Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 11 2024 07 11 646 653 Mahdi Shooraj Student Research Committee, Amol School of Paramedicine, Mazandaran University of Medical Sciences, Sari, Iran. Kiarash Fekri Department of Preclinical, Amol Campus of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. AND Department of Paramedicine, Amol School of Paramedicine, Mazandaran University of Medical Sciences, Sari, Iran. Noushin Mousazadeh Department of Nursing, Amol School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran. Seif Ali Mahdavi Department of Preclinical, Amol Campus of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. AND Department of Paramedicine, Amol School of Paramedicine, Mazandaran University of Medical Sciences, Sari, Iran. 2023 07 19 2024 02 14 - Pharmacology is the cornerstone of health science courses the same as biomedical programs in educational setting. New educational intuitions and methodical progresses in teaching and learning, as well as recent findings in pharmacology research, can help pharmacology educators reconsider and regulate their teaching approaches. Thus, the aim of this article is to review existing studies on the different methods of teaching pharmacology and investigate different outcomes in this regard. In the present investigation, recent articles in the databases of Web of Science, PubMed, Scopus, Embase, Google Scholar, IranDoc and Scientific Information Database (SID) were examined, and the delegated documents were reviewed. The gathered data showed that students’ cognitive, metacognitive, and cooperative learning besides collaborative skills are effective factors for teaching. Additionally, application of blended learning or flipped instruction via technologies such as computer ameliorates the process of teaching and learning pharmacology in academic setting. Consequently, to overcome the difficulties in managing the data overload, it sounds necessary to introduce new teaching methods in academic context. Therefore, the current investigation is useful for practitioners, curriculum designers and educational administrators in medical and paramedical educational context. https://acta.tums.ac.ir/index.php/acta/article/view/10739

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 11 2024 07 11 654 659 Ali Shahriari Anesthesia, Critical Care and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran. Masoomeh Nataj-Majd Anesthesia, Critical Care and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran. Majid Akrami Anesthesia, Critical Care and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran. Maryam Khooshideh Department of Obstetrics and Gynecology, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mahsa Soleimani Department of Obstetrics and Gynecology, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2024 04 21 2024 04 27 Epidural analgesia (EA) is an effective and common method of pain relief during labor. However, EA may also have some adverse effects like prolonged labor, increased risk of operative delivery, and some unwanted complications. It's unclear how maternal position affects the outcomes of natural birth with EA. This study aimed to compare mode of delivery and maternal and neonatal outcomes between recumbent and upright positions in nulliparous women with EA. This randomized clinical trial involved 540 women who received EA at cervical dilatation of 4 to 6 cm. During the second stage of labor, they were instructed to adopt upright or recumbent position. The main outcome was the mode of delivery. The secondary outcomes included duration of labor, pain intensity, the Apgar score, and other maternal and neonatal complications. Finally, 528 women were included in the final analysis. The upright group had a higher rate of cesarean section than the recumbent group. The duration of the labor stages did not differ between the groups. The pain intensity in the second stage was higher in the upright position. The Apgar score at 1 and 5 minutes was higher in the recumbent group. There was no difference in terms of other outcomes between the groups. Recumbent positions are beneficial in the case of rate of cesarean, mother’s pain, and Apgar score in women with EA. So, adopting a recumbent position during the second stage of labor may be preferable for women with EA.   https://acta.tums.ac.ir/index.php/acta/article/view/11086

