Jahrom University of Medical Sciences

Background The rising prevalence of antimicrobial resistance (AMR) poses a critical global health challenge. Healthcare workers (HCWs) play a pivotal role in combating AMR by implementing effective preventive strategies and adhering to good practices. This study aimed to evaluate the global knowledge, attitudes, and practices (KAP) of HCWs towards AMR. Methods A comprehensive search of PubMed/MEDLINE, ScienceDirect, Scopus, Web of Science, Cochrane Library, and Google Scholar was conducted for English-language articles published up to August 2024. Inclusion criteria were observational studies reporting KAP data among HCWs related to AMR. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklist. Statistical analyses, including heterogeneity (I² statistic, Cochran Q), were conducted using STATA version 14. Random-effects models were applied for pooled estimates, and subgroup analyses, meta-regression, and sensitivity analyses were performed. Publication bias was assessed via Egger’s test and adjusted using the trim-and-fill method. Geographical distribution was analyzed with ArcGIS 10.3 software, and evidence certainty was evaluated using the GRADE framework. Results A meta-analysis of 108 studies involving 29,433 HCWs assessed their knowledge of AMR. Additionally, 51 studies with 13,660 HCWs evaluated attitudes, and 43 studies with 10,569 HCWs examined practices regarding AMR. The pooled proportion of HCWs with good knowledge of AMR was 56.5% (95% CI: 50.4–62.6%, I² = 99.5%), with the highest prevalence in Europe (70.3%) and the lowest in the Western Pacific (45.9%). Positive attitudes towards AMR were reported in 60.4% (95% CI: 48.5–72.3%, I² = 99.8%), with the highest prevalence in the Eastern Mediterranean Region (64.5%) and among those with less than five years of experience (77.8%). Good practices were observed in 48.5% (95% CI: 36.5–60.5%, I² = 99.7%), with the highest adherence in Europe (56.6%) and the lowest in Africa (39.1%). Subgroup analysis revealed that younger HCWs (under 30 years) showed better KAP scores across all domains. Conclusion The findings underscore the need for targeted interventions to enhance the knowledge, attitudes, and practices of HCWs regarding AMR. Priority should be given to designing and implementing robust training programs tailored to the specific needs of HCWs in resource-constrained settings. Strengthening AMR-related education and practice among HCWs is crucial for combating the global AMR crisis effectively.

Background Stomach cancer represents a significant global health challenge, particularly in Asia, where it is one of the leading causes of cancer-related mortality. Aim This study aims to determine the link between socioeconomic inequality and stomach cancer using 2021 Global Burden of Disease data. This study, analyzing incidence rates, mortality, and disability-adjusted life years (DALYs), explores how socioeconomic factors affect stomach cancer outcomes in various Asian countries. Methods Our methodology involves a review of publicly available data to estimate the prevalence and mortality associated with stomach cancer in the region. We specifically calculate years of life lost (YLLs) and years lived with disability (YLDs) to provide a nuanced understanding of the disease burden. The Human Development Index (HDI) serves as a primary measure of socioeconomic status, allowing us to explore how disparities in health outcomes correlate with socioeconomic conditions. Results Preliminary findings indicate a clear correlation: lower HDI values are associated with higher incidence and mortality rates of stomach cancer. Countries exhibiting greater socioeconomic inequality demonstrate a disproportionate burden of disease, reflected in elevated DALYs, YLLs, and YLDs. Conclusion These results underscore the pressing need for targeted public health interventions aimed at addressing these disparities. Addressing socioeconomic inequalities is crucial for reducing the burden of stomach cancer in Asia. Our findings advocate for implementing strategic public health measures that focus on improving access to healthcare, enhancing nutritional education, and promoting preventive strategies in high-risk populations. This study contributes to the growing body of evidence linking socioeconomic factors to health disparities and emphasizes the importance of equitable healthcare access in combating stomach cancer effectively.

