Shiraz University Research Articles

Exploring the relationship between contextual factors and health-promoting lifestyle profile (HPLP) among medical students: A cross-sectional study.

The present study was conducted with the aim of investigating the relationship between health-promoting lifestyle profile (HPLP) among medical students and contextual factors such as gender, age, field of study, academic level, marital status, history of physical and mental illnesses, and smoking. The present research was conducted in a cross-sectional method in 2021 on 500 students of Shiraz University of Medical Students. An e-questionnaire link was sent to them via email. The research tool was the HPLP questionnaire consisting of 52 questions in six domains in a 4-point Likert scale. Data were analyzed using SPSS software version 24 with one-sample t-test, independent t-test, analysis of variance, and Tukey's post hoc test. A total of 500 students fully answered the questions completely. All components of a healthy lifestyle-except for exercise-obtained a score higher than the cut-off point. The component of Self-Actualization (spiritual growth) (3.035 ± 0.68) had the highest score, while the lowest score was related to exercise and physical activity (2.126 ± 0.60). Married individuals had a better average health score compared to singles (p = 0.047). The average health score did not have a significant relationship with gender, but significantly related to age, field of study (p < 0.001), history of mental illnesses (p < 0.001) and Smoking (p < 0.001). It seems that university officials should pay more attention to the health domain of students' lifestyles, such as nutrition, the development of exercise and physical activities, and the management of stress and mental health. Additionally, providing necessary awareness and considering training courses, as well as developing sports and recreational facilities, can be effective in creating a better environment for the growth and development of students and ensuring their well-being.

The relationship between cleft palate repair technique and audiological outcomes: A retrospective cohort study.

Otitis media with effusion is common in children with cleft palates. This study aimed to investigate the link between palatal closure techniques and audiological outcomes. In this retrospective-prospective cohort study, we examined the relationship between palate repair techniques and hearing outcomes in children with cleft palates. From 2017 to 2022, 190 ears of 95 cleft patients were studied at the Cleft Lip and Palate Department of Shiraz University of Medical Sciences. Variables assessed included the surgical technique, cleft severity, auditory brainstem response (ABR) threshold, and tympanometry configuration. The mean ABR improved from a prepalatoplasty value of 39.51(11.62) decibels (dB) to a postpalatoplasty mean of 26.61(11.60) dB (Cohen's d: 1.12 [95% CI; 0.90-1.34]). Initially, 87.9% of the studied ears exhibited abnormal tympanometry, but this significantly decreased to 47% postsurgery (risk ratio: 4.43 [95% CI; 1.20-16.43]). When compared with Sommerlad intravelar veloplasty, the Nadjmi modified Furlow palatoplasty was associated with a notably lower mean ABR (β: -6.58 [95% CI: -10.43 to -2.73], p-value = .001) and a reduced frequency of abnormal tympanometry (odds ratio [OR]: -1.10; 95% CI: -1.85 to -0.36, p-value = .004). Factors like prepalatoplasty ABR, cleft palate severity, gender, and syndromic did not confound these findings. Although the Nadjmi modified Furlow palatoplasty showed better results, our findings indicate a significant improvement in ABR and tympanometry outcomes for both techniques. Future randomized controlled trials are suggested to confirm the influence of palatal closure techniques on audiological outcomes. 3b.

Identification and analysis of e-Learning development components and validation of e-LDC questionnaire based on four-lens model

The development of e-learning in recent decades is one of the main policies of higher education administrators, but it requires the identification of development requirements and infrastructure. The aim of this study was to achieve two objectives: identifying the components of e-learning development (e-LDC) and validation of the eLDC tools. The study was conducted in 2020 on 156 faculty members of the Shiraz University of Medical Sciences. The research utilized random sampling through email and e-questionnaires. The research tool employed was a valid questionnaire based on a four-dimensional model . The research tool was a valid questionnaire based on the four-dimensional model (Bolman and Deal, 2003) with 32 items in four components: human resource (9), structural (8), political (6) and symbolic (9). The validity of the instrument was confirmed by CVI = 0.914, CVR = 0.83 and Cronbach’s-alpha of 0.969. 18 (11.5%) were instructors, 80 (51.3%) were assistant professors, 39 (25%) were associate professors, and 19 (12.2%) were professors. In the factor analysis test, KMO = 0.944 and the significance of Bartlett’s Test of Sphericity with ( p &lt; 0.0001) confirmed the adequacy of the sample and the appropriateness of the test. According to the Scree Polt diagram and the variance explained, the four factors are cultural, structural, political, and manpower, respectively, influencing the development of e-learning. The explained common value of all items was more than 0.5 and the fit of the questionnaire at the special point was 67.12%. The development of e-learning in the universities requires a comprehensive view on the provision of infrastructure and e-learning requirements. But cultural development and modification of faculty members’ beliefs in e-learning is the most important factor and can be effective in the development of other factors.

