Tehran University Of Medical Sciences Research Articles

The Role of Uterocervical Angle on Preterm Birth Incidence

Background: Preterm birth (PB) is associated with significant morbidities in surviving infants. Accurate prediction of PB is essential for effective prevention and management. Continuous monitoring of cervical parameters has shown utility in several studies. Objectives: This study aimed to investigate the role of the anterior uterocervical angle (UCA) in predicting the incidence of PB. Methods: A prospective, descriptive-analytic study was conducted with 165 pregnant women referred to the prenatal care clinic at Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran, in 2021 - 2022. Participants were selected through convenience sampling. Cervical parameters, including UCA, length, and width, were measured via vaginal ultrasound during each trimester. All women were followed until delivery to determine PB incidence. Data were analyzed using descriptive and analytical statistical tests, including the chi-square or Fisher’s exact test and the independent samples t-test or Mann-Whitney U test. Results: Among the participants, 12 (7.3%) experienced preterm delivery. Cervical length was significantly shorter in women with PB during the second trimester (32.58 ± 4.77 mm vs. 34.68 ± 3.80 mm, P = 0.042) and third trimester (30.00 ± 4.74 mm vs. 32.77 ± 3.88 mm, P = 0.022). The mean UCA in women with preterm delivery was higher than in those with term delivery during both the second (90.58 ± 17.21° vs. 88.66 ± 16.76°) and third (100.25 ± 14.56° vs. 98.89 ± 17.78°) trimesters (P > 0.05). A UCA greater than 105° in the second trimester had a sensitivity of 16.7% and specificity of 81.5% for predicting PB. In the third trimester, a UCA greater than 105° showed a sensitivity of 58.3% and specificity of 60.7% for predicting PB. Conclusions: This study emphasizes the importance of regular cervical parameter measurements throughout pregnancy. A UCA greater than 105° in the third trimester appears to be a potential predictor of PB.

Surface ablation laser surgery: Bibliometric and visualized analysis from 2004 to 2023.

Surface ablation laser surgery has resurged in popularity recently because of its safety in correcting myopia and favorable postoperative corneal biomechanical properties. This study aimed to investigate the current focal points and future trends in surface ablation laser surgery over the last 2 decades. The Web of Science Core Collection was used as the primary data source to retrieve literature related to surface ablation laser surgery. All records, including full records and reference details, were exported in plain text format. VOSvivewer, CiteSpace, and Pajek were used to perform the bibliometric and visual analyses of the countries/regions, institutions, authors, journals, and keywords of relevant publications. A total of 3415 articles on surface ablation laser surgery were published in 253 journals. These articles were authored by 9681 individuals from 2751 institutions across 79 countries. The United States leads in terms of productivity and influence in this field. The Tehran University of Medical Sciences and Kymion GD were the most productive institutions and authors, whereas the University of Crete and Randleman JB were the most influential. The Journal of Cataract and Refractive Surgery was the most productive and influential in this area, and citation analysis revealed that the top 10 most-cited references focused primarily on postoperative wound healing and wavefront aberration. The keywords were grouped into the following 5 clusters: clinical effects and complications, special indications, iatrogenic corneal ectasia, haze, and pain management. High-frequency keywords in recent years included transepithelial photorefractive keratectomy, retreatment, transepithelial phototherapeutic keratectomy, and biomechanical properties. This bibliometric analysis examined the development trends, global cooperation, research hotspots, and future directions of surface ablation over the past 20 years.

Traveling with a desirable destination: a dialogical analysis of professional identity formation among freshman medical students.

We aimed to examine medical students' perceptions regarding their professional identity and explore their creative narratives utilizing the Dialogical-Self Theory (DST). This is a mixed-method study. First-year medical students at Tehran University of Medical Sciences (TUMS, Tehran, Iran wrote a creative narrative about their perspectives on their future profession. Based on DST, qualitative-directed content analysis and summative approach were used to identify and quantify different "I-positions" to assess professional identity formation. One hundred eighty-eight first-year medical students at TUMS participated in the study in 2021-2022. In the creative narratives, the reference to "I" was more than other pronouns (he/she/they). The use of "I" positively correlated with rank in the university entrance exam (P value = 0.03). The highest application of "I" per participant belonged to the "present I-position," and the lowest to the "promoter," which has the highest rank in the formation of professional identity. Women tended to use the "present I-position" more than men (P value = 0.03). First-year medical students have accepted their self-role in forming professional identity; however, they have not found a vast perspective of it, as shown by their inability to use meta I-position and promoter I-position. Therefore, educators must provide plans within the curriculum to enhance competencies of professional identity formation. These plans can include incorporating narration writing to encourage medical students to reflect on their professional identity.

