Lesson learned from assessing teachers' and students' perspectives regarding the quality of e-learning in medical education during the pandemic: a mixed-methods study.

BACKGROUND: The evaluation of e-learning systems ensures the provision of quality training. The goal was to identify the perspectives of teachers and students on e-learning in medical education during the COVID-19 pandemic at Shiraz University of Medical Sciences (SUMS), Iran. METHODS: This study utilized a convergent mixed methods research design with a two-phase approach to collect and analyze data between June and August 2022. In the first stage, a cross-sectional descriptive study was conducted to evaluate the quality of e-learning systems from the perspective of 400 students. In the second stage, semi-structured interviews were conducted with 10 virtual education professors and 10 student representatives to identify the strengths, weaknesses, opportunities, and threats of virtual education. A validated questionnaire was administered to assess the quality of the e-learning system, and data were analyzed using SPSS-21. Qualitative data were subjected to content analysis. RESULTS: Our findings revealed that the student support system, the course structure, and the infrastructure and technology subscales' mean scores were significantly higher than the average level (P < 0.001). However, the professors' methods of teaching and learning strategies were unsatisfactory. The results of the present study showed that the evaluation mean score was significantly higher among, younger, female, and undergraduate students. Virtual education has strengths and weaknesses, and innovative approaches are needed to enhance student engagement. The lack of appropriate infrastructure and virtual teaching tools for teachers and students is a significant challenge that needs to be addressed. Blended learning is effective in medical education, and the shift from teacher-centered to learner-centered teaching approaches is an opportunity to explore innovative teaching approaches. CONCLUSION: From the perspective of students, the quality of eLearning systems at the universities was moderate. Virtual education offers both benefits and drawbacks, and there is a requirement for innovative solutions to enhance student engagement and lessen boredom.

Intimate partner violence during pregnancy in COVID-19 pandemic: a cross-sectional study from South-west of Iran.

BACKGROUND: Intimate partner violence (IPV) against pregnant women can cause several complications for the mother and her baby, which are life-threatening. Thus, we aimed to find the prevalence of IPV and its associated factors in pregnant women in Shiraz, Iran. METHODS: This cross-sectional study was conducted among pregnant mothers in Shiraz between July 2020 and January 2021. The questionnaire consisted of four parts: demographic data, socio-economic status (SES), obstetric and medical history, and questions about IPV. Univariate analysis was performed using Chi-square, McNemar, or Fisher's exact test, and variables with p-value < 0.20 were included in Logistic regression. The odds ratio and CI 95% for variables with p-value < 0.05 were considered statistically significant. RESULTS: The overall prevalence of IPV was 93.1% among 830 pregnant women in Shiraz. Psychological violence was the most prevalent type (92.9%), followed by sexual (11%) and physical (7.7%) violence. High SES (OR = 3.21, (CI:1.61-6.41)) was the only risk factor for overall violence, and the age group, 30-34, was a risk factor for physical violence. Mother-desired pregnancy (OR = 26 (Cl:0.09-0.79)) and father-desired pregnancy (OR = 0.91, (CI:0.22-3.80)) were protective factors against physical and sexual violence, respectively. Furthermore, Psychological violence and sexual violence increased during COVID-19 Pandemic (P.value < 0.05). CONCLUSION: According to the obtained results, the prevalence of IPV during pregnancy in Shiraz was very concerning, especially psychological violence. Improving conflict-solving skills among family members and addressing economic problems could be considered by health policymakers when designing interventional programs and policies to reduce IPV during pregnancy.

Tissue presentation of human pegivirus infection in liver transplanted recipients.

