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Background: Hypertensive disorders during pregnancy (HDP) are a significant cause of maternal mortality. The present study examined the extent of preeclampsia and eclampsia guideline use across different healthcare provider groups, aiming to provide evidence-based recommendations for better guideline implementation., Methods: A cross-sectional study was conducted from 2021-10-04 to 2022-04-04. Participants were maternal health providers from 63 medical universities in the country. For evaluating clinical applicability of the guideline, an online questionnaire developed. Questionnaire was designed to evaluate the Implementation, Usability, Validity, Applicability, Accommodation, and Evaluation of national guideline. The mean score for each question was calculated and categorized in unfavorable, relatively favorable, and favorable values. The online questionnaire was delivered to the all-guideline users. The answered questionnaires were sent back to the research team after a week., Results: Totally, 1,283 health care providers as the respondents completed the questionnaires. The ways to access the guideline that were expressed by the participants were: printed book in 57.9%, medical websites in 11.2%, CDs in 10.5%, and posters, bulletins, and brochures in 20.4%. The results delineated that general practitioner had the highest scores related to the majority of domains consisting of Implementation, Usability, Evaluation, and Validity than Behvarz (community health workers in the rural and urban healthcare centers), midwife, and obstetrician groups (p < 0.01). The results showed that mother's non-compliance, non-practical content of guideline, and lack of facilities were the most important reported challenges in guideline implementation., Conclusion: To effectively enhance the national preeclampsia guideline, it is critical to adopt a structured approach based on feedback from diverse healthcare providers. Key areas identified for improvement include ensuring comprehensive guideline awareness through better distribution, enhancing usability by simplifying language and offering quick-reference tools, regularly updating the guideline with new research, adapting it for varied clinical environments, accommodating the specific needs of different provider groups, and establishing a continuous evaluation mechanism through feedback loops. These steps aim to refine the guideline's practicality, reliability, and comprehensiveness in managing preeclampsia across diverse healthcare settings., Competing Interests: Declarations. Ethics approval and consent to participate: Ethics approval was obtained from the institutional review board of the Tehran University of Medical Sciences according to the Helsinki declaration (IR. TUMS. IKHC.REC.1400.168). Written informed consent was obtained from the participants. Consent for publication: Written informed consent for publication of personal or clinical details was obtained from the participant. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Cow's milk protein allergy (CMPA) is the most common food allergy in infants. The current standard of care (SOC) involves eliminating the allergen from both the infant's and mother's diet for 2-4 weeks. The purpose of this study is to assess the effectiveness of Lactobacillus rhamnosus (Ramnoflor) in reducing the duration of bleeding in these infants. Methods: This randomized clinical trial was conducted at Bahrami Children's Hospital on breastfed infants who were diagnosed with CMPA and had a positive occult blood (OB) test. Patients were randomly assigned to either the control or case groups. All patients received SOC therapy, with the case group receiving Ramnoflor and the control group receiving a placebo. Data were recorded on the checklist, and the children were followed and visited three times during the study, with an OB assessment at each visit. Results: The study enrolled 48 infants. Among the infants in the case group, the OB test was positive in four cases (8.3%) on the fifth day. However, there were no positive cases on the 14th and 30th days. The prevalence of this test was significantly lower in patients who received probiotics compared to the control group on the fifth day ( p < 0.001). There were no positive OB tests on the 14th and 30th days in any of the groups, and no significant difference was observed between the groups. Conclusion: The addition of L. rhamnosus to SOC therapy led to a decrease in the duration of rectal bleeding in infants with CMPA compared to the control group.

Background: End-of-life care for patients with advanced cancer can impose a significant financial burden. However, data on the economic impact of end-of-life care in low- and middle-income countries are limited., Objective: This study aims to compare the costs associated with palliative care units (PCUs) and non-PCU settings for cancer patients in Iran., Design: We designed a retrospective study at the largest hospital in the country., Methods: We conducted a comprehensive evaluation of hospitalization costs and care service delivery for 150 patients in the final 5 days of life, who were admitted to the largest hospital complex in Iran. All costs were adjusted based on the 2018 USD exchange rate., Results: Among the 150 patients included in the study, 56 (37%) were admitted to the PCU. The average total treatment cost during the final 5 days of life was three times higher in general wards compared to PCUs. In non-PCU settings, the total cost of care during this period amounted to $2873, while in PCU settings, it was $909.63., Conclusion: The establishment of PCUs within tertiary hospitals and the provision of palliative consultation services to patients with advanced cancer can yield significant benefits, even when resources are limited., Competing Interests: The authors declare that there is no conflict of interest., (© The Author(s), 2024.)

