https://rcm.mums.ac.ir/ Reviews in Clinical Medicine en daily 1 Fri, 01 May 2026 00:00:00 +0330 Fri, 01 May 2026 00:00:00 +0330 https://rcm.mums.ac.ir/article_27664.html Ocular trauma is a major cause of visual impairment in children, and those with behavioral disorders may be at greater risk because of impulsivity, limited hazard awareness, and difficulty adhering to safety instructions. This narrative review provides an updated overview of the epidemiology, risk factors, clinical presentations, and management of ocular trauma in children with behavioral disorders, with emphasis on prevention strategies and long-term outcomes. A comprehensive literature search was conducted to identify studies investigating the association between behavioral disorders, such as attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and conduct disorders, and ocular injuries in children. The available evidence was synthesized to highlight recent findings, clinical challenges, and advances in management approaches. Children with behavioral disorders appear to have a higher incidence of ocular trauma and often present with more severe injuries, partly because of delayed recognition and treatment. Common causes include accidental self-inflicted injuries, falls, and object-related trauma. Diagnostic and management challenges arise from communication difficulties, sensory sensitivities, and limited behavioral cooperation. Recent evidence suggests that tailored preventive interventions, caregiver education, and multidisciplinary management may reduce the burden of ocular trauma in this vulnerable population. https://rcm.mums.ac.ir/article_27666.html Inherited retinal diseases (IRDs) are significant causes of legal blindness in some working-age adults. Among these conditions, cone-rod dystrophies (CRDs) are characterized by the progressive loss of cone and rod photoreceptors, leading to visual impairment. The pathogenesis of CRDs is multifactorial and often involves genetic mutations in proteins critical for phototransduction, photoreceptor maintenance, and cellular homeostasis within the retina. Over time, photoreceptors deteriorate, resulting in decreased visual acuity, color vision abnormalities, and, in some cases, night blindness. The diagnosis of CRDs requires a comprehensive approach that includes clinical evaluation, electrophysiological testing, and advanced imaging modalities such as optical coherence tomography (OCT). Current treatments are primarily supportive, focusing on the management of visual symptoms and the enhancement of patients’ quality of life. Emerging therapies, including gene therapy, retinal implants, and regenerative medicine, show promise for slowing or reversing disease progression. Low vision aids, environmental modifications, and regular monitoring remain essential components of CRD management. Identifying the genetic variants responsible for CRDs enables personalized counseling and may facilitate the development of targeted, gene-specific interventions. This review summarizes recent advances in the epidemiology, molecular mechanisms, and therapeutic strategies for CRDs, providing updated insights into diagnosis and long-term care. By analyzing these developments, we aim to guide both clinical practice and research toward novel interventions that could preserve or restore vision in affected individuals. https://rcm.mums.ac.ir/article_27667.html Syndromic cone-rod dystrophies (CRDs) represent a heterogeneous group of genetic retinal disorders characterized by the progressive degeneration of photoreceptors. These conditions, through their impact on both cone and rod cells, lead to significant visual impairment, manifesting as diminished central visual acuity, compromised color perception, and increased light sensitivity. In addition to the associated ocular symptoms, syndromic CRDs are frequently seen accompanied with systemic manifestations, including that of skeletal, metabolic, neurological, renal, and cardiac anomalies, which complicate diagnosis and management. The genetic basis of syndromic CRDs is complex, involving several mutations in multiple genes linked to a diverse array of syndromic conditions, such as that of Bardet-Biedl, Usher, Alström, Jalili, Refsum disease, Senior-Loken, Cohen syndrome, Jeune, Sensenbrenner, and Joubert syndrome. Non-genetic assessments, such as that of electroretinography, play vital roles in differentiating CRDs, in particular syndromic forms, from pure cone dystrophies an, as they tend to reveal functional deficits in both cone and rod photoreceptors. This review aims to clarify the distinct genetic origins and clinical characteristics for these disorders. https://rcm.mums.ac.ir/article_27668.html Introduction: Healthy nutrition is the main aspect of obesity prevention and management. Lack of nutrition knowledge is one of the leading causes of unhealthy food choices. In this regard, nutritional education interventions can be a noteworthy approach in boosting students’ dietary habits. The objective of the current study was to assess the effect of a nutritional education intervention on knowledge, fat intake, anthropometric indices and dietary intake among students. Methods: This randomized controlled study was carried out on a sample of 68 university students aged 18-26 years, in Maragheh University of Medical Sciences. Demographic characteristics, anthropometric indices, dietary intake, physical activity levels, and nutritional knowledge, were collected via face-to-face. The nutritional education intervention consisted of four on-site sessions education applied by two independent PhD-level nutritionists. Following the intervention, the nutritional knowledge questionnaire was re-administered to all participants.Results: Based on body mass index, the