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Schwannomas are benign tumors of the nerve sheath and are usually single encapsulated and slow growing in peripheral or sympathetic nervous system. In this report a 49 year-old man is presented with one year complain of abdominal pain and intermittent hematospermia. The CT scan of the abdomen showed a 60 × 65 × 60 mm mass in anterior pelvic cavity with deviation to the sacral bone, originated from nerve. Several examinations revealed neurofibroma. Due to the large size of the tumor and it's position to the pelvic nerves, to remove the mass the patient only underwent laparotomy with partial resection. Pathology tests confirmed Ancient Schwannoma with degenerative changes. Radiotherapy was done with the aim of reducing the size of the rest of tumor. In our case, schwannoma was diagnosed incidentally. The size of the tumor indicated a relatively long period from the time that tumor was generated until the time of diagnosis. Despite using paraclinical findings, a definite diagnosis of the disease was made by histopathological tests.

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Background and purpose: Fatigue is a common symptom in patients undergoing hemodialysis. Reflexology is a nursing intervention that could reduce fatigue. This study aimed at determining the effects of foot reflexology on fatigue in patients undergoing hemodialysis.

Materials and methods: A clinical trial with before and after design was conducted in hemodialysis patients attending Imam-Ali and Iran-mehr clinic in Bojnurd, 2013. Using randomized sampling 78 patients were allocated into three groups: intervention, placebo, and control group. The patients in intervention group received foot reflexology, and simple foot reflexology without pressing certain parts of the foot was done in placebo group. The patients in control group received only routine care. Piper Fatigue Scale was used to measure fatigue level before and after the intervention. Data was analyzed using descriptive statistics, one-way ANOVA and Paired t-test.

Results: The results showed a significant difference between fatigue scores in intervention and control groups before and after the intervention (P<0.001). After the foot reflexology, the fatigue score in intervention group reduced to 3.8±1.27 (vs. 4.34±1.35 before the intervention), while the fatigue score in control group increased to 5.19±0.87 (vs. 4.91±1.04 before the intervention) (P<0.05). The placebo group showed no significant difference before and after the intervention (P=0.9).

Conclusion: Reflexology can be used as a nursing intervention in reducing fatigue among patients undergoing hemodialysis.

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Background and purpose: Neurofibromatosis type 1 (NF1) is a dominant genetic disorder of the skin and the nervous system that is seen in equal proportions in both sexes. The incidence of NF1 is about one in every 3,000. Chronic skin diseases have a significant impact on the individual's mental image and also affect mental health and quality of life. The aim of this study was to investigate the quality of life in a group of Iranian patients with NF1 suffering from skin problems.
Materials and methods: A cross-sectional, descriptive-analytical study was conducted in 2015-2017 in 193 patients with NF1 attending the Iranian Neurofibromatosis Society, using convenient sampling. Data were collected by Skindex-16 quality of life measure which is composed of 16 questions in three dimensions (emotions, symptoms, and performance). Data were analyzed using SPSS applying Pearson Correlation and ANOVA.
Results: Of 193 patients with NF1, 69.5% (n=132) were females. The mean age of patients was 31.58±9.21. The mean score for quality of life was 44.88±22.06. In the domains of symptoms, emotions, and performance the mean scores were 6.57±4.99, 24.76±11.64, and 13.64±8.86, respectively. Quality of life was not statistically correlated with age and sex, but the relationship between the domain of symptoms with age was found to be significant (P=0.01).
Conclusion: The results showed that patients with neurofibromatosis have moderate quality of life and lower quality in terms of emotions and performance. These findings can be used to provide better health care for this group of patients and improve their quality of life.
 

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Background and purpose: Drugs are essential components of health services in all communities and pharmacists play a major role in delivering appropriate health care. There are lack of comprehensive studies on the knowledge, attitude, and practice of pharmacists in dealing with prescription drugs in Mazandaran province, Iran, so, this study aimed at assessing the performance of pharmacists on these issues.
Materials and methods: A cross-sectional study was carried out in 179 community pharmacies in Mazandaran province selected via random sampling. A trained shopper with a prescription attended the pharmacy and based on researcher-made flowchart and questionnaire, the pharmacist's performance on drug interactions, side effects, etc. was evaluated.
Results: Among the pharmacies investigated (n=179), pharmacists were available in 154 (86%) and pharmacist consultations were observed in 67 (37%) pharmacies. Right medications were given in 157 (88%) pharmacies and in 166 (93%) instructions for use were completely correct and in accordance with the prescription.
Conclusion: At the community pharmacy, pharmacists usually focus on dispensing correct medication and pay less attention to pharmacy counseling. Trainings on drug interactions and adverse drug reactions could increase the awareness and knowledge of pharmacists.
 

