Acta Medica Iranica

Influence of Sleep Disruption Before Myocardial Infarction on Cardiac Injury Following Isoproterenol Administration: Insights into Matrix Metalloproteinases

2026-10-31T12:08:04+0330

Epidemiological studies have demonstrated an association between sleep duration and various health risk factors, including obesity and cardiovascular diseases, particularly coronary artery disease (CAD). The present study aimed to examine the impact of sleep disruption (SD) prior to myocardial infarction (MI) on cardiac injury, with a specific focus on matrix metalloproteinases (MMPs) as potential mediators of this relationship. Using a controlled animal model, adult male Wistar rats were subjected to chronic SD for 14 days, followed by induction of MI via isoproterenol administration. The activities of MMP-2 and the level of tissue inhibitor of metalloproteinase-1 (TIMP-1) were assessed, alongside histological evaluations of cardiac tissue and oxidative stress markers. Results indicated a significant reduction in the TIMP-1/β-actin ratio in the MI and SD+MI groups, with a more pronounced decrease in the SD+MI group, and an increase in MMP-2 activity in the MI group compared to the control group, suggesting an imbalance between MMPs and TIMPs that may contribute to myocardial damage. Histological analysis revealed notable disorganization of myocardial fibers, which appeared more severe in the SD+MI group, highlighting the detrimental impact of SD on cardiac tissue integrity. Although no significant alterations in oxidative stress markers were detected, the findings underscore the detrimental role of SD in cardiovascular health and suggest that this imbalance between MMPs and TIMPs could serve as a potential mechanism involved in cardiovascular diseases associated with SD.

The Association Between Critical Thinking Skills and Academic Performance Among Undergraduate Medical Students of Different Educational Levels at Iran University of Medical Sciences

2026-10-31T12:38:22+0330

Given the importance of Critical thinking (CT) skills in medical education and academic performance, along with the lack of recent studies on this topic after the medical education reform in Iran, we aimed to evaluate the association of CT skills with academic performance in undergraduate medical students of Iran University of Medical Sciences. In this cross-sectional study, using the convenience sampling method, 142 medical students entered the study. The Persian version of the California Critical Thinking Skills Test Form B (CCTST-B), previously validated for local populations, was used to measure CT skills, and the test's association with academic performance was measured using participants' cumulative grade point average (GPA). A significant correlation was observed between the total mean score of passed courses (0-20) and the CT skills score across all CT domains (P<0.05). The mean total CT skills scores were 17.53±4.39 for basic science students, 17.17±3.63 for physiopathology students, 16.54±3.77 for clerkship students, and 17.60±3.89 for internship students. Statistical analysis revealed that clerkship students had significantly lower scores compared to the other groups (P=0.011). There were no significant differences between males and females, nor between students living in dormitories and those living in personal accommodations. This study showed a significant positive correlation between CT skills and academic performance. On average, undergraduate medical students possess satisfactory CT skills. However, there is room for improvement in CT skills among undergraduate medical students and in enhancing their academic performance.

Integrated Oxidative and Cardiac Biomarker Profile in Type 2 Diabetes Mellitus With Acute Coronary Syndrome

2026-10-31T12:43:15+0330

Type 2 diabetes mellitus (T2DM) substantially increases the risk of acute coronary syndrome (ACS) through the combined effects of chronic hyperglycemia, dyslipidemia, oxidative stress, endothelial dysfunction, and myocardial injury. This study aimed to comprehensively evaluate metabolic, oxidative stress, and cardiac biomarkers in patients with T2DM complicated by ACS, and to investigate their diagnostic performance and interrelationships. A case-control study was conducted including 60 patients with T2DM complicated by ACS and 30 apparently healthy controls. Fasting blood glucose (FBS), glycated hemoglobin (HbA1c), lipid profile, glutathione, lipid peroxidation, superoxide, homocysteine (HCY), Na+/K±ATPase, and cardiac troponin were determined using standard laboratory methods. Compared with healthy controls, patients with T2DM and ACS exhibited significantly elevated FBS, HbA1c, total cholesterol (TC), triglycerides, low-density lipoprotein cholesterol (LDL-C), very-low-density lipoprotein cholesterol (VLDL-C), HCY, and lipid peroxidation, whereas high-density lipoprotein cholesterol (HDL-C), glutathione, and Na+/K±ATPase activity were significantly reduced (all P<0.001). Superoxide levels were also significantly decreased in patients compared with healthy controls (P<0.001). Correlation analysis demonstrated a significant positive correlation between cardiac troponin and Na+/K±ATPase activity (r=0.337, P=0.008), while no significant correlations were observed between FBS, HbA1c, lipid profile parameters, oxidative stress biomarkers, HCY, and the remaining investigated biomarkers. ROC analysis demonstrated excellent diagnostic performance for Na+/K±ATPase, glutathione, lipid peroxidation, superoxide, and HCY, with high sensitivity and specificity for discriminating patients from healthy controls. In conclusion, patients with T2DM complicated by ACS exhibit profound metabolic disturbances coupled with pronounced oxidative stress, hyperhomocysteinemia, altered Na+/K±ATPase activity, and myocardial damage, highlighting the utility of integrated biomarker profiling.

