Comparison of the effect of phenobarbital & levetiracetam in the treatment of neonatal abstinence syndrome (NAS) as adjuvant treatment in neonates admitted to the neonatal intensive care unit: a randomized clinical trial.

BACKGROUND: Infants who are born from mothers with substance use disorder might suffer from neonatal abstinence syndrome (NAS) and need treatment with medicines. One of these medicines is phenobarbital, which may cause side effects in long-term consumption. Alternative drugs can be used to reduce these side effects. This study seeks the comparison of the effects of phenobarbital & levetiracetam as adjuvant therapy in neonatal abstinence syndrome. METHODS: This randomized clinical trial was performed in one year from May 2021 until May 2022. The neonates who were born from mothers with substance use disorder and had neonatal abstinence syndrome in Afzalipoor Hospital of Kerman were studied. The treatment started with morphine initially and every four hours the infants were checked. The infants who were diagnosed with uncontrolled symptoms After obtaining informed consent from the parents were randomly divided into two groups and treated with secondary drugs, either phenobarbital or levetiracetam. RESULTS: Based on the obtained results, it was clear that there was no significant difference between the hospitalization time of the two infant groups under therapy (phenobarbital: 18.59 days versus Levetiracetam 18.24 days) (P-value = 0.512). Also, there was no significant difference between both groups in terms of the frequency of re-hospitalization during the first week after discharge, the occurrence of complications, and third treatment line prescription (P-value = 0.644). CONCLUSIONS: Based on the obtained results, like hospitalization duration time (P-value = 0.512) it seems that levetiracetam can be used to substitute phenobarbital in treating neonatal abstinence syndrome. TRIAL REGISTRATION: The current study has been registered in the Iran registry of clinical trials website (fa.irct.ir) on the date 25/2/2022 with registration no. IRCT20211218053444N2.

Electroencephalography, Magnetic Resonance Imaging and Response to Treatment in Children with Focal Seizures A Prospective Cohort Study.

Objectives: This study aimed to evaluate patients with focal seizures, their clinical manifestations, and their response to treatment, then compared the accuracy of electroencephalography and Magnetic Resonance Imaging (MRI) to assess the cost-effectiveness of the latter. Materials & Methods: After selecting the appropriate individuals, the authors obtained the data by clinically evaluating the cases and interviewing them or their caretaker(s) on admission and the six-month follow-up visit. The researchers then analyzed the obtained data. Results: Most cases (88.4%) had idiopathic seizures. A positive family history of seizures was observed in eight cases (5.4%). Respectively, the occipital, frontal, and temporal lobes showed the highest frequency of abnormalities on electroencephalography, while periventricular leukomalacia was the highest abnormal MRI finding (4.1%). However, in 87.8% of cases, this modality's results were normal. No recurrence of seizures was observed in 116 cases (78.9%) on the six-month follow-up visit, pointing towards an appropriate response to treatment. Conclusion: While this study revealed that most had normal MRI, reporting an abnormality in electroencephalography was a more prevalent occurrence. This finding undermines the cost-effectiveness of the former modality, even though its importance in diagnosing the underlying abnormalities necessitates further studies regarding the subject at hand. Furthermore, the study of age groups showed that treatment response is less desirable in children under two years of age, suggesting more intense workups.

Psychometric evaluation of Persian version of medical artificial intelligence readiness scale for medical students.

BACKGROUND: Artificial intelligence's advancement in medicine and its worldwide implementation will be one of the main elements of medical education in the coming years. This study aimed to translate and psychometric evaluation of the Persian version of the medical artificial intelligence readiness scale for medical students. METHODS: The questionnaire was translated according to a backward-forward translation procedure. Reliability was assessed by calculating Cronbach's alpha coefficient. Confirmatory Factor Analysis was conducted on 302 medical students. Content validity was evaluated using the Content Validity Index and Content Validity Ratio. RESULTS: The Cronbach's alpha coefficient for the whole scale was found to be 0.94. The Content Validity Index was 0.92 and the Content Validity Ratio was 0.75. Confirmatory factor analysis revealed a fair fit for four factors: cognition, ability, vision, and ethics. CONCLUSION: The Persian version of the medical artificial intelligence readiness scale for medical students consisting of four factors including cognition, ability, vision, and ethics appears to be an almost valid and reliable instrument for the evaluation of medical artificial intelligence readiness.

