مجله علوم پزشکی پارس
سال بیست و یکم شماره 3 (پیاپی 65، پاییز 1402)

Clinical decision-making is done based on data collection, interpretation and evaluation to choose anevidence-based treatment plan from among different ways; Since the clinical environment has dynamic, variable, uncertain and unstable conditions, the clinical decision-making of assistants has different dimensions and is influenced by several factors; As a result, it is not possible to get a deep understanding of it with quantitative and cross-sectional studies; Therefore, the present study was carried out with the aim of explaining the experiences of internal department assistants on the factors and obstacles affecting clinical decision-making in hospitals affiliated to Jahrom University of Medical Sciences. This article is a contract content analysis study in which 8 assistants of the internal medicine department from hospitals affiliated to Jahrom University of Medical Sciences were selected and participated in thestudy by purposeful sampling. Semi-structured in-depth personal interview method was used to collect data. All interviews were recorded and then transcribed and analyzed using Granheim and Lundman's method. Data analysis revealed 4 main themes and 14 sub-categories, which main themes are: "criteria for clinical decision-making", "obstacles to clinical decision-making", "facilitators for clinical decision-making" and "the need for development" Training of assistants". Considering that clinical decision-making is based on the comprehensive benefit of the patient, ethicalprinciples and evidence, and the lack of theoretical knowledge, little experience and insufficient skills, lack of specialists, facilities and equipment along with the lack of amenities and work pressure can prevent correct decision-making, it is better to emphasize more on these matters in educational planning.

Checking the quality of meat products is very important. The purpose of this research is to investigatethe presence of unauthorized tissues in this product to improve its quality and safety level and promote the health of society. In this cross-sectional descriptive study, sausages with meat percentages of 40, 55 and 70 wererandomly purchased from three factories (10 pieces each) and divided into three pieces and then three slides from each piece with hematoxylin-eosin method was prepared (270 slides in total). Finally, 10 microscopic fields were examined from each slide. The data were analyzed by using SPSS software. At the level of less than 0.05, the difference between the groups was considered significant and the results were shown as Mean ± SD. Furthermore, the frequency percentage of tissues in each of the sausages was calculated. Cartilage tissue, bone, skin, kidney, salivary gland, blood vessel, abdominal viscera and plant tissues were observed in all meat products. However, central nervous system and spleen tissues were not seen in any of the samples. In sausage 40%, the highest frequency percentage of tissue was related to skin, in sausage 55%, skin and kidney, and in sausage 70%, kidney. In addition, the amount of illegal tissues was different in 40%, 55% and 70% sausages and this difference was significant in many tissues. By using histological methods, it is possible to detect illegal tissues in meat products and obligate factories to comply with the national standard.

Systemic triazole fungicides such as Penconazole have negative effects on different body tissues. In the Present study, the Protective effects of vitamin D3 on tissue changes and Pituitary-testicular axis in adult rats treated with Penconazole were investigated. In this experimental study, male Wistar rats were divided into 6 groups of 6 including: control, sham (1 ml of distilled water), exPerimental 1 (Penconazole 100 mg/kg), experimental 2 (vitamin IU/kg 1000 D3), experimental 3 (100 mg/kg Penconazole + 500 IU/kg vitamin D3) and experimental 4 (100 mg/kg Penconazole + 1000 IU/kg vitamin D3). At the end of day 28, serum levels of LH, FSH and testosterone hormones were measured by ELISA method and the testicular tissue was removed for histoPathological examination. The serum levels of LH and FSH in experimental group 1 showed a significant increase compared to the control and sham groups (P< 0.05), but the testosterone serum level decreased (P<0.05). The serum levels of LH and FSH in experimental grouPs 3 and 4 showed a significant decrease compared to experimental group 1 (P< 0.05), but testosterone serum levels increased (P<0.05). Histopathological examination showed that in experimental group 1, the testicular tissue was destroyed; however, in experimental groups 3 and 4, the testicular tissue was recovered. Based on the results of this study, vitamin D3 can improve testicular damage caused by Penconazole in rats.

The high prevalence and consequences of hypertension in teachers has doubled the importance of identifying factors affecting blood pressure disease, the purpose of this study was to investigate the role of the diagnostic role of health-oriented strategies, self-management and incompatible strategies on hypertension: A discriminant analysis in Khorram Abad city. The current research method was cross-sectional in year1402. The statistical population was made up of teachers in Khorramabad city, the sample size of the study was equal to 324 people, of which 175 teachers without hypertension and 149 teachers with hypertension were selected by available sampling method. In this study, the standard questionnaire of psychological factors affecting blood pressure was used to collect data, and these data were analyzed with the help of spss-24 software and by variance analysis and discriminant analysis. The results of the discriminant analysis showed that the discriminant function has a very high clean power to distinguish and diagnose teachers with and without hypertension (p<0.05), such that 81.7% of the position of the discriminant function is based on the components of health-oriented strategies, self-management and inconsistent strategies. Also, the diagnostic power related to the subscale of awareness of the disease has been higher(p<0.05). Based on the findings of the present research, it can be concluded that psychological factors play an important role in diagnosing and predicting teacher’s hypertension, and for this purpose, psychologists, counselors and education professionals should pay attention to these factors to prevent and treat teacher’s hypertension.

