The impact of student computer competency on e-learning outcomes: A path analysis model of virtual learning infrastructure, collaboration, and access to electronic facilities.

AIM: This study explored the influence of student computer competency on e-learning outcomes among Iranian nursing students and examined its mediating role in the relationship between virtual learning infrastructure, student collaboration, access to electronic facilities, and e-learning outcomes. DESIGN: A cross sectional study. METHOD: A self-administered online survey was used from August to October 2022, with a sample size of 417 nursing students selected through convenience sampling. Descriptive statistics, correlation analyses, and PROCESS macro v4.1 (Model 4) were used for data analysis. RESULTS: The results revealed that virtual learning infrastructure, access to electronic facilities, and student collaboration, significantly predict student computer competency and e-learning outcomes. Virtual learning infrastructure and access to electronic facilities were found to be the strongest predictors of student computer competency, while student collaboration had a smaller but still significant effect. Student computer competency was found to mediate the relationship between virtual learning infrastructure, access to electronic facilities, student collaboration, and e-learning outcomes.

Use of Massive Online Open Courses (MOOCs) model in virtual education development in first macro-region universities of medical sciences in countrywide territorial planning.

BACKGROUND: Massive online open cources (MOOCs) are a new chapter in the topic of teaching-learning in higher education, which have been able to acquire a significant and valuable position in higher education and prestigious universities worldwide in line with the advancement of technology. The present study was conducted pursuing the goal to investigating the effect of use of MOOCs in the development of virtual education in universities of medical sciences in the first macro-region of countrywide territorial planning. MATERIALS AND METHODS: This research is based on a mixed method and practical in terms of purpose, and it was carried out in 2021 and 2022 in first macro-region of countrywide regional planning Medical Sciences Universities. The data of the qualitative section were converted into a questionnaire using the method of qualitative content analysis in a purposeful and semi-structured interview with 24 experts in the field of virtual education who had sufficient experience in the field of MOOC courses. The statistical population of the quantitative section is 1938 faculty members of the first macro-region of countrywide regional planning, of which 324 were selected by stratified random sampling. Its validity was calculated by Lawshe and Waltz-Bausell method by R software, and the reliability was calculated using Cronbach's alpha method with SPSS-21. RESULTS: Universities are facing challenges in structural, managerial, cultural, social, technological, and evaluation dimensions, and the current situation of using MOOCs in them is not appropriate. CONCLUSION: Besides, the analysis of the optimal situation of using MOOCs in these universities indicates that technological, structural, managerial, evaluation, educational, and personal dimensions are the most important in the effect of using MOOCs on the development of virtual education.

Probiotics on chronic urticaria: A randomized clinical trial study.

Background: Urticaria is a common itchy skin condition characterized by swelling and erythema. A variety of treatments is available today. The purpose of this study was to evaluate the clinical effects of probiotic use in patients with chronic resistant urticaria. Methods: This four-way blind randomized clinical trial was conducted between June 2019 and June 2020. Study population consisted of patients with chronic urticaria who did not respond well to first line treatment with antihistamines. For the intervention group, antihistamine (cetirizine) and probiotics (femilact capsule) and for the control group, antihistamine (cetirizine) and placebo were administered twice a day for 8 weeks. The "Urticarial Activity for 7 Days" (UAS7) questionnaire was used to assess urticaria activity and the Dermatology Life Quality Index (DLQI) questionnaire was used to assess the quality of life of patients. Results: Patients' age range was 7 to 30 years with a mean and standard deviation of 23.6±9.2 years. 31 (81.57%) cases were females and 7 (18.42%) cases were males. Twenty patients were in the intervention group and eighteen patients were in the control group. The mean scores of UAS7 questionnaire were reduced in both groups, but it was more significant in the intervention group (9.6±6.4) compared to the control group (12.7±8.1) at the end of week eight of treatment (P=0.036). Also, there was no significant difference in the quality of life between the two groups after 8 weeks (P=0.805). Conclusion: This study showed that probiotic consumption along with antihistamines significantly improved the activity of urticaria but not the quality of life of patients.