Investigating the Effect of COVID-19 Vaccination on the Course of Disease and Recurrence of Attacks in Patients with Multiple Sclerosis

Background: The COVID-19 pandemic, with its high mortality rate, has underscored the urgent need for the rapid production of vaccines. This has prompted research into the effects of vaccines on specific populations, including patients with immune diseases such as multiple sclerosis (MS). Objectives: This study aimed to examine the impacts of COVID vaccination on individuals with MS. Methods: A retrospective cohort study was conducted involving 302 patients with relapsing-remitting MS who had received the coronavirus vaccine. These patients were referred to the MS clinic of two referral hospitals affiliated with Tehran University of Medical Sciences. The data collection instrument used was a checklist that included demographic information and disease-related details, such as the duration of the disease, underlying conditions, type and timing of vaccine administration, and the occurrence of attacks before and after the vaccination rounds. Results: During the first and second rounds of vaccination, the majority of patients (90.7% and 87.1%, respectively) received the Sinopharm vaccine. In the third round, approximately one-third (32.8%) did not receive the vaccine, and in the fourth round, the majority of individuals (85.8%) also did not receive it. However, most vaccinated individuals had received the Sinopharm vaccine. Among the sample, 34 individuals (11.3%) were newly diagnosed with MS after receiving the vaccine. Additionally, 41.7% of individuals experienced an attack within three months after receiving one of the vaccine doses. Conclusions: Vaccinations during the COVID era have significantly contributed to saving lives and preventing death. However, they have also had consequences that need careful examination and consideration in future vaccine production and epidemic management. The results obtained from this study can be associated with the vaccine, but given the retrospective nature of the study, further research on the long-term effects of the vaccine is needed to generalize the findings.

Indirect estimation of the prevalence of type 2 diabetes mellitus in the sub-population of Tehran: using non-laboratory risk-score models in Iran

BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) in the population covered by the Tehran University of Medical Sciences is unclear but crucial for healthcare programs. This study aims to validate four non-laboratory risk-score models, the American Diabetes Association (ADA) Risk Score, Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK), Finnish Diabetes Risk Score (FINDRISC), and TOPICS Diabetes Screening Score, for identifying undiagnosed diabetes and indirectly estimate the prevalence of T2DM in a subset of the Tehranian population using the selected model.MethodsThis research consisted of two main parts. In the first part, non-laboratory risk-score models to identify undiagnosed T2DM were validated using Iranian data from STEPs 2016 survey. The model performance was evaluated through the Area Under the Curve (AUC) and calibration via the observed-to-expected (O/E) ratio. Additional independent data from STEPs 2011 survey in Iran were utilized to test the model results by comparing indirect prevalence estimates with observed estimates. In the second part, the prevalence of T2DM was estimated indirectly by applying the selected model to a representative random sample from a Tehranian population telephone survey conducted in 2023.ResultsAmong the different models used, AUSDRISK showed the best performance in both discrimination (AUC (95% confidence interval (CI)): 0.80 (0.78, 0.81)) and calibration (O/E ratio = 1.01). After updating the original model, there was no change in the AUC value or calibration. Additionally, our findings indicate that the indirect estimates are nearly identical to the observed values in STEPs 2011 survey. In the second part of the study, by applying the recalibrated model to a subsample, the indirect prevalence of undiagnosed diabetes and T2DM (95% CI) were estimated at 4.18% (3.87, 4.49) and 11.1% (9.34, 13.1), respectively.ConclusionGiven the strong performance of the model, it appears that indirect method can provide a cost-effective and simple approach to assess disease prevalence and intervention effectiveness.Graphical

