Hospital Practices and Research

Abstract The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) showed that over the past decade, the global disability-adjusted life years (DALYs) had increased mainly due to population aging and the associated increase in the incidence of non-communicable diseases (NCDs). In 2021, NCDs caused two-thirds of all-cause mortality, with cardiovascular disease, cancer, chronic respiratory disease, and diabetes accounting for more than 80% of NCD mortality. Thus, NCDs should be prioritized from a public health perspective, with an ambitious Sustainable Development Goal (SDG) of a reduction in NCDs by one-third from 2015 to 2030. Unfortunately, the likelihood of achieving this target appears slim.

Abstract Background: Primiparous lactating women experience complex hormonal, physical, and psychological changes that often impair their sexual function. Non-pharmacological interventions like acupressure and auriculotherapy are promising complementary approaches to address these issues.
Objectives: This systematic review aims to synthesize evidence on the effects of acupressure and auriculotherapy on sexual function, sexual satisfaction, and related health outcomes in primiparous lactating women.
Methods: Electronic databases were searched for relevant studies. We searched for randomized controlled trials, clinical trials, and pilot studies that investigated acupressure or auriculotherapy interventions. Outcomes of interest included sexual function, sexual quality of life, anxiety, depression, sleep quality, and lactation performance. Findings were categorized by intervention type and outcomes.
Results: For this purpose, 13 studies published between 2015 and 2025 met the inclusion criteria. The available evidence suggests that acupressure at specific points (e.g., SP6, CV4) can improve sexual function and increase breast milk volume. Auriculotherapy targeting specific ear points has been shown to improve sexual function, alleviate symptoms of postpartum anxiety and depression, enhance sleep quality, and reduce perineal pain. Both interventions are reported as safe, non-invasive, and low-risk. However, the current body of evidence is limited by small sample sizes, short intervention durations, and limited long-term follow-up.
Conclusion: Overall, this study showed that acupressure and auriculotherapy represent promising complementary therapies for enhancing sexual function and overall well-being in primiparous lactating women. Further large-scale, long-term randomized controlled trials are necessary to confirm these findings and establish standardized clinical protocols.

Abstract Background: Alcohol-based antiseptics are widely used in clinical settings for skin disinfection prior to procedures, with efficacy dependent on both concentration and adequate wet contact time. Despite recommendations to allow antiseptics to air dry naturally, practices such as fanning or blowing are commonly used to hasten drying. The impact of such practices on antiseptic efficacy and safety remains unclear.
Objectives: To systematically map the existing literature on the effects of accelerated drying, particularly through fanning, blowing, or forced evaporation, on the antimicrobial efficacy of alcohol-based antiseptics used for skin disinfection.
Methods: A scoping review was conducted following the Arksey and O’Malley framework and the PRISMA-ScR guidelines. Five databases (PubMed, Embase, Scopus, CINAHL, and Web of Science) and grey literature sources were searched from inception to July 2025. Eligible studies examined alcohol-based antiseptics and assessed drying methods or contact time in relation to antimicrobial efficacy. Data were synthesized thematically.
Results: Eighteen publications met inclusion criteria, comprising experimental studies, clinical guidelines, technical protocols, and reviews. Four key themes emerged: (1) Sufficient wet contact time is essential for antimicrobial efficacy; (2) Fanning or accelerated evaporation reduces microbial kill rates, particularly for Staphylococcus aureus; (3) Surgical and clinical guidelines emphasize complete natural drying due to infection and fire risk; and (4) There is a lack of clinical trials evaluating infection outcomes or real-world adherence to drying recommendations.
Conclusion: Accelerating the drying of alcohol-based antiseptics can compromise antimicrobial efficacy by shortening contact time and has no support in current guidelines. Despite its widespread use, fanning remains unvalidated and potentially harmful. There is a need for clinical research on the impact of drying practices and adherence to protocols in real-world settings.

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.