https://jims.mui.ac.ir/ Journal of Isfahan Medical School en daily 1 Sun, 23 Aug 2026 00:00:00 +0330 Sun, 23 Aug 2026 00:00:00 +0330 https://jims.mui.ac.ir/article_33517.html The COVID-19 pandemic affected public health and individual well-being and transformed face-to-face university education. As a result, virtual and electronic education was operationalized and widely integrated into educational systems and medical education. Based on the findings of a qualitative study aimed at identifying the opportunities of virtual education from the perspective of general medical students, this policy brief was developed. The findings showed that, from the students’ perspective, virtual education created opportunities at three levels: infrastructural, educational, and individual. At the infrastructural level, the most important achievements were the disruption of the traditional classroom model, increased use of technology, strengthening of virtual education platforms, and easier management of educational processes. At the educational level, flexibility in time and place of learning, the emergence of new forms of assessment, and the promotion of academic self-directed learning were identified as important opportunities. At the individual level, saving time, reducing some psychological pressures, and lowering commuting and accommodation costs were among the positive outcomes of virtual education. In order to make optimal use of the opportunities created by virtual education, and in consultation with experts, five policy options were designed and analyzed: integrating virtual and blended education into the official medical education curriculum, strengthening and standardizing virtual education platforms, redesigning the assessment and examination system in the virtual environment, supporting students’ self-directed learning and academic flexibility, and reducing educational costs while using resources more efficiently. https://jims.mui.ac.ir/article_33518.html The right to access health information is a fundamental and essential human right. Despite this, in the country's health system, patients' rights to utilize health information services have received less attention from policymakers and managers. This policy brief aims to analyze the dimensions of these rights and provide practical solutions for their realization, based on the findings of a Delphi study and expert opinions. The study's findings showed that patients' rights to utilize health information services have eight main dimensions, including the right to health knowledge, the right to access information, professional behavior of medical librarians with patients, content richness, information literacy skills, awareness of new services and products, ease of use of health information centers, and professional behavior of healthcare professionals with patients. Based on these findings and related expert opinions, five policy options were examined, including "developing and notifying a national charter of patients' information rights, designing and implementing educational courses for healthcare professionals and librarians, installing a charter of patients' information rights in public areas of hospitals and hospital libraries, defining a related course unit in the educational program of students, and creating a system for registering health information services in the patient's electronic file." Analysis of implementation barriers showed that each of these options faces specific challenges, such as lack of previous experience in developing such documents, time conflicts of educational courses with employees' daily duties, physical limitations in hospitals, long administrative processes for changing educational syllabi, and lack of unified information technology infrastructure. https://jims.mui.ac.ir/article_33519.html Noise pollution represents a significant environmental hazard associated with adverse fetal outcomes during pregnancy, particularly miscarriage and perinatal mortality. This policy brief is developed based on the results of a systematic review and meta-analysis of 13 studies involving over 615,000 pregnant women, revealing a significant 44% increase in the risk of miscarriage following exposure to noise levels of 80 decibels (dB) and higher in both occupational and residential environments. Findings indicate that maternal noise stress, by stimulating hormonal axes and elevating cortisol levels, leads to disruptions in placental blood flow and fetal implantation. Despite extensive scientific evidence and the strategic priority of "Population Youthfulness" in national macro-policies, environmental and occupational exposure