Mahboobe Khoozan, Amir Reza Falahnezhad, H. Shirafkan, Seyyedeh Mahboobeh Mirtabar, M. Faramarzi
Background: Medical students often experience high levels of psychological stress, which can significantly impact their professional lives. Objectives: This study aimed to investigate the quality of professional life among medical students and the influence of psychological self-care and resilience on both professional quality of life and psychological distress among medical clerks and interns at Babol University of Medical Sciences. Methods: This descriptive-cross-sectional study, conducted from May to September 2022, included 270 medical trainees from Babol University of Medical Sciences (Babol, Iran). Participants had not taken academic leave in the past year nor transferred to another university. They completed online questionnaires covering resilience, psychological self-care, quality of professional life, and psychological distress, along with demographic details such as age, gender, and marital status. Data were analyzed using SPSS software. Results: Results indicated a generally favorable quality of professional life among the students, characterized by low compassion fatigue (mean 17.43 ± 7.87 out of 36) and low psychological burnout (mean 15.34 ± 4.10 out of 24), but moderate compassion satisfaction (mean 34.52 ± 8.13 out of 50). Additionally, mean scores for depression (7.84 ± 3.50 out of 21) and anxiety (7.24 ± 3.76 out of 21) were low. Students demonstrated above-average psychological self-care (mean 127.47 ± 17.97 out of 180) but had low resilience against stress (mean 24.12 ± 5.28 out of 38). Regression analysis revealed that psychological self-care significantly influenced the quality of professional life (P < 0.001, β = 0.318). Furthermore, age (P < 0.001, β = 0.299), female gender (P = 0.013, β = -0.136), and self-care (P < 0.001, β = -0.327) significantly affected levels of anxiety and depression. Conclusions: Psychological self-care plays a crucial role in enhancing the quality of professional life and in mitigating anxiety and depression among medical clerks and interns.
{"title":"Quality of Professional Life in Medical Students: The Roles of Psychological Self-care, Anxiety, and Depression","authors":"Mahboobe Khoozan, Amir Reza Falahnezhad, H. Shirafkan, Seyyedeh Mahboobeh Mirtabar, M. Faramarzi","doi":"10.5812/semj-146018","DOIUrl":"https://doi.org/10.5812/semj-146018","url":null,"abstract":"Background: Medical students often experience high levels of psychological stress, which can significantly impact their professional lives. Objectives: This study aimed to investigate the quality of professional life among medical students and the influence of psychological self-care and resilience on both professional quality of life and psychological distress among medical clerks and interns at Babol University of Medical Sciences. Methods: This descriptive-cross-sectional study, conducted from May to September 2022, included 270 medical trainees from Babol University of Medical Sciences (Babol, Iran). Participants had not taken academic leave in the past year nor transferred to another university. They completed online questionnaires covering resilience, psychological self-care, quality of professional life, and psychological distress, along with demographic details such as age, gender, and marital status. Data were analyzed using SPSS software. Results: Results indicated a generally favorable quality of professional life among the students, characterized by low compassion fatigue (mean 17.43 ± 7.87 out of 36) and low psychological burnout (mean 15.34 ± 4.10 out of 24), but moderate compassion satisfaction (mean 34.52 ± 8.13 out of 50). Additionally, mean scores for depression (7.84 ± 3.50 out of 21) and anxiety (7.24 ± 3.76 out of 21) were low. Students demonstrated above-average psychological self-care (mean 127.47 ± 17.97 out of 180) but had low resilience against stress (mean 24.12 ± 5.28 out of 38). Regression analysis revealed that psychological self-care significantly influenced the quality of professional life (P < 0.001, β = 0.318). Furthermore, age (P < 0.001, β = 0.299), female gender (P = 0.013, β = -0.136), and self-care (P < 0.001, β = -0.327) significantly affected levels of anxiety and depression. Conclusions: Psychological self-care plays a crucial role in enhancing the quality of professional life and in mitigating anxiety and depression among medical clerks and interns.","PeriodicalId":507014,"journal":{"name":"Shiraz E-Medical Journal","volume":"81 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141280722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: ChatGPT is a large-scale language model that utilizes artificial intelligence (AI) to answer a broad range of scientific inquiries, create clinical scenarios, and evaluate educational programs. While its use offers numerous advantages, it also presents several challenges. Objectives: The aim of this study is to conduct a comprehensive review of ChatGPT's functionality and explore the benefits, challenges, existing solutions, and future prospects of using AI in medical education. Method: A comprehensive literature review was conducted using various databases such as PubMed, Scopus, Web of Science, and Google Scholar. The search phrases used were ChatGPT, Artificial Intelligence, Chatbot, Medical Education, and large language models (LLMs). Results: The application of ChatGPT in medical education offers several advantages, such as enhanced quality of interaction between medical students and patients, improved education quality, enhanced research opportunities, personalized learning, virtual patient simulations, and cost-effectiveness. However, there are also critical challenges, such as ethical and transparency concerns, limited access to reliable databases, restricted information availability after 2021, limited development of students' critical thinking ability, and the risk of generating hallucinations. Conclusions: Artificial intelligence models have become a popular tool for researchers to access scientific resources, comprehend articles and textbooks, and create scientific texts. ChatGPT has been used extensively in medicine and medical education in a short period. It is essential to weigh the benefits and challenges, use expert supervision, conduct frequent assessments, and provide feedback reviews to guarantee its efficacy. Although this technology should not replace human labor, it is essential to prepare for the changes brought by AI and create appropriate guidelines and curricula by reviewing existing solutions and conducting extensive studies.
