Journal of Iranian Medical Council
Volume:7 Issue: 1, Winter 2024

The present study was conducted to provide an up-to-date understanding of clinical applications in balance capability, as well as delivering a review of pieces of literature on Virtual Reality (VR) on balance control in stroke survivors.

Databases including PubMed, Cochrane Library, and Pedro were searched for published papers from 2010 to 2020 with the terms “Game-based rehabilitation”, “balance training”, “virtual reality”, “stroke”, “neurorehabilitation”, and “virtual environment”. We evaluated the effect of VR on balance improvement after a stroke.

33 articles describing results following the use of VR on balance in patients with stroke that met our inclusion criteria were found. Among these studies, two studies described the results in acute, eight in subacute, twenty-two in chronic stroke patients, and one study included both chronic and subacute stroke patients. The results indicated that balance can be improved with VR.

The results of this study strengthen the idea that VR training has the potential to become an effective adjacent to routine rehabilitation treatments for improving balance status post-stroke. However, conducting a randomized control trial that incorporates all three stroke phases with an appropriate study setting is necessary to achieve an integrated clinical protocol.

Emergency Medical Technicians (EMTs) face many challenges and problems as the front line of dealing with epidemics including COVID-19. Therefore, the present study was aimed at exploring the challenges of EMTs in providing pre-hospital care during the COVID-19 pandemic. This qualitative research was conventional content analysis conducted between November and December 2021. The participants were 15 emergency medical technicians working in the emergency center 115 in Shahroud selected by purposeful sampling method. Data were collected through semi-structured in-depth interviews at the location of the participants. Then, the codes, subcategories and categories were extracted by inductive process.  Challenges among EMTs in providing pre-hospital care during the COVID-19 pandemic were categorized under four themes including (1) work factors (high work pressure, non-cooperation of patients, difficulty working with protective equipment) (2) unprepared organization (lack of coordination between medical centers, (3) threatened health (psychological disorders, physical problems) and (4) restless social (challenges with family members, social isolation). Health care managers, authorities and policy makers should use effective strategies to prevent and reduce the challenges of EMS workers in order to minimize their negative effects on EMTs and improve the quality of services provided.

Infectious diseases are major complications after solid organ transplantation. Heart transplant patients have a high mortality rate after Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) infection. Coronavirus disease 2019 (COVID‐19) vaccines have shown efficacy in generating specific immune response. This study aims to describe the COVID-19 infection before and after vaccination in heart transplant recipients.

This was a single-center cohort study including 95 heart transplant recipients with laboratory radiological confirmed COVID-19. 

COVID-19 infection was present before vaccination in 33 (35.78%) patients. The most frequent COVID-19 clinical presentations before vaccination were cough in 21 (63.63%) and myalgia in 19 (57.57%) patients; 12 (36.36%) were hospitalized; 17 (51.51%) cases had oxygen depletion and required supplemental oxygen; none of them needed invasive ventilation. Of the entire 33 COVID-19 patients, two patients (6.06%) re-experienced the disease about two months after complete vaccination and both of them were recovered. 63 heart transplant patients had not experienced COVID-19 before vaccination, of which 59 patients received vaccination. After two months, 23 vaccinated patients were infected with COVID-19 again, and 2 of the 3 patients who were not vaccinated were also infected. Five patients passed away in the whole study.

Heart transplant patients infected with SARS-CoV-2 are at greater risk of severe infection and death compared with immunocompetent individuals. Thus, COVID-19 vaccination for all HT recipients is of paramount importance.

The aim of this study was to estimate the incidence of reactions caused by blood donations in Iran as well as exploring three potential scenarios of the worst, moderate, and the best situations for adverse reactions among Iranian blood donations by specifying the under-reporting rate.

There are two different designs; first, the ecological study  was coducted to estimate the blood donation adverse effects by using the data registered in the donor vigilance part of Iranian Blood Transfusion Organization (IBTO). Second, the cross-sectional study was conducted  to estimate under-reporting in the data. For the cross-sectional study, 2408 donors were selected randomly in three cities.

