Demanded interdisciplinary subjects for integration in medical education program from the point of view of graduated medical physicians and senior medical students: a nationwide mixed qualitative-quantitative study from Iran

INTRODUCTION

This study aimed to detect interdisciplinary subjects for integration into the medical education program of Iran.

METHODS

A qualitative-quantitative method was used. Firstly, interdisciplinary subjects demanded by medical graduates and senior medical students were defined by qualitative study. In the second stage, questionnaire was developed which based on the findings of qualitative stage, experts' opinion and reviewing of the national general guide of professional ethics for medical practitioners. Questionnaire consisted of demographic, occupational and thirteen interdisciplinary items. These items consisted of social determinants of health, social and economic consequences of disease, social prescribing, physicians' social responsibility, role of gender, racial, ethnic, social and economic issues in approach to patients, role of logic and mathematics in clinical decision-making, philosophy of medicine, maintaining work-life balance, self-anger management, national laws of medicine, religious law in medical practice, health system structure, and teamwork principles. Level and importance of knowledge and self-assessed educational needs were asked about each item. In the third stage, a national online survey was conducted. SPSS 25 was used for statistics.

RESULTS

By content analysis of data in qualitative stage, 36 sub-themes and 7 themes were extracted. In the quantitative part, 3580 subjects from 41 medical universities across Iran participated in this study. 2896 (80.9%) were medical graduates and 684 (19.1%) were senior medical students. Overall, knowledge about interdisciplinary items was low to intermediate, while high to very high knowledge ranged from maximally 38.7% about socioeconomic consequences of disease to minimally 17.2% about social prescribing. Participants gave the most importance to the having knowledge about self-anger management (88.3%), maintaining work-life balance (87.2%) and social determinants of health (85.8%), respectively. However, national laws of medicine (77.6%), maintaining work-life balance (75.4%) and self-anger management (74%) were the first top three educational demands by participants.

CONCLUSION

This study revealed a low to moderate level of knowledge about interdisciplinary topics among both graduated medical physicians and senior medical students. These groups showed a strong demand and tendency to know and to be educated about these topics. These findings underscore the urgency for educational reforms to meet the interdisciplinary needs of medical professionals in Iran.

Assessing the Prevalence of Ectopic Cerebellar Tonsils and Accompanying Symptoms in Individuals with Various Headaches

Objectives

Chiari malformation exhibits well-defined clinical signs, symptoms, and incidence rates in clinical studies. However, cerebellar tonsil ectopia presents with ambiguous symptoms and undetermined incidence rates in numerous studies. Our objective was to determine the incidence of cerebellar tonsil ectopia in individuals with headaches and identify additional clinical symptoms. This aims to improve diagnosis accuracy for clinicians and neurologists, leading to more effective treatment approaches.

Methods

A cross-sectional study conducted in 2022 included 2305 participants aged 4-78 years presenting with headache. Chiari malformation was diagnosed using magnetic resonance imaging (MRI) scans, with a definition of cerebellar tonsil herniation extending beyond 5mm into the cervical canal.

Results

The prevalence of Chiari malformation was 3.4%, with no significant gender difference (p = 0.72). There was a significant correlation between Chiari malformation and headache exacerbation due to the Valsalva maneuver (p < 0.001) and the presence of vertigo (p < 0.001). No significant association was found between Chiari malformation and accompanying symptoms such as nausea (p = 0.43), photophobia (p = 0.2), phonophobia (p = 0.52), and speech disorders (p = 0.45).

Conclusion

These findings suggest a notable prevalence of Chiari malformation among headache patients and its association with specific headache characteristics, such as acute and occipital headaches, exacerbation by the Valsalva maneuver, and the co-occurrence of vertigo. These results underscore the need to consider Chiari malformation in the differential diagnosis of patients presenting with these specific headache features.

Delay in Regular Visits of Chronic Disease Patients and Its Associated Factors during the COVID-19 Pandemic

Background

Chronic patients need regular follow-ups. During the COVID-19 pandemic, these regular visits can be affected. The delay of chronic patients and its contributing factors in their periodic visits during the COVID-19 pandemic are examined here.

