Medical Journal of the Islamic Republic of Iran最新文献

Background: Students with higher academic self-efficacy usually show higher levels of academic adaptation and are agile in using variant learning strategies. In this regard, training-based learning (TBL), a relatively new educational method, can be considered a complementary method in the education of pharmacy students. This research aims to compare the effect of TBL with the lecture method on the academic self-efficacy of pharmacy students in pharmaceutical biotechnology courses.

Methods: This was a quasi-experimental study of pretest and posttest types with random assignment to 2 control and experimental groups, in which the effects of team-based training and lecture methods were studied in the pharmaceutical biotechnology course. In the experimental group, the students were divided into 8 groups of 6 people, and they spent 5 sessions of the pharmaceutical biotechnology course with the TBL method, and the control group also received the same content by the lecture method. Both groups answered the self-efficacy tool before the intervention, and at the end of the intervention, both groups answered the tool again. After the approval of the university ethics committee and obtaining informed consent, the self-efficacy questionnaire was distributed in person and online among the participants. The quantitative data were collected and analyzed using SPSS software Version 19 (mean and standard deviation, homogeneity of the 2 groups, tests, and Kolmogorov-Smirnov).

Results: The data analysis showed that most of the participants were 22 years old. The independent samples t test results showed that the 2 groups did not have a statistically significant difference in the mean age (P = 0.058). Also, there was no statistically significant difference between the 2 groups in the pretest (P = 0.391), and the 2 groups had almost the same mean. Still, there was a statistically significant difference between the 2 groups in the academic self-efficacy variable in the posttest (P < 0.001).

Conclusion: Team-based teaching methods can increase students' participation and enthusiasm in learning and applying self-efficacy and self-management skills, introducing more diverse career and educational opportunities for pharmacy students.

Medial gastrocnemius strain (MGS), is the most common cause of mid-calf pain in athletes due to the stretch of the gastrocnemius muscle when the knee is in extension and the ankle is in dorsiflexion. Chronological age and previous calf injury are the most substantial risk factors for MGS, including high body mass index, previous lower limb injuries, L5 radiculopathy, and inadequate warm-up. The dominant presentation of MGS is a pain that can be diverse from acute to latent, which is felt in the posteromedial aspect of the calf and is often preceded by a feeling of a pop. The signs of MGS include antalgic gait, ecchymosis, swelling, local tenderness, and sometimes a palpable gap felt along the muscle. Passive dorsiflexion of the ankle or resistive ankle plantarflexion with knee extension can indicate a more severe injury, while functional tests can illicit milder injuries of calf muscles-including gastrocnemius. The diagnosis of MGS is usually made by clinical evaluation. However, imaging modalities-including magnetic resonance imaging and ultrasound-can be helpful in case of suspicion. In most cases of MGS, the cornerstone of treatment is nonoperative rehabilitation, which can be performed as a 4-phase program and should be tailored individually. Some instances of MGS are referred for early or later surgical treatment if indicated. In this article, we review the literature about various aspects of MGS, from diagnosis to treatment and rehabilitation, and propose a structured approach to this injury.

Background: Spinal muscular atrophy is an inherited neurodegenerative disorder that typically leads to severe physical disability. The present study aimed to determine the subjective evaluation of this disorder screening and analyze its influencing factors in Iran.

Methods: A cross-sectional study was performed using data from the second survey of women either pregnant or planning to become pregnant in Tehran, the capital of Iran, in 2022. The dependent variable was the willingness to pay for this disease screening test. The independent variables included sociodemographic, economic, and health characteristics, the history of this disease or other diseases of the person and family, and knowledge about this disease in the included population. Logistic regression was utilized to identify independent variables associated with the dependent variable, and the results were reported as unadjusted and adjusted odds ratios and P values with 95% CIs. A questionnaire was used as a research tool, and STATA 17 software was used for data analysis. The monetary value of spinal muscular atrophy (SMA) screening was calculated by estimating willingness to pay using the congenital valuation method.