In general, based on the estimations of this study, adverse reactions to blood donation in Iran is 2%(CI 95%, 1.4-2.6%). Local and systemic reactions estimated are 1.7%(CI 95%, 1.2-2.2) and 0.3%(0.1-0.5), respectively. Based on the national report, in general, adverse reactions to blood donation in Iran is 0.5(CI 95% 0.4-0.6). Local and systemic reactions estimated are 0.38%(CI 95% 0.28-0.48) and 0.03%(0.0.02-0.04), respectively.

Adverse reactions may vary from region to region in Iran, but in total, there is a lot of under-reporting in the incidence of adverse reactions to blood donation in Iran, most of which are related to local reactions.

The aim of this study was to investigate the expression of TLR3, TLR4, TLR7, TLR8 and TLR9 in ovary tissue of ovarian cancer patients. 

In the case control study, 122 paraffin-embedded tissue blocks of patients with ovarian cancer and control groups were collected. Immunohistochemistry technique was used for detecting the expression of TLR3, TLR4, TLR7, TLR8 and TLR 9 in ovary tissues. 

The mean Immunoreactivity Score (IS) of TLR3 in the case and the control groups was 0.6±0.99 and 0.16±0.1, respectively. The mean IS of TLR7 in the case and the control groups was 1.03±1.05 and 0.66±1.07, respectively. A significant difference was observed between the case and control groups in terms of IS of TLR3 (p=0.001) and TLR7 (p=0.013). However, no significant difference was observed between the case and control groups regarding IS of TLR 4, 8 and 9 (p>0.05).

High IS of TLR3 and TLR7 in these patients may confirm the likelihood of association of viral infection with ovarian cancer. Also, considering that TLR3 is one of the receptors that have viral and bacterial ligands, there is a possibility that a bacterial infection is also involved in the development of ovarian cancer. In addition, the expression of TLR4, TLR8 and TLR9 was not different in ovarian tissue of the case and control groups. It is proposed to conduct this study with RT-PCR technique on the paraffin block sample and compare the results with the above results in future studies.

The Laryngeal Mask Airway (LMA) has traditionally become an alternative device for airway management. This clinical trial compared two standard and lateral techniques in inserting laryngeal masks in pediatric airway management. This single-blind clinical trial study was conducted on pediatrics aged 2-6 years who were candidates for elective inguinal herniorrhaphy with ASA I and II under general anesthesia. The pediatrics were randomly assigned to either the standard or lateral methods according to the random number table. The time required to insert LMA and airway pressure as well as the number of attempts to insert in both groups were measured. Data analysis was performed using SPSS version 25; the significance level was less than 0.05. Chest movement and mean airway pressure had no significant difference in both groups (p>0.05). The mean LMA insertion time in the lateral and standard methods was 22.94±7.89 and 65±15.27 seconds, respectively (p=0.001). There was no case of mucosal damage in the lateral method, but ten children had mucosal damage in the standard technique (p=0.001). In the lateral method, LMA was inserted for the first time in 32 pediatrics (94.1%) and two pediatrics (5.9%) in the second time but in the standard group, LMA was inserted in the second time in 11 pediatrics (32.4%) (p=0.006). The lateral method for inserting LMA is practically easy, requires less effort, and has the least complications. Another advantage of the lateral method compared to the standard technique is that inserting a finger into the pharyngeal cavity is unnecessary.

The blended electronic learning system, raised as a new approach in educational planning with great enthusiasm, seeks novel ways to properly combine the media; however, the sequence of in-person and distance educational methods is an issue neglected so far. This study aims to compare the effect of the sequence of blended workshop learning and web-based learning on the learning level of biostatistics in students who were members of the Student Research Committee at Arak University of Medical Sciences.

This is a quasi-experimental study with an alternative treatment design. The statistical population consisted of the students who were members of the Student Research Committee of the university, including 38 medical students and 15 health students, who were selected through census sampling due to their limited number. The data were selected with 2 questionnaires: demographic characteristics and biostatistics multiple-choice questions to assess learning of statistical concepts in three levels of literacy, reasoning, and thinking. The validity and reliability of the translated statistics questions were assessed through content validity and bisection, respectively. The data were analyzed in SPSS-16 through independent and paired t-tests and analysis of variance.

