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Reasons for Retraction of Biomedical Articles Written by Eastern Mediterranean and Turkish Authors; A Comprehensive Cross-Sectional Study During 2010-2019
Background: Article retraction means removing a published article from the journal because of ethical issues or scientific errors in order to correct the literature. In this study, we aimed to determine the reasons for retracting biomedical articles written by authors from Iran, Saudi Arabia, Pakistan, Egypt, and Turkey. Materials and Methods: This cross-sectional study included all retracted biomedical articles with first authors affiliated with Iran, Saudi Arabia, Pakistan, Egypt, or Turkey, retracted between September 1, 2010, and September 1, 2019. Data were extracted from Retraction Watch, MEDLINE, PubMed Central (PMC), Clarivate Analytics, and Scopus. Each article’s information was entered into a data collection form and analyzed using SPSS version 24. Results: Of 436 retracted articles, Iran had the highest number (223), followed by Turkey (80), Egypt (72), Saudi Arabia (35), and Pakistan (26). Common causes of retraction included plagiarism, duplication, authorship issues, and fake peer review. In Iran, fake peer review (42.6%) and authorship issues (41.3%) were most prevalent. Significant inter-country differences were found in retraction frequency and causes. The most affected fields were biology, biochemistry, oncology, cardiovascular, surgery, and pathology. Conclusion: The results showed that scientific misconducts (plagiarism, duplication, authorship issues, and fake peer review) were the main reasons for retracting the articles in the five studied countries. To reduce such misconducts, regional regulatory policies, improved editorial practices, and enhanced research ethics training are urgently needed.
Copyright (c) 2026 Galen Medical Journal https://creativecommons.org/licenses/by/4.0
A Comparison of the Antibacterial Effects of Moringa Oleifera and Eucalyptus As Intracanal Irrigants on Enterococcus Faecalis: An in Vitro Study
Background: Enterococcus faecalis has been considered as a main factor for rendodontic treatment failure. Herbal products are increasingly used as their antimicrobial efficacy. This study aimed to investigate and compare the in vitro antimicrobial effects of two plants, Moringa oleifera and eucalyptus, with sodium hypochlorite as the standard irrigation solution against Enterococcus faecalis. Materials and Methods: In the present in-vitro study, thirty mandibular premolars were decoronated, and root canal instrumentation was performed. Each sample was separately autoclaved, inoculated with E. faecalis, and incubated. The samples were divided into six groups based on the type of intervention (n=5 in each group): 1) microemulsion of M. oleifera, 2) microemulsion of eucalyptus, 3) 2.5% sodium hypochlorite, 4) a solution combining both M. oleifera and eucalyptus, 5) positive control, and 6) negative control. The root canals were obturated with gutta-percha and incubated for 90 days. Microbial sampling from the root canals was performed before (S1) and after root canal irrigation (S2), and the viability of microorganisms was reported in terms of the number of colony-forming units. Results: A significant difference in CFU/mL was observed among all groups (P<0.001). The negative control showed complete inhibition, whereas the positive control exhibited >105 CFU/mL. Mean bacterial counts were lowest in the Moringa+Eucalyptus group (4921±3571 CFU/mL), followed by NaOCl (5720 ± 8952 CFU/mL), Eucalyptus (7246±9257 CFU/mL), and Moringa (8053±6247 CFU/mL). Pairwise comparisons revealed no statistically significant differences between the experimental irrigants (P>0.05). Conclusion: M. oleifera and eucalyptus microemulsions exhibited similar antimicrobial effects against E. faecalis, and no synergistic effect of these two extracts was observed.
Evaluation of Outcomes from Pedicle Screw Fixation Before and After Laminectomy
Background: Pedicle screw fixation is a standard technique for spinal stabilization in patients undergoing laminectomy for decompression. This study aims to compare the outcomes of pedicle screw fixation performed before versus after laminectomy. Materials and Methods: This retrospective cohort study, conducted from July 2017 to July 2020 at the Neurosurgery Departments of Imam Reza and Shohada Hospitals in Tabriz, Iran, assessed outcomes of two approaches to pedicle screw fixation in 104 patients undergoing laminectomy for degenerative spinal conditions. The patients were equally divided into two groups of 52: one group receiving pedicle screw fixation before laminectomy, and the other following laminectomy. Key intraoperative parameters—such as blood loss, operative time, and screw placement accuracy—were evaluated and compared between groups. Data were analyzed using SPSS software, employing Independent Samples T-Tests and Chi-square tests, with statistical significance defined at P<0.05. This retrospective cohort study compares two surgical sequences—pedicle screw fixation before versus after laminectomy—in patients undergoing lumbar decompression, aiming to evaluate intraoperative efficiency and short-term outcomes. Results: The laminectomy-first group had a lower infection rate (5.76% vs. 9.61%) and required fewer blood transfusions (96.1% vs. 90.3%) than the screw-first group, though these differences were not significant (P>0.05). Blood loss and drain output were significantly higher in the laminectomy-first group (P<0.05), but surgery duration was shorter (P=0.01), with similar hospital stays between groups. The laminectomy-first approach also required fewer screw path corrections and fluoroscopy uses, indicating greater intraoperative efficiency (P=0.001). Conclusion: This study demonstrates that pedicle screw fixation after laminectomy demonstrated greater intraoperative efficiency with fewer adjustments and reduced fluoroscopy use. However, due to the retrospective nature of the study and lack of systematic documentation of baseline stability and symptom dominance, future prospective or randomized controlled trials are needed to confirm these findings and guide evidence-based surgical decision-making.
