Journal of Arak University of Medical Sciences

When Caregivers Need Care: The Hidden Challenges of Nurses in the Workplace

Amir Mohammad Dorosti

Nurses, as one of the main pillars of the healthcare system, have always been at the forefront of delivering medical services. However, recent studies reveal that this professional group is facing serious challenges in terms of mental health and job satisfaction, largely due to structural and systemic failures in the workplace (1). Data from the COVID-19 pandemic underscore the severity of this issue, revealing high rates of burnout among nurses. 34.1% experienced emotional exhaustion, and 12.6% reported a loss of professional identity. These figures reflect not only a transient crisis but also chronic deficiencies within the healthcare system (2).
Key factors exacerbating nurse burnout include workforce shortages, inadequate resources, and workplace violence
(3, 4). The global shortage of nurses is estimated at around 5.9 million, placing excessive pressure on the remaining staff. Additionally, lack of resources and specialized training, particularly during crises, significantly contribute to burnout risk. Workplace violence, particularly in emergency departments and psychiatric units, is on the rise, and many reports suggest that the actual number of incidents is much higher than what is officially recorded (2, 5).
The consequences of these conditions extend beyond individual nurse wellbeing, directly compromising patient care quality and safety. Meta-analyses have shown significant associations between nurse burnout and reduced patient safety, increased hospital-acquired infections, and medication errors (5). Furthermore, only 50% of nurses in 2021 felt that their organizations prioritized their health and safety (1).
The mental health crisis among nurses is also alarming. Rates of anxiety, depression, post-traumatic stress disorder (PTSD), and insomnia are considerably higher in this group compared to other professions. Predictive factors include understaffing, excessive workload, workplace violence, and lack of organizational support. In addition, the stigma surrounding mental health services acts as a major barrier for nurses seeking professional help (6).
Effective solutions include adjusting nurse-to-patient ratios, banning mandatory overtime, enforcing zero-tolerance policies against workplace violence, and strengthening managerial support. For example, California’s implementation of minimum nurse-to-patient ratio laws has led to increased direct care time, better patient outcomes, and higher nurse retention. Emphasis must shift from merely increasing nurse numbers to retaining the current workforce—a crucial step in healthcare reform.
In conclusion, considering the critical importance of nurse wellbeing and its direct impact on patient care, structural and supportive reforms must be prioritized by health policymakers and administrators.

Investigating the Effectiveness of Pre-Operative Face-to-Face Training on the Anxiety Levels of Patients Undergoing Cataract Surgery

Nazanin Amini

Introduction: Cataract is one of the common causes of disability in the elderly. Candidates for cataract surgery, like any other type of surgery, experience a lot of anxiety, and this anxiety has an adverse effect on their psychological, physiological and post-operative recovery. This study was conducted with the aim of investigating the effect of pre-operative education on the level of anxiety of cataract surgery candidates.
Methods: In this educational experiment, 80 patients who were candidates for cataract surgery were divided into two experimental and control groups using available sampling method. The patients in the test group received the educational intervention and the patients in the control group received the usual ward care. The anxiety levels of the two groups were determined using the Spielberger questionnaire during hospitalization, after surgery, and upon entering the ward. These levels were then compared between the two groups. The data were analyzed using descriptive statistics, Fisher's exact test, Levene's test, Chi-square test, and T-test.
Results: The results did not show a statistically significant difference between the test and control groups before the educational intervention in terms of overt anxiety (p = 0.54) and anxiety (p = 0.20), but after the implementation of the educational intervention, the results showed a statistically significant difference between the two test and control groups in terms of the mean of overt anxiety (p = 0.00) and hidden anxiety (p = 0.002).
Conclusions: The implementation of pre-operative educational intervention leads to the reduction of post-operative patients' anxiety, hence it is suggested that training be performed as a low-cost and effective method in pre-operative care.

