The group of melanotic lesions (ML) of the orolabial region is extremely diverse, creating objective difficulties in differential diagnosis. To perform a comprehensive differential diagnostic evaluation and to plan treatment strategies, it is advisable to supplement the clinical classification of ML with objective diagnostic criteria. This retrospective, single-center study was designed according to the principles of clinical examination, including objective examination of the oral cavity, periodontal tissue assessment with evaluation of the Greene-Vermillion hygiene index, periodontal indices (papillomarginal-alveolar - PMA, SPITN), and assessment of the location, size, and staining intensity of ML using the authors' method, followed by statistical analysis. Conservative treatment of diseases of the oral mucosa and periodontium with subsequent dynamic observation was carried out for periods of 3 to 10 years. Statistical processing of the clinical data was performed using Microsoft Excel and the Statistica package, including calculation of the mean and standard error, Student's t-test, and analysis of variance with subsequent pairwise comparisons to determine the probability of error (p). Differences between means were considered statistically significant at P < 0.05. A total of 318 cases of ML in the orolabial region were examined. The size of ML foci was found to increase significantly with the depth and extent of the inflammatory process in the periodontium. Depending on the disease form, the average length of lesions increased more markedly (P < 0.01) than the average width (P < 0.05). According to the authors' method for objective assessment of ML staining intensity in the oral mucosa and lips, comparison of staining intensity with the nosological forms of inflammatory periodontal diseases showed the following patient distribution: degree I in 82 patients (25.8%), degree II in 164 patients (51.6%), and degree III in 72 patients (22.6%). Statistically significant differences for ML degree I were identified between the first and second nosological forms of inflammatory periodontal diseases (P < 0.05). For ML degree II, significant differences were observed between the first and second, first and third, first and fourth, second and third, and second and fourth nosological forms (p < 0.05). Analysis of ML degree III also demonstrated a high level of statistically significant differences between the second and third, and second and fourth nosological forms (P < 0.01). For objective assessment of ML, clinical classification criteria and diagnostic principles were developed that reflect the characteristics of their course depending on the hygienic status of the oral cavity and periodontal tissues. Unification of fundamental approaches to formulating a clinical diagnosis allows for differential diagnosis of ML, planning of treatment and preventive measures, and assessment of disease dynamics using objective criteria.
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. 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. 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. 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.
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. 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). 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). 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.
Retraction serves as a critical corrective mechanism in scientific publishing, preventing the spread of flawed or misleading data. This study aimed to systematically analyze the characteristics of retracted articles within the field of diabetes research, highlight potential vulnerabilities in the integrity of diabetes research, and address gaps in understanding the nature and implications of research misconduct in this crucial medical discipline. This study aimed to analyze retracted publications in the field of diabetes published from 1978 to 2024 using the Web of Science database. Information from the selected articles was obtained through the Retraction Watch Database. Extracted details included the journal title, type of article, country of origin, publication and retraction dates, number of authors, and reasons for retraction. The collected data were analyzed using descriptive statistical methods. Between 1978 and 2024, our review revealed 316 retracted articles. The journals Science (n = 1517) and The Lancet (n = 742) accounted for the highest number of these highly cited retractions, while the journals Biomed Research International (n = 31) and Diabetes (n = 15) accounted for the most cited of these retractions. The most common reasons for retraction were investigations initiated by the journal or publisher and concerns related to data integrity. The years with the highest number of retractions were 2023 (n = 91) and 2016 (n = 40), whereas the majority of retracted articles were initially published in 2022 and 2021 (n = 26). Collaborative research involving authors from China (n = 137), the United States (n = 71), and India (n = 24) was most frequently associated with these retractions. Safeguarding the integrity of scientific literature, particularly in high-stakes fields such as diabetes research, requires a fundamental shift from reactive retractions to multilateral proactive systemic reform. Cultivating an ethical research culture (changing incentives to reward research quality and transparency over quantity by Institutions and funders); empowering researchers (providing the skills for rigorous and ethical research through mandatory, ongoing ethics training); and ensuring vigilant publishing (enforcing clear policies, rapidly investigating issues, and performing transparent retractions to protect the scientific record by journals).
