Centers In Shiraz Research Articles

Referral pattern of pregnant mother for fetal echocardiography in Shiraz, South Iran

ObjectiveTo evaluate the referral patterns for fetal echocardiography at a tertiary care center in Shiraz, South Iran.MethodThis retrospective cohort study analyzed data from 22,600 pregnant women who underwent fetal echocardiography between January 1, 2016, and December 31, 2021. Information was extracted from a centralized electronic medical record system used by medical centers affiliated with Shiraz University of Medical Sciences.ResultCongenital heart disease was detected in 14.5% of fetal echocardiograms. The mean gestational age at the time of examination was 21.8 ± 4.2 weeks (range: 13–40 weeks). Notably, 75.9% of pregnant women were referred after 19 weeks of gestation. The most common reason for referral was abnormal fetal laboratory screening (triple or quad test).ConclusionIn our center, fetal echocardiography is optimally performed by 19 weeks of gestation. This timing allows for detailed anatomical assessment and aligns with the legal threshold for abortion, ensuring timely counseling and decision-making when necessary. However, in our study, the mean gestational age at the time of echocardiography was 21 weeks, indicating that a significant proportion of patients underwent the procedure later than the optimal timing.

Pre-admission opioid use disorder as a new predictor of in-hospital mortality and six-month outcomes in traumatic brain injury patients: a retrospective longitudinal cohort study.

The present study aimed to investigate the effect of pre-admission Opioid Use Disorder (OUD) on in-hospital mortality and 6-month follow-up TBI outcomes. This study included 2804 patients with TBI admitted to the Intensive Care Unit of Emtiaz (Rajaee) Hospital, a referral trauma center in Shiraz, Iran. Finally, 1087 eligible participants were selected from included patients. Then, 872 discharged patients were followed for six months. Subsequently, unfavorable neurological outcomes (Glasgow Outcome Scale-Extended ≤ 4) and the mortality rate were compared among the patients with and without OUD. The mean age of the patients was 38.0 ± 18.9 years old (84.7% men). About 9.2% of patients had OUD. Opioid users had a slightly lower risk of in-hospital mortality (OR = 0.62, 95% CI = [0.328, 1.183], P-value = 0.148). In contrast, 6-month follow-up mortality significantly increased in the survived patients with a history of pre-admission OUD (OR = 2.49, 95%CI= [1.29, 2.80], P-value = 0.007). Moreover, 6-month unfavorable outcomes were raised in OUD, though it was not significant (OR = 1.59, 95%CI= [0.89, 2.84], P-value = 0.121). Our results revealed that patients with OUD are at increased risk of 6-month follow-up complications and also death following moderate to severe TBI. Although OUD decreased in-hospital mortality, 6-month follow-up indicated that mortality and unfavorable outcomes were increased in the OUD group. Based on the existing evidence, this effect is probably not only due to the destructive impact of pre-admission OUD on brain physiology. However, it may also be due to an increase in opioid consumption to alleviate pain and withdrawal symptoms after hospital discharge.

Evaluating the barriers to information and communication technology adoption among older adults in Iran

ABSTRACT Technology adoption is a complex and multifaceted phenomenon. This qualitative study employed the grounded theory approach to evaluate the barriers to adopting information and communication technology (ICT) among older adults. The study population included all older adults referred to an adult day care center and Comprehensive Health Centers in Shiraz, Iran, from February 2022 to March 2023. Data collection was performed using semi-structured interviews, field notes, and observation. The data were analyzed using the Corbin and Strauss approach. The four main categories extracted were as follows: technology, cultural, social, and personal factors. A total of 13 subcategories were identified, including software characteristics, hardware characteristics, perceived complexity of work, dealing with cultural norms, lack of cyberspace culture, digital divide, ageism, elder abuse, poverty, hand weakness, declining sensory functions, age-related cognitive changes, and the psychological factors. The results found in the present study indicate that there are many barriers to ICT adoption among older adults. Increased awareness and knowledge among community members about the aging process could help reduce negative stereotypes among older adults during the adoption of ICT. Also, educating the community about the proper use of social networks can effectively reduce the harassment of older adults in this space. On the other hand, the results of this study can guide ICT designers in making devices that are more suitable for the needs of older adults.