Emerging Recalcitrant Tinea Pedis and Management Using Antifungal Susceptibility Testing: A Pilot Study

2026-11-03T13:01:44+0330

Tinea pedis (TP) is a common fungal infection that has become increasingly prevalent with the rise of drug-resistant strains. Traditional antifungal treatments are increasingly less effective, prompting a need for new therapeutic approaches. This pilot study aimed to explore the role of antifungal susceptibility testing (AST) in the management of recalcitrant TP. In this exploratory pilot study, TP Skin specimens were collected and examined microscopically and via culture, with PCR used for species differentiation. Antifungal susceptibility testing (AST) determined MICs for various antifungals, categorizing patients into sensitive, resistant, tolerant, or recalcitrant groups. All patients received clotrimazole 1% cream, with individualized oral antifungal treatments based on AST results and a standard 4-week treatment duration. The study involved 38 patients, with 28 diagnosed with TP. Isolates included T. mentagrophytes complex (67.85%), T. rubrum (25%), E. floccosum (3.57%), M. canis (3.57%). Antifungal susceptibility testing revealed high resistance rates, particularly to terbinafine (43%) and itraconazole (17%). Treatment responses varied, with 64.28% of terbinafine-resistant patients improving, while itraconazole-resistant cases often required a switch to voriconazole. Findings from this pilot study suggest that AST may be a valuable tool in the management of recalcitrant tinea pedis when performed by experienced laboratories in accordance with standardized guidelines. An MIC cut-off value of 2 µg/mL for defining terbinafine resistance is proposed; however, larger studies are required to establish definitive clinical breakpoints. Voriconazole appears to be a promising alternative treatment option in cases resistant to both terbinafine and itraconazole.

The Effect of Distraction Techniques, Ball Squeezing and Immersive Cartoon Projection, on Pain in Children During Venipuncture

2026-11-03T13:04:38+0330

Since venipuncture is a common procedure for obtaining blood samples and establishing intravenous access, these activities can be painful and frightening for children. The majority of children aged 3-6 years who underwent venipuncture procedures reported being traumatized by the experience. It is widely recognized that fear and anxiety are frequently associated with needles. This study employed a randomized controlled trial (RCT) design. Data collection occurred between February 28, 2026, and May 2, 2026. A non-probability convenience sample (N=140) of preschool children was divided into two study groups: the ball-squeezing group (n=70) and the immersive cartoon projection group (n=70). Participants were selected using a convenience sampling technique. Data were collected using the FFLC pain scale, and statistical analysis was performed using descriptive and inferential techniques. The results indicated that ball squeezing helped reduce pain levels to mild, whereas immersive cartoon projection was successful in reducing moderate pain levels. A statistically significant correlation was established between immersive cartoon projection and a history of venipuncture (P=.046). Furthermore, there was a statistically significant inverse correlation between the efficacy of the pain-reduction technique and the child’s weight (r= −.262, P=.028). No statistically significant relationship was established between age, gender, residential location, or family size. The study concludes that the application of ball squeezing effectively reduced venipuncture-related mild pain, while the application of immersive cartoon projection effectively reduced venipuncture-related moderate pain. Based on these findings, this study represents a novel contribution to the field of venipuncture. It advocates for replicating the study on a national level to validate these findings and ensure broader applicability across different healthcare settings. Additionally, it is suggested that future studies incorporate an anxiety and fear scale to further refine these initial findings.

