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A comparative analysis of the impact of three distinct laparoscopic myomectomy techniques on ovarian reserve: a randomized clinical trial
No full textPurposeLaparoscopic myomectomy is one of the preferred surgical treatments for symptomatic uterine fibroids. This study aimed to compare the effects of laparoscopic myomectomy with temporary uterine artery occlusion (TUAO), permanent uterine artery occlusion (PUAO), and vasopressin injection (VPI) on ovarian reserve in women with symptomatic uterine leiomyomas.MethodsThis randomized clinical trial (RCT) study was conducted on women with symptomatic uterine fibroids referred to Shahid Beheshti and Al-Zahra Hospitals in Isfahan, Iran, from January 2024 to July 2024. A total of 54 women were included, with 18 women in each group. The women were randomly grouped based on the used techniques of TUAO, PUAO, and VPI. Moreover, ovarian reserve marker, including anti-Mullerian hormone (AMH) level, were measured before and after surgery. This parameter was evaluated 3 months after surgery for all patients. Also, the amount of hemoglobin was measured before and after 24 h after surgery for participants in each method.ResultsTUAO, PUAO and VPI laparoscopic myomectomy techniques had almost similar effects on ovarian reserve. The AMH level before the surgery in TUAO, PUAO, and VPI groups was reported as 3.87 ng/mL, 3.42 ng/mL, and 3.57 ng/mL, respectively. The AMH level (3 month) after the surgery was 3.78 ng/mL, 3.34 ng/mL and 3.48 ng/mL, respectively. No significant difference was reported between AMH levels among the methods before and after the surgery (P = 0.27, P = 0.12, and P = 0.29, respectively). The Hb level before the surgery in TUAO, PUAO, VPI was 11.23 g/dL, 11.55 g/dL and 11.67 g/dL, respectively. The Hb level after the surgery (24 h) was reported as 10.95 g/dL, 11.31 g/dL and 11.25 g/dL, respectively. No significant difference was reported between Hb levels among the methods before and after the surgery (P = 0.36, P = 0.31, and P = 0.13, respectively).ConclusionAs the choice of technique may depend on the factors such as surgeon preference and patient-specific factors, findings of this study have important implications for women undergoing LM and also highlight the need for further studies on the long-term effects of these techniques on ovarian reserve with larger sample sizes
Curcumin Supplementation as a Preventive Strategy Against Tamoxifen-Induced Nonalcoholic Fatty Liver Disease in ER plus Breast Cancer Patients: A Triple-Blind Randomized Placebo-Controlled Trial
No full textTamoxifen, a common treatment for estrogen receptor (ER)-positive breast cancer, is associated with an increased risk of developing nonalcoholic fatty liver disease (NAFLD). Curcumin, a compound in turmeric, has shown potential in mitigating liver disease progression. This study aims to evaluate the efficacy and safety of curcumin in preventing NAFLD in breast cancer patients initiating tamoxifen therapy.In this 6-month triple-blind, randomized placebo-controlled trial, 44 ER+ breast cancer patients scheduled to receive tamoxifen were assigned to receive either curcumin (500 mg daily) or a placebo. NAFLD grade was assessed via ultrasound at baseline and after 6 months. Laboratory values and demographic data were collected, and adverse effects were monitored. Statistical analyses was performed using SPSS version 16.Data of a total of 44 participants (22 participants in each group, mean age: 47.1 +/- 6.0 years) were analyses. There were no significant differences between the placebo and curcumin groups regarding the demographic and baseline laboratory values. At study completion, significantly fewer patients in the curcumin group showed an increased NAFLD grade compared to the placebo group (13.6 vs. 54.5; p = 0.03). Additionally, the prevalence of NAFLD grade >= 2 was lower in the curcumin group (13.6 vs. 40.9; p = 0.04). No adverse effects related to curcumin were reported. Curcumin supplementation demonstrated a protective effect against tamoxifen-induced NAFLD in ER+ breast cancer patients, suggesting its potential as a prophylactic adjunct to tamoxifen therapy. Larger multi-centric trials are warranted to confirm these findings
Can a theory-based intervention lead primiparous women to decide to have a normal vaginal delivery? A randomized controlled trial
