Evaluation the Effect of Serum Lead Levels on Thyroid Function in Battery Industry Workers.

Objective: To assess the relationships between blood lead levels and thyroid functional tests in battery industry workers. Methods and Materials: This cross-sectional study was performed on 100 personnel of a battery factory in 2019. The checklist including demographic information of employees (age, sex, work experience, smoking, etc.) of the work shift, work environment, and duration of work was completed. Venous blood samples were also taken from the participants to check blood levels of lead and thyroid hormones. Results: The mean age of participants was 36.1 ± 5.6 years and their mean TSH and lead levels were 3.69 ± 2.45 mIU/L and 297.9 ± 174.2 µg/L, respectively. Participants were divided into two groups based on job duties: administrative and working in the production line. Participants were divided into two groups based on blood lead levels: normal (less than 300 µg/L) and high lead level (more than 300 µg/L). Only the work experience between these two groups was significantly different and was higher in the high lead group compared to the normal lead group and no significant difference was observed between different groups based on lead level in terms of TSH level and thyroid hormones. Conclusion: Our study showed that although the amount of whole blood lead concentration is not related to thyroid hormone levels and thyroid function, but with increasing work experience, the amount of whole blood lead also increases significantly and since lead poisoning can have many health hazards, employers must plan to minimize the lead exposure of workers and provide protective equipment for workers.

Achievements in Hypothyroidism Treatment with Herbal Medicine: A Systematic Review of Randomized Controlled Trials.

BACKGROUND: Hypothyroidism is a common endocrine disease in the world that causes morbidity and mortality due to its association with metabolic diseases, especially in old age, and longterm treatment with levothyroxine causes many side effects for patients. Treatment with herbal medicine can regulate thyroid hormones and prevent side effects. OBJECTIVE: The purpose of this systematic review is the evaluation of the effect of herbal medicine on the signs and symptoms of primary hypothyroidism. METHODS: PubMed, Embase, Google Scholar, Scopus, and Cochrane Central Register of Controlled Trials were searched until 4 May, 2021. We selected randomized clinical trials (RCTs) that have assessed the effect of herbal medicine on hypothyroidism. RESULTS: Out of 771 articles, 4 trials with 186 participants were included. In one study, Nigella sativa L. caused a significant decrease in weight (P=0.004) and body mass index (BMI) (P=0.002). TSH levels were reported to be decreased and T3 increased in the treatment group (P =0.03) (P=0.008), respectively. In another study on Nigella sativa L., results did not show a significant difference between the two groups (p=0.02). A significant decrease in total cholesterol (CHL) and fasting blood sugar (FBS) was reported in participants with negative anti-thyroid peroxidase (anti-TPO) antibodies. In patients with positive anti-TPO antibodies, a significant increase in total cholesterol and FBS was observed in the intervention group (p=0.02). In the third RCT, T3 in the ashwagandha group at 4 and 8 weeks significantly increased by 18.6% (p=0.012) and 41.5% (p < 0.001), respectively. A noticeable increase was found in the T4 level from baseline by 9.3% (p= 0.002) and 19.6% (p < 0.001) at 4 and 8 weeks, respectively. TSH levels fell remarkably in the intervention group compared to placebo at 4 weeks (p <0.001) and 8 weeks (p <0.001), respectively. In the last article selected, Mentha x Piperita L. showed no significant difference in fatigue scores between intervention and control groups at the midpoint (day 7), while fatigue scores improved in the intervention group in all subscales compared to the control group on day 14. CONCLUSION: Some herbal remedies, including Nigella sativa L., ashwagandha, and Mentha x Piperita L., can improve the signs and symptoms of primary hypothyroidism, but using a more extensive and advanced methodology will provide us with more complete results.

Are students performing the same in E-learning and In-person education? An introspective look at learning environments from an Iranian medical school standpoint.

