Comparing the effects of upper limb and breathing exercises on six-minute walking distance among patients with chronic obstructive pulmonary disease: a three-group randomized controlled clinical trial

Introduction: Physical exercise can improve patient outcomes and reduce hospitalization and mortality rates among subjectswith chronic obstructive pulmonary disease. This study aimed to compare the effects of upper limb and breathing exercises onsix-minute walking distance among these patients. Material and methods: This three-group randomized controlled clinical trial was conducted in 2017–2018 in Velayat hospital,Qazvin, Iran. Seventy-five patients were purposively selected from the outpatient lung clinic of the hospital and randomly allocatedto either the 25-patient groups of upper limb exercise, breathing exercise, or control. The patients in the first group wereperforming upper limb exercises thrice weekly for one month in the study setting. Their counterparts in the second group weredoing pursed-lip and diaphragmatic breathing exercises four times daily for one month at their homes. However, the patients inthe control group received no exercise intervention. Six-minute walk test was performed by each participant both before andafter the study intervention. The SPSS for Windows program (v. 23.0) was used to analyze the data via the Chi-square test, thepaired-sample t test, and the one-way analysis of variance. Results: Before the intervention, the groups did not significantly differ from each other respecting six-minute walking distance.During the study, walking distance in the control group did not change significantly, while it remarkably increased in both the upperlimb exercise and the breathing exercise groups (p < 0.05). After the intervention, walking distance in the upper limb exercisegroup was significantly greater than the breathing exercise group (p < 0.05) and the control group (p < 0.05); however, thedifference between the breathing exercise and the control groups was not statistically significant (p > 0.05). Conclusion: Upper limb exercise is more effective than breathing exercise in increasing walking distance among patients withchronic obstructive pulmonary disease. Therefore, upper limb exercise can be used as a safe, simple, and inexpensive rehabilitationtechnique for these patients

Exposure to stressful life events among patients with chronic obstructive pulmonary disease: a prospective study

Introduction: Although depression and anxiety have been widely investigated among patients with chronic obstructive pulmonary disease (COPD), experiencing stressful life events and its effect on increasing risk of exacerbations was rarely assessed. This study aimed to clarify the association between facing with stressful events among COPD patients and their disease severity leading to hospitalization.Material and methods: A prospective study was conducted among 128 COPD patients from the population of Qazvin, a north-west, industrialized city of Iran from December 2017 to December 2018. Patients were followed up for one-year and their related measures were gathered. To compare variables among patients stratified by reporting stressful life conditions, Pearson’s chi-square and Fisher’s exact tests were used. Furthermore, to assess the effect of several covariates on the response variable, a logistic regression modelling was applied. Results were reported in form of odds ratios and their 95% confidence intervals. Results: Study findings affirmed that patients who had experienced stressful situation had lower BMI, were retired, experienced more frequent exacerbations, and reported higher levels of anxiety/ depression. Moreover, those with stressful conditions were among current or former smokers (p < 0.05). Logistic regression analysis revealed that facing with stressful situations was significantly associated with the severity of COPD disease (OR 1.9; 95% CI 2.5 to 5.6), smoking habit (OR 2.8; 95% CI 1.6 to 4.2; OR 1.5; 95% CI 1.4 to 2.2), and hospitalization during one-year follow up (OR 1.2; 95% CI 1 to 3.3).Conclusions: To improve health outcomes of COPD patients, close attention should be given to their psychological disorder and appropriate strategies should be applied to reduce patients’ exposure to stressful life events and subsequent anxieties

Appropriate neck/waist circumference cut-off points for gestational diabetes prediction in Iranian pregnant women: The baseline analysis of the Qazvin maternal and neonatal metabolic study (QMNMS), Iran