Mucormycosis, a severe fungal infection, has exhibited a concerning increase in recent years, particularly during the COVID-19 outbreak. This three-year cohort study aims to investigate an overview of the epidemiology, clinical and radiographic signs, treatment, and prognosis of Rhino-Orbito-Cerebral Mucormycosis (ROCM). This prospective cohort study was conducted from 2019 to 2022 at Khalili Hospital in Shiraz, Iran. It focused on proven cases of ROCM. Patients underwent a stepwise treatment protocol, with meticulous documentation of findings from ophthalmological examinations and imaging studies. Additionally, a three-year follow-up period was implemented to monitor patient progress and assess the effectiveness of treatment strategies. Statistical analyses were performed using IBM SPSS statistics. In this study, 77 patients with ROCM participated. Most patients presented with facial pain (75.3%), swelling (62.3%), and vision loss (51.9%). Treatment included combined antifungal therapy and surgical debridement, with 7.8% undergoing ocular exenteration. Notably, despite the extensive disease, all cases that underwent orbital exenteration survived during the 3-year follow-up. Impaired V2 nerve function was associated with higher mortality rates, and patients presenting with an initial visual acuity of No Light Perception (NLP) had higher mortality compared to those with other degrees of visual impairment. The convergence of mucormycosis, specifically in the form of ROCM, with COVID-19 has led to an outbreak characterized by high mortality and morbidity rates. This cohort study meticulously documented the long-term follow-up of these patients, aiming to provide novel insights into the epidemiology, clinical and radiographic signs, treatment, and prognosis of this fungal infection.

Background Mild cognitive impairment (MCI) is a common disorder among the geriatric population (GP). MCI induces adverse effects on life quality by disrupting of natural aging process, daily activities, and memory. This systematic review and meta-analysis study aimed to investigate the global prevalence of MCI in GP with an emphasis on associated influential factors. Methods Electronic databases of PubMed, Scopus, WoS, Embase, ScienceDirect, and Google Scholar were systematically searched (by November 2024) using the MeSH-based keywords. Collected references were imported into the Citation Management Software of EndNote (v.8) for duplicate detection. Paper screenings and quality assessments were applied based on the inclusion and exclusion criteria. Then, eligible papers were gathered and data analysis was performed using CMA software (v.2). Results In the review of 51 eligible studies (n = 287,689 elderly individuals), the global prevalence of mild cognitive impairment in geriatric population was found 23.7% (95%CI:18.6–29.6). According to the meta-regression analysis, following the increase in sample size and year of paper publication, the mild cognitive impairment index decreased and increased, respectively. Besides, age, educational level, and depression status were considered the most critical influential factors of mild cognitive impairment in geriatric population. Conclusion According to the relatively high prevalence of mild cognitive impairment in geriatric population, determination of proper health strategies seems necessary for diagnosis and treatment of mild cognitive impairment along with awareness and management of associated consequences in geriatric population. Clinical trial number Not applicable.

Background Thyroid nodules are mostly benign lesions within the thyroid, with a small percentage being malignant. The decision for surgery is mainly based on the fine needle aspiration (FNA) cytology report, which is categorized into six categories from non-diagnostic to malignant. The accuracy of FNA is of utmost importance to minimize the complications due to misdiagnosis. Methods In a retrospective study, we analyzed 310 patients who underwent thyroidectomy due to suspicious thyroid nodules with both FNA and histopathological results. We reviewed patient files, extracting demographic data, FNA results, and final histopathology reports and grouped them based on the size of the nodules. Sensitivity, specificity, and predictive values were calculated. Results The average age of the patients was 42.9 ± 13.2 years, and the average size of the largest nodule diameter was 2.1 ± 1.89 cm. Histopathological evaluation of specimens obtained during surgery showed that 184 (59.4%) samples were malignant and 126 (40.6%) were non-malignant. The overall specificity was 96.8%, and the sensitivity was 89.6%, and the accuracy of FNA in diagnosing malignancy was 92.2%. Logistic regression analysis revealed that Bethesda classification (OR: 2.34; 95%CI: 1.73–3.16; P < 0.001), and also tumor size (OR: 2.02; 95%CI: 1.32–3.10; P = 0.001) exhibited a significant direct correlation with the capability of FNA in accurately diagnosing malignancy. The highest FNA accuracy of malignancy detection was among nodules above 3 cm (97.1%) while in nodules smaller than 1 cm the accuracy was 73.2%. Conclusion FNA is a suitable diagnostic tool for detecting malignant nodules, while diagnostic capability varies with approaches to indeterminate FNA results. False positive and negative rates are crucial, with challenges in diagnosing malignancy in the context of multinodular goiter cases and smaller nodules.

