Isfahan University Of Medical Sciences Research Articles

Hospital safety index: evaluation of the readiness and safety of hospitals in Isfahan province, Iran

Objective: Hospitals play a vital role in disaster management and their function must be maintained during crises. Isfahan province is susceptible to major crises and disasters at any time of the year. The study aimed to investigate the hospital safety index (HSI) in hospitals in Isfahan province. Methods: This cross-sectional study was conducted using the HSI questionnaire of the world health organization. The safety of all 55 hospitals in Isfahan province was evaluated with the Persian version of the questionnaire from 2017 to 2022. In this study, all hospitals were evaluated by a group of experts from the emergency operations center (EOC) of Isfahan University of Medical Sciences, and the checklists were completed with the cooperation of the hospital disaster committee, visiting the hospitals, and interviewing the personnel. Results: The safety level of hospitals has improved from 2017 to 2022 so in 2022, 38 hospitals (69.09%) had a high safety level, and 17 hospitals (30.91%) had a medium safety level. This increase in safety has happened in all three components of safety (functional, non-structural, and structural safety). There was no significant difference in the overall hospital safety score between academic-educational, non-academic governmental, social security and military, and private and charity hospitals (P<0.05). Conclusion: Although the safety in the hospitals of Isfahan province has improved due to the continuous disaster prevention and preparedness activities, hospitals still need to improve to achieve higher levels of safety. The HSI shows how well a hospital can maintain its organization and performance during disasters. This index will be useful for decision-making and policy-making to prioritize administrative and civil interventions.

Fuchs’ uveitis syndrome: a 20-year experience in 466 patients

Fuchs Uveitis Syndrome (FUS), also known as Fuchs Heterochromic Iridocyclitis, is a chronic form of uveitis characterized by mild inflammation primarily affecting one eye. This study aimed to investigate the clinical and epidemiological features of FUS in an Iranian population. A retrospective analysis was conducted on 466 patients diagnosed with FUS at an ophthalmology center affiliated with Isfahan University of Medical Sciences between 2003 and 2021. The Kimura et al. criteria were used for FUS diagnosis. Demographic data, clinical characteristics, misdiagnosed cases, concurrent diseases, and associated ocular findings were analyzed. The study included 507 eyes of 466 FUS patients, with a mean age of 34.01 ± 11.25 years. Iris atrophy, keratic precipitates, and vitritis were common clinical findings. Heterochromia was an infrequent feature. Initial misdiagnosis occurred in 13 patients, with pars planitis being the most common incorrect diagnosis. Toxoplasmosis and multiple sclerosis were common concurrent diseases. Pediatric FUS cases were noted, possibly attributed to early-onset manifestations. Differences in clinical characteristics were observed when compared to other populations. This study provides insights into the clinical and epidemiological aspects of FUS in an Iranian population. Variations in clinical features, misdiagnosis patterns, and concurrent diseases were noted. Attention to specific clinical parameters can aid in accurate FUS diagnosis. Understanding these differences contributes to a better understanding of FUS presentation and its relationship with other diseases.

Antiepileptic Medication-induced Severe Cutaneous Adverse Reactions in Hospitalized Children: A Retrospective Study

There are limited data on severe cutaneous adverse reactions (SCARs) associated with antiepileptic medications. The current study aims to investigate the clinical and epidemiological characteristics of antiepileptic medication-induced SCARs in hospitalized children.
 This five-year retrospective study was conducted at Isfahan University of Medical Sciences, Iran. The study included all children with a diagnosis of SCARs secondary to antiepileptic medications as defined by the World Health Organization (WHO). In our study SCARs were categorized into three groups: drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), and a group with symptoms overlapping between maculopapular eruptions (MPE) and DRESS.
 Among 259 children with SCARs induced by antiepileptic medications, 199 (76.83%), 42 (16.22%), and 18 (6.95%) had overlapping MPE/DRESS, DRESS, and SJS/TEN, respectively. Phenobarbital was the most common offending drug among SCARs. The multinomial logistic regression model revealed that lymphadenopathy increased DRESS occurrence by 35 times compared to overlapping MPE/DRESS. Girls were at risk of SJS/TEN approximately 6 times more than boys. Age, weight, and mucosal involvement affected hospitalization duration in children with SCARs related to antiepileptic medication.
 There are some similarities and differences in the clinical and epidemiological features of Iranian children suffering from antiepileptic medication-induced SCARs.
  