Safety and Efficacy of Laser Versus Cryotherapy in the Treatment of Lentigines: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Background: Lentignies is one of the pigmentary skin lesions causing abnormal skin color in sun-exposed areas in particular the hands and the face. In this systematic review and meta-analysis, we aimed to study the safety and efficacy of cryotherapy versus laser in lentigines treatment. Materials and Methods: Beginning from inception and up to 19th May 2023, we did a comprehensive search strategy including five databases (Web of Science=33, Scopus=79, PubMed=28, Virtual Health Library=30 and Scholar=622). The search strategy was performed according to the search term “(“solar lentigines” OR “solar lentigo” OR “lentigines” OR “lentigo”) AND (“laser”) AND (“cryotherapy”)”. Results: total of 5 studies (n=13–120, mean age 39–60) comparing lasers (Q-switched Nd:YAG, PDL, argon, CO2, etc.) vs cryotherapy for solar lentigines, mostly using intrapatient randomization, were included. Meta-analysis revealed no significant difference in marked (OR=1.15, 95% CI [-0.42, 2.73], P=0.151, I²=0.6%) or moderate improvement (OR=0.63, 95% CI [-0.01, 1.26], P=0.055, I²=0%), but lasers yielded significantly higher ≥50% improvement in patients (OR=1.36, 95% CI [0.5, 2.21], P=0.002, I²=0.3%), lower mild (OR=-0.96, 95% CI [-1.65, -0.26], P=0.007, I²=0%) and poor response in lesions (OR=-1.72, 95% CI [-3.2, -0.24], P=0.023, I²=0%). Side effects were comparable; heterogeneity remained very low (I²≤0.9%). Four studies showed high risk of bias. One trial demonstrated fractional CO2 or cryotherapy plus 4% pidobenzone significantly outperformed monotherapy. Conclusion: Laser may be superior to cryotherapy in the treatment of lentigines with comparable side effects among the two groups. However, we recommend further RCTs comparing the two modalities to confirm our findings which had many limitations.
Effect of traditional Chinese medicine external treatment in older patients with nocturia: a meta-analysis
Aim: To assess the efficacy and clinical value of traditional Chinese medicine external treatment (TCMET) for older patients with nocturia. Methods: A systematic search was conducted in PubMed, Embase, Cochrane Library, Chinese National KnowledgeInfrastructure (CNKI), Chinese Biological Medicine Database (CBM), VIP Chinese Science and Technology Journal Full-text Database (VP-CSJFD), and Wanfang database from their inception to September 30, 2024. Studies focusing on applying TCMET for older patients with nocturia were included. Primary outcome measures comprised the times of nocturia, Pittsburgh sleep quality index (PSQI) scores, and overall response rate. The extracted data was analyzed using Stata software (Version 17.0). Results: 15 articles were included in this study, including 580 patients in the TCMET group and 318 patients in the conventional western medicine treatment (CWMT) group. The overall response rate after TCMET treatment in patients with nocturia was 94% [ES = 0.94, 95%CI (0.91, 0.94)]. The number of nocturia episodes after treatment decreased by 2.39 times compared to before treatment [SMD = 2.39, 95% CI (1.30, 3.48)]. TCMET treatment resulted in a 4.77-point decrease in patients’ PSQI scores from baseline [SMD =4.77, 95% CI: 1.67, 7.86]. Compared with CWMT, TCMET did not show significant superiority improve overall response rate and PSQI score (P > 0.05) but reduced the number of nocturia after TCMET treatment [SMD = -2.03, 95%CI (-3.15, -0.91), P < 0.05]. Conclusion: According to the existing literature evidence, TCMET can reduce the times of nocturia and improve sleep quality in older patients with nocturia. It is an effective treatment for older patients with nocturia.
Preoperative Synbiotic Supplementation and Postoperative Outcomes in Elective GI Surgery: A Double-blinded, Placebo-controlled Trial
Background: Surgery harms the gastrointestinal (GI) tract barrier and changes intestinal microbiota composition, disrupting the balance of gut flora. Synbiotics, which are mixtures of beneficial bacteria and chemicals that promote gut flora growth, are particularly important for recovery after GI surgery. We aimed to assess the effect of consumption of synbiotics prior to the gastrointestinal surgeries on complications. Materials and Methods: 40 patients who planned to undergo elective gastrointestinal surgery randomized in a double-blinded, placebo-controlled, phase 3 trial to a single dose perioperative and seven-day postoperative intervention with a synbiotic, LactoCare®, or placebo provided by knowledge-based spin-off company, Zist Takhmir. Randomisation was performed by a computer algorithm. Results: 42.5% of participants were men. Nausea and vomiting occurred in eight patients in the placebo group, and seven patients in the synbiotic group, and the two groups were not statistically significant (P>0.99). Other complications, such as (surgical site infection, fever, surgical site infection, pneumonia, and anastomosis site leakage) were not observed in the placebo or synbiotic groups. In assessing variables dependent on time, the mean time to start oral feeding in the synbiotic group was 32.35±28.84 hours after surgery, and in the placebo group was 28.45±24.91 hours (P=0.796). The first gas passing time was 13.00±15.81 hours in the synbiotic group and 9.65±13.90 hours in the placebo group after surgery(P=0.406). The hospitalisation length of patients in the synbiotic group was 2.6±1.27 days, and for patients in the placebo group was 2.35±1.08 days(P=0.42). Conclusion: Administration of synbiotics as a single dose before surgery and seven days postoperatively did not have a significant effect on infectious complications and time-dependent variables in patients with abdominal surgery.
Transformative Approaches to Biomarker Assessment and Clinical Profiles in Pulmonary Hypertension Patients
Background: Pulmonary hypertension (PH) is a progressive disorder marked by elevated pulmonary arterial pressure, leading to right heart failure and high mortality. Emerging evidence links metabolic disturbances, renal dysfunction, and molecular dysregulation to PH pathogenesis. This study aimed to investigate biochemical and molecular biomarkers associated with PH, focusing on renal, metabolic, and vascular parameters. Materials and Methods: A hospital-based case–control study was conducted at Al-Sadr Teaching Hospital, Iraq, from January to June 2024. Sixty-two PH patients and 30 age- and sex-matched healthy controls were recruited. Fasting venous blood samples were analyzed for urea, creatinine, glucose, insulin, uric acid, troponin I, homocysteine, and KCNK3. Insulin resistance (IR) was estimated using HOMA-IR. Comparisons between groups were performed using independent t-tests, correlations via Pearson’s coefficient, and diagnostic performance assessed using ROC curve analysis. Results: PH patients exhibited significantly elevated urea, creatinine, glucose, insulin, uric acid, homocysteine, and IR (P < 0.05) and reduced KCNK3 levels (P = 0.006) compared to controls. ROC analysis showed IR (AUC 0.903), homocysteine (AUC 0.762), and insulin (AUC 0.808) as effective discriminators of PH, whereas KCNK3 had limited diagnostic accuracy (AUC 0.350). Correlation analysis demonstrated positive associations between homocysteine and insulin/glucose, while KCNK3 inversely correlated with renal and metabolic parameters. Subgroup analysis indicated higher urea and glucose in male patients (P < 0.05). Conclusion: PH is associated with systemic metabolic dysregulation, renal impairment, and molecular alterations, including reduced KCNK3 and elevated homocysteine. Insulin resistance and homocysteine may serve as potential non-invasive biomarkers, highlighting the need for integrated biochemical and molecular assessment in PH management.
