bagher larijani

The COVID-19 pandemic has impacted medical education worldwide with several opportunities and challenges. This study aims to provide an overview of medical education's opportunities and challenges according to the experience of the COVID-19 pandemic in order to guide future endeavors in conducting the teaching-learning process in post-COVID era support.

In this systematized review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, databases of PubMed, Cochrane, Scopus, Web of Science, and Eric, in addition to Google Scholar as a search engine, were searched to retrieve relevant original peer-reviewed, review, editorial, and commentary articles published from Dec 2019 to the end of Sep 2022.

As per the qualitative synthesis, a total of 29 articles were included from the 1534 records that were identified. Reviewing the included articles showed that most of the relevant studies were considered Medical and healthcare students (51.8%) at undergraduate level (72.5%) in University settings (62.1%). As per the qualitative synthesis, a total of 29 articles were included from the 1534 records that were identified. Reviewing the included articles showed that most of the relevant studies were considered Medical and healthcare students (51.8%) at undergraduate level (72.5%) in University settings (62.1%). On the other hand, post-COVID medical education opportunities have been grouped into four main categories, which are teaching and learning processes, psychological impact, accessibility and education equity, and management and administrative affairs. Post-COVID medical education opportunities also consist of four main categories: teaching-learning process, psychological impact, accessibility and education equity, and management and administrative affairs. 

Changes in teaching and learning processes in medical education caused by the COVID-19 pandemic created opportunities and caused important challenges that should be considered in the post-COVID era. In this regard, blended learning with the integration of technology using a flexible approach could be an effective recommendation.

Sclerostin, a protein encoded by the SOST gene, is an important genetic risk factor for osteoporosis in postmenopausal women. This study was conducted on the Iranian postmenopausal women, to investigate the association between this gene and the Trabecular Bone Score (TBS) as a novel index used for assessing osteoporosis.

The present study, conducted in 2024, was performed on 1071 women aged 60 years and older who participated in the Bushehr Elderly Health (BEH) program. The associations between seven independent Single Nucleotide Polymorphisms (SNPs) within the SOST gene and mean TBS of L1 to L4 were examined using the additive, dominant, and recessive models. Genetic risk scores (GRS) were calculated for each postmenopausal woman based on the coefficient regressions derived from the additive and dominant models. The relationship between the GRS quartiles and TBS was evaluated using a linear regression model.

After adjusting for age and Body Mass Index (BMI), the associations between the rs2023794-C and TBS were significant in the additive (β = 0.03, P= 4.7×10-5, PFDR= 0.0003) and dominant (β = 0.032, P= 5×10-5, PFDR= 0.0003) models. The GRS derived from both additive and dominant models were related to TBS (P<0.05). For the additive model GRS, TBS showed an average increase of 0.022 score for the fourth quartile in comparison with the first quartile, adjusted for age, BMI, type 2 diabetes mellitus (T2DM), and smoking status (P=0.001).

SOST gene is associated with TBS and may have implications for personalized medicine. Targeting sclerostin through SOST could offer a therapeutic approach in managing osteoporosis in high-risk postmenopausal women.

 Infective endocarditis (IE), a severe and economically impactful condition, lacks substantial epidemiological data in the North Africa and Middle East (NAME) region. This study focused on analyzing the trends and burden of IE in NAME from 1990 to 2019, taking into account factors like age, gender, and socio-demographic index (SDI).

 The Global Burden of Disease data from 1990 to 2019 was retrieved from the Institute for Health Metrics and Evaluation (IHME) website.

 Between 1990 and 2019, the age-standardized rates (ASR) for IE incidence increased by 59%, and prevalence and years lived with disability (YLDs) rose by 12% and 9%, respectively, while the ASRs for deaths, disability-adjusted life years (DALYs), and years of life lost (YLLs) saw reductions of 22%, 34%, and 34% in the NAME region. Death rates among children under five declined by 72%. Gender and the SDI did not significantly influence these changes. Saudi Arabia witnessed the most significant increase in ASR of IE incidence since 1990, while Turkey had the highest rates in 2019. The year 2019 also saw the highest death rate among those aged 70 and over, with over 91000 DALYs from IE. DALYs decreased by 71.5% for children under five from 1990 to 2019 but remained stable for individuals in their seventies. Jordan showed the most notable decrease in ASRs for deaths, DALYs, and YLLs among children under five.

 This study highlights the changing epidemiology of IE in the NAME region, recommending the establishment of multidisciplinary IE registries, antibiotic prophylaxis guidelines for healthcare-associated IE, and strategies to control antimicrobial resistance as key mitigation measures.