Human pegivirus-1 (HPgV-1) is known for its protective role in HIV co-infected individuals. This immunomodulatory effect raised questions concerning the possible role of HPgV-1 infection and the risk of rejection in liver transplanted patients. We aimed to evaluate the possible protective effect of HPgV-1 on graft outcome of liver transplanted patients. A total of 283 patients were recruited. Formalin-fixed paraffin-embedded tissue samples were collected from the explanted liver. HBV-DNA, HCV-RNA, and HPgV-1-RNA were determined using PCR and multiplex RT-PCR assays. The clinical course of patients including the occurrence of acute cellular rejection was compared between HPgV-1-infected vs. uninfected patients. HBV-DNA, HCV-RNA and HPgV-1-RNA were detected in 42.6%, 4.9%, and 7.8% of samples, respectively. None of the HPgV-1-infected patients experienced graft rejection. Group LASSO logistic regression revealed that HPgV-1 infection was the only factor which significantly reduced the odds of graft rejection (OR = 0.5, 95% CI = 0.29-0.89). No significant association was found between the presence of HPgV-1 with HBV and HCV infections. The lack of graft rejection in HPgV-1-infected liver transplanted patients might indicate a possible role of this virus for graft surveillance. Since these are still preliminary findings, prospective studies should further elucidate the role of HPgV-1 in liver transplantation outcomes.

A telemonitoring system to support CPAP therapy in patients with obstructive sleep apnea: a participatory approach in analysis, design, and evaluation.

BACKGROUND: Continues positive airway pressure (CPAP) therapy is a gold standard treatment for moderate to severe cases of OSA (obstructive sleep apnea). The present research aimed to describe the analysis, design, and evaluation of a telemonitoring system to improve CPAP adherence in patients afflicted with OSA. METHODS: The telemonitoring system was developed in five phases. In the exploratory phase, the body of related literature was reviewed. Then a need analysis was conducted through a focus group discussion with sleep medicine specialists and sales company representatives and an interview with patients. The third phase involved data integration. Then the content and system development were done based on the previous phases. Finally, usability and functionality tests were used to evaluate the system. RESULTS: The exploratory phase and the needs analysis were conducted by four sleep medicine specialists, two medical informatics specialists, six key figures of the sales companies, two system developers, and 46 patients in different phases. Based on the results obtained from the data integration phase, the telemonitoring system involved three main parts: a patient's application, a doctor's portal, a selling companies' portal (operator's portal) along with facilitating software for patients to send the CPAP data. Usability and functionality tests were given to 7 and 10 patients, respectively. The total number of usability issues reported by users in the evaluation process was 18, with an average of 2.5 issues per user. The installation problems, disrupted links and improper playing of videos were the main functionalities problems that were solved. CONCLUSION: The telemonitoring system, as a means of communication between patients, doctors, and selling companies, can be used to support patients clinically and technically. It has the potential to improve CPAP adherence in patients with OSA.

Predictive value of vascular endothelial growth factor and placenta growth factor for placenta accreta spectrum.

