Medical Journal of the Islamic Republic of Iran最新文献

{"title":"Social Determinants of Health (SDH) History Taking in Medical Students' Curriculum; Challenges and Opportunities.","authors":"Kourosh Kabir, Seyyed Amir Yasin Ahmadi, Sedigheh Yousefzadegan, Soheila Mahdavynia, Ramin Zare Mahmoudabadi, Zahra Rampisheh, Neda SoleimanvandiAzar, Zahra Sadr, Ali Tayebi, Maryam Vafapour, Ashraf Mousavi, Marzieh Nojomi","doi":"10.47176/mjiri.40.93","DOIUrl":"https://doi.org/10.47176/mjiri.40.93","url":null,"abstract":"<p><strong>Background: </strong>The aim of the current study was to evaluate the feasibility of implementing SDH history taking by medical students using a checklist, as well as to identify the advantages and barriers associated with this implementation. The checklist was developed during the first phase of an action research study, which comprised three phases: development, implementation, and assessment of SDH history taking during the clerkship course of medical education.</p><p><strong>Methods: </strong>The implementation of history taking of SDH by medical students involved a briefing session on the importance of SDH for medical students, utilizing a developed checklist for taking SDH history, presenting interesting cases during morning reports, conducting community medicine consultations, and establishing connections with community organizations to support cases. Medical students were instructed to take SDH history alongside routine patient history taking in the pediatric ward of a teaching hospital during their clerkship rotation.</p><p><strong>Results: </strong>One hundred SDH history-taking forms were collected and reviewed following a briefing session conducted by medical students during their pediatrics ward rotation. The briefing session concluded with a question-and-answer segment, providing an opportunity for discussion and clarification. The complex cases identified in the history-taking forms were presented during the morning report. Of these, five cases were referred for community medical counseling. When necessary, patients were referred to a community mental health center.</p><p><strong>Conclusion: </strong>Despite several implementation challenges, the incorporation of SDH history taking by medical students using the checklist was feasible during the clerkship course. The program supported the integration of education with patient care and enabled students to acquire practical experience in identifying and addressing SDH in clinical settings.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"93"},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Policy Brief on the Language-Specific Rehabilitation of Persian-Speaking Individuals with Stroke-Induced Agrammatic Aphasia.","authors":"Samaneh Sazegar Nejad, Fariba Yadegari","doi":"10.47176/mjiri.40.92","DOIUrl":"https://doi.org/10.47176/mjiri.40.92","url":null,"abstract":"<p><strong>Background: </strong>Aphasia rehabilitation in Persian is limited by the lack of widely adopted language-specific assessment and rehabilitation guidance. This policy brief draws on evidence from Persian-speaking individuals with stroke-induced agrammatic aphasia.</p><p><strong>Methods: </strong>A descriptive-analytical study included 21 individuals with agrammatic aphasia and 21 non-brain-damaged participants. Language performance was examined across word, sentence, and discourse production and complex sentence comprehension.</p><p><strong>Results: </strong>Participants with agrammatic aphasia showed reduced language output and grammatical resources, shorter and simpler sentence and discourse structures, verb production difficulties, and poorer comprehension of longer and noncanonical sentences.</p><p><strong>Conclusion: </strong>The findings support five priorities: Persian-specific assessment standards, interdisciplinary workforce training, a national aphasia database, shared research infrastructure, and functional, person-centered rehabilitation guidance.