Background The global prevalence of myopia among children has considerably increased over the past few decades, affecting the children’s eye health and quality of life. According to the inconsistent reports of myopia among children, the purpose of this systematic review and meta-analysis study was to determine the global prevalence of myopia in children using digital devices. Methods Various databases (PubMed, ScienceDirect, Embase, Web of Science, Scopus, and Google Scholar) were searched systematically (No time limit until September 2023, last updated in May 2024) using keywords of “Myopia Prevalence”, “Children”, “TV”, “Computer”, “Video games”, and “Smartphone”. PRISMA guideline was also used for paper collection based on the Inclusion/Exclusion criteria. The quality of articles was determined based on the STROBE checklist. Data analysis, heterogeneity assessment, publication bias, and all factors influencing heterogeneity were executed using the CMA software (v.2). Results Initially, 828 articles were identified through database assessment. 563 and 133 papers were evaluated using primary and secondary assessments, respectively. Ultimately, 17 eligible articles were selected for meta-analysis following paper exclusion. In this era, the global prevalence of myopia among children using computer and video games was reported 28.8% (95%CI:21.1–38), using TV (TV watching) was 35.4% (95%CI:20.6–53.7), and smartphone usage was 31.4% (95%CI:13.5–57.3). Conclusion Myopia is now recognized as a critical global issue with a daily increasing rate. Technology, along with various digital devices, causes several issues in this era. It is suggested that the application of all digital screens and smart devices can potentially increase the risk of myopia among children. Thus, the reduction of these smart device applications in children can alleviate the potential risk of myopia. The results of this study can be a guide for health policymakers and a useful advertisement for society and families in paying attention to this problem in children, as well as increasing health interventions such as early screening and timely diagnosis for treatment. In this regard, it can be effective in both prevention and increasing the quality of life of children.

Background There is a strong connection between physical activity and major non-communicable diseases. Women’s sexual health is a vital aspect of life at any age; however, it is influenced by many factors. The aim of this study is to investigate the global prevalence of female sexual dysfunction based on physical activity through a systematic review and meta-analysis. Methods In this study, electronic repositories including PubMed, Google scholar, Scopus, Web of Science, Embase, and ScienceDirect were systematically searched using specified keywords, without a lower time limit, up until March 2025. A random effects model was employed to perform the meta-analysis. The heterogeneity of the studies was assessed using the I² index. Data analysis was conducted within the Comprehensive Meta-Analysis (CMA) software (version 2). Results In the review of 7 studies with a sample size of 1,776 participants, the pooled prevalence of female sexual dysfunction with high physical activity was estimated to be 47% (95% CI: 28.8–65.9). Also, in the review of 6 studies with a sample size of 2,094 participants, the pooled prevalence of female sexual dysfunction among those with low physical activity or a sedentary lifestyle was found to be 64.6% (95% CI: 44.5–80.6). Conclusion In this meta-analysis, the pooled prevalence of sexual dysfunction among inactive women was reported to be higher and more significant than that of physically active women. Thus, it is necessary for health policymakers to further promote the importance of physical activity to prevent and reduce female sexual dysfunction.

