Effect of empagliflozin on liver function in type 2 diabetes: A systematic review and meta-analysis of randomized trials

Many reports are indicating the blood sugar-lowering potential of empagliflozin in type 2 diabetes mellitus and its anti-lipogenesis effects in the liver, as studied in mice models; while few clinical trials have evaluated its effect on liver fat content and liver function. This study aimed to evaluate the effect of empagliflozin on the treatment of non‐alcoholic fatty liver disease in type 2 diabetes mellitus patients. Scopus, Cochran Library, PubMed, and Web of Science databases were searched from 1990 to 2022 with reference checking and citation searching to identify additional studies. The inclusion criteria for studies included were the evaluation of patients with non‐alcoholic fatty liver disease and type 2 diabetes being treated with empagliflozin for 24 weeks. Our interest outcomes were Liver fat, Alanine transaminase (ALT), and Aspartate transaminase (AST). Data analysis random effect size model was used for pooling data to calculate mean differences in RevMan Version 5.3. I2 was used to evaluate heterogeneity. Three clinical trial studies were included with 2344 patients. In pooled ALT mean difference evaluation within 24 weeks of studies, there was a significant difference between subjects receiving empagliflozin versus controls (MD = -6.6 CI95% (-10.27 to -3.73; P = 0.06; I2 = 99%). In the case of AST (MD = -9.06 CI95% (-20.45 to 2.34; P = 0.12; I2 = 98%) and Liver fat (MD = -4.46 CI95% (-10.06 to 0.77; P = 0.09; I2 = 98%), there was not any significant difference between subjects receiving empagliflozin versus controls. While empagliflozin seems to be effective in lowering ALT levels; further studies are needed to confirm its efficacy in lowering liver fat

The Position of Women in Treatment and Consent to Initiate Therapeutic Interventions

زمینه و هدف: در فقه پویای شیعه جایگاه برابری در بسیاری از امور برای زنان در نظر گرفته شده است. بسیاری از افراد باوری غلط در خصوص ولایت مرد بر زن دارند و انجام امور زن را منوط به اجازه شوهر ایشان می‌دانند، در حالی که با اطمینان می‌توان گفت در خصوص یک خانم عاقل بالغ رشید، فرد تصمیم‌گیرنده در خصوص جسم خود برای فرآیند درمان می‌باشد. تنها مورد استثنا، انجام اعمال جراحی است که ممکن است سبب ناباروری شود و اندیکاسیون درمانی نیز نداشته باشد است. مواد و روش‌ها: این پژوهش بر اساس مطالعه کتابخانه‌ای و از نوع تحلیلی ـ توصیفی است. ملاحظات اخلاقی: صداقت و امانتداری در ارائه مطالب و انتشار گزارش‌ها رعایت گردید. یافته‌ها: متأسفانه در نظام سلامت کنونی ما باورهای غلطی برای اخذ رضایت از همسر بیمار در کلیه فرآیندهای درمانی وجود دارد که نه‌تنها هیچ جایگاه فقهی نداشته، جایگاه حقوقی نیز ندارد و حتی در بسیاری از موارد خلاف قوانین موضوعه نیز می‌باشد. نتیجه‌گیری: کسب رضایت از همسر مبنای قانونی نداشته و فاقد ارزش حقوقی در صورت اقامه دعوی می‌باشد. تنها استثنا در مواردی که منجر با ناباروری خواهد شد، چنانچه بیم جان زن نباشد، نیاز به اخذ رضایت از زن و شوهر می‌باشد.Background and Aim: In the Shia dynamic jurisprudence, equality in many matters has been considered for women. Many people have mistaken beliefs about the male guardianship of a woman and regard the affairs of the woman as subject to the permission of her husband. She is the woman herself. The only exception is surgery that may cause infertility and has no therapeutic indication. Materials and Methods: This is a descriptive-analytic study. Ethical considerations: Honesty and trustworthiness were observed in presenting and publishing reports. Findings: Unfortunately, in our current health system, there are misconceptions about obtaining consent from the patient's spouse in all therapeutic processes that not only have no juridical status but also have no legal status and even in many cases are contrary to the laws. Conclusion: Spouse consent has no legal basis and no legal value in lawsuits. The only exception to cases that lead to infertility is the need to obtain the consent of the spouse if there is no life-threatening condition.   Please cite this article as: Delpasand K, Firouzabadi Z, Ghanbari A. The Position of Women in Treatment and Consent to Initiate Therapeutic Interventions. Med Hist J 2019; 11(39): 7-13

Inclusion of Traditional and Complementary Medicine in the United Nations Strategy and the World Health Organization

