Hospital Practices and Research

Abstract Background: Treatment adherence is a critical factor in controlling symptoms and determining the success of treatment in chronic disease management.
Objectives: The aim of this study was to investigate the relationship between health literacy levels and adherence to pharmacological treatment in patients with Rheumatoid Arthritis (RA).
Methods: This cross-sectional study included 196 patients. The mean age of participants was 47.35 ± 15.95 years. Socio-demographic and clinical characteristics of the patients were recorded. Health literacy levels were assessed using the Türkiye Health Literacy-32 (THL-32) Scale. Medication adherence to the pharmacological treatment was assessed using the Medication Adherence Report Scale (MARS).
Results: THL-32 and MARS scores were compared according to the demographic characteristics, and a significant difference was found between the education level and place of residence groups. A multivariate regression model was used to assess the connection between them. Health literacy was found to be 3.88 times higher in urban areas compared to rural areas, 4.12 times higher in those with high school education compared to primary school, and 4.39 times higher in those with higher education compared to other levels. In terms of medication adherence, it was found to be 4.18 times higher in urban areas compared to rural areas, 3.1 times higher in those with high school education compared to primary school, and 3.6 times higher in those with higher education compared to other levels.
Conclusion: This study demonstrated that health literacy is positively associated with medication adherence in patients with rheumatoid arthritis. These findings highlight the importance of focusing on health literacy to improve adherence to treatment. Health professionals should prioritize enhancing health literacy to support better disease self-management and treatment outcomes.

Abstract Background: Psychosomatic disorders, characterized by the interplay of psychological and physical factors, often manifest as gastrointestinal symptoms, and traditional medical treatments alone may not effectively address the underlying psychological factors, leading to persistent or recurring issues.
Objective: The present study aimed to investigate whether Intensive Short-Term Dynamic Psychotherapy (ISTDP) is more efficacious than a control group in enhancing ego strength and alleviating gastrointestinal symptoms in individuals diagnosed with psychosomatic disorders.
Methods: A quasi-experimental study with pre- and post-assessments, a two-month follow-up, and a control group was conducted on 32 randomly assigned participants in District 3 of Tehran in 2020. The experimental group received 15 sessions of 90-minute ISTDP, while the control group received no intervention. Participants were assessed using the Psychological Inventory of Ego Strength (PIES) and the Gastrointestinal Symptom Rating Scale (GSRS). Repeated measures ANOVA was used to analyze the data using SPSS-22. Bonferroni post hoc tests were conducted to compare the experimental and control groups at each time point (pre-test, post-test, and follow-up).
Results: Findings revealed a significant difference between the experimental and control groups in terms of ego strength and gastrointestinal dysfunctions at the post-test (P<0.001). ISTDP led to a significant improvement in ego strength and a reduction in gastrointestinal symptoms in psychosomatic patients with gastrointestinal complaints at post-test (P<0.001).
Conclusion: ISTDP is a promising treatment for psychosomatic disorders, particularly those involving gastrointestinal symptoms. ISTDP effectively enhances ego strength, a key factor in mental health, and can also alleviate physical symptoms.

Abstract Background: The process of discharge is one of the important factors related to patient satisfaction. As the final step in the hospital experience, the discharge process is likely to be well remembered by the patient. Even if everything else goes satisfactorily, a slow, frustrating discharge process can result in low patient satisfaction.
Objectives: The present study was carried out with the aim to reduce the time taken in the discharge process. The objectives were to find the average duration in the process of discharge in major clinical wards and to find key steps affecting the duration of discharge.
Methods: A mixed methodology observational study involving Google forms for recording observations and focus group discussions of key stakeholders were used to carry out this study.
Results: The mean duration of discharge process was 372 minutes with the standard deviation of 68.5. The mean time of 248 minutes with a SD of 43.3 was taken for preparation of discharge summary. The mean time of completing files was 164 minutes with a SD of 37.
Conclusion: The biggest bottleneck in the process of discharge was the preparation of discharge summary, followed by the clearance of files from various departments. The common found reasons were overburdened junior residents, lack of planning of discharge, untrained nursing staff, incomplete documentation, patient counseling, lack of manpower, and lack of coordination among nursing staff and junior residents. It is recommended to plan the discharge better and hold regular workplace meetings of junior residents, nursing staff, billing department, and medical superintendent to manage the communication gaps and better coordination.