Abstract Background: Gestational diabetes is the most common complication during pregnancy and it is essential to identify the high-risk groups for gestational diabetes mellitus (GDM) in the first trimester. A large neck circumference (NC) in the first trimester is a measure of obesity. Objective: The present study investigated whether pregnant women's first-trimester NC and waist circumference (WC) measurements present a predictive index for GDM diagnosis. Materials and methods: This longitudinal cohort study was conducted on 676 pregnant women aged ≥20 years. Pregnant women at 12-14th (baseline) gestational weeks underwent measurement of neck and other anthropometric indices. GDM was diagnosed with 75-g oral glucose tolerance test at 24-28th gestational week. Results: GDM was developed in 110 (16.3%) pregnant women. The logistic regression analysis showed that baseline NC > 33.5 cm (OR: 2.037, 95% CI: 1.313-3.161; P = 0.002) and WC > 90.5 (OR: 2.299, 95% CI: 1.510-3.501; p 33.5 cm, with 68.5% sensitivity and 48.3% specificity, and for baseline WC it was >90.5.50 cm, with 57% sensitivity and 63.4% specificity. Conclusion: Pregnant women with an NC > 33.5 cm and a WC > 90.5 cm at baseline (12-14th gestational weeks) had a higher chance of developing GDM. first-trimester NC and waist circumference (WC) measurements present a predictive index for GDM diagnosis. Keywords: Cut-off points; Gestational diabetes mellitus; Neck circumferences

Diagnostic performance of ocular ultrasonography compared to fundoscopy to predict papilledema

BAC KGR OUND: The aim of this study was to determine the association between the diameters of optic nerve sheath assessed by ultrasonography, grading of papilledema in fundoscopy among patients suspected to raising intracranial pressure and determining the sensitivity and specificity of ultrasonography to detect optic nerve sheath dilatation. MET HODS: This prospective blinded cohort study was performed on 223 consecutive patients with clinical suspicion to optic papilledema. The patients were assessed using direct fundoscopy. The diameter of the optic nerve sheath was determined by ocular ultrasonography. RESULTS: In fundoscopy, 46 patients were revealed to have papilledema in at least one of the two eyes. A significant correlation was found between diameter of optic nerve sheath and age in total population as well as in those without papilledema, but not in the group with papilledema. The mean diameter of optic nerve sheath in bilateral assessment was significantly higher in the group with papilledema. The association between the mean diameter of optic nerve sheath and grade of papilledema was strongly significant. The assessment of the area under ROC analysis showed that measuring diameter of optic nerve sheath could effectively discriminate papilledema from normal condition. CONCL USIONS: Ultrasonography can effectively discriminate papilledema from normal condition by measuring diameter of optic nerve sheath. (Cite this article as: Namdar P, Yousefian S, Farzaneh Khanshir Z, Zohal MA, Kazemifar AM, Torabi Goodarzi Z. Diagnostic performance of ocular ultrasonography compared to fundoscopy to predict papilledema. Minerva Oftalmol 2017;59:1-6. DOI: 10.23736/S0026-4903.17.01770-6) Key words: Ultrasonography - Papilledema - Intracranial hypertension - Optic nerve. Minerva Oftalmol 2017 March;59(1):1-6 DOI: 10.23736/S0026-4903.17.01770-6 © 2017 EDIZIONI MINER VA MEDICA Online version at http://www.minervamedica.it COPYRIGHT© 2017 EDIZIONI MINERVA MEDICA This documen

Association of social jetlag with gestational diabetes: Qazvin Maternal and Neonatal Metabolic Study

The association of social jetlag (SJL), as a quantitative measure of circadian misalignment, with insulin resistance and metabolic syndrome has been reported. The present study was designed to investigate the association of SJL with gestational diabetes mellitus (GDM). Pregnant women with gestational age ≤14 weeks were enrolled in this longitudinal study. The participants with pre-GDM, shift workers and those who used alarms for waking up on free days were excluded from the study. SJL as well as behavioral and psychological parameters were evaluated at enrollment. The participants were categorized based on each 1-h increment of SJL. The association of SJL with the occurrence of GDM in the late second trimester was evaluated using univariate and multivariate methods. In total, 821 pregnant women entered the study, and after omitting individuals with excluding criteria, analyses were performed on 557 participants. The frequencies of SJL < 1 h,1 ≤ SJL < 2 h and SJL ≥ 2 h were 44.7%, 37.2% and 18.1%, respectively. Average sleep duration was higher in SJL < 1 h compared with the two other groups (p < 0.001). During follow-up, 90 (16.1%) women with GDM were identified. SJL ≥ 2 h was associated with a 4.4-5.6 times higher risk of GDM in different models of adjustment (p < 0.05). Pregnant women with high SJL are at a higher risk of GDM. Further studies for evaluating the mechanisms by which SJL affects GDM are warranted

