Search

Abstract Background The shadow curriculum is an emerging concept in curriculum studies that has not yet garnered significant attention in medical education. It includes programs and activities outside formal education to improve students’ academic performance in the formal educational system. Objective In this study, we designed and developed an online course based on the shadow curriculum and evaluated its effect on students’ learning and academic performance. Methods This study represents a form of developmental research, with the study population comprising medical and dental students from universities of medical sciences in Iran. The course was conducted at the Smart University of Medical Sciences, following the ADDIE instructional design approach in three phases. The initial two phases involved designing and implementing the program according to the students’ needs and requirements. In the third phase, we evaluated the program using the Kirkpatrick model. In the first level evaluation, the reaction of 70 students in the course was investigated. To assess the impact of the course, pre and post-tests were administered to 30 students. Finally, the effect of the course on students’ success in the comprehensive exams for basic medical sciences, dentistry, and pre-internship was analyzed by examining the passing and failing statuses of 83 and 57 students who participated in the September 2023 and February 2024 exams. Results The results indicated that the students responded positively to the program. The analysis of pre-test and post-test scores showed a significant improvement in the students’ academic performance across all the subjects presented in the course, including basic medical sciences, dentistry, and pre-internship (p

Abstract Background: The lack of improvement in some endometriotic people's pain after surgery even while using hormone treatment may suggest an inappropriate response to routine hormonal therapies. Objective: This study aimed to determine a cut-off point for selecting the most appropriate treatment based on the hormone receptors of endometriotic lesions. Materials and Methods: In this cross-sectional study, by reviewing the medical records of participants and testing their archive samples and phone interviews (if needed), 86 symptomatic women after endometriosis surgery who were operated into governmental hospitals, Shahid Faghihi and Hazrate Zeinab Shiraz Iran were enrolled between March 2017 and March 2019. Women were divided into 2 groups: responsiveness (n = 73 for dysmenorrhea, n = 60 for dyspareunia) to medical treatment and surgery, and unresponsiveness (n = 13, n = 7). We examined the pathological slides of 86 women to determine the amount of hormone receptors and the relationship between the type of medical treatment and the level of hormone receptors on pain relief within 1 yr after surgery. Results: Based on the receiver operating characteristic curve, dysmenorrhea in the presence of tissue estrogen receptors > 60% (p = 0.1065), and dyspareunia in the presence of tissue progesterone receptors > 80% (p = 0.0001) responded well to medical treatment after surgery. In the presence of endometrioma-dysmenorrhea showed the best response to oral contraceptive pills (69.4%), while in deep infiltrative endometriosis-dyspareunia showed the best response to progesterone treatment (75%). Conclusion: Prescribing an appropriate hormone therapy based on a specific immunohistochemistry staining pattern can improve the life quality of postoperative endometriosis individuals.

Abstract Background Gender dysphoria, characterized by a misalignment between one’s gender identity and assigned sex, propels individuals towards medical interventions like gender reassignment surgery (GRS) to harmonize their bodies with their gender. This process aims to enhance overall quality of life (QoL), functioning, and body image. Recognizing the importance of cultivating a positive body image for transgender individuals navigating societal norms, this narrative highlights the ongoing debate surrounding QoL post-GRS. In response, our study is outlined, aiming to scrutinize QoL and self-image among transgender men post-GRS, offering valuable insights into societal perceptions and psychological well-being in this context. Method This cross-sectional survey focused on transgender men aged 15 to 35 who underwent gender reassignment surgery (GRS) in 2018–2022 in Shiraz, Iran. Participants, after passing psychiatric evaluations, completed World Health Organization Quality of Life (WHOQOL-100) questionnaires pre- and at least one-year post-surgery. The scores of the Brief-WHOQOL questionnaire were evaluated in four domains of physical health, psychological health, social relationships, and environmental health. Results A total of 60 individual who underwent GRS completed our questionnaire. The average age of the patients was 24.1 ± 3.8 years. Following GRS, the most increase was observed in the psychological factor (by 25.6%). The increase in score was statistically significant in all subgroups (P

