Medical Journal of the Islamic Republic of Iran最新文献

{"title":"Combined Core Stability and Short Foot Exercises Improve Medial Longitudinal Arch and Dynamic Balance More Than Short Foot Exercises Alone in Female Child Badminton Players with Pes Planus: A Randomized Controlled Trial.","authors":"Arash Khaledi, Behnaz Sotodeh Rad, Shahrzad Zandi","doi":"10.47176/mjiri.40.83","DOIUrl":"10.47176/mjiri.40.83","url":null,"abstract":"<p><strong>Background: </strong>Badminton involves rapid, multidirectional movements and unilateral landings that impose substantial mechanical stress on the foot-ankle complex. Athletes with pes planus are at an increased risk of instability and injury due to altered kinetic chain function. While short foot exercises (SFE) enhance medial longitudinal arch (MLA) integrity in individuals with flat feet, core stability training (CST) is increasingly incorporated into sports rehabilitation programs. However, the effects of CST on pes planus remain insufficiently explored. This study investigates the combined effects of CST and SFE on MLA integrity and dynamic balance in semi-professional female badminton players with pes planus.</p><p><strong>Methods: </strong>In this randomized controlled trial, 30 female badminton players aged 9-12 years with mild to moderate pes planus (Staheli Arch Index [SAI]: 0.70-1.15) were randomly allocated to either a combined training group (CST + SFE) or a control group (SFE only). Following attrition, 24 participants (12 per group) completed the study and were included in the final analysis. Both groups trained three times per week for eight weeks under professional supervision. MLA function and dynamic balance were assessed using the Staheli Arch Index (SAI) and the Star Excursion Balance Test (SEBT), respectively. Between-group differences were analyzed using analysis of covariance (ANCOVA), with baseline values included as covariates.</p><p><strong>Results: </strong>Both groups improved post-intervention, with the experimental group (SFE+CST) showing significantly greater enhancements than the control (SFE) in both foot arch structure (SAI decreased by 14% vs. 7.0%) and dynamic balance (SEBT composite increased by 5.22% vs. 1.86%). ANCOVA revealed a significant main effect for group on post-intervention SAI (F(1,21)=611.74, <i>P</i><0.001, η2=0.97, mean difference = 0.07) and SEBT composite score (F(1,21)=3695.82, <i>P</i><0.001, η2=0.99, mean difference = 3.36). Despite a violation of the homogeneity of regression slopes for SAI, pairwise comparisons confirmed the superior efficacy of the combined training over short foot exercises alone.</p><p><strong>Conclusion: </strong>An eight-week combined CST and SFE program significantly improved MLA height and dynamic balance compared to SFE alone. It is recommended to integrate proximal (core) and distal (foot) exercises to enhance postural control, support the correction of pes planus, and enhance athletic performance in young badminton players.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"83"},"PeriodicalIF":0.0,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220384","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":"Recurrent Generalized Tonic-Clonic Seizures During Emergence from Propofol Target-Controlled Infusion in a Patient Undergoing Gastrointestinal Endoscopy: A Case Report.","authors":"Vu Thanh Lam","doi":"10.47176/mjiri.40.82","DOIUrl":"10.47176/mjiri.40.82","url":null,"abstract":"<p><strong>Background: </strong>Seizure-like phenomena (SLPs) associated with propofol have been reported in several publications. The mechanisms underlying these phenomena remain incompletely understood. Some studies suggest that rapid fluctuations in propofol concentration within the brain may contribute to the occurrence of SLPs. Therefore, theoretically, target-controlled infusion (TCI) of propofol, which facilitates the achievement and maintenance of more stable drug concentrations compared to bolus injection or manual infusion, could mitigate the risk of SLP occurrences. However, data regarding SLPs during propofol administration via TCI are limited.</p><p><strong>Case: </strong>This case describes a 45-year-old female patient with no history of epilepsy or neurological disorders who developed generalized tonic-clonic seizures immediately following the discontinuation of propofol TCI using the Schnider pharmacokinetic model for sedation during gastroscopy and colonoscopy. These seizures recurred after the first two intravenous doses of midazolam; however, after the third seizure was treated with intravenous diazepam, the patient experienced no further seizures.