Jahrom University of Medical Sciences

Nature exposure has been associated with mental health and cognitive benefits among older adults. However, controlled trials evaluating specific types of nature-based interventions are limited. This study aims to examine the effects of two structured outdoor activities, walking with meaningful conversation and group meditation, on mental vitality and cognitive empowerment in elderly women. This is a three-arm parallel randomized controlled trial (RCT) enrolling 111 women aged ≥ 60 from 9 urban and rural health centers in Khafr County, Iran. Participants will be randomized into the following: (1) Walking with meaningful conversation group, (2) meditation in nature group, and (3) control group with no intervention. Each intervention consists of eight 2-h sessions across 8weeks. Assessments will occur at baseline, post-intervention (week 8), and 3-month follow-up using validated questionnaires on mental vitality and cognitive empowerment. The generalized estimating equation (GEE) model will be applied to analyze changes over time. We hypothesize that both intervention groups will show significant improvements compared to the control, with walking expected to yield greater gains in mental vitality and meditation to better enhance cognitive empowerment. Findings may support the implementation of community-based, non-pharmacological programs to promote active aging. Iranian Registry of Clinical Trials IRCT20241023063481N1. Registered on 18 February 2025.

The global rise of chronic diseases requiring long-term management highlights the need for effective palliative care. Nurses play a central role in providing this care, yet frequently face ethical challenges such as moral distress, complex decision-making, and occupational stress. This systematic review aimed to identify, categorize, and synthesize evidence on nurses’ ethical perspectives, challenges, and professional interventions in palliative care for patients with chronic diseases in both hospital and home settings. The review addressed the following questions: (1) What are nurses’ ethical perspectives in delivering palliative care ? (2) What ethical challenges and decision-making dilemmas do they encounter? (3) Which strategies and interventions support ethically sound care? Following PRISMA 2020 guidelines, five databases (PubMed, Scopus, Web of Science, SID, and Magiran) and gray literature via Google Scholar were systematically searched for studies published between 2015 and 2025 in English or Persian. Eligible studies included qualitative, quantitative, mixed-methods, and peer-reviewed reviews addressing nurses’ ethical challenges in palliative care. Qualitative data were analyzed using inductive content analysis, quantitative findings were synthesized descriptively, and mixed-methods results were integrated to allow convergence across study designs. Extracted codes were organized into themes, grouped into categories, and synthesized into overarching domains. Thirty-four studies met inclusion criteria. Four main domains of ethical challenges emerged: (1) Clinical decision-making and patient autonomy—dilemmas regarding life-sustaining treatments, medication and fluid management, palliative sedation, and conflicts between patient preferences and family/cultural expectations; (2) Justice and resource allocation—insufficient ethics education, high workload, limited organizational support, poor interprofessional collaboration, and scarce resources; (3) Beneficence and patient-centered care—ethical issues related to technological innovations, informed consent, data privacy, and environmental pressures such as ICU or emergency care conditions; (4) Non-maleficence and moral distress prevention—moral distress, burnout, reduced ethical courage, and legal concerns affecting clinical decisions. Nurses encounter substantial ethical challenges in delivering palliative care for patients with chronic diseases. Addressing these challenges requires ethics education, structured organizational guidance, interprofessional collaboration, and context-sensitive strategies to safeguard patient dignity and reduce moral distress. These findings provide evidence for policymakers, educators, and managers to develop practical interventions and ethical frameworks across diverse care settings.

Thymoquinone (TQ), a bioactive compound derived from Nigella sativa herbal plant, exhibits antioxidative, anti-inflammatory, and antimicrobial effects against various bacteria, viruses, fungi, protozoa, and flatworms. A systematic search was conducted across Embase, PubMed, Scopus, and Web of Science until January 2025. All preclinical studies discussing the bactericidal, virucidal, fungicidal, and parasiticidal effects of nano-based formulations of N. sativa/TQ were included. Overall, 148 studies—comprising in vitro, in vivo, ex vivo, and in silico research—were identified involving 185 unique N. sativa/TQ-loaded nanocarriers with antimicrobial properties. The predominant nanoencapsulation methods included inorganic nanoparticles (27%), nanocomposites (23.2%), and nanofibers (13.5%). The essential oil (27.6%) and aqueous extract (20.5%) of the seeds, along with TQ (22.2%), were the most common natural cargos. 149 nanoformulations showed effectiveness against bacteria, 42 against fungi, 8 against viruses, and 7 against parasites. Additionally, 29 nanoformulations showed antibiofilm properties, and 41 showed efficacy against multidrug-resistant pathogens. Only 18 nanoformulations were not effective against at least one tested pathogen. 91.9% of the tested nanoformulations against Staphylococcus aureus showed effectiveness, while this percentage for Escherichia coli and Candida albicans was 88.5% and 96.9%, respectively. These three were the most widely examined pathogens in preclinical studies. The proposed clinical and practical applications were most prominent in wound healing (42 nanoformulations), followed by food preservation (33 nanoformulations) and water purification (9 nanoformulations). Integrating nano-based drug delivery systems with the antimicrobial benefits of TQ can address TQ’s limitations, including instability and low oral bioavailability. This review identifies knowledge gaps regarding TQ nanomedicines and emphasizes the need for regulatory frameworks for safety and clinical applicability, thereby facilitating their progression into human clinical trials.