Abstract Background: Students who have lost a parent often experience low levels of self-efficacy and quality of academic life due to the psychological distress caused by this loss.
Objectives: The study aimed to determine if positive psychology training could improve the self-efficacy and academic performance of students who had lost a parent.
Methods: This quasi-experimental research adopted a pretest-posttest design with a two-month follow-up. The study focused on female senior high school students in Ahvaz, Iran, who had lost a parent in 2022. Forty eligible students were selected through purposive sampling and then randomly assigned to either an experimental group or a control group. The participants in the experimental group received a ten-week positive psychology training intervention, consisting of weekly 90-minute sessions. The control group served as a no-intervention comparison group. The research data, collected using questionnaires on self-efficacy and quality of academic life, were analyzed using a repeated measures ANOVA in SPSS-23.
Results: The results showed that positive psychology training significantly affected the self-efficacy and quality of academic life in participants (P<0.001). The positive psychology group exhibited significantly higher mean post-test scores on both self-efficacy (83.90 ± 7.56) and quality of academic life (146.40 ± 10.64) compared to the control group (45.20 ± 5.35 and 101.05 ± 6.88, respectively).
Conclusion: The study found that positive psychology training can significantly improve the self-efficacy and quality of academic life of students who have experienced the loss of a parent. This suggests that such interventions could be beneficial for supporting the overall well-being and academic success of these students.

Abstract Background: Health Literacy (HL) is closely related to health status. Measuring public HL levels helps to warn about health status and manage health problems through timely interventions. The items of relevant evaluation tools are complex and numerous in Iran, and there is no recognized HL brief scale for the whole population.
Objectives: The aim of this study was to translate the Health Literacy Scale Short-Form (12-item) (HLS-SF12) and test the validity and reliability of the Persian version of the HLS-SF12 in the Iranian population.
Methods: This research was descriptive with a psychometrics aim. The research population included 289 male and female students from four faculties of Islamic Azad University of Dezful, who were selected using a random sampling method. The Persian version of HLS-SF12 was used to collect data. The construct validity (exploratory factor analysis and confirmatory factor analysis) and internal reliability of the instrument were evaluated. The research data was analyzed using SPSS-26 and AMOS-26 software.
Results: The Cronbach's alpha reliability of the HLS-SF12 and subscales were in the range of 0.72 to 0.88. Exploratory factor analysis confirmed the existence of three factors in HLS-SF12. Confirmatory factor analysis supported the original three-factor model of the questionnaire, and fit indices indicated a good model fit index for Persian HLS-SF12 (GFI=0.961, CFI=0.974, IFI=0.966, TLI=0.971, and RMSEA=0.073).
Conclusion: The Persian version of HLS-SF12 has good reliability and validity, and can be used as a tool to evaluate the HL of Iranian students. In addition, due to the strength of the structure and having appropriate psychometric specifications, HLS-SF12 had the capability to be used by researchers.

Abstract Background: Leishmania major is one of the main causative agents of cutaneous leishmaniasis in many world regions, including Iran. Common treatments for this disease include pentavalent antimonial compounds, amphotericin B, and paromomycin-based formulations. However, these treatments face challenges such as drug resistance, high toxicity, and high costs. Consequently, there is a growing need for alternative therapeutic approaches.
Objectives: The present study evaluates the inhibitory effect of nano-chitosan loaded with Allium ursinum (A. ursinum) extract against L. major under in vitro conditions.
Methods: Initially, chitosan/extract nanoparticles (NChi/Ex) were synthesized by loading A. ursinum extract onto chitosan, and their physicochemical properties were analyzed using Fourier-transform infrared spectroscopy (FTIR), dynamic light scattering (DLS), and field emission scanning electron microscopy (FESEM). Subsequently, Leishmania major parasites were cultured in RPMI 1640 medium, and the effect of NChi/Ex on the parasites was assessed using the MTT assay.
Results: The results showed that the average size of the synthesized nanoparticles was 145.3 nm, with a polydispersity index (PI) of 0.277, indicating a relatively uniform particle distribution. The FTIR spectrum confirmed the successful loading of A. ursinum extract onto chitosan, as characteristic peaks corresponding to the functional groups of both components were observed. The NChi/Ex nanoparticles exhibited a dose-dependent inhibitory effect, with the highest inhibition occurring at a concentration of 50 µg/ml after 48 hours, achieving 100% inhibition of Leishmania major.
Conclusion: The results demonstrated that NChi/Ex exhibited greater efficacy than chitosan or A. ursinum extract alone. This study underscores the potential of chitosan nanoparticles loaded with A. ursinum extract as a promising therapeutic strategy against Leishmania major, with potential applications in laboratory research and possibly in animal models.

