fatemeh maleki

Grand Round is one of the methods of medical education in the hospital environment, which is conducted as a discussion on patients in the presence of a group of specialists and students of different medical departments. This study was conducted to review the history of medical grand rounds research in Iran in order to evaluate its efficiency, new methods, advantages and challenges.

This study used a systematic review in accordance with PRISMA standards and evaluated the role of Grand Round in medical education. PubMed, EMBASE, Scopus, Web of Science databases as well as FarsiSID.ir, Elmentnet and Magiran databases were searched using specific terms. Two referees independently reviewed the articles based on the entry criteria and resolved the differences through discussion. Quality and bias were assessed using the MMAT tool. Thematic codes extracted from the responses guided the qualitative synthesis of evidence.

In this study, 15 articles were examined. Medical students experience challenges in the quality of teaching grand rounds compared to faculty and residents, potentially influenced by gender differences or stages of medical education. Acknowledging these disparities is critical to effective educational strategies, especially in the Grand Round context. Adapting to challenges such as the COVID-19 pandemic, it is recommended that virtual group discussions be implemented to increase student satisfaction and knowledge transfer during Grand Rounds. Despite the strengths of bedside grand rounds, managing the lack of evidence-based issues and clinical decision-making is critical to increasing the overall quality of grand rounds.

The current review study showed that in order to increase the productivity of medical grand rounds, there is a need to plan to increase the interaction and involvement of all educational members and learners in a group; Also, to increase the quality of meetings, it is necessary to present discussions based on scientific evidence.

Lithium is the lightest alkali metal with unique chemical properties, such as high electrochemical activity, high reduction potential, and high specific heat capacity. This element has a wide range of applications in various industries, including the nuclear industry. For instance, lithium-6 is a source of tritium for nuclear fusion fuel by absorbing neutrons. Therefore, the separation of lithium from relevant sources is highly important. Since the separation of lithium from these resources is not possible without knowledge of its inventory, in this report, the characterization of the coal gangue is done using XRF and ICP-OES analysis for geochemical studies and measurement of major and minor oxides, as well as XRD analysis for determining the crystalline phases present in the samples. Due to the ICP-OES analysis, the amount of Li in B1 and B2 samples are 279 and 214 ppm, respectively, which makes the B1 sample a suitable source for the extraction of this element. Moreover,as XRD analysis shows, both samples have similar structural minerals, with montmorillonite and quartz being the primary minerals.

The use of literary tools is not only to decorate a work; rather, great poets sometimes use some literary arrays to better explain what they cultivate in their creative minds. One of these tools is the "Style of Equation ". By using this style, the poet depicts the explanation of an intangible, complex and thought-provoking matter by creating harmony with a tangible, simple, universal and experienced matter. In the present study, we first introduced and compared this literary industry with other industries and expressed its characteristics, and then compared the use of equation style in Sanaei and Saadi's poetry. The main question of the current research is that Saadi and Sanaei used the subtleties in using the literary art of equation style, and what similarities are there in the use of these two talented poets in the use of this literary art? The findings of the research show that Sanaei used this literary technique more in his mystical poems; But Saadi has benefited from this literary art in other subjects due to his creative and argumentative mind

Ethanol and methanol poisoning pose significant clinical challenges due to their overlapping clinical presentations. This literature review and consensus statement aim to provide evidence-based guidelines for differentiating these two poisonings.

We conducted a comprehensive literature review of relevant literature, including individual patient data (IPD) meta-analysis, to assess clinical, laboratory, and diagnostic findings in cases with ethanol and methanol poisoning. A literature review was also performed to gather case series of electrocardiograms of ethanol and methanol poisoning. We synthesized the evidence and convened an expert panel to develop consensus-based recommendations.

Based on the literature review and IPD analysis, cases of methanol poisoning often present later than 24 hours after alcohol consumption, emphasizing the importance of assessing patients with delayed referrals. Methanol-poisoned patients are frequently awake and responsive after 12 hours of ingestion, but symptoms alone do not reliably differentiate between the two poisonings. Declines in visual acuity and symptoms are strongly associated with methanol poisoning and should prompt immediate hospitalization and ophthalmic examination. Oliguria and anuria are more common in cases of methanol poisoning, warranting detailed urinary symptom assessment and close monitoring of urinary output. Electrocardiograms are essential for all alcohol poisoning patients, with non-sinus rhythm suggesting methanol poisoning. Arterial blood gas analysis, with low pH values, favors methanol poisoning. However, blood sugar levels alone cannot definitively determine the type of poisoning. Laboratory point-of-care tests to diagnose methanol in serum are urgently needed.