Decisions on life-sustaining treatment depend on evaluating fundamental ethical principles regarding taking human life. This study aimed to compare the Islamic standpoint with secular views on ethical decision-making in end-of-life care. We conducted a scoping review to analyze and compare articles published in 2000-2022, regarding ethical criteria for withdrawing life-prolonging treatments in dying patients, and the final decision-maker in such cases. The main difference between the two viewpoints, however, lies in the perspective that in Islam to save human life is of utmost importance, and therefore the criteria for treatment benefits, indications, and goals should all be evaluated in the light of this profound Islamic concept. The most significant similarity discovered between the two standpoints was that a terminal patient's wish not to prolong the process of dying should be respected, and the physician's opinion in determining the benefit or futility of treatment is of utmost importance. Comparison of Islamic and Secular perspectives about ethical decision-making in end-of-life care regarding life sustaining treatment indicates that benefits of treatments for patients, and healthcare goals are among the major factors in decision-making according to both viewpoints, and patients, their families, physicians, and the medical team are all involved in making the final decision., Competing Interests: The authors stated that there was no conflict of interest.

Background and Objectives: Diffusion of hydroxide (OH) - and calcium (Ca) ++ ions through dentin may cease external root resorption. Calcium hydroxide (Ca(OH) 2 ), mineral trioxide aggregate (MTA), and calcium-enriched mixture (CEM) cement are the choices for this purpose due to their optimal properties. This study sought to analyze the effects of ultrasonic activation (UA) on pH and the release of calcium ions from Ca(OH) 2 , MTA, and CEM cement in external root resorption artificial defects. Materials and Methods: This in vitro research involved the instrumentation and shaping of the root canals of 150 single-rooted teeth (#F4). External defects were intentionally made on the middle one-third of the root surface. Teeth were randomly assigned to a negative control group ( n  = 10), one positive control group ( n  = 20), and six experimental groups (each n  = 20) according to the root canal filling material (Ca(OH) 2 paste, MTA, CEM, gutta-percha, Ca(OH) 2 paste+ultrasonic, MTA + ultrasonic, and CEM + ultrasonic). Ultrasonic energy was transferred to the test materials using a #25 spreader. Ca ++ concentration and pH were measured after 1, 7, 15, and 30 days in all groups. Statistical analysis involved the use of repeated measure analysis of variance (ANOVA) and paired-sample T -test ( P ≤ 0.05). Results: The levels of calcium ions and pH increased significantly over time in all groups ( P < 0.001). There were significant differences between the experimental groups in terms of pH and the concentration of released calcium ions at different times ( P < 0.001). The Ca(OH) 2 plus ultrasonic energy group ranked first, while the gutta-percha group ranked last in terms of release of calcium ions and pH. Conclusion: The Ca(OH) 2 , MTA, and CEM cement groups showed an increase in pH and the release of calcium ions at the external root resorption defects. Additionally, the application of ultrasonic energy increased the release of calcium ions at these sites., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Azadeh Kheradyar et al.)

Managing chronic, refractory nausea and vomiting in advanced cancer patients is challenging, especially when unrelated to cancer treatment. Mirtazapine, a tetracyclic antidepressant, effectively alleviates these symptoms, improving quality of life. It offers a promising palliative care alternative, addressing multiple symptoms and reducing polypharmacy, thereby enhancing patient satisfaction., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

Background: Gestational diabetes mellitus (GDM) is a common complication of pregnancy that can lead to adverse outcomes. In this retrospective cohort study, maternal fasting blood sugar (FBS) in the second trimester of pregnancy, body mass index (BMI), and age were assessed as potential screening indicators of later GDM., Methods: The study population included information on 4007 Iranian pregnant women documented by the Integrated Health Record System (SIB) record system (2019-2020)., Results: In the adjusted analysis, FBS maintained a significant relationship with GDM ( P ≤0.001). In the simple ROC analysis, the AUC (SE) of FBS for the prediction of GDM was 0.905(0.09), and considering the cut-off point as 85.95, sensitivity (Se) and specificity (Sp) were equal to 0.81 and 0.71, respectively, but by stillbirth, abortion, prematurity, neonatal weight, height, and head circumference not obtained acceptable AUC (≥.60) for detection of FBS cut-off point. The cut-off point of FBS in the presence of maternal age (AUC>0.6) and BMI (AUC>0.6) by GDM was 83.75(Se= 86.4%, Sp= 80.0%)., Conclusion: Based on the evidence presented, maternal weight and BMI are important in predicting hyperglycemia leading to GDM. It is necessary to conduct more precise national studies to standardize the FBS cut-off point by controlling age and BMI variables., (Copyright© 2024 Hantoushzadeh et al. Published by Tehran University of Medical Sciences.)

