فهرست مطالب

Medical Council - Volume:8 Issue: 2, Spring 2025

Journal of Iranian Medical Council
Volume:8 Issue: 2, Spring 2025

  • تاریخ انتشار: 1403/11/13
  • تعداد عناوین: 23
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  • Shahin Akhondzadeh* Pages 211-212
  • Mohammadbagher Owlia, Hamidreza Soltani * Pages 213-225

    Diabetes Mellitus (DM) stands as one of the most widespread non-infectious diseases globally. Although diagnosis of diabetes is possible with the fasting plasma glucose test after 12-hour fast, once diabetes is diagnosed, it cannot be reversed. Therefore, it is crucial to identify early indicators for predicting diabetes. Presently, DM can be discerned through various methods involving the analysis of human facial features. One method for facial recognition in diabetes relies on experimental evidence, with its accuracy contingent on the skill and expertise of the physician. Another approach involves diagnosis based on facial morphological features. These morphological changes may be attributed to oxidative stress, damage of blood vessels and collagen, edema and craniofacial abnormalities stemming from hyperglycemia. While cephalometric analysis remains the gold standard for diagnosing skeletal craniofacial morphology, it is a costly and technique-sensitive procedure. Facial recognition based on Artificial Intelligence (AI) has proven to be a valuable tool in the diagnosis and screening of diabetes. Its combination of simplicity, accuracy, and cost-effectiveness makes it a promising addition to the healthcare landscape, ultimately contributing to advancements in pre-clinical diagnosis and leading to enhanced patient outcomes. Given the rapid global increase in diabetes, the importance of early detection of diabetes and the limited information about the role of facial recognition in this regard, this study assesses diabetes through facial features using AI approaches.

    Keywords: Artificial Intelligence, Diabetes Mellitus, Facial Recognition, Oxidative Stress
  • Hojatolah Gharaee *, Razie Jahanian, Khadije Bande-Ehahi, Mohammadhasan Saati, Yadolah Hamidi, Majid Barati Pages 226-239
    Background

    Due to the limited number of valid and reliable tools available to measure the opinions of service recipients regarding the quality of Primary Health Care (PHC), the aim of this study was to develop and validate a patient-centered questionnaire to measure the quality of PHC services.

    Methods

    The initial questionnaire was designed through literature review, and then, nine Focus Group Discussion (FGDs) sessions with 102 participants were held. To determine the content validity of the questionnaire, two qualitative (experts’ opinions and suggestions) and quantitative (CVR & CVI) methods were used. A total of 26 experts and 650 Service Recipients (SRs) participated in the validation process of the questionnaire. To measure reliability, test-retest methods and internal consistency were utilized.

    Results

    A total of 46 items in five dimensions were recognized as necessary, relevant and understandable by the experts. Content validity was confirmed by experts. According to the experts, the optimal model was explained in the form of five factors: “patient-centeredness”, “continuity of care”, “quality of facilities and basic amenities”, “access and availability” and “trust”. The fit of the extracted model was confirmed by confirmatory factor analysis at the desired level. The internal consistency of the constructs and all sub-constructs of the questionnaire was favorable (Cronbach’s alpha=0.942 and ICC=0.868). Also, the results of the test-retest in all constructs and all sub-constructs confirmed the reliability of the questionnaire.

    Conclusion

    In this study, a valid and reliable questionnaire was developed to measure the quality of PHC services from the perspective of service recipients. This measure could be applied for better management of PHC centers and improving the quality of services.