The effect of education based on planned behavior theory on women’s knowledge and attitudes about human papillomavirus

Human papillomavirus is the most common sexually transmitted infection in the world. Improving knowledge and attitude is the key to controlling and preventing, but women’s knowledge about this virus is not enough. This study aimed to determine the effect of educational intervention based on planned behavior theory on knowledge and attitude toward HPV and its vaccination in women of reproductive age. The study was a single-blind, randomized clinical trial study with a control group was done in 2022, which was conducted on 85 women referred to selected comprehensive health centers in Shiraz, Iran. In this study, the sampling was performed is a multi-stage random way. Eighty-three women who met the inclusion criteria were randomly divided into two intervention and control groups. The data collection tool was the knowledge and attitude questionnaire about HPV and its vaccine, which was confirmed to be valid and reliable. Data analysis was performed with descriptive and analytic statistics at a significance level of P < 0.05 with SPSS (22) software. The results showed that the educational intervention has caused a significant increase in the components of knowledge, attitude, social norms, perceived behavior control, and willingness to receive the HPV vaccine in the intervention group. So that in both stages after the intervention, there was a significant difference between the intervention group and the control group in the studied components (P < 0.05). The educational intervention based on the planned behavior theory significantly affected the knowledge, attitude, social norms, and intention for HPV vaccination in women of reproductive age. Therefore, educational intervention recommended as awareness-raising programs and strategies for women.Trial registration: (RCT code: IRCT20220131053891N1). First Registration date: 28/04/2022.

The factors affecting substance abuse relapse based on theory of planned behavior in male addicts covered by addiction treatment centers in Southern Iran

BackgroundGiven the destructive nature of addiction and its relapse after quitting, the present study aimed to investigate the factors affecting substance abuse relapse based on the Theory of Planned Behavior (TPB) in male addicts covered by addiction treatment centers in Shiraz, Iran.MethodsThis cross-sectional study was conducted on 400 male addicts covered by addiction treatment centers in Shiraz, Iran, in 2021–2022. The data collection tool was a researcher-made questionnaire. Data were analyzed using SPSS-22 software through descriptive statistical methods, linear regression, and binary logistic regression.Results190 people (47.50%) were aged 31–40 years, 265 people (66.25%) were married, 224 people (56%) lived with their spouses, and 192 people (48 percent) had their first use at the age of 16–20. The substance respondents used were methamphetamine (59.5%), heroin (53%), opium (48%), and alcohol (40%). 138 people (34.5%) had their first place of consumption at friends’ houses (Tables 1 and 2).342 people (85.5%) had a history of relapse, and 172 people (50.29%) had 1–5 relapses. Marital status, occupation, and income were among the demographic risk factors, and addicted friends and close relatives were among the behavioral risk factors for drug relapse among people with a history of relapse. Personal desire and the insistence of friends were also among the individual and interpersonal factors of drug use among participants. The regression results showed that the constructs of awareness, attitude, subjective norms, perceived behavioral control, and behavioral intention were predictors of drug relapse among addicts (P < 0.05).ConclusionThe current study’s findings indicate that among the behavioral risk factors for drug relapse in individuals with a history of relapse are addicted friends and close relatives, while marital status, occupation, and income are among the demographic risk variables. Among the individual and interpersonal factors influencing drug usage among participants were personal desire and friends’ insistence. Furthermore, the findings indicated that the TPB’s structures might be used to predict drug relapse in addicts.

Five-factor model personality traits, exclusive breastfeeding, and self-efficacy: a mediational analysis