Serum melatonin levels and in a sample of Iranian patients with migraine

Migraine, a complex disorder, is characterized by recurrent headache episodes. The production of melatonin in the pineal gland, which is crucial for controlling circadian rhythms and sleep–wake cycles, is altered in various conditions, including neurological disorders such as migraine. Recent studies underscore the significance of serum melatonin levels in patients with chronic and episodic migraine, the focus of this study. This case‒control study, conducted from September 2017 to June 2020 in Tehran, Iran, selected potential participants aged 18–65 years from a headache clinic at Sina Hospital (affiliated with Tehran University of Medical Sciences). Both episodic migraine and chronic migraine were diagnosed following the diagnostic criteria in the International Classification of Headache Disorders’ third edition. Melatonin levels were measured according to the instructions of the ELISA kits. There were significant differences in the frequency of headache days and the duration of abortive medication usage between the two groups (P value < 0.001). Besides, analysis revealed significantly lower serum melatonin levels in patients with episodic ((80.45–45.06) 72.83) and chronic migraine ((154.34–63.34) 70.38, P value < 0.001) than in healthy controls (281.25–160.86) 280). Although no considerable differences were found between episodic and chronic migraine patients, the current study demonstrated that serum melatonin levels were substantially greater in healthy controls than in patients with migraine.

CHRNE-related Congenital Myasthenic Syndrome in Iran: Clinical and Molecular Insights

Variants in the CHRNE gene can lead to a condition called congenital myasthenic syndrome (CMS), which affects the neuromuscular junction (NMJ). CHRNE mutations are the most common cause of CMS. Seventy-seven patients with a possible diagnosis of CMS were referred to the neuromuscular clinic of Shariati Hospital affiliated with the Tehran University of Medical Sciences. We performed whole-exome sequencing (WES) to determine the underlying defect in a group of individuals with a possible diagnosis of CMS. Clinical features and morphological and molecular data on 33 patients with mutations in CHRNE were described. Age of onset, age at diagnosis, consanguinity, family history, motor milestone delay, ophthalmoparesis, generalized fatigue, dysphagia, neurophysiologic findings, and response to treatment of the patients were assessed. Nineteen CHRNE variants including 10 novel ones were identified. The most common mutations were c.1327del; (p.Glu443LysfsTer64) in four different families and c.1252-1267dup; (p.Cys423SerfsTer38) in three families. Clinical onset was mostly at birth or under one year with bilateral fatigable ptosis, ophthalmoplegia, bulbar weakness, and proximal muscle weakness. All patients were treated with pyridostigmine ± salbutamol, which resulted in improvement of motor function, dysphagia, and breathing.

An Empirical Investigation of Organizational Readiness towards Hospital Autonomy.

We aimed to investigate Tehran's University of Medical Sciences (TUMS) affiliated hospitals organizational readiness toward implementing the 'Autonomous Hospitals' program as a change initiative from a managerial perspective in 2020. A census covering all eligible managers working in TUMS affiliated hospitals, Tehran, Iran (350 individuals) was carried out. Overall, 281 questionnaires were returned (a 30% non-responsiveness rate). A standard construct was adopted for data collection which was validated through a process of translation- back translation, face validity, and content validity (CVI=0.86, CVR=0.76). The reliability was acquired using Cronbach's alpha coefficient (0.87 and over 0.7). Both descriptive and inferential statistics were employed to draw conclusions .SPSS 26 was used for data analysis. Total organizational readiness for change (TORC) in hospitals was 60.75%±10.11 showing a state of medium to upper-medium readiness status. Also, the 'Clear mandate and centralized leadership' theme scored the lowest mean (53.02%±15.78) for ORC. 'Hospital accreditation level' (r=-0.14, P≤0.05), 'bed occupancy rate' (r=-0.19, P ≤0.05), and 'leadership status' (r=0.26, P≤0.001), also showed significant association with TORC. In addition, 'standardized bed occuPancy rate' (P≤0.05, B=-2.41), a 'male' leader (P ≤0.05, B=3.42), and 'academic affiliation' (P≤0. 1, B=-9.52), were good Predictors of TORC based on 'Backward Multiple Linear Regression' analysis. Full support from hospital and headquarters executives, delegation of sufficient decision-making authority to hospital managers, and implementation of comprehensive performance evaluation criteria were prerequisites for robust hospital autonomy in TUMS-affiliated hospitals.