    Keywords: Healthcare Quality, Patient Centered Care, Primary Health Care, Questionnaire Design, Validity, Reliability
  • Lida Jarahi, Seyed Masoud Hosseini *, Sadaf Shamshirgaran, Mehri Yavari Pages 240-247
    Background
    A significant gap exists between patient-centered health policies and medical graduates’ practice. Medical education is not restricted to the formal curriculum. The hidden curriculum has a powerful effect on students’ learning and behavior. This study measured the patient-centeredness of the hidden curriculum in Mashhad Medical School. 
    Methods
    The participants were medical students at Mashhad Medical School who were about to graduate. The sample size was determined 100 students based on the Morgan table and selected in a convenient method. The validated Persian version of the Haidet instrument with three content areas of “role modeling, student’s experiences and support for students’ patient-centered actions” was used to evaluate the patient-centeredness of the hidden curriculum. Descriptive indexes and Independent samples T-Test were used for analysis.
    Results
    The mean±SD score of patient-centeredness of the hidden curriculum was 54.9±9.4, slightly more than half of the total questionnaire score. The area of "support for students' patient-centered actions" received a higher mean±SD score (62.1±16.5) compared to role modeling (53.9±12.3) and student experiences (53.6±9.4). Additionally, medical students emphasized the professor's role in acquiring patient-centered care.
    Conclusion
    Despite the formal education for patient-centeredness, students learn mainly from the practical environment and their educators’ behaviors. There was a relative dissonance between the formal and implicit curriculum regarding patient-centeredness associated with the medical student. The medical students’ experiences regarding patient-centered manners and giving encouraging feedback are two chief points for improving patient-centeredness.
    Keywords: Curriculum, Education, Patient-Centered Care, Physicians, Schools, Medical, Universities
  • Fateme Souni, Marzieh Mahmoodi, Zainab Shateri, Moein Askarpour, Amirhossein Asadi, Kimia Leilami, Saba Jalali, Zeinab Heidari, Mehran Nouri *, Bahram Rashidkhani Pages 248-256
    Background
    Breast cancer is the most common cancer among women worldwide. Diet is recognized as an important factor in the prevention of cancer. No research has evaluated the association between the Planetary Health Diet Index (PHDI) and breast cancer risk in the Iranian population. Therefore, the association between PHDI and breast cancer odds in Iranian women was examined in this study.
    Methods
    The present case-control study (n=134 cases, n=267 controls) was conducted in two hospitals in Tehran, Iran. Women aged 30 or older diagnosed with breast cancer through biopsy were included. In the current study, the participants’ food consumption was assessed using a food frequency questionnaire, a reliable and valid tool. 
    Results
    A lower odds of breast cancer was observed in the last tertile of the PHDI compared to the first tertile in both crude and adjusted models [adjusted model: Odds Ratio (OR)=0.54; 95% Confidence Interval (CI): 0.31-0.95]. In the subgroup analysis, based on the menopausal status, in the fully adjusted model, lower odds of breast cancer were found in the last tertiles of PHDI compared to the first tertile in the post-menopausal group (OR=0.38; 95% CI: 0.17-0.84).
    Conclusion
    The findings suggest an inverse association between higher PHDI scores and breast cancer risk. An inverse association between PHDI and breast cancer risk was also evident, particularly among post-menopausal women.
    Keywords: Biopsy, Breast Neoplasms, Confidence Intervals, Diet, Iran, Odds Ratio, Postmenopause, Surveys, Questionnaires
  • Soheila Norouzi, Siamak Aghlmand, Ahmad Faramarzi * Pages 257-267
    Background
    The COVID-19 pandemic has resulted in massive loss of life and an unprecedented economic crisis, with far-reaching social impacts. This study aimed to estimate the economic burden of Coronavirus from a societal perspective in Iran.
    Methods
    This cross-sectional study was conducted between March 20, 2020 to March 19, 2021. To calculate the direct cost associated with COVID-19, a bottom-up approach was used with a record of 264 on the prevalence-based method and using the human capital approach. All the costs hospitalized patients. Indirect costs related to COVID-19 patients were estimated based were reported as US Dollars, using the exchange rate ($US 1=172,430 Rials) in 2020 and a 3% discount rate.
    Results
    From March 20, 2020 to March 19, 2021, this study included 467,883 patients with COVID-19 and 5,806 deaths in West Azerbaijan. Due to the economic burden, COVID-19 was approximately estimated at $647.37 million ($1,384 per patient), of which $425.32 million was caused by lost productivity and $222.05 million by direct costs. The results show that the mean cost of direct medical services was $1415 in the ICU ward and $426 in the general ward.
    Conclusion
    The findings of this study underscore the substantial economic impact of the COVID-19 pandemic, particularly in developing countries. Notably, the economic burden primarily arises from indirect costs, such as lost productivity due to premature mortality and morbidity. This investigation revealed that medicine and consumables account for 50% of the direct medical costs associated with COVID-19.
    Keywords: COVID-19, Economic Recession, Financial Stress, Iran: COVID-19, Cost Of Illness, Iran
  • Ali Talaei, Fahimeh Farzanegan, Zohreh Fasihi Harandi, Zahra Ghaseminejad, Homa Azarian, Kimia Molooghy, Saba Askari Noghani, Sahar Omidvar Tehrani * Pages 268-275
    Background

    The demand for orthodontic treatment to correct malocclusion has increased worldwide. A main cause of applying for orthodontics treatment may arise from mental disorders, such as Body Dysmorphic Disorder (BDD). This study aimed to investigate the relationship between BDD, the real need for orthodontic treatment based on the ICON index, and inquiry about orthodontics treatment in women. 

