مجله دانشگاه علوم پزشکی مازندران
پیاپی 241 (بهمن 1403)

Gastric ulcers pose significant health challenges due to their high prevalence in various populations. Several factors contribute to the development of this condition, including Helicobacter pylori (H. pylori) infection, excessive use of nonsteroidal anti-inflammatory drugs (NSAIDs), smoking, age, and gender. Given the high incidence of gastric ulcers induced by NSAID consumption, this study aims to investigate the protective effects of hydroalcoholic extracts of Satureja hortensis and Froriepia subpinnata against indomethacin-induced gastric ulcers in animal models.

n this experimental study, the leaves of Satureja hortensis and Froriepia subpinnata were dried and extracted using 60% ethanol. The toxicity of these plant extracts was assessed using Artemia salina. The total phenolic and flavonoid contents of the extracts were measured spectrophotometrically. For the animal study, 48 Balb/c mice (n= 6 per group) were used. The treatment groups included omeprazole (30 mg/kg) and three different doses (250, 500, and 1000 mg/kg) of Satureja hortensis and Froriepia subpinnata, administered separately by gavage. A negative control group received normal saline. One hour after treatment, indomethacin was administered via gavage to induce gastric ulcers. Four hours after indomethacin administration, the animals were anesthetized, and their stomachs were collected for histopathological evaluation.

Histopathological findings revealed that inflammation, gastric tissue bleeding, and congestion were reduced in the Satureja hortensis and Froriepia subpinnata groups. Moreover, the 1000 mg/kg dose of both extracts demonstrated greater efficacy compared to the lower doses tested.

Extracts of Satureja hortensis and Froriepia subpinnata exhibit a protective effect against gastric ulcers induced by NSAIDs. This protective effect is likely attributed to the antioxidant and anti-inflammatory properties of phenols and flavonoids present in the extracts and appears to be dose-dependent.

 Due to the increasing importance of protecting human health and preserving the environment, drug resistance and water pollution have drawn significant attention. Nanoparticles have emerged as one of the most promising solutions, with cobalt nanoparticles being particularly interesting due to their unique properties. This study focuses on the green synthesis of cobalt nanoparticles using Mentha pulegium and investigates their potential antimicrobial and photocatalytic activities.

n this experimenal study, cobalt nanoparticles were synthesized through green methods using M. pulegium aqueous extract. The synthesized nanoparticles were characterized using various analytical techniques, including UV-visible spectroscopy, SEM, EDX, FTIR, and XRD. Furthermore, the antibacterial effects of these nanoparticles were investigated against ATCC strains and ciprofloxacin-resistant strains. Their photocatalytic activity was evaluated for the degradation of methylene blue (MB) in the presence of NaBH4.

XRD analysis revealed that the synthesized nanoparticles were amorphous, while SEM images showed irregularly shaped particles with an average diameter of 53.91 nm. The cobalt nanoparticles demonstrated excellent antibacterial activity. The maximum antibacterial effects were observed against ATCC strains, specifically K. pneumoniae (MIC and MBC values of 0.859 and 13.75 μg/mL, respectively) and S. aureus (MIC and MBC values of 1.72 and 27.5 μg/mL, respectively). For ciprofloxacin-resistant strains, the maximum effects were observed against E. coli (MIC and MBC values of 0.859 and 6.87 μg/mL, respectively) and P. mirabilis (MIC and MBC values of 0.859 and 1.72 μg/mL, respectively). These nanoparticles efficiently degraded methylene blue in the presence of NaBH4 within 30 minutes, following first-order kinetics with a rate constant of 0.0567 min-¹.

The results showed that M. pulegium effectively contributed to the formation of nanoparticles, acting as a reducing, stabilizing, and capping agent. In this study, the synthesized cobalt nanoparticles exhibited significant antibacterial activity and effective dye degradation properties. These findings suggest the potential application of cobalt nanoparticles in various biological fields.

 Bleeding is a serious complication of cesarean sections that can lead to decreased hemoglobin levels and increased maternal and neonatal mortality. This study aimed to compare the effects of tranexamic acid and position changes on the amount of bleeding and the satisfaction of the surgical team.

This study is a randomized, controlled, parallel clinical trial. The amount of bleeding, hemodynamic parameters, demographic data, clinical parameters, and surgical team satisfaction were measured using validated instruments. The study population consisted of patients aged 18 to 40 years who were candidates for cesarean sections under general anesthesia at Shohada Kargar Hospital in Yazd. The samples were randomly assigned to three groups each containing 33 participants: tranexamic acid, position change, and control. Data were analyzed using SPSS V.22 software.