The results showed a statistical difference between the groups in both faculties in statistical literacy and reasoning in blended learning (p>0.05). However, regarding statistical thinking, the difference was significant in the health faculty (p=0.044) and insignificant in the medical school (p>0.05).

Given the statistical difference observed in the health group, we suggest holding in-person courses at first and online courses then.

There has been multiple methanol poisoning outbreaks in Iran throughout the years, thus understanding patient’s socioeconomic status, the type of alcohol they consumed or the reason behind their alcohol consumption will help us to establish ways to prevent these incidences from happening. The aim of this investigation is to assess the prognosis and complications of methanol intoxication.  This cross-sectional study was carried out on patients in Tabriz Sina Hospital during 5 months. The data of the investigated patients was entered into SPSS26. Chi-Square and Logistic Regression tests were used in this analysis.  From the 184 patients, 77.72% (143) recovered completely, 14.67% (27) recovered with permanent complications, and 7.61% (14) died. The most significant predictors of mortality were an increase in levels of Basal excess and creatinine and decrease in respiratory rate, systolic blood pressure and mean arterial pressure on admission and occurrence of arrhythmia. Visual symptoms on admission had protective effects against morbidity and mortality. According to this study, poor outcome was associated with respiratory rate, systolic blood pressure, mean arterial pressure, levels of Basal excess and creatinine, and occurrence of arrhythmia, thus the clinician should evaluate the severity of methanol intoxication based on the history, lab results, vital signs and clinical symptoms in order to minimize morbidity and mortality.

This study aimed to assess the prevalence and correlation of Concha Bullosa (CB) and Nasal Septal Deviation (NSD) with maxillary sinus Mucosal Thickening (MT) using Cone-Beam Computed Tomography (CBCT). This descriptive, cross-sectional study was conducted on CBCT scans of 228 females and 157 males (mean age of 44.82±15.10 years) retrieved from the archives of the Radiology Department of Shahid Beheshti Dental School. The images were evaluated by one oral and maxillofacial radiologist for presence/absence of NSD, CB, and maxillary sinus MT, and their correlations. Statistical analyses were performed by independent t-test, Chi-square test, and binomial test (alpha=0.05). The prevalence of CB, NSD, and MT was 61.6, 80, and 70.6%, respectively. NSD (p=0.131) and CB (p=0.211) had no significant correlation with MT. However, CB and NSD were significantly correlated (p=0.006). NSD had a significant correlation with contralateral presence of CB as well (p=0.000). The prevalence of CB was significantly higher in females (p<0.05), while the prevalence of NSD and MT was significantly higher in males (p<0.05). The present study revealed no significant correlation between CB and NSD with maxillary sinus MT. Thus, in absence of clinical symptoms, patients with CB or NSD should not be necessarily referred for treatment of sinus abnormalities. However, considering the significant correlation of CB and NSD, in case of presence of one entity, the other one should be suspected.

Due to the poor mechanical properties of Glass Ionomer Cement (GICs), their use is limited to low stress-bearing areas. This study aimed to assess the effect of the addition of Titanium Dioxide (TiO2) nanoparticles on the flexural strength and surface hardness of GIC.  In this in vitro study, 3, 5, and 10 wt.% TiO2 nanoparticles were added to Fuji II conventional GIC powder. The purity and composition of the as-synthesized titania were investigated by using XRD and FT-IR tools. The homogeneity of powder particles within the used matrix was evaluated under a Scanning Electron Microscope (SEM). The SEM micrographs confirmed the homogenous mixing of TiO2 nanoparticles with GIC powder. Nevertheless, the flexural strength of experimental groups was not significantly different from that of the control group (p=0.384). However, the surface hardness of experimental groups was decreased in comparison with that of the control group (p<0.001).

Valid and reliable tools are required to measure non-nutritive sucking and oral feeding readiness of preterm infants. The aim of this study was to translate the Non-Nutritive Sucking scoring system (NNS) into Persian language and to evaluate its measurement properties.