    Methods

    In a case-control study, 414 women from the public outpatient dental clinic of Mashhad University of Medical Sciences, completed a demographic questionnaire, Beck Depression Inventory (BDI II), Beck Anxiety Inventory (BAI), and Yale-Brown Obsessive-Compulsive Scale Modified for BDD (BDD-YBOCS). A specialist also determined the ICON index for each participant. 

    Results

    Among 414 subjects, 52 patients (31 in the orthodontics and 21 in the control group) (p=0.182) had a BDD-YBOCS score of 20 or above. The frequency of BDD, based on a definite diagnosis by an interview with a psychiatric specialist, was 6.28% among the orthodontic patients, which was significantly more than that of other dental patients (p<0.05). The mean ICON index score was found to have a significant difference between the orthodontic patients and the controls (p<0.001). No correlation was found between the severity of ICON and BDD-YBOCS scores in all the participants (p=0.804), in the cases (p=0.655), or the controls (p=0.403). 

    Conclusion

    The current study found no correlation between ICON and BDD score. However, a significantly higher rate of BDD subjects receiving orthodontic procedures suggests using the BDD-YBOCS survey in dental clinics to screen patients suspected of having BDD for further psychological management.

    Keywords: Anxiety, Body Dysmorphic Disorder, Control Groups, Depression, Malocclusion, Outpatients
  • Maryam Najafpour, Mahnaz Mozdourian, Shima Nabavi, Farnoosh Ebrahimzadeh *, Hassan Mehrad-Majd Pages 276-283
    Background
    The literature on the potential protective role of serum bilirubin levels in the development of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) has produced conflicting findings. This study aimed to investigate the potential relationship between serum total and direct bilirubin levels and the risk of acute exacerbation in COPD. 
    Methods
    Over a period of 18 months, a total of 99 patients were recruited from two major hospitals in Mashhad, Iran, comprising 49 individuals with stable COPD and 50 with AECOPD. After obtaining informed consent and conducting a comprehensive medical history and physical examination, both groups underwent an assessment of various laboratory indices, such as total and direct bilirubin levels. Appropriate statistical analysis was applied to assess the potential associations between bilirubin concentrations and the risk of AECOPD. 
    Results
    The study population had a mean age of 64.97±10.12 years, and there was no significant difference in gender distribution (p=0.546). The majority of subjects (55.6%) were male. The serum levels of AST and ALT were significantly higher in the AECOPD group (p<0.001). Additionally, although there were no significant differences in total bilirubin levels between the two groups (p=0.323), there was a significantly higher level of direct bilirubin in the AECOP group (p<0.001). 
    Conclusion
    Serum direct bilirubin levels were higher in COPD patients with acute exacerbation. It may be an independent biomarker for screening the COPD patients with and without acute exacerbation. Further studies are required to validate the findings.
    Keywords: Bilirubin, Biomarkers, Chronic Obstructive Pulmonary Disease, Iran, Physical Examination
  • Sunday Olakunle Olarewaju, Toluwase Christiana David, Shine Tofunmi Oyegbami, Idowu Deborah Animashaun, Quadri Olalekan Ayandele, Hillary Temitope Akomolafe, Monsurat Adekemi Dauda, Maroof Adebayo Alatise, Moroof Oladeji Gbadamosi, Demilade Olusola Ibirongbe, Anifat Oladele Opeyemi * Pages 284-293
    Background
    Multidrug-Resistant Tuberculosis (MDR-TB) poses a significant challenge to Nigeria’s efforts in tuberculosis prevention and control, as well as the achievement of Sustainable Development Goal 3 (Good health and well-being). Identifying the predictors of successful MDR-TB treatment outcomes is crucial for guiding health policy implementation and containing the spread of the disease. This study aims to identify the predictors of unfavorable treatment outcomes among patients with multidrug-resistant tuberculosis in Osun State, Nigeria.
    Methods
    This was a retrospective study that included 181 TB patients from all chest clinics in Osun state’s 30 LGAs. Data were collected using a proforma, and analysis was conducted using SPSS version 26. Univariate and bivariate analyses were performed, with the chi-square test used to determine the associations between the categorical variables. The significance level was set at 0.05.
    Results
    Clinically, majority of the patients had pulmonary MDR-TB (181, 100.0%), were newly diagnosed with DRTB (Drug-resistant TB) (75, 41.4%), and were underweight (89, 49.2%). Regarding the laboratory profiles, nearly all the patients (92.8%) were anemic. More than four-fifths of respondents (156, 86.2%) experienced favorable treatment outcomes (cured or treatment completed), while 25 (13.8%) had unfavorable treatment outcomes. Associations were observed between drug intake (second-line drugs) and treatment outcome (p=0.001, X2=10.53), as well as hemoglobin status (p=0.045, X2=2.245).
    Conclusion
    Successful treatment was found to be influenced by drug adherence and hemoglobin status. Therefore, there is a need to enhance adherence counseling and ensure early commencement of treatment among patients with MDR-TB.