زمینه و هدف: یکی از روشن‌ترین شواهد برای ورود طب سنتی و مکمل در محدوده حق بر سلامت، اظهار نظر عمومی شماره 14 کمیته حقوق اقتصادی، اجتماعی و فرهنگی سازمان ملل متحد است. عدم اجرای مؤثر سیاست‌های ملی و حقوق نرم در طب سنتی و مکمل برای بسیاری از جوامع، زیان‌بار و مانع از تحقق حقوق بنیادین بشر است. این نوشتار به تجزیه و تحلیل شمول حق بر طب سنتی و مکمل در دامنه حق بر سلامت و جایگاه آن در برنامه‌های راهبردی سازمان بهداشت جهانی و اسناد بین‌المللی سازمان ملل می‌پردازد. آیا تئوری حق بر سلامت شامل طب سنتی و مکمل است و آیا در اسناد بین‌المللی سخت و یا نرم مصرح است؟ در پاسخ به سؤالات مطرح‌شده به برخی از کاستی‌های سیاستگذاری و مقررات طب سنتی و مکمل پرداخته می‌شود. مواد و روش‌ها: این تحقیق بر اساس روش تحلیلی ـ توصیفی و بر پایه اسناد و منابع معتبر کتابخانه‌ای است. چارچوب نظری تحقیق، حقوق مبتنی بر عدالت است. یافته‌ها: تحول در دامنه حق بر سلامت و شمول طب سنتی و مکمل که مربوط به بهره‌مندی مؤثر از بالاترین استاندارد قابل دستیابی به سلامتی است، به وضوح قابل درک است، اگرچه طب سنتی و مکمل به وضوح در چارچوب قانون بین‌المللی حقوق بشر برای سلامتی است، اما بیان صریح حق آن می‌تواند در دستیابی به هدف سازمان بهداشت جهانی در بهبود دسترسی عادلانه به طب سنتی ایمن، باکیفیت و مؤثر کمک کند. نتیجه‌گیری: هیچ یک از معاهدات بین‌المللی صریحاً طب سنتی و مکمل را ممنوع نمی‌کنند. در قوانین بین‌المللی حقوق بشر، حق بر سلامت که در معاهدات قانونی الزام‌آوری تنظیم شده است، صریحاً حق استفاده از طب سنتی و مکمل را شامل نمی‌شود. تجزیه و تحلیل این موارد شواهدی را برای ایجاد پایه و اساس قانونی برای درج طب سنتی و مکمل در کالبد بین‌المللی در رابطه با حق سلامت ارائه می‌دهد و پیشنهاد می‌کند تا جامعه جهانی یک حق صریح و قانونی را در قالب یک سند بین‌المللی الزام‌آور برای طب سنتی و مکمل تنظیم کند.Background and Aim: The most compelling evidence for the inclusion of traditional and complementary medicine in the area of the right to health is General Comment NO.14 of the United Nations Committee on Economic, Social and Cultural Rights. Lack of effective implementation of national policies and soft law in traditional and complementary medicine is harmful to many societies and impedes the realization of fundamental human rights. This paper analyzes the inclusion of traditional and complementary rights in the domain of the right to health and its place in the WHO's strategic plans and the UN International Documents.Does the theory of health right include traditional and complementary medicine and is it hard or soft in international documents? In response to the questions raised, some of the shortcomings of the policy and regulations of traditional and complementary medicine are addressed. Materials and Methods: This research is based on a descriptive-analytical method and is based on valid library documents and resources. The theoretical framework of research is justice-based rights. Findings: The transformation is evident in the scope of the right to health and the inclusion of traditional and complementary medicine that relate to the effective enjoyment of the highest standard of attainable health. Although traditional and complementary medicine is clearly within the scope of international human rights law for health, explicit expression of its right can assist in achieving the goal of the World Health Organization in improving fair, effective and quality access to traditional and safe complementary medicine. Conclusion: None of the international treaties explicitly prohibit traditional and complementary medicine. In international human rights law, the right to health as set forth in mandatory legal treaties does not explicitly include the right to use traditional and complementary medicine. The analysis of these cases provides evidence for establishing a legal basis for the inclusion of traditional and complementary medicine in the international human rights framework regarding the right to health. And proposes that the international community regulate an explicit and statutory right in the form of an internationally binding (hard rights) document on traditional and complementary medicine.   Please cite this article as: Ghanbari MA, Delpasand K, Ghanbari A. Inclusion of Traditional and Complementary Medicine in the United Nations Strategy and the World Health Organization. Med Hist J 2020; 11(41): 7-22

A survey of medical students' attitudes and practices towards narcotics and psychotropic drugs

