Evaluation of the Quality of Teaching in Neurology Ward, Kerman University of Medical Sciences, Iran, from the Point of View of Medical Students

Background & Objective: In educational systems, evaluation is considered as one of the key elements. The evaluation of university students on the educational processes is of specific value. There has been no study on the evaluation of the Neurology Department, Kerman University of Medical Sciences, Iran, through carrying out a poll. Therefore, we intended to improve the quality of education in the department through evaluation. Methods: From among the medical students admitted in 2007 in Kerman University of Medical Sciences, Iran, 67 students participated in the present study. The questionnaire used was prepared according to reliable sources and the professors’ points of view, and considered validity and reliability. The questionnaire’s data was entered into SPSS, and it was statistically analyzed through descriptive and analytical statistical methods. Results: 63 students (94%) rated the methodology of the professors of the ward, and 62 students (92.5%) rated the methodology of the professors of theoretical courses a moderate or high score. 65 students’ (97%) evaluation of good behavior of professors with students was moderate or high. In terms of efficiency, 35 students (52.2%) rated morning reports, 28 students (41.7%) rated weekly conferences, and 18 students (26.8%) rated journals a moderate to high score. Conclusion: According to the medical student’s opinion, the neurology department has a good position in general standards of medical education, ethics, and regulation. However, it has to reconsider some parts of educational procedures such as conferences and journal clubs which are held in collaboration with the residents. Keywords Medical students Evaluation Neurolog

Comparison of Brain Magnetic Resonance Imaging Lesions in Opium Addict and Non-addict Patients with Thrombotic Stroke: A Case-Control Study

Background: There is no consensus on the effect of opium on stroke yet. Some studies show the negative effects of opium on ischemic strokes. Here, we attempt to compare the volume of lesions in opium addict and non-addict patients with thrombotic stroke. Methods: This case-control study was conducted on patients with thrombotic stroke at Shafa Hospital in Kerman, Iran. The diagnosis was confirmed by clinical examinations, imaging, and laboratory tests. The volume of lesions was calculated by magnetic resonance imaging (MRI), and the data were analyzed by descriptive statistics, Mann-Whitney U test, Chi-square test, and linear regression analysis. Findings: A total of 60 patients were studied, 30 of whom were opium addicts and the rest were non-addicts. The mean volume of the lesion was 46.008350 ± 7.488990 (in the addict group) and 31.023335 ± 1.441570 (in the non-addict group), indicating a significant difference between the two groups (P = 0.005). Regression analysis results showed a significant relationship between the volume of stroke with opium addiction (P = 0.017), ischemic heart diseases (IHDs) (P = 0.006), hyperlipidemia (HLP) (P = 0.016), age (P = 0.035), and smoking (P = 0.044). Conclusion: The results of this study showed a higher volume of lesion in opium-addict patients compared to that in non-addicts as an indicator of stroke severity

Effects of Iron Deficiency and Iron Deficiency Anemia on Visual Evoked Potential in Women

Background: Visual evoked potential is one of the main methods to investigate visual pathway. Some studies in children show that iron deficiency anemia affects on visual evoked potential waves. In this study, we evaluated the effect of iron deficiency and iron deficiency anemia on visual evoked potential in adults. Materials and Methods: This cross sectional study was conducted on 99 non-pregnant women. Patients divided into three groups. Women whose ferritin and hemoglobin levels are less 15 ng/1 and 12 mg/dl placed in iron deficiency aimena group, women whose ferritin level is less than 15 ng/1 and hemoglobin level is more than 12 mg/dl, placed in iron deficiency puorg and women whose ferritin and hemoglobin levels are more than 50 ng/1 and 12 mg/dl, chosen as control group. Visual evoked potential was done from both eyes and the results evaluated by ANOVA test. Results: The average of N75 latency was 65.24±5.06 miliscecond in anemia group, 66.27±7.77 miliscecond in iron deficiency group and 67.19±6.79 miliscecond in control group. The average of P100 latency was 101.60±9.05 miliscecond in anemia group, 102.75±7.91 miliscecond in iron deficiency group and 100.67±7.34 miliscecond in control group. The average of N135 latency was 139.18±31.21 miliscecond in anemia group, 144.81±10.73 miliscecond in iron deficiency group and 141.81±10.73 miliscecond in control group. There is no significant difference between the average of waves’ latency in iron deficiency and anemic groups with control group. Conclusion: Iron deficiency and iron deficiency anemia don’t make any disruptions on visual evoked potential and are not considered as confounding factor of visual evoked potential in adults

