Gonabad University of Medical Sciences

As a critical social determinant of health, occupational fatigue can be a key indicator for tracking mental health inequalities in working populations. A systematic assessment of fatigue and its impact on safety performance indicators is essential for developing effective preventive strategies in industrial settings. This study aimed to investigate the correlation between occupational fatigue and safety and health performance within an industrial sector in Gonabad, Iran. A descriptive-analytical, cross-sectional study was conducted among industrial workers. Data were collected using a demographic questionnaire, the Swedish Occupational Fatigue Inventory (SOFI) to quantify fatigue, and the ELMERI index to assess safety and health performance levels. Kolmogorov-Smirnov, t-test, Mann-Whitney, and Spearman's rank correlation coefficient tests were used for statistical analysis between variables. The study included participants with a mean work experience of 8.49 (±4.63) years. The mean SOFI score for occupational fatigue was 52.75, indicating a significant burden of fatigue. The mean ELMERI index score was 59.50, reflecting a moderate level of safety and health performance. A significant inverse correlation was found between occupational fatigue and safety performance (r=-0.40, p<0.05), suggesting that higher levels of fatigue were associated with poorer safety and health outcomes. The findings demonstrate a significant negative relationship between occupational fatigue and safety performance, highlighting the detrimental impact of fatigue on workplace safety. These results underscore the need for implementing fatigue risk management systems and ergonomic interventions in the workplace. Future longitudinal research is recommended to elucidate further the causal mechanisms underlying this relationship.

Central nervous system lymphomas (CNSL) are aggressive and rare malignancies that are associated with a poor prognosis and limited treatment options. While high-dose methotrexate (HD-MTX) and whole-brain radiotherapy (WBRT) are primary options, they are correlated with recurrence and neurotoxicity. Stereotactic radiosurgery (SRS) has emerged as a potential targeted option; however, its effectiveness in CNSL remains largely unexplored. This study aimed to evaluate the role of SRS in CNSLs. A systematic search was conducted in PubMed, Embase, Scopus, and Web of Science. Studies reporting local control (LC), progression-free survival (PFS), overall survival (OS), distant brain failure (DBF), and adverse radiation effects (ARE) were included. Sixteen studies involving 321 patients and 462 lesions were analyzed. The pooled LC was 97% (95% CI: 94%-100%), and the DBF rate was 58% (95% CI: 43%-72%). The PFS at 6, 12, and 24 months was 75% (95% CI: 67%-83%), 54% (95% CI: 44%-63%), and 29% (95% CI: 13%-48%), while the OS was 90% (95% CI: 78%-98%), 73% (95% CI: 56%-88%), and 42% (95% CI: 26%-59%). The pooled ARE rate was 7% (95% CI: 4%-11%). Human immunodeficiency virus (HIV)-positive status and larger tumor size were associated with less favorable outcomes. SRS is associated with promising clinical and radiologic outcomes and low ARE rates in patients with CNSL, serving as a complementary or salvage option.

The monetary value assigned to a quality-adjusted life year (QALY) serves as a fundamental threshold in cost-effectiveness evaluations, contributing to informing resource allocation decisions within healthcare systems given the more severe resource constraints. The present study aims to conduct a systematic review of the existing literature in terms of the methodologies employed, estimated values, and key determinants affecting willingness to pay per QALY in the context of Iran. We undertook a systematic review of the published work on willingness to pay (WTP) per QALY by searching eight international and national databases from inception of databases to March 2025, including PubMed, Embase, Web of Science, Scopus, Iran Medex, SID, Magiran, and the Barkat Knowledge Network system. NIH quality assessment tool was used for quality appraisal. The search yielded in 517 articles. After screening, seven articles were eligible. The findings showed that the range of WTP per QALY in Iran is very wide, varying from $1,032 (0.22 times GDP per capita) for neck and back pain interventions to $14,173 (1.98 times GDP per capita) for cancer interventions. The median of WTP/QALY was 0.4 of GDP per capita and was roughly $1921 per QALY, substantially lower than the WHO’s recommended threshold. Education, income, employment, marital status, being head of household, age, gender, were the most important determinants of WTP among all included studies. Current WTP/QALY estimates fall substantially below WHO thresholds, suggesting the need to revise Iran’s cost-effectiveness threshold framework. However, further studies are needed and future research should aim to minimize bias in WTP estimates and decision-making criteria to enhance the resource allocation process.

