Teachers and managers experiences of virtual learning during the COVID-19 pandemic: A qualitative study.

The closure of universities and schools interrupted learning outcomes and deprived students from growth and development opportunities as well as hindering their academic progress. Indeed, the COVID-19 Pandemic changed educational mechanism from traditional method to staying at home and virtual education globally. On the other hand, the educators and student particularly in developing countries faced shortage of necessary software and hardware infrastructures. Accordingly, introduction of virtual education along with some organizational and regional obstacles as well as poor planning caused low-quality online courses. Therefore, the present study extrapolated teachers' virtual education experiences during the COVID-19 pandemic. This qualitative study conducted on Iranian teachers using the conventional content analysis method in 2022. To do this, the targeted sampling method with maximum variation continued until data saturation. Hence, a total of 17 teachers (10 women and 7 men) included in the study. Data collected through five focus group discussions on the Sky room platform and two individual in-depth interviews. Male teachers had an average age of 44.42 years, while female ones had an average age of 47.80 years. The qualitative analysis categorized 22 themes as virtual education's pros and cons. Mental, physical, and social injuries; economic problems; insufficient virtual teaching skills; lack of virtual infrastructure; lack of motivation were identified as the main disadvantages of virtual education. Virtual education benefits included familiarity with modern science and education, time management, the durability of video and course topics, and not forcing students to attend class. Removing structural barriers (like creating a good platform for practical education and stopping new restrictive policies) and individual barriers (like economic and family problems, lack of motivation, psychological pressures, and occupational stress) could possibly improve virtual education. Virtual education should be different from face-to-face teaching because it can only meet some students' needs.

The Assessment Metabolic Markers and Cardio Risk Index Among Controlled and Uncontrolled Type 2 Diabetic Patients in Primary Health Clinics in Medan City, North Sumatera, Indonesia: Cross-sectional Study.

Background: Diabetes mellitus is the most common metabolic disorder affecting people worldwide. Diabetes mellitus has been known to be associated with lipid metabolic disorders and macrovascular and microvascular complications. Objective: This study assesses the correlation between cardio risk index and metabolic markers in type 2 diabetes mellitus patients. Methods: This study was conducted on type 2 diabetes mellitus with the cross-sectional analytic method. The inclusion criteria of the samples were all the patients diagnosed with type 2 diabetes mellitus of both sexes. We recorded Body Mass Index, Blood Pressure, disease duration, and family history. The laboratory parameters, including Fasting Blood Sugar, Hba1c, HDL, LDL, TG, and Cholesterol, were examined by Paramita Laboratory Clinic. The data of the samples were processed using a computer with the SPSS program.. Results: There were significantly different mean of age, abdominal circumference, FBG, Hba1c, cardio risk index, and HDL controlled and uncontrolled type 2 diabetes groups, but the mean cholesterol and LDL levels were not different in the two groups.At uncontrolled type 2 diabetic we found that there was a significant correlation between the cardio risk index with Cholesterol (r= 0.3 p=0,004), triglycerides (r=0.5 p=0,001), and negative correlation cardio risk index with HDL (r= -0.5 p=0.012). There was no significant correlation between the cardio risk index with LDL (r=0.157 p=0.101). Conclusion: Hba1c and FBS are higher in uncontrolled type 2 diabetes accompanied by lipid profile and cardio risk index levels that are higher than expected values are the risk of complications in type 2 diabetes mellitus.

The Effect of Hypoxia Inducible Factor -1 Alpha and Vascular Endothelial Growth Factor Level in Type 2 Diabetes Microvascular Complications and Development.