</p><p><strong>Conclusion: </strong>In addition to further strengthening the evidence regarding rare neurological events associated with propofol, this case suggests that propofol administration via TCI based on the Schnider model may not completely eliminate the risk of drug-induced seizures; thus, anesthesiologists should remain vigilant. Furthermore, the sequential administration of midazolam and diazepam may represent a suitable option for seizure control.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"82"},"PeriodicalIF":0.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220309","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":"Timing of Cardiac Rehabilitation After Primary Percutaneous Coronary Intervention for Myocardial Infarction: A Randomized Clinical Trial.","authors":"Ashkan Dabiri, Mohammadreza Nikoo, Azadeh Mozayanimonfared, Azar Pirdehghan, Saeed Ghiasvandi, Lobat Majidi","doi":"10.47176/mjiri.40.81","DOIUrl":"10.47176/mjiri.40.81","url":null,"abstract":"<p><strong>Background: </strong>Cardiac rehabilitation (CR) is a cornerstone of post-acute care for patients experiencing cardiovascular events or interventions. It aims to improve cardiorespiratory capacity, enhance quality of life, and maximize physical function, facilitating a return to daily activities. However, the optimal timing for initiating CR following acute coronary events or procedures remains uncertain.</p><p><strong>Methods: </strong>In this randomized clinical trial, 40 patients diagnosed with acute myocardial infarction and treated with primary percutaneous coronary intervention (PCI) were randomly assigned to two groups. Group A commenced cardiac rehabilitation one month after PCI, while Group B initiated rehabilitation two months post-PCI. Both groups completed a supervised 12-session rehabilitation program under the guidance of a physical medicine specialist. Functional outcomes were assessed before and after rehabilitation using the SF-36 quality of life questionnaire and echocardiographic parameters. Data were analyzed using SPSS version 25. Within-group changes were evaluated with paired t-tests, and between-group comparisons of change scores were conducted using independent samples t-tests. A <i>P</i>-value < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>Post-rehabilitation, the mean SF-36 score was 65.85±6.67 in Group A and 67.05±5.96 in Group B (<i>P</i>=0.192). The mean change in Left Ventricular Ejection Fraction (LVEF) was 2.25% in Group A and 0.15% in Group B (<i>P</i>=0.305). After rehabilitation, grade 1-2 diastolic dysfunction remained present in 85% of patients in both groups, while 15% of patients in each group showed no evidence of diastolic dysfunction (<i>P</i>=0.506).No significant differences were found between groups in heart rate (HR) Max (107.45±15.04 vs. 115.20±13.12; <i>P</i>=0.091), HR Recovery (22.50±7.05 vs. 23.10±7.78; <i>P</i>=0.800), or MET change (6.60±1.83 vs. 6.20±2.39; <i>P</i>=0.556).</p><p><strong>Conclusion: </strong>Initiating cardiac rehabilitation one month as opposed to two months after primary PCI did not yield significant differences in quality of life or cardiac functional parameters. These findings indicate that there may be flexibility in the timing of CR initiation without compromising short-term functional outcomes.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"81"},"PeriodicalIF":0.0,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220462","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":"Coagulation Disorders and Thrombotic Events in Patients with COVID-19: A Narrative Review.","authors":"Mahdi Khatuni, Behnaz Varaminian, Maryamolsadat Ghoreyshi, Marziyeh Ghalamkari","doi":"10.47176/mjiri.40.80","DOIUrl":"https://doi.org/10.47176/mjiri.40.80","url":null,"abstract":"<p><strong>Background: </strong>This review explores the coagulation disorders and thrombotic events observed in COVID-19 patients, highlighting the underlying pathophysiological mechanisms and current management strategies.</p><p><strong>Pathophysiology and clinical impact: </strong>Important mechanisms contributing to thrombosis include cytokine storm-induced thrombosis, antiphospholipid antibody syndrome, macrophage activation syndrome, complement cascade activation, and renin-angiotensin system dysregulation. Thrombotic complications significantly impact mortality and morbidity, with pulmonary emboli frequently observed in autopsy studies. Notably, this prothrombotic state may persist for weeks post-hospitalization.