Methods

This cross-sectional study was conducted between February and June 2021, in Fars, Iran. Two hundred and eighty-six households with at least one chronic patient were recruited. Then, several trained questioners called the studied households and asked about the studied variables. The dependent variable was the number of delays in regular visits during the COVID-19 pandemic. The results were analyzed through Poisson regression by SPSS Statistics version 22 and GraphPad Prism software version 9. A significance level of 0.05 was considered for this study.

Results

Out of 286 households 113 (73.4%) fathers, 138 (70.1%) mothers, and 17 (58.6%) children in the households reported delayed referral. In fathers, referring to the health center was significantly associated with a decrease in the number of delays (P=0.033). The higher age of the householder (P=0.005), the higher number of children (P=0.043), and having a family physician (P=0.007) in the mothers' group, also the number of children in households (P=0.001) in the children group were significantly associated with increasing the number of delays.

Conclusion

COVID-19 pandemic not only creates direct harmful effects but also adversely affects people in danger of chronic diseases. Delays in follow-ups are taken into account as a major challenge during the COVID-19 pandemic. This issue is not limited to rural or urban residency.

Seroprevalence of SARS-COV-2 antibodies among health-care workers exposed to COVID-19 patients in a large reference hospital, Iran

Background and Objectives

Health care workers (HCWs) are a high-risk group for acquiring and transmitting severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Aim of the study was the evaluation of seroprevalence of SARS-CoV-2 in a random sample of HCWs at a large acute care hospital in Iran.

Materials and Methods

We collected blood samples of 180 medical staffs from September 22, 2020 to January 26, 2021. The enzyme linked immunosorbent assays (ELISA) tests were used for evaluation of the presence of IgG antibodies. Participants completed a self-report questionnaire, comprising demographics, occupational, the work area, and personal protection data.

Results

Of the 180 HCWs who participated in this study, 44 (24.4%) were seropositive for anti-SARS-CoV-2 IgG. The percentage of IgG positivity was higher in males than females (P<0.05). Also, there was statistically significant difference between presence of the antibodies and the occupation, location, and infecting family members with Covid -1 (P<0.05). Other factors did not associate significantly to antibody presence against SARS-CoV-2 (P>0.05).

Conclusion

According to this point that the number of COVID-19 cases is still growing rapidly among HCWs. So, the epidemiological estimate of SARS-CoV-2 infection remains a major challenge that is needed to prevent the spread of infection in the hospitals.

Role of fatty liver in coronavirus disease 2019 patients' disease severity and hospitalization length: a case-control study

Background and purpose

Fatty liver is one of the most common pre-existing illnesses; it can cause liver injury, leading to further complications in coronavirus disease 2019 patients. Our goal is to determine if pre-existing fatty liver is more prevalent in hospitalized COVID-19 patients compared to patients admitted before the SARS-CoV-2 pandemic and determine the disease severity among fatty liver patients.

Experimental approach

This retrospective study involves a case and a control group consisting of 1162 patients; the case group contains hospitalized COVID-19 patients with positive PCR tests and available chest CT-scan; the control group contains patients with available chest CT-scan previous to the COVID-19 pandemic. Patients’ data such as liver Hounsfield unit, hospitalization length, number of affected lobes, and total lungs involvement score were extracted and compared between the patients.

Results

The findings indicate that 37.9% of hospitalized COVID-19 patients have a pre-existing fatty liver, which is significantly higher (P < 0.001) than the prevalence of pre-existing fatty liver in control group patients (9.02%). In comparison to hospitalized non-fatty liver COVID-19 patients, data from hospitalized COVID-19 patients with fatty liver indicate a longer hospitalization length (6.81 ± 4.76 P = 0.02), a higher total lungs involvement score (8.73 ± 5.28 P < 0.001), and an increased number of affected lobes (4.42 ± 1.2 P < 0.001).

Conclusion

The statistical analysis shows fatty liver is significantly more prevalent among COVID-19 against non-COVID-19 patients, and they develop more severe disease and tend to be hospitalized for more extended periods.

