Journal of Arak University of Medical Sciences

Efficacy of Thymus vulgaris and Trigonella foenum-graecum Extracts Alone and in Combination in Candida albicans Hyphae Model and in Downregulation of Secreted Aspartyl Proteinase 1 Gene Expression

Fahimeh Alizadeh

Introduction: The emergence of antifungal resistance in Candida albicans diseases poses a threat to global public health. New treatments are needed to target C. albicans and its ability to produce hyphae. The aim of this study was to investigate the potential synergistic effects and antifungal properties of Thymus vulgaris and Trigonella foenum-graecum extracts alone and in combination on C. albicans.
Methods: In this experimental study, extracts of Thymus vulgaris and Trigonella foenum-graecum were prepared using hot water (60 ^°C) and Soxhlet extraction with methanol (10%). Yeast susceptibility testing was performed according to the Clinical and Laboratory Standards Institute disk diffusion and broth microdilution guidelines. The hyphal model was created in the presence of alcoholic extracts of Thymus vulgaris and Trigonella foenum-graecum alone and in combination. Crystal violet staining, microscopic observation and gene expression analysis were used to evaluate the inhibition of hyphal growth.
Results: The results showed that 90% of the C. albicans isolates were resistant to fluconazole. Aqueous and alcoholic extracts of Thymus vulgaris in combination with Trigonella foenum-graecum showed synergistic, partially synergistic and additive effects. Alcoholic extracts of Thymus vulgaris with Trigonella foenum-graecum alone and in combination have anti-hyphae activity by reducing the percentage of hyphae, reducing the number of planktonic cells and the transition of planktonic cells to hyphae, and down-regulating the Secreted Aspartyl Proteinase 1 (SAP1) gene.
Conclusions: Taken together, these results indicate that extracts of Thymus vulgaris alone and in combination with Trigonella foenum-graecum may offer a potent alternative strategy to combat resistant C. albicans infections and their ability to reduce hyphae formation. Additionally, the SAP1 gene could be a likely target in the synergistic interaction of alcoholic extracts of Thymus vulgaris in combination with Trigonella foenum-graecum against the C. albicans hyphae model.

Epidemiology of Patients Presenting to Emergency Department in Vali-Asr Hospital in Arak University During 2020-2023: A Cross-Sectional Study

Saeed Jafari

Introduction: The emergency department is an essential part of the health care system in any country, providing 24-hour service to patients requiring urgent medical, surgical, or other care. The main aim of the present study was to determine the epidemiological characteristics of patients referred to the emergency department at the referral center in Arak city.
Methods: The present cross-sectional study was conducted on 226,127 patients referred to the emergency department during 2020-2023. The information in this study was based on the registration system of patients referred to the emergency department in Vali-asr Hospital in Arak. Data analysis was done by using descriptive statistics and t-test and Chi-square statistical tests. The significance level of the tests was considered P < 0.05.
Results: The mean (standard deviation) age of patients was 36.3 (20.5) years with an age range of (1-103). 147,088 patients were male (65%). Death occurred in 2,633 (1.2%) patients. More than 50% of patients were referred between 8:00 AM and 4:00 PM. Hospital admission was required for 32.1% of patients. 63% underwent surgical procedures. A statistically significant association was observed between gender, age, year of visit, season, time of visit and surgical procedures with the type of admission and the condition of the patient at the time of discharge (P < 0.05).
Conclusions: Understanding the epidemiology and the demographic and clinical characteristics of patients can facilitate timely planning for staff deployment and resource allocation. This can help prevent overcrowding, improve patient outcomes, and increase patient satisfaction through effective management.

The Effect of Platelet-Rich Plasma on Parameters of Frozen‐Thawed Sperm in Asthentertospermia