Background: Angiogenesis in diabetic patients is often caused by hyperglycemia induced by hypoxia. Objective: The aim of this study was to analyze the serum level of Hypoxia Inducible Factor -1α (HIF-1α) and Vascular Endothelial Growth Factor (VEGF) between March until Desember 2020. Methods: This is a cross-sectional analytic methods, 135 patients with Type 2 Diabetes 48 samples with Microvascular complication and 87 samples with non-microvascular complication were recruited from the various primary health care centers in Medan city and surrounding areas in North Sumatera. VEGF levels and HIF-1α tested were done with ELISA methods in the laboratory of Medical Faculty, Universitas Sumatera Utara. Statistical analysis was performed using the IBM SPSS Statistics version 24. The significance level was set up to 0.005. Results: The median HIF-1 levels in patients with microvascular complications were lower than those without microvascular complications, with a range of HIF-1α values in non-complicated samples (0.02-13.96) ng/ml and a range of HIF-1α values in vascular complications (0.52- 8.87) mg/dL. There was a significant difference in HIF-1α levels in patients with Type-2 DM with complications compared to those without complications (p<0.05). Median VEGF levels were higher in complicated Type-2 DM. There was no difference in VEGF levels in patients with Type-2 DM with complications compared to those without complications (p > 0.005). Conclusion: HIF-1α and VEGF levels showed the development in vascularity. With the higher level of HIF-1α, an increase in VEGF levels were found, indicating the angiogenesis is occurring. Although complications have not yet occurred, it is predicted that high VEGF values will cause vascular complications in the future.

The effect of short message service (SMS) on knowledge and preventive behaviors of diabetic foot ulcer in patients with diabetes type 2.

OBJECTIVE: The present study aimed at evaluating the effectiveness of an educational intervention via mobile cells on foot care knowledge and foot care practices in patients with type 2 diabetes. MATERIAL AND METHODS: This is an interventional quasi-experimental study carried out in 4 community health centers in Andimeshk City in Iran in 2017. Of 160 patients 80 cases were randomly assigned as intervention group and 80 patients as the control one. A three-section questionnaire completed by a face-to-face interviewing used for data collection before and after the intervention and three months after the education. Fasting Blood Sugar (FBS) and Hemoglobin A1C (HbA1c) tests were done for both groups in a single laboratory before and three months after training. RESULTS: The mean age of patients in intervention group was 48.11 ±â€¯9.7 and control group was 47.3 ±â€¯7.9 years. The awareness of the patients related to diabetes foot care, in the intervention group after the training significantly improved (P < 0.001). The mean scores of preventive behaviors of diabetic foot significantly increased in the intervention group (P < 0.001). CONCLUSION: The findings indicate that educational intervention based on short message service (SMS), resulting in improve foot care knowledge, foot care practices and metabolic control in patients with diabetes type 2.

Determine the prevalence of gestational diabetes in Ardakan and its related factors.

Gestational Diabetes (GD) is amongst the most common metabolic disorders. Due to the important complications of GD on maternal and fetal health and in order to identify the prevalence of GD in various climate and cultures, the present studies aimed to determine the prevalence of GD in Ardakan and its related factors in 2014-2015. This cross-sectional study was conducted in 3808 pregnant women referring to rural and urban health centers in Ardakan city in 2013-14. Demographic, clinical, and obstetrics history of the subjects was gathered. GD was defined based on Glucose Tolerance Test (GTT). Descriptive and Logistic regression models were applied. The prevalence of GD was estimated to be 7.5% (286) which was higher in 35-39 age group, urban residents, obese mothers, and pregnancies ended with macrosome babies. The odds of GD was higher in obese mothers by 1.62 times (95%CI: 1.18-2.24), in mothers above ages of 40 by 10.53 (95%CI: 3.8-29.3), in mothers with a history of GD by 3.86 (95%CI:1.65-8.93), and in pregnancies ended with a macro some baby by 2.2 (95%CI: 0.97-5.1). The prevalence of GD in Ardakan was similar to other studies in the area. It seems that improvement of GD screening in older mothers and those with a history of GD could be a priority of surveillance system in Yazd Province.

The Value of Multi-slice Computed Tomography Compared to Conventional Coronary Angiography for Detecting In-stent Restenosis.