Abstract Background: Multiple Sclerosis (MS) is the most common demyelinating inflammatory disease of the central nervous system. Rituximab is an anti-CD20 monoclonal antibody used as a primary drug for MS; however, it can cause injection and post-consumption side effects.
Objectives: This study aimed to determine the side effects of rituximab in patients with Multiple Sclerosis.
Methods: This descriptive-analytical study focused on MS patients who had received Rituximab and regularly visited Isfahan Multiple Sclerosis clinics in 2021. These patients had received at least two doses of Rituximab (1000 mg), and their symptoms and examinations were documented during face-to-face visits using checklists. The data were analyzed using SPSS version 22.
Results: In this study, 150 patients with MS participated. The number of attacks (more than one) before and after using Rituximab was 22% and 4.7%, respectively. The mean EDSS score among them before and after Rituximab was 3.53 ± 1.30 and 3.66 ± 1.51. 68.7% of the patients showed infusion side effects, such as a sore throat and dyspnea. Moreover, post-consumption side effects included muscle spasm, weight gain, arthralgia, and edema of the extremities.
Conclusion: The mean EDSS score before and after using Rituximab showed a slight increase, indicating no significant effects on improving dysfunctions, but the attack rate was reduced.

Abstract Background: Mothers of children with Autism Spectrum Disorder (ASD) often experience significant social stigma and challenges with distress tolerance, impacting their well-being and parenting effectiveness.
Objectives: This study aimed to evaluate the effectiveness of mindfulness-based parenting training and transdiagnostic therapy in reducing social stigma and improving distress tolerance among these mothers.
Methods: This study utilized a quasi-experimental, pretest-posttest control group design with three-month follow-up assessments. The target population comprised mothers of children aged 5 to 12 years, diagnosed with ASD, who were attending autism centers in Mashhad during 2024. A convenience sample of 45 mothers was recruited and subsequently randomly allocated to two experimental groups and a single waitlist control group. Data collection instruments included the Social Stigma Scale and the Distress Tolerance Scale. Statistical analyses were conducted using repeated measures analysis of variance (ANOVA), with Bonferroni post-hoc tests employed for pairwise comparisons.
Results: Findings demonstrated that both the mindfulness-based parenting intervention and transdiagnostic therapy yielded statistically significant reductions in perceived social stigma and increases in distress tolerance at both the post-test and follow-up assessments when compared to the control group (P<0.001). Additionally, no statistically significant difference was observed in the effectiveness between the two intervention modalities, indicating that they were statistically equivalent in their impact on social stigma and distress tolerance.
Conclusion: This research demonstrated that both mindfulness-based parenting and transdiagnostic therapy effectively reduced social stigma and improved distress tolerance in mothers of children with ASD, with sustained benefits observed during follow-up. Clinicians can consider either, or a combined approach, as both yielded equivalent improvements. This allows tailored interventions based on individual needs and preferences.

Abstract Background: Spiritual health literacy, as a multidimensional concept, encompasses the knowledge, awareness, and abilities necessary to understand spirituality, spiritual values, and spiritual connections in students' lives.
Objectives: This research was conducted with the aim of qualitatively analyzing the factors affecting spiritual health literacy in students.
Methods: The design of this qualitative research was based on the framework of thematic analysis. The statistical population included all specialists and experts in the field of health literacy and spiritual health at Gonabad University of Medical Sciences in 2024. By using a purposeful sampling and achieving data saturation, a semi-structured interview was conducted after explaining the purpose of the research. The interview guide was prepared with a combination of open-ended, probing, and supplemental questions regarding spiritual health literacy. With the consent of the participants, all interviews were digitally recorded and transcribed. Saturation was attained after interviewing 13 individuals. Interview data were analyzed using thematic analysis method.
Results: According to the findings of the present study, nine main themes emerged: culture, family factors, education, justice, characteristics of society, modeling, socio-economic conditions, belief in spirituality, and laws. These themes are based on 35 sub-themes, including existing values, Iranian culture, Islamic culture, cultural norms, ethnic structure, familial beliefs, types of relationships, quality of relationships, emphasized values, educational styles, formal education, informal education, methods of advertising, educational perspectives, social equality, individual equality, gender equality, equal conditions, types of democracy, types of policies, types of relationships, emphasized patterns, national heroes, historical heroes, etc., serving as precursors to the concept of spiritual health literacy.
Conclusion: The findings highlight that spiritual health literacy is a multifaceted concept influenced by cultural, familial, educational, and socio-economic factors, and can be cultivated through intentional practices and alignment with cultural values.

