Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 2 2026 04 03 45 57 Hossein Dargahi Department of Health Management, Policy, and Economics, School of Public Health, Health Information Management Research Center, Tehran University of Medical Sciences, Tehran, Iran Mohsen Seyed Mahmoudi Ph.D. in Health Services Management, Health Management, Policy, and Economics Department , School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Nasrin Abolhasanbeigi Gallehzan Ph.D. in Health Economics, Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran 2025 10 14 2025 11 16 In the new century and in the era of post-modernist, managerialism and leaderism theories have replaced the words management and leadership for driving of new public management such as healthcare organizations. each of these two theories cannot be alone successful to managing these organizations. several authors believed the integration of these two discourses can effectively drive healthcare organizations. According to these considerations, the current research was aimed to develop an integrated model of managerialism and leaderism theories among healthcare organizations. This study was a scoping review, conducted from 2000-2024. The data in this study included English articles and documents using related keywords, searched alone and in combination with Boolean operators through six international databases, and google scholar for additional documents. After doing screening and selection process through the PRISMA flow diagram, finally 30 studies as total number selected for in-depth analysis. The results of several studies showed that managerialism and leaderism discourses could not developed health care organizations alone effectively. Therefore, some authors suggested the need to develop leaderism discourses toward managerialism as an integration and combining the strengths of these two theories for managing health care organizations. The fusion of managerialism and leaderism discourses as a paradigm in health care organizations is, in fact, a new public management in the postmodernism era, arising from the converging strengths and the conversion of their own weaknesses and challenges into new opportunities. https://acta.tums.ac.ir/index.php/acta/article/view/11846 https://acta.tums.ac.ir/index.php/acta/article/download/11846/6015

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 2 2026 04 03 11951 11951 Mohamed Shawky Abd Elall Department of Internal Medicine, Hepatology and Gastroenterology Unit, Faculty of Medicine, Mansoura University, Nile Delta, Egypt Ashraf Abdelmegid Elfakhry Department of Internal Medicine, Hepatology and Gastroenterology Unit, Faculty of Medicine, Mansoura University, Nile Delta, Egypt Mohamed Ali Atwa Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Nile Delta, Egypt. Fatma Adel Abo Zeid Department of Internal Medicine, Hepatology and Gastroenterology Unit, Faculty of Medicine, Mansoura University, Nile Delta, Egypt 2025 12 21 2026 01 25 Leptin and ghrelin are key metabolic hormones involved in energy balance and inflammation. Their dysregulation has been implicated in chronic inflammatory conditions such as inflammatory bowel disease (IBD). However, their association with disease activity and nutritional status remains unclear. This study aimed to evaluate the association between serum ghrelin and leptin concentrations and disease activity, nutritional status, and inflammatory markers in patients with IBD. A case-control study was conducted involving fifty-five IBD patients (31 with ulcerative colitis [UC] and 24 with Crohn’s disease [CD]) and fifty-five healthy controls, recruited from Mansoura Specialized Medical Hospital between January 2022 and January 2023. Disease activity was assessed using the Mayo score for UC, the Crohn’s Disease Activity Index (CDAI) for CD, and fecal calprotectin levels. Plasma ghrelin and leptin concentrations were measured using commercially available enzyme-linked immunosorbent assay (ELISA) kits, according to the manufacturer’s instructions. Blood samples were obtained after overnight fasting, immediately centrifuged, and plasma aliquots were stored at −80°C until analysis. All samples were analyzed in duplicate, and concentrations were expressed as pg/mL for ghrelin and ng/mL for leptin. A total of 110 participants were evaluated (34 active IBD, 21 inactive IBD, and 55 controls). Demographic characteristics showed no significant differences among the groups. Both hormones differed significantly across the disease activity categories (P<0.001). Leptin levels were highest in controls and lowest in active IBD, whereas ghrelin levels were highest in controls and lowest in inactive IBD. Ghrelin showed significant negative correlations with BMI, total nutritional score, and ALP, and a positive correlation with folic acid. Leptin correlated positively with BMI, ESR, and fecal calprotectin, and negatively with the nutritional score. Receiver operating characteristic (ROC) analysis demonstrated very poor predictive capacity for food decline, weight loss, and overall nutritional status for both leptin (AUC range: 0.106–0.308) and ghrelin (AUC range: 0.337-0.394). In conclusion, leptin and ghrelin levels in IBD patients appear to be more closely associated with disease activity and inflammatory burden than with nutritional status alone. Their combined assessment may offer descriptive insights into metabolic adaptation during active disease; however, these findings are associative and do not imply causality. Further longitudinal studies are required to clarify their potential clinical utility. https://acta.tums.ac.ir/index.php/acta/article/view/11951 https://acta.tums.ac.ir/index.php/acta/article/download/11951/6025