INTRODUCTION: This study investigated medical students' intended learning outcomes based on e-learning and in-person education. METHODS: In this cross-sectional comparative analytical study, a group of 126 undergraduate medical students' intended learning outcomes under two different teaching methods, including e-learning and in-person, were repeatedly measured based on the census sampling method. Participants were in the preclinical curriculum phase (physiopathology) at Mashhad University of Medical Sciences (MUMS), Iran. Due to expert panel opinion, the same medical teachers and similar difficulty of lessons were considered in two investigated academic semesters. In addition, difficulty and discrimination indexes of formative and summative assessments were controlled for two study groups. The students' learning outcome index was the knowledge test scores participants received in the relevant lessons of the General Medicine (GM) curriculum preclinical courses. RESULTS: The findings indicated that students learning outcomes were significantly higher during e-learning than in in-person education for all examined variables (P < 0.05). Moreover, the difference between students' Grade Point Average (GPA) categories among the two groups was significant (P = 0.022). Students with a GPA of less than 14 experienced higher increments in their average scores after the e-learning compared to in-person education. Compared to face-to-face courses, improvements in pharmacology, theoretical semiology, and pathology scores after e-learning courses were statistically significant (P < 0.001). The differences in mean scores related to practical pathology and semiology in the two approaches were not statistically significant, P = 0.624 and P = 0.149, respectively. Furthermore, the overall students' average scores increased significantly during e-learning versus in-person education (P < 0.001). CONCLUSION: We concluded that e-learning could be appreciated as a successful method of medical education and can be used as an alternative educational method. However, considering the importance of practical or clinical courses in medical education, further research about the efficacy of the e-learning approach is highly recommended.

Correlation of Sonographic Classification of Neck Adenopathy (A-RADS) and Malignancy.

Introduction: Cervical adenopathy can be involved in various pathological processes. This study aimed to evaluate the ultrasound classification of cervical adenopathy (A-RADS) to choose the appropriate approach. Materials and Methods: This cross-sectional study was conducted among 294 patients with cervical adenopathy at Mashhad University of Medical Sciences during 2020-2021. The data of the long axis diameter, short axis diameter, shape, border, vascular pattern, presence of calcification and changes in cyst/necrosis, cortical echogenicity, hilum visibility, and location of involved lymph nodes were extracted. Lymph nodes was classified into four normal, reactive, suspicious & lymphoid disorders, and metastatic groups, based on ultrasound appearance (Adenopathy-reporting and data system). Diagnostic methods included follow-up, core needle biopsy (CNB), and fine needle aspiration (FNA), and surgical results. After determining the final diagnosis, demographic, sonographic, and pathological data were analyzed at a significance level of p<0.05. Results: Of 294 patients, 185 were benign, and 109 were malignant. There were no significant differences in the location, long axis diameter, shape, cystic or necrotic changes, calcification, and margins of the lymph nodes between the benign and malignant groups. The enlarged short axis diameter, invisible hilum with isoechoic cortex, and non-hilar vascularity were significantly higher in the malignant group (p<0.001). The malignancy rate was 8.7% in reactive cases, 48.5% in lymphoid disorders, and 90% in metastatic nodes. Conclusion: The results of this study shows that cervical lymph nodes can be classified based on short axis diameter, cortex and hilum echo-texture and vascular pattern into normal, reactive, suspicious & lymphoid disorders, and metastatic, which have a high concordance with pathologic results.

Evaluation of a Polyherbal Formulation on the Management of Migraine Headaches due to Functional Dyspepsia: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial.

A holistic concept based on traditional Persian medicine (TPM) describes a headache with a gastrointestinal (GI) origin (gastric-headache). Although the neurological manifestations of this headache are similar to those of other headaches, its etiology is different. Considering its simultaneous effects on the brain and GI system, a formulation was designed based on this concept. This study aimed to determine the safety and efficacy of the designed formulation on migraine headache (MH) associated with functional dyspepsia (FD). A total of 75 diagnosed cases of MH patients with concurrent FD were randomly divided equally into 3 groups: (i) the polyherbal formulation, sodium valproate (VPA), and amitriptyline group, (ii) VPA, amitriptyline, and polyherbal formulation placebo group, and (iii) the polyherbal formulation and VPA placebo group. The primary outcomes, including frequency, duration, and severity of MH attacks, were measured at baseline and weeks 4, 8, and 12. However, secondary outcomes, including the Headache Impact Test 6 (HIT-6) Questionnaire and Parkman's score, were evaluated at baseline and end of treatment. The frequency, duration, and severity of migraine (P < 0.001 for all cases), HIT-6 (P < 0.001 for all cases), and FD (P < 0.001 for all cases) scores at the end of treatment showed a significant decrease in the 3 groups compared to the baseline. However, the differences in those variables between the 3 groups were not significant at the end of the study. The polyherbal formulation alone may improve the symptoms of migraine patients and other groups. This effect could be due to improving digestion and FD in migraine patients.

