Medical Journal of The Islamic Republic of Iran (MJIRI)

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In order to assess the prevalence of Echinococcus granulosus (EO) infection (hydatidosis) in nomadic tribes of southern Iran, 1000 individuals from a total population of 1 12,519 were selected by randomized single blind cluster sampling method and studied from 1994- 1995. The study included: ( l ) a physical examination by a gastroenterologist, (2) abdominal ultrasonography (US), and (3) detection of anti-EO-antibodies (EOA) by an enzyme-linked immunosorbent assay (ELISA) and counterimmunoelectrophoresis (CIE). The statistically significant prevalences were: US: 1.8%, eIE: 6.8%, and ELISA, 13.7%. The rate of infection varied with age, sex, education, occupation, life style, geographical location of tribal subgroups and the frequency of contact with dogs and cattle. The power of agreement between a combination of each two methods were significant as determined by kappa statistics method. The results obtained indicated that a combination of ELISA and CIE was the most reliable method with a high sensitivity and specificity.

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Various biological bone g rafts have been used for osteogenes i s , osteoconduction and even osteoinduction, but due to systemic influences and local factors, the outcome of successful incorporation of a bone graft has not been satisfactory. This study was therefore conducted on 15 clinically healthy adult dogs between 1 to 3 years of age weighing 20 to 30 kg to evaluate the effect of bone cement and autogenous bone grafts. A piece of 3 cm complete mid-shaft right tibial cortical bone was removed in all animals. Then they were subsequently divided into three groups of 5 animals each. In group I the bone was fixed with a suitable intramedullary pin, whereas the gap was filled with harvested autogenous rib bone graft in group II animals. Bone cement was used to fill the gap in animals of group III for the first 30 days, then it was replaced with iliac bone chips and observation was made accordingly for 60 days in all animals of the three groups. After 60 days, before collection of callus samples, there was granulation and fibrocartilage tissue in groups I and II respectively, whereas a thick fibrous capsule or pseudomembrane layer was seen around bone cement on day 30 before removal of cement and on day 60 after replacement by iliac bone graft in group III animals. There were combinations of heavily impacted fibrous a n d fibrocartilagineous tissues with thick bundles of collagen fibers among hypertrophic chondroblasts in histomorphological cross section in group I animals, whereas active sequestra were present in group II animals. Fibrotic capsule, periosteal layer, lacunae, osteoblasts, osteocytes and well formed bone marrow with RBC and adipose tissue were noted in group III animals. It appears that the local reaction induced by bone cement leading to fibrotic capsule formation was quite helpful in delaying iliac bone graft resorption and enhancing osteogenic stimulation as to fill the gap with impacted callus with normal cortical structure. The application of bone cement in gap non:::union:::, crushed bone and fragmental fractures is therefore highly recommended.

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Iran is recognized as an endemic area for lung hydatidosis. Surgical removal of some hydatid cysts may have setious morbid consequences. To determine the characteristics of these special cysts, a retrospective survey was carried out on patients admitted to Modarres Hospital in Tehran between 1989 and 1998. We have found that ruptured, bilateral, lung located, and giant cysts (> ] 0 cm) cause more surgical and anesthetic complications, thus we named them "complicated cysts". Of 110 patients, 62(56.4%) had complicated hydatid cysts. Of these, 2 individuals died during anesthesia induction because of hypoxemia. Since sudden severe hypoxemia did not respond to all essential measures, the patients were returned to the supine position (from lateral decubitus position), then rigid bronchoscopy was performed for drainage of cyst secretions and fragments of laminated membrane. At the time of induction of anesthesia, the contents of a ruptured cyst may spill into the airway and cause hypoxemia and even death. In order to prevent this complication, two different approaches were used: (l)A chest tube was introduced into the cyst through the chest wall and its contents were drained (2) Patients were placed in the sitting position during intubation. Double lumen endotracheal tube (DLT) may allow salvage of unaffected lung from inadvertent leakage of cyst contents or laminated membrane emboli formation, but it does not guarantee a safe operation. Thus, rigid bronchoscopy should always be available. Cystostomy was the most common surgical technique performed in our center (80%). Massive air leakage, bronchial fistula, and permanent lobar collapse were the main indications for lung resection in our series. Surgical complication rates of our study were higher than reports from the west. Coordination and cooperation of experienced surgeons and anesthetists can result in better outcomes following complicated cyst removal.