THE ANTICOAGULATION STRATEGIES FOR MANAGEMENT AND PREVENTION OF STROKE IN NEUROLOGICAL PRACTICE

Strokes are categorized as either ischemic or hemorrhagic and the specific interventions will be based on the type of stroke. About 13% of stroke is hemorrhagic and 87% is ischemic. Transient Ischemic Attacks require emergency intervention to decrease the threat of stroke, which is thought to be maximum within the first few days after TIA. Anticoagulants play a major role in the primary and secondary prevention of ischemic strokes. The optimal timing of anticoagulants initiation or resumption inpreventing and managing ischemic strokes is very important. This article will explore certain controversies surrounding this issue, while also highlighting the benefits of antithrombotic therapy used in prevention of ischemic strokes in antiphospholipid antibody syndrome (APS), atrial fibrillation, prosthetic heart valve, cancer, and vascular disorders. Aggressive local and regional efforts to organize stroke care and greater use of evidence-based recommendations may help improve outcomes. Peer Review History: Received 16 May 2024; Reviewed 11 July 2024; Accepted 24 August; Available online 15 September 2024 Academic Editor: Essam Mohamed Eissa, Beni-Suef University, Egypt, dressamceutics@yahoo.com Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Taha A.I. El Bassossy, Medicinal and Aromatic Plants Department, Desert Research Center, Cairo, Egypt, tahachemist2008@gmail.com Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com

THE IMPACT OF COLLABORATIVE CARE ON COST OF TREATMENT FOR THE MANAGEMENT OF HYPERTENSION- A SYSTEMATIC REVIEW

Introduction: For evaluation of the long term costs and benefits of physician-pharmacist collaboration associated with physician management for the treatment of essential hypertension. Around the world the major cause of death is hypertension. It is an incurable condition that requires proper therapeutic regimens for its life-long management. Due to this, hypertension therapy can be financially burdensome to the patient, and the rates of non-compliance are increased. Aims and Objectives: To observe the results of collaborative, clinical, and interventive approaches to hypertension management, on the cost-effectiveness of therapy, this study aimed to collect and compare cost information on hypertension management, mortality, and morbidity across different countries and cost groups. Using this information, future healthcare expenses can be better planned; for example, by initial emergency response or by changing the way money is distributed. This will lead to more high-pressure jobs. Therefore, it will be more costly to control blood pressure. Method: A systematic review was conducted using 6 major electronic databases that investigated the influence of collaborative care upon healthcare expenses in hypertensive patients and hypertension therapy costs, before and after the intervention of medical personnel, was observed. Conclusions: It was concluded that interventions provided by the collaboration of medical personnel, in the management of hypertension, made the therapy more cost-effective and hence the rate of patient compliance and adherence to the therapy were increased. Peer Review History: Received 18 May 2024; Reviewed 11 July 2024; Accepted 26 August; Available online 15 September 2024 Academic Editor: Dr. Tamer Elhabibi, Suez Canal University, Egypt, tamer_hassan@pharm.suez.edu.eg Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Ogbonna B. Onyebuchi, Nnamdi Azikiwe University, Awka, Nigeria, summitpharm@yahoo.com Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com

EFFECT OF INTERMAXILLARY FIXATION ON BIOCHEMICAL AND BLOOD MARKERS IN A SAMPLE OF YEMENI ADULTS

Background: Intermaxillary fixation is a technique that is used in the treatment of jaw fractures, orthognathic surgery, temporomandibular joint disorders, and occasionally morbid obesity. However, it disrupts normal nutrition, leading to weakened immunity, impaired healing, and higher complication risks, negatively impacting treatment outcomes and patient recovery. Thus, the aim of this study was to investigate the physiological changes in a sample of Yemeni patients following four weeks of IMF treatment. Materials and Methods: A study involving ten Yemeni adults underwent intermaxillary fixation for mandibular fractures. Parameters like body weight, lipid profile, liver function tests, kidney function tests, electrolytes, and hemoglobin levels were analyzed before and after treatment at a central blood bank. Results: The majority of patients were male (80.0%) and aged between 25 and 35 years, and the majority had a unilateral mandibular body fracture (50%). Clinical results after 4 weeks of intermaxillary fixation demonstrated significant reductions in body weight (4.2 kg) and BMI (1.0 kg/m2). post-IMF application, lipid profile analysis showed non-significant changes in total cholesterol, high-density lipoprotein levels, low-density lipoprotein, and triglycerides (p&gt;0.05), liver function tests exhibited significant decreases in AST (7.7 µ/l, p=0.044), kidney function tests and electrolyte analysis revealed non-significant changes, and there were significant reductions in T.WBC (2.48 x 10⁹/L) and neutrophils (19.5%) after IMF (p=0.007). Conclusions: Intermaxillary fixation in Yemeni adults leads to weight loss and changes in liver and blood parameters, indicating its systemic effects. These findings highlight the importance of nutritional support and close monitoring during IMF treatment to mitigate malnutrition risks and optimize healing outcomes. Peer Review History: Received 21 May 2024; Reviewed 15 July 2024; Accepted 25 August; Available online 15 September 2024 Academic Editor: Dr. Marwa A. A. Fayed, University of Sadat City, Egypt, maafayed@gmail.com Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Prof. Abdulwahab Ismail Al-kholani, Dean of Faculty of Dentistry at 21 September University, Yemen. prof_khholani@yahoo.com Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com