Uncovering psychobehavioural implications of SARS-CoV-2 infection in Iran

Iran is the country in Western Asia most impacted by the COVID-19 outbreak. A survey was conducted among the general public in Iran aimed at investigating psychobehavioural issues related to the COVID-19 outbreak, namely (a) barriers to preventive measures against SARS-CoV-2 infection; (b) negative emotions towards SARS-CoV-2 infection; and (c) anxiety levels among the general public in Iran. A cross-sectional, web-based survey using an online questionnaire was carried out between 16 March and 1 April 2020. The six-item version of the State-Trait Anxiety Inventory (STAI-6) was used to assess anxiety levels. A total of 1,789 complete responses were received. Nearly 60% reported having difficulty in wearing a face mask to protect against SARS-CoV-2 infection. The mean and standard deviation (SD) for the total prevention barrier score was 35.8 (SD ± 7.1; range 18-68) out of a possible score of 72. Male respondents [odds ratio (OR) = 1.25; 95% confidence interval (CI) 1.03-1.51] and respondents who perceived their health status as poor/fair (OR = 1.49; 95% CI 1.31-1.82) were predictors of high prevention barriers. Negative emotions such as fear (74.6%) followed by depression (43.4%) and stigma (23.0%) associated with SARS-CoV-2 infection were reported. Respondents who perceived their health as poor/fair (OR = 2.19; 95% CI 1.57-3.04) reported a higher likelihood of having higher negative emotions. Findings on anxiety level revealed 68.0% (95% CI 65.8-70.1) reported moderate to severe anxiety. Respondents who perceived their health as poor/fair (OR = 3.46; 95% CI 12.22-5.40) and who were females (OR = 1.91; 95% CI 1.55-2.36) were predictors of moderate to severe anxiety. In conclusion, psychobehavioural interventions are needed to facilitate management and control of the COVID-19 outbreak.

Molecular and serological characterization of occult hepatitis B virus infection among patients with hemophilia

BACKGROUND

The occult hepatitis B virus infection (OBI) is a health concern among high-risk groups and immunosuppressed individuals. There is still a paucity of data regarding the occult hepatitis B virus infection among hemophilic patients. With this in mind, we aimed to evaluate the molecular prevalence of OBI among clients with hemophilia.

METHODS

Totally, 87 hemophilic patients were selected to be studied. To detect OBI, nested polymerase chain reaction test was used to amplify HBV-S, X, and Core regions. Viral load was determined using an in-house real-time PCR assay. Finally, sequence of S gene was used for genotyping and analysis of mutations.

RESULTS

The mean age of patients was 28.4 ± 5.3 years old, with 90.7% of whom were men. HBV-DNA was detected in eight subjects (9.3%). The rate of OBI was much higher in anti-HBs seronegative subjects than that in other patients (P = 0.019). All OBI cases had HBV genotype D, subgenotype D1. In addition, five out of eight cases (62.5%) showed detectable viral loads (a mean viral load of 4.5 × 10 ² copies/mL). sR73H, sI110L, sP120A, sP127T, sQ129H, sG130R, and sC137S were shown to be the most determinant escape mutation and OBI-relevant mutants.

CONCLUSION

The rate of OBI among the studied population of hemophilia seems to be remarkable. Therefore, screening for OBI must be a routine practice in patients with hemophilia and also patients undergoing immunosuppressive treatments. Amino acid substitutions were observed in the major hydrophilic region. However further investigations are needed for analysis of exact function.

Evaluation of vancomycin use in university-affiliated hospitals in Southern Khorasan Province (East Iran) based on HICPAC guidelines

Background

Vancomycin resistance has raised concerns about its effectiveness prospect in the treatment of patients with Gram-positive infections. The Healthcare Infection Control Practices Advisory Committee (HICPAC) has recently established guidelines to delineate improper use of vancomycin. In this light, we sought out to determine the appropriateness of vancomycin prescription using the HICPAC guidelines.

Setting

The study was carried out in two university-affiliated hospitals, Valiasr and Imam Reza, with 297 and 234 beds, respectively, from May 2012 to May 2013.