Copyright (c) 2025 Galen Medical Journal https://creativecommons.org/licenses/by/4.0
Facilitators and Barriers to Role Adaptation in Newly Graduated Nurses in Medical-Surgical Units: A Qualitative Content Analysis Study
Background: The high turnover rate among newly graduated nurses (NGNs) is a significant concern globally, particularly in medical-surgical units (MSUs). Identifying the key facilitators and barriers to their professional role adaptation is crucial for improving retention and facilitating a smoother transition into clinical practice. This study explored facilitators and barriers to professional role adaptation among NGNs in MSUs. Materials and Methods: A qualitative study was conducted using inductive content analysis. Twenty-one NGNs with less than one year of clinical experience were purposively selected from teaching hospitals affiliated with Tehran University of Medical Sciences. Data were gathered through semi-structured in-depth interviews and analyzed using Graneheim and Lundman’s five-step approach with MAXQDA software. Results: The findings revealed that multiple interacting factors shape role adaptation at three levels: individual, interpersonal, and organizational. Facilitating factors included personal motivation, clinical preparedness, supportive colleagues, and structured organizational support. In contrast, barriers such as stress, lack of structured orientation programs, negative work culture, and excessive workload hindered adaptation. Conclusion: This study revealed that the adaptation of NGNs to professional roles in MSUs is shaped by individual, interpersonal, and organizational factors. Enhancing structured support at all three levels — through targeted educational programs, professional communication, and organizational infrastructure — can improve transition outcomes, reduce early turnover, and promote workforce retention in healthcare settings.
Comparing the Effect of Subcutaneous and Intradermal Mesotherapy on Pain and Function in Knee Osteoarthritis: A Randomized Clinical Trial
Background: Knee osteoarthritis (KOA) is the most common form of osteoarthritis and is associated with pain and functional impairment. Mesotherapy, which involves localized intradermal or subcutaneous injection of active agents, may provide targeted pain relief. This study aimed to compare the effects of intradermal and subcutaneous mesotherapy on pain and function in patients with KOA. Materials and Methods: A single-center, randomized, assessor-blinded clinical trial was conducted in Isfahan, Iran, between 2023 and 2024 among patients with mild-to-moderate KOA. Each patient received six sessions of intradermal or subcutaneous piroxicam-lidocaine mesotherapy at six acupuncture points over three weeks (two sessions per week). Pain and function were assessed at baseline, immediately after treatment, and one month after treatment. Statistical analyses included chi-square tests for qualitative variables, independent-samples t-tests for quantitative variables, and repeated-measures analysis of variance to assess changes over time. Statistical significance was set at P<0.05. Results: A total of 50 patients were included. The demographic characteristics and baseline pain and function scores did not differ significantly between the two groups. At the one-month follow-up, the intradermal group showed significantly greater improvement, with a mean difference in pain score reduction of 1.6 points (95% CI: 0.57 to 2.67, P=0.003) compared to the subcutaneous group. For dysfunction scores, the intradermal group demonstrated immediate post-treatment benefits (mean difference: 9.4 points, 95% CI: 1.36 to 17.44, P=0.02), with sustained improvement at the one-month post-treatment follow-up (mean difference: 15.5 points, 95% CI: 7.95 to 23.01, P<0.001). Repeated measures ANOVA showed that pain and dysfunction scores significantly changed over time in both groups (P<0.001). Conclusion: Both subcutaneous and intradermal mesotherapy appeared to be effective short-term treatments for patients with KOA. However, intradermal mesotherapy demonstrated greater effectiveness at the one-month follow-up, with superior pain reduction and functional improvement compared with subcutaneous mesotherapy.
Evaluation of the Predominant Dietary Pattern and Sleep Disorders in Obese Diabetic Patients and Non-diabetic Obese Individuals
Background: Objective: Diabetes mellitus is a chronic metabolic disorder and a major public health concern worldwide, particularly in developing countries. Dietary habits and sleep quality are important factors influencing metabolic health and diabetes outcomes. This study aimed to compare dietary patterns and sleep disorders among obese patients with diabetes and obese individuals without diabetes. Materials and Methods: This quasi-experimental study was conducted in 2023 on 140 obese adults, including 70 patients with diabetes and 70 non-diabetic individuals, who attended the endocrinology subspecialty clinic of Imam Khomeini Hospital in Ahvaz, Iran. Dietary intake was assessed using a 147-item Food Frequency Questionnaire (FFQ), while sleep quality and daytime sleepiness were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), respectively. Healthy, traditional, and Western dietary patterns were identified and compared between the groups. Results: No significant difference was observed in mean age between the two groups. However, diabetic participants had significantly higher body weight than non-diabetic subjects (P=0.02). Sleep quality was poor in both groups, but diabetic patients had significantly worse PSQI scores than non-diabetic individuals (13.35±1.26 vs. 9.41±0.98, P=0.001). Consumption of fruits, vegetables, and low-fat dairy products did not differ significantly between groups, whereas intake of high-fat dairy products was significantly higher among diabetic patients (P=0.03). Adherence to the traditional and Western dietary patterns was associated with a 4.42-fold and 3.63-fold increased risk of type 2 diabetes, respectively, while no significant association was found for the healthy dietary pattern. Conclusion: Obese patients with diabetes exhibit poorer sleep quality and less favorable dietary habits than obese non-diabetic individuals. These findings highlight the importance of promoting healthy dietary patterns and improving nutritional awareness to support diabetes prevention and management.
