مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هشتاد و یکم شماره 12 (پیاپی 275، اسفند 1402)

The experience of existential distress, along with other forms of distress, is one of the common experiences in end-of-life patients. Therefore, the purpose of this research is to review related studies and conceptualize existential distress in palliative care of cancer patients.

This study was a systematic review, which was conducted from May 1 to July 31, 1402 at Allameh Tabatabai University and search strategy was written and performed in MEDLINE, Web of Science/PubMed and Scopus databases from the beginning of 2003 to the end of 2022. The inclusion criteria included all quantitative, qualitative, mixed and review studies that focused on the experience of adult patients. Lack of access to the full text of the article and studies in non-English language, clinical trial (randomized and non-randomized), letter to the editor, case report and protocol were excluded from the list of studies. After removing duplicate articles, two research authors reviewed the studies independently according to the inclusion and exclusion criteria, and the differences between them were resolved by discussion.

After searching, screening and selecting articles based on inclusion and exclusion criteria, finally 22 articles were included in the study, of which three were review articles, eight were quantitative and 11 were qualitative. Terminally cancer patients experience existential distress, and the data are significant for estimating the prevalence of these symptoms, especially in the severe category. In addition to examining the prevalence of this symptom, patients have described their experience of existential distress in several categories: Feelings of loneliness and isolation (or loss of support system), relationship concerns (concerns about family, changes in relationships, and conflictual relationships), loss of control/autonomy (physical control, cognitive and emotional control), burden on others, loss of sense of continuity (loss of roles, pleasurable activities and sense of self), uncompleted life tasks, hopelessness/helplessness, dissolving of the future, uncertainty and frightening ambiguity, feeling guilt/ regret about the past, lack of meaning, inevitable thoughts of death.

It seems that the themes raised beyond cultural differences show the universal human suffering, whose accurate conceptualization can help to develop effective therapeutic interventions to reduce existential distress.

For over 50 years, bone cement has been used to strengthen artificial joints like hip, knee, shoulder, and elbow joints. The main purpose of bone cement is to fill the space between the prosthesis and the bone. This absorbs the forces on the joint by creating an elastic area. Besides ensuring the long-term stability of the artificial implant, it also improves the damaged bone. Polymeric bone cement consists of a polymer matrix known as polymethyl methacrylate (PMMA) and a liquid monomer called methyl methacrylate (MMA). When these two components are mixed, a free radical polymerization reaction occurs, leading to the cement's hardening at the place of use. The properties of bone cement, such as mechanical strength, biocompatibility, and handling characteristics, can be adjusted by combining the effective polymerization parameters. However, there are some challenges, such as heat generation during polymerization.
Ceramic bone cement is a composite material of ceramic particles dispersed in a polymer matrix, including calcium phosphate and calcium sulfate. The ceramic particles provide strength and bioactivity, while the polymer matrix enhances the transport properties of the cement. This combination results in a mechanically stable, bone-conductive, and biocompatible cement. Moreover, ceramic bone cement can be engineered to release therapeutic agents, such as antibiotics or growth factors, to prevent infection and foster bone regeneration. Ceramic bone cement is a promising alternative material for bone cement in joint replacement. However, more research and development are required to optimize the properties of bone cement and overcome the challenges associated with its use. With continued advancements in biomaterials, ceramic and polymer bone cement could revolutionize the field of orthopedic surgery and improve patient outcomes. Recent research has focused on developing new bone cement with improved properties like bioactivity, antibacterial activity, and drug delivery capabilities. These developments aim to enhance the performance of bone cement and remove the current limitations in orthopedic applications. In this review study, we will focus on the types of bone cement, their mechanical, biological, and structural properties, and how to optimize them.

Fatty liver disease is the most common cause of chronic liver diseases in the world, which can cause cardiovascular diseases, so this research aims to scrutiny a period of intense intermittent sports activity and growth hormone perfuse on cardiac mitochondrial PGC1α and some indicators of oxidative stress in mice with liver damage.

The present research was conducted from September 2022 to March 2023 in the specialized physical training laboratory of Ferdowsi University of Mashhad. The statistical population was twenty one adult male Syrian mice with an average weight of twenty three grams. The sports activity protocol was adopted for fifty-six days using the special video recorder for rodents. The intense interval training program was carried out in the form of ten one-minute repetitions and two-minute active rest, so that the total daily training time for each person was thirty minutes.The vaccination protocol includes the daily vaccination of somatropin injected intraperitoneally.

