Components related to ethical decision making in medical science students: A structural equation model.

BACKGROUND: Evaluating moral principles in the Society of Medical Sciences and health care workers (HCWs) is imperative due to their direct contact with the community and the significant impact of their attitudes and decisions on people's lives. This study aimed to determine the components related to ethical decisions in medical sciences students. METHODS: One thousand two hundred thirty-five eligible students in the Alborz University of Medical Sciences participated in this descriptive study. We gathered their socio-demographic information, assessed their moral reasoning, and used the ethical decisions questionnaire, Lutsen moral sensitivity questionnaire, and general health questionnaire (GHQ) for data gathering. The data were analyzed with SPSS software version 25 and LISREL version 8.8. RESULTS: According to the path analysis test findings, ethical reasoning significantly correlated with ethical decision-making (B = 0.40). The number of clinical courses passed, moral sensation (moral sensitivity), and the total number of passed academic semesters had the greatest positive and negative association with ethical decision-making, respectively. (B = 0.54), (B = 0.524) and (B = -0.11). CONCLUSION: Based on the findings of the moral reasoning test, the moral sensation was associated with ethical decision-making, which indicates the necessity of attending to ethical aspects, promoting moral reasoning, sensitivity, and students' accuracy.

Social networks and internet emotional relationships on mental health and quality of life in students: structural equation modelling.

BACKGROUND: Social networks and relationships create a sense of belonging and social identity; hence, can affect mental health and the quality of life, especially in young people. The present study was conducted to determine the predicting role of social networks and internet emotional relationships on students' mental health and quality of life. METHODS: The present cross-sectional study was conducted in 2021 on 350 students at Alborz University of Medical Sciences selected by convenience sampling. Data were collected using five questionnaires: socioeconomic status, social networks, internet emotional relationships, stress, anxiety, depression scale (DASS-21), quality of life, and a checklist of demographic details. Data were analyzed in SPSS-25, PLS-3, and Lisrel-8.8. RESULTS: According to the path analysis, the DASS-21 score had the most significant positive causal association with internet emotional relationships in the direct path (B = 0.22) and the most negative association with socioeconomic status (B = - 0.09). Quality of life had the highest negative causal association with the DASS-21 score in the direct path (B = - 0.26) and the highest positive association with socioeconomic status in the indirect path (B = 0.02). The mean duration of using social networks (B ≈ - 0.07) and internet emotional relationships (B ≈ - 0.09) had the highest negative association with quality of life. CONCLUSION: The use of the internet and virtual networks, internet emotional relationships, and unfavorable socioeconomic status were associated with higher DASS-21 scores and reduced quality of life in the students. Since students are the future of countries, it is necessary for policymakers to further address this group and their concerns.

A cross-sectional multicenter linkage study of hospital admissions and mortality due to methanol poisoning in Iranian adults during the COVID-19 pandemic.

A methanol poisoning outbreak occurred in Iran during the initial months of coronavirus disease 2019 (COVID-19) pandemic. We aimed to evaluate the epidemiology of the outbreak in terms of hospitalizations and deaths. A cross-sectional linkage study was conducted based on the hospitalization data collected from thirteen referral toxicology centers throughout Iran as well as mortality data obtained from the Iranian Legal Medicine Organization (LMO). Patient data were extracted for all cases aged > 19 years with toxic alcohol poisoning during the study period from February until June 2020. A total of 795 patients were hospitalized due to methanol poisoning, of whom 84 died. Median [interquartile ratio; IQR] age was 32 [26, 40] years (range 19-91 years). Patients had generally ingested alcohol for recreational motives (653, 82.1%) while 3.1% (n = 25) had consumed alcohol-based hand sanitizers to prevent or cure COVID-19 infection. Age was significantly lower in survivors than in non-survivors (P < 0.001) and in patients without sequelae vs. with sequelae (P = 0.026). Twenty non-survivors presented with a Glasgow Coma Scale (GCS) score > 8, six of whom were completely alert on presentation to the emergency departments. The time from alcohol ingestion to hospital admission was not significantly different between provinces. In East Azerbaijan province, where hemodialysis was started within on average 60 min of admission, the rate of sequelae was 11.4% (compared to 19.6% average of other provinces)-equivalent to a reduction of the odds of sequelae by 2.1 times [95% CI 1.2, 3.7; p = 0.009]. Older patients were more prone to fatal outcome and sequelae, including visual disturbances. Early arrival at the hospital can facilitate timely diagnosis and treatment and may reduce long-term morbidity from methanol poisoning. Our data thus suggest the importance of raising public awareness of the risks and early symptoms of methanol intoxication.