Preoperative anxiety in children is common and may negatively affect anesthetic management and postoperative recovery. Parental Presence during Induction of Anesthesia (PPIA) is widely used as a non-pharmacological strategy, but its effectiveness remains uncertain. This systematic review and meta-analysis evaluated the effect of PPIA on perioperative anxiety in children. Randomized and quasi-randomized trials comparing PPIA with no parental presence or alternative interventions for perioperative anxiety in children undergoing elective procedures under general anesthesia were systematically reviewed. Five electronic databases were searched from inception to June 30, 2025. Study quality was assessed using the Cochrane Collaboration’s Risk-of-Bias tool and GRADE framework. Data were pooled using a random-effects meta-analysis, with effect sizes reported as Weighted Mean Differences (WMDs) or Standardized Mean Differences (SMDs). The primary outcome was perioperative anxiety assessed at follow-up time points, and the secondary outcome was the change in perioperative anxiety from baseline to each follow-up time point. A total of 24 studies were included, evaluating four intervention comparisons: PPIA versus no parental presence, PPIA versus sedative premedication, PPIA combined with sedative premedication versus sedative premedication alone, and PPIA versus other non-pharmacological interventions. Compared with no parental presence, PPIA was associated with reductions in children’s anxiety and heart rate from baseline to induction (SMD= ˗1.13, P = 0.022; WMD= ˗8.74, P = 0.004). In contrast, PPIA alone was less effective than midazolam in reducing anxiety at induction and from baseline to induction (SMD = 1.06, P = 0.022; SMD = 2.15, P = 0.004), and combining PPIA with midazolam offered no additional benefit over midazolam alone at induction (SMD: ˗0.40, P = 0.402). One study suggested that video distraction may be more effective than PPIA. The certainty of evidence ranged from low to moderate, and only five studies were rated as high quality. PPIA modestly reduces perioperative anxiety and heart rate in children compared with no parental presence but is less effective than midazolam and provides no additional benefit when combined with it. Therefore, high-quality studies are needed to clarify the clinical relevance of PPIA and to optimize its implementation in pediatric anesthesia. CRD42024596457

Carotid endarterectomy (CEA) is a critical intervention for carotid artery stenosis, a leading cause of stroke. This study compares two CEA techniques primary closure and patch angioplasty, evaluating their impact on short- and long-term outcomes, particularly recurrent stenosis and stroke incidence. This retrospective study evaluated 140 patients who underwent endarterectomy for severe carotid artery stenosis (> 70%). Using consecutive sampling, participants were divided into two groups based on intraoperative criteria: a primary closure group (n = 70) and a patch angioplasty group (n = 70). The surgical approach (primary/conventional) was determined intraoperatively based on vessel diameter and the surgeon’s judgment. Patients were retrospectively assessed for early and late restenosis rates (defined as > 50% lumen narrowing) using ultrasound every 6 months over a 5-year follow-up period. This study compared outcomes in 140 patients with severe carotid stenosis (> 70%) who underwent primary closure (n = 70) or patch angioplasty (n = 70) based on intraoperative anatomical criteria. The results of this study showed no statistically significant difference between the two treatment groups regarding recurrent carotid stenosis (> 50% lumen narrowing) and recurrent stroke in both short-term and long-term follow-ups. Both techniques, primary closure and patch angioplasty, were similarly effective in reducing the recurrence of stenosis and stroke. The data were analyzed using independent t-tests and Chi-square tests. The results from the statistical tests indicated that the differences observed between the groups were not statistically significant (p > 0.05). Based on the findings of this study, it can be concluded that both primary closure and patch angioplasty are acceptable methods for carotid endarterectomy. The choice of technique should be based on the patient’s clinical characteristics and the surgeon’s experience. However, further studies with larger sample sizes and longer follow-up periods are needed to obtain more definitive results.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is among the leading causes of chronic liver disease, with few approved treatment options. Vitamin D supplementation has been proposed as a safe and efficacious supplement intervention for MASLD. The current study aimed to systematically evaluate the effect of vitamin D supplementation in any preparation on hepatic (histological, radiological, and biomarker) and metabolic parameters (glucose regulation, lipid profile, and indices of obesity) in patients diagnosed with steatotic liver disease. These effects were compared with patient baseline and/or placebo response, where available. MEDLINE, Scopus, Web of Science, the Cochrane Library, clinicaltrials.gov, and International Clinical Trials Registry Platform were systematically searched for relevant randomized or nonrandomized studies of intervention. Screening and data extraction were completed by independent pairs of reviewers. Effects were pooled using random-effects meta-analyses. One-stage dose-response analysis was performed for alanine aminotransferase (ALT) and γ-glutamyl transferase. The effect of baseline vitamin D, ALT, body mass index, and vitamin D response on treatment response was explored via metaregression. Treatment efficacy was evaluated in subgroup analyses according to patient and intervention characteristics. A total of 28 studies (21 randomized controlled trials) were analyzed. Statistically significant improvements were noted in FibroScan parameters, liver enzymes, insulin resistance, serum triglyceride, and high-density lipoprotein. However, the magnitude of effect regarding these improvements was smaller than thresholds for clinical benefit, and analyses demonstrated inconsistencies. Subgroup analyses failed to identify a specific subset of patients with MASLD benefiting from supplementation. Vitamin D supplementation was safe and well-tolerated, but no meaningful clinical benefit was identified for hepatic or metabolic parameters of interest in MASLD. This trial was registered at PROSPERO as CRD420251125809.