Background Stroke is one of the leading causes of death worldwide, and it can lead to the development of small vessel disease in the brain, which in turn exacerbates the unintended and long‐term consequences of this condition. Given that various factors are involved in the development and exacerbation of this disease, the aim of the present study is to determine the relationship between blood omega‐3 levels and the small vessel disease in ischemic stroke patients. Methods The present study is a case‐control study. The target population in this study consists of ischemic stroke patients enrolled in a hospital through a census over the course of 1 year. The sample size was 72 patients, who were assessed using MRI and/or CT scans for the extent of small vessel blood vessel changes. They were then divided into two groups: those with small vessel changes (31 individuals—cases) and those without small vessel changes (41 individuals—controls). Subsequently, individuals in both groups were evaluated for their blood omega‐3 levels. Statistical analysis was conducted using SPSS‐20. Results The research findings revealed that the majority of individuals in both the case and control groups were in the 51–70 age range and were female. Apart from the gender variable, the two groups did not significantly differ in other variables. Upon comparing the two groups, it was evident that men comprised a larger portion of the case group. Analytical findings also indicated a significant relationship between blood omega‐3 levels and small vessel changes in the brain. This is because the results of the mean blood omega‐3 levels of the two case and control groups showed a statistically significant difference between the two groups (p = 0.001 < 0.05). Conclusion Based on the research findings, there is an association between low levels of omega‐3 in blood and the occurrence of small vessel changes in the brain.

Background Review various causes of optic disc-related decreased vision and present a rare anterior ischemic optic neuropathy (AION) case in a patient with beta-thalassemia. Case presentation A 38-year-old man with a known case of major beta-thalassemia presented with a chief complaint of acute decrease in central and peripheral vision in the right eye. The patient was on deferoxamine and had previous splenectomy surgery. Fundus examination revealed visible vascular obstruction, more prominent superior disc swelling, hyperemia, and retinal nerve fiber layer (RNFL) edema in the right eye. After 6 months, the visual acuity improved in the follow-up examination, and the fundus examination revealed subtle right disc pallor. Conclusion AION with visible vascular occlusion can be a rare retinal cause of acute decreased vision in beta-thalassemia patients.

Background Anxiety is very common among patients undergoing surgery. Like other forms of surgery, neurosurgery can affect patients both physically and emotionally. One of the ways to control and reduce anxiety is to pay attention to spiritual interventions and spiritual health. The present study aimed to investigate the effect of the Qur'an on the anxiety of neurosurgery Muslim candidates. Methods This study is interventional research with a pretest and posttest design with a control group. The research population included all patients who were candidates for brain and nerve surgery in the teaching‐treatment hospitals in 2019. The samples were selected by probability and simple random sampling methods. The data collection tool included the Spielberger questionnaire and demographics (age, gender, marital status, education degree, job, etc.) and the vital signs checklist (blood pressure, heart rate, and respiration). Results The results of this study showed that the sound of the Quran leads to a decrease in the level of anxiety in the experimental group. The effect size of the group for overt anxiety and anxiety subscales is 53.5% and 40%, respectively; blood pressure is 4.3%, breathing is 20.9%, and heart rate is 21.5%. Conclusion Anxiety is an unpleasant complication that many people suffer from before various surgeries. The results of this study indicated that the sound of the Quran is a positive and effective factor in reducing anxiety before neurosurgery in Muslim patients who are candidates for this surgery, so health policymakers can use the results of this study as a research priority to reduce anxiety before surgery.

Background Anorexia nervosa (AN) is a mental disorder characterized by severe loss of appetite and low nutrient intake. Along with many complications, the anorexia nervosa eventually disrupts hematogenesis and the occurrence of anemia. Thus, the present study aimed to investigate the global prevalence of anemia in anorexia nervosa patient. Methods Systematic searching was applied (by August 10, 2024) in databases of PubMed, Scopus, WoS, ScienceDirect, Embase, and the Google Scholar search engine. Selected investigations were imported to the EndNote Citation Management Software and duplicate papers were merged. Following consideration of inclusion and exclusion criteria (during primary and secondary screening) relevant papers were selected and underwent validation. Finally, eligible papers were selected for data extraction and meta-analysis (CMA v.2). The I2 index was used for heterogeneity assessment, and the Random Effect Model was used for meta-analysis. The results were categorized based on hematocrit and hemoglobin levels, and study type, and meta-regression was also applied for sample size and year of paper publication. Results In the review of 9 eligible studies, the global prevalence of anemia in anorexia nervosa patient was found to be 44.8% (95%CI:25.7–65.7). Also, this value was detected in 48% (95%CI:19.9–77.4) and 43.4% (95%CI:18.6-72) based on hematocrit and hemoglobin levels, respectively. Meta-regression analysis showed that following the increase in sample size and year of paper publication, the global prevalence of anemia in Anorexia nervosa patient decreased and increased, respectively. Conclusion A relatively high prevalence of anemia in individuals with anorexia nervosa requires proper attention to the regular blood monitoring and laboratory evaluations of the patients.

