Medical Journal of the Islamic Republic of Iran最新文献

{"title":"Genetic Characterization of Joubert Syndrome with COACH Features and in Silico Prediction of <i>TMEM67</i> Gene Variants Based on Iranome Database.","authors":"Seyyed Saleh Hashemi, Mohammad Amir Beigi Habibabadi, Vahid Tayebi-Khorrami, Pegah Haidari, Saeed Esmaeili Dizghandi, Samaneh Zafarabadi, Shahram Salari, Mahdia Sayed, Ramin Raoufinia, Mehdi Hassani, Hamed Afarande, Mir Salar Kahaei, Amin Tadayoni Nia, Ali Arabnezhad, Setayesh Zamanpour, Karim Naghipour Kojur","doi":"10.47176/mjiri.40.53","DOIUrl":"https://doi.org/10.47176/mjiri.40.53","url":null,"abstract":"<p><strong>Background: </strong>Joubert syndrome (JS) is an uncommon genetic condition presenting with diverse clinical manifestations involving the nervous system, liver, and eyes. A specific form of JS, known as cerebellar vermis hypoplasia, oligophrenia, ataxia, coloboma, and hepatic fibrosis (COACH) syndrome, is primarily associated with variants in the <i>TMEM67</i> gene. This study aimed to identify the causative genetic variant in a patient with JS exhibiting the COACH phenotype and to investigate the spectrum and potential founder effects of <i>TMEM67</i> gene variants within the Iranian population using the Iranome database.</p><p><strong>Methods: </strong>This study reports an 8-year-old girl with a family history of developmental delay who shows clinical features typical of JS with the COACH phenotype. To verify the disease-causing nature of the genetic variant, whole exome sequencing along with in silico analysis was conducted. The variant's conservation across species highlighted its functional significance, and a co-segregation study confirmed its inheritance pattern. Moreover, we collected all <i>TMEM67</i> gene variants identified in the Iranome project.</p><p><strong>Results: </strong>Our investigation revealed a homozygous missense variant in <i>TMEM67</i> (c.725A>G; p.Asn242Ser) in the affected individual. Collective evidence from the Iranome database and previous studies demonstrates that this is a founder variant (c.725A>G) in the Iranian population.</p><p><strong>Conclusion: </strong>This study highlights the intricate nature of JS and its genetic foundations, emphasizing the significance of founder variants in specific populations and the potential of national databases to enhance the precision of genetic diagnoses.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"53"},"PeriodicalIF":0.0,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182727","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":"Provincial Disparities in the COVID-19 Burden: Hospital Data Analysis from Iran.","authors":"Soheila Damiri, Behzad Raei, Hossein Ranjbaran, Rajabali Daroudi, Abolfazl Zendehdel, Reza Bakhtiari Dastgerdi, Zahra Shahali, Roghayeh Esmaeili, Mahboubeh Ghavidast Kuhpayeh","doi":"10.47176/mjiri.40.52","DOIUrl":"10.47176/mjiri.40.52","url":null,"abstract":"<p><strong>Background: </strong>Despite extensive evidence regarding the significant impact of the COVID-19 pandemic on population health in Iran, its effects at the sub-national level and comparisons across different geographic regions have garnered less attention. This study aimed to estimate key disease burden indicators, including incidence rate, mortality rate, case fatality rate, and disability-adjusted life years, across Iranian provinces during 2020 and 2021.</p><p><strong>Methods: </strong>We obtained and analyzed hospital billing records of beneficiaries from the Iran Health Insurance Organization (IHIO) who were admitted for COVID-19 across Iran from the onset of the pandemic until December 2021. We identified cases using the WHO-recommended ICD-10 codes U07.1 and U07.2. In addition to reporting provincial-level rates of incidence, mortality, and case fatality rates, we also assessed disease burden by aggregating Years of Life Lost and Years Lived with Disability. Data management and analysis were conducted using Microsoft Excel Office 19 (Microsoft Corporation).</p><p><strong>Results: </strong>Substantial interprovincial disparities were observed. Semnan (3,331) and Yazd (3,171) recorded the highest incidence rates per 100,000 people, whereas Qom (224) and Alborz (212) reported the highest death rates. In 2020, the highest case fatality rate (18.59%) was recorded in Razavi Khorasan province, while in 2021, the peak rate (12.52%) was observed in Qom province, both rates exceeding the national average. The burden of disease peaked in Qom (4,287) and the central provinces, while the lowest burden was observed in Kohgiluyeh and Boyer-Ahmad (1,042).</p><p><strong>Conclusion: </strong>This study indicates geographic, age, and sex-based disparities in the burden of COVID-19 in Iran. Therefore, future pandemic preparedness policies must account for regional differences and allocate resources equitably based on the needs of various population subgroups. Further research on health inequalities and comprehensive data on social determinants of health is essential.This provides stronger evidence for policymakers to address disparities in COVID-19 case fatality and mortality rates.