humans

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

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

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

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

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

External-Beam Radiation Therapy (EBRT) is one of the most important treatments for prostate cancer. Metformin is a multifunctional drug that can control complications following radiotherapy.  This double-blind, randomized clinical trial was conducted on patients with prostate cancer candidates for EBRT. Patients were randomly assigned to two groups receiving oral Metformin (n=20) or placebo (n=20). The incidence of acute complications was investigated using radiation therapy oncology group acute complications criteria.  There was no significant change in the number of blood cells before and after treatment in the two groups (p<0.05). The micronuclei number in both groups showed a significant increase during radiotherapy, immediately and one month later (p<0.001). There was no significant difference in number of micronuclei between the two groups (p<0.05). The frequency of urinary complications ≥ grade 2 in the metformin group was lower (p=0.005). There was no significant difference in the incidence of gastrointestinal complications ≥ grade 2 between the metformin and placebo groups (p=0.5).  It is recommended that further studies on Metformin as a radioprotective agent in prostate cancer patients who are candidates for radiotherapy be carried out. This research project was registered in the clinical trial center (IRCT: IRCT20211213053377N1).

Abstract Using an effective method to enhance nurses’ knowledge of ECG interpretation is one of the most essential requirements for nursing managers. Self-directed learning approaches can help to introduce lifelong learning in learners, especially in clinical settings. This study purposed to detect the effect of the implementation of the clinical teammate nurse program on the critical care nurses’ knowledge of ECG interpretation on cardiac arrhythmia.  A pilot study was performed by a quasi-experimental design with a nonequivalent control group. The participants were 32 critical care nurses divided into two groups: the clinical teammate nurse program and control groups. The data were collected by a knowledge assessment questionnaire that measured nurses’ knowledge of ECG interpretation of cardiac arrhythmia. The nurses’ knowledge was measured three times: initial study, one month, and six months later. The mean and standard deviation of age of participants was 32.38±7.03 years. There was a significant difference between three scores of repeated measurement of nurses’ knowledge (p<0.001), as the nurses’ knowledge one month after the study was significantly higher than in the initial test six months later. Also, pairwise comparisons showed that nurses in the clinical teammate program had higher knowledge scores than the control group (p<0.001).  The clinical teammate nurse program can be used as an easy and economical way to improve nurses’ knowledge in interpreting ECG. This method can also be an excellent alternative to formal and traditional methods such as lecturing programs in continuing education programs.

Temporomandibular Disorders (TMDs) are a group of disorders associated with masticatory dysfunction. TMDs are usually diagnosed late which leads to complicated treatments. Early diagnosis and treatment of TMDs are essential. A valid and reliable version of Fonseca’s Anamnestic Index (FAI) was prepared in Persian from the English version. It was used to assess TMD in 350 patients. Clinical signs of TMD were also recorded based on examination. FAI scores showed 161(46%) people had TMD. There was no significant difference between occlusion classes in terms of the frequency of TMD. There was no significant difference between the mean maximum mouth opening and severity of TMD. In this study the validity and reliability of the FAI in Persian language, as a simple tool for TMD screening in health centers, was confirmed.  Based on results, there is a relationship between clinical findings and the severity of TMD by using FAI and it can be used for screening TMD patients.

Atrial fibrillation (AF) is a prevalent arrhythmia, and predicting its occurrence plays a crucial role in reducing its complications. This study aimed to investigate the relation between simple P wave parameters and paroxysmal AF (pAF). In this case-control study, demographic and laboratory data were gathered by a checklist. P wave parameters were measured in electrocardiography (ECG). The relationship between these parameters and AF in groups was analyzed.  Eighty individuals were included (40 patients with pAF (57.5% female, mean age = 64.9 ± 2.04) and 40 individuals without AF (57.5% female, mean age = 60.3 ± 2.01)). The P wave peak time (PWPT) in leads D2 (p = 0.003) and V1 (p = 0.001) were longer in the case group. In addition, the prolongation of the PR interval (PR) in lead D2, P wave duration (PWD) in lead D2, and P terminal force (PTF) in V1 were associated with an increase in the occurrence of pAF. Adjusted regression analysis showed that two variables, PWPT in V1 (OR, 95% CI: 1.04 (1.01-1.07), p = 0.005) and PWD in D2 (OR, 95% CI: 1.03 (1.00-1.05), p = 0.018), were predictors for AF.  Our results underscore the potential utility of simple ECG parameters, especially PWD in lead D2 and PWPT in V1, in predicting and assessing the risk of pAF. These findings provide valuable insights for clinical practice and risk stratification in patients without structural cardiac disease. Additionally, these findings may potentially contribute to the prevention of complications and injuries associated with pAF.