Investigation of social capital and its relationship with emotional adjustment in infertile couples: A cross-sectional study.

Background: Infertility is an abnormal event in the life of families and can have various consequences on a personal and social level. Therefore, infertile couples need to manage their emotional responses. Social capital, as one of the social determinants of health, can affect mental health. Objective: This study was conducted to determine the relationship between social capital and emotional adjustment in infertile couples. Materials and Methods: This cross-sectional study was conducted from October 2018 to February 2019 with 170 infertile couples visiting infertility centers in Sari, Iran. The data collection instruments included the social capital integrated questionnaire, an emotional adjustment scale and a demographic-reproductive checklist. Results: All the social capital dimensions, except for the groups and networks dimension, had a score of higher than 50 (more than the mean score). Based on ANCOVA and the multiple linear regression results, the dimension of trust and solidarity had a significant negative relationship with emotional adjustment (p = 0.01), but no significant relationship was observed between the other social capital dimensions and emotional adjustment. Conclusion: The trust and solidarity dimension had a significant relationship with emotional adjustment in infertile couples. Accordingly, increasing mutual trust between neighborhood residents can strengthen social capital, and in turn, improve emotional adjustment in infertile couples.

Effect of melatonin on stress-induced hyperglycemia and insulin resistance in critically-ill patients: A randomized double-blind, placebo-controlled clinical trial.

BACKGROUND: Hyperglycemia is a common finding which is associated with increased mortality and morbidity among critically ill patients. There is currently no evidence that melatonin could improve stress induced hyperglycemia (SIH). In this study, we evaluated the effect of melatonin on blood sugar and insulin resistance (IR) in critically-ill patients. METHODS: 104 critically-ill patients with SIH divided into two groups, receiving melatonin (6 mg BD for 3 days) or placebo. Changes of blood sugar, IR indices including homeostasis model assessment for insulin resistance and homeostasis model assessment adiponectin (HOMA-AD) ratios, Glasgow coma scale (GCS) were evaluated on the 4th day of melatonin prescription. On the 7Th day of study, changes of ventilator dependency and delirium were considered. Mortality and intensive care unit (ICU) stay were also compared between groups. RESULTS: On day 4, patients in the melatonin group had significantly lower blood glucose and HMOA-IR level compared with the placebo group (P=0.04 and P=0.03, respectively) whereas HOMA-AD level did not differ significantly from placebo group (p>0.2). Also, we did not observe any significant difference in GCS level at this time between groups (p>0.2). On day 7, melatonin could not improve ventilator dependency and delirium significantly (p>0.2) and also could not reduce mortality and ICU stay in comparison with placebo (p>0.2, P=0.2, respectively). CONCLUSION: Melatonin supplementation showed positive effect on blood sugar and somehow insulin resistance whereas it could not improve ICU complications.

Aldolase C Profiling in Serum after Mild Traumatic Brain Injury: A Prospective Cohort Study.

BACKGROUND: After a traumatic brain injury (TBI), in addition to clinical indices, the serum level of neurological biomarkers may provide valuable diagnostic and prognostic information. The present study aimed to investigate the aldolase C (ALDOC) profile in serum for early diagnosis of brain damage in patients with mild TBI (mTBI) presented to the Emergency Department (ED). METHODS: A single-center prospective cohort study was carried out in 2018-2019 at Imam Khomeini Hospital affiliated with Mazandaran University of Medical Sciences, Sari, Iran. A total of 89 patients with mTBI were enrolled in the study. Blood samples were taken within three hours after head trauma to measure ALDOC serum levels. Brain CT scan was used as the gold standard. Statistical analysis was performed using the Kruskal Wallis, Mann-Whitney U, and Chi square tests. The receiver-operating characteristic (ROC) curve plot was used to determine the optimal cutoff point for ALDOC. The sensitivity and specificity of the determined cutoff point were calculated. P values less than 0.05 were considered statistically significant. RESULTS: Of the 89 patients, the CT scan findings showed a positive TBI in 30 (33.7%) of the patients and in 59 (66.3%) a negative TBI. The median ALDOC serum level in the patients with positive CT scan findings (8.35 ng/mL [IQR: 1.65]) was significantly higher than those with negative CT scan findings (5.3 ng/mL [IQR: 6.9]) (P<0.001). The optimal cutoff point for ALDOC serum level was 6.95 ng/mL, and the area under the curve was 99.6% (P<0.001). The sensitivity and specificity of the determined cutoff point were 100% and 98%, respectively. CONCLUSION: The ALDOC serum level in patients with mTBI significantly correlates with the pathologic findings of the brain CT scan. This biomarker, with 100% sensitivity, is a suitable tool to detect brain structural abnormalities in mTBI patients.

