2026-08-08T15:11:40+03:30 http://jccs.yums.ac.ir/browse.php?mag_id=20&slc_lang=en&sid=1

20-219 2026-08-08 10.1002

Journal of Clinical Care and Skills J Clinic Care Skill 2645-7687 2645-7687 10.58209/jccs 2024 5 1 H. Ganjali H. Attaran A. Hedjazi H. Chavoshi Aims: Nasal septoplasty is one of the most frequently performed surgical procedures with several common and uncommon complications. Although rare, intracranial adverse events of septorhinoplasty are life-threatening, and there are few case reports of fatal intracranial complications. Patient & Methods: A healthy 47-year-old woman underwent septorhinoplasty, then had a decreased level of consciousness and finally died due to subarachnoid and intraventricular hemorrhage caused by a bone fragment isolated from the fractured sphenoid sinus. Findings: The complication was attributed to the surgeon's carelessness, and he was considered liable for patient death due to medical negligence. Conclusion: Surgeon experience in septoplasty surgery is essential, and meticulous attention to anatomical landmarks is paramount to prevent a serious outcome that may lead to patient death and surgeon conviction.   Nasal Septum Skull Base Autopsy Medical Errors 2024 2 01 1 4 http://jccs.yums.ac.ir/article-1-219-en.pdf 10.58209/jccs.5.1.1

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Journal of Clinical Care and Skills J Clinic Care Skill 2645-7687 2645-7687 10.58209/jccs 2024 5 1 S. Nouripour-Sisakht A. Diba D. Razmjoue H. Sadeghi Mansourkhani P. Zanganeh M. Salahi M. Gharaghani Aims: Candidiasis is the most opportunistic infection with a high rate of recurrent infection. Salvia macrosiphon has an antibacterial effect; however, its antifungal effect was not studied. This study aimed to investigate the chemical composition of essential oil from leaves of Salvia macrosiphon and its antifungal activity compared with fluconazole. Materials & Methods: Salvia macrosiphon leaves, a native plant of Kogiluyeh and Boyerahmad province, were collected from Zagros Heights and used in this study. Then, the essential oil of this plant was tested for antibacterial and antifungal properties and compared with fluconazole.  The chemical composition of the essential oil was analyzed by GC/MS (Gas Chromatography Mass Spectrometry), and the antifungal activity of the plant's essential oil was compared with that of fluconazole. Findings: The results of GC-MS analysis proved the presence of at least 29 compounds in the essential oil of Salvia macrosiphon. Amon these constitute butyl benzoate (49.16%), n-hexyl benzoate (7%), and isopatolenol (4.83%) were the main compounds. The minimum inhibitory concentration (MIC) of the essential oil (µl/ml) of Salvia macrosiphon and fluconazole (μg/ml) were 0.44 and 0.7 for Candida albicans, 0.056 and 0.7 for C. glabrata, and 0.1 and 0.088 for C. parapsilosis, respectively. Also, statistical analysis demonstrated a significant difference between the mean of fluconazole and essential oil in total Candida isolates (p=0.001). Conclusion: The essential oil of Salvia macrosiphon has stronger antifungal activity than fluconazole.   Salvia macrosiphon Essential Oils Candida albicans Candida glabrata Candida parapsilosis 2024 2 01 5 9 http://jccs.yums.ac.ir/article-1-217-en.pdf 10.58209/jccs.5.1.5

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Journal of Clinical Care and Skills J Clinic Care Skill 2645-7687 2645-7687 10.58209/jccs 2024 5 1 A. Heydari Z.S. Manzari M. Bagheri Aims: Nurses caring for patients with obesity face difficulties in providing services. The difficulty of care causes inaccurate and incomplete care and sometimes not receiving care, which can lead to many complications for the patient. For this purpose, this study was conducted to explain nurses' experiences facilitating and impeding factors in providing care to patients with obesity. Participants & Methods: In this qualitative conventional content analysis study, 20 nurses and 6 patients with obesity in two large hospitals affiliated with Mashhad University of Medical Sciences were interviewed. The participants were selected by purposeful sampling, and the interviews were conducted in-depth and semi-structured. Data analysis was done using content analysis & MAXQDA software. Findings: The facilitating and impeding factors in providing care to patients with obesity in the hospital were divided into four categories; "cooperation versus passivity in the process of self-care," "influential level family involvement at the patient's bedside," "organizational challenges in care," and "nurse competence level in care ." Conclusion: Organizational changes such as creating collaborative care in difficult situations, considering the patient classification system for patients with obesity, providing large-sized welfare and treatment equipment, increasing the skill level of nurses, and ways to improve interaction with the patient and his family can be practical solutions in providing care to patients with obesity. Obesity Nursing Caring Experience Facilitating Factors Barriers Patient Care 2024 2 01 11 17 http://jccs.yums.ac.ir/article-1-235-en.pdf 10.58209/jccs.5.1.11