Novel anthropometric indices for predicting type 2 diabetes mellitus

BackgroundThis study aimed to compare anthropometric indices to predict type 2 diabetes mellitus (T2DM) among first-degree relatives of diabetic patients in the Iranian community.MethodsIn this study, information on 3483 first-degree relatives (FDRs) of diabetic patients was extracted from the database of the Endocrinology and Metabolism Research Center of Isfahan University of Medical Sciences. Overall, 2082 FDRs were included in the analyses. A logistic regression model was used to evaluate the association between anthropometric indices and the odds of having diabetes. Furthermore, a receiver operating characteristic (ROC) curve was applied to estimate the optimal cutoff point based on the sensitivity and specificity of each index. In addition, the indices were compared based on the area under the curve (AUC).ResultsThe overall prevalence of diabetes was 15.3%. The optimal cutoff points for anthropometric measures among men were 25.09 for body mass index (BMI) (AUC = 0.573), 0.52 for waist-to-height ratio (WHtR) (AUC = 0.648), 0.91 for waist-to-hip ratio (WHR) (AUC = 0.654), 0.08 for a body shape index (ABSI) (AUC = 0.599), 3.92 for body roundness index (BRI) (AUC = 0.648), 27.27 for body adiposity index (BAI) (AUC = 0.590), and 8 for visceral adiposity index (VAI) (AUC = 0.596). The optimal cutoff points for anthropometric indices were 28.75 for BMI (AUC = 0.610), 0.55 for the WHtR (AUC = 0.685), 0.80 for the WHR (AUC = 0.687), 0.07 for the ABSI (AUC = 0.669), 4.34 for the BRI (AUC = 0.685), 39.95 for the BAI (AUC = 0.583), and 6.15 for the VAI (AUC = 0.658). The WHR, WHTR, and BRI were revealed to have fair AUC values and were relatively greater than the other indices for both men and women. Furthermore, in women, the ABSI and VAI also had fair AUCs. However, BMI and the BAI had the lowest AUC values among the indices in both sexes.ConclusionThe WHtR, BRI, VAI, and WHR outperformed other anthropometric indices in predicting T2DM in first-degree relatives (FDRs) of diabetic patients. However, further investigations in different populations may need to be implemented to justify their widespread adoption in clinical practice.

Relationship between professional self-concept and perceived organizational support with family functioning in nurses in Isfahan, Iran

BACKGROUND: Vocational issues affect nurses’ family functioning in long term. So the purpose of this study is to investigate the relationship between professional self-concept and perceived organizational support with nurses’ family functioning. MATERIALS AND METHODS: This descriptive correlational study conducted in hospitals affiliated to Isfahan University of Medical Sciences and 250 nurses who met the inclusion criteria participated in this study. The samples were selected conveniently from December 2022 to August 2022. To collect data, Cowin’s professional self-concept questionnaire, Eisenberger’s perceived organizational support questionnaire, and Epstein’s family function measurement were used. Data collection was done in one step and cross-sectional. Descriptive statistics and inferential methods of data analysis consisted of Pearson’s correlation coefficient and multiple linear regression were used. Data were analyzed with statistical package for the social sciences (SPSS) version 22. RESULTS: One of the six dimensions of professional self-concept consisted of staff relations significantly predicted the family function of nurses (P = .004). No significant relationship was found between perceived organizational support and nurses’ family function (P = .825). CONCLUSION: Promoting the healthcare organizations’ human climate may improve nurses’ wellbeing and hereby their family functioning which could further improve quality of healthcare services. It may be worthwhile to suggest supporting interpersonal and interprofessional relationships to ensure a healthy professional life for the nurses.

