مجله سازمان نظام پزشکی جمهوری اسلامی ایران
سال چهل و دوم شماره 3 (پیاپی 167، پاییز 1403)

Artificial intelligence in medicine is a relatively young and inherently interdisciplinary field that includes medical, legal and social studies. Smart medical technology is a wide range of tools that enable health professionals to provide a better quality of life for patients and society by performing early diagnosis, reducing complications, reducing hospitalization time and optimizing treatment. The present study deals with the practical applications of artificial intelligence in the diagnosis of congenital heart diseases and other aspects of medicine. This shows the fundamental importance of this technology in the advancement of medical sciences. The purpose of the upcoming article is to show the challenges and gaps in Iran’s criminal policy in medical technology and the field of artificial intelligence.

To investigate Iran’s criminal policy in the field of applying artificial intelligence in the field of health, a descriptive-analytical method and library study, as well as artificial intelligence algorithms, have been used.

Investigations show that without considering a well-considered legislative criminal policy in the field of medical technology, which itself helps the development of legal science and legislation, the executive criminal policy in the capacity of identifying perpetrators, imposing criminal liability and imposing punishment will face serious challenges. This creates a suitable opportunity for potential criminals to commit behaviors that are against personal and social interests for their personal interests and at the same time do not consider themselves criminals; as they have started a process where the behavior committed in Iran’s criminal law system is not considered a crime or it is difficult to find a title for it in the current laws.

In the field of health, it is possible to keep the initiative in the hands of the law by performing calibrations and regular turn controls, which are effective techniques of situational prevention. Also, by implementing the assumptions of this article, which states that in order to have a reasonable criminal policy in the face of artificial intelligence technology, the science of law, especially criminal law, needs to consider the rights of robots as well as broader scientific research than by recognizing the challenge. More up-to-date and appropriate laws and regulations with advanced technologies should be formulated and approved, and following such a plan, the rights of patients will be significantly respected.

Patient awareness regarding the potential complications and consequences of surgical or non-surgical management of impacted third molars is crucial for better decision-making and facilitates the process of obtaining informed consent. This study aimed to assess the awareness among patients attending public and private dental clinics in Qom city concerning the necessity of removing impacted and partially impacted third molars and the possible consequences of this surgery during the 2021-22 academic year

This descriptive cross-sectional study collected data through a specially designed questionnaire. A total of 201 patients were included as the study sample. Data were analyzed using SPSS 2022 software, employing descriptive statistics such as mean and frequency percentage.

Only 78 patients (39.8%) believed that impacted or partially impacted wisdom teeth should be removed before causing any problems. Patient awareness was high regarding the potential soft tissue inflammation, decay, and resorption of adjacent teeth caused by impacted teeth. However, only 54 patients (28.7%) believed that impacted or partially impacted wisdom teeth could lead to the formation of cysts or tumors in the jaw. The average awareness score concerning surgical complications was 4.4 out of a maximum of 8.

Patient awareness regarding the necessity of surgery for impacted/partially impacted wisdom teeth and the possible complications of this surgery was assessed weak. This highlights the need for enhanced patient education and underscores the important role of dentists in improving awareness in this area

Acinetobacter baumannii (A. baumannii) is a Gram-negative, aerobic, catalase-positive, and oxidase-negative bacterium that causes respiratory, urinary, blood, wound, and burn infections in patients. Antibiotic resistance, especially in A. baumannii, has become a global challenge. Previous studies have shown an increasing prevalence of OXA-48 and OXA-23 genes in this bacterium. This study aimed to investigate the frequency of OXA-48 and OXA-23 resistance genes in A. baumannii isolates resistant to cephalosporins and carbapenems using the molecular PCR method.

In this descriptive-cross-sectional study, 497 clinical samples, including blood (135 samples), sputum (92 samples), urine (130 samples), pleural fluid (61 samples), wound, and tracheal aspirates (79 samples) were collected from hospitalized patients at Ali-Nasab Hospital in Tabriz. After culturing on general and specific media and performing biochemical tests, A. baumannii was identified. Following antibiogram testing to determine the drug resistance of the isolates, molecular PCR was used to detect the presence of OXA-48 and OXA-23 genes.

