Comparison of Combined Guidance of Fluoroscopy and Ultrasonography in Total Tubeless Percutaneous Nephrolithotomy with the Standard Method: A Randomized Clinical Trial.

OBJECTIVE: utilizing the combination of fluoroscopy and ultrasonography during Percutaneous Nephrolithotomy (PCNL) to minimize radiation exposure. METHODS: In this randomized clinical trial, 118 patients with urinary stones who were candidates for PCNL surgery in the prone position were selected and divided into two groups (with an allocation ratio of 1:1). Cases were grouped according to whether ultrasonography was used for renal tract dilation and Amplatz sheath placement. The number of attempts to establish proper renal access, the time interval between access to the targeted calyx and nephroscope entrance, and the Clavien-Dindo score were collected. RESULTS: The mean age of all patients was 46.12±11.28 (45.6±11.2 in the total fluoroscopy group and 46.5±11.4 in the combined group) years (20-66). The intergroup differences in the baseline features were not significant. The mean duration of fluoroscopy time was significantly reduced in the combined guidance group (36.22±10.73 vs. 23.05±8.94 seconds, [P-value = 0.001]). Moreover, the difference in the distribution of Amplatz location on the nephroscopy time was meaningful (P-value = 0.016). However, intergroup differences in the number of attempts to successful puncture, length of hospitalization, recovery time, and postoperative complications, including gross hematuria duration, blood loss volume, pack cells requirement, pain score immediately and 6 hours after the surgery, and Clavien-Dindo score were not meaningful. CONCLUSION: It can be concluded that the use of ultrasound with X-ray in prone PCNL compared to the use of X-rays alone can significantly reduce the duration of radiation without increasing the risk of intra-operative and postoperative detrimental events.

Effectiveness of Fortified Garlic Extract Oral Capsules as Adjuvant Therapy in Hospitalized Patients with Coronavirus Disease 2019: A Triple-Blind Randomized Controlled Clinical Trial.

Background: Herbal medicines have been extensively used to treat coronavirus disease 2019 (COVID-19). Garlic, known to exert antiviral and anti-inflammatory effects, can be coadministered with standard treatments to combat COVID-19. Objectives: The aim of the study was to evaluate the efficacy and safety profile of Gallecina oral capsules (Samisaz Pharmaceutical Company, Mashhad, Iran), a fortified garlic extract, as adjunctive therapy to improve the clinical status and symptoms in noncritically ill patients hospitalized for COVID-19. Methods: This triple-blind randomized, placebo-controlled clinical trial was conducted on noncritically ill patients with COVID-19 hospitalized in the nonintensive care wards of Imam Hassan Hospital. Patients received remdesivir plus 90 mg Gallecina capsule or a placebo every 8 hours for 5 days or until discharge. The clinical status, respiratory symptoms, and laboratory parameters were recorded during the study period. Results: Patients were enrolled between April 24 and July 18, 2021. Data from 72 patients in the Gallecina group and 69 patients in the placebo group were analyzed. Oxygen saturation, C-reactive protein levels, and the distribution of respiratory distress and cough were similar between groups on the day of discharge. Although body temperature was significantly lower in the Gallecina group than that in the placebo group on the day of discharge (P = 0.04), it was within the normal range for both groups. The proportion of patients requiring supplemental oxygen for at least 1 day during the study was significantly reduced in the Gallecina group on days 3 and 4 and the day of discharge (P < 0.05). Gastrointestinal complaints were more prevalent in the Gallecina group than in the placebo group but the difference was not statistically significant (P = 0.12). Conclusions: There was no significant effect on the primary outcome of clinical status on study day 6. Although the proportion of Gallecina-treated patients who needed supplemental oxygen significantly decreased on days 3 and 4 and the day of discharge, there was no significant difference between the groups on other days. The possible beneficial effects on oxygen requirements in noncritically ill COVID-19 patients may warrant further investigation. (Curr Ther Res Clin Exp. 2023; 84:XXX-XXX). Clinical trial registration: IRCT20201111049347N1.

Health system-related barriers to prenatal care management in low- and middle-income countries: a systematic review of the qualitative literature.