maryam Baazm

Introduction: Sperm cryopreservation is a crucial method for preserving fertility in patients with asthenoteratozoospermia. However, this process can lead to a reduction in sperm parameters due to the production of free radicals and damage to the cell membrane. Various substances are added to the cryopreservation medium to prevent cellular damage. In this study, platelet-rich plasma (PRP), which contains growth factors and bioactive molecules, was used to improve sperm parameters after freezing.
Methods: Semen samples were collected from 20 men diagnosed with asthenoteratozoospermia. The samples were randomly divided into five groups: control (no PRP), PRP₅₀, PRP₁₀₀, PRP₂₀₀, and PRP₄₀₀. Homologous PRP was prepared and added to the respective groups. The sperm samples were cryopreserved in liquid nitrogen. Twenty days after freezing, samples were thawed and subjected to a comprehensive evaluation of viability, motility, morphology, malondialdehyde (MDA) levels, and DNA fragmentation using specific assay kits. The findings were evaluated using one-way analysis of variance followed by Tukey's post hoc test.
Results: The results of this study demonstrated that cryopreservation led to a significant decrease in all sperm parameters in the control group. The addition of PRP at concentrations of 50 and 400 among the concentrations used resulted in a significant increase in total motility, progressive and non-progressive motility, sperm viability, and a decrease in immotile sperm, DNA fragmentation, and MDA levels compared to the control group (p<0.05).
Conclusions: Cryopreservation and subsequent thawing can have detrimental effects on the biological properties of sperm samples. Therefore, the dose-dependent addition of platelet-rich plasma as a cryoprotectant may offer a promising approach to mitigate the negative impacts of freezing on samples from men with asthenoteratozoospermia.

Comparing the Effectiveness of Emotional Schema Therapy and Group Psychotherapy Based on Acceptance and Commitment Using the Matrix Method on Sexual Function and Personality Disorders in Women with Vaginismus

Maeideh Bina

Introduction: The problems in the field of sexual function and personality that most women with vaginismus face, highlight the need for research and increased attention to this area. Therefore, the aim of this study was to compare the effectiveness of emotional schema therapy and group psychotherapy based on acceptance and commitment using the matrix method on sexual function and personality disorders in women with vaginismus.
Methods: In this quasi-experimental study, the statistical population included all women with vaginismus in Alborz, Kermanshah, and Torbat Jam. Among them, 60 were selected by convenience sampling and randomly assigned to two intervention and control groups (20 in each group). The Women's Sexual Function Questionnaire (Rosen, 1997) and the Personality Disorder Questionnaire (Kohl & Kazen, 2009) were used to collect data. The first experimental group underwent emotional schema therapy intervention (10 sessions) and the second experimental group underwent group psychotherapy based on the matrix method of acceptance and commitment (6 sessions), and the control group was placed on the waiting list. Multivariate analysis of covariance, analysis of variance, and t-test were used to analyze the research data.
Results: The results indicated that there was a significant difference between emotional schema therapy and acceptance and commitment-based group psychotherapy and the control group in the post-test of sexual function variables (P=0.000, F=26.53) and personality disorders (P=0.000, F=7.27). Also, the effect size for sexual function variables and personality disorders in the first and second intervention groups and the control group was 49.7% and 33.9%, respectively.
Conclusions: The results of the present study showed that emotional schema therapy intervention has a greater effect on sexual function than group therapy based on acceptance and commitment using the matrix method, and group therapy based on acceptance and commitment using the matrix method has a greater effect on personality disorders in women with vaginismus than emotional schema therapy.

Identification of a Novel Nonsense Variant in ABCD1 Gene in a Patient with Adrenoleukodystrophy by Whole Exome Sequencing

Milad Gholami

Introduction: Adrenoleukodystrophy, inherited in an X-linked manner, is a progressive neurodegenerative disorder. It is the most common peroxisomal disorder and results from mutations in the ABCD1 gene. The disease manifests with a wide range of symptoms that can vary depending on the age of onset. Its estimated prevalence is approximately 1 in 17,000 live births. This study aimed to analyze the genetic profile of an individual with X-linked Adrenoleukodystrophy (X-ALD) through whole-exome sequencing.
Methods: A peripheral blood sample was obtained from a patient with clinical features consistent with adrenoleukodystrophy. Following the extraction of genomic DNA, whole-exome sequencing (WES) was conducted to identify potential genetic variants. Subsequent data analysis revealed a disease-causing mutation, which was confirmed by Sanger sequencing. The patient's mother was also tested to determine her carrier status. All ethical considerations were observed in accordance with the guidelines established by the National Committee for Ethics in Biomedical Research and the COPE standards.
Results: The study identified a hemizygous variant in the ABCD1 gene, (NM_000033.4) c.1777G>T (p.Gly593Ter), likely pathogenic, confirming the patient's diagnosis of X-linked Adrenoleukodystrophy (X-ALD). Genetic analysis of the patient’s mother revealed that she was a carrier.
Conclusions: A hemizygous variant in the ABCD1 gene was identified using whole exome sequencing. This variant can lead to X-linked Adrenoleukodystrophy.