A cross-sectional study was conducted to translate and cross-culturally adapt the NNS to Persian language (P-NNS) following steps described in guidelines. Eighty-eight preterm infants participated in this study. Psychometric properties of floor/ceiling effects, internal consistency reliability, inter-rater reliability, Standard Error of Measurement (SEM), Smallest Detectable Change (SDC) and construct validity were tested. Factor analysis was performed to determine the P-NNS structure.

There were no floor or ceiling effects that indicate the content and responsiveness of P-NNS. Internal consistency was high (Cronbach’s α 0.905). Item–total correlations exceeded acceptable standard of 0.3 for the all the items (0.3–0.9). The inter-rater reliability was excellent (k=0.91, SE=0.04; p<0.001). SEM and SDC were 8.04 and 22.28, respectively. Construct validity was supported by a significant correlation between the P-NNS total score and the Persian version of the Early Feeding Skills (EFS) total score (r=0.94, p<0.001). Explanatory factor analysis revealed 2 components for p-NNS.

The P-NNS was cross-culturally adapted to Persian and demonstrated to be a reliable and valid instrument to measure non-nutritive sucking and oral feeding readiness of preterm infants.

The present study was conducted to report the incidence rate of ureteral avulsion and its management in two referral medical centers.

We retrospectively reviewed a total of 36683 transurethral lithotripsy procedures performed during 17 years. All ureteral avulsions were also included in the current study as an intraoperative complication of Transurethral Lithotripsy (TUL). Data including stone location, avulsion site and management details were recorded. 

Fourteen cases of complete ureteral avulsion had occurred in the study period (0.038%), consisting of 8 healthy males and 6 healthy females aged 26 to 73 years (mean age: 50 yrs). Out of these 14 cases, 7 cases had distal ureteral avulsion and seven others had proximal ureteral avulsion. Six cases of distal ureteral avulsion had been promptly treated by the reimplant method whereas immediate nephrectomy had been performed in the remaining case due to a history of poor condition of the renal unit. Proximal ureteral avulsions had been treated by combined Boari flap-psoas hitch procedures with renal mobilization in 3 cases, the autotransplant method in another 3 and by ileal interposition in one case. 

Although the present study is a case series which is normally classified as low level of evidence, it seems that both autotransplant and combined Boari flap-psoas hitch procedures with renal mobilization are safe and feasible techniques for the management of full-length complete ureteral injury.

This study was carried out to evaluate the effect of non-preserved tetracaine 0.5% on pain alleviation in the first 24 hr after Trans-epithelial Photorefractive Keratectomy (TPRK) excimer laser surgery.

This quasi-experimental study was conducted on 50 patients who were candidates for TPRK surgery using SCHWIND AMARIS 1050RS (eye-tech-solutions, Germany) excimer laser. One eye randomly received standard treatment including the eye drops of betamethasone, chloramphenicol, artificial tear, diclofenac, and diclofenac tablet (25 mg daily), and the fellow eye received standard treatment plus non-preserved tetracaine 0.5% drop every 4 hr. Post-operative pain was the main outcome measure, and the secondary outcome measures including burning sensation, epiphora, foreign body sensation, and photophobia were compared using Fisher’s exact test and ANOVA with a significance level of 0.05.

Nineteen patients (38%) were male and 31 (62%) were female. Thirty patients (60%) reported no pain. The numeric scale of pain showed that the severity of pain was 4.4±0.8 for the cases’ eyes and 4.5±0.6 for the controls’ eyes, but the difference was not significant (p=0.75). Also, there was no difference regarding the burning sensation (p=0.49), epiphora (p=0.16), foreign body sensation (p=0.44), and photophobia (p=0.19). No significant difference was noted between the two groups.

Administering the eye drop of non-preserved tetracaine 0.5% every 4 hr had no significant effect on pain alleviation within the first day after TPRK surgery.

With the expansion of the COVID-19, the study of different oxygen therapy methods has yielded different results. In the current study, we compare the effects of non-invasive ventilation and oxygen therapy through the high-flow nasal cannula.

Non-intensive care unit-admitted COVID-19 patients were randomly divided into two groups. The first group received oxygen therapy with High Flow Nasal Cannula (HFNC) and the second group received Non-Invasive Ventilation (NIV). Clinical conditions and results obtained from laboratory tests were compared in two groups before oxygen therapy, and after 24 and 48 hr.

