ISSN: 2676-7597

Vol. 2 No. 3 (2020)

Editorials


Although in the general medical doctoral training program approved by the Ministry of Health and Medical Education in 2017, one of the professional duties of the graduates of this field is to participate in all educational and research activities approved by the competent authorities. However, in the main competencies and skills expected by the graduates of this field, there is no reference to research competencies (1).


In this program, there are 293 credits, of which six are related to the dissertation. The study of this program shows that only the courses "Research Methods and Evidence-Based Medicine", "Medical Statistics", and "Principles of Epidemiology" are about how to conduct research, search for articles, basic principles of vital statistics, and types of studies (1).


It is suggested that the following issues be considered before the next review of this program – Cont.

Research/Original Article


In Silico Identification of Potentially Effective Herbal Inhibitors of SARS-Cov-2 Main Protease by Virtual Screening Method

Amirreza Dowlati Beirami, Dara Hatamabadi, Sayna Iranpanah, Mitrasadat Rezaei, Seyed Ali Ziai

School of Medicine Students' Journal, Vol. 2 No. 3 (2020), 12 September 2020 , Page 2-6
https://doi.org/10.22037/smsj.v2i3.31997

Background: The COVID-19 pandemic is a global health emergency caused by SARS-CoV-2. Unfortunately, no effective drugs have been found to date. There is also a major need for new therapies to treat this disease. The main protease is an attractive drug target among coronaviruses due to its important role in the processing of viral RNA-translated polyproteins. Objective of This study was conducted to screen databases of herbal compounds for potential main protease inhibitors.
Material and Methods: Natural products from 3 database banks were first tested and filtered by ADME / toxicity, then their molecular energy was minimized, and finally, they were docked into the SARS-CoV-2 main protease and compared with indinavir.
Results: The binding energies of 6570 molecules from different herbal compounds comprising databases were tested and five of the molecules with the highest binding energies for SARS-CoV-2 main protease docking were selected and key interactions were studied.
Conclusion: In conclusion, five herbal compounds including Sodwanone B, Cyclomulberrin, and a glycosylated derivative of kaempferol had lower docking energy compared to indinavir and were suggested for further research.

Investigating the relationship between gastric polyp and dyspepsia in Iranian patients

Saeed Abdi, Elham Moradi, Zhaleh Mohsenifar

School of Medicine Students' Journal, Vol. 2 No. 3 (2020), 12 September 2020 , Page 7-13
https://doi.org/10.22037/smsj.v2i3.30888

Abstract


Background and aim: Chronic dyspepsia is one of the common medical problems in patients referred to internal and gastrointestinal clinics. According to the results of some studies, most patients with dyspepsia are simultaneously suffering from gastric polyps. We aimed to clarify the association of gastric polyp and dyspepsia in an Iranian population.
Materials and methods: We enrolled 2772 dyspeptic and 1294 non-dyspeptic subjects in this cross-sectional study, who referred to the gastrointestinal clinic at Ayatollah Taleghani Hospital in Tehran from2016 to 2018.All subjects underwent upper gastrointestinal (GI) endoscopy andpatients with GI malignancy, severe GI bleeding and history of GI surgery excluded from study. They were evaluated for age, sex, endoscopicfindings, gastric polyp (GP) count, size and localization, diagnosticmethods used for histology, and polyp features. The relationshipbetween gastric polyp and dyspepsia was alsoevaluated.
Results: In 4066 consecutive upper GI endoscopy in patients with and without dyspepsia, 129 patients (3.2%) had gastric polyps (GPs).The prevalence of GPs was 3.04% and 3.32% in with and without dyspepsia subjects, respectively. There was no observed statistically significant relationship between GPs and dyspepsia (P=0.709). Hyperplastic polyps(HPs)were the most common pathologic form in patients with and without dyspepsia in 53.5% and 34.9% of patients, respectively. The most common location was the gastric antrum polyps (76.7%) and the common size of the polyps was between 5-10 mm in (80.6%) patients.

Conclusion: In the present study, there was no statistically significant difference within the pathologic findings of gastric polyp in terms of dyspepsia.Hyperplastic polyps(HPs) are the most common type of pathologic stomach polyps and it is maybe high due to the highfrequency of Helicobacter pylori(H. pylori) infection in our country.

Background and aims: Postoperative pain after cesarean section is one of the important issues in gynecology. Opioids and non-steroidal anti-inflammatory drugs (NSAIDs) are two of the drugs that are used for cesarean pain management. Considering the adverse effects of opioids in the mother and the baby, NSAIDs are preferred in the post-cesarean pain management. This study was designed to compare the effect of oral diclofenac potassium (Cataflam) with diclofenac sodium suppository on postoperative cesarean pain.
Materials and Methods: This randomized clinical trial was conducted on patients who underwent cesarean section in Taleghani Hospital during 2019. Patients were randomly divided into two groups based on flipping coin. The first group received 100 mg of oral diclofenac potassium every 6 hours and the second group received 100 mg of diclofenac sodium suppository every 6 hours. The pain was assessed 30 minutes, 2 hours, 6 hours, 12 hours, 18 hours and 24 hours after the intervention using visual analogue scale (VAS) before and after analgesics.
Results: Eighty-four patients were included in the final analysis. The mean of VAS during the intervention in the diclofenac sodium suppository group and in the Cataflam group was 3.42 ± 2.1 and 1.93 ± 2.4 respectively (P value = 0.011). Twenty-eight among 46 patients who received opioids due to severe pain (66.7%) were in the diclofenac suppository group and 18 of them (42.9%) were in the Cataflam group (P value = 0.021).
Conclusion: Diclofenac potassium tablets and diclofenac sodium suppository can reduce the post cesarean pain. The efficacy of diclofenac potassium tablets (Cataflam) is significantly higher than the diclofenac suppository; however, the complication rate was not significantly different.

