International Students Seeking Medical Education in Iran; Challenges and Opportunities

No Abstrac

Cellular and Molecular Medicine; the Lost World in Postgraduate Medical Education

Cellular and molecular medicine is an integrated part of translational medicine, which endeavors to bridge between the traditional classification of "basic and clinical" medicine; aiming clinician-scientists to use their knowledge in designing and developing novel interventions and other specific tools for prevention, diagnosis and treatment of abnormal health conditions

Problem-Based Learning

No Abstrac

A Web-based Multilingual Intelligent Tutor System based on Jackson's Learning Styles Profiler and Expert Systems

Nowadays, Intelligent Tutoring Systems (ITSs) are so regarded in order to improve education quality via new technologies in this area. One of the problems is that the language of ITSs is different from the learner's. It forces the learners to learn the system language. This paper tries to remove this necessity by using an Automatic Translator Component in system structure like Google Translate API. This system carry out a pre-test and post-test by using Expert System and Jackson Model before and after of training a concept. It constantly updates learner model to save all changes in learning process. So this paper offers an E-Learning system which is web-based, intelligent, adaptive, multilingual and remotely accessible where tutors and learners can have non-identical language. It is also applicable Every Time and Every Where (ETEW). Furthermore, it trains the concepts in the best method with any language and low cost.Comment: 12 pages, 2 figures, IAENG Transactions on Electrical Engineering Volume 1 - Special Issue of the International MultiConference of Engineers and Computer Scientists 2012. arXiv admin note: substantial text overlap with arXiv:1304.404

Comparison of Remifentanil and Alfentanil Bolus Dose on Extubation Emergence Hemodynamic Profiles, a Randomized Double-blinded Placebo-Controlled Trial

Background: Hemodynamic instability is common during emergence from anesthesia which predisposes patients to development of different side effects. The primary purpose of the present study is to evaluate the effect of Remifentanil and Alfentanil on the hemodynamic profiles during and after extubation.Methods: Ninety-nine patients aged 20-50 years undergoing minor orthopedic surgery under general anesthesia were randomly allocated into control, Remifentanil and Alfentanil groups. Before extubation patients received Remifentanil (1 μg/kg), or Alfentanil (10 μg/kg) or 5 mL of Saline as a placebo based on their group. Baseline heart rate (HR), mean arterial pressure (MAP) plus systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded and documented again on extubation, and 1, 3 and 5 minutes after extubation. Cough status before and after extubation was recorded.Results: The basic characteristics of participants in all the three groups were similar. The rise in SBP on extubation in the placebo group was statistically significant compared to the Alfentanil (p=0.01) and the Remifentanil (p<0.001) groups. Mean arterial pressure decreased during the extubation in group R (97.0±13 mmHg) in contrast to other two groups (A=101.9±13 mmHg, P=101.4±13 mmHg). Heart rate increased in group A and P contrary to group R on extubation.Conclusion: Remifentanil (1μg/kg) and Alfentanil (10μg/kg) attenuate the rise in SBP on extubation but no significant changes were seen between these two drugs

BOTH ORAL PASSIFLORA INCARNATA AND OXAZEPAM CAN REDUCE PRE-OPERATIVE ANXIETY IN AMBULATORY SURGERY PATIENTS: A DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY

Objectives: Pre-operative anxiety control without increased post-operative psychomotor dysfunction is an anesthesia concern especially in ambulatory surgery; so, the development of a strong anxiolytic with minimal psychomotor impairment for premedication is desirable. In this study, it was hypothesized that Passiflora incarnata decreases pre-operative anxiety (PAN) similar to oxazepam.Methods: In this double-blinded placebo controlled study, 128 patients were randomized into Passiflora group (n=68) who received oral P. incarnata and oxazepam group (n=60) who received oxazepam (10 mg) as premedication, 90 minutes before surgery. A numerical rating scale (NRS) was used for each patient to assess anxiety before, and 90 minutes following premedication. Psychomotor function was assessed with the trigger dot test (TDT) and the digit-symbol substitution test at arrival in the operating room, and 90 minutes after tracheal extubation.Results: The 90th minutes NRS anxiety scores were significantly lower in the Passiflora group compared with oxazepam group (p<0.001). There were no significant differences in psychological variables, in groups, in the postanesthesia care unit.Conclusion: In outpatient surgery, administration of oral P. incarnata as a premedication reduces PAN with similar psychomotor function impairment compared with pre-operative oral oxazepam

