Teaching clinical reasoning to medical students: A brief report of case-based clinical reasoning approach.

BACKGROUND: Case-based clinical reasoning (CBCR) is the proposed method to improve clinical reasoning. This brief report aimed to evaluate CBCR effectiveness to improve clinical reasoning via an online course. SETTINGS AND DESIGN: This study is a brief report of a before-after quasi-experimental study to evaluate CBCR in medical students of Shahid Beheshti University of Medical Sciences. MATERIALS AND METHODS: Ten online weekly 2-hour sessions of CBCR presentations were instructed to medical students. Each session started with an illness script, and then, the instructor posed the students' five clinical questions in five steps according to the CBCR approach. The clinical reasoning ability of students was evaluated before and 2 weeks after the online courses using four types of standard clinical questions. STATISTICAL ANALYSIS USED: A Wilcoxon signed-rank test was used to assess the difference between pretest and posttest examination scores. RESULTS: This brief report revealed that twenty-one medical students participated in all ten sessions of the CBCR online course and were evaluated in pretest and posttest examinations. A significant improvement in the clinical reasoning total scores in the posttest examination compared with the pretest examination was observed (P = 0.001). In terms of specific types of clinical questions, the mean posttest scores for clinical reasoning problem (CRP) and key feature (KF) examinations were higher than the pretest scores (P = 0.001 and P = 0.005, respectively). CONCLUSIONS: Applying the CBCR approach improved the total clinical reasoning score of medical students during the course. Further studies are needed to evaluate whether this improvement would persist in workplace settings or not.

Best Evidence Topic report: does blood group type O decrease the risk of severe COVID-19 infection?

A short-cut systematic review was conducted using a described protocol. The three-part question addressed was: In patients with COVID-19 infection, does blood group type O versus non-O blood groups lead to a lower risk of severe COVID-19 infection? MEDLINE, Embase, and Cochrane databases were searched for relevant evidence. Altogether, 238 papers were found using the search strategy developed. Seventeen provided the best evidence to answer the three-part question. The data on first author name, publication year, country of origin, study type, study sample size, participant's gender, reported effect sizes, main findings and limitations were extracted from the relevant studies and listed in a table. Finally, 4 out of 17 studies revealed that having blood group type O may be associated with a lower risk of severe COVID-19 among patients with COVID-19 infection and the 13 remaining studies reported no significant relationship between having O blood group and risk of COVID-19 severity among the infected individuals. Of three systematic reviews and meta-analyses identified, none detected a protective effect of blood group type O. The clinical bottom line is that the best available evidence does not support the notion that blood group type O is protective against serious outcomes in COVID-19.

Name game conundrum: identical specific epithets in Microgastrinae (Hymenoptera, Braconidae).

It is a privilege to recognize a new species and immortalize it with a name. Taxonomists may use etymologies recalling the sampling locality, habitat, species morphology, people (actor, writer, singer, politician, scientist), culture (customs, beliefs), fictional characters (gods, demons, cartoons), brands, ancient names, and others. Naming a species is a creative act that allows scientists to express their love for nature. By drawing on personal and cultural associations, species names are often imbued with far greater meaning than one might initially assume. Unconventional names for species can be an effective way to capture the imagination of the public and make the species memorable. In other words, species names can be both meaningful and whimsical. The central focus of this study was to pinpoint species in the subfamily Microgastrinae that share the same specific epithet that often creates confusion regarding which species is being referred to. The findings showed that 153 specific epithets were repeated representing 340 species in 52 genera, while the remaining 2,823 species have unique epithets. Three of the five categories proposed accommodate the majority of the etymologies: people (42%), morphology (27%), and geography (15%) whereas the categories of other (9%) and biology (7%) achieve the least representation. Approximately 95% of the same specific epithets had a single clear meaning, while for the remaining 5%, it was not possible to trace etymology. The study revealed that the average length of specific epithets was 9.01 letters, the longest contains 18 (eliethcantillanoae) while the shortest four (eros and erro). Additionally, most identical specific epithets were repeated two times (85.25% of the occurrences), although three (12.82%), five, six, and even nine (each one with 0.64%) repetitions were also found. Finally, a list of recommendations for taxonomists when faced with the task of naming a new species is provided.

