Guilan University of Medical Sciences

Perseverative negative thinking is a significant cognitive process strongly associated with psychological distress and mental disorders. In light of Afghanistan’s ongoing social and economic challenges, a reliable self-report measure is essential for accurate clinical assessment among Afghan populations. The present study aimed to translate and validate the Dari/Farsi version of the Perseverative Thinking Questionnaire (PTQ) in a sample of Afghan students. The statistical population of this study consisted of 254 undergraduate students at Herat University, Afghanistan, who were enrolled in the 2024-25 academic year. In this study, students were selected using convenience sampling and completed an online survey (Qualtrics). To calculate test-retest reliability, 40 individuals were also selected and completed the PTQ within two weeks. In this study, the PTQ and the Depression Anxiety Stress Scale- 21 Items (DASS-21) were administered. The confirmatory factor analysis (CFA) results showed that the three-factor model and the second-order three-factor model of PTQ had the same and a good fit ( χ 2 /df = 2.35, CFI = .94, RMSEA = .07). Furthermore, PTQ showed a moderate positive association with depression, anxiety, and stress ( r (254) = .66, .56, .60, p < .05), a strong test-retest reliability, ( r (40) = .73, p < .05), and excellent internal consistency ( α = .92). Given its strong psychometric properties, the Dari/Farsi version of the PTQ can be considered a reliable tool for both research purposes and clinical assessment. Its use is highly recommended for psychologists and mental health practitioners in diagnostic contexts as well as in investigative and applied studies.

Artificial sweeteners (AS) are widely used as sugar substitutes, particularly among individuals with metabolic disorders. Although AS are approved by regulatory authorities, concerns regarding their potential association with cancer risk persist due to inconsistent findings across studies. This umbrella review aimed to comprehensively synthesize evidence from published meta-analyses evaluating the association between AS consumption and cancer risk. A systematic search of PubMed, Web of Science, and Scopus was conducted to identify meta-analyses examining the association between AS consumption and cancer outcomes in human populations. Data synthesis was performed using random-effects models, and evidence certainty was evaluated using the GRADE framework. Sensitivity analyses, prediction intervals, and publication bias assessments were conducted when applicable. Overall AS consumption was not significantly associated with breast cancer (OR = 0.99, 95% CI 0.92–1.08, P = 0.99), colorectal cancer (CRC) (OR = 0.90, 95% CI 0.76–1.05, P = 0.18), pancreatic cancer (OR = 1.04, 95% CI 0.93–1.17, P = 0.44), gastric cancer (OR = 0.93, 95% CI 0.63–1.36, P = 0.71), or bladder cancer (OR = 1.19, 95% CI 0.75–1.88, P = 0.44). Dose-specific analyses showed no significant associations between AS consumption and breast cancer across low-dose (OR = 1.00, 95% CI 0.95–1.06, P = 0.83), moderate-dose (OR = 0.97, 95% CI 0.94–1.01, P = 0.21), or high-dose categories (OR = 0.88, 95% CI 0.73–1.06, P = 0.18). For CRC, low-dose AS consumption was associated with a reduced risk (OR = 0.87, 95% CI 0.76–0.99, P = 0.04; GRADE: low), whereas moderate-dose (OR = 1.11, 95% CI 0.92–1.33, P = 0.25) and high-dose AS consumption (OR = 0.89, 95% CI 0.79–1.00, P = 0.05) showed no significant associations with CRC risk. Based on the GRADE framework, the certainty of evidence was rated as low for breast cancer, CRC, and pancreatic cancer, very low for bladder cancer, and not assessable for gastric cancer due to the limited number of studies. Although no significant cancer risks were identified, the overall strength of the evidence was weak. More well-designed, high-quality studies are necessary to further explore and clarify the long-term impact of AS on cancer risk. Additionally, there is insufficient evidence available to assess the effects of AS on other cancer types, and further research is needed in this area.