Cost Effectiveness of Rivaroxaban versus Warfarin to Prevent Stroke in Iranian AF Patients

Hesamaddin Gordan, Mohammad Reza Beyranvand , Mehdi Sheibani , Mohamad Asadpur Piranfar , Mohamad Amin Pourhoseingholi

School of Medicine Students' Journal, Vol. 2 No. 3 (2020), 12 September 2020 , Page 18-24
https://doi.org/10.22037/smsj.v2i3.31619

Background and objectives: Atrial fibrillation (AF) is the most common sustained arrhythmia in adults which need anti-coagulant to prevent stroke. Due to high cost of Rivaroxaban compared to warfarin, it`s not prescribed as much as warfarin by physicians despite its superiority in intracranial hemorrhage. Therefore, this study aimed to evaluate the cost-effectiveness of rivaroxabane versus warfarin in preventing stroke in AF patients.


Methods: This study is a cost-utility analysis with cost-effectiveness assessed by the incremental cost per quality-adjusted life-year (QALY). Two strategies were used to obtain the costs; the first was from available resources and the next was to collect data using a questionnaire. Utility values for obtaining ∆QALYs were sourced from published data. Finally the cost-effectiveness of Warfarin versus Rivaroxaban was assessed using an incremental cost-effectiveness ratio (ICER), which was calculated as the incremental cost per QALY (Quality-adjusted life year) gained.


Results: A total number of 98 patients who met the inclusion criteria were answered the questionnaire. Mean annually physician visits were 4 times in rivaroxaban and 14 times in warfarin group. The patients in Warfarin Group checked their INR (international normalised ratio) 15 times a year, while the patients in Rivaroxaban group did not check at all. The wasting time for each physician visit and doing Lab test was approximately 3 hour. Total cost of Rivaroxaban in both private (16699000IRR) and public services (15755000IRR) were less than Warfarin in both private and public services (24233700 & 20345600 IRR). We analyzed the ΔQALYs of 7 different articles in which the mean ΔQALY was 0.21 (Variance: 0.0072). The Incremental cost per QALY per patient for warfarin in Private versus public services was 18514762 Rial /QALY, while the ICER between Rivaroxaban versus warfarin in both private and Public services was negative                                   (-35879523.8 and -21860000 Rial/QALY). So the calculated threshold based on the per capita gross national product (GDP), which was 702576000 Rials (calculated at 42,000IRR/$), showed that Rivaroxaban is more cost-effective than Warfarin.


Conclusions The results of present study demonstrated that use of Rivaroxaban versus Warfarin in both public and private services is a cost-effective choice. So, due to its economic and potential benefits, it is recommended to prescribe Rivaroxaban rather than warfarin.

Review


Viral Outbreaks of SARS-CoV1, SARS-CoV2, MERS-CoV, Influenza H1N1, and Ebola in 21st Century; A Comparative Review of the Pathogenesis and Clinical Characteristics

Fateme Sadat Rahimi, Siamak Afaghi, Farzad Esmaeili Tarki, Kian Goudarzi, Nasser Malekpour Alamdari

School of Medicine Students' Journal, Vol. 2 No. 3 (2020), 12 September 2020 , Page 1-8
https://doi.org/10.22037/smsj.v2i3.30455

 

Throughout the past twenty years, humankind had its fair share of challenges with viral epidemics. In late December 2019, a zoonotic member of the coronaviruses was responsible for the COVID-19 outbreak of viral pneumonia in Wuhan, China. As a worldwide crisis, meanwhile, conclusive prevention or therapy has yet to be discovered, the death toll of COVID-19 has exceeded 278000 by May 11th, 2020. Alike other members of Coronavirus family such as MERS and SARS-CoV-1, SARS-CoV-2 provokes influenza-like syndrome which might further progress to the severe state of acute respiratory disease in some patients. Comparably, in 2009 the H1N1 influenza outbreak affected countless people by manifestations of respiratory system involvement. Additionally, Ebolavirus, as a member of the Filoviridae family, had also made a global catastrophe by causing hemorrhagic diseases in the past twenty years.  The unknown intrinsic nature of SARS-CoV-2, as a great missing piece of this pandemic puzzle, has had physicians to empirically test the possibly efficacious agents of the former viral epidemics on the COVID-19 cases. Here, the current knowledge in SARS-CoV-2 clinical features, transmissibility, and pathogenicity are all summed up as against the other emerging viruses in the last two decades, and the data crucially required for a better management of the illness has been spotlighted.

Case Report


It's time to revise the role of positive D- penicillamine challenge test in diagnosis of Wilson disease

fereshteh karbasian, Amirhossein Hosseini, Naghi Dara, Sarah Javdani Yekta, Negar Imanzadeh

School of Medicine Students' Journal, Vol. 2 No. 3 (2020), 12 September 2020 , Page 27-29
https://doi.org/10.22037/smsj.v2i3.29977

Hepatic involvement in Wilson disease consists of isolated elevated liver enzyme, asymptomatic hepatomegaly, cirrhosis and acute liver failure. Here we report three patients with unexplained elevated liver enzyme. By considering the level of urinary excretion of copper after penicillamine challenge test we had some problems in the process of diagnosis. Therefore we think of cautiously applying the diagnostic cut-off in mentioned challenge test.