standards for the protection of pregnant women have not yet been rigorously revised. This document demonstrates that while no significant correlation between noise and perinatal mortality was observed in this specific study, the high risk of miscarriage in noisy industrial and urban settings poses a serious threat to reproductive health and demographic objectives. Therefore, prioritizing preventive programs, such as "transferring pregnant women from high-noise industrial units" and "enforcing strict acoustic engineering regulations in residential areas adjacent to highways and noise-polluted hotspots," is recommended. These actions can lead to a reduction in spontaneous and therapeutic miscarriage rates, facilitating a safe environment for fetal development and enabling the realization of the "Family Support and Population Youthfulness Law." https://jims.mui.ac.ir/article_33520.html Personalized medicine is based on the principle that each patient's treatment should be designed according to their unique characteristics rather than universal protocols. This approach is particularly critical in oncology, where the disease is complex, dynamic, and adaptive. This policy brief is developed based on research aimed at modeling the interaction between drugs and cancer cells using Game Theory and Stackelberg competition. The findings demonstrated that the Stackelberg model is capable of predicting three patterns of drug resistance: rapid, gradual, and cross-resistance. By determining optimal dosing strategies including a strong initial dose, gradual adaptation, and rest periods the model can increase patient survival by up to 23% and reduce side effects by 31%. Based on these findings and expert consultation, three policy options were presented: "development and implementation of the Stackelberg model in selected cancer centers," "maintaining the status quo," and "developing simple statistical models based on retrospective data." Analysis of these options showed that, given current limitations in data infrastructure, specialized human resources, and budget, the first priority should be the development of simple statistical models and the standardization of clinical data collection. This action can institutionalize a culture of data-driven decision-making within the medical community and pave the way for adopting more advanced models, such as Stackelberg, in subsequent phases. Simultaneously, establishing a national consortium for genomic and clinical cancer data, allocating specialized research funds for multidisciplinary projects, and designing clinical trials to validate these models are essential steps to facilitate the implementation of mathematical-modeling-based personalized medicine. https://jims.mui.ac.ir/article_33521.html Cardiovascular diseases (CVDs) claim millions of lives annually and impose a heavy financial burden on healthcare systems worldwide. Iran, as a developing country, is facing an increasing prevalence of these diseases. In this context, the "Isfahan Healthy Heart Program" investigated the relationship between a healthy lifestyle and the incidence of CVDs. The study findings indicated that an intervention program aimed at community empowerment reduced CVD risk factors and can effectively manage the prevalence and mortality of these diseases. Based on the study findings and expert consultations, policy options were proposed: "a comprehensive national program to promote a healthy lifestyle at the population level," "targeted interventions for high-risk groups," and "fiscal and pricing policies to encourage the consumption of healthy goods and reduce the consumption of unhealthy ones." Analysis of these options showed that, considering budget constraints and the existing capacities of the country's health system, the first priority is assigned to targeted interventions for high-risk groups. Practical steps in this direction include designing a screening and identification system for women and the elderly at the level of health houses and comprehensive health centers, training nutritionists and health care providers to offer counseling, and providing insurance coverage for nutrition and physical activity counseling services. The second priority is the comprehensive national program to promote a healthy lifestyle at the population level, which requires the formulation of a national document with the participation of all relevant agencies and a pilot-based approach. https://jims.mui.ac.ir/article_33522.html This analytical document examines the epidemiological trends of Anthrax in Isfahan Province over a decade (2011–2021) based on data collected from authoritative sources. The