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This study aims to investigate the effectiveness of flipped learning in surgical education in trauma. The participants were 15 first-year general surgery residents in Shiraz medical school. After completing a pre-test, the participants received the learning content in interactive multimedia, podcasts, movies, and books. One month later, they had a face-to-face class based on case-based discussions. An early post-test was performed immediately after the class, and a late post-test was performed one month later. In these tests, the residents' problem-solving abilities were assessed using multiple-choice questions. A semi-structured phone interview was used to measure their attitude towards the learning program. The results showed a significant difference between pre-test and early post-test scores and between pre-test and late post-test scores. However, there was no significant difference between early and late post-test scores. The residents were satisfied with the program's overall usefulness for junior residents. The participants tended to use podcasts more than other materials. They mentioned that the videos and books helped more to foster theoretical knowledge. The case-based discussion makes them more confident in dealing with patients in daily encounters.

Background: The aim of this study was to determine morphological variations and normal parameters of the cross-sectional tibiofibular syndesmotic anatomy. Methods: Configurations of syndesmosis, anterior syndesmotic width (ASW), posterior syndesmotic width (PSW), and overlap distance, defined as the overlap of medial fibula with a drawn line from tip of anterior tubercle of incisura fibularis to the posterior tip, were measured on normal computed tomography (CT) scans of 110 cases. Results: Seventy seven male (70%) and 33 female (30%) (left: 50 and right: 60) were assessed. Mean age of the cases was 33 ± 13 (range: 15-80) years. Three different syndesmotic configurations were crescent (55.5%), rectangular (39.1 %), and semicircle (5.4 %). Overall, mean ASW, PSW, and overlap distance were 2.72, 3.98, and 1.02 mm, respectively. Upper limit of normal ASW in crescent, rectangular, and semicircle was 4.80, 4.85, and 3.89 mm, respectively. The maximum of PSW in crescent, rectangular, and semicircle was 6.25, 6.50, and 4.97 mm, respectively. There was not significant difference between syndesmotic configurations based on age (P =.69) and sex (P =.16). Conclusions: During interpreting axial CT scan to diagnose syndesmotic injuries, the normal range of parameters according to the different configurations of the tibiofibular syndesmosis should be carefully considered. Level of Evidence: Level 4 [ABSTRACT FROM AUTHOR]

Introduction : Hirsutism is a common problem in young women. It could be a sign of internal glands diseases (e.g. : ovary , adrenal , hypophysis , …). The aim of this research was measurment of the serum level of hormones produced by these glands in women with hirsutism . Materials and methods : This cross – sectional , descriptive research was conducted on all the hirsute women that referred to Dermatology clinic of Jahrom from April 2004 to April 2005. Their serum level of Testosterone , Dehydroepiandrosterone - sulphate (DHEA-S) , prolactin , Luteinizing hormone (LH) and Follicle – Stimulating Hormone (FSH) were measured with ELISA method . Testosterone > 1/2 , DHEA-S >4/1 , prolactin > 25 and >3 were considered abnormal . The Data was analysed using chi –square method . Results : On the results of this study , 59 patients out of 81 (72/8%) had positive FHx of hirsutism and 42 (52%) had irregular mensturation . Serum testosterone , DHEA-S and prolactin were high in 9/9%, 12/7%, 10/1%,respectively and 23/8% had >3 . High level of serum testosterone , DHEA-S and prolactin didnot have a significant correlation with irregular mensturation, Positive FHx and marrital status . > 3 had significant correlation with irregular mensturation (P3 ) . Conclusion :59 Out of 81 patients (72/8%) had positives FHx of hirsutism .Therefore, it seems that genetics has a significant role in inducing hirsutism . Many patients with hirsutism [34 pts (42/5%)] had at least one hormonal abnormality . Thurs screening tests , measurment of hormones such as testosterone , DHEA-S , prolactin , LH and FSH are neccessary for patients with hirsutism .