Evaluating the diagnostic value of multi-detector brain CT angiography in diagnosing acute cerebral venous thrombosis.

Cerebral venous sinus thrombosis (CVST) is a rare type of venous thromboembolism mostly affecting young adults. Despite improved imaging studies, the diagnosis is usually delayed by several days. An average diagnostic delay of seven days from the onset of symptoms is still reported for this condition, and it is crucial for radiologists to detect this potentially lethal condition in routine imaging studies. In this study we aimed to investigate the diagnostic value of multi-detector brain CTA in diagnosing acute CVT. We searched our Picture Archiving and Communicating System (PACS) of our tertiary-level academic hospital between March 2016 and March 2019, and collected all patients for whom both contrast-enhanced MRV and brain CTA were acquired at the same admission. A total of 242 patients were found on our PACS database who met our criteria. In the blinded multidetector-row computed tomographic angiography (MDCTA) evaluation, there was a sensitivity of 96.1%, specificity of 98.6% and accuracy of 98.3% for MDCTA in detecting CVST. In the emergency settings, and in centers in which MRI scanners are not available, MDCTA can be used instead of CE-MRV for diagnosis of CSVT with a good sensitivity and specificity.

Comparison the Emergency Severity Index and Manchester Triage System in Trauma Patients.

Objective: To compare the emergency severity index (ESI) and Manchester triage system (MTS) in trauma patients. Methods: This cross-sectional study was conducted by census method in Hasheminejad hospital during 2019. Patients referred to a trauma center triaged by five trained triage nurses based on ESI and MTS. Outcomes were considered as length of stay at the emergency department, admission to the other sectors and discharge or leave the hospital. Information from the triage form, nursing registry office and hospital registry system were extracted and analyzed by SPSS software. Results: Totally 447 and 468 patients triaged with the ESI and MTS were included, respectively. Seventy percent of patients triaged with ESI and 34% with MTS were placed in level 3 or the yellow group (equivalent group 3 triage). The hospitalization rate is approximately equal at each triage level in the both systems. The mortality rate in both groups was 0%. Mean length of stay was significantly lower in the MTS group compared to ESI in the emergency department (p<0.05). Conclusion: Using of ESI triage in the trauma center causes to arrive more patients to the emergency department instead of the fast track and leads to waste the time and energy of staff'. However, further studies are needed to prove this result.

Comparison of oral Dydrogesterone and 17-α hydroxyprogesterone caprate in the prevention of preterm birth.

BACKGROUND: Preterm birth (PTB) remains a significant problem in obstetric care. Progesterone supplements are believed to reduce the rate of preterm labor, but formulation, type of administration, and dosage varies in different studies. This study was performed to compare oral Dydrogesterone with intramuscular 17α-hydroxyprogesterone caproate (17α-OHPC) administration in prevention of PTB. METHODS: In this randomized clinical trial, we studied 150 women with singleton pregnancy in 28Th-34Th Gestational week, who had received tocolytic treatment for preterm labor. Participants were divided to receive 30 mg oral Dydrogesterone daily, 250 mg intramuscular 17α-OHPC weekly, or no intervention (control group). All treatments were continued until 37Th Week or delivery, whichever occurred earlier. Obstetric outcomes, including latency period, gestational age at delivery, birth weight, neonatal intensive care unit (NICU) admission, and neonatal mortality were recorded. All patients were monitored biweekly until delivery. RESULTS: Baseline gestational age was not significantly different between groups. Latency period was significantly longer in the progesterone group compared with Dydrogesterone and control groups (41.06 ± 17.29 vs. 29.44 ± 15.6 and 22.20 ± 4.51 days, respectively; P < 0.001). The progesterone group showed significantly better results compared with the other two groups, in terms of gestational age at delivery, birth weight, and Apgar score (P < 0.001). None of the participants showed severe complications, stillbirth, or gestational diabetes. CONCLUSION: Progesterone caproate can strongly prolong the latency period and improve neonatal outcomes and therefore, is superior to oral Dydrogesterone in the prevention of PTB.