This study aimed to assess the maternal features, Vascular Endothelial Growth Factor (VEGF) and Placenta Growth Factor (PLGF) in the Placenta Accreta Spectrum (PAS); then, to determine a predictive value of VEGF and PLGF in the PAS. This prospective case-control study was conducted on 90 pregnant women including 45 PAS, and 45 Normal Placenta (NP). Maternal age, gravidity, C/S, and serum levels of VEGF and PLGF were assessed between NP and PAS, and among NP and PAS sub-groups, including Placenta Accreta (PA), Placenta Increta (PI), and Placenta Percreta (PP). The Multi-gravidity, previous C/S, maternal age, and serum level of PLGF were significantly higher in the PAS group compared to the NP group OR = 42, 8.1, 1.17, and 1.002 (p-value <.05 for all); however, there was no difference regarding serum level of VEGF (p-value >.05). The same differences were seen among NP with PA, PI, and PP sub-groups (p-value <.05 for all, but p-value >.05 for VEGF). Placenta Previa was uniformly distributed across the PAS sub-groups (p-value >.05), also the VEGF and PLGF serum levels did not differ between PAS with Previa and PAS without Previa groups (p-value >.05). A valid cut-off point for PLGF was reported at 63.55. A predictive value of PLGF for the PAS patients is presented enjoying high accuracy and generalisability for the study population.Impact statementWhat is already known on this subject? The Placenta Accreta Spectrum (PAS), in which the placenta grows too deep in the uterine wall, is responsible for maternal-foetal morbidity and mortality worldwide; so, the antenatal diagnosis of PAS is an important key to improve maternal-foetal health. Normal placental implantation requires a fine balance among the levels of angiogenic and anti-angiogenic factors, such as the Placenta Growth Factor (PLGF), the Vascular Endothelial Growth Factor (VEGF), and soluble Fms-like tyrosine kinase-1. However, there is still controversy regarding The PLGF and VEGF level changes in PAS patients.What do the results of this study add? Despite traditional measuring the levels of PLGF and VEGF from the placenta at the time of delivery; in this study including 90 participants (28-34 weeks of gestation) the maternal serum levels of PLGF and VEGF were measured in advance (temporality causation), resulted in presenting a more valid cut-off point for PLGF in PAS group. In addition, the serum level of PLGF was significantly higher in the PAS and PAS sub-groups compared to the Normal Placenta group. Also, the Previa status of PAS patients did not affect the VEGF and PLGF serum levels.What are the implications of these findings for clinical practice and/or further research? PLGF cut-off point derived from the maternal serum level could predict PAS validly and, if used as a screening test in an earlier pregnancy, the maternal-foetal morbidity and mortality would decrease.

Electron microscopy study of 496 cases of lupus nephritis: A single-center experience.

INTRODUCTION: Renal involvement is seen in about 40-82% of systemic lupus erythematosus (SLE) Asian patients. The exact diagnosis and classification of lupus nephritis are important for treatment and prognosis. This study aimed to investigate the value of electron microscopy (EM) in the diagnosis and classification of lupus nephritis compared with light microscopy. METHOD: In this cross-sectional referral-center 16-year study of lupus nephritis, the final diagnosis was based on the EM study. Primary light microscopy findings were compared with EM diagnosis. Moreover, Immunofluorescence patterns distribution was assessed. RESULTS: From 496 patients diagnosed with lupus nephritis based on EM, 225(45.4%) of patients were categorized in class IV, followed by 98(19.7%), 93(18.8%), 46(9.3%), and 14(2.8%) who were categorized into classes of II, III, V, and VI respectively. Only 1(0.2%) patient belonged to class I, and 19(3.8%) cases were diagnosed with mixed two classes. Using EM was essential for diagnosing 25.6% of cases taking the correct classification by light microscopy into account; however, disregarding correct classification, this could change to a 7.4% contribution rate of EM. The most common cause of misdiagnosis, disregarding incorrect classification, was inadequate or wrong tissue. Positive associations were detected between tubular atrophy and interstitial fibrosis of both electron and light microscopy with different classes (P < 0.001). CONCLUSION: While light microscopy is highly accurate for diagnosing lupus nephritis regardless of correct classification, EM contributes substantially to the correct classification of lupus nephritis types.

Non-communicable diseases in the southwest of Iran: profile and baseline data from the Shahrekord PERSIAN Cohort Study.