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Cerebrovascular disease is one of the leading causes of death in the world, and about one-fourth of cerebrovascular deaths are due to ruptured cerebral aneurysms (CA). Hence it is important to find a way to reduce aneurysm formation and its subsequent morbidity and mortality. Proteolytic activity capable of lysing gelatin has been shown to be increased in aneurysm tissue and expression of plasmin, membrane-type matrix metalloproteinase- 1(MT1-MMP), and matrix metalloproteinase-2 (MMP-2) in aneurysmal wall is more than what we observe in normal cerebral arteries. MMP inhibitors such as doxycycline and statins may prohibit aneurysm formation and growth. MMPs are important in tissue remodeling associated with various physiological and pathological processes such as morphogenesis, angiogenesis, apoptosis and tissue repair. In this article we review the role of MMPs and MMP inhibitors in formation of aneurysm.

 

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  Background :Delayed :::union:::, non:::union:::, and mechanical failure is still problems encountered in limb salvage surgery (LSS) using extracorporeal irradiation (ECI). This study aimed to determine whether bone marrow mesenchymal stem cells (MSC) and recombinant human bone morphogenetic protein-2 (rhBMP-2) improve host-graft :::union::: after osteotomy and also increase its mechanical strength.

  Methods : Thirty Sprague Dawley rats were randomly divided into five groups. Group I (control) underwent LSS using ECI method with 150 Gy single doses. Similar procedures were applied to other groups. Group II received hydroxyapatite (HA) scaffold. Group III received HA scaffold and MSC. Group IV received HA scaffold and rhBMP-2. Group V received HA scaffolds, MSC, and rhBMP-2. Radiograph were taken at week-2, 4, 6, and 8 serum alkaline phosphatase and osteocalcin were measured at week-2 and 4. Histopathological evaluation and biomechanical study was done at week-8.

  Results : The highest radiological score was found in group IV and V Similar result was obtained in histological score and ultimate bending force. These results were found to be statistically significant. There was no significant difference among groups in serum alkaline phosphatase and osteocalcin level.

  Conclusion : Combination of MSC and rhBMP-2 was proven to accelerate :::union::: and improve mechanical strength of ECI autograft.

  

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  Background: Intra-operative radiation therapy (IORT) is the transfer of a single large radiation dose to the tumor bed during surgery with the final goal of improving regional tumor control. This study aimed to investigate the safety, effectiveness and economic evaluation of intra-operative radiation therapy.

  Methods : The scientific literature was searched in the main biomedical databases (Centre for Reviews and Dissemination, Cochrane Library and PubMed) up to March 2014. Two independent reviewers selected the papers based on pre-established inclusion criteria, with any disagreements being resolved by consensus. Data were then extracted and summarized in a structured form. Results from studies were analyzed and discussed within a descriptive synthesis.

  Results : Sixteen studies met the inclusion criteria. It seems that outcomes from using intra-operative radiation therapy can be considered in various kinds of cancers like breast, pancreatic and colorectal cancers. The application of this method may provide significant survival increase only for colorectal cancer, but this increase was not significant for other types of cancer. This technology had low complications and it is relatively safe. Using intra-operative radiation therapy could potentially be accounted as a cost-effective strategy for controlling and managing breast cancer.

  Conclusion : According to the existing evidences, that are the highest medical evidences for using intra-operative radiation therapy, one can generally conclude that intra-operative radiation therapy is considered as a relatively safe and cost-effective method for managing early-stage breast cancer and it can significantly increase the survival of patients with colorectal cancer. Also, the results of this study have policy implications with respect to the reimbursement of this technology.