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Journal of Clinical Care and Skills J Clinic Care Skill 2645-7687 2645-7687 10.58209/jccs 2024 5 1 H. Naderifar L. Ghanbari R. Najafi-Vosough Aims: Scapula dyskinesis and reduced strength of the glenohumeral external rotator muscles are shoulder risk factors. The shoulder joint's unstabilizing mechanisms can cause a decrease in the strength of the external rotator muscles, an imbalance of the rotator cuff muscles, and scapula dyskinesis. This study aimed to investigate the effect of an exercise program on scapula dyskinesis and the strength of glenohumeral rotator cuff muscles in overhead athletes. Materials & Methods: The present quasi-experimental study with a control group and pre- and post-test plan was conducted on 62 female handball players (club-level, 18-25 years old) with scapula dyskinesis from 2021 to 2022 in Hamadan City, Iran. The lateral scapular slide test and hand dynamometers were used to measure scapula dyskinesis and the strength of glenohumeral rotator cuff muscles, respectively. The participants in the intervention group participated in eight weeks of three sessions of an exercise program. Data were measured before and after the intervention and were analyzed using the Mann-Whitney U test. Findings: According to this test, there is a significant difference between the strength of external rotator muscles (p<0.001) in the intervention and control groups after exercises, so the strength of external rotator muscles and the strength of external/internal rotator muscles ratio (p<0.001) has increased after exercises. Also, scapula dyskinesis after exercises has decreased significantly (p=0.013). Conclusion: The exercise program increases the strength of external rotator muscles and the ratio of external/internal rotator muscles and improves scapula dyskinesis in overhead athletes.   Shoulder Exercises Scapular Dyskinesia 2024 2 01 19 24 http://jccs.yums.ac.ir/article-1-233-en.pdf 10.58209/jccs.5.1.19

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Journal of Clinical Care and Skills J Clinic Care Skill 2645-7687 2645-7687 10.58209/jccs 2024 5 1 H. Jamshidi J.M. Malekzadeh A. Afrasiabifar A.K. Alamdari H. Zamani Habibabad N. Hosseini Aims: Fatty liver disease is a type of fat accumulation in the liver parenchyma that can be related to lifestyle. Therefore, this study compared the effectiveness of nutrition education with and without physical activity on blood lipids and liver aminotransferase enzymes in men with non-alcoholic fatty liver disease. Materials & Methods: This study is a randomized clinical trial with a control group, carried out on 80 employees working in the South Pars gas complex in Jam, Iran, suffering from fatty liver. The participants were allocated to four nutrition education groups; a physical activity group, a nutrition education group with physical activity, an education group without physical activity, and a control group (20 people each) using a random block sampling method. In all four groups, 48 hours before the intervention, 3 and 6 months after the intervention, blood lipids and liver enzymes were measured and recorded in a form. Data were analyzed using SPSS 21 software and chi-score statistics, one-way ANOVA, and repeated measures ANOVA test. Findings: Alanine aminotransferase enzyme showed a significant improvement in each of the 3 intervention groups compared to the control group at 3 and 6 months after the research intervention (p=0.001). Low-density lipoprotein showed a significant improvement in 6 months, which was related to the group of physical activity combined with nutrition education (p=0.005). Conclusion: Exercise and education interventions are more effective over a longer period of time in preventing and treating non-alcoholic fatty liver disease.   Non-Alcoholic Fatty Liver Diet Physical Activity Education Lipoprotein Alanine Aminotransferase 2024 2 01 25 31 http://jccs.yums.ac.ir/article-1-236-en.pdf 10.58209/jccs.5.1.25

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Journal of Clinical Care and Skills J Clinic Care Skill 2645-7687 2645-7687 10.58209/jccs 2024 5 1 E. Babadi Z. Abbaspoor S. Ghanbari S. Mohammadi M. Javadnoori Aims: The cesarean section rate in Iran is much higher than the rate recommended by the World Health Organization. Implementation of effective measures to reduce the cesarean rate requires proper analysis and classification. Robeson's classification can be useful in identifying the groups that play the most important role in the cesarean section rate. The present study was conducted to analyze the rate of cesarean section based on Robson's system in hospitals affiliated with Jundishapur University of Medical Sciences, Ahvaz, Iran. Instrument & Methods: This multi-center cross-sectional study, in 2019, examined 950 pregnant women admitted for delivery or cesarean section in two teaching hospitals affiliated with Jundishapur University of Medical Sciences, Iran, using a convenient sampling method. The data collection tool was a checklist based on Robson's ten classification system. Data were analyzed using SPSS 22 software and descriptive-analytical statistical tests. Findings: The overall cesarean rate was 48.94%. the largest relative contributions to the CS rate were group 5, group 10, and group 1, respectively. The main causes of cesarean section in all groups were previous cesarean section, fetal distress, and severe pre-eclampsia. The number of cesarean sections in midwife-led hospitals was less than in physician-centered hospitals. Conclusion: Group 5 of Robeson's classification, representing repeated cesarean sections, contributed the most to the overall cesarean rate.   Childbirth Cesarean Section Robson's Classification 2024 2 01 33 39 http://jccs.yums.ac.ir/article-1-239-en.pdf 10.58209/jccs.5.1.33