primary findings indicate a distinct geographical pattern of the disease, with a major concentration in the western and southwestern regions of the province, and a significant correlation with livestock-related occupational activities. The seasonal peak of incidence was observed during the spring and summer months, along with a relative increase in cases between 2013 and 2017. Based on this evidence, five key policy options for the control and prevention of Anthrax were identified and analyzed: 1) Strengthening livestock vaccination in high-risk areas, 2) Establishing a seasonal surveillance and monitoring system prior to high-risk periods, 3) Education and empowerment of livestock farmers and agriculturists, 4) Increasing supervision over livestock entry and movement, and 5) Launching mobile laboratories in rural areas. The prioritization of these options—based on their impact on the disease transmission cycle, feasibility regarding provincial capacities, and expert consensus is as follows: Strengthening livestock vaccination was identified as the first priority due to its maximum impact on disease reduction. Subsequently, seasonal surveillance systems (due to their essential role in early detection and rapid response) and community education (as a complement to ensure the sustained effectiveness of other interventions) are placed in the next priorities. Options regarding livestock movement supervision and the development of mobile laboratories are proposed as supportive and long-term measures. https://jims.mui.ac.ir/article_33536.html Healthy dietary behaviors are among the key components of preventing noncommunicable diseases and promoting public health. However, evidence from a cross-sectional study showed that individuals’ readiness to change behavior is not uniform and is influenced by personal and contextual characteristics. Accordingly, designing identical and generalized interventions for all individuals cannot address differences in readiness for change. This policy brief emphasizes the need to adopt stage-based, targeted, and tailored interventions appropriate to each individual’s condition. The findings indicate that variables such as age, sex, education, employment status, marital status, tobacco use, sleep duration, and anthropometric indicators including BMI and waist circumference are associated with stages of change in dietary behaviors, and this can serve as a basis for identifying groups in need of intervention. In such a context, the health system should adopt personalized interventions and incorporate readiness to change assessment into primary care. Implementing this approach requires staff training; simultaneous intervention on high-risk behaviors such as diet, sleep, and tobacco use; systematic recording of assessment results in health records; and a focus on high-risk groups, including individuals with higher BMI, smokers, and those with insufficient sleep. Overall, this policy brief suggests that health policymakers should prioritize stage-based educational interventions and the use of screening data to create conditions for improving healthy dietary behaviors among middle-aged adults. https://jims.mui.ac.ir/article_32939.html Background: Osteoporosis is a common and silent disorder with significant clinical consequences, particularly in postmenopausal women. Menopause increases the risk of osteoporosis, and metabolic diseases such as type 2 diabetes may further intensify this risk. Despite conflicting findings on osteoporosis prevalence among diabetic and non-diabetic postmenopausal women, no comprehensive study has been conducted in the population of Mashhad. This study aimed to determine the prevalence of osteoporosis and its associated risk factors in postmenopausal women with and without type 2 diabetes. Methods: In this cross-sectional study, all postmenopausal women who visited the bone densitometry unit at Ghaem Hospital in Mashhad over one year were enrolled. Participants were divided into diabetic and non-diabetic groups. Demographic, clinical, and biochemical data were collected. Bone mineral density (BMD) was assessed at the femoral neck and lumbar spine. Data were analyzed using appropriate statistical tests. Results: A total of 224 postmenopausal women (132 with diabetes, 92 without) were included. No significant differences were found in mean femoral T-scores or the prevalence of osteopenia/osteoporosis between groups. However, lumbar spine T-scores were significantly lower in non-diabetic women (–1.82 ± 1.01 vs. –1.50 ± 1.01; P = 0.019). Additionally, osteopenia/osteoporosis was more prevalent in the non-diabetic group (83.1% vs. 68.9%; P = 0.031). Other potential risk factors showed no significant differences. Conclusion: Non-diabetic postmenopausal women had lower lumbar spine T-scores and a higher prevalence of osteoporosis compared to their diabetic counterparts. These findings may guide preventive strategies targeting this high-risk group. https://jims.mui.ac.ir/article_33020.html Introduction: Type 2 diabetes mellitus (T2DM) is a major public health issue in Iran, affecting 1.3% to 14.5% of the population. Management includes lifestyle modifications, oral antihyperglycemic agents, and insulin therapy. This study compares the efficacy and safety of Novomix insulin with a regimen of insulin glargine and aspart for improving glycemic control in Iranian T2DM patients.Materials & Methods: A cross-sectional study at Yazd Medical Research Center included participants aged 30 and older with T2DM for over a year. Patients used either Novomix insulin or insulin glargine plus aspart, with specific kidney function criteria (GFR <30). Glycemic control data (HbA1c, fasting blood glucose, and 2hPP glucose) were collected at baseline, 24, and 48 weeks. Ethical approval was granted by Shahid Sadougi University. (IR.SSU. MEDICINE.REC.1399.198).Results: A total of 243 patients participated, with 130 assigned to the glargine plus aspart group and 113 to the Novomix group. Baseline glycemic measurements were comparable (P>0.05). Both regimens achieved significant reductions in FBG, 2hPP, and HbA1c levels from baseline to 24 and 48 weeks (P<0.05). However, the differences in the changes between the two groups were not statistically significant (P>0.05).Conclusion: Both insulin regimens effectively lowered glycemic levels without significant differences. Future studies with larger samples and longer durations are needed for further evaluation. https://jims.mui.ac.ir/article_33183.html Introduction: Skeletal muscle is known as an organ that can produce molecules with vital functions. The aim of this study was to determine the effect of 8 weeks of resistance training and IsoVie supplementation on the levels of activin A, decorin, and TGF-β in middle-aged men.Methods: The study was conducted as a quasi-experimental and applied study. The statistical population included sedentary men aged 40 to 45 years in Bandar Mahshahr. 40 people were purposively selected and divided into four groups: resistance training, supplementation, exercise + supplementation, and control (10 people in each group). Resistance training was performed for 8 weeks, three sessions per week, with an intensity of 60 to 70% of one repetition maximum. A 25-gram whey protein isolate supplement was consumed twice a day after breakfast and lunch. The data were analyzed using a two-way ANOVA test at a significance level of 0.05.Findings: In the exercise group (P=0.001), supplement (P=0.01) and exercise + supplement (P=0.001), the amount of activin A significantly decreased. . In the exercise group (P=0.001), supplement (P=0.01) and exercise + supplement (P=0.001), the amount of activin A significantly decreased. In the exercise group (P=0.003) and exercise + supplement (P=0.001), the amount of TGF-β significantly decreased. Conclusion: Exercise alone and in interaction with whey protein has a better effect in improving myokines effective in muscle hypertrophy. https://jims.mui.ac.ir/article_33333.html Background: Urinary incontinence is a common disorder among women that negatively affects health and quality of life. Biofeedback has been introduced as an adjunctive approach to improve PFMT effectiveness. This study aimed to systematically review the evidence regarding the role of biofeedback in optimizing PFMT in women with urinary incontinence. Methods: This systematic review followed the PRISMA 2020 guidelines. A systematic search was conducted in PubMed, Scopus, Web of Science, and Google Scholar for studies published between 2017 and 2026. Randomized controlled trials investigating biofeedback combined with PFMT in women with urinary incontinence were included. Methodological quality was assessed using the modified Downs and Black checklist, and risk of bias was evaluated with the RoB2 tool. Due to heterogeneity among studies, results were synthesized narratively. Findings: Twelve studies were included in the final analysis. Most studies reported that PFMT combined with biofeedback improved pelvic floor muscle strength, reduced urinary incontinence severity, and enhanced quality of life. Some studies also reported improved self‑efficacy and exercise adherence. However, several studies found no significant differences between PFMT with and without biofeedback. Conclusion: Biofeedback may be a useful adjunct for improving the performance of pelvic floor muscle training in women with urinary incontinence, although its additional benefit over PFMT alone remains inconclusive. https://jims.mui.ac.ir/article_33375.html Background and Objectives: Liver transplantation is often associated with significant intraoperative bleeding, exposing patients to extensive use of allogeneic blood products. Intraoperative blood salvage (IBS) is a solution to mitigate this effect; however, its oncologic and infectious safety remains a matter of debate. This narrative review aims to synthesize the current evidence regarding the efficacy and safety of IBS and provide risk-based practical recommendations.Methods: A critical search and synthesis of cohort studies, prospective investigations, and systematic reviews/meta-analyses was conducted, with a focus on: reduction in allogeneic blood product utilization, oncologic outcomes, infectious safety, and moderating factors such as leukocyte depletion filtration (LDF).Findings: Selective application of IBS tailored to bleeding risk and surgical field conditions consistently reduces the need for allogeneic transfusion, and the hematologic quality of salvaged products is acceptable. In hepatocellular carcinoma, the body of evidence suggests that IBS —particularly with standard use of LDF— is comparable to allogeneic transfusion strategies in terms of recurrence and survival, although cautionary signals have been reported in high-risk subgroups, such as patients with elevated alpha-fetoprotein levels. From an infectious standpoint, in living donor liver transplantation, bile is frequently sterile and LDF effectively reduces contamination; however, in deceased donor transplantation, the performance of LDF may be inadequate in the presence of a high bacterial load.Conclusions: IBS represents a safe and effective option for reducing allogeneic exposure in many liver transplant recipients. Decision-making in high-risk subgroups should be guided by individualized risk assessment. https://jims.mui.ac.ir/article_33481.html Background: Due to the unavailability of BCNU in countries like Iran, alternatives are being explored. This study compares chemotherapy regimens including Carboplatin versus CCNU as pre-transplant conditioning for refractory/relapsed lymphoma at Seyed-al-Shohada Hospital.Methods: This non-randomized clinical trial included patients hospitalized for autologous stem cell transplantation(ASCT) due to relapsed/refractory lymphoma at Hospital. Patients treated between 2016 and October 2018 received regimen A(Carboplatin, Etoposide, ARAC, Melfalan, 23 patients), while those treated from October 2018 to 2021 received regimen B(CCNU, Etoposide, ARAC, Melfalan, 25 patients). Data on demographics, disease status, and post-transplant outcomes were analyzed by SPSS version 22.Results: Overall survival(OS) was 32.47 ± 10.41 months for group A and 34.40 ± 4.65 months for B. Progression-free survival(PFS) was 28.47 ± 13.51 months for group A and 26.87 ± 11.99 for B(P=0.071). The average hospitalization for group A was 21.39±4.08 days and 17.72 ± 1.59 days for B (P=0.0001). The time to engraftment was 12.55 ± 2.92 days for group A and 11.56 ± 1.32 for B (P=0.253). Duration of neutropenia for group A was 9.82 ± 3.14 days and for group B was 8.80 ± 1.87 days (P=0.290). Duration of antibiotic treatment for group A was 9.33 ± 3.23 days and for group B was 6.28 ± 1.74 days (P=0.0001). Mortality was 17.4% (4 patients) in group A and 12% (3 patients) in group B.Conclusion: Carboplatin is a viable alternative to CCNU in the BEAM regimen before ASCT.Keywords:, autologous stem cell transplantation, lymphoma, BEAM. https://jims.mui.ac.ir/article_33500.html AbstractBackground: The COVID-19 pandemic has been impacting worldwide and long-term complications are not clearly understood yet. The present study aimed to assess the presence and distribution of SARS-CoV-2 in lung and heart biopsies from patients who underwent coronary artery bypass grafting surgery (CABG).Methods and Materials: This observational cross-sectional study was conducted in Chamran hospital in Isfahan, Iran, between June 2021 and November 2021. The heart and lung biopsies were collected from previously documented infected patients with SARS-CoV-2 who underwent CABG. After the RNA extraction, RT-qPCR was performed against the RdRp (RNA-dependent RNA polymerase) region and the nucleocapsid protein N region using COVID-19 One-Step RT-PCR (Reverse Transcription-Polymerase Chain Reaction) Kit (Pishtazteb, Iran). The analysis was performed using IBM SPSS Version 22. All The experimental