</p><p><strong>Management: </strong>Effective management of COVID-19-associated coagulopathy requires prompt treatment of underlying infections and comprehensive assessment of co-infections in critically ill patients. While heparin and its derivatives remain the cornerstone for managing venous thromboembolism, their efficacy for COVID-19-associated coagulopathy remains to be a subject of investigation.</p><p><strong>Conclusion: </strong>Understanding the complex interplay between inflammation and thrombosis in COVID-19 is crucial for developing targeted therapeutic strategies that address coagulation disorders and the underlying infection.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"80"},"PeriodicalIF":0.0,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182941","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":"Which Domains of Cognition in Older Adults Are Affected by Sleep Duration? A Scoping Review.","authors":"Narges Kheirollahi, Nafiseh Ghassab-Abdollahi, Saeed Sadigh-Eteghad, Seyyed Mohammad Bagher Fazljou, Reza Mohammadinasab, Nafiseh Rezaei, AliHossein Zeinalzadeh","doi":"10.47176/mjiri.40.79","DOIUrl":"https://doi.org/10.47176/mjiri.40.79","url":null,"abstract":"<p><strong>Background: </strong>Over the past decade, research on the impact of sleep duration on cognitive domains in older adults has been emerging; however, a formal synthesis of the focused literature that addresses all cognitive domains has not yet been conducted. Therefore, this review study was conducted to investigate the effects of sleep duration on various cognitive domains in older adults.</p><p><strong>Methods: </strong>This scoping review was conducted according to Arksey and O'Malley (2005). A systematic search was conducted across three research databases: PubMed, Web of Science, and Scopus, with relevant gray literature also reviewed. Studies that reported on the relationship between sleep duration and cognition among older adults were included in the review. Data were extracted, charted, and synthesized into a narrative. Consistent with the purpose of a scoping review, the methodological quality of the studies was not appraised.</p><p><strong>Results: </strong>A total of 23 studies published between 2009 and 2024 fulfilled the inclusion criteria. The findings revealed that both excessively long and short sleep durations were strongly linked to impairments in learning, memory, and complex attention. Only a limited number of studies explored all cognitive domains, with none addressing social cognition. Additionally, analyses considering gender differences were notably absent.</p><p><strong>Conclusion: </strong>This review highlights cognitive domains affected by inadequate sleep in older adults and emphasizes the need for more research on gender-specific differences in sleep duration. It also pointed out a gap in understanding the link between sleep duration and social cognition, emphasizing the need for further studies in this area.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"79"},"PeriodicalIF":0.0,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182902","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":"Introducing Prostaglandin Endoperoxide Synthase-2 as a Remarkable Player in the Development of Gastroesophageal Reflux Disease.","authors":"Mostafa Rezaei Tavirani, Babak Arjmand, Zahra Razzaghi, Fatemeh Bandarian, Mitra Rezaei, Reza M Robati, Farideh Razi","doi":"10.47176/mjiri.40.78","DOIUrl":"https://doi.org/10.47176/mjiri.40.78","url":null,"abstract":"<p><strong>Background: </strong>Gastroesophageal reflux disease (GERD), a common disorder of the upper gastrointestinal tract, is associated with abdominal pain and acid regurgitation. GERD is considered a risk factor for esophageal adenocarcinoma. In this study, the key genes associated with GERD are determined and discussed.</p><p><strong>Methods: </strong>Gene expression profiles of GERD samples and controls were obtained from the Gene Expression Omnibus (GEO) database and assessed via PPI network analysis to find crucial genes. These crucial genes were validated using the GeneCards database by comparison with the top GERD-related genes. The crucial genes are evaluated via directed PPI network analysis, and the key genes are determined.</p><p><strong>Results: </strong>A total number of 104 central significantly differentially expressed genes (DEGs) were identified as separators of GERD samples of controlled individuals. GeneCards analysis demonstrated that <i>ACE, COL5A1, IL1A, IL1B, NGF, POSTN</i>, and <i>PTGS2</i> are the crucial genes. Findings showed <i>PTGS2</i> and <i>IL1B</i> are two key genes that promote GERD development.