The Effect of a Period of Endurance Training with Electrical Stimulation on the Expression of ICAM and VCAM Genes in Heart Tissue of Fasted Obese Rats

Mehdi Moradi

Introduction: Since endurance training and a fasting diet are effective in reducing the symptoms of heart disease, this study aimed to investigate the effect of a period of endurance training with electrical stimulation on the expression of ICAM and VCAM genes in the heart tissue of obese fasting rats.
Methods: In this study, 35 male Wistar rats (8 weeks old, average weight 200 ± 19 g) were rendered obese and then randomly assigned to five groups of seven: obese control, fasting, fasting with endurance training, fasting with electrical stimulation, and fasting with endurance training with electrical stimulation. All groups except the obese control followed a 16/8 intermittent fasting protocol. The endurance training lasted 4 weeks, with 5 sessions per week, starting at 50% of maximal oxygen consumption in the first week and progressing to 65% by the fourth week. Electrical stimulation was delivered via foot shock (0.5 mA for 20 min). 24 hours after the last session, cardiac tissue was extracted under deep anesthesia. The expression levels of ICAM-1 and VCAM-1 genes in the heart were measured using real-time PCR. Data were analyzed using two-way analysis of variance (ANOVA) followed by Tukey's post-hoc test, with the significance level set at P ≤ 0.05.
Results: The results of the present study demonstrated that intermittent fasting, endurance training, and electrical stimulation—each independently—led to a significant reduction in the gene expression of vascular adhesion molecules in the cardiac tissue of obese rats (P = 0.001). Moreover, it appears that the combination of all three interventions exerts a greater effect in reducing the expression levels of these adhesion molecules in the cardiac tissue of obese rats (P = 0.001).
Conclusions: Based on the findings, the simultaneous application of endurance training, intermittent fasting, and electrical stimulation exerts a considerable impact on decreasing the expression of VCAM and ICAM in cardiac tissue. However, it is still not possible to definitively determine the directionality of the individual or combined effects of intermittent fasting, endurance training, and electrical stimulation (foot-shock stimulation) on adhesion molecules under conditions of obesity and intermittent fasting.

Effects of Intraperitoneal Injection of Botox on Biochemical and Structural Parameters of the Kidneys of Female Wistar Rats

Mohammad Reza Dayer

Introduction: Botulinum neurotoxin protein (Botox) is widely used for cosmetic purposes to reduce facial wrinkles without regard to its side effects. The present study was conducted to investigate the effects of Botox on blood biochemical factors and the kidney tissue structure of female rats.
Methods: In this study, 28 adult female Wistar rats were selected and randomly divided into four groups (n = 7). The first three groups received intraperitoneal injections of Botox (in the lower third of the abdomen, one centimeter below and to the left of the navel) at doses of 4, 6, and 8 units, respectively, while the fourth group (the control group) received a saline injection. Then the animals were kept in the animal house for three months with full access to food and water at a temperature of 22°C and a 12-hour light-dark cycle. Following a 24-hour fasting period at the end of the study, blood samples were collected via cardiac puncture under ether anaesthesia. Then, the animals were euthanized without pain, and their kidney tissue samples were extracted for histological examination.
Results: Biochemical results indicated a significant increase in serum creatinine levels following injection with 6 and 8 units of Botox, indicating renal impairment. Although the increase in the amount of serum uric acid levels compared to the control group did not reach statistical significance at the 95% confidence level (P < 0.05), it showed significance at the 94% level (p < 0.06), suggesting primary renal damage. Histopathological examination demonstrated that intraperitoneal injection of 8 units of Botox induced scattered and limited structural alterations in renal tissue, including vacuolar degeneration of tubular epithelial cells.
Conclusions: The results of this research show that the long-term and repeated use of Botox may cause significant renal damage in addition to local lesions and threaten a person's life.

The Effect of Eight Weeks of Endurance Training with Purslane Seed Supplementation on the Pro-Inflammatory Factor IL-6 and CRP in Middle-Aged Type 2 Diabetes Men on the Threshold of Obesity

