Acta Medica Iranica

Twelve Tips for Establishing an Effective Quality Assurance System for Medical Schools

Sun, 24 Nov 2024 00:00:00 +0330

Quality standards must be established and continually improved through innovations and regular monitoring in medical educational institutions. In addition, medical education must be supported by a quality culture, as well as quality assurance systems. Assuring quality in medical education institutions is a serious concern for policymakers. A major problem is that the quality assurance system is not fully implemented locally, and the institutes lack a robust and comprehensive quality assurance system that can function effectively. These 12 tips provide guidance to medical schools involved in the installation of quality assurance systems. Using these tips will allow medical schools to ensure their quality assurance system reflects their overall mission and goals.

Redefining the Superficial Peroneal Nerve: Stimulation Technique, Normal Values, Clinical Significance

Ali Sreij, Ali Ezzedine, Hassan Doumiati, Raja Sawaya — Sun, 24 Nov 2024 00:00:00 +0330

Polyneuropathy diagnosis often depends on sural sensory response values. The superficial peroneal nerve may serve as an alternative. This study aims to establish techniques for studying the superficial peroneal nerve and its branches while documenting normative values. It also seeks to compare nerve conduction values with those of the sural sensory nerve. This study attempts to validate the reliability of the superficial peroneal sensory nerve for sensory neuropathy diagnosis by comparing it with the sural nerve in diabetics. The first part studies 23 healthy subjects aged 20 to 50. Nerve conduction studies were conducted on sural and superficial peroneal nerves and parameters were collected. The second part examines the trunk of the superficial peroneal sensory response and sural nerves in 13 diabetic patients with clinically diagnosed diabetic polyneuropathy, comparing values with age-matched healthy controls. In the first part which included 23 healthy subjects, mean values for distal latency, amplitude, and conduction velocity were documented for the trunk of the superficial peroneal nerve, IDCN, MDCN, and sural nerve. In the second part, diabetic patients of which 6 were males and 7 were females between the ages 50 and 80 years demonstrated lower amplitudes in both the trunk of the superficial peroneal nerve and sural nerve compared to healthy controls. This study substantiates the reliability of the trunk of the superficial peroneal sensory nerve in sensory nerve conduction testing. The results suggest that this method could be used as an alternative to sural nerve studies in evaluating patients with peripheral neuropathy.

Can Underlying Co-Morbidities Affect Cerebral Oximetry in Cardiac Surgery Patients?

Kianoush Saberi, Shahnaz Sharifi, Amirhossein Orandi — Sun, 24 Nov 2024 00:00:00 +0330

Today, there is a growing number of monitoring Equipment accessible. These equipments ranging invasive to non-invasive. Choosing suitable monitoring methods depends on their benefits, drawbacks, and expenses. Overall, non-invasive brain monitoring is growing in importance because of its precision in performance and increased stability in output. Like the assessment of regional brain oxygen levels and the assessment of anesthesia depth using the BIS device, whose specific role in guidelines remains undefined. Many patients who undergo heart surgeries including valvular, dissection and CABG have various comorbidities. To add details, according to literatures about CVA 28% of patients had (Cerebrovascular Accident), 74% IHD (Ischemic Heart Disease), 82% HTN (Hypertension), 52% DM (Diabetes Mellitus), 61% Smoking History, 36% CKD (Chronic Kidney Disease) and 42% CHF (Congestive Heart Failure). Current study delves into the correlation of short-term complications after cardiac operations with cerebral oximetry alterations and the space under the curve (duration of rSo2 drop) to take the best advantages of cerebral oximetry for heart surgery in the future. This prospective observational study was conducted among 101 patients undergoing cardiac surgery at Imam Khomeini Hospital in Tehran between 2019 and 2020. Following admission to the operating room, standard monitoring of vital signs, including non-invasive blood pressure (NIBP), electrocardiogram (ECG), central venous pressure (CVP), oxygen saturation (SpO2), and end-tidal carbon dioxide (ETCO2), was established. Prior to anesthesia induction, cerebral oxygen saturation (rSO2) was continuously monitored using the INVOS 5100c cerebral oximeter. Patients were followed for 7 days postoperatively, with documentation of intubation duration, intensive care unit (ICU) stay, and complications such as renal failure, cerebrovascular accident (CVA), and mortality. Data analysis was performed using SPSS 25.0 statistical software, with a P of less than 0.05 considered statistically significant. This study investigated rSO2 levels, as measured by a cerebral oximeter, in patients aged 19 to 79 undergoing cardiac surgery. Data were collected from both the right and left sides of the forehead during the operative period. Overall, these findings highlight the importance of rSO2 monitoring during cardiac surgery, particularly in patients with underlying cardiovascular conditions. Further research is needed to elucidate the specific mechanisms underlying these observations and to explore potential strategies for optimizing cerebral oxygenation in this vulnerable patient population.