TREATMENT OUTCOMES IN PCOS (POLYCYSTIC OVARIAN SYNDROME)-RELATED INFERTILITY

Polycystic ovarian syndrome (PCOS) is one of the underdiagnosed endocrine disorders found to be prevalent among females in the reproductive age group. PCOS effects on an average 8-13% of reproductive aged women, globally. This condition is responsible for causing distress physiologically and psychologically paving the way for a poor quality of life. One of the devastating complications of PCOS is infertility. At present, there is no treatment for PCOS but could be managed by alternate options such as lifestyle modification to in-vitro fertilization. The primary objective of this review article is to analyze the outcomes of certain pharmacological treatment options such as clomiphene citrate which is a selective estrogen receptor modulator, Letrozole an aromatase inhibitor, and gonadotropins for PCOS-related infertility. Clomiphene citrate binds to estrogen receptors indirectly increasing the gonadotropins. Studies confirm a 35-40% successful outcome. Letrozole similarly increases gonadotropins by indirectly decreasing estrogen. A notable increase in the successful outcome was observed with both clomiphene citrate and letrozole, with almost near similar results. The pregnancy outcome was approximately 40% with clomiphene citrate, while letrozole showed 50%. Notably, more side effects were observed in the administration of clomiphene citrate compared to letrozole. Human menopausal gonadotropin (hMG) and recombinant follicle-stimulating hormone (FSHr), that are gonadotropins, were used as they are directly responsible for the maturation of follicles and ovulation itself. The use of gonadotropins increased the pregnancy rate outcome to 20 -30 %, albeit with the risk of multiple births. Furthermore, we have discussed why letrozole and clomiphene citrate are used as the primary therapy compared to gonadotropins. Peer Review History: Received 22 May 2024; Reviewed 14 July 2024; Accepted 23 August; Available online 15 September 2024 Academic Editor: Dr. Rola Jadallah, Arab American University, Palestine, rola@aauj.edu Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com Dr. Ogbonna B. Onyebuchi, Nnamdi Azikiwe University, Awka, Nigeria, summitpharm@yahoo.com

PREVALENCE OF PAROTID TUMORS AMONG YEMENI PATIENTS IN SANA'A CITY, YEMEN

Background and aims: Parotid gland tumors (PGT) are a moderately scarce group of tumors with a broad range of histopathological manifestations and clinical characteristics. To date, most epidemiological studies on salivary gland tumors including PGT are limited in Yemen and this is one of the first studies, so the aim of the study was to determine the prevalence of different tumors affecting the parotid glands and the effect of age and sex on their distribution. Methods: Epidemiological information as well as demographic data, anatomical site, and histological analysis of PGT were analyzed. The data analyzed included age, sex, site, and histological diagnosis. Data were collected from all histopathological centers covering the majority of Sana'a city between 2019 and 2023. Results: A total of 284 cases- 69% benign and 31% malignant tumors were examined. Both benign and malignant tumors showed a little male inclination (52.5%) and a peak occurrence between the third and fifth decade. Malignant tumors make up 31% of patients, while benign tumors make up 69%. Mucoepidermoid carcinoma (36.4%) and adenoid cystic carcinoma (11.4%) are two common malignant tumor types. Benign parotid tumors include pleomorphic adenoma (71.4%) and Warthin tumors (11.2%) of benigns. Other malignants and benigns are less frequent. Conclusions: This study presents the first prospective study to date to analyze PGT data from health centers spread across Sana'a city. These results should serve the same as the basis for prospect studies assessing the epidemiological geography of these tumors in Sana'a in particular and Yemen in general. Peer Review History: Received 18 May 2024; Reviewed 12 July 2024; Accepted 23 August; Available online 15 September 2024 Academic Editor: Dr. Nuray Arı, Ankara University, Turkiye, ari@ankara.edu.tr Average Peer review marks at initial stage: 6.5/10 Average Peer review marks at publication stage: 7.5/10 Reviewers: Asmaa Ahmed Mohamed Ahmed Khalifa, Pharos University, Alexandria, Egypt, asmaa.khalifa@pua.edu.eg Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com