BACKGROUND: Appropriate prenatal care (PNC) is essential for improving maternal and infant health; nevertheless, millions of women in low- and middle-income countries (LMICs) do not receive it properly. The objective of this review is to identify and summarize the qualitative studies that report on health system-related barriers in PNC management in LMICs. METHODS: This systematic review was conducted in 2022. A range of electronic databases including PubMed, Web of Knowledge, CINHAL, SCOPUS, Embase, and Science Direct were searched for qualitative studies conducted in LMICs. The reference lists of eligible studies also were hand searched. The studies that reported health system-related barrier of PNC management from the perspectives of PNC stakeholders were considered for inclusion. Study quality assessment was performed applying the Critical Appraisal Skills Programme (CASP) checklist, and thematic analyses performed. RESULTS: Of the 32 included studies, 25 (78%) were published either in or after 2013. The total population sample included 1677 participants including 629 pregnant women, 122 mothers, 240 healthcare providers, 54 key informed, 164 women of childbearing age, 380 community members, and 88 participants from other groups (such as male partners and relatives). Of 32 studies meeting inclusion criteria, four major themes emerged: (1) healthcare provider-related issues; (2) service delivery issues; (3) inaccessible PNC; and (4) poor PNC infrastructure. CONCLUSION: This systematic review provided essential findings regarding PNC barriers in LMICs to help inform the development of effective PNC strategies and public policy programs.

Comparative Efficacy of Different Classes of Antiemetic Medications for the Prevention of Nausea and Vomiting in Cesarean Section: A Network Meta-Analysis.

Background: Antiemetic medications have been associated with the prevention of nausea and vomiting in cesarean section, although less is known about the comparative efficacy of different medication classes. Methods: We conducted a systematic review with network meta-analyses to compare and rank antiemetic medication classes (5-HT3 receptor antagonists, dopamine receptor antagonists, corticosteroids, antihistamines, anticholinergic agents, sedatives, and opioid antagonists or partial agonists) in terms of preventing intra- and postoperative nausea and vomiting among patients undergoing cesarean section. We included all randomized controlled trials (RCTs) that evaluated any antiemetic medication classes' treatment for target outcomes. Network meta-analysis was conducted with a frequentist approach using the R netmeta package. A total of 58 trials were included (6,665 women undergoing cesarean section; mean age, 28.1 years). Results: Compared with placebo, all interventions reduced the odds of intraoperative nausea (except antihistamines), intraoperative vomiting (except antihistamines), postoperative nausea (except anticholinergic agents and opioid antagonists), and postoperative vomiting (except opioid antagonists). In terms of intraoperative nausea and both intra- and postoperative vomiting, sedatives ranked first among other medication classes. Conclusions: The relative effect sizes for various classes of antiemetic medication in preventing nausea and vomiting in the cesarean section were modeled using the principles of network meta-analysis which may facilitate informed clinical decision-making.

The Outcome of Cochlear Implantations in Deaf-Blind Patients: A Multicenter Observational Study.