Factors Affecting Nursing Work Teams: A Cross-Sectional Study in Teaching Hospitals Affiliated with Shiraz University of Medical Sciences

Background: Nurses, as vital members of healthcare system, play a crucial role in improving society's health, which makes it very important to develop work teams among them. This study aims to investigate the factors affecting nursing work teams in teaching hospitals affiliated with Shiraz University of Medical Sciences in 2022.&#x0D; Methods: This study was a cross-sectional study conducted in 2022 on a sample of 267 nurses from teaching hospitals affiliated with Shiraz University of Medical Sciences who were selected using simple random sampling and the stratified method proportional to the size. Data collection tool used in this study was a valid and reliable questionnaire comprising 2 parts: nurses' demographic characteristics and 39 items related to factors affecting work teams. Data analysis was performed using SPSS 23 software through Spearman correlation coefficient, Mann-Whitney, and Kruskal-Wallis tests, and finally, multiple linear regression (the Backward method).&#x0D; Results: The results showed that the dimensions of "team goals" (22.93 ± 5.44) and "personality traits" (8.41 ±1.79) obtained the highest and lowest mean scores, respectively. Furthermore, the results of linear regression analysis showed that the effectiveness of work teams had a significant inverse relationship with the number of shifts (p = 0.034) and a significant direct relationship with employment in the intensive care units (p = 0.032).&#x0D; Conclusion: Based on the findings, several suggestions can be made to enhance the effectiveness of nursing work teams, including hiring adequate staff to reduce the number of nurses' work shifts, particularly in the intensive care units, ncouraging other hospital wards to follow the example of the work in intensive care units, establishing a system for determining and adjusting nurses' work shifts based on their opinions and priorities, conducting monthly, quarterly, and annual assessment based on attendance and participation in nursing work teams, encouraging more active nurses in this field, and considering various rewards for effective nursing work teams.

Gene Expression Patterns of Colorectal Cancer Stem Cells Following Ibuprofen and Hyperthermia Treatment.

Cancer stem cells (CSCs) substantially influence the development of colorectal cancer (CRC), metastasis, relapse, and resistance to therapy. Ibuprofen and hyperthermia can be effective in the treatment of cancer. Herein, we evaluated the effects of hyperthermia and ibuprofen on the isolated-CSCs of CRC. This experimental study was conducted between Sep 2020 and Jan 2022 at the Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Iran. A non-adhesive culture system was used to isolate CSCs from HT-29 cells. To confirm the stemness nature of isolated-CSCs, the expression of stemness genes and protein markers was evaluated by quantitative Real-time PCR (qRT-PCR) and flow cytometry assay. The isolated-CSCs were treated with hyperthermia and ibuprofen. The cell viability was determined by MTT assay and trypan blue staining. The expression of stemness, proliferation, Wnt signaling pathway and apoptosis genes was assessed by qRT-PCR. CSCs were isolated within 14 days. The expression of CD-133 marker and OCT3/4, C-MYC, KLF4, and NANOG genes in isolated-CSCs was higher than HT-29 cells (P<0.05). Cell viability of treated-CSCs were considerably reduced (P<0.05). Hperthermia reduced the expression of OCT3/4, NANOG, PCNA, WNT1 and CTNNB1 genes and increased the expression of P53, BAX, and KLF4 genes (P<0.05). Ibuprofen decreased the expression of OCT3/4, BCL2, NANOG, PCNA, WNT1, and CTNNB1 genes and increased the expression of P53, BAX, and KLF4 genes in treated-CSCs (P<0.05). Hyperthermia and ibuprofen treatment demonstrate an inhibitory effect on colorectal CSCs. However, using combination therapy is remaining to be tested.

Dental students in an orthodontic course flipped classroom: A semi-experimental study on knowledge, practice, attitude, and satisfaction.