majority of students were classified as having normal or being overweight. The mean dietary macronutrient distribution was 57% carbohydrate, 13.81% protein, and 31.65% fat. The findings showed no statistically significant change in knowledge score before and after the intervention. Also, no significant associations were observed between changes in nutritional knowledge score and demographic characteristics and anthropometric indices, or fat intake when comparing the two groups (p>0.05).Conclusion: Given the findings that students exhibited adequate nutritional knowledge and acceptable fat intake levels, yet a moderate prevalence of overweight persisted, future studies should focus on bridging the gap between knowledge and practice through targeted behavioral interventions. https://rcm.mums.ac.ir/article_27669.html Background: Several factors play a role in improving birth experience, and it seems presence of a trained companion can play a role in birth process. Despite there is insufficient evidence in this regard among Iranian health system, so this study was conducted to investigate role and effect of a trained companion in birth process.Methods:This RCT was conducted in 2018 on 60‌ pregnant mothers referred to Um‌al-Banin Hospital in Mashhad. Both control group (CG) and intervention group (IG) received eight 90-minute childbirth preparation classes. Additionally, IG recived ‌two joint sessions (companion&mother) and two sessions alone (companion). Before and after training, demographic form, companion, s role and impact researcher-made questionnaire were completed by two groups. Data were analyzed using independent&paired t-test, Fisher's exact, and chi-square tests in SPSS vol.16 software.Results: The mean age of mothers in IG was 26.7±8.3 and CG was 28.3±5.9.A significant finding was that 83.3% of mothers in the IG, compared to 56.7% in the CG, considered the companion’s presence effective in their choice of delivery mode (Chi-square test,P=0.024). Furthermore, 96.7% of mothers in the IG, versus 66.7% in the CG, reported the companion to be effective in enhancing self-efficacy and expectations of a positive birth outcome (Chi-square test,P=0.003).Conclusion: Findings indicate that presence of a trained birth companion significantly enhances maternal self-efficacy, improves childbirth experience, and promotes more informed decision-making regarding mode of delivery. As a simple and cost-effective intervention, it holds practical potential for improving maternity care and should be considered in health policy planning. https://rcm.mums.ac.ir/article_27670.html Abstract:Encephalitis is one of the relatively uncommon causes of hospitalization in children's wards, which is associated with long-term debilitating complications. The purpose of the present study is to determine the prevalence and symptoms of herpes encephalitis in the Imam educational and therapeutic center. The methodology of the present study is a descriptive retrospective study on children who discharged from the children's ward of Imam Hospital with the diagnosis of encephalitis (between April 2014 and September 2019). The information obtained by referring to the patients' files. The virology test used in this study is HSV PCR.18 patients who diagnosed with meningoencephalitis and herpes simplex encephalitis in Imam Hospital during the last 5 years (2014-2019) and treated 11 male patients (61%) and 7 female patients (39 %) in 18 hospitalized patients.The most common clinical symptoms were fever above 38°C, followed by decreased level of consciousness and convulsions, among which behavioral changes have the lowest prevalence Considering the high morbidity and mortality of the disease and the need for early treatment, a detailed history and complete clinical examination, observing symptoms related to brain and meningeal involvement and performing tests including CSF examination, CT scan and MRI can They provide the doctor with key points in the early diagnosis of the disease.Considering the many advances made in the field of viral agent detection, laboratory methods such as PCR and Ab sampling method against HSV in blood and CSF can be more helpful in diagnosing the disease. https://rcm.mums.ac.ir/article_27674.html Background: Poisoning from toxic plants and fungi remains an important topic in clinical toxicology education. Interactive digital atlases may support learning through providing structured and visually rich content.Methods: An interactive digital atlas of poisonous plants and fungi was developed using validated scientific sources and expert review and published on a dedicated website. Medical trainees and interns were introduced to the platform and used it during an academic semester. Students’ perceptions and satisfaction were assessed using a researcher-developed questionnaire with established face and content validity, based on a 5-point Likert scale.Results: A total of 107 participants completed the survey. Overall, 66.4% rated the website’s quality as good or very good, 66.4% were satisfied with the relevance of the information, and 63.5% rated the content comprehensiveness favourably. No significant differences were observed between trainees and interns.Conclusions: The digital atlas was well received by medical students and demonstrated acceptable user satisfaction. Such web-based resources may serve as supportive tools in toxicology education. Further studies are needed to assess their impact on learning outcomes. https://rcm.mums.ac.ir/article_27694.html Metformin (1,1-dimethylbiguanide hydrochloride) has been the most commonly prescribed blood sugar-lowering medication for over six decades and is the most important treatment for individuals newly diagnosed with type 2 diabetes mellitus (T2DM). The major