Voices unheard, insights into the lives of people with disabilities: A needs assessment study

BACKGROUND: The phenomenon of disability in society is as ancient as human history itself. Approximately one billion people worldwide experience some form of disability, with a fifth of these individuals facing significant disabilities. Disability affects various life dimensions, including access to health services. This study aimed to identify the needs and challenges encountered by people with disabilities and to propose solutions for these issues. MATERIALS AND METHODS: This qualitative content analysis research was conducted at Isfahan University of Medical Sciences in 2019. Participants included faculty members from the rehabilitation school, senior students, therapists, disabled individuals, and their families (23 interviews in total). These participants were chosen for their extensive knowledge of the challenges faced by people with disabilities. Semi-structured interviews were conducted, with informed consent obtained before each interview. The interviews were analyzed using the Graneheim and Lundman content analysis method and MAXQDA software. To ensure data accuracy, the criteria of conformability, credibility, dependability, and transferability were applied. RESULTS: The analysis of the interviews yielded two main categories and 10 subcategories. In the category of disability-related problems, family problems, therapeutic problems, psychological problems, academic problems, and social problems were identified as the most significant. As for solutions, educational solutions, therapeutic solutions, social solutions, research solutions, and solutions for reintegrating patients into normal life were proposed to address the problems faced by disabled individuals. CONCLUSION: People with disabilities are an integral part of any country’s society. To adequately address their therapeutic needs, it is essential to equip our health workers with the knowledge and skills tailored to the specific needs and challenges of disabled individuals.

Prevalence of acute kidney injury following percutaneous nephrolithotomy

Background: The objective is to evaluate the prevalence of acute kidney injury (AKI) as an early complication of the percutaneous nephrolithotomy (PCNL) procedure. Materials and Methods: From May 2022 to October 2022, we conducted a retrospective study on patients undergoing PCNL procedures in two of the tertiary medical centers affiliated with Isfahan University of Medical Sciences. Patients’ baseline characteristics, laboratory values, perioperative data, and stone features were documented. AKI was defined either as a ≥0.3 mg/dL increase in the serum creatinine level within 2 days, or a ≥1.5-fold increase in baseline serum creatinine level within 7 days after the operation. Laboratory values were measured 1 day before PCNL and daily thereafter until discharge. Patients were followed 1 week later to detect all of the possible cases of AKI. Results: The final analysis was performed on 347 individuals. AKI developed in 16 (4.61%) cases. The two groups were comparable regarding age (P = 0.887), gender (P = 0.566), and underlying comorbidities including diabetes mellitus (P = 0.577) and hypertension (P = 0.383). The mean body mass index (BMI) (P < 0.001) and both frequency and severity of hydronephrosis (P < 0.001) were significantly different. A higher mean PCNL duration (P < 0.001), period of hospitalization (P < 0.001), and blood loss volume (P < 0.001) were observed in those who developed AKI. Overall, 56.3% (9) of patients in the AKI group and 2.7% (9) in the non-AKI group required the establishment of more than one access tract, during the procedure (P < 0.001). A lower preoperative hemoglobin level was observed in the AKI group (P < 0.001). Those with AKI had significantly larger stones (3.08 ± 0.46 vs. 2.41 ± 0.23 cm, P < 0.001) and higher Hounsfield units (P < 0.001). In addition, in the AKI group, most of the calculi (81.3%, 13) were of staghorn type, whereas in the non-AKI group, calculi were most frequently located in the middle calyx (30.2%, 100), (P < 0.001). Conclusion: The prevalence of post-PCNL AKI is approximately 4.61%. The mean BMI, preoperative hemoglobin level, PCNL duration, intraoperative blood loss volume, and hospitalization period were significantly higher among patients who developed AKI. Those with AKI had significantly larger stones with higher Hounsfield units and more frequently of staghorn type. The two groups were not statistically different regarding age, gender, and presence of comorbidities (hypertension and diabetes mellitus).

