The Defects of Infectious Diseases Residency Curriculum in Iran

Background & Objective: To train specialists in infectious diseases, a comprehensive and responsive curriculum to community needs is essential. We checked the infectious diseases residency curriculum in Iran and comprised it with same curricula of other country with the aim of identifying the defects. Methods: This descriptive-comparative study had three steps. First, researchers studied the infectious diseases curriculum of Iran. Then, the same curricula in some other countries were extracted and finally, information such as mission and goals, type and duration of postgraduate training and rotations, teaching strategies and approaches, and amount of elective courses were compared within these curricula. Results: In Iran, the curricula of postgraduate courses for all medical universities are formulated by Ministry of Health. There are many similarities between infectious diseases residency curriculum of Iranian universities and other countries; but in many countries, it is offered in fellowship courses. In Iranian domestic curriculum, learning objectives, themes and subthemes, assessment methods blueprint, and rotational period details are not mentioned. However, other issues such as the epidemiology and health issues are considered in the short-term courses. Based on domestic curriculum, resident cannot be selectively trained in any course, or procedure. Most of the instructional content of curriculum was organized by topics. Conclusion: Policy makers in Iranian Ministry of Health should attend internal consistency of infectious diseases residency curriculum considering other trainee levels curricula and utilize exclusive subject-based models in curriculum formulation to promote education in this field. Keywords Curriculum Professional Infectious Residenc

Medical residents’ attitude toward professionalism and assessment of their professional behaviors: a cross-sectional survey

Background: Professionalism training is a core component of medical education. This study’s aim was to determine medical residents’ attitudes toward professionalism and self-reported professional behaviors. Methods: In a cross-sectional survey at Qazvin University of Medical Sciences, 100 medical residents in their first through third years were invited to participate in a survey between April and June of 2015. Participants responded to a written questionnaire consisting of 7 demographic and 42 content items in 4 domains. Content items were rated on a 5-point Likert scale. Results with a mean of less than three were considered undesirable. A non-parametric Kruskal-Wallis test was used to compare distributions in the study groups. All statistical analyses were performed using SPSS version 22. Results: With a response rate of 87%, a mean age of 31.9 (SD: 3.0) was recorded. The mean Likert score for the perception of residents on the ethical importance of “colleague report” and “reporting error” was undesirable. The percentage of residents’ self-reported unprofessional behaviors during their training was high. Moreover, 71% (95% CI: 61-80) of residents believed that ethics should be formally taught in the medical school curriculum. Over 97% (95% CI: 94-100) believed that learning medical ethics and professionalism requires more than a theoretical course. A longitudinal approach was the most agreed-upon format. Conclusion: Based on the findings of this research, despite a relatively acceptable rate of professional behaviors, residents perceive a need for a more comprehensive curricular attention to practical ethics and ethically important professional development during residency training

Concept Mapping in Learning Histology from the Viewpoint of Midwifery Students

Background & Objective: Concept mapping is an active, creative, and objective practice which improves the advanced learning process and students’ required skills. The aim of this study was the evaluation of concept mapping method in learning histology lessons from the point of view of midwifery students. Methods: The present research was a descriptive, cross-sectional study. The target population consisted of all first-semester midwifery students of Qazvin University of Medical Sciences, Iran, in 2015. After concept mapping education, the students were asked to make a concept map of the lessons of the same week and to hand it in the following session. At the end of the semester, students' views regarding the effect of concept mapping on learning were collected by completing the researcher-made questionnaire. The collected data were analyzed in SPSS software. Frequency distribution was presented in the form of frequency tables. One-sample ttest was used to compare the mean score of each question with its mean and 3 (the value of the mean). Results: In this study, 68.9% of students confirmed the usefulness of concept mapping during the semester. Among the students, 6.9% believed other methods to be more effective. However, 58.6% of students found it effective in memorizing histological terms and 65.5% emphasized that concept mapping helped them better understand histology lessons. Independent t-test results showed a significant difference between the mean score of each question and 3. This revealed that mapping was useful in better understanding (P = 0.003), maintaining terminology (P = 0.004), and answering questions (P = 0.001). In general, the majority of students approved the use of concept mapping as an effective learning method during the term (P < 0.001). Conclusion: This study showed that concept maps are acceptable among students as a means of learning new information. Therefore, in order to facilitate learning for students, the application of different training strategies, like concept mapping, is suggested in basic medical sciences educations. Key Words: Concept map, Learning, Histolog

