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مداخله برنامه تمرینات هوازی شدت متوسط بر شاخص های منتخب بیوژنز میتوکندریایی بافت میوکارد رت های نر ویستار دیابتی شده Effect of Moderate-Intensity Aerobic Exercise on Selected Indicators of Mitochondrial Biogenesis in the Myocardial Tissue of Diabetic Male Wistar Rats 1 1 سابقه و هدف: اختلال در فرآیند بیوژنز میتوکندریایی بافت قلب، از مسیرهای ایجاد پاتوژنز T2DM است. فعالیت بدنی از مداخلات غیر دارویی در بهبود مسیر بیوژنز میتوکندریایی است. لذا مطالعه حاضر با هدف بررسی تاثیر تمرینات هوازی بر بیان ژن‌های برخی شاخص‌های بیوژنز میتوکندریایی بافت قلب رت‌های دیابتی، انجام پذیرفت. مواد و روش‌ها: این مطالعه آزمایشگاهی، بر روی 32 رت‌ نر ویستار، در چهار گروه کنترل، دیابتی شم، دیابتی مداخله با ۳ و ۵ روز ورزش در هفته، انجام شد. بیماری دیابت با استرپتوزوتوسین (60 mg/kg) القا شد. پروتکل تمرین ورزشی روی تریدمیل برای ۱۰ هفته (3 و 5 روز در هفته و مدت 30 تا 55 دقیقه در روز) اجرا گردید. نمونه‌گیری خون و بافت قلب برای تحلیل‌های بیوشیمیایی، qRT-PCR و مطالعه ژن‌های PGC-1α، NRF1، NRF2 و TFAM انجام شد. داده‌ها به روش آماری ANOVA یک طرفه تحلیل شدند. یافته ها: نتایج نشان داد، بیان ژن‌های  PGC-1αو NRF2 در بافت قلب گروه‌ شم نسبت به گروه کنترل کاهش و در مقابل سطوح FBS و HbA1c افزایش معنی‌دار داشت (0/05>P). اما بیان ژن‌های  NRF1و TFAM بافت قلب بین این گروه‌ها تفاوت معنی‌داری نشان نداد. مداخله تمرین هوازی بر رت‌های دیابتی آشکار نمود که در گروه مداخله با 3 روز ورزش در هفته، سطوح بیان ژن های PGC-1α، NRF2 و TFAM بافت قلب به‌طور معنی‌داری نسبت به گروه شم افزایش داشت (0/05>P)، اما سطوح این ژن ها درگروه مداخله با 5 روز ورزش در هفته با گروه شم تفاوت معنی‌داری به‌دست نیامد. هم‌چنین اندازه بیان ژن NRF1 در هیچ یک از گروه های تمرینی، تفاوت معنی‌دار نسبت به گروه شم مشاهده نشد (P>0.5) استنتاج: تمرینات هوازی با شدت متوسط 3 روز در هفته با افزایش در بیان ژن‌های PGC-1α، NRF2 و TFAM بافت قلب رت‌های دیابتی می‌تواند در بهبود مسیر بیوژنز میتوکندریایی میوکارد نمونه‌های دیابتی نقش مثبت داشته باشد.   2 Background and purpose: Impaired mitochondrial biogenesis in heart tissue is one of the contributing factors to the pathogenesis of type 2 diabetes mellitus (T2DM). Physical activity represents a non-pharmacological intervention for enhancing the mitochondrial biogenesis pathway. The present study aimed to investigate the effect of aerobic exercise on the expression of genes associated with key indicators of mitochondrial biogenesis in the heart tissue of diabetic rats. Methods & Materials: A laboratory-based experimental study was conducted on 32 male Wistar rats, randomly assigned to four groups: control, sham, diabetic, and intervention diabetic (with aerobic exercise for either 3 or 5 days per week). Diabetes was induced using streptozotocin (60 mg/kg). Exercise training was performed on a treadmill for 10 weeks (3 or 5 days per week, 30 to 55 minutes per day). Blood and heart tissue samples were collected for biochemical analyses and gene expression studies using qRT-PCR, focusing on PGC-1α, NRF1, NRF2, and TFAM genes. Data were analyzed using one-way analysis of variance (ANOVA). Results: The expression of PGC-1α and NRF2 genes in the heart tissue of the sham diabetic group was reduced compared to the control group, accompanied by a significant increase in fasting blood sugar (FBS) and HbA1c levels (P<0.05). However, the expression of NRF1 and TFAM genes did not show a significant difference between these groups. The effect of aerobic exercise on diabetic rats demonstrated that, in the intervention group with three alternating days of exercise per week, the expression levels of PGC-1α, NRF2, and TFAM genes in cardiac tissue significantly increased compared to the sham group (P<0.05). In contrast, no significant difference was observed in the levels of these genes in the intervention group with five days of exercise per week, compared to the sham group. Furthermore, NRF1 gene expression did not differ significantly in any of the training groups compared to the sham group (P>0.05). Conclusion: Moderate-intensity aerobic exercise performed three days per week plays a beneficial role in enhancing the mitochondrial biogenesis pathway in the myocardium of diabetic rats by upregulating the expression of PGC-1α, NRF2, and TFAM genes in heart tissue.   1 14 2025/02/24 1403/12/6 2025/04/20 1404/1/31 صادق جعفری Sadegh Jafari دانشجوی دکتری فیزیولوژی ورزش ،دانشکده علوم ورزشی ،دانشگاه بوعلی سینا، همدان، ایران ایران s.jafari56@yahoo.com فرزاد ناظم Farzad Nazem استاد،گروه فیزیولوژی ورزش، دانشکده علوم ورزشی، دانشگاه بوعلی سینا،همدان، ایران ایران f.nazem@basu.ac.ir حسام پارسا Hesam Parsa استادیار،گروه فیزیولوژی ورزش، دانشکده علوم ورزشی، دانشگاه بوعلی سینا، همدان، ایران ایران h.parsa@basu.ac.ir aerobic exercise type 2 diabetes PGC-1α NRF1 NRF2 TFAM تمرینات هوازی دیابت نوع 2 PGC-1α NRF1 NRF2 TFAM 1. Ramaccini D, Montoya-Uribe V, Aan FJ, Modesti L, Potes Y, Wieckowski MR, et al. Mitochondrial function and dysfunction in dilated cardiomyopathy. Front Cell Dev Biol 2021; 8: 624216. 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طراحی یک ایمونوتوکسین انسانی بر پایه قطعه متغیر تک زنجیره ای مشتق شده از پروتزماب و زیر واحد A Shiga like toxin2 علیه سرطان پستان: یک مطالعه in-silico Design of a Humanized Immunotoxin Based on Pertuzumab-Derived scFv and Shiga-Like Toxin 2 Subunit A Against Breast Cancer: An In Silico Study 1 1 سابقه و هدف: سرطان پستان دومین علت مرگ ناشی از سرطان در زنان است. Her2، یک گیرنده فاکتور رشد اپیدرمی است که تقریباً در 25 درصد از سرطان‌های پستان بیش از حد بیان می‌شود. این گیرنده ممکن است در درمان بیماران مبتلا به سرطان پستان نقش مهمی داشته باشد. برای درمان سرطان پستان در بیماران Her2 مثبت، اثرگذاری تعدادی از عوامل دارویی، از جمله (Herceptin) Trastuzumab تایید شده است. هرسپتین یک آنتی‌بادی با توانایی اتصال به گیرنده Her2 است. قطعه V تک زنجیره‎ای (scFv) مشتق شده از هرسپتین نیز می‎تواند برای ایجاد ایمونوتوکسین هایی استفاده شود که سلول‎های سرطانی Her2 مثبت را هدف قرار می‎دهد. توکسینوم شیگا، توکسینوم باکتریایی هستند که اغلب از باکتری‌های شیگلا دیسنتری و اشریشیا کلی تولید می‎شوند. زیر واحد A مربوط به Shiga- like toxin 2 (Stx2A) یک عامل سیتوتوکسیک است که پتانسیل کشتن سلول‎های سرطانی را دارا می‎باشد. مواد و روش‎ها: در این مطالعه درون رایانه‌ای (in-silico)، از ابزارهای بیوانفورماتیک برای ایجاد یک ایمونوتوکسین حاوی scFv اختصاصی Her2 و Stx2A استفاده گردید. برای ایجاد یک ساختار ایمونوتوکسین، توالی اسید آمینه scFv و Stx2A با استفاده از یک لینکر پپتیدی به هم متصل شدند. ساختار دوم و سوم، خواص فیزیکوشیمیایی، حلالیت و حساسیت زایی سازه پیش بینی شده ارزیابی شد. اتصال به گیرنده ایمونوتوکسین و پایداری ایمونوتوکسین به ترتیب با استفاده از اتصال پروتئین-پروتئین و دینامیک مولکولی مورد بررسی قرار گرفت. یافته‎ها: بر اساس یافته‎ها، سازه طراحی شده می‌تواند پروتئینی پایدار با حلالیت کافی باشد که حساسیت زا نیست و ساختار مناسبی برای اتصال به Her2 دارد. در نهایت نیز، انتظار می‌رود این سازه قابلیت تولید یک ایمونوتوکسین Her2 را داشته باشد. استنتاج: این ایمونوتوکسین پس از انجام مطالعات in vitro و in vivo می‎تواند به عنوان گزینه جهت درمان سرطان پستان به کار رود.. 2 Background and purpose: Breast cancer is the second cause of mortality among women. HER2, a member of the epidermal growth factor receptor family, is overexpressed in approximately 25% of breast cancer cases. This receptor represents a valuable therapeutic target in the management of breast cancer. For the treatment of HER2-positive breast cancer, several agents, including trastuzumab (Herceptin), have been approved. Herceptin is a monoclonal antibody capable of binding to the HER2 receptor. A single-chain variable fragment (scFv) derived from Herceptin can also be utilized in the development of immunotoxins targeting HER2-positive cancer cells. Shiga toxins are bacterial exotoxins commonly produced by Shigella dysenteriae and certain strains of Escherichia coli. The A subunit of Shiga-like toxin 2 (Stx2A) is a potent cytotoxic agent with the potential to kill cancer cells. Materials and methods: In this insilico study, we employed bioinformatics tools to design an immunotoxin composed of a HER2-specific single-chain variable fragment (scFv) and the A subunit of Shiga-like toxin 2. To construct the immunotoxin, the amino acid sequences of the scFv and Shiga-like toxin 2 subunit A were joined via a peptide linker. The secondary structure, physicochemical properties, solubility, and potential allergenicity of the construct were predicted. The tertiary structure of the immunotoxin was modeled, refined, and evaluated. Protein-protein docking was performed to assess immunotoxin-receptor binding, and molecular dynamics simulations were used to evaluate immunotoxin stability. Results: According to the findings, the designed construct appears to be a stable protein with adequate solubility, non-allergenic properties, and a structurally favorable configuration for binding to HER2. Conclusion: In conclusion, the designed construct demonstrates potential for the production of a HER2-targeted immunotoxin. However, further validation through comprehensive in vitro and in vivo immunological assays is necessary to confirm the efficacy and therapeutic potential of the construct. 15 29 2025/02/242024/10/28 1403/8/7 2025/04/202025/04/13 1404/1/24 زینب قسمتی Zeinab Ghesmati دکتری پزشکی مولکولی، گروه پزشکی مولکولی، دانشگاه علوم پزشکی تبریز، تبریز، ایران ایران خدیجه احمدی Khadijeh Ahmadi استادیار، مرکز تحقیقات بیماری‌های عفونی و گرمسیری، دانشگاه علوم پزشکی هرمزگان، بندرعباس، ایران ایران نوید نظافت Navid Nezafat استادیار، مرکز تحقیقات علوم دارویی، دانشگاه علوم پزشکی شیراز، شیراز، ایران ایران فرزانه واحدی Farzaneh Vahedi دکتری زیست فناوری پزشکی، مرکز تحقیقات سلولی و مولکولی، دانشگاه علوم پزشکی بابل، بابل، ایران ایران مرتضی طاهری انگنه Mortaza Taheri-Anganeh استادیار، مرکز تحقیقات سلولی و مولکولی، پژوهشکده پزشکی سلولی و مولکولی، دانشگاه علوم پزشکی ارومیه، ارومیه، ایران ایران سید حسین خاتمی Seyyed Hossein Khatami دکتری بیوشیمی بالینی، گروه بیوشیمی بالینی، دانشکده پزشکی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران ایران حسن قاسمی Hasan Ghasemi دانشیار، گروه علوم پایه، دانشگاه علوم پزشکی آبادان، آبادان، ایران ایران رحمت اله سلطانی Rahmatollah Soltani استادیار، گروه علوم پایه، دانشکده علوم پزشکی بهبهان، بهبهان، ایران ایران وحید زارع زاده Vahid Zarezade استادیار، گروه علوم پایه، دانشکده علوم پزشکی بهبهان، بهبهان، ایران ایران احمد موحدپور Ahmad Movahedpour استادیار، گروه علوم پایه، دانشگاه علوم پزشکی آبادان، آبادان، ایران ایران احسان قاسمی Ahmad Movahedpour استادیار، مرکز تحقیقات سلولی و مولکولی، دانشگاه علوم پزشکی یاسوج، یاسوج، ایران ایران breast cancer Shiga-like toxin 2 subunit A Herceptin Her2 bioinformatics immunotoxin سرطان پستان Shiga- like toxin 2 هرسپتین Her2 ایمونوتوکسین 1. 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بررسی تاثیر مداخله آموزشی مبتنی بر مدل فرانظریه ای بر رفتار سیگار کشیدن در مردان Investigating the Effect of an Educational Intervention Based on the Transtheoretical Model on Smoking Behavior Among Men Attending Comprehensive Health Service Centers in Qom 1 1 سابقه و هدف: افراد در مراحل مختلف رفتار ترک سیگار قرار دارند و میزان آمادگی آن‌ها برای تغییر رفتار متفاوت می‌باشد. این مطالعه با هدف تعیین تاثیر مداخله آموزشی مبتنی بر مدل فرانظریه ای بر رفتار سیگار کشیدن در مردان سیگاری شهر قم، انجام پذیرفت. مواد و روش ‌ها: پژوهش مداخله‌ای حاضر، در بین مردان سیگاری 30 تا 60 سال و مراجعه‌کننده به مراکز خدمات جامع سلامت شهر قم در سال 1402 انجام شد. نمونه‌گیری با روش نمونه‌گیری در دسترس، با احتساب 10 درصد ریزش برابر با 55 نفر برای هر گروه مداخله و کنترل که به‌صورت تصادفی(جهت تصادفی سازی افراد در دو گروه از روش بلوک‌های جایگشتی 4 تایی (Permuted block randomization)، به‌دست آمد. پس از تکمیل پرسشنامه‌های پیش آزمون، شش جلسه آموزشی 45 دقیقه به روش سخنرانی، پرسش و پاسخ و بارش افکار انجام شد. دو ماه پس از مداخله آموزشی مرحله پس آزمون انجام شد. برای تجزیه و تحلیل داده‌های کمی، فراوانی، درصد فراوانی و میانگین و انحراف معیار آزمون‌های توصیفی و استنباطی و آزمون‌های کای اسکوئر، t-مستقل، t-زوجی استفاده شد. سطح معنی‌داری کم‌تر از 05/0 بود. یافته‌ها: میانگین سن شرکت‌کنندگان 7/6±39/6 سال بود. بعد از مداخله آموزشی، میانگین نمره رفتار سیگار کشیدن در گروه آزمون به‌صورت معنی‌دار نسبت به قبل از مداخله، کاهش یافته بود (0/001P<، قبل مداخله 1/9±9/4، بعد از مداخله 1/3±8/04). میانگین نمره سازه مراحل تغییر، سازه فرآیندهای تغییر در گروه آزمون بعد از آموزش به صورت معنادار نسبت به قبل از مداخله، افزایش یافته بود (0/001P<، 7/3±73/05). میانگین نمره سازه وسوسه، نیز بعد از آموزش درگروه آزمون، کاهش آماری معنی‌داری مشاهده شد (0/001p<،5/1±29/2). استنتاج: مداخلات آموزشی مبتنی بر مدل فرانظریه‌ای همراه با آموزش مهارت‌های مقابله‌ای و مشاوره فردی می‌تواند در مراحل تغییر، تصمیم‌گیری، وسوسه انگیزی و ترک سیگار کشیدن تاثیر گذار باشد.   2 Background and purpose: Smokers and their readiness to change behaviour varies accordingly. This study aimed to determine the effect of an educational intervention based on the Transtheoretical Model on smoking behaviour among male smokers in Qom. Materials and methods: This interventional study was conducted among male smokers aged 30 to 60 years who attended comprehensive health service centers in Qom in 2023. Sampling was performed using the convenience sampling method. Considering a 10% dropout rate, a sample size of 55 participants was allocated to each of the intervention and control groups. Participants were randomly assigned to the two groups using permuted block randomization with a block size of 4. After completing the pre-test questionnaires, six 45-minute educational sessions were delivered using lecture, question-and-answer, and brainstorming methods. The post-test phase was conducted two months after the educational intervention. For quantitative data analysis, descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential tests (chi-square test, independent t-test, and paired t-test) were used. A p-value of less than 0.05 was considered statistically significant. Results: The average age of participants was 39.6 ± 7.6 years. After the educational intervention, the mean score of smoking behaviour in the intervention group decreased significantly compared to before the intervention (P<0.001; before:9.4 ±1.9, after:8.04 ±1.3). The mean scores of the Stages of Change and Processes of Change constructs in the intervention group increased significantly after the training compared to baseline (P<0.001; after:73.05±7.3). The mean score of the Temptation construct also showed a statistically significant decrease after the intervention in the intervention group (P<0.001; after: 2.5±1.29). Conclusion: Educational interventions based on the Transtheoretical Model, combined with coping skills training and individual counselling, can be effective in improving stages of change, decision-making, temptation management, and promoting smoking cessation.   