To evaluate the relationship between serum magnesium and parathyroid hormone levels in peritoneal dialysis and hemodialysis patients.

OBJECTS: This study aimed to determine the relationship between magnesium and PTH levels in peritoneal dialysis (PD) and hemodialysis (HD) patients. METHODS: This cross-sectional study was performed on HD and PD patients in Kerman, Iran. After recording demographic and clinical data, the pre-dialysis levels of hemoglobin, 25-hydroxy vitamin D, ferritin, creatinine, calcium, phosphorus, albumin, PTH, and magnesium were measured for all patients. The P value of less than 0.05 was considered statistically significant. RESULTS: Magnesium levels in PD patients were significantly higher than in HD patients (P < 0.001). The median PTH level in PD patients was significantly lower than in HD patients (P = 0.046). The correlation between PTH and serum magnesium levels was not significant in PD or HD patients. In the regression model, dialysis modality (PD or HD) was the only significant variable in determining serum magnesium levels (P = 0.005). CONCLUSION: Magnesium is a neglected ion in peritoneal dialysis and hemodialysis patients. In dialysis centers that use a dialysate with standard magnesium concentration (0.5 mmol/L in HD and 0.75 mmol/L in PD), special attention is necessary to hypomagnesia and its complications because magnesium levels in PD patients were significantly higher than in HD patients. As the correlation between magnesium and PTH levels in both PD and HD patients were not significant, the association of high magnesium levels with low PTH in PD patients should be considered in terms of increasing the potential for adynamic bone disease. It seems that ordering serum magnesium in the routine tests of dialysis patients is necessary.

Online learning self-efficacy: A necessity for virtual education.

BACKGROUND: Online learning self-efficacy is considered a major contributor to academic success. The present study was conducted to assess the psychometric properties of the Persian version of the Online Learning Self-Efficacy Scale. MATERIALS AND METHODS: A cross-sectional study was conducted on 211 medical students at Kerman University of Medical Sciences in 2021 who were selected through the convenience method. Data were collected using a two-part self-administered online questionnaire containing demographic information and the Persian version of the Online Learning Self-Efficacy Scale (OLSES). Forward and back-translation methods were used to provide the Persian version of OLSES. Internal consistency of the Persian version was determined by the Cronbach alpha coefficient in a pilot study. Exploratory and confirmatory factor analyses were conducted using SPSS version 20.0 and LISREL version 8.80. RESULTS: The mean of the participants' age was 21.40 ± 2.52 years, and most of them (56.4%) were female. The Cronbach alpha coefficient was determined as 0.74, 0.90, 0.75, and 0.89 for learning, time management, technology use subscales, and the whole scale, respectively. Exploratory factors analysis revealed the justifiability of factor analysis. In confirmatory factor analysis, most of the goodness of fit indices had an acceptable level. CONCLUSIONS: Our study found that the Persian version of OLSES had good psychometric properties and can be used as a simple, valid, and reliable tool to assess students' self-efficacy related to the e-learning environment.

Thyroid Cancer-Specific Health-Related Quality of Life Questionnaire: Psychometric Properties of the Persian Version.

Background: Adverse effects related to treatment negatively affect the quality of life of patients with thyroid cancer. The current study aimed to evaluate the psychometric properties of the Persian version of the thyroid-cancer-specific health-related quality of life (TC-specific HRQoL) questionnaire among patients with thyroid cancer in Kerman province, Iran. Methods: This research was a cross-sectional study conducted on 240 patients with thyroid cancer in Kerman province from 2000 to 2015. The patients were selected through the census method and were asked to complete the thyroid-cancer-specific quality of life questionnaire. Data were analyzed by SPSS version 19.0 and LISREL version 8.80. The reliability of the Persian version was determined by Cronbach's α coefficient and the intraclass correlation coefficient (ICC). Exploratory and confirmatory factor analysis (CFA) was also conducted. Results: The Cronbach's α and ICCs were determined as 0.92 and 0.88, respectively. Five factors were extracted in the exploratory factor analysis with a total of 55.76% explained variance. Acceptable goodness of fit indices were found in CFA. Conclusions: The Persian version of the TC-specific HRQoL has sufficient psychometric properties and can be used to assess HRQoL among patients with thyroid cancer.