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 2 2026 04 03 58 64 EN Hesam Jahandideh Department of ENT and Head and Neck Research Center, The Five Senses Health Institute, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran Fateme Abedin Department of ENT and Head and Neck Research Center, The Five Senses Health Institute, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran Niloufar Abbasi Islamic Azad University, Abhar Branch, Abhar, Iran. 2024 09 23 2025 03 18 According to new reports, the burnout rate among doctors has increased dramatically in recent years. Some studies have found a higher prevalence of burnout in otolaryngologists. We aimed to quantify the incidence of burnout among our community otolaryngologists, identify risk factors, and assess its impact on well-being. Members of our national society of otolaryngologists were invited to complete an anonymous survey. The survey included a validated burnout measure and assessed surgeon demographics, professional and personal risk factors, and professional satisfaction and well-being. Out of the 200 surgeons invited, 170 completed the survey. Significant risk factors for burnout included age, self-identification as more of an aesthetic surgeon than a non-aesthetic surgeon, the surgeon's practice setting (private or public centers), work experience, legal conflicts with patients, and insufficient time for sleep. Emotional exhaustion scale was reported by 20.6 percent, depersonalization scale by 14.7 percent, and personal accomplishment scale by 37.1 percent. The validated burnout rate among Iranian otolaryngologists was 61.8 percent, with a multifactorial etiology. This occupational peril is avertible and can be mitigated through a series of preventive actions. Otolaryngologists need to be aware of this and seek support when needed in their professional endeavors (supplementary data). https://acta.tums.ac.ir/index.php/acta/article/view/11268 https://acta.tums.ac.ir/index.php/acta/article/download/11268/6016

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 2 2026 04 03 80 84 Ramesh Omranipour Department of Surgical Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran. Negar Mashoori Department of Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Sadaf Alipour Department of Surgery, Breast Disease Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran. Azin Saberi Department of Surgery, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran 2024 03 08 2025 02 10 Corticosteroids, generally prescribed at high doses, have been used with good results in the treatment of idiopathic granulomatous mastitis (IGM). However, side effects of steroids are a serious concern, and prescribing lower doses sound safer if they provide similar efficacy. Thus, this study was performed to investigate the effect of moderate-dose versus high-dose prednisolone on IGM. Medical records of IGM patients were evaluated retrospectively. Patients who received prednisolone were classified as the moderate-dose group (MDG, <25 mg/day) and the high-dose group (HDG, ≥25 mg/day); their response and recurrence rates were compared. Among 108 patients, 82.5% in HDG and 85.3% in MDG responded to treatment (P=0.7). Total recurrence was 21.7% and 22% in HDG and MDG, respectively (P=0.984). Moderate doses of corticosteroids may be used to treat IGM patients without decreasing the treatment efficacy. Prospective randomized trials are necessary to further clarify this issue. https://acta.tums.ac.ir/index.php/acta/article/view/10986 https://acta.tums.ac.ir/index.php/acta/article/download/10986/6018

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 2 2026 04 03 74 79 Zahraa Abed al-kareem Department of Pharmacology and Toxicology, Collage of Pharmacy, University of Kerbala, Kerbala, Iraq Zahraa Mohammed Kadhim Department of Pharmaceutics, College of Pharmacy, University of Kerbala, Kerbala, Iraq. Amal Umran Mosa Department of Pharmacology and Toxicology, Collage of Pharmacy, University of Kerbala, Kerbala, Iraq . Noor Aziz Department of Clinical Pharmacy, College of Pharmacy, University of Kerbala, Kerbala, Iraq Hassanain Shakir Mahmood Department of Pharmaceutics, College of Pharmacy, University of Alkafeel, Najaf, Iraq 2025 12 20 2026 01 24 Diclofenac sodium is a commonly used nonsteroidal anti-inflammatory drug (NSAID) known for its analgesic and anti-inflammatory properties. However, prolonged or high-dose use can harm the kidneys, leading to renal tissue damage. This condition, known as renotoxicity, can adversely affect kidney function. This experimental preclinical in vivo study aimed to investigate the renal tissue damage caused by diclofenac sodium in rats and to evaluate the preventive effects of vitamin B complex. The researchers divided 96 rats into four groups of 24, each with similar weights ranging from 165 to 230 grams. The groups were designated as control, diclofenac sodium, B-complex, and a combination of diclofenac sodium and B-complex. After 14 days, biochemical analyses (including blood urea and serum creatinine levels) and histological examinations (of kidney tissue cross-sections) were performed. The results showed that groups treated with diclofenac sodium had elevated levels of blood urea and serum creatinine, indicating kidney dysfunction. Histological analysis revealed degeneration and congestion in the kidney tissues, pointing to toxicity from diclofenac sodium. In contrast, the B-complex group exhibited nearly normal values for biochemical parameters and maintained healthy kidney tissue, suggesting a protective effect. The adverse effects of diclofenac sodium on the kidneys may be linked to free radicals and mitochondrial dysfunction. Treatment with B-complex reduced oxidative damage and apoptotic cell death associated with diclofenac sodium. In conclusion, diclofenac sodium can lead to renal tissue damage; however, the administration of vitamin B complex seems to mitigate these harmful effects. Further research is needed to explore the underlying mechanisms and establish appropriate clinical dosages. https://acta.tums.ac.ir/index.php/acta/article/view/11944 https://acta.tums.ac.ir/index.php/acta/article/download/11944/6020