Elastofibroma dorsi (ED) is a rare, slow-growing benign soft tissue mass that typically develops beneath the scapula. It often remains asymptomatic and is incidentally discovered during imaging conducted for other reasons. When symptoms do manifest, they are generally mild and associated with shoulder movement. Due to the potential for ED to mimic more serious conditions on imaging, it is crucial to recognize its characteristic features. This study aimed to evaluate the demographic, clinical, and imaging characteristics of ED in a cohort of patients. This retrospective observational study was conducted using imaging and clinical records archived at a single radiology center. Data were collected from two distinct periods (2013-2016 and 2022-2024) to enhance the study's statistical power and achieve a larger sample size. Scans were included if both the scapular and axillary regions were clearly visible and if complete clinical data were available. Patients with poor image quality, incomplete records, or a history of scapular surgery or malignancy were excluded. Three experienced radiologists independently evaluated the images for predefined features of ED. Cases with disagreement or atypical findings were referred for biopsy. Clinical data, including age, sex, handedness, BMI, symptoms, and occupation, were recorded. Lesion characteristics were quantitatively assessed, and statistical tests were employed to examine associations between clinical variables, lesion features, and interobserver agreement. The prevalence of ED was 1.1% based on 13,042 imaging records. The majority of patients (69%) were women. The overall mean age ± SD was 62.7 ± 7.3 years, with the highest frequency observed in individuals over 50 years of age. Among right-handed patients, 82% (n=112) had unilateral lesions on the right side, while 75% (n=6) of left-handed patients exhibited unilateral lesions on the left side. A total of 63.3% (n=91) of the patients were asymptomatic, with the prevalence of symptoms significantly higher in women (43.4%) compared to men (22.2%). The overall mean lesion size was 55 × 36 mm, which was significantly larger in the heavy manual labor group (mean area = 3060 mm2, SD=450 mm2, P<0.05). In the subgroup analysis of bilateral lesions, the dominant side demonstrated a significantly larger mean lesion area than the non-dominant side (1536 mm2 vs. 1120 mm2, P<0.05). Furthermore, we found that symptomatic patients also had a markedly higher mean lesion area (2257 mm2 vs. 1705 mm2). The mean ± SD HU of the lesions was 33 ± 4.1 (range, 19-48), compared to 46 ± 3.7 (range, 35-55) for the adjacent muscle. Elastofibroma dorsi is more prevalent among women. Most patients remain asymptomatic, and the majority of lesions present unilaterally, in accordance with handedness. Occupational physical activity levels were positively correlated with lesion size, and larger lesions were associated with the presence of symptoms. In bilateral cases, the lesion on the dominant side exhibited greater dimensions than that on the non-dominant side.
This study aimed to determine the prevalence of cardiac arrhythmias in COVID-19 patients undergoing Continuous Renal Replacement Therapy (CRRT) during the first 24 hours of ICU admission. This cross-sectional study was conducted to assess the prevalence of cardiac arrhythmias among 78 COVID-19 patients undergoing CRRT hemoperfusion during the first 24 hours of hospitalization in the ICU of Kowsar Hospital, Semnan, in 2020. Data were collected using a checklist that included demographic characteristics, underlying diseases, and types of cardiac arrhythmias, extracted from patients' medical records in the hospital's medical records department. Data analysis was performed using SPSS software, version 26. The mean (± SD) age of the patients was 54.68 ± 1.61 years. The proportions of males and females were 41% and 59%, respectively. The overall prevalence of cardiac arrhythmia was 21.8%, with bradycardia being the most common type (7.7%). The prevalence rates of heart disease, hypertension, diabetes, and hyperlipidemia were 48.7%, 39.7%, 28.2%, and 26.9%, respectively. Additionally, 20.5% of patients had a history of cardiovascular disease. No statistically significant associations were found between cardiac arrhythmia and age, gender, or underlying conditions such as heart disease, hypertension, diabetes, and hyperlipidemia (P>0.05). However, the prevalence of supraventricular arrhythmia (100%) and ventricular arrhythmia (66.7%) was significantly higher among patients with a history of cardiovascular disease (P<0.001). Our study demonstrated a substantial prevalence of cardiac arrhythmia in COVID-19 patients undergoing CRRT within the first 24 hours of ICU admission. The findings emphasize the importance of recognizing this vulnerable period for arrhythmia development and highlight the need for proactive measures to mitigate risks in this high-risk population.