The effect of egg white diet on phosphorus control in dialysis patients.

INTRODUCTION: Nutritional interventions have been envisaged to improve hyperphosphatemia and malnutrition, two important risk factors associated with mortality in dialysis patients. We evaluated the effects of egg white consumption on serum phosphate and malnutrition in dialysis patients. METHODS: In an open-label, per protocol clinical trial, conducted in Kerman dialysis centers, 150 hemodialysis patients aged ≥18 years with serum phosphorus ≥5.5 mg/dl were included in the study. All participants limited their intake of foods containing phosphorus for 4 weeks, and then they were divided into a control and an intervention group. The control group continued their ordinary diet and the participants in the intervention group consumed a Telavang egg white pack (containing six egg whites, 96 calories, 24 g protein) as a substitute for meat products 3 days a week for 8 weeks. Finally, changes in serum albumin, phosphorus, calcium, PTH, and cholesterol were measured. FINDINGS: At the baseline, there were no significant differences in the laboratory variables between the two groups. After 8 weeks, serum cholesterol (124.3 ± 38.1, vs. 135.8 ± 28.8, p = 0.003) and phosphorus levels (4.5 ± 1.03, vs. 6.7 ± 1.5, p = 0.001) were significantly lower in the intervention group compared with the control group. Also, serum albumin (4.5 ± 0.07 vs. 3.7 ± 0.4, p = 0.001) was significantly higher in the intervention group. Moreover, phosphorus, PTH, and cholesterol levels in the intervention group were significantly lower than their baseline values (p = 0.001). CONCLUSION: The results showed that the egg white could be a useful source of protein for dialysis patients, as it simultaneously reduces serum phosphorus and cholesterol, and increases serum albumin.

The effect of preoperative oral magnesium oxide on the severity of postoperative pain among women undergoing hysterectomy.

BACKGROUND: Magnesium sulfate has been reported to be effective in perioperative pain treatment and in blunting somatic, autonomic, and endocrine reflexes provoked by noxious stimuli. The pre-emptive analgesic effects of magnesium in reducing postoperative pain could be beneficial in abdominal and gynecologic surgeries. OBJECTIVE: The aim of study was to compare the pre-emptive analgesic effects of oral magnesium oxide and naproxen for hysterectomy surgery. METHODS: This study evaluated all patients who were candidates for hysterectomy in 2 months. The 64 patients were randomly divided into two groups using a random allocation sequence. The patients in the intervention and control groups received either magnesium oxide tablet (500 mg) or naproxen tablet (500 mg) orally half an hour before surgery, respectively. The severity of postoperative pain is assumed as a primary outcome which is evaluated using the visual analogue scale (VAS). RESULTS: In this study, 64 patients were assessed. The results showed age, weight, systolic and diastolic blood pressure, and pulse rate of the patients in the two groups were not significantly different (p > 0.05). The mean score of pain intensity for these patients was significantly lower than the patients receiving naproxen (p-value: 0.03). Besides, more than one-quarter of patients in the magnesium oxide group (n = 9, 28.12%) received this analgesia with lower dose than the patients in the naproxen group (p-value: 0.03). CONCLUSION: The results of this study showed that preoperative oral magnesium oxide had a significant effect on the severity of postoperative pain and consumption of postoperative analgesia.

Baby-Risk of malocclusion assessment index: An assessment tool for preventive orthodontic treatment needs in a selected population of children in southeast of Iran.

