Researcher Bulletin of Medical Sciences

Background and Objective: Better understanding of immunopathogenesis and finding the relationship between disease severity and some cytokines, is an introduction to further research on new biological drugs with the specific aim of obtaining these cytokines can be provided. The present study was performed to determine the ratios of IL-6 and IL-8 (IL-6, IL-8) in Iranian patients with COVID-19.

Materials and Methods: One of our goals is to find a relationship between serums levels of hypothetical cytokines involved in the severity of COVID-19 disease by measuring the serum concentrations of these cytokines in COVID-19 patients at baseline as a prognostic factor.

Results: Regarding right lung involvement as well as involvement of both lungs, there was a significant difference between patients with severe and mild disease severity (p-value <0.001). Ferritin levels were significantly higher in the severely ill group than in the mildly ill group (p-value = 0.003). CRP levels were higher than normal in 93.3% of patients in the present study. CRP levels were not associated with disease severity but were effective in predicting the disease.  ESR level was higher than normal in 88% of patients and was effective in prognosis the disease. The mean serum level of interleukin-8 in 38 severe patients was significantly higher than the mean serum level of interleukin 8 in 21 mild patients (p-value <0.001). Death was reported in 11 patients (18.6%). Mortality rate and disease severity showed a significant relationship (p-value = 0.006). The disease was significantly more severe in patients with positive PCR (p-value = 0.026).

Conclusions: In several patients, the serum level of interleukin 8 has been a good evaluator of disease prognosis. Symptoms of COVID-19 may be due to elevated levels of interleukin-8 and its receptor. Therefore, it is suggested that in future studies, interleukin 8 receptor mRNA be tested for the discovery of new biological drugs against COVID-19.

Background and Objective: Prompt diagnosis and treatment of prostate cancer is important to improve the prognosis. Hence in this study the role of radiology and FNA were compared for diagnosis of prostate cancer.

Materials and Methods: In this correlational-descriptive comparative study, 100 patients suspected to have prostate cancer were assessed. The results of FNA and radiology were compared.

Results: The final diagnosis was BPH in 68%, prostatitis in 24% and malignancy in 8%. Sensitivity and specificity of fine needle aspiration (FNA) were calculated respectively 100% and 90.22%, for ultrasonography 100% and 69.57%, for digital rectal exam (DRE) 75% and 58.7% finally for prostate serum antigen (PSA) 87% and 55%.

Conclusions: In general, we found out FNA has the highest validity index but regarding the invasive nature of the test it is not the primary exam to assess the patients. The high false positive cases found by PSA suggests that it may be a suitable screening test but not a reliable diagnostic one to find the patients with cancer.

Background and Objective: Higher education, as a driving force for sustainable development has a strategic role in ensuring quality in the society. Thus, higher education is expected to play its crucial role in creation of change and innovation in an appropriate way to underpin the quality. The study aimed to provide a model for improving the quality of the teaching-learning environment for cardiovascular assistants at Shahid Beheshti University of Medical Sciences, Iran.

Materials and Methods: After implementation of open and axial coding, due to the lack of specific standards and explicit measurable criteria, the nine components approved by the experts were considered as a basis for the formation of a "model for improving the quality of the teaching-learning environment". The questions were designed based on 9 components and 27 sub-components in the form of a researcher-made questionnaire to determine the current status of teaching-learning environment for cardiovascular assistants.

Results: The results showed that the contribution of each component in improving the quality of teaching-learning environment based on factor load distribution. Also, the degree of appropriateness of the components was determined.

Conclusions: The analysis of the current status of teaching-learning environment for cardiovascular assistants indicates that despite the relatively favorable situation with a positive trend, the proposed model can contribute to the betterment of the situation in policy-making, planning, training, evaluation and resource development among cardiology human capital.