    Keywords: Counseling, Nigeria, Sustainable, Development, Thinness, Treatment Outcome, Multidrug-Resistant, Tuberculosis, Pulmonary
  • Maryam Khazaei Poul, Parvin Raji *, Mohammadreza Gharib, Elham Faghihzadeh Pages 294-306
    Background
    This study aimed to investigate the effectiveness of volleyball exercises on executive function and daily living skills in schizophrenia. 
    Methods
    In this randomized study, 28 individuals with schizophrenia participated. The intervention was volleyball exercises for two months. The Functional Independence Measure, The Lawton instrumental activities of daily living scale‏, and Loewenstein Occupational Therapy Cognitive Assessment battery tests were used in this study. Repeated measures and effect size were utilized for analysis. 
    Results
    Volleyball exercises improve cognitive function and Activities of Daily Living (ADLs) in the intervention group in the following: group effect, time effect, and group and time interaction. They were significant respectively (p-value1=0.041, p-value2=0.001, p-value3=0.001, Cohen’s d=1.267,1.266), (p-value1=0.001, p-value2=0.001, p-value3= 0.001, Cohen’s d=3.967,3.749). With this intervention, no significant difference was observed between the control and intervention groups in instrumental activities of daily Living.
    Conclusion
    Volleyball exercises improve executive function and ADLs in individuals with schizophrenia.
    Keywords: Activities Of Daily Living, Cognitive Function, Instrumental Activities Of Daily Living, Schizophrenia, Volleyball
  • Sahar Ravanshad, Fahimeh Gandomi Sani, Hourieh Koohkan, Pegah Bahrami, Parsa Shoqi, Hassan Mehrad-Majd * Pages 307-315
    Background
    Warfarin has been the primary anticoagulant medication for a long period. However, its efficacy presents clinical challenges, particularly due to the increased risk of bleeding. The introduction of NOACs, such as rivaroxaban, has revolutionized anticoagulation therapy. Nevertheless, evidence regarding their potential side effects has been conflicting. This study aimed to compare the incidence of major bleeding between rivaroxaban and warfarin.
    Methods
    This cohort study was conducted at Ghaem Hospital’s emergency department, involving patients admitted between December 2019 and September 2021 for any reasons. To qualify, the participants were required to have a recorded history of taking warfarin or rivaroxaban for at least one year. The data on major bleeding incidents within the first year of medication usage were collected and then the outcomes were compared between rivaroxaban and warfarin users. 
    Results
    A cohort of 402 patients were enrolled in this study, with 203 patients on warfarin and 199 on rivaroxaban. During a one-year follow-up, there were four cases of bleeding in the rivaroxaban group and six in the warfarin group. Upper gastrointestinal bleeding occurred in four patients taking warfarin and one patient taking rivaroxaban, while lower gastrointestinal bleeding was reported in two warfarin users and three rivaroxaban users. Despite these differences, they were not statistically significant (p=0.370), and no patient experienced cerebral hemorrhage.
    Conclusion
    Recommending rivaroxaban might help lower complications and offer a safer treatment option for patients with a history of atrial fibrillation, pulmonary embolism, deep vein thrombosis, or ischemic cerebrovascular accident.
    Keywords: Gastrointestinal Hemorrhage, Rivaroxaban, Warfarin
  • Farhood Khaleghimehr, Amirreza Elahian, Ali Maadelat, Mazaher Hadi, Nasrollah Abian * Pages 316-320
    Background
    To assess prevalence of prostate cancer and clinically significant prostate cancer in patients with PI-RADS 3 on bpMRI and factors associated with them.
    Methods
    Patients suspicious for prostate cancer following serum Prostate Specific Antigen (PSA) screening, who had PI-RADS 3 on bpMRI, were included. All patients underwent systemic plus MRI targeted biopsy of prostate. Gleason score 3+3 was considered positive for prostate cancer but clinically non-significant one. Higher scores were pertained to as clinically significant prostate cancer. The relationship between patient age, PSA level, PSA density, number of core biopsies, and number of PI-RADS 3 lesions on bpMRI with presence of prostate cancer per se and presence of clinically significant prostate cancer in our patients is assessed.
    Results
    244 patients were enrolled. 101 patients had prostate cancer (41.4%). Out of these 101 patients, 34 (13.9% of total) had clinically significant prostate cancer. Among different factors, only PSA density was associated with both prostate cancer (OR=1.05, p=0.001) and clinically significant prostate cancer (OR=1.03, p=0.001). According to receiver operating characteristic curve analysis, best cut off value of PSA density which has highest association with clinically significant prostate cancer in PI-RADS 3 patients would be 0.36; with a sensitivity of 0.38 and specificity of 0.93.
    Conclusion
    Considering PSA density with threshold of 0.36 for performing biopsy in patients with PI-RADS 3 on bpMRI might lower the rate of unnecessary biopsies.
    Keywords: Biparametric MRI, Clinically Significant Prostate Cancer, PI-RADS, PSA, PSA Density
  • Mohammad Saleem *, Ashima Salhotra Pages 321-332
    Background

