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Abstract Background Cancer-related fatigue (CRF) is still undertreated in most patients, as evidence for pharmacological treatments is limited and conflicting. Also, the efficacy of the pharmacological agents relative to each other is still unclear. Therefore, medications that may potentially contribute to improving CRF will be investigated in this head-to-head trial. Our main objective is to compare the efficacy of methylphenidate vs. bupropion vs. ginseng vs. amantadine vs. placebo in patients with advanced cancer. Methods The 5-EPIFAT study is a 5-arm, randomized, multi-blind, placebo-controlled, multicenter trial that will use a parallel-group design with an equal allocation ratio comparing the efficacy and safety of four medications (Methylphenidate vs. Bupropion vs. Ginseng vs. Amantadine) versus placebo for management of CRF. We will recruit 255 adult patients with advanced cancer who experience fatigue intensity ≥ 4 based on a 0–10 scale. The study period includes a 4-week intervention and a 4-week follow-up with repeated measurements over time. The primary outcome is the cancer-related fatigue level over time, which will be measured by the functional assessment of chronic illness therapy-fatigue (FACIT-F) scale. To evaluate safety, the secondary outcome is the symptomatic adverse events, which will be assessed using the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events in cancer clinical trials (PRO-CTCAE). Also, a subgroup analysis based on a decision tree-based machine learning algorithm will be employed for the clinical prediction of different agents in homogeneous subgroups. Discussion The findings of the 5-EPIFAT trial could be helpful to guide clinical decision-making, personalization treatment approach, design of future trials, as well as the development of CRF management guidelines. Trial registration IRCT.ir IRCT20150302021307N6. Registered on 13 May 2023.

Introduction: Given the importance of empathy in the process of caring for patients, this study investigated the level of empathy and its associated factors among medical residents at Ahvaz Jundishapur University of Medical Sciences (AJUMS). Method: This cross-sectional study was conducted at AJUMS in 2022. All 473 medical residents who were studying at AJUMS were included in the study using census method. Participants completed the Jefferson Scale of Physician Empathy. This scale has 20 items that are scored based on a 7-point Likert scale. Data were analyzed using independent t-test, ANOVA, and Pearson's correlation coefficient. Results: The number of medical residents who completed the questionnaires was 290 (response rate 61.3%). These medical residents' mean score of empathy was 102.81±12.75 (out of a total of 140 points). Empathy scores had no statistically significant relationship with sex, marital status, and entry year (p˃ 0.05). Pearson's correlation coefficient showed that there is a significant relationship between the level of empathy and age (r=0.223, p=0.001). Also, there was a significant difference between the empathy scores of medical residents of different specialties (p=0.0001, F=5.249), with the psychiatry residents having the highest mean empathy score (118.31±6.1) and the ophthalmology residents having the lowest (92.85±14.2). Conclusion: The findings showed that the empathy score of the residents is at a moderate level, and given the significant difference between the empathy scores of residents of different specialties, it can be argued that empathy changes under the influence of the clinical education environment and is a teachable skill.

BackgroundBurnout is a work-related syndrome that can affect physicians' performance. Empathy is one of the clinical competencies in whose formation many factors play a role. Empathy and burnout are important topics of research in medical sciences, and both are related to the communication between the patient and the physician. This study investigated the relationship between occupational burnout and empathy among medical residents.MethodThis cross-sectional study was conducted on 297 medical residents in Ahvaz Jundishapur University of Medical Sciences from January to March 2021. The data collection tools were the Jefferson Scale of Empathy (JSE) and the Maslach Burnout Inventory (MBI). The reliability of the instruments was measured by calculating Cronbach's alpha. Data were analyzed by SPSS-18, using the Pearson correlation test and linear regression models.ResultsThe average age of the study population was 33.06 ±4.7 years, with more than half being females (57.6%) and married (51.9%). The residents' mean scores of empathy and overall burnout were 102.87 out of 140 and 55.90 out of 132, respectively. The burnout scores showed an inverse correlation with the overall empathy scores (r = -0.123, P = 0.035), and the score of standing in the patient's shoes (r = -0.165, P = 0.004). Linear regression test was used to detect which dimension of empathy was a better predictor for the reduction of burnout scores. Results showed that the best predictor was standing in the patient's shoes (P = 0.014).ConclusionThe findings showed a negative association between empathy and burnout among medical residents, which suggests the need for adjustment of the existing burnout management at the institutional level. Therefore, residents should be supported by managers to reduce burnout and improve their empathic behavior.