The prevalence of overweight, obesity and related complications is increasing rapidly in the world. Also, treating this disease in the presence or absence of co-morbidities has become a challenge. In this article, based on the clinical recommendations of the American Endocrinology Association and the American College of Endocrinology, a comprehensive clinical guide has been written for the stages of treating obese patients and its individualization, and it has been tried to be adjusted as much as possible based on the conditions in Iran.

with a specific search strategy, a complete search was performed in PubMed, Scopus, ISI Web of Science, EMBASE and Google Scholar Cochrane databases. Then, the best clinical guidelines suitable for the Iranian society were selected and using the opinions of specialists and clinical experts, a clinical guideline was prepared for the treatment of obesity in Iranian adults.

In this article, in continuation of the previous article, we answered the questions number 4 to 6 regarding the stages of obesity treatment and its individualization in adults of Iranian society, and presented a total of 60 recommendations in this regard.

In this part of the clinical guide for obesity in Iranian adults, we tried to have a special view on the treatment of these patients and by providing evidence-based recommendations and statements, the treatment process was personalized as much as possible for patients with special conditions so that decision-making in this regard is facilitated for the relevant colleagues in this field.

Low BMD is a common problem in major thalassaemia patient, but the use of DXA in chronic disease children with smaller bones, has some problems. Utilizing bone mineral apparent density (BMAD) helps in preventing this obstacle.  Testing the usefulness of this method in resolving the effects of bone size on BMD by comparing the BMD and BMAD of our thalassemics with results of our healthy ones, is our goal.

Sample size was 110 cases with mean age of 9.6 ± 4.3 y/o and contained 73 males. Gauge of BMDs done by dual x-ray absorptiometry. Then BMAD was calculated. We did comparison of BMDs and BMADs results of thalassemic children with results of healthy Iranian pediatrics.

Mean of femoral BMD and BMAD, spinal BMD and BMAD was 0.579±0.134 g/cm2, 0.162±0.096 g/cm3, 0.563±0.118 g/cm2 and 0.107±0.015, respectively. When results of 9-18 patients compared with BMDs and BMADs of normal children, BMD of femur and BMD and BMAD of spine of patients found significantly lower (P-values,  0.003,  <0.001, <0.001, respectively). BMAD of femur of patients was not significantly different from normals.

When bone mineral density of femur modifies by bone mineral apparent density formula, the remarkable difference between BMD of patients and normals; vanishes. Utilizing bone mineral apparent density helps in interpretation of femoral dual X-ray absorptiometry at least in thalassemic patients. As the results of vertebrae, after modification by calculating BMAD, remains significantly different, we cannot bring forward BMAD for mentioned aim in the spine of thalassemics.

In recent years, alarming trends in non-communicable diseases (NCDs) have grown into some of the most important health concerns worldwide. The present research attempts to address the controversial approaches to the practical function of medical ethics while critically reviewing the main concepts of ethical considerations in NCD prevention literature. After refining the searched documents, we integrated related concepts and research, particularly emphasizing ethical considerations in NCD management. All four functional areas of NCD prevention (general health policymaking, social interventional, primary prevention, and secondary prevention) are affected by parallel associated factors of health determinants: environmental modification, lifestyle improvement and physiological characteristics, respectively. In addition to the practical aspects of implementing a response to NCDs, a variety of ethical considerations should be taken into account. For instance general policies, equity in care, interventional programs, and clinical/research data protection. A comprehensive, holistic approach considering all the involved parties can accommodate the wide spectrum of needs and continuum of management for NCDs.Creating an ethical procedure structure in public health systems can provide insight into managing the challenges posed by NCDs to health systems and assist in systematically confronting ethical problems in the management of NCDs.

Complementary and alternative medicine (CAM) is a rapidly growing industry, with millions worldwide seeking these treatments for various ailments. While many CAM therapies have shown promise in improving health outcomes, there are also ethical challenges associated with them. In this article, we explore some of the most pressing ethical issues in CAM, including informed consent, justice in accessibility, and evidence-based therapies. This survey provides a comprehensive overview of the ethical issues in CAM and offers practical guidance for health-care providers navigating these complex issues. By understanding the ethical dilemmas in CAM, health-care providers can offer their patients safe and effective care while maintaining their professional and ethical obligations.