30 43 2025/02/242024/10/282024/11/20 1403/8/30 2025/04/202025/04/132025/04/13 1404/1/24 طاهر اروجی Taher Oroji کارشناسی ارشد آموزش بهداشت، دانشکده بهداشت. دانشگاه علوم پزشکی قم. قم، ایران. ایران taherorouji6806@gmail.com احسان وصالی منفرد Ehsan Vesali-Monfared دکتری تخصصی آموزش بهداشت و ارتقا سلامت، مرکز تحقیقات بیماری‌های گوارش و کبد، دانشگاه علوم پزشکی قم، قم، ایران ایران vesalimonfared@gmail.com بهرام محقق Bahram Mohagheg دکتری تخصصی آموزش بهداشت و ارتقا سلامت، گروه آموزش و ارتقاء سلامت، دانشکده بهداشت. دانشگاه علوم پزشکی قم. قم، ایران ایران bmohaghegh@gmail.com محمد ابراهیم غفاری Mohammad Ebrahim Ghafari دکتری تخصصی آمار زیستی، گروه آمار زیستی و اپیدمیولوژی، دانشکده بهداشت. دانشگاه علوم پزشکی قم. قم، ایران ایران m.gh19@yahoo.com محمد علی گل Mohammad Aligol دکتری تخصصی آموزش بهداشت و ارتقا سلامت، گروه آموزش و ارتقاء سلامت، دانشکده بهداشت. دانشگاه علوم پزشکی قم. قم، ایران ایران aligol1389@gmail.com smoking behavior Transtheoretical model educational intervention رفتار سیگار کشیدن مدل فرانظریه‌ای مداخله آموزشی 1. 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بررسی ارتباط سوء تغذیه اولیه و پیامدهای آن در بیماران بستری در بیمارستان کوثر شهرستان سمنان در سال 1401 Investigating the Relationship Between Primary Malnutrition and Patient Outcomes Among Individuals Admitted to Kosar Hospital, Semnan, 2022 1 1 سابقه و هدف: سوءتغذیه با افزایش مـدت بـستری، تأخیر در بهبودی و افزایش مرگ و میر بیمـاران بـستری منجر به افزایش هزینه‌های بیمارسـتانی می‌شود که در صورت انجام مداخلات به هنگام و تشخیص به موقع قابل پیشگیری است. این مطالعه با هدف بررسی غربالگری تغذیه‌‌ای بیماران بالای 19 سال در هنگام پذیرش در بیمارستان کوثر سمنان انجام پذیرفت. مواد و روش‌ها: در این مطالعه‌ی مقطعی، 506 نفر از بیماران بزرگسال بستری شده در 6 ماه نخست سال 1401 در بیمارستان کوثر سمنان وارد مطالعه شدند. پس از جمع‌آوری اطلاعات مربوط به وضعیت تغذیه‌‌ای از چک لیست ارزیابی اولیه تغذیه‌‌ای، بیماران در معرض سوء تغذیه در سه گروه کم‌خطر، خطر متوسط و پرخطر برای سوء ‌تغذیه غربالگری و طبقه‌‌بندی شدند. داده‌‌ها در سطح معنی‌‌داری کم‌تر 05/0 تحلیل شدند. یافته‏ها: 350 بیمار از 506 بیمار بررسی شده در هنگام پذیرش در معرض خطر سوء تغذیه بودند که 7/49 درصد مرد و 3/50 درصد زن با میانگین سنی 22/18 ± 9/60 سال بودند. شدت خطر سوء تغذیه در هنگام پذیرش در 71/33 درصد موارد کم، در 71/1 درصد موارد متوسط و در 57/64 درصد موارد بالا بود. به‌علاوه خطر سوء تغذیه در بدو پذیرش در بیماران مسن (05/0>P) و در بیماران بستری در بخش داخلی (001/0P<) به‌طور معنی‌داری بالاتر بود. مدت بستری در بیماران با خطر بالا برای سوء ‌تغذیه به‌طور معنی‌‌داری بیش‌تر از بیماران با خطر کم و متوسط بود (049/0=P). خطر مرگ و میر در افراد با خطر بالای سوء‌ تغذیه افزایش می‌یافت (032/0=P). استنتاج: سوء تغذیه در بیماران بزرگسال بستری در بیمارستان شایع بود و باعث افزایش طول مدت بستری در بیمارستان و مرگ و میر شد. بنابراین، ارزیابی وضعیت تغذیه بیماران در مراحل اولیه بستری و درمان، تغذیه مناسب برای کاهش پیامدهای آن بر بیماران و سیستم مراقبت بهداشتی، ضروری است.   2 Background and purpose: Malnutrition is associated with prolonged hospitalization, delayed recovery, increased mortality among hospitalized patients, and elevated hospital costs. These outcomes can be mitigated through appropriate diagnosis and timely interventions. In this regard, the present study aimed to evaluate the nutritional status of patients aged over 19 years upon admission to Kosar Semnan Hospital. Materials and methods: In this cross-sectional study, 506 adult patients hospitalized during the first six months of 2022 at Kosar Semnan Hospital were included. After collecting demographic data and nutritional status information using a nutritional status assessment checklist, patients were screened and classified into three groups: low risk, moderate risk, and high risk for malnutrition based on predefined criteria. The data were analyzed using a significance level of P< 0.05. Results: Of the 506 patients examined, 350 (69.2%) were at risk of malnutrition upon admission. Among the participants, 49.4% were men and 50.6% were women, with a mean age of 60.9 ± 18.22 years. The risk of malnutrition at admission was low in 33.7%, moderate in 1.7%, and high in 64.9% of cases. The risk of malnutrition at admission was significantly higher among elderly patients (P<0.05) and among those hospitalized in the internal medicine ward (P<0.001). The length of hospitalization was significantly longer in patients with a high risk of malnutrition compared to those at low or moderate risk (P=0.049). In addition, the risk of mortality was significantly higher in patients classified as high risk for malnutrition (P= 0.032). Conclusion: Malnutrition was highly prevalent among hospitalized adult patients and was associated with prolonged hospital stays and increased mortality rates. Therefore, early assessment of patients' nutritional status during hospitalization, along with the implementation of appropriate nutritional interventions, is crucial to minimizing its impact on both patient outcomes and the healthcare system.   44 55 2025/02/242024/10/282024/11/202024/11/27 1403/9/7 2025/04/202025/04/132025/04/132025/04/13 1404/1/24 مریم نظری Maryam Nazari دانشیار، گروه تغذیه، دانشکده تغذیه و علوم غذایی آرادان، دانشگاه علوم پزشکی سمنان،سمنان، ایران ایران maryam.nazary1@yahoo.com ملیحه صادقی Malihe Sadeghi استادیار، گروه فناوری اطلاعات سلامت، دانشکده پیراپزشکی، دانشگاه علوم پزشکی سمنان، ایران ایران sadeghiii.m@gmail.com نگار آدینه Negar Adineh دانشجو، کمیته تحقیقات دانشجویی، دانشگاه علوم پزشکی سمنان، سمنان، ایران ایران negaradineh76@icloud.com عاطفه اصحابی Atefeh Ashabi دانشیار، گروه تغذیه، دانشکده تغذیه و علوم غذایی آرادان، دانشگاه علوم پزشکی سمنان،سمنان، ایران ایران ashabi_nutrition@yahoo.com nutrition screening malnutrition inpatients غربالگری تغذیه‌ای سوء تغذیه بیماران بستری 1. 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Nutritional screening for improving professional practice for patient outcomes in hospital and primary care settings. Cochrane Database Syst Rev 2013; (6). PMID: 23744516.##29. Mirmiran P, Hosseinpour-Niazi S, Mehrabani HH, Kavian F, Azizi F. Validity and reliability of a nutrition screening tool in hospitalized patients. Nutrition 2011 Jun; 27(6): 647–652. PMID: 20800450.##30. Weekes CE, Elia M, Emery PW. The development, validation and reliability of a nutrition screening tool based on the recommendations of the British Association for Parenteral and Enteral Nutrition (BAPEN). Clin Nutr 2004 Oct; 23(5): 1104–1012. PMID: 15380902.##31. Middleton MH, Nazarenko G, Nivison-Smith I, Smerdely P. Prevalence of malnutrition and 12-month incidence of mortality in two Sydney teaching hospitals. Intern Med J 2001 Nov; 31(8): 455–461. PMID: 11720058.##32. Raja R, Lim AV, Lim YP, Lim G, Chan SP, Vu CKF. Malnutrition screening in hospitalized patients and its implication on reimbursement. 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پیش‌بینی عوامل خطر مرتبط با خونریزی خودبه‌خودی پس از زایمان Prediction of Risk Factors Associated with Postpartum Spontaneous Bleeding 1 1 سابقه و هدف: خونریزی پس از زایمان (PPH) یکی از عوامل اصلی مرگ و میر مادران، به ویژه در آفریقا و آسیا، محسوب می‌شود و حتی در کشورهای پیشرفته نیز روند افزایشی داشته است. عوامل ایجاد این عارضه می‌توانند بسته به مناطق جغرافیایی متفاوت باشند. با توجه به شیوع خونریزی پس از زایمان در شهر بابل، مطالعات نشان می‌دهند که این مشکل یکی از معضلات شایع در دوران بارداری و زایمان است. این مطالعه با هدف، بررسی عوامل خطر خون‌ریزی زودرس پس از زایمان در بیمارستان روحانی بابل بود. مواد و روش ‌ها: این تحقیق کاربردی و به روش توصیفی-تحلیلی و مقطعی گذشته‌نگر، انجام شده است. پرونده‌های بیماران باردار بستری در بیمارستان روحانی بابل از سال 1389 تا 1400 که با تشخیص خون‌ریزی پس از زایمان تحت درمان دارویی، جراحی، یا تزریق و رزرو خون قرار گرفتند، بررسی شد. یافته‌ها: میانگین سن افراد شرکت‌کننده در پژوهش 6/31 ± 7/16 سال بود، نتایج تحلیل‌ها نشان داد که تعداد سقط، تعداد زایمان، تعداد بارداری، جفت سرراهی، چسبندگی غیرطبیعی، جفت قدامی، ترومای جراحی و پارگی رحم ارتباط معنی‌داری با خونریزی پس از زایمان داشتند (05/0P <). استنتاج: مهم‌ترین عوامل خطر خونریزی پس از زایمان شامل جفت سرراهی، چسبندگی غیرطبیعی و جفت قدامی است که به طور معناداری با میزان خونریزی مرتبط است. هم‌چنین، پارگی رحم و ترومای جراحی نیز با خونریزی پس از زایمان ارتباط دارند. توجه به این عوامل خطر می‌تواند به شناسایی و مدیریت بهتر خطرات در زنان باردار کمک کرده و از بروز خونریزی‌های شدید پس از زایمان جلوگیری کند. 2 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 56 65 2025/02/242024/10/282024/11/202024/11/272025/01/20 1403/11/1 2025/04/202025/04/132025/04/132025/04/132025/05/4 1404/2/14 حدیث موسوی Hadis Musavi استادیار، دانشکده پزشکی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران فاطمه کلاکی جویباری Fatemeh Kalaki-Jouybari دکتری تخصصی بیوشیمی بالینی، دانشکده پزشکی، دانشگاه علوم پزشکی بابل، بابل، ایران ایران امیر عباس الویری Amir Abbas Alviri گروه زیست شناسی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران ایران عباس خنکدار طارسی Abbas Khonakdar-Tarsi دانشیار، مرکز تحقیقات ژنتیک ایمنی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران زینت السادات بوذری Zinatosaadat Bouzari استاد، مرکز تحقیقات ناباروری و بهداشت باروری، پژوهشکده بهداشت، گروه زنان و زایمان، دانشگاه علوم پزشکی بابل، بابل، ایران ایران زهرا صادق نژاد Zahra Sadeghnezhad پزشکی عمومی، دانشکده پزشکی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران Postpartum early postpartum hemorrhage body mass index placenta previa macrosomia زایمان خونریزی زودرس بعد از زایمان شاخص توده بدنی جفت سرراهی ماکروزومی 1. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Williams obstetrics. 24th ed. New York: McGraw-Hill Medical; 2014.##2. Huang CR, Xue B, Gao Y, Yue SW, Redding SR, Wang R, et al. Incidence and risk factors for postpartum hemorrhage after vaginal delivery: A systematic review and meta-analysis. J Obstet Gynaecol Res 2023; 49(7): 1663-1676. PMID: 37069822.##3. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014; 2(6): e323-e333. PMID: 25103301.##4. Gary CF, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Williams obstetrics. 22nd ed. New York: McGraw-Hill; 2005. p. 823-829.##5. American College of Obstetricians and Gynecologists. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol 2017; 130(4): e168-e186. PMID: 28937571.##6. Rogers MS, Chang AM. Postpartum hemorrhage and other problems of the third stage. In: James DK, Steer PJ, Weiner CP, Gonik B, editors. High Risk Pregnancy: Management options. 3rd ed. Philadelphia: Elsevier Saunders; 2006. p. 1559-1578. PMID: 35411672.##7. Hofmeyr GJ, Abdel-Aleem H, Abdel-Aleem MA. Uterine massage for preventing postpartum haemorrhage. Cochrane Database Syst Rev 2013; (7): CD006431. PMID: 23818022.##8. Włodarczyk Z, Śliwka A, Maciocha H, Paruszewski S, Wyszyńska J, Kłopecka M, et al. The Role of Accurate Estimations of Blood Loss and Identification of Risk Factors in the Management of Early Postpartum Hemorrhage in Women Undergoing a Cesarean Section. J Clin Med 2025; 14(6): 1861. PMID: 17320496.##9. Flood MM, Pollock WE, McDonald SJ, Davey M-A. Monitoring postpartum haemorrhage in Australia: opportunities to improve reporting. Women Birth 2018; 31(2): 89-95. PMID: 28838805.##10. Pubu ZM, Bianba ZM, Yang G, CyRen LM, Pubu DJ, Suo Lang KZ, et al. Factors Affecting the Risk of Postpartum Hemorrhage in Pregnant Women in Tibet Health Facilities. Med Sci Monit 2021; 27: e928568. PMID: 33579890.##11. Bienstock JL, Eke AC, Hueppchen NA. Postpartum hemorrhage. N Engl J Med 2021; 384(17): 1635-1645. PMID: 33913640.##12. Buzaglo N, Harlev A, Sergienko R, Sheiner E. Risk factors for early postpartum hemorrhage (PPH) in the first vaginal delivery, and obstetrical outcomes in subsequent pregnancy. J Matern Fetal Neonatal Med 2015; 28(8): 932-937. PMID: 25023434.##13. Fukami T, Koga H, Goto M, Ando M, Matsuoka S, Tohyama A, et al. Incidence and risk factors for postpartum hemorrhage among transvaginal deliveries at a tertiary perinatal medical facility in Japan. PLoS One 2019; 14(1): e0208873. PMID: 30625154.##14. Ononge S, Mirembe F, Wandabwa J, Campbell OM. Incidence and risk factors for postpartum hemorrhage in Uganda. Reprod Health 2016; 13: 38. PMID: 27080710.##15. Sosa CG, Althabe F, Belizán JM, Buekens P. Risk factors for postpartum hemorrhage in vaginal deliveries in a Latin-American population. Obstet Gynecol. 2009 Jun;113(6):1313-1319. doi: 10.1097/AOG.0b013e3181a66b05. PMID: 19461428; PMCID: PMC2730945##16. Blitz MJ, Yukhayev A, Pachtman SL, Reisner J, Moses D, Sison CP, et al. Twin pregnancy and risk of postpartum hemorrhage. J Matern Fetal Neonatal Med 2020; 33(22): 3740-3745. PMID: 30836810.##17. Rocha Filho EA, Costa ML, Cecatti JG, Parpinelli MA, Haddad SM, Pacagnella RC, et al. Severe maternal morbidity and near miss due to postpartum hemorrhage in a national multicenter surveillance study. Int J Gynaecol Obstet 2015; 128(2): 131-136. PMID: 25468058.##18. Ashouri N, Kordi M, Shakeri MT, Tara F. Diagnostic value of risk nomogram for the prediction of postpartum hemorrhage following vaginal delivery. Evid Based Care 2019; 9(1): 26-34.##19. Kramer MS, Berg C, Abenhaim H, Dahhou M, Rouleau J, Mehrabadi A, et al. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol 2013; 209(5): 449.e1-449.e7. PMID: 23871950.## ##