No full textINTRODUCTION: Although cesarean section (CS) plays an important role in reducing the complications and mortality of childbirth, the increase in unnecessary CSs is an indicator of the improper functioning of the health system. This study aimed to measure the effect of an educational intervention based on the theory of planned behavior (TPB) on the intention and type of delivery of primiparous pregnant women. MATERIALS AND METHODS: This was conducted as a randomized controlled trial in Isfahan city, Iran. In total, 112 primiparous pregnant women participating in childbirth preparation classes were divided into two intervention and control groups by nonrandom sampling method. The intervention group received an educational intervention that included a combination of childbirth preparation classes based on TPB during the 16th to 38th weeks of pregnancy. The data were completed in the form of an online survey using a validated self-report questionnaire and analyzed in SPSS software version 24. The significance level of the tests was considered as P < 0.05. RESULTS: The average score of attitude, subjective norms, and perceived behavioral control in the intervention group significantly increased after intervention (P < 0.05). Physicians, spouses, and parents were the most important sources of social norms for selecting the type of delivery for pregnant women in both groups before and after the intervention. There was a significant difference between the intention of women in the intervention group, before and after the intervention (P = 0.031), but no significant difference was observed between the two groups regarding the type of delivery (P = 0.556). CONCLUSION: Reconstructing childbirth preparation classes based on TPB improved the intention and other predictive structures of TPB in the intervention group, but the final behavior of the two groups regarding the type of delivery was the same. It seems that the stressful conditions of delivery, along with the final opinion of the physicians, are effective in choosing the final type of delivery
Development of Iranian clinical practice guidelines: An experience in cardiovascular diseases-A policy brief
No full textIn the wake of the dominance of evidence-based thinking, clinical practice guidelines (CPGs) within the country's health system have gained a key position in recent years and playing an important role in enhancing all functions of this system. However, the absence of a standard model, the inadequacy of existing documentation for designing clinical guidelines, data obtained from the national self-care project (IMPROVE-CARE), the Persian Registry of Cardiovascular Disease, the national priorities declared by the Iranian Network of Cardiovascular Research, and most importantly, the order from the Ministry of Health, all highlight the necessity of establishing a structure followed by the creating of a standard model for the development of guidelines, and subsequently, the creation of Iranian clinical guidelines. This policy brief article discusses the process of establishing the structure and the produced content and presents the necessary policies for the development of national clinical guidelines
Machine learning-based interpretation of non-contrast feature tracking strain analysis and T1/T2 mapping for assessing myocardial viability
No full textAssessing myocardial viability is crucial for managing ischemic heart disease. While late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is the gold standard for viability evaluation, it has limitations, including contraindications in patients with renal dysfunction and lengthy scan times. This study investigates the potential of non-contrast CMR techniques-feature tracking strain analysis and T1/T2 mapping-combined with machine learning (ML) models, as an alternative to LGE-CMR for myocardial viability assessment. A retrospective analysis was conducted on 79 patients with myocardial infarction (MI) 2-4 weeks post-event. Patients with prior ischemia or poor imaging quality were excluded to ensure robust data acquisition. Various ML algorithms were applied to data from LGE-CMR and non-contrast CMR techniques. Random forest (RF) demonstrated the highest predictive accuracy, with area under the curve (AUC) values of 0.89, 0.90, and 0.92 for left anterior descending (LAD), right coronary artery (RCA), and left circumflex (LCX) coronary artery territories, respectively. For the LAD territory, RF, k-nearest neighbors (KNN), and logistic regression were the top performers, while RCA showed the best results from RF, neural networks (NN), and KNN. In the LCX territory, RF, NN, and logistic regression were most effective. The integration of T1/T2 mapping and strain analysis significantly enhanced myocardial viability prediction, positioning these non-contrast techniques as promising alternatives to LGE-CMR. ML models, particularly RF, provided superior diagnostic accuracy across coronary territories. Future studies should validate these findings across diverse populations and clinical settings
Radioprotection and enhanced efficacy by curcumin-loaded chitosan nanoparticles in mitigating radiation-induced liver injury