The average age of the participants was 56.25. According to the results, after 24 hr of respiratory intervention, dyspnea was the most frequent in the NIV group with 83.33% and in the HFNC group with 90%. After 48 hr, in the NIV group, nasal flaring was observed with a frequency of 60%, and in the HFNC group, weakness and lethargy were the most common symptoms (56.66%). Comparison of clinical status and laboratory indices of the two groups of patients showed that most of the indices in patients in three time periods were not significantly different, while the results demonstrated that after 24 hours, the mean PaCo2 in the HFNC group was significantly lower than the NIV group (0.002) and the mean PH in the HFNC group was significantly higher than the other group (p=0.039).

The effectiveness of using HFNC compared to NIV is the same and shows no significant difference.

This study was conducted to evaluate the psy-chometric properties of a Persian version of the Adolescent Leisure Interest Profile (ALIP) in Persian-speaking adolescents with Cerebral Palsy (CP). 

Thirty adolescents with CP participated. The test-retest reliability, construct validity of the ALIP with the Children’s Assessment of Participation and Enjoyment (CAPE), and discriminative validity were examined. 

There were no floor and ceiling effects. Test-retest reliability of the Persian version of the ALIP for the total scores ranged from 0.69-0.94. Cronbach alpha for internal consistency of the Persian ALIP was obtained 0.98. Evidence for construct validity was found with significant correlations between the ALIP and the CAPE domains (r=-0.45-0.69). The standard error of measurement and the smallest detectable change values were 0.08-8.22 and 0.22-22.87, respectively.

The Persian version of the Adolescent Leisure Interest Profile is a useful tool for measuring leisure activities in Persian-speaking adolescents with CP.

Cheiloscopy is a forensic investigation technique based on the identification of lip traces. This study sought to assess the distribution of lip print patterns and their stability during the time.

Lip prints were obtained from 133 dental students and the distribution of patterns was evaluated, using the Five-stage Suzuki and Tsuchuhashi’s classification. Six months later, lip prints were obtained again from 40 out of 133 students who were chosen accidentally to assess the stability. The individual lip formula was determined by Paired T-test and ANOVA at p<0.05. 

Type I was the most common pattern in the lips. Lip formulas were found to be unique for each individual. No significant difference existed in the distribution of lip print patterns between males and females, or between the upper and lower lips. In terms of stability, 73.8% of lip print patterns remained unchanged during a 6-month period. 

Lip print patterns are unique to each individual and have medium stability over time. Therefore, cheiloscopy may be considered a useful identification tool in forensic dentistry. However, the lip print pattern cannot indicate the sex of people.

Micronutrient interventions for Adult Attention-Deficit/Hyperactivity (ADHD) could be helpful. We used a naturally processed whole wheat grains supplement containing higher doses of micronutrients named Nutrition Bio Shield (NBS). We aimed to determine its effects on ADHD symptoms in adults. 

Fifty-two medication-free adults with ADHD were randomly assigned to receive 5 g of NBS supplement or placebo daily for eight weeks. 

Twenty-three participants in the NBS group and 24 participants in the placebo group completed the study. After 8 weeks, compared with the placebo, the ADHD scores significantly decreased (mean difference 95%CI): -4.9 (-8.6 to -1.1); p=0.01; Cohen’s d=0.74), and quality of life significantly improved (mean difference 95%CI): 5.6 (0.12 to 11.3); p=0.04; Cohen’s d=0.59) in the NBS group. The observed side effects were minimal and did not differ statistically between groups. 

Quality of life increased during consumption of the NBS supplement, compared to the placebo. However, despite the statistically significant findings, these changes in ADHD symptoms were small and the clinical significance may be low (about 5%).

Tongue Squamous Cell Carcinoma (TSCC) is one of the most consequential oral Squamous Cell Carcinomas (SCC) worldwide. 

This retrospective cross-sectional study was conducted on 29 TSCC patients treated with High Dose Rate Brachytherapy (HDR-BT) with or without External Beam Radiotherapy (EBRT) between 2017-2020. Patients without distant metastasis at the time of treatment and at least one year after completion of brachytherapy were included. 