Substance abuse is one of the major behavioral problems in today's human society. One of the medical uses of drugs is to relieve the pain and suffering of patients. Today, due to the widespread use of narcotics and psychotropic drugs in the control and treatment of the disease and also its use among medical students, the present study aimed to determine the attitude and practice of medical students towards the use of narcotics and psychotropic drugs. The present study was a cross-sectional analytical study that was performed on 102 medical interns of Guilan University of Medical Sciences who were selected by available methods. To collect information, a researcher-made questionnaire was used which has three sections including a checklist of demographic information, attitude assessment questionnaire of medical students and performance assessment questionnaire. The mean age of the interns was 23.8±0.21 years. In the analysis of the results, it was found that there is a significant relationship between marital status and residence status with performance score. Based on the results of the present study, the level of students' knowledge about narcotics and psychotropic drugs among them is not at the desired level. Therefore, due to the lack of knowledge of medical students about the dangerous side effects of these drugs, education on the nature, symptoms, and side effects of psychotropic substances is recommended

The Ethical and Legal Challenges of a Surgeon in Expressing Medical Error

زمینه و هدف: اخلاق در جراحی جایگاه ویژه‌ای دارد. امنیت بیماران به عنوان اولویت اصلی در سیستم‌های ارائه‌دهنده خدمات سلامت مطابق با تعریف سازمان بهداشت جهانی، این جایگاه را برجسته می‌سازد. از این رو اولین قدم در یک خطای پزشکی، برگرداندن بیمار به فرآیند درمان و از دست‌نرفتن فرصت بهبودی وی می‌باشد. گزارش خطاهای پزشکی و پاسخگوبودن در برابر آن‌ها علاوه بر این‌که نشانه تعهد، مسؤولیت‌پذیری و قابل اعتمادبودن پزشک و سازمان‌های پزشکی است، موجب تأمین حقوق بیمار نیز می‌گردد. در مطالعه پیش رو، به تجزیه تحلیل جنبه‌های اخلاقی و حقوقی دانش و آگاهی اساتید، رزیدنت‌ها و دانشجویان در خطاهای پزشکی اتفاق‌افتاده در بخش جراحی پرداخته شده است. مواد و روش‌ها: این تحقیق بر اساس روش مشاهده‌ای از نوع توصیفی و بر پایه گزارش موارد (Case series) و با استناد به اسناد و منابع معتبر کتابخانه‌ای است. یافته‌ها: گزارش خطاهای پزشکی باعث بهبود و اصلاح عملکرد کادر درمان می‌گردد. طبق تجزیه و تحلیل صورت‌گرفته در پاسخ به 5 پرسش از جامعه آماری مورد بحث، همه اساتید، در مواردی خطای پزشکی را افشا می‌کردند که عارضه جدی و خاصی را برای بیمار در پی نداشته باشد، ولی در مواردی که عارضه ایجادشده جدی و قابل پیگیری است، بیش از دوسوم اساتید اعلام نموده‌اند که آن را اعلام نکرده یا تصمیم‌گیری در این خصوص برایشان سخت است. نتیجه‌گیری: از حقوق یک بیمار، حق بر دانستن وی در افشای یک خطای پزشکی است و بنا بر اصل حفظ تمامیت جسمانی هرگونه مداخله و فرآیند درمانی باید با اجازه وی انجام پذیرد. پزشک به عنوان یک فرد متعهد، وظیفه دارد که اگر خطایی در طول درمان برای بیمار اتفاق افتاد، بیمار را از این قضیه آگاه سازد. افشای خطا، اطمینان بیمار به پزشک و نظام سلامت را افزایش داده، احتمال اقامه دعوی بر علیه بیمارستان یا پزشک را کاهش داده و موجب احترام به حقوق شهروندی بیمار می‌گردد.Background and Aim: Ethics has a special Position in surgery. Patients' safety highlights this position as a top priority in WHO-defined Health service provider systems. Therefore, the first step in a medical error is to return the patient to the treatment process and not miss the opportunity to therapy. Reporting medical errors and being accountable to them, In addition to being a sign of commitment, responsibility and trustworthiness of physicians and medical organizations, it also provides patient rights. In the present study, we analyze the ethical and legal aspects of the knowledge of professors, residents and students about medical errors that occurred in the surgical department. Materials and Methods: This research is based on a case series descriptive method and citing authentic library documents and resources. Findings: Reporting medical errors improves the performance of treatment staff. According to the analysis, in response to 5 questions from the statistical community in question, all professors disclosed medical errors in cases that did not cause a serious complication for the patient. But in cases where the complication is serious and traceable, more than two-thirds of professors have stated that they have not reported it or that it is difficult for them to make a decision. Conclusion: A patient has the right to know about medical error disclosure and any intervention and therapeutic process must be performed with his or her consent on the basis of the principle of preserving the Physical integrity. As a committed individual, the physician has the duty to inform the patient if an error occurs during treatment for the patient. Error disclosure increases patient confidence in the physician and health system and reduces the likelihood of a lawsuit being filed against the hospital or physician and results in respect for the patient's citizenship rights.   Please cite this article as: Moayeri H, Faridi Saghezloo Y, Biroudian S, Ghanbari A, Delpasand K. The Ethical and Legal Challenges of a Surgeon in Expressing Medical Error. Med Hist J 2019; 11(40): 7-18