Ophiclypeus, a new genus of Cardiochilinae Ashmead (Hymenoptera, Braconidae) from the Oriental region with descriptions of three new species.

A new genus of the braconid subfamily Cardiochilinae, Ophiclypeusgen. nov., is described and illustrated based on three new species: O.chiangmaiensis Kang, sp. nov. type species (type locality: Chiang Mai, Thailand), O.dvaravati Ghafouri Moghaddam, Quicke & Butcher, sp. nov. (type locality: Saraburi, Thailand), and O.junyani Kang, sp. nov. (type locality: Dalin, Taiwan). We provide morphological diagnostic characters to separate the new genus from other cardiochiline genera. A modified key couplet (couplet 5) and a new key couplet (couplet 16) are provided with detailed images for Dangerfield's key to the world cardiochiline genera to facilitate recognition of Ophiclypeusgen. nov.

'I Hope You Can Rise Again': Linguistic Variation in Online Condolences.

In the wake of tragic events such as the 'Paris Attacks of 2015', the expression of condolences through e-messages has become a common way for individuals to offer support and sympathy to those affected. However, limited research has been conducted on the linguistic aspects of condolence e-messages and how they reflect the speech act of condolence. This study aims to fill this gap by examining the syntactic and pragmatic elements present in these messages. The aim is to understand how the syntactic and pragmatic elements of these messages contribute to the expression of the communicative speech act of condolence. Condolence e-messages were identified and analyzed using an adapted version of Elwood's (2004) coding scheme. The analysis focused on common themes in the condolence sentences, revealing that some linguistic functions were overtly used to express grief. Additionally, specific words such as 'pray', 'love', and 'condolence' were frequently used in conjunction with the expressions of condolence. The findings highlight the influence of sociocultural factors in shaping the norms and variations in the production of speech acts across different cultures. Understanding these linguistic variations can contribute to effective communication and cultural sensitivity in expressing condolences.

Dietary Challenges for Parasitoid Wasps (Hymenoptera: Ichneumonoidea); Coping with Toxic Hosts, or Not?

Many insects defend themselves against predation by being distasteful or toxic. The chemicals involved may be sequestered from their diet or synthesized de novo in the insects' body tissues. Parasitoid wasps are a diverse group of insects that play a critical role in regulating their host insect populations such as lepidopteran caterpillars. The successful parasitization of caterpillars by parasitoid wasps is contingent upon their aptitude for locating and selecting suitable hosts, thereby determining their efficacy in parasitism. However, some hosts can be toxic to parasitoid wasps, which can pose challenges to their survival and reproduction. Caterpillars employ a varied array of defensive mechanisms to safeguard themselves against natural predators, particularly parasitoid wasps. These defenses are deployed pre-emptively, concurrently, or subsequently during encounters with such natural enemies. Caterpillars utilize a range of strategies to evade detection or deter and evade attackers. These tactics encompass both measures to prevent being noticed and mechanisms aimed at repelling or eluding potential threats. Post-attack strategies aim to eliminate or incapacitate the eggs or larvae of parasitoids. In this review, we investigate the dietary challenges faced by parasitoid wasps when encountering toxic hosts. We first summarize the known mechanisms through which insect hosts can be toxic to parasitoids and which protect caterpillars from parasitization. We then discuss the dietary adaptations and physiological mechanisms that parasitoid wasps have evolved to overcome these challenges, such as changes in feeding behavior, detoxification enzymes, and immune responses. We present new analyses of all published parasitoid-host records for the Ichneumonoidea that attack Lepidoptera caterpillars and show that classically toxic host groups are indeed hosts to significantly fewer species of parasitoid than most other lepidopteran groups.

Effects of Ocimum basilicum L. Extract on Hippocampal Oxidative Stress, Inflammation, and BDNF Expression in Amnesic Aged Rats.