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"52"},"PeriodicalIF":0.0,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604702","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":"Clinical Evaluation of Two-Stage Revision Total Knee Arthroplasty Using Silicone Mold-Based and Metal Mold-Based Antibiotic-Loaded Knee Spacers: A Comparative Study.","authors":"Mohamad Amin Younessi Heravi, Reza Ganji, Ismaeil Garivani, Negin Armide","doi":"10.47176/mjiri.40.51","DOIUrl":"10.47176/mjiri.40.51","url":null,"abstract":"<p><strong>Background: </strong>The gold standard for managing infection following total knee arthroplasty (TKA) is two-stage revision surgery, which entails the placement of a spacer in the knee during the initial stage. This study aimed to compare metal mold-based and silicone mold-based spacers regarding clinical evaluation and infection control in patients with infected TKAs.</p><p><strong>Methods: </strong>In this study, we assigned fourteen individuals with infected knees following arthroplasty to either the metal mold-based spacer group (control) or the silicon mold-based spacer group. The WOMAC Score, Knee Society Score (KSS), and range of motion (ROM) were utilized for clinical evaluation prior to spacer implantation and during the post-first stage of surgery follow-up. Gain score analysis (post-pre difference) was conducted to assess functional improvement over time. The Wilcoxon signed-rank test and the Mann-Whitney U test were applied for statistical analysis using SPSS software.</p><p><strong>Results: </strong>Knee infection was eliminated in all participants across both groups. Post-surgery, ROM improved from 59.28 ± 20.29° to 99.00 ± 5.65° in the control group, while the intervention group demonstrated an increase in ROM from 66.42 ± 24.78° to 101.42 ± 8.01°. Additionally, the KSS improved from 38.28 ± 23.78 to 123.71 ± 20.53 in the control group and from 35.71 ± 30.99 to 124.85 ± 27.49 in the intervention group. The WOMAC score increased from 48.71 ± 9.23 to 70.57 ± 5.28 in the control group and from 47.71 ± 12.03 to 72.57 ± 6.32 in the intervention group. There were no statistically significant differences between the two groups in terms of ROM (<i>P</i> = 0.751), WOMAC (<i>P</i> = 0.678), or KSS (<i>P</i> = 0.806) in the gain scores analysis.</p><p><strong>Conclusion: </strong>Metal mold-based spacers and silicone mold-based spacers demonstrate no significant differences in functional assessment (ROM, KSS, and WOMAC) or infection control. These findings indicate that silicone mold-based spacers may serve as a reliable alternative to conventional metal mold-based spacers, particularly in low-income countries.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"51"},"PeriodicalIF":0.0,"publicationDate":"2026-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13403875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604802","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":"Health Diplomacy in Times of Crisis: Reflections on the Islamic Republic of Iran's Participation in the Seventy-Ninth World Health Assembly.","authors":"Mohammad-Reza Zafarghandi, Khosro Sadeghniiat-Haghighi, Elham Ahmadnezhad","doi":"10.47176/mjiri.40.50","DOIUrl":"10.47176/mjiri.40.50","url":null,"abstract":"","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"50"},"PeriodicalIF":0.0,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220328","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":"Empathy Throughout the Clinical Years in Iranian Generation Z Medical Students: Validity and Reliability Properties of the Persian Version of the Jefferson Scale of Empathy.","authors":"Somayeh Delavari, Farzaneh Barzkar, Seyed Kamran Soltani Arabshahi, Zohreh Sohrabi, Ahmad Madankan, Neda Rahimian, Mitra Amini, Mohammadreza Pourahmadi, Seyed Vahid Shariat","doi":"10.47176/mjiri.40.49","DOIUrl":"https://doi.org/10.47176/mjiri.40.49","url":null,"abstract":"<p><strong>Background: </strong>The Jefferson Scale of Empathy-Student Version (JSE-S) is among the most widely used instruments for assessing empathy in medical students. This study aimed to evaluate the validity and reliability of the Persian version of the JSE-S among Iranian undergraduate clinical trainees, specifically clerks and interns.</p><p><strong>Methods: </strong>A cross-sectional study was conducted involving 531 medical students. Content validity was assessed using the CVR, CVI, and kappa coefficient, while face validity was evaluated through student ratings. A PLS-based confirmatory measurement model was implemented in SmartPLS 4 to evaluate construct validity and reliability, which included item loadings, CR, AVE, and discriminant validity.</p><p><strong>Results: </strong>The Persian JSE-S exhibited excellent content validity, as indicated by the S-CVI/UA of 0.80, I-CVI of 0.97, and κ ≥ 0.87, along with satisfactory face validity (S-FVI/Av = 0.80). Cronbach's alpha coefficients for the subscales of Perspective Taking, Compassionate Care, and Standing in the Patient's Shoes were 0.846, 0.817, and 0.849, respectively, demonstrating strong internal consistency. The CR values ranged from 0.850 to 0.865. Following the removal of item JSE-18, the AVE for Compassionate Care surpassed the 0.50 threshold, whereas Perspective Taking remained slightly below it at 0.42. Discriminant validity was confirmed through cross-loadings, Fornell-Larcker, and HTMT criteria (all <0.90).