Since brain temperature fluctuations are related to cognitive disorders, regulating brain temperature has become a key focus in cognitive studies. This study examined the effect of frontopolar cortical cooling on working memory using a cortical thermal stimulation device (CTSD).  This phase II, randomized, controlled trial included twenty participants randomly divided into two groups to receive 30 minutes of frontopolar cortical cooling across four sessions. The control group received sham cooling, while the intervention group received real cooling. Spatial working memory tests were recorded from both groups before and after the first and after the fourth sessions. The cortical thermal stimulation device used for cooling operates through the flow of water and alcohol in a closed loop. After four sessions of frontopolar cortical cooling, a significant improvement in working memory was observed. The analysis of working memory results, based on an ANCOVA test, showed an improvement in the Spatial Working Memory (SWM) test in the intervention group compared to the control group (p < 0.05). Considering the positive effect of frontopolar cortical cooling on working memory capacity, the results suggest that using an appropriate tool for cooling the cerebral cortex could become a practical approach in cognitive rehabilitation.

Brucellosis, a zoonotic bacterial disease caused by Brucella, affects humans and domestic animals, leading to significant economic loss. This study examined suspected cases in North Khorasan, Iran, to understand the prevalence of infection and its characteristics in this region.

Blood specimens were collected from 200 patients suspected of brucellosis after obtaining informed consent. Serum samples were tested using RBPT, Wright, and 2-ME agglutination tests. Blood samples were cultured on Brucella agar, and positive cultures underwent biotyping and PCR assays. A questionnaire identified correlated risk factors.

RBPT, Wright, and 2-ME tests showed 25% brucellosis seroprevalence in symptomatic patients. In contrast, the prevalence was 2.5% among those with positive blood cultures. Notably, all culture-positive patients were also serologically positive, with titers exceeding 1:320 in Wright and 2-ME tests. Most positive cases were in people in their 30s, with B. melitensis biovar 1 identified as the causative agent, and the results were confirmed by multiplex PCR. Significant risk factors include contact with livestock and consumption of raw milk (P < 0.0001).

The findings highlighted the importance of comprehensive diagnostic approaches for accurate identification of brucellosis. Furthermore, education regarding close contact with animals and pasteurization of dairy products is essential for controlling human brucellosis.

The improper length and direction of pedicle screw may also cause it to penetrate the adjacent organs. Unknowing the safe zone of dimensions and directions of the pedicles is essential to proper screw placement. 

The present study is a cross-sectional morphometric study on patients with spinal trauma referred to the neurosurgical department in 2021. The MARCO PACS software scale measured the CT scan images and included the vertebral left pedicle diameter, pedicle body distance, body aorta distance, pedicle diameter, height, and area. The entry point and direction of the pedicle screw were made with the “free-hand” method. 

301 patients were included, consisting of 113 females (37.5%) and 188 males (62.5%). The mean age of the participants was 42.87±12.3 years. “Among all T12 vertebra parameters, just body aorta distance was not significant between genders (p-value=0.311). The pedicle height and body aorta distance were lowest among 18-35 years patients (p-value=0.001) (p-value=0.003), respectively. Post-hoc analysis revealed a significant difference between 18-35 and 51-70 years for body aorta distance in the L1 vertebra (p-value=0.002). 

The present investigation has shown significant differences between genders for optimal left pedicle screw parameters, which should be considered before surgery.

Anemia is considered as one of the risk factors affecting the outcomes after cardiac surgery. Accordingly, the improvement of iron deficiency anemia through injection or oral may be associated with the improvement of post-procedure results, especially the improvement of cardiovascular function. This study was aimed at investigating the effectiveness of iron treatment shortly before surgery in reducing the need for blood transfusion and improving myocardial performance parameters (left ventricular ejection fraction) in coronary bypass surgery patients. This study was a single-blind randomized clinical trial. In total, 60 candidates for coronary bypass surgery having iron deficiency anemia before the operation were randomly divided into two groups treated with injectable iron supplement (iron sucrose at a dose of 200 mg/200 ml of normal saline injected in 30 minutes) 48 to 72 hours before surgery or without therapeutic intervention. The patients were examined during and after the operation in terms of surgical outcomes. Treatment with injectable iron before surgery was associated with improvement in serum hemoglobin level after surgery and a significant reduction in the need for intraoperative and postoperative transfusions. Preoperative treatment of iron deficiency was associated with a reduction in the length of hospitalization of the patients after surgery.  Treatment of iron deficiency anemia within 48 to 72 hours before surgery will improve the condition of patients’ anemia and compensate serum hemoglobin, reduce the need for blood transfusion during surgery and the length of hospitalization of the patients after surgery.