BACKGROUND: Diagnostic value of multi-slice computed tomography (MSCT) for detecting in-stent restenosis in comparison with conventional coronary angiography remained uncertain. The present study aimed to determine the value of MSCT for detecting in-stent restenosis. MATERIALS AND METHODS: This historical cohort study was included 226 patients with the history of percutaneous coronary intervention from 2000 to 2014 that referred to MSCT Unit at Alzahra Heart Center in Isfahan. The subjects were followed-up by telephone with regard to performing coronary angiography up to 3 months after MSCT and their status about cardiac events. RESULTS: Among all participants, 63 stents (27.9%) underwent coronary angiography up to 3 months after MSCT that 2 stents in left circumflex artery (LCX) assessment, 2 in left anterior descending (LAD) assessments and none in right coronary artery (RCA) assessment were uninterpretable. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MSCT was 92.9%, 66.6%. 92.9%, 66.6%, and 88.2%, respectively for detection of occlusion in LCX stents, 100%, 100%, 100%, 100%, and 100%, respectively for detection of occlusion in LAD stents, and 80.0%, 0.0%, 80.0%, 0.0%, and 66.7%, respectively for detection of occlusion in RCA stents. Overall, MSCT had sensitivity of 93.8%, specificity of 70.0%, PPV of 93.8%, NPV of 70.0%, and accuracy 89.7% for detection of coronary stent restenosis. CONCLUSION: MSCT has high diagnostic value for detecting in-stent restenosis. Diagnostic accuracy of MSCT for detecting stent restenosis is considerably different between the coronary arteries with the highest diagnostic values for LAD and the lowest diagnostic values for RCA.

Beneficial effects of platelet-rich plasma on improvement of pain severity and physical disability in patients with plantar fasciitis: A randomized trial.

BACKGROUND: The present study aimed to clinically examine the effects of platelet-rich plasma (PRP) on improvement of plantar fasciitis and its related manifestations. PATIENTS AND METHODS: This single-blind randomized controlled trial was performed on 32 consecutive patients with the final diagnosis of plantar fasciitis that were randomly assigned to the case group (that received PRP, n = 16) and the control group (that received corticosteroid as methylprednisolone 1 ml plus lidocaine 1 ml, n = 16). The endpoints in the present study were changes in the visual analog scale score and the modified Roles and Maudsley score (RMS) from baseline, 1-month, 3 months, and 6 months follow-up. Plantar fascia was also assessed by B-mode sonography before and also 3 months after primary assessment. RESULTS: Regarding the pain severity, the PRP group had significantly higher mean pain score at 3 time points of before injection, as well as 1 and 3 months after PRP use when compared to the corticosteroid group (P < 0.05); however, the control group experienced significantly higher pain severity than the PRP group at 6 months after interventions. Also, RMS was lower in PRP group than in corticosteroid group at baseline as well as at 1 and 3 months after injections (P < 0.05). In sonography assessment, no difference was revealed. CONCLUSION: Administration of PRP leads to significant improvement in pain severity and physical limitation in patients with plantar fasciitis. This healing effect may be begun at least 3 months after injection.

Skin manifestations in sulfur mustard exposed victims with ophthalmologic complications: Association between early and late phase.

CONTEXT: Sulfur mustard (SM) was used during the Iraq-Iran war (1980-1988). Exposed veterans continue to suffer from its ocular, skin, and respiratory complications. OBJECTIVE: We aimed to evaluate associations between early (at the time of acute exposure) and decades later skin manifestations in individuals with severe ophthalmologic complications secondary to sulfur mustard exposure. MATERIALS AND METHODS: One hundred forty-nine veterans with severe ocular injuries were evaluated for acute and chronic skin complications. Logistic regression models were used to examine the associations between early and late skin manifestations. RESULTS: Late skin complaints were observed in nearly all survivors who had early skin lesions (131 out of 137; 95.62%). Seven out of 12 patients (58.33%) who did not have early skin lesions ultimately developed late skin complications. There was a significant relationship between the presence of lesions at the time of exposure and developing late skin complaints (two-sided Fisher's exact test, OR = 15.59, p < 0.001). There was an association between having at least one early skin lesion and occurrence of late skin complications. Survivors with blisters at the time of chemical exposure were more likely to complain of itching (95% CI: 3.63-25.97, p < 0.001), burning (OR = 11.16; 95% CI: 2.97-41.89, p < 0.001), pigmentation changes (OR = 10.17; 95% CI: 2.54-40.75, p = 0.001), dryness (OR = 6.71, 95% CI: 1.22-37.01, p = 0.03) or cherry angioma (OR = 2.59; 95% CI:1.21-5.55, p = 0.01) during the late phase. Using multivariate logistic models, early blisters remained significantly associated with latent skin complaints. Of note, the genitalia and great flexure areas were the most involved anatomical sites for both early and late skin lesions in SM exposed survivors. CONCLUSION: According to this study, the presence of blisters at the time of exposure to SM is the most important predictor of developing dermatologic complications decades later in patients with severe ophthalmologic complications from sulfur mustard exposure.