Latent class of depressive symptoms of and its determinants: A cross-sectional study among Iranian University students.

According to the report of the World Health Organization, mental disorders are one of the 10 most important causes of disability in the world. This study was conducted with the aim of determining the number and frequency of latent classes of depression and its determinants in Isfahan university of medical students. A total of 1408 medical students from Isfahan University of Medical Sciences, Iran, were enrolled in the study in 2017. The symptoms and severity of depression were assessed using the standard Hospital Anxiety and Depression scale questionnaire. Latent class analysis was applied to seven symptoms of depression, all of which had four levels. Latent class subgroups were compared using the Chi-square test and analysis of variance test. The regression model was used to check the relationship between identified classes and related factors. Analyzes were done using SPSS-21 and Mplus7 software. In this study, three latent classes were identified, that is, the group of healthy people, the group of borderline people, and the group of people suspected of depression. The prevalence of identified latent classes among medical students is 0.52, 0.32, and 0.16%, respectively. The regression results showed that compared to the healthy group, the factors affecting depression in the borderline and suspicious group were increasing age, female gender, interest in the field of study, physical activity, history of depression, and history of anxiety. The three classes that were identified based on the students' answers to the depression symptoms questions differed only based on severity. The history of depression and anxiety were the strongest predictors of latent classes of depression.

A qualitative report on experiences of participants in the young innovative leadership program

BackgroundLeadership in health system is a universal challenge. The Young Innovative Leadership Program (YILP) designed for undergraduate and postgraduate medical sciences students, implemented at the Isfahan University of Medical Sciences, aimed to cultivate leadership capacities through a 16-week training program. This program comprises ten modules covering innovation, change leadership, and management skills, with mentor-facilitated group discussions. This study aimed to provide a qualitative report of the experiences of participants in the YILP.MethodsA qualitative study was conducted in 2022, three months after the end of the training program, to investigate the participants’ perspectives. Data was extracted through in-depth, semi-structured interviews with 14 participants.ResultsIn this study 14 undergraduate and postgraduate medical sciences students who had participated in the YILP the previous year were included. Four main categories emerged from the interviews: “emergence of new horizons”, “values as beacon”, “an expanded toolbox”, and “program’s structure: a learning atmosphere”.ConclusionsThe results of our study indicated that medical science students would benefit from leadership development programs. In this regard, the framework utilized to implement YILP could serve as a role model.

Comparing the Effect of Internet-Delivered Interpersonal Psychotherapy and Compassion-Focused Therapy on the Quality of Life and Grief Experience of First-Degree Relatives of the Deceased Due to COVID-19

Background: The COVID-19 pandemic presents an extreme threat to global health and stands as one of the leading causes of death worldwide. Loss, as a broader theme, intertwines with various aspects of people’s lives during these challenging times. Failing to address the urgent needs of individuals experiencing loss and grief can result in poor mental and physical health. Objectives: Our study aimed to evaluate the impact of interpersonal psychotherapy (IPT) and compassion-focused therapy (CFT) on the grief and quality of life (QoL) of first-degree relatives who lost loved ones due to the COVID-19 pandemic. Methods: This study was a randomized clinical trial. Participants who had lost a family member to COVID-19 between March 2019 and September 2020 and who visited the hospitals affiliated with Isfahan University of Medical Sciences were selected based on specific inclusion and exclusion criteria. Forty participants were randomly assigned to either IPT or CFT, and each group underwent 6 weekly sessions. The Grief Experience Questionnaires and the World Health Organization’s Quality of Life Questionnaires were administered to all individuals via phone interviews before commencing treatment and 1 month after completing the sessions. Results: The results indicated a significant improvement in both treatment groups individually (P < 0.001). However, when comparing the 2 groups while adjusting for the pre-test effects, there were no significant differences between them in any of the following areas: Physical response (P2 = 0.45), notoriety (P2 = 0.53), justification and coping (P2 = 0.59), guilt (P2 = 0.31), feelings of abandonment (P2 = 0.52), judgment by others (P2 = 0.78), and embarrassment and shame (P2 = 0.79). Conclusions: The findings from our study demonstrate that both IPT and CFT resulted in improved QoL and reduced grief experiences. Therefore, these therapeutic approaches can be employed to alleviate grief symptoms and enhance overall QoL.