Understanding the relationship between incisor inclination, Collum angle, and alveolar bone thickness is crucial for accurate orthodontic diagnosis and treatment planning. This study is one of the first to assess the Collum angle and buccal and lingual bone plate thickness of maxillary and mandibular central incisors with tooth inclination on cone-beam computed tomography (CBCT) scans. In this cross-sectional study, 112 CBCT scans of the maxilla and 112 CBCT scans of the mandible were three-dimensionally reconstructed using Ez3D-I version 4.1 software. The Collum angle and the labial and lingual bone plate thickness were measured on CBCT scans. The U1-palatal plane angle and the incisor mandibular plane angle (IMPA) were used to determine the inclination of maxillary and mandibular central incisors, respectively. Accordingly, the patients were assigned to three groups of low, normal, and high inclination. Data were analyzed by ANOVA, and the Kruskal-Wallis and Bonferroni tests (α = 0.05). The mean value of the Collum angle was significantly different among the three groups in both the maxilla and mandible (P < 0.001). The smallest value was recorded in the high inclination group, and the largest value was recorded in the low inclination group. The difference in labial and lingual bone plate thickness was significant among the three groups at the apex of maxillary central incisors, and at the apex and mid-root of mandibular central incisors (P < 0.05). Patients with highly inclined maxillary and mandibular central incisors had a significantly smaller Collum angle and vice versa. Tooth inclination had a significant effect on labial and lingual bone plate thickness at the apex of maxillary central incisors, and at the apex and mid-root of mandibular central incisors. Orthodontists should carefully evaluate these parameters during treatment planning to minimize the risk of complications such as root resorption and cortical bone perforation.

Chronic heart failure is a growing health concern globally, with rising prevalence and considerable social and economic impact as a leading cause of death. Although significant progress has been made in cardiovascular disease treatment over the last two decades, this condition continues to pose a significant clinical challenge. The connection between red blood cell parameters and major cardiovascular complications in patients with chronic heart failure remains poorly understood. Assessing these metrics could enhance our ability to predict long-term cardiovascular outcomes in this patient population. In this single-center, retrospective analysis of a prospective cohort, 419 chronic HF patients (mean age 63.70 ± 11.67 years) were enrolled between 2023 and 2024 and categorized into anemic (n = 251) and non-anemic (n = 168) groups based on WHO hemoglobin criteria. Baseline demographic, clinical, and hematological parameters (MCV, MCH, MCHC, RDW, Hb, HCT) were recorded. Patients were monitored over 12 months for major adverse cardiovascular events, encompassing cardiovascular mortality, non-fatal myocardial infarction, non-fatal stroke, or cardiac rehospitalization. Statistical analysis was conducted using SPSS version 16, with significance defined as p < 0.05. Anemic patients had a higher prevalence of diabetes, hyperlipidemia, prior CABG, and smoking (all p < 0.05). They also exhibited significantly lower MCH, MCHC, Hb, and HCT, and higher RDW (p < 0.05). Correlation analyses revealed significant associations between various RBC indices and hematological parameters in both groups. However, in the multivariable analysis, none of the RBC indices including hemoglobin, hematocrit, MCH, and MCHC were independent predictors of rehospitalization or all-cause mortality (all p > 0.05). Hyperlipidemia showed a non-significant trend toward increased all-cause mortality (OR: 1.675; 95% CI: 0.954–2.942; p = 0.073). Although anemia and aberrant red blood cell indices correlate with an unfavorable clinical profile in heart failure patients, they did not independently predict short-term major adverse cardiovascular events in this study population. This implies that the prognostic significance of these standard hematologic parameters may be constrained in advanced heart failure.