Background: In the name of extensive vaccine uptake, understanding the public's attitude, perception, and intent toward COVID-19 vaccination is a significant challenge for public health officials. Methods: A cross-sectional survey via an online questionnaire rooted in the Health Belief Model and Integrated Behavioral Model was conducted to evaluate COVID-19 vaccination intent and its associated factors. Factor analysis and multivariate logistic regression were operated to be satisfactory. Results: Among the 4,933 respondents, 24.7% were health care workers, and 64.2% intended to accept COVID-19 vaccination. The adjusted odds (aOR) of COVID-19 vaccination intent was higher for individuals with greater exposure to social norms supportive of COVID-19 vaccination (aOR = 3.07, 95% Confidence Interval (CI) = 2.71, 3.47) and higher perceived benefits of COVID-19 vaccination (aOR = 2.9, 95% CI = 2.49, 3.38). The adjusted odds of vaccination intent were lower for individuals with greater COVID-19 vaccine safety concerns (aOR = 0.28, 95%CI = 0.25, 0.31). Lower vaccination intent was also associated with increasing age ((aOR = 0.99, 95% CI = 0.98, 0.999), female sex (aOR = 0.76, 95% CI = 0.65, 0.88), and working in the health care field (aOR = 0.75, 95% CI = 0.63, 0.9). Conclusions: The odds of COVID-19 vaccination intent were higher three or more times among those with a greater belief in vaccine effectiveness, lower concerns about vaccine safety, and greater exposure to cues to vaccinate, including from doctors. This last finding is concerning as vaccine acceptance was surprisingly lower among health care workers compared to others. The remarkable results of factor analysis and reliability of the questionnaire may encourage local health authorities to apply it to their regional population. [ABSTRACT FROM AUTHOR]

Background: Diagnosis of associated mid-foot fractures in Lisfranc injuries is important for proper treatment. We aimed to describe frequency of different types of Lisfranc injuries in surgically treated cases and to find the accuracy of non-weight bearing radiographs to determine associated mid-foot fractures. Methods: In a retrospective study, preoperative non-weight bearing plain radiographs and CT studies of 118 surgically treated Lisfranc injuries were evaluated by 2 orthopaedic surgeons. The sensitivity and specificity of fleck sign, fractures of metatarsal bases, cuneiforms, navicular, and cuboids were calculated. Results: Among 118 patients with the mean age of 35.0±15.7 years, most were male (77.1%). The most common type was Myerson type B (44.1 %) followed by D2 (40.7%). Fractures of the second metatarsal base (87 patients, 73.7%), the fleck signs (85 patients, 72.0 %), and fractures of the third metatarsal base (65 patients, 55.0 %) were the three most frequent injuries. Oppositely, fractures of the fitih metatarsal base (5 patients, 4.3%), middle cuneiform (14 patients, 12.0%), and navicular (15 patients, 12.7%) were the three least common associated mid-foot fractures. Plain radiographs could not show high sensitivity to distinguish associated mid-foot fractures in Lisfranc injuries with the highest for the second metatarsal base fractures (78.2%). The maximum specificity was for fractures of the first metatarsal base (100%). Conclusion: Non-weight bearing radiographs of the foot cannot detect all associated mid-foot fractures particularly fleck sign. Therefore, preoperative CT scan is highly recommended. [ABSTRACT FROM AUTHOR]

Introduction: Understanding the factors affecting the survival of patients undergoing hemodialysis is the mainstay of care in this population. The present study aims at finding these features using novel cure models that discover factors important in both long term and short-term survival of patients undergoing HD.Methods: Data were retrospectively collected from the database of Shiraz University of Medical Sciences Special Diseases Administration including patients of 34 HD centers during 2011 to 2015. The primary outcome was death. Considering people with no death event as cured, the rest of the patients considered as uncured. To evaluate the factors affecting mortality, we used a mixture cure model (MCM) that model the long-term and short-term survival of patients separately.Results: Of 506 patients, 68.75% of women and 75.0% of men were long-term survivors. The mean (± SD) age of the patients was 57.5 (± 16.5) years and the empirical value of the cure rate was 72.9%. Sex, age, and Kt/Vurea were recognized as important factors in the long-term survival. In other words, lower age, male sex, and Kt/ Vurea ≥ 1.2 significantly increased the odds of being cured. The factors effective in short-term survival were mean corpuscular hemoglobin concentration (MCHC) and serum hemoglobin. The serum hemoglobin between 11 and 12.5 and a high MCHC decreased the risk of death.Conclusion: Using cure model survival analysis, it was found that factors affecting the proportion of the patients with long-term survival might be different from those affecting short-term survival. [ABSTRACT FROM AUTHOR]