OBJECTIVE: This multicenter study aimed to evaluate the auditory and speech outcomes of cochlear implantation (CI) in deaf-blind patients compared with deaf-only patients. STUDY DESIGN: Retrospective cohort study. SETTING: Multiple cochlear implant centers. PATIENTS: The current study was conducted on 17 prelingual deaf-blind children and 12 postlingual deaf-blind adults who underwent CI surgery. As a control group, 17 prelingual deaf children and 12 postlingual deaf adults were selected. INTERVENTION: Cochlear implantation. MAIN OUTCOME MEASURES: Auditory and linguistic performances in children were assessed using the categories of auditory performance (CAP) and Speech Intelligibility Rating (SIR) scales, respectively. The word recognition score (WRS) was also used to measure speech perception ability in adults. The mean CAP, SIR, and WRS cores were compared between the deaf-only and deaf-blind groups before CI surgery and at "12 months" and "24 months" after device activation. Cohen's d was used for effect size estimation. RESULTS: We found no significant differences in the mean CAP and SIR scores between the deaf-blind and deaf-only children before the CI surgery. For both groups, SIR and CAP scores improved with increasing time after the device activation. The mean CAP scores in the deaf-only children were either equivalent or slightly higher than those of the deaf-blind children at "12 months post-CI" (3.94 ± 0.74 vs 3.24 ± 1.25; mean difference score, 0.706) and "24 months post-CI" (6.01 ± 0.79 vs 5.47 ± 1.06; mean difference score, 0.529) time intervals, but these differences were not statistically significant. The SIR scores in deaf-only implanted children were, on average, 0.870 scores greater than the deaf-blind children at "12 months post-CI" (2.94 ± 0.55 vs 2.07 ± 1.4; p = 0.01, d = 0.97) and, on average, 1.067 scores greater than deaf-blind children at "24 months post-CI" (4.35 ± 0.49 vs 3.29 ± 1.20; p = 0.002; d = 1.15) time intervals. We also found an improvement in WRS scores from the "preimplantation" to the "12-month post-CI" and "24-month post-CI" time intervals in both groups. Pairwise comparisons indicated that the mean WRS in the deaf-only adults was, on average, 10.61% better than deaf-blind implanted adults at "12 months post-CI" (62.33 ± 9.09% vs 51.71 ± 10.73%, p = 0.034, d = 1.06) and, on average, 15.81% better than deaf-blind adults at "24-months post-CI" (72.67 ± 8.66% vs 56.8 ± 9.78%, p = 0.002, d = 1.61) follow-ups. CONCLUSION: Cochlear implantation is a beneficial method for the rehabilitation of deaf-blind patients. Both deaf-blind and deaf-only implanted children revealed similar auditory performances. However, speech perception ability in deaf-blind patients was slightly lower than the deaf-only patients in both children and adults.

A Systematic Review and Meta-Analysis of the Prevalence of Malnutrition Among 6-14-Year-Old Children in Iran.

Background: Malnutrition is a major public health issue worldwide. It has significant consequences, including weakened immune systems, which may lead to increased incidences of infectious disease and higher mortality, particularly in children. A systematic review and meta-analysis were conducted to estimate the overall prevalence of malnutrition (wasting, underweight, and stunting) among children of 6-14 years of age in Iran. Methods: Data were collected in 2018 based on searches of the PubMed, Science Direct, Scopus, Google Scholar, Science Information Database (SID), Magiran, Irandoc, and Iranmedex databases using the following keywords: childhood, childhood malnutrition, children, nutrition, malnutrition, wasting, underweight, stunting, child, student, boy, girl, cause, prevalence, and Iran, in order to identify studies eligible for inclusion in the review. Comprehensive Meta-Analysis, version 2 (CMA: 2) was used to estimate the overall prevalence of malnutrition. Results: Nine out of 328 articles were included in our analyses. The overall of wasting among children of 6-14 years of age in Iran based on the random-effects model (according to nine studies and 18,296 participants) was 12.5% (95% Confidence Interval, 7.1-21.2). The overall prevalence of underweight based on the random-effects model (according to 10 studies and 19,185 participants) was 19% (95% CI, 8.1-38.6). Also, the overall prevalence of stunting based on the random-effects model (according to 10 studies and 19,185 participants) was 20% (95% CI, 9.4-37.8). Conclusions: The results of this study show that the prevalence of malnutrition among 6-14-year-old children in Iran is similar to the global average. We need solutions that can be used for both prevention and reduction of malnutrition, especially in areas with middle or low socioeconomic status. It is necessary to identify factors associated with malnutrition in various geographic regions in order to implement appropriate programs based on factors with the highest impact in each region.

Challenges of routine diabetes care during COVID-19 era: A systematic search and narrative review.

BACKGROUND: The world is facing the current COVID-19 pandemic. The pandemic response is affecting routine health care provision all over the world. We aimed to review the relevant literature and highlight challenges in the provision of routine care for patients with diabetes during the COVID-19 outbreak. METHODS: We systematically searched PubMed, ScienceDirect, and Embase databases up till August 13, 2020 and retrieved relevant articles published on difficulties on routine diabetes management during the COVID-19 pandemic. RESULTS: Through our reading of the recent literature discussing the difficulties of routine healthcare provision for patients with diabetes amid the COVID-19 pandemic, we have identified nine themes as follows: lockdown of standard outpatient clinics, decreased inpatient capacity, staff shortage, medicine shortage, unaffordable medicine, delayed care seeking, limited self-care practice, transport difficulties, and undiagnosed cases/events. CONCLUSION: Diabetes management during lockdown is particularly challenging. This review specified a summary of difficulties of diabetes care during COVID-19 pandemic. Healthcare policy makers as well as healthcare providers could take advantage of the results of this review to mitigate the adverse effect of the crisis on provision of routine care for diabetes as well as other chronic conditions.

