مجله سازمان نظام پزشکی جمهوری اسلامی ایران
سال چهل و سوم شماره 1 (پیاپی 169، بهار 1404)

In recent years, much attention has been paid to using natural substances to treat many chronic diseases. Boswellic acid, obtained from the gum resin of Boswellia serrata (B. serrata) and Boswellia carteri, which consists of five-ring triterpene molecules, has been of interest since ancient times to treat various diseases. This review aims to provide an in-depth explanation of the origin, structure, pharmacokinetics, and especially the biological activities of boswellic acid derivatives.

Articles were reviewed to find studies on B. serrata and isolated boswellic acid derivatives and properties such as anti-cancer, anti-microbial, anti-inflammatory, anti-arthritic, blood lipid-lowering, immune modulator, anti-diabetic, liver protective, anti-asthmatic,  and anti-Alzheimer disease. For this purpose, the keywords “Boswellia, Boswellic acid, Therapeutic reviews, Anti-inflammatory” which were selected according to the MeSH pattern were searched in Google Scholar, PubMed, and Scopus databases separately and together.

The antitumor effects of B. serrata are due to its triterpenoid content, especially boswellic acid. Among boswellic acid derivatives, acetylketoboswellic acid has shown the greatest potential as a cytotoxic molecule. Activation of caspases, increase in Bax expression, decrease in NF-kB level, inhibition of TNF, cyclooxygenase, and lipoxygenase, and suppression of free radical production all play major roles in the cytotoxic and antitumor effects, blood lipid-lowering, immune system modulation, antidiabetes and treatment and prevention of neurodegenerative diseases.

Numerous preclinical researches and a wide range of clinical trials have shown that boswellic acid and its derivatives have a wide range of beneficial medicinal effects against many chronic diseases. These factors can inhibit several mechanisms that contribute to disease progression. However, doubts about the pharmacokinetic quality of this compound have been a decisive challenge in the development of boswellic acid derivatives as an effective drug. Many studies have been initiated to find ways to overcome these barriers and progress in this area will be gradual.

The rapid advancement of artificial intelligence (AI) technology in recent years, particularly with the rise of chatbots in the medical sector as healthcare or therapeutic assistants, has prompted numerous healthcare professionals, service providers, and patients to embrace these innovations. Since the initial concepts surrounding AI and intelligent robots emerged, numerous ethical and legal challenges have arisen, which continue to evolve. Key issues include how AI should be treated, the nature of interactions with it, and the accountability for the outcomes it delivers to users.

To explore this topic, the scoping review method was employed due to its emerging nature and resource constraints. A thorough search was conducted using the keywords “AI” and “autonomy” in Google Scholar and PubMed, focusing on articles published between 2021 and 2024. The insights gathered from the literature review and the views of various authors culminated in the writing of this article.

The most prominent themes identified across the reviewed literature include the importance of transparency in decision-making, justice and informed consent, as well as privacy concerns. These aspects warrant serious consideration given the increasing utilization of AI to ensure equitable and comprehensive access to healthcare services.

In addition to the issues highlighted by the literature review, the implementation of AI as an assistant therapist or caregiver within the healthcare system necessitates a commitment to upholding patient dignity and respecting their independence and autonomy as users of technology. Consequently, it is imperative to establish clear frameworks regarding the respect for autonomy, obtaining informed consent, safeguarding privacy, ensuring transparency in data and outcomes, and defining the nature of human-machine interactions. This clarity is essential for assigning ethical and legal responsibilities in the relationship between AI and its users (the patients). This article will delve into these critical topics.

The present study aimed to provide a model for the implementation of executive measures for sustainable financial resource policies in the healthcare sector.

This research employed a mixed-method approach. In the qualitative section, semi-structured interviews were conducted with 12experts in the field of healthcare finance. The data were analyzed using the thematic analysis method with MAXQDA 10 software. A Delphi method was utilized in two rounds, employing a researcher-made questionnaire to validate dimensions, components, and factors. The questionnaire was administered to a statistical population consisting of 80 experts in healthcare financing. Selection was based on expertise criteria, and through a complete enumeration approach, 66 questionnaires were completed and subjected to analysis.

