Association between Cardiovascular Risk Factors and High-Risk Features in Myocardial Perfusion Imaging: A Multicenter Study.

Background: Myocardial perfusion imaging (MPI) is a noninvasive method with acceptable sensitivity and specificity in diagnosing coronary artery disease (CAD) in moderate-risk patients, including those with CAD risk factors. Methods: The present cross-sectional, prospective study was conducted on 4886 patients from April 2020 through March 2023 at Chamran and Tehran Heart Center hospitals. A questionnaire regarding anthropometric variables, demographic characteristics, CAD risk factors, and MPI findings was designed. Results: Totally, 2179 patients (44.6%) had abnormal MPI. Patients with abnormal MPI were significantly older than those with normal MPI. Older age (OR, 1.64; 95% CI, 1.2 to 1.72; P<0.001), diabetes mellitus (DM) (OR, 1.36; 95% CI, 1.1 to 1.48; P=0.012), hypertension (OR, 1.24; 95% CI, 1.04 to 1.37; P=0.032), and dyslipidemia (OR, 1.54; 95% CI, 1.25 to 1.8; P<0.001) were associated with abnormal MPI independently. Patients with more CAD risk factors were more likely to have abnormal MPI. Thus, in patients without or at most with 1 risk factor and those with 8 CAD risk factors, the likelihood of abnormal MPI was 3.7% and 76.2%, respectively. The frequency of left ventricular dilation and right ventricular prominence was significantly higher in patients with older age (P<0.001 and P=0.043, respectively), dyslipidemia (P<0.001 and P=0.007, respectively), DM (P<0.001 and P<0.001, respectively), and hypertension (P=0.048 and P=0.057, respectively). Conclusion: Individuals with CAD risk factors, especially those with older age, DM, hypertension, or dyslipidemia, require meticulous attention during CAD evaluation, particularly via MPI.

Highly regioselective and diastereoselective synthesis of novel pyrazinoindolones via a base-mediated Ugi-N-alkylation sequence.

An efficient base-mediated/metal-free approach has been developed for the synthesis of 1-oxo-1,2,3,4-tetrahydropyrazino[1,2-a]indole-3-carboxamide derivatives via intramolecular indole N-H alkylation of novel bis-amide Ugi-adducts. In this protocol the Ugi reaction of (E)-cinnamaldehyde derivatives, 2-chloroaniline, indole-2-carboxylic acid and different isocyanides was designed for the preparation of bis-amides. The main highlight of this study is the practical and highly regioselective preparation of new polycyclic functionalized pyrazino derivatives. This system is facilitated by Na2CO3 mediation in DMSO and 100 °C conditions.

The co-effect of sensate focus technique and sexual position changing on sexual function of women who use medical treatment for endometriosis.

Endometriosis is one of the most common chronic diseases of women. This study aimed to investigate the effect of sensate focus technique and sexual position changing on sexual function of women who used medical treatment for endometriosis. This clinical trial study was performed on 80 women who used medical treatment for endometriosis. Women were randomly assigned to two groups: in the intervention group, 2 h of verbal educational session were held and at the end of the session, an instruction booklet about sensate focus technique was given to them, the control group received routine treatment. The sexual function and the dyspareunia of the participants were evaluated after 4 and 8 weeks. Eight weeks after the intervention, the mean total score of sexual function in the intervention group was significantly improved compared to before the intervention (p < 0.001). The mean score of sexual pain in the follow-up periods in the intervention group was significantly different compared to before the intervention and control groups (p < 0.001). The sensate focus technique and sexual position change simultaneously improve sexual function in women with endometriosis who used medication.Trial registration: Approval number from Iranian Registry of Clinical Trials: IRCT2200617047812N1 (Registration date: 2020-11-05).Impact StatementWhat is already known on this subject? The role of endometriosis in the genesis of sexual dysfunction in women has been mentioned in several articles. Researches have shown that some sexual positions put less pressure on parts of the pelvis that contain endometrial tissue. The sensate focus technique can improve sexual dysfunction, including hypoactive sexual desire disorder (HSDD) and female sexual arousal disorder (FSAD), orgasm, dyspareunia, and vaginismus.What do the results of this study add? Have a positive effect on sexual function and dyspareunia in women with endometriosis undergoing medical treatment and improve their sexual function.What are the implications of these findings for clinical practice and/or further research? Medical staff recommended becoming familiar with these techniques to teach sensate focus and sexual position changing to women with endometriosis to improve their sexual function.

Topical Mentha piperita Effects on Cutaneous Wound Healing: A Study on TGF-ß Expression and Clinical Outcomes.