</p><p><strong>Conclusion: </strong>The Persian version of the JSE-S demonstrated satisfactory psychometric properties, affirming its reliability and validity for assessing empathy among Iranian Generation Z clinical medical students. Despite minor limitations in convergent validity regarding Perspective Taking, the scale's robust structure, internal consistency, and discriminant validity confirm its utility in educational and research contexts. Further multicenter studies with larger samples are recommended to enhance cross-cultural generalizability.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"49"},"PeriodicalIF":0.0,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182073","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":"Effect of Comorbidities on In-hospital COVID-19 Mortality across Age Groups: A Retrospective Cohort Study in Iran.","authors":"Reza Sadeghi, Mahmood Reza Masoudi, Mohammad Moqaddasi Amiri","doi":"10.47176/mjiri.40.48","DOIUrl":"10.47176/mjiri.40.48","url":null,"abstract":"<p><strong>Background: </strong>COVID-19 has emerged as one of the most significant healthcare challenges globally in recent years, affecting numerous individuals and resulting in fatalities, particularly among older adults and those with comorbidities. While the influence of comorbidities on mortality in COVID-19 patients has been explored in various studies, it has not been examined across different age groups. We evaluated the impact of comorbidities on COVID-19 mortality in three distinct age groups.</p><p><strong>Methods: </strong>A total of 10,496 hospitalized patients with positive PCR results for COVID-19 in Sirjan city were included in the study. Underlying conditions, including diabetes, hypertension, cardiovascular disease, and chronic kidney disease, were documented alongside age, sex, and COVID-19 status. The chi-square test and logistic regression were employed to assess the impact of comorbidities on mortality across different age groups.</p><p><strong>Results: </strong>A total of 2,038 (19.4%) patients had at least one comorbidity. The number of deaths from COVID-19 was 466 (4.4%), of which 197 had comorbidities. Hypertension and diabetes were the most prevalent underlying conditions among COVID-19 patients, occurring in 11.9% and 8.6% of cases, respectively. The presence of comorbidities was significantly associated with mortality in the overall population (OR=3.26, 95% CI: 2.69-3.94) as well as in individuals aged between 30 and 60 years (OR=2.63, 95% CI: 1.77-3.91) and those over 60 years (OR=1.58, 95% CI: 1.26-1.99). Furthermore, the number of comorbidities influenced the mortality rate among COVID-19 patients (OR=1.65 for two comorbidities and OR=1.97 for three or more comorbidities compared to patients with one comorbidity), although it did not vary across different age groups.</p><p><strong>Conclusion: </strong>Comorbidities can influence the mortality rate associated with COVID-19 among individuals aged 30, particularly within the 30-60 year age group. While the presence of multiple comorbidities significantly elevates the risk of death in the overall population, this association was not found to be statistically significant when analyzed by age group.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"48"},"PeriodicalIF":0.0,"publicationDate":"2026-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604882","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":"Prevalence and Content of Generative Artificial Intelligence Use Policies in Iranian Medical Science Journals.","authors":"Maral Alipour-Tehrani, Seyede Mahsa Hojati, Homa Arshadi, Mohammadamin Erfanmanesh","doi":"10.47176/mjiri.40.47","DOIUrl":"10.47176/mjiri.40.47","url":null,"abstract":"<p><strong>Background: </strong>The rapid growth of generative artificial intelligence (AI) tools has created new opportunities for scientific publishing while also introducing challenges related to research integrity and editorial ethics. Although awareness of these opportunities and challenges is increasing globally, there is limited evidence regarding how Iranian journals have addressed the use of AI through formal policies in scientific publishing. This study investigates the prevalence and content of AI use policies in Iranian medical science journals.</p><p><strong>Methods: </strong>A cross-sectional descriptive study was conducted using medical journals listed in the Iranian Research Information System (IRIS). Of the 429 journals initially identified, inactive or inaccessible journals were excluded, resulting in a final sample of 411 journals. From August to October 2025, each journal website was manually examined using a structured checklist designed to assess 25 variables related to the existence and specific content of AI use policies. The data were analyzed using descriptive and inferential statistical methods in Microsoft Excel and SPSS.