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 11 2024 07 11 660 666 Parisa Khosravi Social Determinants of Health Research Center, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran. Soheila Pirdadeh Beiranvand Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran. Farzad Ebrahimzadeh Nutritional Health Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran. Arefeh Tadayon 1 Social Determinants of Health Research Center, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran. Maryam Hasani Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran. 2023 11 24 2024 02 17 This study aims to determine the effect of gestational hypertension on neonatal hemoglobin levels. This cohort study was performed on 150 pregnant women, 60 of whom had gestational hypertension and 90 were healthy. Participants were selected using sequential and quota non-probability sampling methods, respectively. The data were collected from interviews and examination forms. The newborns’ umbilical cords were clamped 30-60 sec after the delivery in both groups. Umbilical cord blood samples were taken to determine neonatal hemoglobin levels and sent to the laboratory immediately. Independent t-test was used to compare the two groups in terms of mean hemoglobin; general linear model with an identical link function was used to compare the two groups in terms of mean hemoglobin, considering the effect of confounding variables. SPSS software version 25 was used for the statistical analysis of the data. The statistical significance level in this study was considered to be 0.05. The mean neonatal hemoglobin level in women with gestational hypertension was significantly higher than that in the healthy group (16.73±1.81 gr/dl vs. 15.56±1.79, P<0.001). This difference remained significant after adjusting for demographic and background variables as well as medical records of the participants (P=0.008). The results revealed the hemoglobin level of newborns of mothers who had gestational hypertension, was higher than newborns of healthy mothers. Therefore, performing proper screening tests and knowledge of the hemoglobin level in these infants routinely helps the healthcare staff to prevent, decide and provide more and more useful services. https://acta.tums.ac.ir/index.php/acta/article/view/10882

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 11 2024 07 11 667 676 Fatemeh Sarhadi kholari Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Mitra Nourbakhsh Department of Clinical Biochemistry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. AND Metabolic Disorders Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran. Golsa Shekarkhar Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran . Ahmad Reza Dehpour Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Abolfazl Golestani Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2022 01 12 2024 01 28 Cirrhosis is the consequence of chronic liver injury Considering the crucial role of oxidative stress in the progression of liver cirrhosis, we aimed to investigate the ameliorative effect of NTX against oxidative stress in carbon tetrachloride (CCl4)-induced cirrhotic rats. Eighty-four male Wistar rats were randomly assigned into 4 groups (21 rats /group I) receiving CCl4; (II) NTX+CCl4; (III) mineral oil (M) (as the control); (IV) NTX+M. The animals in each group were sacrificed in 3 different time-points 2 weeks, 6 weeks (early cirrhosis) and 8 weeks (advanced cirrhosis). Liver function tests, NO metabolites, GSH level, as well as the activity of antioxidant enzymes including superoxide dismutase (SOD), catalase (CAT), glutathione peroxides (GPX), and hexokinase (HK) were assessed. NTX was able to ameliorate liver injury, revealed by attenuation of ALT activity, which was significantly enhanced due to cirrhosis induction, as well as pathological evaluation. HK was also increased significantly after treatment with CCl₄ while NTX moderated this increase. Although CCl4 treatment did not have a significant effect on GSH levels, NTX was able to considerably increase GSH in blood. The activity of CAT and SOD as well as NO levels were all augmented by NTX in CCl4-treated rats. Naltrexone demonstrates antioxidative effects in liver cirrhosis and may confer a protective effect against hepatic cirrhosis through modulation of oxidative stress.   https://acta.tums.ac.ir/index.php/acta/article/view/9922 https://acta.tums.ac.ir/index.php/acta/article/download/9922/5869

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 11 2024 07 11 677 684 EN Sara Monjezi Department of Neurology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Shahram Rafie Department of Neurology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Ebrahim Behzad Department of Neurology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Shooka Mohammadi Department of Neurology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 2024 01 31 2024 06 15 Precise categorization of the causes of ischemic stroke (IS) is crucial for optimizing stroke treatment and assessing the prognosis of patients. This cross-sectional study aimed to determine the risk factors and various subcategories of IS in Iranian patients. The study included all patients with IS referred to Golestan Hospital (Ahvaz, Iran) for one year. Their demographics and clinical data were collected. The etiology of IS was classified based on the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria. A total of 1100 patients with IS were evaluated, 658 were male and 442 were female. They had an average age of 66 years (ranging between 20 and 99 years). The majority of them were in the 61-80 age group. The prevalence of risk factors for IS included hypertension (HTN) (71.4%), diabetes (50.4%), smoking (42.4%), history of previous stroke (28%), dyslipidemia (15.4%), and cardiovascular disease (22.5%). Three months after admission, the mortality rate was 10.7% and the majority of patients exhibited a lower level of disability based on the modified Rankin Score (mRS) compared to the time of admission. The frequency of all risk factors, except for HTN, differed significantly between genders (P<0.05). Furthermore, the prevalence of risk factors varied significantly among different stroke etiologic subgroups (P<0.05). The most common etiological factors identified by TOAST classification were associated with large artery atherosclerosis (LAA) and small artery occlusion (SAO). Significant variations were observed in the prevalence of different etiologic subtypes of stroke among genders and across different age groups. https://acta.tums.ac.ir/index.php/acta/article/view/10955