</p><p><strong>Conclusion: </strong>The results of the current study suggest that PTGS2 inhibition may represent a potential therapeutic strategy that requires further experimental validation<b>.</b></p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"78"},"PeriodicalIF":0.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182873","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":"Evaluation of Effective Factors in the Prognosis of Patients with Acute Myocardial Infarction Transferred by Emergency Medical Services and Self-Referred Patients in Tehran.","authors":"Zahra Kolivand, Samad Azari, Parisa Hasani Sharamin, Zahra Shajari, Mostafa Rouzitalab, Negar Omidi, Peyman Saberian","doi":"10.47176/mjiri.40.77","DOIUrl":"https://doi.org/10.47176/mjiri.40.77","url":null,"abstract":"<p><strong>Background: </strong>Little is known about the current scenario of acute myocardial infarction (AMI) under primary angioplasty; Transferred by emergency medical services and self-referred patients in Iran.</p><p><strong>Methods: </strong>The study population consisted of AMI patients with ST-segment elevation myocardial infarction (STEMI) who were consecutively admitted with Emergency Medical Services (EMS) or directly in the first six months of 2021 in 2 PCI-capable selected hospitals in Tehran. We analyzed the pattern of transfer by emergency medical services and compared in-hospital treatments and outcomes between transferred patients and self-referred patients in Tehran. Statistical comparisons were performed using chi‑square, t‑tests, or Mann-Whitney U tests, and multivariable logistic regression was used to assess factors associated with in‑hospital mortality, with significance set at <i>P</i><0.05.</p><p><strong>Results: </strong>In-hospital mortality was higher in the self-referred than in patients transferred by EMS (9.8% versus 5.2%) (<i>P</i>=0.014). The average door-to-balloon (DTB) time in the self-referred patients was significantly higher (60.26±59.0 minutes vs 49.30±48.82 minutes) (<i>P</i>=0.020). Results show that the average DTB time of patients who died in the hospital was higher than that of patients who were alive in the self-referred patients. The average time from pain onset to Balloon (OTB) in the self-referred patients and those transferred by EMS was 348.74±316.07 minutes and 226.26±183.15 minutes, respectively (<i>P</i><0.001). Multivariable logistic regression models the chance of in-hospital mortality in patients who self-referred is 2.17 times that of patients who were transferred by EMS, which is statistically significant (<i>P</i>=0.008).</p><p><strong>Conclusion: </strong>Our results indicated that there are significant differences in treatment delay and use of early revascularization, such as time of first medical contact (FMC) to the device, time of pain onset to Balloon (OTB), and DTB time between transferred-by-EMS patients and self-referred patients.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"77"},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182321","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 Role of Systemic Inflammatory Ratios in Refractory Chronic Spontaneous Urticaria Patients with Gastroesophageal Reflux Disease.","authors":"Mohammad Sina Bamedi, Hossein Ansari, Ebrahim Alijani, Hossein Shahriari, Hossein Ali Khazaei, Seyed Ghader Azizi","doi":"10.47176/mjiri.40.76","DOIUrl":"https://doi.org/10.47176/mjiri.40.76","url":null,"abstract":"<p><strong>Background: </strong>Refractory chronic spontaneous urticaria (R-CSU) is characterized by systemic mast-cell-driven inflammation, which may present with extra-cutaneous conditions such as gastroesophageal reflux disease (GERD). The utility of simple blood-derived inflammatory ratios that characterize this systemic inflammation is currently limited. We investigated the neutrophil-to-lymphocyte ratio (NLR), eosinophil-to-lymphocyte ratio (ELR), and platelet-to-lymphocyte ratio (PLR) as potential inflammatory markers in patients with R-CSU, both with and without GERD.</p><p><strong>Methods: </strong>A retrospective case-control study was conducted involving 116 patients with recurrent chronic spontaneous urticaria (R-CSU) between 2023 and 2024 at Ali ibn Abi Talib Hospital in Zahedan. Among these patients, 58 were diagnosed with GERD, while the remaining 58 were not. Initially, GERD was clinically confirmed, after which complete blood count (CBC) parameters were utilized to calculate the neutrophil-to-lymphocyte ratio (NLR), eosinophil-to-lymphocyte ratio (ELR), and platelet-to-lymphocyte ratio (PLR). Group differences were analyzed using Mann-Whitney U tests and multivariate regression, adjusted for potential confounders. Receiver operating characteristic (ROC) analysis was employed to assess diagnostic accuracy.