背景介绍ChatGPT 是一种大规模语言模型，它利用人工智能（AI）回答各种科学问题、创建临床情景和评估教育项目。使用该模型有很多好处，但也面临一些挑战。研究目的本研究旨在对 ChatGPT 的功能进行全面回顾，并探讨在医学教育中使用人工智能的优势、挑战、现有解决方案和未来前景。研究方法使用 PubMed、Scopus、Web of Science 和 Google Scholar 等各种数据库进行了全面的文献综述。使用的搜索关键词包括 ChatGPT、人工智能、聊天机器人、医学教育和大型语言模型（LLMs）。研究结果ChatGPT 在医学教育中的应用具有多种优势，如提高医学生与患者之间的互动质量、提高教育质量、增加研究机会、个性化学习、虚拟患者模拟以及成本效益。然而，也存在一些严峻的挑战，如道德和透明度问题、可靠数据库的访问受限、2021 年后信息可用性受限、学生批判性思维能力的发展受限以及产生幻觉的风险。结论：人工智能模型已成为研究人员获取科学资源、理解文章和教科书以及创建科学文本的常用工具。ChatGPT 在短时间内已广泛应用于医学和医学教育。权衡利弊、专家指导、经常评估、反馈审查是保证其有效性的关键。虽然这项技术不应该取代人类的劳动，但有必要为人工智能带来的变化做好准备，并通过回顾现有解决方案和开展广泛研究来制定适当的指导方针和课程。
{"title":"ChatGPT, a Friend or a Foe in Medical Education: A Review of Strengths, Challenges, and Opportunities","authors":"Mahdi Zarei, Maryam Zarei, S. Hamzehzadeh, Sepehr Shakeri Bavil Oliyaei, Mohammad-Salar Hosseini","doi":"10.5812/semj-145840","DOIUrl":"https://doi.org/10.5812/semj-145840","url":null,"abstract":"Background: ChatGPT is a large-scale language model that utilizes artificial intelligence (AI) to answer a broad range of scientific inquiries, create clinical scenarios, and evaluate educational programs. While its use offers numerous advantages, it also presents several challenges. Objectives: The aim of this study is to conduct a comprehensive review of ChatGPT's functionality and explore the benefits, challenges, existing solutions, and future prospects of using AI in medical education. Method: A comprehensive literature review was conducted using various databases such as PubMed, Scopus, Web of Science, and Google Scholar. The search phrases used were ChatGPT, Artificial Intelligence, Chatbot, Medical Education, and large language models (LLMs). Results: The application of ChatGPT in medical education offers several advantages, such as enhanced quality of interaction between medical students and patients, improved education quality, enhanced research opportunities, personalized learning, virtual patient simulations, and cost-effectiveness. However, there are also critical challenges, such as ethical and transparency concerns, limited access to reliable databases, restricted information availability after 2021, limited development of students' critical thinking ability, and the risk of generating hallucinations. Conclusions: Artificial intelligence models have become a popular tool for researchers to access scientific resources, comprehend articles and textbooks, and create scientific texts. ChatGPT has been used extensively in medicine and medical education in a short period. It is essential to weigh the benefits and challenges, use expert supervision, conduct frequent assessments, and provide feedback reviews to guarantee its efficacy. Although this technology should not replace human labor, it is essential to prepare for the changes brought by AI and create appropriate guidelines and curricula by reviewing existing solutions and conducting extensive studies.","PeriodicalId":507014,"journal":{"name":"Shiraz E-Medical Journal","volume":"124 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141282026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Nikkhoo, Muhammad Rasul Fathi, Sherko Nasseri, Bayazid Ghaderi, Hassan Moaiery, Leila AzizKhani, Khaled Rahmani
Background: Breast cancer, the most prevalent cancer in women and the second leading cause of cancer-related deaths worldwide, is a complex and heterogeneous disease characterized by multiple tumor types with distinct tissue patterns, biological characteristics, and clinical behaviors. Given the critical role of histopathological and molecular characteristics in the treatment and management of breast cancer. Objectives: This study was undertaken to investigate the histopathological characteristics of malignant breast masses in the city of Sanandaj from 2019 to 2021. Methods: In this descriptive-analytical study, out of 1,631 pathology reports from breast tissue samples collected in Sanandaj, a city in northwest Iran, between 2019 and 2021, 597 (36%) malignant cases were examined for their pathological type and molecular characteristics. Data analysis was performed using SPSS 26 software, employing chi-square and Fisher's exact tests. Results: The mean age of the patients at diagnosis was 49.7 ± 11.9 years. The most prevalent molecular subtype was luminal A (56.4%), followed by triple-negative (16.7%), human epidermal growth factor receptor 2 (HER2)-positive/enriched (14.1%), and luminal B (14%). Invasive ductal carcinoma was the predominant histological type, accounting for 82.7% of cases, followed by lobular invasive carcinoma (8.2%). Papillary carcinoma accounted for 5.9% of cases, metaplastic carcinoma for 1.8%, and mucinous carcinoma for 1.3%. Higher grades at the time of diagnosis were associated with the metaplastic subtype (P < 0.001). The only biomarker that showed a significant association with pathological types of breast cancer was Ki-67. The percentage of cases positive for Ki-67 was higher in three types of breast cancer: Infiltrating ductal carcinoma, metaplastic, and papillary (intraductal) carcinoma, compared to the other types (P < 0.001). Conclusions: According to our data, infiltrating ductal and lobular carcinoma are the most prevalent pathological types, and luminal A is the most common molecular subtype among Kurdish women in Iran. It is recommended that future studies examine patient survival based on the pathological and molecular types of tumors, including the evaluation of additional biomarkers. Furthermore, comparing these results with those from other ethnic groups could provide valuable insights into the impact of ethnicity on breast cancer characteristics and outcomes.