Abstract Background: The influence of social media on mental health and body image necessitates investigating its relationship with the pursuit of cosmetic surgery, particularly in women.
Objectives: The present study investigated the associations between social media addiction, psychopathology, and intentions to seek cosmetic surgery in women, examining the mediating role of self-esteem in these relationships.
Methods: This study utilized a cross-sectional, descriptive-correlational design. Two hundred women were recruited via convenience sampling. Participants were included if they expressed intentions to seek cosmetic procedures. Data were collected using the Symptom Checklist-90 (SCL-90), the Social Media Addiction Questionnaire, the Rosenberg Self-Esteem Scale, and the Cosmetic Surgery Tendencies Questionnaire. Statistical analyses were performed using SPSS-22 and AMOS-22.
Results: This study found significant positive correlations between social media addiction and both cosmetic surgery tendencies and psychopathology in women, and a significant negative correlation between self-esteem and cosmetic surgery tendencies (P<0.001). Self-esteem significantly mediated the relationships between both social media addiction and psychopathology with cosmetic surgery tendencies (P<0.001). The model demonstrated a good fit to the data (RMSEA = 0.060, IFI = 0.97, CFI = 0.96, and GFI = 0.96).
Conclusion: This study found significant correlations between social media addiction, psychopathology, and intentions to seek cosmetic surgery in women, with self-esteem playing a crucial mediating role. These findings underscore the importance of integrating self-esteem enhancement into interventions designed to address body image concerns and mitigate the influence of social media and psychological distress on intentions regarding cosmetic procedures.

Abstract Background: Diabetes is a chronic disease requiring ongoing self-care, which can be emotionally challenging and lead to difficulties with coping and adherence, ultimately impacting health outcomes.
Objectives: This study investigated the impact of Acceptance and Commitment Therapy (ACT) on self-care behaviors and coping strategies in individuals with diabetes.
Methods: The present study used a quasi-experimental design incorporating pre-test, post-test, and follow-up assessments with a control group. The study population consisted of female patients aged between 30 and 50 years with a diagnosis of type 2 diabetes who were registered with the Ahvaz Diabetes Association between January and April 2023.Thirty participants with type 2 diabetes were recruited using convenience sampling and subsequently randomly assigned to either the intervention group (n = 15) or the control group (n = 15). The intervention group participated in eight weekly 90-minute sessions of ACT, whereas the control group received treatment as usual. Data were collected at three time points (pre-intervention, post-intervention, and follow-up) using the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire and the Coping Inventory for Stressful Situations (CISS). Repeated measures analysis of variance (ANOVA) was performed using SPSS version 26 for data analysis.
Results: Findings indicated a significant effect of ACT, leading to decreased utilization of avoidance strategies and increased engagement in problem-focused coping and self-care behaviors among individuals with diabetes (P<0.001). Conversely, ACT did not demonstrate a significant impact on emotion-focused coping strategies in this population.
Conclusion: This study supports the potential benefits of ACT for improving diabetes self-care. Significant reductions in avoidance and increases in problem-focused coping and self-care following ACT suggest its potential to empower individuals to actively manage their condition. While ACT did not demonstrate a statistically significant impact on emotion-focused coping, its positive effects on other coping mechanisms and self-care highlight its potential to improve patient outcomes.

Abstract Background: The novel coronavirus has been found to have neurological manifestations, and cerebrospinal fluid (CSF) analysis could be helpful in the differential diagnosis of critically ill patients with neurological symptoms and act as a prognostic factor in these patients.
Objectives: In this study, we assessed the CSF of patients with COVID-19 who presented with encephalopathy to elucidate any common characteristics.
Methods: This cross-sectional study included 36 patients with positive COVID-19 PCR who presented with encephalopathy and were hospitalized. We evaluated RT-PCR, total cell counts, LDH, protein, and glucose levels of CSF samples. Clinical manifestations, neurological complaints, and outcomes (death or survival) were extracted from patients' files.
Results: A total of 36 patients underwent lumbar puncture and CSF analysis. RT-PCR for SARS-CoV-2 RNA was negative in all thirty-six cases. Fever was present in 29 (80.6%) patients, shortness of breath in 23 (63.9%), and cough in 14 (38.9%) as primary clinical manifestations. Seizures were reported in 12 (33.3%) patients as a neurological presentation. The mortality rate was 7 (19.4%) in our cases. Abnormalities in WBC count were found in 6 (16.6%) of CSF samples. The remaining patients had normal CSF results, indicating no specific pattern of CSF markers.
Conclusion: Our study did not reveal any usual patterns in CSF analysis. Moreover, we were unable to detect SARS-CoV-2 RNA in CSF samples definitively. These findings suggest that the indirect mechanisms of SARS-CoV-2 may play a significant role in the neurological manifestations associated with COVID-19.