Abstract Background The role of bacterial contamination in the development and progression of endometriosis lesions is currently a hot topic for gynecologists. In this study, we decided to compare the endometrial cultures of women affected by endometriosis with those of non-endometriotic women, focusing on specific microbial pathogens. Material and method In this cross-sectional case-control study, 30 women with endometriosis in stages 4 of the disease whose endometriosis was confirmed based on clinical, ultrasound, and histopathological findings, and 30 women without endometriosis who were candidates for surgery due to benign uterine diseases with regular menstrual cycle, underwent endometrial biopsy with Novak Kort in sterile conditions before starting their operation, and the results of their endometrial culture were analyzed and compared. Results Results of the study indicate that there were no significant differences in terms of age, BMI, smoking, education level, place of residency, use of the intrauterine device, or vaginal douche, and age of menarche between the case and control groups. The only demographic difference observed was in parity, where the control group had a significantly higher parity than the case group (P = 0.001). Out of the 60 cultures, only 15 samples were positive in the endometriosis group, and E. coli was the most prevalent species, with 10 (33.3%) samples testing positive for it. Klebsiella spp. and Enterobacteria spp. were also detected in 3 (10.0%) and 2 (6.7%) samples, respectively. The comparison between the two groups showed that only E. coli had a significant association with the presence of endometriosis (P = 0.001). There was no significant relationship between the location of endometriosis in the pelvic cavity and culture results. It was observed that parity among the E. coli negative group was significantly higher compared to the E. coli positive group (P

In the last decade, with the entry of spirituality in the organizational and management research, Spirituality leadership, also, has attracted a considerable amount of attention. The new realm of spiritual leadership, similar to both areas of spirituality and leadership, suffers from a lack of consensus and from variety in definition and impression. Proposed models of spiritual leadership have been quite narrow, leader-centered and universal. They ignored the role of followers and context in leadership equation. In this paper, with a developmental approach, and after using experts' opinions and surveying in some public organization, we aim to define new construct of spiritual followers and spiritual context, and explore the role of them in leadership effectiveness. The results of this study show that new defined constructs have a significance contribution in the prediction of leadership effectiveness and with simultaneous considering all constructs of spiritual leader, spiritual followers and spiritual context, better than pervious approaches, we can explain spiritual leadership complexities and dynamics

Background: Tuberculin skin test (TST) is a readily available test for the diagnosis of latent tuberculosis infection (LTBI). This study was designed to evaluate LTBI in low-risk children aged 1-15 years.Methods: This cross-sectional study was performed in Shiraz, Iran, over six months during 2009. Totally, 1289 boys and girls were selected by stratified multistage random sampling from four municipality areas before allocating them to 15 groups. Inclusion criteria included age 1-15 years, documented history of BCG vaccination at birth, Iranian nationality and a healthy state of being. Children with acute febrile diseases, immunosuppression, on medication and immigrants were excluded. We considered a TST ≥ 10 mm of induration as positive.Results: The prevalence of LTBI in 1-15 years old children was 4.5%. The percentage was 3.5% in 1-5 year old, 4.1% in 6-10 year old and 5.7% in 11-15 year old children. The highest rate of infection was 9.8% in 15 year olds and the lowest was 2.2% in 3-year old children. Gender had no effect on LTBI rate. There is no significant difference of LTBI prevalence between four municipality areas.Conclusion: The prevalence of LTBI in this study was lower in comparison with other studies performed in Iran. Positive predictive value of TST decreases in low endemic areas for tuberculosis, especially in low-risk groups therefore, most positive results are false-positive created by nonspecific reactions and infection with environmental mycobacteria. Hence, there is a need for new diagnostic tools that are easy and cost-effective.