{"title":"Histopathological and Molecular Characteristics of Malignant Breast Tumors in the Kurdish Population During 2019 - 2021","authors":"B. Nikkhoo, Muhammad Rasul Fathi, Sherko Nasseri, Bayazid Ghaderi, Hassan Moaiery, Leila AzizKhani, Khaled Rahmani","doi":"10.5812/semj-143049","DOIUrl":"https://doi.org/10.5812/semj-143049","url":null,"abstract":"Background: Breast cancer, the most prevalent cancer in women and the second leading cause of cancer-related deaths worldwide, is a complex and heterogeneous disease characterized by multiple tumor types with distinct tissue patterns, biological characteristics, and clinical behaviors. Given the critical role of histopathological and molecular characteristics in the treatment and management of breast cancer. Objectives: This study was undertaken to investigate the histopathological characteristics of malignant breast masses in the city of Sanandaj from 2019 to 2021. Methods: In this descriptive-analytical study, out of 1,631 pathology reports from breast tissue samples collected in Sanandaj, a city in northwest Iran, between 2019 and 2021, 597 (36%) malignant cases were examined for their pathological type and molecular characteristics. Data analysis was performed using SPSS 26 software, employing chi-square and Fisher's exact tests. Results: The mean age of the patients at diagnosis was 49.7 ± 11.9 years. The most prevalent molecular subtype was luminal A (56.4%), followed by triple-negative (16.7%), human epidermal growth factor receptor 2 (HER2)-positive/enriched (14.1%), and luminal B (14%). Invasive ductal carcinoma was the predominant histological type, accounting for 82.7% of cases, followed by lobular invasive carcinoma (8.2%). Papillary carcinoma accounted for 5.9% of cases, metaplastic carcinoma for 1.8%, and mucinous carcinoma for 1.3%. Higher grades at the time of diagnosis were associated with the metaplastic subtype (P < 0.001). The only biomarker that showed a significant association with pathological types of breast cancer was Ki-67. The percentage of cases positive for Ki-67 was higher in three types of breast cancer: Infiltrating ductal carcinoma, metaplastic, and papillary (intraductal) carcinoma, compared to the other types (P < 0.001). Conclusions: According to our data, infiltrating ductal and lobular carcinoma are the most prevalent pathological types, and luminal A is the most common molecular subtype among Kurdish women in Iran. It is recommended that future studies examine patient survival based on the pathological and molecular types of tumors, including the evaluation of additional biomarkers. Furthermore, comparing these results with those from other ethnic groups could provide valuable insights into the impact of ethnicity on breast cancer characteristics and outcomes.","PeriodicalId":507014,"journal":{"name":"Shiraz E-Medical Journal","volume":"21 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140979950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elham Rahimpour, Sara Shojaei Zarghani, S. Amooee, A. Safarpour, B. Geramizadeh, M. Zahmatkeshan
Background: Celiac disease (CD) is a multifactorial systemic disease that causes enteropathy and can lead to a wide spectrum of disorders related to infertility. Objectives: This case-control study aimed to evaluate the frequency of celiac disease (CD) and its association with infertility in women. Methods: This study was conducted on women referred to Ghadir Mother and Child Hospital in Shiraz. Women with infertility served as the case group, while fertile women comprised the control group. Blood samples were collected from participants, and tissue anti-transglutaminase (Anti-TTG Ab) levels were measured. Patients with elevated Anti-TTG Ab levels were referred for duodenal biopsy. Results: One hundred subjects were enrolled in the case group and 200 in the control group. Eight patients in the case group tested positive for serology, and four of these had duodenal biopsies confirming CD. In the control group, one individual tested positive for serology, but the duodenal biopsy was negative (P for between-group differences: 0.001 for serology and 0.012 for biopsy results). There was a significant association between high levels of Anti-TTG Ab and infertility (odds ratio = 17.30, 95 % CI: 2.13 - 140.39), which remained even after adjusting for age and body mass index (odds ratio = 9.92, 95 % CI: 1.17 - 84.21). Conclusions: The frequency of CD was higher among infertile women compared to fertile women. Increased levels of Anti-TTG Ab were independently associated with infertility.
