25) was used for data analysis.

The results showed that gestalt therapy and behavioral activation in comparison with placebo and control groups increased the mean scores of adaptive cognitive emotion regulation strategies (p=0.001) and decreased the mean scores of non-adaptive strategies (p=0.001) in post-test and follow-up. Gestalt therapy, in comparison with behavioral activation, increased the mean scores of adaptive strategies (p=0.027) and also decreased the mean scores of non-adaptive strategies (p= 0.020) more significantly in post-test and follow-up.

Gestalt therapy is more effective than behavioral activation and placebo in improving cognitive emotion regulation in patients with multiple sclerosis.

Economic resistance means strengthening the economy to accelerate economic growth and GDP when the country is under the illegal and oppressive sanctions of hostile regimes. The health system is one of the important parts of production cycles in our country, relying on the capability and skills of experts in this field. Under the influence of sanctions, health system has also received a severe pressure and difficulty in supplying some basic health-related items and financing. However, properly allocating resources and applying the Supreme Leader's guidelines on the economic resistance can help solve these problems. Also, using the health system's production potentials in health tourism, etc., can promote this system as an important part of the country's production system. In addition, current situation and the coronavirus outbreak shed light on the importance of the health system worldwide. During the epidemic, the lack of resources and workforce in the health system can be solved based on the economic resistance guidelines.

.Various methods have been proposed to treat Cervicovaginal agenesis with the functional uterus, but unfortunately, some of these methods eventually lead to a hysterectomy. In this study, we investigated a new surgical method in treating these patients and its short and long-term consequences, which is performed for the first time in the world by the laparoscopic method.

Seven women aged 18 (12-27) years who had a functional uterus with cervicovaginal agenesis (between 2016 and 1398) in the Ghadir and Dena hospital underwent cervicovaginoplasty with sigmoid colon replacement by laparoscopic method to establish normal menstrual cycles and have a functional uterus and vagina. The average follow-up duration was 25.9 months (2-48 months).

The mean BMI of the patients was 19.7 (17.6-22.4). The average time interval between the initiation of disease symptoms and the operation was 52.28 months (2-156 months). All the patients had regular menstrual cycles. The average length of the vagina was 8.9 cm (7.6-10.5 cm). One patient observed proximal stenosis of neovagina 12 months after surgery. We had no significant postoperative complications. We did not perform hysterectomies on our patients. Two subjects had sexual activities without dyspareunia, post-coital bleeding, or malodor vaginal discharge.

Sigmoid cervicovaginoplasty is a safe and effective procedure with satisfactory long-term outcomes. This surgery eliminates the psychological burden of hysterectomy in these patients.