The purpose of this study was to determine the students' attitudes before and after the flipped classroom, and the effectiveness of this method to promote the students' lateral cephalograms tracing abilities, students' satisfaction and their final exam scores. This is a single-group quasi-experimental research conducted on dental students of Shiraz University of Medical Sciences (SUMS), Iran in 2019. The intervention was carried out in a blended learning approach with the flipped classroom model. Thirty-five fourth-year dental students participated in a flipped classroom held during a semester for the lateral cephalograms tracing course. The students were provided with the educational materials before the class time through multimedia learning tools and the class time was devoted to discussions. The students were asked to fill out four questionnaires (pretest/posttest attitudes, pretest/posttest self-assessments of theoretical knowledge and practical skills in cephalograms, posttest of satisfaction from quality of the course, and posttest of students' views about effectiveness of blended learning tools) and final exam scores of students. Students' attitudes toward e-Learning were improved after the flipped classroom and the quality of this method was acceptable to the students (p < .001). Their self-assessment of theoretical knowledge and practical skills were promoted (p < .001). While all blended learning tools averaged more than the cut-off-point, short lecture (5.11 ± 0.98) and live feedback (4.98 ± 1.07) were considered to be the most efficient interactive tools. It seems that the flipped classroom has a positive effect on increasing students' knowledge, attitude, and satisfaction. In general, this method of learning seems to be favored by dental students. The findings showed that blended learning had a positive effect on increasing knowledge, performance, and satisfaction among dental students. Therefore, blended learning as a reliable method might be used in training dental students.

Suicidal ideation amongst medical students in Shiraz, South of Iran: a cross-sectional study

Suicide is a preventable act, but irreversible once committed; Hundreds of thousands of people commit suicide annually around the globe. One of the groups at high risk of suicide is medical students. Suicidal ideation (SI) is a forerunner to suicidal attempts which could be assessed. Since there are not enough data about this issue among Iranian medical students, we aimed to estimate the prevalence of SI and risk factors among Shiraz University of Medical Sciences (SUMS) undergraduate medical students. An institutional-based cross-sectional study was conducted from December 2022 to February 2023 in the medical school of SUMS. Students willing to participate were recruited by stratified random sampling technique. Data were collected using a self-administered questionnaire along with Beck Scale for Suicidal Ideation (BSSI) and Depression, Anxiety, and Stress Scale (DASS-21). Bivariate analysis and multivariate logistic regression model were carried out using BlueSky software. The study identified that 76 out of 308 attendees (24.7%, 95% CI: 19.9%-29.5%) reported experiencing suicidal ideation. Very severe depression [AOR= 26.705, 95% CI: (8.825 – 91.046)], Severe depression [AOR= 17.142, 95% CI: (5.567 – 58.121)], positive family history of psychiatric disorders [AOR= 4.181, 95% CI: (1.773 – 10.014)], comorbid mental illness [AOR= 2.502, 95% CI: (1.123 – 5.553)], were found to be statistically related to having SI. This study showed that one out of every four undergraduate medical students at SUMS has SI, which warns everyone to plan and act to prevent the loss of more lives. Depression, family history of psychiatric disorders, and comorbid mental diseases were found to be strongly associated with SI.

Evaluation of Staphylococcus Aureus and Pseudomonas Aeruginosa in Saliva of Patients with Acute Myeloid Leukemia.

Patients with leukemia are prone to infectious and often life-threatening complications. Evidence suggests that a specific oral microbiota may contribute to septicemia, which can delay antineoplastic treatment, compromise treatment efficacy, or even endanger patients' lives. This study investigated the prevalence of Staphylococcus aureus and Pseudomonas aeruginosa in the saliva of patients with acute myeloid leukemia who were candidates for bone marrow transplantation. This cross-sectional study was conducted in 2019 in the Hematology-Oncology Department of Namazi Hospital, Shiraz University of Medical Sciences. The study included 28 patients with acute myeloid leukemia eligible for bone marrow transplantation as the case group and age- and sex-matched healthy individuals as the control group. Unstimulated saliva samples were collected to determine the frequency of Staphylococcus aureus and Pseudomonas aeruginosa. Data were analyzed using SPSS version 18, the chi-square test, and the independent t-test. In the patients with acute myeloid leukemia, 26 (86%) were positive for Staph-ylococcus aureus and 18 (60%) were positive for Pseudomonas aeruginosa. In the healthy group, 11 (22.9%) were positive for Staphylococcus aureus and 3 (6.2%) were positive for Pseudomonas aeruginosa. The frequency of Pseudomonas aeruginosa and Staphylococcus aureus in the saliva samples of patients with acute myeloid leukemia was significantly higher than in the healthy control subjects (p value < 0.05). Chi-square test showed no significant association between age and the frequency of bacteria (p value= 0.27). In the current study, the frequency of Staphylococcus aureus and Pseudomonas aeruginosa in the saliva of patients with acute myeloid leukemia was higher than in the healthy control group.