The Social Determinants of Health (SDH) encompass the systemic conditions shaping daily life and health outcomes. In the Islamic Republic of Iran, health equity and SDH have been institutionalized as core components of sustainable national policy to address the "causes of the causes" behind health disparities. This study aims to evaluate the strategic evolution of Iran's health system, focusing on upstream SDH policies, intersectoral institutional frameworks, national research productivity, and the longitudinal development of monitoring mechanisms established to identify and mitigate inequities. This is a policy review article with qualitative key-informant input, covering the initiation of SDH efforts through the end of 2023. The study analyzed 25 national upstream policies, the functionality of 32 effective intersectoral councils, and the outputs of 38 specialized SDH research centers. Primary data were gathered through 26 semi-structured interviews with key authorities conducted between 2020 and 2023 and verified through member checking. Since the 1980s, Iran has established significant infrastructure, primarily through the Primary Health Care (PHC) network. Key reforms include the Universal Health Insurance Act (1994) and the Comprehensive Welfare and Social Security System (2004). Governance is driven by the Supreme Council of Health and Food Safety. While research output is robust-exceeding 4,200 indexed articles-operational challenges persist, including a 39% out-of-pocket expenditure rate, overlapping council mandates, and the deteriorating impact of international sanctions on equitable access. Iran possesses an advanced architecture for tracking 69 health equity indicators. However, reducing disparities requires moving beyond indicator collection to sustained political commitment, legally institutionalized intersectoral alignment, and translating data into targeted socioeconomic interventions.
Consumer Health Information (CHI) encompasses the dissemination of information and the cultivation of appropriate attitudes toward healthcare, as well as specific professional skills, aimed at altering behaviors and enhancing the health status of consumers. The aim of this study was to introduce the concept, features, and associated issues of CHI, provide an overview of current research, and examine the information-seeking behavior of health information consumers. On February 28, 2025, the keywords "consumer health information," "health literacy," and their related terms were searched in PubMed, Web of Science, Google Scholar, and grey literature sources. Out of 1,058 retrieved records, 55 met the inclusion criteria and were analyzed to extract the relevant characteristics. The findings of this study indicate that consumer health information (CHI) is a dynamic concept that encompasses the provision of information and the enhancement of skills related to healthcare, with the aim of influencing behavior and improving consumers' health. A review of the existing literature demonstrates that the evaluation components of this concept encompass a range that includes comprehensiveness, credibility, readability, and usefulness. Furthermore, the Internet, social media, and artificial intelligence tools serve as the primary platforms for searching for and accessing such information. The results also suggest that challenges such as misinformation, information overload, and limitations in health literacy significantly influence information-seeking behavior, underscoring the necessity for increased attention to the role of librarians as trusted information intermediaries. The necessity of disseminating accurate and reliable health information tailored to consumers' needs is underscored by the increasing trend of scientific output in this domain in recent years. It is essential to develop standard guidelines and regulations, as well as to create appropriate infrastructure for CHI at the macro level. Furthermore, conducting economic studies to evaluate the return on investment and utility of CHI can aid policymakers in their decision-making processes.
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. 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. 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. 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.
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. 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. 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). 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.