Evaluation of the Effect of Combination Therapy on Treatment of COVID-19: A Cohort Study

Background: COVID-19 is a new disease for which a definitive treatment has not yet been proposed. Objectives: The present study aimed to investigate the effect of combination therapy on the treatment of COVID-19 due to the importance of finding an appropriate treatment for this epidemic disease. Methods: This two-center cohort study included 175 confirmed COVID-19 inpatients at two medical centers designated for the treatment of COVID-19 patients in Qom and Qazvin, Iran. In this study, four different groups of drug regimens were studied which included G1 (azithromycin, prednisolone, and naproxen), G2 (lopinavir/ritonavir, azithromycin, naproxen, and prednisolone), G3 (hydroxychloroquine, azithromycin, naproxen, and prednisolone), and G4 (levofloxacin, vancomycin, hydroxychloroquine, and oseltamivir). It should be noted that G1, G2, G3, and G4 treatment regimens were used on 48, 39,30, and 77 patients, respectively. Results: The study participants included 175 confirmed COVID-19 patients with mean±SD age of 58.9 ±15.1 years, out of whom 80 (46%) patients were male and the rest were females. The results indicated that the hospital stay period was significantly shorter in the G1 compared to other groups (G1:5.9±2.4, G2:8.1±4.2, G3: 6.3±1.7, and G4: 6.4±2.9; [P-value=0.008]). It should be noted that pulse rate, oxygen saturation, hemoglobin, and platelet count (PLT) changed significantly during the study in four treatment groups; however, a significant change in temperature, creatinine, and white blood cell (WBC) was observed only in G3, G4, and G1 groups, respectively. The number of ICU admissions and deaths were not statistically significant among the patients who received the four treatment regimens (P=0.785). Based on the results, the history of ischemic heart disease, baseline oxygen saturation, WBC, neutrophil, lymphocyte count, and C-reactive protein (CRP) are the risk factors for the prolonged hospital stay in COVID-19 patients. Conclusion: The obtained results in this study indicated that the combination of azithromycin, prednisolone, and naproxen is the most effective regimen for the treatment of COVID-19, compared to three other combination treatment regimens. Keywords: Anti-inflammatory drugs, Antiviral drugs, Combination therapy, Corticosteroid, COVID-19, Immunomodulators drug

Effect of high-dose Spirulina supplementation on hospitalized adults with COVID-19: a randomized controlled trial

ObjectiveSpirulina (arthrospira platensis) is a cyanobacterium proven to have anti-inflammatory, antiviral, and antioxidant effects. However, the effect of high-dose Spirulina supplementation on hospitalized adults with COVID-19 is currently unclear. This study aimed to evaluate the efficacy and safety of high-dose Spirulina platensis for SARS-CoV-2 infection.Study DesignWe conducted a randomized, controlled, open-label trial involving 189 patients with COVID-19 who were randomly assigned in a 1:1 ratio to an experimental group that received 15.2g of Spirulina supplement plus standard treatment (44 non-intensive care unit (non-ICU) and 47 ICU), or to a control group that received standard treatment alone (46 non-ICU and 52 ICU). The study was conducted over six days. Immune mediators were monitored on days 1, 3, 5, and 7. The primary outcome of this study was mortality or hospital discharge within seven days, while the overall discharge or mortality was considered the secondary outcome.ResultsWithin seven days, there were no deaths in the Spirulina group, while 15 deaths (15.3%) occurred in the control group. Moreover, within seven days, there was a greater number of patients discharged in the Spirulina group (97.7%) in non-ICU compared to the control group (39.1%) (HR, 6.52; 95% CI, 3.50 to 12.17). Overall mortality was higher in the control group (8.7% non-ICU, 28.8% ICU) compared to the Spirulina group (non-ICU HR, 0.13; 95% CI, 0.02 to 0.97; ICU, HR, 0.16; 95% CI, 0.05 to 0.48). In non-ICU, patients who received Spirulina showed a significant reduction in the levels of IL-6, TNF-α, IL-10, and IP-10 as intervention time increased. Furthermore, in ICU, patients who received Spirulina showed a significant decrease in the levels of MIP-1α and IL-6. IFN-γ levels were significantly higher in the intervention group in both ICU and non-ICU subgroups as intervention time increased. No side effects related to Spirulina supplements were observed during the trial.ConclusionHigh-dose Spirulina supplements coupled with the standard treatment of COVID-19 may improve recovery and remarkably reduce mortality in hospitalized patients with COVID-19.Clinical Trial Registrationhttps://irct.ir/trial/54375, Iranian Registry of Clinical Trials number (IRCT20210216050373N1