Effect of Tamsulosin on Osteopontin Gene Expression in Preventing Ethylene Glycol-Induced Kidney Stone in Male Wistar Rats
Background: Tamsulosin, an α1-adrenergic receptor antagonist, has been proposed as a potential therapeutic agent against urolithiasis-induced renal damage. However, limited in vivo evidence exists regarding its renoprotective mechanisms. Materials and Methods: Forty male Wistar rats were randomly allocated into four groups (n=10/group): positive control, negative control (ethylene glycol-induced urolithiasis), prevention (tamsulosin administered simultaneously with ethylene glycol), and treatment (tamsulosin administered after model induction). Biochemical parameters including serum creatinine, urea, uric acid, calcium, and phosphorus were measured using rat-validated commercial kits (Pars Azmun, Iran). Normal ranges were defined based on published reference values. Gene expression was analyzed by qPCR using the 2^−ΔΔCt method. Study design and reporting followed the ARRIVE checklist. Results: At day 30, the prevention group exhibited significantly lower serum creatinine (0.60 ± 0.08 mg/dL) compared to the negative control (0.98 ± 0.12 mg/dL, P<0.01). Although urea levels were slightly higher in the prevention group (4.0 ± 0.7 mg/dL) versus the negative control (3.22 ± 0.6 mg/dL), the calculated BUN/creatinine ratio was significantly improved (46.7 vs. 33.0, P<0.05). No significant changes were observed in serum calcium or phosphorus. Gene expression analysis showed upregulation of protective markers in the prevention group. Conclusion: In vivo findings on the beneficial effects of tamsulosin on the renal profile in ethylene glycol-induced urolithiasis illustrate its protective effects on the renal system through improvement of creatinine clearance and BUN/creatinine balance. This underscores its probable use as a protective therapeutic agent against renal injury of crystallization origin.
Surface Topography and Pushout Bond Strength of Glass Fiber Posts with Different Surface Treatments to Root Dentin Following Cementation by Precuring and Co-Curing Methods
Background: This study assessed the surface topography and pushout bond strength (PBS) of glass fiber posts (GFPs) with different surface treatments to root dentin following cementation by precuring and co-curing methods. Materials and Methods: In this in vitro study, 80 extracted single-rooted premolars were decoronated and randomly assigned to 4 groups (n=20) for surface treatment of GFPs with 20% H2O2, Er,Cr:YSGG laser (2780 nm, 90 mJ, 4.5 W, 50 Hz, 60 seconds) and sandblasting (50 µm aluminum oxide particles, 2.8 bar pressure, 10 mm distance, 20 seconds). No surface treatment was performed in group 4. Each group was randomly divided into two subgroups (n=10) for cementation of GFPs with precuring and co-curing methods. The PBS was measured, the mode of failure was determined, and the surface topography of the posts was assessed under a scanning electron microscope (SEM). Data were analyzed by ANOVA, Tukey, and Dunnett tests (alpha=0.05). Results: The mean PBS of H2O2-treated GFPs was significantly higher in co-curing than precuring method (P=0.04). No significant difference was found between the precuring and co-curing in PBS of GFPs with other surface treatments (P>0.05). The mean PBS of sandblasted, laser-treated, and H2O2-treated GFPs was not significantly different in precuring method. In co-curing cementation, sandblasting significantly decreased the PBS (P=0.04) while laser and H2O2 surface treatments had no significant effect on PBS (P>0.05). Conclusion: The co-curing cementation method yielded a significantly higher PBS than the precuring method in H2O2-treated GFPs. Sandblasting significantly decreased the PBS of GFPs cemented by the co-curing method.
The Impact of the COVID-19 Pandemic on Medical Faculty's Academic Performance and Well-Being
Background: To investigate the effects of stress related to the pandemic on the medical faculty's well-being. Materials and Methods: This study investigated the impact of pandemic-related stress on the well-being of medical faculty at King Abdulaziz University. Using a mixed-methods approach, 82 faculty members completed online surveys, including the GAD-7 and PHQ-9 scales to measure anxiety and depression, and participated in focus group discussions. The analysis explored the relationship between these psychological stress factors and self-reported academic performance across different demographics. Results: A high prevalence of psychological distress was found: 89.6% of faculty reported at least mild anxiety, and 84.4% reported at least mild depressive symptoms. Most participants self-rated their academic performance as good (54.5%) or excellent (36.4%), and 80.5% reported missing no crucial deadlines. Regression analyses revealed a significant positive association between depression severity and higher self-reported academic performance (β = 1.48, p = 0.025). Male gender (OR = 0.20, p = 0.022) and longer weekly working hours (OR = 0.53, p = 0.019) were associated with significantly lower odds of missing deadlines. Anxiety, depression, and other covariates were not significant predictors of overall quality of life. Conclusion: While the pandemic was associated with a high burden of anxiety and depression among faculty, this distress did not translate into widespread self-perceived declines in academic output. The counterintuitive link between higher depression scores and self-reported performance, alongside the protective effect of male gender and increased work hours against missed deadlines, suggests complex coping mechanisms and potential resilience or presenteeism.