Improvement in use of best practice in the care of patients with oral mucositis in a comprehensive cancer center in Iran: a best practice implementation case study.

INTRODUCTION: Oral mucositis is a common debilitating complication of cancer treatments, particularly chemotherapy and radiation. OBJECTIVES: The purpose of this study was to improve oral mucositis prevention and control among cancer patients through the implementation of best practice guidelines in a tertiary referral center in Northern Iran. METHODS: A clinical audit design was utilized in this implementation project. A preimplementation audit was conducted against nine best practice criteria for the prevention and treatment of oral mucositis among new cases of cancer patients in November and December 2019. Fifty cancer patients and 20 nurses participated in this phase of the clinical audit. The next step included a facilitated multidisciplinary focus group identifying targeted strategies and implementing them, completed in late December 2019. A postimplementation audit was then conducted on another 50 cancer patients and the same 20 nurses in January and early February 2020. The project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice software. RESULTS: The preimplementation audit revealed gaps between the current practice and best practice across eight of the nine criteria. After implementing the targeted strategies, the outcomes improved across most of the criteria in the follow-up audit: 80% increase was observed in compliance of staff education, 100% increase in providing standard oral hygiene protocol in place, 64% increase in carrying out a dental examination and conducting initial oral cavity examination, and also 34% increase in conducting of ongoing oral cavity examination by a dentist, and finally 100% increase in providing preventive and therapeutic oral care regimens in place and oral pain assessment using a validated tool. CONCLUSION: The results of this project indicate that clinical auditing is an effective approach to the assessment of evidence-based care practices for oral mucositis among new cancer patients. Evidence-based oral mucositis management among cancer patients can be achieved by educating the patients and nursing staff using the newest guidelines and dentists' comprehensive dental and oral hygiene examinations.

Evaluation of the effectiveness of N-acetylcysteine on accelerating the recovery of renal failure in patients with leptospirosis, a randomized clinical trial study.

BACKGROUND: Limited studies have been conducted on patients with renal function recovery regarding severe leptospirosis. The purpose of this study is to evaluate the effectiveness of N-acetylcysteine (NAC) in accelerating the reduction of serum creatinine in patients with leptospirosis. PATIENTS AND METHODS: This is a clinical trial study involving 64 patients with leptospirosis, with microscopic agglutination tests used to confirm the diagnosis of acute kidney injury. NAC was given to patients with a glomerular filtration rate of less than 60 ml/min at 1200 mg every 12 h, and it lasted for 48 h. Next, 32 patients were measured and the relationship between the length of hospitalization, age, and sex was also examined. Additionally, the two groups of case and control were compared in terms of the rate of decrease in serum creatinine level in three different time periods. The Shapro-Wilk test was used to investigate the distribution of data. RESULTS: No significant differences were observed in the decrease in serum creatinine level on the first, third, and seventh days of hospitalization and also in the use of NAC between the case and control groups (P = 0.255). In addition, the use of NAC had no significant effect on reducing the length of hospitalization (P = 0.067). CONCLUSION: Recovery of acute kidney injury following leptospirosis and drugs that accelerate the healing process in these patients require further studies with greater sample size and longer follow-up time.

Idiopathic granulomatous mastitis: challenges of treatment in iranian women.