Comparison of safety and efficacy of general and spinal anesthesia in kidney transplantation: Evaluation of the peri-operative outcome.

General anesthesia is a routine anesthetic technique for kidney transplantation. This study evaluated and compared the peri-operative hemodynamic, cardiopulmonary and general condition status in patients in whom spinal anesthesia (SA) or general anesthesia (GA) was used for kidney transplantation. A prospective study was carried out on 49 consecutive patients who underwent kidney transplantation with either GA (19 patients, mean age 37.53 ± 11.78 years) or SA (30 patients, mean age 42.17 ± 14.89 years), without any selection bias. One obese patient with a body mass index of 32.52 kg/m 2 died 22 days after transplantation in the GA group. One other patient, who developed severe nausea and vomiting, was changed from SA to GA. There were no statistical differences in gender, mean age, body mass index and hemodynamic and cardiopulmonary status between the two groups. Time to post-operative diet tolerance, defecation, ambulation and adequate urination were significantly better in the SA group. The mean operation time was 264.32 ± 18.91 and 233 ± 15.12 min in the GA and SA groups, respectively. Brisk diuresis was seen in all patients except one in the SA group. Our study suggests that kidney transplantation under SA is feasible and safe, particularly for patients who cannot receive GA.

Health status and quality of life in patients with psoriasis: an Iranian cross-sectional survey.

BACKGROUND: Psoriasis has a significant negative impact on patients' health-related quality of life (HRQOL). This study aims to evaluate HRQOL of adult patients with psoriasis in Iran, and explore the relationship between general and disease-specific outcome measures in psoriasis. METHODS: Between May and August 2013, a cross-sectional questionnaire survey of consecutive outpatients was conducted at a single clinic in Shiraz, Iran. HRQOL was assessed by the general measure EuroQol 5 dimensions (EQ-5D), visual analogue scale (EQ VAS), and the disease-specific Dermatology Life Quality Index (DLQI). Disease severity was measured by the Psoriasis Area and Severity Index (PASI). RESULTS: Sixty-two patients (76% males) completed the questionnaire with a mean age (SD) of 40.4 (17.5) years. Overall, 39% of the patients used only topical and 48% received systemic non-biological therapy in the past 12 months. Median EQ-5D, EQ VAS, DLQI and PASI scores were 0.73, 60, 8 and 11.75, respectively. Out of the 62 patients, 18%, 26%, 28%, 63%, and 63% reported some or severe problem in mobility, self-care, usual activities, pain/discomfort and anxiety/depression, respectively. EQ-5D and EQ VAS correlated moderately with DLQI (rs = -0.44 for both, p < 0.001), but only EQ VAS correlated significantly with PASI (rs = -0.31, p < 0.01). CONCLUSION: This is the first study from Iran that assesses HRQOL in adult patients with psoriasis by EQ-5D and EQ VAS. Reduction in general HRQOL measured with EQ-5D and EQ-VAS is considerable, mostly in anxiety/depression and pain/discomfort dimensions. EQ-5D scores evaluated in this study provide country-specific data for economic evaluations.

Three-dimensional visualization and quantification of water content in the rhizosphere.

• Despite the importance of rhizosphere properties for water flow from soil to roots, there is limited quantitative information on the distribution of water in the rhizosphere of plants. • Here, we used neutron tomography to quantify and visualize the water content in the rhizosphere of the plant species chickpea (Cicer arietinum), white lupin (Lupinus albus), and maize (Zea mays) 12 d after planting. • We clearly observed increasing soil water contents (θ) towards the root surface for all three plant species, as opposed to the usual assumption of decreasing water content. This was true for tap roots and lateral roots of both upper and lower parts of the root system. Furthermore, water gradients around the lower part of the roots were smaller and extended further into bulk soil compared with the upper part, where the gradients in water content were steeper. • Incorporating the hydraulic conductivity and water retention parameters of the rhizosphere into our model, we could simulate the gradual changes of θ towards the root surface, in agreement with the observations. The modelling result suggests that roots in their rhizosphere may modify the hydraulic properties of soil in a way that improves uptake under dry conditions.