Prognostic Value of Doppler Ultrasound Findings in Patients with Middle Cerebral Artery Ischemic Stroke

Background: There is still no finding available about malignant clinical course in patients with middle cerebral artery stroke. The aim of this study was to compare Doppler ultrasound findings in patients with malignant and non-malignant middle cerebral artery stroke in order to obtain its prognostic value in detecting malignant course. Methods: This cross-sectional study was conducted on 40 patients with acute ischemic stroke in Shafa Hospital in Kerman, Iran, 2017. All patients were admitted within 24 hours of the onset of symptoms, and brain CT-scan was performed to confirm ischemic stroke. If more than 50% of the middle cerebral artery showed signs of hypo-density, it was considered as the massive MCA infarction (MMI), while others were excluded. In the first 24 hours, transcranial Doppler ultrasound was performed for all patients. Patients were then examined until discharge or death. In the case of fixed unilateral mydriasis in the clinical course or a displacement of more than 5 mm in septum pellucidum in the control CT-scan on days 3 to 7 (depending on the changes in the consciousness level), m-MCAI was diagnosed. Data were analyzed using SPSS. Results: In the malignant cases, the mean PSV and MFV in MCA in the contralateral side of the lesion were significantly higher than those in the non-malignant cases. A significant increase in mean PSV and MFV in ACA in the contralateral side of the lesion was found in the malignant cases compared to the non-malignant cases (P=0.01). Significant difference was observed in terms of mean RI of ICA of contralateral side of the lesion between malignant and non-malignant cases (P=0.02). Conclusion: Our study showed increase in PSV and MFV in MCA and ACA in the contralateral side of the lesion in cases that lead to malignancy, which can be helpful in early identification of cases that advance to malignancy

Educational Needs Assessment for General Practitioners in the Field of Neurological Diseases in the Regulatory Zone of Rafsanjan University of Medical Sciences, Iran

Background & Objective: Regarding the significance of neurological diseases, training general practitioners has a key role and they should be well-trained in diagnose and approaching different diseases in this field. We focused on educational needs assessment for general practitioners in the field of neurological diseases. Methods: All the general practitioners practicing in the regulatory zone of Rafsanjan University of Medical Sciences, Iran, (urban and rural areas), who agreed to participate, were entered the study. 104 participants of the total of 170 general practitioners in this area completed a researcher-made questionnaire and mailed us. The questionnaire encompassed 54 neurological diseases, four paraclinical tests and 9 approaches for neurological signs and symptoms, as well as their practical framework, satisfaction from their education, and demographic and educational items. Results: In 47.9% of cases, educational expectations were at the level of screening and refer, in that 31.4%, at the level of diagnosis and treatment and in 18.8%, at the level of acquaintance and describing. The remainders (1.88%) were the cases with no need to know and unfamiliar ones. Statistically, screening and refer, just the diagnosis, and the treatment were the mentioned educational expectations, respectively. Most of general practitioners were not fully satisfied from their externship and internship educational programs. Conclusion: This study, in a more systematic way, outlines the general practitioner’s points of view and their tendency to intervene in the procedure of neurological managements which can also be of great use to any further modifications in medical training curricula. Absence of perfect satisfaction about educational programs shows us that we should change our educational methods to more practical and clinical forms. Key Words: Educational needs, Neurological diseases, General practitioner

The Effects of Citicoline on Cerebrovascular Hemodynamic Status in Ischemic Stroke Patients