Assessment of the Learning styles of MBBS Students at the University of Kassala, Kassala State, Sudan, 2022

Introduction: Since the 1970s, Learning styles of health science students have been researched. It’s important to know the Learning styles of medical students these will be rewarding for both the instructor and the student. Objectives: This study aims to determine the learning styles of the medical students at the University of Kassala. Methodology: Cross sectional descriptive study conducted between 21/3/22 to 23/8/22 at the University of Kassala. After collecting the completed questionnaires, the data was analyzed using R language software Version R i386 4.0.2. Results: Out of 251 study sample, 228 responded with Questionnaire response rate of 90.8%. Wrong filled questionnaires were excluded resulting in 206 usable survey. 66.50485 % of our participants were females, 33.49515 % were males. The average age of the participants in years was 21.71359 +/- 1.933755. Reflectors (61.16505%) were the most prevalent learning style among medical students at the University of Kassala. Differences was noted in learning styles among the different sexes (p-value= 0.0371). No difference between the educational levels concerning the learning style (p-value = 0.09029). The living area does not affect the learning style (P-value = 0.3143). Conclusion and recommendations: Most of our students are reflectors, thus they prefer to watch rather than practice, they might be good at subjects that are more of watching type more than subjects that need practice. The results reveal the need to endorse self-directed learning. Further research is need to identify the most reliable teaching modality and instructional strategies. Keywords: Learning styles, Klob’s Inventory, Medical students DOI: 10.7176/JEP/13-30-01 Publication date:October 31st 202

External assessment – Intra College of School of Nursing and Midwifery, Qazvin University of Medical Sciences

Background: The external evaluation of the quality of school education, research and treatment will be determined. External evaluation team suggested approaches for improving the quality and continuous improvement are discussed. External evaluation stimulates growth and improves the quality and overall contribution of the members of the training evaluation process. Objective: The aim was accommodating the college's performance and school educational programs with needs of the community, enhancement the quality of education and transparency in accountability. Methods: This descriptive and analytical survey Qazvin University of Medical Sciences in the School of Nursing and Midwifery. After the Design Evaluation Process of external evaluation process by the manager of Committee, with using standard manual basic medical training course approved by the ministry in 2006 and conducted workshops justification for the authorities of the university, the university external evaluation team was set up. Members of the assessment team, including experts and academic center school of medicine, dentistry, medicine and health. To explain and justify the assessment team members, several meetings in the evaluation committee were done. Reports of internal evaluation of nursing and midwifery school, day and evening, were studied. Educational evaluation was done in 8 areas: goals and mission, faculty, students, research, training and evaluation, management and educational resources. Findings: The mean external evaluation of the University School of Nursing and Midwifery, Faculty in the area of welfare and educational resources was not desirable, but in other areas Analysis was moderate to good Conclusion: The external evaluation is as an indicator to showing the achievement of goals and analyses the quality of school performances. External assessment Intra College can be a good method to assess more accurately the quality of education. Keywords: external evaluation of - intra University, School of Nursing and Midwifery, Qazvin University of Medical Science