مجله دانشگاه علوم پزشکی شهید صدوقی یزد
سال سی و یکم شماره 12 (پیاپی 208، اسفند 1402)

Malingering is a differential diagnosis in the field of medical disorders, especially in the field of forensic medicine. In medicine, malingering is when a person imitates a medical or psychiatric disorder with external motivations to gain financial gain or avoid social or occupational duties. In some cases, diagnosing a medical or psychological condition from malingering can be challenging and difficult. In this case report, a patient with a history of multiple hospitalization, neurodevelopmental disorders, and intellectual disability requested to receive injectable Biperiden due to aggression, irritable mood, and neck deviation, and in order to receive it, he deliberately showed neck dystonia. This report aimed to discuss on a neuropsychiatric symptom, after which the patient requested a drug injection to resolve it, in order to differentiate possible diagnoses such as drug complication, factitious disorder, and functional neurological symptom disorder. On the other hand, during the recent searches of similar texts, conflicting results and suggestions have been presented.

Familial adenomatous polyposis (FAP) is a hereditary disorder that is the most common colon cancer syndrome in an autosomal dominant form. At first, germline mutations in the APC gene (adenomatous polyposis) were identified as the main genetic factor causing FAP, but during subsequent studies, the human MutY (MYH) gene with an autosomal recessive pattern was also identified as the factor causing this disease, which is commonly referred to as MutYH-dependent apoptosis (MAP). FAP and MAP present with an early onset of hundreds of adenomatous polyps in the colon, at a median age of 35–40 years, and are associated with a significantly increased risk of colon cancer (CRC). In some other patients, gastrointestinal polyps, congenital hypertrophy in the retinal pigment epithelium, desmid tumors, and extracolonic malignancies are seen. The common treatment method in patients is through endoscopic and surgical methods. However, the patients with FAP and their relatives should receive appropriate genetic counseling. The purpose of this review article was to describe and investigate the clinical aspects and genetic diseases of FAP and MAP. For this purpose, the latest articles related to FAP genetic disease were selected by searching Google Scholar and PubMed sources.

Despite the progress made in discovering the molecular mechanisms of FAP, its genetic factors are still not fully understood. A deeper understanding of the molecular biology and genetics of this disease can lead to healthy therapies that can be used to rezone intestinal polyps and neoplastic malignancies and be a new target for future treatment.

Repeated implantation failure (RIF) is one of the main challenges in modern infertility treatments. Although assisted reproductive technology (ART) has undergone a lot of progression over the last recent years, some women still experience implantation failure after several embryo transfers (ET). Disruption of the mother's immunologic tolerance towards the fetus is one of the risk factors that increases the possibility of rejection the semi-allogeneic embryo by the mother’s immune system and causes failure of embryo implantation. Studies have shown that immunomodulatory treatment approaches, if used in a timely and appropriate manner, have promising results in improving pregnancy outcomes and live birth rates in this group of women. This review focuses on changes in the immune system and the use of immunomodulatory treatments in women with recurrent implantation failure.

It seems that the appropriate use of immunologic tests and proper immunomodulatory treatments can manage IVF failure after repeated embryo transfers.

The purpose of using nano-carriers for drugs delivery, such as nanotubes, was slow release of drug and reducing side effects of drugs. Drugs are very active due to their many functional groups. Therefore, reactivity of drug is reduced by being in nanotube field due to electronic resonance of drug with nanotube and it stays longer in body. The present study aimed to investigate the interaction of isoniazid with functionalized single-walled carbon nanotubes.

In the present theoretical study, considering the importance of isoniazid as the first line of treatment for tuberculosis disease, the performance of carbon nanostructures for adsorption of isoniazid was evaluated using quantum computation. Using density functional theory at theoretical level of B3LYP/6-31G** structure of drug and f-SWCNT and nano-drug complexes were optimized.

Effect of adsorption on the electronic properties and stability of the nanotube was also examined. In this regard, for different configurations, the strength and nature of intermolecular interactions were evaluated by energy parameters and molecular orbitals. Based on the obtained results, a specific configuration displayed the most negative adsorption energy and enthalpy, establishing itself as the most stable structure among the various configurations.

Results showed that the electron density of the HOMO (Highest Occupied Molecular Orbital) was localized on the nanotube, while the electron density of the LUMO (Lowest Unoccupied Molecular Orbital) was situated on the drug molecule. The energy gap between two molecular orbitals increased due to the adsorption process; changes lead to an increase in the electrical conductivity of the complex following adsorption. According to the natural bond orbitals, results, the isoniazid molecule and functionalized single-walled carbon nanotube act as both electron donor and acceptor in the complex. Analysis of the results obtained from quantum theory of atoms in molecules, showed the intermolecular interaction between the drug and the functional group of the nanotube has been established, the most important of which is the hydrogen bond. Finally, the findings showed that functionalized SWCNTs can be acted as a drug carrier for isoniazid anti-tuberculosis drug.

In today's societies, the health sector is growing rapidly, and hospitals, as institutions that provide health and survival of the society and provide health services, have experienced many changes over time.  People have understood that health is a valuable service for their lives, especially when the spread of new diseases threatens the life and health of society. Therefore, the main goal of this research was to investigate the relationship between innovation and service quality on customer satisfaction and loyalty during the Covid-19 pandemic.