  

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Background: Substance abusers are not able to withdraw drugs eternally despite the abundance of different treatments; therefore, withdrawal programs are not quite successful and notwithstanding all the successes of methadone maintenance therapy, there are some defects found in the manner this treatment is applied. Thus, this study was conducted to explore the experience of drug abusers regarding methadone maintenance therapy.
   Methods: This is a qualitative study using content analysis methodology. The research community includes drug abusers admitted to the treatment centers of the western cities of Mazandaran Province, Iran in 2016. The sampling was purposive and the data were collected by face-to-face single interviews with 20 patients. The interviews were continued up to data saturation. Finally, the Lundman and Grenheim method was used to analyze the interviews and the four criteria of Guba and Lincoln were applied to check data integrity.
   Results: “Buying time,” “methadone dependence,” and “looking from a narrow view to the patient” were the main three categories that fit the results.
   Conclusion: Governmental free services for drug abusers; paying attention to different aspects of treatment such as mental, emotional, and social recovery; lifelong support of the family and society members; and balance in prescribing and following the treatment process prescribed by health care providers can enhance both the quality and safety of the treatment process. Psychological consultation alongside social services can facilitate the recovery process in methadone maintenance therapy.
   
 

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Background: There is no global consensus about the relationship between dairy consumption and cardiovascular diseases (CVD). This study aimed at integrating the results of several studies to predict the dairy effects on CVD, e.g. stroke and CHD.
   Methods: In the present study, some major databases such as Scopus, Science Direct, and PubMed were searched up to September 2014. All prospective cohort studies dealing with dairy products consumption and CVD were surveyed regardless of their publication date or language. This reference population includes all individuals without any delimitation with regard to age, gender, or race. The quality of the study was evaluated using STROBE Checklist. Study selection and data extraction were done by 2 independent researchers separately. The indices in this study were RR and HR. The random model was used to combine the results.
  Results: Out of 6234 articles, 11 were included in the meta-analysis. No relationship was found between stroke and consumption of milk, cream, and butter, and the results are as follow: RR = 0.91 (95%CI: 0.81-1.01) for milk, RR = 0.97 (95%CI: 0.88-1.06) for cream, and RR = 0.95 (95%CI: 0.85-1.07) for butter. However, cheese was found to decrease stroke risk: RR = 0.93 (95%CI: 0.88-0.99).
The relationship of CHD with consumption of milk, cheese, cream, and butter are as follows, respectively: RR = 1.05 (95% CI: 0.96-1.15), RR = 0.90 (95%CI: 0.81-1.01), RR = 0.96 (95% CI: 0.87-1.06), and RR = 0.99 (95%CI: 0.89-1.11). In other words, no relationship existed between dairy products and CHD.
   Conclusion: No relationship was found between consumption of various dairy products and CHD or stroke, except for cheese that decreased stroke risk by 7%. Considering the small number of studies, the result of the present study is not generalizable and more studies need to be conducted.
 
 

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Background: Despite a lot of studies carried out on catastrophic and impoverishing health expenditures, exposure to these expenditures have not been studied among health staffs and their families yet. So that our study has analyzed exposure to CHE (Catastrophic Health Expenditures) and factors affecting them among the health staffs affiliated to army medical universities in Tehran.
   Methods: This study was a descriptive-analytical and cross-sectional study implemented in 2016. Among all health staffs of a university of medical sciences, the full details of 240 households (838 individuals) were collected by using a stratified random sampling method. The data gathering and analyzing process have been done based on WHO standard guideline. Finally, the odds ratio of CHE determinants is reported using logistic regression by backward elimination method and chi-square test.
   Results: The results of this study showed that 7.5% (CI: 7.3-7.7) of health staff households (54 individuals) are faced with CHE. The odds of exposure to CHE for households with 3 members and less, households with lower education level and households with two or more outpatient visits were significantly more than others (p<0.05). Households who have used dental services during the past year were 8.77 times (p<0.001) more at risk of CHE. Also, households with 3 members and less, households with lower education level and households with two or more outpatient visits were 8.59, 7.96, and 3.39 times more at risk of such payments, respectively.
   Conclusion: CHE is a common financing dilemma even among health staffs.  Families who have more referring to health centers and less education level and also dental service users are more at risk of exposure. Health policy-makers should pay more attention to such vulnerable and high-risk groups. Finally, our study results recommended the increase of dental insurance coverage as an effective strategy to reduce exposure to CHE.
 