A total of 99 pregnant women with a mean age of 31.20±5.82 years were included in the study. No significant differences were found in changes in hemoglobin, hematocrit, platelets, blood pressure, or oxygen saturation between the groups (P>0.05). The mean total bleeding in the tranexamic acid and position change groups was significantly lower than that in the control group (P<0.05). Additionally, satisfaction rates in the tranexamic acid and position change groups were higher than in the control group (P<0.001), but no significant difference was observed between the tranexamic acid and position change groups (P=0.472).

The results indicated that tranexamic acid and position changes significantly reduced bleeding and increased surgical team satisfaction, without negatively affecting postoperative complications. Therefore, the use of tranexamic acid and position changes can be recommended as effective strategies for reducing bleeding and enhancing surgical team satisfaction during cesarean section procedures.

 Intramuscular injection (IM) of medications is an invasive and painful procedure for many patients. Various forms of electrical stimulation may play a role in pain modulation. The aim of this study was to assess the effects of cathodal and anodal direct current (DC) on reducing pain caused by IM injections.

This study was conducted as a triple-blinded, randomized clinical trial on 120 patients who were candidates for IM. Patients in the control group did not receive any intervention. In the cathodal and anodal groups, direct current (DC) with a current intensity of 5 mA was applied via a connection to the needle tip during the injection. In the anesthetic group, EMLA ointment was applied locally. The pain level was measured based on the Visual Analog Scale (VAS) immediately after the injection and at 1,3-, and 5-minutes post-injection. Heart rate changes, injection duration, and injection frequency were also recorded. Data were analyzed using one-way and two-way analysis of variance (ANOVA) tests, as well as repeated measures.

There was no statistically significant difference between the groups in terms of age (P=0.2), gender (P=0.83), and body mass index (P=0.056). The pain level was significantly lower in the groups receiving anesthetic ointment (P<0.01), anodal (P<0.001), and cathodal (P<0.0001) direct current stimulation compared to the control group. Moreover, pain levels in the cathodal group were significantly lower than those in the anodal group (P<0.01) and the anesthetic group (P<0.05). The injection time was significantly shorter in the intervention groups than in the control group (P<0.0001), while there was no significant difference in the frequency of attempts required to perform a successful injection between the groups (P>0.05). The increase in heart rate was significantly lower in the intervention groups than in the control group during and after the injection (P<0.05), while no significant difference was observed between the intervention groups (P>0.05).

Applying electrical stimulation directly to the needle insertion area effectively reduced the pain and tachycardia caused by IM. Greater analgesic effects were observed with cathodal stimulation.

 (Clinical Trials Registry Number: IRCT20240123060780N1)

 Cognitive impairments significantly impact individuals' lives. Cognitive rehabilitation aims to enhance their physical, social, and occupational performance. This study evaluates the current state of cognitive rehabilitation in Iran and reports on related research and practices.

This mixed-method study utilized the Rehabilitation Service Assessment Tool (RSAT) tool, focusing on five main areas. Data collection included a comprehensive search of national resources (guidelines, regulations) and a scoping review of articles from PubMed and Scopus. Information on epidemiological data, intervention tools, and validated instruments was structured using the RSAT checklist.  

Despite legal support for disabled individuals, cognitive impairments are not explicitly recognized, complicating planning and resource allocation. In higher education, notable efforts have been made for academic development. Of 1055 retrieved articles, 260 met the inclusion criteria, with over half focusing on epidemiological objectives. A total of 169 tools were identified, with the Mini-Mental Status Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Stroop Test being the most used. A large number of studies were conducted in the past decade, accounting for 85.1% of the total, primarily by 62 national research institutions, with minimal private sector involvement.

The aging population and high prevalence of brain injuries underline the urgent need for cognitive rehabilitation development in Iran. Significant gaps remain in policymaking, planning, resources, infrastructure, and evidence-based guidelines. Existing academic and private sector capacities, alongside recent research, provide a foundation for growth. Addressing these gaps requires collaborative efforts across legislative, educational, and research institutions.