data are shown as the mean ± standard deviation.Findings: Ten patients (F/M: 3/7) were included in the study with a mean age of 60.4±5.3 years. All samples were positive for RNase P; therefore, they were included in the study. None of the biopsies were positive for SARS-CoV-2. Conclusion: The absence of the virus in the examined samples suggests that, at least in some cases, the immune system may effectively clear the virus from these tissues. However, further research is needed to confirm these findings in larger and more diverse patient populations and explore the potential long-term effects of COVID-19 on the heart and lungs.Keywords: SARS-CoV-2, COVID-19, Heart, Lung, PCR https://jims.mui.ac.ir/article_33503.html Background: Red blood cells (RBCs) are nucleus- and organelle-free cells that play an essential role in respiratory gas transport, acid-base balance regulation, blood viscosity, and blood volume maintenance. Dysregulation in their quantity or function is associated with a broad spectrum of hematologic and systemic disorders. In recent years, extracellular vesicles (EVs), as cell-released membrane-bound nanoparticles, have garnered increasing attention for their capacity to transfer bioactive molecules and modulate the behavior of target cells. This article aims to provide a comprehensive overview of Red Blood Cell-Derived Extracellular Vesicles (RBCEVs) by examining their pivotal roles in both physiological and pathological processes.Methods: In this review article, relevant scientific literature indexed in Scopus, PubMed, Web of Science, and Google Scholar databases was examined to explore the structural features, molecular composition, and physiological and pathological roles of RBCEVs. Findings: Findings indicate that RBCEVs, carrying a diverse cargo of proteins, lipids, and nucleic acids, play a dual role in regulating physiological homeostasis and contributing to the pathophysiology of cardiovascular disease, diabetes, and transfusion-related adverse effects. Conclusion: Despite significant advances in studying and characterizing these vesicles, many aspects of their biological functions and molecular interactions remain unclear. Accordingly, further studies are needed to elucidate the precise molecular mechanisms of RBCEVs. https://jims.mui.ac.ir/article_33511.html Background: The basic sciences in the pathobiology domain (bacteriology, virology, mycology, parasitology, immunology, and pathology) require innovative teaching methods due to their complex and extensive content. This meta-analysis aimed to compare the effectiveness of blended learning versus traditional lecture-based instruction on the learning outcomes of medical students.Methods: Following the PRISMA and Cochrane guidelines, international databases and regional databases were systematically searched. Qualitative and quantitative data (mean, standard deviation, sample size) were extracted from studies with a concurrent control group (lecture-based instruction) and analyzed using the random-effects model in CMA software. Risk of bias was assessed using the Cochrane ROB2 tool. Results: Out of 1,067 retrieved articles, 24 studies met the criteria for systematic review, of which 22 were included in the meta-analysis. The results demonstrated that blended learning was significantly more effective than lecture-based instruction in theoretical courses (effect size = 0.783; 95% CI: 0.592 to 0.975; p < 0.001) and practical courses (effect size = 0.841; 95% CI: 0.571 to 1.111; p < 0.001). Considerable heterogeneity was observed among theoretical studies (I² = 77.45%; p < 0.001), mainly attributable to variations in instructional design and blended learning implementation. The flipped classroom model (employed in 80% of studies) was the most common blended learning approach, and microbiology was the most frequently taught subject area.Conclusion: The findings confirm the superior effectiveness of blended learning in enhancing both theoretical knowledge and practical skills in pathobiology education. Adoption of this method is recommended as an optimal educational paradigm,. https://jims.mui.ac.ir/article_33513.html Background: Genetic variations in miRNAs and their binding sites may increase schizophrenia risk by disrupting miRNA-target interactions, impairing brain development, and elevating susceptibility to this disorder. This study employed in silico tools to predict the deleterious effects of single-nucleotide polymorphisms (SNPs) in overlapped miRNAs related to Th1/Th2 differentiation in schizophrenia, focusing on their impact on miRNA stability, structure, and target binding.Methods: Overlapped miRNAs