Ali Ghasemi Kahrizsangi

Introduction: Today, diabetes is one of the main problems in the world. Type-2 diabetes is more common in obese and overweight people, and obesity is a serious health problem. In addition to the importance of exercise in diabetes, some supplements can be effective on inflammatory factors. Therefore, the aim of the present study was to determine the effect of 8 weeks of endurance training along with purslane seed supplement consumption on the pro-inflammatory factors IL-6 and CRP in middle-aged type-2 diabetic men on the threshold of obesity.
Methods: In this semi-experimental study, 40 male patients with type 2 diabetes with an average age of 40-55 and fasting blood sugar above 120 were selected, then randomly divided into four groups of 10 including: control group, exercise group, exercise+supplement group. And the complementary group was divided. The subjects had no history of regular sports activity (for the previous 6 months) and consumption of purslane and were on the threshold of obesity (BMI between 28 and 30). The subjects walked 3 sessions a week and each session was for one hour without rest. The duration of the training session started from 30 minutes in the first week and reached 45 minutes of training in the eighth week with an intensity equal to 50-70% of the maximum reserve heart rate. The supplement group consumed 7.5 grams of purslane seeds per day for 8 weeks. The control group was not subjected to any training or supplements during 8 weeks. Paired t-test was used to compare the results before and after check the significant difference between the four groups, the analysis of covariance test was used, and if a significant difference was observed, the Bonferroni post hoc test was used to determine the location of the difference between the groups using SPSS 25 and EXCEL2010 statistical software at the significance level (P<0.05).
Results: The results of covariance analysis showed a significant difference in CRP (P=0.000). The results of Bonferroni's post hoc test indicated a difference between the two groups of exercise-supplement and placebo exercise compared to the control group (P<0.05). No difference was observed in IL-6 values.
Conclusions: It seems that the consumption of purslane seeds along with exercise improves the inflammatory index and CRP predicts heart problems. As a result, the use of purslane seed supplement if combined with exercise can be an effective method for middle-aged men with type 2 diabetes on the verge of obesity, but the effect of endurance training is more effective than purslane seed supplement.

The Short-Term Effect of Anti-Pronation Insoles on Plantar Pressure Variables in Individuals with Anterior Cruciate Ligament Reconstruction with Pronated Feet during Running

AmirAli Jafarnezhadgero

Introduction: Using treatment interventions in patients with anterior cruciate ligament (ACL) are essential. Also, some studies have reported that medical insoles decrease the rate of incidence of ACL injury. Therefore, the objective of this study was to investigated the acute effect of short-term anti-pronation insoles on foot pressure variables in individuals with anterior cruciate ligament reconstruction with pronated feet during running.
Methods: The present study was a semi-experimental type that was done at 2022 in Ardabil city. The sample of this study consisted of 13 individuals with both ACLR and pronated foot aged 23.4±2.5 years and 13 healthy ones aged 22.9±4.1 years that was selected with available sampling method. Plantar pressure values were recorded during running with and without anti pronated foot orthoses by foot scan device (sampling rate: 300 Hz). Two-way analysis of variance with repeated measures was used for statistical analysis.
Results: Results of the present study demonstrated a decreasing of peak plantar pressure variables on first (P=0.044), second (P=0.010), and fifth metatarsal (P=0.027) regions after using anti-pronated insoles during running stance phase.
Conclusions: Overall, it could be stated that foot orthoses possibly reduced plantar pressure and ground reaction force variables after anterior cruciate ligament reconstruction in individuals with pronated feet during running. However, further study is needed to better establish this issue.

Evaluation of the Effects of Alternating Magnetic Fields on the Growth of Escherichia coli and Staphylococcus Aureus Bacteria

Fatemeh Seif

Introduction: In today’s world, with the expansion of electronic technologies and equipment generating electromagnetic fields, humans and other living organisms are continuously exposed to these fields. This exposure can have significant biological effects on the growth and function of living organisms. This study aimed to evaluate the effects of alternating magnetic fields with different intensities and frequencies on the growth of Escherichia coli (E. coli), a Gram-negative bacterium, and Staphylococcus aureus (S. aureus), a Gram-positive bacterium.
Methods: This study investigated the effects of alternating magnetic fields with intensities of 1 and 2 millitesla and frequencies of 50, 75, 100, and 150 Hz on the growth of Escherichia coli and Staphylococcus aureus. The standard plate counting technique was used for this purpose. Samples were incubated at 37°C for 24 hours, and the number of colonies was counted as colony-forming units per milliliter (CFU/ml).
Results: The results showed that the number of Escherichia coli colonies significantly increased under the influence of magnetic fields compared to the control group (P < 0.05). In contrast, the number of Staphylococcus aureus colonies significantly decreased after exposure to the magnetic field (P < 0.05).
Conclusions: The results of this study indicate that alternating magnetic fields can have different effects on the growth of various bacteria. According to these findings, a decrease in the number of colonies was observed in Staphylococcus aureus due to the magnetic field, while an increase in the number of colonies was observed in Escherichia coli. These findings could be used in the development of new methods for controlling bacterial growth and in biotechnological applications.