The research findings, following the extraction of sub-codes, comprised 51 factors classified into 22 components under 5 dimensions, including: (Integrated Financial Information Technology and Intelligence- Transparency and Financial Reporting in Healthcare- Innovative Financial Management, Budgeting and Strategies Management of Healthcare Financial Resources and Expenditures-General Factors in Healthcare Financial Resource Procurement and Distribution).

The Ministry of Health and medical universities, in implementing executive measures for sustainable financial resource policies in the healthcare sector, can utilize the obtained components, including, integrated information systems, transparency-intelligent, financial information systems, pricing systems, innovative financial management in health records and online prescription systems, financial performance monitoring, budgeting, and stakeholder accountability, operational transparency and financial resource information and succession planning for managers and staff-operational planning and budgeting. These components, identified as having the highest scores, can be operationalized to enhance financial sustainability and efficiency in the healthcare sector.

The global diabetes prevalence is rising.The comorbidity of diabetes and depression add complexity to diabetes management. The focus of new studies is on finding a way to improve psychological problems and increase the motivation of patients to perform and continue exercise and medical orders. The mindfulness has attracted special attention due to its focus on the thought patterns and emotions of people that can play an important role in controlling diabetes. This study aimed to compare the effectiveness of aerobic exercise with or without mindfulness in fasting blood sugar levels and depression among women with type 2 diabetes.

This study employed a semi-experimental design featuring a pre-test, post-test, and a three-month follow-up. The statistical population consisted of women with type 2 diabetes who were referred to Diabetes Center in 2023 in Karaj city. 60 participants were randomly selected and divided into four groups, with 15 individuals in each group. In addition to medical treatment, the aerobic exercise group participated in 12 sessions of exercises, while the second group underwent 12 sessions of mindfulness intervention. The third group received both 12 sessions of mindfulness and 12 sessions of aerobic exercises. The control group received only medical treatment. All four groups completed the Beck Depression Inventory during the pre-test, post-test, and follow-up phases, their fasting blood sugar levels were measured. Data were analyzed using repeated measures analysis of variance (ANOVA) and Bonferroni post hoc tests.

The results revealed significant differences in the effectiveness of aerobic exercise compared to the combined aerobic exercise/mindfulness intervention (p=0.003), as well as between mindfulness therapy and the combined intervention (p=0.015) in reducing depression and fasting blood sugar levels in patients with type 2 diabetes. The combination of aerobic exercise and mindfulness was more effective in reducing both depression and fasting blood sugar.

The combination of aerobic exercise and mindfulness training has an ideal therapeutic effect in reducing fasting blood sugar levels and depression on patients with type 2 diabetes.
Although combination therapy showed promising results, more clinical trials are needed to assess effectiveness in different populations.

Health services should be considered one of the essential components of development, aimed at improving the physical, mental, and social health of individuals. To ensure equitable access to healthcare resources for all members of society, these resources must be uniformly distributed across the country. This study aims to evaluate the level of development in different provinces of the country concerning the healthcare sector.

The research was conducted in three phases. In the first phase, we identified the indicators from the literature. Then, using the fuzzy Delphi technique by 14 experts, we refined the factors. In the next phase, the Intuitionistic Fuzzy Analytic Hierarchy Process (IFAHP) was used to weight the indicators. In the third phase, we employed the TOPSIS method to rank the provinces.

A total of 26 indicators were identified, categorized into two groups: general and technological. The results of the weighting indicated that the access to technology indicator was given the highest priority. Ranking the provinces based on general indicators revealed that Golestan had the best status, whereas Qom had the worst. When considering both general and technological indicators together, Tehran received the highest rank, while Sistan and Baluchestan was ranked the lowest.

The results of this study can provide valuable information for policymakers in the healthcare sector, enabling them to make informed decisions. This can aid in effective planning toward achieving equity in healthcare access and services.