BACKGROUND: Critical inter-provincial differences within Iran in the pattern of non-communicable diseases (NCDs) and difficulties inherent to identifying prevention methods to reduce mortality from NCDs have challenged the implementation of the provincial health system plan. The Shahrekord Cohort Study (SCS) was designed to address these gaps in Chaharmahal and Bakhtiari, a province of high altitude in the southwest of Iran, characterized by its large Bakhtiari population, along with Fars and Turk ethnicity groups. METHODS: This ongoing cohort, a prospective, large-scale longitudinal study, includes a unique, rich biobank and was conducted for the first time in Chaharmahal and Bakhtiari Province in Iran. SCS is a part of the PERSIAN (Prospective Epidemiological Research Studies in IrAN) cohort. The study began in 2015, recruited 10075 participants (52.8% female, 47.2% male) from both urban (n=7034) and rural (n=3041) areas, and participants will be annually followed up for at least 15 years. A cross-sectional analysis was conducted using baseline data from the SCS, using descriptive statistics and logistic regression. Data analysis was performed using Stata software. RESULTS: The prevalence of NCDs was 9.8% for type 2 diabetes, 17.1% for hypertension, 11.6% for thyroid disease, 0.2% for multiple sclerosis and 5.7, 0.9 and 1.3% for ischemic heart disease, stroke and myocardial infarction, respectively. The prevalence of multimorbidity (≥2 NCDs) was higher in women (39.1%) than men (24.9%). The means (standard deviations) of age, BMI, systolic blood pressure and fasting blood glucose were 49.5 (9) years, 27.6 (4.6) kg/m2, 115.4 (17.3) mmHg and 96.7 (27.3) mg/dL, respectively. Logistic regression models showed that older age, female gender, living in an urban area, non-native ethnicity, high wealth index, unemployment, obesity, low physical activity, hypertriglyceridemia, high fasting blood sugar, alkaline urine pH and high systolic and diastolic blood pressure were associated with increased prevalence of NCDs. CONCLUSIONS: The SCS provides a platform for epidemiological studies that will be useful to better control NCDs in the southwest of Iran and to foster research collaboration. The SCS will be an essential resource for identifying NCD risk factors in this region and designing relevant public health interventions.

A 16-year Survey of Clinicopathological Findings, Electron Microscopy, and Classification of Renal Amyloidosis.

Background: Electron microscopy (EM) is a valuable tool in the diagnosis of renal amyloidosis, particularly in the early stages of the disease. In Iran, studies on EM and the clinical features of renal amyloidosis are scarce. The objective of the present study was to survey EM investigations, pathological classifications, and clinical features of renal amyloidosis. Methods: This cross-sectional study was performed in Shiraz, Iran, during 2001-2016. Out of 2,770 kidney biopsies, 27 cases with a diagnosis of renal amyloidosis were investigated. EM investigation and six staining procedures for light microscopy (LM) were performed. Two pathological classifications based on glomerular, peritubular, perivascular, and interstitial involvement were made. Finally, the association between these classifications and the clinical features was assessed. Chi-square, Fisher's exact, Independent t test, and Multiple logistic regression analysis were used. P values<0.05 were considered statistically significant. Results: In 51.9% of the cases, the clinical diagnosis was nephrotic syndrome. Proteinuria and edema were the most prevalent clinical manifestations. The role of EM investigation for diagnosis was graded "necessary" or "supportive" in 48.2% of the patients. In the classification based on glomerular classes, variables such as the mean blood pressure (P=0.003), history of hypertension (P=0.02), creatinine >1.5 (P=0.03), and severe tubular atrophy (P=0.03) were significantly higher in class B (advanced amyloid depositions). Conclusion: EM plays an important role in the diagnosis of renal amyloidosis. EM in conjunction with LM investigation with Congo red staining is recommended, to prevent misdiagnosis of patients with a clinical suspicion of renal amyloidosis. Among different pathological features of renal amyloidosis, the severity of glomerular amyloid depositions had a clear relationship with clinical presentations.

Correlation of resting heart rate with anthropometric factors and serum biomarkers in a population-based study: Fasa PERSIAN cohort study.