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Background and purpose: The prevalence of antibiotic resistance in Acinetobacter baumannii is increasing worldwide, causing significant clinical problems. This study aimed to determine the antibiotic resistance pattern of clinical A. baumannii isolated from different different wards in Sari hospitals.
Materials and methods: This study was performed on 100 clinical A. baumannii isolated from Sari hospitals, north of Iran, 2018. The clinical isolates were identified by biochemical tests, while identification of the bla_OXA-51 gene was performed by PCR for the final confirmation of the isolates. Antibiotic susceptibility pattern of the isolates was determined by the disk agar diffusion method. Data were analyzed in SPSS applying Chi-square test.
Results: Among 100 clinical isolates of A. baumannii, the lowest resistance rate (75%) was detected against imipenem, while the highest resistance rate (100%) was observed against ciprofloxacin. Resistance rates to meropenem, doripenem, levofloxacin, cefotaxime, ceftazidime, cefepime, piperacillin, piperacillin/ tazobactam, and trimethoprim/sulfamethoxazole were 97, 96, 93, 93, 76, 92, 86, 78, and 92%, respectively. In this study, the highest and lowest cases of MDR and XDR isolates were found in urine and blood samples, respectively, while the highest and lowest cases of MDR and XDR in terms of hospital departments were found in ICU and surgery, respectively.
Conclusion: Due to the high prevalence of multidrug resistant isolates, using antibiogram prior to antibiotic administration and proper use of antibiotics for the treatment of infections caused by Acinetobacter baumannii should be seriously considered.

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 Background and purpose: Given the role of cancer stem cells in cancer, the aim of this study was to determine the expression of LGR5 marker in gastric cancer and its association with cagA genotype of Helicobacter pylori infection.
Materials and methods: A case-control study was performed in gastric biopsy specimens from antrum and body during endoscopic examination of patients attending Sari Touba Clinic, 2017-2018. After reviewing the patient records, the samples from those aged 50 and higher were studied. Case group included gastric cancer specimens with H. pylori infection (n=30) and control group included non-cancerous samples with H. pylori infection (n=30). LGR5 expression and presence of cagA were evaluated by IHC and PCR methods, respectively.
Results: The mean ages of gastric cancer and control group were 69.5±10.1 and 62.3±7.8, respectively (P= 0.003). Twenty three patients (76.7%) in cancer group and 24 patients (80%) in control group were positive for cagA genotype. Overexpression of LGR5 was observed in 15 patients (51.7%) with gastric cancer and 11 patients (39.3%) in control group (P= 0.429).  LGR5 was also overexpressed in 18 cases (40.9%) with cagA positive genotype and 8 cases (61.5%) with negative cagA genotype (P=0.22).
Conclusion: High expression of LGR5 was observed in half of patients with gastric cancer but it was not significantly associated with cagA H.pylori genotype.

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 Background and purpose: Gastric adenocarcinoma is the fifth most common cancer and the fourth leading cause of cancer death in both men and women. Transthyretin (TTR) is a useful marker for cancer diagnosis and prediction in patients undergoing surgery. The diagnostic value of this biomarker in gastric cancer has not yet been determined conclusively. This investigation aimed at studying the diagnostic role of serum TTR in patients with gastric cancer.
Materials and methods: This case-control study, was performed in 40 patients whose gastric cancer was confirmed pathologically and 42 healthy individuals without family history of gastrointestinal and liver cancers. The sandwich prepared ELISA kit was used to determine the concentration of transthyretin protein produced in serum.
Results: The mean age of patients with gastric cancer was 63 ± 13 years and the mean age of the control group was 64 ± 16 years (P= 0.681). The mean serum concentrations of transthyretin in patients and healthy people were 138.45 ± 49.64 pg/mL and 113.53 ± 60.12 pg/mL, respectively. Findings showed a significant difference in serum transthyretin levels between the two groups (P= 0.045). Therefore, TTR could be used as a diagnostic marker.
Conclusion: In this study, serum levels of transthyretin were significantly higher in patients with gastric cancer than healthy individuals.