Analysis of Cesarean Section Causes Using Robson’s Ten Group Classification System in Selected Hospitals Affiliated to Shiraz University of Medical Sciences: A Cross-sectional Study

Background: Robson’s Ten Group Classification System (RTGCS) is widely used to evaluate, monitor, and compare cesarean delivery (CD) rates within and between delivery service centers. This study aimed to investigate the causes of CD in Shiraz teaching hospitals using RTGCS. Materials and Methods: A cross-sectional study on 1787 pregnant women who underwent CD in selected teaching hospitals in Shiraz, Iran, was selected via convenience sampling within 3 months. The data collection tool was a demographic, midwifery, and fertility information questionnaire completed through interviews and medical records. Subjects’ classification was performed based on midwifery concepts and parameters described in RTGCS. The Robson's 10-group classification is based on simple obstetrical parameters (parity, previous CS, gestational age, onset of labour, fetal presentation, and number of fetuses). Data were analyzed using SPSS software and descriptive tests were used to describe the data. Results: Of the 1787 subjects, 455 (25.5%) had planned CS and 1332 (74.5%) had emergency CS. The most common causes of CD were previous CD (58.6%) and fetal distress (27.6%). Overall, 823 (46.1%) had fetal and placental causes, 1268 (71%) had uterine causes, and 78 (4.4%) had maternal causes. Conclusion: The biggest factors that played a role in the CD rate in the present study were termed multipara women with a history of previous CD. The CD rate and the overall size of this group are still increasing, and as a result, women with a history of a previous CD must be motivated more effectively to have a vaginal birth after cesarean delivery (VBAC).

The Potential Role of Autophagy in Progression of Liver Fibrosis in Chronic Hepatitis B Patients Receiving Antiviral Treatment: A Brief Report.

Despite antiviral treatment, some patients with chronic hepatitis B (CHB) progress to cirrhosis. Enhancement of autophagy was implicated in the proliferation of hepatitis B in hepatocytes. This study aimed to evaluate the potential role of autophagy in the progression of liver fibrosis in patients receiving antiviral treatments and having completely inhibited viral replication. This descriptive-analytical study was designed and conducted in 2020 at Mottahhari Hepatitis Clinic affiliated with Shiraz University of Medical Science (Shiraz, Iran). Patients who were on anti-hepatitis B nucleotide treatments for at least two years, and those who were not cirrhotic at baseline but later progressed to cirrhosis were identified to be included in the case group. Besides, for the control group, patients on the nucleotide regimens who did not have cirrhosis at baseline or during follow-up were randomly selected. Ultimately, 16 cases and 14 controls were included in the study. Data were analyzed using SPSS software, and P<0.05 was considered statistically significant. Serum Beclin-1 and LC3 levels were compared between the two groups using enzyme-linked immunosorbent assays. The t test was used to assess the statistical differences between the case and control groups. Beclin-1 level was significantly higher in cirrhosis patients than the control group (1283±244 vs. 1063±257, P=0.024). However, there was no statistical difference between the level of LC3 in the cirrhotic group (168±31) and the control group (150±16) (P=0.065). Autophagy may have a role in the progression of cirrhosis in patients with CHB. Future larger prospective studies are required to determine the effect of blocking on the progression of liver disease in this population A preprint of this study was published at https://www.researchsquare.com/article/rs-1435490/v1.pdf.

Comparative analysis of risk factors for retinopathy of prematurity in single and multiple birth neonates