Dietary and protein intake reduce the risk of mortality in critically ill patients in the intensive care units.

Najmeh Hejazi

Introduction: The aim of the present study was to investigate the relationship between the nutritional status of patients with different methods on the day of admission and dietary intake during the stay with the ICU mortality rate.
Methods: In this prospective cohort study, 125 patients were studied from admission to discharge in eight ICUs. At the time of admission, the nutritional status of the patients was assessed using the SGA questionnaire, anthropometric measurements, biochemical indices, body composition markers and the assessment of Organ Function Impairment (SOFA) and Severity of Illness (APPACHE) scores. The prescribed and received diet of the patients during their stay was recorded. By recording the mortality cases of this unit, the factors related to the mortality were also determined.
Results: Based on the SGA questionnaire, the rate of malnutrition on the day of admission was 28.8% and 29.6% of patients died during their stay in the intensive care unit. It was also found that a one-unit increase in serum IL-6 level and SOFA score at admission increased the risk of death during the stay in the ward by 1.008 and 1.14, respectively (P=0.003 and P=0.01), and with a one-gram increase in protein intake, the risk of death during the stay in the ward decreased by 8% (P<0.001).
Conclusions: This study showed that serum interleukin-6 level and SOFA score at the time of admission and the amount of protein intake during the stay in the ward affect the mortality rate in the ICU patients.

Association between Urinary Concentrations of Heavy Metals (Lead, Cadmium, Mercury, Arsenic, Chromium, Nickel, and Zinc) in Pregnant Women in Arak City and the Risk of Low Birth Weight, SGA, and LGA in Newborns

Behrooz Karimi

Introduction: Exposure to heavy metals during pregnancy is associated with adverse health outcomes for both the mother and fetus. This study aimed to examine the impact of maternal exposure to heavy metals on pregnancy outcomes.
Methods: This cross-sectional study was conducted on 270 pregnant women in Arak between 2023 and 2024. Urine samples were collected from 127 participants before 28 weeks of gestation and from 143 participants after 28 weeks until delivery. The concentrations of heavy metals, including lead, cadmium, mercury, arsenic, chromium, nickel, and zinc, were determined using inductively coupled plasma mass spectrometry (ICP-MS), a method known for its high accuracy, precision, and reproducibility in simultaneous element measurement. Birth weight, small-for-gestational-age (SGA), and large-for-gestational-age (LGA) infants were assessed. Multivariate linear regression was used to analyze the relationship between heavy metal concentrations and birth weight after adjusting for confounding factors such as maternal age, body mass index, education, and smoking status. Logistic regression models were employed to examine the association between metal concentrations and the likelihood of SGA and LGA outcomes
Results: The mean concentration of lead in maternal urine decreased from 0.7 to 0.65 µg/L, while mercury increased from 1.95 to 2.7 µg/L. Cadmium levels remained stable at 0.46 µg/L. Higher concentrations of lead, cadmium, and nickel were significantly associated with lower birth weight (Beta for lead: -34.0, P = 0.002; cadmium: -21, P = 0.005; nickel: -44, P = 0.01) and increased risk of SGA (OR for lead: 1.04, P = 0.03; cadmium: 1.03, P = 0.042; nickel: 1.12, P = 0.03). Mercury and zinc were linked to a higher likelihood of LGA (OR for mercury: 1.07, P = 0.018; zinc: 1.011, P = 0.012). No significant associations were observed for arsenic and chromium.
Conclusions: Exposure to heavy metals is associated with an increased risk of adverse pregnancy outcomes, such as SGA and reduced birth weight. These findings underscore the need for biomonitoring of heavy metal exposure, maternal education for at-risk populations, and policy measures to mitigate industrial pollution.