This literature review and consensus statement offer guidance for healthcare providers facing cases of alcohol poisoning where point-of-care testing methods of blood alcohol concentrations are unavailable. A comprehensive assessment, considering clinical history, physical examination, laboratory data, and specialized evaluations such as ophthalmic examination and electrocardiograms, is essential for accurately differentiating ethanol and methanol poisoning.

Type 2 diabetes is a health problem and is an emergency that has the fastest growth worldwide. Diabetes is one of the priorities of all public health systems this study aimed to determine the quality of diabetes control in urban family physician centers of Sari city in 1382-1398.

This study was a cross-sectional and cross-sectional study. The required sample size was 275 patients who were selected randomly (a total of 300 patients) and 20 clusters (center), each consisting of 15 diabetic patients, were controlled. The population of the study included all patients with type 2 diabetes referred to health care centers of sari. The cases included age, sex, level of FBS, 2 hpp, HbA1c, blood pressure, triglyceride, cholesterol, HDL, LDL, and body mass index as well as eye examination and amputation were also recorded all the information contained the seal of the family physician. In this study, after data collection, the degree of conformity was compared with ADA guidelines. According to the American diabetes association (ADA), the goal of the treatment of this disease is reaching FBS: 90-130, HbA1c below 7%, BS2hpp<180, BMI; 18.5 to 24.9, TG below 150, LDL below 100 and HDL is equal to 50. All statistical analyses were performed in SPSS software. Descriptive statistics including mean and standard deviation for quantitative and frequency and percentage for qualitative variables were discussed.

The study of 300 type 2 diabetic patients showed that the range of age ranged between 30 to 86 years with a mean and standard deviation of 57.5±10.4 years. Also, the lowest body mass index of the patients was 21 and the highest was 53 with a median of 29.4 and an interquartile range (of 27.20 - 32.8). The systolic blood pressure of patients had a median of 120 and interquartile range (110-130) and diastolic blood pressure had a median of 75 and interquartile (75-80). followed by ADA protocol, the frequency of fasting blood glucose (38.4%), blood glucose two hours after meal (37.1%), total 52cases (17.2%) blood sugar control patients according to the American diabetes association .triglyceride (39.7%), HDL in (49% ) and LDL (55.6%) were matched with ADA protocol .also, 32 cases (10.6%) had blood lipid by ADA protocol. Eye examination (14.6%), one turn, (8.3%), three times (1.3%), and three times (0.3%) were performed. also, in 65 cases (21.6%), careful foot examination was done.in addition, 4 cases (1/3%) had amputation due to diabetes and 12 cases (4%) had microalbuminuria.

The result obtained in this study shows that the status of diabetes control in the studied population is better than other studies in Iran however it is far from the standards of the American Diabetes Association, the need for more planning and intervention in the need for correct education and timely referral to There are specialized centers, training and intervention to reduce the weight of these patients. Factors such as lifestyle and socio-economic conditions that institutions and service providers have no control over should be corrected by policymakers

While new studies are being published on the prehospital continuous positive airway pressure (CPAP) application in patients with respiratory failure with conflicting results, previous meta-analyses are showing the benefits of CPAP in the prehospital transfer of patients with respiratory distress. Before the clinical application of high-level evidence, updated pooled estimates are needed based on the growing literature. This study aimed to compare prehospital CPAP with the usual standard oxygen therapy of respiratory failure patients.

PRISMA guidelines served as the framework for this updated review study. It is an extension of a prior systematic review. We conducted comprehensive searches across several databases, including PubMed, Web of Science, Embase, and Scopus, focusing on randomized trials that juxtaposed pre-hospital CPAP application against standard care. Our primary interest was to assess the in-hospital mortality risks, and we employed random effect models to aggregate risk ratios from the selected studies.

Four articles were gathered based on the review of the updated literature (2013 to November 2022) in conjunction with the research incorporated in the preceding meta-analysis with a total number of 747 patients receiving prehospital CPAP with 101 events of in-hospital mortality. In the standard treatment control groups, there were 713 patients and 115 deaths occurred. Pooled mortality risk comparison between the group of prehospital CPAP and standard care patients had no statistically significant difference (P=0.16). There was no heterogenicity. A regression between the year of the studies and the effect size showed increased RR in new studies (P=0.017).

Still more randomized trials are needed with higher sample sizes to conclude the lifesaving efficacy of the out-of-hospital CPAP.