 Obesity has been recognized as a risk factor for COVID-19 infection in children. Multisystem Inflammatory Syndrome in Children (MIS-C) is a multisystem inflammatory disease following COVID-19, characterized by the involvement of at least two organs. Considering the significant role of obesity in the severity of COVID-19, this study investigates the prevalence of obesity and the factors affecting it in MIS-C patients.

This descriptive study included MIS-C patients younger than 21 years of age from December 2019 to September 2023. The patients were identified using the Centers for Disease Control and Prevention (CDC) checklist. Based on growth charts developed by the World Health Organization (WHO), the classification of overweight and obese children was determined according to the age and sex of each child. The demographic characteristics, clinical features, and outcomes were collected from the medical records. Data were analyzed using the t-test (or Mann-Whitney), Chi-square test, and logistic regression in STATA 14.

A total of 174 MIS-C patients were referred to hospitals, of whom height and weight measurements were documented for 149 patients. Of these, 11.41% of patients were overweight, and 17.45% were classified as obese. The median age was 62 months, and most of the patients were boys. The most common symptoms were gastrointestinal. In terms of clinical outcomes, ICU admission, death, and the median hospital stay in the obese group were 60%, 2%, and nine days, respectively, while in the non-obese group, they were 22%, 0.94%, and eight days, respectively. Significant differences were observed between the two groups in cardiac symptoms, comorbidity, duration of hospitalization, length of ICU stay, and need for ICU care (P<0.05). In the adjusted model, comorbidity was identified as a significant predictor (OR= 6.17; 95% CI: 0.34, 16.24).

The study's results indicate that obesity is associated with more severe clinical presentations and outcomes among MIS-C patients. Consequently, early intervention is crucial for preventing complications in obese MIS-C patients.

 Mycoplasma pneumoniae, which causes respiratory tract infections, has been associated with COVID-19 co-infections. This study aimed to investigate serum M. pneumoniae IgM and IgG levels in COVID-19 patients, assessing their connections with disease outcomes, including disease severity and mortality.

For this cross-sectional investigation, 70 COVID-19 patients hospitalized at Afzalipour Hospital in Kerman, Iran, during the first wave of the pandemic were chosen. Serum IgM and IgG levels for M. pneumonia were clinically tested, and demographic and clinical data were gathered using a review of medical records. The data were analyzed using SPSS version 23.

The research found a low incidence of M. pneumoniae IgM, while a considerable number of patients had positive IgG. Serum IgM levels differed depending on demographic and clinical characteristics, with younger patients and those without comorbidities having higher levels. Co-infected individuals experienced more frequent symptoms, such as anorexia, myalgia, and a productive cough. Patients who recovered had significantly higher levels of IgG than those who did not survive. Co-infection or past exposure to M. pneumoniae may impact COVID-19 clinical outcomes. Elevated blood IgM levels were associated with particular symptoms, whereas higher IgG levels were linked to better outcomes.

Previous or co-infection with M. pneumoniae can affect the symptoms and outcomes of COVID-19. Therefore, diagnosing co-infections with this bacterium can significantly improve the management and recovery of these patients.

 Constipation is a significant health issue among children, requiring prompt screening and early diagnosis due to its substantial contribution to disease burden. Probiotics, which colonize the bowel, are known to exert positive effects on the gut microbiota. While probiotics have been extensively studied in relation to various gastrointestinal disorders, there is limited research specifically addressing their efficacy in managing pediatric constipation. To address this gap, we designed a study to evaluate the impact of probiotics on the treatment of constipation in children attending the Imam Sajad hospital clinic in Ramsar, Iran.

This double-blind clinical trial involved 90 children diagnosed with constipation, who were randomly assigned to either an intervention or a control group. For each child, a checklist was first completed, and all children received toilet training conducted by the researcher. The control group received standard treatment for constipation, which included 0.7-1.5 grams per kilogram of Polyethylene Glycol (PEG) powder (Pidrolox). The intervention group received the same standard treatment in addition to a probiotic supplement (Kidy Lact). The study duration was four weeks and all the patients were clinically examined at two and four weeks after the intervention. The primary assessment criteria included stool consistency, the frequency of incontinence episodes per week, the presence of abdominal pain, and painful bowel movements. Secondary evaluations focused on treatment success and any adverse effects, such as diarrhea and vomiting.