Background: The optimal approach to luteal-phase support in infertility treatment remains a subject of debate. This study was conducted to investigate the clinical outcomes, side effects, and patient satisfaction associated with vaginal, subcutaneous, and intramuscular progesterone administration in infertile women undergoing Frozen Embryo Transfer (FET)., Methods: This three-armed randomized clinical trial assigned infertile patients eligible for FET to three progesterone treatment groups: vaginal suppositories (400 mg twice daily; n = 100), subcutaneous injections (25 mg daily; n = 102), and intramuscular injections (50 mg daily; n = 108). The primary outcomes were chemical and clinical pregnancy rates per embryo transfer cycle, with chemical pregnancy defined as beta-human chorionic gonadotropin levels > 50 IU/mL two weeks post-transfer and clinical pregnancy confirmed by ultrasound four weeks later. Exploratory outcomes included progesterone-related adverse effects and participant satisfaction, assessed via a Likert-scale survey 12 weeks post-transfer. Statistical analyses included Chi-square tests for categorical data, one-way analysis of variances, and Kruskal-Wallis tests for continuous data., Results: The intramuscular progesterone group had significantly higher chemical pregnancy rates compared to the vaginal and subcutaneous groups (41.7% vs. 26.0% and 27.5%, respectively; p = 0.026). Although the clinical pregnancy rate was also higher in the intramuscular group (32.4%) compared to the vaginal (23.0%) and subcutaneous groups (21.6%), this difference was not statistically significant (p = 0.148). Additionally, patient satisfaction was greater with vaginal and subcutaneous applications than with intramuscular injections (p < 0.001), likely due to a significantly higher incidence of side effects, such as pain and edema at the injection site, in the intramuscular group (p < 0.001)., Conclusions: We found that intramuscular progesterone resulted in higher chemical pregnancy rates than vaginal or subcutaneous routes, but this did not translate into higher clinical pregnancy rates. Despite its effectiveness, intramuscular administration was associated with more adverse effects and lower patient satisfaction. Future research should explore optimizing progesterone regimens to balance efficacy and patient comfort., Trial Registration: The trial protocol was registered on December 6, 2020, in the Iranian Registry of Clinical Trials (IRCT), a primary registry in the World Health Organization (WHO) Registry Network, under the registration number IRCT20141217020351N12., (© 2024. The Author(s).)

Background: In recent years, Iran has witnessed a remarkable increase in the incidence of cancer. This has led to an emerging challenge in the field of oncofertility, which seeks to address the impact of cancer treatments on fertility and endeavors to preserve reproduction. The study assessed healthcare providers' awareness, attitudes, and practices regarding fertility preservation (FP) in Iran., Methods: A cross-sectional study was conducted to assess healthcare providers' knowledge, attitudes, and practices regarding oncofertility. An online self-made oncofertility survey of twenty-four items was administered to randomly selected participants from a list of healthcare providers registered with the Medical Council. The data were collected anonymously via Google Forms. Descriptive statistics, including number (n), prevalence (%), mean, and standard deviation, were calculated using SPSS 26.0. Additionally, chi-square tests were used to examine associations between categorical variables. Participants were categorized into oncology, obstetrics and gynecology (OB/GYN), and other specialties., Results: A total of 423 responses were received and analyzed. Approximately 60% of the participants were obstetrics and gynecology subspecialists, while the remaining participants represented various disciplines such as surgery (9.7%), radiotherapy (6.4%), nuclear medicine (5.2%), and pediatrics (1.4%). More than 30% of the participants had not received any specific education about oncofertility, and more than 20% stated that FP strategies are not part of their routine treatment plan for young cancer patients. Oncologists had more education than those in the Obstetrics & Gynecology group. Half the participants were unaware of insurance coverage, and FP options were infrequently recommended., Conclusions: These findings highlight the urgent need to enhance healthcare workers' knowledge and attitudes toward FP in Iran and enable them to provide comprehensive support and guidance to cancer patients., (© 2024. The Author(s).)

The aim of this systematic review and meta-analysis was, for the first time, to explore whether postpartum maternal iodine status or supplementation is associated with thyroid function after delivery. The MEDLINE/PubMed, Web of Science, Embase, and Scopus were searched up to December 2021 to identify relevant studies. The pooled mean thyroid stimulating hormone (TSH), free thyroxine (fT4), and thyroxine (T4) concentrations and 95% confidence intervals (CIs) were estimated based on maternal urinary iodine concentration (UIC) (< 50, 50-100, 100-200, and > 200 µg/L) or breast milk iodine concentration (BMIC) (< 100 µg/L vs. ≥ 100 µg/L) during postpartum. A fixed/random effects model was used based on the absence/presence of heterogeneity, respectively. The study is registered with PROSPERO, number CRD42022336145. A total of 2175 studies were identified, of which 18 were eligible for the meta-analysis. The pooled values for TSH, fT4, and T4 concentrations in all subgroups were within the normal range; however, except for TSH, comparing the 95% CI showed no statistically significant difference among different subgroups. The pooled mean for TSH concentration in women with UIC > 200 µg/L was 2.23 mIU/L, whereas the corresponding values in women with UIC < 50, 50-100 and 100-200 µg/L were 0.56, 0.56 and 0.95 mIU/L, respectively. Thyroid hormones in women with BMIC < 100 µg/L and ≥ 100 µg/L were within the normal range. Iodine supplementation during postpartum was not associated with any differences in thyroid parameters, compared to non-supplemented women. In conclusion, iodine status or supplementation had no effect on thyroid hormones in postpartum women., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Numerous strategies have been investigated for addressing recurrent implantation failure (RIF) and enhancing endometrial receptivity, yet agreement on the optimal intervention remains elusive. Our investigation endeavors to assess the effect of low-level laser therapy (LLLT) on pregnancy outcomes in individuals who have undergone a minimum of three unsuccessful embryo transfer cycles (ET). Methods: In our randomized single-blinded clinical trial, we enrolled thirty females with a medical history of RIF who were eligible for frozen-thawed embryo transfer (FET). Through a random allocation sequence, the participants were divided into two groups. The LLLT was performed one cycle before blastocyst transfer in 15 cases using a New Age BIOLASER device (New Age Co., Italy) with a 900-milliwatt power output and an 850-nm wavelength. The irradiation sessions were conducted transabdominal on the hypogastric area. The considered outcomes were biochemical pregnancy, identified by a positive blood pregnancy test, and clinical pregnancy, confirmed through visualization of the gestational sac using ultrasonography. Results: The mean age of the subjects was 34.17 years, and they had undergone three to seven previous embryo transfers. There was no significant difference in basic characteristics between the group undergoing laser treatment and the control group. However, the laser-treated group exhibited elevated rates of both biochemical and clinical pregnancies compared to the control group (46.7% vs. 33.3%; P ==0.710 and 33.3% vs. 20.0%; P =0.682 respectively). Conclusion: To our knowledge, this study represents the first single-blinded randomized clinical trial to assess the effectiveness of LLLT pretreatment in individuals with RIF. The findings propose that LLLT may potentially enhance biochemical and clinical pregnancy rates among RIF patients., Competing Interests: We would like to confirm that all the authors of this manuscript have no conflicts of interest to declare., (Copyright © 2024 J Lasers Med Sci.)