BackgroundDespite the World Health Organization’s (WHO) emphasis on exclusive breastfeeding, the documents show a declining trend worldwide. Studies assert that the mother’s personality traits appear to have an impact on this issue. This study aimed to investigate the potential influence of personality traits on exclusive breastfeeding, which might be channeled by self-efficacy as a mediator variable.MethodsData were analyzed from the cross-sectional study. The exclusive breastfeeding scale, the breastfeeding self-efficacy questionnaire, and the Five-Factor Model questionnaire (as follows: neuroticism, extraversion, openness experience, agreeableness, and conscientiousness) were completed by120 Iranian volunteer mothers with an infant aged 6–12 months referred to health centers in Shiraz (a major city in southern Iran) between May to December 2019. The structural equation modeling (SEM) approach was used to obtain the direct and indirect effects of personality traits and self-efficacy on exclusive breastfeeding.ResultsThe study showed the significant direct effect of some personality traits (agreeableness, extraversion, and consciousness) and self-efficacy on exclusive breastfeeding. The indirect effect of extraversion on exclusive breastfeeding through self-efficacy was also obtained from the result of SEM analysis. The model fit the data satisfactorily, according to the fit indices criteria extracted from the mediational analysis.ConclusionsSelf-efficacy appears to be a significant predictor of exclusive breastfeeding. Therefore, exclusive breastfeeding could be enhanced by safe education in pregnancy, reinforcing the self-efficacy of pregnant women and considering their personality traits.

Demographic, clinical, and surgical features of patients undergoing thyroidectomy due to thyroid lesions in Southern Iran: A cross-sectional study.

The incidence of thyroid cancer has witnessed a significant global increase and stands as one of the most prevalent cancers in Iran. This surge is primarily attributed to the escalating incidence of papillary thyroid cancer (PTC), with overdiagnosis emerging as an equally noteworthy factor. Consequently, this study aims to ascertain the incidence of thyroid cancer, along with its clinical presentation, demographic characteristics, and surgical features in patients undergoing thyroid surgery. This cross-sectional study involved the evaluation of patient files from referral centers in Shiraz spanning the years 2015-2020. Demographic and clinical information pertaining to thyroid cancer was extracted and subsequently analyzed using SPSS software. A total of 533 documented cases of thyroid cancer undergoing surgery revealed an annual rate of 89 cases in our location. The average age of the patients was 43.9 ± 13.4 years (ranging from 13 to 92), with females constituting 429 (83.5%) of the cases, and 278 (54.1%) being malignant. Conventional PTC emerged as the most prevalent pathology, accounting for 239 (45.0%) of the cases. Patients with thyromegaly exhibited significantly higher incidences of nonmalignant tumors (p = 0.01), while those with malignant tumors were notably younger than those with nonmalignant tumors (p = 0.001). Our study revealed a progressive rise in the number of patients undergoing thyroidectomy over the years, with PTC constituting the majority of cases. Malignant cases were more frequently observed in younger patients, and in smaller lesion sizes, highlighting the importance of early screening and optimizing detection methods, especially in high-risk populations.

Food insecurity is associated with low diet quality and unhealthy cooking and eating habits in Iranian women

BackgroundFood insecurity affects diet and nutrition intakes. We explored the relationship between food insecurity and dietary intakes in a group of Iranian women.MethodsThe cross-sectional study was performed on 190 healthy females aged 20–55 years attending primary healthcare centers in Shiraz. Food insecurity was evaluated by Household Food Insecurity Access Scale, which is a validated tool for assessing food insecurity in developing countries. Diet was assessed using a food frequency questionnaire. The association of dietary patterns and food insecurity was assessed by linear regression.ResultsAssessment of dietary intakes revealed that consumption of red meat, poultry, fish, dairy, fruits, non-starchy vegetables, and nuts decreased whereas that of grains, processed meats, potato, and sugary foods increased with increasing food insecurity. Among nutrients, carbohydrates, fiber, vitamin A, vitamin C, folic acid, potassium, calcium, and magnesium decreased while fat and sodium increased as food insecurity increased. Three major dietary patterns were detected. Healthy dietary patterns showed inverse associations with food insecurity in the crude (β = -0.422 and − 0.435, P < 0.001) and adjusted (adjusted for age, marital status, and educational level) (β = -0.475 and − 0.341, P < 0.001) models of regression analysis but unhealthy pattern did not show an association with food insecurity. Compared to food secure participants, a higher percentage of food insecure individuals indicated unhealthy eating habits, such as skipping breakfast, lower snack ingestion, more fast and fried food consumption, and using unhealthy cooking methods.ConclusionOverall, this study showed that food insecurity was associated with less healthy diet and unhealthy cooking and eating habits.