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Background: Evidence-based medicine is one of the most important topics in medical sciences that requires a proper teaching method. Very few studies have evaluated EBM education outcomes through peers and TBL workshops. The purpose of this study was to compare the effect of evidence-based medicine (EBM) education through peers with TBL workshop method in medical students.
   Methods: This quasi-experimental study was conducted on 42 medical students of the Faculty of Medicine in Iran University of Medical Sciences (IUMS) in 2019 who were selected through convenience sampling. Students were divided into 2 experimental and control groups based on the randomized blocking method. The data collection tools were 2 questioners that evaluated EBM knowledge and satisfaction in both intervention and control groups. The knowledge of students was compared using pretest and posttest and their satisfaction was evaluated at the end of the TBL workshop and peer education. Data were analyzed by SPSS software and descriptive tests (t test and ANOVA), and significance level was set at 0.95.
   Results: A significant difference was found between the level of basic knowledge (pretest) and secondary knowledge (posttest) in the EBM education through TBL workshop method compared to peer method. The average scores gained by students in TBL workshop were 3.8 more than the peer teaching method. The results of the Satisfaction Questionnaire were 74% in control group and 86% in the experimental group.
   Conclusion: EBM education through TBL workshop both increased students’ knowledge and satisfaction compared to peer education. Thus, it can be concluded that providing EBM education by expert and qualified teachers through face to face teaching strategy can be effective in knowledge translation. However, peers can participate in educational sessions as facilitators.
 

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Background: Prisoners are at higher risk for sexually transmitted infections (STIs) than the general population. This study reported the prevalence and correlated factors of STI-related symptoms among male prisoners in Iran.
   Methods: Participants were selected from 27 prisons across 16 Iranian provinces in 2013 using a multistage cluster sampling (N = 5490). Men aged ≥18 years who spent at least one week in prison and self-reported having had sex during the previous year were eligible and asked if they have had penile discharge (PD) or genital ulcers (GU) within the last year. Demographic variables, HIV/STIs-related knowledge, STIs care-seeking practices, HIV self-perceived risk, history of substance use, and sexual behaviors were collected by face-to-face interviews. HIV tests were completed using the ELISA method. Factors associated with STIs-related symptoms were examined using logistic regression models, and adjusted odds ratios (AOR) along with their 95% confidence intervals (CI) were reported.
   Results: Of 2,620 eligible male prisoners (mean age ± SD = 35.7 ± 8.9), 6.9% reported symptoms for PD, GU, or both; of whom 36.2% had not sought STIs care inside prison. A history of injection drug use (AOR = 2.14; 95% CI: 1.45, 3.14), having access to condoms inside prison (AOR = 1.57, 95% CI: 1.08, 2.82), self-perceived risk of HIV (AOR = 1.52, 95% CI: 1.03, 2.24), and HIV-seropositivity (AOR = 3.30, 95% CI: 1.02, 10.61) were positively and having sufficient STIs-related knowledge (AOR = 0.63, 95% CI: 0.44, 0.89) was negatively associated with reporting STIs-related symptoms.
   Conclusion: Despite the low prevalence of STIs among Iranian prisoners, initiation of screening among high-risk prisoners, including people who inject drugs and prisoners living with HIV, may prevent subsequent health effects. Current HIV/STIs prevention policies across Iranian prisons to help improve prisoners’ HIV/STIs knowledge and encourage their HIV/STIs preventive practices should be reinforced.