AimTo conduct a comparative analysis of risk factors for retinopathy of prematurity (ROP) in single- and multiple-born neonates.MethodsIn a retrospective evaluation of 521 premature neonates, encompassing singletons, twins, and triplets born at or before 34 weeks of gestational age with a birthweight of less than 2000 g and who completed the ROP screening program, between 2020 and 2023, in outpatient referral ROP screening clinic affiliated by Shiraz University of Medical Sciences, were included. Neonates with the eligibility criteria were enrolled in the screening program from 28 days old age and followed up to discharge or treatment based on national ROP screening guideline. Data on ROP severity, outcome, treatment modality, and risk factors, including gestational age (GA), birth weight (BW), sex, duration of neonatal intensive care unit (NICU) admission, oxygen supplementation, mechanical ventilation, blood transfusion, method of delivery, and maternal and neonatal comorbidities, were extracted and compared between premature neonates from singleton and multiple births.Results The analysis of the ROP severity distribution revealed 238 neonates (45.7%) with low-risk (type 2 prethreshold ROP or less severe) ROP and 16 (3.1%) with high-risk (type I prethreshold ROP or more severe) ROP who underwent treatment. According to the comparative analysis of risk factors in neonates with ROP requiring treatment, multiple birth neonates exhibited significantly greater GA (27.50 ± 3.27 vs. 30.00 ± 2.00 vs. 31.14 ± 0.38 weeks, p = 0.032 for singletons, twins and triplets, respectively); greater BW (861.67 ± 274.62 vs. 1233.33 ± 347.75 vs. 1537.14 ± 208.86 g, p = 0.002); and shorter duration of NICU admission (60.17 ± 21.36 vs. 34.00 ± 12.17 vs. 12.00 ± 6.32 days, p = 0.001) and oxygen supplementation (47.33 ± 16.57 vs. 36.00 ± 8.49 vs. 4.60 ± 2.41 days, p = 0.001). There was no significant difference between single-born neonates and multiple-born neonates regarding the prevalence of other risk factors. Multiple-born neonates with no ROP and low risk ROP showed significantly lower GA and BW compared to singletons (p < 0.001).ConclusionMultiple gestation neonates may develop high-risk ROP requiring treatment at a greater gestational age and birth weight and at a lower duration of oxygen supplementation and NICU admission compared to the single birth neonates. This pattern prompts a reevaluation of screening criteria, suggesting a potential need to consider multiple birth neonates with lower traditional risk factors in screening programs. This pattern should be further evaluated in larger populations of multiple born premature neonates.

Lesson learned from assessing teachers’ and students’ perspectives regarding the quality of e-learning in medical education during the pandemic: a mixed-methods study

BackgroundThe evaluation of e-learning systems ensures the provision of quality training. The goal was to identify the perspectives of teachers and students on e-learning in medical education during the COVID-19 pandemic at Shiraz University of Medical Sciences (SUMS), Iran.MethodsThis study utilized a convergent mixed methods research design with a two-phase approach to collect and analyze data between June and August 2022. In the first stage, a cross-sectional descriptive study was conducted to evaluate the quality of e-learning systems from the perspective of 400 students. In the second stage, semi-structured interviews were conducted with 10 virtual education professors and 10 student representatives to identify the strengths, weaknesses, opportunities, and threats of virtual education. A validated questionnaire was administered to assess the quality of the e-learning system, and data were analyzed using SPSS-21. Qualitative data were subjected to content analysis.ResultsOur findings revealed that the student support system, the course structure, and the infrastructure and technology subscales’ mean scores were significantly higher than the average level (P < 0.001). However, the professors’ methods of teaching and learning strategies were unsatisfactory. The results of the present study showed that the evaluation mean score was significantly higher among, younger, female, and undergraduate students. Virtual education has strengths and weaknesses, and innovative approaches are needed to enhance student engagement. The lack of appropriate infrastructure and virtual teaching tools for teachers and students is a significant challenge that needs to be addressed. Blended learning is effective in medical education, and the shift from teacher-centered to learner-centered teaching approaches is an opportunity to explore innovative teaching approaches.ConclusionFrom the perspective of students, the quality of eLearning systems at the universities was moderate. Virtual education offers both benefits and drawbacks, and there is a requirement for innovative solutions to enhance student engagement and lessen boredom.

