Jahrom University

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

BACKGROUND:Blood transfusions are vital in medical practice, especially during surgeries and anesthesia. However, carry significant risks, mainly due to human error. In Iran, many blood transfusions are performed during surgery every year. This study evaluates the effectiveness of a multifactorial educational intervention in enhancing blood transfusion safety among anesthesia technologists.MATERIALS AND METHODS:A quasi-experimental study was conducted with 80 anesthesia technologists from Rasoul Akram and Firouzgar medical centers, divided into control (40) and intervention (40) groups. The intervention group received a 30-day educational program including educational materials such as booklets, posters, pamphlets, and a safe blood transfusion checklist. Data were collected via a self-assessment questionnaire before and after the intervention and analyzed using SPSS software (v. 27).RESULTS:The baseline evaluation showed no significant difference in knowledge and adherence to safe blood transfusion protocols between groups (P = 0.129). Performance levels were classified as follows: good (75–100%), moderate (50–74%), and poor (<50%). Overall, The performance of anesthesia technologist regarding their adherence to safe blood transfusion standards was evaluated as moderate. The intervention significantly improved the compliance scores in the intervention group by 9.25 points compared to before the intervention (P < 0.001), which indicates the statistically significant effectiveness of the training program.CONCLUSION:Based on the results of the present study the multifaceted educational intervention improved knowledge and adherence to safe transfusion protocols among anesthesia technologists. These findings highlight the role of structured training in enhancing patient safety in anesthesia.

Background. Multiple myeloma is a cancerous disease of the hematopoietic system marked by the uncontrolled proliferation of monoclonal plasma cells within the bone marrow. Bone disease is a characteristic feature and a diagnostic criterion of multiple myeloma. Aim. This paper aims to discuss the pathophysiological mechanisms underlying bone damage in multiple myeloma and to present current diagnostic and therapeutic approaches designed to improve clinical outcomes in patients affected by myeloma bone disease. Material and methods. A review of the scientific literature from the past eight years was conducted using topic-specific keywords, primarily through databases such as PubMed and Google Scholar. Results. Bone mass loss is a complex process that involves elevated osteoclast activity, impaired osteoblast function, and the release of pro-inflammatory cytokines, resulting in a disruption of the balance between bone resorption and formation. As a consequence, patients may develop chronic bone pain, pathological fractures, and postural changes. Therapeutic strategies that aim to slow the course of the disease and inhibit osteoclast activity are essential for minimizing the risk of skeletal-related complications and markedly enhancing patients' quality of life. Conclusion. Multiple myeloma is a malignancy that frequently leads to bone damage. This review discusses the underlying mechanisms, diagnostic methods, and current treatments aimed at preventing skeletal complications and improving patient outcomes

The research focuses on managing power within renewable flexible integrated energy systems in intelligent distribution systems, considering factors such as harmonic compensation, voltage stability, and environmental indices. The proposed system is based on a deterministic model that aims to optimize four distinct objectives. This objective function collectively minimizes the network's operating costs, emissions, total voltage harmonics, and the symmetrical value of the voltage stability index. Key constraints involve the operational and flexible models of the renewable integrated energy system, along with the linearized AC harmonic optimal power flow model and voltage stability limits. The study acknowledges inherent uncertainties related to the power output from renewable units, electric vehicles energy, price of energy, and load. To address these uncertainties, adaptive robust optimization is employed to ensure resilient solutions. Results indicate that despite these uncertainties, the operation of SDNs remains robust even with a prediction error margin of up to 45%. Moreover, the proposed system reduces voltage drop by 57.7%, emissions by 49.3%, operational cost by 55.2%, energy loss by 45.4%, and harmonic index by 48.6% under 45% uncertainty. In this condition, voltage stability increases 15%.

ABSTRACT Adenomyosis and endometriosis are chronic gynecological disorders with overlapping mechanisms and symptoms, both linked to impaired sexual health and relationships. This study compared sexual function, sexual quality of life, and relationship satisfaction in affected women and healthy controls. This cross-sectional comparative study (2022–2023) included 90 women in three groups: endometriosis (n = 30), adenomyosis (n = 30), and healthy controls (n = 30), recruited from Jahrom University clinics in Iran. Participants completed the SQOL-F.FSFI, and RAS questionnaires. Data were analyzed with ANOVA and regression (SPSS 25, p < 0.05). Women with endometriosis (21.8 ± 3.8; 95% CI: 20.5–23.2; 19.3 ± 2.9; 95% CI: 18.3–20.4; 42.3 ± 8.9; 95% CI: 39.2–45.5) and adenomyosis (23.2 ± 4.6; 95% CI: 21.6–24.9; 19.3 ± 3.0; 95% CI: 18.2–20.4; 49.7 ± 11.0; 95% CI: 45.8–53.7) had significantly lower scores than controls (26.6 ± 4.8; 95% CI: 24.9–28.3; 22.2 ± 3.5; 95% CI: 20.9–23.4; 51.5 ± 12.3; 95% CI: 47.1–55.9; p < 0.0001). Univariate analysis showed sexual function, desire, and arousal were positive, and pain negative, predictors of sexual quality of life. Regression indicated marriage age and duration were negative, while spouse’s age, sexual function, and relationship satisfaction were positive predictors, explaining 36.5% of variance.Endometriosis and adenomyosis significantly reduce sexual function and quality of life. Counseling and supportive care are recommended to address these challenges.

ABSTRACTCutaneous leishmaniasis (CL) remains a therapeutic challenge in endemic regions, with 600,000–1 million new cases annually facing limited treatment options. We present a case series evaluating an innovative topical combination therapy for acute‐phase CL in Shiraz, Iran. Three treatment‐naïve patients (45‐year‐old female with forearm lesions, 18‐year‐old male with foot involvement, and 52‐year‐old female with hand lesions) received daily applications of a novel solution containing ciprofloxacin, ketoconazole, and metronidazole for 30 days, followed by alpha hydroxy acid for scar rehabilitation. Remarkably, all patients demonstrated complete lesion resolution and significant cosmetic improvement without treatment‐related adverse events. This well‐tolerated regimen offers several advantages over conventional systemic antimonials, including reduced toxicity, improved accessibility, and simplified administration. Our findings support the growing body of evidence for topical CL treatments, offering a potentially safer, more accessible option that warrants further clinical investigation in endemic regions. This study highlights the importance of developing targeted therapies that consider both clinical efficacy and practical implementation challenges in resource‐limited settings.