</p><p><strong>Results: </strong>NLR was significantly higher in R-CSU patients with GERD compared to those without GERD (NLR: 2.05 ± 1.7 vs 1.05 ± 0.91, <i>P</i> = 0.041; ELR: 0.26 ± 0.18 vs 0.21 ± 0.11, <i>P</i> = 0.084). In contrast, PLR did not differ significantly (<i>P</i> = 0.500). In the multivariate analysis, NLR remained an independent predictor of GERD comorbidity after adjustment (β = 0.41, <i>P</i> < 0.001). ROC analysis identified an NLR cut-off of 1.24, demonstrating 81% sensitivity and 64% specificity for distinguishing R-CSU with GERD.</p><p><strong>Conclusion: </strong>Elevated NLR and ELR indicate systemic inflammation in patients with refractory CSU and GERD. These findings support the hypothesis that systemic inflammation contributes to extracutaneous symptoms in this population. Routine, readily available CBC-derived ratios may serve as cost-effective markers for identifying systemic inflammatory activity in R-CSU.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"76"},"PeriodicalIF":0.0,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182912","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":"Mechanisms of Vestibular System Damage in Diabetes Mellitus: Implications for Benign Paroxysmal Positional Vertigo Pathogenesis and Recurrence.","authors":"Seyedeh Nazanin Hajjari, Fatemeh Jafarlou","doi":"10.47176/mjiri.40.75","DOIUrl":"https://doi.org/10.47176/mjiri.40.75","url":null,"abstract":"<p><strong>Background: </strong>Diabetes mellitus (DM) is increasingly recognized as an independent risk factor for falls and balance disorders in elderly populations. While diabetic neuropathy and retinopathy are well-established complications, the role of vestibular system dysfunction has been underappreciated. Benign paroxysmal positional vertigo (BPPV), the most common peripheral vestibular disorder, demonstrates markedly increased prevalence and recurrence in diabetic patients, yet the underlying mechanisms remain incompletely understood. Therefore, the aim of the present review was to investigate the mechanism and pathophysiology of vestibular system damage in diabetes and its association with increased risk of BPPV recurrence.</p><p><strong>Methods: </strong>We conducted a narrative review by searching PubMed, Scopus, and Web of Science databases using keywords related to diabetes mellitus, hyperglycemia, vestibular system, and BPPV. Our initial search yielded 847 articles; after screening and manual reference review, 12 studies (4,937 total participants) meeting inclusion criteria were selected for detailed analysis. Study designs included histopathological analyses, cross-sectional studies, retrospective cohorts, and one randomized controlled trial.</p><p><strong>Results: </strong>Evidence identifies four convergent mechanisms: selective saccular hair cell loss, nerve demyelination, disrupted calcium/vitamin D metabolism causing otoconia fragility, and microangiopathy. DM independently predicts BPPV onset (OR 1.5-2.1) and recurrence (>50% vs. 27%), with VEMP latencies correlating with HbA1c levels.</p><p><strong>Conclusion: </strong>Diabetes induces multifactorial vestibular damage, significantly increasing BPPV occurrence and recurrence. Management requires metabolic optimization, vestibular screening with VEMP, vitamin D supplementation, and integration of vestibular rehabilitation.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"75"},"PeriodicalIF":0.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182819","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":"Policy and Systemic Barriers to Accurate Diagnosis of Childhood Apraxia of Speech in Iran: A Policy Brief.","authors":"Mersede Imani-Shakibayi, Talieh Zarifian","doi":"10.47176/mjiri.40.74","DOIUrl":"https://doi.org/10.47176/mjiri.40.74","url":null,"abstract":"<p><p>Accurate diagnosis of Childhood Apraxia of Speech presents a significant clinical challenge in Iran, where the lack of culturally and linguistically appropriate assessment tools frequently leads to misdiagnosis, delayed intervention, and increased healthcare costs. The effective implementation of these tools necessitates sufficient knowledge resources, financial support, and specialized human capital to conduct experimental research and provide equitable, evidence-based clinical services.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"74"},"PeriodicalIF":0.0,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182844","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}