Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 14 1 2026 01 01 Less Recognized ECG Changes Associated with Significant Ischemia; Concerning the Minnesota Coding System 1 13 118615 10.30483/rjm.2025.254652.1426 EN Hossein Hatamzadeh Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Azadeh Izadi-Moud Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Pooria Salehi-Sangani Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Mohsen Moohebati Heart and Vascular Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Muhammad Islampanah Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Ghazaleh Pourali Metabolic Syndrome Research Center, Mashhad University of Medical Science, Mashhad, Iran Asal Yadollahi Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Helia Rezaeifard International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran Gordon A Ferns Brighton and Sussex Medical School, Division of Medical Education, Brighton, UK Sara Saffar Soflaei Metabolic Syndrome Research Center, Mashhad University of Medical Science, Mashhad, Iran International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran Majid Ghaour-Mobarhan Metabolic Syndrome Research Center, Mashhad University of Medical Science, Mashhad, Iran International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran Journal Article 2025 07 19 Background: An electrocardiogram (ECG) is a commonly used, noninvasive, cost-effective tool widely available for diagnosing patients with coronary artery disease. It is associated with significant myocardial ischemia due to Coronary artery disease (CAD), which is associated with specific ECG changes. Objectives: The goals were to determine less well-known ECG changes associated with significant ischemia and assess their potential value as early markers for diagnosing myocardial ischemia in patients with CAD. Methods: Data were obtained from participants in the MASHAD cohort study. The characteristics obtained, including fasting blood glucose, lipid profile, history of diabetes mellitus, history of hypertension, and history of previous CVD, were recorded. A 12-lead ECG was also obtained for each subject and coded for specific ECG changes using Minnesota (MN) codes. Patients were divided into two groups based on MN coding for significant ischemia. A p-value less than 0.05 was considered significant. Results: Out of 9035 coded ECGs,1276 (14.1%) had significant myocardial ischemia. After applying backward binary logistic regression, left- and right-axis deviations were significantly associated with significant ischemia (OR=2.482, p<0.001; OR=2.757, p=0.023, respectively). Left Ventricular (OR=2.171, p=0.020) and right ventricular hypertrophy (OR=5.747, p=0.004) showed significant associations. Other indicators, including minor T-wave abnormalities (OR=3.249, p<0.001), left anterior hemiblock (OR=4.711, p=0.001), and notched and widened P wave (OR=2.415, p<0.001), were also significantly associated with significant ischemia. Conclusion: These findings suggest that the identified ECG changes may serve as novel indicators or associated markers of central ischemia. However, more longitudinal studies are needed to evaluate each of these abnormalities in patients with CAD.

https://journal.razavihospital.ir/article_118615_c9dffd2c9949dc33174c9b28aba07781.pdf

Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 14 1 2026 01 01 Two vs. Three-Stage Abdominoperineal Resection in Rectal Cancer: A Surgical Strategy Debate 14 21 118611 10.30483/rjm.2025.254640.1416 EN Sadegh Hashemi Moghadam Bygi Innovative Medical Research Center, MMS.C., Islamic Azad University, Mashhad, Iran 0009-0006-8321-3619 Abbas Abdollahi Endoscopic and Minimally Invasive Surgery Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran 0000-0001-6834-5759 Reza Roshanravan Endoscopic and Minimally Invasive Surgery Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Ali Mehri Endoscopic and Minimally Invasive Surgery Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran 0000-0002-8989-974X Tooraj Zandbaf Department of General Surgery, MMS.C., Islamic Azad University, Mashhad, Iran 0000-0002-4882-5058 Journal Article 2025 05 09 Background: Although Abdominoperineal Resection (APR) rates have declined over the last fifty years, it remains the best treatment option in many circumstances. Objectives: This study aimed to investigate the short-term outcomes of two-stage versus three-stage laparoscopic abdominoperineal resection in rectal cancer. Methods: This retrospective cohort study included 113 patients with rectal cancer eligible for laparoscopic APR at Razavi Hospital in Mashhad from 2020 to 2023. Inclusion criteria were age over 18 and a confirmed diagnosis via pathology, while exclusion criteria included recurrent rectal cancer, anal canal, and rectosigmoidal tumors, tumors located more than 15 centimeters from the anal verge, and concurrent colonic lesions. Data analysis was conducted using R software and SPSS. Results: The study included 42 patients undergoing a two-step surgical technique and 71 patients with a three-step technique. Results showed that the two-step group had a longer mean hospital stay (9.48 ± 4.09 days) than the three-step group (7.63 ± 1.30 days; p = 0.002). Surgical site infections occurred in 15.6% of the two-step patients, whereas none occurred in the three-step group (p=0.020). The mean surgery duration was also longer in the two-step group (222.18±56.08 minutes) than in the three-step group (170.78±29.13 minutes; p=0.00). Revision surgery was required in 23.8% of the two-stage group, compared with 4.2% in the three-stage group (p=0.002). Blood transfusion rates were similar: 23.8% in the two-step group and 22.5% in the three-step group (p=0.876). Conclusion: The three-stage approach to APR may improve surgical outcomes. However, larger prospective studies are needed to confirm these findings.