Abstract Background: Klebsiella pneumoniae is a gram-negative, short, facultative anaerobic bacillus that commonly grows in laboratory culture environments, including blood agar, EMB, Mueller-Hinton agar, and nutrient agar. As an opportunistic pathogen, it poses significant treatment challenges due to increasing antibiotic resistance. Objectives: The purpose of this study is to determine the relationship between antibiotic resistance and the frequency of qnrS and qnrA genes in clinical isolates of Klebsiella pneumonia. Methods: In this study, 100 patients referred to Sina Hospital in Tabriz due to urinary tract infections (UTIs) were examined. Common biochemical tests confirmed the presence of Klebsiella in 20 samples. The antibiotic sensitivity pattern of the isolates was determined using the disc diffusion method, and the results of the antibiogram test were analyzed. The resistance of the samples to five different types of antibiotics was assessed. Results: In this study, the highest antibiotic resistance was observed against nalidixic acid. The presence of the qnrS gene was confirmed in five isolates of Klebsiella pneumoniae, while the qnrA gene was absent in all isolates. The sensitivity of the Klebsiella pneumoniae strain to iron oxide nanoparticles was evaluated using the well method at a concentration of 0.08 g in 100 ml of water. One sample in a volume of 100 ml and two samples in a volume of 200 ml formed halos with diameters of 11 mm, 14 mm, and 12 mm, respectively. Conclusion: The findings of the present study showed that the frequency of qnrS genes was high in fluoroquinolone-resistant samples of Klebsiella pneumoniae, and this factor could lead to progressive antimicrobial resistance in different hospital departments.

Abstract Background: Emergence and dissemination of resistance to carbapenems among carbapenemase-producing Enterobacteriaceae (CPE) has led to limited therapeutic options for patients infected with CPE. Objectives: This study aimed to determine the prevalence of CPE colonization among newly admitted patients scheduled for surgery, identify the risk factors for acquiring CPE, and assess post-surgical outcomes among CPE carriers. Methods: A total of 152 patients scheduled for various types of planned surgery were included in the study. Two rectal swabs were collected from each patient and processed following the CDC-recommended method for screening Carbapenem-resistant Enterobacteriaceae (CRE). Probable CRE colonies were then tested using the mCIM for carbapenemase production according to CLSI guidelines. Patients were followed up after two months to monitor for any post-surgical infections. Surveillance swab sampling was conducted to detect the spread of CPE in the hospital environment by CPE carriers. Results: A high occurrence (15.13%) of CPE colonization was recorded in patients admitted for different planned surgeries. A history of antibiotic therapy was significantly associated with CPE acquisition (P<0.001). A significantly higher proportion of CPE carriers developed post-surgical infections compared to non-carriers (87% vs. 13.1%; P<0.0001). All the patients who developed post-surgical infections with CRE were already harboring CPE in their intestines. On environmental sampling, 15 (65.2%) of the 23 CPE-colonized patients were found to be positive for CPE. Conclusion: High rates of intestinal carriage of CPE among freshly admitted patients, as detected in our study, pose a risk to individuals for CPE infection, leading to antibiotic therapy, long-term hospital stays, and loss of daily wages. Therefore, infection control policies should be formulated by hospitals to screen for CPE carriage during hospital admission, followed by containment of CPE to prevent transmission.

Abstract Background: Today, providing household health expenses for the health system is an important challenge. The increase in health service costs has created some problems. In this regard, the insurance seems to play a key role in such expenses for the household. One of the major problems between healthcare centers and insurance organizations is about the reimbursement of services provided to patients by the insurers according to the contract. Substantial amounts of these expenses, categorized as deductions, are not reimbursed to the healthcare centers by the insurance organizations.
Objectives: The purpose of this study was to investigate the effective measures in reducing insurance financial deductions with an emphasis on the role of insurance.
Methods: The current research was descriptive-analytical and cross-sectional, which was conducted in Shahid Rajaei Hospital of Gachsaran. For this purpose, 170 patients (families) were selected as research samples, and finally 165 patients (families) were included in the study. The research population consisted of 400 employees of Shahid Rajaei Hospital in Gachsaran, and a simple random sampling method was employed to select 196 participants, according to Cochran's formula. A researcher-developed questionnaire with 21 questions was used for data collection. The formal and content validity of the questionnaire was confirmed, and its reliability was verified using Cronbach's alpha. The collected data were analyzed using parametric tests by SPSS software.
Results: The research data indicated that uncompromised elements such as not distorting the date and prescription, having the stamp and signature on insurance prescriptions, transparent and digitally typed medical orders, proper completion of medical procedures descriptions by physicians, accurate and precise registration of equipment, drugs, and supplies, proper registration and documentation of daily requests, and request for basic care instructions in medical and nursing orders, have an impact on reducing insurance financial deductions at Shahid Rajaei Hospital in Gachsaran, across the inpatient, clinical, and administrative departments.
Conclusion: Based on the obtained results, by implementing effective and transparent measures, identifying and eliminating factors contributing to the increase in insurance deductions, it is possible to reduce the disputes between hospitals and insurance organizations. The findings show a significant relationship between health insurance coverage and use of preventive care services, adverse health outcomes, reduced performance, preventable health problems, severe disease at the time of diagnosis, and premature mortality.