The present research has focused on the impact of service innovation and its quality on patients' satisfaction and loyalty during the Covid-19 pandemic in Yazd Shahid Sadoughi Hospital. The statistical population of the present study was the patients admitted to Shahid Sadoughi Hospital in Yazd, Iran. Because the size of the population was uncertain, Cochran's formula was used to calculate the number of samples, which resulted in 384 people. SPSS and Smart PLS3 software were also used for data analysis.

Among the patients with corona virus, service innovation had a positive and significant effect on the patient satisfaction and 0.11 (p<0.05) on loyalty, respectively. Likewise, service quality has affected the satisfaction and loyalty of the patients by 0.77 and 0.45 with (P<0.05); the effect of the patient satisfaction on loyalty was positive and significant at the rate of 0.41 (P<0.05).

The results have shown that the relationship between service innovation and its quality had a positive and significant effect on patients' satisfaction and loyalty during the Covid-19 pandemic. The reason is that if the quality of the services provided is in accordance with the expectations of the patients, it will cause the satisfaction of the patients and will lead to their loyalty.

Breast cancer has been recognized as the most common malignancy in women during the last 10-15 years. Quality of life is the result of several physical and psychosocial effects. The result of this study was conducted to investigate the strategies of mental adjustment to cancer and its impact on the quality of life of breast cancer patients.

This descriptive-correlational study was conducted on 240 breast cancer patients using simple random sampling who were referred in Shahid Ramezanzadeh Radiotherapy Center, Yazd, Iran, from April to October 2021. Data collection tools were standard quality of life questionnaires (EORTC QLQ-C30) and Mini-Comparison of Mental Adaptation to Cancer (Mini-MAC). Data were analyzed using t-test, correlation and regression in SPSS version 16 software.

The mean age of patients was 44.77(±11.00) years. There was a significant and negative correlation between quality of life and Helplessness hopelessness (r= -.795, p<0.001) and anxious preoccupation (r= -.705, p<0.001). Quality of life was significantly and positively correlated with fighting spirit (r= .368, p<0.001) and cognitive avoidance (r= .364, p<0.001) and Fatefulness(r= .155, p<0.05). In general, cancer coping strategies explained 59% of the quality of life variation in breast cancer patients.

In order to improve the quality of life of patients, it is necessary to teach them adaptive strategies to adjust with cancer, such as fighting spirit and cognitive avoidance.

Identifying factors that influence the patient experience are critical to implementing strategies that support patient engagement and ultimately achieve better health outcomes. The present study was conducted with the aim of presenting a model of empowerment of hospitalized patients.

The current research was a qualitative-quantitative study that was cross-sectional by stratified sampling method with proper allocation in hospitals affiliated to Shahid Sadoughi University of Medical Sciences, Yazd, Iran, on 230 heads, managers, matrons, supervisors, heads of clinical and paraclinical departments and hospital headquarters units, nurses and doctors were done. The data were collected using the demographic information tool and the questionnaire made by the researcher to design a model of empowering patients admitted to the hospital. Determining the ability of the designed model by fitting the data was done with the confirmatory factor analysis method. Data were analyzed by SPSS version 16 software and Amos.v 24 software.

Questionnaire for designing a model of empowering patients in the hospital has 8 areas and 61 items or components. In the present study, the Chi-square ratio to the degree of freedom was significant (p<0.001), which indicated the appropriate fit of the model. The value of the GFI index was estimated at 0.93, which indicated that the model fits well. The values of GFI and AGFI for the empowerment model of hospitalized patients were higher than 0.8.

Organizations and medical institutions have the opportunity to utilize this model to empower patients. The universities of medical sciences and affiliated hospitals should create an enabling environment for enhancing patient empowerment.

Exercise training by modulating blood pressure and heart rate have a protective role for middle-aged cardiac patients. Aim of this study was to compare the effect of eight weeks of aerobic and combined exercise on some hemodynamic indicators in middle-aged male patients undergoing coronary artery bypass graft surgery.

In this clinical trial, a sample of 30 middle-aged men who underwent coronary artery surgery in 2023 were enrolled after meeting predetermined eligibility criteria and randomized for participation. They were divided into three aerobic (n=10), combined (n=10) and control (n=10) groups. The individuals of the 2 intervention groups performed selected aerobic and combined exercises (with an intensity of 55 - 75% of the maximum heart rate, for 60 minutes) for 8 weeks, 3 sessions per week. Blood pressure, heart rate and peripheral oxygen saturation (SpO2) were measured before and after the intervention. The parametric paired sample t-test, one-way ANOVA test and Tukey's Test were used to examine differences at a significance level of P ≤ 0.05.

The effect of aerobic exercises on systolic blood pressure (P=0.036), diastolic blood pressure (P=0.040) and heart rate (P=0.013) was significant and caused a decrease in these indicators, but the decrease in the combined group was not significant (P>0.05). The intergroup effect difference was not significant (P>0.05). In both aerobic (P=0.000) and combined (P=0.007) groups, the peripheral oxygen saturation has increased significantly and intergroup mean difference was significant (P=0.004).

It seems that aerobic and combined exercises as a helpful intervention strategy to improve hemodynamic indicators, make the patient more adaptable to the conditions after coronary artery bypass graft surgery.