Impact of delayed presentation and surgical management on radiologic and clinical outcomes of pediatric septic hip

BackgroundSeptic arthritis of the hip joint (septic hip) is the bacterial infection of the hip. Delayed treatment increases the risk of extensive joint damage, systemic infection, prolonged recovery, higher healthcare costs, and long-term disability. This study explores the repercussions of delayed surgical treatment in pediatric septic hip. MethodsIn this observational study, pediatric patients diagnosed with septic hip between 2012 and 2021 were retrospectively selected from a major referral center in Shiraz, Iran. We collected clinical and radiological data, including Kocher score and determined Choi classification in follow-up radiographs. Multivariate logistic regression analysis was used to assess the impact of delay to surgery on the development of clinical sequelae and radiological deformities in the presence of potential confounders of age and Kocher criteria. ResultsOut of 49 children with delayed presentation, 46 survived and entered the study. Mean delay from symptom presentation to admission was 12.67 ± 10.51 days, and mean delay from admission to surgery was 5.33 ± 6.47 days. Of the 46 patients, 28.26% developed clinical sequelae. The Choi classification revealed that 54.35% of patients developed no residual deformity. A multivariate logistic regression analysis indicated a statistically significant association between delay to surgery and the development of radiological deformities (adjusted odds ratio: 1.36, 95% CI: 1.14–1.64, p = 0.001). Additionally, a separate analysis revealed that each additional day of delay was associated with a 12% increase in the odds of clinical sequelae (adjusted odds ratio: 1.12, 95% CI: 1.03–1.22, p = 0.006). Sensitivity analyses confirmed the relationship of delay from admission to surgery in developing both outcomes. ConclusionDelay in medical care and surgical management remains the most important factor affecting the outcomes of septic hip. The study underscores the critical role of timely surgical intervention in reducing complications in pediatric septic hip patients.

Uterine smooth muscle tumors of uncertain malignant potential: a retrospective evaluation of clinical pathology and immunohistochemistry features

BackgroundUterine smooth muscle tumor of uncertain malignant potential (STUMP) is a group of uterine smooth muscle tumors which cannot be classified as a subtype of leiomyoma or leiomyosarcoma. Diagnosis, prognosis, and treatment of these tumors are challenging due to recurrence, potential of malignancy, and metastasis.MethodsA retrospective cohort study was conducted in southern Iran during 2011 to 2020. We included records of 21 patients with STUMP and 24 patients with leiomyoma by simple randomized sampling in the tertiary health care centers in Shiraz, southern Iran. Slides were reviewed by an expert pathologist for examining mitosis, necrosis, and atypia, and also proper blocks were selected for immunohistochemistry (IHC) staining.ResultsFrom 45 participants, 21 (46.7%) and 24 (53.3%) patients were in the STUMP and normal leiomyoma groups, respectively. Odds ratio and 95% confidence interval (OR (95% C.I)) of pathologic size in the range of 5–10 cm was significantly higher in the STUMP group compared with normal leiomyoma. (CI: 7.22 (1.44–36.22)). Additionally, hyaline necrosis 0.05 (0.0-0.91), mild to moderate atypia 0.02 (0.0-0.4), moderate to severe atypia 0.01 (0.0-0.22), focal atypia 0.01 (0-0.26) and diffuse atypia 0.01 (0-0.26) were significantly fewer in normal leiomyoma compared to the STUMP group. Negative P16 0.01 (0.0007-0.24) and negative Bcl2 0.22 (0.06–0.81) were significantly higher in the normal leiomyoma group compared with the STUMP group. The cut-off points for predicting STUMP were 2.5% (sensitivity = 62% and specificity = 100%) and 45% (sensitivity = 43% and specificity = 96%) for P16 and bcl2, respectively.ConclusionThe category and management of STUMP continues to progress. The diagnosis for STUMP mainly depends on the histopathological manifestations. No single IHC marker such as P53, P16, and Bcl-2 has proved robust enough in separating STUMP from other leiomyoma variants; however, according to our study, we suggest combination use of P16 and Bcl-2 (cut off 2.5 and 45%, respectively) to distinguish equivocal cases of STUMP.

Effect of low fibrinogen level on in-hospital mortality and 6-month functional outcome of TBI patients, a single center experience.

