Sleep deprivation negatively affects a person's emotions, cognition, and performance and ultimately reduces safety. The main purpose of this systematic review is to study and report the evidence on the effect of sleep deprivation on the performance of pilots. This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. International databases including PubMed, Web of Science (WOS) and Scopus were considered for the search of English articles up to April of 2023. Keywords were sleep deprivation, pilot, flight, performance, airline, air force, flight safety, fatigue, pilot performance, flight performance, eye movement, workload, motion, visual, attention, errors, cognition, sleep quality, and circadian rhythm. In this systematic review, 12 studies consisting of 259 subjects remained. Most of the studies have reported the negative effects of sleep deprivation in a different way, and the decrease in performance was expressed as one of the important issues following sleep deprivation. As various studies show, any type of sleep deprivation in pilots can have negative effects on their performance, and this decrease in performance can have irreparable consequences.

Human beings are faced with numerous behavioral options in different situations, but they can only choose a limited number of them. Ethical beliefs, values, and principles guide individuals in decision-makings. This study focuses on medical residents' perspectives towards four ethical principles (Deontology, Utilitarianism, Virtue, and Principlism) in various clinical situations. This descriptive-analytical study was performed cross-sectional basis among a population of medical residents of Shiraz University of Medical Sciences. Data were gathered by multi-stage cluster sampling method using a researcher-made questionnaire including demographic information and five different clinical scenarios. The data were analyzed using the Chi-square test and descriptive and inferential statistics in SPSS22. The results of this study showed that there was no significant relationship between gender, specialty, year of study, and the four ethical principles mentioned in the participants. However, a significant correlation was observed between the types of scenarios and their alignment with a particular type of decision or ethical theory. The ethical philosophy of medical residents has been evolving gradually over time, even before entering the residency period. Therefore, focusing on practical ethics training and the commitment of residents to implementing the principles and values of professional ethics can shape the ethical philosophy of residents towards professional ethics and humanity.

Hashimoto's thyroiditis (HT) is one of the common causes of hypothyroidism. Although various factors are involved in its development, recently the role of oxidative stress in its pathogenesis has been known. The present study aimed to investigate the level of total antioxidant capacity (TAC), catalase (CAT), and salivary superoxide dismutase (SOD) in patients with HT compared with the control group. The present case-control design included patients aged 18-80 years suffering from HT referred to the endocrine clinic. Eligible patients were selected by the available sampling method. Complete unstimulated saliva was collected under a rest state in a comfortable room between 10:00 AM and 12:00 AM and a checklist was used to collect data. The chi-square, t-test, and Mann-Whitney U tests were used for data analysis using SPSS 22 software. The mean age of the participants was 36.55±9.37 years (range: 20-56). The two groups were the same in terms of age and gender (P>0.05). The findings indicated that the difference in the means CAT between the two groups was 22.63 which was strongly and statistically significant (P<0.001). In this study, the level of TAC and SOD in Hashimoto's thyroid patients was decreased and the level of CAT was increased. These initial findings show that oxidative stress can be associated with Hashimoto's thyroid disease or the possibility of developing this disease increase.

Statins affect the bone metabolism. Considering the role of nitric oxide (NO) in many physiological processes, this study assessed the effects of atorvastatin (ATOR) and NO on the mandible and skull bone density (BD) in ovariectomized rats. This study evaluated 48 female Sprague-Dawley rats in 6 groups (n=8). Groups 1 and 2 underwent sham surgery. Group 1 (sham) did not receive any medication, but group 2 (sham/ATOR) received atorvastatin. Groups 3 to 6 underwent ovariectomy. Group 3 (OVX) did not receive any medication, group 4 (OVX/ATOR) received atorvastatin, group 5 (OVX/L-NAME) received L-NG-nitro arginine methyl ester (L-NAME), and group 6 (OVX/ATOR/L-NAME) received both atorvastatin and L-NAME. Atorvastatin (40 mg/kg) was gavaged and L-NAME (3 mg/kg) was administered intraperitoneally for 4 weeks. All rats underwent lateral cephalometry before and after the interventions, and BD was measured at 2 points in the mandible and skull before and after the intervention by a digital densitometer. Data were analyzed by t-test, ANOVA, and Sidak test (alpha=0.05). The change in BD was 26.5±10.17 in the mandible and 22.17±9.45 in the skull in OVX group. These values were 25.63±5.55 and 28±8.59 in OVX/ATR, 1.5±7.78 and -1.88±4.39 in OVX/L-NAME, and 6.63±7.37 and 4.33±6.35 in OVX/ATOR/L-NAME, respectively. OVX/ATOR showed no significant difference (P=1), but OVX/L-NAME (P<0.001) and OVX/ATOR/L-NAME (P<0.001) groups showed significant differences with OVX group. The present findings indicated that atorvastatin had no significant effect on BD, but administration of L-NAME prevented osteoporosis in ovariectomized rats.