Purpose: Diagnosing the placenta accreta spectrum is crucial to prevent morbidities and mortalities among women with the suspicion of this pathology. We aim to evaluate novel ultrasonography markers for these patients in diagnosing and predicting prognosis., Methods: This cross-sectional study was performed in a referral academic hospital. The population was composed of 51 pregnant women with a suspect of placenta accreta spectrum who had scheduled C-sections. Their primary information and past medical histories were documented. Then the ultrasonography markers, including the most bulging volume behind the bladder (area, perimeter, and volume), the Lacune (diameter, length, number, and surface of the largest lacuna obtained by multiplying the length by the width), the most considerable thickness of placenta on the cervix in patients with placenta previa, the most considerable thickness of the placenta behind the bladder, the Jellyfish sign, and sponge cervix were evaluated. Their comparison to the severity of the bleeding, the rate of the hysterectomy, and the following pathology of the placenta accreta spectrum were analyzed., Results: The results showed that 17 (33.3%) of patients had severe bleeding (more than 2500 cc). The diameter, length, and surface of the largest lacunae limited to women with severe bleeding were 13.50 (5.5-21) mm, 20.50 (11-56) mm, 273.00 (60-1176) mm 2 , and they were 11.00 (5-24) mm, 16.25 (10-39) mm, and 176.25 (50-744) mm 2 for women without severe bleeding (P value = 0.039, 0.027, 0.021). 13 (76.5%) women with severe bleeding had Jellyfish signs,16 (94.2%) had bulging on the cervix, and 10(58.8%) had a sponge cervix (P value = 0.046, 0.036, 0.006). Also, 34 (66.66%) patients needed hysterectomy. The diameter, length, and surface of the largest lacunae limited to women with hysterectomy were 12.00 (5-24) mm, 18.00 (11-56) mm, 231.00 (60-1176) mm 2 , and they were 9.00 (5-18) mm, 15.00 (10-28) mm, and 136.00(50-504) mm 2 for women without hysterectomy (P value = 0.012, 0.070, 0.021). 24(70.6%) women with hysterectomy had Jellyfish signs, 29 (85.3%) of them had bulging on the cervix, and 15 (44.1%) had sponge cervix (P value = 0.05, 0.036, 0.028). The cut-off associated with the Lacunar surface was 163.5 mm 2 . Its sensitivity was 80%, and its specificity was 48% (P value = 0.021)., Conclusion: The presence of single large lacunae could be a suitable predictive factor for bleeding in the placenta accreta spectrum; Moreover, there are some other US criteria, including the presence of a sponge cervix or the Jellyfish sign that are valuable predictive factors for negative outcomes for this spectrum, including hysterectomy., (© 2024. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

Objective: Voiding Dysfunction (VD) is one of the most common disorders among women, which is characterized by a disorder in urination. Pelvic organ prolapse is one of the factors that can affect VD. In this study, the relationship between prolapse in the anterior, posterior, and apical areas and VD has been evaluated., Materials and Methods: This is a cohort retrospective study. The participants in this study were women with VD, who referred to the pelvic floor disorders clinic of Imam Khomeini Hospital in Tehran in 2018-2020. Clinical information was obtained retrospectively from the hospital's electronic data system, also symptoms (intermittent stream, incomplete voiding, poor flow, post void dribble, straining to void, stage anterior, posterior and apical) and urodynamic parameters (including EMG, PVR100, Qmax12, and pdet20) were evaluated, which included detailed questionnaires (Urinary Distress Inventory 6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7)), pelvic examination, and complete urodynamic evaluation., Results: There was a direct relationship between the age of the patients and the stage of prolapse (p<0.001). So that, the stage increased with age. In addition, it was found that the severity of urinary symptoms is related to the stage of prolapse in the apical area (p=0.001). Also, the results showed that intermittent stream symptoms and the symptoms of staining to void had a significant relationship with the stage of prolapse (III and IV) in the apical and anterior areas. Also, it was shown that only PVR > 100 had a significant relationship with the stage of prolapse in the apical area (p=0.001)., Conclusion: Intermittent stream and straining to void were related to the stages of prolapse in the apical and anterior regions. It was also concluded that the greater the prolapse, the higher the value of PVR > 100., Competing Interests: Conflict of Interests Authors declare no conflict of interests., (Copyright © 2024 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.)