Abstract

Perfectionism is a set of very high standards of performance that is accompanied by self-assessments of negativity, criticism, and blame. According to some classifications, perfectionism is based on three dimensions of self-oriented perfectionism (the tendency to set strict and unrealistic criteria for itself and focus on defects and failures in performance along with precise self-monitoring), other-oriented (the tendency high standards for others, and high and irrational expectations from them) and socially prescribed perfectionism (the perceived need for perceptions to meet the expectations and standards prescribed by the society and others) are categorized and evaluated. Students in a community, like other classes in a community, will have such high expectations of themselves, others, and the society as a whole, but what matters is how much perfectionism can affect the field of study and, in particular, the work and social aspects of the individual. What we did in this cross-sectional study was using the Tehran multidimensional perfectionism questionnaire to evaluate and compare the three dimensions of perfectionism in a specified number of medical and non-medical students of Shahid Beheshti University of Medical Science in 2019. As a conclusion, among the three dimensions of perfectionism, the dimension of self-oriented perfectionism was more bolded among medical students and other-oriented perfectionism is more evident among non-medical students. Socially prescribed perfectionism seems to be similar in both groups.

Background and Objective: Healthcare Workers (HCWs) are among at-risk population for trauma exposure and Posttraumatic Stress Disorder (PTSD) development, especially during the Covid-19 pandemic. The aim of the present study was to investigate three different variables, namely coping dimensions, resilience, and spiritual well-being, as protective factors for PTSD development among HCWs during the Covid-19 pandemic.

Materials and Methods: In the present study, 300 HCWs were recruited using convenience sampling method. The participants completed a battery of measures, including Posttraumatic Stress Disorder Checklist, Life Paths Measurement Packet Coping Scale, Brief Resilience Scale, and Spiritual Well-being Questionnaire.

Results: The Pearson correlation coefficient results revealed that there was a significant positive correlation between PTSD and communication with others (P<0.05, r=0.135), and between other components of spiritual well-being, i.e, communication with self, communication with God, communication with others, and communication with nature. Simultaneous regression analysis results revealed that coping dimensions, resilience, and spiritual well-being explained 4% of the variance in PTSD among the study sample. Also, the results showed that there was a significant positive correlation between communication with others and PTSD (P=0.001, β=0.211, B=0.290), while there was a significant negative relationship between communication with nature and PTSD (P=0.006, β=0.217, B=0.233).

Conclusions: These results suggest that spiritual well-being, coping strategies, and resilience, might play a protective role (although minimal) in the development of PTSD among HCWs. Further research is needed in order to make a conclusive decision about using these factors as therapeutic factors to mitigate the onset of PTSD among HCWs during the Covid-19 pandemic.

Background and Objective: The COVID 19 pandemic affected almost on all of the economic, political and social aspects of countries in the world. According to researches, anxiety and depression are common psychological reaction on the Coronavirus virus pandemic. The aim of this study was to investigate the moderating role of coping strategies in predicting of Coronavirus anxiety based on personality traits in patients with COVID-19.

Materials and Methods: From all of the patients with COVID-19 referred to Masih Daneshvari Hospital, 120 patients (60 men, 60 women) were selected randomly. According to inferences criteria.  Subjects complete Hexaco-PI-R, Coping Inventory for successful Situations (CISS), and Coronavirus Disease Anxiety Scale (CDAS). Data were analyzed using structural equation modeling. 

Results: The results of structural equation modeling showed that the direct effects of conscientiousness on problem-based coping strategies, and direct effects of emotionality and extraversion on emotion- based coping strategies were significant (P<0/05). Also, the direct effects of conscientiousness, emotionality and extraversion on and Coronavirus disease anxiety components were significant (P<0/05). Also, the goodness of fit indices for the hypothetical model had significant coefficients at P<0.05.

Conclusions: Thus, results of the present study in addition to expanding the research literature, emphasis to the role of individual differences in predicting of Coronavirus disease anxiety and highlight the necessity of remarking these factors for designing appropriate interventions.

Background and Objective: Hernia is the weakening or disruption of the fibrous-muscle tissue of the body wall through, which intra-abdominal structures pass. The lack of consensus about the antibiotic prescription and the appropriate time led to some non-appropriate antibiotic use. Recognition of the best time can help to better preventive approaches in the patients.

Materials and Methods: In this study, 110 male patients who were electively referred for inguinal hernia repair were enrolled and divided into two sections of 55 patients, with one group receiving preoperative antibiotics and the other receiving postoperative antibiotics. The infection rates were compared between the groups.

Results: The results of this study showed that age, BMI, duration of operation, and hospital stay were alike across the groups (P > 0.05). There was no infection in any of the classes.