Association Between the Number of Harvested Lymph Nodes and Overall Survival After Gastrectomy for Gastric Cancer: A Retrospective Cohort Study

2026-10-31T13:02:35+0330

Gastric cancer remains one of the most prevalent and lethal malignancies globally. Continual advancements in staging modalities aim to optimize prognostic stratification and survival prediction. Among the highly useful approaches that have consistently garnered the attention of researchers is the examination of the lymph nodes of patients undergoing gastrectomy. Studies have shown a strong correlation between the number of involved lymph nodes and patient prognosis; however, other studies have reported insufficient sensitivity and specificity for these findings, which may be attributed to inadequate numbers of lymph nodes being removed during surgery. In this retrospective cohort study, patients diagnosed with gastric adenocarcinoma who were admitted to Sina Hospital between 2017 and 2023 and underwent gastrectomy were included. Demographic information, tumor pathology data, the number of excised lymph nodes, and the number of metastatic lymph nodes were collected. The survival status of the patients was assessed through telephone contact. A total of 118 patients were included in the study. The mean age was 62.59 years, and 78% of the patients were male. The most common tumor location was at the cardia and the gastroesophageal junction. The median tumor size was approximately 3 centimeters, with around 44% of the tumors being poorly differentiated. Approximately 70% of the patients had received neoadjuvant chemotherapy prior to surgery. The median number of resected lymph nodes was 14.0, which did not predict mortality in the analysis. However, the number of positive lymph nodes and the ratio of positive lymph nodes were significantly associated with mortality. Based on the results of this study, the number of positive lymph nodes and the ratio of positive lymph nodes to the total number of excised lymph nodes can be used to predict patient survival. The removal of a sufficient number of lymph nodes aids in accurately staging the disease and facilitates better treatment planning.

PCR-DHPLC for Non-Invasive Prenatal Evaluation of the IVS-II-1 (G>A) Mutation in Fetal DNA of β-Thalassemia Major: A Pilot Diagnostic Performance Study

2026-10-31T13:15:13+0330

β-thalassemia is one of the most common autosomal recessive single-gene disorders, particularly in high-prevalence regions. This study aimed to explore the feasibility and diagnostic performance of polymerase chain reaction-denaturing high-performance liquid chromatography (PCR-DHPLC) for non-invasive prenatal detection of the IVS-II-1 (G>A) mutation in fetal DNA. Fifty pregnant women at risk of carrying a fetus with β-thalassemia major were enrolled. Cell-free DNA was extracted from maternal plasma and analyzed using high-resolution melting (HRM) real-time PCR, followed by PCR amplification. Amplicons were assessed by electrophoresis, purified using a PCR purification kit, and subsequently analyzed by DHPLC under predefined buffer and temperature conditions to detect the IVS-II-1 (G>A) mutation. DHPLC analysis identified 13 true positive, 11 true negative, 19 false negative, and 7 false positive cases compared with the invasive reference method. The calculated sensitivity and specificity were 40.6% and 61.1%, respectively, indicating limited diagnostic performance in the current setting. PCR-DHPLC does not provide sufficient sensitivity and specificity for reliable non-invasive prenatal detection of the IVS-II-1 (G>A) mutation in β-thalassemia major. Further methodological optimization and extended mutation panels in larger cohorts are necessary to assess its potential for clinical validation.

The Impact of Spinal Anesthesia Technique on Post-Dural Puncture Headache: A Randomized Controlled Trial Comparing Paramedian and Midline Approaches in Orthopedic Patients

2026-10-31T13:21:44+0330

Post-dural puncture headache (PDPH) is a common complication of spinal anesthesia. This trial compared the impact of paramedian versus midline approaches on PDPH incidence in orthopedic patients. This randomized controlled trial enrolled 160 orthopedic surgery candidates at Imam Khomeini Hospital, Jiroft (2023). Randomization was performed using computer-generated numbers and sealed opaque envelopes for allocation concealment (1:1 ratio). Patients received spinal anesthesia via paramedian (Group P, n=80) or midline (Group M, n=80) approach using a 25-G Quincke needle. The anesthesiologist performing the block could not be blinded to the technique; however, participants, outcome assessors (neurologist), and data analysts were blinded. PDPH was diagnosed according to ICHD 3 criteria (headache developing within 5 days, postural component, and associated symptoms). Incidence, duration, severity, and onset timing were recorded. Odds ratio (OR) with 95% confidence interval (CI) was calculated for the primary outcome. PDPH occurred in 31.3% of Group P vs. 62.5% of Group M. The midline group had significantly higher odds of PDPH (OR=3.67, 95% CI: 1.98-6.80, P<0.001). Mean headache duration was 2.56 days (Group P) vs. 5.34 days (Group M). Most headaches in both groups began within the first 24 hours. The paramedian technique significantly reduces the incidence, duration, and severity of PDPH compared to the midline approach. Adoption of the paramedian technique is recommended to improve patient outcomes.