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"92"},"PeriodicalIF":0.0,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges and Proposed Solutions for Optimizing the Pharmaceutical Supply Chain Using the WHO Health System Building Blocks Framework: A Systematic Review.","authors":"Sajjad Bahariniya, Jalal Arabloo, Seyed Masood Mousavi, Hasan Abolghasem Gorji","doi":"10.47176/mjiri.40.91","DOIUrl":"https://doi.org/10.47176/mjiri.40.91","url":null,"abstract":"<p><strong>Background: </strong>Equitable access to medicines is a cornerstone of the health system and is essential for achieving universal coverage. The pharmaceutical supply chain faces challenges that lead to drug shortages and disruptions in service delivery. This study aimed to identify challenges and effective solutions for optimizing the pharmaceutical supply chain.</p><p><strong>Methods: </strong>This systematic review was conducted in 2025 in accordance with a predefined protocol and the PRISMA guidelines. Web of Science, Scopus, PubMed, and Embase were searched up to October 25, 2025, supplemented by a search of grey literature through Google Scholar. Studies addressing challenges or optimization strategies related to pharmaceutical supply chains were included. Methodological quality was independently assessed using the CASP, JBI, and MMAT appraisal tools according to study design. Data were synthesized using the WHO Health System Building Blocks framework.</p><p><strong>Results: </strong>A total of 23,110 studies were identified, of which 30 met the inclusion criteria. The included studies were conducted across 16 countries, reflecting a geographically diverse and internationally representative evidence base. Frequently reported challenges included weak governance and supervision, insufficient financial resources, shortages of raw materials and dependence on foreign markets, inadequate forecasting and planning, and weaknesses in pharmaceutical production and distribution systems. The most proposed optimization strategies included strengthening policymaking and centralized monitoring, enhancing intersectoral collaboration, investing in digital information systems and demand forecasting, supporting domestic production capacity, and ensuring sustainable financing to prevent medicine shortages and improve supply chain resilience.</p><p><strong>Conclusion: </strong>Evidence suggests that strengthening governance structures, improving inter-sectoral coordination, and increasing transparency and accountability are key prerequisites for optimizing pharmaceutical supply chains. Financial stability, developing domestic production capacity, and strategic investments in human resources further contribute to supply chain resilience. These findings highlight the need for policymakers to prioritize governance reforms, sustainable financing strategies, domestic manufacturing capacity, and digital supply chain systems to improve medicine availability and reduce the risk of drug shortages.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"91"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Scoping Review of Challenges and Solutions in the Successful Implementation of Hospital Management Information Systems (HMIS).","authors":"Marzie Zarqi, Hamid Pourasghari, Elaheh Hooshmand, Asgar Aghaei Hashjin, Abbas Sheikhtaheri","doi":"10.47176/mjiri.40.90","DOIUrl":"https://doi.org/10.47176/mjiri.40.90","url":null,"abstract":"<p><strong>Background: </strong>A Hospital Management Information System (HMIS) is a comprehensive, computer-based system designed to manage and streamline the entire spectrum of hospital operations, including administrative, clinical, and financial processes. It integrates various functions such as patient registration, medical records management, appointment scheduling, billing, and reporting into a cohesive network that facilitates efficient information flow and decision-making within a hospital setting (1-3). HMIS is essential for improving hospital efficiency through the integration of medical, administrative, and financial data. However, HMIS implementation may face a variety of challenges. This scoping review aims to identify these challenges and propose solutions for successful HMIS adoption.</p><p><strong>Methods: </strong>A Hospital Management Information System (HMIS) is a comprehensive, computer-based system designed to manage and streamline the entire spectrum of hospital operations, including administrative, clinical, and financial processes. It integrates various functions such as patient registration, medical records management, appointment scheduling, billing, and reporting into a cohesive network that facilitates efficient information flow and decision-making within a hospital setting (1-3). HMIS is essential for improving hospital efficiency through the integration of medical, administrative, and financial data. However, HMIS implementation may face a variety of challenges. This scoping review aims to identify these challenges and propose solutions for successful HMIS adoption.