    The current study investigates the intricate relationship between dispositional optimism, core self-evaluation, and mental well-being among nursing students. The present research aims to understand the mediating role of core self-evaluation on nursing students’ well-being and dispositional optimism. 

    Methods

    The present study was cross-sectional in nature and included a purposively selected sample of 286 (112 females, 172 males) nursing students from Punjab (India). Students completed a measure of a short version of the Warwick–Edinburgh Mental Well-being Scale, The Revised Life Orientation Test (LOT-R), and the Core Self-evaluations Scale. The collected data was analyzed using correlational and multiple regression analysis. Moreover, the mediational analysis was analyzed using the Hayes PROCESS macro.

    Results

    The results indicated that core self-evaluation (β=0.606, p<0.01) and dispositional optimism (β=0.394, p<0.01) are significant predictors of nursing students’ mental well-being. Mediation analysis showed that core self-evaluation completely mediated the relationship between dispositional optimism and mental well-being. Furthermore, it was found that the measures of t-value of dispositional optimism (t=-1.536), and mental well-being (t=-1.594) were non-significant at the 0.05 level, while significant differences were found in core self-evaluation (t=-2.223).

    Conclusion

    The results of the present study demonstrated the predictive role of dispositional optimism and core self-evaluation in the mental well-being of nursing students. Moreover, the current study highlighted the underlying mechanism through which dispositional optimism influences nursing students’ mental well-being.

    Keywords: Cross-Sectional Studies, Diagnostic Self Evaluation, Female, Male, Mediation Analysis, Nursing, Regression Analysis, Students
  • Narges Panahandeh, Mohammad Fazeli Kangani, Zahra Hosseini, Farzaneh Sadeghi Mahounak * Pages 333-343
    Background

    This study compared the opinion of dental clinicians and patients regarding dental appearance and the need for cosmetic dental procedures. This information can serve as a basis for efficient treatment planning.

    Methods

    This cross-sectional study was conducted on 200 dental patients, 5 general dentists, and 5 restorative dentists. A standardized questionnaire with 17 questions was used to collect information regarding the opinion of patients about the appearance of their anterior teeth and the need for cosmetic dental procedures. Tooth shade, overjet, and overbite were also recorded, and three photographs were obtained from their teeth and assessed by dental clinicians. Data were analyzed by the Spearman, independent t, Mann-Whitney, and Bonferroni tests and ANOVA (alpha=0.05). 