Nowadays, prolonged and continuous use of electronic devices such as smartphones, laptops, and tablets has become an integral part of students’ academic and personal lives, especially in medical and nursing education. This excessive screen time has raised increasing concerns regarding visual health, with eye fatigue being one of the most common and troublesome consequences. Eye fatigue may manifest as symptoms such as dryness, burning sensation, blurred vision, sensitivity to light, eye pain, and reduced concentration, all of which can negatively impact students’ academic performance and quality of life. In recent years, yoga eye exercises have gained attention as a non-pharmacological, non-invasive, and natural method to improve eye health and relieve visual fatigue. These exercises are believed to improve blood circulation around the eyes, relax the eye muscles, and reduce tension. Therefore, this study aimed to investigate the effectiveness of yoga eye exercises in reducing eye fatigue among nursing students.

This semi-experimental research followed a pre-test–post-test design. The study population consisted of nursing students who were selected through simple random sampling. A two-part questionnaire was used to collect data before and after the intervention. Students in the intervention group were trained in yoga eye exercises and were asked to practice them five times a week, for 30 minutes per session, over a period of six consecutive weeks.

The results showed a significant reduction in the average eye fatigue scores after the intervention. The mean score before the exercises was 3/46±1/30, while after the exercises it decreased to 1/21±1/23. Statistical analysis confirmed the significance of this difference (p<0/001), indicating the effectiveness of yoga eye exercises in alleviating eye fatigue.

Yoga eye exercises can be considered an effective, low-cost, and accessible method to reduce eye fatigue, especially for students who are required to spend extended periods using digital screens. Incorporating these exercises into daily routines may contribute to the promotion of visual health in academic settings.

Profuse bleeding is a leading cause of death due to trauma, for which proper hemostatic agents are required. Kaolin mineral and potash alum, due to their ability to promote blood coagulation and rapid hemostatic action, have received more attention than other generations. The aim of this study was to determine the coagulation power ability of these materials for producing dressings with high efficiency and ease.

30 male Wistar rats were divided into five groups of positive control (Tabastop), negative control (sterile gas), gauze impregnated with potash alum, chitosan, kaolin and gauze impregnated with all three of these substances. After inducing bleeding by making deep cuts in the femoral area, dressings were placed on the wounds and the amount of bleeding, stopping time and weight of the dressings were measured. The data were analyzed by SPSS statistical software using one-way ANOVA and Tukey`s test, and the significance level was p<0.05.

The highest number of applied dressings belonged to Group 1, and the least belonged to group 6, which showed a significant difference. The longest required time to achieve complete hemostasis was in the group 1 and the least belonged to group 6. (p<0.05). The highest volume of blood loss was related to group 1, while the lowest volume of blood loss was observed in group 6. The difference between these two groups was also significant (p<0.05).

Dressings impregnated with chitosan, kaolin, and potash alum can effectively stop bleeding more quickly than other compounds.

This letter to the editor examines the historical significance of Dar al-Fonun, established in 1851 by Amir Kabir, as the first modern institution of higher education in Iran. Founded during a time of scientific and technological lag, Dar al-Fonun aimed to modernize Iran’s educational system, particularly in medicine and pharmacy. With the help of European experts such as Dr. Jacob Eduard Polak and Dr. Focchetti, the institution introduced advanced surgical methods, vaccination practices, anatomy, and pharmaceutical sciences. Polak was instrumental in promoting modern medical practices and public health measures, including the first systematic smallpox vaccination in Iran. Focchetti contributed to the foundation of pharmaceutical education, reducing dependency on imported medicine. The letter also highlights the role of Iranian scholars trained at Dar al-Fonun, such as Nizam al-Atibba and Reza Qoli Hedayat, in localizing and expanding modern medical knowledge. Despite facing religious and cultural resistance, especially regarding dissection, supportive religious authorities helped integrate modern science with Islamic principles. Though Dar al-Fonun declined in later decades due to political and institutional changes, its legacy in shaping Iran’s scientific modernization remains profound. Today, it stands as a cultural museum, symbolizing the country’s first structured engagement with modern science.