Surgical or medical treatment for type B or descending aortic dissections with difficult presentation or stable hemodynamics is debatable. This study aimed to review the type B aortic dissection therapy to assess safety and effectiveness.

Online databases of PubMed, Science Direct, Web of Science, Cochrane, and Scopus were searched for relevant systematic reviews, guidelines, and meta-analysis studies on the management of type B aortic dissection, up to July 2023. The conclusions were qualitatively synthesized.

Best medical therapy (BMT], thoracic aortic endovascular repair (TEVAR), and open surgeries (OS) were management approaches. Hemodynamics classify type B aortic dissection as complex or simple. Both examples reveal decreased in-hospital all-cause mortality with TAVR than OS. Guidelines recommend TEVAR for difficult situations and OS if it fails. Complication analyses favour TEVAR, however left subclavian artery coverage without revascularization increases stroke risk. Studies show Type B aortic dissection is simpler than TEVAR and BMT. Acute or subacute presentation did not affect reintervention rates between treatments. TEVAR had a greater early stroke risk than BMT but a decreased long-term aortic-related and all-cause mortality. The best data showed no differences in in-hospital mortality or early re-intervention between regimens. BMT reduced early stroke but increased late all-cause death.

In conclusion, addressing Type B aortic dissection is complicated, depending on presentation and hemodynamics. TEVAR is best for difficult patients, however BMT and OS also work. TEVAR may reduce in-hospital mortality but increase early stroke risk.

Myocardial perfusion imaging (MPI) with pharmacologic stress is a useful technique for evaluation of suspected coronary artery disease (CAD). Heart rate responses (HRR) to vasodilators such as dipyridamole mirror autonomic activity and may provide important prognostic information in CAD patients. In this study, the impact of baseline characteristics of patients including age and gender on the expected HRR has been assessed. This retrospective study included database of 2584 patients (1575 female, 1009 male) who were referred to the nuclear medicine department for pharmacologic MPI. The HRR to dipyridamole was calculated as ratio of maximal heart rate (HR) during or shortly after dipyridamole infusion to baseline HR. The association of HRR with age, gender, presence of other known CAD risk factors and perfusion findings was evaluated. Significant correlation was found between HRR and sex, age, diabetes mellitus (DM), hypertension (HTN), and chronic kidney disease (CKD) (P < 0.001) in both univariate and multivariate analysis. The mean HRR was also significantly higher in patients with normal perfusion on SPECT MPI as compared to patients with abnormal findings, however, multivariate regression analysis showed no significant correlation. In the subgroup of patients with no CAD risk factors, HRR was significantly higher in women under age 55 years. The HRR during dipyridamole infusion depends on age and gender, irrespective of presence of other CAD risk factors and should be considered in the interpretation of. Besides, DM, HTN and CKD are also correlated with lower HRR to dipyridamole stress.

The extract of Thymus kotschyanus Boiss, in addition to its antioxidant properties, also has a marvellous anti-amyloidogenic effectthat can be used for the treatment of amyloidosis. The aim of this study was to prepare silver nanoparticles from the aqueous extract of mountain thyme (Thymus kotschyanus Boiss), to investigate its antioxidant and inhibitory effect on the production of amyloid nanofibrils (bovine serum album (BSA) as a model protein).

This study was conducted experimentally in the laboratory of Payam Noor University in Qom Province in 2022. First, nanoparticles were prepared from aqueous thyme extract and added to AgNo3 silver nitrate solution (one millimolar). ThenFTIR, EDX, DLSand SEM methods were used to study the properties and size of the nanoparticles. The removing of free radicals 2,2-diphenyl-1-picrylhydrazyl (DPPH) method was used to study the antioxidant effects of the extract and the Concorde absorption method was used to study the production of amyloid nanofibrils. The chemical composition of the extract was analysed using the gas chromatography method. For statistical analysis, descriptive statistics and ANOVA tests were used with SPSS software version 23.

The phytochemical analysis of the extract revealed seven compounds. Most compounds were associated with 5,4-alpha-epoxy-3-methoxy (43.53%), 2-ethyl-piperidine-1-methyl (31.02%) and thymol (23.65%). The UV-Vis spectrum showed the highest absorbance at 460 nm. The SEM results confirmed the production of spherical nanoparticles with a size of 70-93 nm. The concentrations of 0.8 and 1 mg/ml of the extract were able to inhibit DPPH by more than 50%. The highest antioxidant activity in the sample containing 2 ml of the nanoparticle solution (sample 5) was 56.82%. The highest inhibition of amyloid nanofibril production was observed at a concentration of 2 mg/ml with 95%.