We present unprecedented datasets of current and future projected weather files for building simulations in 15 major cities distributed across 10 climate zones worldwide. The datasets include ambient air temperature, relative humidity, atmospheric pressure, direct and diffuse solar irradiance, and wind speed at hourly resolution, which are essential climate elements needed to undertake building simulations. The datasets contain typical and extreme weather years in the EnergyPlus weather file (EPW) format and multiyear projections in comma-separated value (CSV) format for three periods: historical (2001-2020), future mid-term (2041-2060), and future long-term (2081-2100). The datasets were generated from projections of one regional climate model, which were bias-corrected using multiyear observational data for each city. The methodology used makes the datasets among the first to incorporate complex changes in the future climate for the frequency, duration, and magnitude of extreme temperatures. These datasets, created within the IEA EBC Annex 80 "Resilient Cooling for Buildings", are ready to be used for different types of building adaptation and resilience studies to climate change and heatwaves., (© 2024. The Author(s).)

Background: Electroretinogram (ERG) is one of the tools used to investigate the electrophysiological underpinnings of mental health illnesses and major clinical phenomena (e.g., suicide) to improve their diagnosis and care. While multiple studies have reported specific ERG changes among individuals with suicidal behaviors, we know of no review that has been done to characterize their findings to inform future research., Methods: This review included available literature concerning ERG and suicidal behaviors. The paper's first section briefly overviews the theoretical basis of ERG and neurotransmitters involved in suicidal behaviors. The second section describes the findings of a review of studies reporting ERG findings among individuals with suicidal behaviors., Results: Most reviewed studies reported normal amplitude and implicit time of the a-waves, but the latency in individuals with suicidal behaviors was lower than normal. Additionally, the b-waves amplitude was reduced, but the implicit time and latency were increased. The b-a amplitude ratio and oscillatory potential were decreased., Conclusion: Despite identifying certain ERG correlates with suicidal behaviors in the existing studies, there is a need for adequately powered and methodologically robust studies to advance clinical translation., (© 2023. The Author(s).)

Background: In Canada, ensuring public safety, and the safety and well-being of accused individuals under the jurisdiction of the provincial review board are very important. While previous studies have reported a significant risk of self-harming behaviors (non-suicidal self-injury and suicide attempt) in forensic psychiatric settings, no large population study has assessed any relationship between forensic system-related factors and self-harming behaviors. A better understanding of these factors can help clinicians implement protective measures to mitigate self-harming behaviors or actions., Methods: Using the Ontario Review Board (ORB) database covering 2014-2015 period (n = 1211, mean age = 42.5 ± 13.37 years, males = 86.1%), we analyzed the prevalence and factors associated with self-harming behaviors, emphasizing the characterization of the forensic system-related factors (ORB status, legal status, type of offense, previous criminal history, and victim relationship). The relationships between the forensic system-related factors and self-harming behaviors were explored using five separate logistic regression models, controlling for clinical and sociodemographic characteristics., Results: Approximately 4% of the individuals in the forensic system over the study period engaged in self-harming behaviors Among the studied patients, individuals determined to be unfit to stand trial and inpatients were significantly more likely to have self-harming behaviors. There was no significant relationship between the type of offence, victim relationship, and previous criminal history with self-harming behavior., Conclusion: Forensic psychiatry inpatients should have close observation, screening, monitoring, and individual tailored management strategies for self-harming behaviors. The findings of this study indicate that forensic system-related factors, especially those that pertain to the status of individuals in the forensic system (i.e., unfit to stand trial and being an inpatient) are more responsible for self-harming behaviors among forensic patients in Ontario., (© 2023. The Author(s).)

Objective: Ultrasonography (US) is an acceptable tool to diagnose the placenta accreta spectrum (PAS) among pregnant women. However, the lack of a robust criteria for diagnosis and predicting the severity of the consequences facing pregnant women requires identification of novel biomarkers., Material and Methods: This prospective, cross-sectional study was performed on pregnant women with a probable diagnosis of PAS. Their demographic information, medical and surgical history, blood loss severity (severe ≥2500 mL) following hysterectomy, and the histopathology after the surgery were collected. In addition, the Doppler imaging of both uterine arteries, including the pulsatility index, resistance index, peak systolic velocity (PSV), the PSV of the posterior part of the bladder, cervix, the largest lacuna, and the posterior lacuna of the bladder were calculated by Doppler US. Data were analyzed to investigate the relationship between Doppler markers and the severity of PAS in terms of bleeding, hysterectomy, and histopathology., Results: Fifty-one women were enrolled with a mean age of 35.4±4.11 years and 17 (33.3%) had severe bleeding. There were significant differences between median (range) bladder PSV [57 (34-90) vs. 33 (20-64); p<0.001], cervix PSV [26 (0-63) vs. 18 (0-76); p=0.04] and left uterine artery [89 (81-135) vs. 68 (61-113); p=0.045] for women with and without severe bleeding, respectively. Thirty-four (66.66%) had hysterectomy. Comparison of bladder PSV, cervix PSV, and left uterine PSV for women with and without hysterectomy were 46 (20-90) vs. 39.5 (33-46) (p=0.005), 20 (0-76) vs. 20 (14-26) (p=0.013) and 68 (61-135) vs. 82 (63-101) (p=0.003), respectively., Conclusion: Bladder PSV, cervix PSV, and uterine PSV were significantly higher in pregnant women with PAS, and they may be useful diagnostic and prognostic markers., Competing Interests: Conflict of Interest: No conflict of interest is declared by the authors., (©Copyright 2023 by the Turkish-German Gynecological Education and Research Foundation. Journal of the Turkish-German Gynecological Association is published by Galenos Publishing House.)