BACKGROUND: There is a positive association between raised resting heart rate (RHR), and all causes of mortality and shorter life expectancy. Several serum biomarkers and some anthropometric factors can affect the resting heart rate. This study aimed to investigate the determinants of resting heart rate in a large random sample of the Iranian population. MATERIAL AND METHODS: It is a standardized, retrospective study and the subjects were chosen from the baseline survey of the Prospective Epidemiological Research Study in IrAN (PERSIAN) Fasa non-communicable disease cohort study. It was conducted from winter 2014 to summer 2019 and after obtaining informed consent from a random sample, all the eligible subjects were enrolled. All anthropometric factors and biologic laboratory factors were collected and analyzed by implement smoothly clipped absolute deviation (SCAD) linear regression and SCAD quantile regression. The comparisons between males and females were done via independent T-test. RESULTS & CONCLUSION: A total number of 9975 persons from 35 to 90 years old were included. The overall median resting heart rate was 74 (interquartile range:66-80). Mean age has no important difference between males and females (P = 0.79) but, resting heart rate was significantly higher in females (76.6 versus 71.4, P < 0.001). All anthropometric factors except wrist circumference were higher in females (P < 0.05). Age has an adverse effect on resting heart rate and also, there was a direct association between resting heart rate and systolic blood pressure and blood glucose. Alpha-blockers (coefficient = 5.2) and Beta1-blockers (coefficient = - 2.2) were the most effective drugs with positive and negative effects on resting heart rate respectively. Lower hemoglobin, obesity, and more body mass index, and more low-density lipoprotein were associated with more resting heart rate. Continuing the monitoring of this sample via our cohort study and put to action multinational prospective researches with large sample sizes and long follow-ups can lead to more precise results and better scientific judgments.

Introducing an efficient model for the prediction of placenta accreta spectrum using the MCP regression approach based on sonography indexes: how efficient is sonography in diagnosing accreta?

BACKGROUND: For the first time, we aimed to introduce a model for prediction of placenta accreta spectrum (PAS), using existing sonography indices. METHODS: Women with a history of Cesarean sections were included. Participants were categorized "high risk" for PAS if the placenta was previa or low-lying. Sonography indices including abnormal placental lacuna, loss of clear zone, bladder wall interruption, myometrial thinning, placental bulging, exophytic mass, utero-vesical hypervascularity, subplacental hypervascularity, existence of bridging vessels, and lacunar flow, were registered. To investigate simultaneous effects of 15 variables on PAS, Minimax Concave Penalty (MCP) was used. RESULTS: Among 259 participants, 74 (28.5%) were high risk and 43 individuals had PASs. All sonography indices were higher among patient with PAS (p < 0.001) in the high risk group. Our model showed that utero-vesical hypervascularity, bladder interruption and new lacunae have significant contribution in PAS. Optimal cut off point was p = 0.51 in ROC analysis. Probability of PAS for women with lacunae was between 96 and 100% and probability of PAS for women without lacunae was between 0 to 7%, therefore accuracy of the proposed model was equal to 100%. CONCLUSIONS: Using the introduced model based on three factors of abnormal lacuna structures (grades 2 and 3), bladder wall interruption and utero-vesical vascularity, 100% of all cases of PASs are diagnosable. If supported by future studies our model eliminates the need for other imaging assessments for diagnosis of invasive placentation among high risk women with previous history of Cesarean sections.

Evaluation of restless leg syndrome symptoms in patients with lumbosacral canal stenosis comparison with normal population.

Introduction: Restless leg syndrome (RLS) is a neurological disorder that causes an irresistible urge to move the legs often associated with an unpleasant sensation. Due to some common presentations between RLS and lumbosacral spinal stenosis, the purpose of this study was to evaluate the symptoms of RLS in the presence of spinal stenosis at the same time as normal populations.Materials and methods: This cross-sectional study examined 45 patients with lumbosacral spinal canal stenosis and 45 normal individuals without a specific disease. Patients aged 50-70 years were included in the study. All the statistical analyses were carried out using SPSS 21.0 software and p < 0.05 was considered statistically significant.Results: 19 subjects (42.22%) in the patient group and eight in the normal group (17.8%) suffered from restless leg syndrome. Multiple linear regression analysis revealed that patients with lumbosacral canal stenosis had almost five score less than others in RLS scale.Conclusion: RLS symptoms were more prominent in lumbosacral canal stenosis patients compared to the normal group. The awareness of its symptoms can help reduce misdiagnosis.