associated with Th1/Th2 differentiation in schizophrenia were retrieved from miRTarBase and miRWalk databases. To identify and predict the functional effects of SNPs located in the precursor and mature regions of candidate miRNAs, Ensembl, miRNASNP-v4, and SNP2TFBS databases were used. Finally, enrichment analysis of biological pathways was performed using NcPath database.Findings: miRNASNP-v4 identified multiple SNPs across seven overlapped miRNAs (hsa-miR-107, hsa-miR-1827, hsa-miR-206, hsa-miR-320e, hsa-miR-4429, hsa-miR-4467, and hsa-miR-936), with the highest SNP counts in pre-miRNA and mature miRNA regions, particularly in hsa-miR-320e, hsa-miR-4467, and hsa-miR-936. SNPs rs1350983737 and rs1043872367 in hsa-miR-4467 exhibited the strongest and weakest influences on mature miRNA production, respectively. Notably, miR-4467 and miR-320e harbored the most seed region SNPs, potentially disrupting miRNA binding to 3′UTR of target mRNAs. Several SNPs were also found in miRNA promoter regions, potentially impairing transcription factor binding.Conclusion: SNPs in miRNAs can affect both their expression and regulatory functions. Genetic variations in schizophrenia-related miRNAs represent important targets for further investigation to elucidate disease molecular mechanisms. https://jims.mui.ac.ir/article_33515.html Exosomes are a subset of extracellular vesicles (EVs) ranging in size from 30 to 150 nm that can be released from most cell types and circulate in body fluids including blood, saliva, urine, breast milk, follicular fluid (FF) and endometrial fluid. They act as a cell-to-cell communication mechanism that determines the gene expression profile and fate of target cells. Exosomes carry components such as proteins, lipids and nucleic acids that are involved in a variety of physiological processes as well as in the pathogenesis of various diseases. Exosomes have been shown to influence processes in the female reproductive system, including fertilization, implantation, placentation and fetal development. Therefore, they contain genetic and proteomic information that can be used as biomarkers or therapeutic targets in pregnancy-related disorders. In this context, the present review aims to gather information on exosomes with molecular components leading to diseases such as polycystic ovary syndrome (PCOS), premature ovarian failure (POF), endometriosis and Asherman syndrome. This work may help us understand the cause of reproductive disorders and their early diagnosis. https://jims.mui.ac.ir/article_33523.html Background: Streptococcus mutans and Candida albicans are major microorganisms implicated in dental caries and oral candidiasis. Although chlorhexidine is considered the gold standard for chemical plaque control, its long-term use is associated with several adverse effects, prompting interest in natural antimicrobial alternatives. This study aimed to compare the in vitro antimicrobial activity of Mentha longifolia essential oil with chlorhexidine against these two clinically important oral pathogens.Methods: Standard strains of Streptococcus mutans (PTCC 1683) and Candida albicans (PTCC 10231) were evaluated in this in vitro experimental study. The minimum inhibitory concentration (MIC), minimum bactericidal/fungicidal concentration (MBC/MFC), and microbial killing time of Mentha longifolia essential oil and 0.2% chlorhexidine mouthwash were determined using the broth microdilution method.Results: Chlorhexidine exhibited markedly lower MIC and MBC/MFC values than Mentha longifolia essential oil against both microorganisms, indicating greater antimicrobial efficacy at lower concentrations. However, differences were observed in their killing kinetics. Against Candida albicans, the essential oil achieved complete fungal elimination within 1 hour, whereas chlorhexidine required 24 hours despite its superior activity at lower concentrations. Against Streptococcus mutans, both agents completely eliminated bacterial growth within 5 hours.Conclusion: Although chlorhexidine demonstrated greater antimicrobial potency at substantially lower concentrations, Mentha longifolia essential oil showed considerable antimicrobial activity, particularly a rapid fungicidal effect against Candida albicans. These findings suggest that Mentha longifolia essential oil may serve as a promising natural adjunct for the management of oral microbial infections. Further in vivo and clinical studies are required to confirm its therapeutic potential. https://jims.mui.ac.ir/article_33524.html Introduction: Sudden cardiac death in athletes, although rare, is a catastrophic event often caused by asymptomatic heart