Impact of Rs657152 Gene Polymorphisms on Inflammatory Markers in COVID-19 Patients With Type 2 Diabetes Mellitus

Ahmed Amshawee, Maryam A. Hussain — Sun, 24 Nov 2024 00:00:00 +0330

COVID-19 has significantly affected people with pre-existing conditions, particularly those suffering from type 2 diabetes mellitus (T2DM), as it increases the risk of complications and mortality. The dysregulated inflammatory response in T2DM patients is a critical factor contributing to severe disease progression in these individuals. Recent research suggests that genetic variations, such as Rs657152 polymorphisms, could influence inflammatory markers and immune responses in T2DM patients infected with COVID-19. Understanding this genetic relationship is crucial for improving treatment strategies and predicting outcomes in this high-risk group. The present was designed to evaluate the correlation of Rs657152 gene polymorphisms with inflammatory markers in COVID-19 patients with T2DM. This study enrolled 91 participants, including 31 healthy individuals, 30 COVID-19 patients with T2DM, and 30 non-diabetic COVID-19 patients. Inflammatory markers (CRP, IL-6, D-dimer, and ferritin) were measured, and Rs657152 polymorphisms were genotyped. Statistical analysis was conducted using SPSS version 23. COVID-19 patients with T2DM showed significantly higher BMI, greater severity of COVID-19, and increased levels of inflammatory markers compared to non-diabetic patients. A significant correlation was observed between the Rs657152 polymorphisms and elevated levels of IL-6, D-dimer, and ferritin in T2DM patients (P<0.05). The polymorphisms of the Rs657152 gene may exacerbate the inflammatory response in COVID-19 patients with T2DM, contributing to increased severity of the disease.

Morbidity and Mortality of Premature Birth at Ramadi Teaching Hospital for Maternity and Children/West of Iraq

Sabah M Ali, Rana F Shitran — Sun, 24 Nov 2024 00:00:00 +0330

The consequences of prematurity is a very fundamental subject. With improvement of neonatal care facilities, it still comprises a burden on health care centers, with a lot of costs and increasing mortality. To determine the morbidity and mortality of premature birth at Ramadi teaching hospital for maternity and children. A prospective cohort study was done at Ramadi teaching hospital for maternity and children/Anbar/Iraq. Data was collected from 1st July 2022 till 1st January 2023, all live births at Ramadi Teaching Hospital during that period were included. All admitted premature newborns were followed up in neonatal care unit for variable periods depending on clinical situation and those who develop complications were recorded (Respiratory distress syndrome, Intracranial hemorrhage, asphyxia, sepsis, hypoglycemia, pneumothorax) furthermore any newborn died during hospitalization period also recruited. The total number of neonates was 204. All of them were preterm babies. About 121 (59.3%) need resuscitation while 83 (40.7%) not need resuscitation. Regarding complications respiratory distress syndrome 156(76.5%), intracranial hemorrhage 9(4.4%), asphyxia 17(8.3%), sepsis 35(17.2%), hypoglycemia 22 (10.8%), pneumothorax 31(15.2%). 148 premature babies discharged well (72.5%) while 56 premature newborns died (27.5%). Result of analysis of logistic regression to determine the relationship between different risk factors and mortality shows significant association with birth weight <1500-gram Odd’s ratio (30.041), and triplet pregnancy Odd’s ratio (3.62). Respiratory distress syndrome is the most prevalent complication of preterm babies followed by sepsis. Extremely low birth weight and triplet pregnancy have significant association with preterm mortality

Evaluation of the Effect of “Honey Zufa” Herbal Syrup on Cough in Hospitalized Patients With COVID-19: A Double Blind Randomized Clinical Trial