Out of a total of 497 clinical samples, 50 A. baumannii isolates were identified, of which 60% were from female patients. Clinical samples from the ICU accounted for the highest proportion of A. baumannii isolates with a frequency of 26%. The highest resistance rate was observed against ceftazidime with a frequency of 98%. On the other hand, molecular analysis showed that 97.95% of the 50 resistant isolates carried the OXA-48 gene and 77.55% carried the OXA-23 gene. For the OXA-48 gene, P-value <0/001, and for the OXA-23 gene, P-value=0.075, indicated a significant association between the presence of the OXA-48 gene and antibiotic resistance, with no significant association between the presence of the OXA-23 gene and antibiotic resistance.

The high prevalence of resistance to ceftazidime and the OXA-48 and OXA-23 genes in A. baumannii indicates excessive antibiotic use. The results of this study align with previous findings showing a high prevalence of OXA-48 and OXA-23 genes in A. baumannii and emphasize the importance of hospital infection control and rational antibiotic use.

Allogeneic hematopoietic stem cell transplantation (HSCT) is considered the only effective therapeutic option for eradicating acute myeloid leukemia (AML) after achieving remission. Evaluating treatment outcomes and addressing challenges at each center are essential for improving conditions and overcoming obstacles. Thus, this study aimed to evaluate the outcomes of HSCT in AML patients who had. undergone transplantation at our center over the past three decades.

This retrospective cohort study was conducted at the Oncology, Hematology, and Transplant Research Institute on adult AML patients who underwent allogeneic HSCT between January 1991 and January 2022. Data on demographic, clinical, and laboratory characteristics were collected from medical records. The primary objectives included evaluating overall 5-year overall survival (OS) and disease-free survival (DFS) across all patients, and comparing outcomes based on the timing of transplant and pre-transplant remission status. Secondary objectives included assessing non-relapse mortality (NRM) and relapse incidence (RI). Statistical analyses were conducted to compare outcomes between two groups: those who received transplants before 2010 (D1) and those who received transplants after 2010 (D2).

In total, 1,337 AML patients were analyzed, with 477 in group D1 and 860 in group D2. The median follow-up duration was 111 months for D1 and 62 months for D2. OS was similar between the two groups (56.64% for D1 vs. 57.86% for D2), but OS improvements were observed only in patients who underwent transplantation in later remissions (CR2 and CR≥3) after 2010. DFS were also generally similar between the two groups, but significant improvements were noted for CR2 and CR≥3 patients transplanted after 2010. The 5-year RI and NRM were comparable between the two periods, except for CR2 patients who transplanted after 2010 and have had lower RI and NRM. Notably, a higher percentage of transplants involved haploidentical and unrelated donors in D2, reflecting evolving transplantation strategies.

Our findings indicate that despite significant advances in transplant techniques, supportive care, and donor availability, OS and DFS have remained relatively stable between the two periods. This is likely due to higher rate of HSCT from alternative donor and in high-risk patient after 2010. The study highlights the need for personalized approaches in managing AML, focusing on optimizing donor selection and addressing transplant-related complications.

Plantar fasciitis is a common, important and complicated disorder for which no fully effective treatment has been introduced to reduce the intensity of the pain caused by it, or the existing treatments have been associated with various complications. Therefore, according to the positive effects of extracorporeal shockwave therapy (ESWT) in previous studies, this study was conducted with the aim of determining the effect of ESWT on the pain caused by plantar fasciitis according to gender, age and body mass index, duration of symptoms, patient’s occupation, and the number of treatment sessions.

This analytical-cross-sectional study included 18 patients with plantar fasciitis who were referred for ESWT. They underwent ESWT with Radial device of the Novin company with a pressure of 2.5 bar, 10 Hz and 2000 pulses at weekly intervals. Heel pain in the morning and standing time were evaluated using the Visual Analogue scale (VAS), at four time points: before, after the last session, after one week from the last session, and after one month from the last session. A between-group comparison was also performed based on patients baseline variables.

The intensity of pain decreased with a significant difference in all the investigated times compared to baseline. The amount of morning pain and pain while standing was reduced by more than 30% in 82% and 77% of patients, respectively. Among the different variables only patients with prolonged standing jobs demonstrated significant pain improvement 1 month after the intervention (P < 0.028). Only mild local pain and burning after ESWT was reported in 7 patients (39.9%) and other patients did not report any specific complications.