Abstract Background The screening process for systematic reviews and meta-analyses in medical research is a labor-intensive and time-consuming task. While machine learning and deep learning have been applied to facilitate this process, these methods often require training data and user annotation. This study aims to assess the efficacy of ChatGPT, a large language model based on the Generative Pretrained Transformers (GPT) architecture, in automating the screening process for systematic reviews in radiology without the need for training data. Methods A prospective simulation study was conducted between May 2nd and 24th, 2023, comparing ChatGPT’s performance in screening abstracts against that of general physicians (GPs). A total of 1198 abstracts across three subfields of radiology were evaluated. Metrics such as sensitivity, specificity, positive and negative predictive values (PPV and NPV), workload saving, and others were employed. Statistical analyses included the Kappa coefficient for inter-rater agreement, ROC curve plotting, AUC calculation, and bootstrapping for p-values and confidence intervals. Results ChatGPT completed the screening process within an hour, while GPs took an average of 7–10 days. The AI model achieved a sensitivity of 95% and an NPV of 99%, slightly outperforming the GPs’ sensitive consensus (i.e., including records if at least one person includes them). It also exhibited remarkably low false negative counts and high workload savings, ranging from 40 to 83%. However, ChatGPT had lower specificity and PPV compared to human raters. The average Kappa agreement between ChatGPT and other raters was 0.27. Conclusions ChatGPT shows promise in automating the article screening phase of systematic reviews, achieving high sensitivity and workload savings. While not entirely replacing human expertise, it could serve as an efficient first-line screening tool, particularly in reducing the burden on human resources. Further studies are needed to fine-tune its capabilities and validate its utility across different medical subfields.

Endovascular treatment is widely applied as the first-line treatment for intracranial aneurysms and includes simple coiling (SC), stent-assisted coiling (SAC), flow diversion stent, and flow disruption stent. The present study is a retrospective cohort study performed in Imam Khomeini Hospital, Department of Neurovascular Intervention, between March 2016 and March 2021. A total number of 229 patients with intracranial aneurysms who underwent therapeutic intravascular interventions were enrolled, of which 89 were treated with SC, 111 with SAC, 25 with flow diversion stent, and 4 with flow disruption stent. The mean age of the subjects was 51.8±12.6 years, and 51.1% were male. Modified Raymond-Roy classification (MRRC) was used to define the occlusion outcome. The success rate, considered as Class I and Class II of MRRC at treatment time was 89% (94.4% in SC, and 84.7% in SAC), which was increased to 90.9% (94% in SC, 93% in SAC, 69.6% in flow diversion stenting, 100% in flow disruption) at 6-month follow-up, and 84.6% (80.8% in SC, 87.8% in SAC, 78.3% in flow diversion stenting, and 100% in flow disruption) at 12-month follow-up. The mean modified Rankin Scale (mRS) before the procedure was 0.05±0.26 which was increased to 0.22±0.76 after the procedure, 0.22±0.76 at 6 months, and 0.30±0.95 at 12 months (P

In chronic granulomatous disease (CGD) patients, esophageal stricture is a rare complication and the treatment of choice is still controversial. There are few reports of successful therapy with antibiotics, corticosteroids, multiple balloon dilatations or their combination. We report a 3-three-year-old Iranian boy with recurrent esophageal obstruction due to CGD. The patient transiently responded to dilatation in one occasion and at another time to short term steroid therapy. We observed an excellent response when long term and high dose of corticosteroid was administered. It showed that a long term and high dose steroid therapy is more effective than a short term in a patient with CGD and esophageal stricture.

Summary: Background: The multifactorial nature of inflammatory bowel disease (IBD), which manifests differently in individuals creates a need for a better understanding of the behaviour and pattern of the disease due to environmental factors. The current study aimed to study the changes in IBD behaviour, presentation, and characteristics in patients over the past two decades with a goal of improving patients’ diagnosis, management and outcomes. Methods: During a 6-month period (1/02/2022–30/07/2022), the information of patients with IBD who attended IBD outpatient clinics of 11 referral centre's in six countries was collected, and based on the first time of diagnosis with IBD, they were allocated as group A (those who were diagnosed more than 15 years ago), group B (those who were diagnosed with IBD between 5 and 15 years ago) and group C (IBD cases who diagnosed in recent 5 years). Then the most prevalent subtypes and characters of the disease are evaluated and compared to make clear if the presenting pattern and behaviour of the disease has changed in the last 2 decades. Findings: Overall 1430 patients with IBD including 1207 patients with ulcerative colitis (UC) (84.5%) and 205 patients with Crohn's disease (CD; 14.3%) included. Mean age of participants at the first time of diagnosis with IBD was 30 years. The extra-intestinal involvement of IBD in groups A and B was more prevalent in comparison with group C. Most of those in groups A & B had academic education but in group C, the most prevalent educational status was high school or diploma (P = 0.012). In contrast to groups A and B, the relative prevalence of medium socioeconomic level in group C had decreased (65%). Relative prevalence of UC subtypes was similar among groups A and B (extensive colitis as most prevalent) but in group C, the most prevalent subtype is left side colitis (38.17%). The most prevalent subtype of CD in groups A and B was ileocolic involvement while in group C, upper GI involvement is significantly increased. The rate of food sensitivity among groups A and B was more than group C (P = 0.00001). The relative prevalence of patients with no flare has increased with a steady slope (P