Thus, the synthesized nanoparticles have potent antioxidant and anti-amyloidogenic properties and can be used as antioxidants.

Adipokines play an essential role in the pathogenesis of obesity and insulin resistance. The aim of this study was to investigate the effect of alternate day low-calorie diet and resistance training on inflammatory and metabolic indicators in obese women. In this semi-experimental study, 32 healthy obese women aged 30-45 years old and with a body mass index between 27 and 35 kg/m2 were purposefully selected and equally randomly divided into four groups: control, resistance training, alternate day low-calorie diet, resistance training and alternate day low-calorie diet (combined). The training groups performed a resistance training program with an intensity of 50 to 85% of 1RM, three sessions per week, for eight weeks. During this period, the diet groups were subjected to a diet plan including days with calorie restriction (odd days) and free days (even days). Before starting the research protocol and 72 hours after the last training session, body composition and serum levels of inflammatory and metabolic indices were measured. Factorial repeated-measured ANOVA was used for data analysis, at the level of P<0.05. The interaction effect of time × group was significant for body weight (P=0.006) and BMI (P=0.007). The results showed a significant increase in body weight (P=0.016) and BMI (P=0.005) in the control group. While in the alternate day low-calorie diet (P=0.035) and combined (P=0.032) groups, a significant decrease in body weight was observed. The interaction effect of time × group was also significant for the serum levels of TNF-α (P=0.027) and insulin (P=0.025). The serum concentration of TNF-α was associated with a significant increase in the alternate day low-calorie diet group (P=0.000) and the combined group (P=0.011). Serum levels of insulin in the alternate day low-calorie diet (P=0.026) and combined (P=0.022) groups had a significant decrease compared to the control group. Significant changes in serum adiponectin levels were observed in the alternate day low-calorie diet (P=0.021) and combined (P=0.003) groups compared to the control group. It seems that a longer period of time is needed to observe the effects of alternate day low-calorie diet alone or combined with resistance training in obese women on improving body composition and, as a result, inflammatory and metabolic indicators.

Hydatidosis, a chronic zoonotic disease, has a distribution worldwide and is caused by the larval stage of the Echinococcus helminth. The Dot-ELISA test can diagnose hydatidosis quickly and accurately. Additionally, unlike other hydatid disease tests now used, this quick and affordable enzyme immunoassay is very serum-conservative and antigen-conservative, needing just nanogram levels of parasite antigen.

In the present cross-sectional study, crude and B antigens of hydatid cyst fluid were obtained to diagnose human hydatidosis using CIEP (Counter Immunoelectrophoresis), ELISA (Enzyme-linked Immuno Sorbent assay), and Dot- ELISA (Dot Enzyme linked Immuno Sorbent Assay) methods. Infected liver with a hydatid cyst was collected from Tehran's slaughterhouses to prepare cyst fluid in different stages. After extracting and purifying the Cyst fluid, it is centrifuged at 4ºc, then prepared to concentrate. The study also included sera from hydatidosis (n=60), samples of helminth parasites (n=55), fascioliasis (n=35), toxocariasis (n=20) and negative control (n=35) were tested by CIEP (Counter Immunoelectrophoresis), ELISA (Enzyme-linked Immune Sorbent assay), and Dot- ELISA (Dot Enzyme linked Immuno Sorbent Assay) methods. All statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) for Windows release 25.0 (SPSS Inc., Chicago, IL, USA).   

Crude antigen of hydatid cyst showed a specificity of 76.7%,  a sensitivity of 93.3% using the ELISA method, and B antigen showed a specificity of 96.7% and sensitivity of 88.3% using the same method.
The crude antigen of the hydatid cyst exhibited a specificity of 68.9% and a sensitivity of 86.7% using CIEP. The B antigen showed a specificity of 87.8% and sensitivity of 83.3% using the same method. The crude antigen of hydatid cyst having serum dilution at 1:800 exhibited a specificity of 83.3% and sensitivity of 100% using the Dot-ELISA method and B antigen having serum dilution at 1:800 serum showed a specificity of 100% and sensitivity of 98.3% using the same method. The results of this finding showed that B antigen has the maximum specificity to diagnose hydatid test using the Dot- ELISA method.  

Hydatid cysts present with varied symptomatology. History of exposure to infected animals may not be present. A high degree of clinical suspicion combined with meticulous history and clinical examination supported by laboratory investigations are required for its diagnosis. The Dot-ELISA system with native antigen B is a viable approach for the immunodiagnosis of human hydatidosis that is preferred to infection.