Flexible bronchoscopy is employed to diagnose a range of respiratory disorders. Local airway anesthesia is mandatory to facilitate tracheal intubation. It is commonly done by injection of diluted lidocaine through working channel of bronchoscope via Spray-as-you-go (SAYGO) method. Other methods such as airway nerve block (ANB) by direct injection of lidocaine are also used to increase patient comfort. The aim of this study was to compare patient and physician satisfaction during bronchoscopy in two groups receiving SAGO alone versus combination of SAYGO and ANB. In a double-blinded randomized clinical trial, 68 patients undergoing bronchoscopy were divided into two groups. The first group received local anesthesia solely through the SAYGO method, while the second group received a combination of SAYGO and ANB. Both groups received intravenous sedation. The anesthesia level was assessed using Ramsay score. Patient and physician satisfaction with bronchoscopy was evaluated on a numeric scale of 1 to 5. Combination of ANB and SAYGO resulted in significantly higher satisfaction score both in physician [3.4±1.6 and 4.6±0.8] and patients [3.5±1.3 and 4.9±0.4] (P<0.001). Thirteen individuals (38.2%) in the SAYGO and four individuals (11.8%) in SAYGO+ANB experienced a drop in oxygen levels (P=0.023). Additionally, sedation levels (Ramsay sedation scale score) were significantly higher in the first group (4) compared to the second group (3) (P=0.001). Combining ANB with SAYGO resulted in higher patient and physician comfort during bronchoscopy in comparison to SAYGO alone with no increase in complications.

With the increasing number of pediatric surgeries and the transfer of caregiving roles to parents, appropriate preparation and reduction of their stress levels for proper care of children before and after surgery is essential. If parental anxiety can be reduced through various methods, not only can it improve parental performance and their comfort, but it can also prevent the impact of anxiety on the child. Therefore, we aimed to investigate the effect of educational film presentation on the anxiety level of mothers visiting the obstetric anesthesia clinic at the Children's Medical Center in 2020. This study was a randomized double-blind controlled trial conducted as an intervention. Sampling was done randomly, and the study population consisted of two groups of 38 individuals, whose children were candidates for MRI. The intervention group watched the educational film, while the second group served as the control group. Subsequently, their anxiety levels were assessed and compared using the Beck Anxiety Inventory. The data were entered into SPSS Ver. 21 software and analyzed accordingly. The mean age of mothers in this study was 33.41 years with a standard deviation of 7 years. The mean age of children was 3.79 years with a standard deviation of 3.4 years. Among the children, 30 were girls (39.5%) and 46 were boys (60.5%). The mean age of girls was 4.35 years with a standard deviation of 4.16 years, while the mean age of boys was 3.433 years with a standard deviation of 2.787 years. Overall, 39 participants (50.6%) watched the educational film, while 38 participants (49.4%) were in the control group. The mean score of anxiety level according to the Beck Anxiety Inventory (BAI) was 9.47 with a standard deviation of 9.77. The level of anxiety was significantly higher in the intervention group who watched the educational film compared to the control group (P=0.012). The results of the present study indicated that parental anxiety increased after watching the educational video on anesthesia methods. It is recommended that alternative strategies be considered for reducing parental anxiety in future studies.