Vanishing bile duct syndrome is a rare, acquired disease that has been described in different pathologic conditions‚ including adverse drug reactions, autoimmune diseases, graft vs host disease, and neoplasms. It is a condition characterized by progressive loss of intrahepatic bile ducts leading to ductopenia and cholestasis.Here we report a 27-year-old female who presented with jaundice and cholestatic hepatitis and was finally diagnosed with vanishing Bile duct syndrome secondary to Hodgkin lymphoma.Physicians need to consider a range of differential diagnoses, especially malignancies, in suspected cases of vanishing bile duct syndrome.

Abstract Successful cancer treatment using magnetic hyperthermia therapy (MHT) strongly depends on biocompatible magnetic nanoparticles (NPs). They can effectively accumulate in tumor tissues after systemic injection and generate heat in the therapeutic temperature range (42–48 °C) by exposure to an AC magnetic field (AMF). For this purpose, folic acid-conjugated dextran-coated Zn0.6Mn0.4Fe2O4 (FA-Dex-ZMF) NPs were synthesized as smart nano heaters with self-regulating temperatures for MHT of liver tumors. Animal studies on BALB/c mice showed that the prepared NPs did not cause acute toxicity upon administration up to 100 mg kg−1. Likewise, no significant changes in hematological and biochemical factors were observed. FA-Dex-ZMF NPs were studied by exposing them to different safe AC magnetic fields (f = 150 kHz, H = 6, 8, and 10 kA m−1). Calorimetric experiments revealed that the NPs reached the desired temperature range (42–48 °C), which was suitable for MHT. Moreover, the efficacy of FA-Dex-ZMF NPs in MHT of liver tumors was investigated in vivo in liver-tumor-bearing mice. The obtained results revealed that the average volume of tumors in the control group increased 2.2 times during the study period. In contrast, the tumor volume remained almost constant during treatment in the MHT group. The results indicated that folic acid-conjugated dextran-coated Zn0.6Mn0.4Fe2O4 NPs with self-regulating temperature could be a promising tool for systemically delivered MHT.

Background: Urinary stones are among the most common urological diseases. Certain preventive behaviors have been recommended to decrease the recurrence of urinary stones in patients with a prior history. Aim and Objectives: To determine the extent of adherence to preventive measures in patients with a history of urinary stones referred to urology clinics of Shahid Rahimi and Shohada-ye Ashayer hospitals in Khorramabad, Iran, in 2021-2022. Material and Methods: In this cross-sectional study, 208 subjects with a history of urinary stones were included. Demographic characteristics, lifestyle habits, behaviors to prevent the recurrence of urinary stones, and the overall score of preventive behaviors were collected. Results: The mean age of the studied population was 44.72 ± 14.4 years. The majority of patients 120 (57.7%) were male. There was no significant relationship between preventive behaviors with gender, age, occupation, and educational level (p > 0.05). However, there was a significant relationship between the overall score of preventive behaviors and the severity of the disease and physical activity (p < 0.001). Conclusion: Patients who have a history of urinary stones or are at risk of the development of urinary stones should be educated about preventive behaviors to reduce the risk of urinary stones.