مقایسه مشخصات دموگرافیک و روانشناختی مرتبط با تردید واکسن کووید-19 در دو جمعیت واکسینه کامل و واکسن نزده در شهر بابل Demographic and Psychological Determinants of COVID-19 Vaccine Hesitancy: A Comparative Analysis of Fully Vaccinated and Unvaccinated Populations in Babol, Iran 1 1 سابقه و هدف: تردید واکسن از چالش‌های مهم در اپیدمی‌ها است و حتی با وجود دسترسی به واکسن، برخی افراد از دریافت آن امتناع می‌کنند، این موضوع باعث تأخیر در کنترل بیماری و افزایش پیامدهای جانی، اقتصادی و روانی می‌شود. این مطالعه با هدف بررسی عوامل مرتبط با تردید واکسن کووید-19 در شهر بابل ایران، انجام پذیرفت تا بتوان راهکارهای بهتری برای مقابله با این مشکل پیشنهاد داد. مواد و روش‌‌ها: این مطالعه مقطعی- تحلیلی، بر روی 570 نفر از جمعیت بالای 18 سال واجد شرایط دریافت واکسن کووید-19 در دو گروه انجام شد. گروه اول شامل افراد واکسن نزده (میانگین سنی 37 سال) و گروه دوم افراد واکسینه کامل (سه دوز واکسن، میانگین سنی 42 سال) بود. داده‌ها با استفاده از پرسشنامه استاندارد و تحلیل آماری توسط نرم‌افزار SPSS بررسی شد. آزمون‌های آماری کای‌اسکوئر و دقیق فیشر و من- ویتنی (0/05 P<) شاپیرو-ویلک (0/05 P>) رگرسیون لجستیک برای تعدیل متغیرهای مخدوش‌ کننده استفاده شدند. یافته‌ها: آنالیز تک متغیره نشان داد که تردید واکسن با سن (0P=)، وضعیت تاهل (0/017P=)، سطح تحصیلات (0P=) و سطح درآمد (0/003P=)، سابقه بیماری جسمی (0/007P=)، سابقه بیماری اعصاب و روان (0/004P=) و سابقه ابتلا به کووید-19 (0/002P=) مرتبط است و با ادراک سلامت (0/028P=) و سابقه ابتلای کووید- 19در خانواده (0/232P=) و اضطراب سلامت (0/5P=) ارتباطی ندارد. آنالیز چند متغیره نشان داد تردید واکسن با درک خطر (1/09-1/68: 95 درصد=CI) 78/1 =OR ، اعتماد (1/95-1/771: 95 درصد=CI) 1/86 =OR ، مسئولیت‌ پذیری اجتماعی (1/97-1/78: 95 درصد=CI) 87/1 =OR ، موانع و محدودیت‌ها (2/20-2/01: 95 درصد=CI) 2/10 =OR  و سود و زیان (2/59-2/23: 95 درصد=CI) 2/40 =OR ، مرتبط است. استنتاج: تردید واکسن کووید-19 در افراد جوان، مجرد، با تحصیلات و درآمد پایین‌تر بیش‌تر است و با درک پایین از وخامت بیماری، اعتماد کم به نظام سلامت و موانع محیطی و روانی مرتبط است. برای تقویت پذیرش واکسن، انجام مداخلات مناسب و هدفمند بر اساس ویژگی‌های جمعیتی و نگرشی ضروری است.   2 Background and purpose: Vaccine hesitancy during epidemics poses significant challenges to healthcare systems. Despite the availability of vaccines, some individuals refuse vaccination, delaying disease control and exacerbating the health, economic, and psychological consequences. This study aimed to investigate the factors associated with COVID-19 vaccine hesitancy in Babol, Iran. Materials and methods: In a cross-sectional analytical study, 570 individuals aged 18 years and older and under urban family physician coverage were evaluated during a two-month period (August–September 2022). Participants were divided into two groups: 285 vaccine-hesitant individuals (mean age: 37 years) and 285 fully vaccinated individuals (three doses, mean age: 42 years). Data were collected using a standardized questionnaire assessing demographic, social, psychological, and behavioral factors. Statistical analyses, including Chi-square, Fisher’s exact test, Shapiro-Wilk test, and Mann-Whitney U test, were performed using SPSS version 26. Logistic regression was applied to adjust for potential confounding variables. Results: Univariate analysis revealed significant associations between vaccine hesitancy and age (P=0.000), marital status (P=0.017), education level (P=0.000), and income (P=0.003). Hesitancy was also linked to a history of physical (P=0.007) or mental illness (P=0.004), and prior COVID-19 infection (P=0.002). No significant associations were observed with perceived health status (P=0.280), family history of COVID-19 (P=0.232), or health anxiety (P=0.500). Multivariate logistic regression analysis, after adjusting for confounding variables, showed significant associations between vaccine hesitancy and perceived risk (Adjusted OR =1.78; 95% CI: 1.68–1.90), trust (Adjusted OR = 1.86; 95% CI: 1.77–1.95), social responsibility (Adjusted OR = 1.87; 95% CI: 1.78–1.97), barriers (Adjusted OR = 2.10; 95% CI: 2.01–2.20), and perceived cost-benefit (Adjusted OR = 2.40; 95% CI: 2.23–2.59). Conclusion: COVID-19 vaccine hesitancy was more prevalent among younger, single individuals with lower levels of education and income. It was associated with reduced risk perception, low trust in healthcare systems, negative attitudes toward vaccination, and environmental barriers, but not associated with perceived health, family history of COVID-19, or health anxiety. Targeted interventions addressing demographic and attitudinal factors are essential for improving vaccine uptake.   66 75 2025/02/242024/10/282024/11/202024/11/272025/01/202024/12/6 1403/9/16 2025/04/202025/04/132025/04/132025/04/132025/05/42025/04/14 1404/1/25 محمد خادملو Mohammad Khadamlou استاد، گروه پزشکی اجتماعی، دانشکده پزشکی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران mohkhademloo@gmail.com محمود موسی زاده Mahmoud Mousazadeh دانشیار، مدیر مرکز تحقیقات بیماری های غیر انتقالی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران mmoosazadeh1351@gmail.com افسون ماهوری Afsoun Mahouri پزشک خانواده شهری بابل، دانشجوی مدیریت بهداشت عمومی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران amahouri@yahoo.com Vaccine hesitancy COVID-19 demographics psychological factors تردید واکسن کووید-19 دموگرافیک روانشناختی 1. Fontanet A, Cauchemez S. COVID-19 herd immunity: where are we? Nat Rev Immunol 2020; 20(10): 583-584. PMID: 32908300.##2. MacDonald NE, Hesitancy SWGoV. Vaccine hesitancy: Definition, scope and determinants. Vaccine 2015; 33(34): 4161-4164. PMID: 25896383.##3. Roy DN, Biswas M, Islam E, Azam MS. Potential factors influencing COVID-19 vaccine acceptance and hesitancy: A systematic review. PLoS One 2022; 17(3): e0265496. PMID: 35320309.##4. Murphy J, Vallieres F, Bentall RP, Shevlin M, McBride O, Hartman TK, et al. psychological characteristics associated with COVID-19 vaccine hesitancy and resistance in Ireland and the United Kingdom. Nat Commun 2021; 12(1): 29. PMID: 33397962.##5. Nargesi F, Izadi F, Kariminejad K, Rezaii Sharif A. The investigation of the reliability and validity of Persian version of Health anxiety questionnaire in students of Lorestan University of Medical Sciences. Q Educ Meas 2017; 8(27): 147-160.##6. Saffarinia M, Kaikhavani S, Damavandian A, Saffarinia S, Mohtashami T. Construction and Evaluation of psychometric properties of vaccine attitude scale and its relationship with health anxiety. Soc Psychol Res 2021; 11(43): 187-205.##7. Fajar JK, Sallam M, Soegiarto G, Sugiri YJ, Anshory M, Wulandari L, et al. Global Prevalence and Potential Influencing Factors of COVID-19 Vaccination Hesitancy: A Meta-Analysis. Vaccines 2022; 10(8). PMID: 36016242.##8. Lin C, Tu P, Beitsch LM. Confidence and Receptivity for COVID-19 Vaccines: A Rapid Systematic Review. Vaccines 2020; 9(1). PMID: 33396832.##9. Dadras O, SeyedAlinaghi S, Karimi A, Shamsabadi A, Mahdiabadi S, Mohammadi P, et al. public acceptability of COVID-19 vaccines and its predictors in Middle Eastern/North African (MENA) countries: a systematic review. Hum Vaccin Immunother 2022; 18(5): 2043719. PMID: 35318872.##10. Umakanthan S, Lawrence S. Predictors of COVID-19 vaccine hesitancy in Germany: a cross-sectional, population-based study. Postgrad Med J 2022; 98(1164): 756-764. PMID: 37062994.##11. Tsai R, Hervey J, Hoffman K, Wood J, Johnson J, Deighton D, et al. COVID-19 Vaccine Hesitancy and Acceptance Among Individuals with Cancer, Autoimmune Diseases, or Other Serious Comorbid Conditions: Cross-sectional, Internet-Based Survey. JMIR Public Health Surveill 2021; 7(11): e30672. PMID: 34709184.##12. Ruiz JB, Bell RA. Predictors of intention to vaccinate against COVID-19: Results of a nationwide survey. Vaccine 2021; 39(7): 1080-1086. PMID: 33461833.##13. Asadi-Pooya AA, Barzegar Z, Sadeghian S, Nezafat A, Shahisavandi M, Nabavizadeh SA. COVID-19 Vaccine Hesitancy Among Patients with Epilepsy or Other Chronic Conditions. Disaster Med Public Health Prep 2022; 16(5): 1848-1850. PMID: 34629142.##14. Nazli SB, Yigman F, Sevindik M, Deniz Ozturan D. Psychological factors affecting COVID-19 vaccine hesitancy. Ir J Med Sci 2022; 191(1): 71-80. PMID: 33990893.##15. Cai H, Bai W, Du X, Zhang L, Zhang L, Li YC, et al. COVID-19 vaccine acceptance and perceived stigma in patients with depression: a network perspective. Transl Psychiatry 2022; 12(1): 429. PMID: 36195590.##16. Schwarzinger M, Watson V, Arwidson P, Alla F, Luchini S. COVID-19 vaccine hesitancy in a representative working-age population in France: a survey experiment based on vaccine characteristics. Lancet Public Health 2021; 6(4): e210-e221. PMID: 33556325.##17. Bendau A, Plag J, Petzold MB, Strohle A. COVID-19 vaccine hesitancy and related fears and anxiety. Int Immunopharmacol 2021; 97: 107724. PMID: 33951558.##18. Karlsson LC, Soveri A, Lewandowsky S, Karlsson L, Karlsson H, Nolvi S, et al. Fearing the disease or the vaccine: The case of COVID-19. Pers Individ Dif 2021; 172: 110590. PMID: 33518869.##19. Pires C. Global Predictors of COVID-19 Vaccine Hesitancy: A Systematic Review. Vaccines 2022; 10(8). PMID: 36016237.##20. Biswas MR, Alzubaidi MS, Shah U, Abd-Alrazaq AA, Shah Z. A Scoping Review to Find Out Worldwide COVID-19 Vaccine Hesitancy and Its Underlying Determinants. Vaccines 2021; 9(11). PMID: 34835174.## ##

بررسی روند و مقایسه شاخص‌های باروری و مرگ و میر کودکان و مادران قبل و در طول پاندمی کووید- 19 در استان مازندران A Comparative Analysis of Fertility and Maternal and Child Mortality Indicators Before and During the COVID-19 Pandemic in Mazandaran Province 1 1 سابقه و هدف: بهداشت باروری به عنوان یکی از ضروری‌ترین گام‌ها برای دستیابی به توسعه پایدار در جوامع مختلف تلقی می‌شود. ظهور ناگهانی بیماری COVID-19 به شدت بهداشت باروری و سلامت جنسی را در سطح جهان تحت تاثیر قرار داد. به دلیل قرنطینه مداوم، مردم با مشکلات مالی مواجه شدند که به دنبال آن میزان زیادی استرس، اضطراب و افسردگی ایجاد شد که موجب تغییر قابل توجهی در رفتار جنسی افراد گردید. این مطالعه با هدف بررسی روند و مقایسه شاخص‌های باروری و مرگ و میر کودکان و مادران در دو مقطع زمانی قبل و بعد از پاندمی کووید– 19، انجام پذیرفت. مواد و روش‌‌ها: مطالعه حاضر از نوع توصیفی تحلیلی- مقطعی، بود. جامعه آماری شامل کلیه زنان مراجعه‌ کننده به مراکز درمانی از فروردین 1390 تا اسفند 1400 بودند و اطلاعات مربوط به دوره قبل کرونا هم از معاونت درمان گرفته شد. شاخص‌های مربوط به باروری در جمعیت از معاونت بهداشتی استخراج شد. تجزیه و تحلیل آماری با استفاده از نرم‌افزار STATA نسخه 14 انجام گرفت. یافته‌ها: میزان مرگ و میر مادران ناشی از عوارض بارداری و زایمان بیش‌تر از دو برابر سال‌های قبل بوده است. خطر به دنیا آمدن نوزاد مرده 39/1 برابر سال‌های قبل بوده است. اما در میزان مرگ و میر نوزادان و کودکان در گروه‌های سنی مختلف بین سال‌های قبل از پاندمی و در حین آن تفاوت معنی‌داری مشاهده نشد. استنتاج: اپیدمی کووید-19 بر مرگ و میر مادران و جنین و هم‌چنین میزان باروری تاثیر مستقیم داشته است و با تاکید به دستورالعمل‌های مربوط به افزایش نرخ باروری و رشد جمعیت در کشور، به نظر می‌رسد مسئولین باید سیاست‌های جدیدی را برای مقابله با این گونه اپیدمی‌ها و بحران‌ها در پیش بگیرند. دستورالعمل‌های مشخص و ثابت در ارائه خدمات با کیفیت سلامت جنسی و باروری مورد نیاز است. 2 Background and purpose: Reproductive health is considered one of the most essential components for achieving sustainable development in various societies. The sudden emergence of the COVID-19 pandemic severely impacted reproductive and sexual health worldwide. Due to prolonged lockdowns, individuals faced financial hardships, leading to increased levels of stress, anxiety, and depression. These factors significantly influenced individuals' sexual behaviors. In this study, we examined and compared fertility indicators, as well as child and maternal mortality rates, before and after the COVID-19 pandemic. Materials and methods: This study was a descriptive-analytical, cross-sectional investigation. The statistical population included all women who visited healthcare centers from March 2011 to February 2022. Data related to the pre-COVID-19 period were obtained from the Deputy for Treatment, while fertility indicators were extracted from the Deputy for Health. Statistical analysis was performed using STATA version 14. Results: The maternal mortality rate due to pregnancy and childbirth complications more than doubled compared to previous years. The risk of stillbirth was 1.39 times higher than in the pre-pandemic period. However, no significant differences were observed in neonatal and child mortality rates across different age groups between the pre-pandemic and pandemic periods. Conclusion: Based on the results of this study, which demonstrate the direct impact of the COVID-19 pandemic on maternal and fetal mortality rates, as well as fertility rates, it is essential for policymakers to adopt new strategies to address such epidemics and crises. Clear and consistent guidelines for the provision of high-quality sexual and reproductive health services are urgently requir 76 84 2025/02/242024/10/282024/11/202024/11/272025/01/202024/12/62023/12/17 1402/9/26 2025/04/202025/04/132025/04/132025/04/132025/05/42025/04/142025/03/4 1403/12/14 مرضیه زمانیان Marzieh Zamaniyan مرکز تحقیقات دیابت، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران محبوبه امید Maboubeh Omid کارشناسی ارشد گروه مامایی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران ملیحه قاسمی Malihe Ghasemi Tirtashi استادیار، گروه بهداشت خانواده، مدیریت جمعیت و مدارس، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران قاسم اویس Ghasem Oveis دکتری حرفه ای پزشکی، گروه بهداشت خانواده، مدیریت جمعیت و مدارس، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران فاطمه جعفری Fatemeh Jaefari کارشناسی ارشد گروه مامایی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران سید محسن سلیمانی راد Seyed Mohsen Soleimani rad دکتری حرفه ای پزشکی، گروه بهداشت خانواده، مدیریت جمعیت و مدارس، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران جمشید یزدانی چراتی Jamshid Yazdani charati استاد، مرکز تحقیقات علوم بهداشتی، دانشکده بهداشت، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران محمود موسی زاده Mahmood Moosazadeh دانشیار، مرکز تحقیقات سرطان دستگاه گوارش، موسسه بیماری های غیر واگیر، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران pregnancy pregnant women COVID pandemic fertility indicators بارداری زنان باردار پاندمیک کووید شاخص‌های باروری 1. Rodriguez-Morales AJ, Bonilla-Aldana DK, Tiwari R, Sah R, Rabaan AA, Dhama K. COVID-19, an emerging coronavirus infection: current scenario and recent developments-an overview. J Pure Appl Microbiol 2020;14(1):5-12.