The PGC1α levels were significantly higher in both the HIIT (P=0.02) and H- GH (P=0.03) groups collationed to the witness team. Moreover, the levels of SOD were considerably increased, in both the HIIT (P=0.05) and H-GH (P=0.005) team s compared to the witness team. Moreover, the levels of MDA were considerably decreased, in both the HIIT (P=0.007) and H-GH (P=0.04) teams compared to the witness team. The decrease in insulin resistance was significant only in the HIIT (P=0.05) team compared to the witness team and slightly increased in the H-GH (P=0.36) team but was not considered. The difference between HIIT and H-GH team (P=0.03) was also significant.The proportion of ALT/AST in both HIIT (P=0.02) and H-GH (P=0.03) teams had a significant decrease compared to the witness team. LDL/HDL proportion evidenced considered decrement at just in the HIIT team (P=0.01).

Intense intermittent sports activity was able to produce a more optimal response compared to GH peptide in improving NAFLD-related indices. Injection of this hormone single may have adverse outcomes on some indexes of this abnormality.

Psychosocial improvements of successful strabismus surgery have been reported in previous studies. But the effect of strabismus surgery on the emotional intelligence of patients is unclear. The aim of this study was to evaluate the effect of strabismus surgery on emotional quotient in patients referring to Imam Khomeini Hospital, Ahvaz.

This prospective interventional study conducted on patients underwent strabismus surgery in Imam Khomeini Hospital, Ahvaz during May 2021 to March 2022. A total of 38 patients between 8-37 years were included. Patients with previous surgery were excluded. All subjects were evaluated before and three months after successful strabismus surgery. Three months post-surgery the improvement of emotional quotient, self-esteem, body image, social anxiety and social avoidance were evaluated and compared with previous surgery. All data were analyzed by SPSS (V25). P-Value less than 0.05 was considered as significant level.

38 subjects including 18 males (47.4%) and 20 females (52.6%) were included. The mean age of patients was 18.11±9.33 years old. Our results showed that compared with before surgery, significant improvements were noted after surgery, within the emotional quotient subscales including self-awareness (P=0.016), self-regulation (P<0.0001), self-motivation (P<0.0001), empathy (P<0.0001), social skills (P<0.0001) and emotional quotient total score (P<0.0001). Further analysis revealed statistically significant improvements in body image (P<0.0001), social anxiety (P=0.004) and social avoidance (P=0.002). The result showed that the improvement of emotional quotient after strabismus surgery was significantly higher in the age group of less than 12 years (P<0.0001). No significant difference was fund between two  genders for emotional quotient subscales (P>0.05).

The results of this study showed a significant improvement in the psychosocial factors including emotional quotient, body image, social anxiety and social avoidance after strabismus surgery. This result suggests that beyond functional and cosmetic improvements, successful strabismus surgery can result in improved emotional quotient and social anxiety, with the greatest effect noted in younger patients.

Being sedentary due to internet addiction is a common public health problem that causes overweight and obesity. Novel methods are needed for weight control behaviors. This study aimed to determine effects of short-term (two weeks) and moderate-term (four weeks) of virtual reality (VR) exercise program with and without interval Nordic walking (INW) in adolescent boys on novel body composition and maximal oxygen uptake (VO2max) parameters; body adiposity index (BAI), abdominal volume index (AVI), conicity index (CI), waist-to-height ratio (WHtR), and a body shape index (ABSI).

In a semi-experimental trial during July to December 2023, 70 adolescent boys (age 14.8 years, body mass index (BMI)=24.4 kg/m2 and VO2max 38 ml/kg/min) with the Young IA tests score ranging over five, were selected from the city of Karaj and randomly was classified to VR, INW, VR+INW and control groups. Individual and combined exercise programs of VR and INW were performed (three session in week for 30 min) for two and or four weeks. The parameters were evaluated at the baseline and the follow up phases (two and four weeks after the interventions period) with a repeated measure ANOVA.

According to Young's internet addiction test scores at the beginning of the study, there was no significant difference between the control and intervention groups (P≥0.05). It has been observed that internet addiction negatively affects cardiorespiratory fitness. When a 2-week intervention of VR exercises was implemented along with INW, the improvement in cardiorespiratory fitness (VO2max) was better than when VR exercises alone lasted for four weeks (P≤0.05). After four weeks of INW intervention, separately and in combination with VR, a significant improvement was observed in VO2max, WHtR and BAI values compared to the control group (P≤0.01).