Electrocardiographic manifestations in acute methanol poisoning cannot predict mortality.

The aim of this retrospective observational case series was to determine electrocardiographic (ECG) manifestations in patients poisoned with methanol and see whether they could predict mortality. We also wanted to see whether there was an association between ECG changes and time elapsed between ingestion and treatment, age, sex, seizure, coma (Glasgow Coma Scale ≤8), arterial blood gas (ABG) parameters, and serum potassium levels on hospital admission. The study included 42 patients aged 31.14±12.5 years. Twenty-five survived and 17 died. Almost all patients had one or more abnormal ECG findings, including heart rate, rhythm, and conduction abnormalities. However, we found no significant difference between survivors and non-survivors. QTc interval did not correlate with time elapsed between ingestion and treatment, age, sex, seizure and coma, HCO3(-), or serum potassium level. Similarly, T waves showed no correlation with serum potassium. ECG abnormalities did not correlate with coma or seizure. Even though cardiotoxicity in methanol poisoning is high, none of the ECG abnormalities found in our study predicted mortality. This however does not rule out the need to routinely run ECG for cardiotoxicity in every single patient poisoned by methanol.

Tramadol-induced apnea.

BACKGROUND AND OBJECTIVES: In contrast with other opioids, there are few cases of tramadol-related respiratory depression described in the literature, and renal impairment is a proposed risk factor. The aim of this study is to determine the prevalence of and predisposing factors for tramadol-related apnea in patients referred to our center. PATIENTS AND METHODS: All patients referred to Loghman-Hakim Hospital between February 2009 and April 2010 with pure tramadol intoxication were identified retrospectively. Data collected included the patient's age, sex, ingested dose, route of exposure, reason for poisoning (acute overdose or supratherapeutic use), previous history of suicidal attempts, previous history of drug or substance abuse (including tramadol), and clinical features on admission including seizures and apnea. RESULTS: We identified 525 patients with deliberate self-poisoning (359; 68.4%) or abuse (146; 27.8%), and in 114 (21.7%) of these, there was a history of tramadol abuse. Four hundred twenty-nine (81.7%) of patients had acute poisoning and were referred to hospital within 6 hours of ingestion. Nineteen patients (3.6%) experienced apnea and received respiratory support (16; 84.2%) or naloxone administration (3; 15.8%) within 24 hours of ingestion (mean, 7.7 ± 7 hours; range, 1-24 hours). The mean dose ingested by patients experiencing apnea was 2125 ± 1360 mg (range, 200-4600 mg), which was significantly higher than those who did not experience apnea, 1383 ± 1088 mg (range, 100-6000 mg), P < .001. One death occurred in each group, which was significant (P < .001). Renal impairment was not observed in any of the patients who experienced apnea.

Clinical features and successful management of suicidal digoxin toxicity without use of digoxin-specific antibody (Fab) fragments--is it possible?

A retrospective study of 147 consecutive cases of suicidal digoxin poisoning was undertaken in order to determine the severity and outcome of toxicity without use of digoxin-specific Fab fragments. This study showed that suicidal digoxin poisoning in young patients is usually mild to moderate; even underlying cardiac disease and chronic use of digoxin has no effect on the severity of toxicity and incidence of lethal dysrhythmia in these cases. This type of toxicity responds appropriately to conventional treatment.