Abstract Background: The pervasive impact of depression on cognitive-attentional processes and future hope in young individuals underscores the critical need to investigate targeted interventions. Objectives: This study aimed to evaluate the effectiveness of Acceptance and Commitment Therapy (ACT) in improving Cognitive-Attentional Syndrome (CAS) and enhancing hope for the future in young adults experiencing depression. Methods: A quasi-experimental design was employed with a pre-test/post-test control group. The target population consisted of young adults aged 18-35 years diagnosed with depression, who presented for services at psychology and counseling centers in Ahvaz during 2021. A convenience sample of 40 eligible individuals was recruited and randomized into two groups: an experimental group and a control group, each comprising 20 participants. Data were collected using the Cognitive Attentional Syndrome Questionnaire (CAS-Q) and the Adult Hope Scale (AHS). The experimental group underwent eight weekly 90-minute sessions of ACT, while the control group was placed on a waitlist with no intervention. Analysis of Covariance (ANCOVA) was employed to analyze the collected data. Results: A statistically significant reduction was found in CAS scores (F=255.28, P<0.001, η=0.83) and a significant increase in hope scores (F=296.46, P<0.001, η=0.93) among young adults with depression in the post-intervention assessment within the ACT group, relative to the control group. These findings indicate that ACT is an effective treatment for mitigating maladaptive cognitive-attentional patterns and cultivating greater hope for the future in this demographic. Conclusion: This study provides robust evidence for the efficacy of ACT in reducing CAS and enhancing dispositional hope in young adults with depression. These findings suggest ACT’s potential as a scalable clinical intervention to address core psychological processes and improve long-term mental health outcomes.

Abstract Background: Bulimia nervosa is a complex eating disorder often associated with maladaptive schemas and anxiety sensitivity. Objectives: This study investigated the effectiveness of Compassion-Focused Therapy (CFT) and Emotion-Focused Schema Therapy (EFT) individually on early maladaptive schemas and anxiety sensitivity in women with bulimia nervosa. Methods: This study employed a quasi-experimental, pretest-posttest control group design. The study population consisted of 75 female patients with a confirmed diagnosis of bulimia nervosa, recruited via convenience sampling from those seeking treatment at the Ahvaz Eating Disorders Association. Participants were assigned to one of three groups (n = 25 per group): two experimental groups and a control group. One experimental group received EFT (10 sessions, 90 minutes each), while the other received CFT (8 sessions, 90 minutes each). The control group received no intervention. The Early Maladaptive Schema Questionnaire and the Anxiety Sensitivity Index were used to assess outcomes. Data were analyzed using analysis of covariance (ANCOVA) within SPSS. Results: Results indicated that both treatments significantly reduced early maladaptive schemas and anxiety sensitivity in women with bulimia nervosa. EFT demonstrated greater efficacy, with larger reductions in early maladaptive schemas (η=0.80, P<0.001) and anxiety sensitivity (η=0.74, P<0.001) compared to CFT. The control group showed no significant changes in either outcome. Conclusion: This study revealed that EFT and compassion-focused therapy reduce maladaptive schemas and anxiety sensitivity in women with bulimia nervosa, with the former showing greater efficacy. Future research should explore the mechanisms driving these differential effects and their long-term outcomes. These findings suggest that EFT may be prioritized in clinical settings to effectively target maladaptive schemas and anxiety sensitivity in women with bulimia nervosa.

Abstract Background: Sudden Cardiac Death (SCD) and Acute Coronary Syndrome (ACS) are major public health concerns, particularly in individuals with a family history of early-onset Coronary Artery Disease (CAD).
Objectives: The impact of family history on ACS and SCD risk remains underexplored.
Methods: This retrospective study included 689 patients diagnosed with ST-Elevation Myocardial Infarction (STEMI) who underwent Primary Percutaneous Coronary Intervention (PPCI) between January 2011 and June 2015. Patients with a parental history of SCD due to Myocardial Infarction (MI) were identified (n = 29, 4.2%). Demographic data, cardiovascular risk factors, and angiographic findings were evaluated.
Results: The median age at STEMI onset in patients with a parental history of SCD was 49 (41.5-52) years, 8.9 years younger than their parents’ age at SCD. Most patients were male (96%) and smokers (83%). Hyperlipidemia was present in 80%, although only 7% had been previously diagnosed. Multi-vessel disease was observed in 80%, and 28% required Coronary Artery Bypass Grafting (CABG). Two patients (7%) died due to cardiogenic shock.
Conclusion: Patients with a parental history of SCD develop STEMI at younger ages. Smoking and low HDL levels were key risk factors. Early screening and preventive measures, including smoking cessation and lipid control, were essential for high-risk individuals. Further studies are needed to explore genetic predisposition and targeted prevention strategies.