Results: In total, 578 women were included. About 64.85% of respondents had a willingness to pay for SMA screening as the dependent variable, with a mean of $526. University education (P = 0.009) and pregnancy experience (P = 0.021) were associated with the dependent variable.

Conclusion: Iranian women expressed their willingness to undergo screening tests, but due to financial constraints, they expected the government and nongovernmental organizations to bear most of the cost.

Background: Many patients with bipolar disorder (BD) experience sleep problems. Sleep abnormalities are associated with immune dysfunction, which may be reflected by hematological indices. Purpose: This study aimed to investigate the association between sleep quality and the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) in patients with BD.

Methods: This cross-sectional study was performed at Imam Hossein Hospital, Tehran, Iran, from March to September 2023. Hospitalized patients newly diagnosed with BD were interviewed to complete questionnaires. Sleep quality and manic and depressive symptoms of the participants were assessed using the Pittsburg Sleep Quality Index (PSQI), the Young Mania Rating Scale (YMRS), and the Hamilton Depression Rating Scale (HDRS), respectively. Furthermore, blood samples were taken from each patient to investigate hematological indices. Continuous and categorical variables were compared between groups using an independent-sample t test and chi-square/Fisher's exact tests, respectively. The Poisson regression model was also used to investigate predictors of the PSQI score.

Results: Of 305 patients included in the study, 78.7% and 21.3% were experiencing manic and depressive episodes, and 90.20% had poor sleep quality. The prevalence of poor sleep quality was significantly higher in depressed patients than in manic patients (100% vs. 87.5%; P = 0.003). Depressed patients had significantly higher platelet counts (mean difference [MD], 34.09 [95% CI, 9.35-58.83]; P = 0.007) and PLR (MD, 38.14 [95%CI, 10.25-66.02]; P = 0.008) and lower lymphocyte counts (MD, 266.04 [95% CI, [14.41-517.67]; P = 0.038) compared with manic patients. The Poisson regression model with adjustment revealed that men (risk ratio [RR], 1.113; P = 0.025), those with lower educational levels (RR, 1.164; P = 0.001), and those with higher HDRS scores (RR, 1.370; P < 0.001) had significantly deteriorated sleep quality.

Conclusion: Most bipolar patients have poor sleep quality, particularly those with depressive episodes. Depressed patients had significantly higher platelet counts and PLR. Also, depressed patients with male sex, lower educational levels, and more severe depressive symptoms had poorer sleep quality.

Background: Despite the implementation of national iodine supplementation programs, structural thyroid diseases are still highly prevalent in most countries. Thus, the link between trace elements other than iodine, such as selenium, and thyroid diseases should be investigated.

Methods: In this case-control study, adult patients with newly diagnosed papillary thyroid carcinoma, benign thyroid nodules, and healthy euthyroid controls without nodules were recruited. Thyroid function tests and serum selenium levels were assessed and compared between groups. The One-way ANOVA test was used to assess the mean difference of numerical variables among the three studied groups (PTC, Benign nodule, and healthy control group). In addition, a post-hoc comparison was conducted based on Bonferroni correction for a pairwise comparison of these three groups.

Results: Data from 182 patients with papillary thyroid carcinoma (PTC), 185 patients with benign thyroid nodules, and 180 healthy individuals as a control group were analyzed. The mean serum selenium levels in the PTC, benign thyroid nodules, and control group were 94.9, 121.6, and 134.3 µg/l, respectively (P < 0.001). There was a significant relationship between the cancer stage and selenium level in the PTC group. Patients in higher stages of cancer had a lower mean of selenium (P < 0.001). In univariate logistic regression, TSH and selenium were significant variables for PTC compared with patients with benign thyroid nodules. Each unit increase in selenium reduces the chance of PTC by about 6%.

Conclusion: The low levels of selenium were associated with PTC. Also, serum selenium levels were inversely correlated with the stage of thyroid cancer.