</p><p><strong>Results: </strong>The initial search of the selected databases retrieved 2,419 records, of which 2,058 were duplicates. After duplicate removal, 361 titles and abstracts were screened according to the eligibility criteria. Following full-text assessment, 18 studies were relevant to the research objective. Four categories of key factors in successful HMIS implementation were identified, including technical, organizational, human, and environmental factors. The proposed solutions include advanced security measures, phased implementation, comprehensive user training, and strong leadership support.</p><p><strong>Conclusion: </strong>The results showed that a multidimensional approach that can simultaneously address technical, organizational, human, and environmental factors is crucial for successful HMIS implementation. Employing targeted strategies to overcome these challenges and improve the efficiency of hospital information management is essential, as these strategies were identified. It should also focus on localizing strategies related to these factors in line with the country-specific challenges and solutions in different healthcare settings.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"90"},"PeriodicalIF":0.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes Status and the Association Between a Coronary Artery Disease Polygenic Risk Score and Incident Coronary Artery Disease in an Iranian Prospective Cohort.","authors":"Farzad Maleki, Mahdi Akbarzadeh, Siamak Sabour, Leila Najd-Hassan-Bonab, Hossein Lanjanian, Maryam Sadat Daneshpour, Ali Delpisheh","doi":"10.47176/mjiri.40.89","DOIUrl":"https://doi.org/10.47176/mjiri.40.89","url":null,"abstract":"<p><strong>Background: </strong>Polygenic risk scores (PRSs) for coronary artery disease (CAD) may provide a quantitative assessment of inherited susceptibility that extends beyond conventional clinical risk factors. However, the relationship between CAD PRS and the incidence of CAD may differ across various cardiometabolic risk groups. This study aimed to evaluate whether baseline diabetes status influences the association between CAD PRS and the incidence of CAD.</p><p><strong>Methods: </strong>This cohort comprised 5,139 adults from the Tehran Cardiometabolic Genetic Study (TCGS) who were free of CAD at baseline. The CAD PRS was constructed using a maximum clumping-and-thresholding approach based on external CAD genome-wide association summary statistics. Associations between the PRS and cumulative incident CAD were assessed according to diabetes status using logistic regression. Model discrimination and prediction error were evaluated using the area under the curve (AUC) and the Brier score.</p><p><strong>Results: </strong>Among 5,139 participants, 1,171 had diabetes while 3,968 did not; incident CAD occurred in 334 diabetic and 427 non-diabetic participants. After adjusting for traditional risk factors, each 1-SD increase in the PRS was associated with higher odds of incident CAD in diabetic participants (OR, 1.36; 95% CI, 1.20-1.55) and non-diabetic participants (OR, 1.27; 95% CI, 1.14-1.41). A significant interaction between PRS quintiles and diabetes status was observed (<i>P</i> = 0.017). The model incorporating the PRS alongside traditional risk factors demonstrated greater discrimination in non-diabetic compared to diabetic participants (AUC, 0.776 vs 0.600).</p><p><strong>Conclusion: </strong>CAD PRS was associated with incident CAD across diabetes-defined strata; however, its predictive relevance varied according to baseline diabetes status. These findings support the use of PRS as a marker of inherited susceptibility rather than as evidence for clinical risk reclassification or as a stand-alone predictive tool.