A study on musculoskeletal complaints and working postures in pathology specialists in Iran.

BACKGROUND: Musculoskeletal disorders (MSDs) are one of the most common causes of occupational injuries and disabilities among health care workers. This study investigates the relationship between musculoskeletal complaints and pathologist postures in laboratories. METHOD: In this cross-sectional study, 40 pathologists were evaluated. MSDs in different body segments of the participants were evaluated by Nordic questionnaire. For postural analysis, 20 min film was recorded while using a microscope by subjects. Posture analysis was done by the Rapid Upper Limb Assessment (RULA) method and their repetitive movements were scored. The data was analyzed by SPSS Version 11.5. RESULTS: The mean age and duration of employment of subjects was 36.57 ± 7.54 years and 6.50 ± 6.30 years, respectively. Most MSDs were found in neck (65%), wrist (57.5%), upper back (50%) and lower back (47.5%). The mean RULA grand score was higher in participants with upper back and shoulder pain. A statistically significant relationship was found between the mean RULA grand, the upper back pain (P = 0.02) and the wrist pain (P = 0.003), as well as between the mean RULA B, the neck pain (P = 0.02) and the lower back pain (P = 0.05). The results showed a significant relationship between mean weekly working hours and tight (P < 0.001), wrist (p = 0.01) and ankle (P = 0.008). CONCLUSION: This study revealed high prevalence of MSDs among the pathologists. Therefore, performing ergonomic corrective actions is essential in order to improve their physical conditions at work.

Combination of pioglitazone and clomiphene citrate versus clomiphene citrate alone for infertile women with the polycystic ovarian syndrome.

BACKGROUND: Anovulation is one of the common causes of infertility. Polycystic ovary syndrome (PCOS) is the most common disorder with chronic Anovulation. To the best of our knowledge, insulin resistance relates significantly to PCOS. Therefore administration of insulin-sensitizing drugs such as pioglitazone can be used for ovulation stimulation in PCO patients. METHODS: After obtaining approval from the Ethics Committee of Mashhad University of Medical Sciences, 61 patients with PCOS were enrolled in the study based on inclusion/ exclusion criteria. Patients were divided into two groups. The first group received 30 mg (mg) of pioglitazone daily from the second day of the menstrual period. The second one received a placebo. 150 mg clomiphene citrate was administered from the third to the seventh day of the menstrual cycle. Vaginal sonography was performed in all women, and in cases with the mature follicle, intrauterine insemination was conducted after human chorionic gonadotropin injection. Ovary stimulation and pregnancy rate were compared between groups. RESULTS: There were no differences between groups regard to demographic characteristics and infertility type. Body mass index was higher in the pioglitazone group (28.3 ± 3.8 versus 26.2 ± 3.5, P value = 0.047). The size of the follicle was not significantly different between groups (2.2 ± 1.4 versus 1.3 ± 1.1, P value = 0.742). pregnancy rate [4 (12.9%) versus 4 (13.3%), P value = 1] had no differences between groups. CONCLUSION: Although the number of follicles was higher in the pioglitazone group, our study showed no differences in ovary stimulation and pregnancy rate.

Prevalence of Respiratory Disorders during Sleep among Subjects of Methadone Maintenance Therapy Program.