Oral Health and Related Quality of Life in Older People: A Systematic Review and Meta-Analysis.

BACKGROUND: Of the most important implications and complaints in the elderly group of the population, is oral and dental health problems. This study aimed to assess oral health- related quality of life in older people. METHODS: To data collection, databases were searched including PubMed, EMBASE, Scopus, SID, MagIran, Cochrane Central Register of Controlled Trials and scholar google The keywords were "older adults", "Geriatric" Elderly", "Older", "Aged", "Ageing", "Oral health", "Oral hygiene" and "Quality of life", "QOL. For manual searching, several specialized journals of related scope as well as the finalized articles' reference list were searched. Studies from 1st Jan 2000 to 30th Jan 2017 were included. Studies were subjected to meta-analysis to calculate indexes, using CMA:2 (Comprehensive Meta-Analysis) software. RESULTS: Totally, 3707 articles were searched that 48 of them were subjected to the oral and dental health-related quality of life in 59 groups of the elderly population with the mean age of 73.57+6.62 in the 26 countries. The obtained percentage values of dental and oral health were 80.2% (0-60), 14.8% (0-12), 16.4% (0-70), 22% (0-14 or 0-59) and 19.2% (0-196) for GOHAI with the additive method, GOHAI with Simple Count Method, OHIP-14 with the additive method, OHIP-14 with Simple Count method and OHIP-49 with additive method indexes, respectively. CONCLUSION: The elderly group of the population had no proper oral health-related quality of life. Regarding the importance and necessity of oral and dental health and its effect on general health care in the target group, it is recommended to improve dental hygiene in the mentioned group of population.

Development of quality indicators to measure pre-hospital emergency medical services for road traffic injury.

BACKGROUND: Pre-Hospital Emergency Care (PEC) is a fundamental property of prevention of Road Traffic Injuries (RTIs). Thus, this sector requires a system for evaluation and performance improvement. This study aimed to develop quality indicators to measure PEC for RTIs. METHODS: Following the related literature review, 14 experts were interviewed through semi-structured interviews to identify Quality Measurement Indicators (QMIs). The extracted indicators were then categorized into three domains: structure, performance, and management. Finally, the identified QMIs were confirmed through two rounds of the Delphi technique. RESULTS: Using literature review 11 structural, 13 performance, and four managerial indicators (A total of 28 indicators) were identified. Also, four structural, four performance, and three managerial indicators (A total of 11indicators) were extracted from interviews with experts. Two indicators were excluded after two rounds of Delphi's technics. Finally, 14 structural, 16 performance and, seven managerial indicators (A total of 37indicators) were finalized. CONCLUSION: Due to the importance and high proportion of RTIs compared to other types of injuries, this study set out to design and evaluate the QMIs of PEC delivered for RTIs. The findings of this research contribute to measuring and planning aimed at improving the performance of PEC.

Single Free Flap for Large Defects in Head and Neck Reconstruction, Double Paddle Anterolateral Thigh Flap.

ABSTRACT: The purpose of the study is to evaluate the efficacy of double skin paddle anterolateral thigh flap (ALT) to reconstruction of through and through oral cavity defect due to cancer surgery.A prospective review was performed of patients referred to Firoozgar and Erfan hospitals with oral cavity defects with two or more oral cavity subunits and skin simultaneously involvement and immediate reconstruction using double-skin paddle ALT flap at the same time of tumor ablation from January 2019 to November 2020.A total number of 6 patients was evaluated. The mean area of skin paddle was 110.4 cm2 and 92.8 cm2 in distal and proximal paddle respectively. Except one patient was complicated and expired in hospital admission, the remaining 5 patients got fully oral intake and completely survived flaps with primarily closed donor site. Tumor recurrence was not found in the mean follow-up time of 12 months.The double skin paddle anterolateral thigh flap serves as an efficient reconstruction technique in complex and perforating oral cavity defects with the same functional outcome and the same flap related complications as conventional ALT flap.