Background: Eating disorders (EDs) are known as chronic mental disorders that can cause adverse physical and mental effects and affect different age groups, including children, and disrupt their growth and development. Based on this, the aim of this research is to determine the global prevalence of EDs in children. Methods: To conduct this research, each of the databases PubMed, Scopus, Web of science, Embase, ScienceDirect and Google Scholar search engine were systematically searched using relevant keywords ("prevalence,""outbreak,""eating disorder,""feeding disorder,""eating problem,""appetite disorder,"to find all the studies that refer to the prevalence of EDs in children until July 23, 2024 to obtain and perform further evaluations. After data extraction, their analysis was done by Comprehensive Meta-Analysis software (Version 2); Random effects model was used for analysis and I2 index was also used to check the heterogeneity of studies. Results: Based on the global prevalence of EDs in children based on meta-analysis was 1% (95% CI: 0.6-1.6); Subgroup analysis based on the study of eating disorders in children showed that the prevalence of pica among children is 2.1% (95% CI: 1-4.6), the prevalence of binge eating disorder is 1% (95% CI: 0.6-1.8), and the prevalence of anorexia nervosa and Bulimia nervosa among children is 0.6% (95% CI: 0.01-34.4) and 0.1% (95% CI: 0-0.4), respectively. Conclusion: Considering the importance of nutrition in children and the report of EDs among them, healthcare workers and medical personnel must pay attention to this category of disorders by timely informing parents to reduce the complications caused by it.

Background Little is known about the relationship between circulating electrolyte concentrations and paroxysmal atrial fibrillation in the emergency department. We aimed to characterize circulating electrolyte concentrations in patients with paroxysmal atrial fibrillation compared with those of nonspecific control patients admitted to the emergency department. Methods In total, data from 520 individuals with paroxysmal atrial fibrillation and 1,040 randomly selected 1040 patients without atrial fibrillation (1:2 ratio), all admitted to the emergency department (January 2010–December 2015), were analyzed. A classification model was developed using a tree‐based machine learning algorithm, and the importance of variables was measured. Results Patient age, serum glucose, sodium, potassium, calcium, phosphate, and sex were significantly associated with paroxysmal atrial fibrillation (all p < 0.001). For serum magnesium, the difference approached significance (p = 0.096). The model had a moderate performance with a 10‐fold cross‐validation accuracy of 0.728 and a sensitivity, specificity, area under the curve, and likelihood ratio of 0.613, 0.770, 0.692, and 2.67, respectively. Overall, age and glucose were the most important variables followed by serum sodium, potassium, and calcium. Male sex, older age, and a higher serum sodium, calcium, potassium, and magnesium, and a lower serum glucose and phosphate were associated with a higher likelihood of paroxysmal atrial fibrillation in the emergency department. Conclusion Serum electrolyte imbalances, particularly in sodium, potassium, and magnesium, are significantly associated with paroxysmal atrial fibrillation in emergency settings. Emergency physicians should monitor and correct these electrolytes to improve early PAF management and potentially prevent adverse outcomes.