Dysregulation of TTN Gene Expression, Titin Protein Levels, and Circulating ncRNAs (miR-200a, lncRNA FOXD2-AS1, and snoRNA-42) in Dilated Cardiomyopathy: A Pilot Study

2026-11-01T09:32:20+0330

Dilated Cardiomyopathy is the major cause of congestive heart failure and sudden cardiac death. It is a type of cardiomyopathy characterized by ventricular dilatation, wall thinning and systolic dysfunction. TTN gene is implicated in DCM and encodes for giant titin protein. This study explores the association between TTN gene expression with some types of non-coding RNAs in DCM patients. The study comprised three age- and sex-matched groups (20 individuals each): healthy controls, male patients, and female patients. Relative expression levels of TTN, miR-200a, lncRNA FOXD2-AS1, and snoRNA-42 were quantified using qRT-PCR, whereas serum titin protein levels were measured via ELISA. TTN gene expression was significantly elevated in both male and female DCM patients compared with controls (P<0.001). Furthermore, miR-200a and snoRNA-42 levels were also significantly increased in DCM patients particularly in females. In contrast, lncRNA FOXD2-AS1 was significantly decreased in both sexes of DCM patients. ROC curve analysis for TTN gene demonstrated high diagnostic performance, sensitivity and specificity with (P=0.0022), supporting TTN as a reliable molecular biomarker for DCM. Similarly, miR-200a showed strong diagnostic potential, particularly in females (P=0.0275 in males and P=0.0022 in females), underscoring its efficiency as a sex-specific biomarker. Furthermore, Titin protein level was significantly elevated in DCM patients, particularly in females. Pearson correlation analysis detected a negative correlation between miR-200a and TTN mRNA in both males and females, negative correlations were also observed between miR-200a and titin protein levels. In contrast, TTN gene expression and titin protein levels showed a positive correlation, indicating transcription-driven increases in titin level. To the best of our knowledge, this is the first study in Iraq, particularly in Mosul, to integrate Titin protein and TTN gene expression with multiple circulating ncRNA classes (miR-200a, lncRNA FOXD2-AS1 and snoRNA-42) in patients with DCM. The combined analysis of TTN gene / Titin protein axis and ncRNAs within a clinical group from Mosul city provides a comprehensive view of post-transcriptional regulation and revealed sex-dependent molecular differences. Moreover, the strong diagnostic performance of TTN and miR-200a supports their potential as non-invasive biomarkers for DCM. By focusing on a Middle Eastern population, this study contributes novel region-specific molecular data and expands current understanding of DCM beyond previously studied populations. In DCM patients the expression level of TTN gene was significantly increased, demonstrating that transcriptional activation was correlated with myocardial remodeling. The dysregulated expression of ncRNAs (miR-200a, lncRNA FOXD2-AS1 and snoRNA-42), suggested the existence of a complex post-transcriptional regulatory network affecting TTN expression. All of these findings highlight the potential of TTN and ncRNA signatures as promising non-invasive molecular biomarkers for DCM.

Successful Fertility Restoration in a Patient With Severe Asherman’s Syndrome Through Serial Hysteroscopic Adhesiolysis: A Case Report

2026-11-01T09:38:30+0330

Severe Asherman’s syndrome, characterized by extensive intrauterine adhesions and endometrial fibrosis, poses a significant challenge to fertility restoration. In cases where the uterine cavity is non-visualized, surrogacy is often considered the only viable option. We report a rare and successful case of fertility restoration in a 30-year-old woman with severe Asherman’s syndrome and multiple comorbidities. Following secondary amenorrhea post-curettage, imaging revealed a completely obliterated uterine cavity. Despite initial recommendations for surrogacy, the patient underwent three serial hysteroscopic adhesiolysis procedures. Gradual anatomical reconstruction and endometrial regeneration were achieved, culminating in a receptive cavity and near-normal menstruation. IVF was performed, resulting in a twin pregnancy. Despite a high-risk gestation complicated by PPROM and preterm delivery at 30+6 weeks, both infants were discharged in good health. This case underscores the transformative potential of staged hysteroscopic intervention in restoring fertility, even in the most severe presentations of Asherman’s syndrome. It challenges traditional prognostic assumptions and highlights the importance of individualized, persistent surgical care.