Mehdi Akhavan Sales is one of the contemporary Persian poets whose unique mastery over Persian classical literature is remarkable. He is a poet, critic, and theoretician of Neo-Nimai poetry as well as a story writer. Therefore, there are various types of intertextual relationships such as inter-author (link with works of past and contemporary peers), intra-author (links between all verse and prose works), intertextual (links between all verse works), and intra-text (link and relationships of an independent work). Also, the types of transtextuality considered by Genette, such as intertextuality, hypertextuality, architextuality, and paratextuality can be identified in his works. In line with the intertextual approach proposed by Genette, the goal of this descriptive-analytical research is to read and examine the poems of Mehdi Akhavan Sales while focusing on the relationships between them. Findings suggest that reading all the poems together frequently helps to clear up the ambiguities and to facilitate understanding.

Intertextuality is one of the new topics in literary criticism that deals with the relationship and interaction between texts. According to this theory, any text makes sense with the texts before it and no text is independent and conscious or unconscious speakers have benefited from each other's literary and intellectual sources. Intertextuality was first proposed by Julia Kristova, and later Geragent, as one of the most influential researchers in the field, developed this theory by examining his studies. Genet called his collection of studies transmittent. He divided the transtextuality into five categories, which are: intertextuality, paratextuality, hypertextuality, supertextuality, hypertextuality. Each of these five categories examines a type of relationship between a text and others. Among which intertextuality received more attention. This study has analyzed the effectiveness of the "Unseen Witness" manuscript of Abdolrahman Jami's "Yousef and Zuleikha" Masnavi based on the intertextual approach. The fruits of this research show that although these two works are completely different in terms of subject matter, but they have a lot in common in terms of text, verbal structure and narrative. And the author of "The Unseen Witness" has been influenced by Jami's thoughts and ideas in "Haft Orang", especially his "Bosef and Zuleikha", and intertextual relations are explicitly, explicitly and implicitly.

Lidocaine is one of the medications that is proposed as an alternative in acute pain management. Lidocaine is routinely used in topical and dental anesthesia and is known for its analgesic effects. But various evidences are proposing an intravenous administration of lidocaine for pain management; while in acute limb pain, its safety, and efficacy are not reviewed yet. In this review study, PubMed, Medline, Scopus, and EMBASE were quarried for studies on an acute traumatic limb injury pain treated with intravenous lidocaine. Critical Appraisal Skills Program and GRADEpro tools were used to critically evaluate the collected literature based on the evidence-based approach. Recommendations were synthesized based on the highest levels of evidence.  Eleven studies were included in the review. While some studies were showing effective analgesic properties of intravenous lidocaine for pain relief in extremities when compared with conventional opioids, the ‎high rate of Adverse Events (AEs) reported in some studies and the need for a close observation of patients for major side effects restrict clinical application of the systemic lidocaine. ‎ Blood lidocaine level studies are required but are missing in the literature. ‎Post-operative outcomes of limb trauma patients who receive lidocaine are not clear. The AEs’ monitoring is not followed during the hospitalization or after discharge. Systematic review and meta-analyses on the topic are heterogeneous due to different indications of intravenous lidocaine administration.  Our systematic review of literature could draw the conclusion of cautions on high dose intravenous lidocaine administration due to potential side effects and unclear outcomes.

Advanced stages of dementia interfere with elderly self‑care. Consequently, they need caregivers who take responsibility for their care in the long‑term. Restrictions to the caregiver’s access to information, resources, and organizational support have created problems in their caregiver role, which is why the World Health Organization (WHO) emphasizes caring for caregivers by providing evidence‑based information and training programs. As there is no clinical practice guideline for home care in the Islamic Republic of Iran, this study aims to develop a home health care guideline for the elderly with dementia.

The ADAPTE process provided by the Guidelines International Network was considered as the basis. In order to identify the care needs of Iranian patients with dementia, semi‑structured interviews were added to this guideline.

The identification and implementation of the perspectives of patients and caregivers during the process of guidelines adaptation increase the applicability of the guidelines. Improved quality of life for the patients in their place of residence is one of the expected consequences of this guideline’s implementation. The developed guidelines will be used at home health care centers, and dementia and Alzheimer’s associations in Iran.