BACKGROUND: Respiratory disorders during sleep are considered a health problem affecting the life quality. There is some evidence indicating the higher prevalence of apnea in substance-dependent patients. However, there is no information on the prevalence of the disease in people under methadone maintenance therapy (MMT). Therefore, the present study was designed to estimate the disease rate in these patients and consider the relationship of the increasing risk of apnea with some psychiatric problems. METHODS: Study group included 152 individuals under the MMT program. Baseline data were collected with the interview, and patients were considered using the STOP-BANG questionnaire to evaluate the risk of apnea. Furthermore, Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HDRS) tests were performed for all participants. Data were analyzed using SPSS software. FINDINGS: Based on the STOP-BANG score categories, 37.5%, 40.1%, and 22.4% of patients indicated low, intermediate, and high risk of apnea, respectively. Moreover, severe daytime sleepiness, fatigue, depression, and anxiety were observed in 5.3%, 5.5%, 6.0%, and 21.1% of participants, respectively. Sex (P = 0.007) and daytime sleepiness (P = 0.048) were significantly different between low and high-risk groups of apnea after adjustment. Besides, age (P < 0.001) and fatigue (P = 0.007) were factors predicting the STOP-BANG score. CONCLUSION: These findings revealed the higher prevalence of apnea in MMT patients compared to the general population of Iran and rising of the risk of apnea along with an increase in age and fatigue score. However, attention to the sleep disorders in MMT is a prominent factor that should be considered as a route of therapy.

Relationship between workplace violence and work stress in the emergency department.

BACKGROUND: Work place violence (WPV) is one of the workplace factors that can affect many aspects of the emergency staff's life. In this study, we are investigating the relationship between WPV and occupational stress. METHODS: We surveyed emergency department (ED) staff in a cross-sectional study design in three Mashhad Hospitals between 2017 and 2018. World Health Organization WPV and occupational stress questionnaire was used and 171 out of 200 collected data were analyzed. To investigate the relationship between different variables, t-test and logistic regression were implemented. RESULTS: In general, 58 (34.5%) participants had reported a physical assault, 116 (71.6%) verbal abuse, and 76 (44.4%) bullying/harassment within the past year. Males reported more experience of physical assault (P less than 0.001), verbal abuse (P less than 0.04) and bullying/harassment (P less than 0.01). The educational level and time shifts were associated with the frequency of physical violence and bullying/harassment (P less than 0.03), respectively. We noticed an association between the job stress scales and some types of work place violence including physical assault (P=0.02), bullying/harassment (P=0.006) and demands scale in recent cited violence (P=0.07). CONCLUSIONS: We presented considerable prevalence of WPV among ED staff. Improving workplace condition and reducing occupational stress could be decrease WPV frequency.

How to Treat a Patient with Thromboangiitis Obliterans: A Systematic Review.

To date, there is still no treatment protocol for patients with thromboangiitis obliterans (TAO) who are also afflicted with critical limb ischemia (CLI). Smoking cessation on its own cannot be considered a treatment for the purposes of salvaging a limb of a TAO patient with CLI. The aim of this review was to evaluate different studies of various treatment protocols for avoiding amputation in TAO patients. A systematic search for relevant studies dating from 1990 to the end of 2016 was performed on the PubMed, SCOPUS, and Science Direct databases. Only 24 studies fulfilled the inclusion criteria, of which only one was a randomized controlled trial (RCT). The remaining studies were quasi-experimental with various treatments and follow-up durations. Therefore, meta-analysis was not performed. Judging from the major amputation rates after the suggested treatments were performed, no treatment was particularly effective. This review demonstrated that more standard RCTs are needed to resolve this treatment issue involved in TAO. In addition, because health insurance coverage for TAO patients differs by country, regional cost-benefit and cost-efficacy studies of the suggested treatments for TAO are highly recommended.

Assessment of life skills of medical students in Mashhad, Iran, in 2015.

BACKGROUND: Developing social skills and mental health is a crucial part of the psychosocial health status of medical students. OBJECTIVE: The aim of this study was to assess the life skills of medical students in Mashhad University of Medical Sciences (MUMS). METHODS: This cross-sectional study was performed in Mashhad University of Medical Sciences, Iran in 2015. By census method, 146 interns were entered into the study. The life skill questionnaire, consisting of 144 questions, was used as the measurement tool. Over 3 months, all the medical students in internship period were asked to complete the questionnaire. Data were analyzed by independent-samples t-test, one-way ANOVA, and Mann-Whitney with SPSS version 11.5 software. RESULTS: Women were shown to have higher decision-making ability than men (p=0.046). It was also shown in the study that social behavior (p=0.018), participation in activities that improve benefits (p=0.006), critical thinking (p=0.007), observing and using safety points (p=0.005), and mental health status (p=0.034) were significantly lower in men than in women. The data also suggests that men (13.97±4.7249) are more likely to become global citizens than women (12.15±3.6298) (p=0.010). Furthermore, there was a significant difference when comparing smoking and non-smoking in freedom and justice (p=0.003) and becoming a global citizen (p=0.012). CONCLUSION: Our study provides helpful information about medical students' life skills for policy makers and university authorities. We suggest that gender differences should be considered during life skill training.