Background & aim: Midwives need to have knowledge and skills of human communication to provide their professional services in the most efficient way. The purpose of this study was to investigate the general and professional communication skills of Iranian midwifery students and to explore their viewpoints on the ways of its improvement.Methods: This cross-sectional study using a data triangulation approach was conducted on 343 midwifery students who were selected using convenience sampling from Ahvaz Jundishapur University of Medical Sciences and Semnan Azad University, Iran, in 2020. Data were collected using Queendom Communication Skills Test-Revised (CSTR) and Professional Communication Skills Assessment Questionnaire. There was an open-ended question at the end of the questionnaire that assessed students' views on improving communication skills. The quantitative data were analyzed by SPSS version 22, and qualitative data by qualitative content analysis. Results: The mean scores of the students' general and professional communication skills were 64 ± 4.3 (poor) and 92 ± 3.1(moderate), respectively. No significant relationship was found between demographic or academic characteristics of midwifery students and their general and professional communication skills. Analysis of students’ experiences and perceptions resulted in two main categories indicating the need to promote direct training and to control the impact of hidden curriculum.Conclusion: Most students had poor general communication skills while their professional communication skills were at a moderate level. Communication skills training in the midwifery curriculum needs to be revised. Results reflected the need to empower instructors and students in terms of their communication skills.

Many Earthworm (EW) related effects have been introduced so far including, wound healing effects as well as anti-microbial, anti-inflammatory and anti-thrombosis effects. EW biomaterials could also be a therapeutic agent for various neuroinflammatory conditions. Besides, indigenous people traditionally have practiced the extraction of medicinal compounds from EW. Therefore, the present study aimed to investigate the EW capacities in nerve regeneration. An exhaustive literature search was performed using databases including PUBMED, SCOPUS, Web of Science and GOOGLE. A total of 13 studies were included. All of them included an animal model or were cell culture studies between 2009 and 2018. The description of these findings is given in table 1. Despite the limited number of publications and their controversial results, EW can be regarded as a new promising option for nerve repair, given the several pieces of evidence confirming the effects of EW biomaterials on nerve injury and regeneration.

Background: Empathy is an important component of effective communication of a patientpractitioner relationship. Medical students are expected to know this ability as part of their education.Objectives: This study aimed to assess the effect of a short-training course on the empathy levels of medical students.Methods: This is a quasi-experimental study conducted on eighty second-year medical students in Ahvaz Jundishapur University of Medical Sciences (AJUMS), Iran, 2019. The intervention comprised of a lecture-based short training course, which was taught by a psychiatrist and was held in two sessions (Two hours each) for two consecutive weeks. Empathy was assessed using the Jefferson Scale of Empathy-Student version (JSE) before and after the intervention. Students with empathy scores higher than average were considered high empathy group, and those with scores lower than average as low empathy group. Data were analyzed using paired T-tests through SPSS software, version 16.Results: The mean JSE score was 99.66±13.4 and 101.62 ± 16.37, before and after the -intervention, respectively. However, despite the score increased, the difference was not statistically significant (p=0.054). Nevertheless, the empathy scores of high-empathy students significantly increased after the-intervention (110.49 Vs 114.15, p=0.002). The empathy level also showed a significant enhancement in female students after training (p=0.006).Conclusion: This study shows that a short training course is somewhat effective in developing medical student empathy. The findings suggest a need for revision of content and implementation of this course training into the existing medical curriculum.