</p><p><strong>Results: </strong>Among 411 journals, 117 (28.5%) had a publicly accessible AI use policy. The adoption of such policies was significantly more prevalent in English-language journals, those indexed in major international databases, and journals affiliated with the Committee on Publication Ethics (COPE). Among the journals with policies, the most commonly included elements were mandatory disclosure of AI use (99.1%), clarification of permission type (98.3%), and author responsibility (88.0%). In contrast, only a small proportion of journals specified the consequences of policy violations or provided guidance on AI-assisted translation.</p><p><strong>Conclusion: </strong>The findings indicate that AI policy development within Iranian medical science journals remains in its nascent stages. It is essential to establish clearer and more comprehensive AI usage policies to promote transparency, accountability, and responsible AI practices in scientific publishing.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"47"},"PeriodicalIF":0.0,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604522","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 Fully Expert Human-Based Retrieval Augmented Generation (FEH-RAG) Framework: A Proof of Concept Study in Labelling Patients with Sjögren Syndrome.","authors":"Asghar Hajiabbasi, Ahmad Reza Jamshidi, Shervan Shoaee, Irandokht Shenavar Masooleh, Hourvash Ebrahimi, Mahsa Mehdipour Dalivand, Pooneh Ghavidel Parsa","doi":"10.47176/mjiri.40.46","DOIUrl":"10.47176/mjiri.40.46","url":null,"abstract":"<p><strong>Background: </strong>Accurate application of reference standards (RSs) is essential for correct decision-making in areas governed by such standards. Yet in real-world practice, even fully trained users often apply RSs inconsistently, due to cognitive overload, stress, or other contextual factors, generating misleading evidence. This problem is exemplified by the fact that up to 80% of board-certified hematologists mislabel patients with Sjögren syndrome (SS), a connective tissue disorder (CTD) associated with the greatest risk of lymphoproliferative disorders compared to other CTDs. Embedding RS-based consultations with full objectivity into the decision-making layers of digitalized and non-digitalized settings is critical for improving both decision-making and the quality of resulting evidence. The aim of this proof-of-concept (POC) study is to apply a newly developed framework, the Fully Expert Human-based Retrieval Augmented Generation (FEH-RAG) framework, to provide such a foundation for augmenting SS case labeling in routine daily clinical practice.</p><p><strong>Methods: </strong>In this POC study, using the nine steps of the FEH-RAG framework, seven expert end-users systematically selected the most widely used SS classification criteria (SSCC) and extracted their elements, including items, definitions, item weights, and inter-item relationships. Extracted items were profiled based on their usage in routine clinical practice. A pathway layout and decision tables were developed accordingly. Following pathway generation, the residual misalignment of the outputs with the SSCC was assessed in a cohort of patients at risk of SS. The experts predefined that the residual misalignment rate of the FEH-RAG outputs with the SSCC must be ≤2% (95% confidence, using the rule of three).</p><p><strong>Results: </strong>The FEH-RAG framework objectively generated RS-based, transparent, and traceable outputs, including decision tables, an SS classification pathway, and a list of misinterpretations of the SSCC. These misinterpretations involved definitions of dry eye and dry mouth, application of secondary SS criteria, handling SS criteria-specific exclusion rules, and interpretation of serological and objective test results. This POC study achieved its expert-defined maximum misalignment threshold of ≤2% with 95% confidence (0 misalignment in 150 consecutive patients at risk of SS).</p><p><strong>Conclusion: </strong>This POC study established the needed foundation for improving SS case labeling in daily clinical practice across both digital and non-digital settings. As shown here, publishing FEH-RAG outputs while highlighting potential RS misinterpretations offers a transparent and traceable basis for augmenting decision-making in domains governed by RSs.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"46"},"PeriodicalIF":0.0,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13403724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604921","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 Craniofacial Abnormalities and Orthodontic Interventions in Residual Obstructive Sleep Apnea after Adenotonsillectomy in Children: A Scoping Review.","authors":"Mehdi Abrishami, Pegah Alizadeh Pahlavan, Nasim Nikoubakht","doi":"10.47176/mjiri.40.45","DOIUrl":"10.47176/mjiri.40.45","url":null,"abstract":"<p><strong>Background: </strong>Obstructive sleep apnea (OSA) in children is often treated with adenotonsillectomy, yet residual or persistent OSA occurs in 20-75% of cases, particularly in children with craniofacial abnormalities. These structural features contribute to ongoing airway obstruction and highlight the need for phenotype-specific management. The objective of this scoping review was to map the evidence on craniofacial and dentofacial contributions to residual OSA and assess the potential role of orthodontic interventions, particularly rapid maxillary expansion (RME), within a multidisciplinary framework.