Frequency of using complementary herbal medicines among Helicobacter pylori-infected patients in the North of Iran

Helicobacter pylori is a prevalent infection and one of the most critical factors that result in gastric cancer. Besides antibiotic therapy, some plants are suitable as an alternative treatment against H. pylori infection due to their role in protecting the gastric mucosa. This study investigated the frequency of using complementary herbal medicines among H. pylori-infected patients in the North of Iran. This cross-sectional study was conducted on 390 patients with H. pylori infection undergoing treatment in Rasht, Iran, 2022. The demographic data, clinical characteristics, and consumption of complementary herbals were recorded. The mean age of the patients was 40 years, and 63.6% were female. The majority of the patients were educated. About 55.9% of patients consumed at least one herbal product, and the most consumed herbal product was mint extract. Most patients purchased herbal products from the grocery (93.1%); none referred to the pharmacy. About 89.2% of the patients recovered completely, and 10.8% had a disease recurrence. No particular complications were observed in most patients (97.7%). However, no significant association between the consumption of herbal products and patients' recovery was reported (P0.05). According to our results, consuming herbal products results in no specific improvement in patients with H. pylori infection

Use of nanotechnology in the diagnosis and treatment of coronavirus

Coronavirus is a beta virus that has caused a worldwide pandemic since December 2019. Many treatments such as antiviral drugs, immunosuppressive drugs, neutralizing antibodies, and monoclonal antibodies have been tested on coronavirus disease 2019 (COVID-19) that most of them were effective. Given that nanotechnology-based approaches have been successful in detection and treatment of viral systems such as human immunodeficiency virus (HIV), influenza A virus subtype H1N1 and Middle East respiratory syndrome coronavirus (MERS-CoV), they also seem to be effective in detecting and treating COVID-19. Nanotechnology is used in various methods for early and rapid diagnosis of the disease. Nanoparticles can be used in products for the diagnosis, treatment and prevention of COVID-19. These substances are very effective in the controlled delivery of antiviral drugs and biomolecules and they are also used in the manufacture of personal safety equipment, widely, and the production of anti-virus coatings for surfaces, air filters and the production of vaccines. In general, nanomaterial can play an important role in controlling the disease, based on strategies to prevent the virus from entering the host cell, inhibiting virus replication, virus delivery systems, and nano-based vaccines. Nanotechnology is a multidisciplinary tool that can offer a variety of solutions based on disease prevention, diagnosis and treatment strategies

Erratum: A survey of medical students' attitudes and practices towards narcotics and psychotropic drugs

There was an error in the author list of the published article.Two authors (A Kohansal Vajargah, K Ghaderi) requested to add to the authors lists. After obtaining the agreement of the authors and the corresponding author, and describing author contributions, Editor-in-Chief accept the corrections as listed below.The correct author list is:Shahab Dastmardi, Alireza Kohansal Vajargah, Morteza Rahbar Taromsari, Hamid Mohammadi Kojidi, Ardalan Majidinia, Fariba Asgari Bozayeh, Kaveh Ghaderi, Kourosh Delpasand We apologize for any inconvenience this may have caused. Erratum for:A survey of medical students' attitudes and practices towards narcotics and psychotropic drugsShahab Dastmardi, Morteza Rahbar Taromsari, Hamid Mohammadi Kojidi, Ardalan Majidinia, Fariba Asgari Bozayeh, Kourosh DelpasandJ Curr Biomed Rep. 2021; 2(3): 120-124

Nursing Students' Attitude toward the Importance of Patient Privacy

Background: Observing patient privacy is one of the most important nurses' ethical responsibilities. Objective: This study is aimed to investigate nursing students' attitudes toward the importance of patient privacy in nursing care. Methods: This cross-sectional study was conducted between September 2018 and April 2019 in the School of Nursing and Midwifery of Guilan University of Medical Sciences, Iran. One hundred and fifty nursing students responded to the study questionnaires. Descriptive statistics were used to analyze the data. Results: A total of 142 nursing students with a mean age of 21.91 ± 4.67 years participated in this study. A majority of the students (63.5) were female, 82.2 were single and 31.8 had clinical experience. The mean students' attitudes scores were, respectively, 8.36 ± 1.53, 6.84 ± 2.04, 6.24 ± 2.23, and 11.42 ± 2.17 for the physical, psychological, spatial, and informational dimensions of patient privacy. Conclusion: The mean students' attitude toward patient privacy was at a moderate level. Nurse educators and all the authorities of nursing education should instruct nursing students to pay special attention to the observance of patient privacy