ESWT could be suggested as a safe and effective treatment in patients with plantar fasciitis.  Based on our preliminary results, ESWT may be of more benefit to the patients with prolonged standing jobs.

One of the physiological effects of high velocity low amplitude (HVLA) manipulation is change in motor neuron activity, which can be evaluated by measuring the H reflex and F wave latencies. The lack of specific objective and measurable criteria in previous studies related to the treatment of neck pain may have caused bias in effectiveness of treatment options؛ For this reason, proper treatment plans cannot be made. Nevertheless, use of measurable prognostic criteria such as H-reflex and F-wave latencies can have a major role in treatment of mechanical neck pain with cervical HVLA manipulation. Therefore, in this study, we will examine and compare the onset latencies of H-reflex and F-wave parameters of the median and tibial nerves before and after cervical HVLA manipulation.

In this interventional study, patients with mechanical neck pain who referred to Imam Reza Hospital in Tehran during 2018-19 were selected. Before and- after the HVLA manipulation of the neck, the onset latency index related to the H-reflex and F-wave parameters in the upper and lower limbs were measured using an EDX EMG machine. Statistical analysis was performed to compare the before and after results with Kolmogorov-Smirnov and paired t-tests and p-value less than 0.05 was considered significant.

In this study, 35 patients were examined. F wave in the right median nerve did not change significantly after the intervention (p=0.295), but this amount had decreased significantly on the left side (p=0.048). There was no significant change in the tibial F wave latency (p=0.245 on the right side and p=0.133 on the left side). There was a significant change in H reflex in the median nerve after the intervention (p=0.001 for the right side and p=0.030 for the left side). In the tibial nerve, the H reflex decreased significantly after the intervention (p=0.026 for right side and p=0.036 for left side).

H reflex latencies in both left and right median and tibial nerves and F wave latencies only in the left median nerve had a significant decrease after the intervention. HVLA manipulation by inhibiting the motor system reduces muscle tone, and in this way can break the cycle of pain and spasm and is effective in treating neck pain.

Isolated Flexor Digitorum Longus (FDL) muscle tear is extremely rare and so far, a handful of cases have been reported in the literature. Proper diagnosis and treatment will reduce the complications caused by this tear and helps to reduce the burden of the injury to the athlete and team.

A 38-year-old professional athletics male, presented with medial tibial pain that started while running. He did not have any history of diabetes, infectious and inflammatory joint diseases, and the use of drugs such as fluoroquinolone and corticosteroids and supplements containing it, statins, and other drugs that damaged the tendons was not reported. He presented with right leg claudication, despite normal lower limb alignment. Ultrasonography revealed evidence of a grade 3 strain of the FDL muscle with extensive hematoma. MRI confirmed the diagnosis of a grade 3 FDL strain. Treatment included hematoma aspiration, injection of Platelet rich plasma (PRP) in the train side under ultrasound guidance, physiotherapy and specific rehabilitation protocol. The patient adhered to the rehabilitation program and reported significant improvement in pain and function.

So far, only a few case reports have reported the rupture of this muscle spontaneously or after ankle dislocation or malleolus and talus fracture. The treatment was effective based on the patient’s response. Careful attention should be given to similar cases to ensure accurate diagnosis and appropriate treatment.

Pandemics pose significant threats to global health systems, as exemplified by COVID-19, which placed unprecedented strain on healthcare infrastructures worldwide. One innovative solution that emerged during this crisis was the use of multifunctional centers. These facilities, capable of rapid conversion for various healthcare services, played a crucial role in alleviating pressure on hospitals. In Iran, the Iran Mall Convalescent Center demonstrated the effectiveness of such centers by converting into the country’s largest vaccination hub. This paper explores the importance and benefits of multifunctional centers in managing future pandemics. Multifunctional centers offer reduced pressure on hospitals, cost-effective and rapid setup, flexibility in services, optimized resource use, and increased healthcare system resilience. However, challenges include the need for rapid adaptation, specialized training, and coordination among various stakeholders. The Iran Mall Convalescent Center’s successful operation highlights the potential of multifunctional centers to enhance pandemic preparedness and response.