The present study was conducted to predict attitudes towards illness based on early maladaptive schemas and intolerance of uncertainty in individuals with Multiple Sclerosis (MS). This was a cross-sectional study conducted on 62 patients with MS (72% of them were female). They were selected based on availability and voluntary participation. Data were collected through three questionnaires: the Illness Attitudes Scale, the Intolerance of Uncertainty scale, and the Yang Schema Questionnaire. The mean age (±SD) of the participants and duration of diagnosis was 36.10±7.05 yr, and 4.21±3.78 yr, respectively. The results showed that 18 early maladaptive schemas, together with intolerance of uncertainty, can predict up to 8.9% of illness attitude in patients with MS. Among the early maladaptive schemas, schemas of emotional deprivation, social isolation-alienation, abandonment-instability, failure, dependence-underdeveloped self, vulnerability, trapped-victim, emotional inhibition, stubborn/fault-finding standards, self-control disciplinary, seeking attention-seeking approval, and negativity/pessimism had a significant relationship with attitudes towards illness (p<0.05). Additionally, there was a significant relationship between intolerance of uncertainty and all its dimensions with attitudes towards illness (p<0.05). Early maladaptive schemas and intolerance of uncertainty can predict illness attitudes in patients with MS. Patients with MS who have high intolerance of uncertainty are more likely to interpret ambiguous information as threatening. Therefore, effective interventions in the field of uncertainty intolerance for these patients can likely be effective in improving their attitudes towards illness and preventing the exacerbation of their symptoms.

The situation of the relatives of surgery patients in waiting areas is an important issue, which has not been investigated in Guilan province, so this study was planned.

This cross-sectional descriptive study was conducted in Guilan academic hospitals (Razi-Poorsina-Heshmat-Alzahra–Amir al Momenin) from Feb 2022 to Dec 2022. Relatives of patients who underwent elective surgeries enrolled the survey. A questionnaire containing two parts of demographic data and 12 items assessing relative’s conditions in waiting area was filled out via a direct interview. 

318 relatives enrolled the survey. 93.2% of patients’ relatives were first-degree relatives.76.7% had information about the surgery. 41.5% were informed of their patient’s status in operating room. Fear of not emergence from anesthesia 109(34.3%) and death 105(33.0%) were the main causes of anxiety which was reported as 8.23±28.2 from 10 and only 6(1.9%) had financial concern. 86.8% of the responders declared that being informed from their patient’s condition in operating room, was the most effective approach to reduce their anxiety. A positive and highly significant association was observed between the level of education and receiving explanation from surgeon, anesthesiologist and being informed from patients’ status in waiting area (p=0.001).

It was found that relatives of surgery patients suffered from high degrees of anxiety mainly due to fear of death and not emergence from anesthesia. They stated that being informed from their patient’s conditions was the most powerful factor in reducing their anxiety.

Autism Spectrum Disorder (ASD) is a neurodevelop-mental disorder. According to the DSM-V, this condition has a variety of symptoms including impaired social relationships, and behavioral disorders. Various studies have shown that these children also have balance problems that are rarely investigated in this population. The purpose was to investigate the effect of single- and dual-task exercises on the functional balance of these children.

The study design was a clinical trial research. The participants were 40 children with ASD (9 to 14 years) who were randomly divided into two groups. The single-task exercise group only performed balance exercises, while the dual-task exercises group performed both balance exercises and cognitive tasks at the same time. The sessions consisted of 45-minute sessions (3 times a week for 4 weeks). The functional balance tests were performed before and after the intervention.

There were no significant differences between two groups in the Timed Up and Go test, 10-meter walk test and Mini-BESTest endpoint of the study, but there was a significant difference in Pediatric Berg Balance Scale (p=0.01, effect size=0.82). Dual-task exercises could not cause significant improvements in the functional balance of the participants compared to the single-task group. 

It seems that evidence that dual-task exercises cause significant improvements of functional balance of the participants compared to the single-task group is inconclusive.

Despite significant advances in patient treatment, infection remains a complication after surgery. The present study compared the incidence and severity of wound infection with two methods of washing the primary prep area with 70% alcohol and normal saline in patients who are candidates for orthopedic surgery in Kowsar Hospital of Sanandaj, Iran.