ASSESSMENT OF THE ANATOMICAL STRUCTURE OF CANALIS SINUOSUS IN THE ANTERIOR MAXILLA TO AVOID SURGICAL COMPLICATIONS

Aims: The study's objective was to evaluate the canalis sinuosus (CS) anatomical structure in the front maxilla in order to prevent surgical problems in an adult Yemeni population sample acquired using cone-beam computed tomography (CBCT). Materials and Methods: A retrospective descriptive cross-sectional study was carried out to assess 226 participants' CBCT pictures. 452 sides in total were assessed. There were 140 females (61.9%) and 86 males (38.1%) among the samples. The age distribution was 18–34 years (65%) and over 35 years (35%), with a mean age of 32.13. Version 25 of the Statistical Package of the Social Sciences (SPSS) was used for all statistical analyses. Result: It was discovered that 160 right (35.4%) and 175 left (38.7%) of the 226 patients and 452 sides had CS. Among these individuals, 117 (51.8%) had unilateral CS and 109 (48.2%) had bilateral CS. The CS was 8.12 mm from the nasal cavity floor (D1), 6.99 mm from the buccal cortical bone ridge (D2), and 13.47 mm from the crest of the alveolar ridge (D3), as the mean distances were measured. Males and females had somewhat higher mean values for the linear measurements D1 and D3, but females had slightly higher mean values for the linear measurement D2. The CS had a mean diameter of 1.11 mm. Left central incisor area was the most commonly observed location of CS, and palataly was the most frequently recorded location of CS. Conclusion: Since the CS is present in 100% of adult Yemenis, it is imperative that general practitioners and maxillofacial surgeons become more knowledgeable about the position and structure of the CS. Peer Review History: Received 19 May 2024; Reviewed 12 July 2024; Accepted 23 August; Available online 15 September 2024 Academic Editor: Dr. Iman Muhammad Higazy, National Research Center, Egypt, imane.higazy@hotmail.com Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Prof. Gorkem Dulger, Duzce University, Turkey, gorkemdulger@yandex.com Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com

HEPATITIS C VIRUS AND LEUKEMIA PATIENTS: PREVALENCE AND RISK FACTORS ASSOCIATED WITH INFECTION AMONG LEUKEMIA PATIENTS WHO ACHIEVE LONG-TERM REMISSION AFTER CHEMOTHERAPY

Aim and objective: Leukemia patients are at elevated risk of hepatitis C virus infections, with anti-HCV prevalence ranging from 4.3% to 70% post-chemotherapy remission. Long-term leukemia survivors' natural histories are unclear. We measured anti-HCV antibodies to investigate the frequency of HCV infections and the associated odds factors of contracting HCV among leukemia patients who achieved long-term remissions after chemotherapy. Methods: This study is a cross-sectional study, comprising leukemia patients at the oncology center at Kuwait Hospital in Sana'a, Yemen. It included people with leukemia of different ages and genders. Data was collected through a standard questionnaire prepared for this study, which includes clinical symptoms, risk factors, demographic data, and the results of diagnostic tests. Antibody tests for the hepatitis C virus (HCV) were done by ELISA. Results: The majority of patients with HCV are male, with a mean age of 12.8 years. The prevalence is 5.5%, with males having a higher prevalence. Most patients receive blood transfusions more than twice, with major blood banks, Al-Kuwait hospitals, and private hospitals being the primary sources. AML and ALL are the two most common leukemias. Male patients have a higher risk, and those over 15 years old have a higher risk. Conclusions: This study is the first in Yemen to investigate the prevalence of HCV infections in patients with leukemia. According to our research, leukemia patients had a greater prevalence of HCV than the general population's national prevalence. However, health care workers (HCWs) and patients receiving maintenance hemodialysis (HD) patients have prevalence's of HCV that are comparable. Peer Review History: Received 14 May 2024; Reviewed 13 July 2024; Accepted 22 August; Available online 15 September 2024 Academic Editor: Dr. DANIYAN Oluwatoyin Michael, Obafemi Awolowo University, ILE-IFE, Nigeria, toyinpharm@gmail.com Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Tamer Elhabibi, Suez Canal University, Egypt, tamer_hassan@pharm.suez.edu.eg Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com