https://journal.razavihospital.ir/article_118611_ee15b818b1a487fb33f5b26d400e96c8.pdf

Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 14 1 2026 01 01 The Effect of Infusion of Dexmedetomidine to the Aortic Root before Aortic Cross-Clamp Removal on the Myocardial Protection in Patients Undergoing Mitral Valve Surgery; A Triple-Blinded Randomized Clinical Trial 22 32 118613 10.30483/rjm.2025.254653.1427 EN Shahram Amini Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran 0000-0002-2785-1812 Fatemeh Hajipour Department of Extra-Corporeal Circulation (ECC), Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Mohammad Reza Naghibi Sistani Pediatric and Congenital Cardiology Division, Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran 0000-0002-0124-4555 Zahra Zandi Department of Cardiovascular disease, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran 0000-0002-1357-7605 Mohsen Yaghubi Department of Extra-Corporeal Circulation (ECC), Razavi Hospital, Imam Reza International University, Mashhad, Iran 0000-0001-8061-3779 Journal Article 2025 05 13 Background: Myocardial protection during cardiopulmonary bypass is a challenging dilemma. Some protective strategies have been introduced to ameliorate ischemic-reperfusion injury, although no optimal strategy has emerged. Objectives: Herein, we evaluated the effect of aortic root infusion of Dexmedetomidine before cross-clamp removal on myocardial preservation. Methods: This randomized, multicenter, triple-blinded controlled trial enrolled 56 patients who underwent mitral valve surgery. After randomization, the patients were allocated to the case group (Dexmedetomidine infusion in the aortic root before cross-clamp removal) and the control group (isotonic saline). Based on the study goals, Troponin-I and Creatinine kinase-MB were measured as primary outcomes at different time points during the study. Other clinical parameters were also measured as secondary outcomes. Statistical analysis was performed using SPSS software version 26.0 (Chicago, IL, USA). The significance level was considered as P<0.05. Results: A total of 54 patients in the case and control groups were included in the analysis. The main finding of this study was that troponin-I levels at all time points showed statistical differences between the two groups (P=0.001). Also, evaluation of CK-MB levels showed a significant decrease at 1 hour (P=0.001), 12 hours (P=0.001), and 24 hours (P=0.001) after ICU admission, in the case group compared with the control group. Conclusion: This study found that administering a Dexmedetomidine infusion before aortic cross-clamp removal can ameliorate ischemia-reperfusion injury-induced myocardial damage.

https://journal.razavihospital.ir/article_118613_8df0aa51f5f79cd3f0c04b7452d79d55.pdf

Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 14 1 2026 01 01 Design and Validation of a Tool to Measure the Knowledge, Attitude, and Performance of Health Workers Regarding Population Growth Policies 33 45 118608 10.30483/rjm.2025.254633.1411 EN Najmeh Khodadadi Department of Health, Safety, and Environment management, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran2. Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran 0000-0002-5655-9183 Maryam Paydar Department of Environmental Health Engineering, School of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran 0000-0002-9152-5333 Zahra Amiri Department of Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran 0009-0008-3920-4496 Mostafa Boskabady Faculty of Medicine, Mashhad University of Medical Sciences, Khorasan Razavi, Iran 0000-0002-8465-580X Journal Article 2025 02 06 Background: The decline in fertility rates, including in Iran, poses demographic challenges like an aging population and a reduced workforce. Iran's fertility rate has fallen below replacement levels. In 2021, legislation was passed to improve fertility and population quality. The law's success depends on the Ministry of Health personnel, as their knowledge and attitudes affect community reproductive behaviors. However, there are no standardized tools to evaluate these factors among Iranian healthcare professionals regarding the new population policies. Objectives: This study aims to create and validate a reliable tool to assess Iranian healthcare workers' knowledge, attitudes, and practices regarding population growth policies. Methods: This instrument development study was conducted in Mashhad during 2022–2023 to design and validate a questionnaire on healthcare providers’ awareness. The initial item pool was derived from the Ministry of Health’s checklist and refined through expert review and consultations with officials from the Health Vice-Chancellor of Mashhad University of Medical Sciences. Overlapping items were removed, and the finalized questions were compiled into the preliminary instrument. Content validity was evaluated using CVR and CVI by 12 experts. Reliability was assessed among 65 healthcare personnel, including physicians, midwives, nurses, and health workers, using Cronbach’s alpha and test–retest methods. Data analysis was performed with SPSS using descriptive and nonparametric statistics. Results: The results showed that 12 items were not suitable in terms of content validity and were removed from the questionnaire, while the other questions remained in the questionnaire with some minor modifications in the writing. The final questionnaire comprised 40 valid items encompassing the domains of knowledge, performance, attitudes towards population growth, and attitudes towards socio-legal and cultural contradictions. Reliability metrics indicated robust internal consistency, with Cronbach's alpha exceeding 0.85 across all domains, and demonstrated satisfactory test-retest reproducibility, with an Intraclass Correlation Coefficient (ICC) of 0.83 or greater. Conclusion: This validated questionnaire is a key tool for assessing health workers' knowledge, attitudes, and practices about population growth policies in Iran. It aids in targeted educational interventions and policy monitoring, supporting demographic goals amid declining fertility trends.

https://journal.razavihospital.ir/article_118608_396e86e88d3315f2dd9b99cf38d0942c.pdf

Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 14 1 2026 01 01 Evaluation of Cardiac Risk Factors in Patients with Rheumatoid Arthritis and Systemic Lupus Erythematosus 46 54 118606 10.30483/rjm.2025.254630.1409 EN Samaneh Moghimi Shahri Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran Khadijeh Gholami Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran Toba Kazemi Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran Zohreh Nobakht Department of Internal Medicine, MMS.C., Islamic Azad University, Mashhad, Iran Ehsan Afkar Master of Statistics, Birjand University of Medical Sciences, Birjand, Iran Journal Article 2025 03 06 Background: Rheumatoid arthritis (RA) is a systemic inflammatory disease with irreversible joint destruction. Chronic inflammation is also associated with cardiovascular disease. Systemic lupus erythematosus (SLE) is a connective tissue autoimmune disease characterized by varying clinical manifestations and severity. Objectives: We aimed to evaluate the cardiac risk factors in patients with RA and SLE. Methods: In this cross-sectional study, the files of 274 patients with RA and SLE who were referred to the rheumatology private clinic and hospitals were reviewed. Demographic and biochemical data were extracted. Anthropometric measurements and blood pressure were also measured. The statistical analysis was performed using Chi-Square and independent T-Test (SPSS software). A p-value <0.05 was considered statistically significant. Results: Ninety-two point seven percent of the subjects were female. Two hundred twenty-eight patients had RA, and 46 patients had SLE. The mean waist circumference was significantly higher in RA patients compared to SLE patients (92.5 ± 15.3 vs 87.3 ± 12.8 cm, p = 0.04). No significant differences were observed in terms of the other cardiac risk factors. The rate of abdominal obesity (86.60%) and dyslipidemia (80.50%) was higher in the SLE than the RA patients. The prevalence of overweight and obesity (78.5%), hypertension (28.80%), diabetes (13.10%), history of heart disease (9.60%), and smoking (2.60%) was higher in the RA than the SLE patients. Conclusion: Among the study population, there was a high rate of obesity, dyslipidemia, and abdominal obesity among the RA and SLE patients. Regular monitoring and timely strategies are essential to manage these risk factors and improve patients' outcomes.