Comparison of the Antibacterial Effect of Nano-calcium Hydroxide and Nano-chlorhexidine Against Enterococcus Faecalis
Background: Intracanal medicaments are used to eliminate residual microorganisms and provide a suitable environment for the healing of periapical tissues. This study aimed to compare the antibacterial effect of nano-calcium hydroxide and nano-chlorhexidine as intracanal medicaments against Enterococcus faecalis. Materials and Methods: In this study, 170 single-rooted mandibular premolars were included. After crown removal, canal preparation was performed. Five teeth were randomly selected as the negative control group. Nano-intracanal medicaments were synthesized using the encapsulation method. Drug release tests were carried out, and particle sizes were determined using electron microscopy and dynamic light scattering analysis. Samples were inoculated with E. faecalis for 21 days. Subsequently, five teeth were randomly selected as the positive control group. The remaining samples were randomly divided into four groups of 40 teeth each (20 for day 3 and 20 for day 7). The intracanal medicaments used in each group were: calcium hydroxide, nano-Ca(OH)2-PLGA, 2% chlorhexidine gel, and 2% nano-chlorhexidine gel (MCM-41), respectively. After 3 and 7 days, microbial biofilm samples were collected, and bacterial colony-forming units (CFU) were counted. Two-way ANOVA was used to compare the mean CFU counts among the groups at different time intervals. The significance level was set at 0.05. Results: Based on statistical analysis, on day 3, the 2% nano-chlorhexidine gel (MCM-41) and nano-Ca(OH)2-PLGA groups showed a significantly greater reduction in CFU/ml (P<0.05) compared to the other groups. On day 7, the 2% nano-chlorhexidine gel (MCM-41) and 2% chlorhexidine gel groups demonstrated significantly greater reductions in CFU/ml (P<0.05) than the remaining groups. Over time, the antibacterial efficacy of the nano-formulations declined, whereas the effectiveness of the 2% chlorhexidine gel and calcium hydroxide increased. Conclusion: According to the findings of the present study, nano-formulated medicaments were more effective in eliminating E. faecalis biofilm from the root canal only in short-short term.
Melatoninergic Modulation of Benzene-Induced Pre-Leukemic Alterations in Rats: Effects of Melatonin, Agomelatine, and Luzindole
Background: Benzene is a well-established leukemogen associated with hematotoxicity, oxidative injury, inflammation, and genotoxic alterations, particularly in relation to acute myeloid leukemia (AML). Melatonin has antioxidant and anti-inflammatory properties that may exert protective effects against benzene-induced pre-leukemic alterations. Materials and Methods: This study evaluated melatoninergic modulation in a benzene-induced pre-leukemic rat model. Rats were assigned to five groups (n=8): control, benzene-only, benzene + melatonin (10 mg/kg), benzene + agomelatine (10 mg/kg), and benzene + melatonin + luzindole (0.2 mg/kg). Benzene was administered intravenously as a benzene:2-propanol: distilled water mixture (1:5:5, v/v/v) every 48 h for 4 weeks. Melatonin and agomelatine were administered orally once daily, while luzindole was used to assess melatonin receptor blockade. Hematological indices, leukocyte ratios, platelet parameters, bone marrow micronucleus endpoints, Activin A, Follistatin, MDA, 8-OHdG, CAT, and SOD were assessed. Results: Benzene exposure induced hematological disruption, altered leukocyte and platelet-related indices, increased micronucleus formation, and disturbed oxidative stress markers. Melatonin and agomelatine attenuated several benzene-induced alterations, including changes in erythropoietic indices, micronucleus frequency, leukocyte distribution, platelet-related parameters, MDA, and CAT activity. Luzindole partially reduced selected protective effects, suggesting that some responses may involve melatonin receptor-related pathways. However, inconsistent Activin A trends and unchanged Follistatin levels require cautious interpretation. Conclusion: Melatonin and agomelatine attenuated several hematological, genotoxic, and oxidative alterations in benzene-exposed rats. Luzindole partially modified these effects, suggesting possible melatonin receptor involvement alongside non-receptor antioxidant and anti-inflammatory actions.
Evaluation of The Effect of Acute-normovolemic Hemodilution on Blood Transfusion Rate in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass: A Prospective Randomized and Controlled Trial
Background: Perioperative use of allogeneic blood products is associated with increased mortality, morbidity, and postcardic therapy. The effectiveness of blood preservation strategies such as acute isovolemic hemodilution (ANH) has been demonstrated with varying degrees of success. This study presents an analysis of the effects of isovolemic hemodilution on blood transfusion in patients undergoing cardiopulmonary bypass. Material and Methods: We tested the efficacy of ANH in reducing cardiac morbidity during anesthesia prior to cardiopulmonary bypass using a randomized trial. They were divided into two groups: ANH (88 patients) and standard control (88 patients), both selected as CS. The ANH group aimed to achieve a hematocrit level of 28% by performing full blood exchange with colloids. Patients underwent myocardial protection procedures, including cold blood cardioplegia and anesthesia preconditioning. Outcomes were evaluated by measuring cardiac enzymes, including serum troponin I and creatinine phosphokinase. Changes in demand for cardiovascular and cerebrovascular drugs were also taken into account. Results: Intraoperative fluid balance (crystalloids, colloids, and urine), postoperative fluid balance (crystalloids plus colloids, urine, and chest tube fluid), and RBC concentrate were not statistically different between the two groups (P>0.05). However, the results showed that the hematocrit level was more stable in the ANH group than in the control group. Conclusion: Preoperative ANH provides better hematocrit stability and better cardio protection in patients receiving a myocardial perfusion pump; but does not affect water and urine treatment.
Investigating the Role of Carbohydrates Quantity and Quality in the Incidence of Metabolic Syndrome: A Two-Year Cohort Study
Background: Metabolic syndrome (MetS) defines as a cluster of risk factors and is a global public health problem. Quality and quantity of carbohydrates (CHOs) intake plays a crucial role in the development of MetS. This study aimed to investigate the role of CHOs quantity and quality in relation to MetS. Materials and Methods: This prospective cohort study was conducted among healthy adults aged 18–65 years in Kerdabad, Isfahan, Iran. Participants (n=1904) were selected through a census-based sampling method. Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire (FFQ). CHOs quantity and quality were evaluated using measures such as dietary glycemic index (DGI), dietary glycemic load (DGL), and fiber intake. MetS was defined by established clinical criteria ATPΙΙΙ and assessed annually over a two-year follow-up. Anthropometric measurements, blood pressure, and fasting blood samples were collected at baseline and yearly to monitor metabolic parameters. Statistical analyses included multivariate logistic regression models adjusting for potential confounders including age, sex, energy intake, physical activity, socioeconomic factors, and BMI. Results: Among 1904 participants (45% male; mean age: 39.6 ± 10.2 years; mean BMI: 27.1 ± 4.9 kg/m²), in fully adjusted models, none of the dietary CHOs quantity or quality indices were significantly associated with MetS during the two-year follow-up. Conclusion: quantity and quality of CHOs not significantly associated with MetS after adjusting for confounders. Although some trends indicated potential metabolic effects, these were not statistically significant. Further long-term research with more detailed dietary assessments is needed to clarify these relationships.