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Background and purpose: Caring for patients with COVID-19 at home is mainly the responsibility of the family which leads to high burden of care. The burden of care refers to psychological pain, physical problems, financial and social pressures, disruption of family relationships, feelings of hopelessness, and other negative consequences of care tasks. The aim of this study was to determine the care burden in caregivers of patients with COVID-19 at home.
Materials and methods: This cross-sectional descriptive-analytical study was carried out in 390 family caregivers of patients with COVID-19 attending medical centers in Gorgan, Iran 2021, using convenience sampling. Caregiver Burden Inventory (CBI) was administered which consists of five domains and a score range of 24-120. Data were analyzed in SPSS V18 applying equivalent non-parametric tests.
Results: The mean total score for care burden was 52.70±17.03 and the mean scores for other subscales were as follows: 14.90±6.22 for time dependence=, 10.80±4.88 for developmental, 9.60±4.36 for physical burden, 7.80±2.91 for social burden, and 9.60±3.84 for emotional burden. As the age of the caregivers increase, the burden of time dependence increased. Women and caregivers with low educational backgrounds perceived a higher burden of care. There was a significant relationship between the burden of care and patient's economic status and the health status of the caregiver (P<0.05).
Conclusion: Family caregivers of patients with COVID-19 at home received a moderate burden of care that could negatively affect their health and wellbeing. Family caregivers need to be supported psychosocially and financially by formal community health systems.

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Background and purpose: Childbearing, as one of the structural elements of demographic changes, has attracted considerable attention in the field of social issues. In light of the new population policies of the country aimed at increasing the population, the present study was conducted with the aim of examining the factors related to childbearing in Iran through a systematic review of qualitative studies.
Materials and methods: The current study is a meta-synthesis of qualitative studies that was conducted using the Noblit and Haar method in six stages. To this end, all the qualitative studies related to the factors of affecting childbearing in Iran were scrutinized at information banks within the country without year restrictions using keywords "childbearing" and "qualitative studies". It was also searched in PubMed, Scopus Google scholar databases using keywords "Childbearing", "fertility", "Qualitative Study" and Iran. To ensure the quality of the selected articles, all stages of searching, screening and final selection of articles were done by two independent researchers.
Results: Twenty-two qualitative studies on the factors affecting childbearing were identified and analyzed based on the inclusion criteria. Consequently, two main categories were extracted: "facilitators of childbearing" and "barriers to childbearing."
Conclusion: In this meta-synthesis study, various factors play a role in couples having children, which are religious, individual, family-social factors that are facilitators, and demographic, economic, selfish, cultural, social, political, health-related factors are barriers to having children. Regardless of the problems and societal expectations, the likelihood of an increase in the country's population is not feasible.
 

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Papillary carcinoma is considered the most common thyroid malignancy. This cancer often presents with a good prognosis. This report introduces a patient with papillary thyroid carcinoma with multiple metastases and elevated CA19-9 levels. The 65-year-old male patient presented with weight loss. Gastrointestinal investigations were normal. CA19-9 levels were requested and reported as high. Additionally, blurred vision was present, and metastasis to the choroid was mentioned. Imaging revealed a mass in the left lobe of the thyroid. Fine-needle aspiration was performed, and the histopathology report confirmed papillary thyroid carcinoma. The patient underwent a thyroidectomy and was subsequently treated with iodine-131. Initial tests showed low thyroglobulin levels and high anti-thyroglobulin antibody levels. CA19-9 levels also showed an increasing trend in serial tests. Three months later, the patient experienced abdominal pain, generalized bone pain, neck pain, and right shoulder swelling. Further investigations confirmed metastases from papillary thyroid carcinoma. The patient also developed speech problems and memory loss, with brain metastasis evident in magnetic resonance imaging. The patient underwent ten sessions of brain radiotherapy and was subsequently prescribed sorafenib. During the course of treatment, the patient contracted COVID-19 and passed away due to the resulting pneumonia. In papillary thyroid carcinoma, it is important to take diagnostic measures to rapidly detect metastatic forms in case of any new symptoms. Additionally, if anti-thyroglobulin antibodies are present, CA19-9 can be used as a tumor marker.