After two weeks, no significant differences were observed between the intervention
and control groups regarding stool frequency, painful defecation, incontinence, and abdominal pain (P=0.30, P=0.85, P=0.53, and P=0.23, respectively). Furthermore, after four weeks, stool frequency and incontinence did not show significant differences between the two groups (P=0.22 and P=0.53, respectively). However, the frequency of painful bowel movements in the intervention group was significantly lower than in the control group (P=0.04).

Based on the findings of this study, adding probiotics to the standard treatment for functional constipation, such as Polyethylene Glycol powder, may be beneficial for children. To obtain more precise results, it is recommended that long-term studies be conducted using probiotics.

 Pharmacists perform a diverse range of activities and services in the field of pharmaceutical care. Therefore, the quantitative and qualitative monitoring of these pharmaceutical services in hospital wards is essential. Since monitoring such services in hospitals requires a valid instrument, the aim of this research is to develop and conduct a scientometric evaluation of a questionnaire to quantify the quality of pharmaceutical care services in general hospital wards.

This methodological research was conducted between December 2023 and July 2024. To compile the questionnaire, the relevant areas were first identified. Subsequently, questions related to these areas were developed through a focused group discussion. Next, the appropriate scoring method was determined, and the initial questionnaire was constructed in two parts (technical and professional), formatted as a checklist. The content validity of the instrument was assessed in terms of clarity, simplicity, relevance, and necessity of each question. Internal consistency of the questionnaire was assessed using Cronbach's alpha.

The mean content validity ratio of the technical part was 0.84 and 0.88 for the professional part. Also, the content validity index was 0.85 for the technical and 0.84 for the professional part. The alpha values were 0.771 for the first part and 0.773 for the second part, indicating an acceptable internal consistency.

While introducing a practical instrument, our results revealed acceptable validity and reliability indices for it. This tool can be used to evaluate and quantify pharmaceutical care services in hospital wards, and also as an indicator to identify high-risk areas where medication errors could occur.

 The Family Physician Program is a community-based initiative designed to provide healthcare services to all members of society, regardless of age or gender, in a comprehensive, coordinated, continuous, and patient-centered manner. The quality of services provided by family physicians plays a crucial role in achieving the fundamental objectives of the Family Physician Plan. Therefore, this study was conducted with the aim of developing a model to enhance the quality of services in the management of social security healthcare in Mazandaran Province.

The statistical population of the qualitative section included family physicians and treatment managers with at leas five years of experience. The sample size in the qualitative section was determined using snowball sampling until data saturation was reached, which in this study occurred with 17 participants. To collect data, interviews and questionnaires were used, with the questionnaire developed based on interview results and content analysis. The face validity of the questionnaire was assessed by supervisors and consultants, while its content validity was evaluated using the CVR index. Data analysis was conducted using the meta-synthesis technique.

Based on the research findings, 32 indicators were identified, categorized into two main themes and six sub-themes. For the tangible service quality dimension, diagnostic criteria were established for the quality of cost-related services and the quality of electronic services. In contrast, for the intangible service quality dimension, criteria were identified for the quality of insurance services and responsiveness, the quality of obstetrics and gynecology services, and the quality of consulting services.

The identified family physician empowerment indicators have led to an improvement in the quality of services in the management of social security healthcare in Mazandaran. It is essential for policymakers and health system managers to address the challenges of the Family Physician Policy by utilizing the findings of this study. This can be achieved by enhancing transparency in guidelines and executive agreements, addressing the motivational and educational needs of family physicians, revising and improving methods for collecting environmental data, and adopting evidence-based decision-making.

 Rapid population growth and uneven development in Iran have resulted in a critical water scarcity crisis, with domestic water consumption significantly exceeding global averages. This study aimed to evaluate the knowledge, attitudes, and practices of citizens in Sari regarding appropriate water consumption.

This cross-sectional descriptive study was conducted in Sari in 2023. A sample of 450 individuals was selected from the target population using a simple stratified sampling method. Data were collected using a revised version of the Amiri Baghbadrani Questionnaire (2022), which was tailored to align with the study's objectives and the characteristics of the participants. The questionnaire assessed knowledge (score range: 0-12), attitudes (score range: 9-45), and practices (score range: 10-50) related to water consumption. Data analysis was performed using SPSS software, employing the Mann-Whitney and Kruskal-Wallis tests.