CONTEXT: Preventive orthodontic treatments are performed in the primary or mixed dentition period and provide a proper development of occlusion to avoid dentofacial anomalies. AIMS: This study aims to evaluate the Baby-Risk of Malocclusion Assessment Index (ROMA) index regarding ease of use, reproducibility, and the epidemiological assessment of major orthodontic problems in children aged 4-6-year-old in Kerman (Iran) kindergartens. SETTING AND DESIGN: This cross-sectional study was conducted on 1000 children aged 4-6 in Kerman (Iran) kindergartens, selected by cluster sampling, and data were collected using the Baby-ROMA index. METHODS: After recording a demographic data collection form, the clinical examination of the teeth was carried out by a dental student. The data were analyzed with SPSS 18 using t-test, analysis of variance, Chi-squared test, and Mann-Whitney test at a significance level of P < 0.05. RESULTS: In this study, the most common cause of malocclusion was dental caries (7.5%), followed by crossbite (6.1%). Furthermore, 31.6% of the subjects had one type of malocclusion, and 20.5% needed monitoring the occlusion before the growth spurt, while 11.1% needed immediate orthodontic treatment (mostly 6-year-old children). Moreover, 15.3% of the subjects had systemic problems; 3.4% had craniofacial, 22% had dental, and 2% had functional problems. The prevalence of class I canine relationship in the right canines was 82.32%, with 82.5% on the left side. The prevalence of open bite was higher in females with thumb-sucking habit. CONCLUSION: The Baby-ROMA index presented good reliability and ease of use for evaluating early orthodontic treatment needs in primary and mixed dentition periods.

Self-Management Barriers Perceived by Patients with Type 2 Diabetes: A Confirmatory Factor Analysis.

BACKGROUND: Self-management remains poor among most of the diabetic patients due to various individual and environmental barriers which affect it. These barriers should be identified and intervened promptly. The current study aimed to determine self-management barriers perceived by patients with type 2 diabetes. METHODS: A cross-sectional study carried out on 681 patients with type 2 diabetes who referred to the diabetes center which is affiliated to Kerman University of Medical Sciences, Kerman, Iran during 2018. Through a structured interview, demographic and disease-related data were recorded and the Persian version of the modified Personal Diabetes Questionnaire (PDQ) was used to assess self-management barriers. The tool has four subscales including diet, medication, monitoring, and exercise barriers. The higher score in each subscale indicates a higher level of barriers in that section. Data analyzed by SPSS 20 using T-test, ANOVA, and multiple linear regressions. RESULTS: The majority of the patients (62.8%) were female, married (78.3%) with monthly income 10 to 20 million IRRLs (78.4%) and the mean age of 55.65 ± 14.65 years. Body Mass Index, marital status, monthly income, and HbA1C significantly predicted the barriers' score. The instrument had excellent reliability (α = 0.95). In confirmatory factor analysis, the fit indices had approximately acceptable levels. CONCLUSIONS: The Persian version of modified PDQ had good psychometric properties and can be used as a valid and reliable instrument in the primary health care setting. The significant perceived barriers should be identified and intervened by health care providers through the comprehensive management of diabetic patients.

Fall-Risk Assessment in the Elderly Using the Persian Version of Fall-Risk Screening Tool: A Population-Based Study.

BACKGROUND: Falling is a serious challenge for public health and a leading cause of morbidity and mortality among the elderly. This study conducted to evaluate the psychometric properties of the Persian version of fall risk screening tool (P-FRST). METHODS: A cross-sectional study carried out from September 2018 to March 2019 on 537 elders who referred to urban health centers in Kerman, Iran. Demographic data recorded and fall-risk assessment was performed using P-FRST and the timed up and go test (TUG). The maximum possible score is 33 for P-FRST and score ≥18 is considered as high risk. The time ≥12 s in TUG test considered as a risk for falling. Data analyzed by SPSS using t-test, analysis of variance, and linear regression. RESULTS: The mean age of participants was 67.18 ± 6.93. According to P-FRST, 22% of the elderly were high risk and 62% had a moderate risk for falling. The mean score for falling risk was significantly higher in the females, illiterates, income <10 million IRRLs, and the unemployed. CONCLUSIONS: Due to the risk of falling in the elderly, it is suggested that in the comprehensive health care for the elderly, to assess the risk of falling, especially in high-risk groups, so that preventive interventions can be made.

Assessment of the effect of sachet formulation of almond (Amygdalus dulcis L.) on diarrhea prominent irritable bowel syndrome (IBS-D) symptoms: A clinical trial.