Cardiovascular Disease Risk Factors Profile in Individuals With Diabetes Compared With Non-Diabetic Subjects in North-East of Iran.

BACKGROUND: Diabetes mellitus is assumed to be a strong risk factor for cardiovascular diseases (CVD) and is frequently associated with other CVD risk factors. OBJECTIVES: The aims of this study were to assess the prevalence of different patterns of dyslipidemia in individuals with diabetes compared with non-diabetic subjects and evaluate other accompanied CVD risk factors between the two groups. PATIENTS AND METHODS: This was an analytical cross-sectional study on 230 participants, aged 28 - 66 years old, who were referred to different urban health centers of Khorasan Razavi province (north-east of Iran). Data from the participants were collected during their first visit by primary care physicians. Statistical package for social science (version 11.5) was used to analyze the data. The chi-square or Fisher's exact, student's t or the Mann-Whitney U and correlation tests were used in the analysis. RESULTS: The age and gender of the participants were not different between the two groups (P = 0.1 and P = 0.4, respectively). The most common patterns of dyslipidemia in both groups were isolated dyslipidemia followed by combined dyslipidemia. Prevalence of dyslipidemia as a whole (one, two or three lipid profile abnormalities) in patients with diabetes and non-diabetic participants was 89.3% and 82.6%, respectively and the difference between the two groups was not statistically significant (P = 0.1). Subjects with diabetes had higher systolic blood pressure (P < 0.001), higher diastolic blood pressure (P = 0.002) and higher body mass index (P = 0.09) compared to non-diabetics. Moreover, they were more likely to have higher levels of total cholesterol (P = 0.01), triglycerides (P = 0.001) and low density lipoprotein cholesterol (P = 0.009) and lower levels of high density lipoprotein cholesterol (P = 0.2). CONCLUSIONS: Cardiovascular diseases risk factors are more common in patients with diabetes; however, non-diabetic individuals also had a high prevalence of risk factors in our region, predisposing them to diabetes. Therefore, further attention by the medical community is necessary to choose effective strategies for a more a aggressive approach to prevent and manage these risk factors.

Atherogenic Index of Plasma (AIP): A marker of cardiovascular disease.

BACKGROUND: Cardiovascular disease (CVD) is the cause of one third of deaths worldwide and this will progress because of increasing CVD's risk factors. The most basic task of dealing with the epidemic of CVD is primary prevention of risk factors. As Atherogenic Index of Plasma (AIP) is a strong marker to predict the risk of atherosclerosis and coronary heart disease, we assessed the correlation between AIP and other important factors. METHODS: This cross-sectional study was a part of national non-communicable risk factors surveillance system data that has been established since 2004 in Iran. This was done on 1000 people between 2008 and 2010. The study was approved by Ethics Committee of Mashhad University of Medical Science. Chi square, Mann-Whitney U, correlation tests were used in this study. Statistical analysis was performed using SPSS version 11. In all calculations, p <0.05 was considered as statistically significant level. RESULTS: The study population consisted of 500 men and 500 women with mean±SD age 41.9±14.2 years. According to the AIP category, 9.8% (98) were in low risk group, 12.7% (127) were in intermediate risk and 77.5% (775) were in increased risk of CVD. AIP was significantly correlated with waist circumference (r=0.35, p<0.001), BMI (r=0.33, p<0.001) and physical activity (r=-0.09, p<0.01). CONCLUSION: AIP can be used as a regular monitoring index of CVD in every day practice, especially in persons with other cardiovascular risk factors.