In patients affected by traumatic brain injury (TBI), hypofibrinogenemia within the initial hours of trauma can be expected due to vascular and inflammatory changes. In this study, we aimed to evaluate the effect of hypofibrinogenemia on the in-hospital mortality and 6-month functional outcomes of TBI patients, admitted to Rajaee Hospital, a referral trauma center in Shiraz, Iran. This study included all TBI patients admitted to our center who had no prior history of coagulopathy or any systemic disease, were alive on arrival, and had not received any blood product before admission. On admission, hospitalization, imaging, and 6-month follow-up information of included patients were extracted from the TBI registry database. The baseline characteristics of patients with fibrinogen levels of less than 150mg/dL were compared with the cases with higher levels. To assess the effect of low fibrinogen levels on in-hospital mortality, a uni- and multivariate was conducted between those who died in hospital and survivors. Based on the 6-month GOSE score of patients, those with GOSE < 4 (unfavorable outcome) were compared with those with a favorable outcome. A total of 3049 patients (84.3% male, 15.7% female), with a mean age of 39.25 ± 18.87, met the eligibility criteria of this study. 494 patients had fibrinogen levels < 150mg/dl, who were mostly younger and had lower average GCS scores in comparison to cases with higher fibrinogen levels. By comparison of the patients who died during hospitalization and survivors, it was shown that fibrinogen < 150mg/dl is among the prognostic factors for in-hospital mortality (OR:1.75, CI: 1.32:2.34, P-value < 0.001), while the comparison between patients with the favorable and unfavorable functional outcome at 6-month follow-up, was not in favor of prognostic effect of low fibrinogen level (OR: 0.80, CI: 0.58: 1.11, P-value: 0.19). Hypofibrinogenemia is associated with in-hospital mortality of TBI patients, along with known factors such as higher age and lower initial GCS score. However, it is not among the prognostic factors of midterm functional outcome.

The Effect of an Educational Intervention on Breast Cancer Screening of Rural Women: Application of the Theory of Planned Behavior.

Early diagnosis of breast cancer is a key factor affecting patient survival, so screening can reduce the burden of this disease. The present study aimed to investigate the effect of education based on the theory of planned behavior (TPB) on breast cancer screening in rural women. In this quasi-experimental study, 480 women referring to the health care centers in the cities of Fasa and Shiraz were divided into two groups, intervention (n = 240) and control (n = 240), using cluster random sampling method, in 2021-2022. We randomly selected two health care centers in Shiraz and Fasa and invited them to participate in the study. The demographic information questionnaire and a researcher-made questionnaire based on the TPB were used to collect the data. The intervention included 50-minute sessions on topics such as breast cancer basics, screening methods, barriers to mammography, and the role of peer groups. Data were collected before and 4months after the intervention. The results showed no difference between the two groups in awareness, attitude, perceived behavioral control, subjective norms, behavioral intention, and breast cancer screening performance before the intervention. Four months after the intervention, a significant increase was found in the intervention group in awareness (7.46 ± 1.50 to 18.54 ± 1.20), attitude (28.55 ± 4.62 to 58.69 ± 4.35), perceived behavioral control (22.52 ± 3.32 to 40.88 ± 3.84), and subjective norms (20.37 ± 3.34 to 21.99 ± 3.38). Instead, no significant difference in the mentioned constructs (P < 0.05) was observed in the control group. This study demonstrated that TPB-based education enhanced awareness, attitude, perceived behavioral control, subjective norms, and behavioral intention towards breast cancer screening. The TPB empowers women in rural communities to prioritize their health and seek timely breast cancer screening. Continued efforts and improved access to screening services are crucial for improved outcomes.

Psychosocial predictors of quality of life among women living with HIV/AIDS: a cross-sectional study in a VCT centre in Shiraz, Iran.