Background: Case-control studies are efficient designs for investigating gene-disease associations. A discovery of genome-wide association studies (GWAS) is that many genetic variants are associated with multiple health outcomes and diseases, a phenomenon known as pleiotropy. We aimed to discuss about pleiotropic bias in genetic association studies.

Methods: The opinions of the researchers on the basis of the literature were presented as a critical review.

Results: Pleiotropic effect can bias the results of gene-disease association studies if they use individuals with pre-existing diseases as the control group, while the disease in cases and controls have shared genetic markers. The idea supports the conclusion that when the exposure of interest in a case-control study is a genetic marker, the use of controls from diseased cases that share similar genetic markers may increase the risk of pleiotropic effect. However, not manifesting the disease symptoms among controls at the time of recruitment does not guarantee that the individual will not develop the disease of interest in the future. Age-matched disease-free controls may be a better solution in similar situations. Different analytical techniques are also available that can be used to identify pleiotropic effects. Known pleiotropic effects can be searched from various online databases.

Conclusion: Pleiotropic effects may result in bias in genetic association studies. Suggestions consist of selecting healthy yet age-matched controls and considering diseases with independent genetic architecture. Checking the related databases is recommended before designing a study.

Background: Success in COVID-19 vaccination depends on understanding why people refuse or hesitate to take the vaccine. This study aims to explore vaccine refusal and hesitancy among Iranians who participated in the national COVID-19 vaccine hesitancy survey.

Methods: A qualitative content analysis approach was used. Twenty-six participants were selected by purposive sampling. In-depth, semi-structured telephone interviews were conducted during the year 2022. A directed content analysis approach was used for analyzing the data by extracting the codes, subcategories, and categories.

Results: Four major categories and their respective subcategories related to refusal and/ or hesitancy against COVID-19 vaccination emerged: "lack of confidence" (distrust in policymakers and pharmaceutical companies, distrust in national media, belief in conspiracy theory, and lack of confidence in the vaccine's safety and effectiveness), "complacency" (Fatalism and philosophical beliefs, low perceived risk, and belief in the adequacy of the precautionary principles), "constrains" (personal and psychological barriers), and "coercion" (coercion by relatives and unsteady imposed mandatory vaccination by the government).

Conclusion: Distrust, fatalism, low perceived risk, and overconfidence in traditional Persian medicine were important barriers to COVID-19 vaccine acceptability needing a variety of measures for improving COVID-19 vaccine uptake, including enhancing public trust in government and policymakers, clarifying vaccine safety and effectiveness, dealing with religious fatalism, and regulating anti-science messages on social media.

Background: Monitoring households' exposure to catastrophic health expenditure (CHE) based on out-of-pocket (OOP) health payments is a critical tool for evaluating the equitable financial protection status within the health system. The COVID-19 pandemic has brought unprecedented global change and potentially affected the mentioned protection indicators. This study aimed to assess the prevalence of CHE among households in Iran during the COVID-19 period.

Methods: The present study employed a retrospective-descriptive design utilizing data derived from two consecutive cross-sectional Annual Household Income and Expenditure Surveys (HIES) undertaken by the Statistical Centre of Iran (SCI) in 2020 and 2021. The average annual OOP health payments and the prevalence of households facing CHE were estimated separately for rural and urban areas, as well as at the national level. Based on the standard method recommended by the World Health Organization (WHO), CHE was identified as situations in which OOP health payments surpass 40% of a household's capacity to pay (CTP). The intensity of CHE was also calculated using the overshoot measure. All statistical analyses were carried out using Excel-2016 and Stata-14 software.