{"title":"The Frequency of Celiac Disease and Its Association with Infertility in Women Attending Infertility Clinics: A Case-Control Study in Southern Iran","authors":"Elham Rahimpour, Sara Shojaei Zarghani, S. Amooee, A. Safarpour, B. Geramizadeh, M. Zahmatkeshan","doi":"10.5812/semj-145384","DOIUrl":"https://doi.org/10.5812/semj-145384","url":null,"abstract":"Background: Celiac disease (CD) is a multifactorial systemic disease that causes enteropathy and can lead to a wide spectrum of disorders related to infertility. Objectives: This case-control study aimed to evaluate the frequency of celiac disease (CD) and its association with infertility in women. Methods: This study was conducted on women referred to Ghadir Mother and Child Hospital in Shiraz. Women with infertility served as the case group, while fertile women comprised the control group. Blood samples were collected from participants, and tissue anti-transglutaminase (Anti-TTG Ab) levels were measured. Patients with elevated Anti-TTG Ab levels were referred for duodenal biopsy. Results: One hundred subjects were enrolled in the case group and 200 in the control group. Eight patients in the case group tested positive for serology, and four of these had duodenal biopsies confirming CD. In the control group, one individual tested positive for serology, but the duodenal biopsy was negative (P for between-group differences: 0.001 for serology and 0.012 for biopsy results). There was a significant association between high levels of Anti-TTG Ab and infertility (odds ratio = 17.30, 95 % CI: 2.13 - 140.39), which remained even after adjusting for age and body mass index (odds ratio = 9.92, 95 % CI: 1.17 - 84.21). Conclusions: The frequency of CD was higher among infertile women compared to fertile women. Increased levels of Anti-TTG Ab were independently associated with infertility.","PeriodicalId":507014,"journal":{"name":"Shiraz E-Medical Journal","volume":" 53","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140992928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The incidence of gestational diabetes mellitus (GDM) has increased in recent decades. Established prevention methods for GDM include diet and exercise. Recent interest has focused on the roles of vitamin B12 and folate in the development of GDM. These micronutrients are essential for one-carbon metabolism, which is involved in many metabolic pathways. However, the study results were conflicting and varied by geographic area. Objectives: The aim of this study was to evaluate the relationship between GDM and vitamin B12 levels in our region. Methods: This case-control study enrolled 180 pregnant women at 24 - 28 weeks of gestation. Half of the participants had GDM, and the other half were healthy individuals. All participants attended outpatient pregnancy care clinics at Shiraz University of Medical Sciences from June 2020 to April 2021. Gestational age, age, and body mass index were matched between the two groups. Vitamin B12, folate, insulin, and homocysteine levels were measured in both groups and insulin resistance was calculated. The results were compared between the two groups, and the relationship between vitamin B12 levels and insulin resistance in each group was investigated. Results: Vitamin B12 deficiency was present in 15.6% of the women with GDM. There were no cases of vitamin B12 deficiency in the control group. The GDM group had lower vitamin B12 levels (365.22 ± 136.82 pg/mL vs. 496.08 ± 156.46 pg/mL, P = 0.001). There was a negative correlation between serum vitamin B12 level and insulin resistance index (P = 0.001, r = -0.62). Folate levels were higher in the GDM group (17.93 ± 3.66 ng/mL vs. 14.60 ± 5.32 ng/mL, P = 0.001), but these levels did not significantly relate to insulin resistance or GDM. Conclusions: In our region, there is a significant relationship between low levels of vitamin B12 and both insulin resistance and GDM, which suggests the need for larger studies and attention to the detection and treatment of vitamin B12 deficiency during pregnancy.