Major depressive disorder (MDD) is one of the most common mental illnesses. The results obtainedfrom previous studies conducted in this field show that inflammatory processes increase in MDD patients. However, few studies have addressed the issue of inflammatory markers in the brains of MDD patients. The aim of this study was to investigate the expression of regulatory axis related to cytokine signaling including IL6, TNF, NRG1 and BDNF in prefrontal cortex tissue samples. In the present study, using a bioinformatics approach based on microarray data analysis, the expression of a regulatory axis related to cytokine signaling, including four genes (IL6, TNF, NRG1, and BDNF),in prefrontal cortex tissue (PFC) samples was investigated. Background correction, gene filtering and data normalization were done using different packages in R. Data quality was also evaluated using AgiMicroRna package and PCA plot.The limma package in R was used in order to identify the genes with expression changes. In addition, Pearson's correlation analysis was performed in R to check the correlation between the selected genes. The obtained results showed that the expression of BDNF and NRG1 genes in the PFC tissue of MDD patients was associated with a significant decrease (P= 0.037), and on the other hand, the expression of IL6 and TNF genes was significantly increased (P< 0.001). Also, a strong negative correlation between the IL6 and BDNF (P < 0.001) genes was obtained. In this study, the results show that there is a complex relationship between MDD disease progressionand cytokine signaling. This research provides evidence for a better understanding of the mechanisms of MDD pathogenesis.

The importance of effective treatment for prostate cancer cannot be ignored. Maintaining the quality oflife of people with this common type of cancer is vital. Identifying new treatments through modern sciences such as bioinformatics is essential and provides the possibility of personalized medical programs tailored to individual needs. In addition, these advances can help develop preventive measures that can ultimately reduce the risk of developing this type of cancer. We downloaded the GSE55945 gene expression data set from NCBI-GEO and analyzed thedifferentially expressed genes (DEG). The role of genes in biological processes, and the enrichment pathways of genes in the Enrichr database are displayed by the Kyoto Encyclopedia of Genes and Genomes (KEGG), Reactome, Bioplanet, etc. Also, protein-protein (PPI) networks drawn and discussed. A total of 7 hub or key genes, including CAV1, MYLK, CACNA1D, CALM1, NOX4, CCK, and AOX1, were identified. Analyzes related to molecular processes showed that most genes with differential expression are involved in the "mechanism of drug metabolism". Also, the results showedthat the molecular function of most genes is related to "G-protein dependent", and "inositol phosphatemetabolism" processes. DEGS, key genes and signaling pathways identified in this study may help to understand the molecularmechanisms of prostate cancer and provide possible targets diagnosing and treating this disease.

Difficult tracheal extubation is defined as unsuccessful or incomplete attempts at targeted removal ofan endotracheal tube (ETT). Difficult extubation is a rare and dangerous complication after surgery or in the intensive care unit. The present study has reported a case of disorder in patient extubation following inappropriate fixation of the endotracheal tube.Case Personation: The patient is a 42-year-old man who underwent laminectomy surgery due to lumbar disc problems.There was no specific disease in the previous history of the patient. The patient was intubated with a size 8 spring tracheal tube and the tube cuff was filled with air according to the standard. The surgery was performed in the prone position. After the end of the operation, the patient turned back to the supine position and the process of waking up the patient began. After reversing the effect of relaxants by atropine and neostigmine at the appropriate time, the tube was removed. The cuff of the tube was emptied with a 10 cc syringe, but the tube could not be removed. The anesthesiologist tried to remove the spring tube several times, but it was not possible to extubate the patient. At first, it was assumedthat the tube would break and the metal spring would come out and the spring would get stuck in the trachea. Finally, with double force, this tube was removed while its cuff was full of air, and after investigation, the reason was that the air drain tube was folded by the glue that was used to fix the tube on the patient's face. Based on the results of the present study, improper fixation in patients undergoing general anesthesiacan increase the risk of difficult extubation by disrupting the process of emptying the tracheal tube cuff.

The diversity in outcomes of COVID-19 infection and understanding its underlying reasons have led toa global health challenge. Genetic features, especially variations in immune system genes, are considered as crucial factors contributing to the clinical diversity resulting from infections with viruses such as SARS-CoV-2. In this study, DNA was extracted from blood samples of 220 COVID-19 patients. The PCR-RFLPmethod was employed to identify single nucleotide polymorphisms in the Tyrosine Kinase 2 (TYK2) gene. After PCR amplification, the PCR products were enzymatically digested with AluI enzyme, and the resulting fragments were separated using gel electrophoresis. Phenotypes of each patient were determined by analyzing the created fragments, and for final confirmation, some samples were sent for sequencing. The study population included 102 recovered patients with mild COVID-19 and 118 deceased patients with severe disease. The frequency of the rs11085727 polymorphism in the TYK2 gene was statistically examined in both patient groups, revealing a significantly higher frequency in the deceased group compared to the recovered group (p< 0.05). Examining genetic factors and their variations, especially investigating single nucleotide polymorphisms in genes related to the innate immune system, can play a significant role in predicting susceptibility to COVID-19 and adopting personalized therapeutic approaches based on patients' genetics. According to the results obtained in this research, the rs11085727 polymorphism in the TYK2 gene is likely associated with the severity of COVID-19.