مجله پزشکی بالینی ابن سینا
سال سی و یکم شماره 3 (پیاپی 113، پاییز 1403)

Cervical ripening plays a crucial role in the success of labor induction. When the Bishop score is less than 4, the use of cervical ripening methods becomes necessary. Various mechanical and pharmacological methods exist for this purpose, but the comparison of their effectiveness and safety remains a subject of debate. The present study aimed to compare the effects of traction catheters and extra-amniotic saline infusion (EASI) on cervical readiness in primiparous mothers with a Bishop score of less than 4 who were candidates for pregnancy termination.

This single-blind randomized clinical trial was conducted on nulliparous women aged 18-35 years, with the gestational age of 37-42 weeks and Bishop scores less than 4, who were referred to the gynecology clinic of Ayatollah Mousavi Hospital in Zanjan City, Iran, in 2022. Women with a history of uterine surgery, active vaginal bleeding, rupture of membranes, and fetal anomalies were excluded from the study. The patients were randomly assigned to either the EASI or transcervical balloon catheter group. The time from oxytocin administration to complete dilation, duration of the second stage of labor, mode of delivery, patient satisfaction, maternal complications, and neonatal outcomes—including birth weight, Apgar scores at 1 and 5 minutes, and need for NICU admission—were recorded.

The average age of participants was approximately 27.4. Neonatal outcomes, including Apgar scores and birth weight, indicated no significant differences (P>0.05). However, post-intervention Bishop scores were significantly higher in the traction group compared to the EASI group (P=0.03). A significant difference was observed in the Bishop score before and after intervention in the EASI and traction group (P<0.05). Moreover, satisfaction levels were significantly lower in the EASI group compared to the traction group (P=0.002).

The study concluded that maternal and neonatal complications were similar between the EASI and traction groups. Due to the better clinical outcomes and higher satisfaction levels associated with the traction method, it is recommended as the preferred approach for primiparous women.

One of the new treatment methods for obsessive-compulsive disorder (OCD) in patients who do not respond to the first line of drug treatment is brain stimulation from transcranial direct current stimulation (TDCS). However, there has been limited research regarding its effectiveness, with the results often being contradictory. In the present study, the effect of TDCS with sertraline drug on the severity of the disease and the improvement of various areas of obsessive thoughts and actions was investigated.

In this double-blind randomized clinical trial, 50 patients with OCD were randomly assigned to two groups of 25: an intervention group and a control group. The intervention group underwent active TDCS and the control group underwent passive TDCS each for 16 sessions (20 min per session). The intensity of OCD symptoms in both groups was evaluated using the Padua questionnaire at four time points: before treatment, 4 weeks after the start of treatment, 8 weeks after treatment initiation, and 1 month after the conclusion of the treatment.

The two groups were similar in terms of age, gender, duration of illness, and severity of OCD before treatment (P<0.05). However, from the 8th and 16th sessions after the treatment, the overall score of OCD and its sub-domains in the intervention group was significantly lower than the control group (P<0.001).

In patients with OCD, TDCS as a non-invasive method during 8 and 16 sessions had a significant effect on the reduction of the symptoms related to OCD.

Anxiety is a common problem in old age. This research was conducted to determine the effect of progressive muscle relaxation on the level of anxiety and vital signs of hospitalized elderly patients with chronic diseases.

This study was a two-group, single-blind, randomized clinical trial conducted on all elderly patients hospitalized in Rasool Akram (PBUH) Hospital in Kalaleh, except those in the intensive care unit and coronary care unit. In the intervention and control groups, 38 hospitalized elderly patients were included after assessing inclusion and exclusion criteria. In the intervention group, the progressive muscle relaxation technique was performed for 3 consecutive days. The method of data collection included the valid and reliable Beck's Anxiety Inventory, a demographic information form, and a checklist of vital signs including systolic and diastolic blood pressure, heart rate, and breathing. Ethical considerations were observed in this study. The results were analyzed using SPSS22 software and descriptive and analytical statistical tests.

The participants in this study were mostly women, 83.33% with an average age of 69.94 years in the control group and 72.5 years in the intervention group. The results of the study showed that although progressive muscle relaxation caused a decrease in the average anxiety of the elderly in the intervention group, this change was not significant. However, it caused significant downward changes in the vital signs of the elderly over time (P<0.05).

These results can help doctors and health professionals provide more appropriate solutions for managing and controlling anxiety and vital signs.

Chemotherapy-induced fever and neutropenia are side effects of chemotherapy regimens that, in addition to disrupting the treatment process of patients, threaten their health as well. In this study, the prevalence of chemotherapy-induced fever and neutropenia in different chemotherapy regimens in hospitalized patients with non-metastatic breast cancer was investigated.

In this descriptive cross-sectional study, a total of 200 adult patients hospitalized at Seyed al-Shohada (Omid) Hospital in Isfahan, Iran, from 2016 to 2021 due to breast cancer were selected. These patients had received chemotherapy regimens including AC, AC-T, and TAXANE. The data were extracted from the breast cancer registry and the hospital's HIS systems and analyzed with the SPSS software at a 95% confidence level.

The mean age of the patients was 46.90±11.28 years. The frequency of chemotherapy-induced neutropenia and fever was 15.5% and 9.5%, respectively. A significant relationship was observed between chemotherapy-induced fever and neutropenia with older age, higher cancer stage, and hypertension (P<0.05 for all). However, no significant relationship was found between the type of chemotherapy regimen and diabetes.