Local tissue reaction and histopathological characteristics of three different bulking agents: a rabbit model

ABSTRACT Purpose: We assessed the efficacy and safety of a single injection of three bulking agents over the short- and long-term follow-ups in rabbits. Dermal and preputial matrices were compared with Deflux (DxHA) injection. Material and methods: Twenty-four rabbits were divided into three groups. Group I (n=8) underwent the injection of a lyophilized dermal matrix (LDM) beneath the seromuscular layer of the bladder wall. Rabbits in group II (n=8) were injected with lyophilized preputial matrix (LPM). Rabbits of group III (n=8) were injected with DxHA as the control group. They were followed up for 1 and 6 months after the injection. Subcutaneous injection of all bulking agents was also performed in nude mice. Biopsies were stained with LCA (leukocyte common antibody), CD68, CD31, and CD34. Scanning electron microscopy (SEM) and MTT assay were also performed. Results: Immunohistochemistry staining with CD68 and LCA revealed higher inflammation grade in LDM as compared with LPM and DxHA. Fibrosis grade was also higher in LDM both in short- and long-term follow-ups. However, no significant difference was detected in CD31 and CD34 staining between control and experimental groups. SEM analysis showed that the particle size of LPM was more similar to DxHA. MTT assay revealed that cell proliferation was similar in DxHA, LDM, and LPM. In-vivo assay in nude mice model showed more promising results in LPM as compared with LDM. Conclusion: The long-term results demonstrated that LPM was more similar to Deflux with the least local tissue reaction, inflammation, and fibrosis grade.

The effect of edaphic factors on the distribution and abundance of ants (Hymenoptera: Formicidae) in Iran.

The current study is aimed at investigating the effect of edaphic factors on the distribution and abundance of ants in different habitats of the central areas of Iran, while considering the vegetation. During 2018 to 2019, 20 stations from four habitats, including deserts, mountainous and submontane, plains and rural areas and urban areas, were selected. In general, a total of 311 sample units were collected from all the stations, out of which, 32 species belonging to 13 genera, nine tribes and three subfamilies were identified. The biological distribution and abundance of species were argued by computing the physical and chemical parameters of the soil, such as salinity, pH, total nitrogen, organic carbon, calcium and vegetation. The present study has demonstrated that the calcium content significantly affects the species richness of ants, although the impact of this element on various genera is different. We found that increasing in the abundance and richness of plant species has a positive impact on the abundance and richness of ants. Our results also show that some genera are meaningfully adaptable to a variety of habitats. In Kahak station, which is an urban habitat, with enormous diversity, 14 species were found, while in Sadrabad Historic Karvansara, a desert habitat, only Cataglyphis lividus (André, 1881) was collected. Cataglyphis bellicosus (Karavaiev, 1924), as the most abundant species, collected from 12 stations, was the most dominant species.

Local tissue reaction and histopathological characteristics of three different bulking agents: a rabbit model.

PURPOSE: We assessed the efficacy and safety of a single injection of three bulking agents over the short- and long-term follow-ups in rabbits. Dermal and preputial matrices were compared with Deflux (DxHA) injection. MATERIAL AND METHODS: Twenty-four rabbits were divided into three groups. Group I (n=8) underwent the injection of a lyophilized dermal matrix (LDM) beneath the seromuscular layer of the bladder wall. Rabbits in group II (n=8) were injected with lyophilized preputial matrix (LPM). Rabbits of group III (n=8) were injected with DxHA as the control group. They were followed up for 1 and 6 months after the injection. Subcutaneous injection of all bulking agents was also performed in nude mice. Biopsies were stained with LCA (leukocyte common antibody), CD68, CD31, and CD34. Scanning electron microscopy (SEM) and MTT assay were also performed. RESULTS: Immunohistochemistry staining with CD68 and LCA revealed higher inflammation grade in LDM as compared with LPM and DxHA. Fibrosis grade was also higher in LDM both in short- and long-term follow-ups. However, no significant difference was detected in CD31 and CD34 staining between control and experimental groups. SEM analysis showed that the particle size of LPM was more similar to DxHA. MTT assay revealed that cell proliferation was similar in DxHA, LDM, and LPM. In-vivo assay in nude mice model showed more promising results in LPM as compared with LDM. CONCLUSION: The long-term results demonstrated that LPM was more similar to Deflux with the least local tissue reaction, inflammation, and fibrosis grade.