Examining workload variations among different surgical team roles, specialties, and techniques: a multicenter cross-sectional descriptive study

BackgroundA high workload may negatively impact the surgical team's performance and jeopardize patient safety. The aim of this study was to measure the workload of the surgical team across different surgical roles, specialties, and techniques in several hospitals.MethodsThis cross-sectional multicenter study was performed in the operating rooms of eight teaching hospitals affiliated with Isfahan University of Medical Sciences, Iran. At the conclusion of each surgical procedure, all members of the surgical team completed the Surgery Task Load Index (SURG-TLX) questionnaire to assess workload levels. Descriptive statistics, analysis of variance (ANOVA), and Pearson correlations, were performed to compare surgical roles, specialties, techniques, and surgical time on workload overall and by subscale.ResultsA total of 409 workload questionnaires were obtained from 76 surgical teams or cases, involving 346 surgical team members. The total workload among all participants was 32.41 ± 17.21. Surgical complexity, physical demands, and mental demands were the highest workload subscales and distraction was the lowest workload subscale. Cardiovascular specialty had a higher workload compared to other specialties. Open techniques resulted in a higher workload compared to minimally invasive techniques. Surgical technologists who act in both the role of circulating and scrub nurse (C&Ss) experienced the highest workload, followed by surgical residents and surgeons.ConclusionsThe results of the study showed that the workload for some members of the surgical team is disproportionately high and is influenced by factors such as specialty, technique, role, and surgical duration. By knowing the distribution of workload among the members of the surgical team, efforts can be made to optimize the team members’ workload.

Hesitancy among Iranian nursing students regarding future career trajectory: a qualitative analysis

BackgroundThe shortage of skilled nurses is a major concern for health systems worldwide. This may be partly due to the hesitancy of some nurses to enter or remain in the nursing career. This shortage consequently reduces the quality of standard patient care, increases patients’ length of stay in a hospital, increases medical costs, and results in patients’ dissatisfaction. This study aimed to explore hesitancy among senior undergraduate nursing students to pursue a career in nursing.MethodsThis qualitative study adopted a thematic analysis approach. The population comprised senior undergraduate nursing students at Isfahan University of Medical Sciences, Iran, who indicated that they were hesitant to pursue a career in nursing. The study sampling was performed from May 2021 till February 2022 and continued until data saturation. Twenty-four interviews were conducted with the selected students. The attributes related to hesitancy among senior undergraduate nursing students to pursue a career in nursing were extracted as themes and sub-themes.ResultsFour themes were identified: academic idiosyncrasies, individual characteristics, poor nursing market regulations (sub-themes: nursing as a tough and intense career, and unfavorable employment contracts), and the peculiarities of the workplace (sub-themes: conflict within work environment, and barriers to professional nursing practice).ConclusionsThe findings of this study showed that senior undergraduate nursing students weigh their future career options from various academic, personal, professional, and work environment dimensions. The findings provide new insights for decision makers to design and implement innovative strategies to promote retention in nursing careers. We recommend to provide academic counseling for all students and applicants of nursing before they enter the nursing education. Furthermore, we suggest to improve study and work environments, and to implement incentive programs to enhance enthusiasm of nursing students for pursuing a nursing career.

Opportunities and Challenges of E-learning for Nursing Students at the Beginning of the COVID-19 Pandemic in Iran: A Qualitative Content Analysis.