No full textIntroduction: This study aimed to evaluate the protective effect of curcumin-loaded chitosan nanoparticles (CurCsNPs) against radiation-induced liver damage in rats. Curcumin's antioxidant and anti-inflammatory properties, combined with chitosan's drug delivery potential, were leveraged to mitigate the harmful effects of ionizing radiation (IR) on the liver. Methods: Cur-CsNPs were characterized using TEM, XRD, DLS, and FTIR. Spectrophotometry assessed drug loading and curcumin release. Cytotoxicity was evaluated using MTT assay on HepG2 cells. The experimental design involved eight groups: a control group, three groups receiving different doses of Cur-CsNPs (25, 50, 100 mg/kg), three groups receiving the same doses plus irradiation (6Gy), and one group receiving irradiation only. H&E and MTC staining were used for histopathological evaluation. The activity of liver enzymes ALT, AST, ALP, and GGT was measured. Results: In this study, three types of Cur-CsNPs were synthesized using varying ratios of chitosan to TPP ratios, resulting in average sizes of 660 nm, 230 nm, and 120 nm. Cur-CsNPs which exhibited the highest encapsulation efficiency, was selected for further evaluation. TEM confirmed its spherical shape with an average size of 37 nm. Drug release studies demonstrated an 85 release at pH 5.4 within 70 h. MTT assays indicated low cytotoxicity, with high cell viability maintained across all concentrations and time points. Liver enzyme analysis in rats revealed that Cur-CsNPs, particularly when combined with radiation, mitigated radiation-induced liver damage. Histological examination showed that treatment with Cur-CsNPs reduced liver damage, inflammation, necrosis, and fibrosis in irradiated groups compared to the radiation-only group, which exhibited severe liver damage. Conclusion: The findings of this study show that Cur-CsNPs possess significant potential as a therapeutic agent for protecting against radiation-induced liver injury. The favorable drug release profile, low cytotoxicity, and protective effects observed in enzyme levels and histological assessments highlight the efficacy of Cur-CsNPs. The findings imply that Cur-CsNPs could be an effective strategy for enhancing liver protection in radiation exposure scenarios, warranting further investigation into their mechanisms of action and potential clinical applications
Developing the Short-Form of Lymphedema Needs Questionnaire for Iranian Breast Cancer Patients
No full textPurpose The informational needs of patients with Breast Cancer-Related Lymphedema (BCRL) have not been sufficiently addressed in the scientific literature. Moreover, the only existing questionnaire in this field contains many items. Therefore, the purpose of this study is to develop a short-form version of this questionnaire. Methods The questionnaire items were extracted from the Lymphoedema Needs Questionnaire-Breast Cancer (LNQ-BC). Demographic variables and clinical characteristics were considered separately. Out of 62 items, 24 were selected, and 2 additional questions were included based on feedback from 10 experts. 100 participants with BCRL completed the short-form questionnaire. Exploratory Factor Analysis (EFA) was performed using principal components extraction and varimax rotation, and Cronbach's alpha was calculated for each dimension. Results After evaluating the content validity, the instrument's construct validity with 26 items was conducted using EFA. The KMO (Kaiser-Meyer-Olkin) value was equal to 0.879 and Bartlett's sphericity test was significant (p-value < 0.001), indicating the data's adequacy and appropriateness to perform EFA. Five extracted dimensions were named: "Lymphedema information needs" (5 items), "Informational support, peers" (5 items), "Access to a lymphedema care specialist" (5 items), "Physical and daily activities" (7 items) and "Financial issues and compression garments" (4 items). The level of needs in this study in all dimensions was high (more than 77). Conclusions The high factor loadings and the total explained variance of 78.152 support the construct validity of the short questionnaire. Although some items exhibited cross-loadings, the majority loaded strongly on a single factor, indicating good discriminant validity. Providing services according to the needs of patients can be prioritized. Healthcare providers, insurers, and individuals should be better informed about lymphedema, its associated costs, and the importance of implementing appropriate management programs
Patient-Reported Outcomes Following Systemic Antibiotic Adjunct to Nonsurgical Treatment of Periodontitis: A Randomized Controlled Clinical Trial