BACKGROUND: Wound healing is a critical clinical concept. We aimed to evaluate the effects of topical Mentha piperita essence on cutaneous wound healing. METHODS: This randomized controlled trial was conducted in Tehran University of Medical Sciences, Tehran, Iran in 2019. Square-shaped 1.5×1.5 cm wounds were made on the neck of 60 male Wistar rats in a sterile condition. Samples were randomly divided into a control group and three experimental groups. Group A treated with M. piperita essence and Vaseline. The second group received the M. piperita essence, and the third group received Vaseline. Histological specimens were obtained in 4th, 7th, and 14th days and were explored for fibroblasts, epithelial cells, inflammatory cells, and vessels. RT-PCR was performed for molecular and gene expression evaluation of TGF-ß. RESULTS: The M. piperita essence increases TGF-ß gene expression as an important factor in wound healing. After 14 d, group A, who received M. piperita and Vaseline, had 99.73% of wound healing with the mean wound size of 0.006 cm2 while wound healing in the control group was only 52%. Samples treated with M. piperita have 74.58% wound healing following by group treated with Vaseline, which was 67.02% (P<0.05), respectively. CONCLUSION: The application of the M. piperita essence for wound healing accelerates the process and improves outcomes.

Effects of a curriculum integrating critical thinking on medical students' critical thinking ability in Iran: a quasi-experimental study.

PURPOSE: Improving physicians' critical thinking abilities could have meaningful impacts on various aspects of routine medical practice, such as choosing treatment plans, making an accurate diagnosis, and reducing medical errors. The present study aimed to measure the effects of a curriculum integrating critical thinking on medical students' skills at Tehran University of Medical Sciences, Iran. METHODS: A 1-group pre-test, post-test quasi-experimental design was used to assess medical students' critical thinking abilities as they progressed from the first week of medical school to middle of the third year of the undergraduate medical curriculum. Fifty-six participants completed the California Critical Thinking Skills Test twice from 2016 to 2019. RESULTS: Medical students were asked to complete the California Critical Thinking Skills Test the week before their first educational session. The post-test was conducted 6 weeks after the 2 and half-year program. Out of 91 medical students with a mean age of 20±2.8 years who initially participated in the study, 56 completed both the pre- and post-tests. The response rate of this study was 61.5%. The analysis subscale showed the largest change. Significant changes were found in the analysis (P=0.03), evaluation (P=0.04), and inductive reasoning (P<0.0001) subscales, but not in the inference (P=0.28), and deductive reasoning (P=0.42) subscales. There was no significant difference according to gender (P=0.77). CONCLUSION: The findings of this study show that a critical thinking program had a substantial effect on medical students' analysis, inductive reasoning, and evaluation skills, but negligible effects on their inference and deductive reasoning scores.

Risk factors of developing critical conditions in Iranian patients with COVID-19.

COVID-19 due to novel Coronavirus was first reported in Wuhan, China. Nowadays, the Islamic Republic of Iran stands among countries with high COVID-19 prevalence and high burden of disease. Since the medical resources are limited, we aimed to identify the risk factors for patients developing critical conditions. This can help to improve resource management and treatment outcomes. In this retrospective study, we included 12,677 patients who were from 26 hospitals, supervised by Tehran University of Medical Sciences with signs and symptoms of COVID-19, until April 12. University integrated IT system was adopted to collect the data. We performed Logistic regression to evaluate the association between death in COVID-19 positive patients and other variables. Cough, respiratory distress and fever were the most common symptoms in our patients, respectively. Cancer, chronic lung diseases and chronic neurologic diseases were the strongest risk factors for death in COVID-19 patients.

Enzyme-Linked Immunosorbent Spot (ELISpot) monitoring of cytokine-producing cells for the prediction of acute rejection in renal transplant patients.

The purpose of this study was to evaluate T-cell immunity markers using serial post-transplantation monitoring of cytokine-producing cells during the first post-transplant months for the prediction of acute rejection and potentially chronic rejection of kidney allograft. We followed 57 kidney allograft recipients for meanly 3 years post-transplantation. Blood samples were collected pre-transplant, 2, 4 and 12 weeks post-transplant. The frequencies of IL-10-, IL-17- and IFN-γ-producing cells were determined in all time-points using ELISPOT assay. The results of ELISpot monitoring and levels of IL-23 and TGF-ß were compared between recipients with acute (n = 12) or chronic rejection episodes and patients with stable graft function (n = 45). In all post-transplant time-points, significantly high frequencies of IFN-γ- and IL-17-producing cells and low frequency of IL-10-producing cells were observed in rejection group versus patients with stable graft function (P < 0.0001). The ROC curve analysis for determining the reliability of cytokine-producing cells for the prediction of acute rejection revealed that AUC was 0.046 for IL-10 (P < 0.001), 0.927 for IL-17 (P < 0.001) and 0.929 for INF-γ-producing cells (P < 0.001). Our results indicate that analyzing the frequencies of INF-γ/IL-10/IL-17-producing cells may define a reliable panel for the prediction of acute rejection within the first post-transplant year which could also be applicable for the prediction of chronic rejection episodes.