Nanoemulsion Containing Essential Oils of Rosemary and Peppermint Reduces Neuropathic Pain in Rats with Chronic Constriction Injury of the Sciatic Nerve

Sayyed Alireza Talaei

Introduction: The analgesic effects of rosemary and peppermint essential oils have been shown in many studies. Low solubility of essential oils in water and low bioavailability limit their consumption, and nanoparticles can help solve these limitations. This study aimed to investigate the analgesic effect of a nanoemulsion containing rosemary and peppermint essential oils in a rat model of neuropathic pain.
Methods: Forty male rats were assigned to four groups: control (CON), neuropathic pain received normal saline (NPS), nanoemulsion (NPN), or gabapentin (NPG). Neuropathic pain was induced using the CCI model. Animals received a nanoemulsion containing 10% rosemary extract and peppermint essential oil via gavage for 21 days. Behavioral tests (Thermal Hyperalgesia, Thermal Allodynia, and Mechanical Allodynia) were done on days 1, 4, 7, 14, and 21 of the study. Biochemical tests were also done on the sciatic nerve of animals at the end of the study.
Results: The NPS rats had a significantly increased pain threshold compared to the control group (P < 0.001). Furthermore, the analgesic potential of nanoemulsion containing rosemary and peppermint essential oils was seen in allodynia and hyperalgesia tests. Biochemical analyses showed that CCI reduced total antioxidant capacity, superoxide dismutase, and glutathione peroxidase activity, and also increased MDA levels in the rats' sciatic nerve (P < 0.001 for all comparisons). Administering nanoemulsion containing rosemary and peppermint essential oils reversed all the above-mentioned changes in the biochemical parameters (P < 0.001).
Conclusions: Our findings revealed that treating rats with a nanoemulsion containing rosemary and peppermint essential oils can reduce neuropathic pain symptoms by balancing their sciatic nerve's oxidant and antioxidant systems.

Evaluating Two Decades of Graduate Scholarship in the History of Medicine in Iran (2001–2021): Growth Trends and Academic Patterns

Seyed Abdollah Mahmoodi

Introduction: Studies examining scientific output provide valuable insights into the development and growth of research activities. The primary objective of this article is to evaluate graduate theses in the field of the history of medicine in Iran from 2001 to 2021, with a particular focus on research trends, the contributions of universities and academic institutions, and patterns of scholarly activity.
Methods: This research is of an applied type and was conducted using the quantitative content analysis method. The statistical population of the research consisted of 558 theses published in universities and scientific centers of the country. Data were collected using a structured content analysis checklist and subsequently analyzed employing descriptive statistical methods.
Results: The research findings indicate that Tehran University produced the highest number of theses with 66, followed by Shahid Beheshti University of Medical Sciences with 49, and Payame Noor University with 36. The highest number of theses were written in 2017 (9.67%), and the lowest number was in 2003. Moreover, the history, professional doctorate, and Persian language and literature departments published the highest number of theses, with 160, 78, and 46, respectively.
Conclusions: The results of this research show that the history of medicine in Iran has experienced significant growth in the past two decades. This growth is evident in the increasing number of theses and the increased participation of universities and scientific centers.

Investigating the Relationship between Serum Adropin Levels and Markers of Renal Function in Active and Inactive Young People

Seyed Sarmad Zahmatkeshan

Introduction: The aim of this study was to investigate the relationship between serum adropin levels and markers of renal function in active and inactive young people.
Methods: The present research was conducted using a correlational method.Fifty young men and women with an average age of 28.22 ± 2.27 years, height 170 ± 8 cm, and body mass index 24.72 ± 4.88 kg/m² participated in the present study. Subjects were divided into active and inactive groups based on Beck's questionnaire, and 3 cc of blood was taken from their brachial vein to measure levels of adropin, urea, uric acid, creatinine, blood urea nitrogen (BUN), albumin, and total serum protein. The normality of the data was determined through the Kolmogorov-Smirnov test, and the independent t-test was used to compare the mean of the data, and the Pearson correlation coefficient was used to determine the correlation.
Results: Although a strong, positive (r = 0.78 +) and significant (p < 0.05) correlation was observed between adropin and physical activity, the renal function markers did not show a significant difference between the two active and inactive groups. No significant correlation was observed between renal function markers and adropin levels and between renal function markers and physical activity.
Conclusions: With increasing physical activity, the amount of adropin increases, but this increase does not change the levels of renal function markers in healthy people. Therefore, it seems that there is no relationship between adropin levels and renal function markers in healthy young people.