Hospital managers' skills required and onward challenges: A qualitative study.

INTRODUCTION: The qualification of managers in terms of management skills is one of the most important factors in the continuous success of each organization, and utilizing such skills can have a positive contribution in the effectiveness of the organization while improving the performance of the employees in line with the objectives and goals of the organization. The study's primary objective was to examine the necessary skills of the hospital managers and their capabilities to manage the challenges in providing health care facilities to their patients and employees. MATERIALS AND METHODS: This study is a qualitative that deep interviews were performed with 22 managers (senior and middle managers) of educational hospitals of Kermanshah city, and the sample size was 22 individuals. The interviews were analyzed by a MAXQDA software application after transcription. RESULTS: This study includes 8 themes and 23 subthemes. The strategic skill, the perceptive skill, the human relations skill, work experience, and personal characteristics were among the skills necessary for hospital managers. Some of the challenges facing the hospital managers included rapid changes in the policies, the limitations of financial resources, and lack of proportion between the educational and occupational spheres. CONCLUSION: Because of their existential philosophy and differences with other service sectors, managing hospitals poses a particular sensitivity. In this regard, the role of the hospital manager is very important. Therefore, in order to meet the satisfaction of those receiving services, decision-makers and policy-makers must think twice when selecting and appointing hospital managers and evaluate and appraise this group in terms of abilities and skills necessary for managing such an important service section.

Endoscopic Versus Microscopic Cartilage Myringoplasty in Chronic Otitis Media.

INTRODUCTION: Operations on the tympanic membrane of the middle ear, myringoplasty, and tympanoplasty are now widely accepted, and attempts are underway all over the world to standardize the surgical techniques. This study aimed to compare postoperative outcomes of endoscopic and microscopic cartilage myringoplasty in patients suffering from chronic otitis media (COM). MATERIALS AND METHODS: This clinical trial study compared 130 patients with COM who underwent transcanal endoscopic myringoplasty by repairing perforation using auricular concha cartilage under general anesthesia (n=75) and conventional repairing method by postauricular incision and tympanomeatal flap elevation under microscopic surgery (n=55). RESULTS: According to the results, there was no significant difference between the two groups in terms of hearing gain 1, 6, and 12 months after surgery (P=0.063); however, higher hearing gain scores were observed in the endoscopic group. Moreover, lower recovery time and post-operative pain were reported in patients who underwent the endoscopic approach, compared to those who treated with the conventional repairing method (P<0.001). CONCLUSION: Endoscopic myringoplasty technique is a safe and effective way to improve hearing loss as much as the conventional method. However, due to the lower recovery time and post-operative pain, it seems to be the method of choice in myringoplasty surgery.

Developing a model for prevention of malnutrition among children under 5 years old.

BACKGROUND: Serious consequences leading to the increase of infectious diseases and mortality of children justifies the importance of interventions for eradication of malnutrition. Thus, this study aimed to provide a model for the prevention of malnutrition among children under 5 years old (CU5) in Iran. METHODS: This paper is part of a bigger study, conducted in 2017 using a mixed methods approach. A model for prevention of malnutrition in CU5 was proposed based on the earlier steps, with the cooperation and consultation of experts and specialists. In the final step, a Delphi method was used to determine the validity of the proposed model. RESULTS: The main dimensions of the prevention model of malnutrition for CU5 in Iran included four level: basic causes, interventions, outcomes and impact. The proposed interventions are presented based on twelve areas: structural, intersectoral, political, economic, sanitary, health-oriented, research, educational/cultural, evaluation related, production, infrastructures and legal. Based on these areas, 118 solutions were finally selected for the final model. This model is designed based on the current conditions in different regions of Iran, the factors related to child malnutrition, affective context on policy making, the content of previous policies, the process of policy making in Iran, and key stakeholders and actors in policy making. CONCLUSION: In order to prevent malnutrition, the causing factors should be identified and resolved. The adopted policies should be, more seriously, based on the presence of key stakeholders and actors. Most of the existing nutritional problems among children are because of inappropriate consumerism culture and habits in families and its transfer to children.