BACKGROUND AND OBJECTIVE: As a chronic inflammatory disease of an unknown origin, the treatment of granulomatous mastitis has always been controversial. According to some researchers, surgical treatment and certain medications, especially steroids, are more effective in treating the disease. This study aimed at evaluating the results of treatment in a group of patients with granulomatous mastitis. MATERIALS AND METHODS: This longitudinal cohort study evaluated the treatment outcomes of 87 patients with pathology-confirmed granulomatous mastitis referred to the surgical clinic of Central Hospital in Sari, Iran. Demographic, clinical, and pathological information, treatment methods and results, and the recurrence rate were analyzed. FINDINGS: A total of 87 female patients with granulomatous mastitis aged 22-52 years with a mean age of 34 years were evaluated. All patients had palpable masses; the breast masses were painful in 48.3% of patients, and 55.2% of patients suffered from erythema and inflammation, and8% had fistulas and ulcers at the inflammation site. The patients were followed-up for an average duration of 26 months (8-48 months) after treatment and recovery. The overall recurrence rate was 24.1%, and the recurrence rate was 29.4% in patients underwent surgery, 34.8% in patients received high-dose prednisolone, and 17% in those received low-dose prednisolone together with drainage (p < 0.001). CONCLUSIONS: According to the results, the low-dose prednisolone plus drainage was more effective with a lower recurrence rate than only surgical excision or high-dose prednisolone. In fact, the use of minimally invasive methods such as drainage plus low-dose steroids is a more effective method with fewer side effects than the other two methods.

Clinical Effectiveness of a High Dose Versus the Standard Dose of Meropenem in Ventilator-associated Pneumonia Caused by Multidrugresistant Bacteria: A Randomized, Single-blind Clinical Trial.

BACKGROUND: Meropenem standard doses are based on the minimum inhibitory concentration of sensitive pathogens and the pharmacokinetic parameter of not critically ill patients. We compared the efficacy of high versus standard dose of meropenem in ventilator-associated pneumonia (VAP). ; Methods: 24 out of 34 eligible patients were randomized to receive meropenem 3 g q8h (high dose group, 11 patients) or 2 g q8h (standard-dose group, 13 patients) as a 3h infusion. The primary outcome was considered as clinical success that was defined as stable hemodynamic, improved sequential organ failure assessment (SOFA) score, stable or improved PaO2/FiO2 after 7 days. Sputum culture was taken before the intervention. ; Results: Clinical success rate was not significantly different between the high and standard-dose group (54.5% vs. 38.5%, P= 0.431). There was a significant difference in the reduction of clinical pulmonary infection score (CPIS) compared to a high dose to the standard group (P=0.038). SOFA score declined significantly in the high dose group throughout the study (P=0.006). A shorter duration of VAP treatment was recorded in the high dose group (P=0.061). We did not observe any significant adverse event related to meropenem. Acinetobacter spp. (34.8%), Klebsiella spp. (32.6%) and Pseudomonas aeruginosa (19.5%) isolated more frequently from sputum cultures. ; Conclusion: Treatment with the high dose of meropenem seems to be safe. However, it did not provide a significantly higher clinical success rate in comparison with the standard dose, but could be considered as an appropriate empirical treatment in patients with severe infection due to reduction in SOFA and CPIS. ; The trial protocol was registered with IRCT.ir (registration number IRCT2010010700 3014N19 in April 2018).

Effect of platelet-rich plasma on pregnancy outcomes in infertile women with recurrent implantation failure: a randomized controlled trial.