Changes in plasma lipid and in-hospital deaths in patients with sepsis

Background: Lipid profiles are infrequently measured in clinical management of sepsis patients. Sepsis leads to significant alterations in the metabolism of lipids. The aim of the present study was to determine whether changes in plasma lipid concentrations during sepsis treatment were associated with clinical outcome. Methods: In this study, 74 adult septic patients were included in this prospective observational study from January to December 2017. Patients taking lipid lowering agents were excluded. A detailed medical history was obtained and clinical examination was performed. Serum total cholesterol (STC) and its fractions [low-and high-density lipoprotein] and triglyceride levels were measured in the morning of the first day after admission and then once weekly. The primary outcomes of the study were in-hospital mortality, and hospital stay and hypocholesterolemia were defined as STC levels < 50 mg/dL. Manne-Whitney U and chi-squared tests were used for data analysis, and significance level was set at p<0.05. Results: In this study, 78.4% (CI 95%: 67.3-87.1) of patients had hypocholesterolemia. During the study period, 21.6% (CI 95%: 12.9- 32.7) of patients died. All lipid (except TG) concentrations continuously decreased in deceased sepsis patients but increased in recovering patient (p value for STC (p=0.004), LDL (p=0.006), HDL (p=0.010), and TG (p=0.052)). The serum lipids concentration was not associated with length of hospital stay (p value for STC (p=0.524), LDL (p=0.813), HDL (p=0.799) and TG (p=0.581)). Conclusion: In this study it was found that the additional decline of lipid profile was significantly associated with increased mortality rate of sepsis patients. Thus, the clinically termed 'the lipaemia of sepsis' is not true in all situations

Problems of Continuing Medical Education Programs and Their Solutions from the Viewpoint of Faculty Members

Background & Objective: The majority of surveys have demonstrated the inadequate success rate of continuing education programs in Iran from the viewpoint of participants. However, no studies have been conducted on the viewpoints of lecturers (influential individuals and beneficiaries in this issue) in this regard. Thus, the present study aimed to investigate the problems of continuing education programs and their solutions from the perspective of lecturers. Methods: This qualitative study was conducted in 2015 on 15 university faculty members who had previous experience of lecturing continuing education programs. The participants were selected using purposive sampling (n = 15). Data were gathered through focus group discussion. All discussions were recorded on audiotapes, transcribed, and then, analyzed through inductive content analysis. Results: Data analysis led to the extraction of 3 main themes (problems), 12 categories, 42 subcategories, and 68 suggested solutions. The main themes included the reduction of incentive to participate in programs (4 categories), low effectiveness of implemented programs (5 categories), and the ineffective evaluation of programs (3 categories). Conclusion: The main motivation for general practitioners to participate in these programs must be the correction of professional practice. It seems that intervention in the implementation and assessment fields are more likely than participants’ motivation. Providing teaching methods workshops for faculty members, improving awareness of the goals and timetable of workshops, holding workshops rather than lectures, evaluating performance instead of satisfaction, and providing feedback on the assessment results are effective factors in the efficiency of programs. Key Words: Effectiveness, Continuing education, General practitioner, Evaluation, Qualitative stud

Factors Determining Primary Coronary Slow Flow Phenomenon among Opium Users and Non-users: A Case Control Study in Northern Iran

Background: Coronary slow flow phenomenon (CSFP) represents a clinical entity with recurrent chest pain leading to living impairment. The present study aimed to investigate whether opium use correlates with primary CSFP. Methods: This study included Iranian patients with suspected coronary artery disease who underwent myocardial perfusion imaging. Coronary blood flow was measured quantitatively using the thrombolysis in myocardial infarction (TIMI) frame count and slow flow was defined as TIMI grade 2 standard deviations. Age and clinical conditions including diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLP), history of chest pain, and opium use were recorded. First, the characteristics of the two groups were compared and then the main analyses were conducted to examine the relationship between CSFP and opium use. Data were analyzed using t test and chi-square test via SPSS 25.0. The significance level was set at P<0.05. Findings: This study was conducted on 44 male patients with documented CSFP who had no stenotic lesions and 134 control group male patients who had normal coronary arteries with normal flow. The mean age was similar in the two groups (54.25 vs.52.69, P=0.474). Two groups were significantly different in terms of history of chest pain (P=0.003), but there was no significant difference in HTN (P=0.084), DM (P=0.284), HLP (P=0.183), smoking (P=0.696), and opium use (P=0.107).  Conclusion: This study indicated that opium use is not associated with primary CSFP