Comparison of the Effects of Two Selected Training Protocols on Brain-Derived Neurotrophic Factor, Working Memory, and Aerobic/Anaerobic power in Adolescent Futsal Players

Mohammad Parastesh

Introduction: Physical and cognitive fitness are crucial in futsal, making the identification of effective training methods essential. This study aimed to investigate the effects of two high-intensity interval training (HIIT) protocols on plasma brain-derived neurotrophic factor (BDNF) levels, working memory, and selected physical fitness factors (aerobic and anaerobic capacity) in adolescent futsal players.
Methods: This semi-experimental study was conducted on 15–16-year-old futsal players from Arak city with at least three years of club experience (approved by Arak University Ethics Committee, code: IR.ARAKU.RCE.1401.027). Twenty-four participants were randomly assigned to HIIT1 (10×1-minute intervals with 1-minute rest) or HIIT2 (3×4-minute intervals with 2-minute rest) groups, training for eight weeks. Aerobic capacity, anaerobic capacity, plasma BDNF levels, and working memory were assessed pre- and post-intervention. Data were analyzed using Paired and Independent T-tests (P <0.05).
Results: The HIIT1 group showed significant improvements in aerobic capacity (P = 0.001) and BDNF levels (P = 0.001). Similarly, HIIT2 demonstrated significant increases in aerobic capacity (P = 0.001), anaerobic capacity (P = 0.014), and BDNF levels (P = 0.001). Working memory showed no significant changes in either group (P = 0.780), with no between-group differences observed.
Conclusions: Both HIIT protocols significantly improved aerobic capacity and BDNF levels, while only HIIT2 enhanced anaerobic capacity. Neither protocol affected working memory. HIIT appears effective for enhancing physiological and physical fitness factors in adolescent futsal players.

Comparison the Effectiveness of Cognitive Behavioural Therapy and Acceptance and Commitment- Therapy on Distress Tolerance and Social Adjustment of Adolescents with Social Anxiety

Majid Pourfaraj

Introduction: Adolescence is a stressful stage that can affect the mental health and social adjustment of adolescents. The purpose of this study is to compare the effectiveness of cognitive behavioral therapy and acceptance and commitment therapy on distress tolerance and social adjustment in adolescents with social anxiety.
Methods: This was a quasi-experimental study with a pre-test-post-test design and a control group. The statistical population consisted of male high school students with social anxiety in district one of Babol city, who were studying in the 2022-2023 academic year. From this population, 45 individuals who met the study's entry criteria were selected via purposive sampling and were randomly assigned to three groups (15 in the first experimental group, 15 in the second experimental group, and 15 in the control group). Data were collected using the Bell Social Adjustment Inventory (1961) and the Simmons & Gaher Distress Tolerance Scale (2005). The data were analyzed using multivariate analysis of covariance (MANCOVA) (P < 0.05).
Results: The findings showed that cognitive behavioral therapy and acceptance and commitment therapy caused a significant increase in distress tolerance and social adjustment of adolescents with social anxiety (P < 0.001), and there was no significant difference between the effectiveness of these treatments on distress tolerance and social adjustment.
Conclusions: The results showed that the effectiveness of cognitive behavioral therapy and therapy based on acceptance and commitment therapy on distress tolerance is not different. Therefore, these two treatment methods can be recommended to improve distress tolerance and social adaptation in adolescents with social anxiety.

Protective Effects of Low-Frequency Electromagnetic Fields on the Cerebral Cortex in a C57BL/6 Female Mouse of Experimental Autoimmune Encephalomyelitis: A Histological and Molecular Study

Mohammad Hasan Sakhaie

Introduction: Experimental Autoimmune Encephalomyelitis (EAE) is an immune-mediated inflammatory model of multiple sclerosis that induces axonal loss, demyelination and motor disabilities. Electromagnetic fields (EMFs) possess multiple biological capabilities that affect the nervous system. The aim of the present study is to investigate the beneficial effect of low-intensity electromagnetic field on clinical symptoms, histological structure and gene expression in the cerebral cortex.
Methods: Forty-eight female C57BL/6 mice were used for this study. The EAE model was induced by immunization with myelin oligodendrocyte glycoprotein (MOG). Subsequently, the animals were exposed to EMFs (1 mT, 50 Hz) daily over a period of two weeks. At the end of the experiments, body weight, clinical score (paralysis score), and lymphocyte infiltration of the cortex were evaluated in the experimental groups. Moreover, the mRNA expression levels of Bcl2, BDNF, and Nrf2 were also studied using quantitative polymerase chain reaction (qPCR).
Results: EMF exposure significantly reduced the clinical symptom scores and decreased lymphocytic infiltration. The applied EMF also upregulated the expression of Bcl2, BDNF, and Nrf2 in the cerebral cortex compared to the EAE model.
Conclusions: Overall, the present study demonstrated that electromagnetic fields, as a complementary therapy, exert significant neuroprotective properties in EAE by inhibiting oxidative stress and reducing neural tissue inflammation.