The COVID-19 pandemic continues to pose a significant threat to global health and economies. While initial surges may have subsided, vigilance remains crucial. Improvised methods for managing COVID-19 intensive care units (ICUs) highlight the need for improved management strategies. Machine learning techniques offer promise in this fight by enabling better medical resource allocation, faster triage of potentially critically ill patients, and efficient treatment delivery. Overwhelmed ICU capacity and suboptimal mechanical ventilation configuration are key challenges in such situations. This study proposes a novel approach for automated diagnosis of lung damage severity and prognosis of COVID-19 patients using high-resolution computed tomography (HRCT) scans. We combined HRCT analysis with clinical laboratory data to develop a simple and rapid lung damage severity score. This score was then utilized to predict ICU admission and mortality risk with promising accuracy. The U-Net neural network was employed to identify lung regions damaged by COVID-19 from axial HRCT images. These results were subsequently fed into separate machine learning models (support vector machines and Naive Bayes) for patient outcome prediction. Image processing techniques were also implemented to analyze axial HRCT scans. These combined results were used to train an artificial neural network to diagnose treatment stages and predict final patient outcomes. We further addressed the crucial yet under-investigated question of optimal timing for ventilator configuration adjustments. The proposed solution achieved comparable or superior performance compared to existing methods. This study demonstrates the potential of Machine Learning techniques for improved COVID-19 patient management. The proposed method offers a robust and automated approach for lung damage severity assessment and patient outcome prediction, potentially aiding in better resource allocation and patient care decisions.

Background Aging is considered a natural developmental process in which physical, psychological, and social changes occur; hypertension can be one of these problems. Structured teaching, like the Health Action Process Approach (HAPA), may improve self-care and health in chronic conditions. This study aimed to examine the effect of teaching intervention based on HAPA on self-care behavior in older people with hypertension. Methods This quasi-experimental study was performed from October 2023 to March 2024 at Valiasr health services center affiliated with Jahrom University of Medical Sciences; 70 older people were divided into an intervention group (35 subjects) and a control group (35 subjects). Teaching intervention was carried out based on HAPA for the intervention group through seven teaching sessions over seven weeks. Data were collected using demographic and Hypertension Self-care Profile at baseline and 2 months post-intervention. Data were analyzed using SPSS 21 with the Chi-square test, Fisher test, Wilcoxon, and Mann-Whitney tests. Statistical significance was considered for P value<0.05. Results The median of self-care was not significantly different between the control (median: 51(IQR 54-45)) and intervention groups (median: 50(IQR 58-47)) before the intervention (P=0.26). Two months after the intervention, the median of self-care was significantly different between the intervention (median: 73(IQR 74-71)) and control groups (median: 50(IQR 54-45)) (P<0.001). Conclusions The HAPA could improve self-care behavior in older people with hypertension. It is suggested that healthcare authorities should pay attention to HAPA in teaching and preventive programs for self-care behavior in older people with hypertension.

Background Moral distress in nurses is a widespread issue with lasting consequences. Understanding the relationship between spiritual factors, like spiritual sensitivity, workplace spirituality, and moral distress, is important due to the significant role of spirituality in nursing ethics. This study explores the connections between these three phenomena, focusing on the psychological, spiritual, and ethical dimensions of nursing. Methods This cross-sectional study involved 120 nurses from hospitals affiliated with Jahrom University of Medical Sciences, selected randomly using a number table. Inclusion criteria were having at least a bachelor’s degree in nursing, at least 6 months of work experience, and no history of mental health issues or medication use. Participants completed questionnaires on moral distress (Hamrick et al.), workplace spirituality, and spiritual sensitivity. Descriptive tests were used to determine the frequency distribution of demographic variables. Analysis of variance (ANOVA) and independent t-tests were used to compare the mean scores of variables across different groups of nurses based on demographic factors. Pearson’s correlation coefficient and linear regression were used to determine relationships between the variables. Data were analyzed using SPSS version 23, with a significance level set at 0.05. Results In determining the relationship between moral distress and the study variables, demographic and occupational variables (i.e., gender, age, and type of department and moral distress) were significantly related. Similarly, it shows that gender, level of education, and the organization’s type of department significantly impact spiritual sensitivity. Conversely, there is a significant relationship between age, the organization’s department type, and workplace spirituality. Workplace spirituality and spiritual sensitivity displayed substantial negative correlations with moral distress. Conclusion According to this study, positive environmental and individual spiritual factors significantly influenced and reduced moral distress in nurses. The findings highlight the significance of spiritual education for nurses to strengthen spiritual awareness and environmental strategies to promote a spiritual environment in healthcare settings. More studies are suggested in this field. Clinical trial number Not applicable.