Investigation of Antibiotic Resistance Pattern in Isolated From Urine and Blood Samples of Patients Admitted To the Intensive

Background and objectives: Antibiotic resistance is a global health challenge that affects both individuals and the health system in many ways. The aim of this study was to evaluate the antibiotic resistance pattern in isolates from patients admitted to the intensive care unit (ICU) of a hospital in Qazvin, Iran. Methods: This descriptive and retrospective study was performed on urine and blood samples collected from 1318 ICU patients in the Velayat Hospital of Qazvin (Iran) during 2017-2019. Data were collected from patients’ medical records. All statistical analyses were performed using SPSS software (version 25). Results: Based on the findings, 65.2% of the samples were related to urinary tract infections and 34.7% to bloodstream infections. Escherichia coli (68.6%) and Stenotrophomonas (41.0%) were the most common bacteria isolated from urinary tract infections and bloodstream infections, respectively. Moreover, the rate of antibiotic resistance was higher among Acinetobacter, Escherichia coli, Stenotrophomonas, Enterococcus and Pseudomonas isolates. Conclusion: The rate of drug resistance in isolates from ICU patients is alarmingly high and requires immediate attention. It is recommended to modify antibiotic prescriptions in the hospital based on the results of antibiotic resistance pattern, particularly for treatment of infections caused by E. coli and Stenotrophomonas. Keywords: Drug resistance, Intensive care units, Hospitals

Comparison of the Effect of Two Kinds of Iranian Honey and Diphenhydramine on Nocturnal Cough and the Sleep Quality in Coughing Children and Their Parents

Coughing in a child induced by upper respiratory tract infections (URTIs) can be a problem, both for the child and its parents. Current studies show a lack of proven efficacy for over-the counter (OTC) medications, but promising data support the use of honey for children. The aim of this study was to compare the effects of two kinds of Iranian honey with diphenhydramine (DPH) on nocturnal pediatric coughs and the sleep quality of children and their parents. This was a clinical trial (registered in IRCT; No.: 28.20.7932, 15 October 2013). The study consisted of 87 patients. All the parents completed a standard previously validated questionnaire. The children were randomly assigned to one of three treatment groups: Group 1, Honey type 1 (Kimia Company, Iran) (n = 42), Group 2, Honey type 2 (Shahde-Golha, Iran) (n = 25), and Group 3, DPH (n = 20). Each group received double doses of the respective treatments on two successive nights. A second survey was then administered via a telephone interview in which the parents were asked the same questions. The mean scores for all aspects of coughs were significantly decreased in each group before and after the treatment. All three treatments improved the cough and sleep scores. Honey type 1 was superior to DPH in improving all aspects of coughs, except the frequency, and Honey type 2 was more effective than DPH in improving all aspects of coughs, except the sleep quality of the child. There was no significant difference between Honey type 1 and 2 in any aspects of cough relief in the present study. The results suggest that honey may provide better cough relief than DPH in children and improve the sleep quality of children and their parents

Ivermectin-Induced Clinical Improvement and Alleviation of Significant Symptoms of COVID-19 Outpatients: A Cross-Sectional Study

Although several drugs have been proposed and used to treat the COVID-19 virus, but recent clinical trials have concentrated on ivermectin. It appears that ivermectin can potentially act against COVID-19 and stop the development in its infancy. The purpose of this study was to determine the effect of ivermectin on the recovery of outpatients with COVID-19. In this cross-sectional study, we compared the symptoms reduction in COVID-19 disease in two groups of patients by administering ivermectin. A total of 347 mild outpatients in the Iranian provinces of Qazvin and Khuzestan with a conrmed PCR were enrolled. The symptoms of outpatients with COVID-19 were analyzed using SPSS (V23). In this cross-sectional study, the sex ratio was 0.64 (female/male: 37.9/59.8) and most patients were under 50 years old (72.8%). The results of this study demonstrated a signicant decrease in several COVID-19 disease symptoms, including fever, chills, dyspnea, headache, cough, fatigue, and myalgia in the group administered ivermectin compared to the control group. In addition, the odds ratio of the above symptoms was signicantly lower in patients who received ivermectin than in patients who did not receive the drug (OR = 0.16, 95% CI = 0.09, 0.27). Keywords COVID-19 Ivermectin Cross-sectional study Outpatients Sympto