This retrospective study aimed to evaluate the metabolic and biochemical abnormalities in children with nephrocalcinosis to identify its important risk factors and better understand the disease pathophysiology. Data were collected from the medical records of 163 children diagnosed with nephrocalcinosis. Their clinical and laboratory characteristics at admission were recorded, and a 24-hour urinalysis was performed to measure parameters such as calcium, oxalate, citrate, uric acid, magnesium, and cystine. Family history of kidney stones and parental consanguinity were present in 58.8% and 58.2% of patients, respectively. The most common underlying conditions were hyperparathyroidism (24%), distal renal tubular acidosis (16.6%), and medullary sponge kidney (12.9%). The main abnormalities included hypocitraturia (65.2%), hypercalciuria (51.9%), hypomagnesuria (44.6%), hyperoxaluria (39.1%), hyperuricosuria (31.5%), vitamin D deficiency (30.06%), and metabolic acidosis (27%). Patients with kidney stones and failure to thrive had higher rates of hypercalciuria. Metabolic acidosis was more common in those with parental consanguinity and vitamin D deficiency. Renal failure at final follow-up was more evident in older patients, those with parental consanguinity, hypokalemia, acidosis, and hyperparathyroidism. End-stage renal disease was more frequent in patients with consanguineous parentage, hyperparathyroidism, hypokalemia, and acidosis. Parental consanguinity, family history of kidney stones, and urinary metabolic disorders are important risk factors for pediatric nephrocalcinosis. This highlights the need for genetic counseling, screening, and monitoring of biochemical abnormalities. Early diagnosis and timely treatment are crucial to maintain glomerular function and prevent kidney failure.

Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease that may result in adverse pregnancy outcomes, posing a significant risk to both the mother and the fetus. The major purpose of the current study was to investigate the impact of SLE on the outcomes of pregnancy among women with SLE. This was a retrospective cohort study. Two groups of pregnant women, one with Systemic Lupus Erythematosus (SLE) and one without SLE, were included at the Gynecology and Obstetrics Clinic of Ayatollah Mousavi Hospital in Zanjan, Iran, from 2019 to 2020. Participants from both cohorts completed a checklist of study variables based on their medical records. The data were analyzed using binary logistic regression, chi-square test, analysis of variance, and independent samples t-test with SPSS software version 23. The research involved 400 pregnant women, with the mean age of the SLE and non-SLE groups being 36.68±4.90 and 29.46±6.56 years, respectively. The most prevalent adverse outcome was cesarean section (271 [67.8%]), significantly higher in the SLE group (54.5% vs. 10.0%, P=0.0001). The likelihood of experiencing spontaneous abortion, preterm labor, cesarean section, and LBW was increased by more than 6.5 times (odds ratio, 6.54; 95% CI, 2.22-19.27; P=0.001), 3.6 times (odds ratio, 3.67; 95% CI, 1.47-9.18; P=0.005), 18.9 times (odds ratio, 18.94; 95% CI, 6.46-55.49; P=0.0001), and 3 times (odds ratio, 3.04; 95% CI, 1.09-8.46; P=0.030) in individuals with SLE, respectively. Women with SLE have an increased likelihood of encountering spontaneous abortion, preterm labor, cesarean section, and delivering a low-birth-weight infant.

Parry-Romberg Syndrome (PRS) is an atypical condition characterized by hemiatrophy of the face. Despite its rarity, the precise pathophysiological processes underlying its etiology remain elusive. While previous reports have hinted at the potential involvement of autoimmune factors, our case report aims to explore a novel perspective. Specifically, we pose the question of whether multiple sclerosis (MS) could be a plausible causative factor for PRS. Additionally, we investigate the potential association between Radiologically Isolated Syndrome (RIS) and the development of Parry-Romberg Syndrome.

Prosthetic valve malfunction is a hazardous clinical entity that needs early diagnosis and management. Hereby, we present a case of tricuspid valve (TV) malfunction due to interaction of central venous pressure (CVP) catheter with TV leaflets. Our case was a 38-year-old male who referred to our center with the diagnosis of TV malfunction. Confirming the diagnosis of TV malfunction, intravenous Heparin was initiated. Anticoagulation therapy was discontinued early due to the development of significant headache in the setting of subarachnoid hemorrhage. Due to contraindication of anticoagulation therapy, he underwent redo TV. On the 4^th post-operative day, echocardiography examination illustrated significant increase in gradients of TV prosthesis. At this time, fluoroscopy depicted interaction of CVP catheter with TV leaflets due to its cardiac advancement resulted in fixed TV leaflets in semi-open position. By extraction of CVP catheter the TV gradients improved immediately. Malposition of CVP catheter or large CVP catheter could be considered as one of the rare causes of TV malfunction. Repositioning of CVP catheter brings dramatic improvement in this case.