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"89"},"PeriodicalIF":0.0,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Latent Class Analysis for Clustering Iranian Individuals Based on Cardiovascular Risk Factors.","authors":"Hajar Nikbakht, Seyyed Amir Yasin Ahmadi, Abbas Aghaei, Mahdi Chinichian","doi":"10.47176/mjiri.40.88","DOIUrl":"https://doi.org/10.47176/mjiri.40.88","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) remains a major public health concern, and conventional risk-stratification tools, such as WHO/ISH (IraPEN), may not adequately capture the heterogeneity of risk profiles within the population. This study aimed to identify the underlying patterns of CVD risk factors among employees undergoing routine occupational health assessments in Iran.</p><p><strong>Methods: </strong>In this cross-sectional secondary analysis, data from 1,281 adults aged 40-79 years attending a governmental occupational health clinic in 2024 were analyzed. Core cardiovascular risk variables-including sex, diabetes, smoking, systolic blood pressure, and total cholesterol-were used. Latent class analysis (LCA) employing a five-class model was conducted.</p><p><strong>Results: </strong>Five latent classes of cardiovascular risk were identified, reflecting heterogeneous conditions. These classes included high-risk males without DM (population share: 0.1824), hyperlipidemic non-smoking females (population share: 0.1487), low-risk individuals (population share: 0.3011), high-risk males without hypertension (population share: 0.36), and high-risk males without hyperlipidemia (population share: 0.0079).</p><p><strong>Conclusion: </strong>The LCA-based classification identified five distinct and internally homogeneous cardiovascular risk profiles that captured sex-specific and metabolically clustered patterns of risk. This approach reveals heterogeneity not reflected in the conventional IraPEN five-tier risk groups.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"88"},"PeriodicalIF":0.0,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Validity and Reliability of the Persian version of the Motion Sickness Assessment Questionnaire and Misery Scale.","authors":"Mehrnaz Hosseini, Abdollah Moossavi, Reza Eslami, Mohsen Ahadi, Shohreh Jalaie, Arash Zare Sadeghi","doi":"10.47176/mjiri.40.87","DOIUrl":"10.47176/mjiri.40.87","url":null,"abstract":"<p><strong>Background: </strong>Motion sickness can be induced by both real and simulated movement. Questionnaires such as the Motion Sickness Assessment Questionnaire (MSAQ) and the Misery Scale (MISC) assess susceptibility but require cultural adaptation for non-English speakers. This study aims to translate and adapt these instruments into Persian (MSAQ-P and MISC-P) and evaluate their validity and reliability.</p><p><strong>Methods: </strong>The MSAQ and MISC were translated into Persian and underwent cross-cultural adaptation. A sample of 70 participants, comprising 21 experienced pilots, 27 pilot students, and 22 non-pilot students, completed the MSAQ-P, MISC-P, Numerical Rating Scale-Persian (NRS-P), and MSSQ-Short-P. The psychometric properties of the MSAQ-P and MISC-P, including face validity, concurrent validity, discriminant validity, internal consistency, and test-retest reliability, were evaluated.</p><p><strong>Results: </strong>The MSAQ-P and MISC-P demonstrated strong face validity. Concurrent validity was confirmed by high correlations between total MSAQ-P and NRS-P (r=0.79, <i>P</i>=0.002), MISC-P (r=0.86, <i>P</i><0.001), and MSSQ-short-p (r=0.84, <i>P</i><0.001). Discriminant validity was supported by significant differences in mean scores of MSAQ-P and MISC-P among the three study groups (<i>P</i><0.05). Internal consistency was evidenced by Cronbach's alpha of 0.97 for the MSAQ-P total score and 0.83, 0.86, 0.89, and 0.88 for gastrointestinal, central nervous system, peripheral, and sopite-related symptoms, respectively. Finally, test-retest reliability was excellent, with ICC values ranging from 0.96 to 0.998 for the MSAQ-P and 0.88 for the MISC-P.</p><p><strong>Conclusion: </strong>The MSAQ-P and MISC-P exhibit cultural appropriateness, robust validity, and reliability, rendering them valuable instruments for evaluating motion sickness in Persian-speaking populations.