Zanjan University of Medical Sciences

Type 2 diabetes mellitus (T2DM) presents significant comorbidity with emotional disorders, with approximately 25% of patients experiencing clinically significant depression and anxiety symptoms. While some disorder-specific interventions, such as cognitive-behavioral therapy, have demonstrated efficacy in addressing emotional symptoms in T2DM patients, they often do not fully address the interconnected nature between diabetes and emotional distress, highlighting the need for integrated, transdiagnostic treatment approaches. This study evaluated the efficacy of group-based transdiagnostic cognitive-behavioral therapy (gTCBT) for improving depression, anxiety, quality of life, and medication adherence in adults with T2DM and comorbid emotional disorders. This randomized controlled trial recruited 52 participants with T2DM and emotional disorders. Participants were randomly assigned to either a 12-session gTCBT intervention based on the Unified Protocol (n = 26) or waitlist control (n = 26). Primary outcomes included Beck Depression Inventory-II and Beck Anxiety Inventory. Secondary outcomes were assessed using the Diabetes Quality of Life questionnaire for quality of life and the Morisky Medication Adherence Scale for medication adherence. Assessments were conducted at pre-treatment, post-treatment, and one-month follow-up. 48 participants completed the study (23 intervention, 25 waitlist). Mixed-model ANOVAs revealed significant time × group interactions for all outcomes (p < .001). The intervention group demonstrated large effect sizes for depression (g = 2.48), anxiety (g = 1.65), quality of life (g = 1.72), and medication adherence (g = 1.66) improvements from pre- to post-treatment. Effects were sustained at one-month follow-up. gTCBT effectively reduced emotional symptoms and improved diabetes-related outcomes in patients with T2DM and comorbid emotional disorders. The transdiagnostic approach offers a effective intervention for addressing complex comorbidities in diabetes care settings. This randomized clinical trial comprised an intervention and a waitlist that was registered in the Iranian Registry of Clinical Trials (ID: IRCT20241116063741N1). (Registration Date: 05/07/2025).

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.

Background: Transdermal drug delivery by means of polymeric microneedles (PMNs) offers the advantage of overcoming some of the disadvantages of oral medication, such as first-pass metabolism, through painless, controlled drug release. Lawsone, isolated from Lawsonia inermis, exhibits reported antioxidant, anti-inflammatory, antimicrobial, and antitumor properties, suggesting its use as a promising candidate for topical application. Objectives: Fabrication and optimization of hyaluronic acid-carboxymethylcellulose (HA-CMC) PMNs loaded with lawsone with respect to enhancing transdermal delivery and understanding release and physicochemical characteristics. Methods: Hyaluronic acid-carboxymethylcellulose-lawsone patches were prepared by micromolding. The Box-Behnken design approach was then utilized to identify the appropriate concentrations of carboxymethylcellulose (CMC) (0.15% to 0.35% w/w), hyaluronic acid (HA) (0.01% to 0.09% w/w), and polyethylene glycol 400 (PEG 400) (0.5% to 1.5% w/w), all of which are dependent on drug release after 90 minutes. Morphological examination was conducted using light and scanning electron microscopy (SEM). The levels of transepidermal water loss (TEWL), drug content, insertion rate, mechanical properties, and release of the patches were assessed. Results: The optimized formulation showed a cumulative release of 59.63% in 90 min, following Higuchi release kinetics. Polymeric microneedles showed uniform morphology, a failure force of 0.48 N, full penetration of 375 μm, and reversible changes in TEWL. Conclusions: Hyaluronic acid-carboxymethylcellulose PMNs offer a promising formulation strategy for the transdermal delivery of lawsone. This preliminary study establishes a biocompatible platform with potential for future development towards anti-inflammatory and antitumor therapies, pending further in vivo validation.

This study aimed to evaluate groundwater quality and assess the health risks associated with nitrate contamination in Poldasht County, northwest Iran. Groundwater samples were collected from 17 wells over a ten-year period, and key physicochemical parameters including pH, TDS, total hardness, major ions, and nitrate were analyzed. The Groundwater Quality Index was applied to assess overall water quality, while non-carcinogenic risk was calculated following USEPA guidelines for four age groups: infants, children, teenagers, and adults. The results indicated that approximately 64.7% of the samples were classified as "acceptable," while 35.3% fell into the "moderate" quality range. The dominant groundwater facies were Mg-SO4 and Mg-HCO3, reflecting the combined effects of geological formations and, to some extent, human activities such as agriculture. Health risk assessment revealed that HQ values for all age groups were below 1.0, indicating no significant non-carcinogenic risk. However, children exhibited relatively higher HQ values due to their higher water intake relative to body weight, emphasizing their increased vulnerability. These findings highlight the need for continuous monitoring, particularly for wells with moderate quality and in areas showing signs of localized contamination. The study underscores the importance of adopting integrated groundwater management strategies, including regular quality assessment, pollution prevention practices, and targeted interventions to protect sensitive populations.