The present study was conducted to investigate the effects of Ocimum basilicum L. (OB) extract on learning and memory impairment in aged rats. Male rats were divided into the following experimental groups: Group 1 (control): including 2 months old rats, Group 2 (aged) including 2 years old rats, Groups 3-5 (aged-OB): including 2 years old rats received 50, 100, and 150 mg/kg OB for 8 weeks by oral gavage. Aging increased the delay to find the platform but, however, decreased the time spent in the target quadrant when tested by Morris water maze (MWM). Aging also reduced the latency to enter the dark chamber in the passive avoidance (PA) test compared to the control group. Moreover, interleukin-6 (IL-6) and malondialdehyde (MDA) levels were raised in the hippocampus and cortex of aged rats. In contrast, thiol levels and enzymatic activity of superoxide dismutase (SOD) and catalase (CAT) significantly reduced. In addition, aging significantly reduced BDNF expression. Finally, OB administration reversed the mentioned effects. The current research showed that OB administration improves learning/memory impairment induced by aging. It also found that this plant extract protects the brain tissues from oxidative damage and neuroinflammation.

Ottawa Risk Scale in Predicting the Outcome of Chorionic Obstructive Pulmonary Disease Exacerbation in Emergency Department; a Diagnostic Accuracy Study.

Introduction: The disposition decision is a great challenge for clinicians in managing patients with chronic obstructive pulmonary disease (COPD) exacerbation. This study aimed to evaluate the accuracy of Ottawa COPD Risk Scale (OCRS) in predicting the short-term adverse events in the mentioned patients. Methods: This prospective diagnostic accuracy study was conducted on COPD exacerbation cases who were referred to the emergency department (ED). Patients were followed up for 30 consecutive days for adverse events including the need for intubation, non-invasive ventilation, myocardial infarction, readmission, and death from any cause, and finally the accuracy of OCRS in predicting the outcome was evaluated. Results: 362 patients with the mean age of 65.55 ± 10.65 (6- 95) years were evaluated (58.0% male). Among the patients, 164 (45.3%) cases were discharged from ED, and 198 (54.7%) were admitted to the hospital. 136 (37.6%) cases experienced at least one of the studied short-term adverse events. The mean OCSD score of this series was 1.96 ± 2.39 (0 - 10). The area under the curve of OCRS in predicting the outcome of COPD patients was 0.814 (95%CI: 0.766 - 0.862). The best cut-off point of the scale in predicting the outcome was 1.5. The sensitivity and specificity of the scale were 75.75% (95%CI: 69.6% - 81.42%) and 89.63% (95%CI: 83.67% - 93.66%), respectively. By employing this threshold, 48 (13.25%) cases would have unnecessary hospitalization, and 17 (0.04%) would be discharged incorrectly. Conclusion: The OCRS has acceptable level of prediction accuracy in predicting the short-term adverse event of COPD patients. The use of this scoring in the routine practice of ED clinicians can lead to a reduction in unnecessary admissions and unsafe discharge for these patients.

Microplitis manilae Ashmead (Hymenoptera: Braconidae): Biology, Systematics, and Response to Climate Change through Ecological Niche Modelling.