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Background: Salmonella induced infections remain one of the most important health problems worldwide. The purpose of this study is to investigate the incidence and geographical distribution of typhoid using GIS and to predict its incidence in Iran in 2021.
   Methods: This study is a descriptive analytical study. Information on pertussis was obtained from the Center for Communicable Diseases Control during 2009-2015. In the next step, ArcGIS 9.3 was used to prepare geographic maps of the disease incidence and frequency Therefore, using the Raster Calculator tool, the disease prediction map was drawn.
   Results: The results showed that the highest incidence of typhoid during 2009-2014 was in Kermanshah, Lorestan, Hamadan, Kurdistan, and Ilam provinces. The incidence of typhoid in Iran increased during 2009-2010. The annual incidence of typhoid decreased from 0.85 per 100,000 in 2010 to 0.5 in 2014. Based on the modeling results for Iran, Kermanshah, Lorestan, Kurdistan, Ilam and Hamadan provinces with 92.17%, 46.56%, 31.74%, 25.62% and 22.96% of their areas (Km2) are at high risk for typhoid in the coming years, respectively.
   Conclusion: Considering that the provinces of Kermanshah, Lorestan, Kurdistan, Ilam, and Hamadan are at risk of typhoid incidence in the coming years in Iran, and given that salmonella infections have a direct relationship with the individual’s health status and individual’s environmental health and socioeconomic status, improving the health status and disease control in carriers as well as improving the socio-economic status of the population living in these areas can prevent the disease in the years to come.

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Background: Despite studies about anxiety in the older adult, the prevalence of anxiety in this age group is not exactly clear, which may be due to the use of tools and criteria that were not born for this age group. One of the instruments designed to assess anxiety in the elderly is the Geriatric Anxiety Inventory (GAI). The aim of this research was to analyze the psychometric properties of the Persian version of the Geriatric Anxiety Inventory (GAI-PV) and its short form (GAI-PV-SF) in a sample of older adults in Iran.
   Methods: In this cross-sectional study, a sample of 150 community-dwelling and a psychogeriatric sample of 48 adults older than 60 years completed the GAI-PV and GAI-PV-SF, the anxiety sub-scale of the General Health Questionnaire (GHQ-28), the Geriatric Depression Scale (GDS-15), and the Structured Clinical Interview for DSM-IV (SCID-I). Different types of validity and reliability were evaluated for GAI-PV and GAI-PV-SF using SPSS and the LISREL software.
   Results: Both the GAI-PV and GAI-PV-SF exhibited excellent internal consistency (over 80 %) and desirable concurrent validity against GHQ-28 and GDS-15. The optimal cutpoint score to detect current generalized anxiety disorder (GAD) was 10/11 and 13/14 for GAI-PV in the community-dwelling and psychogeriatric samples, respectively, and 3/4 for GAI-PV-SF in both study samples.  Good test-retest reliability (correlation coefficient: 0.96 and 0.88 for GAI-PV and GAI-PV-SF, respectively) and a single-factor structure were also demonstrated.
   Conclusion: Sound psychometric properties of the GAI-PV in both subsamples suggest that the instrument could be used successfully as an accurate screening instrument in the elderly Iranian population.
 

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Background: Uropathogenic Klebsiella pneumoniae is one of the well-kown uropathogens that have the main rule in biofilm formation. Increased prevalence of ESBL enzyme is one of the therapeutic problems. However, the aims of this study were to characterize  the ability of biofilm formation and ESBL-producing isolates produced by urinary tract infection’s K. pneumoniae to identify the prevalence of this type of infection in the studied area.
   Methods: Between the 500 nonrepetitive clinical isolates, 128 isolates were detected as K. pneumoniae. Biofilm production of these isolates was showed by Merrit and Christensen method. The standard Kirby-Bauer disk diffusion method was used for antimicrobial susceptibility testing.  The phenotype ESBL was confirmed by double disc synergy test (DDST). Genotypic identification of ESBLs did by molecular detection. The statistical analysis was done  using software IBM SPSS Statistics (SPSS Inc) and chi-square and Fisher exact tests.
   Results: The result of microtiter plate was observed and it was found that 86 (67.2%) isolates had weak biofilm, 24 (18.8%)  moderate biofilm, and 18 (14.1%) strong biofilm. Also, 57 (44.5%) out of 128 isolates were diagnosed as MDR. The highest frequency of resistance was identified for cefotaxime 60 (46.9%) and tetracycline 60 (46.9%), and the lowest rate was for amikacin 16 (12.5%). The results of DDST showed 55 of 128 (43%) produced ESBL enzymes. PCR detection in ESBL-producing isolates showed contained bla_TEM  33 of 55(63.1%), and bla_VEB  13 of 55 (23% ). Also, 1 of 55 (2%) had both bla_TEM and bla_VEB. Also, 5 of 13 (38.4%) isolates that had the bla_VEB gene were also MDR and had weak biofilm (8/13; 61.5%),  intermediate biofilm (3/13; 23%),  and strong biofilm (2/13; 15.4%).
   Conclusion: To decrease treatment complications and mortality rate of drug-resistant bacterial infections, rapid detection of β-lactamases genes and evaluation of these properties and infection management programs can help to prevent the transmission of drug resistant-strains.
 