BackgroundAerobic exercise improves fitness but can induce oxidative stress, muscle damage, and inflammation. Sesame (Sesamum indicum L.), rich in lignans and antioxidants, may help reduce these effects and support immune function.AimThis systematic review examines the synergistic effects of sesame supplementation and aerobic exercise on oxidative stress, muscle damage, immune response, and inflammatory markers in athletes.MethodsFollowing PRISMA guidelines, a systematic search of PubMed, Scopus, Web of Science, CENTRAL, and EMBASE was conducted up to September 2024. Eligible randomized controlled trials included semiprofessional athletes receiving sesame supplementation (oil, extract, capsule, or whole seed) for ≥4 weeks, with placebo or no-supplement comparators under identical training protocols. Primary outcomes assessed oxidative stress biomarkers, muscle damage markers, inflammatory cytokines, and immune response parameters.ResultsA total of 290 studies were initially identified, with four randomized controlled trials meeting the inclusion criteria after screening. These trials, spanning 4-10 weeks with a total of 140 participants, revealed that sesame supplementation significantly enhanced antioxidant defenses, as indicated by increased levels of glutathione peroxidase (GPx), superoxide dismutase (SOD), and vitamins A, C, and E, while reducing oxidative stress markers such as malondialdehyde (MDA). Additionally, the combination of aerobic exercise and sesame improved anti-inflammatory markers, including a reduction in interleukin-6 (IL-6) and interleukin-1β (IL-1β), though cytokine modulation appeared to be primarily attributable to exercise alone.ConclusionThese findings highlight the potential of sesame supplementation as a natural adjunct to exercise regimens in mitigating oxidative and inflammatory stress, with implications for enhancing athletic performance and recovery.

Differentiating follicular thyroid carcinoma (FTC) from follicular adenoma (FA) is challenging due to their histological similarities. This systematic review and meta-analysis aimed to assess the difference in Ki-67 expression between FTC and FA to evaluate its diagnostic utility. We conducted a comprehensive search of PubMed, Embase, Scopus, and Web of Science databases for studies reporting Ki-67 expression in FTC and FA. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. A random-effects model was applied to calculate the pooled mean difference of the Ki-67 index, with heterogeneity assessed by the Cochran Q and I-squared tests. Meta-regression was used to explore sources of heterogeneity, and publication bias was evaluated using Egger's test, Begg's test, and funnel plot. The meta-analysis revealed a pooled mean difference in Ki-67 expression between FTC and FA of 1.13 (0.63-1.63), indicating a significant difference. In addition, the difference in the Ki-67 index between minimally invasive follicular carcinoma and FA was 0.56 (0.12-1.00), which was also statistically significant. The heterogeneity among included studies was due to variations in Ki-67 index calculation methods. The reviewed studies demonstrated low sensitivity but high specificity of Ki-67 for differentiating FTC vs. FA, although diagnostic cut-offs were inconsistent. This study demonstrates a significant difference in Ki-67 expression between FTC and FA, supporting its potential role as a diagnostic marker. Further research is required to establish standardized diagnostic cut-offs and evaluate Ki-67's sensitivity and specificity in clinical practice.

Abstract Background Pemphigus vulgaris (PV) is a potentially fatal autoimmune mucocutaneous blistering disease. Rituximab (RTX) is a chimeric anti-CD20 monoclonal antibody that is increasingly being used and becoming the first-line therapy in the management of PV. Its impact on cervical cytology and human papillomavirus (HPV) infection risk in this population remains unclear. Objectives To prospectively evaluate cervical Papanicolaou ( Pap) smear results and HPV prevalence before and 6 months after rituximab therapy in women with PV. Methods Twenty-eight women with PV underwent Pap smear and HPV genotyping before and after two rituximab infusions (1 gram, 2 weeks apart) Results The mean age was 55.5 ± 12.1 years; 75% were postmenopausal. After treatment, the proportion of inflammatory smears increased (from 35.7% to 57.1%), though no high-grade lesions appeared ( p = 0.368). HPV DNA was detected in 25% of patients, predominantly high-risk genotypes. HPV positivity correlated with shorter disease duration (24.0 vs. 84.0 months, p = 0.005) and mucosal PV type (66.7%, p = 0.019). Conclusions Rituximab did not significantly alter Pap smear Bethesda categorization at 6 months, but coincided with increased inflammatory cytology and frequent high-risk HPV. Findings support regular Pap/HPV co-testing and vaccination in women with PV undergoing B-cell depletion therapy.