THE IMPACT OF DRUG COST ON MEDICATION ADHERENCE IN NIGERIA: A PERCEPTION AMONG PHARMACISTS

Background: Given Nigeria's huge economic instability, medication expenses may significantly impact medication adherence, creating a barrier to the treatment of various ailments. The study aimed to assess pharmacists' perceptions about the impact of drug costs on medication adherence in Nigeria. Methods: The study was cross-sectional among practicing pharmacists across Nigeria. The 25 items semi-structured questionnaire was administered online using simple random sampling with the snowballing technique to recruit the pharmacists for the study. The collected data was coded into Microsoft Excel 2016 and subsequently analyzed using IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were utilized to summarize the data, providing an overview of the demographic characteristics and key findings. Inferential statistics, specifically Pearson’s Chi-square test, were employed where applicable to determine the relationships between variables. Results: Total 161 pharmacists responded to the survey, giving an 80.5% response rate. The respondent rate was mainly young pharmacists (20–30 years old; 82.6%) and predominantly male (51.6%). Almost all the respondents possess only a bachelor of pharmacy degree (91.9%). Total 90% have practiced for 5 years or less, mostly in community settings (60.9%). Generic substitution has been cited as the most important technique to manage drug costs. Non-adherence due to cost was associated with practice settings, whereas adherence counseling was correlated with gender and setting of practice. All differences were not statistically significant at p&lt;0.05. Conclusions: Most participants believe that the cost of medication is a major barrier to accessing quality healthcare and drives massive non-adherence among those who can barely afford the medicines. Implementing a comprehensive national strategy to enhance the healthcare system, expand the reach of the national health insurance program, and promote cooperation among healthcare practitioners will result in improved clinical outcomes for patients. Peer Review History: Received 22 May 2024; Revised 11 July 2024; Accepted 26 August; Available online 15 September 2024 Academic Editor: Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Prof. Hassan A.H. Al-Shamahy, Sana'a University, Yemen, shmahe@yemen.net.ye Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com

Bibliometric Mapping of the Scientific Production of Lasers in Endodontics: Collaborative Networks, Impact, and Trends

Abstract Aim: The objective of this study is to perform a bibliometric mapping of the scientific production of lasers in endodontics using collaborative networks, impact, and trends. Materials and Methods: This retrospective and descriptive study used a bibliometric design to analyze laser use in endodontics in Scopus from 2018 to 2024. In total, 877 documents were identified using key terms and MeSH. Bibliometric indicators were used to explore scientific activity and impact, and VOSviewer was used for data analysis. Results: It was found that the year with the highest number of publications was 2023, with 166, and the quartiles with the highest productivity were Q1 (40.3%) and Q2 (31.1%). Among the top 5 countries with the highest publications production, Brazil led the group with 125, followed by India (111). Among the institutions with the highest production, the Universidade de São Paulo tops the list with 51 research papers, closely followed by the Tehran University of Medical Sciences with 32 and the Universidade Estadual Paulista Júlio de Mesquita Filho with 30. Among the most outstanding authors, we have Chiniforush Nasim, who has 20 papers; however, Duarte Marco has an h-index of 48, and Sivieri-Araújo Gustavo has the highest number of citations. Conclusion: This bibliometric mapping reaffirmed the vision and trends of lasers in endodontics, with 2023 being the most relevant in terms of scientific production and, among the countries with the highest number of publications, Brazil stood out.