Abstract Background: Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disease characterized by impaired glucose homeostasis, insulin resistance, and progressive β-cell dysfunction, leading to significant multisystem complications and high global prevalence.
Objectives: This study was conducted to (I) measure and compare concentrations of ghrelin, leptin, and insulin in individuals with T2DM and non-diabetic controls; (II) analyze differences in metabolic profiles between the two groups; and (III) explore potential associations among insulin levels, BMI, and other hormonal and metabolic parameters assessed in the study.
Methods: A case-control study was conducted, comprising 80 individuals diagnosed with T2DM (cases) and 80 non-diabetic controls matched for age, sex, and body mass index (BMI). Clinical data were collected via standardized interviews, and venous blood samples were obtained to assess serum concentrations of ghrelin, leptin, insulin, glucose, lipid profile components, urea, and creatinine.
Results: Compared with the control group, participants with T2DM exhibited significantly higher insulin levels (28.8 ± 23.9 vs. 18.8 ± 13.5 μIU/ml; P = 0.025) and slightly elevated leptin concentrations (7.1 ± 2.7 vs. 5.9 ± 2.2 ng/ml; P = 0.081). Conversely, ghrelin concentrations were significantly lower among cases compared with controls (1189 ± 580 vs. 1531 ± 822 pg/ml; P = 0.038). Glucose (187.4 ± 74.1 vs. 98.3 ± 17.0 mg/dl; P<0.001) and triglyceride levels (212.5 ± 78.9 vs. 143.2 ± 50.4 mg/dl; P<0.001) were also markedly elevated in the cases group. Significant positive correlations were observed between insulin and both glucose (P = 0.011) and triglycerides (P = 0.049), whereas a weak, non-significant inverse correlation was identified between ghrelin and insulin levels (r = -0.213, P = 0.057).
Conclusion: Individuals with T2DM display distinct metabolic and hormonal alterations compared to non-diabetic controls, reflecting a complex endocrine interplay. The presence of both positive and inverse associations among insulin, leptin, and ghrelin highlights the multifaceted regulatory mechanisms underlying the pathophysiology of T2DM.

Abstract Background: IL-1β is a key mediator of inflammation in the body. Upon inflammasome activation, the IL-1 receptor antagonist (IL-1Ra) serves as the primary natural inhibitor of IL-1β by competitively binding to its receptor, thereby limiting inflammatory signaling. Due to this mechanism, IL-1Ra has garnered significant interest as a biological anti-inflammatory drug.
Objectives: This study aimed to produce recombinant IL-1Ra (rIL-1Ra) in E. coli using optimized expression conditions and to develop a highly efficient purification process utilizing Ni/silica-coated magnetic nanoparticles.
Methods: The IL-1Ra gene was cloned into the pET-28a expression vector. The correct construction of the recombinant plasmid was verified by PCR and DNA sequencing. Expression of rIL-1Ra was carried out in E. coli BL21 (T7 Express) under optimized conditions (induction with 0.5 mM IPTG at 25 °C for 16-18 h). The expressed protein was analyzed by SDS-PAGE and Western blot. Purification was performed using Ni/silica-coated magnetic nanoparticles, followed by protein concentration via polyethylene glycol (PEG). The protein concentration was determined by Bradford assay, and the product was subsequently stabilized by buffer exchange into PBS (pH 7.4) through dialysis, supplemented with 10% glycerol, and stored at -20 °C.
Results: PCR and sequencing confirmed the successful construction of the expression cassette, showing the expected ~450 bp insert. SDS-PAGE and Western blot analyses detected a protein of approximately 19.8 kDa, confirming the expression and identity of rIL-1Ra. Maximum soluble expression was achieved under the optimized conditions. Purification using Ni/silica-coated magnetic nanoparticles yielded 10 mg of rIL-1Ra per 1000 ml of bacterial culture (10 mg/L).
Conclusion: The E. coli BL21 (T7 Express) system proved to be an effective and cost-efficient host for producing soluble rIL-1Ra. Furthermore, the use of Ni/silica-coated magnetic nanoparticles provided an efficient and scalable purification method, yielding a substantial amount of the recombinant protein suitable for further research and potential therapeutic applications.