Social vulnerability is an inherently context-dependent concept that has recently gained increasing attention within the framework of the social determinants of health. This study aimed to define and conceptualize social vulnerability within the specific context of Iran. A sequential mixed-methods design was employed. An initial pool of indicators was systematically developed through a literature review. The Delphi consensus technique was used to conceptualize social vulnerability in Iranian society by identifying context-sensitive and culturally relevant indicators. Over six months, 23 national experts in health and social welfare participated in three rounds of discussions. To assess the relevance and importance of these indicators, statistical indices, including the mean, standard deviation, and coefficient of variation, were applied. A directed qualitative content analysis was conducted to systematically categorize the indicators into distinct dimensions. Experts identified 65 relevant indicators of social vulnerability. Indicators with the strongest consensus included families living below the poverty line, the unemployment rate, the ratio of marginalized populations, the number of malnourished individuals, people lacking social insurance, the share of housing costs, the number of out-of-school children, the proportion of food expenses in total household spending, education levels below a diploma, and the under-five mortality rate. The ten identified dimensions of social vulnerability in Iran were: Populations at Risk; Family and Gender; Economic; Health Infrastructure and Public Health; Education; Housing and Built Environment; Transportation and Mobility; Crime and Social Security; Emergency Response and Disaster Preparedness; and Social Capital and Institutional Support. In developing countries such as Iran, social vulnerability is strongly influenced by macroeconomic fragility, governance constraints, and cultural factors. Developing a robust, context-sensitive framework for conceptualizing social vulnerability provides a foundation for practical tools to assess and monitor vulnerability more effectively. Ultimately, this approach supports targeted interventions aimed at improving the social determinants of health and enhancing population well-being.
Mental health disorders can significantly impact medical learners, hinder their education, and potentially affect their future practice in profound ways. This study aimed to determine the general health of residents at Tehran University of Medical Sciences (TUMS). We conducted this cross-sectional study in 2016 to assess the general health of 349 TUMS residents, using the General Health Questionnaire (GHQ). The GHQ is a widely used screening tool that evaluates general mental health across 4 domains: somatic symptoms, anxiety and insomnia, social dysfunction, and severe depression. This tool is known for its reliability and validity in identifying individuals at risk for mental health issues. For data analysis, we applied the Mann-Whitney and Kruskal-Wallis tests, logistic regression, and chi-square tests to examine associations among study variables. Overall, general health dysfunction was observed in 54.7% of residents (95% CI, 49.4-59.8). The prevalence of somatic symptoms, anxiety, social dysfunction, and depression was 44.1% (95% CI, 39.3-49.8), 57.6% (95% CI, 52.3-62.7), 23.8% (95% CI, 19.6-28.6), and 51.5% (95% CI, 46.2-56.7), respectively. General health dysfunction was significantly associated with sex, marital status, interest in the field, exercise habits, satisfaction with leisure time and curriculum, use of sleep-aid medications, smoking, residency level, and living arrangements. This study highlights the high prevalence of mental health challenges among residents at TUMS. The findings indicate that a substantial proportion of residents experience general health dysfunction, including anxiety, depression, somatic symptoms, and social dysfunction. These results emphasize the importance of ongoing monitoring and support for residents' mental well-being during their training.
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. 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). 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). 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.
Early detection of cognitive impairments is crucial for preventing progression to dementia. An effective diagnosis necessitates a tool with robust diagnostic characteristics. The Saint Louis University Mental Status (SLUMS) exam is a widely utilized instrument for diagnosing neurocognitive disorders. This study assessed the psychometric properties of its Persian version (P-SLUMS) among Iranian community. This cross-sectional study was conducted with 450 community-dwelling older adults who were referred to one of the Tehran Municipality centers and participated in a cultural program from March to November 2021. Data collection tools included a demographic questionnaire, the Mini-Mental State Examination (MMSE) for concurrent validity, and the SLUMS exam. Dementia was assessed using the Persian version of the Global Deterioration Scale (GDS), while depression was evaluated with the Persian version of the Patient Health Questionnaire-9 (PHQ-9). The SLUMS exam was translated into Persian in accordance with the World Health Organization's protocol. Participants were recruited through convenience sampling based on the inclusion criteria. The P-SLUMS exam was evaluated for content validity, face validity, concurrent validity, and construct validity using Confirmatory Factor Analysis (CFA), as well as reliability, which was assessed over a two-week interval among 20 participants. CFA indicated acceptable model fit indices. The goodness-of-fit indices for the model, including CFI, PCFI, and PNFI, were 0.82, 0.66, and 0.44, respectively, indicating a moderate fit that falls below the recommended thresholds for excellent parsimony. However, these indices are considered acceptable for our sample, which encompasses diverse education levels and a moderate number of items. The tool demonstrated high internal consistency (Cronbach's alpha = 0.866) and excellent test-retest reliability (ICC = 0.979). The P-SLUMS exam is a valid, reliable, and user-friendly tool for early detection of Mild Cognitive Impairment (MCI) and dementia.