Evaluation of Hemodialysis Efficacy for Serum and Salivary Clearance of Urea, Creatinine, and Uric Acid in Chronic Kidney Disease Patients
ackground: Chronic kidney disease (CKD) is a progressive and irreversible loss of kidney function that may progress to end-stage renal disease requiring hemodialysis. While hemodialysis is an established life-saving therapy, simple methods to assess its adequacy are needed. This study evaluated changes in urea, creatinine, and uric acid levels in serum before and after hemodialysis and compared them with salivary levels to assess the adequacy of hemodialysis. Materials and Methods: A case-control study was conducted on 32 patients undergoing hemodialysis and 30 healthy controls. Blood and saliva samples were collected immediately before and after dialysis from patients and controls. Serum and salivary levels of markers were analyzed by biochemical methods. Serum and salivary levels of markers were compared between the patient group and the control group by t-test and the diagnostic accuracy of salivary markers compared to serum markers was evaluated by the receiver-operating characteristic (ROC) curve and area under the curve (AUC). Results: There were significant differences between the serum and salivary levels of urea, creatinine, and uric acid in patients before and after hemodialysis, and also with the control group (P<0.05). There was a positive correlation between the serum and salivary levels of urea, creatinine and uric acid before hemodialysis, and creatinine after hemodialysis. The AUC for salivary urea and creatinine was 0.87 and 0.88, respectively, and the cut-off point for urea and creatinine was 55 mg/dL and 0.5 mg/dL, respectively. The ROC analysis for uric acid was not significant. Conclusion: This study showed that before hemodialysis, the changes in salivary urea, creatinine, and uric acid in CKD patients (in the fasting state) were similar to serum. Additionally, after hemodialysis, changes in salivary creatinine levels were similar to serum. Therefore, saliva analysis is suggested as a non-invasive alternative to serum analysis for assessment of the efficacy of hemodialysis.
The Relationship between Jaundice and Weight Loss after Birth in Neonates Referring to the KOSAR Hospital, Qazvin-Iran
Background: This study aimed to determine the association between the incidence of neonatal jaundice and the weight loss of newborns in postnatal days. Materials and Methods: In this cross-sectional study, 200 infants with jaundice were examined. The required information was obtained from the medical records. In this study, newborns were divided into two groups based on hyperbilirubinemia. Bilirubin level was compared in two groups on the fourth day of referral. Effect of weight loss was determined on hyperbilirubinemia by logistic regression. Results: The study compared 137 healthy neonates with 53 hyperbilirubinemic neonates, finding significantly greater weight loss (0.25±0.18 kg vs. 0.09±0.11 kg, P<0.001) and higher bilirubin levels (17.13±1.05 vs. 12.60±1.89 mg/dL, P<0.001) in the latter group. Hyperbilirubinemic neonates had younger mothers (27.23±3.26 vs. 28.63±3.21 years, P=0.007), lower nulliparity (60.4% vs. 75.9%, P=0.033), and higher breastfeeding rates (96.2% vs. 18.6%, P<0.001). Logistic regression confirmed weight loss as a strong predictor (aOR=2.14×106, P<0.001), with ROC analysis showing high diagnostic accuracy (AUC=0.86-0.88). Optimal cutoffs were 0.175 kg (89% sensitivity) and 4.95% weight loss (91% sensitivity). Maternal and neonatal blood groups also influenced risk. Conclusion: Neonates at risk need to be more closely monitored for jaundice and weighting, thus, early detection and timely treatment can be done.
Novel Antithrombotics in Geriatric PCI for STEMI: Balancing Ischemic Protection with Bleeding Risk
Focused Echocardiography to Guide Management in Acute Decompensated Heart Failure: From Rapid Phenotyping to Therapeutic Precision
Pediatric Dental Management for Children With Special Health Care Needs and Disabilities
Background: Children with special health care needs and disabilities experience a disproportionate burden of preventable oral disease, unmet dental needs, behavioral barriers to treatment, and fragmented access to specialist dental services. Materials and Methods: This scoping review mapped contemporary evidence on pediatric dental management strategies for children with special health care needs, with emphasis on prevention, behavior guidance, interdisciplinary care, teledentistry, and service delivery. A structured search was planned across PubMed/MEDLINE, Scopus, Web of Science, Embase, the Cochrane Library, Google Scholar, ClinicalTrials.gov, and grey-literature sources for English-language evidence published from January 2015 to August 2025. Evidence was charted using a population-concept-context framework and synthesized narratively according to source type and clinical theme. Results: The final evidence map comprised 20 topic-relevant sources, including systematic reviews, observational studies, qualitative studies, educational program reports, narrative reviews, textbooks, and expert consensus documents. No randomized controlled trial was verified among the cited sources; therefore, the manuscript was framed as a scoping review rather than an effectiveness-focused systematic review. Four major themes were identified: preventive and caregiver-mediated oral-health support, individualized behavior guidance and sensory adaptation, interdisciplinary medical-dental collaboration, and technology-enabled access, including teledentistry. Conclusion: Current evidence supports integrated, family-centered, function-based, and prevention-oriented dental care for children with special health care needs and disabilities. However, the evidence base remains limited by heterogeneous designs, provider-centered outcomes, small samples, narrative sources, and limited comparative child-outcome data. Future research should prioritize prospective multicenter studies using standardized clinical, behavioral, access-related, and quality-of-life outcomes. [GMJ.2026;15:e4270]
Maternal Psychological Distress and Repeated Implantation Failure: A Mini Review
Infertile couples can try assisted reproductive technology (ART) interventions to become pregnant. Repeated implantation failure (RIF) is diagnosed when pregnancy is not achieved after three or more transfers of high-quality embryos. Despite the psychological research indicating that repeated ART failure is strongly associated with negative psychological consequences for both men and women, there are currently no studies addressing the potentially traumatic aspects of the experiences of RIF women. Thereby, we present a summary of the current research to emphasize the intersections between traumatic experiences and RIF, particularly the different features of RIF women in ART programs potentially more at risk for trauma. The aim of this study is to examine the role of psychological factors in RIF and to emphasize the need for further research to better understand these processes in ART treatments for women with RIF.