</p><p><strong>Methods: </strong>This scoping review followed PRISMA-ScR guidelines and Joanna Briggs Institute methodology. A systematic search was conducted in PubMed, Web of Science, and Scopus from January 2010 to December 2025 using combinations of terms related to residual OSA, adenotonsillectomy, craniofacial abnormalities, and orthodontic interventions. Studies including children <18 years with residual/persistent OSA post-adenotonsillectomy were considered. Screening, selection, and data extraction were performed independently by two reviewers, with discrepancies resolved by discussion or a third reviewer. Data extracted included study design, sample size, craniofacial features, orthodontic interventions, outcomes (AHI, snoring, quality of life), and multidisciplinary management.</p><p><strong>Results: </strong>Six studies met the inclusion criteria. Craniofacial features such as high/narrow palate, maxillary constriction, retrognathia, and Class II tendencies were consistently associated with residual OSA, with prevalence up to 93%. Orthodontic interventions, particularly RME, reduced AHI by up to 70%, decreased snoring, and improved quality of life in children with transverse maxillary deficiency. Multidisciplinary approaches involving ENT, sleep specialists, and orthodontists were emphasized for optimal assessment and management.</p><p><strong>Conclusion: </strong>Craniofacial abnormalities are important but under-recognized contributors to persistent pediatric OSA post-adenotonsillectomy. Orthodontic treatments, especially RME, offer a valuable non-surgical adjunct in multidisciplinary care. Current evidence is limited by small sample sizes and few long-term trials. Future research should focus on high-quality, phenotype-driven studies to guide evidence-based management of residual OSA in children.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"45"},"PeriodicalIF":0.0,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604829","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":"Pattern of Healthcare Utilization Related to Hypertension and Associated Factors: A Survey Study in the Capital of Iran.","authors":"Ahmad Mehri, Manoochehr Karami, Mohsen Barouni, Maryam Farhadpour, Seyed Saeed Hashemi Nazari, Koorosh Etemad","doi":"10.47176/mjiri.40.44","DOIUrl":"10.47176/mjiri.40.44","url":null,"abstract":"<p><strong>Background: </strong>Updating hypertension-related healthcare services requires understanding of the utilization status and its associated factors. This study aimed to assess patterns of healthcare utilization related to hypertension and its associated factors in Tehran.</p><p><strong>Methods: </strong>This population-based cross-sectional study was conducted on adult residents over 30 years of age using a multistage stratified random sampling from December 2024 to May 2025. The data were collected using telephone interviews via a researcher-made questionnaire that included demographic information and information on the utilization patterns of health services related to hypertension. Multiple logistic regression was used to evaluate factors associated with health service utilization at the 95% confidence level using STATA-Command Survey software version 18.</p><p><strong>Results: </strong>Among the 4,500 participants, 14.6% (95% CI= 13.4-15.8) reported the utilization of healthcare services in healthcare facilities in Tehran during the past two years, with 22.3% (95% CI= 19.5-25.3) utilization observed among individuals with hypertension. In total, the largest proportion of reasons for receiving related health services were related to having worrying about symptoms (75.5%), good response and behavior from service providers (61.3%), and a high level of centers-doctors/healthcare providers (42.4%). Among the 3843 people who did not receive health services, the greatest proportion were related to financial problems and a lack of favorable insurance status (81.2%) and inadequate health service to meet needs (63.2%). Utilization was significantly related to increasing age (OR =3.94, 95% CI= 2.01--5.09), higher education level (OR =3.74, 95% CI= 1.85--5.02), better socioeconomic status (OR =3.21, 95% CI= 1.61--4.96), having armed forces health insurance good (OR =4.03, 95% CI= 1.27--6.98), and supplementary insurance good (OR =6.13, 95% CI= 2.41--8.14).</p><p><strong>Conclusion: </strong>Utilization of hypertension-related services in Tehran is suboptimal and is not only due to individual inattention but also the result of the interaction of various individual, economic, and social factors, which must be viewed as a package of intervenable issues to improve it.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"40 ","pages":"44"},"PeriodicalIF":0.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604914","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}