{"title":"Association of Maternal Vitamin B12 and Folate Levels with Gestational Diabetes Mellitus and Insulin Resistance","authors":"Shahram Zarei, Mahmood Soveid","doi":"10.5812/semj-142064","DOIUrl":"https://doi.org/10.5812/semj-142064","url":null,"abstract":"Background: The incidence of gestational diabetes mellitus (GDM) has increased in recent decades. Established prevention methods for GDM include diet and exercise. Recent interest has focused on the roles of vitamin B12 and folate in the development of GDM. These micronutrients are essential for one-carbon metabolism, which is involved in many metabolic pathways. However, the study results were conflicting and varied by geographic area. Objectives: The aim of this study was to evaluate the relationship between GDM and vitamin B12 levels in our region. Methods: This case-control study enrolled 180 pregnant women at 24 - 28 weeks of gestation. Half of the participants had GDM, and the other half were healthy individuals. All participants attended outpatient pregnancy care clinics at Shiraz University of Medical Sciences from June 2020 to April 2021. Gestational age, age, and body mass index were matched between the two groups. Vitamin B12, folate, insulin, and homocysteine levels were measured in both groups and insulin resistance was calculated. The results were compared between the two groups, and the relationship between vitamin B12 levels and insulin resistance in each group was investigated. Results: Vitamin B12 deficiency was present in 15.6% of the women with GDM. There were no cases of vitamin B12 deficiency in the control group. The GDM group had lower vitamin B12 levels (365.22 ± 136.82 pg/mL vs. 496.08 ± 156.46 pg/mL, P = 0.001). There was a negative correlation between serum vitamin B12 level and insulin resistance index (P = 0.001, r = -0.62). Folate levels were higher in the GDM group (17.93 ± 3.66 ng/mL vs. 14.60 ± 5.32 ng/mL, P = 0.001), but these levels did not significantly relate to insulin resistance or GDM. Conclusions: In our region, there is a significant relationship between low levels of vitamin B12 and both insulin resistance and GDM, which suggests the need for larger studies and attention to the detection and treatment of vitamin B12 deficiency during pregnancy.","PeriodicalId":507014,"journal":{"name":"Shiraz E-Medical Journal","volume":"8 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140665071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nahid Dehghan Nayeri, Kourosh Farzin, Mahdi Shafiee Sabet, Abbas Tafakhori
Background: Migraine is a chronic condition characterized by moderate to severe headache attacks, adversely affecting individual and social quality of life. Given the chronic nature of this disease, it is crucial to find medications that offer fewer side effects and enhanced effectiveness. Agomelatine, a synthetic analogue of the hormone melatonin, shares similar pharmacodynamics, such as stimulating melatonin receptors and inhibiting the 5HT2c receptor. Due to its favorable side-effect profile and high tolerability, agomelatine presents a viable alternative to traditional preventive treatments for migraines. Objectives: The primary objective of this trial is to evaluate the effectiveness of agomelatine in reducing the severity and frequency of episodic migraine attacks without aura. Methods: This study utilizes a parallel, triple-blind controlled trial design. Patients, aged between 18 and 60 years, who have been definitively diagnosed with episodic migraine without aura and have not received prior severity treatment, are eligible for this randomized controlled trial (RCT). A convenience sample of patients will be recruited from individuals visiting the clinic for migraine issues. If these individuals agree to participate and meet the inclusion criteria, they will be randomly assigned to either the intervention or control group using a random number table or software. The intervention group will receive 25 mg of agomelatine daily, while the control group will be given vitamin B1 as a placebo. Both the frequency and severity of migraine attacks will be monitored, along with the mean monthly migraine days (MMD) and migraine disability assessment (MIDAS) scores, before and after the intervention.
{"title":"Study Protocol for Assessing the Effectiveness of Agomelatine on the Severity and Frequency of Episodic Migraine Attacks Without Aura: A Randomized Triple-Blind, Placebo-Controlled Trial","authors":"Nahid Dehghan Nayeri, Kourosh Farzin, Mahdi Shafiee Sabet, Abbas Tafakhori","doi":"10.5812/semj-142956","DOIUrl":"https://doi.org/10.5812/semj-142956","url":null,"abstract":"Background: Migraine is a chronic condition characterized by moderate to severe headache attacks, adversely affecting individual and social quality of life. Given the chronic nature of this disease, it is crucial to find medications that offer fewer side effects and enhanced effectiveness. Agomelatine, a synthetic analogue of the hormone melatonin, shares similar pharmacodynamics, such as stimulating melatonin receptors and inhibiting the 5HT2c receptor. Due to its favorable side-effect profile and high tolerability, agomelatine presents a viable alternative to traditional preventive treatments for migraines. Objectives: The primary objective of this trial is to evaluate the effectiveness of agomelatine in reducing the severity and frequency of episodic migraine attacks without aura. Methods: This study utilizes a parallel, triple-blind controlled trial design. Patients, aged between 18 and 60 years, who have been definitively diagnosed with episodic migraine without aura and have not received prior severity treatment, are eligible for this randomized controlled trial (RCT). A convenience sample of patients will be recruited from individuals visiting the clinic for migraine issues. If these individuals agree to participate and meet the inclusion criteria, they will be randomly assigned to either the intervention or control group using a random number table or software. The intervention group will receive 25 mg of agomelatine daily, while the control group will be given vitamin B1 as a placebo. Both the frequency and severity of migraine attacks will be monitored, along with the mean monthly migraine days (MMD) and migraine disability assessment (MIDAS) scores, before and after the intervention.","PeriodicalId":507014,"journal":{"name":"Shiraz E-Medical Journal","volume":"48 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140667352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Madjid SoltaniGerdfaramarzi, Seyed Ali Enjoo, Leila Afshar, M. Fadavi, M. Kiani, S. Bazmi
Background: Umbilical cord blood serves as a potent source of hematopoietic stem cells, utilized in treating specific diseases and preserved in blood banks. Objectives: This study aims to explore the ethical issues associated with these repositories. Methods: This qualitative research involved conducting 14 interviews with experts and the families of recipients or donors of umbilical cord blood. Participants were selected purposefully from May to November 2021. Results: The investigation identified five principal ethical challenges: presentation of information, interpersonal relationships among involved parties, respect for human dignity, adherence to rules and regulations, and the handling of tissue samples. These challenges encompassed various categories and subcategories, including informed consent, communication and advertising of information, financial considerations, conflicts of interest, professional interactions, ownership rights concerning the child and parents, privacy and confidentiality issues, compliance with regulations and guidelines, and the clinical and research uses of the tissue samples. Conclusions: The study unveiled significant ethical concerns in the domain of umbilical cord blood stem cell banking. Addressing these ethical dilemmas necessitates the involvement of health policymakers and medical ethics experts, along with a comprehensive understanding of these banks' multifaceted nature by the community.