Methods

This retrospective study evaluated the vancomycin prescription and usage in the hospitals. Total vancomycin use was determined and expressed as vancomycin courses per 298 admitted patients. The patient information was collected on a data collection sheet as follows: demographic variables, etiology and localization of infection, microbiological data, duration of vancomycin treatment, reasons for vancomycin prescription, prescribed antibiotic dosing, and patient regimen.

Results

The average age of the patients and vancomycin treatment duration were 55.965 years and 10.5 days, respectively. Septicemia (15.7%) was the most common cause of vancomycin administration. Vancomycin use was documented to be appropriate and inappropriate in 236 (89.4%) and 28 (10.6%) patients, respectively. No statistically significant differences were found among the wards and hospitals (P values =0.66 and 0.54, respectively) in terms of appropriateness of vancomycin use based on the HICPAC criteria. In addition, 29.21% and 62% of all patients exhibited complete and partial recovery, respectively. We found that 90% of the cases showed compliance with the HICPAC recommendations.

Conclusion

Comprehensive programs are required to improve the vancomycin use in the hospitals. Vancomycin use should be monitored due to its large-scale empiric use. The rate of improper use of vancomycin in the infection and intensive care unit services may be high, and pharmacists must take appropriate action to optimize the use of the drug.

Co-crystal polymorphic control by nanodroplet and electrical confinement

The polymorphic control of the co-crystal carbamazepine–saccharin (CBZ–SAC) metastable form II was achieved by nano-droplet confinement in tandem with droplet surface charging induced by electrospraying the precursor solution.

Identification of Mucorales isolates from soil using morphological and molecular methods

Background and Purpose:

Soil is the main habitat of saprophytic and pathogenic fungi. Mucoromycotina constitutes a large group of soil fungi, with certain opportunistic members causing systemic infections in immunocompromised hosts. The majority of human and animal infections are caused by the members of the genera Rhizopus, Mucor, Rhizomucor, Lichtheimia (Absidia), Cunninghamella, and Mortierella. Accordingly, in the present study, we aimed to isolate and identify the main genera of the order Mucorales, using molecular assays and morphological features.

Materials and Methods:

In total, 340 soil samples were collected from seven public parks throughout the city and sidewalk gardens in 14 municipal districts in Isfahan, Iran. All the samples were cultured on the appropriate media, incubated at 27°C for 2- 4 days, and examined daily for visible fungal growth. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was applied and macroscopic, microscopic, and physiological characteristics were assessed to identify fungal colonies.

Results:

400 pure colonies, belonging to the orders Mucorales and Mortierellales, including the genera Lichtheimia, Rhizopus, Rhizomucor, Mucor, Cunninghamella, and Mortierella, were identified. The genus Rhizopus (35.5%) was the most frequent isolate, followed by Mucor (32.25%) and Rhizomucor (27.5%).

Conclusion:

The results emphasize the importance of opportunistic fungi in public areas and indicate the risk of exposure for immunocompromised individuals.

Association of metabolic syndrome components with insulin resistance in normal weight population: the Qazvin Metabolic Diseases study

PURPOSE

Metabolically obese but normal weight (MONW) is associated with higher risk of type 2 diabetes, dyslipidemia, and hypertension. The aim of this study was to evaluate the association of metabolic syndrome components with MONW in each sex in Iranian population.

METHODS

This cross-sectional study was performed on 417 normal weight subjects in Qazvin, Iran between September 2010 and April 2011. MONW was defined by insulin resistance (IR) using the homeostatic model assessment (HOMA). Cut off point for IR was defined as the lower limit of top quintile of HOMA-IR values in normal weight population without any metabolic risk factors. Data were analyzed using T test, Mann-Whitney U test, and multi-variant logistic regression analysis.

RESULTS

Of 417 subjects, 44.3 % were female. The prevalence of MONW was 33.8 % in men and 39.8 % in women. Triglycerides levels were significantly higher in both men and women with MONW. Waist circumference was significantly higher in men with MONW, while high-density lipoprotein cholesterol levels were significantly lower in women with MONW. In logistic regression analysis, hypertriglyceridemia in women (OR 3.398; 95 % CI 1.306-8.846) and waist circumference (per 5 cm increment) in men (OR 1.653; 95 % CI 1.279-2.136) had independent association with MONW.

