Atefeh Sadeghi, Hadi Hasani, Mobina Kaviani, Ramin Mohammadi,
Volume 28, Issue 5 (12-2025)
Abstract
Introduction: With the advancement of science and knowledge worldwide, ethical challenges are increasing, and nurses' inability to face these challenges significantly impacts the quality of healthcare. Moral courage in nurses helps overcome fear and unethical values. The complexity of nursing work affects spiritual health and prevents nurses from adapting well to nursing challenges.
Methods: This was a correlational study using a convenience sampling method. In 2024-2025, nurses working at Amirul Mominin Hospital were selected, with a calculated sample size of 221. The instruments used were Sekerka's Moral Courage Questionnaire and Ellison and Paloutzian's Spiritual Well-being Scale.
Results: A total of 186 nurses participated in the study, including 119 women and 67 men. The mean scores of moral courage indicated that the moral courage score was higher among women and those with higher educational qualifications. Also, age and existential health were important factors in predicting moral courage, while religious health had no significant effect.
Conclusions: The study's results showed that moral courage and spiritual health, especially in existential dimensions, play important roles in moral decision-making. Gender and age are also factors that can affect the level of moral courage.
Behrooz Karimi, Maryam Shekarpour Roudbari, Katayoun Vakilian, Mohammad Javad Ghanadzadeh, Marjan Mahlouji,
Volume 28, Issue 6 (1-2026)
Abstract
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.
Shirin Irani, Mohammadreza Firouzifar, Farrokh Heidari, Hamed Abdollahi,
Volume 28, Issue 6 (1-2026)
Abstract
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.