Although improvement in cardiorespiratory fitness of boys with IA can be achieved by doing short and medium term INW, VR and INW+VR exercises, longer interventions, i.e., four weeks or more, cause more significant changes in the novel body composition.

Managing overweight and obesity is associated with lower risks of chronic diseases like diabetes. Digital health, particularly smartphones or m-health, effectively manages body weight. Technologies such as telemedicine services, mobile health (mHealth) or the use of mobile phones or portable digital devices in healthcare services and wearable devices can be used in this field. Therefore, this study was conducted to understand the impact of digital health technologies on weight management in diabetic patients.

The present study is a systematic review study that was initially searched using a systematic review of published studies in the field of digital health for weight management in diabetic patients from October 1401 to October 1402. Our study was conducted in two rigorous steps. Firstly, we performed a systematic review by searching for publications on Digital Health Solutions for Body Weight Management in Diabetic Patients until 12 October 2022. We meticulously combed through two comprehensive databases, PubMed and Web of Science, using a set of specific and relevant keywords. After a thorough screening and full-text assessment, we handpicked eight documents for this study. We cross-referenced with the companies' websites producing the identified applications to enrich our findings further.

In the initial search, 223 documents were identified and after screening and qualitative evaluation, eight documents were selected for this study. Our research uncovered a range of mHealth apps that have shown promise in weight management for diabetic patients. These apps have demonstrated potential efficacy, high acceptability, and favorable user experiences. Importantly, they have also improved diabetes management and quality of life for the users.

Our review of digital health solutions has not only illuminated their potential in weight management for diabetic patients but also opened up new avenues for a more personalized, engaging, and practical approach to this issue. As technology continues to advance, these interventions hold the potential to revolutionize diabetes self-management, significantly enhance the quality of life, and contribute to better health outcomes for individuals living with diabetes.

One of the factors affecting the outcome of pregnancy is the primary body mass index (BMI) and the amount of weight gain during pregnancy. This study aimed to check the relationship between mother's initial body mass index and weight gain in pregnancy with pregnancy outcomes.

This cross-sectional study was conducted on 455 pregnant women referred to Afzalipour Hospital in Kerman, Iran, from August 2021 to August 2022. These pregnant women were included in the study through easy and accessible sampling. The mother's initial weight was recorded through the mother's health card. The height of the mother was measured using a standard meter and the final weight of the mother before delivery was measured using a standard scale available in the department. Other information of the mothers was extracted from their records. Weight gain during pregnancy and initial body mass index were calculated and divided into four categories, less than normal, normal, overweight and obese. Maternal-fetal complications were included in the information registration form. Descriptive and analytical statistical methods and SPSS version 24 software were used to analyze the data.

The average age of women was 27.56±6.82 years. Body mass index of more than 40% of them (44.4%) was normal (19.8-26) and more than 45% of them were overweight 11.5-16 (45.5%). There was a significant relationship between initial body mass index and weight gain during pregnancy (P=0.001), gestational diabetes (P=0.001) and newborn weight (P=0.019). There was also a significant relationship between weight gain during pregnancy with premature birth (P=0.001), vaginal delivery (P=0.001), gestational diabetes (P=0.001) and newborn Apgar (P=0.001).

High body mass index of the mother and weight gain during pregnancy can cause complications in the mother and the fetus. Therefore, prenatal care should be done more carefully and health care providers should place mothers who have abnormal body mass index and inappropriate weight gain in pregnancy in the high-risk group and under special care to minimize maternal and fetal complications.

One of the first-line treatments to prevent migraine attacks is Sodium Valproate. "Booali Daroo" pharmaceutical company has made a herbal capsule called Sodae based on traditional Iranian medicine. The aim of this study is to compare the effect of Sodae and Sodium Valproate on migraine headaches.

This two-center, double-blind, randomized clinical trial was conducted between December 2021 and July 2022 in the cities of Kermanshah and Hamadan. In this study, 76 migraine patients were randomly divided into two groups. One group received routine medication with Soda capsules and the other group received routine medication with Valproate capsules. Tow group were examined and followed up for three months. Data related to demographic and clinical information of patients were collected and entered into SPSS software version 25. Data analysis was done with a significance level of 0.05.