##2. Hashem NM, Abdelnour SA, Alhimaidi AR, Swelum AA. Potential impacts of COVID-19 on reproductive health: Scientific findings and social dimension. Saudi J Biol Sci 2021;28(3):1702-1712. PMID: 33519273.##3. Ardakani TS, Poshti BAT, Poshti BAT. The Effect of Covid-19 Pandemic on Women's Reproductive Health issues: A Narrative Review. J Midwifery Reprod Health 2021;9(3).##4. Pan F, Xiao X, Guo J, Song Y, Li H, Patel DP, et al. No evidence of severe acute respiratory syndrome–coronavirus 2 in semen of males recovering from coronavirus disease 2019. Fertil Steril 2020;113(6):1135-1139. PMID: 32482249.##5. Kh MN, Babazadeh R, Mousavi A, Shariati M. Iranian adolescent girls’ challenges in accessing sexual and reproductive health information and services. J Health 2018;8(5):561-574.##6. Ibarra FP, Mehrad M, Mauro MD, Godoy MFP, Cruz EG, Nilforoushzadeh MA, et al. Impact of the COVID-19 pandemic on the sexual behavior of the population. The vision of the east and the west. Int Braz J Urol 2020; 46:104-112. PMID: 32550703.##7. López-Bueno R, López-Sánchez GF, Gil-Salmerón A, Grabovac I, Tully MA, Casaña J, et al. COVID-19 confinement and sexual activity in Spain: A cross-sectional study. Int J Environ Res Public Health 2021; 18(5):2559. PMID: 33806553.##8. Mohammad S, Acharya N, Borkar K, Mohammad S. Effects of COVID-19 on Sexual and Reproductive health. Int J Res Pharm Sci 2020; 11:1841-1845.##9. Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol 2020;222(5):415-426.##10. Yuksel B, Ozgor F. Effect of the COVID‐19 pandemic on female sexual behavior. Int J Gynaecol Obstet 2020; 150(1):98-102. PMID: 32392400.##11. Sasanipor M. The effect of the covid-19 epidemic on the fertility status in Iran. Popul Mag 2022;28(115):1-24.##12. Zamaniyan M, Rahmani Z, Ghasemian R, Karimi Z, Arab R-K, Ebadi A, et al. Maternal and Neonatal Outcomes in Pregnant Women With COVID-19 Admitted to Imam Khomeini Hospital of Sari, Iran, 2019-2020. Arch Clin Infect Dis 2023;18(1).##13. Chmielewska B, Barratt I, Townsend R, Kalafat E, van der Meulen J, Gurol-Urganci I, et al. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. Lancet Glob Health 2021;9(6):e759-e772. PMID: 33811827.##14. Khalil A, Von Dadelszen P, Draycott T, Ugwumadu A, O’Brien P, Magee L. Change in the incidence of stillbirth and preterm delivery during the COVID-19 pandemic. JAMA 2020; 324(7): 705-706. PMID: 32648892.##15. Dell’Utri C, Manzoni E, Cipriani S, Spizzico C, Dell’Acqua A, Barbara G, et al. Effects of SARS Cov-2 epidemic on the obstetrical and gynecological emergency service accesses. What happened and what shall we expect now? Eur J Obstet Gynecol Reprod Biol 2020; 254:64-68. PMID: 32942077.##16. Rimmer MP, Al Wattar BH, members U, Barlow C, Black N, Carpenter C, et al. Provision of obstetrics and gynaecology services during the COVID‐19 pandemic: a survey of junior doctors in the UK National Health Service. BJOG 2020;127(9):1123-1128. PMID: 32460422.##17. Brooks SK, Weston D, Greenberg N. Psychological impact of infectious disease outbreaks on pregnant women: rapid evidence review. Public Health 2020; 189:26-36. PMID: 33142123.##18. Micelli E, Cito G, Cocci A, Polloni G, Russo GI, Minervini A, et al. Desire for parenthood at the time of COVID-19 pandemic: an insight into the Italian situation. J Psychosom Obstet Gynecol 2020; 41(3): 183-190. PMID: 32379999.##19. Lin TK, Law R, Beaman J, Foster DG. The impact of the COVID-19 pandemic on economic security and pregnancy intentions among people at risk of pregnancy. Contraception 2021;103(6):380-385. PMID: 33587906.##20. Roberton T, Carter ED, Chou VB, Stegmuller AR, Jackson BD, Tam Y, et al. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. Lancet Glob Health 2020; 8(7): e901-e908. PMID: 32405459.##21. Coutinho RZ, Lima LCd, Leocádio VA, Bernardes T. Considerations about the COVID-19 pandemic and its effects on fertility and sexual and reproductive health of Brazilian women. SciELO Brasil 2020.## ##

مقایسه‌ی سن رویش دندان های شیری در کودکان شهر بجنورد با رفرنس جهانی Timing of Deciduous Tooth Eruption in Children from Bojnurd, Iran: A Comparison with Global Reference Standards” 1 1 سابقه و هدف: آگاهی از زمان و ترتیب صحیح رویش دندان‌های شیری برای دندانپزشکان و متخصصین دندانپزشکی کودکان جهت ارائه یک طرح درمان مناسب و هم‌چنین تعیین زمان‌های فالوآپ و معاینات دوره‌ای جهت مراقبت و حفظ این دندان‌ها تا زمان مورد نیاز ضروری به نظر می‌رسد. از این رو مطالعه حاضر با هدف مقایسه‌ی سن رویش دندان‌های شیری در شهر بجنورد با رفرنس جهانی انجام پذیرفت. مواد و روش‌ها: در این مطالعه توصیفی-تحلیلی از نوع مقطعی، 400 کودک (در بازه سنی 4 تا 36 ماه) وارد مطالعه شدند. سن رویش دندان شیری با استفاده از معاینه بالینی ارزیابی و در چک لیست مطالعه ثبت شد. پس از معاینه، قد و وزن کودکان در هنگام تولد، نوع تغذیه کودک (تغذیه با شیر مادر یا شیرخشک) و سن مادر در هنگام بارداری نیز ثبت گردید. داده های جمع‌آوری شده با استفاده نرم‌افزار SPSS24 تحلیل شد. یافته‌ها: مطالعه حاضر با هدف بررسی عوامل موثر بر رویش دندان‌های شیری و مقایسه میانگین سن رویش دندان های شیری با رفرنس جهانی انجام شد. نتایج مطالعه نشان داد بین کودکان پسر و دختر از نظر متغیرهای قد (0/45=P)، سن مادر هنگام بارداری (0/54=P) و نوع تغذیه (0/35=P) تفاوت آماری معنی‌داری وجود نداشت. اما وزن کودکان پسر در هنگام تولد به‌طور معنی‌داری بیش‌تر از کودکان دختر بود (0/001=P). هم‌چنین سن رویشی دندان‌های سنترال (0/001>P)، لترال (0/001>P)، کانین (0/028=P) و مولر اول ماگزیلا (0/001>P) و سنترال (0/001>P)، لترال (0/001>P)، مولر اول (0/001>P) و دوم مندیبل (0/003=P) بیش‌تر از رفرنس جهانی بود. تغذیه نیز تنها بر رویش دندان سنترال در دو فک موثر بود. استنتاج: به طور کلی سن رویشی دندان‌های شیری در کودکان شهرستان بجنورد بیش‌تر از رفرنس جهانی می‌باشد.   2 Background and purpose: Knowledge of the timing and correct sequence of primary tooth eruption is essential for dentists and pediatric dental specialists in developing appropriate treatment plans, determining optimal follow-up intervals, and scheduling periodic examinations. This ensures proper care and preservation of these teeth until their natural exfoliation. Therefore, the present study aims to compare the eruption age of primary teeth in children from Bojnurd, Iran, with global reference standards. Materials and methods: This cross-sectional study included 400 children aged 4 to 36 months, selected based on predefined inclusion criteria. The eruption age of primary teeth was assessed through clinical examination and recorded using a standardized checklist. Following the dental examination, additional information was collected, including birth height and weight, type of feeding (breast milk or formula), and maternal age during pregnancy. All collected data were entered into SPSS software (version 24) and subjected to statistical analysis. Results: In the present study, which aimed to investigate the factors influencing tooth eruption and to compare the average eruption age of primary teeth with global reference standards, no significant differences were observed in relation to birth height (P=0.45), maternal age during pregnancy (P= 0.54), or type of nutrition (breast milk vs. formula) (P = 0.35) between boys and girls. However, a statistically significant difference was found in birth weight, with boys having a higher average birth weight than girls (P= 0.001). The eruption age of the maxillary central incisors (P> 0.001), lateral incisors (P > 0.001), canines (P= 0.028), and first molars (P> 0.001), as well as the mandibular central incisors (P > 0.001), lateral incisors (P > 0.001), first molars (P > 0.001), and second molars (P = 0.003), was found to be significantly later than the global reference values. Additionally, type of nutrition showed a statistically significant effect only on the eruption timing of the central incisors in both the maxilla and mandible. Conclusion: In the present study, it was found that, overall, the eruption age of primary teeth in children from Bojnurd was significantly later than the global reference standards.   85 93 2025/02/242024/10/282024/11/202024/11/272025/01/202024/12/62023/12/172024/08/7 1403/5/17 2025/04/202025/04/132025/04/132025/04/132025/05/42025/04/142025/03/42025/04/20 1404/1/31 فاطمه علیزاده جمال Fatemeh Alizadeh Jamal دندانپزشک، خراسان شمالی، بجنورد، ایران ایران fateme9512917@gmail.com حسن سعادتی Hassan Saadati استادیار، اپیدمیولوژی و آمار زیستی، دانشکده بهداشت، خراسان شمالی، بجنورد، ایران ایران hasansaadati1391@gmail.com مرضیه صاحب نسق Marzieh Sahebnasagh استادیار، دندانپزشکی کودکان، دانشکده دندانپزشکی، خراسان شمالی، بجنورد، ایران ایران marzieh.saheb@gmail.com primary dentition tooth eruption pediatric dentistry دندان‌های شیری رویش دندان دندان پزشکی کودکان 1. Sajjadian N, Shajari H, Jahadi R, Barkett MG, Sajjadian A. Relationship between birth weight and time of first deciduous tooth eruption in 143 consecutively born infants. Pediatr Neonatol 2010; 51(4): 235-237. PMID: 20713288.##2. Pavičin IS, Dumančić J, Badel T, Vodanović M. Timing of eruption of the first primary tooth in preterm and full-term delivered infants. Bull Int Assoc Paleodontol 2014; 8(1): 19-23. PMID: 26123712.##3. Ramos-Jorge J, Pordeus IA, Ramos-Jorge ML, Paiva SM. Prospective longitudinal study of signs and symptoms associated with primary tooth eruption. Pediatrics 2011; 128(3): 471-476. PMID: 21824888.##4. Neto PG, Falcão MC. Eruption chronology of the first deciduous teeth in children born prematurely with birth weight less than 1500g. Rev Paul Pediatr 2014; 32(1): 17-23. PMID: 24676185.##5. Logan WH, Kronfeld R. Development of the human jaws and surrounding structures from birth to the age of fifteen years. J Am Dent Assoc 1933; 20(3): 379-428.##6. Folayan M, Sowole C. Association between breastfeeding and eruption of the first tooth in preschool children in Nigeria. Eur J Paediatr Dent 2013; 14(1): 51-54. PMID: 23597221.##7. Kobayashi TY, Gomide MR, Carrara CFdC. Timing and sequence of primary tooth eruption in children with cleft lip and palate. J Appl Oral Sci 2010; 18(3): 220-224. PMID: 20856997.##8. Fatemifar G, Hoggart C, Prokopenko I, Horikoshi M, Tobias J, Jarvelin M-R, et al. Genome-wide association study of primary tooth eruption identifies pleiotropic loci associated with height and craniofacial distances. Hum Mol Genet 2013; 29(18): 3807-3817. PMID: 23704328.##9. Talatof Z, Haghshenas-Mojaveri H, Haghshenas-Mojavaeri V, Kheradmand M. First primary tooth eruption and its relationship with birth weight. J Mazandaran Univ Med Sci 2020; 29(182): 117-122.##10. Khalkhali H, Mohammadpour M, Entezar mahdi R, Eslamlu N, Gharaaghaji R. Timing of the first deciduous tooth eruption (incisors) and its related factors in infants: a longitudinal study using Cox's proportional hazards model. J Res Appl Basic Med Sci 2020; 6(2): 59-64.##11. Mahmoodian J, Ghandehari M, Khojani M. Longitudinal study of time and sequence of primary teeth eruption in children, residents in Tehran, from birth (2000-2002). J Iran Dent Assoc 2005; 17(1): 34-39.##12. McDonald RE, Avery DR, Dean JA. Dentistry for the child and adolescent. 11th ed. St. Louis: Elsevier; 2022.##13. Muthu MS, Vandana S, Akila G, Anusha M, Kandaswamy D, Narayanan MBA. Global variations in eruption chronology of primary teeth: A systematic review and meta-analysis. Arch Oral Biol 2024; 158: 105857. PMID: 38128337.##14. Verma N, Bansal A, Tyagi P, Jain A, Tiwari U, Gupta R. Eruption chronology in children: a cross-sectional study. Int J Clin Pediatr Dent 2017; 10(3): 278-282. PMID: 29104389.##15. Folayan M, Owotade F, Adejuyigbe E, Sen S, Lawal B, Ndukwe K. The timing of eruption of the primary dentition in Nigerian children. Am J Phys Anthropol 2007; 134(4): 443-448. PMID: 17935155.##16. Al-Jasser N, Bello L. Time of Eruption of Primary Dentition in Children from Saudi Arabia. J Contemp Dent Pract 2003; 4(3): 65-75.##17. Gatta EA, Al-Alousi WS, Diab BS. Primary teeth emergence in relation to nutritional status among 4-48 months old children in Baghdad city. MDJ 2008; 5(1): 62-70.##18. GunaShekhar M, Tenny J. Longitudinal study of age and order of eruption of primary teeth in Indian children. J Clin Exp Dent 2010; 2(3): e113-e116.##19. Al-Batayneh OB, Shaweesh A. Clinical duration of eruption of deciduous teeth in Jordanian children: A cross-sectional study. Arch Oral Biol 2018; 90: 86-90. PMID: 29587135.##20. Choi N-K, Yang K-H. A study on the eruption timing of primary teeth in Korean children. J Dent Child (Chic) 2001; 68(4): 244-249. PMID: 11862875.##21. Dodo M, Ota Ch, Ishikawa M, Koseki I, Sugawara J, Tatsuta N, et al. Timing of Primary Tooth Eruption in Infants Observed by Their Parents. Pediatr Dent Oral Med 2023; 10(11): 1-9. PMID: 38002821.##22. Coban B, Kansu L, Dolgun A. Timing and sequence of eruption of primary teeth in southern Turkish children. Acta Med Alanya 2018; 2(3): 199-205.##23. Ogodescu E, Popa M, Isac C, Pinosanu R, Olaru D, Cismas A, et al. Eruption Timing and Sequence of Primary Teeth in a Sample of Romanian Children. Diagnostics (Basel) 2022; 12(3): 606. PMID: 35328159.##24. Al-Batayneh OB, Shaweesh AI, Alsoreeky ES. Timing and sequence of emergence of deciduous teeth in Jordanian children. Arch Oral Biol 2015; 60(1): 126-133. PMID: 25299672.##25. Indira MD, Bhojraj N, Narayanappa D. A cross-sectional study on eruption timing of primary teeth in children of Mysore, Karnataka. Indian J Dent Res 2018; 29(6): 726-733. PMID: 30588999.## ##