Brain metastases occur in up to 50% of patients with HER2-positive breast cancer, posing significant therapeutic challenges due to the limited penetration of systemic therapies across the blood-brain barrier and the constraints of radiation therapy (RT). While small-molecule tyrosine kinase inhibitors (TKIs) show promise for crossing the blood-brain barrier and local RT provides initial control, optimal combination strategies remain unclear. This study assesses the safety and efficacy of RT combined with TKIs for HER2-positive breast cancer brain metastases (BCBM), aiming to identify optimal strategies and synergistic benefits.A comprehensive search was conducted through February 12, 2025, for studies on HER2-positive BCBM patients treated with combined RT and TKI versus either alone. Pairwise meta-analyses were conducted using a random-effects model. Bayesian network meta-analysis (NMA) was conducted to integrate direct and indirect comparisons, addressing the lack of head-to-head trials.Eleven studies (2 RCTs, 9 retrospective; 826 patients) evaluated four treatment strategies: pyrotinib + RT, pyrotinib alone, RT alone, and lapatinib + RT. Pairwise meta-analyses showed pyrotinib + RT demonstrated a significantly superior overall response rate (ORR) compared to pyrotinib alone (OR = 3.10, 95% CI = 1.86-5.18) and improved intracranial progression-free survival (PFS) over pyrotinib alone (HR = 0.61, 95% CI = 0.38-0.99) and RT alone (HR = 0.33, 95% CI = 0.12-0.89). Lapatinib + RT was associated with significantly higher severe adverse events (SAEs) than RT alone (OR = 6.13, 95% CI = 2.17-17.27). Bayesian NMA further revealed pyrotinib + RT had superior ORR compared to lapatinib + RT (logOR = 2.18, 95% CI = 0.07-4.58). Ranking probabilities from the Bayesian NMA confirmed pyrotinib + RT as most effective for ORR (97.05%) and DCR (88.57%), with lapatinib + RT associated with the highest SAE risk (95.38%).Based on the available evidence, pyrotinib + RT may represent a promising therapeutic approach, associated with improved ORR and intracranial PFS compared to monotherapies and a favorable safety profile. In contrast, lapatinib + RT appeared to offer limited benefit and a higher risk of SAEs. Further randomized controlled trials are needed to validate these findings.

Glossopharyngeal neuralgia (GPN) is a rare craniofacial pain disorder causing paroxysmal throat and ear pain. For medically refractory cases, microvascular decompression (MVD) targets the underlying neurovascular compression and offers a potentially curative treatment. This systematic review and meta-analysis aimed to evaluate the efficacy, safety, and durability of MVD for GPN and identify predictors of outcome. A comprehensive search of PubMed, Embase, Scopus, and Web of Science was conducted up to August 24, 2025, following PRISMA guidelines. Eligible studies included patients with clinically or radiologically confirmed GPN treated with MVD. Pooled estimates were calculated using random- or fixed-effects models, and heterogeneity, publication bias, and meta-regression analyses were performed. Twenty-five studies encompassing 1,009 patients were analyzed. The pooled rate of initial complete pain relief was 94.2% (95% CI: 90.2-97.3%), and long-term complete relief was 92.1% (95% CI: 86.9-96.2%). Pain recurrence occurred in 2.3% (95% CI: 0.5-4.8%), and permanent complications in 1.7% (95% CI: 0.2-4.2%). Meta-regression identified longer disease duration and prior MVD as negative predictors, while arterial compression and older age favored better outcomes. MVD provides excellent and durable pain relief with minimal morbidity, confirming its role as the gold-standard treatment for classical GPN. Prospective, standardized studies are warranted to refine patient selection and optimize outcomes.

Propofol infusion syndrome (PRIS) is a rare, severe complication from prolonged high-dose propofol use. Predictive biomarkers, especially in spinal surgery, remain unclear. This study aimed to biochemically and pharmacologically characterize risk markers of PRIS following high-dose propofol infusion in patients undergoing elective spinal surgery. A quasi-experimental interventional study was conducted in 2024 at Allameh Bohlool Gonabadi Hospital. Fifty-four patients aged 20–70 years scheduled for elective spinal surgery and classified as ASA physical status I or II were enrolled via convenience sampling. Baseline blood samples were collected one day prior to surgery. Propofol maintenance anesthesia were performed using standardized dosages, including continuous intravenous infusion at 10 mg/kg/h. A second blood sample was taken four hours after propofol infusion initiation. Biochemical parameters assessed included triglycerides, HDL, LDL, total cholesterol, arterial blood pH, bicarbonate ion (HCO3−), and base excess (BE). Data analysis employed paired t-tests and Pearson correlation coefficients with significance set at p < 0.05. Serum triglyceride levels increased significantly postoperatively from a mean of 153.07 mg/dL to 214.30 mg/dL (p < 0.001, CI = (− 1.19,− 0.57)). Other biochemical markers showed no statistically significant changes. Additionally, surgical duration correlated with changes in bicarbonate levels and lipid profiles. High-dose propofol infusion during elective spinal surgery was associated with a significant increase in serum triglycerides, emphasizing the potential risk of PRIS. These results underscore the importance of perioperative monitoring of lipid profiles in patients receiving high doses of propofol to enable early detection and timely intervention. A notable limitation of our study was the lack of a control group.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-31739-y.

Background: Teaching skull base anatomy is challenging due to its complex threedimensional structures.This study aimed to evaluate the effect of creativity-based learning (CBL) on medical students' satisfaction.methods: This randomized controlled trial was conducted in the first semester of the 2023-2024 academic year at Gonabad University of Medical Sciences with 57 third-year medical students (56 included in the final analysis).Simple random sampling was performed using the RAND function in Excel.Participants were randomly assigned to either the intervention group (traditional teaching combined with schematic drawing) or the control group (traditional teaching only).Satisfaction was assessed using a standard 10-item Likert questionnaire (0-10, Cronbach's alpha = 0.799).Results: he intervention group reported significantly higher satisfaction compared to the control group (mean SD: 8.24 0.90 vs. 7.30 1.04; p < 0.001).Additionally, 85.7% of students in the intervention group recommended the CBL method, compared to 60.7% in the control group.Conclusion: Creativity-based learning, by enhancing active student participation, can be considered an effective approach for teaching medical anatomy.