Background: Nausea and vomiting are two common symptoms in myocardial infarction patients. This study aims to determine the impact of p6 acupressure on nausea, vomiting, comfort, and the need for anti-vomiting drugs in myocardial infarction (MI) patients., Methods: This research involved 90 patients with acute heart attacks experiencing persistent nausea despite taking anti-vomiting drugs. They were divided into three groups: acupressure, placebo, and control. The acupressure group wore a wristband with a button, the placebo group had a similar wristband without a button, and the control group received no wristband. Data on nausea severity, comfort, frequency of nausea, vomiting, and retching was collected before and after the intervention at different time points. The study also assessed the use of anti-vomiting drugs within 24 h of the intervention., Results: The patients in the acupressure group, compared to those in the placebo and control groups, experienced significantly lower severity of nausea, frequency of vomiting, nausea, and retching and a substantially higher level of comfort level during the two, four, and 6 h after the start of the intervention (P < 0.05). However, no significant difference between the placebo and control groups was observed (P > 0.05). During the 24 h after the start of the intervention, administration of anti-vomiting drugs to the acupressure group was significantly less than that done in the placebo and control groups (P < 0.05)., Conclusions: The results illustrated that p6 acupressure reduces nausea, vomiting, and retching and increases the comfort level in myocardial infarction patients., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors. Published by Elsevier Inc.)

Patients often search on the Internet information about different medical conditions and procedures. This study aimed to evaluate online health information on colonoscopy, focusing on quantity and comprehensibility of internet resources dedicated to the colonoscopy. This information could be used by European Union (EU) colorectal cancer (CRC) screening providers to address patient's unfilled educational needs, fear of colonoscopy, and other barriers that deter from CRC screening. The term "colonoscopy" translated into 22 official EU languages was searched using the Google search engine. For each translation, generated list of websites was assessed with Google Translate. The first 50 websites in each language were assessed for suitability. Records in other languages were excluded. Included websites were free, focused on patient education, and did not have password. Readability assessments were performed with Lix score. A total of 588 websites in Bulgarian, Croatian, Czech, Danish, Dutch, English, Estonian, Finnish, French, German, Greek, Hungarian, Italian, Latvian, Lithuanian, Polish, Portuguese, Romanian, Slovak, Slovenian, Spanish, and Swedish were evaluated. The overall mean Lix score was 56 ± 8 and was classified as very hard to comprehend. There were significant differences in mean Lix scores across the included languages (P<.001). There was not significant correlation (R 2 = 0.1, P = 0.142) between Lix score and number of search hits. Although there was a wealth of online patient information on colonoscopy, the comprehensibility of the available information is low. Physician guidance to reliable resources could increase patient's willingness to undergo a screening colonoscopy., (© 2023. The Author(s).)