Chemotherapy-induced neutropenia and fever caused by neutropenia are relatively common side effects in breast cancer chemotherapy regimens. Older age, higher stage of cancer, and hypertension increased the prevalence of chemotherapy-induced neutropenia and neutropenia-induced fever.

Infertility is one of the most stressful events in people's lives. Stress can affect a person's sleep by affecting the hypothalamus and pituitary axis, leading to sleep disorders. The present study aimed to determine the relationship between sleep disorders and the outcome of infertility treatment with intrauterine insemination (IUI).

This prospective cohort study was conducted on 131 infertile women aged 18 to 45 referring to infertility clinics in Bojnurd City, Iran. Data collection was conducted using questionnaires that assessed demographic characteristics and sleep disorders, specifically the Pittsburgh Sleep Quality Index. Information was gathered at three separate time points: 0, 14, and 30 days, relative to the time of IUI. In addition, statistical analysis was performed using repeated measures analysis of variance (ANOVA).

The average age of the women in the study was 29.85 years, with a standard deviation of 5.75. The most common causes of infertility were ovulation disorders, accounting for 37.3%, and primary infertility, which represented 72.9% of cases. Changes in sleep quality scores (within-group effect) were significant in both the positive and negative IUI result groups, with p-values of 0.042 and 0.001, respectively. However, when comparing the effects between the two groups, there was no significant difference in sleep quality scores at any time point.

In general, there was no significant difference in the sleep quality score.

Disorders related to the quality and quantity of sleep are among the most important issues of old age. In this regard, the present study aimed to determine the efficacy of an educational program based on the theory of planned behavior for the improvement of sleep hygiene behaviors in the elderly.

This semi-experimental study with efficacy intervention was performed on 60 elderly people in Hamadan City, Iran who were divided into the intervention (n=30) and control (n=30) groups. Development, implementation, and evaluation of the intervention program were carried out based on needs assessment by using the theory of planned behavior and intervention mapping approach. The data collected before and two months after the implementation of the program were analyzed in SPSS software (version 16).

The average scores for attitude, perceived behavior control, and intention significantly increased in the intervention group after the implementation of the program (P<0.05). The estimated effect sizes, based on Cohen's d index, were moderate for attitude (0.7) and perceived behavioral control (0.6), and very large for intention (0.83). However, the estimated effect sizes for subjective norms (0.16) and sleep hygiene behaviors (0.06) were low.

The results were promising in terms of enhancing the intention to engage in sleep hygiene behaviors following the implementation of the program. This suggests that the theory of planned behavior can serve as a useful framework for the development, implementation, and evaluation of programs aimed at the improvement of sleep hygiene behaviors among older adults.

Information therapy is one of the new methods of providing health-related information to patients. This method plays an important role in empowering patients to make informed health decisions and participate in the recovery process. In this regard, the present study was conducted to explain the understanding of elderly people with type 2 diabetes regarding information therapy related to self-care.

This study was carried out qualitatively using the content analysis method on 18 patients with type 2 diabetes referred to some specialized diabetes centers in Hamadan City in 2024. Participants were selected based on purposeful sampling method and content saturation with maximum diversity based on gender, education level, marital status, employment status, and duration of diabetes among patients eligible for the study. A semi-structured, in-depth personal interview method was used for data collection. All interviews were recorded, transcribed, and then analyzed using MAXQDA 2020 software.

After data analysis, three categories and thirteen subcategories were extracted in relation to the theme of diabetes control and management. The obtained categories included promoting self-care behaviors, increasing individuals' motivation to perform self-care behaviors, and accessing information therapy communication channels. Subcategories included paying attention to physical, psychological, social, and spiritual self-care; boosting awareness; improving attitude; controlling disease and its complications; reducing costs and making better decisions; and interpersonal media, traditional media, digital media, and social networks.

According to the results, it seems that information therapy is one of the methods of increasing individuals' motivation to perform self-care behaviors and promoting self-care behaviors. Ultimately, it may assist elderly patients in controlling and managing type 2 diabetes.

Brucellosis is a zoonotic disease common in the Middle East, including Iran. Musculoskeletal manifestations, particularly in the spine, are frequent symptoms of brucellosis, often leading to delays in diagnosis due to its varied and non-specific symptoms. The present study aimed to investigate the prevalence, clinical presentation, and diagnostic challenges of musculoskeletal brucellosis, focusing on spinal involvement.

This retrospective study reviewed the medical records of 782 patients with brucellosis admitted to Sina Hospital in Hamadan, Iran, from 2011 to 2020.

The results indicated that a significant portion (87.6%) of the patients had a history of consuming unpasteurized dairy products, and more than half (57.2%) had been exposed to livestock in the past year. The most common clinical symptoms were weakness and fatigue (66.7%), joint pain (62.7%), and fever (73.1%), while back pain (65.7%) and knee pain (48.3%) were the dominant musculoskeletal symptoms. In addition, arthritis (24.4%), spondylitis (15.4%), and sacroiliitis (13.4%) were the primary identified musculoskeletal complications.

The clinical manifestations of brucellosis include common symptoms, such as fever, weakness, fatigue, and joint pain, which were more prevalent in male patients. In addition, musculoskeletal complications are prominent features of the disease. According to bone scan and MRI results, approximately 20% of hospitalized brucellosis patients had bone-joint complications, including arthritis, spondylitis, and sacroiliitis.