Background: COVID-19, which began in December 2019 in China, can have a broader impact on individuals' mental dimensions. Meanwhile, the medical staff battling this epidemic are more at risk of mental and emotional problems. This study aimed to examine the level of stress, anxiety, and depression and their relationship with the level of knowledge of medical staff battling in COVID-19 pandemic treatment. Methods: This descriptive-analytical study was conducted on 641 medical staff using an online platform to design the questionnaire, and its link was placed in different groups of social networks all over the country in which the medical staff battling COVID 19 were members. Statistical analysis was performed by SPSS 25 and Kolmogorov-Smirnov test, independent samples t-test, independent one-way analysis of variance, and chi-square. Results: Higher knowledge about COVID-19 was associated with younger age, clinicians, and nurses. Moreover, females were more knowledgeable in terms of support; while males were more reliable in washing hands and disinfecting wet places. Based on the categorical version of psychological factors, the majority of cases had severe stress ( 39.80 % ), normal depression ( 48.50 % ), and normal anxiety ( 57.30 % ). Finally, it was found that married participants had more knowledge about COVID-19, but knew less about its fatality. Conclusion: Studies have shown negative psychological experiences caused by COVID-19 in nurses, including negative emotions, such as fatigue, discomfort, helplessness due to high-intensity work, anxiety, and worry about family members.

Background: Due to persistent infections of human central nervous system (CNS), polyomaviruses have been identified as one of the risk factors for brain tumor development. Human BK virus is of significant interest due to its experimental neuro-oncogenic potential and the possible association with CNS neoplasms. However, the results of different studies are discrepant. In the present study, we aimed to investigate the prevalence of BK virus genome and quantify BK viral load in Iranian patients with primary and metastatic brain malignancies. Methods: To assess the prevalence of BK virus sequences, a total of 58 fresh brain tumors were examined by quantitative real-time PCR. The BK viral load was determined as viral copy number per cell. Results: Of the 58 brain tumor samples BK tumor antigen (TAg) sequences were detected in 26 (44.8%) of cases. In primary brain tumors, BK virus sequences were recognized more frequently in schwannomas (15.5%) and meningiomas (12.1%). The mean BK virus TAg copy number in positive cases was 0.20×10-3±0.27×10-3 (range 0.01×10-3- 0.8×10-3) copies per cell. Conclusion: Taken together, in the present study low copy numbers of BK virus TAg gene was detected in brain tumor cells, which can indicate that BK virus may contribute to tumor induction by indirect mechanisms or neuro-persistence of this virus without any pathological consequences.

Background: Due to numerous side effects of common drugs in treatment of leishmaniasis, new therapeutic approaches focus on herbal compounds. Therefore, we aimed to determine the effect of crocin and stigmasterol on in-vitro growth of promastigotes and amastigotes of Leishmania major in the Department of Parasitology, Pasteur Institute, Tehran, Iran in 2018. Methods: The effect of different concentrations of crocin and stigmasterol were evaluated by determining their in-vitro inhibitory effects on promastigotes and amastigotes of the L. major using MTT assay. Results: The fatality rate was 65.27% and 71.96% for crocin and stigmasterol respectively at 24 h post-culture in concentration of 50 μg/mL. The mean inhibitory effect of crocin and stigmasterol on L major amastigotes after 72 h were 52.22% and 38.96%. Conclusion: The crocin and stigmasterol had efficient adverse effects on promastigote and amastigotes of L. major, hence, further studies on the anti-leishmanial effects of these herbal compounds in human and animal models are recommended.

Publishing in English has brought about great difficulties for scholars whose first language is not English. After submitting their manuscripts to English-language journals, they usually receive comments from the reviewers on the quality of their English. One of these challenges is how links and transitions are managed in the flow of discourse. The present study aimed to investigate how the successfully revised text differs from its originally submitted counterpart within the framework of systemic functional linguistics. Based on our examination of the revisions made to our corpus, the increased use of marked theme is believed to contribute significantly to textual cohesion and coherence, and thereby to the achievement of the writer’s argument. This would contribute to transforming a relatively immature and unpublishable piece of writing into a well-crafted and mature version. However, this is a necessary but not a sufficient condition for the texts to be published.