OBJECTIVES: Almond has been listed in the low FODMAPs (Fermentable Oligo-, Di-, Mono saccharides And Polyols) and is recommended for infant diarrhea and gastrointestinal problem in Iranian folk medicine. In this work, sachet of almond has been designed, formulated and is studied on the clinical symptoms of diarrhea prominent irritable bowel syndrome (IBS-D). DESIGN: almond was standardized on the basis of total protein and carbohydrate content. A sachet of almond and wheat flour (placebo) was formulated and their physicochemical characteristics were investigated. INTERVENTION: In a double blind randomized trial, fifty IBS-D patients were randomly enrolled into the almond and placebo groups, ranked in respect to the severity of symptoms to mild-moderate and severe disease. The patients received almond or placebo sachet (40 g/day,20 days) respectively. MAIN OUTCOME MEASURE: Patients were assessed for bowel habit, pain severity and frequency and bloating and data was recorded in a data collecting form. RESULTS: The results showed that none of the primary outcomes of the disease is improved in the patients treated with almond. The bowel movement and severity of the pain was significantly increased in the almond treated patients compared to the placebo and baseline (p < 0.05). CONCLUSION: Almond contains high content of oligo-fructan which in high intake might result in a large amount of fermentable carbohydrates that can exacerbate the symptoms of the disease. So, despite the almond inclusion in the low-FODMAPs, the amount of almond intake is a determining factor and here we have controversial results for almond intake in patients with IBS. Mental health and physical activity of patients are also involved in the disease.

Psychometric Properties of the Persian Version of Weight Efficacy Lifestyle Questionnaire-Short Form.

BACKGROUND: Currently, in low- and middle-income countries, the problem of overweight and obesity is increasing at alarming rate. Along with well-known factors, psychosocial factors such as low self-efficacy highly associated with these problems. Hence, it is necessary to assess individual self-efficacy in weight management consultations using valid instrument. The aim of this study was to determine psychometric properties of the Persian version of the Weight Efficacy Lifestyle Questionnaire-Short Form (WEL-SF). METHODS: A cross-sectional study carried out on 400 women referring to urban community health centers in Kerman Province, Iran. Data collected using a questionnaire contained demographic data and Persian version of WEL-SF. The reliability of the questionnaire determined using Cronbach's alpha. The construct validity evaluated by exploratory principal component analysis (PCA) and confirmatory factor analysis. Data were analyzed by SPSS version 19 and Lisrel 8.8. RESULTS: Internal consistency of WEL-SF was 0.83 using Cronbach's alpha. In the PCA, two factors were extracted with the total amount of 62.6% explained variance. In confirmatory factor analysis, the model had acceptable goodness of fit indices. CONCLUSIONS: The Persian version of WEL-SF had excellent psychometric properties.

A Survey of Knowledge, Attitude and Practice of Iranian Dentists and Pedodontists in Relation to Child Abuse.

STATEMENT OF THE PROBLEM: Since almost half of the child abuse cases affect the head and neck region, dentists have an important role in the diagnosis and report of oral and dental aspects of child abuse cases. PURPOSE: The objective of the current study was to evaluate the knowledge, attitude and practice of the general dentists and pedodontists regarding child abuse and child neglect. MATERIALS AND METHOD: This cross-sectional study was carried out on the participants of the 12th congress of pedodontists of Iran. A self-administered questionnaire was used for evaluating their knowledge, attitude and practice toward child abuse. T-test and ANOVA were applied to analyze the data by SPSS software. p <0.05 was considered statistically significant. RESULTS: The mean score of knowledge, attitude and practice of the participants regarding child abuse was 10.24±2.68, 41.54±11.24 and 2.78±1.05, respectively. The knowledge of pedodontists was significantly higher than knowledge of general dentists. No statistically significant difference was observed in attitude and practice (p> 0.05). CONCLUSION: Dentists had a moderate knowledge, poor attitude and moderate practice regarding child abuse. Considering this fact, improvements in child abuse education for undergraduate students and continuing post-graduate training in this field are recommended.

Why mistreatment of medical students is not reported in clinical settings: perspectives of trainees.