IntroductionBrain neoplasms and central nervous system (CNS) disorders, particularly gliomas, have shown a notable increase in incidence over the last three decades, posing significant diagnostic and therapeutic challenges. MicroRNAs (miRNAs) have emerged as promising biomarkers due to their regulatory role in gene expression, offering potential enhancements in glioma diagnosis and prognosis.MethodsThis systematic review and meta-analysis, adhering to PRISMA guidelines, included 25 studies for diagnostic accuracy and 99 for prognostic analysis, published until August 27th, 2023. Studies were identified through comprehensive searches of PubMed, Web of Science, and Scopus databases. Inclusion criteria encompassed peer-reviewed original research providing sensitivity, specificity, and area under the curve (AUC) for miRNAs in glioma diagnosis, as well as survival outcomes with hazard ratios (HRs) or mean survival.Results and discussionMeta-analysis demonstrated miRNAs’ high diagnostic accuracy, with a pooled sensitivity of 0.821 (95% CI: 0.781–0.855) and specificity of 0.831 (95% CI: 0.792–0.865), yielding an AUC of 0.893. Subgroup analysis by specimen type revealed consistent accuracy across blood, cerebrospinal fluid (CSF), and tissue samples. Our results also showed miRNAs can be potential prognostic biomarkers. miRNAs showed significant associations with overall survival (OS) (pooled HR: 2.0221; 95% CI: 1.8497–2.2105), progression-free survival (PFS) (pooled HR: 2.4248; 95% CI: 1.8888–3.1128), and disease-free survival (DFS) (pooled HR: 1.8973; 95% CI: 1.1637–3.0933) in tissue specimens. These findings underscore miRNAs’ potential as valuable biomarkers for improving glioma diagnosis and prognosis, offering insights for enhancing clinical decision-making and patient outcomes.

Purpose: This research was done with the aim of providing a dynamic model of factors affecting the effective implementation of the civil service law in the field of human resources measures. Methodology:The research approach in terms of method is mix method. In the qualitative part, with the theoretical sampling method, 46 scientific documents in the field of civil service law and implementation of public policy were content analyzed and effective factors in the implementation of civil service law in the form of three main dimensions, 29 components and 108 indicators after screening. Two rounds of fuzzy Delphi were explained with the participation of 11 experts. The statistical population of the quantitative part includes executive and academic experts who are proficient in the civil service law, which are 11 informed and knowledgeable experts in the field of non-probability (targeted) sampling in the form of a snowball. Civil Service Law were selected and their opinions and views were used in order to screen the research indicators in Delphi technique and analyze the trend of influential variables in the design of the dynamic model of effective implementation of the Civil Service Law in the field of human resources in the Venzym software environment. Findings: The dynamic analysis of the variables showed that the accumulation variables include infrastructure, government, society, organizational structure and human resources. Flow variables also include human and financial capacities, organizational strategy, political factors, legal, cultural and social factors, recruitment and employment, service compensation and improvement of human resources, and by extracting the flow chart and simulating data over 5 years, Four dynamic hypotheses were presented for the effective implementation of the civil service law. Originality: In terms of concept, for the first time with a qualitative and comprehensive approach, the factors affecting the implementation of the civil service law in the field of human resources management are explained, and in terms of methodology, modeling using the system dynamics method in this field is another new aspect. in this research. In terms of practical value, this research, by identifying the important feedback cycles of intervening factors in law enforcement, by presenting a scenario, has provided the context to pay attention to strengthening positive circles and planning to break negative reinforcing circles in effective law enforcement.

Introduction: Subjective well-being is the subjective component of quality of life. People with higher subjective well-being are expected to feel a good sense toward their surrounding environment, especially their residence place. Investigation of the relationship between subjective well-being and place loyalty is especially important for rural areas of Iran, which have lost a large number of their population. Method: The present study is an applied research with the descriptive-analytical approach. The research data were collected mainly by filling in the questionnaire. The statistical population of this study is the rural areas with a population of at least 100 people located in Dasht-e-Arzhan rural district, and the analysis unit is all people aged 18 and over. Data were analyzed using one-sample T-test, one-way ANOVA, Pearson correlation coefficient and ETA coefficient applying the SPSS software. Findings: The levels of place loyalty and subjective well-being are higher than the average. There is no significant difference between the studied villages in terms of level of subjective well-being, and the level of place loyalty as well. At the 95% confidence level, there is a positive and significant relationship between subjective well-being and place loyalty. There is a significant relationship between subjective well-being and variables of marital status, immigration history of relatives, age and residence length in the village. The relationship between place loyalty and variables of marital status, relatives' immigration history, age and residence length in the village is also significant. Discussion: Subjective well-being along with objective well-being and some other factors can explain the loyalty of individuals and households to their settlements. These findings can be used by rural policymakers and planners to take appropriate actions aimed at sustainable development of rural communities.