    Results

    Of 100 male and 100 female patients participating in this study, 73% were satisfied with the appearance of their teeth, which was higher than the satisfaction rate reported by general dentists (65%) and restorative dentists (48%). The difference in opinion was not significant between the patients and general dentists (p=0.325). The satisfaction level of the restorative dentists was significantly lower than the patients (p<0.001) and general dentists (p<0.001). The patients were mostly dissatisfied with the color of their teeth (60%), and 88.5% were interested in cosmetic procedures (mostly bleaching). The opinion of the three groups was not significantly different regarding the need for cosmetic procedures (p=0.414). 

    Conclusion

    Restorative dentists had a significantly lower satisfaction with dental appearance of the patients, compared with general dentists and patients themselves. However, the opinion of the three groups was not significantly different regarding the need for cosmetic procedures.

    Keywords: Angle Class II, Cross-Sectional Studies, Dentistry, Dentists, Malocclusion, Personal Satisfaction, Surveys, Questionnaires
  • Faeze Poshtchaman, Zahra Poshtchaman, Alemeh Dehnabi, Rahil Mahmoudi, Batul Birjandi * Pages 344-349
    Background

    Diabetic retinopathy is a common vascular complication of diabetes. Vitamin D has been found to play a role in the development and progression of diabetic retinopathy. The aim of this study is to investigate the relationship between vitamin D levels and proliferative and non-proliferative retinopathy in diabetic patients.

    Methods

    The present study is a cross-sectional analytical study. This study was conducted at Hafiz Sabzevar Diabetes Clinic and involved diabetic patients. A total of 80 diabetic patients were categorized into three groups: patients without retinopathy, patients with proliferative diabetic retinopathy, and patients with non-proliferative retinopathy. Patients’ information was collected through a demographic questionnaire and a researcher-made checklist. The data were analyzed using SPSS 28, with descriptive statistical tests, Chi-square, ANOVA, and Bonferroni’s post hoc test.

    Results

    The results of the study showed a significant difference in vitamin D and creatinine levels among the three groups (p<0.001). The post hoc test was used to accurately determine this significant difference. The data revealed that both retinopathy groups had lower levels of vitamin D and higher creatinine compared to the non-retinopathy group, and this difference was statistically significant (p<0.001). However, there was no significant difference between the groups in terms of HDL (p=0.23), LDL (p=0.52), and total cholesterol (p=0.95).

    Conclusion

    Vitamin D deficiency increases the risk of developing diabetic retinopathy, both proliferative and non-proliferative. Therefore, it is recommended to consider taking vitamin D supplements in diabetic patients to maintain normal vitamin D levels, since it has positive effects in preventing the occurrence of diabetic retinopathy.

    Keywords: Creatinine, Diabetic Retinopathy, Retinal Diseases, Vitamin D, Vitamin D Deficiency, Vitamins
  • Elaheh Foroumandi, Azadeh Dehghani, Mahdieh Abbasalizad Farhangi *, Ranasadat Abedi Pages 350-363
    Background

    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. 

    Methods

    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. 

    Results

    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). 

    Conclusion

    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.

    Keywords: Cross-Sectional Studies, Diet, Economic Status, Educa-Tional Status, Female, Humans, Surveys, Questionnaires
  • Sina Owlia, Mahdieh Bahri, Amirpasha Amelshahbaz, Mohammad Bagher Owlia * Pages 364-372
    Background

    Recent evidence suggests a potential association between Modic Changes (MC) and inflammation in nonspecific low back pain patients. Inflammation, characterized by the activation of immune cells and the release of pro-inflammatory molecules, is known to play. This research aims to investigate the clinical and laboratory features suggestive of inflammation in patients with MC on lumbar MRI. 

    Methods

    A retrospective analysis was conducted on 169 patients with MC identified on lumbar Magnetic Resonance Imaging (MRI). Laboratory investigations were also obtained, including Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) levels. The MC were categorized based on their MRI signal patterns. The presence of inflammatory markers and their association with clinical features was assessed using appropriate statistical methods. 