Given the limited presence of students in universities and the closure of educational centers, including nursing schools, during the COVID-19 outbreak, there has been a significant shift toward e-learning. However, there is a lack of research in this area. Therefore, this study aimed to explore the experiences of undergraduate nursing students with e-learning during the COVID-19 outbreak in 2020. This qualitative-descriptive study focused on 12 undergraduate nursing students from the School of Nursing and Midwifery at Isfahan University of Medical Sciences. The participants were selected using purposive sampling. In-depth and semi-structured interviews were conducted to collect the data. The collected data were analyzed using MAXQDA10 and conventional content analysis. The study was conducted between May and September 2020. Analysis of the findings led to the emergence of 11 subcategories and two main categories: E-Learning opportunities and Challenges of E-Learning, providing a comprehensive description of the experiences reported by the participants. Unforeseen crises, such as the current COVID-19 pandemic, can significantly affect the quality of education by disrupting face-to-face learning. To mitigate such disruptions, it is crucial to plan and establish infrastructure that supports alternative modes of education, such as e-learning. Additionally, providing training to students and educators on effectively utilizing digital platforms and producing electronic content can help ensure a smoother transition during crises.

Comparing the Effect of Internet-Delivered Self-Care Training and Play Therapy on the Quality of Life of Children with Type 1 diabetes in 2021 in Isfahan City- Randomized Clinical Trial

Objective: Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases in childhood, and its management is associated with many problems. The study aimed to compare the effect of group self-care training and patient child play (PCP) on quality of life (QoL) in children with type 1 diabetes in Isfahan, Iran
 Materials and Methods: This randomized trial was done from January 2020 to October 2021 in Endocrine and Metabolism research center of Isfahan University of medical sciences. Seventy- five children aged 8 to 11 years with T1DM who did not have a severe behavioral problem based on the child behavior checklist (CBCL) were simple randomly assigned to three groups: self-care training, play therapy, and control. The self-care group received ten education sessions via the Skyroom and the playgroup performed PCP for ten sessions. The control group did not receive any psychological intervention. All participants received routine diabetes medication. They completed a health-related QoL questionnaire for children (KIDSCREEN-52) before and after the intervention. Data were analyzed using SPSS-23 software and analysis of covariance.
 Results: A significant difference between the mean scores of the post-test subscales of physical well-being (P= 0.003), psychological well-being (P= 0.003), moods and emotions (P= 0.02), self-perception (P= 0.002), self-autonomy (P= 0.002), parental relationships and family life (P= 0.001), social and peers support (P= 0.04), school environment (P= 0.003) and social acceptance (P= 0.001) in PCP group.
 Conclusion: Self-care training and PCP are effective in increasing the QoL, and can be used as a complementary treatment in children with T1DM.

On genotype-phenotype relationship of dystrophinopathies among Iranian population.

Background: Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) are inherited X-linked disorders resulting from alterations in the dystrophin gene. Genotype-phenotype matching studies have revealed a link between disease severity, the amount of muscle dystrophin, and the extent of mutation/deletion on the dystrophin gene. This study aimed to assess the relationship between genetic alterations in the dystrophin gene and the clinical status of patients with dystrophinopathies among the Iranian population. Methods: This cross-sectional study examined 54 patients with muscle weakness caused by abnormalities in the dystrophin gene at a hospital affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, in 2021. The participants' demographic information, including age, family history of muscle dystrophies, and family history of other medical diseases as well as the type of muscular dystrophy were recorded. Furthermore, the number and region of deleted exons based on dystrophy types were also evaluated using multiplex ligation-dependent probe amplification (MLPA). The patients' gaits were also assessed as using a wheelchair, the presence of waddling gaits, or toe gaits. The patients' clinical status and the coexistence of pulmonary, bulbar, and mental conditions were also examined and compared between the two groups of dystrophinopathies. Results: In this study, 54 patients with dystrophinopathy with the mean age of 16.63 ± 12.10 years were evaluated, of whom 22 (40.7%) and 30 (55.6%) patients were classified as BMD and DMD, respectively. The most affected regions with deleted exons were exons 45-47 (n = 5) and 45-48 (n = 4) in patients with BMD, while exons 45, 48-52, 51-55, and 53 (2 cases per exon) were the most common affected exons in patients with DMD. Further analyses revealed that deletions in exons 45-47 and 51-55 were significantly associated with older and younger ages at the onset of becoming wheelchair-bound in patients with dystrophy, respectively. The hotspot range in both BMD and DMD was within exons 45-55 (n = 15 for each group); 63% of the patients had alterations on the dystrophin gene within this range [30 patients (68.18%) in the BMD group, 15 patients (53.57%) in the DMD group]. Conclusion: Exon deletion was the most common genetic alteration in patients with dystrophinopathies. No significant difference was observed between DMD and BMD regarding the number of deleted exons. Deletions in exons 45-47 and 51-55 were linked to later and earlier onset of becoming wheelchair-bound, respectively.