The Effect of Premedication by Remifentanil and Magnesium Sulfate in Hemodynamic Responses to Tracheal Intubation in Cesarean Section Delivery: 1 A Randomized Double-Blinded Controlled Study

Background: The preventing effects of remifentanil and magnesium sulfate on hemodynamic responses to tracheal intubation were evaluated in a double-blinded controlled trial on pregnant women undergoing cesarean section delivery.Methods: A total of 54 American Society of Anesthesiologists Class I-II women candidate for cesarean section delivery were randomly assigned to one of three groups (n = 18) to receive one of the following premedication: Intravenous (IV) remifentanil 0.75 µg/kg, IV magnesium sulfate 30 mg/kg, or IV normal saline 10 cc as placebo. All hemodynamic profiles were recorded immediately before and after intubation, and 2, 3, 5 minutes after tracheal intubation.Results: Heart rate and systolic and diastolic blood pressures were significantly lower in the remifentanil group than in other groups both before and immediately after intubation. The trend of the changes in homodynamic responses within 5 minutes following intubation in the magnesium sulfate and placebo group was similar, but this trend in the remifentanil group was significant difference. In the same time, 1st and 5th minute Apgar scores were slightly lower in the remifentanil group than others. The measured parameters of umbilical cord blood pH and PO had no significant differences between the groups.Conclusions: Remifentanil can attenuate hemodynamic response to tracheal intubation more effectively than magnesium sulfate, and thus it can be considered safe for a pregnant candidate for cesarean section

EFFECT OF VAGINAL SILDENAFIL ON IN VITRO FERTILIZATION SUCCESS RATES IN WOMEN WITH PREVIOUS FAILED IN VITRO FERTILIZATION ATTEMPTS

Objectives: Endometrial thickness of <9 mm is a predictor of in vitro fertilization (IVF) failure, although neither pregnancy rates nor the pregnancy outcomes are dependent on the endometrial thickness alone. The impact that uterine artery blood flow has on endometrial growth is dependent on nitric oxide which concentrations could be altered by halting a cyclic guanosine monophosphate-mediated pathway with a phosphodiesterase type 5 selective inhibitor such as sildenafil.Methods: In this clinical trial, 72 patients aged below 45 years which have had at least two earlier failed IVF attempts were randomly split into two groups each consisting of 36 patients. Both groups were started on a long IVF protocol. The case group was also administered 100 mg vaginal sildenafil suppositories daily, starting on day 3 of menstruation which was continued until human chorionic gonadotropin administration. Endometrial thickness was measured using ultrasonography in both groups plus pregnancy rates were assessed in both groups.Results: The mean age of the patients in Group A who received sildenafil; in this clinical trial, 72 patients aged below 45 years which have had at least two previous failed IVF attempts were randomly split into two groups each consisting of 36 patients was 33.8±4.8 in contrast to Group B (control group) with the mean age of 33.8±4.8. Mean endometrial thickness of 8.6±0.1 mm was recorded in Group B compared to 9.0±0.7 mm in Group A (p=0.03). Of all the 36 participants who received sildenafil citrate during the IVF cycle, 12 (33.3%) patients had successful pregnancies while 24 (66.7%) failed to get pregnant. In the control group, out of the 36 participants, 10 (27.8%) patients got pregnant while 26 (72.2%) failed the cycle (p=0.9).Conclusion: This study showed that although using vaginal sildenafil during the IVF cycle does improve endometrial thickness before implantation, this does not necessarily lead to higher pregnancy rates