تبیین مؤلفه‌های بیمارستان سبز با رویکرد اعتباربخشی یک مطالعه کیفی Exploring the Components of Green Hospitals Through an Accreditation-Based Approach: A Qualitative Study 1 1 سابقه و هدف: تبیین مؤلفه‌های بیمارستان سبز، تأثیر قابل‌ توجهی بر عملکرد نظام سلامت و دستیابی به اهداف سلامت پایدار دارد. با وجود این مفهوم‌سازی در مورد عناصر تشکیل ‌دهنده آن پیچیده است و اجماعی در خصوص ابزارهای اندازه‌گیری آن وجود ندارد. تحقیق حاضر با هدف تبیین مؤلفه‌های بیمارستان سبز با رویکرد اعتباربخشی، انجام پذیرفت. مواد و روش ‌ها: پژوهش به روش کیفی، در سال 1402 انجام شد. شرکت‌کنندگان 17 نفر از خبرگان علمی، مدیران و سیاست‌گذاران نظام سلامت آشنا به موضوع بیمارستان سبز بودند. داده‌ها با مصاحبه‌ی نیمه ساختار یافته‌ و به روش هدفمند و سپس گلوله‌ی برفی جمع‌آوری و تا اشباع داده‌ها ادامه یافت. سپس رونویسی مصاحبه‌ها، تعیین واحدهای مبتنی بر معنا، کدگذاری، طبقه‌بندی بر اساس شباهت و تقارن، شناسایی مضامین انجام و با روش تحلیل محتوا مضامین مورد تجزیه ‌و تحلیل قرار گرفت. یافته‌ها: از تحلیل تجربیات مشارکت‌ کنندگان، 6 درون‌مایه‌ی اصلی و 18 درون‌مایه‌ی فرعی استخراج شد. درون‌مایه‌ها‌ی اصلی شامل، مدیریت و رهبری، طراحی ساختمان بیمارستان، فضای سبز، مدیریت انرژی، بهره‌وری آب و پسماند بود. درون‌مایه‌های فرعی شامل، خرید ارجح زیست ‌محیطی، برنامه‌ریزی و سیاست‌گذاری، حمایت مدیران ارشد، بهینه‌سازی مصرف کاغذ، مکان‌یابی مناسب، نوآوری در طراحی، مواد و مصالح اولیه، پوشش گیاهی مناسب، مساحت فضای سبز، آبیاری فضای سبز، مصرف بهینه انرژی، استفاده از انرژی‌های پاک، حمل‌ و نقل سبز، مصرف بهینه آب، مدیریت فاضلاب، دفع زباله‌های غیر عفونی، دفع زباله‌های عفونی و دفع زباله‌های شیمیایی بود. استنتاج: مؤلفه‌های تبیین شده، ابعاد وسیع بیمارستان سبز و نقش آن بر توسعه پایدار مبتنی بر محیط ‌زیست را نمایان کرد. از این ‌رو تقویت عناصر مدیریت و رهبری، طراحی مناسب ساختمان بیمارستان، فضای سبز، مدیریت انرژی، بهره‌وری آب و دفع پسماند به‌منظور شناسایی و ارتقا عملکرد بیمارستان سبز توصیه می‌شود.   2 Background and purpose: Defining the components of a green hospital has a significant impact on the performance of healthcare systems and the achievement of sustainable health goals. However, the conceptualization of these components remains complex, and there is currently no consensus on the development of appropriate measurement tools. This study aimed to identify and define the components of a green hospital using an accreditation-based approach. Materials and methods: This qualitative study was conducted in 2023. The participants included 17 experts, managers, and policymakers in the healthcare system who were familiar with the concept of green hospitals. Data were collected through semi-structured interviews using purposive sampling, complemented by snowball sampling, and continued until data saturation was reached. The interviews were transcribed, and meaningful units were identified, coded, and categorized based on thematic similarity and conceptual symmetry, then analyzed using a conventional content analysis approach. Results: Analysis of participants’ experiences led to the extraction of six main themes and 18 sub-themes. The identified main themes included management and leadership, hospital building design, green space, energy management, water efficiency, and waste management. The corresponding sub-themes were: environmentally preferable purchasing, strategic planning and policymaking, support from senior management, paper use optimization, appropriate site selection, innovative design, use of sustainable materials, selection of suitable vegetation, allocation of green space, efficient irrigation methods, energy efficiency, use of clean energy, promotion of green transportation, water conservation, wastewater management, non-infectious waste disposal, infectious waste disposal, and chemical waste management. Conclusion: The defined components highlight the multifaceted nature of green hospitals and their essential role in promoting environmentally sustainable development. Strengthening key elements such as management and leadership, hospital building design, green space, energy and water efficiency, and waste management is recommended to more effectively identify, assess, and enhance green hospital performance in accordance with accreditation-based frameworks.   94 106 2025/02/242024/10/282024/11/202024/11/272025/01/202024/12/62023/12/172024/08/72024/05/29 1403/3/9 2025/04/202025/04/132025/04/132025/04/132025/05/42025/04/142025/03/42025/04/202025/05/11 1404/2/21 قاسم عابدی Ghasem Abedi دانشیار، گروه مدیریت و خدمات بهداشتی درمانی، دانشکده بهداشت، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران iq134589@yahoo.com رویا ملک زاده Roya Malekzadeh استادیار، گروه مدیریت و خدمات بهداشتی درمانی، دانشکده بهداشت، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران roya.malekzadeh30@yahoo.com سیده فاطمه علمدار Seyedeh Fatemeh Alamdar کارشناس ارشد مدیریت خدمات بهداشتی درمانی، دانشکده بهداشت، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران samira.ald.1376@gmail.com green hospital accreditation hospital sustainable development بیمارستان سبز اعتباربخشی بیمارستان توسعه پایدار 1. Mahboubi M, Tabibi J, Ghahramani F, Nasiripour AA, Gouhari MR. A model for evaluation and validation of different dimensions of accountability in teaching hospitals in Iran: 2012. J Health Manag. 2013;16(51). (Persian)##2. Haghdoost A, Momtazmanesh N, Shoghi F, Mohagheghi M, Mehrolhassani M. Accreditation the education development centers of medical-sciences universities: another step toward quality improvement in education. Iran J Public Health. 2013;42(Suppl 1): 134-140. (Persian)##3. Zamanzadeh V, Mansuri Arani M, Rezagolifam A. Compilation of accreditation model of nursing schools with continuing nursing baccalaureate of Iran University of Medical Sciences: an integrative review. Nurs Midwifery J. 2018;16(8): 544-563. (Persian)##4. Hakkak M, Hozni SA, Shahsiah N, Akhlaghi T. Design of hospital accreditation model: a qualitative study. Manag Strat Health Syst. 2017;2(3): 201-214. (Persian)##5. Gholampour M, Pourshafei H. The role of organizational justice in job satisfaction with nursing burnout mediation. JHC. 2018;20(1): 7-17. (Persian)##6. Noroozi D, Vahdat S, Hesam S. Contributing factors for a green hospital: a scoping review. Health In Manag. 2020;16(6): 314-320. (Persian)##7. Shaabani Y, Vafaee Najar A, Meraji M, Hooshmand E. Culture of health economics in clinical care: a qualitative study. J Health Adm. 2018;21(72). (Persian)##8. Teymourzadeh E, Ghanizadeh GH, Zaboli R, Yaghoubi R. Review of key indicators of the "green hospital" in a selected military hospital. J Mil Med. 2020;22(4): 401-409. [Persian]##9. Movaafegh MR, Hosseini M, Ali MohammadZadeh Kh. The readiness level of the medical services centers in the establishment and implementation of green hospital standards in Rasht. J Guilan Univ Med Sci. 2020;29(1): 11-21. (Persian)##10. Harison Sigalingging B, Nadiroh, Sucahyanto. Theoretical studies green hospital. In: International Conference on Humanities, Education, and Social Sciences. KnE Soc Sci. 2020: 531-542.##11. Noroozi D, Akbari Sh, Vahdat Sh, Hesam S. Prioritizing criteria for establishing a green hospital in Fars Province. Sadra Med Sci J. 2020;8(4): 367-380. (Persian)##12. Hazrati M, Ale mirdamad SN. Evaluation of the status of green hospital indicators in public hospitals in Rasht. J New Res Approaches Manag Account. 2022;83(5): 1547-1566. (Persian)##13. Shaabani Y, VafaeeNajar A, Hooshmand E. Investigation and comparison of available models for green hospitals. J Healthc Manag. 2016;7(1): 15-24. (Persian)##14. Graneheim U, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2): 105-112. PMID: 14769454.##15. Guba E, Lincoln Y. Competing paradigms in qualitative research. In: Denzin NK, Lincoln YS, editors. Handbook of qualitative research. Thousand Oaks: Sage; 1994.##16. Karliner J, Guenther R. A comprehensive environmental health agenda for hospitals and health systems around the world. California: Global Green and Healthy Hospitals; 2011: 42.##17. Arzemani M, Sedghi S, Nasiripour AA. Standard evaluation of green hospital in medical centers of north khorasan university of medical sciences in 2016. Manag Strat Health Syst. 2017;2(2): 118-129.##18. Susanto AJ, Nopiyanti E. Leadership, cultural values and motivation on employee’s performance about green hospital. J Phys Conf Ser. 2020;1625(1): 012065.##19. Azar FE, Farzianpour F, Foroushani AR, Badpa M, Azmal M. Evaluation of green hospital dimensions in teaching and private hospitals covered by Tehran University of Medical Sciences. J Serv Sci Manag. 2015;8(2): 259.##20. Andervazh L, Naiemi E, Rezayati L, Atf Z, Ghasemi Hamedani I. The effect of green education on green citizenship behavior with moderating role of green management performance, green creativity and green employee’s involvement in a hospital. J Healthc Manag. 2020;10(34): 103-112. (Persian)##21. Dhillon VS, Kaur D. Green hospital and climate change: their interrelationship and the way forward. J Clin Diagn Res. 2015;9(12): LE01-LEXX. PMID: 26814377.##22. Intraruangsri J, Mateekul C. The evolution of green hospital concept for Thailand’s hospital. Thammasat University; 2018: 1-66.##23. Danilov A, Benuzh A, Yeye O, Compaore S, Rud N. Design of healthcare structures by green standards. E3S Web Conf. 2020;164: 05002.##24. Chías P, Abad T. Green hospitals, green healthcare. Int J Energy Prod Manag. 2017;2(2): 196-205.##25. Kumari S, Kumar R. Green hospital-A necessity and not option. J Manag Res Anal. 2020;7(2): 46-51.##26. Sahamir SR, Zakaria R. Green assessment criteria for public hospital building development in Malaysia. Procedia Environ Sci. 2014;20: 106-115.##27. Ali Taleshi M, Nejadkoorki F, Azim Zadeh H, Ghaneian M. Toward green hospital standards in Yazd educational hospitals in 2013. J Ilam Univ Med Sci. 2014;22(5): 114-127. (Persian)##28. Heo S, Bell ML. The influence of green space on the short-term effects of particulate matter on hospitalization in the US for 2000–2013. Environ Res. 2019;174: 61-68. PMID: 31039514.##29. Caceres Guido P, Varela BG, Bach HG, Balbarrey Z, Wagner ML. Green spaces in a tertiary care childrens hospital benefits, taxonomic survey, and perspective. [Journal info missing]. PMID: 29557613.##30. Pourian D, Naderbeigi E. Recognition and prioritization of effective indicators in the design and construction of hospitals and green treatment centers in the country. Journal of Mashhad University of Medical Sciences Medical School##31. Setyowati E, Harani AR, Falah YN. Green building design concepts of healthcare facilities on the orthopedic hospital in the tropics Procedia Soc Behav Sci. 2013;101: 189-199.## ##

بررسی کیفیت فیزیکوشیمیایی و میکروبی آب استخرهای شنای شهر کاشان در سال 1403 Assessment of the Physicochemical and Microbial Quality of Swimming Pool Water in Kashan, Iran, 2024 1 1 سابقه و هدف: عدم رعایت اصول بهداشتی و گندزدایی مناسب آب استخر، باعث ایجاد مشکلات بهداشتی و انتقال بیماری‌های عفونی به شناگران می‌شود. با توجه به اهمیت کنترل کیفیت آب، مطالعه حاضر به بررسی کیفیت فیزیکی، شیمیایی و میکروبی آب استخر پرداخته است. مواد و روش‌ها: در این مطالعه توصیفی- تحلیلی، از 5 استخر شنای سرپوشیده فعال در شهر کاشان به صورت نمونه‌برداری جامع میکروبی و شیمیایی انجام شد. نمونه‌ها از هر استخر با 4 مرتبه تکرار جمع‌آوری گردید پارامترهای کلر آزاد باقیمانده، درجه حرارت، کدورت، PH، باکتری‌های هتروتروف و کلیفرم مدفوعی وکلیفرم کل مورد بررسی قرار گرفت. نمونه‌برداری میکروبی و شیمیایی به صورت هفتگی طی مدت 1 ماه انجام شد و نمونه‌ها مطابق با روش‌های استاندارد آزمایش شدند. یافته‌ها: در این تحقیق 65 درصد نمونه‌ها در گستره‌ی PH استاندارد (7/8-2/7) بودند.90 درصد نمونه‌ها دارای کلر باقیمانده بالاتر از mg/l 1 بودند. در هیچ کدام از نمونه‌ها باکتری اشریشیا کلی مشاهده نشد.20 درصد نمونه‌ها دارای آلودگی کلیفرم مدفوعی بر حسب MPN بودند. 10 درصد نمونه‌ها دارای کدورت بیش از حد مجاز NTU 5/0 بوده‌اند، دمای میانگین استخر ها 30/99 درجه سلسیوس محاسبه شد. استنتاج: درجه حرارت استخرهای شنای شهر کاشان تطابق با استاندارد نداشت. موارد آلودگی میکروبی زمانی اتفاق افتاده بود که میزان کلر باقیمانده در حد استاندارد نبود. با توجه به نتایج پژوهش، لازم است پایش مداوم کلر باقیمانده و کنترل PH به منظور حفظ کیفیت باکتریولوژی آب استخرهای شنا انجام شود و پیشنهاد می‌شود که استخرها به‌منظور جلوگیری از آلودگی‌های میکروبی، اقداماتی نظیر نصب سیستم‌های پیشرفته گندزدایی، پایش مستمر PH و کلر باقیمانده، و بهبود کنترل دما اتخاذ کنند.   2 Background and purpose: Non-compliance with the principles of swimming pool water hygiene leads to health problems and the transmission of diseases to swimmers. Given the importance of water quality control, the present study examined the physical, chemical, and microbial quality of pool water. Materials and Methods: In this descriptive-analytical study, comprehensive microbial and chemical sampling was conducted on five active indoor swimming pools in Kashan, Iran. Samples were collected from each pool in four replicates. The parameters of residual free chlorine, temperature, turbidity, pH, heterotrophic bacteria, fecal coliform, and total coliform were examined. Microbial and chemical sampling was performed weekly for one month, and the samples were tested according to standard methods. Results: In this study, 65% of the samples were within the standard pH range (7.2–7.8). Ninety percent of the samples had residual chlorine levels higher than 1 mg/l. Escherichia coli bacteria were not observed in any of the samples. Twenty percent of the samples had fecal coliform contamination in terms of most probable number (MPN). Ten percent of the samples had turbidity exceeding the permissible limit of 0.5 nephelometric turbidity unit (NTU). The average temperature of the pools was calculated to be 30.99 C. Conclusion: The temperature of swimming pools in Kashan did not comply with the standard. Half of the microbial contamination cases occurred when the residual chlorine level was outside the standard range. According to the findings, it is necessary to continuously monitor residual chlorine levels and control pH to maintain the bacteriological quality of swimming pool water. It is recommended that swimming pools implement measures such as installing advanced disinfection systems, continuously monitoring pH and residual chlorine, and enhancing temperature control to prevent microbial contamination.   