We aimed to assess psychosocial predictors of quality of life (QOL) among women living with HIV/AIDS (WLHIV). QOL has been considered as an important indicator in evaluating the outcome of psychological and physical healthcare in people living with HIV (PLHIV). This cross-sectional study was carried out from October 2021 to April 2022 at the Voluntary, Counselling, and Testing (VCT) center in Shiraz, Iran. A total of 452 WLHIV were included in this study. Socio-demographic and clinical data, social support (MSPSS questionnaire), food insecurity (HFIAS questionnaire), resilience (CD-RISC questionnaire), mental health status (DASS questionnaire), and QOL (WHOQOL-BREF questionnaire) were collected through direct interviews and patients' files at Shiraz VCT. Physical and social relationships domains of QOL had the highest (60.48 ± 18.00) and lowest (36.76 ± 23.88) scores, respectively. Higher clinical stage, psychotropic substances use, having a husband infected with HIV, history of hypertension, and higher socioeconomic status had a significant relationship with some domains of QOL. The score of social support, food insecurity, resilience, and mental health status had a significant relationship with all domains of QOL. Social relationships domain of QOL had the lowest scores in WLHIV. Also, the mental health status of WLHIV was more related to their QOL than the physical status related to HIV/AIDS. Interventions such as improving the mental health care and resilience skills of WLHIV, including their social network in counseling services to promote their social support, could help them to improve their QOL.

Development and Validation of a Resilience Skills Questionnaire for Health Sector Professionals Based on Social Cognitive Theory.

Good resilience skills support effective and timely adjustment to demanding situations in the workplace. Existing tools are insufficient to develop and evaluate workplace interventions to improve employee's resilience skills. The aim of this study was to develop and validate a Resilience Skills Questionnaire (RSQ) using the key constructs of social cognitive theory-self-efficacy, self-regulation, and social support-as a theoretical framework. Following DeVellis' guidelines for scale development, first an expert panel of thirteen professors was recruited to support the item development stages and determine content validity. At this stage, the initial pool of 38 items was reduced to 25 items and CVR and CVI were calculated as 0.92 and 0.93, respectively, indicating good content validity. A second panel of ten health professionals confirmed face validity. An online survey comprised of the 25 developed items was then completed by 336 health professionals working in urban healthcare centers in Shiraz, Iran, in November 2021. The data were used to assess the psychometrics of the questionnaire according to its hypothesized three-dimensional structure. Confirmatory factor analysis yielded a final model of seventeen items in three dimensions, self-efficacy (six items), social support (six items), and self-regulation (five items), with good psychometric properties (χ2/df = 2.44 (p < 0.001), RMSEA = 0.06, GFI = 0.92, AGFI = 0.90, IFI = 0.93, CFI = 0.93). All standardized factor loadings were significant (p < 0.001). Internal consistency, as measured by Cronbach's alpha, was very good: RSQ (0.90), self-efficacy (0.86), social support (0.83), and self-regulation (0.86). Based on these results, the RSQ can be used as a standard and valid measure to develop and evaluate the effect of educational intervention programs to improve resilience skills and reduce job stress.

Comparison of the Effectiveness of Emotion Regulation-Based Therapy and Unified Transdiagnostic Treatment on Cognitive Insight in Women Engaged in Emotional Divorce with Early Marriage

Objective: The objective of this study was to compare the effectiveness of emotion regulation-based therapy and unified transdiagnostic therapy on cognitive insight in women engaged in emotional divorce with early marriage. Methods and Materials: This quasi-experimental research employed a pre-test and post-test control group design. The sample consisted of 45 women involved in emotional divorce, diagnosed by psychologists at counseling centers in Shiraz, and were selected through convenience sampling. Participants were randomly assigned to three groups: one control group (n=15) and two experimental groups (n=30). The experimental groups received either emotion regulation-based therapy or unified transdiagnostic therapy. Data were collected using Beck's Cognitive Insight Questionnaire (BCIS) and analyzed using SPSS (version 26) through descriptive statistics and Multivariate Analysis of Covariance (MANCOVA). Findings: The results indicated that both unified transdiagnostic therapy and emotion regulation-based therapy were effective in increasing cognitive insight in women engaged in emotional divorce with early marriage. The post-test scores showed significant improvement compared to the pre-test scores in the experimental groups, while the control group showed little change. The analysis revealed significant differences in cognitive insight components (self-reflectiveness and self-certainty) between the experimental and control groups. However, there was no significant difference in the effectiveness between the two therapeutic methods. Conclusion: This study highlights the importance of employing these therapeutic approaches in counseling centers to improve cognitive insight and other psychological variables in women with early marriages.