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 2 2026 04 03 85 90 EN Younes Doostian Department of Counseling, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran. Zahra Asgari Department of Counseling, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran. Azam Naghavi Department of Counseling, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran. 2025 09 23 2025 12 13 Individuals with substance use disorders (SUDs) experience above-general-population levels of unemployment. Vocational rehabilitation (VR) is a central component of integrated SUD treatment, but the nature of effective interventions is not well synthesized. This overview tries to synthesize systematic review evidence regarding the nature of effective VR interventions in individuals with SUDs in all stages of recovery. We will conduct systematic searches in Web of Science, CINAHL, PsycINFO, EBSCOhost, Embase, Cochrane Library, Scopus, and PubMed for English-language peer-reviewed literature systematic reviews, meta-analyses, and literature reviews between 2018 and 2025. The timeframe was selected to identify the newest developments in combined VR and SUD treatment. Search strategy, created following PRESS guidelines, will be done using MeSH terms and keywords in SUDs and VR. Study selection will follow PRISMA, with screening and deduplication in Covidence and EndNote. Overlap between the primary studies will be established via citation matrices and the corrected covered area (CCA) approach. Methodology quality in the included reviews will be measured using AMSTAR-2 and certainty of the scoping evidence via PRISMA-ScR. The primary outcome will be the determination of the key characteristics (e.g., components, delivery modalities) of effective VR interventions. This review will synthesize and consolidate key effective practices in terms of intervention components (e.g., skill-building workshops, psychological support, and contingency management) and delivery formats (e.g., in-person, telehealth, integrated care models). By building this overall framework, the findings will guide practitioners directly as to how to develop evidence-based VR programs and instruct policymakers as to how to allocate funds to the most effective VR models. The summary will also highlight important evidence gaps and recommend areas of future research to improve employment outcomes and support long-term recovery for individuals with SUDs. https://acta.tums.ac.ir/index.php/acta/article/view/11821 https://acta.tums.ac.ir/index.php/acta/article/download/11821/6021

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 2 2026 05 19 98 101 Arash Mansouri Department of Neurosurgery, Vali-e-Asr Hospital, Meshgin Shahr, Iran . AND Medical School, Ardabil University of Medical Sciences, Ardabil, Iran . Yousef Rezaei https://acta.tums.ac.ir/index.php/acta/article/view/7312 https://acta.tums.ac.ir/index.php/acta/article/download/7312/5233

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 3 2019 05 13 180 183 EN Reza Boostani Department of Neurology, Quaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Pouran Layegh Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Mohammad Javad Yazdanpanah Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Elham Vosoughi Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Azadeh Mohammadi School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Noseibe Joneidi Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Reyhaneh Bazargani Research Center of Iranian Blood Transfusion Organization, Khorasan Razavi, Mashhad, Iran. Delaram Sayadpour Zanjani Research Center of Iranian Blood Transfusion Organization, Khorasan Razavi, Mashhad, Iran. Saeed Ebrahimzadeh Department of Biostatistics and Epidemiology, Health Sciences Research Center, School of Health, Mashhad University of Medical Sciences Mashhad, Iran. 2018 04 28 2018 12 19 The human T cell lymphotropic virus type-1 (HTLV-1) is associated with adult T cell leukemia/lymphoma (ATL) and other disorders, including a slowly progressive demyelinating paraparesis, known as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Dermatologic manifestations are common in patients infected with HTLV-1 infection. In this study, we evaluated the dermatologic lesions associated with HAM/TSP patients in Mashhad, Iran. Dermatological findings of 37 patients with HAM/TSP were investigated and compared with those of an HTLV-1 negative control group. A cutaneous biopsy was performed as needed, and the results were statistically analyzed. Results of the present study showed that 34 cases with HAM/TSP (91.9%) and 24 cases in the control group (64.9%) had at least one skin lesion or history of skin lesion before (P=0.010). Xerosis was found in 22 persons (59.5%) in the case group and 4 persons in the control group (10.8%) (P=0.000). Only xerosis was significantly associated with HAM/TSP. Skin manifestations were quite frequent in patients with HAM/TSP. Xerosis was significantly associated with HAM/TSP. https://acta.tums.ac.ir/index.php/acta/article/view/7222 https://acta.tums.ac.ir/index.php/acta/article/download/7222/5234

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 3 2019 05 13 184 193 EN Niaz Mustafa Kamal Department of Anesthesia, Technical College of Health, Sulaimani Polytechnic University, Sulaimani, Iraq. Mardian Othman Abdul Qadir Department of Community Health, Technical College of Health, Sulaimani Polytechnic University, Sulaimani, Iraq. Bestun Ibrahim Hama Rahim Department of Community Health, Sulaimani Technical Institute, Sulaimani Polytechnic University, Sulaimani, Iraq. Abdulrahman M. Ibrahem General Directorate of Health in Sulaimani, Sulaimani Technical Institute, Sulaimani, Iraq.