Background: Uncontrolled hemorrhage still remains a major cause of trauma-associated mortality. The events resulting in acute traumatic coagulopathy, particularly hypofibrinogenemia, make control of bleeding difficult. It is essential to timely predict, diagnose, and manage trauma-induced coagulopathy. Aims: The aim of this study is to determine clinical and easily available laboratory variables that are predictive of hypofibrinogenemia in acute trauma patients. Settings and Design: This 2-year retrospective work examined the data of major trauma patients that were referred to Shahid Rajaee Hospital's emergency room in hemorrhagic shock condition. Materials and Methods: Fibrinogen level was assessed for these patients on their arrival at our facility. Along with clinical and routine paraclinical variables, we evaluated the predictive value of these variables for a fibrinogen level below 100 mg/ml. Results: A total of 855 cases were included (females: 16.4%; and males: 83.6%) in the study. The mean ± SD age was 36 ± 17.9 years, and the mean ± SD injury severity score was 12.2 ± 9. Motor vehicle accident was the most common cause of injury. Three factors, including arterial pH (cut off point = 7.34; area under the curve [AUC]: 0.59), base excess (cutoff point = -4.3; AUC: 0.60), and patients' gender had a significant association with the fibrinogen level under 100 mg/ml. When three factors of pH, BE, and patients' gender are being assessed simultaneously, the AUC became 0.62 (the predictive ability improved). Conclusions: Variables, including arterial pH, BE level, and patients' gender have predictive value for fibrinogen transfusion in trauma. [ABSTRACT FROM AUTHOR]

Background: Nowadays, infertility problems have become a social concern, and are associated with multiple psychological and social problems. Also, it affects the interpersonal communication between the individual, familial, and social characteristics. Since women are exposed to stressors of physical, mental, social factors, and treatment of infertility, providing a psychometric screening tool is necessary for disorders of this group. Objective: The aim of this study was to determine the factor structure of the general health questionnaire-28 to discover mental disorders in infertile women. Materials and Methods: In this study, 220 infertile women undergoing treatment of infertility were selected from the Yazd Research and Clinical Center for Infertility with convenience sampling in 2011. After completing the general health questionnaire by the project manager, validity and, reliability of the questionnaire were calculated by confirmatory factor structure and Cronbach's alpha, respectively. Results: Four factors, including anxiety and insomnia, social dysfunction, depression, and physical symptoms were extracted from the factor structure. 50.12% of the total variance was explained by four factors. The reliability coefficient of the questionnaire was obtained 0.90. Conclusion: Analysis of the factor structure and reliability of General Health Questionnaire-28 showed that it is suitable as a screening instrument for assessing general health of infertile women. [ABSTRACT FROM AUTHOR]

Background: In recent years, the study of birth intervals has been a main determinant of the levels of fertility in the populations, as it is associated with rates of fertility and population growth. Objective: The purpose of this study was to firstly apply survival analysis for modeling of first birth interval and secondly to explore its determinants. Materials and Methods: In a cross sectional study, the fertility history of 858 women was collected in rural areas of Shiraz (southern Iran) in 2008. We used the survival analysis such as cox regression and alternative parametric models to evaluate the prognostic factors of first birth interval. Results: Among the explanatory variables of interest, age at marriage, level of women's education, and menstrual status had highly significant effects on the duration of birth interval after marriage (p<0.01). Conclusion: It is concluded that the suitable parametric models would be a useful tool for fitting to first birth interval, the fact that has been less paid attention to in researches. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic value of blood cells surface markers in patients with acute appendicitis., Methods: In this cross-sectional study, 71 patients who underwent appendectomy following a diagnosis of appendicitis were recruited during a one-year period. The patients were divided into two groups: patients with histopathologically confirmed acute appendicitis and subjects with normal appendix. Blood cell surface markers of all patients were measured. Univariate and multivariate analytical methods were applied to identify the most useful markers. Receiver operating characteristics (ROC) curves were also used to find the best cut-off point, sensitivity, and specificity., Results: Overall we included 71 patients with mean age of 22.6±10.7 years. Of the 71 cases, 45 (63.4%) had acute appendicitis while 26 (36.6%) were normal. There was no significant difference between two study groups regarding the age (p=0.151) and sex (p=0.142). The initial WBC count was significantly higher in those with acute appendicitis (p=0.033). Maximum and minimum area under the ROC curve in univariate analysis was reported for CD3/RA (0.71) and CD38 (0.533), respectively. Multivariate regression models revealed the percentage of accurate diagnoses based on the combination of γ/δ TCR, CD3/RO, and CD3/RA markers to be 74.65%. Maximum area under the ROC curve (0.79) was also obtained for the same combination., Conclusion: the best blood cell surface markers in the prediction of acute appendicitis were HLA-DR+CD19, a/β TCR, and CD3/RA. The simultaneous use of γ/δ TCR, CD3/RA, and CD3/RO showed the highest diagnostic value in acute appendicitis.