METHODS: This study was directed to assess the efficacy of autologous platelet-rich plasma (PRP) on pregnancy rate in recurrent implantation failure. Between 2016 and 2019, a total of 98 women who unsuccessful to be pregnant after three or more high-quality embryo transfers undergoing frozen-thawed embryo transfer with or without an intrauterine infusion of platelet-rich plasma. Thus, 0.5 ml of platelet-rich plasma at 4-6 times higher concentration than peripheral blood infused intrauterine 48 h before embryo transfer. A control group underwent standard protocol. RESULTS: There were no significant differences between the two groups in terms of age, body mass index and duration and cause of infertility and total transferred embryos and kind of treatment protocol, but secondary infertility and endometrial thickness 96 h before embryo transfer, was more in the intervention group. The clinical pregnancy (48.3% versus 23.26; p = .001) and ongoing pregnancy (46.7% versus 11.7%; p = .001) and implantation rate (58.3% versus 25%; p = .001) was more significant in the intervention group rather than controls. In conclusion, intrauterine infusion of platelet-rich plasma 48 h before freeze-thawed embryo transfer may have more effectiveness in in vitro fertilization (IVF) outcomes in recurrent implantation failure.

Comparison of the Efficacy and Safety of Atazanavir/Ritonavir Plus Hydroxychloroquine with Lopinavir/Ritonavir Plus Hydroxychloroquine in Patients with Moderate COVID-19, A Randomized, Double-blind Clinical Trial.

This was a randomized, double-blind clinical trial to compare the efficacy and safety of Atazanavir/Ritonavir (ATZ/RTV) with Lopinavir/Ritonavir (LPV/RTV) in moderate Coronavirus disease 2019 (COVID-19). Participants were randomly assigned to receive a single dose of hydroxychloroquine (HCQ) plus ATZ/RTV or LPV/RTV for a minimum of 5 to a maximum of 10 days. The primary outcomes were the reduced length of hospital stay and clinical recovery within 10 days from starting the intervention. The rate of intensive care unit (ICU) admission, intubation, and mortality, the lengths of ICU stay and being intubated, recovery within 14 days, and the frequency of adverse reactions were considered as secondary outcomes. Among 132 enrolled patients, 62 cases in each arm were analyzed at the end of the intervention. Fifty-one (82.3%) cases in the ATZ/RTV arm versus 41 (66.1%) in the LPV/RTV arm were discharged within 10 days (P = 0.06). The median number of the intervention days was 6 (IQR: 5-8) in ATZ/RTV arm versus 7 (IQR: 6-9) in LPV/RTV arm (P = 0.01). The rate and length of ICU admission and intubation (P ≥ 0.99), rate of mortality (P = 0.49), and recovery within 14 days (P = 0.09) were not statistically different between groups. The most reported adverse reactions were nausea and vomiting that all cases were in the LPV/RTV arm (P = 0.006). ATZ/RTV is better tolerated in comparison with LPV/RTV; however, it did not show more efficacy than LPV/RTV in clinical outcomes of COVID-19 in this study.

Anterior cervical spine surgery opens up concerns about thyroid function.

BACKGROUND AND OBJECTIVES: The anterior approach for cervical discectomy and fixation is a valuable procedure for decompression of the spinal cord in patients with severe canal stenosis and stabilization of cervical vertebral column. Although some studies have investigated the thyroid complications especially in cervical cancer surgery or recently in tracheostomy, little research has been performed on the anterior spine surgery so far. The present study aimed to evaluate possible changes in the thyroid in patients experiencing anterior cervical approaches for degenerative diseases. MATERIALS AND METHODS: Seventy patients who were undergoing anterior cervical spine surgery were selected and their demographic information was recorded, including age, sex, weight, body mass index (BMI), and medical records. Thyroid hormones (TSH, free T4, and free T3) were measured before surgery and three months after surgery. RESULTS: Most patients had cervical disc herniation (60%). The mean duration of surgery was 71.9 ± 8.36 minutes (range: 60-90 minutes). Twenty-one patients (30%) had anterior plating while 49 patients (70%) did not. Spearman's correlation coefficient was used to examine the correlation of the following variables with TSH changes: Number of operated cervical levels, level of operated spine, incision type, duration of surgery, type of surgery (ACDF or ACCF). None of these variables showed a significant correlation. Meanwhile, a significant and direct correlation was observed between TSH changes and age. CONCLUSIONS: Although the results of our study did not show any signs of functional changes due to thyroid tissue injury during surgery, based on rare case reports and age-related laboratory changes, we recommend thyroid function tests for diagnosing subclinical thyroid dysfunction before anterior cervical spine surgery in patients with degenerative diseases and especially in older adults.