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Aida Soghi¹,
Samira Saeedi²,
Akram Sanagoo³,
Leila Jouybari³,
Mohamad Ebrahimirad⁴,
Fatemeh Mehravar<sup>5

1</sup> MD Student, Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
² BSN Student, Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
³ Associate Professor, Department of Nursing, Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Iran
⁴ Assistant Professor, Department of Dermatology, Medical School, Golestan University of Medical Sciences, Gorgan, Iran
⁵ Instructor, Clinical Research Development Unit (CRDU), 5 azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran





In the article published in volume 28, issue 162, 2018, the first author’s name was incorrect. It should have been Aida Soghi, which is now corrected.


 

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Background and purpose: Degenerative joint disease, especially osteoarthritis (OA), is a global disease characterized by the destruction of articular cartilage, and subchondral bone. It is estimated that about 250 million people currently suffer from cartilage defects. So far, no definite and standard treatment method for OA has been reported. Recently, cell-based therapeutic techniques have been considered one of the best therapeutic strategies for the long-term treatment of articular cartilage diseases. However, many challenges include the large scale of cells required, thus the cell-free approaches are novel tools for cartilage defect treatment. For instance, extracellular vesicles (EVs) secreted by various cells such as MSCs are in charge of the therapeutic effects of stem cells. Therefore, recently EVs have advanced as powerful cell-free transfer tools, due to their high physicochemical strength and biocompatibility.
Materials and methods: This study is a review study that summarizes the preclinical and clinical studies that used EV-derived from different cell sources and investigates their effectiveness in treating cartilaginous tissue lesions. Current studies used small or large animal models with experimental critical size defects in knee articular cartilage to examine the effectiveness of EVs derived from MSCs. The EVs were isolated from cell sources such as adipose-derived MSCs, Bone marrow-derived MSCs, or transgenic cells. In addition, EV isolation techniques as a main challenge in studies using EVs to treat OA, specifically described in the current study. We also showed EVs isolated from each cell have unique features such as anti-inflammatory, differentiation, and therapeutic properties. We explain recent studies that use EVs as a drug carrier such as small molecules, and microRNA bioactive factors. In addition, the isolation techniques of EVs and their characterization are other challenges that we explain.
Results: Recent studies have shown that EVs isolated from different sources inhibit the progression of OA. Also, the results of some studies indicate the ability of EVs to repair injured cartilage. Many studies showed that in critical size defects of cartilage, the use of EVs needs scaffolds. Several studies have investigated the challenges of EV release and the required EV dose based on the size of the lesion. EVs are rapidly emerging as novel therapeutic approaches for treating cartilage lesions and OA. Despite many advances in cell therapy and promising results reported in numerous disease models, the use of cells especially genetically modified cells has limitations in regenerative medicine. It is worth noting that the use of EVs derived from stem cells or transgenic cells has no harm to the human body. As a result, therapeutic EVs have been introduced as a new therapeutic approach that does not have the same potential risks as cells.
Conclusion: Despite the positive results of EV in the treatment of cartilaginous lesions, it appears that the EV therapeutic barrier requires further testing in larger animal models before clinical trials. For instance, the regeneration of critical-size lesions requires the use of EVs incorporated by suitable scaffolds under dynamic conditions. Therefore, the fundamental questions to be considered are: How to use EVs as a nanoparticle instead of stem cells in combination with tissue engineering methods? What are the biological properties of EVs? What doses of EVs have the mechanistic potential for the treatment of different sizes of cartilage lesions and how EVs are stable in lesions? What is the role of EVs in the homeostasis and pathogenesis of junctions?
 