Olanzapine, an atypical antipsychotic widely used for psychiatric disorders, is typically associated with tachycardia and QT prolongation in overdose, while bradycardia remains a rare and underrecognized effect. We report a 20-year-old woman with major depressive disorder who presented 4 h after ingesting 100 mg of olanzapine in a suicide attempt. She exhibited marked sinus bradycardia (41 bpm) with stable hemodynamics and no QT prolongation. Laboratory and toxicology results were unremarkable. Supportive care, including oxygen, fluids, and cardiac monitoring, led to complete recovery within 48 h. This case highlights isolated bradycardia as an uncommon but important manifestation of olanzapine toxicity. Clinicians should consider bradycardia in the cardiovascular spectrum of olanzapine overdose and ensure vigilant monitoring to prevent potential complications.

Clinical education is a fundamental component of medical training that faced numerous challenges during the COVID-19 pandemic. Understanding faculty members' experiences and strategies can inform plans for enhancing educational quality during future health crises. This study aimed to explore faculty members' experiences in delivering clinical education during the pandemic. This qualitative study used a conventional content analysis approach. Data were collected through semi-structured interviews employing purposive sampling. Interviews continued until data saturation was achieved. In total, 14 participants were interviewed. The credibility of the findings was assessed using the criteria proposed by Guba and Lincoln. The analysis yielded three main themes. The first theme, challenge-based experience, consisted of subcategories including intrapersonal psychological challenges, environmental misinformation, and systemic management deficiencies. The second theme, change-based experience, comprised subcategories such as shifts in protective roles, modifications in clinical education environments, changes in patient collaboration, heightened attention to professionalism, and strengthened role modeling. The third theme, problem-solving-based experience, encompassed subcategories such as an emphasis on feedback, clinical education strategies, educational equity approaches, systemic solutions, exploration of international approaches, and comprehensive assessment strategies. The study delineates a three-phase adaptation trajectory-through confronting challenges, navigating changes, and implementing problem-solving strategies-that enabled faculty to sustain clinical education during the pandemic. These experiences yield critical, actionable recommendations for future crisis preparedness. We recommend that institutions integrate hybrid clinical training models and develop formal faculty development programs focused on digital pedagogy and crisis management. Embedding these evidence-based strategies into medical education policy is crucial for building a resilient and equitable clinical education system capable of withstanding future disruptions.

Human papillomavirus (HPV) is the leading cause of cervical cancers and anogenital warts. Regional studies provide better insights to HPV prevalence and genotype trends in different populations. This cross-sectional study was done in Zanjan City, Iran from May 2022 to May 2023 for determination of specific high-risk HPV and low-risk types applying PCR in Pap smear samples collected from women aged from 24 to 60years old. 211 women were enrolled and the total HPV prevalence was 6.63% in this population. HPV16 and HPV11 accounted for 28.50% equally as the most prevalent genotypes in infected cases. Multiple HPV infections were seen 21.40% in whom HPV16 was dominant. There was a significant association between HPV positive status and cellular changes in Pap test and notably, of the cases with multiple HPV infections, HPV16+6 and HPV6+11 were detected in two cases with AS-CUS whereas HPV16+31+6 were detected in a case with HSIL. HPV prevalence has been estimated 6.63% with HPV16 and HPV11 dominancy in the present study. However, there is a high prevalence of multiple HPV infections in certain individuals. Therefore, it seems rational to provide an integrated approach, including vaccination, education, and access to preventative healthcare services.

Abdominal bloating is a common gastrointestinal complaint, especially among women, and can significantly affect quality of life. Despite its high prevalence, the role of dietary fat intake in the development or exacerbation of bloating remains poorly characterized. This study aimed to examine the association between abdominal bloating and the consumption of various types of dietary fats among Iranian women. A case-control study was performed on 229 women with bloating and 224 women without bloating in Tehran, Iran. Dietary intake was assessed using a validated 168-item food frequency questionnaire (FFQ), and nutrient analysis was conducted using Nutritionist IV software. A binary logistic regression method, adjusted for confounders was applied to assess the link between bloating and the intake of fats. An inverse association was found between abdominal bloating and omega‑3 PUFA intake (OR = 0.34, 95% CI: 0.13-0.87, p = 0.024), which remained significant after multivariable adjustment. Following correction for multiple comparisons using the Benjamini-Hochberg false discovery rate (FDR, q < 0.10), statistical significance was retained only in the fully adjusted model (q = 0.091). No significant associations were found for total fat, saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs), total PUFA, cholesterol, or omega‑6 PUFA. Higher dietary intake of omega-3 PUFAs may be associated with reduced bloating, while other types of fats showed no significant association. This highlights the potential role of omega-3 fatty acids in managing bloating. Further research is needed to explore causal relationships and the therapeutic implications of these findings.