action of metformin is to directly suppress hepatic gluconeogenesis and improve insulin sensitivity. However, metformin also indirectly enhances insulin secretion by increasing glucagon-like peptide-1 (GLP-1) concentration. Recent research highlights the broader therapeutic potential of metformin in chronic diseases associated with inflammation. The aim of this study is to investigate the effects of metformin beyond blood sugar reduction in chronic diseases by examining indicators related to inflammation and immunity. The anti-inflammatory and antioxidant mechanisms of metformin involve both AMP-activated protein kinase (AMPK)-dependent and -independent pathways. AMPK mediates the anti-inflammatory and antioxidant effects of metformin by regulating the activity and levels of NF-κB, NLRP3, inflammatory cytokines, NRF2, as well as oxidative and antioxidant markers. In addition, other roles of metformin that contribute to reducing the incidence of T2DM and chronic complications—including cardiovascular diseases, cerebrovascular diseases, nephropathy, retinopathy, neuropathy, autoimmune diseases, neurodegenerative diseases, and cancer—include direct inhibition of mitochondrial ROS, inhibition of mTORC1, modulation of gut microbiota, GDF15 upregulation, and regulation of innate and adaptive immunity. https://rcm.mums.ac.ir/article_20327.html AbstractThis research was aimed at studying the stress, anxiety, and depression epidemiology among highschoolers in Mashhad, Iran. The sample included 605 students (341 males & 264 females) coming from various grades of high school ranging in age from 14 to 19. To fulfill the objectives of the study, three instruments (scales) were employed including the Perceived Stress Scale (PSS), Cattell Anxiety Scale (CAS), and Children Depression Scale (CDS-A). Since the PSS and CDS-A had no norm in Iran, they were then normed revealing reliability of 0.76 for PSS through Spearmen-Brown split half while it was 0.77 through Cronbach’s alpha. Similarly, the reliability for CDS-A was 0.9 and 0.89, respectively. In addition, the validity of the tests proved to be significant at p<0.001 once the correlation of each item with the whole test was obtained. Besides, factor analysis was conducted and examining the items which had the highest loadings on each item indicated that the items of the two tests were completely reliable. The epidemiology results indicated that the stress prevalence was 9.1% among the boys and 22% among the girls while it was 14.7% in the whole sample. This implies that the EBtela rate in girls was two and half times greater that the boys. https://rcm.mums.ac.ir/article_21445.html Magnetic resonance spectroscopy (MRS) is an imaging technique that provides spectroscopic information about the changes of biological markers. Studies suggest that MRS can be helpful in the prognosis of patients with diffuse axonal injury (DAI)Methods: PubMed and Scopus as two major database were systematically searched in June 2015 by using following search strategy ((((Magnetic resonance spectroscopy OR MRS OR MR spectroscopy)) AND (Diffuse axonal injury OR DAI)) AND Prognosis) to find relevant articles in which the prognostic value of MRS had been investigated in patients with traumatic DAI. All necessary information were extracted and used for data synthesis based on the main purpose of this study. Of total 19 articles found in PubMed and 151 found in Scopus, 8 documents were selected for data extraction in several steps of article selection according to inclusion/exclusion criteria. Total number of patients participated in the selected documents was 197. All of the selected documents showed that MRS can be used for quantitative analysis of metabolite changes in patients with DAI.Discussion: The results of studies show that MRS imaging as a sensitive method can quantitatively determine even small variation of metabolites. Since any changes in metabolite level of the brain after traumatic injury may be useful in the prediction of patient’s outcome; therefore, if such sensitivity of MRS is proven, this method can have prognostic value in patients with DAI. Based on the concluded results of included articles, MRS as a sensitive tools is helpful in the prognosis of patients with DAI. https://rcm.mums.ac.ir/article_21449.html The coronavirus disease 2019 (COVID-19) has afflicted individuals of all ages, which has a high rate of morbidity and fatality. Although most children with COVID-19 infection experience minor symptoms, a growing proportion of COVID-19 infections in children are linked to a novel multisystem inflammatory syndrome with Kawasaki disease-like clinical features. Multisystem inflammatory syndrome in children (MIS-C) is a novel hyperinflammatory syndrome that can impact about any organ system. The most frequent symptoms are fever and gastrointestinal disorders, although neurologic and dermatologic manifestations are also well-documented. The clinical symptoms of MIS-C coincide with those of Kawasaki disease, toxic shock syndrome, and shock syndrome, making diagnosis challenging. Elevated inflammatory markers are common in MIS-C patients, and an abnormal echocardiogram or electrocardiogram may be present. Intravenous immunoglobulin, anticoagulation, and corticosteroids should all be considered in the treatment of MIS-C patients. Even those with significant cardiovascular involvement, the majority of patients recover without complications. Echocardiographic follow-up is required as coronary aneurysms have been documented. This narrative review is to review the epidemiology, pathophysiology, clinical presentations, laboratory findings, diagnostic criteria, and treatment options for MIS-C patients in order to increase pediatricians’ knowledge of this novel syndrome.