Background: The healthcare system of the Islamic Republic of Iran provides special maternal health care services for mothers, regardless of their nationality., Aim: This study, supported by the United Nations Population Fund, was conducted to review available data associated with health indicators of Afghan mothers living in Islamic Republic of Iran., Methods: This descriptive study used data from the electronic registration system of the Maternal Health Office of the Ministry of Health and Medical Education on characteristics, morbidity and mortality among Afghan mothers in the Islamic Republic of Iran from 2017 to 2019. The data were analysed using SPSS version 23.0. Based on the results, we propose interventions to improve health services for vulnerable Afghan mothers., Results: There were 168 488 deliveries over the 3 years of the study (2017-2019). Deliveries by Afghan women increased from 3.4% in 2017 to 5.2% in 2019, and more than 70% of these Afghan women were vulnerable. Ten percent of deliveries among Afghan mothers were performed by traditional birth attendants. The rate of caesarean section among Afghan mothers was 30%. Maternal mortality ratio among the Afghan mothers was 43 per 100 000 for the 3 years., Conclusion: Afghan mothers in the Islamic Republic of Iran use primary health care services provided for mothers in the country. However, healthcare delivery to these mothers is inadequate, although considered better than the care provided to Afghan mothers living in Afghanistan. We recommend targeted interventions to improve the health status of Afghan women living in the Islamic Republic of Iran., (Copyright © Authors 2023; Licensee: World Health Organization. EMHJ is an open access journal. This paper is available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Objective: Platelet Rich Plasma (PRP) is proposed to have important role in cell division and proliferation, angiogenesis and health. This study evaluates the effect of a single injection of autologous PRP on ovarian response markers in women with poor ovarian response (POR)., Materials and Methods: This non-randomized clinical trial was conducted between August 2020 and September 2021. Fifty six women with Bologna criteria for POR willingly chose to participate in one of the following groups: PRP for one cycle in the time of oocyte pickup (OPU) (intervention group, n= 34) or control group (n=22).The primary outcomes were: number and quality of oocytes in coming 2 cycles of ICSI, and Anti Mullerian Hormone (AMH) level two months after PRP injection. The secondary outcomes were the number and quality of embryos and chemical pregnancy rate after embryo transfer., Results: A total of 45 participants continued the study, of which 23 were in the intervention group and 22 in control group. There were no demographic differences between two groups. At a two cycle follow up, PRP group experienced a significant improvement in AMH level and there was no respective change in control group. In one year follow up the overall pregnancy rates were same in both groups (3% Vs. 0, p=.60), while there was no difference in cumulative number and quality of embryos., Conclusion: PRP injection can improve ovarian reserve marker without adverse effects. Further evidence is required to evaluate the impact of PRP on assisted reproduction outcomes., Competing Interests: Conflict of Interests Authors declare no conflict of interests., (Copyright © 2023 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.)

Background and Objectives: This study aimed to investigate epidemiology of Staphylococcus epidermidis (S. epidermidis) and Acinetobacter baumannii (A. baumannii) infections in neonatal intensive care unit (NICU) in a period of 8 years., Materials and Methods: This retrospective cohort study was conducted on 46 cases of nosocomial infection by S. epidermidis, and 44 neonates with A. baumannii in NICU of Valiasr hospital, Iran., Results: The trend of A. baumannii and S. epidermidis infection were as follows: 1 and 7 in 2014, 11 and 7 in 2015, 20 and 11 in 2016, 1 and 4 in 2017, 4 and 6 in 2018, 4 and 4 in 2019, 0 and 1 in 2020, and 3 and 6 in 2021-March 2022 respectively. Mortality proportion (%) in neonates with S. epidermidis and A. baumannii infection was at 8.3 and 32.1, respectively. There was a strong positive correlation between number of infected neonates in month and average of prescribed antibiotics before incidence of infection in every baby in that month. Fluconazole prescription before incidence of infection were associated with the A. baumannii infection in month too. Amikacin prescription had adjusted correlation on increasing of A. baumannii and S. epidermidis infection in month., Conclusion: It seems reducing of hospitalization duration and medication prescriptions management plays an important role in reducing of nosocomial infections., (Copyright © 2023 The Authors. Published by Tehran University of Medical Sciences.)

The prediction and prevention of aggression in individuals with schizophrenia remains a top priority within forensic psychiatric settings. While risk assessment methods are well rooted in forensic psychiatry, there are no available tools to predict longitudinal physical aggression in patients with schizophrenia within forensic settings at an individual level. In the present study, we used evidence-based risk and protective factors, as well as variables related to course of treatment assessed at baseline, to predict prospective incidents of physical aggression (4-month, 12-month, and 18-month follow-up) among 151 patients with schizophrenia within the forensic mental healthcare system. Across our HARM models, the balanced accuracy (sensitivity + specificity/2) of predicting physical aggressive incidents in patients with schizophrenia ranged from 59.73 to 87.33% at 4-month follow-up, 68.31-80.10% at 12-month follow-up, and 46.22-81.63% at 18-month follow-up, respectively. Additionally, we developed separate models, using clinician rated clinical judgement of short term and immediate violent risk, as a measure of comparison. Several modifiable evidence-based predictors of prospective physical aggression in schizophrenia were identified, including impulse control, substance abuse, impulsivity, treatment non-adherence, mood and psychotic symptoms, substance abuse, and poor family support. To the best of our knowledge, our HARM models are the first to predict longitudinal physical aggression at an individual level in patients with schizophrenia in forensic settings. However, it is important to caution that since these machine learning models were developed in the context of forensic settings, they may not be generalisable to individuals with schizophrenia more broadly. Moreover, a low base rate of physical aggression was observed in the testing set (6.0-11.6% across timepoints). As such, larger cohorts will be required to determine the replicability of these findings., Competing Interests: Declaration of competing interest Devon Watts reports a CIHR Doctoral Scholarship, outside of the submitted work. Taiane de Azevedo Cardoso reports a CIHR Postdoctoral Scholarship, outside of the submitted work. Heather Moulden, Mini Mamak, Casey Upfold, and Gary Chaimowitz report no biomedical financial interests or potential conflicts of interest. Flávio Kapczinski reports personal fees from Daiichi sankyo, and Janssen-Cilag; grants from Stanley Medical Research Institute 07TGF/1148, grants from INCT - CNPq 465458/2014-9, and from the Canadian Foundation for Innovation - CFI, outside the submitted work., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background & Objective: It was declared that COVID-19 might be more severe in symptomatic pregnant patients. This study was conducted to examine the pathological indices of the placenta in pregnant women who were diagnosed with COVID-19., Methods: A total of 20 COVID-19-positive mothers were enrolled in this study. Detailed placental pathology findings were compared between subjects based on the history of abortion or occurrence of preterm delivery, hypertension, and diabetes., Results and Conclusion: Intervillositis was the most frequent abnormality of the placenta. There was also a significant association between abortion history and maternal vascular malperfusion (MVM; P =0.02). The placental abnormalities were found to be increased in women with COVID-19, regardless of maternal comorbidities. Further studies are needed to compare the placental pathology between COVID-19-positive women and healthy women., Competing Interests: The authors declare no conflict of interest.