This single-blinded randomized clinical trial was conducted on 190 candidates for upper limb orthopedic surgery aged 18 to 65. Patients were randomly assigned to two alcohol and normal saline groups based on the table of random numbers. The primary outcome of this clinical trial was the incidence and severity of wound infection after surgery, which was measured by the standard scale of the Asepsis index. The results were analyzed using SPSS version 23, and statistical values less than 0.05 were considered significant.

Patients’ hospitalization duration in the intervention group was (3.02±1.04 days) and in the control group (2.86±1.03 days) showed no significant statistical difference (p=0.297). The frequency of wound infection in the alcohol group was lower than in the normal saline group. this difference was statistically significant (p=0.023). Also, the severity of wound infection in the 70% alcohol group (Mean=5.12, SD=3.19) was lower than in the normal saline group (Mean=7.69, SD=4.12). This difference was statistically significant (p<0.001).

The present clinical trial showed that the incidence and severity of wound infection after surgery were lower in the group washing the skin of the surgical area with alcohol compared to the group washing with normal saline.

SARS-CoV-2, the causative agent of the COVID-19 pandemic, spreads through both direct and indirect pathways. Among the latter, surface contamination is a significant concern due to the virus’s prolonged viability on surfaces. There is ongoing discussion over the impact of environmental surface contamination, especially in light of the introduction of novel viral types. The present study aimed to examine the extent of environmental surface contamination across different hospital wards and evaluate the effectiveness of disinfectants in inactivating the virus.

The samples were collected from critical areas in a hospital, both pre-disinfection (n = 40) and post-disinfection (n = 17), using reverse transcription-polymerase chain reaction (RT-PCR) to detect SARS-CoV-2.

The findings indisputably confirm the presence of SARS-CoV-2 on swab samples from frequently-touched surfaces. Notably, 10 samples were virus-positive before disinfection, highlighting persistent viral contamination in vital hospital zones.

This study underscores the critical role of environmental surface contamination in SARSCoV-2 transmission, particularly in healthcare settings. Detecting the virus on frequently-handled surfaces underscores the urgent need for rigorous and frequent surface disinfection. Effective surface disinfection remains a rapid, straightforward, and practical strategy to mitigate virus transmission to healthcare workers and patients. These findings hold significant implications for infection control, particularly amid emerging virus variants. They emphasize the need to maintain stringent hygiene and disinfection practices within healthcare facilities to combat the spread of COVID-19.

This study aimed to compare the effects of Triadent (triamcinolone mucoadhesive paste) and Ora-Aid mucoadhesive patch on the severity of pain, burning sensation, and size of minor aphthous ulcers.

This double-blind clinical trial was conducted on 40 patients with minor aphthous ulcers. The patients were randomly assigned to two groups (n=20) to use Triadent paste or Ora-Aid mucoadhesive patch (3 times/day). The severity of pain and burning sensation of patients was quantified by a visual analog scale (VAS). Size of lesions was also measured before, and at 3, 5, and 7 days after the treatment by using a graded paper placed next to the lesions. Data were analyzed by the t-test and the Mann-Whitney test (alpha=0.05). 

The mean reduction in lesion diameter at 3 days (compared with baseline) was significantly greater in the Ora-Aid than the Triadent group (P=0.000). However, the mean reduction in lesion diameter at 5 and 7 days was significantly greater in the Triadent group (P=0.000). The mean reduction in the severity of pain and burning sensation was significantly greater in the Ora-Aid group than the Triadent group at 3, 5, and 7 days (P=0.000).

Both Triadent and Ora-Aid significantly decreased pain, burning sensation, and size of minor aphthous lesions. However, Triadent was significantly more effective for reduction of size of lesions while Ora-Aid was significantly more effective for reduction of pain and burning sensation.

Over the past decade, Iranian households have experienced a decline in dairy product consumption. This study aimed to evaluate the population-attributable risk of prevalent non-communicable diseases related to dairy product consumption.

This cross-sectional analytical study involved 628 adults over 18 years old in Hamadan City in 2021. Clusters were selected based on comprehensive urban health centers. The standardized Iranian version of the food frequency questionnaire was used. Participants were categorized into 3 levels of dairy product consumption: >1 serving per day, 1–2 servings per day, and ≥3 servings per day.

The mean age of the 628 participants was 38.05 (SD: 12.5), with 42.36% being male. Cheese (54.5%), yogurt (39.7%), and milk (30.4%) were consumed most frequently. The prevalence of insufficient dairy product consumption was 48.6%, higher than that reported in previous studies. Insufficient dairy product consumption was associated with hypertension (9.3%), cardiovascular disease (5.6%), and osteoporosis (5.1%).