A text messaging service, among other functions of mobile phones, allows mobile phone subscribers to send and receive alphanumeric characters and emoticons. The discourse of the text messages characterizes a kind of interaction, mostly on the boundary between verbal and visual communication. Adopting Halliday's Socio-semiotic Model of Language, this study considered three register variables of filed, mode, and tenor in a text message corpus comprising 2440 text messages collected from 122 medical students at Ahvaz Jundishapur University of Medical Sciences to investigate how the discourse of text message can be affected by the sociolinguistic dimensions of the context of language use. To that end, text messages were analyzed and categorized in term of the social interaction that constituted the content of the messages. The findings revealed that mobile phone text messaging is an asynchronous mode of communication which is characterized with particular register variables, and there are also pragmatic reasons in addition to the technical restrictions for the creation of this register as its users actively and selectively make use of the resources of spoken and written discourses in constructing the message.

Background: Stroke is the third leading cause of mortality worldwide. One of the factors that affect the occurrence of stroke can be attributed to changes in the levels of trace elements. Accumulating evidence has been shown that magnesium, as an important element, is a new predictor of stroke. We aimed to determine the levels of Mg in ischemic stroke patients in comparison with those having the hemorrhagic type. Methods: This study was conducted on 447 stroke patients. Demographic characteristics of patients, stroke severity, and risk factors such as hypertension, ischemic heart disease, diabetes mellitus, and hyperlipidemia were recorded. Stroke was diagnosed based on the neurological examination and neuroimaging findings e.g. computed tomography (CT) or magnetic resonance imaging (MRI). The colorimetric technique was used to determine the concentration of Mg at 450 nm according to the commercial kit. Results: The mean of magnesium levels in ischemic patients was significantly higher than that in the hemorrhagic patients (P=0.001). Difference in magnesium status was associated with gender in thrombotic patients (P

Background: As an essential principle, the collective life of human beings can constitute a human society only when human rights are respected. Demanding and respecting the rights of patients, as an inevitable part of human society, requires familiarity with patient-involved individuals. The present study aimed to determine the awareness level of Ahvaz Jundishapur University of Medical Sciences (AJUMS) students about the Charter of Patients’ Rights (CPR). Methods: This descriptive-analytical study was conducted on 200 senior university students who had been in contact with patients during their undergraduate program. They were invited from different faculties of the university. The data collection tool was a two-section questionnaire. The first section covered the demographic information, and the second included 29 questions about the 5 principles of the CPR. The obtained data were analyzed in SPSS by descriptive statistics, and analytical tests, including Independent Samples t-test, Analysis of Variance (ANOVA), and Spearman’s correlation coefficient. Results: From the 200 study participants, 103 (51%) were female. The Mean±SD of students’ awareness was 14.50±2.3. The highest and lowest mean scores belonged to the areas of access to services and confidentiality. There was no statistically significant difference between the awareness score of students from different faculties (P=0.359). Conclusion: This study results suggested that the awareness level of the medical students about the CPR was unsatisfactory. Instituting ethical codes among students and providing them knowledge of their professional lives is an essential part of the university’s responsibilities.