Aging is a natural process involving the loss of several abilities, including cardiovascular, neurologic, musculoskeletal, and social capabilities. In addition to the usual needs, older adults face specific physical and mental challenges. Considering the increase in life expectancy and the large percentage of older adults in most populations, societies should be prepared for the ethical challenges associated with high-demand older generations. A search was conducted across the three main databases: PubMed, Web of Science, and Scopus. Next, 57 qualitative studies were selected to evaluate the ethical concerns and solutions in providing healthcare and treatment for older generations. Two independent researchers screened and assessed the studies, and the results were reported. Our findings showed that the main concern of policymakers and healthcare planners should be observance of principles such as autonomy, dignity, and fair and balanced distribution of medical resources while not prioritizing others over older adults due to their age. The elderly have specific needs, and considering their increasing prevalence and physical and emotional fragility, countries should be prepared to meet their rapidly growing needs.

This study presents estimates for type 2 diabetes mellitus (T2DM) burden and attributable risk factors in Iran from 1990–2019, using data from the 2019 Global Burden of Disease study.

This study reports prevalence, incidence, death, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) of T2DM in Iran, by sex, age, and province, from 1990 to 2019. We also present the T2DM burden attributable to risk factors. Results are reported in absolute number and age-standardized rates.

Overall, the burden of T2DM had increased greatly since 1990. In 2019, the T2DM incidence and prevalence cases were 291,482 (a 374% increase) and 5,035,012 (a 417% increase) respectively. Moreover, the number of death and DALYs were 14,191 (a 488% increase) and 716,457 (a 417% increase) respectively. DALYs and YLDs in women were consistently higher than men were, whereas women experienced slower increases in YLLs from 1990 to 2019. The age-standardized DALYs rate increased for all Iranian provinces during study period. High body-mass index, ambient particulate matter pollution, and low physical activity remained the three major attributable risk factors in all provinces in 2019.

T2DM constitutes a major health burden in Iran. The remarkable upsurge in the T2DM burden represents an ongoing challenge, given the rapidly aging population in Iran. Thus, integrated and multi-sectoral actions that decrease exposure to risk factors and improve the prevention and early diagnosis are needed.

Beta-thalassemia major patients frequently have endocrinopathies. We tried to determine relation between demographic and transfusion factor and endocrinopathies.

Major beta-thalassemia patients (n=114 cases), 3–38 yr of age, entered this study. Female to male ratio was 51/63. Children (less than 20 yr) formed 57% of participants. Information about bone mineral density (BMD) and hormonal and biochemistry blood evaluation including fasting blood sugar (FBS), ferritin, triiodothyronine (T3), thyroxine (T4) and thyroid-stimulating hormone (TSH), luteinizing hormone (LH) and follicle-stimulating hormone (FSH), testosterone (males), and estradiol (females) entered data sheet.

Sex and ferritin level showed no significant correlation with above disorders. Age significantly correlated to short stature, diabetes, low BMD at femur and neck (P, 0.031, 0.008, 0.009 and <0.001, respectively). The risk of short stature had increased in 12 yr and older patients 7.71 times than younger patients (P= 0.008). The risk of diabetes had increased in 35 yr and older patients 26.25 times than younger patients (P= 0.03).  The risk of Z-score ≤ -2 in femoral region has increased in 19 yr and older patients 5.84 times than younger patients (P= 0.002). The risk of Z-score ≤ -2 in spinal region has increased in 14 yr and older patients 17 times than younger patients (P= 0.007).

The main factor related with endocrinopathies was age. The correlation between age and short stature, diabetes and low BMD was positive. Therefore, we recommend early monitoring of thalassemia patients (in their late childhood and early teenage) for these complications.

The prevalence of short stature was reported high in thalassemia major patients. It causes mental and social problems for them. As different cut-off points for growth retardation are suggested in these patients, it is desirable to find a careful cut-off age using statistical analysis to help patients before it is too late. 

Data from 803 thalassemia major patients was extracted from questionnaires completed in person by the operator. They contained demographic data, family, medical, and drug history. Height and weight measurements were conducted by only one device. The mean age was 20±7 years and there were 420 females in the sample. Children (<20 years of age) constituted 47% of the participants. Patients who reported a major risk factor for osteoporosis were omitted from this study. The SPSS software, version 16 was used for the statistical analysis

Short stature was found in 32% of patients. Being 10 to 11 years old or above increased the risk of short stature, 28.5 and 21.4 times, respectively compared to younger patients (P<0.001). On the other hand, after 7 years of age up to 18 years of age, similar to 10 years of age and 11 years of age, increases the risk of short stature. Also being 27 years old and 30 years old and above increases the risk of short stature 1.4 and 1.7 times, respectively, compared to younger patients (P=0.042 and <0.018, respectively). 

Awareness of short stature and monitoring it in thalassemic patients should be done in their childhood. Accordingly, being 7 years old or above increases the risk of short stature; therefore, we suggest the start of monitoring as early as 5 years of age.