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"87"},"PeriodicalIF":0.0,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triglyceride- Glucose Index Strongly Predicts Dysglycemia in First-Degree Relatives of People with Type 2 Diabetes Mellitus: A Retrospective Cohort Study.","authors":"Nasrin Babazadeh, Shakiba Rahimi, Zahra Emami, Mojtaba Malek, Fariba Alaei-Shahmiri, Mohammad E Khamseh","doi":"10.47176/mjiri.40.86","DOIUrl":"10.47176/mjiri.40.86","url":null,"abstract":"<p><strong>Background: </strong>First-degree relatives (FDRs) of people with type 2 diabetes mellitus (T2DM) are at substantially increased risk of dysglycemia. However, practical approaches for early risk stratification to dysglycemia remain limited. To determine the long-term incidence of dysglycemia and identify baseline metabolic predictors of progression to dysglycemia among normoglycemic FDRs of people with T2DM.</p><p><strong>Methods: </strong>A total of 169 normoglycemic first-degree relatives of patients with type 2 diabetes mellitus were included in this retrospective cohort study. All participants were recruited through the Clinical Research Unit of the Endocrine Research Center, Institute of Endocrinology and Metabolism, Tehran, Iran. Baseline evaluation included anthropometric measures, fasting and 2-hour post-load plasma glucose, HbA1c, lipid profile, insulin-related indices, renal parameters, and lifestyle factors. Dysglycemia was defined as progression to prediabetes or diabetes during follow-up. Independent predictors were identified using multivariable logistic regression, and predictive performance was assessed by receiver operating characteristic analysis.</p><p><strong>Results: </strong>The study included 169 participants with a mean age of 42.94±10.46 years at baseline. During a median follow-up of 7.1 years, 144 (85.2%) participants developed dysglycemia, including 129 (76.3%) who progressed to prediabetes and 15 (8.9%) who developed diabetes. In adjusted analyses, baseline triglyceride-glucose index and 2-hour post-load plasma glucose were independently associated with progression to dysglycemia. One standard deviation (0.25) increase in the triglyceride-glucose index was associated with 84% higher odds of dysglycemia (standardized odds ratio 1.84 (1.10-3.09); <i>P</i> = 0.020), while a comparable increase in 2-hour glucose was associated with 70 % higher odds (standardized odds ratio 1.70 (1.05-2.76); <i>P</i> = 0.031). The triglyceride-glucose index demonstrated modest discriminative ability, with an optimal cut-off value of 4.42.</p><p><strong>Conclusion: </strong>Normoglycemic first-degree relatives of people with type 2 diabetes mellitus experience a high incidence of early glycemic deterioration. Triglyceride-glucose index and 2-hour post-load glucose are the main risk factors, supporting their integration into risk-based screening strategies in order to enable earlier, targeted prevention in high-risk populations.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"86"},"PeriodicalIF":0.0,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nebulized Magnesium Sulfate as an Adjunct to Standard Therapy in Infants with Acute Bronchiolitis: A Double Blind Randomized Controlled Trial.","authors":"Pegah Karimian, Fahimeh Dehghani Mohammadabadi, Forugh Charmduzi, Hamidreza Khoshnezhad Ebrahimi, Alireza Javan, Negin Mousaeinejad, Somayeh Esmaeilian, Motahare Aghajani Delavar","doi":"10.47176/mjiri.40.85","DOIUrl":"10.47176/mjiri.40.85","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The evidence regarding the efficacy of magnesium sulfate (MgSO₄) in bronchiolitis is conflicting, and high-quality trials involving very young infants are limited. To compare the efficacy of nebulized magnesium sulfate, salbutamol, and 3% hypertonic saline against nebulized salbutamol and 3% hypertonic saline in infants aged 1-6 months who are admitted with a first episode of mild-to-moderate bronchiolitis. The primary outcomes were physiological parameters including oxygen saturation (SpO₂), respiratory rate (RR), and pulse rate (PR). Length of hospital stay (LOS), and Respiratory Distress Assessment Instrument (RDAI) score were evaluated as exploratory outcomes, along with escalation of care and adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this parallel, double-blind randomized controlled trial conducted from August 2022 to February 2023, 62 eligible infants were allocated (1:1) to receive three consecutive 20-minute nebulizations of salbutamol, MgSO₄, and 3% saline (intervention) or salbutamol and 3% saline (control), followed by identical doses every 6 hours for up to 72 hours. All caregivers, clinicians, and outcome assessors were blinded. Outcome assessments were performed at baseline (pre-intervention), 1 hour after the initial dose, and every 24 hours thereafter (± 2 hours) until discharge or 72 hours, whichever occurred first. LOS was defined as the duration (in hours) from randomization until predefined discharge criteria were met (SpO₂ ≥ 94% in room air for ≥ 12 hours, adequate oral intake, respiratory rate within age norms, RDAI ≤ 3).