Diet in relation to Metabolic, sleep and psychological health Status (DiMetS): protocol for a cross-sectional study

IntroductionMetabolic disturbances are of major health concerns in the world. In addition to their high prevalence, these disorders have substantial roles in developing other physical and mental diseases. Diet could...

Sun protection behaviors among children aged 6-18 years old, the role of socioeconomic factors: A cross-sectional study.

Evaluation of sun protection behavior and related factors in children aged between 6 and 18 years in Isfahan, Iran. This cross-sectional study was conducted at outpatient pediatric clinics affiliated with Isfahan University of Medical Sciences, Isfahan, Iran during the summer of 2021. A checklist was designed, and the interviewer used that to gather the required information including children's demographic characteristics, families' socioeconomic data, and sun-protective behaviors in children. The mean ± standard deviation (SD) age of children was 10.54 ± 3.61. Among the study population, 63.7% of children were male. The most common skin phototypes were II and III (33.5% each). 83.8% of children used at least one method of sun protection (94.5% of girls, 77.6% of boys, p < 0.001). Wearing long-sleeved clothes was the most frequent UV-protection method (48%), while sunscreen application was the least prevalent method (28.1%). Sun protection behaviors were more frequent among urban children (86.7%, p = 0.009) and children with wealthy families (94%, p = 0.035). Sun protection methods were used by most of the children whose mothers applied sunscreen on a daily basis (90.2%, p = 0.002) and all of the children whose mothers held a master's degree or above (100%, p = 0.004). Children's sun protection behavior is directly associated with demographic characteristics, families' socioeconomic level and maternal usage of sun protection measures. It is necessary to provide information and education about sun protection methods and the risks of excessive sun exposure to families and children, as well as facilitate their access to these.

Multiple sclerosis is associated with worse COVID-19 outcomes compared to the general population: A population-based study.

We carried out the current study to compare COVID-19-related hospitalization and mortality rates between people living with multiple sclerosis (PLWMS) and MS-free controls from the Isfahan general population. In this retrospective population-based study, we used available data from four datasets of Isfahan University of Medical Sciences from January 1, 2020, to August 22, 2021. Data on all PLWMS, SARS-CoV-2 polymerase chain reaction (PCR) and rapid antigen test, hospitalization, and death were included. We compared the odds of COVID-19-related hospitalization and mortality between PLWMS and the control group before and after adjustment for age and sex. We categorized all people into young (18-49 years) and old age (50-79 years) groups and compared the hospitalization rate between people with and without MS. In total, 829 PLWMS and 2494 MS-free controls with confirmed COVID-19 were included. Hospitalization rates among PLWMS and MS-free controls were 16.2% and 16.5% (crude OR= 0.978, 95%CI: 0.79, 1.21). In the adjusted model, PLWMS with COVID-19 had 56% increased odds of hospitalization (OR=1.56, 95%CI: 1.23, 1.97). During follow-up, there were 11 (1.3%) and 49 (2%) COVID-19-related deaths among PLWMS and MS-free controls, respectively. No significant difference between people with and without MS in COVID-19-related mortality rate was observed (crude OR= 0.678, 95%CI: 0.351, 1.31; adjusted OR=2.013, 95%CI: 0.95, 4.26). We found increased odds of hospitalization in young PLWMS compared to those without MS at the same age (OR=1.699, 95%CI: 1.289, 2.240). But, no difference between older people with and without MS was detected (OR=1.005, 95%CI: 0.662, 1.524). This study revealed higher odds of hospitalization and mortality due to COVID-19 among PLWMS in comparison to age- and sex-matched controls from the general population. Nevertheless, it remains unclear whether the elevated odds are directly associated with MS itself or if they are influenced by factors such as rituximab using, comorbidity, and disease severity.