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 11 2024 07 11 685 690 Mehrdad Dargahi-Malamir Department of Pulmonology, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Seyed Hamid Borsi Department of Pulmonology, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Zahra Mehraban Department of Pulmonology, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Fatemeh Kianizadeh Department of Internal Medicine, Faculty of Medicine. Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Hoda Mohsenikia Department of Internal Medicine, Faculty of Medicine. Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. 2024 01 21 2024 05 21 Pinen Hydronoplacton Ribonucleic acid (PHR160) medicine contains compounds that can be useful in the recovery of respiratory patients. The aim of this study was to determine the effect of PHR spray on improving lung function, severity and asthma attacks in patients with severe asthma. This study is a pioneering interventional study (pilot study) conducted during the years 2021-2022 on patients with severe asthma resistant to treatment who referred to the lung clinic of Imam Khomeini, Golestan Hospitals and the private practice of lung specialists of this academic center. The study includes two groups of patients with asthma, both groups were given the usual treatment according to the stage of the disease, in addition, the intervention group was given two puffs of PHR spray every eight hours, and the control group was given a placebo spray with the same dose. Before and after the intervention, GSK 2002 questionnaire, six-minute walk distance (6MWD) and spirometry tests were completed. Among of 60 patients, 27 (45%) were male. The mean age of the patients was 44.33±6.94 years. Based on findings, the forced vital capacity (FVC) and forced expiratory flow between 25% and 75% (FEF 25-75%) were significantly better in the intervention group than the control group (P<0.001 and P=0.019, respectively), but there was a statistically remarkable difference between the two groups in terms of forced expiratory volume (FEV1) and FEV1/FVC (P=0.505, P=0.575, respectively). In addition, the GSK questionnaire score in the intervention group was higher than the control group (P<0.001), however there is no significant difference between the two intervention groups in terms of the 6MWD test and the number of exacerbation (P=0.114 and P=0.09, respectively). It is generally concluded that PHR160 spray can lead to improvement of spirometry parameters and severity of disease in severe asthma patients by affecting small airways. https://acta.tums.ac.ir/index.php/acta/article/view/10937

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 11 2024 07 11 160 169 Ahmed Ali Al-Mashhadani Surgery department, College of Medicine, University of Al-Mustansiriyah, Iraq. 2025 12 24 2026 01 24 Background: Endo-Venous Radio-Frequency Ablation (EVRF) is widely used for treating varicose veins, offering a minimally invasive alternative to traditional surgery. However, the trajectory of postoperative symptoms, recurrence patterns, and patient-centered outcomes remains variable across populations. Objective: To evaluate postoperative symptom changes, vein occlusion patterns, recurrence, cutaneous effects, patient satisfaction, and quality of life in patients undergoing EVRF over a one-year follow-up period. Methods: A prospective observational study was conducted on 125 patients treated with EVRF in Dijlah Privet Hospital, Miysan, Iraq. Clinical outcomes—including paresthesia, thrombophlebitis, ecchymosis, redness and skin changes, cellulitis, recurrence, occlusion rate, patient satisfaction, and quality of life—were assessed using a standardized four-point scoring system. Evaluations were performed at week one, 30 days, and one year. Paired t-tests were applied to compare temporal changes. Results: Significant early improvements were observed across most clinical indicators. Paresthesia decreased from 1.3462 at week one to 1.0692 at 30 days (p < 0.001). Redness, skin changes, thrombophlebitis, and ecchymosis demonstrated similar reductions. Recurrence improved significantly from 0.9846 to 0.6769 at one year (p < 0.001). In contrast, occlusion scores declined from 2.8846 at week one to 1.9231 at one year (p < 0.001), suggesting partial recanalization. Quality-of-life scores improved significantly from 3.6154 to 2.4154 (p < 0.001). Despite these objective improvements, patient satisfaction decreased from 2.8154 to 1.8538 over the same period (p < 0.001). Cellulitis showed no significant change (p = 0.074). Conclusion: EVRF provides substantial early postoperative benefits and long-term improvements in quality of life, with low complication rates. However, reduced occlusion durability and declining patient satisfaction highlight the importance of standardized imaging follow-up and enhanced patient counseling to optimize long-term outcomes.   https://acta.tums.ac.ir/index.php/acta/article/view/11956 https://acta.tums.ac.ir/index.php/acta/article/download/11956/6035