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Background: Role modeling is the essence of the teaching process and one of the important functions of educators and clinical instructors. In clinical education situations, many clinical instructors are responsible as mentors. On the other hand, clinical instructors, although not obvious, are seen as role models. This study is aimed at explaining the internal medicine and surgery residents' perceptions of mentors as role models.
   Methods: This qualitative (content analysis) study was carried out using purposive sampling and conducting semi-structured interviews with 18 medical residents (internal medicine and surgery departments) at Iran University of Medical Sciences. The resulting data were analyzed using inductive qualitative content analysis.
   Results: Based on the results of the analysis of the transcribed interviews, 60 initial codes, 31 subthemes, and 5 main themes were identified. The dimensions of the mentor's role modeling were as follows: structural, executive, managerial, ethical, and scientific.
   Conclusion: Role modeling is a very effective learning method, especially for medical students. Role modeling in clinical learning environments seems to be valuable to facilitate students' learning. Using the role of clinical instructors as an educational model is one of the important ways of teaching professional ethics in clinics.

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Background: The instructor is one of the key factors in attaining educational goals in medical education, and the instructor’s competencies facilitate students’ educational achievement. The present study is an attempt to explain the experiences of faculty members and students of characteristics of competent professors who play an influential role in the academic achievement of basic medical sciences students in universities of medical sciences across the country.
   Methods: The present study is a conventional qualitative content analysis. Fifteen faculty members and students of medicine from Iranian universities of medical sciences from different regions of the country were selected using a purposive and then theoretical sampling. A semi-structured interview was used for data collection.
   Results: In this study, four themes and nine sub-themes were extracted from interviews. The themes included “clinical knowledge”, “teaching competency”, “monitoring students’ performance”, and “cognitive-psychological arousal”. The sub-themes were “clinical knowledge’ including “Non-applied teaching of basic sciences and unfamiliarity of instructors of basic sciences with the clinic”;  “teaching competency” including “having instructional design skills, teaching based on the psychology of learning, and professional development”; “monitoring students’ performance” including “fair evaluation and valid evaluation”, and “cognitive-psychological arousal” including “student support and reinforcement”.
   Conclusion: The present study identified the important characteristics of the competencies of professors of basic medical sciences working in Iranian medical universities. The competency of professors is essential in promoting students’ educational achievement and training efficient and professional students in the field of medicine to render quality health services. The results of this study will assist administrators and educational policymakers in planning for the promotion of professors and medical education.

 

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Background: Nurses’ and physicians’ collaboration is a precedent for patient care. This study examined attitude change and interprofessional collaboration competencies among medical and nursing students of Iran University of Medical Sciences.
   Methods: This study was quantitative cross-sectional. The study tools were two questionnaires, Attitudes Toward Interprofessional Education and IPEC Interprofessional Collaborative Competencies, which were completed by 211 medical and nursing students in online or in-person forms. The collected quantitative data were analyzed by SPSS 19 software.
   Results: The results showed that nurses and physicians constituted 35.5% and 64.5% of the sample. The results of the independent T-test displayed no statistically significant difference in the mean age of both groups (P = 0.054). There was a statistically significant difference in the participants’ attitudes toward interprofessional learning, and the medical group (46.68) obtained a higher mean score than the nurse group (34.92) (P = 0.001). The two groups with varying mean scores (179.34 for medical students and 131.72 for nursing students) were significantly different in their interpersonal collaboration competencies (P = 0.001). Considering Mauchly’s test, there were statistically significant differences among medical students of varying academic years in their attitudes toward interprofessional education (P < 0.001). Nursing students were also different in their attitudes toward interprofessional education based on their academic years.
   Conclusion: The results of this study showed that the attitude of nursing students towards interprofessional education and interpersonal collaboration competencies should be increased in line with medical students in order to improve the quality of medical and health services.
 