Evaluation of last-year dental students’ knowledge of prescription of analgesics and anti-bacterial agents for pregnant and lactating women

Oral health in pregnant and lactating women can affect maternal and child health. Dental treatments in this period should not have adverse effects on maternal and child health. This study was conducted to investigate the last-year dental students’ knowledge of the prescription of analgesics and antibiotics for pregnant and lactating mothers in Isfahan city, Iran. Methods: A total of 104 last-year dental students of Khorasgan Islamic Azad University and Isfahan University of Medical Sciences were recruited in this descriptiveanalytical study. They completed a 16-item questionnaire on the prescription of analgesics and antibiotics for pregnant and lactating mothers. Data were analyzed by SPSS (Version 22) statistical software(t-test). Results: The total mean score of students’ knowledge was 9.02±1.91. The highest level of knowledge about the safest analgesic (acetaminophen) was reported for the pregnant patients so that 100% of them had correct information in this regard. Further, the lowest level of knowledge was found for the use of dexamethasone during lactation, as only 10.6% of respondents were able to provide a correct response in this regard. Conclusion: The dental students had average knowledge about the prescription of antibiotics and analgesics for pregnant and lactating patients. To prevent the possible risks for these patients, further information should be provided to dental students.

Effectiveness of High-intensity Laser Therapy for Pain and Function in Knee Osteoarthritis: A Randomized Controlled Trial

Background: High-intensity laser therapy (HILT) is still a controversial physical therapy modality for individuals with knee osteoarthritis (OA). Objectives: This study aimed to evaluate the effect of HILT on pain and function in patients with knee OA. Methods: This randomized controlled trial included 56 patients with knee OA referred to Amin Hospital affiliated with Isfahan University of Medical Sciences, Isfahan, Iran, from April 19 to August 30, 2022. Patients were randomized into two groups (HILT and control), receiving isometric exercises targeting the quadriceps muscle, meloxicam 15 mg tablet, and Rahamin ointment for two weeks. The HILT group also received high-intensity laser irradiation three times a week for two weeks. The primary outcome was pain assessed using a Visual Analog Scale (VAS), and the secondary outcome was the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) and its subscales (pain, stiffness, and physical function). Outcomes were evaluated at baseline, immediately, and three months after the last treatment session. Results: After adjusting for age, sex, and baseline values, immediately and three months after treatment, VAS pain scores were significantly lower in the HILT group than in controls (P &lt; 0.001), with a large effect (standardized mean difference (SMD) = -1.22, 95% confidence interval (CI): -1.81; -0.62 and SMD = -1.31, 95% CI: -1.90; -0.70, respectively). The results were similar for WOMAC's pain subscale. Despite the difference in WOMAC stiffness score was not significant between the two groups immediately after treatment (P = 0.135), this score was significantly lower in the HILT group than in the control group (SMD = -0.98, 95% CI: -1.56; -0.40, P = 0.002) three months after treatment. Furthermore, WOMAC physical function scores were significantly lower with HILT immediately and three months after treatment (P &lt; 0.001). The same was true for the total WOMAC score. Conclusions: High-intensity laser therapy significantly improved pain and the WOMAC score in patients with knee OA immediately and three months after the last treatment session compared to the control group.