Conclusion: Overall, the findings of this study indicate that the rate of infection in cases of mesh reconstruction of inguinal hernia is minimal, and the rate is the same in those with a preoperative and postoperative antibiotic prescription. This suggests the guidelines should be changed in order to shorten the duration and dosage of antibiotic treatment as well as the length of stay for these patients in hospitals.

Background and Objective: Meaning in life is an important parameter in many aspects of human life; and one of the most important aspects of it is relational meaning in life. Relational meaning in life questioner (RMLQ) is the newest instrument that measures this parameter. This study aimed to investigate the psychometric properties of relational meaning in life questioner (RMLQ) in a sample of Iranian medical students.

Materials and Methods: In this study, after translating and back‑translating RMLQ, comparisons were made with the original version. The study population consisted of 217 Iranian medical students. Cronbach’s alpha method was used to examine the reliability of the scale and it's score for RMLQ was 0.87. Furthermore, the correlation of the scale was evaluated to determine its criterion validity, using Pearson’s correlation coefficient. Exploratory and confirmatory factor analysis methods were applied for construct validity.

Results: Investigation of the psychometric properties of the Iranian version of RMLQ showed its high reliability and confirmatory factor analysis results show the model’s satisfactory fitting.

Conclusions: The Persian version of RMLQ is a useful self‑report tool for evaluating the relational meaning in life of Iranian medical students.

Infertility is characterized by the failure to attain a successful pregnancy after one year of normal intercourse.  Infertility has a negative impact on the mental and psychosocial well-being of influenced couples, result to reduced quality of life. Infertility is recognized as a global health problem, plague nearly 15% of couples worldwide. It can result from female-related factors (30%), such as premature ovarian failure and uterine disease [1]. Despite recent advances in assisted reproductive technology (ART), many couples are incapable to conceive except through gamete and embryo donation or adoption [2]. Cell-based therapy for fertility restoration is an active research field in some countries. Stem cells are primitive cells found in almost all tissues. They are unspecialized cells with the ability to differentiate, self-renew and proliferate. The mechanism of stem cell function in infertility treatment is to replace injured cells and restore the structure and function of affected organs [3]. Stem cells show renewed hope in overcoming problems associated with infertility in several preclinical and clinical studies [4]. For women infertility, stem cells may be applied to regenerate ovaries, oocyte and/or endometrium [5, 6]. This field started with a provocative publication in 2004. In this publication, endometrial biopsies from a small number of women who underwent bone marrow transplantation were examined and found donor-derived cells levels is nearly half of the epithelial and stromal cells in the biopsy samples [7]. 

Dr. Verter reviewed 5695 advanced cell therapy clinical trials from 2011 to 2020 from the CellTrials.org database and extracted 112 of this trials specifically targeting medical diagnoses that affect fertility [8]. Clinical research report that stem cells can be used to increase the thickness of the uterus [9]. Stem cell-derived gametes can now be used as an in vitro model for evaluating drug effects [10]. Overall, stem cell research has provided new breakthroughs in fertility treatment [4]. Clinical use of stem cells must be consistent with ethical requirements, such as free and informed consent and other ethical principles of clinical research. Endometrial cell therapy may be cheaper and more accessible than surrogacy if it can progress from clinical trials to an approved treatment available to the public [11]. However, increasingly large-scale clinical trials are needed to demonstrate the safety and efficacy of stem cell therapy in the human reproduction field.

Background and Objective: Lead poisoning has harmful effects on various body organs. Coenzyme Q10 (COQ10) plays a decisive role in many biological activities, such as intracellular antioxidant protection. Apoptosis is expressed and regulated in the liver by the mfn1 and mfm2 family genes. We aimed to investigate the effect of COQ10 gastric gavage on the expression of these genes in the liver of lead-infected rats.

Materials and Methods: Twenty-four male rats weighing 160-210 grams were randomly divided into three groups. The control group received deionized water. The intervention groups received either 1 mg/L lead dissolved in acetic acid or q mg/K pbcl12 lead table salt dissolved in acetic acid plus 10 mg/kg COQ10 for 28 days. The expression of mfn1 and mfn2 genes were investigated by the real-time polymerase chain reaction (PCR) method.