Profitability is a fundamental aspect of corporate survival in the pharmaceutical industry, shaped by both firm-level and macroeconomic factors. In Iran, the sector encounters challenges such as reliance on imports, inflation, and sanctions, alongside a lack of empirical evidence regarding the determinants of profitability. This study aims to fill this gap by investigating these factors in listed firms. Panel data from 28 companies listed on the Tehran Stock Exchange (2009-2023) were analyzed using fixed-effects Feasible Generalized Least Squares (FGLS) regression. The dependent variables were return on assets (ROA) and return on equity (ROE). The independent variables included firm-specific factors (e.g., leverage, sales growth) and macroeconomic factors (e.g., GDP, inflation). Diagnostic tests, including unit root, cointegration, and heteroskedasticity tests, were conducted. Results indicated that GDP, money supply, and sales growth were positively associated with profitability. Conversely, interest rates, exchange rates, inflation, government expenditure, leverage, P/E ratio, and liquidity ratios exhibited negative associations. The effects of firm size and tax revenue were mixed. The models accounted for 69-89% of the variation (R-squared), with significant F-statistics (P<0.001). The hypotheses were confirmed, partially supported, or contradicted, as summarized. The profitability of Iranian pharmaceuticals is susceptible to macroeconomic volatility and firm-specific strategies. It is imperative that policies are implemented to stabilize exchange rates and promote domestic production to enhance sustainability.
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. 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. 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. 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.
The provision of unnecessary services within healthcare systems is prevalent, costly, prone to complications, and detrimental to patient care. The aim of the present study is to examine physicians' attitudes toward unnecessary tests and procedures at a referring hospital. This study was conducted as a cross-sectional study. The sampling population comprised all physicians employed at a referral University Hospital in 2024. The study utilized a validated questionnaire to collect data over a 6-month period. Analyses were reported descriptively for qualitative variables as frequency and percentage, and for quantitative variables as mean and standard deviation. Chi-square tests and Fisher's exact test were employed for comparisons. Analyses were conducted using SPSS-22.0. A total of 196 physicians participated in the study, with a mean age of 34.69 (± 9.29) years and an average of 9.45 (± 6.36) years of clinical experience. Approximately 89.8% of the participants regarded the repetition of unnecessary tests and procedures as a significant issue within the healthcare system. About 92.3% reported that patients sometimes or rarely comply with physicians' recommendations to avoid unnecessary procedures. Furthermore, 55.1% identified patient insistence as the primary reason for prescribing unnecessary services. A substantial 83.2% of physicians believed that spending more time with patients and educating them about alternative tests or procedures would effectively reduce unnecessary services. Additionally, 81.6% of physicians considered reforms in medical malpractice follow-up to be effective in decreasing unnecessary service prescriptions, while 88.2% deemed changes to the financing system as effective in this regard. However, 90.8% reported actively working to reduce unnecessary tests. The attitude scores of specialist physicians regarding unnecessary services were significantly higher than those of residents (P-value=0.027). The provision of unnecessary services poses a significant challenge within the healthcare system. The primary causes of this issue include patient insistence and physicians' fear of legal complaints. Addressing this problem necessitates systemic reforms focused on the role of physicians.