The parasitoid wasp Microplitis manilae Ashmead (Braconidae: Microgastrinae) is an important natural enemy of caterpillars and of a range of noctuids, including pest species of armyworms (Spodoptera spp.). Here, the wasp is redescribed and, for the first time, illustrated based on the holotype. An updated list of all the Microplitis species attacking the noctuid Spodoptera spp. along with a discussion on host-parasitoid-food plant associations is offered. Based on information about the actual distribution of M. manilae and a set of bioclimatic variables, the maximum entropy (MaxEnt) niche model and the quantum geographic information system (QGIS) were explored to predict the potential distribution of this wasp in a global context. The worldwide geographical distribution of potential climatic suitability of M. manilae at present and in three different periods in the future was simulated. The relative percent contribution score of environmental factors and the Jackknife test were combined to identify dominant bioclimatic variables and their appropriate values influencing the potential distribution of M. manilae. The results showed that under current climate conditions, the prediction of the maximum entropy model highly matches the actual distribution, and that the obtained value of simulation accuracy was very high. Likewise, the distribution of M. manilae was mainly affected by five bioclimatic variables, listed in order of importance as follows: precipitation during the wettest month (BIO13), annual precipitation (BIO12), annual mean temperature (BIO1), temperature seasonality (BIO4), and mean temperature during the warmest quarter (BIO10). In a global context, the suitable habitat of M. manilae would be mainly in tropical and subtropical countries. Furthermore, under the four greenhouse gas concentration scenarios (representative concentration pathways: RCP2.6, RCP4.5, RCP6.0, and RCP8.5) in the future period of the 2070s, the areas with high, medium, and low suitability showed varying degrees of change from current conditions and are expected to expand in the future. This work provides theoretical backing for studies associated with the safeguarding of the environment and pest management.

Persuasive Language in ELT-Related Ads on Social Media.

In line with the concept of mobile learning in English Language Teaching (ELT), the aim of this research is to explore how Iranian ELT practitioners take advantage of social media to propose supportive and impactful language learning programs by adhering to persuasive linguistic devices. The research design is nonexperimental and explorative. ELT-related commercial videos and pictures were identified on social media platforms, including Instagram, Facebook, TikTok, and YouTube. We delved into the syntactic and pragmatic features of the data on ELT-related ads to identify the persuasive techniques and strategies these ads resort to for attracting language learners to online classes and services. To analyze the data, the widely-used and acknowledged Cialdini's (The psychology of persuasion, Quill William Morrow, 1984) principles of persuasion are employed. The results manifested that 'reciprocity' and 'scarcity' were the most used persuasive strategies, while 'commitment and consistency' and 'consensus' were the least favorable persuasion principles in these ads. The analysis of the Iranian ELT-related ads indicated that the language used within this context is purposeful and strategic. A contextual investigation of the ELT-related ads on social media can meaningfully contribute to social practices underlying English language pedagogy and digital literacy.

Linguistic Variation in Iranian University Student Graffiti: Examining the Role of Gender.

Research on the discursive features of graffiti in institutional settings is in its infancy and few studies have investigated the phenomenon and its implications in educational contexts. In this paper, we report on a study in which we employed systemic functional linguistics (Halliday in Learning how to mean, Edward Arnold, 1975). to probe communicative functions and gender differences in Iranian university student graffiti that appeared in all-male and all-female locations. The data comprised authentic instances of graffiti generated by students, analysis of which suggests that male and female university students each have their own distinctive motives for using graffiti, as realised in significant differences observed in the context-specific functions they perform. Graffiti pieces represented a distinctive and meaningful way of communicating, and its most salient features were creativity, simplicity and variation. Indications are that university students' graffiti reflects psychological and social challenges, and the thoughts, attitudes and feelings expressed through it serve students' personal and interactional purposes.

First record of Anteon xericum Olmi & van Harten (Hymenoptera, Dryinidae) from Palaearctic region.

The Malaise trap program was implemented to carry out periodic sampling in southeastern Iran, specifically targeting Kerman province, in order to investigate and study specimens belonging to the family Dryinidae. Among the assemblage of collected specimens, notable identifications were made within the subfamily Anteoninae, including the discernment of Anteon xericum Olmi & van Harten. This significant finding signifies a previously unreported occurrence in the Palaearctic region (Iran). A detailed diagnosis of the species, an identification key to Iranian Anteon species, a modified key to the Anteon females of the Eastern Palaearctic, along with a distribution map are provided.

Effects of carbon monoxide, nitrogen dioxide, and fine particulate matter on insect abundance and diversity in urban green spaces.