Synthesizing Evidence on Adverse Events of Perioperative Clonidine: An Umbrella Review
Background: Clonidine, a potent α2-adrenoceptor agonist, is used in anesthesia for its sedative and analgesic properties, but its administration requires careful monitoring due to potential risks of hypotension and bradycardia. As there are increasing number of trials on clonidine, this study aimed to synthesize a conclusion on unwanted consequences of clonidine use in the perioperative period. Materials and Methods: This umbrella review synthesizes evidence on adverse events associated with perioperative prescription of clonidine, following the PRIOR guidelines using three prominent databases of Scopus, PubMed, and Web of Science with a strategic combination of keywords. Studies included were systematic reviews, meta-analyses, and network meta-analyses published in English; studies reviewing prescribing systematic clonidine perioperative; and reporting adverse events. Primary outcomes were cardiovascular events, respiratory, neurological, and gastrointestinal complications. Data were extracted systematically by two independent reviewers and analyzed using random effects models in Stata. Pooled odds ratios and mean differences were calculated, with heterogeneity assessed using the I² statistic. Results: Our umbrella review of 8 systematic review studies including 223 studies from 1980 till now; all of which included only randomized controlled trials (RCTs). The bradycardia analysis, comprising four studies, shows a significant increased risk of bradycardia compared to control (OR: 1.653, 95% CI: 1.013 to 2.700) with some heterogeneity (P=0.0609). Hypotension meta-analysis (four studies) reveals a substantial increased risk (exp(theta): 3.281, 95% CI: 1.696 to 6.347), albeit with moderate heterogeneity (I^2=62.37%, P=0.0355). Heart rate reduction (two studies) and MAP reduction (two studies) meta-analyses indicate significant effects of clonidine, with substantial heterogeneity. Conclusion: Our comprehensive umbrella review highlights significant associations between perioperative clonidine and complications such as bradycardia and hypotension, suggesting the need for careful consideration and further investigation in clinical practice.
The Statistical Scalpel: Sharpening Clinical Research Through Statistical Literacy in Neurosurgery: A Short Review
Modern neurosurgery clearly relies on evidence-based medicine. The integrity, interpretation, and application of research depended on a solid understanding of the statistical methods used. This review highlights the important need for neurosurgeons and trainees to gain proficiency in basic statistical concepts. We emphasize this need throughout the research process—from forming hypotheses and defining variables to selecting tests, analyzing power, and interpreting key indices. Also, we provide practical guides for choosing suitable statistical tests and translating research findings into useful clinical metrics. We believe that statistical literacy is not an extra skill but a key part of clinical expertise and academic success. It allows neurosurgeons to evaluate literature, conduct valid research, and effectively apply evidence in patient care.
Intravascular Imaging–Guided Percutaneous Coronary Intervention: A Critical Appraisal of Evidence and Clinical Practice
Intravascular imaging has emerged as a critical adjunct to percutaneous coronary intervention (PCI), providing detailed insights into coronary anatomy, plaque morphology, and stent optimization beyond conventional angiography. Despite advances in PCI, adverse outcomes such as stent thrombosis and restenosis persist, often related to suboptimal lesion assessment and stent deployment. This review critically evaluates contemporary evidence from randomized controlled trials, large registries, and meta-analyses comparing intravascular imaging–guided and angiography-guided PCI. Current data consistently demonstrate that imaging guidance, particularly with intravascular ultrasound (IVUS), improves procedural optimization and reduces adverse cardiovascular events, with the greatest benefit observed in complex coronary lesions. Optical coherence tomography (OCT) provides superior spatial resolution and enhances detection of stent-related complications, although its impact on clinical outcomes appears more context-dependent. While recent guidelines strongly endorse intravascular imaging in complex PCI, real-world adoption remains limited due to economic, procedural, and training-related barriers. Variation in study design and variability in imaging protocols further complicate interpretation of existing evidence. Intravascular imaging–guided PCI represents a transition toward precision-guided coronary revascularization. Future research should focus on standardized imaging strategies, long-term outcomes, and integration with emerging technologies to optimize patient selection and procedural outcomes.
Comparative Bibliometric Analysis of Herbal Medicine Research in Chinese and Iranian Complementary and Alternative Medicine (CAM) Clinical Trials
Background: Traditional medicine, rooted in ancient history, resurged due to concerns over synthetic pharmaceuticals’ adverse effects. This study goal was to conduct a bibliometric analysis of herbal medicine research in Iranian and Chinese CAM clinical trials to identify trends, patterns, and differences in research productivity. Materials and Methods: This bibliometric study compared Chinese and Iranian CAM clinical trials using Web of Science data. It focused on RCTs, applying search terms for CAM and Chinese or Iranian CAM, with exclusion criteria to filter out irrelevant publications. The dataset included author information, article details, keywords, and citation history. It calculated the Annual Growth Rate (AGR) and used visual tools like the Three-Field Plot to illustrate associations. Additionally, Lotka’s Law was applied to author productivity, and a co-citation collaboration network was analyzed using Bibliometrix r package. Results: Key findings for Iranian CAM include 71 documents by 342 authors with an average document age of 3.11 years. Chinese CAM featured 255 documents by 1857 authors with an average document age of 5.75 years. Iranian CAM showed a negative annual growth rate of -18.05%, while Chinese CAM had a positive rate of 5.65%. The included studies for Chinese CAM span from 2004 to 2024, while those for Iranian CAM range from 2015 to 2024. The most cited Iranian CAM document had 66 citations, and in Chinese CAM, “TONG XL, 2012” and “LIU XL, 2019” had the highest total citations. Decentralized research practices were observed in China, while Tehran and Shiraz universities led clinical trials in Iran. Conclusion: Our study indicates differing research trends in Iranian and Chinese herbal medicine. Iranian CAM research showed a declining trend, with Tehran and Shiraz universities leading clinical trials, while Chinese CAM research displayed a growing landscape with a more decentralized approach among authors.