    Results

    The majority of patients exhibited type 2 MC (n=139, 82.4%), followed by type 1 MC (n=28, 16.5%) and type 3 MC (n=2, 1.1%). Among the clinical features, patients with type 1 MC had a significantly higher prevalence of nocturnal low back pain (OR=6.76 [95%CI: 2.25-20.24], p<0.001) and morning low back stiffness (OR= 4.27 [95%CI: 1.42-12.85], p=0.006). Additionally, patients with type 1 MC were more likely to have elevated CRP levels (OR=2.61 [95%CI: 1.18-5.78]).

    Conclusion

    Although the majority of patients had type 2 MC (82.4%), type 1 MC was strongly associated with higher CRP levels, morning stiffness, and nocturnal pain. These associations suggest that type 1 MC may represent a more inflammatory and clinically severe form of the condition, emphasizing the importance of recognizing it in clinical practice.

    Keywords: Inflammation, Low Back Pain, Magnetic Resonance Imaging, Seronegative Rheumatoid Arthritis
  • Saeid Jodi *, Ahmad Separham, Amirreza Jabbaripour Sarmadian, Naeem Rakhsha Pages 373-382
    Background

    The SYNTAX score is a strong predictor of adverse cardiovascular events such as cardiac death, myocardial infarction, and lesions with revascularization. This rating was also confirmed for patients with left ventricular problems and all the patients referred for percutaneous coronary interventions Percutaneous Coronary Interventions (PCI).

    Methods

    This study was conducted on 107 patients with ST-Elevation Myocardial Infarction (STEMI) who underwent thrombolytic treatment and then angiography. SYNTAX score was calculated in all the patients. Finally, the short-term and long-term prognoses were examined. Finally, the STR values were compared in two groups of people with high syntax and low syntax.

    Results

    Eighteen patients (16.8%) suffered Congestive Heart Failure (CHF), one (0.9%) experienced GI bleeding, and one (0.9%) suffered ReMI. The patients’ mean±standard deviation, maximum, and minimum SYNTAX scores were 12.82±7.19, 35, and 3, respectively. Twelve patients (11.2%) had SYNTAX scores higher than 22 (high risk), and 95 (88.8%) had scores lower than 22 (low risk).

    Conclusion

    Results of the present study indicated that patients with SYNTEX scores >22 had STR lower than 50. CHF incidence rate in patients with SYNTAX scores higher than 22 (high risk) was higher. There was also a significant relationship between the patients’ prognosis and SYNTAX scores.

    Keywords: Angiography, Heart Failure, Myocardial Infarction, Percutaneous Coronary Intervention, ST Elevation Myocardial Infarction
  • Mohsen Rezaee, Shahin Kasraei, Mohammadhamed Zabihi, Narges Panahandeh * Pages 383-388
    Background

    Some previous studies have suggested that laser irradiation improves the bond strength of composite to dentin. This study aimed to assess the effect of 810 and 970 nm diode laser on microtensile Bond Strength (µTBS) of universal adhesives to dentin. 

    Methods

    In this in vitro, experimental study, the occlusal third of 54 extracted third molars was cut, and they were randomly divided into 9 groups (n=18). In groups 1-3, Tetric N-Bond Universal (TNB), G-Premio Bond (GPB), and Single Bond Universal (SBU) adhesives were applied, respectively and the teeth were built-up by applying three 1-mm thick composite increments. The same was performed for groups 4-6 and 7-9 with the difference that they underwent 810 and 970 nm diode laser irradiation (0.8 W, 20 s), respectively, prior to light curing. All the teeth were then sectioned into 1×1 mm blocks and their µTBS was measured. Data were analyzed by two-way ANOVA and Tukey test.

    Results

    The interaction effect of type of bonding agent and laser irradiation on µTBS was not significant (p=0.79). There was a statistical difference between the bond strength of the adhesive systems used (p=0.009).

    Conclusion

    Laser irradiation of universal adhesives applied by the etch and rinse (E&R) technique using 810 and 970 nm diode laser (0.8 W, 20 s) prior to their polymerization did not increase their µTBS to dentin.