The impact of three air pollutants, carbon monoxide, nitrogen dioxide, and fine particulate matter (PM2.5) on the diversity and abundance of insect fauna associated with Chinese thuja, Platycladus orientalis, was evaluated for the first time in Iran. Sampling was performed in Lashkar, Sadaf, and Sajjad, three urban green spaces in Mashhad, a city located in Razavi Khorasan province. A total of 29 insect species including 16 natural enemies and 13 herbivores were identified. The results indicated that herbivore abundance was positively and significantly correlated with the level of carbon monoxide and nitrogen dioxide, but not with the level of fine particulate matter. In contrast, herbivore diversity was negatively and significantly correlated only with the level of carbon monoxide. As for natural enemies, abundance and diversity both were not significantly correlated with the levels of none of all three pollutants. The aphid, Cinara thujafilina Del Guercio was the most dominant herbivore species in all the sampling sites with a relative abundance of 86% at Lashkar, 93% at Sadaf, and 95% at Sajjad. Regarding natural enemies, the ladybird, Coccinella septempunctata was the most abundant species both at Lashkar (49%) and Sadaf (35%) while the ladybird, Oenopia conglubata was the most abundant at Sajjad (21%). The highest diversity of herbivores and natural enemies across the four seasons were at the Lashkar and Sadaf sites. The results highlight that of the three air pollutants, carbon monoxide is the one that affects both on abundance and diversity of herbivore guild associated with Platycladus orientalis in urban green spaces.

Revision of Embolemidae (Hymenoptera: Chrysidoidea) from the Middle East.

The family Embolemidae (Hymenoptera: Chrysidoidea) from the Middle East is taxonomically reviewed. Three species are reported, redescribed, and illustrated, Ampulicomorpha thauma Rasnitsyn Matveev from Iran, Embolemus harteni Olmi from Yemen, and E. huberi Olmi from Iran. The extremely rare genus Ampulicomorpha Ashmead is here recorded for the first time from the Middle East. Embolemus harteni is further recorded from two more governorates of Yemen. A species identification key of Embolemidae from the Middle East, distribution maps, details of the morphological characters, and extensive colour photographs of every species are also provided. A brief discussion on the species relationships and their relevant ecoregions based on the currently limited available information is offered.

Red Blood Cell Immunization and Contributing Factors in 685 Thalassemia Patients.

Background: An analysis of red blood cell alloimmunization in patients with thalassemia can help to devise specific strategies to decrease the alloimmunization rate. This study explored the frequency and specificity of alloantibodies and autoantibodies against red blood cell (RBC) antigens in patients with thalassemia referring to the Iranian Blood Transfusion Organization (IBTO) Immunohematology Reference Laboratory (IRL) in Tehran. Materials and Methods: This study first examined the laboratory records of 23,113 patients suffering from different diseases referring to IBTO's IRL for pretransfusion testing in the 2008-2015 period. ABO and Rh(D) typing and antibody screening tests were performed for all 23,113 patient records and 685 (2.97%) beta-thalassemia patients with positive pre-transfusion test results (antibody screening and/or DAT) were selected for further investigation. Results: The antibody screening test was positive in 640 out of 685 thalassemic patients (93.4%). DAT was performed for 529 patients, 226 (33%) of which showed positive results. Meanwhile, 161 out of 685 beta-thalassemia patients (23.5%) had positive auto control test results, reflecting the possible presence of allo- and/or autoantibodies. The most common antigen-specific alloantibodies were directed against K and E RBC antigens with a frequency of 25% (Anti-K) and 11.91% (Anti-E), respectively. The development of two antibodies (double antibodies) in one patient was observed in 80 individuals (11.46%). Conclusion: Age, gender, history of pregnancy, and splenectomy were not contributing factors to the antibody presence in the patient population under study. Extended red blood cell phenotyping should be considered as an essential procedure for expected multi-transfused thalassemia patients before blood transfusion. Considering the high frequency of anti-K and anti-E observed in this study, it is recommended that thalassemia patients in Iran are tested through phenotyping of RBC units for K and E antigens before transfusion.

