مجله دانشگاه علوم پزشکی نیشابور
پیاپی 39 (تابستان 1402)

Ankylosing spondylitis is a systemic inflammatory disease that causes back and lower limb pain. This disease is rare among women, especially during pregnancy. The present study reports on the pregnancy and delivery of a patient with ankylosing spondylitis.

The patient was a 34-year-old multiparous woman with a history of giving birth to a live baby, who was diagnosed with lumbar disc protrusion nine years ago during the postpartum period due to the sudden onset of symptoms of lower back and hip pain, joint stiffness, and mobility disability. Years later upon performing the HLA-B27 test, it was found that she was suffering from ankylosing spondylitis. At first, she was prescribed sulfasalazine and naproxen, but the patient showed signs of allergy to these drugs, and according to the doctor's prescription, the drugs were changed to adalimumab, methotrexate, and prednisolone. After changing the drugs, the patient's symptoms were controlled. In 2023, with the patient's decision to get pregnant, methotrexate was stopped and adalimumab was stopped after the 23rd week of pregnancy. During pregnancy, the flare-up of spondylitis symptoms caused her hospitalization. Ultimately, the patient, with a gestational age of 40 weeks and one day, passed all stages of labor without any problems and without epidural analgesia, and the result of delivery was a baby with normal perinatal outcomes.

Considering that patients with ankylosing spondylitis are physically and psychologically vulnerable during pregnancy, psychological support and special medical care for them can help improve perinatal outcomes.

Postoperativeanalgesia and immobility are among the most important issues that significantly impact surgical outcomes and surgeon satisfaction. Therefore, the purpose of this study was to compare the effects of ropivacaine and bupivacaine on the extent of hemodynamic changes in patients undergoing nephrolithotripsy surgery with spinal anesthesia.

This study is a double-blind randomized clinical trial. In total, 93 patients who underwent nephrolithotripsy surgery with anesthesia classes 1 and 2 were included in the study. Patients were randomly divided into two groups: bupivacaine and ropivacaine. The data collection tool in this study included a checklist containing information; Age, gender, systolic, and diastolic blood pressure, heart rate and arterial blood oxygen saturation percentage.

The results of the present study showed that the bupivacaine and ropivacaine groups were similar in terms of gender. The results of Ozone's t-test showed that there was no statistically significant difference between the bupivacaine and ropivacaine groups in terms of systolic and diastolic blood pressure, shortness of breath. There was a significant difference between bupivacaine and ropivacaine groups in the heart rate in ten minutes (P=0.038). However, no significant difference was observed between the two groups at other time points. The average heart rate in 10 min was higherin the ropivacaine group than in the bupivacaine group.

The results of the present study indicated no statistically significant difference between the ropivacaine and bupivacaine groups regarding the number of hemodynamic changes in patients undergoing nephrolithotripsy surgery with spinal anesthesia. Further studies with higher sample sizes and higher doses.

Among the challenges of the healthcare system are the shortage of specialists, the lack of quality knowledge, and the unequal distribution of skills among healthcare workers, which are of concern to the World Health Organization until 2030. Therefore, the purpose of the present study was to localize the second goal of the global human resources for health strategy, which including assessing the current and future needs of the population for human resources, while taking into account the dynamics of the labor market in Iran.

This study was conducted in 2023 using a mixed method approach through a review of related articles and semi-structured interviews with 18 experts in the field of human resources nationwide using MAXQDA2020 software. Then, in a quantitative phase, with the opinions were gathered from243 managers and human resources experts from medical universities, statistical analysis and confirmatory factor analysis (CFA) were employed, and finally, the localized model of the second goal of the global health human resources strategy in Iran was developed.

In the qualitative interview phase, 21 variables were identified and after quantitative phase, they were reduced to 14 variables. This variables were categorized as current and future needs assessment of the population for human resources (3 variables) and dynamics of the health labor market (11 variables). The standard deviation for the second objective was reported to be 0.891. The values related to these criteria, namely Cronbach's alpha and the composite reliability of the research factors, were greater than 0.7 in all factors, indicating the appropriate reliability of the model.

Strategic investment in human resources is essential to improve health services and achieve long-term sustainability of health care systems, especially in developing countries. The study also calls for increased collaboration and knowledge sharing between countries, improved working conditions, and targeted training programs to effectively address workforce challenges.

Social anxiety disorder is a disorder that can increase psychological distress and reduce the quality of social life. The purpose of this study is to investigate the effectiveness of acceptance and commitment-based therapy on distress tolerance and social adjustment of adolescents with social anxiety.

The design of the research was semi-experimental with a pre-test-post-test design and a control group. The statistical population of this research included 83 male students with social anxiety in the second high school who were studying in the academic year of 1401-1402 in the schools of District One of Babol city. Thirty people were selected from the mentioned population using the available sampling method, who met the entry criteria of the research, and were randomly divided into 2 groups (15 people in the first experimental group and 15 people in the control group). To collect information, Simmons and Gaher's social adjustment and distress tolerance questionnaire was used. Analysis of covariance (ANCOVA)and SPSS26 software were used to analyze the data.

The results of the Eta coefficients indicate that 29% of the improvement in distress tolerance scores and 51% of the improvement in social adjustment for the experimental group can be attributed to the effect of acceptance and commitment therapy.