Considering the increasing and alarming trend of overweight and obesity as well as its related complications, in this study, a comprehensive clinical guide for the medical care of patients with obesity was written based on the clinical recommendations of the American Endocrinology Association and the American College of Endocrinology, and it has been adjusted as much as possible based on the conditions in Iran.

A complete search was performed in the available databases without any restrictions with a specific strategy. Using the opinions of experts in this field, the best clinical guidelines were selected and obesity clinical guidelines were written for Iranian adults. Recommendations were given based on a detailed review of available clinical evidence and considering objective factors.

A total of 1788 references were used and in response to 9 clinical questions, 123 recommendations, including 160 special statements, were provided to determine a comprehensive medical care program for obesity. In this article, we discuss the prevention, screening, diagnosis, benefits and goals of obesity treatment. Questions 6 to 9 regarding obesity treatment steps and its individualization will be published in the next part of the article.

The detailed evidence-based questions and recommendations outlined in this study identify clinical considerations that facilitate decision-making in obese patients from screening and diagnosis to goals of treatment.

human right with a long history of appreciation, indicating that governments should guarantee the highest possible level of access to health and provide health-care serivces with no discrimination based on nationality, race, gender, language or religion. The present study explored this topic using an analytic-descriptive approach. We reviewed related laws, policies and other available documents with the aim to investigate the ethico-legal aspects of Afghan refugees' and immigrants' access to health care and the challenges in in this regard within the Iranian health law system. According to the results of this study, the Iranian health law could be interpreted to include all Afghan immigrants in the country’s public health system as a legal commitment. In addition, while basic and primary health coverage is available for all Afghan immigrants in Iran, provision of other medical and rehabilitative health services to documented and undocumented immigrants follow different methods. In order to alleviate the current situation, we recommend strategies such as supporting policy changes intended to register undocumented immigrants, which naturally results in an increase in their access to health care.

The concept of common morality is fundamental in medical ethics, and lack of universal content and characteristics of common morality is a product of its multifaceted nature. This study aimed to identify the ideas and experiences of academic faculties regarding common morality in a pluralistic setting to promote conceptual knowledge and strengthen moral reasoning and ethical decision-making. The study was conducted using a qualitative method, employing semi-structured in-depth interviews with thirteen faculty members who were selected purposively. In order to assess their ideas and experiences, the transcripts of the interviews were analyzed using the content analysis method through directed and conventional approaches. The interviews were coded manually. Two themes were reflected in the interviews: ontology and epistemology of common morality. The study indicates that the debate about the subjective or objective dependence of common morality questions the coherence of Beauchamp and Childress' common morality (CM) theory, as common morality is the result of various individual and social factor that influence moral and decision -making in pluralistic environments. Additional studies are needed in order to investigate the effect of cultural, social, theoretical, ideological and individual factors on promoting clinical ethical reasoning and decision-making skills.

The higher health education system in the Islamic Republic of Iran is an integrated system with multiple stakeholders responsible for training human resources in the health sector at different levels. The Academy of Medical Sciences of the Islamic Republic of Iran is one of the effective institutional factors in this system. This study aimed to explain the position of the Academy of Medical Sciences in the country’s medical sciences education system and outline its major directions in this field. In this study, the knowledge-to-action framework was implemented in four steps. Effective institutional factors in system development were explained, and the role of the various stakeholders of the country’s medical sciences education system was compared with them. Then, the functions of the academy as a main beneficiary based on the degree of connection with the stages of the knowledge-to-action framework were weighted, and finally, these functions were classified into different categories. According to this model, although the academy plays a role in many stages of the development of the country’s medical sciences education system, it primarily functions as a think tank and observatory and to a lesser extent as a knowledge implementation unit. The model presented in this study will help the trustees of the Academy of Medical Sciences to play the largest and most effective role in the development of the country’s medical sciences education system, with optimal resource management and principled development of human capacities, thereby laying the groundwork for the improvement of the integrated health system.

The right to access health services as a part of fundamental human rights, affected by the conditions and facilities of governments and the international status, has always faced challenges. Despite the clarity of the general policies and upstream documents in the Iranian health system regarding the need to provide immigrants and refugees with health services and Iran’s membership in the relevant conventions, the implementation of the provisions of these documents is not consistent and complete for various reasons, including the inadequacy of laws related to immigrants and refugees and the incorrect implementation of some existing laws. The first draft of the ethical guidelines for providing health services to immigrants was prepared by the research team using the results of a review of relevant documents as well as a qualitative study and finalized according to the opinions of the participants in a panel of experts. In this draft, after explaining the values and ethical principles governing the provision of services to Afghan immigrants, the suggested guidelines and assignments were presented to the main stakeholders involved, including the policymakers and macro planners of the health system, institutions and centers providing health services, professionals and health service providers, professional organizations, civil society activists, media and non-governmental organizations,  and medical research and education authorities and researchers.