A New Clustering Method for Knee Movement Impairments using Partitioning Around Medoids Model.

BACKGROUND: The movement system impairment (MSI) model is a clinical model that can be used for the classification, diagnosis, and treatment of knee impairments. By using the partitioning around medoids (PAM) clustering method, patients can be easily clustered in homogeneous groups through the determination of the most discriminative variables. The present study aimed to reduce the number of clinical examination variables, determine the important variables, and simplify the MSI model using the PAM clustering method. METHODS: The present cross-sectional study was performed in Shiraz, Iran, during February-December 2018. A total of 209 patients with knee pain were recruited. Patients' knee, femoral and tibial movement impairments, and the perceived pain level were examined in quiet standing, sitting, walking, partial squatting, single-leg stance (both sides), sit-to-stand transfer, and stair ambulation. The tests were repeated after correction for impairments. Both the pain pattern and the types of impairment were subsequently used in the PAM clustering analysis. RESULTS: PAM clustering analysis categorized the patients in two main clusters (valgus and non-valgus) based on the presence or absence of valgus impairment. Secondary analysis of the valgus cluster identified two sub-clusters based on the presence of hypomobility. Analysis of the non-valgus cluster showed four sub-clusters with different characteristics. PAM clustering organized important variables in each analysis and showed that only 23 out of the 41 variables were essential in the sub-clustering of patients with knee pain. CONCLUSION: A new direct knee examination method is introduced for the organization of important discriminative tests, which requires fewer clinical examination variables.

Identifying genotype profile of chronic hepatitis C infection in Southwest Iran.

BACKGROUND: Hepatitis C virus (HCV) infection is one of the most important risk factors for liver failure which can lead to chronic hepatitis, cirrhosis, and hepatocellular carcinoma. Approximately 170-200 million (almost 3% of the world's population) people have been reported to have HCV infection worldwide. HCV has six genotypes and multiple subtypes. HCV genotyping and identification of subtypes are critical steps for HCV vaccine development. MATERIALS AND METHODS: In this community-based study, we aimed to investigate the HCV genotypes in infected patients referring to the laboratory of Hajar Hospital of Shahrekord city (the capital of Chaharmahal and Bakhtiari Province) in Iran from November 21, 2016, to October 21, 2017. During 2016-2017, the sera were obtained from 2377 individuals referring to the laboratory of Hajar Hospital of Shahrekord, Iran. The anti-HCV antibody was tested for all sera by enzyme-linked immunosorbent assay test. Following HCV RNA isolation and cDNA synthesis, HCV genotype detection was performed by quantitative reverse transcription-polymerase chain reaction. RESULTS: Genotypes 3, 1a, and 1b were found in 28.6% (95% confidence interval [CI]: 17.0%-40.0%), 9.5% (95% CI: 2.1%-17.0%), and 3.2% (95% CI: 0.0%-7.6%) of the patients, respectively. In 5 patients (7.9%, 95% CI: 1.1%-14.8%), however, we did not observe any genotypes. We could not find any significant difference between the plasma viral load of infected patients and different genotypes. There was no significant difference either between age groups and genotypes (P > 0.05). CONCLUSION: The findings of the present study determined that HCV genotype 3 was the predominant genotype followed by the genotypes 1a and 1b in Chaharmahal and Bakhtiari Province.

Introducing novel and comprehensive models for predicting recurrence in breast cancer using the group LASSO approach: are estimates of early and late recurrence different?