Results: The expression of mfn1 mRNA at a dose of 1 mg/L in the group receiving lead significantly decreased compared with the control group (P<0.05). In the group receiving lead+COQ10, a significant increase was seen in mfn1 expression compared with the lead group (P<0.05). The mRNA expression of the mfn2 gene at a dose of 1 mg/L lead significantly decreased in the group receiving lead compared with the control group (P<0.05). The mRNA expression of the mfn2 gene significantly increased at a dose of 1 mg/L lead and 10 mg/kg COQ10 in the group receiving lead+COQ10 compared with the lead group (P<0.05).

Conclusions: Lead induces apoptosis by reducing the expression of antiapoptotic genes mfn1 and mfn2, while COQ10 increases their expression.

Abstract

Background and Objective: The ultrasound guided axillary block provides good anesthesia for orthopedic surgery below the elbow. However, an upper arm tourniquet may be painful because the block may not anesthetize the area under the inflated cuff. The aim of this study was to determine whether subcutaneous injection of a local anesthetic in the axilla decrease the incidence of tourniquet pain in orthopedic surgery performed under axillary block.

Materials and Methods: 68 ASA I-III patients undergoing orthopedic surgery for forearm, wrist and hand under ultrasound guided axillary block entered into this prospective, randomized, double-blinded clinical trial. 34 axillary blocks in conjunction with a subcutaneous injection of lidocaine (study group) and 34 axillary blocks with subcutaneous saline injection (control group) were performed. The incidence and severity of tourniquet pain, tourniquet pain onset time, tourniquet inflation time, supplementary analgesia requirement for tourniquet pain and patient satisfaction were evaluated.

Results: 16 women and 52 men, age of 17-70 years were included. The characteristics of the patients and operation and onset of tourniquet pain were similar in two groups. The incidence of tourniquet pain, pain scores at the tourniquet site, and the incidence of supplementary intravenous analgesia was significantly higher in the control group than in the study group.

Conclusions: The incidence and severity of tourniquet pain with combining axillary brachial plexus block and a subcutaneous injection of lidocaine was significantly less than that associated with axillary block alone. It is an effective simple and safe method in prevention of tourniquet pain in the upper arm.

Background and Objective: We hypothesized that preoperative different doses of celecoxib would reduce pain scores and morphine consumption after tibial fracture surgery under spinal anesthesia.

Materials and Methods: In this randomized, double-blind, controlled study of 484 subjects undergoing tibial surgery, patients received a placebo (Group O) or celecoxib (Group A: 100 mg, Group B: 200 mg, Group C: 400 mg) one hour before surgery. The primary endpoint was pain severity in the recovery room at 6, 18, and 24 hours postoperatively. The secondary endpoints were postoperative nausea and vomiting (PONV), agitation in the recovery room, total opioid use, and time to the patient's first request for analgesics.

Results: Compared to the placebo group, the celecoxib groups had significantly lower postoperative pain scores (p<0.001). They also had significantly lower PONV (P-value<0.05), agitation in the recovery room (P-value=0.001), and a longer time to request analgesics (P-value<0.05). The difference within the celecoxib groups was almost insignificant. The difference between the groups for total opioid use was not significant (p>0.05).

Conclusions: Administration of celecoxib before tibial fracture surgery under spinal anesthesia was associated with significantly reduced early VAS pain scores, PONV, agitation in the recovery room, and delayed time to initiation of postoperative analgesic use, but not for total opioid use. We recommend premedication with low-dose (100 mg) celecoxib for the above purposes.

Background and Objective: The aim of the current study was to investigate three factors, including coping, resilience, and spiritual well-being as protective factors for the development of PD among hospital staff during the COVID-19 pandemic.

Materials and Methods: In the current research, convenience sampling method was used to select 300 hospital staff from various hospitals in Tehran. The collected data were analyzed using multiple statistical methods, i.e., Pearson’s correlation coefficient, Structural Equation Modeling, and regression analysis.