Identifying and Explaining the Challenges of Health System Planning in Iran: A Qualitative Study

Seyed Mojtaba Hosseini

Introduction: Health system planning, as a core function of health governance, plays a crucial role in resource allocation, performance improvement, and equity promotion. Despite recent reforms, evidence suggests that planning processes in Iran’s health system still face significant structural, managerial, and implementation challenges. This study aimed to identify and explain the key challenges of health system planning in Iran.
Methods: qualitative study was conducted using a thematic analysis approach. Seventeen participants—including senior and middle managers, faculty members, and health planning experts at national and university levels—were selected through purposive sampling with maximum variation. Data were collected via semi-structured interviews over eight months and analyzed using MAXQDA version 20. Credibility, transferability, dependability, and confirmability were ensured to strengthen the trustworthiness of the findings.
Results: Thematic analysis led to the identification of 160 initial codes, 36 organized themes, and 9 overarching themes. The main categories of challenges included: human resources, leadership and governance, processes and regulations, inter- and intra-sectoral coordination, budgeting and financing, physical infrastructure and equipment, health information and technology, service delivery, and sociopolitical–cultural–economic factors. Major issues were found in managerial transparency, cross-sectoral collaboration, financial constraints, and the lack of systematic monitoring and evaluation mechanisms.
Conclusions: The Iranian health planning system suffers from centralization, structural ambiguities, limited stakeholder participation, and weak information systems. Strengthening evidence-informed policymaking, enhancing transparency and accountability, and reforming governance structures are essential for improving the effectiveness and efficiency of health system planning.

Examining the Prevalence of Suicidal Ideations in the General Population During the COVID-19 Pandemic

Sahar Bayat

Introduction: Suicidal ideation is influenced by social, economic, cultural, biological, psychological, and environmental factors. This study aimed to estimate the prevalence of suicidal ideation in the general population during the COVID-19 pandemic based on global studies.
Methods: All cross-sectional and cohort studies conducted on the prevalence of suicidal ideations in the general population during the COVID-19 pandemic were included in a systematic search of the following databases: Medlib, SID, Iranmedx, PubMed, Magiran, Science Direct, Scopus, and Web of Science, in English and Persian from 2019 to March 2023, without any restrictions. A random effects model was used for data analysis at a 95% confidence level to obtain a summary measure. Heterogeneity among results was assessed using the I² statistical test.
Results: In this review, 39 articles met the study inclusion criteria. According to the studies, the prevalence of suicidal ideations in the general population during the COVID-19 pandemic was 10% (CI: 0.09–0.12, 95%), and the prevalence of suicidal ideations was equal among women and men.
Conclusions: Assessing suicidal ideation is a primary indicator for predicting future suicidal behavior and provides vital insight into an individual's psychological distress and specific needs. However, when these thoughts are accompanied by clear intent and a concrete plan, the situation constitutes a psychiatric emergency and necessitates immediate and serious intervention.

Cerebrospinal Fluid (CSF) Leakage Due to COVID-19 Diagnostic Test

Mohammadreza Firouzifar

COVID-19 is caused by SARS-CoV-2 and has been declared a pandemic by the World Health Organization. One of the diagnostic methods is performing a swab test from the nasopharynx, which carries a risk of complications. In this article, we present a patient who developed cerebrospinal fluid (CSF) leakage from the nose following a COVID-19 test. A 54-year-old woman presented with unilateral nasal rhinorrhea after undergoing the swab. A skull base defect was identified on computed tomography (CT) scan. The defect was repaired via an endoscopic approach using periumbilical fibro-fatty tissue. This case highlights the need to standardize protocols for performing swab tests.