Abstract Background: In 2023, there were 8.2 million Tuberculosis (TB) cases, primarily in South-East Asia. The World Health Organization (WHO) is advocating for increased funding, enhanced diagnostics, and improved healthcare to eradicate TB by 2035. Wealthy nations exhibit lower relapse rates, while poorer countries face higher risks. The challenges of drug-resistant TB and COVID-19 are complicating treatment efforts.
Objectives: This study aims to examine TB recurrence rates in Iran and neighboring countries using data from the WHO. The objective is to comprehend the rate of disease recurrence and the correlations among the results of the studied countries from 2010 to 2023.
Methods: Data on TB relapse cases from 2010 to 2023 in Iran and neighboring countries were analyzed using SPSS v27. Correlations were assessed using Pearson and Spearman tests.
Results: The study highlights TB relapse trends per 100,000 people in the Middle East and Central Asia from 2010-2023. The UAE and Jordan witnessed significant decreases in cases, while Oman and Egypt reported modest declines. Iran initially showed improvement in rates but later experienced an increase, indicating treatment challenges. Lebanon, Saudi Arabia, and Kuwait also achieved lower rates, but Iraq's rates remain high. Yemen and Qatar saw increases, prompting concerns about control. Turkey and Azerbaijan showed improvement, whereas Afghanistan and Pakistan experienced rising cases, suggesting a need for improved strategies. Accordingly, socioeconomic and healthcare factors play a critical role in effectively managing TB.
Conclusion: Enhancing diagnostic and treatment infrastructure in remote, high-incidence areas is crucial for addressing TB recurrence. Training healthcare workers, implementing Directly Observed Therapy (DOT), monitoring drug resistance, addressing social determinants, and conducting awareness campaigns are essential strategies for enhancing community education and treatment adherence.

Abstract Background: Post-Traumatic Stress Disorder (PTSD) affects women at approximately twice the rate of men, often leading to complex symptoms like alexithymia and experiential avoidance.
Objectives: This study aimed to compare the effectiveness of Written Exposure Therapy (WET) and Cognitive Processing Therapy (CPT) on decreasing alexithymia and experiential avoidance in women with PTSD.
Methods: This research was a quasi-experimental study conducted in 2024. The statistical population included all women aged 18 to 40 with PTSD referred to counseling centers and psychological clinics in Tehran. A convenience sample of 90 eligible participants was selected and randomly assigned to a WET group (n = 30), a CPT group (n = 30), and a control group (n = 30). The WET group received five sessions, while the CPT group received 12 sessions. Data were collected using the Toronto Alexithymia Scale and the Acceptance and Action Questionnaire-II, and analyzed using repeated-measures ANOVA.
Results: Both WET and CPT interventions were effective, leading to significant reductions in alexithymia (F = 68.42, P<0.001, η²p = 0.44) and experiential avoidance (F = 59.87, P<0.001, η²p = 0.41) at post-test and three-month follow-up. The findings showed that WET was more effective than CPT in decreasing alexithymia (mean reduction: 16.6 vs. 14.2 points), whereas CPT had a greater effect on reducing experiential avoidance (mean reduction: 12.6 vs. 16.6 points) (P<0.05).
Conclusion: Both therapies significantly reduce alexithymia and experiential avoidance, with WET showing greater efficacy for alexithymia and CPT for experiential avoidance, sustained at three-month follow-up. These findings inform clinicians in selecting targeted interventions based on patients’ predominant symptoms, enhancing personalized treatment for women with PTSD.

Abstract Background: By recognizing the profound influence of premarital patterns and vulnerabilities on long-term marital outcomes, there is a compelling need for robust premarital education programs tailored to diverse cultural contexts.
Objectives: This study aimed to assess how premarital education, specifically approaches based on Dialectical Behavior Therapy (DBT) and acceptance-based approaches in a caregiving relationship, impacted premarital patterns and reduced vulnerabilities among young adults aged 20-40 years in Isfahan, Iran.
Methods: A three-group quasi-experimental design evaluated two distinct premarital education approaches—DBT and acceptance -based approaches in a caregiving relationship—alongside a control group. Data were collected via pre-test, post-test, and a one-month follow-up from a convenience sample of 90 young adults (30 per group) approaching marriage, attending psychological centers in Isfahan during spring and summer 2023. Participants were randomly assigned, and the Premarital Patterns and Vulnerabilities Assessment Questionnaire was used. Both intervention groups received eight 90-minute sessions. Data were analyzed using SPSS 26 with descriptive statistics and repeated measures ANOVA.
Results: Both interventions significantly improved all five premarital patterns and vulnerabilities (maladaptive communication patterns, maladaptive management patterns, couples’ value system, schematic mindset, and detrimental effects of family of origin) at post-test (P<0.01). DBT outperformed acceptance-based approaches in mitigating detrimental effects of family of origin at post-test (P = 0.001, η² = 0.41). At the one-month follow-up stage, DBT showed superior efficacy in addressing maladaptive communication patterns (P = 0.009, η² = 0.12) and detrimental effects of family of origin (P = 0.001, η² = 0.41) compared to acceptance-based approaches, with moderate to large effect sizes.
Conclusion: Both DBT and acceptance-based interventions effectively reduce premarital vulnerabilities and improve relational patterns in young adults. DBT demonstrated superior and sustained efficacy, particularly in addressing maladaptive communication patterns and detrimental effects of family of origin, highlighting its potential for fostering healthier relationship foundations in the Iranian cultural context.