Edward Said's analysis of "Orientalism" critically examines how the East is portrayed in Western art and how this portrayal reinforces the colonial mindset. It goes beyond just distorting the ideology to establish a new political order. Instead, it creates a separate reality of the Orient, distant from the West and objectifies it as a source of Western knowledge. The world exhibition serves as an arena to showcase various Western and Eastern cultures. It juxtaposes logical and imaginary, chronological order, and mythical disorder. The exhibition has been used to shape transcultural and advance Orientalist discourse strategies and expectations of imperialism. The representation and construction of “self” and “others” found an ontological and epistemological relationship with Orientalist alienation. Also, due to the newly acquired strategic position during the first Pahlavi era and the ancient history of the country's science and art, Iran's presence there earned special position in the eyes of Orientalists and the Western knowledge domain. Therefore, it was necessary to depict it by classifying the structure of knowledge and related historiography. In fact, the concepts and political rules of the historical interpretation of Orientalism were derived from Iran's participation in international exhibitions. The goal was to identify a connection between Orientalist ideas and the pavilions' physical, content, and functional aspects. The study found that Iran's pavilions, in particular, reflected Orientalist expectations. They were designed like museums showcasing Iranian art and arranged exotically to appeal to Western audience.

Abstract Background Metabolic-associated fatty liver disease (MAFLD), one of the most common liver diseases, is detected in patients with concomitant hepatic steatosis and Type 2 Diabetes (T2D). We looked into the relationship between Fibrosis-4 (FIB-4) index and coronary artery diseases (CAD) in patients with MAFLD, to further look into the efficiency of FIB-4 in screening for CAD among patients with MAFLD. Method In this study, we included 1664 patients with MAFLD (T2D, who also had hepatic steatosis) during 2012–2022 and divided them into 2 groups; CAD and non-CAD. Demographic, Anthropometric indices, liver function tests, lipid profile and FIB-4 index of all patients were evaluated and compared. Result Among the 1644 patients (all have MAFLD), 364(21.4%) had CAD. Patients with MAFLD and CAD were more probable to be hypertensive, have longer duration of diabetes and be older (with p-values

Context: Interleukin-6 (IL-6), a pro-inflammatory cytokine, plays an important role in the pathogenesis of myocardial hypertrophy. By integrating its membrane receptor complex (gp80), IL-6 activates the signal guidance components (gp130) and activates the hypertrophic signaling pathways. There is some evidence that 1,25 dihydroxyvitamin D exerts antihypertrophic effects, but the cellular and molecular mechanisms are not fully understood. The aim of this study was to evaluate the effect of calcitriol on the level of IL-6 and its receptor components in hypertrophied rat heart. Subjects and Methods: Male rats were divided into control, hypertrophy, Vitamin D + hypertrophy, and propylene glycol + hypertrophy groups. The groups receiving Vitamin D and propylene glycol were treated 2 weeks before induction of hypertrophy and 2 weeks after hypertrophy. Myocardial hypertrophy was induced by abdominal aortic stenosis. Mean arterial blood pressure was measured by cannulation of the left carotid artery, and expression of genes was determined by reverse transcription-polymerase chain reaction. Results: Blood pressure and heart-to-body weight ratio increased in hypertrophic groups compared to the control group (P < 0.01), but Vitamin D administration decreased these parameters (P < 0.05). Abdominal aortic stenosis increased IL-6 expression levels (P < 0.001) and Vitamin-D decreased IL-6 mRNA levels (P < 0.01). The expression of gp80 in the hypertrophic group increased compared to the control group (P < 0.05), but Vitamin D did not affect the expression of receptor subunits genes. Conclusions: The data from this study suggest a possible mechanism for the antihypertrophic effects of Vitamin D through the regulation of inflammatory responses during hypertrophy. Thus, Vitamin D can reduce IL-6 expression levels, thereby reducing hypertrophy.