Of the 300 distributed questionnaires, the average scores for knowledge, attitude, and practice of Sari citizens regarding proper water consumption were 5.14±1.92 (moderate), 36.36±4.25 (good), and 49.42±5.05 (good), respectively. Additionally, the knowledge domain demonstrated a significant relationship with occupation, gender, and place of residence; the attitude domain exhibited a significant relationship with age and education; and the practice domain revealed a significant relationship with gender, occupation, and education (P<0.05).

The findings revealed that the levels of knowledge, attitudes, and practices regarding water-saving behaviors among citizens in Sari were moderate, good, and good, respectively. These results underscore the importance of education and the cultivation of a culture of water conservation to transform knowledge and positive attitudes into action.

Acute necrotizing encephalopathy (ANE) is a rare but severe neurological condition characterized by rapid deterioration of the patient's cognitive and motor functions, often accompanied by seizures, altered consciousness, and coma. This condition can be triggered by various pathogenic factors including viral infections such as influenza and the coronavirus. Initially reported in East Asia, particularly in Japan, ANE has since been documented in other regions globally, with a marked increase in cases associated with the coronavirus in recent years. This article presents the case of a six-year-old Iranian girl who developed acute necrotizing encephalopathy following an acute respiratory illness characterized by fever and convulsions. The patient had no previous medical history or known exposure to influenza, nor had she received influenza vaccination. She was brought to the emergency department by her parents after two days of fever, headache, muscle pain, and sore throat, presenting with seizures, a reduced level of consciousness, and hemodynamic instability. Upon admission to the pediatric intensive care unit (ICU), initial interventions included stabilizing vital signs, administering serum therapy, prescribing antibiotics, and conducting diagnostic tests such as COVID-19 and influenza screening. Further diagnostic and therapeutic measures included brain imaging, which confirmed the diagnosis of acute necrotizing encephalopathy. As part of the treatment protocol, the patient received intravenous immunoglobulin and corticosteroids. Despite aggressive management, including intubation and intensive care, the patient's condition deteriorated rapidly due to extensive involvement of the brainstem and the onset of multiple organ failure. Unfortunately, despite the best efforts of the medical team, the patient passed away. While several cases of acute necrotizing encephalopathy have been documented in East Asia and other parts of the world, reports from Iran remain scarce. This case highlights the importance of considering acute necrotizing encephalopathy in the differential diagnosis of children who experience progressive neurological decline following an acute febrile illness.

Receptor-targeted radionuclide therapy (RTRT) combines the power of particle-emitting radionuclides with the receptor-targeting capabilities of biomolecules, including antibodies and peptides. There are numerous radionuclides, but only a handful possess the necessary characteristics for targeted alpha therapy (TAT). Among them are actinium-225 (²²⁵Ac), bismuth-213 (²¹³Bi), radium-224 (²²⁴Ra), lead-212 (²¹²Pb), thorium-227 (²²⁷Th), astatine-211 (²¹¹At), and terbium-149 (¹⁴⁹Tb). Lead-212 (²¹²Pb) is a radionuclide that release both alpha and beta particles during its decay. The distinctive properties of ²¹²Pb, such as its relatively short half-life (10.64 hours), the commercial availability of ²²⁴Ra/²¹²Pb generators, in vivo generation of alpha particles through ²¹²Bi at its target site, simple conjugating process, and strong binding to chelators such as DOTA and TCMC make this radionuclide particularly promising for targeted alpha therapy. TAT with ²¹²Pb has demonstrated significant therapeutic effectiveness in both in vitro and in vivo models. To date, numerous biological molecules, including antibodies and peptides, have been labeled with ²¹²Pb in preclinical studies to evaluate their therapeutic efficacy and receptor-targeting potential. These studies have focused on receptors such as the epidermal growth factor receptor (EGFR) family, somatostatin receptor 2 (SSTR2), melanocortin 1 receptor (MC1R), prostate-specific membrane antigen (PSMA), CD37, CD38, CD46, vascular cell adhesion molecule 1 (VCAM-1), and chondroitin sulfate proteoglycan 4 (CSPG4). This review will first examine the physical properties of ²¹²Pb, followed by an analysis of its chemical characteristics, particularly its interactions with DOTA and TCMC. Finally, it will explore preclinical studies on ²¹²Pb-radiolabeled molecules and assess the clinical applications of radiotracers developed for receptor-targeted radionuclide therapy.