Results: The findings revealed that nearly 40 percent of the study sample experienced a severe mental disorder. Also, the study findings showed that there was a significant positive correlation between various aspects of spiritual well-being among hospital staff, i.e., communication with self and with God (P<0.01, r=0.676), communication with others and with God (P<0.01, r=0.605) and with self (P<0.01, r=0.626), and lastly communication with nature and with God (P<0.01, r=0.686) and with self (P<0.01, r=0.722) and with others (P<0.01, r=0.640). The results of the simultaneous regression analysis indicated that the three variables of coping, resilience, and spiritual well-being explained 0.072% of the total variance in psychological distress among the hospital staff sample.

Conclusions: The findings of the current study suggested that the three factors of coping, resilience, and spiritual well-being may have a minimal protective role in PD development among the hospital staff population. More research is necessary to draw a conclusion on the role of these variables regarding PD

One of the most important obstacles to organ donation is when a family refuses to consent to donate the organs of a brain-dead case. This affects the number of people who die while waiting for an organ transplant. Thus, to increase the number of organs available for transplantation, we need to understand the causes of family refusal. Indeed, there are many reasons why a family refuses to donate organs after the brain dead, including cultural, religious, scientific, social, moral, spiritual, and legal reasons. Therefore, this article reviews and summarizes the significant and influential causes of family refusal among the next keen brain death cases.

Background: Due to changes in lifestyle and the rising incidence of metabolic syndrome in different societies, aim of this study was to evaluate factors associated with metabolic syndrome in pregnancy.

Materials and Methods: This cross-sectional study was performed in the years 2015 - 2016 on 500 pregnant women in their first trimester of pregnancy who attended for routine tests Niloo laboratory in Tehran. A demographic /reproductive questionnaire was completed for all pregnant women by the researcher at time of entry into the study. Inclusion criteria were gestational age less than 14 weeks, no history of systemic diseases including diabetes, and singleton pregnancy. The mothers weight, height and blood pressure (BP)were measured and their BMI (Body mass Index) was calculated . A fasting blood sample was obtained for measuring fasting blood sugar (FBS) triglyceride (TG) and High-Density Lipoprotein (HDL) levels. If the mother had 3 or more of the following criteria, they were considered as having gestational metabolic syndrome (GMS) .1-Pre-pregnancy BMI ≥ Kg/m^{2 ,}2- FBS≥100 mg/dl, 3-TG≥150mg/dl, 4-HDL<50mg/dl, 5-BP≥130/85mm/Hg. The data analysis was performed using the software SPSS21, K ², t-test  and P <0.05 was considered as significant level.

Results: The occurrence of gestational metabolic syndrome was observed in 21 (4% of mothers) happened. In K² analysis, folic acid intake had a significant protection effect on GMS (P-value:0.014), in T-test pre-pregnancy BMI (P-value<0.001).

Conclusion: In this study, pre-pregnancy BMI and increased number of pregnancies were associated with an increased incidence of gestational metabolic syndrome. But folic acid intake was a protective factor in reducing the risk of metabolic syndrome. These results need to be further evaluated in future studies.

Background: Due to the higher prevalence of suicidal ideation in patients with multiple sclerosis compared to the general population and the prevalence of sleep disorders and depression in these patients and the role of sleep disorders and depression in the incidence of suicidal ideation this study aimed to investigate the role of sleep disorders and depression in multiple sclerosis.

Materials and Methods: The method of the present study was a cross-sectional descriptive correlational study. The population of the present study consisted of patients with multiple sclerosis who were selected by using the inclusion criteria in the winter of 1400 and 252 people filled the Suicide Behaviors Questionnaire-Revised (SBQ R), the Mini sleep Questionnaire (MSQ), and the Patient Health Questionnaire-9 (PHQ-9) by online available methods.

Results: The findings show the sleep disorder variable was able to explain 0.037% of the variance of suicidal ideation (R2 = 0.037) and depression was able to predict 0.070% of the variable of suicidal ideation.

Conclusion: According to the research findings it may be effective to consider treatments for sleep disorders and depression in patients with MS, especially in the first few years of receiving the diagnosis to prevent suicidal ideation.

Objective: This study aimed to determine the effectiveness of family-focused therapy using cyberspace on the quality of relationships in patients with bipolar disorder.