Evaluating the Decision-Making Proficiency Among Medical Residents at Tehran University of Medical Sciences in the Year 2022-2023: A Descriptive Cross-Sectional Study

Background: To evaluate the decision-making proficiency among medical residents at Tehran University of Medical Sciences in the year 2022-2023. Methods: A structured online web-survey via national approved services Author’s designed questionnaire was used to collect the relative data based on variables of the study and was developed by the authors of the study by reviewing the previously conducted studies. The forms were sent to the medical residents at Tehran University of Medical Sciences as a link via electronic mail and social media; assistance was offered via direct or indirect contact upon request. Results: In this study, 88 medical residents of Tehran University of Medical Sciences were evaluated. Out of 88 participants, the frequency of females was 52(59.09%) and frequency of males was found out to be 36(40.91%). The frequency of the first- year residents was 28(37.50), second year residents was 33(21.59), third year residents was 19(9.09) and the fourth- year residents was found out to be 8(31.82). The frequency of different specialties were: Pathology 1(1.14%), Infectious diseases 1(1.14%), Cardio vascular diseases 1(1.14%), Emergency medicine 1(1.14%), Orthopedics2(2.27%), Psychiatry 3(3.41%), ENT 12(13.64%), Internal Medicine 13(14.77%), Pediatrics13(14.77%), OB&amp;GYN 19(21.59%), Anesthesiology19(21.59%), Dermatology 2(2.27%), General Surgery 1(1.14%). Conclusion: There is a significant relationship based on linear regression between not having self - reported availability bias and surgical residency specialties. The surgical specialty is less prone to the availability bias. A difference of communication exists between the surgical and nonsurgical speciality and the nonsurgical specialties need to confirm their decision using other methods to prevent the patient harm.

The Assessment of Effectiveness of Anesthesiology Rotation in Acquiring Proficiency in Cardiopulmonary and Cerebral Resuscitation for Medical Students at Tehran University of Medical Sciences in the Years 2021-2022

Background: Whether in a hospital setting or in the community, medical students are exposed to cardiac arrests. Fast response and effective resuscitation are main determinants for decreasing mortality and morbidity due to cardiac arrests. We assessed the effectiveness of anesthesiology rotation in acquiring cardiopulmonary and cerebral resuscitation for medical students. Methods: A pre-test/post-test quasi experimental design was undertaken, comprising A fortuitious sample of medical students who were undergoing anesthesiology rotation at Tehran University of Medical Sciences hospital complexes during the academic year 2021-2022 using a self-administered questionnaire to evaluate their theoretical comprehension, knowledge, skills and before and after the rotation. Results: The study revealed an increase in theoretical scores (mean dif +2.6/20), increased in self-assessment knowledge scores (mean dif + 0.84/5), as well as an increased in self-assessment skill scores (mean dif +0.96/5). The highest scored were witness in students with previous cardiopulmonary resuscitation (CPR) experience. Conclusion: It is of extreme importance for medical students to participate in anesthesiology rotations. It is essential for possessing the appropriate knowledge and skills to provide effective resuscitation care and gain confidence to perform CPR.

The relationship between nurses’ professional commitment and missed nursing care: a cross-sectional study in Iran

Background & aimsMissed nursing care is a global challenge that can have many consequences and it’s known as a common threat to the patient safety and quality of nursing care. The nurses’ professional commitment plays the final role in the occurrence of this issue. This study aimed to investigate the relationship between nurses’ professional commitment and missed nursing care in Iran.Materials & methodsThis cross-sectional descriptive-analytical study was conducted on 270 nurses working in two hospitals affiliated to Tehran University of Medical Sciences (Sina & Shariati) from September to December 2023. The research community included all nurses working in medical-surgical wards in the designated hospitals. The research samples were included in a targeted and quota method after obtaining organizational permits, ethical approval and informed consent. Data collection was done using three questionnaires including demographic information form, Nursing Professional Commitment Scale, and MISSCARE Questionnaire. The collected data was analyzed in SPSS software, version 25.ResultsThe results of Pearson’s correlation test showed that there is a significant negative relationship between nurses’ professional commitment and missed nursing care scores (r=-0.23) (p < 0.001). The mean score of nurses’ professional commitment was reported at a moderate to high level (83.72 ± 16.02) and the mean score of missed nursing care was reported at a low level (47.84 ± 16.48). Nurses over 40 years old, morning shift and employed nurses showed higher professional commitment. Also, nurses under 29 years old and male nurses had more missed nursing care other than their participants. No relationship was observed between other demographic variables with nurses’ professional commitment and missed nursing care.ConclusionThe results of this study showed that higher nurses’ professional commitment leads to higher quality of care and less missed nursing care. Based on findings of this research, it is recommended for health care providers and nursing managers to adopt programs to increase nurses’ professional commitment and consequently reduce missed nursing care.