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Journal of Clinical Care and Skills J Clinic Care Skill 2645-7687 2645-7687 10.58209/jccs 2024 5 1 A. Zakerian Zadeh M. Dadashi M. Maghbooli F. Zarei R. Zakeryanzade Aims: Stroke leads to many symptoms, such as defects in motor, sensation, language, and cognitive functions, which may help patients recover sooner using complementary techniques. Therefore, this study was conducted to evaluate depression symptoms, motor learning, and cognitive function after transcranial direct current stimulation in patients with ischemic stroke. Materials & Methods: The current randomized controlled clinical trial was conducted on patients with ischemic stroke in Zanjan City in 2019-2020. 35 patients were randomly selected and assigned to the tDCS (12), Sham (12), and Control (11) groups. The Fugl-Meyer Assessment, Hamilton depression symptoms test, Montreal Cognitive Assessment, and Mini-Mental State Examination were used for evaluation. The first group received consecutive anodal stimulation in M1damH+Left-DLPFC areas, 12 sessions of 60 minutes, the second group received Sham-tDCS, and the third group (the control group) did not receive any intervention. The Data were analyzed using descriptive statistics and multivariate covariance analysis using SPSS 23 software. Findings: A significant difference was observed between the study groups after the intervention and one month later in motor function, depression symptoms, and cognitive function (p=0.001). According to the paired comparison, the differences between the tDCS group and each of the sham and control groups were bigger. Still, no significant difference was detected between the control and sham groups in these outcome variables. Conclusion: tDCS leads to the improvement of motor learning, cognitive functions, and depression symptoms in stroke patients, and its effects remain significant after the intervention. Transcranial Direct Current Stimulation Cognitive Functions Ischemic Stroke Depression Symptoms Motor Cortex 2024 2 01 41 48 http://jccs.yums.ac.ir/article-1-227-en.pdf 10.58209/jccs.5.1.41

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Journal of Clinical Care and Skills J Clinic Care Skill 2645-7687 2645-7687 10.58209/jccs 2024 5 1 F. NematiShahri O. Pouresmaeil A. Sharifi F. Mardani J. Mardaneh Aims: Female genital tuberculosis is an infrequent form of tuberculosis that is often underestimated due to its low prevalence in developed countries, difficult and delayed diagnosis, and misleading clinical presentation. This systematic review aimed to describe the epidemiology, clinical presentation, diagnosis, and treatment of female genital tuberculosis during 2000-2021. Information & Methods: The current study is a systematic review that was conducted through exploration of English keywords like “female genital tuberculosis”, “vulva tuberculosis”, “tuberculosis”, and “genital system” as well as, Persian keywords. Furthermore, a similar search methodology was employed in various international databases, including PubMed, Scopus, and Web of Sciences, as well as in certain Iranian databases, like Irandoc and Magiran, between 2000 and 2021. Findings: Most patients (37.5%) were from India. Upper genital tuberculosis was more common among women of reproductive age, and the most involved upper genital organs were the endometrium and fallopian tubes. In contrast, vulvar tuberculosis was more prevalent in postmenopausal women, and the vulva was the most common site involved in lower genital tuberculosis. Weight loss (31.25%) and vaginal discharge (31.25%) were the most common symptoms reported by the study participants. The main histologic finding in female genital TB was the presence of epithelioid cell granulomas (81.25%). 29 (90.6%) patients received the standard antibiotic therapy (combination of rifampicin, isoniazid, ethambutol, and pyrazinamide), all of whom responded positively. Conclusion: Most patients experience prolonged vulva ulcers and inadvertently receive various antibiotics. The typical lesions are epithelioid cell granulomas, which may be accompanied by Langerhans giant cells.   Tuberculosis Female Fertility Genital Infection 2024 2 01 49 54 http://jccs.yums.ac.ir/article-1-229-en.pdf 10.58209/jccs.5.1.49