CONCLUSION

Association of metabolic syndrome components with MONW is different in men and women. Waist circumference had an independent association with IR in men but not in women. IR and its complications should be considered in lean women with hypertriglyceridemia.

Association between health-related quality of life and impaired glucose metabolism in Iran: the Qazvin Metabolic Diseases Study

AIM

To evaluate the association between health-related quality of life and glucose metabolism status in a study population in Qazvin, Iran.

METHODS

This cross-sectional study was conducted in 1044 people (aged 20-78 years old) between September 2010 and April 2011 in Qazvin, Iran. An oral glucose tolerance test was performed for each participant who had never been diagnosed with diabetes. Participants were characterized as having normal glucose metabolism, pre-diabetes or diabetes according to American Diabetes Association criteria. The short-form 36 questionnaire was used to measure quality of life. Data were analysed using a chi-squared test, anova and ancova.

RESULTS

A total of 530 (51.7%) of the participants were women, and 24.1 and 11.6% of the participants were categorized as having prediabetes and diabetes mellitus, respectively. Except for the role emotional domain, there was a gradual decrease in the mean scores of every domain of the short-form 36 scale across the three study groups. The mean scores in the physical domains were significantly different among the participants with normal glucose metabolism and those with diabetes. After adding age as covariate, there were no significant differences between the categories in any of the domains.

CONCLUSION

There is no association between quality of life domains and glucose metabolism status in Iranian subjects. More longitudinal studies are necessary to investigate the natural history of pre-diabetes, diabetes and quality of life.

Prevalence of metabolic syndrome in Qazvin Metabolic Diseases Study (QMDS), Iran: a comparative analysis of six definitions

OBJECTIVE

The aim of the present study was to compare the prevalence of metabolic syndrome (MS) according to six definitions and evaluate the agreement between them in an urban sample in Qazvin, Iran.

METHODS

In a cross sectional study, 529 men and 578 women in age of 20-78 years were attended from September 2010 to April 2011 in Qazvin, Iran. Standardized measurements were available for waist circumference, blood pressure, fasting serum high-density lipoprotein cholesterol, triglycerides, glucose, and insulin. The diagnostic criteria proposed by World Health Organization (WHO), National cholesterol education program third Adult Treatment Panel (ATPIII 2001, 2004), International Diabetes Federation (IDF), American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI), and new Joint Interim Societies (JIS) were applied. The degree of agreement between different definitions was assessed by kappa statistic.

RESULTS

The prevalence of MS was found to be 28% (WHO), 26.2% (ATPIII 2001), 30.6% (ATPIII 2004), 34.2% (IDF), 33% (AHA/NHLBI), and 39.3% (JIS). With regards to the gender, the prevalence of MS according to ATPIII 2001 and IDF was significantly greater in women than men. However, using other definitions, the prevalence of MS was similar in both genders. The agreement of JIS criteria with IDF and AHA/NHLBI definitions was excellent (IDF: 0.902; AHA/NHLBI: 0.862), while the agreement of IDF criteria with ATPIII 2004 and AHA/NHLBI was good (ATPIII 2004:0.719; AHA/NHLBI: 0.756).

CONCLUSIONS

Although JIS definition resulted in a higher prevalence of MS than other definitions, an excellent agreement has been seen between these criteria. Widespread acceptance of JIS definition may lead to management and therapy in a greater part of the population.

Collateral vessel physiology and functional impact–in vivo assessment of collateral channels

The existence and recruitment of collateral vessels within the coronary circulation may account for the tremendous variability in presentation, symptoms and outcome in patients with coronary atherosclerosis. Multiple episodes of ischemia have been found to produce the stimuli necessary for the growth of new vessels which result in collateral blood flow. Furthermore, there is also a subset of patients with readily recruitable collateral vessels that function to limit myocardial necrosis during an acute ischemic event. Promising early studies have utilized angiogenic growth factors as a means to stimulate collateral growth, bringing a renewal interest in their assessment and significance. We review, in brief, the significance and understanding of the development of coronary collaterals as well as the available means to assess them.