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Background and purpose: COVID-19 is one of the biggest pathogens that mainly targets the human respiratory system. Among the preventive methods against contracting COVID-19, vaccination has had an important effect in preventing COVID-19 and is an essential component in prevention. Various vaccines were provided to prevent COVID-19, one of these vaccines was Sinopharm, which was used for cancer patients in Iran, so this study aimed to determine the antibody response following the injection of Sinopharm vaccine in cancer patients in Iran in 2021.
Materials and methods: This cross-sectional study was conducted in 2021 on 74 patients with various types of cancers in Amol and Sari cities who received two doses of the Sinopharm vaccine. Subjects participated in the study after obtaining informed consent. Cancer patients who were referred to vaccination centers were asked to refer to the reference laboratory 4 to 6 weeks after the second dose if they wished to determine the antibody level. A 5 cc blood sample was taken 4-6 weeks after receiving the second dose of the vaccine, and then the serum was separated from the samples and stored at -20. The level of SARS-CoV-2 Neutralizing antibody, Anti-RBD, and Anti-Spike IgG were provided by Kit Eliza, Pishtaz Tab Company. The sensitivity and specificity of the kits used for neutralizing antibodies are 100% and 99% respectively, for Anti-RBD 98.4% and 97.7%, and Anti-Spike IgG 98.16% and 99.01% respectively. Finally, according to the instructions of the kit, neutralizing antibody values greater than 2.5 Mg/ml and optical absorption greater than 1.1 for RDB antibody and anti-spike antibody values greater than 8 RU/ml were considered positive.
Results: The average age of the subjects was 57.1±11.7 years. In terms of gender distribution, 45 people (60.8%) were women. The neutralizing antibody status was positive in 41 people (55.4%). There was no significant relationship between the presence of neutralizing antibodies and gender (P=0.811) and age (P=0.443). Antibody against RDB antigen was positive in 31 people (41.9%). There was no significant relation between the presence of antibodies against RDB antigen with gender (P=0.091) and age (P=0.336). Antibody against Spike virus antigen was positive in 20 people (27%). A significant relationship was observed between the presence of antibodies against the Spike antigen and gender (P=0.008) and the proportion of women who produced antibodies against the Spike virus antigen was more than men, but there was no significant relationship between the presence of antibodies against the Spike gene and age (P=0.336).
Conclusion: The results of the present study showed that the vaccination of COVID-19 by Sinopharm in immunocompromised patients such as cancer patients can induce an antibody response, although the percentage is not high. Also, no significant relationship was observed between antibody production and age.


 

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Background and purpose: Ethical decision-making is a fundamental aspect of management and a vital competency for healthcare professionals, enabling them to handle complex responsibilities effectively. Surgical technology students, as one of the key groups involved in bedside care, train and work in a complex environment. Due to their close interaction with patients and their presence in the high-risk environment of the operating room, this group experiences higher levels of stress and must make proper ethical decisions in response to ethical dilemmas encountered at the bedside. This study aims to explore the experiences of ethical decision-making among surgical technology trainees.
Materials and methods: This qualitative study was conducted in 2023 at Golestan University of Medical Sciences. Using a purposive sampling method, 15 eighth-semester surgical technology students voluntarily participated in the study. Data were collected through semi-structured, interactive, face-to-face interviews with open-ended questions focusing on students' experiences of ethical decision-making during clinical training. For data analysis, MAXQDA software (version 24) and the conventional content analysis approach proposed by Graneheim and Lundman were employed.
Results: Data analysis yielded a total of 283 meaning units, categorized into three main themes: "Violation of Patient Rights," with four subcategories; "Violation of Student Rights," with five subcategories; and "Educational Shortcomings in Students", with two subcategories.
Conclusion: This study highlights the crucial need for ethical decision-making skills among surgical technology students and underscores the importance of addressing educational shortcomings to better prepare them for the challenges of the operating room environment

 

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Background and purpose: Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality worldwide, particularly in developing regions such as Africa and Asia. Even in developed countries, the incidence of this complication has shown an upward trend. Risk factors associated with PPH may vary depending on geographical and demographic conditions. In the city of Babol, studies have indicated that postpartum hemorrhage is a common obstetric complication. This study aims to investigate the risk factors associated with early-onset postpartum hemorrhage in Babol.
Materials and methods: This retrospective cross-sectional study analyzed the medical records of women diagnosed with PPH at Rouhani Hospital, Babol, during the period 2010–2011. Cases were included if blood loss was ≥500 mL following vaginal delivery or ≥1000 mL following cesarean section within 24 hours postpartum. Data collection focused on treatment modalities, including the use of uterotonic drugs, surgical interventions (such as uterine packing or hysterectomy), blood transfusions, and prophylactic measures. Statistical analysis was performed using SPSS software to identify potential risk factors and evaluate treatment outcomes.
Results: The mean age of the participants was 31.6 ± 16.7 years. The analysis revealed that several factors were significantly associated with the occurrence of postpartum hemorrhage, including the number of previous pregnancies, abortions, and deliveries, as well as placenta previa, abnormal placental adhesions, uterine rupture, and surgical trauma (P< 0.05).
Conclusion: The findings underscore the critical need for proactive risk assessment and tailored clinical strategies to prevent and manage postpartum hemorrhage. Enhancing prenatal screening protocols, improving access to emergency obstetric care, and training healthcare professionals in early intervention techniques are essential steps toward reducing maternal morbidity and mortality associated with postpartum hemorrhage