Utilization of the Parenteral Morphine in Emergency Department using the Anatomical Therapeutic Chemical Classification/Defined Daily Doses (ATC/DDD) System.

OBJECTIVE: To evaluate the utilization of the parenteral morphine in Emergency Department (ED) using the Anatomical Therapeutic Chemical Classification/Defined Daily Doses (ATC/DDD) system. METHODS: In this retrospective cross-sectional study, morphine administration was recorded in 4-year time period from January 2013 to December 2016 in the ED of a referral center. The dose of the administered morphine was evaluated using the ATC/DDD system. The ATC/DDD of the parenteral morphine was calculated based on the world health organization (WHO). The data was evaluated based on the different diagnosis and conditions using the ATC/DDD protocol. RESULTS: In this study, 500 patients referred to ED with mean age of 48.29 ± 10.10 years were included. There were 306 (61.2%) men and 194 (38.8%) women among the patients. The lowest and highest DDD of parenteral morphine were 0.1 and 0.43, respectively. The utilization of parenteral morphine was significantly higher in men when compared to women (p<0.001). Those with history of tricyclic anti-depressant (TCA) consumption (p<0.001) and opium addiction (p<0.001) had significantly higher parenteral morphine utilization. Those with pain in the extremities and chest pain had significantly higher parenteral morphine utilization (p<0.001). CONCLUSION: The utilization of parenteral morphine in the ED of our center was higher than the WHO standard dosage. The morphine utilization was associated with male gender, opium addiction and TCA consumption.

Evaluation of the efficacy of sofosbuvir plus daclatasvir in combination with ribavirin for hospitalized COVID-19 patients with moderate disease compared with standard care: a single-centre, randomized controlled trial.

BACKGROUND: New therapeutic options are urgently needed to tackle the novel coronavirus disease 2019 (COVID-19). Repurposing existing pharmaceuticals provides an immediate treatment opportunity. We assessed the efficacy of sofosbuvir and daclatasvir with ribavirin for treating patients with COVID-19. METHODS: This was a single-centre, randomized controlled trial in adults with moderate COVID-19 admitted to the Ghaem Shahr Razi Hospital in Mazandaran Province, Iran. Patients were randomly assigned to 400 mg sofosbuvir, 60 mg daclatasvir and 1200 mg ribavirin (intervention group) or to standard care (control group). The primary endpoint of this study was length of hospital stay. This study is registered by IRCT.ir under the ID: IRCT20200328046886N1. RESULTS: Between 20 March 2020 and 8 April 2020, 48 patients were recruited; 24 patients were randomly assigned to the intervention group and 24 to the control group. The median duration of hospital stay was 6 days in both groups (P = 0.398). The number of ICU admissions in the sofosbuvir/daclatasvir/ribavirin group was not significantly lower than the control group (0 versus 4, P = 0.109). There was no difference in the number of deaths between the groups (0 versus 3, P = 0.234). The cumulative incidence of recovery was higher in the sofosbuvir/daclatasvir/ribavirin arm (Gray's P = 0.033). CONCLUSIONS: This randomized trial was too small to make definitive conclusions. There were trends in favour of the sofosbuvir/daclatasvir/ribavirin arm for recovery and lower death rates. However, there was an imbalance in the baseline characteristics between the arms. Larger randomized trials should be conducted to investigate this treatment further.

Comparison of the effects of the Feldenkrais method versus core stability exercise in the management of chronic low back pain: a randomised control trial.