107 114 2025/02/242024/10/282024/11/202024/11/272025/01/202024/12/62023/12/172024/08/72024/05/292025/01/12 1403/10/23 2025/04/202025/04/132025/04/132025/04/132025/05/42025/04/142025/03/42025/04/202025/05/112025/04/15 1404/1/26 سارا کیهانی Sara Keyhani کارشناس بهداشت محیط، مرکز تحقیقات عوامل اجتماعی موثر بر سلامت و گروه مهندسی بهداشت محیط، دانشکده بهداشت، دانشگاه علوم پزشکی کاشان، کاشان، ایران ایران akbarzadehfatemeh759@gmail.com فاطمه اکبرزاده Fatemeh Akbarzadeh کارشناس ارشد بهداشت محیط، مرکز تحقیقات عوامل اجتماعی موثر بر سلامت و گروه مهندسی بهداشت محیط، دانشکده بهداشت، دانشگاه علوم پزشکی کاشان، کاشان، ایران ایران akbarzadehfatemeh759@Gmail.com اکرم یزدانی Akram Yazdani استادیار، مرکز تحقیقات بیماری های خود ایمنی و گروه آمارزیستی و اپیدمیولوژی، دانشکده بهداشت، دانشگاه علوم پزشکی کاشان، کاشان، ایران ایران akram.yazdani@gmail.com نرجس زیلوچی Narjes Zilochi کارشناس بهداشت محیط، مرکز تحقیقات عوامل اجتماعی موثر بر سلامت و گروه مهندسی بهداشت محیط، دانشکده بهداشت، دانشگاه علوم پزشکی کاشان، کاشان، ایران ایران nargesziloochii@gmail.com نفیسه صانعی Nafiseh Saneei کارشناس بهداشت محیط، مرکز تحقیقات عوامل اجتماعی موثر بر سلامت و گروه مهندسی بهداشت محیط، دانشکده بهداشت، دانشگاه علوم پزشکی کاشان، کاشان، ایران ایران nafisehsanei110781@Gmail.com روح الله دهقانی Rouhullah Dehghani استاد، مرکز تحقیقات عوامل اجتماعی موثر بر سلامت و گروه مهندسی بهداشت محیط، دانشکده بهداشت، دانشگاه علوم پزشکی کاشان، کاشان، ایران ایران dehghani37@yahoo.com swimming pool microbial quality physicochemical parameters coliform residual free chlorine مدیریت کیفیت آب استخر آلودگی میکروبی پارامترهای آب استخر کلیفرم کلر آزاد باقیمانده 1. Hassanein F, Masoud IM, Fekry MM, Abdel-Latif MS, Abdel-Salam H, Salem M, et al. Environmental health aspects and microbial infections of the recreational water: Microbial Infections and Swimming pools. BMC Public Health 2023; 23(1): 302. PMID: 36765300.##2. Firuzi P, Asl Hashemi A, Samadi Kafil H, Gholizadeh P, Aslani H. Comparative study on the microbial quality in the swimming pools disinfected by the ozone-chlorine and chlorine processes in Tabriz, Iran. Environ Monit Assess 2020; 192: 1-18. PMID: 32666262.##3. Dilnessa T, Demeke G. Microbiological, physical and chemical quality of swimming water with emphasize bacteriological quality. Glob J Med Res 2016; 16: 18-27.##4. Bonadonna L, La Rosa G. A review and update on waterborne viral diseases associated with swimming pools. Int J Environ Res Public Health 2019; 16(2): 166. PMID: 30634384.##5. Adhikary RK, Mahfuj MS-E, Starrs D, Croke B, Glass K, Lal A. Risk of human illness from recreational exposure to microbial pathogens in freshwater bodies: a systematic review. Expo Health 2022; 14(2): 325-343.##6. Ubuoh E, Onyeizu U, Uzonu U, Okechukwu I. Assessment of water quality of the selected recreational swimming pools in Umuahia Metropolis, Southeastern Nigeria. Umu J Eng Technol 2022; 8(1): 74-87.##7. Robles E, Ramírez E, Sáinz MG, Martínez B, Ayala R, González ME, et al. Microbiological and physico-chemical study of swimming pool water. Int Res J Adv Eng Sci 2019; 4(4): 15-20.##8. Huang Z. Swimming pool-associated viral outbreaks in China: causes and solutions. Front Public Health 2024; 12: 1480680. PMID: 39776478.##9. Ptak A, Szyc M. The Impact of Swimming Training on the Course and Symptoms of Bronchial Asthma and Respiratory System Function: A Literature Review. Qual Sport 2024; 27: 55-60.##10. Hashish E, Merwad A, Elgaml S, Amer A, Kamal H, Elsadek A, et al. Mycobacterium marinum infection in fish and man: epidemiology, pathophysiology and management; a review. Vet Q 2018; 38(1): 35-46. PMID: 29493404.##11. Cohen PR. Pool toes: case report and review of pool-associated pedal dermatoses. Cureus 2020; 12(11). PMID: 33403185.##12. Gholami-Borujeni F, Mousavi S, Niknejad H. Microbial quality investigation of swimming beaches in Mahmoudabad, Iran 2019. J Mazandaran Univ Med Sci 2020; 30(188): 144-150.##13. Yang L, Chen X, She Q, Cao G, Liu Y, Chang VW-C, et al. Regulation, formation, exposure, and treatment of disinfection by-products (DBPs) in swimming pool waters: A critical review. Environ Int 2018; 121: 1039-1057. PMID: 30392941.##14. Carter RA, Allard S, Croué J-P, Joll CA. Occurrence of disinfection by-products in swimming pools and the estimated resulting cytotoxicity. Sci Total Environ 2019; 664: 851-864. PMID: 30769309.##15. Wyczarska-Kokot J, Dudziak M. Reuse–Reduce–Recycle: water and wastewater management in swimming pool facilities. Desalin Water Treat 2022; 275: 69-80.##16. Rezaei N, Dabiri S, Getso MI, Damani E, Modrek MJ, Parandin F, et al. Fungal contamination of indoor public swimming pools and their dominant physical and chemical properties. J Prev Med Hyg 2022; 62(4): E879. PMID: 35603246.##17. Yarahmadi T. An Investigation of the Sanitary Conditions of Water in Public Swimming Pools in Lorestan, Iran, and Its Comparison with the Current Standards of This Country. Yafteh 2020; 22(1).##18. Baird R, Rice E, Eaton A. Standard methods for the examination of water and wastewaters. Water Environ Fed 2017; 1: 71-90.##19. Emami M, Sobhanardakani S. Investigation of Microbiological and Physicochemical Parameters of Water of Abyaran and Laleh Indoor Swimming Pools in City of Hamedan City in 2015. Med J Tabriz Univ Med Sci 2020; 42(1): 7-15.##20. Natnael T, Hassen S, Desye B, Woretaw L. Physicochemical and bacteriological quality of swimming pools water in Kombolcha Town, Northeastern Ethiopia. Front Public Health 2024; 11: 1260034. PMID: 38259766.##21. Niyungeko C, Ntirampeba J, Bararunyeretse P, Tiimub BM, Nihorimbere M, Ntakiyiruta P. Evaluation of the status of water quality of three swimming pools in Bujumbura city, Burundi. Int J Environ 2022; 11(2): 53-70.## ##

بررسی علل سزارین در زنان باردار نخست زا، یک مطالعه گذشته نگر در بیمارستان امام سجاد رامسر Investigation of the Causes of Cesarean Section in Primiparous Women: A Retrospective Study at Imam Sajjad Hospital, Ramsar 1 1 سابقه و هدف: افزایش نرخ سزارین با توجه به هزینه‌های بالای آن و پیامدهای نامطلوب سلامت مادر و نوزاد، بعنوان یک چالش مهم بهداشت جهانی است. با توجه به روند رو به رشد سزارین در ایران (با برنامه‌ریزی قبلی و یا به علل غیرقابل پیش ‌ینی) و نیز بالا بودن میزان سزارین در رامسر نسبت به استانداردهای ملی وزارت بهداشت و دریافت اخطار جهت ریشه‌یابی، این مطالعه با هدف بررسی علل سزارین در زنان نخست‌زا در بیمارستان امام سجاد رامسر، انجام پذیرفت. مواد و روش ‌ها: مطالعه توصیفی-تحلیلی حاضر، با بررسی داده‌های دموگرافیک مادران تحت عمل سزارین و علت انجام عمل، از پرونده‌های پزشکی ۱۲۳ زن نخست‌زا که در سال‌های ۱۴۰۰ و ۱۴۰۱ در این بیمارستان سزارین کردند، از طریق چک ‌لیستی استاندارد جمع‌آوری شد و با نرم‌افزار  SPSSنسخه ۲۶ با کمک آزمون‌های کای اسکوئر و دقیق فیشر تحلیل صورت گرفت. یافته‌ها: نتایج خصوصیات دموگرافیک نشان داد میانگین سنی مادران 5/19 ± 29/24 سال و میانگین قد آن‌ها 5/15 163/27± سانتی‌متر بود. 8/52 درصد از نوزادان دختر بودند و میانگین نمره آپگار 0/59 ± 89/8۹ ثبت شد. عدم پیشرفت زایمان (26/8 درصد) و آغشته بودن مایع آمنیوتیک به مکونیوم (۲۶ درصد) از مهم‌ترین علل ثبت شده در پرونده‌های بیماران تحت سزارین توسط متخصصین بودند که موارد غیرقابل پیش‌بینی محسوب می‌شدند. در بررسی ارتباط خصوصیات دموگرافیک مادر و بروز سزارین، نتایج نشان داد که علت سزارین با سطح تحصیلات و محل سکونت مادران ارتباط معنی‌داری داشت (0/05< P)، در حالی که با جنسیت نوزاد، سن مادر و هفته بارداری ارتباط معنی‌داری مشاهده نشد. استنتاج: با توجه به نتایج، علل عدم پیشرفت زایمان و دیسترس جنینی باید مورد بررسی دقیق‌تر قرار گرفته و آموزش‌های حین دوران بارداری در جهت افزایش آگاهی والدین داده شود. 2 Background and purpose: The rising rates of cesarean sections represent a significant global health challenge due to their associated high costs and adverse maternal and neonatal health outcomes. In Iran, including the city of Ramsar, the rate of cesarean sections exceeds the national standards set by the Ministry of Health. This study aims to investigate this issue among primiparous women at Imam Sajjad Hospital in Ramsar, addressing concerns raised by the Ministry of Health. Materials and methods: This descriptive-analytical study analyzed demographic data and the underlying reasons for cesarean sections among 123 primiparous women at Imam Sajjad Hospital during the years 2021 and 2022. Data were collected using a standardized checklist and analyzed using SPSS software, employing Chi-square and Fisher’s exact tests. Results: The average age of the mothers was 29.24 ± 5.19 years, with an average height of 163.27 ± 5.15 cm. Female infants accounted for 52.8% of the total, and the mean Apgar score was 8.89 ± 0.59. The primary indications for cesarean sections were non-progression of labor (26.8%) and meconium-stained amniotic fluid (26.0%), both considered unpredictable factors. A significant relationship was found between the indication for cesarean section and the mothers’ educational level and place of residence (P≤ 0.05). However, no significant association was observed with the infant’s gender, maternal age, or gestational age. Conclusion: Based on the findings, the causes of labor non-progression and fetal distress warrant further investigation. Additionally, educational interventions during pregnancy are recommended to enhance parental awareness.   115 123 2025/02/242024/10/282024/11/202024/11/272025/01/202024/12/62023/12/172024/08/72024/05/292025/01/122025/02/4 1403/11/16 2025/04/202025/04/132025/04/132025/04/132025/05/42025/04/142025/03/42025/04/202025/05/112025/04/152025/05/4 1404/2/14 کاملیا یعقوبی نیا Kamelia Yaghoubinia استادیار، گروه زنان و زایمان، دانشکده پزشکی، پردیس خودگردان رامسر، دانشگاه علوم پزشکی مازندران، رامسر، ایران ایران سید ایمان موسوی‌نژاد Seyed Iman Mousavinejad دانشجوی دکتری حرفه ای پزشکی، پردیس خودگردان رامسر، دانشگاه علوم پزشکی مازندران، رامسر، ایران ایران سمانه فرخ فر Samaneh Farrokhfar استادیار، گروه علوم تشریح، دانشکده پزشکی، پردیس خودگردان رامسر، دانشگاه علوم پزشکی مازندران، رامسر، ایران ایران Cesarean section primiparous failure to progress in labor causes of Cesarean section fetal factors سزارین نخست‌زا عدم پیشرفت زایمان علل سزارین عوامل جنینی 1. Słabuszewska-Jóźwiak A, et al. Pediatrics consequences of caesarean section—a systematic review and meta-analysis. Int J Environ Res Public Health 2020; 17(21): 8031. PMID: 33142727.##2. Antoine C, Young BK. Cesarean section one hundred years 1920–2020: the Good, the Bad and the Ugly. J Perinat Med 2021; 49(1): 5-16. PMID: 32887190.##3. Sorrentino F, et al. Caesarean section on maternal request-ethical and juridic issues: a narrative review. Medicina 2022; 58(9): 1255. PMID: 36143932.##4. Carlucci S, et al. The singular case of multiple chorangioma syndrome in an IVF pregnancy. Analysis of the case and review of literature. Placenta 2021; 103: 120-123. PMID: 33120047.##5. Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS Med 2018; 15(1): e1002494. PMID: 29360829.##6. World Health Organization. The Global Numbers and Costs of Additionally Needed and Unnecessary Caesarean Sections Performed per Year: Overuse as a Barrier to Universal Coverage. 2015.##7. Vora KS, et al. Public Health aspects of Cesarean section including overuse and underuse of the procedure. Int Res J Public Health 2019; 3: 30.##8. Betrán AP, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health 2015; 12: 1-10. PMID: 26093498.##9. Rafiei M, et al. Prevalence, causes, and complications of cesarean delivery in Iran: A systematic review and meta-analysis. Int J Reprod Biomed 2018; 16(4): 221. PMID: 29942930.##10. Nasr EH, et al. Fear from childbirth among pregnant women. Open Access Libr J 2020; 7(7): 1-13.##11. Ahmadi L, et al. Effect of couples counseling based on the problem-solving approach on the fear of delivery, self-efficacy, and choice of delivery mode in the primigravid women requesting elective cesarean section. Prev Care Nurs Midwifery J 2018; 7(4): 32-40.##12. Roudsari RL, Zakerihamidi M, Khoei EM. Socio-cultural beliefs, values and traditions regarding women’s preferred mode of birth in the North of Iran. Int J Community Based Nurs Midwifery 2015; 3(3): 165. PMID: 26171405.##13. Dumont A, et al. Caesarean section or vaginal delivery for low-risk pregnancy? Helping women make an informed choice in low-and middle-income countries. PLoS Glob Public Health 2022; 2(11): e0001264. PMID: 36962691.##14. Farzaneh F, et al. Prevalence and Causes of Cesarean Sections in Primiparous Women in Zahedan in a One-Year Period. Int J Pediatr 2022; 10(6): 16246-16251.##15. Ghaem H, et al. Investigating the Factors Affecting Cesarean Section in Fasa: a Case-control Study. Int J Pharm Res 2020; 12(1).##16. Khayyatian N, Nasiri S. Prevalence of cesarean section and its causes in governmental obstetric hospitals of Kashan-2014. J Health Care 2016; 18(1): 28-36.##17. HamdAllah A. Rate and causes of cesarean section in north of Jordan. Iproceedings 2018; 4(1): e10553.##18. Sakai-Bizmark R, et al. Evaluation of hospital cesarean delivery–related profits and rates in the United States. JAMA Netw Open 2021; 4(3): e212235. PMID: 33739430.##19. Cohen WR, Friedman EA. Guidelines for labor assessment: failure to progress? Am J Obstet Gynecol 2020; 222(4): 342. e1-342. e4. PMID: 31954702.##20. Suwanrath C, et al. Why do pregnant women prefer cesarean birth? A qualitative study in a tertiary care center in Southern Thailand. BMC Pregnancy Childbirth 2021; 21: 1-6. PMID: 33407245.##21. Jenabi E, et al. Reasons for elective cesarean section on maternal request: a systematic review. J Matern Fetal Neonatal Med 2020; 33(22): 3867-3872. PMID: 30810436.##22. Amini P, et al. Factors associated with cesarean section in Tehran, Iran using multilevel logistic regression model. Osong Public Health Res Perspect 2018; 9(2): 86. PMID: 29740533.##23. Rahmanian K, Ghasvari M, Rahmanian V. Cesarean, ever to need attention: prevalence and causes of cesarean section in Jahrom, 1387. Pars J Med Sci 2022; 9(1): 46-54.##24. Kawakita T, et al. Indications for primary cesarean delivery relative to body mass index. Am J Obstet Gynecol 2016; 215(4): 515. e1-515. e9. PMID: 27210064.##25. Taye MG, et al. Prevalence and factors associated with caesarean section in a comprehensive specialized hospital of Ethiopia: a cross-sectional study; 2020. Ann Med Surg 2021; 67: 102520. PMID: 34276980.##26. Melesse MB, Geremew AB, Abebe SM. High prevalence of caesarean birth among mothers delivered at health facilities in Bahir Dar city, Amhara region, Ethiopia. A comparative study. PLoS One 2020; 15(4): e0231631. PMID: 32299089.##27. Karim F, et al. Prevalence and factors associated with caesarean section in four Hard-to-Reach areas of Bangladesh: Findings from a cross-sectional survey. PLoS One 2020; 15(6): e0234249. PMID: 32516321.##28. Tsegaye H, et al. Prevalence and associated factors of caesarean section in Addis Ababa hospitals, Ethiopia. Pan Afr Med J 2019; 34(1). PMID: 33708305.##29. Ebtekar F, et al. Comparison of cesarean causes before and after implementation of health sector evolution plan in Kurdistan province. Sci J Nurs Midwifery Paramed Fac 2019; 5(3): 54-62.##30. Striebich S, Mattern E, Ayerle GM. Support for pregnant women identified with fear of childbirth (FOC)/tokophobia–A systematic review of approaches and interventions. Midwifery 2018; 61: 97-115. PMID: 29579696.##31. Coates D, et al. What are women’s mode of birth preferences and why? A systematic scoping review. Women Birth 2020; 33(4): 323-333. PMID: 31607640.## ##