No full textObjectivesConsidering the importance of patient-centered care, we aimed to evaluate the impact of systemic antibiotics on oral health-related quality of life during nonsurgical periodontal treatment. This controlled trial addresses a gap in understanding how systemic antibiotics influence patient-reported outcomes, focusing on Stage III periodontitis.Materials and MethodsSixty-one adults participated in a double-blind, randomized clinical trial, with participants divided into two groups: the test group, which received antibiotics, and the control group. All the participants received nonsurgical periodontal treatment. We conducted follow-up assessments at one and 3 months posttreatment, including recording clinical parameters and administering the Oral Health Impact Profile-14 (OHIP-14) questionnaire.ResultsThe results showed a notable improvement in the quality of life for patients in the test group compared to the control group at 1 month (p value = 0.012) and 3 months (p value = 0.014) after treatment. While there were improvements in pocket probing depth, gingival index, and clinical attachment loss in both groups, it is worth noting that only bleeding on probing exhibited a significant improvement in the test group after 3 months compared to the control group (p value = 0.008).ConclusionsIn summary, incorporating systemic antibiotics alongside nonsurgical periodontal treatments appears to bring about positive outcomes for individuals dealing with Stage III periodontitis during nonsurgical treatment, ultimately enhancing their oral health-related quality of life.Trial RegistrationIranian Registry of Clinical Trials (IRCT Id): IRCT20201221049786N1
Comparison of survival outcomes in preemptive versus non-preemptive kidney transplant recipients
No full textBackground:There are conflicting results regarding survival in preemptive versus non-preemptive kidney transplant recipients. The present study aimed to estimate the risk of death in preemptive versus non-preemptive kidney transplant recipients.Materials and Methods:In the present retrospective cohort study, all end-stage renal disease (ESRD) patients who underwent kidney transplantation between 1996 and 2021 in referral kidney transplantation centers in Isfahan province were investigated. In total, 499 patients who received dialysis before kidney transplantation (non-preemptive) and 168 patients who received no dialysis before kidney transplantation (preemptive) were included in the final analysis. Data regarding demographic and clinical variables including sex, age, body mass index (BMI), follow-up duration, immunosuppressive regimen change, kidney donor type, underlying causes of ESRD, and comorbidities before and after kidney transplantation were collected.Results:The mean age was 55.47 +/- 15.53 years in preemptive and 54.87 +/- 14.69 years in non-preemptive patients (P = 0.65). Mortality rates were 24.44/1000 person-years of follow-up for preemptive and 18.25/1000 person-years of follow-up for non-preemptive patients (P = 0.013). In the crude model of Cox regression analysis, preemptive kidney transplant recipients had a significantly higher risk of mortality compared to non-preemptive kidney transplant recipients (hazard ratio HR = 1.59; 95% confidence interval CI: 1.09-2.33; P = 0.015). However, the association attenuated and became insignificant after adjustment for confounders, including age, BMI, immunosuppressive regimen change, kidney donor type, and comorbidities (HR = 1.35; 95% CI: 0.92-1.99; P = 0.12).Conclusion:The results of the present study indicated that there is no independent association between preemptive kidney transplantation and increased risk of mortality
Immunomodulatory effects of novel nano micelle based curcumin in rheumatoid arthritis patients: A double blind randomized clinical trial
No full textBackground and Objectives Rheumatoid arthritis (RA) is a well-known systemic autoimmune inflammatory disease. This investigation aimed to assess the effects of Sina-curcumin, a novel nano micelle-based curcumin, on immune system responses of RA patients. Methods This pilot study is a randomized double blinded, controlled trial. Patients who fulfilled the European League against Rheumatism-American College of Rheumatology (EULAR-ACR) criteria for RA were assigned to receive curcumin or placebo for 12 weeks. The outcomes of this study were comparison of changes in mean value of Disease Activity Score of 28 joints erythrocyte sedimentation rate (DAS28-ESR), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), frequency of T helper 1 and T helper 2 cells population. Results From 150 RA patients who were assessed for eligibility, data from 30 patients (15 patients in each group) were analyzed. There was no significant difference between the two groups regarding age (P = 0.6441) and body mass index (BMI, P = 0.6016). Our measurement showed a statistically significant reduction in ESR (P < 0.0001), CRP (P < 0.0001) and a non-significant decrease in DAS28-ESR (P = 0.5125) in the curcumin group. Also, the Th1/Th2 ratio favorably decreased in the curcumin group. This finding was due to a significant increase in Th2 cells (P < 0.0001) and a nonsignificant decrease in Th1 cells (P = 0.1532). Conclusion Our trial findings revealed the immunomodulatory effects of curcumin. It could be used and recommended as adjunctive treatment for RA patients