OBJECTIVE: To investigate the effect of the Feldenkrais method versus core stability exercises on pain, disability, quality of life and interoceptive awareness in patients with chronic non-specific low back pain. DESIGN: A single-blinded, randomised, controlled trial. SETTING: Outpatient, sports medicine clinic of Mazandaran medical university. PARTICIPANTS: Sixty patients with chronic non-specific low back pain randomised equally into the Feldenkrais method versus core stability exercises groups. INTERVENTION: Intervention group received Feldenkrais method consisting of training theoretical content and supervised exercise therapy two sessions per week for five weeks. Control group received educational programme and home-based core stability exercises for five weeks. OUTCOME MEASURES: All patients were examined by World Health Organization's Quality of life Questionnaire, McGill Pain Questionnaire, Oswestry Disability Questionnaire and Multidimensional Assessment of Interoceptive Awareness Questionnaire. All outcomes were measured at baseline and the end of the intervention. RESULTS: There were statistically significant differences between groups for quality of life (P = 0.006, from 45.51 to 60.49), interoceptive awareness (P > 0.001, from 2.74 to 4.06) and disability (P = 0.021, from 27.17 to 14.5) in favour of the Feldenkrais method. McGill pain score significantly decreased in both the Feldenkrais (from 15.33 to 3.63) and control groups (from 13.17 to 4.17), but there were no between-groups differences (P = 0.16). CONCLUSION: Feldenkrais method intervention gave increased benefits in improving quality of life, improving interoceptive awareness and reducing disability index.

Is Necessary Intraoprative Frozen Section In Sentinel Lymph Node Biopsy For Breast Cancer Patients?

BACKGROUND: Improvements in the process of staging and surgical treatment of axillary lymph nodes in recent years, have led to the use of intra operative frozen section pathology to examine the sentinel lymph node biopsy in breast cancer patients. MATERIALS AND METHODS: we evaluated the results of the Sentinel biopsy in 102 patients with early stage breast cancer, which were negative clinical lymph nodes, and analyzing the true positive and false negative rate, diagnostic accuracy of frozen section lymph node biopsy. It also studied the factors affecting the sentinel and non-sentinel lymph nodes in patients treated by axillary lymph dissection. RESULTS: In this study, we investigated 102 patients' stage 1and 2 breast cancer with clinical negative axillary lymph node and candidates for sentinel lymph node biopsy, were placed under investigation. 15.7 % of the real positive results of sentinel and 62.7 % of the real negative and 2 % false positives and 20.9 % false negative results and% 78. 4 diagnostic accuracy, has been frozen section. Among the patients who were initially or delayed in the axillary dissection, 37% had more than two lymph nodes. While in general, 16.7% of patients had a need for axillary lymph node dissection based on z11 criteria. Lymph-vascular invasion was a major contributor to lentil involvement in Sentinel and non-Sentinel nodes. CONCLUSION: Frozen section pathology during the operation of sentinel lymph node biopsy has been initiated to prevent the need for a reoperation in early stage breast cancer patients. However, due to low tumor burden in patients who are candidates for this procedure, and the constraints in the initial sections and their false negative results, also the removal of frozen section will not have an effect on the rate of increasing reoperation and can be effective in reducing the time and cost of surgery.

Evaluating the Effect of Dexmedetomidine on Hemodynamic Status of Patients with Septic Shock Admitted to Intensive Care Unit: A Single-Blind Randomized Controlled Trial.

Septic shock, known as the most severe complication of sepsis, is a serious medical condition that can lead to death. Clinical symptoms of sepsis include changes in body temperature in the form of hypothermia or hyperthermia, tachypnea or hyperventilation, tachycardia, leukocytosis or leukopenia, and variations in blood pressure, as well as altered state of consciousness. One of the main problems in septic shock is poor response along with reduced vascular reactivity to vasopressors used to increase blood pressure. Therefore, low vascular response associated with reduced sensitivity or lower number of alpha-1 agonist receptors can result in shock and death. In addition to being the state-of-the-art treatment including volume load and vasopressor, use of alpha-2 agonists e.g. dexmedetomidine (DXM) in septic shock can reduce vasopressors needed to restore adequate blood pressure. They can further moderate massive release of endogenous catecholamine. Therefore, the purpose of this study was to investigate the effect of DXM on outcomes of patients with septic shock, especially their needs for vasopressors and impacts on their hemodynamic status. This single-blind randomized controlled trial was performed on a total number of 66 patients with septic shock admitted to the intensive care unit (ICU) of Imam Khomeini Teaching Hospital in the city of Sari, in northern Iran. To this end, DXM (0.6 µg/kg/h) and normal saline (6 mL/kg/h) were infused for 12 h in the study and control groups, respectively. The results revealed that DXM could increase mean arterial pressure (MAP) (P = 0.021), systolic blood pressure (SBP) (P = 0.002), and reduced heart rate (P < 0.001) but diastolic blood pressure (DBP) (P =0.32) and norepinephrine dose requirement didn't change statistically in septic shock patients (P = 0.12).

