Medical students' satisfaction level with e-learning during the COVID-19 pandemic and its related factors: a systematic review

PURPOSE: This review investigated medical students' satisfaction level with e-learning during the coronavirus disease 2019 (COVID-19) pandemic and its related factors. METHODS: A comprehensive systematic search was performed of international literature databases, including Scopus, PubMed, Web of Science, and Persian databases such as Iranmedex and Scientific Information Database using keywords extracted from Medical Subject Headings such as "Distance learning," "Distance education," "Online learning," "Online education," and "COVID-19" from the earliest date to July 10, 2022. The quality of the studies included in this review was evaluated using the appraisal tool for cross-sectional studies (AXIS tool). RESULTS: A total of 15,473 medical science students were enrolled in 24 studies. The level of satisfaction with e-learning during the COVID-19 pandemic among medical science students was 51.8%. Factors such as age, gender, clinical year, experience with e-learning before COVID-19, level of study, adaptation content of course materials, interactivity, understanding of the content, active participation of the instructor in the discussion, multimedia use in teaching sessions, adequate time dedicated to the e-learning, stress perception, and convenience had significant relationships with the satisfaction of medical students with e-learning during the COVID-19 pandemic. CONCLUSION: Therefore, due to the inevitability of online education and e-learning, it is suggested that educational managers and policymakers choose the best online education method for medical students by examining various studies in this field to increase their satisfaction with e-learning.

Survival of the hospitalized patients with COVID-19 receiving atorvastatin: A randomized clinical trial.

As statins decrease the progression of sepsis and its related mortality, this study aimed to evaluate the effect of atorvastatin on survival and symptom improvement in hospitalized patients with COVID-19. This randomized controlled trial was performed on 156 hospitalized patients with COVID-19 in Bojnourd city in 2021. Patients were randomly divided into comparison (standard therapy: hydroxychloroquine + Kaletra®) and intervention groups (atorvastatin 20 mg, SD, plus standard therapy). The main outcomes were the rate of symptom improvement, duration of hospitalization, need for intubation, and mortality rate. In this study, seven patients died, two patients (2.6%) in the comparison group and five (6.6%) in the intervention group. The mean hospitalization days (p = 0.001), the pulse rate (p = 0.004), and the frequency of hospitalization in the ICU ward (18.4% vs. 1.3%) were longer and greater in the intervention group. The remission probability in the comparison group was greater (p = 0.0001). The median hospitalization days in the intervention group was longer (p < 0.001) and remission in the comparison group occurred 1.71 times sooner (hazard ratio = 1.70, 95% confidence interval = 1.22-2.38, p = 0.002). Totally, adding atorvastatin to the standard regime in this study increased hospitalization days and imposed negative effects on symptom improvement in hospitalized patients with COVID-19.

Role of Herbal Medicines in the Management of Brain Injury.

Brain is susceptible to oxidative stress due to its increased oxygen consumption and low antioxidant levels. Oxidative stress plays a crucial role in the pathogenesis of various neurological diseases. This review on the role of herbal medicines in the management of brain injury was performed by searching Web of Science, PubMed, Google Scholar, Scopus, and Iran Medex between 1976 to January 2020. The search words contained brain injury, and the total number of publications for the review study was 32. Studies with various medicinal plants such as Acanthopanax senticosus, Bacopa monnieri, carnosol, Cassia mimosoides, Centella asiatica, Crocus sativus, Cuminum cyminum, curcumin, Feronia limonia, Gardenia jasminoides, Ginkgo biloba, Kaempferia parviflora, Mentha longifolia, Nigella sativa, olive, orientin, pomegranate, quercetin, rice bran, Rosa damascena, Thymus vulgaris, Viola odorata, Withania coagulans, Zingiber officinale, and Ziziphus spina-christi show a significant improvement in brain injury. The different mechanisms for improvement in brain injury by these medicinal plants include HIF-1 (hypoxia-inducible factor 1) signaling, free-radical scavenging, reduction of nitric oxide (NO) toxicity and acetylcholine esterase (AChE) activity, decrease of pAkt and its downstream targets, downregulation of the aquaporin-4 (AQP-4) and TLR4/NF-ĸB/TNF-α signal, reduction in malondialdehyde and NO levels, increasing neuronal density in the hippocampus, and inhibition of oxidative stress. In this review, the neuroprotective actions and molecular mechanisms of herbal medicines are evaluated by reviewing available studies.