{"title":"The Ethical Challenges of Umbilical Cord Blood Stem Cell Banking: A Qualitative Study","authors":"Madjid SoltaniGerdfaramarzi, Seyed Ali Enjoo, Leila Afshar, M. Fadavi, M. Kiani, S. Bazmi","doi":"10.5812/semj-142330","DOIUrl":"https://doi.org/10.5812/semj-142330","url":null,"abstract":"Background: Umbilical cord blood serves as a potent source of hematopoietic stem cells, utilized in treating specific diseases and preserved in blood banks. Objectives: This study aims to explore the ethical issues associated with these repositories. Methods: This qualitative research involved conducting 14 interviews with experts and the families of recipients or donors of umbilical cord blood. Participants were selected purposefully from May to November 2021. Results: The investigation identified five principal ethical challenges: presentation of information, interpersonal relationships among involved parties, respect for human dignity, adherence to rules and regulations, and the handling of tissue samples. These challenges encompassed various categories and subcategories, including informed consent, communication and advertising of information, financial considerations, conflicts of interest, professional interactions, ownership rights concerning the child and parents, privacy and confidentiality issues, compliance with regulations and guidelines, and the clinical and research uses of the tissue samples. Conclusions: The study unveiled significant ethical concerns in the domain of umbilical cord blood stem cell banking. Addressing these ethical dilemmas necessitates the involvement of health policymakers and medical ethics experts, along with a comprehensive understanding of these banks' multifaceted nature by the community.","PeriodicalId":507014,"journal":{"name":"Shiraz E-Medical Journal","volume":"4 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140703322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Anxiety disorders are the most common mental health problems in adolescents. Uncontrolled anxiety disorders during this period not only negatively affect adolescents' current performance but can also have long-term negative consequences on their physical and mental health. Objectives: This study is designed to investigate the relative frequency of anxiety and its correlation with individual and family characteristics among first-grade high school students in Shiraz, 2020. Methods: This is a descriptive and analytical cross-sectional study, conducted on 360 first-grade high school students who were selected using a multi-stage sampling method in Shiraz, Iran. Data were collected through online questionnaire software, which included the Beck Anxiety Inventory and a Demographic Questionnaire, and were analyzed using SPSS software version 24. Results: The relative frequency of anxiety disorders in the study samples was 59.7% (60.9% in girls and 56.6% in boys); among them, 13.1% experienced severe anxiety, 16.9% had moderate anxiety, and 29.7% had mild anxiety. The results of univariate analysis showed correlations between anxiety disorders and factors such as father's unemployment (P = 0.04), a history of physical and mental problems in teenagers (P = 0.04 and P = 0.001, respectively), and the lack of friendly relations between family members (P = 0.001). Additionally, the results of logistic regression analysis indicated that adolescents with mental illness and those lacking friendly relationships within their family had higher chances of experiencing anxiety disorders compared to other participants (OR = 5.00, P = 0.04 and OR = 9.95, P = 0.002, respectively). Conclusions: In this study, mental illness and the lack of friendly relations between family members emerged as significant factors contributing to adolescents' anxiety. Therefore, identifying and addressing these related factors, along with timely diagnosis and treatment of this disorder in adolescents, should be prioritized by mental health officials.