https://journal.razavihospital.ir/article_118606_f4888b3756a0441297315c4198242f8d.pdf

Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 14 1 2026 01 01 Investigating the Clinical Course of COVID-19 Patients and its Relationship with Vaccine Administration 55 65 118609 10.30483/rjm.2025.254636.1413 EN Arezoo Davarinia Motlagh Quchan Non-communicable Diseases Research Center, Departman of Anesthesia, Faculty of Paramedices, Sabzevar University of Medical Sciences, Sabzevar, Iran Fatemeh Borzoee Non-communicable Diseases Research Center, Department of Operating Room, Faculty of Paramedices, Sabzevar University of Medical Sciences, Sabzevar, Iran 0000-0003-1064-3483 Roghayah Zardosht Iranian Research Center on Healthy Aging, Department of Operating Room, Faculty of Paramedices, Sabzevar University of Medical Sciences, Sabzevar, Iran Ezat Samadipour Iranian Research Center on Healthy Aging, Prehospital medical emergencies Department, Faculty of Paramedics, Sabzevar University of Medical Sciences, Sabzevar, Iran Bita Koushki Non-Communicable Disease Research Center, Departman of Anesthesia, Faculty of Paramedices, Sabzevar University of Medical Sceinces, Sabzevar, Iran Elham Navipour Social Medicine Department, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran PhD Candidate in medical education, Department of Medical Education, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran Mohammad Keyvanlo Shahrestanaki Department of Biochemistry and Nutrition, Sabzevar University of Medical Sciences, Sabzevar, Iran Hamideh Yazdimoghaddam Non-communicable Diseases Research Center, Operating Room Department, Faculty of Paramedices, Sabzevar University of Medical Sciences, Sabzevar, Iran Journal Article 2025 03 17 Background: Assessing and monitoring the clinical progression of COVID-19 can provide valuable insights for developing effective treatment protocols and improving patient stability after discharge. This study aims to assess the clinical course of COVID-19 patients and their association with the administration of recommended vaccines. Objectives: Investigating the clinical course of COVID-19 and its relationship with vaccine administration. Methods: A cross-sectional study was conducted on 140 patients with COVID-19 who were discharged from Vasei Hospital, Sabzevar, Iran, between February and July 2022. Participants were selected via convenience sampling. A researcher-developed questionnaire was used to evaluate recovery progress at 4 and 12 weeks' post-discharge. Data were analyzed using SPSS v.24 with a significance level of 0.05. Results: The administration of recommended vaccine doses showed a significant relationship with the recovery rate at the second follow-up (12 weeks, P = 0.026), but not at the first follow-up (4 weeks). A significant relationship was found between the PCR test result at the second period and the recovery rate at the first follow-up (P = 0.002), but not at the second follow-up (P = 0.51). Conclusion: The study findings indicate that vaccination impacts both immunity levels and the long-term recovery of patients with COVID-19.

https://journal.razavihospital.ir/article_118609_cec0974cf89949d91612dc583619e606.pdf

Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 14 1 2026 01 01 Evaluating the association of oral health with quality of life in Ankylosing Spondylitis patients: A case control study 66 77 118607 10.30483/rjm.2025.254632.1410 EN Erfan Mohammadi Department of Oral Medicine, School of Dentistry, Isf.C., Islamic Azad University, Isfahan, Iran Mansour Salesi Department of Rheumatology, Isfahan University of Medical Sciences, Isfahan, Iran Hajar Shekarchizadeh Department of Community Oral Health, School of Dentistry, Isf.C., Islamic Azad University, Isfahan Naghmeh Salesi Department of Oral Medicine, School of Dentistry, Isf.C., Islamic Azad University, Isfahan, Iran Fatemeh Rashidi Meibodi Department of Oral Medicine, School of Dentistry, Isf.C., Islamic Azad University, Isfahan, Iran Journal Article 2025 02 06 Background: Periodontitis is a chronic inflammatory disease that affects the tissues surrounding the teeth, leading to the destruction of the bone and connective tissue supporting them. The relationship between Ankylosing spondylitis (AS) and periodontitis has been an area of debate in recent studies. Objectives: According to the recent conflicting studies that have been conducted on the periodontal indicators of patients bearing AS, some have reported the existence of a relationship, and others have reported the absence of a relationship. Considering that there are few studies related to oral and dental health and its relationship with quality of life in AS patients, and the results of the existing studies are controversial, we investigated this issue in the present study. Methods: This study employed a case-control design. The study participants consisted of 108 individuals, 54 of whom were in the patient group and 54 in the control group, which comprised healthy individuals. The patients were divided into three groups based on the severity of the disease (mild, moderate, severe). The patients were selected from among people referring to dental clinics in Isfahan (Iran) in 2022. Oral health behaviors, clinical attachment loss (CAL), periodontal pocket depth, gingival bleeding on probing, and DMFT index were measured in the studied individuals. Results: The value of the CPI index was significantly higher in people with severe disease compared to those with mild disease (p = 0.030) and healthy cases (p < 0.001). The CAL index in individuals with severe disease was significantly higher than in patients with mild disease (p = 0.011), moderate disease (p = 0.047), and healthy participants (p < 0.001). A significant difference was observed in the comparison of the DMFT index between healthy individuals (16.78 ± 4.03) and case groups with mild (16.17 ± 5.61), moderate (12.94 ± 5.72), and severe (17.67 ± 6.45) disease (p = 0.021). Conclusion: AS patients had more serious periodontal conditions than the control group; based on the results, it seems that this serious condition is more tangible in patients with severe disease activity.

https://journal.razavihospital.ir/article_118607_232fb4930a31d28b94a44961c3ca3296.pdf

Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 14 1 2026 01 01 Acute Pancreatitis Induced by Codeine: A Rare Case 78 83 118610 10.30483/rjm.2025.254639.1415 EN Hassan Babaee Department of General Surgery, MMS. C., Islamic Azad University, Mashhad, Iran 0000-0003-3017-3650 Alireza Samimi Innovative medical Research center, MMS. C., Islamic Azad University, Mashhad, Iran 0009-0001-8154-2869 Tooraj Zandbaf Department of General Surgery, MMS. C., Islamic Azad University, Mashhad, Iran 0000-0002-4882-5058 Negin Davari Innovative medical Research center, MMS. C., Islamic Azad University, Mashhad, Iran 0009-0003-7958-2567 Narges Mesbah Innovative medical Research center, MMS. C., Islamic Azad University, Mashhad, Iran 0009-0009-2047-4784 Journal Article 2025 04 28 Background: Acute pancreatitis caused by drugs is rare but clinically important. Among pain relievers, codeine has only occasionally been linked to this condition. Recognizing such cases can help physicians avoid misdiagnosis and prevent future attacks. Case presentation: A 19-year-old man was admitted with sharp epigastric pain, nausea, and repeated vomiting. His serum amylase and lipase levels were high, and abdominal CT showed an enlarged pancreas with surrounding inflammation. The patient had been taking an acetaminophen–codeine combination regularly for headaches. There was no history of alcohol use, gallstones, elevated triglycerides, hypercalcemia, or a family tendency to pancreatic disease. Considering these findings, codeine-induced pancreatitis was the most reasonable diagnosis. Conclusion:This case draws attention to codeine as a possible but uncommon cause of acute pancreatitis. It reminds clinicians to ask about opioid-containing drugs, especially in young adults who have used them for a long time and lack other risk factors.

https://journal.razavihospital.ir/article_118610_81c66c36b4cfd2b0cd3262a8dcd8c2ca.pdf