One-year Overall Survival (OS), Disease-Free Survival (DFS), and Local Control Rate (LCR) were 82.8, 79.3, and 100%, respectively. 6 patients (20.7%) had distant metastasis, of which 5 (17.2%) died. Local recurrence was not observed in any patients, and only one (3.4%) regional recurrence occurred. The most common late toxicity of HDR-BT was dry mouth (79.2%) and dysarthria (66.7%). There were no severe and life-threatening complications (grades 3 and 4) during one year. Also, 79.2% of the patients had good functional performance. One-year OS, the significant difference between the two groups of HDR-BT with and without EBRT (p=0.055).

Our findings indicated that the HDR-BT increases the OS of TSCC patients more than EBRT without developing grade 3-4 AEs and metastasis. We showed that the mean 3.2 ±0.7 Gy of HDR-BT has more OS compared to EBRT.

Several cognitive biases may be involved in the pathogenesis and continuation of symptoms in schizophrenia. Metacognitive Training (MCT) is a treatment program that targets cognitive bias in schizophrenia. The current work aimed to evaluate the influence of MCT on schizophrenia using a single-subject design.

Five patients with schizophrenia received metacognitive training. The treatments were done for at least four weeks, two sessions per week (number of sessions ranged from 8 to 18 sessions). The MCT consists of two sets of eight modules that target common cognitive biases and problem-solving difficulties in schizophrenia. Baseline assessment was performed using the Birchwood Insight Scale (BIS), the Positive and Negative Syndrome Scale (PANSS), the Psychotic Symptom Rating Scales (PSYRATS), the Global Assessment of Functioning (GAF), WHOQOL-BREF and the Peters et al, Delusions Inventory (PDI). The post intervention assessments included the afore-mentioned measures as well as treatment satisfaction. The follow-up assessments were conducted three and six months later. Data analysis was administered employing visual analysis diagrams, percentage of recovery and the Reliable Change Index (RCI). 

MCT was associated with a reduction in positive and negative symptoms (up to 18.7, 100 and 100% on the PANSS, PSYRATS and PDI, respectively) in individuals with schizophrenia, and its effects diminish over time. Insight showed significant improvement, but it was mainly the insight into symptoms. In patients with low baseline score of Quality of Life (QOL), an improvement was reported. The GAF did not change significantly.

MCT can be suggested as an adjunct therapy to decrease the symptoms of schizophrenia and improve the patients’ insight. Patients with more symptoms and lower levels of insight, performance and QOL seem to respond better to MCT. Randomized clinical trials are required.

In this note, we focus on statistical analysis and try to show the deleterious effects of inappropriate use of statistical analysis in medical research.Recently, Foji et al published an article entitled above and showed that the dermatology life quality index can predict the quality of life in patients with neurofibromatosis (1). However, these findings are doubtful due to the following reasons:1. The mean score of quality of life (the total score of the SF-36 questionnaire) is not clear.2. Although the correlation between SF-36 and DLQI can be informative, no correlation was found in the results section.3. The main aim of the study is to predict quality of life using the dermatology life quality index but there is no related model. The reported models are about the prediction of SF-36 dimensions.4. All the reported R-squares are very low (about 10%) indicating that the proposed models are not appropriate for the prediction aims.5. In regression modeling, statistical significance reflects no information regarding the prediction capability. Therefore, the interpretation of the results is not true. For more information, reading an article entitled “to explain or to predict” is highly suggested (2).6. To investigate the prediction capability of each variable, the amount of changes in the adjusted R-squares must be reported.7. In the data analysis section, it was claimed that the significant variables in simple regression were included in the multiple regression but it was not performed. For example, in the “role limitations due to emotional problems” dimension, all of the six variables are significant in the simple model, but just one variable was entered in the multivariate model.8. Finally, the linear regression is not appropriate for molding response variables with a limited range (the scores of SF-36 are between 0 and 100). The appropriate method for these outcomes is beta regression (3).In conclusion, the research hypothesis is rejected and the dermatology life quality index cannot predict the quality of life. Thus, the conclusion of Foji’s studies is not acceptable due to the fact that is not based on reported findings.Conflict of InterestNothing to declare.