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Background: Amyloid-beta (Aβ) production is a normal physiological process, and an imbalance in Aβ production/excretion rate is the basis of the plaque load increase in AD. LRP1 is involved in both central clearance of Aβ from the CNS and transport of Aβ toward peripheral organs. In this study, the effect of silymarin combination compared to rosuvastatin and placebo on neuro-metabolites and serum levels of LRP1 and Aβ1-42 proteins and oxidative stress enzymes and lipid and cognitive tests of Iranian AD patients.
   Methods: In this double-blind placebo-controlled study, thirty-six mild AD patients were divided into groups (n=12) of silymarin 140mg, placebo, and rosuvastatin 10mg. Medications were administered 3 times a day for 6 months. Clinical tests, lipid profile (TG, HDL, TC, and LDL), Aβ1-42, and LRP1 markers were measured at the beginning and end of the intervention. Magnetic resonance spectroscopy (MRS) was used to measure metabolites.  Using SPSS software a one-way ANOVA test was used to compare the means of the quantitative variables and Pearson and Spearman's correlations to measure the correlation. GraphPad Prism software was used for drawing graphs. P < 0.05 was considered a significant.
   Results: The levels of LRP1 and Aβ1-42 in the silymarin group were significantly increased compared to the other groups (P < 0.05). NAA/mI in the silymarin group had a significant increase compared to both placebo and rosuvastatin groups (P < 0.05). Right and left hippocampal mI/Cr directly correlated with TG (r = 0.603, P = 0.003 and r = 0.595, P = 0.004, respectively). NAA/Cr of the right and left hippocampus was inversely related to TG (r = -0.511, P = 0.0033, and r = -0.532, P = 0.0021, respectively). NAA/Cr and NAA/mI of bilateral hippocampi directly correlated with HDL (P < 0.05). An inverse correlation was observed between the Aβ1-42 and mI/Cr of the right and left hippocampus (r = -0.661, P = 0.000 and r = -0.638, P = 0.000, respectively).
   Conclusion: Donepezil and silymarin improved lipid profile associated with increased NAA/Cr, and decreased mI/Cr, in AD patients. Biomarker NAA/mI can be clinically significant in examining AD pathology. Measurement of the lipid factors and neurometabolites can be a suitable method for monitoring this disease.
 

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Background: Testosterone replacement therapy (TRT) is pivotal in addressing male hypogonadism, yet uncertainties persist regarding its optimal use and long-term ramifications. This study aims to explore the knowledge map of TRT.
   Methods: In this bibliometric study, we searched Scopus for relevant keywords from the beginning to 2023. Our inclusion criteria were original articles and reviews and our exclusion criteria were non-English and non-related articles and document types other than original articles and reviews. Excel, VOS viewer, and Science of Science (Sci2) software were used for data synthesis.
   Results: From 6712 retrieved articles, 5325 articles were included for analysis. The most productivity belonged to the USA (n=2,570 documents), the United Kingdom (n=476), and Italy (n=339). “Journal of Clinical Endocrinology and Metabolism” (n=168) had the highest participation in publishing. Also, "Journal of Clinical Endocrinology and Metabolism" and the "Journal of Sexual Medicine" exhibited significant bibliographic coupling with other journals in the TRT field. The research topics of interest were mainly related to hypogonadism, prostate cancer, and erectile dysfunction. Bursting analysis of the title and abstract revealed the TRT research prior to the year 2000 was mainly focused on castration, gonadectomy, growth, and aplastic anemia, while the focus of recent research moved towards libido, cardiovascular events, HIV, geriatric issues, diabetes, bipolar disorder, cancer, transmasculine, and transgender individuals.
   Conclusion: This study highlights the growing trend of TRT research over time, with most focus on hypogonadism, prostate cancer, and erectile dysfunction. Insights gleaned from this analysis inform research priorities and resource allocation, facilitating enhanced patient care in androgen deficiency management.