    Keywords: Adhesives, Analysis Of Variance, Curing Lights, Dental, Dentin, G-Bond, Lasers, Light-Curing Of Dental Adhesives, Polymerization, Semiconductor, Single Bond, Tetric
  • Mohammadreza Habibi, Leila Kanafi Vahed *, Ali Faghih Habibi, Soudabeh Haddadi, Fatemeh Sadeghi Gilzad, Gelareh Biazar, Mohadese Ahmadi Pages 389-395
    Background

    Cancellations of elective scheduled surgeries on the intended day is a major problem for healthcare organizations with significant negative outcomes for patients and hospitals. This study aimed to investigate the rate and the reasons for day of surgery cancellations at an academic center in the north of Iran.

    Methods

    This retrospective single center study was conducted at Amir-al-Momenin Hospital, a referral and academic center in Guilan, Iran, during 2018-2022. A detailed review of a total of 187 cases canceled was performed. A responsible medical student filled out a checklist including type of surgery, patients’ age, ASA class and the cause of cancelation. 

    Results

    From 41900 cases, 187 surgeries were canceled representing a cancelation rate of 0.46%. The most common reason for cancellation was “change in the patient’s clinical condition” by 59.1%. The other reasons were ‘patient refusal’ 8%, ‘lack of correct timing for elective surgeries’ 7%, and ‘Technical problems in operating room facilities and equipment and unavailability of surgeon/surgeon’s opinion’ 5.3%. ‘Insufficient paraclinical tests’ and ‘lack of anesthesia pre-operative visits’ 0.5% had the least frequency among the reasons of cancelations.

    Conclusion

    The rate of day of surgery cancelation was low (0.46%). The majority of causes of cancelations were due to patient-related issues, particularly changes in patients’ clinical condition on the scheduled day of the operation. Process improvements need to be considered continuously to further decrease in cancelation rate.

    Keywords: Anesthesia, Hospitals, Surgery, Operating Rooms
  • Hamed Mortazavi, Parham Hazrati *, Shahrzad Askari Pages 396-401
    Background

    Reports of foreign bodies in oral tissues are available in the literature; however, this is the first report of complete embedment of a Stainless-Steel Crown (SSC) in the alveolar soft tissue.

    Case Report: 

    Upon radiographic evaluation of a 19-year-old male patient seeking orthodontic treatment with several missing teeth, an SSC of the primary right mandibular second molar entirely encompassed by soft tissue was observed. The patient had no pain or discomfort in the region. The overlying mucosa had no sign of inflammation except for a slight pallor, and adjacent teeth had tilted into the space of the corresponding absent tooth. The crown was removed with a crestal incision under the local anesthesia.

    Conclusion

    Infraocclusion of deciduous teeth, especially those covered with SSCs, should be strictly monitored clinically and radiographically as they can embed in soft tissue, cause severe bone defects, and complicate future treatments.

    Keywords: Tooth Deciduous, Foreign Bodies, Inflammation, Pallor, Stainless Steel, Tooth Loss
  • Mahdi Ramezani-Binabaj *, Seyed Reza Yahyazadeh Pages 402-406

    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.

    Keywords: Abdominal Injuries, Aged, Conservative Treatment, Cystitis, Humans, Male, Tomography, Urinary Bladder, X-Ray Computed
  • Shahram Molavynejad, Asad Imani * Pages 407-408

    Dear Editor,Nurses are one of the largest groups in the health care and play an important role in supporting patients (1). Communication with patients is an essential part of nursing care, and existence of mutual rights is necessary to establish this communication (2). They have various roles in caring for patients and this issue makes them contact with legal issues every day. Familiarization of nurses with legal bases associated with care issues is a necessity. In Iran, nurses must refer to Iran’s Islamic penal code in their legal challenges. Meanwhile, it seems that there is a controversial issue related to the rights of nurses and patients in the Islamic penal code of Iran.“ In the provision 1 of article 496, it is stated that if the patient or nurse knows that the physician order is wrong and causes damage and do it, the doctor is not the guarantor, but the documented damage is the responsibility of the patient or nurse” (3). In this provision, the legislator has assumed more responsibility on the patient than expected; while there is no guarantee that the patient will perceive the physician’s orders correctly. On the other hand, despite the fact that the nurse warned the physician’s wrong order to him/her, no support provision was mentioned for the nurses. On the other hand, if the nurses do not follow the physician’s orders at the bedside, they face work challenges and must be accountable to the clinical managers.It seems that the amendment of provision 1 of article 496 of Iran’s Islamic penal code is necessary to protect the rights of nurses and patients.