The observed results showed the effectiveness of acceptance and commitment therapy on distress tolerance. Therefore, this treatment method can be recommended to improve distress tolerance and social adaptation of adolescents with social anxiety.

Emergency management in process industries and refineries is critical and the designation of safe assembly points is a core principle in handling such situations. This study identifies the key criteria influencing the   safe assembly points location using a Delphi study approach.

This descriptive-exploratory study was conducted at the National Petrochemical Company. In the first phase, a comprehensive literature review was performed to identify and extract   criteria for locating safe assembly points based on standards, guidelines, and scientific protocols. In the second phase, these criteria were systematically evaluated, screened and refined through a Delphi study involving 15 emergency management experts to establish a finalized list of criteria.

Following a thorough literature review, the initial Delphi phase resulted in a tool containing 21 criteria, which were classified into two groups: internal factors (12 criteria) and external factors (9 criteria). This tool was then shared with the expert panel. Ultimately, after two rounds, the Delphi study concluded with 10 internal and 7 external factors, yielding 17 effective criteria for determining safe assembly points in process industry emergencies.

Criteria such as personnel capacity, vulnerability to incidents, ease of access, evacuation time, visibility, monitoring capabilities, alternative emergency assembly sites within the facility, and the number of safe assembly points on-site can significantly support the effective positioning of safe assembly points in process industries.

Due to the increasing use of drugs and their side effects, the purpose of this study was to compare the effectiveness of cognitive therapy based on mindfulness and metacognitive therapy on repetitive thoughts and negative meta-emotional aspects of drug abuse patients.

The research method was semi-experimental with a pre-test-post-test design and control and follow-up groups. The statistical population included all drug addicts who were referred to addiction treatment centers in Mashhad in 1402. Three addiction treatment centers were selected. From   the statistical population, using the available sampling method and based on the scores of the repetitive thoughts questionnaire by McAvoy (2010) and meta-emotional dimensions of Mitmans Gruber et al. They were selected. These 60 individuals were randomly assigned to three groups of 20. The experimental group (A) received cognitive therapy based on mindfulness, the second group (experimental group B) received metacognitive therapy and the control group (C) did not receive any therapy.

The results of the research showed that both methods, cognitive therapy based on mindfulness and metacognitive therapy, were effective in reducing repetitive thoughts and negative meta-emotional aspects of patients with substance abuse. However metacognitive therapy had a greater effect in reducing repetitive thoughts and suppressing negative meta-emotional aspects.

Based on this, it was concluded that both treatments are effective methods for reducing psychological problems in patients with substance abuse. Therefore, these two treatment methods can be used for other issues of people involved in substance abuse.

Research has demonstrated that the flavonoids found in the leaves of the A. Mariana can enhance neuronal damage resulting from diabetes. This study aims to explore the effect of flavonoid extract from the mangrove (Avicennia marina) leaf extract on neurotrophins in the hippocampus and Alzheimer’s factors in diabetic rats.

In this experimental study، 32 rats were divided into control، diabetic control، and two treatment groups receiving 50 and 100 mg/kg doses of flavonoids from A. Mariana. Diabetes was induced in the diabetic groups with a single intraperitoneal injection of alloxan (120 mg/kg). The treated groups received flavonoids for 30 days. Post-treatment، brains were extracted، and levels of BDNF، NGF، Pt، and Aβ 40 were quantified using the ELISA method.

Based on the results obtained، the levels of BDNF and NGF in diabetic rats treated with doses of 50 and 100 mg/kg of flavonoids from the A. Mariana significantly increased in a dose-dependent manner compared to the diabetic control group، while the levels of Pt and Aβ 40 significantly decreased (p<0. 05).

The flavonoid derived from the A. Mariana mitigates oxidative stress due to its antioxidant properties، regulating free radicals and antioxidants in the body. This process results in enhanced secretion of BDNF، NGF، and ultimately lowering levels of Pt and Aβ 40.

Due to the increasing number of rheumatoid arthritis patients and their psychological problems, the purpose of this study was to compare the effectiveness of schema therapy with mindfulness therapy on pain control and executive function in female patients with rheumatoid arthritis.

The current research method was a semi-experimental type, which was conducted as a pre-test, and post-test, with a control group and a 2-month follow-up. The statistical population of this research included all patients aged 25 to 55 with rheumatoid arthritis who were referred to the rheumatology clinic of Razi Hospital in Rasht in 2001-1401. Among the statistical population, using the available sampling method and based on the scores of the McGill pain control questionnaires (1985) and Barclay's executive function deficits (2010) in the pre-test, 45 patients with rheumatoid arthritis who met the inclusion and exclusion criteria formed the statistical sample. These 45 individuals were randomly selected into 3 groups of 15 each (2 experimental groups and one control group) with   schema therapy for the experimental group (A) and mindfulness therapy for the second group (experimental group B). Control (C) was placed on the waiting list.

The results showed that both schema therapy and mindfulness treatment were effective for pain control and executive function in female patients with rheumatoid arthritis, but there were no significant differences between each other.

Therefore, it can be said that both schema therapy and mindfulness therapy can be used to increase pain control and improve the executive functions of rheumatoid arthritis patients. Both approaches are effective methods for reducing psychological problems in autoimmune patients such as rheumatoid arthritis.