Results: The average OOP health payments increased in 2021, compared to 2020, across rural and urban areas as well as at the national level. Urban residents consistently experienced higher OOP health payments than rural residents and the national level in both years. At the national level, the prevalence of CHE was 2.92% in 2020 and increased to 3.18% in 2021. In addition, rural residents faced a higher prevalence of CHE based on total health services OOP, outpatient services OOP, and inpatient services OOP compared to urban residents and the national level. Regarding the intensity of CHE using overshoot, the results for 2020 and 2021 revealed that the overshoot ranged between 0.60% and 0.65% in rural areas, between 0.30% and 0.33% in urban areas, and between 0.38% and 0.41% at the national level.

Conclusion: A considerable percentage of households in Iran still incur CHE. This trend has increased in the second year of COVID-19 compared to the first year, as households received more healthcare services. The situation is even more severe for rural residents. There is an urgent need for targeted interventions in the health system, such as strengthening prepayment mechanisms, to reduce OOP and ensure equitable protection for healthcare recipients.

Background: The evaluation of VTE risk using risk assessment scales for each hospitalized patient is recommended by the National Institute for Health and Care Excellence. The purpose of this study was to compare the predictive accuracy of two common assessment scales, the Autar and Padua deep vein thrombosis (DVT) risk assessment scales.

Methods: This prospective cohort study was conducted on 228 ICU hospitalized patients. The risk of VTE was estimated using the Autar and Padua scales during the first 48 hours after admission. The predictive accuracy of the above two risk assessment scales for VTE in ICU patients was compared based on the area under the receiver operating curve (ROC).

Results: Results of ROC analysis indicated the area under the curve (AUC) values for the Autar (0.61 ± 0.05) and Pauda (0.53 ± 0.06). Log-rank test showed no difference in AUCs (P = 0.19). Moreover, the accuracy of the Autar scale and Padua obtained 24% and 14% respectively. Both scales had 100% sensitivity but their specificity was low (Autar 14% and Padua 3%). The positive likelihood ratios (LR+) were 1.17 for Autar and 1.03 for Padua. The negative likelihood ratios (LR-) were 0 for Autar and 0.89 for Padua. Inter-rater agreement values obtained 0.99 and 0.95 respectively for the the Autar and Padua scales.

Conclusion: The AUC, accuracy, and LR+ of the Autar risk assessment scale were higher than the Padua scale in predicting VTE. However, both scales had excellent reliability, high sensitivity and low specificity. It is recommended that the risk of VTE is recorded by the Autar scale for patients admitted to ICUs. It can help the healthcare team in the use of prophylaxis for those that are at high risk for VTE.

Background: Non-ST-elevation myocardial infarction (NSTEMI) is a significant component of acute coronary syndrome (ACS) and typically exhibits a relative incidence that is more than double that of ST-segment elevation myocardial infarction (STEMI). Data obtained from the International Long QT Syndrome Registry indicate that the risk of developing malignant arrhythmias in individuals with long QT syndrome is exponentially associated with the duration of the QTc interval. Therefore, the aim of this study was to assess the potential inclusion of prolonged QTc as a prognostic risk factor in NSTEMI patients.

Methods: A cross-sectional study was conducted on patients with NSTEMI diagnosis admitted to the Bu-Ali Hospital of Qazvin between April 2021 and September 2021 by census method. The QT interval was measured in the electrocardiogram at admission. The documented grace score was calculated and its relationship with the corrected QTc interval was estimated using the Hodges formula. Finally, the relationship between QTc and GRACE score was investigated as a prognostic factor in ACS patients. Relationships were assessed by using both the T-test and the chi-square test.

Results: A total of 60 patients (31.7% females, 63.8% males) with a mean age of 63 ± 12.7 years were evaluated. Most of the patients (68.3%) were at low risk regarding the Grace score category. In evaluating the relationship between QTc in the electrocardiogram at admission with total GRACE score, the Pearson correlation results were significant and there was a positive relationship between these two factors (r = 0.497, P < 0.001).

Conclusion: This study revealed a significant relationship between the QTc interval of patients and the GRACE Score. It was shown patients' QTc can be a predictive factor of patients' mortality.