Beneficial effects of vitamin D on anxiety and depression-like behaviors induced by unpredictable chronic mild stress by suppression of brain oxidative stress and neuroinflammation in rats.

The objective of this study was to investigate the protective effects of vitamin D (Vit D) on anxiety and depression-like behaviors induced by unpredictable chronic mild stress and brain tissue oxidative damage criteria and neuroinflammation in rats. The rats were treated as follows: (1) control, (2) UCMS, (3-5) Vit D 100, 1000, and 10,000 iu + UCMS. Rats were subjected to UCMS for a total of 4 weeks. During week 4, they received seven training trials. The brains were then collected to examine inflammation and oxidative stress criteria. Pretreatment with Vit D enhanced performances of the rats in the elevated plus maze (EPM) and open field (OF) and forced swimming test (FST). UCMS also increased MDA and interleukin-6 (IL-6) levels while decreased CAT, SOD, and thiol. Vit D reversed the effects of UCMS. The results of the current research revealed that Vit D improved UCMS-induced anxiety and depression via decreasing brain oxidative stress and inhibiting neuroinflammation.

Different Immune Responses in Dangerous O Blood Donors.

BACKGROUND & OBJECTIVE: Dangerous O is very important to transfusion medicine and there has been reports by Food and Drug Administration (FDA) regarding some death relating incidences. As high iso-antibody production is closely associated with different immune reactions, a survey on the different immune response of dangerous O donors can lead to understanding their immune response profile. Objectives were to assess different immune responses in dangerous O cases. METHODS: Two groups of donors were selected after performing titration as a high titer (>512) and non-high titer (<128). Then CBC, CD markers, total immunoglobulin, complement assay, anti-VZV, -CMV, -EBV, -HSV, -Rubella, -Toxoplasma gondii, -HBV, -ASO, total protein and albumin, protein electrophoresis, lymphocyte proliferation, and gene expression of INF-gamma, IL2/4/10 were evaluated on both study groups. RESULTS & CONCLUSION: Total IgG, IgM, and IgA was higher in high titer group. Moreover, after using PHA and LPS, gamma globulins and lymphocyte proliferation were significantly higher in high titer cases. Real-time PCR also showed higher IL-2 production in high titer group. Identification of high responder's characteristics can be efficient in many complications. Moreover, high titer donors are dangerous for transfusion medicine. This pilot study showed differences in immune responses between HR and LR O blood donors for the first time. So, other aspects of the immune system such as genetic differences can be surveyed.

The First Comprehensive Study of H-Deficient Phenotypes in Iran.

BACKGROUND: The lack of correct blood grouping practices can lead to missing of the rare Bombay Oh phenotype and subjecting patients to the risk of severe hemolytic transfusion reaction. In the absence of blood donor registry, transfusion management of patients is a challenge. We performed this study in order to estimate the prevalence of the Bombay blood group (Oh) in Iran and to determine whether consanguinity plays a role in the prevalence of Oh group. METHODS: This is a descriptive study in the Immunohematology Reference Laboratory of the Iranian Blood Transfusion Organization (IBTO) Tehran, Iran, over a period of 7 years. All donor blood samples showing blood group O and a strong initial reaction with blood group O RBC control cells were tested with anti-H lectin. Also blood samples from blood group O patients were tested with anti-H lectin if all cells on both antibody screening tests and antibody identification panels were reactive with negative auto control test. Specialized tests like adsorption/elution technique and inhibition assay for determination of secretor status were performed on Oh cases. Any history of consanguineous marriages were recorded. All variables were categorical variables, and percentage and proportions were calculated manually. RESULTS: Analysis of the results of over 7 million first-time blood donors in Iran showed that the most common ABO blood group was O, with 2,520,000 (36%) subjects. 56 Oh individuals' (donors and patients) phenotypes (0.0008%) were detected. Consanguinity was observed in 50 cases (89%). CONCLUSIONS: This study shows that the prevalence of Bombay blood group in the general population of Iran is relatively high (0.0008%) and associated with consanguineous marriage. Thus, consanguinity is still an important risk factor present.