Tongluojiunao, a traditional Chinese medication with neuroprotective ability: A review of the cellular, molecular and physiological mediators of TLJN's effectiveness.

The pressing need to discover more effective drugs for various CNS disorders has resurrected the idea of investigating the effectiveness of traditional medicines in modern science. Tongluojiunao (TLJN) is an example of revived modern herbal preparation based on traditional Chinese medicine (TCM) with a long history of administration for various types of cerebrovascular injuries and neurodegenerative diseases. TLJN is prepared from the herbal roots of Panax notoginseng (Sanchi) and dried fruits of Gardenia jasminoides (Cape Jasmine), and so far, it has demonstrated promising results in patients with vascular dementia and cerebral ischemic stroke. TLJN has also demonstrated therapeutic ability regarding the slowly-progressed neurodegenerative diseases like Alzheimer's disease. So it tempted us to undertake a thorough review of various features of TLJN therapeutic effects on the mentioned CNS conditions, including the cellular and molecular targets, inflammatory responses, neurogenesis and angiogenesis mediators and cognitive function. For this purpose, multiple global and local databases, including China National Knowledge Infrastructure (CNKI) were checked out and the retrieved information was grouped according to their scope of studies. Among these, TLJN is reported to restore the deregulated cell-cell communication in the neurovascular unit, prevent the stress-related challenges imposed by ischemia/reperfusion insult, help with the cerebral tissue recovery after traumatic brain damage, avoid the epileptic seizure attack and limit the progression of Alzheimer's disease. We hope that the current review provides new insights into TLJN medication as a prospective neuroprotective medication for further more in-depth investigation in the future.

In vitro antioxidant and antibacterial activity of various extracts from exocarps and endocarps of walnut.

Juglans regia seed has been used in traditional medicines as antimicrobial, antihelmintic and anti-diarrhoeal. In the present study, the antibacterial capabilities dichloromethane, ethyl acetate, methanol and aqueous extracts of endocarp and exocarp of walnut were determined against two Gram-positive bacteria and one Gram-negative bacteria. The antioxidant activity was screened by 2, 2'-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging and ferric reducing antioxidant power (FRAP) assays. The highest antioxidant activity was observed for methanol extract of endocarp in both methods and it was stronger than positive control butylated hydroxy toluene (BHT). The total phenolic contents were ranging between 34.59 to 68.34mg GAE/g DW. The results revealed that all extracts had antibacterial activity against selected bacteria except aqueous extract. The methanol extract of endocarp presented the highest zone of inhibition against tested pathogens (9-21mm). From the results it is conclude that the methanol extract from endocarp of walnut could be used as a natural preservative ingredient in food and pharmaceutical industries.

Chinese herbal formula Tongluo Jiunao injection protects against cerebral ischemia by activating neurotrophin 3/tropomyosin-related kinase C pathway.

The Chinese herbal formula Tongluo Jiunao, containing the active components Panax notoginseng and Gardenia jasminoides, has recently been patented and is in use clinically. It is known to be neuroprotective in cerebral ischemia, but the underlying pathway remains poorly understood. In the present study, we established a rat model of cerebral ischemia by occlusion of the middle cerebral artery, and administered Tongluo Jiunao, a positive control (Xuesai Tong, containing Panax notoginseng) or saline intraperitoneally to investigate the pathway involved in the action of Tongluo Jiunao injection. 2,3,5-Triphenyltetrazolium chloride (TTC) staining showed that the cerebral infarct area was significantly smaller in model rats that received Tongluo Jiunao than in those that received saline. Enzyme-linked immunosorbent assay revealed significantly greater expression of neurotrophin 3 and growth-associated protein 43 in ischemic cerebral tissue, and serum levels of neurotrophin 3, in the Tongluo Jiunao group than in the saline group. The reverse transcription polymerase chain reaction and immunohistochemical staining showed that after treatment with Tongluo Jiunao or Xuesai Tong, tropomyosin-related kinase C gene expression and immunoreactivity were significantly elevated compared with saline, with the greatest expression observed after Tongluo Jiunao treatment. These findings suggest that Tongluo Jiunao injection exerts a neuroprotective effect in rats with cerebral ischemia by activating the neurotrophin 3/tropomyosin-related kinase C pathway.