The COVID-19 pandemic has created opportunities and challenges for education and research as the two main academic activities in medical sciences disciplines, which due to their mutual influence can be used to propose solutions for improving these two areas. The present study was conducted to compare two review articles, each of which dealt with one of these two areas.This comparative study with a qualitative explanatory design was conducted in three steps. First, two review articles were selected that investigated the opportunities and challenges caused by the coronavirus pandemic to propose strategies for the post-corona era. Then, both studies were carefully studied and described. Finally, two researchers separately extracted the similarities and differences mentioned in the two articles and compared them to remove the inconsistencies. A panel of experts confirmed the findings. The opportunities and challenges mentioned in the two articles were extracted and categorized into two areas based on similarities and differences. The similar proposed strategies for the post-corona era were continuing to use virtual space facilities, diversifying the communication methods with students and research participants, and providing and developing suitable electronic infrastructure. Comparing two review articles and determining the similarities and differences between the opportunities and challenges caused by the COVID-19 pandemic and the strategies for the post-COVID-19 era related to medical education and clinical research, led to proposing strategies that could promote these two related areas coherently.

Defensive medicine is performing actions that have no medical indication and benefit for the patient (positive defensive medicine) or refraining from performing risky actions that have a medical indication and benefit for the patient (negative defensive medicine). These actions are carried out by the physicians with the sole motive of protecting themselves against complaints or tensions such as the protest of the patient or colleagues and usually cause physical, psychological, or economic harm to the patient or the institution that pays the treatment fee, such as insurance organizations. It can have consequences in terms of the quality of care and the efficient use of limited health resources. Factors such as the physician’s concerns about lawsuits and proceedings may lead to defensive behaviors. This study presented suggestions for the management and prevention of such behaviors, including three main categories related to the strategies for the reformation of the patient complaint handling system, social strategies for the management and prevention of defensive medicine, and managerial-organizational strategies. These strategies are based on the findings of a mixed-methods research including an unsystematic review of resources and a qualitative study conducted using semi-structured interviews. The results have been discussed by the Medical Ethics Committee of the Academy of Medical Sciences of Iran.

To enhance the level of health literacy among the public, it is essential to take steps towards empowering people to recognize and control the influential factors on health. University professors, as health knowledge promoters, are recognized as educators of health skills and advocates for healthy lifestyles and behaviors. This study aimed to elucidate the role of medical professors in promoting the health literacy of the public. The present study was conducted using conventional content analysis. The participants were selected using purposive sampling with maximum variation. A total of 20 professors from medical universities, the Academic Center for Education, Culture and Research, and the Ministry of Health were purposively selected until information saturation. Data were collected through semi-structured interviews and analyzed simultaneously with data collection. Twenty participants (9 females and 11 males) with an average age of 50.3 and an average work experience of 23.45 years took part in the study. After data analysis, 947 initial codes were extracted, and subsequently, categorized into five main categories and fifteen subcategories. Infrastructure development, content production, role model, self-empowerment, and culture building were identified as the main categories. University professors can, through a skillful combination of various elements within the educational system, either propel students and the general public towards lofty goals or deprive them of achieving such objectives. However, factors such as the low number of professors relative to the number of students, the high workload of faculty members, lack of resources, and the overwhelming life responsibilities of faculty members have influenced their performance and role in this regard. To achieve the goal of encouraging professors in enhancing the health literacy of society, it is imperative to bring these constraints to the attention of authorities for resolution.

Academic faculty members play the most influential role in realizing the goals and ideals of higher education and community health. In the contemporary period, the cultural and educational role of professors, in the most crucial mission of higher education, has not received the required and necessary attention, and neglecting it has resulted in irreparable damages and adverse consequences. This study attempted to identify the prominent cultural roles of professors in relation to students (with an emphasis on higher health education), while explaining the necessity and importance, and effective solutions were examined and proposed. The present study was conducted using a descriptive-analytical method and a focus group discussion. Selected views of expert professors and data from authentic local scientific articles and related topics in upstream documents were utilized. The findings of the study were classified into five main themes and forty categories. “Cultural goals and ideals”; “general mission of professors for the cultural education of all students” and “special mission of professors of higher health education”; “authentic methods”; and “requirements for cultural education of students” were identified and recommended under the eight selected topics in each axis in order of priority. University Professors play a central role in the cultural and ideological education of students. It is appropriate to develop this responsibility in an objective manner and with suitable scientific methods and observe its excellence and realization in the education system.