Diagnostic Performance and Radio–Pathologic Correlation of Image-Guided Biopsy in Head and Neck Lesions: A Systematic Review
Background: Accurate diagnosis of head and neck lesions relies heavily on image-guided biopsy techniques, which facilitate targeted sampling and enable radiologic–pathologic correlation. Increasing use of CT-guided fine-needle aspiration cytology (FNAC) and core-needle biopsy (CNB) necessitates updated evaluation of their diagnostic performance and safety. To systematically identify, appraise, and synthesize published evidence on the diagnostic accuracy, tissue adequacy, and radio–pathologic concordance of image-guided biopsy for head and neck lesions. Materials and Methods: This review followed PRISMA 2020 guidelines and a protocol registered in PROSPERO (CRD420251181567). Searches were conducted across PubMed/MEDLINE, Scopus, Cochrane Library, Web of Science, and Google Scholar (January 2018–September 2025). Eligible studies included human subjects undergoing image-guided FNAC or CNB with reported diagnostic outcomes. Two reviewers independently screened, extracted data, and assessed quality using QUADAS-2. Due to methodological and clinical heterogeneity, meta-analysis was not performed. Results: From 345 records, eight studies met inclusion criteria. Most were retrospective (8/10), evaluating CT-guided FNAC, CNB, or percutaneous needle biopsy across cervical, suprahyoid, salivary, lymphatic, thyroid, and skull base lesions. Diagnostic sensitivities ranged from 85–95%, specificities from 92–97%, and overall accuracies from 90–96%. Diagnostic yield was high (85–100%), and radio–pathologic concordance consistently exceeded 87%. Complications were uncommon and generally minor, except for hilar lymph node biopsies, which showed higher pneumothorax rates. Conclusion: Image-guided biopsy of head and neck lesions demonstrates high diagnostic accuracy and excellent radio–pathologic concordance across diverse anatomic regions, supporting its role as a reliable, minimally invasive diagnostic tool. Despite strong performance in deep and complex spaces, procedure-specific complication risks—particularly in hilar lymph node sampling—should inform clinical decision-making.
Scoping Review of Predictors and Risk Factors for Acute Myocardial Infarction in Patients with Chronic Kidney Disease
Background: Chronic kidney disease (CKD) significantly elevates the risk of acute myocardial infarction (AMI) and associated mortality, with cardiovascular disease accounting for approximately 40% of deaths in CKD patients. Diagnostic and therapeutic challenges arise due to altered biomarker profiles and underutilization of interventions like percutaneous coronary intervention (PCI). This systematic review aims to identify and evaluate predictors of AMI in CKD patients, focusing on clinical, biochemical, demographic, and lifestyle-related risk factors to inform targeted prevention strategies. Materials and Methods: Following PRISMA guidelines, a systematic search was conducted across PubMed, Embase, Scopus, Web of Science, and Cochrane Library up to August 14, 2025, using MeSH terms like “chronic kidney disease” and “myocardial infarction.” Included studies involved adult CKD patients, assessing predictors through observational designs or relevant randomized controlled trial subgroup analyses. Data were extracted by two independent reviewers, with study quality assessed using the Newcastle-Ottawa Scale. Narrative synthesis was employed due to heterogeneity. Results: Twenty studies (54–911,360 participants) identified dyslipidemia, inflammatory (CRP, IL-6) and cardiac biomarkers (NT-proBNP, hs-cTnT), lower eGFR, albuminuria, advanced CKD stage, hypertension, prior AMI, and older age as key AMI predictors. Risk scores (GRACE, PRECISE-DAPT) and novel indices (TyG, TyG-BMI) showed high predictive accuracy. Conclusion: Comprehensive risk assessment integrating biomarkers, clinical factors, and novel indices can enhance AMI prediction and guide interventions in CKD patients, addressing therapeutic underutilization.
Severe Gastroparesis-like Syndrome Following Single-dose Liraglutide Administration: A Case Report
Background: As a GLP-1 analogue, liraglutide is given to patients as a treatment for both obesity and type 2 diabetes. It taken safely most of time, though there are also reports of effects on the digestive system. Case Report: In our case, a 30-year-old healthy female developed severe slowing of her stomach after a single injection of liraglutide (1 mg) for weight loss, without a doctor’s care. Within a few hours of getting the treatment, the patient began having severe abdominal pain and kept vomiting. A thorough review using imaging and lab tests did not find anything wrong with her system to explain her symptoms. It points out that a single dose of liraglutide may result in major gastric motility problems for some patients. She recovered from her condition over two weeks with supportive care which eliminated her symptoms. Conclusion: Further study is required to explain these reactions and to set up rules for safer use of GLP-1 receptor agonists outside the diabetic population.
The Importance of Periodic Electrocardiograms in Individuals with Metabolic Disorders: A Policy Brief
Metabolic disorders, including obesity, type 2 diabetes, metabolic dysfunction-associated fatty liver disease (MAFLD), anemia, and insulin resistance, are increasingly prevalent and represent a major contributor to cardiovascular morbidity and mortality. Emerging evidence indicates that these conditions are associated with prolongation of the corrected QT (QTc) interval, a well-established marker of ventricular arrhythmias and sudden cardiac death. Individuals with metabolic disorders have a significantly higher risk of life-threatening arrhythmias, even in the absence of known cardiovascular disease. Insulin resistance, a central component of cardiometabolic dysfunction, has also been linked to QT interval prolongation. Despite this growing body of evidence, QTc monitoring is not currently included in routine clinical guidelines for the management of metabolic disorders. Electrocardiography (ECG) is a low-cost and widely accessible diagnostic tool that enables early identification of high-risk individuals and supports timely preventive interventions. Routine implementation of baseline and annual ECG-based QTc monitoring has the potential to reduce sudden cardiac death, improve cardiovascular risk stratification, and decrease healthcare costs associated with acute cardiac events. This policy brief advocates for the adoption of a national QTc monitoring strategy as a scalable and cost-effective approach to improving cardiovascular outcomes in patients with metabolic disorders.