Introduction: Bowel preparation for colonoscopy plays an important role in the evaluation of the colon. Many methods for preparing the colon for colonoscopy do not work well. Aim: To use a low-fibre diet as a standard and applicable method for bowel preparation in performing colonoscopy and increasing patients’ adherence to colonoscopy. Materials and Methods: Clinical control trial design was used to compare bowel preparation in people receiving a low-fibre diet with those who did not receive food {Nil Per Os (NPO)} for bowel preparation. The participants included 477 patients who were randomly divided into two groups including 223 patients having a low-fibre diet (for dinner) and 254 patients having nothing for dinner (NPO). Data were recorded including age, sex, weight, height, level of education, bowel preparation score, colonoscopy diagnosis and sedative dose. Both groups were given a solution of 3 L of ethylene glycol and 60 mg of bisacodyl at three occasions: 3 pm and 7 pm the day before colonoscopy and 6 am on the colonoscopy day. Scoring criteria for colonoscopy preparation included excellent (clean and free of any liquids), very good (clean with clear fluid, underlying mucus visible in clear fluid), good (clean with dirty liquid), poor (with particles including stools, but can be assessed at 80% mucus), and very poor (containing stool particles, and mucosal evaluation below 80%, colonoscopy was cancelled in this group). The data were analysed by SPSS version 21.0 using Chi-square and Independent Samples Test. Results: About 82.1% of patients who consumed a lowfibre diet for bowel preparation the night before colonoscopy had an excellent and very good quality of bowel preparation compared with 74.8% of patients not receiving any diet. The number of patients who cancelled the colonoscopy were more in the group not receiving any diet (4.7% versus 2.6%). The data indicated that the quality of colon preparation decreased by age (p=0.0001), whereas Body Mass Index (BMI) did not differ on colon cleansing. When having dinner, patients with Irritable Bowel Syndrome (IBS) had significantly more secretion of air bubble and foam formation than patients not eating dinner (p=0.002). The results showed that the difference in bowel preparation quality between the two groups was not significant (p-value: 0.169), and increased patient adherence to colonoscopy in the first group. Conclusion: Implementing a proper bowel preparation method is very important in improving the quality of colonoscopy and increasing the patient’s adherence to colonoscopy. Using a low-fibre diet on the day before colonoscopy can help achieve this goal.

The new coronavirus pneumonia, which first occurred in China in December 2019, has a wide spectrum of symptoms from asymptomatic to very severe involvement and even death. The main reason for the increase in the severity of this disease is the body's inflammatory response to the virus, and due to the lack of effective antiviral treatment for this disease, it is necessary to take therapeutic interventions to reduce the body's inflammatory response. It is noteworthy that diabetic patients are more severely exposed to this disease and this calls for appropriate treatment to control diabetes in patients with COVID19. In addition to its antioxidant and anti-inflammatory effects, alpha lipoic acid also has therapeutic effects in controlling diabetes and blood sugar. Therefore, it is suggested that clinical trials be performed to evaluate the effects of alpha-lipoic acid on diabetic patients with COVID19

Introduction: There are various applications and health information systems which have been developed to promote the effective retrieval of patient information, statistics, research, and education. Therefore, there is a need to design them in consistency with scientific principles of usability. To this end, the usability of hospital information sub-systems employed at the hospitals of Ahvaz were compared using heuristic evaluation method. The objective of the study was to assess the usability of hospital information system according to heuristic evaluation. Material and Methods: Six trained evaluators, independently determined the ADT subsystem, HIM subsystem, and NIS according to Nielsen’s 10 Heuristic Principles. Since more than half of the hospitals (about 54%) employed Sib application, no specific sampling method was used. After combining the usability problems, the average severity ratings of the problems were calculated, and then the subsystems were compared. Results: The number of the usability problems of the ADT information subsystem, HIM subsystem, and NIS were 40, 39, and 37, respectively. After merging the problems, the features of “user control and freedom” with 20 cases and “flexibility and efficiency of use” with six cases had the highest and the lowest inconsistencies with usability principles. The average severity ratings of the problems also varied between 1.7 and 3. Conclusion: Heuristic evaluation method is regarded as one of the approaches appropriate to identify usability problems in health information systems. Thus, it is advisable to utilize this method to modify the design of the systems and to improve their efficiency before their implementation in order to increase user satisfaction.

Solid tumors are a heterogeneous group of malignancies that result from out-of-control proliferation of cells. Thrombocytopenia is a common complication among patients with solid tumors that predispose them to bleeding disorders. The aim of this review article is to investigate the underlying mechanisms of the risk and incidence of thrombocytopenia in solid tumors. It can be argued that thrombocytopenia is a poor prognostic factor in solid tumors that can result from several factors such as polymorphism and mutation in some transcription factors and cytokines involved in megakaryocytic maturation or from the adverse effects of treatment. Therefore, an understanding of the exact mechanism of thrombocytopenia pathogenesis in each stage of solid tumors can help in developing therapeutic strategies to decrease bleeding complications in these malignancies.