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 3 2026 05 20 170 178 Roozbeh Cheraghali Vascular and Endovascular Surgery Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Sepide Javankiani Department of General Surgery, Tehran University of Medical Sciences, Tehran, Iran Yasin Alipour Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran Seyed Amir Miratashi Yazdi Department of Surgery, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2025 08 03 2025 11 02 Introduction: The survival of arterio-venous (AV) fistula and the high rate of hospitalization of these patients (about 20% of the hospitalizations of these patients) are one of the most important challenges of the health system in the management of ESRD patients all over the world. Since AVF failure increases the mortality of patients and causes an increase in treatment costs, determining the optimal site (distal radiocephalic vs. antecubital brachiocephalic) as well as patient factors influencing functional success is crucial. Methods: This observational study was conducted in 2022 on ESRD patients, candidates for hemodialysis who underwent fistula bypass surgery in a tertiary center. Fifty patients we enrolled in the distal radiocephalic fistulas (DRF) groups, and 50 received antecubital brachiocephalic fistulas (ACBF). Demographic characteristics of the patients, such as age, gender, history of diabetes, high blood pressure, and smoking, were recorded. The primary outcome was AVF maturation at 120 days (functional vs. failed). A secondary outcome was early failure, defined as the absence of bruit or thrill within 30 days. Results: 100 patients were examined in two groups (according to the location of the fistula), and the average age was reported as 52.4 ± 12.5. AVF failure was reported in 38% of patients, of which 26% occurred within the first 30 days and 12% occurred within 30 to 120 days. The AVF failure rate was similar between DRF and ACBF groups (P value: 1.00).  No statistically significant difference was seen for the failure rate of fistulas based on gender (P value: 0.715).  In adjusted analysis, each additional year of age increased the odds of maturation by 4.3% (OR 1.043, 95% CI 1.004–1.083; P value = 0.029), and hypertension was independently associated with higher maturation odds (OR 2.747, 95% CI 1.119–6.746; P value = 0.027). For early failure (<30 days), female patients had 4.7-fold higher odds of failure than males (OR 4.676, 95% CI 1.556–14.048; p = 0.006), while other covariates showed no significant associations. Conclusion: This study examined the factors that contribute to the failure of arteriovenous fistulas in ESRD patients who are eligible for hemodialysis. The findings demonstrated that various factors, including age and history of hypertension, can affect its success rate. These results are congruent with previous articles and emphasize the importance of choosing the correct type of fistula and careful management of risk factors in improving treatment. https://acta.tums.ac.ir/index.php/acta/article/view/11751 https://acta.tums.ac.ir/index.php/acta/article/download/11751/6036

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 3 2026 04 21 133 137 Rana Matrood Alkhazraji Department of Obstetrics and Gynecology, College of Medicine, University of Al-Qadisiyah, Al-Qadisiyah, Iraq. 2025 12 03 2025 12 23 Some studies have concluded that PI and RI play an inadequate role in distinguishing benign tumors from malignant ones; however, later studies have reported different results, showing that Doppler ultrasound is effective in differentiating malignant from non‑malignant ovarian masses by using specific threshold values for both RI and PI. The presence of such conflicting data justifies our study. The purpose of this project was to use color Doppler and ultrasound imaging to differentiate between malignant and benign ovarian tumors and to verify the findings by comparing them with histopathology. Over the course of two years, 86 patients with ovarian masses were evaluated for morphologic features, pulsatility indices (PI), and resistance indices (RI) using Doppler ultrasound. Histopathologic confirmation served as the basis for the final diagnosis. The cutoff value for RI was ≤0.39 and for PI was ≤1.1, as shown in figures 1 and 2 and table 1. The sensitivity, specificity, and positive and negative predictive values were all 100%. Doppler ultrasound provides effective tools, including resistive and pulsatility indices, that can be used to differentiate between benign and malignant ovarian masses.     https://acta.tums.ac.ir/index.php/acta/article/view/11921 https://acta.tums.ac.ir/index.php/acta/article/download/11921/6029

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 3