گزارش یک واریانت جدید آسیب زا در ژن DNAH5 در بیمارن مبتلا به سندرم کارتاژنر در استان اردبیل: گزارش مورد A Novel Potentially Pathogenic DNAH5 Variant in a Patient with Kartagener’s Syndrome from Ardabil Province: A Case Report 1 1 سندرم کارتاژنر یک اختلال ژنتیکی نادر با الگوی وراثتی اتوزومال مغلوب است که با سه‌گانه‌ای بالینی شامل سینوزیت مزمن، برونشکتازی و سایتوس اینورسوس مشخص می‌شود. این سه‌گانه شامل التهاب مزمن سینوس‌ها، گشاد شدگی غیر طبیعی برونش‌ها و آرایش آیینه‌ای اندام‌های داخلی است. این سندرم معمولاً با جهش‌هایی در ژن‌هایی که برای عملکرد مژک‌ها ضروری هستند، به‌ویژه ژن DNAH5 که یک پروتئین مهم برای حرکت طبیعی مژک‌ها را کد می‌کند، مرتبط است .این گزارش مورد یک واریانت جدید بیماری‌زا در ژن DNAH5 را در یک کودک دو ساله ایرانی که با سندرم کارتاژنر تشخیص داده شد، معرفی می‌کند. این کودک از دوران نوزادی، از ۱۲ روزگی، دچار اپیزودهای مکرر ذات‌الریه بوده است. او از والدین خویشاوند به دنیا آمده، هر چند سابقه خانوادگی ابتلا به ذات‌الریه مکرر یا ناباروری وجود نداشته است. تشخیص این بیماری با توجه به وجود دکستروکاردیا به عنوان بخشی از سایتوس اینورسوس در این بیمار انجام شد. از میان تقریباً ۴۹ ژن مرتبط با دیسکینزی اولیه مژکی (PCD) و سندرم کارتاژنر، جهش‌های ژن DNAH5 به عنوان علتی برای عفونت‌های تنفسی مزمن و نقص‌های جانبی اندام‌ها شناخته شده‌اند. بر اساس دستورالعمل‌های کالج ژنتیک پزشکی و ژنومیک آمریکا (ACMG)، واریانت (NM_001369.3)DNAH5 ، 1190-1193 (p.Phe397Ter ) del بر اساس معیارهای PS1 و PM2 به عنوان احتمالاً بیماری‌زا طبقه‌‌بندی شده است. فراوانی بسیار کم این واریانت در پایگاه‌های داده ژنومی، از جمله ایرانوم، همراه با مطابقت با معیارهای ACMG و تظاهرات بالینی بیمار، به طبقه‌بندی این واریانت به عنوان بیماری‌زا کمک می‌کند.   2 Kartagener's syndrome is a rare autosomal recessive genetic disorder characterized by a clinical triad: chronic sinusitis, bronchiectasis, and situs inversus. This triad includes persistent inflammation of the sinuses, abnormal dilation of the bronchi, and a mirror-image arrangement of internal organs. The syndrome is commonly associated with mutations in genes critical for ciliary function, particularly DNAH5, which encodes a protein essential for normal ciliary motility. This case report describes a novel pathogenic variant in the DNAH5 gene identified in a 2-year-old Iranian female diagnosed with Kartagener's syndrome. She presented with recurrent episodes of pneumonia beginning in the neonatal period, with symptoms first appearing at 12 days of age. Notably, she was born to consanguineous parents, although no family history of recurrent pneumonia or infertility was reported. The diagnosis was supported by the presence of dextrocardia, consistent with her situs inversus. Among the approximately 49 genes implicated in primary ciliary dyskinesia (PCD) and Kartagener's syndrome, mutations in DNAH5 are a known cause of chronic respiratory infections and organ laterality defects. In accordance with the American College of Medical Genetics and Genomics (ACMG) guidelines, the variant DNAH5 (NM_001369.3): c.1190_1193del (p.Phe397Ter) was classified as likely pathogenic based on criteria PS1 and PM2. Its very low allele frequency in genomic databases, including Iranome, along with its consistency with ACMG criteria and the patient’s clinical manifestations, supports the classification of this variant as pathogenic.   124 128 2025/02/242024/10/282024/11/202024/11/272025/01/202024/12/62023/12/172024/08/72024/05/292025/01/122025/02/42024/11/26 1403/9/6 2025/04/202025/04/132025/04/132025/04/132025/05/42025/04/142025/03/42025/04/202025/05/112025/04/152025/05/42025/04/21 1404/2/1 اتابک صدیق نمین Atabak Sedigh-Namin کمیته تحقیقات دانشجویان، دانشکده پزشکی، دانشگاه علوم پزشکی اردبیل، اردبیل، ایران ایران sedighnamin.atabak@gmail.com رسول ملاطفی Rasoul Molatefi استادیار،گروه اطفال، بیمارستان کودکان بوعلی، دانشگاه علوم پزشکی اردبیل، اردبیل، ایران ایران rmolatefi@yahoo.com مهران آسایشی Mehran Asayeshi سازمان بهزیستی استان اردبیل، اردبیل، ایران ایران mehran.asayeshi@gmail.com عفت سیدهاشمی Effat Sayyedhashemi آزمایشگاه ژنتیک هما، اردبیل، ایران ایران effat.Sayyedhashemi@gmail.com سید سعید حسینی اصل Seyed Saied Hosseini-Asl دانشیار،گروه تحقیقات ژنومیک، مرکز تحقیقات بیماری های گوارشی، بیمارستان امام رضا، دانشگاه علوم پزشکی اردبیل، اردبیل، ایران ایران saied.hosseiniasl@gmail.com Kartagener’s syndrome mutation DNAH5 whole-exome sequencing سندرم کارتاژنر جهش DNAH5 توالی یابی کل اگزوم 1. Kartagener M. Zur Pathologie der Bronchiektasien: Bronchiektasien bei Situs viscerum invertus. Beitr Klin Tuberk 1933; 83: 489-501. doi: 10. 1007/BF02141468.##2. Seiwert AK. Über einen Fall von Bronchiektasie bei einem Patienten mit situs inversus viscerum. Berlin Klin Wschr 1904; 41: 139-141.##3. Tadesse A, Alemu H, Silamsaw M, Gebrewold Y. Kartagener's syndrome: a case report. J Med Case Rep 2018; 12(1): 5. PMID: 29316973.##4. Wang L, Zhao X, Liang H, Zhang L, Li C, Li D, et al. Novel compound heterozygous mutations of DNAH5 identified in a pediatric patient with Kartagener syndrome: case report and literature review. BMC Pulm Med 2021; 21(1): 263. doi: 10. 1186/s12890-021-01586-4. PMID: 34391405.##5. Suzuki J, Takaku A. Cerebrovascular "moyamoya" disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol 1969; 20(3): 288-299. doi: 10. 1001/archneur. 1969. 00480090076012.##6. Shapiro AJ, Dell SD, Gaston B, O'Connor M, Marozkina N, Manion M, et al. Nasal nitric oxide measurement in primary ciliary dyskinesia. A technical paper on standardized testing protocols. Ann Am Thorac Soc 2020; 17(2): e1-e12. PMID: 31770003.##7. Wallmeier J, Nielsen KG, Kuehni CE, Lucas JS, Leigh MW, Zariwala MA, et al. Motile ciliopathies. Nat Rev Dis Primers 2020; 6: 77. doi: 10. 1038/s41572-020-0209-6. PMID: 32943623.##8. Hornef N, Olbrich H, Horvath J, Zariwala MA, Fliegauf M, Loges NT, et al. DNAH5 mutations are a common cause of primary ciliary dyskinesia with outer dynein arm defects. Am J Respir Crit Care Med 2006; 174: 120-126. doi: 10. 1164/rccm. 200601-084OC. PMID: 16627867.## ##

نقش پروتئین اتصال‌ دهنده فاکتور رشد شبه‌ انسولین-3 در سرطان و التهاب: از مکانیسم‌های مولکولی تا کاربردهای بالینی The Role of Insulin-like Growth Factor-Binding Protein-3 in Cancer and Inflammation: From Molecular Mechanisms to Clinical Applications 1 1 پروتئین اتصال ‌دهنده فاکتور رشد شبه ‌انسولین-3 (IGFBP-3) از اعضای خانواده پروتئین‌های IGFBP نقش گسترده‌ای در تنظیم رشد سلول‌ها دارد. این پروتئین به‌طور خاص با اتصال به فاکتورهای رشد شبه ‌انسولین (IGFs)، دسترسی این فاکتورها به گیرنده‌های خاص را تنظیم می‌کند و با مهار IGFs، مانع رشد سلول‌های سرطانی می‌شود. IGFBP-3 عملکردهای مستقلی از IGFs مانند تنظیم فرآیند آپوپتوز، کنترل چرخه سلولی، اتوفاژی، تنظیم بیان ژن و مهار فاکتور هسته‌ای کاپا-بی (NF-κB) دارد. از آن‌جا که التهاب مزمن به‌عنوان محرک پیشرفت سرطان شناخته می‌شود، نقش IGFBP-3  در سرکوب فاکتور رونویسیNF-κB  و اثرات ضد التهابی آن، به‌ویژه در شرایط التهاب محرک تومور، حائز اهمیت است. با این حال، در شرایط پاتولوژیک خاص، این پروتئین ممکن است به بقای سرطان کمک کند، که نشان ‌دهنده ماهیت دوگانه آن در تنظیم مرگ و بقای سلول‌ها است. ویژگی‌های دوگانه IGFBP-3 باعث شده که به‌عنوان یک هدف مهم در تحقیقات سرطان، التهاب و سرطان مرتبط با التهاب مطرح شود. این مقاله یک مطالعه مروری نقلی است که به بررسی مکانیسم‌های وابسته و مستقل از IGFs پروتئین IGFBP-3، نقش آن در سرطان و بیماری‌های التهابی می پردازد. هم‌چنین ارتباط تغییرات بیان و عملکرد این پروتئین را با انواع بدخیمی‌ها و التهاب تحلیل می‌نماید. علاوه بر این، پتانسیل درمانی IGFBP-3 در انکولوژی و بیماری‌های التهابی را مورد ارزیابی قرار می‌دهد. درک عمیق‌تر عملکرد دوگانه IGFBP-3 و مسیرهای مرتبط با آن می‌تواند به توسعه استراتژی‌های درمانی هدفمند برای مقابله با سرطان و التهاب کمک کند. این مطالعه چشم‌اندازهای نوینی را برای کاربردهای بالینی IGFBP-3 به‌عنوان یک عامل درمانی مستقل، هدف دارویی در ترکیب با رژیم‌های استاندارد (مانند شیمی ‌درمانی، پرتو درمانی یا ایمونوتراپی)، یا حتی پایه‌ای برای طراحی داروهای جدید ارائه می‌دهد.   2 Insulin-like growth factor binding protein-3 (IGFBP-3), a member of the IGFBP family, plays an extensive role in cellular growth regulation. By specifically binding to insulin-like growth factors (IGFs), this protein modulates their accessibility to specific receptors, thereby inhibiting IGFs and suppressing the growth of cancer cells. IGFBP-3 also exhibits IGF-independent functions, including the regulation of apoptosis, cell cycle control, autophagy, gene expression, and the inhibition of nuclear factor kappa-B (NF-κB). Given that chronic inflammation is recognized as a driver of cancer progression, the role of IGFBP-3 in suppressing the transcription factor NF-κB and its anti-inflammatory effects are particularly significant within tumor-promoting inflammatory conditions. However, in certain pathological contexts, this protein may contribute to cancer cell survival, highlighting its dual role in regulating cell death and survival. The dichotomous nature of IGFBP-3 has established it as an important target in cancer research, particularly in the context of inflammation and inflammation-associated malignancies. This narrative review explores both IGF-dependent and IGF-independent mechanisms of IGFBP-3, focusing on its role in cancer and inflammatory diseases. The study examines the association between alterations in IGFBP-3 expression and function with various malignancies and inflammatory conditions. Furthermore, it evaluates the therapeutic potential of IGFBP-3 in the treatment of oncology and inflammatory diseases. A deeper understanding of IGFBP-3's dual functionality and associated signaling pathways could facilitate the development of targeted therapeutic strategies against cancer and inflammation. This review presents novel perspectives on the clinical applications of IGFBP-3, including its potential as a standalone therapeutic agent, a pharmacological target in combination with standard treatment regimens (e.g., chemotherapy, radiotherapy, or immunotherapy), or as a molecular scaffold for novel drug design 129 148 2025/02/242024/10/282024/11/202024/11/272025/01/202024/12/62023/12/172024/08/72024/05/292025/01/122025/02/42024/11/262025/03/5 1403/12/15 2025/04/202025/04/132025/04/132025/04/132025/05/42025/04/142025/03/42025/04/202025/05/112025/04/152025/05/42025/04/212025/04/15 1404/1/26 حورالعین عرب Hourolein Arab دانشجوی دکترای تخصصی بیوشیمی بالینی،گروه بیوشیمی بالینی، دانشکده داروسازی و علوم دارویی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران ایران محمد شکرزاده Mohammad Shokrzadeh استاد، گروه سم شناسی و فارماکولوژی، دانشکده داروسازی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران محبوبه رحمتی Mahboubeh Rahmati دانشجوی دکترای تخصصی سم شناسی، گروه سم شناسی و فارماکولوژی، دانشکده داروسازی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران محمدرضا مفید Mohammad Reza Mofid استاد، گروه بیوشیمی بالینی، دانشکده داروسازی و مرکز تحقیقات بیوانفورماتیک، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران ایران apoptosis cancer IGFBP-3 inflammation tumor growth آپوتوز التهاب پروتئین اتصال‌ دهنده فاکتور رشد شبه‌ انسولین-3 رشد تومور سرطان 1. 