Determination of Serum Procalcitonin Level in Kawasaki Disease

Background: The most frequent cause of coronary artery aneurysm in children is Kawasaki disease (KD). Recently, limited studies on procalcitonin (PCT) were performed to find a biomarker for the diagnosis or prognosis of children with KD. Objectives: This study aimed to compare serum PCT levels between complete and incomplete KD and testify to the predictive validity of PCT for intravenous immunoglobulin (IVIG) resistance and predicting coronary artery lesions (CALs). Methods: This cross-sectional study was conducted at Namazi hospital in Shiraz, Iran, in 2019. All KD patients admitted to the hospital were included, with parental consent obtained. Kawasaki disease patients were categorized as complete KD (cKD) or incomplete KD (iKD). Two-dimensional echocardiography was performed, and peripheral venous blood was examined for PCT levels and other markers. All patients received IVIG and aspirin as standard treatment. The presence of coronary artery abnormalities (CAAs) was determined based on coronary artery size and morphology. We used Stata software version 14.0 for data analysis. Logistic regression models identified predictive factors for coronary complications. This study determined the optimal PCT cut-off point for predicted coronary complications using receiver operating characteristic (ROC) curve analysis. Approval was obtained from the Research Ethics Committees of Shiraz University of Medical Sciences. Results: Procalcitonin values in 38 children hospitalized with acute KD ranged from 0.2 ng/mL to 10 ng/mL, with a mean of 2.65 ng/m. There was no correlation of PCT with patients’ age or gender, incomplete KD, or IVIG resistance. The serum PCT concentration was higher in patients with CAL (P = 0.009). The best PCT cut-off value for CAL prediction was 2.5 ng/mL (corresponding sensitivity = 81.8% and specificity = 68.7%), considering CAL prevalence as the studied group. Conclusions: Supplementary research is needed to determine the sensitivity and specificity of PCT for the diagnosis and prognosis of KD. Procalcitonin might be of value in predicting which children are at increased risk for CALs to intensify therapy.

The association between quality of clinical education and assertiveness in operating room and anesthesia nursing students: A cross-sectional study

BackgroundAssertiveness provides a nurse with the foundation for establishing successful relationships with patients, family members, and healthcare team members. Clinical education creates a unique opportunity to prepare students for professional identity because knowledge alone is not enough to provide safe care, and without clinical education, training efficient and competent people will be very difficult and impossible. This study aimed to determine the association between the quality of clinical education and assertiveness of operating room and anesthesia students. MethodIn this analytical cross-sectional study, 230 students who were in the second year of undergraduate education participated. The research was conducted in the 2022 academic year at the Department of Nursing School, Shiraz University of Medical Sciences. Clinical Education Quality Assessment Questionnaire and Gambler and Ritchie Assertiveness Questionnaire were data collection instruments. Statistical methods used included descriptive statistics such as mean, standard deviation, independent t-test, Chi-square test, and regression analysis. ResultsOut of 230 students participating in this study, 103 were operating room nursing students, and 127 were anesthesia nursing students. One hundred forty-one students were female, and 89 were male, 79 % of whom were aged 18–32 years. A significant relationship was found between the quality of clinical education and interest in the field, the number of children, and employment during education (P = 0.01). Also, a significant relationship was observed between decisiveness and the main variables (P = 0.01). The correlation analysis results showed students who scored higher on assertiveness had reported the quality of their clinical training higher (r = 0.23, p < 0.001). ConclusionAssertiveness as a communication style can play an important role in improving performance and quality of care in tense, stressful care settings. Improving assertiveness can be considered as a useful factor in the clinical training of the operating room and anesthesia nursing students. Therefore, it is suggested that the instructors should include instruction on assertiveness in nursing education courses.

Need assessment of medical school curriculum for MOOCs: perspectives of instructors and students of Shiraz University of Medical Sciences

IntroductionDesigning, developing, and implementing a course without assessing and prioritizing instructional needs may result in inefficiency due to the disregard for the actual needs of the target population. The present study aimed to determine and prioritize medical students’ instructional needs regarding Massive Open Online Courses (MOOCs) at Shiraz University of Medical Sciences.MethodsThis survey study was carried out in three stages (2020–2021) using the Delphi technique. Purposive and snowball sampling methods were used to select the instructors. The students were selected through simple random sampling. The first round of the Delphi technique involved a questionnaire consisting of one open-ended question, completed by 49 basic/clinical faculty members and 47 senior medical students. In the second round, a 5-point Likert scale-based questionnaire was used to prioritize the instructional needs. The reliability of the questionnaire was verified by Cronbach’s alpha coefficient. In the third round, a focus group was used. A total of six expert faculty members and one senior medical student were invited to the focus group session to prioritize the needs. Data were analyzed using Friedman’s non-parametric ranking test in SPSS version 26.ResultsTen instructional needs priorities were extracted, including common pharmacotherapies (antibiotics and narcotics), prescriptions, physiology, anatomy, physical examination, electrocardiography interpretation, radiography, computed tomography scans, serum electrolyte disorders, and cardiovascular and internal (endocrine and metabolic) diseases. The chi-squared calculated value (715.584) indicated a significant difference in the importance of the questionnaire’s questions (P < 0.001). These questions did not have equal value, and the importance, from the respondent’s point of view and the observed distribution of ranks, was not the output of a random factor.ConclusionsThe findings of this study can be used to design MOOCs, revise instructional programs, and adapt the curriculum to meet the needs of general practitioners, which will, in turn, help meet the medical needs of the general population.