{"title":"The Relative Frequency of Anxiety and Its Correlation with Individual and Family Factors Among Adolescents in Shiraz, 2020: A Cross-Sectional Study","authors":"Zahra Zeinali, N. Sharifi, M. Edraki","doi":"10.5812/semj-140159","DOIUrl":"https://doi.org/10.5812/semj-140159","url":null,"abstract":"Background: Anxiety disorders are the most common mental health problems in adolescents. Uncontrolled anxiety disorders during this period not only negatively affect adolescents' current performance but can also have long-term negative consequences on their physical and mental health. Objectives: This study is designed to investigate the relative frequency of anxiety and its correlation with individual and family characteristics among first-grade high school students in Shiraz, 2020. Methods: This is a descriptive and analytical cross-sectional study, conducted on 360 first-grade high school students who were selected using a multi-stage sampling method in Shiraz, Iran. Data were collected through online questionnaire software, which included the Beck Anxiety Inventory and a Demographic Questionnaire, and were analyzed using SPSS software version 24. Results: The relative frequency of anxiety disorders in the study samples was 59.7% (60.9% in girls and 56.6% in boys); among them, 13.1% experienced severe anxiety, 16.9% had moderate anxiety, and 29.7% had mild anxiety. The results of univariate analysis showed correlations between anxiety disorders and factors such as father's unemployment (P = 0.04), a history of physical and mental problems in teenagers (P = 0.04 and P = 0.001, respectively), and the lack of friendly relations between family members (P = 0.001). Additionally, the results of logistic regression analysis indicated that adolescents with mental illness and those lacking friendly relationships within their family had higher chances of experiencing anxiety disorders compared to other participants (OR = 5.00, P = 0.04 and OR = 9.95, P = 0.002, respectively). Conclusions: In this study, mental illness and the lack of friendly relations between family members emerged as significant factors contributing to adolescents' anxiety. Therefore, identifying and addressing these related factors, along with timely diagnosis and treatment of this disorder in adolescents, should be prioritized by mental health officials.","PeriodicalId":507014,"journal":{"name":"Shiraz E-Medical Journal","volume":"8 30","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140708221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Rezaee, Mohamad Azmal, Farhad Lotfi, H. Omranikhoo
Background: Equity in access to health resources is a fundamental goal of health systems worldwide. Objectives: This study aims to assess the distribution of essential health resources necessary for healthcare provision in Bushehr Province. Methods: This cross-sectional study spans ten years and utilizes several widely recognized indices in health resource distribution equity and equality, including the Gini Coefficient, Concentration Index, Horizontal Inequity, Robin Hood Index, Theil Index, Atkinson Index, and Quantile Ratio. These indices were calculated based on both the population level and the proposed resource allocation model (PRAM) using Excel Software 2018 and Stata version 18. Results: The findings indicate a degree of inequality in the distribution of all health resources examined, with special beds exhibiting much higher levels of inequality than others. The sensitivity of the studied indices varied across the distributed resources. Moreover, the trend of inequality generally decreased for all examined resources. The PRAM results suggest that adopting a different approach to resource distribution can significantly reduce inequality levels. Conclusions: Despite a downward trend in the inequality of health resource distribution, significant disparities persist. Altering the resource distribution system from the conventional geographical division could aid in achieving equity and equality in healthcare. Such changes could also reduce the costs associated with the health system.
背景：公平获取卫生资源是全球卫生系统的基本目标。研究目的本研究旨在评估布什尔省提供医疗服务所需的基本医疗资源的分布情况。研究方法这项横断面研究的时间跨度为十年，采用了几种公认的医疗资源分配公平性和平等性指数，包括基尼系数、集中指数、横向不公平、罗宾汉指数、泰尔指数、阿特金森指数和量纲比。这些指数的计算基于人口水平和拟议的资源分配模型（PRAM），使用的是 Excel 软件 2018 和 Stata 版本 18。结果研究结果表明，所有受检医疗资源的分配都存在一定程度的不平等，其中特殊病床的不平等程度远高于其他病床。所研究的指数的敏感性在不同的资源分配中各不相同。此外，在所有研究的资源中，不平等程度普遍呈下降趋势。PRAM 的结果表明，采用不同的资源分配方法可以显著降低不平等程度。结论：尽管医疗资源分配的不平等程度呈下降趋势，但显著的差距依然存在。改变传统的地域分配制度，有助于实现医疗保健的公平和平等。这种改变还可以降低医疗系统的相关成本。
{"title":"Investigating the Inequality Trend in Health Resource Distribution in Iran: A Case Study in Bushehr Province","authors":"M. Rezaee, Mohamad Azmal, Farhad Lotfi, H. Omranikhoo","doi":"10.5812/semj-141095","DOIUrl":"https://doi.org/10.5812/semj-141095","url":null,"abstract":"Background: Equity in access to health resources is a fundamental goal of health systems worldwide. Objectives: This study aims to assess the distribution of essential health resources necessary for healthcare provision in Bushehr Province. Methods: This cross-sectional study spans ten years and utilizes several widely recognized indices in health resource distribution equity and equality, including the Gini Coefficient, Concentration Index, Horizontal Inequity, Robin Hood Index, Theil Index, Atkinson Index, and Quantile Ratio. These indices were calculated based on both the population level and the proposed resource allocation model (PRAM) using Excel Software 2018 and Stata version 18. Results: The findings indicate a degree of inequality in the distribution of all health resources examined, with special beds