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وضعیت تب خونریزی دهندۀ کریمه کنگو و ناقلین آن در ایران یک مرور روایتی Current Status of Crimean-Congo Hemorrhagic Fever and Its Vectors in Iran: A Narrative Review 1 1 سابقه و هدف: تب خونریزی ‌دهنده کریمه-کنگو (CCHF) یک بیماری ویروسی حاد است که توسط ویروس جنس نایروویروس ایجاد و عمدتاً از طریق گزش کنه‌های آلوده به انسان منتقل می‌شود. بیماری به دلیل نرخ بالای مرگ‌ومیر و شیوع در مناطق مختلف جهان، به ویژه در ایران، نیازمند بررسی دقیق‌تری است. این مطالعه یک مرور روایتی است که داده‌های مورد نیاز آن از طریق جستجو در موتورهای جستجوی Google Scholar، پایگاه‌های علمی بین المللی Web of Science، ScienceDirect، Scopus و Pubmed و داخلی شامل پایگاه اطلاعات علمی جهاد دانشگاهی (SID)، بانک اطلاعات نشریات کشور (Magiran) و مرجع دانش (Civilica) با استفاده از کلمات فارسی، تب خونریزی‌دهنده‌کریمه-کنگو، نایروویروس، شیوع، اپیدمیولوژی، ناقلین، کنه، کنترل، ایران و معادل‌های انگلیسی آن‌ها به صورت جستجوی انفرادی و پیشرفته ترکیبی از 1348 تا 1403 گردآوری شد. بررسی‌ها نشان می‌دهد شیوع CCHF در ایران در سال‌های اخیر افزایش یافته و موارد ابتلا از تمامی 31 استان کشور گزارش شده است. استان‌های سیستان و بلوچستان و خراسان رضوی بیش‌ترین موارد ابتلا را دارند. این بیماری در فصول گرم سال، به ویژه از اواسط بهار تا تابستان، همزمان با فعالیت کنه‌ها، بیش‌ترین شیوع را دارد و به دلیل شرایط شغلی، بیش‌تر در مردان مشاهده می‌شود. افرادی مانند قصابان، دامداران و کسانی که به هر نحوی با دام و فرآورده‌های دامی یا بیماران مبتلا سروکار دارند، مخصوصا در مناطق روستایی، در معرض خطر بالای ابتلا به بیماری قرار دارند. از 37 گونه کنه در ایران، 11 گونه آلوده به ویروس CCHF هستند. بیش‌ترین تعداد گونه‌های کنه آلوده به ویروس در استان همدان گزارش شده است. هیالوما مارژیناتوم و هیالوما آناتولیکوم به عنوان ناقلین اصلی CCHF شناخته می‌شوند. با توجه به وضعیت کنونی بیماری در ایران و تأثیر عوامل محیطی و اجتماعی در سال‌های اخیر، ایجاد برنامه‌های جامع و همه‌جانبه در زمینه پیشگیری، آموزش و آگاهی‌رسانی برای کاهش شیوع و کنترل این بیماری از اهمیت ویژه‌ای برخوردار است.   2 Background and purpose: Crimean-Congo Hemorrhagic Fever (CCHF) is an acute viral disease caused by a virus of the genus Nairovirus, transmitted primarily through the bites of infected ticks. Due to its high mortality rate and prevalence in various regions worldwide, particularly in Iran, different aspects of the disease warrant more detailed investigation. In this narrative review, data collection was performed through comprehensive searches of scientific databases, including PubMed, Web of Science, Scopus, and ScienceDirect, as well as Persian databases such as the Scientific Information Database (SID), the National Journals Database (Magiran), and Civilica. The search employed both Persian and English keywords, including “Crimean-Congo fever,” “Crimean-Congo hemorrhagic fever,” “Nairoviruses,” “Prevalence,” “Epidemiology,” “Distribution,” “Vectors,” “Tick,” “Control,” and “Iran,” using both individual and advanced combined search strategies, covering the period from 1969 to December 2024. The findings indicate that the incidence of CCHF in Iran has risen in recent years, with cases reported from all 31 provinces. Sistan and Baluchestan and Khorasan Razavi Provinces have reported the highest number of cases. The disease shows peak prevalence during the warm seasons, particularly from mid-spring to mid-summer, coinciding with heightened tick activity, and is more frequently observed in men due to occupational exposure. Individuals such as butchers, livestock farmers, and those who handle livestock or infected patients are at high risk, especially in rural areas. Among the 37 tick species identified in Iran, 11 are infected with the CCHF virus. The highest number of CCHF-infected tick species has been reported in Hamedan Province. Hyalomma marginatum and Hyalomma anatolicum have been documented as the primary vectors of CCHF. Given the current status of CCHF in Iran and the influence of environmental and social factors in recent years, the establishment of comprehensive programs focusing on prevention, education, and public awareness is crucial to reducing the prevalence and controlling the spread of this disease.   149 169 2025/02/242024/10/282024/11/202024/11/272025/01/202024/12/62023/12/172024/08/72024/05/292025/01/122025/02/42024/11/262025/03/52025/02/1 1403/11/13 2025/04/202025/04/132025/04/132025/04/132025/05/42025/04/142025/03/42025/04/202025/05/112025/04/152025/05/42025/04/212025/04/152025/05/20 1404/2/30 سیدحسن نیکوکار Seyed hassan Nikookar استادیار، مرکز تحقیقات علوم بهداشتی، گروه حشره شناسی پزشکی و کنترل ناقلین، دانشکده بهداشت، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران محمد چراغ‌پور خونکدار Mohammad Cheraghpour Khonakdar دانشجوی کارشناسی‌ارشد، گروه حشره شناسی پزشکی و کنترل ناقلین، دانشکده بهداشت، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران امید دهقان Omid Dehghan مربی، مرکز تحقیقات بیماری‌های گرمسیری و واگیر، دانشگاه علوم پزشکی ایرانشهر، ایران ایران محمود فاضلی دینان Mahmoud Fazeli Dinan دانشیار، گروه حشره شناسی پزشکی و کنترل ناقلین، دانشکده بهداشت، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران فاطمه روزبه Fatemeh Roozbeh متخصص بیماری های عفونی، بیمارستان بوعلی سینا، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران احمدعلی عنایتی Ahmadali Enayati استاد، گروه حشره شناسی پزشکی و کنترل ناقلین، دانشکده بهداشت، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران Crimean-Congo hemorrhagic fever tick prevention and control epidemiology Iran تب خونریزی ‌دهنده کریمه-کنگو کنه پیشگیری و کنترل اپیدمیولوژی ایران 1. 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مروری بر نقش کتامین بر مدیریت دلیریوم بعد از جراحی پیوند عروق کرونر و زمان اکستوباسیون بیمار A Review of the Role of Ketamine in the Management of Delirium Following Coronary Artery Bypass Graft Surgery and its impact on Timing of Patient Extubation 1 1  سابقه و هدف: دلیریوم یک اختلال هوشیاری و شناختی است، که به‌ویژه در دوره‌ی پس از عمل بروز می‌کند. میزان بروز دلیریوم بعد از جراحی قلب باز تا بیش از 90 درصد گزارش ‌شده است؛ که می‌تواند موجب تأخیر در اکستیوب بیماران بستری در بخش مراقبت ‌ویژه شود. کتامین، به‌عنوان یک داروی بیهوشی با ویژگی‌های منحصربه‌فرد، پتانسیل تأثیرگذاری بر مدیریت دلیریوم پس از عمل را دارد و نقش دقیق آن در این زمینه همچنان نیازمند بررسی‌های جامع‌تری است. مطالعه حاضر، به‌منظور بررسی دلیریوم و زمان اکستوباسیون در بیماران جراحی بای‌پس عروق کرونر (CABG) انجام شد. مواد و روش‌ها: جستجو در این مطالعه مروری روایتی، از پایگاه‌های داده شامل Scopus، Web of Science، PubMed، Cochrane و Google Scholar با استفاده از اصطلاحات MeSH طی ده سال اخیر انجام گردید. معیارهای ورود شامل مطالعات کارآزمایی بالینی، کوهورت و متاآنالیزها بودند. یافته‌ها: بر اساس نتایج به‌دست ‌آمده، 11 حیطه‌ی، تعریف دلیریوم، اپیدمیولوژی دلیریوم، پاتوفیزیولوژی دلیریوم، ریسک فاکتورهای بروز دلیریوم پس از جراحی قلب، رابطه کنترل درد بعد از عمل جراحی قلب با دلیریوم، رابطه سطوح آرام ‌بخشی بعد از عمل جراحی قلب با دلیریوم، عوارض دلیریوم پس از اعمال جراحی قلبی، دوز، زمان‌بندی مؤثر و سودمندی تجویز کتامین در جراحی قلب و زمان خارج‌‌سازی لوله ‌تراشه، بررسی ارتباط بین زمان اکستیوب و عوارض بعد از عمل و عوامل مؤثر بر زمان اکستیوب بررسی شد. استنتاج: شواهد نشان می‌دهند که کتامین ممکن است با کاهش دلیریوم پس از جراحی قلب، به‌ویژه از طریق اثرات ضد التهابی، مفید باشد، اما تأثیر مشخصی بر زمان اکستوباسیون ندارد. ناهمگونی مطالعات و عدم وجود پروتکل‌های استاندارد، تعمیم‌پذیری نتایج را محدود کرده است. مطالعات آینده باید کارآزمایی‌های تصادفی و استاندارد شده را در بر گیرند. 2 Background and purpose: Delirium is a disruption of consciousness and cognitive function that frequently occurs in the postoperative period. The incidence of delirium following open-heart surgery has been reported to exceed 90%, potentially leading to delays in extubation among patients admitted to the intensive care unit (ICU). Ketamine, an anesthetic agent with distinct pharmacological properties, may influence the prevention or management of postoperative delirium. However, its precise role in this setting remains unclear and warrants further investigation. Materials and Methods: This narrative review aimed to investigate delirium and extubation time in patients undergoing coronary artery bypass grafting (CABG) surgery. A systematic search was conducted across databases including Scopus, Web of Science, PubMed, Cochrane Library, and Google Scholar, using MeSH terms and relevant keywords covering the past decade. Inclusion criteria consisted of randomized clinical trials, cohort studies, and meta-analyses that addressed postoperative delirium and/or extubation time in CABG patients. Results: This review analyzed 11 key domains, including: the definition of delirium, its epidemiology, and pathophysiology; risk factors for delirium following cardiac surgery; the relationship between postoperative pain control and delirium; the association between sedation levels and delirium after cardiac surgery; complications arising from postoperative delirium; optimal dosing and timing of ketamine administration during cardiac surgery; the effect of ketamine on extubation time; the association between extubation time and postoperative complications; and factors influencing extubation timing. Conclusion: Evidence suggests that ketamine may offer benefits in reducing postoperative delirium following cardiac surgery, particularly due to its anti-inflammatory properties. However, it does not appear to significantly influence extubation time. The heterogeneity among existing studies and the absence of standardized protocols limit the generalizability of these findings. Future research should focus on randomized, controlled trials with standardized methodologies to better evaluate ketamine's role in this context.   170 183 2025/02/242024/10/282024/11/202024/11/272025/01/202024/12/62023/12/172024/08/72024/05/292025/01/122025/02/42024/11/262025/03/52025/02/12024/11/3 1403/8/13 2025/04/202025/04/132025/04/132025/04/132025/05/42025/04/142025/03/42025/04/202025/05/112025/04/152025/05/42025/04/212025/04/152025/05/202025/04/14 1404/1/25 مریم علی قلیزاده Maryam Aligholizadeh مربی آموزش هوشبری، گروه هوشبری و اتاق عمل، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران ایران gholizade001@gmail.com مهرداد مصباح کیایی Mehrdad Mesbah Kiaei دانشیار بیهوشی،گروه بیهوشی و درد، دانشکده پزشکی، مرکز کلیه هاشمی نژاد، دانشگاه علوم پزشکی ایران، تهران، ایران ایران dr.mmesbah@gmail.com سیاوش سنگی Siavash Sangi مربی آموزش هوشبری، گروه هوشبری و اتاق عمل، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران ایران siavashsangi@gmail.com ملیکا علی قلیزاده Melika Aligholizadeh دانشجوی کارشناسی علوم آزمایشگاهی پزشکی، گروه علوم آزمایشگاهی، دانشکده پیراپزشکی لنگرود، دانشگاه علوم پزشکی گیلان، لنگرود، ایران ایران melikaaligholizade@gmail.com همایون بنادرخشان Homayoon Bana Derakhshan استادیار گروه آموزش پزشکی، مدیر گروه اتاق عمل و هوشبری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران ایران h_bderakhshan@yahoo.com زهرا کریمیان Zahra Karimian مربی اتاق عمل، گروه هوشبری و اتاق عمل، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران ایران Zahrra7026@gmail.com delirium CABG ketamine extubation time دلیریوم جراحی پیوند عروق کرونر کتامین زمان اکستوباسیون 1. 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از آزمایشگاه تا دادگاه: تکنیک‌های آزمایشگاهی در تشخیص دوپینگ و چالش‌های قانونی آن From the Lab to the Court: Laboratory Techniques in Doping Detection and Their Legal Challenges 1 1 سابقه و هدف: دوپینگ در ورزش به‌عنوان استفاده غیرمجاز از داروهای نیروزا یکی از معضلات اساسی رقابت‌های ورزشی به شمار می‌رود که پیامدهای جسمانی، اخلاقی و حقوقی فراوانی برای ورزشکاران و نهادهای ورزشی به همراه دارد. هدف از این مقاله، بررسی انواع داروهای دوپینگ، روش‌های آنالیز آن‌ها و چالش‌های حقوقی مرتبط با این حوزه است. این یک مطالعه مروری است که با استفاده از منابع معتبر علمی و حقوقی انجام شده است. ابتدا انواع داروهای نیروزا و تأثیرات آن‌ها بر عملکرد ورزشکاران معرفی شد. سپس روش‌های آنالیز داروها شامل کروماتوگرافی گازی-طیف‌سنجی جرمی (GC-MS)، کروماتوگرافی مایع- طیف‌سنجی جرمی (LC-MS/MS) و روش‌های ایمونواسی مورد بررسی قرار گرفت. هم‌چنین، با مطالعه تطبیقی، چالش‌های حقوقی قوانین ایران در مقابله با دوپینگ با قوانین ایالات متحده و استانداردهای بین‌المللی مقایسه شد. نتایج نشان داد که روش‌های تحلیلی پیشرفته‌ای مانند GC-MS و LC-MS/MS با وجود دقت بالا، به تجهیزات گران ‌قیمت و زمان آماده‌سازی طولانی نیاز دارند. در عین حال، روش‌های ایمونواسی به دلیل سهولت و هزینه کم‌تر، در غربالگری اولیه مؤثرند، اما با محدودیت‌هایی مانند نتایج مثبت و منفی کاذب مواجه هستند. از نظر حقوقی، تفاوت در قوانین ملی کشورها و نبود هماهنگی کامل با مقررات جهانی، از جمله چالش‌های اساسی در اجرای مؤثر قوانین ضد دوپینگ محسوب می‌شود. در ایران، استفاده از مواد نیروزا عمدتاً تخلف انضباطی تلقی شده و تنها در شرایط خاص جرم‌انگاری می‌شود. به‌منظور کاهش تقلب‌های ورزشی و ارتقای سلامت ورزشکاران، توسعه روش‌های دقیق‌تر تشخیص دوپینگ و هماهنگی بین‌المللی در تدوین قوانین ضروری به نظر می‌رسد. هم‌چنین ایجاد بسترهای قانونی مناسب در ایران می‌تواند به بهبود روند مقابله با دوپینگ و افزایش شفافیت در عرصه رقابت‌های ورزشی کمک کند 2 Doping in sports, defined as the unauthorized use of performance-enhancing drugs, is a critical issue in athletic competitions, with significant physical, ethical, and legal implications for athletes and sports organizations. This article aims to explore the types of doping substances, their analytical detection methods, and the associated legal challenges. This is a review study based on reliable scientific and legal literature. It first introduces various performance-enhancing drugs and their effects on athletes’ performance. Subsequently, the analytical methods, including Gas Chromatography-Mass Spectrometry (GC-MS), Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS), and immunoassay techniques, are examined. Furthermore, a comparative analysis is conducted on the legal challenges in Iran’s anti-doping regulations in comparison with those of the United States and international standards. The findings reveal that while analytical techniques such as GC-MS and LC-MS/MS are highly accurate and advanced, they require costly equipment and involve lengthy sample preparation. Meanwhile, immunoassay methods, due to their simplicity and lower cost, are effective for initial screening but are limited by the potential for false-positive and false-negative results. Legally, differences in national regulations and a lack of full alignment with international standards pose significant challenges to the effective enforcement of anti-doping laws. In Iran, the use of performance-enhancing substances is primarily regarded as a disciplinary violation and is only subject to criminal prosecution under specific conditions. Overall, to reduce sports fraud and enhance athletes’ health, the development of more accurate doping detection methods and the international harmonization of anti-doping legislation are essential. Additionally, establishing appropriate legal frameworks in Iran can strengthen the fight against doping and increase transparency in sports competitions.   184 198 2025/02/242024/10/282024/11/202024/11/272025/01/202024/12/62023/12/172024/08/72024/05/292025/01/122025/02/42024/11/262025/03/52025/02/12024/11/32025/02/21 1403/12/3 2025/04/202025/04/132025/04/132025/04/132025/05/42025/04/142025/03/42025/04/202025/05/112025/04/152025/05/42025/04/212025/04/152025/05/202025/04/142025/05/4 1404/2/14 اسماعیل بابانژاد Esmaeil Babanezhad استادیار، گروه مهندسی بهداشت محیط، دانشکده بهداشت، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران میلاد چهاردوری Milad Chahardori دانشجوی دکتری تخصصی سم شناسی و فارماکولوژی، گروه سم شناسی و فارماکولوژی، دانشکده داروسازی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران milad.chahardori@gmail.com محمدصادق امیرخانلو Mohamadsadegh Amirkhanloo دکتری تخصصی در حقوق خصوصی، گروه حقوق،دانشکده حقوق ، دانشگاه ازاد اسلامی واحدگرگان ایران @gmail.com فاطمه شکی Fatemeh Shaki استاد، گروه سم شناسی و فارماکولوژی، دانشکده داروسازی، دانشگاه علوم پزشکی مازندران، ساری، ایران ایران doping performance-enhancing drugs analytical methods chromatography doping laws legal challenges دوپینگ داروهای نیروزا روش‌های آنالیز کروماتوگرافی قوانین دوپینگ چالش‌های حقوقی 1. 1. 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