Increasing Prevalence and High Survival Rate of Liver Transplanted Patients with NASH and PSC Cirrhosis.

Epidemiological studies on liver transplant (LT) patients can provide valuable information about the etiology and trends of cirrhosis. The present study aimed to investigate the prevalence and trend of different etiologies and survival rates of LT patients at the Namazi Transplant Center in Shiraz, Iran, between 2001 and 2018. In this single-center, retrospective cohort study, the demographic and clinical characteristics of 3751 patients who underwent LT and met the study inclusion criteria, including age, gender, blood group, body mass index, model for end-stage liver disease (MELD) score, cause of cirrhosis, and diabetes, were extracted from patients' physical or electronic medical records between 2001 and 2018. The MELD scores of LT patients with primary sclerosing cholangitis (PSC), hepatitis B virus (HBV), and non-alcoholic steatohepatitis (NASH) cirrhosis significantly decreased over the study period (P<0.001). Among the LT patients, HBV infection had the highest frequency (21.09%), followed by cryptogenic (17.33%) and PSC (17.22%). The proportion of patients with PSC and NASH (both P<0.001) cirrhosis was significantly increased, so that PSC cirrhosis (2016: 19.4%, 2018: 18.8%) surpassed HBV (2016: 18.4%, 2018: 13.5%), autoimmune hepatitis (2016: 11.7%, 2018: 12.7%), and cryptogenic cirrhosis (2016: 16.1%, 2018:14%) as the leading indication for LT from 2016 to the end of the study period. Fortunately, these patients had a better survival rate than other common diseases (HR: 0.53, CI: 0.43‒0.66; P<0.001). The proportion of NASH and PSC cirrhosis significantly increased during the 18 years of study. However, these patients had an improved survival rate. Therefore, health organizations should pay more attention to non-communicable diseases, especially fatty liver disease and cholangitis.

Effectiveness of Schema Therapy on Self-Differentiation and Rejection Sensitivity in Patients with Borderline Personality Disorder

Objective: The current research aimed to investigate the effectiveness of schema therapy on self-differentiation and rejection sensitivity among patients with borderline personality disorder in Shiraz in 2022. Methods and Materials: The research method was a quasi-experimental design with a pre-test, post-test, control group, and follow-up. The statistical population consisted of all individuals with borderline personality disorder who visited counseling centers in Shiraz, from which 50 individuals were selected through purposive sampling and randomly assigned to either the experimental group (25 individuals) or the control group (25 individuals). The experimental group underwent 12 sixty-minute sessions of schema therapy, while the control group was placed on a waiting list. The instruments used in this study included the Borderline Personality Questionnaire (Claridge &amp; Brookes, 1984), Self-Differentiation (Skowron &amp; Friedlander, 1998), and Rejection Sensitivity (Downey &amp; Feldman, 1996). Data analysis was performed in two parts: descriptive and inferential (repeated measures ANOVA). Findings: The results indicated that schema therapy training has an impact on self-differentiation and its components (emotional reactivity, I position, emotional cutoff, and fusion with others) in individuals with borderline personality disorder. Furthermore, the results showed that schema therapy training affects rejection sensitivity in individuals with borderline personality disorder. Conclusion: Based on the findings of this study, it can be concluded that schema therapy is an effective treatment for improving self-differentiation and rejection sensitivity in individuals with borderline personality traits. It is recommended that this therapy be used for individuals with borderline personality traits in clinical settings.

Clinical Characteristics of Pediatric Patients with Inborn Errors of Metabolism Admitted to Namazi Hospital, a Tertiary Referral Center in Shiraz, Southern Iran