The Effect of Low Tidal Volume Ventilation during Cardiopulmonary Bypass on Postoperative Pulmonary Function.

BACKGROUND: Postoperative pulmonary dysfunction is one of the most frequent complications after cardiac surgery and it is believed to result from the use of cardiopulmonary bypass (CPB). In this study, we investigated the effect of low tidal volume ventilation during CPB on postoperative gas exchange and lung mechanics. METHODS: This prospective randomized study included 100 patients undergoing elective coronary artery bypass grafting. In 50 patients, low tidal volume ventilation [tidal volume (TV) = 3 ml/kg, respiratory rate (RR) = 12/min, fraction of inspiratory oxygen (FIO(2))= 1.0, positive end expiratory pressure (PEEP) = 5 cmH(2)O] was applied during CPB (group I); and in the other 50 patients (group II), the lungs were open to the atmosphere without ventilation. Measurements were taken preoperatively, after CPB, and before discharge. RESULTS: Post-bypass PaO(2) (just after CPB 85 versus75) was higher significantly in group I (P value < 0.05). Decrease in postoperative forced expiratory volume in 1 second (25% versus 30%) and forced vital capacity (32% versus 35%) was less significant in group I. Also, time to extubation (5 hrs versus 5.5 hrs) was shorter in group I. CONCLUSION: Continued low tidal volume ventilation during CPB improved post-bypass oxygenation and lung mechanics.

Root responses to soil Ni heterogeneity in a hyperaccumulator and a non-accumulator species.

We compared root responses of the Ni-hyperaccumulator plant Berkheya coddii Rossler with the non-accumulator plant Cicer arietinum L. to Ni heterogeneity in soil. We grew plants in growth containers filled with control soil, homogeneously spiked, and heterogeneously spiked soil with Ni concentrations of 62 and 125 mg kg(-1). Neutron radiography (NR) was used to observe the root distribution and the obtained images were analysed to reveal the root volumes in the spiked and unspiked segments of the growth container. There was no significant difference in root distribution pattern of B. coddii among different concentrations of Ni. Unlike B. coddii, the roots of C. arietinum initially grew into the spiked segments. However, the later developing roots did not penetrate the spiked segment suggesting an avoidance strategy. Our results indicate that, B. coddii does not forage towards the Ni-rich patches, although presence of Ni in soil changes its root morphology.

Impact of psoriasis on quality of life in Iran.

BACKGROUND: The Psoriasis Disability Index (PDI) questionnaire is a widely used instrument to measure psychological morbidity in plaque-type psoriasis patients. AIMS: This study aimed to validate the Persian version of the PDI and to evaluate the impact of psoriasis on quality of life (QOL). METHODS: The English language version of the PDI was translated into Persian (Iranian official language) and was used in this study. The questionnaire was administered to a consecutive sample of 125 chronic plaque-type psoriasis patients and statistical analysis was performed to evaluate the impact of psoriasis on QOL. The other health-related QOL assessment tool included the Persian version of the Dermatology Life Quality Index (DLQI). RESULTS: Overall, 125 patients who had received the PDI and DLQI completed all the questions. Reliability analysis showed a satisfactory result (Cronbach's a coefficient=0.92 and 0.79 for PDI and DLQI, respectively). There was a strong statistical correlation between mean PDI and DLQI scores, with mean Psoriasis Area and Severity Index (PASI) (P=0.005 and 0.02). Also, a significant correlation coefficient existed between DLQI and PDI (r=0.94). The higher the PASI index, the higher the PDI and DLQI scores, which indicated greater impact on QOL. In the patients with lesions on visible exposed skin areas, the correlation was statistically significant (P=0.002 and 0.01). CONCLUSION: The Persian PDI is an acceptable, reliable and valid measure of psychological distress, with more suitable content validity than DLQI for assessment of impact of psoriasis on QOL among psoriasis patients. Data provided may improve the physicians' awareness of the importance of the patients' QOL.