Objective: Advances in technology and treatments have improved the survival rate of small for gestational age (SGA) infants that need more concern for their neurodevelopmental outcomes. In the present study, we hypothesized that a history of SGA may affect verbal and non-verbal intelligence indices among pre-school children., Materials and Methods: A case-control study was conducted at the Tehran University of Medical Sciences (Tehran-Iran, 2020). Totally 232 children entered the study. An expert pediatrician examined all included subjects. Based on birth weight (extracted from medical records), participants were divided into the case (born SGA) and control (born Appropriate for gestational age (AGA)) groups. Wechsler Intelligence Scale (WISC) and Conners tests were implemented to assess intelligence quotient (IQ), verbal, attention, development, and executive functions. Finally, total scores were compared between groups., Results: Totally, 232 preschool children were included in the study. Of all, 114 (49.1%) and 118 (50.9%) subjects had the history of born SGA and AGA, respectively. The results related to WISC scores showed that the mean WISC-verbal score among children born SGA was significantly higher than children born AGA; (114.288±18.130 vs. 108.898±20.145; P=0.024). This significant difference was associated with Vocabulary (13.531±2.843 vs. 12.745±3.242; p=0.046) and Similarities (14.054±3.630 vs. 13.279±4.898; p=0.048) domains between the groups. The results related to different domains of the Conners test also showed that the mean scores of Inattention (B) and attention deficit hyperactive disorder score (D) in the case group were higher than these scores in the control group; however, these differences were not significant (4.929±3.511 vs. 4.906±4.300; p=0.495 &10.371±5.867 vs. 10.093±7.588; p=0.211)., Conclusion: Our results indicated that the development of non-verbal intelligence in children born with SGA had been delayed. This finding shows that these children may need more consideration during the preschool period and after that., Competing Interests: Conflict of Interests Authors declare no conflict of interests., (Copyright © 2023 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.)

Background: There is a growing demand for palliative care (PC) in Emergency departments (ED) as the number of patients who need end-of-life (EOL) care is increasing. Despite significant variability amongst residency programs, there is a lack of structured core curriculum for PC/EOL care in most emergency medicine (EM) training programs, which often do not meet the needs of EM physicians. In this study, we evaluate the effect of a short EOL care workshop on changing the attitude of Iranian EM residents towards EOL care in ED., Method: In this prospective before/after educational study at Tehran University of medical science, we enrolled 40 EM residents using a random sampling method. We obtained demographic and practice background information, and participants underwent a half-day PC training workshop designed by an expert panel. We administered a translated and validated Standard PEAS (physician End of Life Care Attitude Scale) questionnaire before and four weeks after an educational intervention. Baseline and differences in attitude were reported and compared by paired t-test, repeated measure ANOVA, and ANOVA., Results: None of the participants had prior experience of formal PC training. All of the 40 participants completed the follow-up questionnaire. Baseline attitude was not different among demographic groups. The mean (SD) PEAS score before and four weeks after the workshop was 86.9 (5.8) versus 89(6.9), respectively (P = 0.023). Residents with no previous close exposure to a terminal illness in their family members had significantly more attitude change than those with such an experience (P = 0.045)., Conclusion: A brief educational intervention improved EM residents' attitudes toward EOL care. The optimal design and characteristics of this educational intervention yet remain to be defined by further studies., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Sadigh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Competing Interests: There are no conflicts of interests.

Background: This study aimed to establish normative spirometric equations in a healthy population of Iranian children and adults, and compare these equations with those developed by the Caucasian Global Lung Initiative (GLI) for the first time., Methods: Spirometric data from healthy Iranian aged 4-82 years sampled in 2019 were used to derive reference equations using the generalized additive model for location (mu), shape (lambda), and scale (sigma)., Results: A total of 418 females and 204 males were included in the study. Applying the GLI standards for the Iranian population resulted from the Z scores of FEV 1 , FVC, FEV 1 /FVC, and FEF 25-75% was not different from zero. Based on the newly calculated LLN, eleven individuals showed significant values below the LLN for FEV 1 /FVC. In all age groups, this frequency was less than 5%, except for men over 70 years of age, which was 12.5%. There are significant differences between new data and GLI for Caucasian data., Conclusion: It is recommended that the values and equations generated from this study should be used by physicians and technicians in their routine practice for the diagnosis and assessment of pulmonary disorders., (© 2022. The Author(s).)