Background: Inborn errors of metabolism (IEMs) are rare genetic disorders that usually cause disease by blocking a metabolic pathway. Delayed diagnosis often occurs due to nonspecific symptoms. This study assesses the demographic and clinical characteristics of pediatric patients with IEMs admitted to Namazi hospital, a referral center in southern Iran. Methods: All 1-month-old to 18-year-old patients who were admitted to the pediatric ward at Namazi hospital, a referral center in southern Iran, and diagnosed with IEMs were enrolled. Patients with incomplete information were excluded. Comprehensive demographic and clinical data, including age, sex, parental consanguinity, family history of IEM, presenting symptoms, number of hospitalizations, age of onset, and diagnosis of the disease, were collected. All the data were entered into SPSS version 22 and analyzed. Results: Two hundred patients, 53.5% male and 46.5% female, were enrolled in the study. The predominant clinical symptoms observed were lethargy and vomiting. The most prevalent IEMs were aminoacidopathies, organic acidemia, and mitochondrial disease. Consanguinity was found in 57.5% of patients, while a family history of metabolic diseases was observed in 16.5%. A statistically significant association was identified between consanguinity and the type of disease. Conclusion: The clinical symptoms of IEMs are nonspecific and may be misdiagnosed as other diseases, such as septicemia. We should always keep IEMs in mind to detect the disease earlier and prevent significant morbidities and mortality through appropriate and timely treatment. Due to the prevalence of family marriages in Iran, we should also consider metabolic screening.

Skeletal complications in patients with hemophilia: a single-center experience

BackgroundArthropathy is a common complication in patients with hemophilia. We examined the prevalence of this skeletal complication in patients with hemophilia who were registered at a Comprehensive Hemophilia Center in Shiraz, Southern Iran.Materials and MethodsIn this cross-sectional study, an orthopedic specialist visited 448 patients and conducted screenings for skeletal complications. The assessment included evaluating the type of hemophilia, disease severity, treatment modality, the presence of inhibitors, and the identification of skeletal complications.ResultsNinety patients with hemophilia A, with a mean age (SD) of 31.6 (14.4) years, and 10 patients with hemophilia B, with a mean age of 30.5 (20.6) years, were assessed. The most frequently affected joints were the knee and ankle joints. In the univariate analysis, patients with severe disease were more likely to exhibit synovitis, a target joint, and bone disease compared to patients with non-severe disease. Additionally, a history of treated or active hepatitis and an annual bleeding rate showed significant associations with the target joint. In the multivariable logistic regression analysis, disease severity (OR 14.43, 95% CI 1.6–129.6) and a higher age at diagnosis (OR 1.06, 95% CI 1.00–1.13) increased the likelihood of developing osteoporosis. A history of hepatitis (OR 3.67, 95% CI 1.28–10.48) was identified as an independent risk factor for the target joint.ConclusionSkeletal complications are a common occurrence in hemophilia. Regular consultations with orthopedic specialists, focusing on bleeding control and hepatitis prevention, are essential for reducing the impact of this debilitating complication.

The frequency of various spinal cord tumors (SCTs) in surgically treated patients at Shiraz Shahid Chamran Hospital from 2012 to 2022

Abstract Aim The incidence of spinal cord tumors (SCTs) in a population considering sex, age, histopathology, and emplacement position of tumors is different between various regions. Therefore, the present study aimed to evaluate the frequency of various SCTs in surgically treated patients in a reference spinal surgery center in Shiraz, Iran. Method Documented information related to 109 SCT patients surgically treated was collected from the archive of Shahid Chamran Hospital (the reference center of spinal cord surgery in the south of Iran) in Shiraz from 2012 to 2022. This information includes demographics, medical history, histology, and position of SCTs within the spinal cord. Result The population of patients included 65 men and 44 women, with a mean age of 44.7 years old. Most patients (26 cases) were in the age group of 50–59 years. Neurological function in most patients (51 cases) was equivalent to level D of the ASIA impairment scale (AIS), and the most common complaints of patients (83 cases) were related to pain. Finally, anatomic and histologic evaluations indicated that intradural and schwannoma tumors were the most common types of tumors, with 64 and 25 cases, respectively. Conclusions In the present study, most of the findings are consistent with the previous reports. Schwannoma and ependymoma tumors were the most common types of SCTs and the most common types of intramedullary tumors, respectively. The sixth decade of life was the most common age of incidence. Neurological function in most patients with SCT was equivalent to levels of D and E of AIS. However, regarding the factor of gender, our results are similar to those of the Asian population. More comprehensive studies in the future likely reveal the probable role of environmental, genetic, and hormonal factors in the etiology of SCTs.