BACKGROUND: In here, we constructed personalized models for predicting breast cancer (BC) recurrence according to timing of recurrence (as early and late recurrence). METHODS: An efficient algorithm called group LASSO was used for simultaneous variable selection and risk factor prediction in a logistic regression model. RESULTS: For recurrence < 5 years, age (OR 0.96, 95% CI = 0.95-0.97), number of pregnancies (OR 0.94, 95% CI = 0.89-0.99), family history of other cancers (OR 0.73, 95% CI = 0.60-0.89), hormone therapy (OR 0.76, 95% CI = 0.61-0.96), dissected lymph nodes (OR 0.98, 95% CI = 0.97-0.99), right-sided BC (OR 0.87, 95% CI = 0.77-0.99), diabetes (OR 0.77, 95% CI = 0.60-0.98), history of breast operations (OR 0.38, 95% CI = 0.17-0.88), smoking (OR 5.72, 95% CI = 2.11-15.55), history of breast disease (OR 3.32, 95% CI = 1.92-5.76), in situ component (OR 1.58, 95% CI = 1.35-1.84), tumor necrosis (OR 1.87, 95% CI = 1.57-2.22), sentinel lymph node biopsy (SLNB) (OR 2.90, 95% CI = 2.05-4.11) and SLNB+axillary node dissection (OR 3.50, 95% CI = 2.26-5.42), grade 3 (OR 1.79, 95% CI = 1.46-2.21), stage 2 (OR 2.71, 95% CI = 2.18-3.35), stages 3 and 4 (OR 5.01, 95% CI = 3.52-7.13), and mastectomy+radiotherapy (OR 2.97, 95% CI = 2.39-3.68) were predictors of recurrence < 5 years. Moreover, relative to mastectomy without radiotherapy (as reference for comparison), quadrantectomy without radiotherapy had a noticeably higher odds ratio compared to quadranectomy with radiotherapy for recurrence < 5 years. (OR 17.58, 95% CI = 6.70-46.10 vs. OR: 2.50, 95% CI = 2-3.12). Accuracy, sensitivity, and specificity of the model were 82%, 75.6%, and 74.9%, respectively. For recurrence > 5 years, stage 2 cancer (OR 1.67, 95% CI = 1.31-2.14) and radiotherapy+mastectomy (OR 2.45, 95% CI = 1.81-3.32) were significant predictors; furthermore, relative to mastectomy without radiotherapy (as reference for comparison), quadranectomy without radiotherapy had a noticeably higher odds ratio compared to quadranectomy with radiotherapy for recurrence > 5 years (OR 7.62, 95% CI = 1.52-38.15 vs. OR 1.75, 95% CI = 1.32-2.32). Accuracy, sensitivity, and specificity of the model were 71%, 78.8%, and 55.8%, respectively. CONCLUSION: For the first time, we constructed models for estimating recurrence based on timing of recurrence which are among the most applicable models with excellent accuracy (> 80%).

Associated Factors of Self-Rated Mental Health Status in Southwestern Iran: Using SCAD Regression Model in a Population-Based Study.

This study aimed to investigate the association between self-rated mental health (SRMH) and current health status of an Iranian population. A cross-sectional study was conducted on 3400 individuals selected through random sampling in Shiraz, Iran between January 2014 and March 2015. Data were gathered through face-to-face interviews. Statistical analyses were performed using the SPSS 19.0, and R.3.1.2 software was used for SCAD penalized logistic regression. The mean age of the participants was 38.5 (± 14.1 years). There were significant relationships between better SRMH and younger ages (p < 0.001), and between better SRMH and better self-rated physical health (p < 0.001). Individuals with poor SRMH were more likely to have signs and symptoms of medical diseases. SRMH, a component of self-rated health, was related to a variety of health problems in our study population. Therefore, paying attention to SRMH and mental well-being could be useful in making decision about implementation of preventive measures.

Evaluation of serum biomarkers for detection of preeclampsia severity in pregnant women.