Relationship between Serum Osteocalcin Level and Gestational Diabetes Mellitus: A Case-Control Study.

BACKGROUND: Osteocalcin (OC) is the most common noncollagenous protein in bone matrix, which is synthesized only in bone tissue and by osteoblasts. The potential role of osteocalcin on glucose and fat metabolism has been previously reported. The aim of this study was to compare the serum OC level in pregnant women with and without gestational diabetes mellitus (GDM). METHODS: In the present case-control study, all pregnant women who were referred to a obstetrics and gynecology clinic in Sari, Iran, and met the inclusion criteria underwent an overall screening with a 75-g glucose tolerance test (GTT) at week 24 to 28 of gestation. The study was conducted between September 2018 and February 2019. Based on criteria, the pregnant women with confirmed GDM were matched with pregnant women without GDM in terms of baseline characteristics such as chronological age and BMI. The serum OC levels were also measured if vitamin D and calcium levels were normal. All data were analyzed using SPSS 21. RESULTS: The two groups with and without GDM had no significant difference in terms of age, BMI and OC level. There was no significant correlation between age and BMI with OC level in healthy pregnant women, respectively (P=0.49 and P=0.58). The correlation between BMI and age with OC level in GTT-positive pregnant women was 0.05 and -0.172, respectively, which was not significant (P=0.77 and P=0.36). CONCLUSION: According to the results of this study, there is no significant difference of serum OC levels in pregnant women with GDM compared to healthy pregnancy. Given that the levels of serum insulin or insulin resistance have not been assessed, these indices are recommended to be evaluated in future studies.

Demographic and epidemiologic evaluation of mushroompoisoning: a retrospective study in 4-year admissions of Razi Hospital (Qaemshahr, Mazandaran, Iran).

Aim Wild mushroom intoxication is a public health problem, which causes a wide range of symptoms: from mild gastrointestinal symptoms to multiple organ failure and death. The present study aims to evaluate the epidemiology of mushroom intoxication in 4-year admissions of Razi Hospital, Qaemshahr, Mazandaran, Iran. Methods Medical records of all identified cases of mushroom poisoning admitted during the period between 2015 and 2018 were extracted and patients' demographic data including age, sex, latency period, season of poisoning, clinical presentations, laboratory findings, prognosis, duration of hospitalization and therapeutic interventions were recorded. Results A total of 65 mushroom poisoning cases were identified (mean age of 35.68 years), of which 32 (49.2%) were females. Latency of ≤ 6 hours was seen in 63 (96.4%) cases. The most prevalent season of intoxication was spring (60.7%). The most frequent symptoms were nausea and vomiting (86.5%) and abdominal pain (51.2%). No case required intensive care unit (ICU) care or mechanical ventilation. Mean hospital stay was 1.89 days without any mortality. Mean aspartate aminotransferase (AST) level was 21.89 (±9.55), but the disturbance of liver function tests (LFTs), coagulopathy, elevated level of bilirubin and/or platelet was not noted. In 93% of patients ranitidine, in 7% Penicillin G, and in 3.6% cefaclor and ceftriaxone was administrated. Conclusion People and health care providers must be educated about mushroom poisoning. Prompt transfer of suspicious cases with history of wild mushroom ingestion to the emergency department is crucial since patients showing toxicity symptoms after 6 hours might have worse and mortal prognosis despite treatment.