Introduction: Some recent studies have shown that citicoline improves clinical symptoms in patients with stroke. Citicoline's mechanism of action in improving the clinical symptoms is not recognized yet. The aim of this study was to evaluate the cerebrovascular hemodynamic status in patients with ischemic stroke treated with citicoline compared with the control group. Methods: In this study, 64 patients (20 male, 44 female) with supratentorial ischemic stroke were included. Patients underwent transcranial and extra cranial ultrasonography within 24 hours of admission and were divided into two equal groups (32 patients per group). One group was treated with citicoline (500 mg/day) and the second group was treated with placebo for one week. Then, patients underwent transcranial and extra cranial ultrasonography again. Data were analyzed by paired t-test and independent t-test. Results: In this study, no significant difference between the groups in terms of age, gender, cardiovascular factors and NIHSS was observed. Peak systolic velocity (PSV) in RCCA, RICA, RVA, LVA, and mean flow velocity (MFV) in RICA and LACA were significantly different between two groups. As there was no significant difference in confounding variables between the two groups, therefore, the difference in PSV and MFV between the groups may be due to citicoline. Conclusion: Prescription of citicoline for treatment of acute ischemic stroke is associated with hemodynamic changes in cerebral arteries. This finding can be one of the citicoline's mechanisms of action in ischemic stroke process

Quality Assessment of Educational Services for Residents in Teaching Hospitals of Kerman University of Medical Sciences, Iran, based on the SERVQUAL Model

Background & Objective: Quality assessment of educational services is one of the most important actions in line with an improvement in the services. If the qualitative dimension of services is not taken into account, we will observe significant academic failure and reduction in creativity among the learners. Therefore, one of the salient steps in improving the quality of educational services is quality assessment from the viewpoints of its users. The aim of the present study was to determine the quality of educational services from the viewpoints of residents based on the SERVQUAL model. Methods: In this descriptive-analytical study, 204 residents from the educational hospitals of Kerman, Iran, participated. The participants were selected using simple random sampling method. The data collection tool was the Evaluation of Educational Quality Questionnaire that evaluates educational quality based on the SERVQUAL gap analysis method. This tool compares respondents’ perceptions and expectations of the quality of educational services in 5 domains (reliability, responsibility, confidence, assurance, empathy, and tangible physical). Content validity of this questionnaire was approved by experts' opinions and its reliability was confirmed using Cronbach's alpha (r = 0.88). To analyze data, SPSS software was used for performing descriptive (mean, standard deviation) and analytical (independent t-test) tests. Results: The findings showed that there was a negative gap between residents' perceptions and expectations of the quality of educational services in all 5 dimensions. The highest and lowest level of gap was related to the tangible physical (-1.50) dimension and the responsibility (-0.51) dimension, respectively. Conclusion: There is a negative gap between residents' perceptions and expectations in different dimensions of educational services quality based on the SERVQUAL model. In order to improve the quality of education, a review of educational infrastructures (environment and facilities) and education management seems necessary. This requires the efforts of relevant authorities toward the development and improvement of these infrastructures. Keywords: Evaluation; Quality; Residents; Educational services; SERVQUAL mode

The Effects of Citicoline on Cerebrovascular Hemodynamic Status in Ischemic Stroke Patients

Introduction: Some recent studies have shown that citicoline improves clinical symptoms in patients with stroke. Citicoline's mechanism of action in improving the clinical symptoms is not recognized yet. The aim of this study was to evaluate the cerebrovascular hemodynamic status in patients with ischemic stroke treated with citicoline compared with the control group. Methods: In this study, 64 patients (20 male, 44 female) with supratentorial ischemic stroke were included. Patients underwent transcranial and extra cranial ultrasonography within 24 hours of admission and were divided into two equal groups (32 patients per group). One group was treated with citicoline (500 mg/day) and the second group was treated with placebo for one week. Then, patients underwent transcranial and extra cranial ultrasonography again. Data were analyzed by paired t-test and independent t-test. Results: In this study, no significant difference between the groups in terms of age, gender, cardiovascular factors and NIHSS was observed. Peak systolic velocity (PSV) in RCCA, RICA, RVA, LVA, and mean flow velocity (MFV) in RICA and LACA were significantly different between two groups. As there was no significant difference in confounding variables between the two groups, therefore, the difference in PSV and MFV between the groups may be due to citicoline. Conclusion: Prescription of citicoline for treatment of acute ischemic stroke is associated with hemodynamic changes in cerebral arteries. This finding can be one of the citicoline's mechanisms of action in ischemic stroke process