Comment on Viderman et al. Remote Monitoring of Chronic Critically Ill Patients after Hospital Discharge: A Systematic Review. J. Clin. Med. 2022, 11, 1010.

Viderman et al. undertook this systematic review with the intent of providing evidence on the potential application of remote monitoring in chronic critically ill patients post-hospital discharge [...].

Iranian medical students' tendency to migrate and its associated factors.

BACKGROUND: Medical staff migration is one of the challenges for both developed and developing countries affecting society's health and welfare, which limits access to equity. Therefore, this study was designed and conducted to investigate the tendency to migrate and the factors affecting it among medical students of the Tehran University of medical sciences, Tehran, Iran, in 2019. METHODS: This cross-sectional study was performed among 472 medical students using a valid questionnaire which was designed after reviewing the literature and using the opinions of experts. The tendency to migrate and its associated factors were analyzed and reported using the Pearson correlation test, independent t-test, one-way ANOVA test, Tukey post-hock test, and Kruskal-Wallis non-parametric test. RESULTS: According to this study, the tendency to migrate was 6.13 ± 2.82 out of 10. While there was no significant relationship between age, marital status, medical educational phase and the tendency to migrate (p > 0.05); There was a significant relationship between willingness to migrate with variables of gender (p = 0.027), pre-university study region (p < 0.001), father's academic degree (p = 0.007), mother's academic degree (p < 0.001), having the relative abroad (p < 0.001), foreign trip experience (p < 0.001), foreign language skills (p < 0.001), number of published articles (p = 0.005) and Iran's National Elite Foundation membership (p = 0.039). CONCLUSIONS: Females, elites, and those with higher socioeconomic state, previous exposure to foreign countries, the ability to speak foreign languages, and research activity are more likely to migrate. Considering the high tendency to migrate among Iranian medical students, urgent and severe strategies must be undertaken to solve this social and health problem.

Preclinical study of formulated recombinant nucleocapsid protein, the receptor binding domain of the spike protein, and truncated spike (S1) protein as vaccine candidates against COVID-19 in animal models.

BACKGROUND: In this pre-clinical study, we designed a candidate vaccine based on severe acute respiratory syndrome-related -coronavirus 2 (SARS-CoV-2) antigens and evaluated its safety and immunogenicity. METHODS: SARS-CoV-2 recombinant protein antigens, including truncated spike protein (SS1, lacking the N-terminal domain of S1), receptor-binding domain (RBD), and nucleoprotein (N) were used. Immunization program was performed via injection of RBD, SS1 +RBD, and SS1 +N along with different adjuvants, Alum, AS03, and Montanide at doses of 0, 40, 80, and 120 µg at three-time points in mice, rabbits, and primates. The humoral and cellular immunity were analyzed by ELISA, VNT, splenocyte cytokine assay, and flow cytometry. RESULTS: The candidate vaccine produced strong IgG antibody titers at doses of 80 and 120 µg on days 35 and 42. Even though AS03 and Montanide produced high-titer antibodies compared to Alum adjuvant, these sera did not neutralize the virus. Strong virus neutralization was recorded during immunization with SS1 +RBD and RBD with Alum. AS03 and Montanide showed a strong humoral and cellular immunity; however, Alum showed mild to moderate cellular responses. Ultimately, no cytotoxicity and pathologic change were observed. CONCLUSION: These findings strongly suggest that RBD with Alum adjuvant is highly immunogenic as a potential vaccine.

Teaching professionalism in cadaver dissection: medical students' perspective.

This study was designed to facilitate freshman medical students' adaptation to the dissection room and familiarize them with the related ethical codes. Single-group post-test design research was conducted at Tehran University of Medical Sciences in 2018 - 2019. The program began with a brief explanation of the necessity of the subject, and after a documentary film was shown, the principles of professional and ethical behaviors in the dissection room were discussed by a panel of experts. In the end, a valid and reliable evaluation questionnaire (Cronbach's alpha coefficient = 0.89) was distributed among the students. A total of 129 questionnaires were completed and returned. Overall, 94.4% of the students believed that the program provided an excellent opportunity to reflect on professional behaviors during practical anatomy sessions. In addition, 92.8% of the students believed that they would use the ethical points mentioned in the program in the future. Content analysis of the open questions produced three main categories: "motivating learning", "application of theory in practice" and "changing the attitude toward responsibility". The results indicate that adequate preparation for cadaver dissection sessions and learning about professional behavior codes in the first exposure can help medical students to better understand the principles of professional behaviors.

Increased Genes Expression Levels of Cytokines Related to Th17/Treg Cells in Peripheral Blood Mononuclear Cell Correlate with Clinical Severity in COPD and Mustard Gas-exposed Patients.

The long lasting inflammation and immune dysregulation is one of the main mechanisms involved in lung complication of veterans exposed to sulfur mustard (SM) gas. Th17/Treg cells have an important role in immunopathogenesis of chronic obstructive pulmonary disease (COPD) and mustard lung disease. In this study, expression of cytokines genes levels related to Th17/Treg cells was determined in peripheral blood mononuclear (PBMC) of mustard lung patients and was compared with COPD patients and healthy controls (HC). Real time-polymerase chain reaction was used to assay genes expression levels of Th17 related cytokines (IL-17, IL-6 and TGF-ß) and Treg related cytokines (IL-10, TGF-ß). IL-17 gene expression level considerably was higher in SM patients (9.98±0.65, p<0.001), and COPD (4.75±0.71, p<0.001), compare to HC group. Also, gene expression level of IL-6 in the SM group (3.31±0.93, p<0.001) and COPD group (2.93±0.21, p<0.001) were significantly higher than the HC group. The IL-10 gene expression level showed a high increase in SM patients (4.12±0.91, p<0.01), and COPD (2.1±0.45, p<0.01). Finally, the TGF-ß gene expression level was increased in SM patients (4.91±0.69, p<0.001) as well as in COPD group (5.41±0.78, p<0.001). In SM patients, IL-17 (R=-0.721, p<0.05), IL-6 (R=-0.621, p<0.05) and TGF-ß (R=-0.658, p<0.05) had significant negative association with FEV1 (%). Inversely, Il-10 showed positive correlation (R=0.673) with FEV1 (%). Th17/Treg cells related cytokines genes were highly expressed and imbalanced in peripheral blood mononuclear cells of SM and COPD patients which correlated with pulmonary dysfunction.