Comparing peer education with TBL workshop in (EBM) teaching.

Background: Evidence-based medicine is one of the most important topics in medical sciences that requires a proper teaching method. Very few studies have evaluated EBM education outcomes through peers and TBL workshops. The purpose of this study was to compare the effect of evidence-based medicine (EBM) education through peers with TBL workshop method in medical students. Methods: This quasi-experimental study was conducted on 42 medical students of the Faculty of Medicine in Iran University of Medical Sciences (IUMS) in 2019 who were selected through convenience sampling. Students were divided into 2 experimental and control groups based on the randomized blocking method. The data collection tools were 2 questioners that evaluated EBM knowledge and satisfaction in both intervention and control groups. The knowledge of students was compared using pretest and posttest and their satisfaction was evaluated at the end of the TBL workshop and peer education. Data were analyzed by SPSS software and descriptive tests (t test and ANOVA), and significance level was set at 0.95. Results: A significant difference was found between the level of basic knowledge (pretest) and secondary knowledge (posttest) in the EBM education through TBL workshop method compared to peer method. The average scores gained by students in TBL workshop were 3.8 more than the peer teaching method. The results of the Satisfaction Questionnaire were 74% in control group and 86% in the experimental group. Conclusion: EBM education through TBL workshop both increased students' knowledge and satisfaction compared to peer education. Thus, it can be concluded that providing EBM education by expert and qualified teachers through face to face teaching strategy can be effective in knowledge translation. However, peers can participate in educational sessions as facilitators.

The Effect of Levothyroxine and Selenium versus Levothyroxine Alone on Reducing the Level of Anti-thyroid Peroxidase Antibody in Autoimmune Hypothyroid Patients.

BACKGROUND: Due to the prevalence of autoimmune hypothyroidism and its effects on physical and mental health it is necessary to provide a treatment which is also effective in preventing the progression of sub-clinical hypothyroidism in these patients. This study aims to investigate the effect of selenium supplementation on of anti-thyroid hormone antibodies in these patients. MATERIALS AND METHODS: In a randomized clinical trial, 70 patients with autoimmune hypothyroidism randomly divided into two groups of 35 each, the first group was treated with oral selenium treatment with levothyroxine (LT4) and to the second group along with LT4, placebo was also prescribed. Serum selenium level, thyroid hormones and anti-thyroid hormone antibodies before and after 3 months of treatment in both groups, were determined, and the results were analyzed using SPSS software. RESULTS: The mean of the serum anti-thyroid peroxidase serum level in the intervention group before and after treatment was 682.18 ± 87.25 and 522.96 ± 47.21 and the difference before and after treatment was statistically significant (P = 0.021). The level of this antibody before and after treatment in the control group was 441 ± 53.54 and 501.18 ± 77.68, and no significant differences between two groups were observed before and after treatment (P = 0.42). CONCLUSION: Selenium supplementation may help to reduce the levels of antibodies in patients with autoimmune hypothyroidism.

Long-term prophylaxis in patients with severe congenital factor XIII deficiency is not complicated by inhibitor formation.

: Congenital factor XIII (FXIII) deficiency is a rare bleeding disorder accompanied by a variety of bleeding events. Severely deficient patients require regular replacement therapy. With development of FXIII concentrate, the risk of viral infections transmitted by fresh frozen plasma and cryoprecipitate is diminished, but the possibility of inhibitor development remains a challenging issue in the management of these patients. The aim of this study was to assess FXIII inhibitor development in Iranian patients with FXIII deficiency (FXIIID). This study enrolled 50 (30 women and 20 men) patients with severe congenital FXIIID from southeast Iran who underwent long-term (more than 4 years or more than 50 injections) prophylaxis with FXIII concentrate (Fibrogammin P, Dade Behring, Marburg, Germany). We evaluated plasma FXIII activity and FXIII inhibitor on day 28 after the last prophylaxis administration. The method for investigation of FXIII inhibitor was based on Bethesda assay. The mean age of the study population was 13.8 ±â€Š8.3 years. The minimum and maximum FXIII activity levels were less than 1-4.5% (mean ±â€ŠSD, 2.6 ±â€Š0.7%). Our investigations showed that all patients with severe form of FXIIID were treated without inciting inhibitor development. Despite long-term prophylaxis in the studied patients, none was found to have developed FXIII inhibitors.