The Effects of Mobile Learning and Group Discussion for Psychotropic Drug Education on Nursing Students’ Learning, Satisfaction, and Attitude: An Educational Intervention

Background: Familiarity with and management of drug side effects is among nurses' main educational needs with respect to pharmacological care in psychiatry departments. Objectives: This study aimed to determine the effects of psychotropic drug education through mobile learning and group discussion on nursing students’ learning, satisfaction, and attitude. Methods: This educational intervention was done at EbneSina Psychiatric Hospital, affiliated with Shiraz University of Medical Sciences, in 2018. A total of 28 students were randomly divided into 2 groups, each containing 16 and 12 subjects. The first group underwent the educational intervention through mobile learning. The second group received the educational intervention through group discussion. The students’ learning and satisfaction were assessed and compared before and 2 weeks after the intervention. Attitudes were also assessed within the mobile learning group. Data were analyzed using paired and independent sample t-tests. Results: The results revealed a significant difference in satisfaction between the 2 groups after the intervention (38.69 ± 4.78 in the mobile learning group vs 33.13 ± 5.51 in the discussion group; P = 0.02). However, no significant difference was found after adjustment for baseline, age, and sex. The results also indicated that the students in the mobile learning group developed a significantly more positive attitude after the intervention compared to the baseline (P = 0.038). Conclusions: The study findings indicated that the utilization of smartphones for learning about psychotropic drug management in psychiatric departments might be effective in enhancing student's learning outcomes, satisfaction, and attitude. Thus, further studies with larger sample sizes are recommended to be conducted on other medical and nursing apprenticeships.

Cytogenetic, Clinical, Hematologic, Demographic, Immunohistochemical, and Flow Cytometry Characteristics of Patients with Plasma Cell Neoplasm in Five Years: A First Report from Iran.

The aggregation of clonal plasma cells causes plasma cell neoplasms, which vary in severity and clinical outcomes. The present research focused on the epidemiological, clinical, immunologic, and cytogenetic characteristics of plasma cell neoplasms. In this five-year retrospective cross-sectional study, demographic information such as age and sex, calcium elevation, renal insufficiency, anemia, and bone lesion (CRAB) characteristics, as well as laboratory data including bone marrow and peripheral blood film results, immunohistochemistry, flow cytometry, and cytogenetic study outcomes were collected at Shiraz University of Medical Sciences, Shiraz, Iran. The collected data were analyzed using SPSS Statistics software (version 20.0). Descriptive statistics were reported as numbers, percentages, and mean±SD. 417 newly diagnosed plasma cell neoplasm patients were confirmed by bone marrow or other tissue biopsy tests. 279 patients were men (66.9%). The most prevalent age group was 60-64 years old (18.46%). Plasma cell myeloma (PCM) affected 355 (85.13%) patients, while monoclonal gammopathy of undetermined significance (MGUS) affected 6 (1.43%) patients. Solitary plasmacytoma was seen in 56 (13.42%) patients. At the time of diagnosis, 119 (33.52%) of 355 PCM patients were asymptomatic, whereas 236 (66.47%) patients had at least one CRAB symptom, 55 (15.49%) had two or more, and 14 (3.94%) had three or more. There were 7 (1.97%) cases of amyloidosis. Cytogenetic abnormalities were found in 51.28% (40/78) of the patients. Twenty-one individuals (52.5%) were hyperdiploid with multiple trisomy, while 19 (47.50%) were not. When diagnosed, Iranian PCM patients might have more advanced disease. PCM was more prevalent in young adults, and hyperdiploid was the most common cytogenetic finding in this investigation.

The trend of mortality rates following hospitals downgrading and closures due to outbreak of COVID-19 in Fars province: A comparative cohort study.