Background Renal-origin Ewing’s sarcoma is an extremely rare malignancy often misdiagnosed owing to its nonspecific presentation and similarities to other renal tumors. Accurate diagnosis requires a combination of clinical evaluation and advanced diagnostic techniques. Limited case reports make understanding its clinical course and management challenging. This case report aims to raise awareness of renal-origin Ewing’s sarcoma, highlight diagnostic challenges, and discuss effective multidisciplinary management strategies to improve patient outcomes. Case presentation A 32-year-old Iranian female patient presented with a chief complaint of progressive dyspnea, anorexia, and night sweating in the last 2 weeks before her admission. Computed tomography scan showed a tumoral lesion in the left kidney with thrombosis extending into the left renal vein and inferior vena cava up to the right atrium. The patient underwent open cardiac surgery and a radical nephrectomy. During surgery, the mass protruded from the inferior vena cava into the right atrium; it was ultimately diagnosed as renal-origin Ewing’s sarcoma, and EWSR1 rearrangement was confirmed on pathology. Conclusion and key clinical message This case highlights the importance of a thorough diagnostic approach in patients presenting with a renal mass and the value of a multidisciplinary strategy, combining clinical presentation, imaging, histopathology, immunohistochemistry, and molecular studies to achieve an accurate diagnosis. It underscores the critical need for increased awareness and research into the rare entity of renal-origin Ewing’s sarcoma, as clinical and pathological information on this condition is limited. Furthermore, this case emphasizes the necessity of timely diagnosis and tailored management to optimize treatment outcomes and improve survival rates in such rare and challenging presentations. Clinical trial number: not applicable.

Background Non-pharmacological methods, either independently or in combination with pharmacological methods, are increasingly used for pain prevention and management. The aim of this study was to investigate the effect of Nature-Based Sound Therapy (NBST) on Apgar score after Cesarean Section (CS) under Spinal Anesthesia (SA). Materials and Methods This randomized clinical trial was conducted from April to December, 2020. Participants were 92 candidates for elective CS under SA conveniently selected from Motahhari hospital, Jahrom, Iran. They were randomly assigned to a control group (n = 46) and an NBST group (n = 46). Participants in the NBST group listened to nature-based sounds from twenty minutes before entering the operating room to the time of childbirth using an MP3 player and a headphone. Neonatal Apgar score was measured at minutes 1, 5, 10, 15, and 20 after birth. Results There were no significant differences between the study groups respecting participants’ demographic characteristics ( P > 0.05). The mean of 1-minute Apgar score in the NBST group was significantly more than the control group ( P = 0.003). Conclusions NBST is effective in significantly improving Apgar score after CS under SA and can be used to improve neonatal outcomes.

Background: We aimed to investigate the prevalence of Enterocytozoon bieneusi and the circulating genotypes in wild boar in the western regions of Iran. Methods: Fifty-two fecal samples were collected from wild boars in Lorestan province, Iran. After DNA extraction, the presence of E. bieneusi was evaluated by real-time PCR. A nested PCR targeting the internal transcribed region (ITS) was employed to characterize genotypes. The PCR products were sequenced, and the genetic diversity and relationships among the genotypes were identified using MEGA X and DnaSp (V5) software. Results: Sixteen (30%) samples were positive for E. bieneusi using real-time PCR, and 11 (21%) were positive for nested PCR, which was sequenced. All 11 positive samples were identified as the BEB6 genotype (Group 2). The haplotype diversity was noted to be 0.182, and the nucleotide diversity, calculated using DnaSp, was 0. 00085. Conclusion: The findings highlight the high prevalence of the genotype BEB6 in wild boars. The presence of this genotype suggests the circulation of E. bieneusi between domesticated animals and wild boars in Iran.