Occupational Burnout and Its Relationship with the General Health of Emergency Medical Technicians in Kashan

Leila Ghanbari-Afra

Introduction: Maintaining general health and preventing occupational burnout are two fundamental components of individuals' lives, and each can influence the other. Therefore, the present study aims to investigate the relationship between occupational burnout and general health among emergency medical technicians (EMTs).
Methods: This descriptive-analytical study was conducted on 150 EMTs from Qom University of Medical Sciences in 2020, who were selected by a simple random sampling method. Data were collected using the Maslach Burnout Inventory and the Goldberg General Health Questionnaire. Data analysis was performed using descriptive statistics and Pearson correlation coefficient.
Results: Based on the findings of the present study, the average age of participants was 35.14 ± 8.09 years. The average scores for occupational burnout and general health were 57.98 ± 19.28 and 48.26 ± 10.97, respectively. Pearson correlation analysis revealed a significant relationship between occupational burnout and general health (r = 0.613, P < 0.001)
Conclusions: Based on the findings of the present study, occupational burnout and general health among the EMTs were at a moderate level. Higher burnout scores were associated with worsened general health disorders among EMTs. It seems that selecting students interested in prehospital emergency professions can enhance the situation of this feeling in individuals working in this field. Additionally, it is essential for prehospital managers to pay attention to the occupational burnout and general health in order to improve the quality of services provided by the EMTs.

The Effect of Training Based on the Self-Efficacy Model on Coping Strategies and Hope in Breast Cancer Patients Undergoing Chemotherapy

Fatemeh Mehrabi

Introduction: The purpose of this study was to investigate the effect of education based on the self-efficacy model on coping strategies and hope in breast cancer patients undergoing chemotherapy.
Methods: This study was conducted on 62 breast cancer patients undergoing chemotherapy. The intervention group received four training sessions on chemotherapy side effects and management strategies based on the self-efficacy model, while the control group received routine care without additional training. Demographic questionnaires, the Billings and Moss Coping Skills Questionnaire, and the Schneider Hope Scale were completed by both groups immediately before and after the intervention. Data were analyzed using appropriate statistical tests.
Results: The average hope in the intervention and control groups was low before and after the intervention. It remained low in the control group but showed a significant increase in the intervention group (P < 0.05). Statistical tests showed that there is a significant relationship between the average total life expectancy and their age, economy and education (P<0.05). Before the intervention, both groups demonstrated low use of coping strategies. After the educational intervention, the control group maintained low usage while, the intervention group showed substantially increased use of coping strategies.
Conclusions: Self-efficacy training intervention increased life expectancy and coping strategies in breast cancer patients undergoing chemotherapy.

Oral Baclofen Withdrawal: A Case Report of an Iranian Infant with Gastroesophageal Reflux Disease, Presenting with Seizure

Maryam Mobedi

Introduction: Baclofen, a GABA-B receptor agonist, acts on presynaptic and postsynaptic neurons in the central and peripheral nervous systems. Baclofen withdrawal causes activation of dopamine and noradrenergic receptors. Symptoms usually develop in 1 to 3 days of cessation, including altered mental status, worsening of spasticity, fever, weakness, autonomic instability, seizures, neuroleptic malignant syndrome, neuropsychiatric manifestations, and a life-threatening state. It can be observed in patients taking oral or intrathecal baclofen following sudden discontinuation or dose reduction. Baclofen is a commonly used medicine in patients with muscle spasticity. It can also relieve gastroesophageal reflux disease (GERD) symptoms.
Case Report: Here, we report a four-month-old Iranian boy with normal neurodevelopment who was referred to the pediatric emergency department due to extreme irritability, intense crying, poor feeding, insomnia, staring, and a seizure episode. He was admitted to the pediatric intensive care unit, with initial assessment of vital signs (mild fever, tachycardia, tachypnea), laboratory tests (anemia), brain CT (computed tomography), and EEG (electroencephalogram), which were non-diagnostic. Meningitis also was ruled out. He was started on serum and antibiotic therapy and intravenous phenobarbital, but symptoms and signs did not completely improve, and the patient was irritable and his poor feeding was continued. Further history revealed GERD treated with oral baclofen for three months, which had been discontinued three days prior to admission. Baclofen was restarted at the previous dosage, resulting in rapid symptomatic improvement. The patient was transferred to the neurology department and then discharged in good general condition with oral baclofen and phenobarbital. Phenobarbital was tapered and discontinued after two weeks without seizure recurrence.
Conclusions: After four months of follow-up, the patient was in normal condition. To the author's knowledge, no cases of seizures after discontinuation of baclofen have been reported in Iranian infants under six months of age with GERD.