Hospitals are one of the most important healthcare centers for providing the patients with different medical needs. Several different factors might cause hospitals to downgrade their services or departments or close down overall. One of the most multifaceted reasons for hospital downgrading or closure is infectious disease outbreaks. In this regard, we aimed to evaluate the effects of hospital closure and downgrading due to the COVID-19 pandemic on the mortality rate of the people residing in Fars province, Iran. We gathered mortality information, including the cause of death, age, sex, place, and time of death of all deceased cases occurring during a period of 3 years, from February 20, 2018 to March 2021 from the forensic medicine and also the Department of Biostatistics in Shiraz University of Medical Sciences. A total of 71,331 deaths have been reported since 2018 through the first quarter of 2021, with 57.9% of total mortality cases attributed to male gender. The total mortality counts ranged from 4229 to 9809 deaths per quarter, from which the minimum rate was reported in the first quarter of 2018 and the maximum in the fourth quarter of 2020. Based on the causes of death, diseases of the circulatory system were shown to be the all-time most frequent cause of death, accounting for a total of 42.8% of recorded deaths, followed by neoplasms (9.77%) and diseases of the respiratory system (9.45%). Although the large number of deaths at the time of the pandemic are immediately due to COVID-19 infection, deaths due to a notable number of other causes have had a significant increase which, along with the specific trend of place and causes of death, shows that the downgrading and closure of hospitals have had a significant impact on overall population mortality.

Prevalence of Influenza Viruses A and B, Adenovirus, Respiratory Syncytial Virus, and Human Metapneumonia Viruses among Children with Acute Respiratory Tract Infection.

Acute respiratory tract infection (ARTI) is a significant cause of morbidity and mortality among children worldwide. The majority of acute respiratory infections in children are caused by viruses, with respiratory syncytial virus (RSV) being the most frequently encountered. Other important viral pathogens include human metapneumovirus, human coronaviruses, adenovirus, and influenza. These infections can lead to complications such as bronchitis and pneumonia. So, this study aimed to evaluate the prevalence of influenza viruses A and B, adenovirus, respiratory syncytial virus (RSV), and human metapneumovirus (HMPV) in children with ARTI. The molecular diagnostic of polymerase chain reaction approach was used to detect influenza (A and B), metapneumovirus, respiratory syncytial virus (RSV), and adenovirus in respiratory samples of children with acute respiratory infection hospitalization in a teaching hospital of the Shiraz University of Medical Sciences in January 2016-March 2017. Of the 340 patients examined, 208 (61.20%) were male and the median age was 3.13 ± 2.38 years. Respiratory viruses were found in 179 (52.64%) patients. The male-to-female ratio was 1.63 : 1 in patients who were viral positive. Detection rates for influenza A, adenovirus, influenza B, RSV, and HMPV were 28.23%, 24.70%, 8.52%, 3.23%, and 2.64%, respectively, and coinfections were detected in 24.02%. The most common combination of two-virus coinfections was IFVA/AdV, followed by IFVB/AdV, AdV, IFVB/IFVA, RSV/IFVA, HMPV/AdV, RSV/AdV, and HMPV/IFVA. The high prevalence of respiratory viruses in children hospitalized with ARTI suggests that viral infection may play a role in disease pathogenesis. This should be confirmed through the conduct of case-control studies and may inform the role of vaccination to prevent respiratory viral infections.

Relationship between sleep quality and marital satisfaction of working women during the premenopausal period

Sleep disorders can adversely affect physical, sexual, and marital health, particularly among middle-aged women. This study aimed to determine the relationship between sleep quality and marital satisfaction of working women during the premenopausal period. In this cross-sectional study, we selected 150 women working at Shiraz University of Medical Sciences in Iran was selected using random cluster sampling. A demographic information form, the Pittsburgh Sleep Quality Index (PSQI), and the Evaluation and Nurturing Relationship Issues, Communication, and Happiness (ENRICH) marital satisfaction scale were used for data collection. The Data were analyzed using SPSS.22 software at a significance level of P < 0.05. Multiple linear regression analysis was employed to predict sleep quality based on marital satisfaction. Our results showed that 79 (52.7%) of the participants had undesirable sleep quality, 87 (58%) had high marital satisfaction, and 32 (21.3%) had very high marital satisfaction. Regression analysis revealed that the total marital satisfaction score could not predict the sleep quality score of the participants. However, as dimensions of marital satisfaction, personality issues negatively (β = 0.327, P < 0.05) and ideological orientation positively (β = 0.336, P < 0.01) predicted the sleep quality score. Based on the prediction of the sleep quality score by personality issues and ideological orientations among the dimensions of marital satisfaction, it seems that life skills training, especially in these two dimensions, may improve the quality of sleep and, as a result, the physical and mental health of working women.