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 62 infants, 33 (53.2%) received triple-drug therapy, while 29 (46.8%) received standard dual therapy. The baseline characteristics were comparable, with a mean age as 3.6 ± 1.25 months and 56.5% male. The median Length of stay (LOS) was shorter in the MgSO₄ group (6.0 days, IQR 5-7) compared to the control group (7.0 days, IQR 6-9; &lt;i&gt;P&lt;/i&gt; = 0.046, Mann-Whitney U). No significant differences were observed between groups for daily RDAI, RR, PR, or SpO₂ (repeated-measures ANOVA, &lt;i&gt;P&lt;/i&gt; &gt; 0.05). None of the infants required intensive care, mechanical ventilation, or experienced serious drug-related events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This double-blind randomized trial did not demonstrate a statistically significant effect on its prospectively registered primary outcomes (oxygen saturation, respiratory rate, heart rate). The observed difference in length of hospital stay (a secondary, unregistered outcome; median 6.0 vs. 7.0 days; unadjusted &lt;i&gt;P&lt;/i&gt; = 0.046) did not reach statistical significance after Bonferroni correction for multiple comparisons (corrected threshold: &lt;i&gt;P&lt;/i&gt; &lt; 0.01) and should be regarded as exploratory and hypothesis-generating only. This trial should be interpreted as null and inconclusive. Adequately powered, prospectively registered confirmatory trials are necessary before any clinical recommen","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"85"},"PeriodicalIF":0.0,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Factors of Abnormal Brain CT Scan in Patients with Opioid Poisoning: A Single-Center Study.","authors":"Alireza Abbasi, Mohammad Farhadi, Robab Sadegh, Kiarash Kavari, Faezeh Rastaghi, Fatemeh Parvizi, Zeinab Azadian, Amir Hossein Rajabi, Amin Nasr","doi":"10.47176/mjiri.40.84","DOIUrl":"10.47176/mjiri.40.84","url":null,"abstract":"<p><strong>Background: </strong>Opioid poisoning is a major cause of morbidity and mortality, particularly in Iran; however, no clear guidelines exist regarding the appropriate timing for non-contrast BCTS in these patients. This study aims to identify clinical and laboratory factors that predict abnormal BCTS findings in individuals with opioid poisoning. We conducted the study among patients presenting to the emergency department of Shiraz Namazi Hospital with opioid poisoning.</p><p><strong>Methods: </strong>This retrospective cross-sectional study was performed on 208 patients with opioid poisoning who were referred to the emergency department of Namazi Hospital between March 2019 and March 2021. Data collection involved accessing the archives of Namazi Hospital to gather the necessary information for this study.</p><p><strong>Results: </strong>Among 208 patients with opioid poisoning who underwent brain CT, 57 (27.4%) exhibited abnormal BCTS findings within this selected subgroup. Multivariable logistic regression identified two independent predictive factors for abnormal BCTS: advanced age (OR 1.041 per year; 95% CI 1.01-1.07; <i>P</i>=0.008) and lower serum bicarbonate (OR 0.908 per mEq/L; 95% CI 0.83-0.99; <i>P</i>=0.025). The most prevalent abnormal findings included microvascular ischemic damage, followed by ischemic infarctions.</p><p><strong>Conclusion: </strong>Advanced age and lower serum bicarbonate levels are independent predictors of abnormal BCTS findings in patients with acute opioid poisoning. Clinicians should consider urgent BCTS in older patients or those with metabolic acidosis, as these groups are at higher risk and may derive the greatest benefit from emergent neuroimaging.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"84"},"PeriodicalIF":0.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}