Materials and Methods: The present study is a quasi-experimental with pretest-posttest design with a follow-up period. The statistical population includes patients with bipolar disorder who were referred to counselling centers and psychological services with one of their family members, from which 30 patients were selected by purposive sampling with a family member. Then Miklowitz intervention was performed using cyberspace for the experimental group and the control group was not trained. The tools of this research included the Pierce (1991) Quality of Relationships Questionnaire.

Results: The analysis results with repeated measures showed that Miklowitz intervention using cyberspace was significant in the quality scores of the experimental group and control scores, and this difference was greater in the experimental group (P <0.05).

Conclusion: As a result, it can be said that family-focused therapy with the Miklowitz approach improves the quality of family relationships and improves the level of family health in patients with bipolar disorder.

Objective: Anesthesiology is a medical specialty that prepares medical doctors to diagnose, treat, and care for patients. It is essential for the educational content of anesthesiology residency programs to encompass assessment, preparation, counseling, and education. This study aimed to evaluate the impact of an educational intervention on the knowledge, attitude, and practice (KAP) of anesthesiology residents regarding their training program.

Materials and Methods: Participants in this study were randomly assigned to one of two groups: an intervention group (N=22) receiving educational training and a control group (N=23) receiving no intervention. All participants completed a demographic questionnaire online, followed by an initial KAP assessment. The intervention group then participated in online training that covered the principles, rationale, therapeutic roles, responsibilities, and curriculum expectations of the anesthesiology program at Shahid Beheshti University of Medical Sciences. One month after the training, the KAP questionnaire was administered again to evaluate changes.

Results: The study found that, at the conclusion of the intervention, the intervention group demonstrated significantly higher scores in knowledge (P=0.010), attitude, practice, and overall KAP (P < 0.001) compared to the control group. Intragroup analyses also revealed significant improvements in KAP for both groups throughout the study; however, the magnitude of these changes was markedly greater in the intervention group (P=0.01).

Conclusion: The findings indicate that anesthesiology residents initially had low levels of knowledge and positive attitudes toward their curriculum, which improved significantly following the educational intervention. Ongoing training for graduates in this field is crucial to ensure effective implementation of the curriculum, ultimately leading to the development of qualified anesthesiology professionals in the country.

Objective: To reduce watching porn in adolescents, identifying its underlying factors is necessary. The purpose of this study was to examine the correlations between personality and parental monitoring with watching porn in male adolescents in Iran.

Materials and Methods: This cross-sectional study was advertised on social media. 154 participants completed the self-reported questionnaires through online link. Analysis was performed to assess the kind of association by SPSS software version 26.

Results: Results indicated that extroversion was significantly correlated with watching porn (rs = 0.179, p<0.05) and there weren’t any correlations between other personality traits and parental monitoring with it.

Conclusion: These results emphasize the importance of extroversion in watching porn. Considering the large range of behaviors that make a person an extrovert, more studies are needed to examine extroversion and its characteristics more precisely to gain a better insight into this correlation.

Objective: The hospital staff are at-risk for the development of Psychological Distress (PD) during and after the COVID-19 pandemic. The aim of the current study was to investigate three factors, including coping, resilience, and spiritual well-being as protective factors for the development of PD among hospital staff during the COVID-19 pandemic.

Materials and Methods: In the current research, convenience sampling method was used to select 300 hospital staff from various hospitals in Tehran. The study sample filled up a number of measures, namely Kessler Psychological Distress Scale (K-10), Brief Resilience Scale (BRS), Life Paths Measurement Packet Coping Scale, and Spiritual Well-being Questionnaire (SWB). The collected data were analyzed using multiple statistical methods.

Results: The findings revealed that nearly 40 percent of the study sample experienced a severe mental disorder (N=114), while nearly 30 percent of them experienced a moderate mental disorder (N=74). The results of the Pearson’s correlation coefficient revealed that PD was significantly and negatively correlated with resilience. Also, the study findings showed that there was a significant positive correlation between various aspects of spiritual well-being among hospital staff.

Conclusion: The findings of the current study suggested that the three factors of coping, resilience, and spiritual well-being may have a minimal protective role in PD development among the hospital staff population. More research is necessary in order to draw a conclusion on the role of these variables with regard to PD. It is essential to conduct more studies in this area in order to develop useful interventions and strategies to support this at-risk population in such a difficult situation, which puts them at a high risk for PD development.