Infertility management and measures to reduce its prevalence are of considerable importance. In recent years, knowledge translation has been emphasized and prioritized in various fields, especially medical sciences, as a means to improve the health of communities. The purpose of this study is to describe the application of knowledge translation in the field of infertility. The necessary measures for effective infertility management are situated within four main areas: building a culture of awareness around infertility, preventing infertility, diagnosing infertility, and treating infertility. Implementing knowledge translation within each of these areas represents an essential and effective step toward reducing infertility prevalence. One of the most influential knowledge translation tools for building awareness and shaping culture is the media, which can play a critical role in educating the public. Infertility is caused by a variety of factors, including some that are specific to men (e.g., developmental diseases in male children), others specific to women (e.g., ovulatory disorders), and factors affecting both sexes (e.g., sexually transmitted diseases). Therefore, providing comprehensive education and increasing community awareness in these areas are crucial steps for infertility prevention. Despite advancements in infertility treatments, many individuals remain unaware of available options. Enhancing public knowledge of treatment methods, including fertility preservation strategies such as ovarian and egg freezing, is essential. Furthermore, raising awareness about issues such as insurance coverage for infertility treatments is equally important, as economic constraints are often significant barriers to seeking care. Additionally, certain aspects of infertility treatment, such as third-party reproduction, warrant focused attention from policymakers and officials. Through the development of strategic policy briefs by experts, policymakers can establish effective frameworks to address these challenges. In conclusion, utilizing knowledge translation tools such as raising awareness through the media, developing strategic policy briefs, and creating evidence-based guidelines by researchers and specialists in infertility management is a critical step toward reducing infertility prevalence and improving overall community health.

Plant proteins are a good alternative to animal sources in the production of bioactive peptides as rich, safe, and suitable sources for industrial scale production. Peptides obtained from the hydrolysis of plant proteins are also compounds with therapeutic properties, safe, low molecular weight, low cost, high bioactivity and easy absorption. The biological activities of peptides derived from plant proteins, depending on the type and sequence of their amino acids, include influencing the main body systems such as the heart and blood vessels, digestive system, nerves and immune system. Due to the promotion of health and the need to prevent diseases, the production and use of bioactive peptides have become increasingly popular due to their antioxidant, anti-blood pressure and antimicrobial properties. In addition to biological activities, plant-derived bioactive peptides have a wide range of functional properties, including various physical and chemical properties such as high solubility, emulsifying, foaming, and hydrophilic/lipophilic properties. This review presents research progress on the biological activities and functional properties of plant-derived peptides and the use of bioactive peptides in various food formulations as nutraceutical, functional or therapeutic food ingredients as well as food preservatives. The bitter taste and toxicity of these bioactive peptides are in some cases potential challenges that need to be overcome before wider use. The purpose of this review is to improve the understanding of bioactive peptides derived from plants and to present their applications. In addition, in this review study, the major challenges and future prospects in the application of plant-derived bioactive peptides in the development of multipurpose products have been discussed.

Do Children of Mothers with Depression During Pregnancy and the First 12 Months Postpartum Face a Higher Risk of Lower IQ? A Review of the Best Available Evidence

Exclusive breastfeeding is a vital factor in improving maternal and child health. Studies among Iranian mothers indicate suboptimal rates of exclusive breastfeeding, as well as low levels of awareness and self-efficacy in this regard. Breastfeeding education plays a crucial role in addressing this issue. However, current training programs in Iranian healthcare centers primarily focus on general literacy rather than health literacy, which encompasses the ability to access, comprehend, evaluate, and apply health-related information. Additionally, a uniform approach to breastfeeding education is applied to all mothers, regardless of their individual needs and literacy levels, highlighting the necessity for more effective and targeted educational interventions. This policy brief emphasizes the importance of adopting a health-literacy-based approach to breastfeeding education as a key strategy for enhancing the quality of exclusive breastfeeding programs in Iran. The objective of this brief is to address this gap through a comprehensive assessment, including policy considerations, database analysis, field research, and adherence to regulations in Mother- and Baby-Friendly Hospitals. Proposed strategies include developing and implementing a national health policy on breastfeeding education, along with monitoring and evaluation mechanisms; integrating breastfeeding education with a health-literacy approach into maternal primary care services and electronic maternal and neonatal health records; enhancing the communication and educational skills of midwives and other maternal and child healthcare providers so they can deliver breastfeeding education in a simple, comprehensible, and practical manner that is tailored to mothers' cultural and social needs; and leveraging modern educational technologies, such as multimedia tools and mobile applications, to facilitate maternal access to essential information.