Predicting patient outcomes in the emergency department is crucial for effective resource management and enhancing the quality of care. Recent advancements in artificial intelligence have facilitated accurate predictions of patient outcomes; however, consistent evidence regarding the diagnostic accuracy of these models in the emergency department remains limited. Therefore, the aim of the present study was to evaluate the diagnostic accuracy of artificial intelligence in predicting admission status, intensive care requirements, and in-hospital mortality in the emergency department. In the present study, the PubMed, Embase, Cochrane Library, and Web of Science databases were searched from January 2020 to November 2025 using targeted keywords. A total of 34 relevant studies were included in the analysis. Meta-analysis was conducted using Stata v.17 software. The overall diagnostic sensitivity and specificity of the models for predicting admission were 0.77 (95% CI, 0.60-0.93) and 0.78 (95% CI, 0.62-0.95), respectively. For critical care, sensitivity was 0.85 (95% CI, 0.57-1.00) and specificity was 0.86 (95% CI, 0.57-1.00). For mortality, sensitivity was 0.83 (95% CI, 0.60-1.00) and specificity was 0.90 (95% CI, 0.67-1.00). Artificial intelligence models, encompassing both machine learning and deep learning, serve as effective tools for predicting the conditions of emergency patients. The findings indicate that AI holds significant potential to enhance clinical decision-making within the emergency department.
Suicidal behavior is a complex and multifactorial phenomenon rooted in both psychological and biological mechanisms. In recent years, there has been an increasing focus on epigenetic factors, which modulate the influence of environmental factors on the expression of genes associated with emotional and cognitive regulation. This review aims to provide a comprehensive analysis of contemporary scientific data concerning the epigenetic mechanisms implicated in the pathogenesis of suicidal behavior. It synthesizes and systematizes findings published between 2013 and 2024, emphasizing DNA methylation, histone modifications, and non-coding RNA (microRNA and long non-coding RNA) regulation as key molecular pathways involved in impaired neuroplasticity, dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, and dysfunction of neurotransmitter systems. The review highlights the role of epigenetic regulation in genes associated with the serotonergic system (SLC6A4), neuroendocrine stress response (FKBP5), and HPA axis regulation (SKA2, NR3C1, NR3C2), as well as relatively novel candidate genes such as CACNA1C, SIRT1, and IMPA2. It underscores how stress-induced and trauma-related epigenetic modifications contribute to suicidal vulnerability and may underlie the biological heterogeneity observed among individuals exhibiting suicidal behavior. The potential reversibility of epigenetic changes positions them as attractive targets for therapeutic and preventive strategies. Epigenetic changes induced by environmental stressors, traumatic experiences, or mental disorders possess diagnostic and prognostic potential. The integration of epigenetic biomarkers into clinical research may enhance the early identification of individuals at risk, support the development of personalized interventions, and contribute to new approaches in suicide prevention. Overall, epigenetics offers a promising framework for bridging molecular biology with psychiatry and deepening our understanding of the biological mechanisms underlying suicidality.
Hypertension is the primary modifiable risk factor for cardiovascular disease. Our study aimed to assess the prevalence, awareness, treatment, and control of hypertension in southwest Iran. This population-based cross-sectional study was conducted in the enrollment phase of Hoveyzeh cohort study in 10,009 adults aged 35-70 in southwest Iran between 2016 and 2018. Information on demographic characteristics socioeconomic status, Hypertension, comorbidities, family history of Hypertension was collected. Logistic regression was employed to identify the factors associated with hypertension, as well as awareness, treatment, and control. The overall prevalence of hypertension was 26.4% (95% confidence interval [CI]:25.5, 27.3). Among the population, 86.04% (95%CI: 84.7, 87.3) were aware of their condition, 81.18% (95%CI: 79.5, 82.8) were receiving treatment, and blood pressure was controlled in 70.15% (95%CI: 68, 72.2) of the treated hypertensive patients. In the adjusted model, older participants, those with low physical activity, individuals with a family history of hypertension, and patients with a history of diabetes or comorbidities of diabetes and dyslipidemia exhibited higher odds of having hypertension, as well as increased awareness. Additionally, being overweight or obese, married, and illiterate were associated with hypertension. Based on gender, women are more aware of their hypertension, receive more treatment, and have better control than men. The prevalence of hypertension is relatively high; therefore, health promotion strategies, including lifestyle modifications to reduce overweight and obesity and to increase physical activity, are recommended.