exhibiting much higher levels of inequality than others. The sensitivity of the studied indices varied across the distributed resources. Moreover, the trend of inequality generally decreased for all examined resources. The PRAM results suggest that adopting a different approach to resource distribution can significantly reduce inequality levels. Conclusions: Despite a downward trend in the inequality of health resource distribution, significant disparities persist. Altering the resource distribution system from the conventional geographical division could aid in achieving equity and equality in healthcare. Such changes could also reduce the costs associated with the health system.","PeriodicalId":507014,"journal":{"name":"Shiraz E-Medical Journal","volume":"84 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140712663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Alemi, Sara Bidel Khoshbakht, O. Paknejad, Keivan Gohari Moghadam, A. Radmard, Mohammad Mehdi Alemi, Rasoul Aliannejad, M. Eshghi, Mahnaz Pejman Sani
Background: Computed tomography pulmonary angiography (CTPA) is an imaging technique widely used in the diagnosis of acute pulmonary thromboembolism (PTE). Despite its disadvantages and potential risks, the overuse of CTPA has been a growing concern over the past decades. Objectives: The objective of this study was to investigate the rate of avoidable overuse of CTPA in patients with suspected PTE and to identify factors contributing to this overuse. The study aimed to highlight the importance of proper training for physicians in using validated diagnostic algorithms to minimize the overuse of CTPA and improve patient outcomes. Methods: In a cross-sectional study conducted between April 2016 and March 2019 at Shariati Hospital at Tehran University of Medical Sciences (TUMS), 1058 patients underwent CTPA due to suspected PTE. Wells scores were calculated retrospectively for all patients. The study defined avoidable overuse of CTPA as an imaging request without prior D-dimer testing or ignoring a negative D-dimer result in patients with low clinical pre-test probability. Results: Two hundred and seventy-three patients were excluded from the study due to unavailable documentation or pregnancy. Among the included 785 patients, 139 (17.7%) revealed PTE on CTPA. Based on the Wells scores, 480 patients were identified as the “PTE-unlikely” group. In this group, 299 patients (62.3%) underwent CTPA directly despite recommendations to order a D-dimer test first. Of these patients, 281 (94%) cases showed negative results. Moreover, CTPA was performed inappropriately in 52 “PTE-unlikely” cases despite negative D-dimer serum levels, and only one patient was diagnosed with PTE. Conclusions: The study revealed that 44.7% of the CTPA requests for patients with suspected PTE were avoidable, indicating the need for better adherence to current diagnostic guidelines to reduce unnecessary radiologic investigations and improve patient care.
{"title":"Avoidable Overuse of Computed Tomography Pulmonary Angiography (CTPA) in Patients with Suspected Acute Pulmonary Thromboembolism (PTE): The Role of Clinical Prediction Rules and D-Dimer Assay","authors":"H. Alemi, Sara Bidel Khoshbakht, O. Paknejad, Keivan Gohari Moghadam, A. Radmard, Mohammad Mehdi Alemi, Rasoul Aliannejad, M. Eshghi, Mahnaz Pejman Sani","doi":"10.5812/semj-141211","DOIUrl":"https://doi.org/10.5812/semj-141211","url":null,"abstract":"Background: Computed tomography pulmonary angiography (CTPA) is an imaging technique widely used in the diagnosis of acute pulmonary thromboembolism (PTE). Despite its disadvantages and potential risks, the overuse of CTPA has been a growing concern over the past decades. Objectives: The objective of this study was to investigate the rate of avoidable overuse of CTPA in patients with suspected PTE and to identify factors contributing to this overuse. The study aimed to highlight the importance of proper training for physicians in using validated diagnostic algorithms to minimize the overuse of CTPA and improve patient outcomes. Methods: In a cross-sectional study conducted between April 2016 and March 2019 at Shariati Hospital at Tehran University of Medical Sciences (TUMS), 1058 patients underwent CTPA due to suspected PTE. Wells scores were calculated retrospectively for all patients. The study defined avoidable overuse of CTPA as an imaging request without prior D-dimer testing or ignoring a negative D-dimer result in patients with low clinical pre-test probability. Results: Two hundred and seventy-three patients were excluded from the study due to unavailable documentation or pregnancy. Among the included 785 patients, 139 (17.7%) revealed PTE on CTPA. Based on the Wells scores, 480 patients were identified as the “PTE-unlikely” group. In this group, 299 patients (62.3%) underwent CTPA directly despite recommendations to order a D-dimer test first. Of these patients, 281 (94%) cases showed negative results. Moreover, CTPA was performed inappropriately in 52 “PTE-unlikely” cases despite negative D-dimer serum levels, and only one patient was diagnosed with PTE. Conclusions: The study revealed that 44.7% of the CTPA requests for patients with suspected PTE were avoidable, indicating the need for better adherence to current diagnostic guidelines to reduce unnecessary radiologic investigations and improve patient care.","PeriodicalId":507014,"journal":{"name":"Shiraz E-Medical Journal","volume":"333 2‐3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140719480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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