OBJECTIVES: To determine serum biomarkers in detection of preeclampsia severity among pregnant women. METHODS: Among 450 pregnant women with various severity of preeclampsia, serum biomarkers ofaspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), hemoglobin (Hb), platelet count (PLT), uric acid, direct bilirubin, total bilirubin, creatinine, and alkaline phosphatase were compared using area under the Receiver operating characteristic (ROC) curve and Area Under the Curve (AUC). RESULTS: The mean age of women was 30.63±6.43 years and with mean gestational age of 34.69±3.97 weeks. The mean level of LDH, ALT, uric acid, and creatinine were significantly higher in the women with severe type of preeclampsia compared to those with mild type. LDH level had ROC and AUC of more than 0.80, with highest sensitivity, and moderatespecificityin comparison to other markers. CONCLUSION: Biomarkers such as ALT, uric acid, and LDH were shown to be prognostic in detection of theseverity of preeclampsia. LDH was demonstrated to significantly be a better prognostic test in detection of preeclampsia severity.

An Epidemiological Study of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis during 2010-2015 at Shahid Faghihi Hospital, Shiraz, Iran.

The Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are two ends of the spectrum of severe immunobullous state characterized by keratinocyte apoptosis. The present study aimed to draw attention to various epidemiological features of SJS and TEN diseases such as causative drugs, underlying diseases, duration of hospitalization, and types of treatment. The records of all patients with the diagnosis of SJS, TEN, and SJS/TEN overlap during 2010-2015 were retrospectively reviewed. The records belonged to patients who were admitted to the Dermatology Tertiary Referral Center of Shahid Faghihi Hospital affiliated to the Shiraz University of Medical Sciences, Shiraz, Iran. From a total of 97 patients with such skin disorders, we identified SJS in 89 (91.8 %), TEN in 5 (5.1%), and SJS/TEN overlap in 3 (3.1%) patients. The most commonly consumed drug was Lamotrigine (21.6%) and the most common drug category was anticonvulsants (46.4%). In line with many studies, especially in Iran, Lamotrigine and anticonvulsant drugs were the most common causative drug and epilepsy was the most common underlying disease. Patients with SJS/TEN overlap or TEN were treated with combination therapy, whereas SJS patients received systemic corticosteroids.

Observational Study of Associations between Voriconazole Therapeutic Drug Monitoring, Toxicity, and Outcome in Liver Transplant Patients.

The aim of this study was to investigate the variability of the voriconazole plasma level and its relationships with clinical outcomes and adverse events among liver transplant recipients to optimize the efficacy and safety of their treatment. Liver transplant recipients treated with voriconazole were included, and voriconazole trough levels were quantified by a validated high-performance liquid chromatography method. Cytochrome P450 genotypes for CYP2C19 were evaluated in allograft liver tissues. A total of 832 voriconazole trough levels from 104 patients were measured. Proven, probable, and possible invasive fungal infections were reported for 8/104 (7.7%), 42/104 (40.4%), and 54/104 (51.9%) patients, respectively. Receiver operating characteristic (ROC) curve analysis indicated that trough concentrations of ≥1.3 µg/ml minimized the incidence of treatment failure (95% confidence interval [CI], 0.68 to 0.91 µg/ml) (P < 0.001) and that those of <5.3 µg/ml minimized the incidence of any adverse events (95% CI, 0.83 to 0.97 µg/ml) (P < 0.001). Voriconazole trough levels were significantly higher for heterozygous extensive metabolizers, poor metabolizers, and individuals receiving coadministration with proton pump inhibitors. For ultrarapid metabolizers, oral administration of voriconazole, and concomitant use of glucocorticoids, voriconazole blood concentrations were significantly reduced. Furthermore, there was no statistically significant association of patient age, weight, or gender or coadministration of tacrolimus and cyclosporine with the voriconazole trough level. In conclusion, the results of our analysis indicate large inter- and intraindividual variabilities of voriconazole concentrations in liver transplant recipients. Voriconazole trough concentrations of ≥1.3 µg/ml and <5.3 µg/ml are optimal for treatment and for minimization of adverse events. Optimization of drug efficacy and safety requires the use of rational doses for voriconazole therapy.