Diagnosis, clinical manifestations and management of rare bleeding disorders in Iran.

BACKGROUND: Rare bleeding disorders (RBDs) are heterogeneous disorders, mostly inherited in an autosomal recessive pattern. Iran is a Mideast country with a high rate of consanguinity that has a high rate of RBDs. OBJECTIVE: In this study, we present prevalence and clinical presentation as well as management and genetic defects of Iranian patients with RBDs. METHODS: For this study, all relevant publications were searched in Medlin until 2015. RESULTS AND DISCUSSION: Iran has the highest global incidence of factor XIII deficiency. Factor VII deficiency also is common in Iran, while factor II deficiency, with a prevalence of 1 per ∼3 million, is the rarest form of RBDs. Factor activity is available for all RBDs except for factor XIII deficiency, in which clot solubility remains as a diagnostic test. Molecular analysis of Iranian patients with RBDs revealed a few recurrent, common mutations only in patients with factor XIII deficiency, and considerable novel mutations in other RBDs. Clinical manifestations of these patients are variable and patients with factor XIII, factor X and factor VII more commonly presented severe life-threatening bleeding, while patients with combined factor V and factor VIII presented a milder phenotype. Plasma-derived products are the most common therapeutic choice in Iran, used prophylactically or on-demand for the management of these patients. CONCLUSION: Since Iran has a high rate of RBDs with life-threatening bleeding, molecular studies can be used for carrier detection and, therefore, prevention of the further expansion of these disorders and their fatal consequence.

Psychometric properties of Persian version of the multifactor leadership questionnaire (MLQ).

BACKGROUND: Outstanding leadership is one of the important and vital concepts in management and educational leadership debates especially in educational organizations such as universities. Thus, effective educational leadership and adopting an appropriate tool to assess leadership in education are crucial in these institutions. The present study was conducted to develop an instrument for measuring the leadership style in faculty members. METHODS: In this descriptive cross-sectional study, content and face validity of Multifactor Leadership Questionnaire (MLQ) was examined using the opinions of 10 experienced faculty members as a panel of experts. For construct validity, 210 questionnaires were administered to faculty members of Tehran University of Medical Sciences. Confirmatory factor analysis was run using principal component analysis and Varimax rotation method. The reliability of the scale was measured through internal consistency using Cronbach's alpha formula. Confirmatory factor analysis was used to examine the construct validity of the questionnaire. Data were analyzed using SPSS v.16 and LISREL software. RESULTS: Factor analysis and expert opinion resulted in a questionnaire with 18 items across six subscales including idealized influence, inspirational motivation, intellectual stimulation, individualized consideration, contingent reward, and management by exception. The reliability coefficient of the questionnaire was acceptable (0.90). Confirmatory factor analysis showed that the scale had appropriate goodness of fit. CONCLUSION: The 18-item Educational Leadership Questionnaire was found to have acceptable validity and reliability for measuring leadership style in the faculty. It is recommended that the questionnaire be administered to a larger sample.

Anemia and thrombocytopenia in acute and chronic renal failure.

BACKGROUND: Acute renal failure describes as a syndrome by rapid decline in the ability of the kidney to eliminate waste products, regulate acid-base balance, and manage water homeostasis. When this impairment is prolonged and entered chronic phase, erythropoietin secretion by this organ is decreasing and toxic metabolic accumulates and causes hematological changes include decrease of HCT, MCV and RBC and platelet counts. This study evaluates present of anemia and thrombocytopenia in patients with acute and chronic renal failure. MATERIALS AND METHODS: This study conducted on 132 patients with renal impairment and also 179 healthy individuals as two separated control groups. Initially patients with renal problem were tested and after confirmation of impairment, patients were divided in two groups, acute with less than 3 months and chronic with more than 3 months renal failure, based on duration of the disease. Then complete blood count performed for each patient and finally obtained data were analyzed by SPSS software. RESULTS: Comparison between 96 patients with acute and 36 patients with chronic renal failure revealed that severity of anemia (HCT, Hb and MCV) between these two groups were statistically high in comparison with control groups (P > 0.05) but thrombocytopenia in patients with chronic renal failure was statistically different from control and the acute ones (P < 0.001). CONCLUSION: It was recommended that in patients with chronic renal failure, to prevent the risk of bleeding, platelet count should be checked periodically.