Individuals with lower education levels, female gender, lowest quartile of socioeconomic status, and those diagnosed with cardiovascular disease were more likely to have insufficient dairy product consumption. Insufficient dairy product consumption was associated with hypertension, cardiovascular disease, and osteoporosis.

Ovarian granulosa cells (GCs) are essential for follicular development. Ovarian advanced glycation end-products (AGEs) accumulation is related to GCs dysfunction. Alpha-lipoic acid (ALA) illustrates therapeutic capabilities for infertility-related disorders. Therefore, this study assessed the effects of ALA on AGEs-induced GCs hormonal dysfunction.

The study was conducted from October 2021 to September 2022 at the Department of Medical Genetics, Shiraz University of Medical Sciences. Isolated GCs (n=50) were divided into control, human glycated albumin (HGA), HGA+ALA, and ALA treatments. Steroidogenic enzymes and AGE receptor (RAGE) genes were assessed by qRT-PCR. Steroid hormones and RAGE protein were evaluated using ELISA and Western blotting. Data were analyzed using GraphPad Prism software (ver. 9), and P<0.05 was considered significant.

Our findings showed that HGA treatment significantly (P=0.0001) increased RAGE (by 140.66%), STAR (by 117.65%), 3β-HSD (by 165.68%), and 17β-HSD (by 122.15%) expression, while it decreased CYP19A1 (by 68.37%) expression. RAGE protein level (by 267.10%) was also increased in HGA-treated GCs. A significant decrease in estradiol (by 59.66%) and a slight and sharp elevation in progesterone (by 30.40%) and total testosterone (by 158.24%) levels was also observed. ALA treatment ameliorated the HGA-induced changes in steroidogenic enzyme mRNA levels (P=0.001) and steroid hormone secretion (P=0.010).

This work shows that ALA therapy likely corrects hormonal dysfunctions caused by AGEs in luteinized GCs. This effect is probably achieved by decreased RAGE expression. Clinical research is needed to understand how AGEs and ALA interact in the ovary, which might lead to a more targeted ovarian dysfunction therapy.

At present, combined provision of direct composite restorations and dental bleaching has become increasingly popular to meet the esthetic demands of patients. This study aimed to assess the effect of internal bleaching on microtensile bond strength of composite to freshly veneered enamel. 

In this in vitro experimental study, 50 sound extracted human premolars were randomly divided into five groups (n=10). All teeth received composite veneers. Two groups underwent no further intervention and were subjected to measurement of microtensile bond strength of composite to enamel 24 hr and one week after the veneering. The remaining three groups underwent internal bleaching. Group 3 underwent bleaching one month after the veneering, and microtensile bond strength was measured after 24 hr. In groups 4 and 5, bleaching was performed immediately after the veneering. Microtensile bond strength was measured after 24 hr in group 4 and after one month in group 5. Data were analyzed using one-way ANOVA.

All the groups were not significantly different regarding the mean bond strength (p=0.110), but they were significantly different in terms of the mode of failure (p=0.01) such that the mode of failure was mainly adhesive in the three bleached groups. 

Internal bleaching after composite veneering has no significant effect on microtensile bond strength of composite to the enamel.

In recent years, there has been a growing emphasis on exploring the influence of spirituality/religion on the management of mental health disorders. The aim of this study was to investigate the viewpoints of Iranian patients with mental health disorders regarding the incorporation of spirituality into their assessment.

This cross-sectional study was conducted in 2021 at Iran University of Medical Sciences. Initially, a questionnaire was developed based on key spiritual concepts identified from a literature review. The content and face validity of the questionnaire were evaluated by an expert panel, and its reliability was assessed using Cronbach’s alpha coefficient. Data collection was carried out in the second phase, with the questionnaire consisting of 4 questions examining the patients’ perceived need and willingness for their therapist to explore their spiritual and religious dimensions. Data analysis was performed using appropriate statistical tests.

The questionnaire’s validity was confirmed, and its reliability was demonstrated with a Cronbach’s alpha value of 0.79. A total of 368 patients participated in the study. No significant associations were observed between the participants’ educational level, diagnosis type, gender, and the questionnaire scores. Approximately half of the patients with mental health disorders expressed a desire to incorporate spiritual assessments into their psychological evaluations, with most welcoming this integration.

The findings of this study suggest that despite challenges and barriers, efforts should be made to integrate spiritual dimensions into the treatment of patients.