Overall, 76 patients assessed (36 in the Sodae group and 40 in the Valproate group). The reduction of headache indicators was not significant between the two groups; in such a way that: the frequency (7.49±6.1 vs. 5.75±4.5, P=0.183), the severity (5.66±1.6 vs. 6.34±1.8, P=0.089), the duration of attacks (23.48±30.5 vs. 32.35±32.6, P=0.069), and the Migraine Disability Assessment Score (53.94±77.3 vs. 95.94±104.2, P=0.061) respectively in Valproate and Sodae. Examining different classes of MIDAS score showed that at the end of the study compared to the beginning of the study, the number of people with severe disability decreased significantly and their disability changed from severe disability to lower degrees of disability (P<0.05). The frequency of side effects was not significantly different between the two groups (12 patients (35%) in Sodae versus 21 patients (55%) in Valproate, P=0.090).

In terms of frequency, intensity and duration of migraine headaches as well as side effects, there was no significant difference between Sodium Valproate and Sodae groups.

The increasing prevalence of non-alcoholic fatty liver disease (NAFLD) in recent years has raised concerns about its significant risks for public health. According to previous studies, a diet with low phytochemicals and high inflammatory index is related to non-alcoholic fatty liver disease. In this study, we intend to investigate the relationship between inflammatory diet and phytochemical diet with NAFLD.

In this case control study, 112 newly diagnosed patients with NAFLD referred to the Shahid Rahimi Hospital clinic in Khorramabad between January 1400 and April 1401 and 112 healthy individuals without NAFLD and any other chronic diseases as the control group, with the range 23-59 years old were selected. General information, demographics, physical activity level and food intake were collected using general information questionnaire, physical activity questionnaire and valid semi-quantitative food frequency questionnaire (FFQ). The energy received between the people of the two groups was adjusted. People's diet was divided into two anti-inflammatory and pro-inflammatory groups based on the DII index based on the score quartiles.

The results showed a significant relationship between DII score and NAFLD in the crude model (OR: 2.22, 95% CI: 1.04 -4.73), model I (adjusted for energy and age classification) (OR: 2.4, 95% CI:1.07-5.58), model II (adjusted for model I+physical activity, sex, education) (OR:2.77, 95% CI:1.14-6.77) and model III (model II+BMI) (OR: 2.16, 95% CI: 0.81-5.71) and DPI score and NAFLD the crude model (OR: 0.69, 95% CI: 0.32-1.47), model I (adjusted for energy and age classification) (OR: 0.56, 95% CI: 1.29-5.58), model II (adjusted for model I+physical activity, sex, education) (OR:0.58, 95% CI: 0.23-1.44) and model III (model II+BMI) (OR: 0.65, 95% CI: 0.24-1.75).

The results obtained from this study showed an inverse relationship between following an anti-inflammatory diet and the risk of NAFLD. However, there was no correlation between receiving a diet with a high phytochemical index and NAFLD.

Overcrowding in the emergency department is considered as a problem of the public health system, and the present study was conducted with the aim of evaluating the overcrowding in the emergency department of Imam Khomeini Hospital in Urmia based on the EDWIN index.

This descriptive-analytical study was carried out cross-sectionally from March 21, 2019 to March 19, 2020, using a simple random sampling method in patients referred to the emergency department of Imam Khomeini Hospital in Urmia. Which was used to collect information from the demographic information checklist and the EDWIN index was calculated. Then the information was entered into SPSS18 software and analyzed with the help of descriptive and analytical statistics.

In this study, the results showed that in terms of the frequency of triage level, 5.4% was level one, 65.6% was level two, 26.3% was level three, 2.7% was level four and there was no disease in level five. In terms of shift, 22.5% visited the hospital in the morning shift, 27.6% in the evening shift and 49.9% in the night shift. The average EDWIN index was 2.7±0.75 on holidays and 5.9±4.6 on non-holiday days. Although emergency room congestion was more on non-holiday days, this difference was not statistically significant (P=0.15). Also, the average of EDWIN in the morning shift was 2.5±2.3, in the evening shift it was 0.71±2.16 and in the night shift it was 9.7±5.8 and even though the average of EDWIN in the night shift was higher than in the evening and night shifts, this difference was not statistically significant (P=0.06).

The results of the present study indicated that on most of the investigated days, the emergency room was evaluated as crowded based on the EDWIN criteria. Also, there is no significant difference between the busyness of the emergency room according to the holiday or working day, as well as the morning, evening and night shift.