Mistreatment of medical students is a major source of stress for them. Studies indicate a high incidence of such mistreatment, especially in clinical settings. In most cases, students who have been mistreated do not report it to the authorities. This study investigated factors related to the failure to report mistreatment. This was a cross-sectional study carried out in Kerman Medical School, Iran. All students in the internship and clerkship stages, as well as residents, were selected through the census method. Experiences of mistreatment and the reasons for not reporting them were evaluated using a questionnaire. The data were analysed with SPSS 19. Ninety-three per cent of the participants experienced mistreatment, but less than half of them reported it. Residents and interns reported emotional and academic mistreatment, respectively, more than other groups. The most common reason for not reporting mistreatment was that the students did not think reporting would accomplish anything. Our study showed that the experience of mistreatment in the clinical setting is common, but the cases reported to the authorities are far fewer than the actual number of cases. Educational systems should make extensive efforts to detect and prevent mistreatment to improve the teaching-learning environment.

Breast and Cervical Cancer Screening in Women Referred to Urban Healthcare Centers in Kerman, Iran, 2015.

Breast and cervical cancers are among leading causes of morbidity and mortality in women worldwide. Regular screening is very important for early detection of these cancers, but studies indicate low rates of screening participation. In this survey we studied the rate of screening participation among women 18-64 years old referred to urban health centers in Kerman, Iran in 2015. A cross-sectional study was carried out on 240 women who were selected using a multistage sampling method. Data collected using a questionnaire covered demographics and questions about common cancer screening status in women. Analysis was by SPSS 19. The mean age of participants was 31.7± 7. Most (97.1%) were married, housewives (83.3%), had high school diploma (43.8%) and a monthly income more than ten million Rls. The frequency of the Pap test performance was higher in women who were employed and with a university degree (p<0.05). The frequency of mammography performance in women over 40 years was also higher in women with university degree (p<0.05). There was no statistically significant difference in the frequency of pelvic examination, and self and clinical breast examinations based on education, household income and employment (p>0.05). Our study found that the rate of screening participation among women is low. Investigation of the barriers, increasing the awareness of women about the importance and advantages of screening and also more incentives for health personnel especially family physicians to pay more attention to preventive programs could be effective.

Medical error and related factors during internship and residency.

It is difficult to determine the real incidence of medical errors due to the lack of a precise definition of errors, as well as the failure to report them under certain circumstances. We carried out a cross- sectional study in Kerman University of Medical Sciences, Iran in 2013. The participants were selected through the census method. The data were collected using a self-administered questionnaire, which consisted of questions on the participants' demographic data and questions on the medical errors committed. The data were analysed by SPSS 19. It was found that 270 participants had committed medical errors. There was no significant difference in the frequency of errors committed by interns and residents. In the case of residents, the most common error was misdiagnosis and in that of interns, errors related to history-taking and physical examination. Considering that medical errors are common in the clinical setting, the education system should train interns and residents to prevent the occurrence of errors. In addition, the system should develop a positive attitude among them so that they can deal better with medical errors.

Secondary prevention by enhancing adherence in diabetic patients.

OBJECTIVES: Adherence to prescribed medications is a key dimension of healthcare quality. Poor medication adherence might be a significant barrier to achievement of positive clinical outcomes. This study aimed to compare the adherence to oral hypoglycemic agents in patients with type 2 diabetes by using two methods of completing diary checklist and collecting drug shells. METHODS: This randomized clinical trial was conducted in Isfahan Diabetes Institute. A number of 100 type 2-diabetic patients were selected through systematic sampling method and then were randomly allocated to two groups of equal number. Each group was invited to attend our 12-week educational program. We asked one group to complete diary checklist about how they took their drugs during the study period. The other group was asked to collect the shells of oral hypoglycemic agents after taking in a pocket. Medication adherence ratio was calculated for both groups. RESULTS: Overall, 87 patients completed the study, of which 30 cases (34.5%) were in the check list group and 57 (65.5%) in the reference group. In the check list group, the adherence ratio was good in 96.7% and moderate in 3.3%, with no case of poor adherence. In the reference group, the corresponding figures were 55.2%, %6.9 and 37.9%, respectively (p<0.05 between groups). CONCLUSIONS: Although the adherence ratio was greater than 80% in both groups, it was significantly higher in the check list group. Therefore, we suggest that by increasing adherence to prescribed medications, diary checklist can be an effective method of secondary prevention of chronic diseases, as diabetes mellitus.