Sun, 24 Nov 2024 00:00:00 +0330

Cough is one of the most prevalent symptoms of COVID-19, affecting over 60% of patients. This symptom significantly diminishes quality of life, causing fatigue, insomnia, dysphonia, musculoskeletal pain, and urinary incontinence. Honey Zufa herbal syrup is a well-known antitussive remedy in the Iranian market and was evaluated for its potential to alleviate this symptom. This study aimed to assess the efficacy and safety of Honey Zufa herbal syrup in treating acute cough resulting from mild to moderate COVID-19. A randomized controlled trial was conducted with 200 patients assigned to either the treatment group, receiving Honey Zufa herbal syrup, or the placebo group, receiving a placebo. Both groups also received standard cough control medications. Cough severity was measured using three different scoring systems. The impact of Honey Zufa on cough severity, the influence of other medications, and changes in laboratory parameters were monitored over a 14-day period. Honey Zufa herbal syrup significantly reduced cough severity compared to the placebo across all scoring systems. The treatment group experienced a greater reduction in cough severity than the placebo group. However, there was no significant difference between the groups in terms of antitussive medication regimens. Laboratory parameters remained stable, and no significant side effects were observed. Honey Zufa herbal syrup effectively reduces cough severity in patients with mild to moderate COVID-19, suggesting it could serve as a useful complementary and alternative treatment option for COVID-19-induced cough.

Exploring Themes in English Language Teaching Publications in Iran’s Medical Education: A Content Analysis

Samaneh Karami, Afsaneh Dehnad, Iman Alizadeh — Sun, 24 Nov 2024 00:00:00 +0330

The present study explored the trajectories of themes in the English for Medical Purposes (EMP) studies in the Iranian medical education context. Informed with the frameworks of language planning, it juxtaposed the extracted themes with the pillars of English for Specific Purposes (ESP)-needs analysis, learning objectives, materials and methods, and evaluation. It explored the EMP themes in a corpus of 41 documents extracted from Google Scholar, Scopus, ISI, and PubMed databases. Then, the researchers performed a content analysis of the corpus based on a matrix incorporating the title, abstract, introduction, discussion, keywords, and the field of expertise of the author(s) of the documents. The analysis revealed the themes of learners’ need analysis, language skills, learning strategies, cognitive and affective variables, teaching methodology, teaching materials, material evaluation, use of technology, evaluation of learners and learning, program evaluation, and evaluation of instructors. The juxtaposition of the themes with the mainstream pillars showed that although there was a match between the themes and the pillars, the size of the themes falling under each pillar differed. While utilizing technology and affective variables were the most frequent themes, learning materials, language skills, and learner variables were the least frequent ones. Most of the themes matched with the learning objectives pillar; the needs analysis pillar, on the other hand, had the fewest number of themes. Notable gaps, particularly in the areas of instructors' needs, administrative needs, learner variables, and instructor variables were discovered. The study also showed that EMP research predominantly focuses on English for medical academic purposes (EMAP) in the absence of studies on English for Medical Occupational Purposes (EMOP). The findings have implications for EMP research, policy setting, teacher education, and materials development, providing guidance for future research endeavors and contributing to the enhancement of English language education in the field of medical sciences.

Obstetricians’ Views for Reasons Decision-Making for Cesarean Section in Iran

Thu, 28 Nov 2024 07:18:10 +0330

By increasing trend of cesarean sections (c-section) has raised the rate of health implications after c-section analogously. This study aimed to identify the factors influencing the choice of cesarean birth from obstetrician' perspective. Present study was a descriptive-analytical cross-sectional study at three medical centers dependent on Tehran University of Medical Sciences in 2022. The questionnaire included parents' demographic and economic factors, parents 'previous experiences and insistence of relatives, environmental and facilities, cultural and religious, the doctor's personal opinion, and the mother's clinical and psychological factors. In general, 67 gynecologists participated in the study. The average (SD) age and work experience of doctors was 42.95 (7.68), and 11.49 (8.35) years respectively. The most determining factors in the choice of cesarean delivery from the doctor's point of view were the maternal clinical and psychological factors. Other important factors were the culture and personal beliefs of the parents. The factor of fear of litigation and court in case of birth problems and complications was one of the other essential factors in choosing cesarean delivery. In the current study, the age and experience of the specialist doctor showed a positive correlation with the personal opinion of the gynecologists. Obstetricians and gynecologists are the final decision makers in choosing the type of delivery. To select the correct method, there is a need for a specific protocol for choosing the kind of delivery, and providing a suitable platform to resolve legal concerns and lawsuits.