diseases. This study aimed to evaluate the cardiovascular status of professional athletes in Mazandaran province and identify high-risk individuals.Methods: A cross-sectional study was conducted on 449 professional athletes (384 males, 65 females) with at least two years of activity history across 22 sports disciplines, at Ayatollah Rouhani Hospital in Babol. All participants underwent history taking, physical examination, 12-lead electrocardiography, and transthoracic echocardiography. Data were analyzed using SPSS version 23.Results: Eighty-three athletes (18.5%) had positive symptoms or history. Chest pain was more prevalent in females (P=0.03). Sixty-three athletes (14%) had abnormal electrocardiograms. The mean corrected QTc interval was 362±28.1 milliseconds. On echocardiography, no cases of hypertrophic cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy were observed. Three high-risk athletes were identified: one with Wolff–Parkinson–White syndrome (underwent ablation), one with bicuspid aortic valve with moderate regurgitation, and one with ischemic heart disease (excluded from competition).Discussion: A combined screening approach using history taking, physical examination, electrocardiography, and echocardiography was able to identify high-risk athletes. Electrocardiography was effective in detecting asymptomatic cases such as WPW, while echocardiography was useful in identifying structural abnormalities like bicuspid aortic valve. The use of these methods can help prevent sudden cardiac death in athletes. https://jims.mui.ac.ir/article_33527.html Background: Postoperative sore throat is a common complication following endotracheal intubation during general anesthesia. Dexamethasone has analgesic properties and is effective in reducing postoperative sore throat. This study investigated the effects of different doses of dexamethasone on reducing sore throat.Methods: This study included 100 patients who were candidates for Ophthalmologic surgery. Participants were randomly divided into four groups of 25 patients. One group received 6 mg, one group received 8 mg, one group received 10 mg of intranasal dexamethasone, and one group received intranasal normal saline. Symptoms of sore throat, cough, and hoarseness were recorded after surgery and analyzed using SPSS version 27.Finding: After analysis, no statistically significant differences were observed in demographic characteristics, tracheal intubation variables, duration of surgery, and postoperative outcomes. During the recovery period and up to 6 hours after admission, the dexamethasone groups showed a significant reduction in sore throat, cough, and hoarseness compared with the control group.Conclusion: The present study showed that increasing the dose of dexamethasone was associated with a decreasing trend in the incidence of sore throat. However, its effectiveness after 6 hours was not significantly different from the control group. In addition, the use of intranasal dexamethasone demonstrated the ability to reduce hoarseness and cough following intubation.Keywords: Intranasal dexamethasone; Sore throat; Endotracheal intubation; Ophthalmologic surgery https://jims.mui.ac.ir/article_33528.html Background: Cesarean scar defect (CSD), also known as isthmocele or uterine niche, may be associated with abnormal uterine bleeding (AUB), postmenstrual spotting, dysmenorrhea, and dyspareunia. However, the relationship between sonographic CSD morphology and gynecologic symptoms remains inconsistent. This study evaluated the association between CSD dimensions and gynecologic symptoms in women undergoing transvaginal ultrasonography.Methods: This two-center cross-sectional analytical study included women with confirmed CSD referred to Firoozabadi and Akbarabadi Hospitals, Tehran, Iran, from March 2025 to March 2026. CSD length, CSD depth, residual myometrial thickness (RMT), and adjacent myometrial thickness were measured by transvaginal ultrasonography. Symptoms, including irregular menstruation, postmenstrual spotting/AUB, severe AUB, dysmenorrhea, and dyspareunia, were recorded as binary outcomes. Statistical comparisons were performed using appropriate parametric or nonparametric tests, with P <0.05 considered statistically significant.Results: Among 207 women included in the final analysis, the mean age was 33.1±5.2 years. Mean CSD length, CSD depth, and RMT were 4.30±1.26 mm, 5.93±2.23 mm, and 4.38±2.04 mm, respectively. Postmenstrual spotting/AUB was reported in 78 women (37.7%), irregular menstruation in 71 (34.3%), severe AUB in 41 (19.8%), dysmenorrhea in 41 (19.8%), and dyspareunia in 35 (16.9%). RMT was significantly