To examine the relationship between wounding-to-door time and wound healing duration in patients with simple traumatic wounds admitted to Shahid Rajaei Emergency Department (ED) in Tonekabon city during the COVID-19 pandemic. This was a prospective longitudinal study on patients with simple traumatic wounds referred to ED of Shahid Rajaei Hospital in Tonekabon from April to the end of September 2021 were examined for demographics, trauma to hospital door, and body mass index. Patients were followed for wound healing for a month. Data was analyzed by considering the wound healing time as the primary outcome. There were 142 were males and 45 were females. The mean age of the subjects was 32.24±18.25. The mean wound-to-door time was 4.3±2.7 hours. The maximum and minimum wound-to-door time was 17 hours and 1 hour, respectively. The average wound healing duration was 14.3±3.6 days. A significant positive correlation was found between the wound healing duration and wound-to-door time (r= 0.435, P<0.001). When analyzing subgroups of patients based on the BMI, antibiotic use, smoking status, and some wound locations, there was no significant correlation between wound healing duration and wounding-to-door time (P>0.05).  This study revealed that delayed visit of ED for receiving proper wound care would be associated with increased wound healing duration; while this relationship is being modified by smoking status, using antibiotics, and the BMI.

Evaluation of platelet volume indices is proposed by literature in predicting and differentiating coronary diseases. Therefore, this study aimed to compare the mean number and volume of platelets in patients with unstable angina (UA), STEMI, and NSTEMI.

In this cross-sectional study, ACS patients were compared for mean platelet volume (MPV) and mean platelet count (MPC), stratified by type of the ACS (unstable angina, STEMI, and NSTEMI). Demographics, pre-existing medical diseases, and medication history were also compared for justification.

A total of 75 patients were studied in 3 age and sex match groups UA (n=25), STEMI(n=25), and NSTEMI (n=25). The MPV in UA patients was significantly higher than in the group of patients with STEMI (P = 0.031). Moreover, the MPC in patients with UA was significantly lower than in the group of patients with STEMI (P = 0.02). The results showed no statistically significant difference between patients with unstable angina and NSTEMI and no significant difference between patients with STEMI and NSTEMI.

In all three groups of ACS patients, the MPV and MPC were in the normal range. So, considering these factors alone may not help to differentiate between these three groups of patients.

Peer guidance has been welcomed in medical science education in recent years. One of the dimensions of the success of this process is the selection of a competent peer leader who can fulfill his role well. The present study was conducted with the aim of reviewing a narrative on the dos and don'ts of selecting peer mentors in medical science education

This study is a narrative review method that was conducted during three stages of literature search, data evaluation and analysis with the aim of providing an overview of the characteristics and dos and don'ts of selecting peer guides. Gathering information by searching for the keywords of Peer Mentors, Peer Mentoring, Peer Mentors, Peer Mentoring, with the help of logical operators from the articles of Persian language databases; SID, Iranmedex, Magiran and other databases. English language Science Direct, web of science and Scopus, Cochrane and PubMed and Google Scholar search engines have been used without time limit

9 characteristics and competences have been extracted for peer educators, which are included in the category of competences, and they are: similarity and common areas (principle of compatibility), having strong communication skills, ability in the field of leadership, passion and enthusiasm for education. and supporting others, paying attention to the training process in guiding with a mutual approach, having enough time for guiding, empathy, flexibility and criticism, trustworthiness; And four negative characteristics were also obtained in the opposite point, which are included in the category of not to choose a peer guide and include: not playing a role in the form of a private tutor, academic advisor and trainer editor, also the peer guide should not have a communication style in relation to the guided follow threatening or hierarchical

Accurate identification of the characteristics and competencies of peer mentors along with the effectiveness of the mentoring program and the competencies of the mentored person can lead to the desired result. The findings of this research can help educational planners to select peer leaders who have the necessary competencies and strive to achieve the goals of the process.

Cardiovascular disease is the most common cause of death, today. Tachycardia is usually a medical emergency that indicates cardiac dysrhythmia. The aim of this study was to compare the knowledge of emergency medicine interns in the management of common rapid heartbeats before and after training by model-based and lecture methods.

In this semi-experimental study, before and after the intervention, 122 emergency medicine interns were included in the study (2019). Students were randomly divided into two groups: model-based workshop (60 people) and lecture (62 people). The data collection tool in this study was a researcher-made questionnaire whose validity and reliability (Cronbach's alpha = 85%) were confirmed. The questionnaire was completed by both groups of students before the intervention and after the intervention. Data analysis was done using SPSS version 20 software and descriptive statistics (percentage, mean and standard deviation) and inferential tests (Mann-Whitney and Wilcoxon). In all calculations, the value of 0.05 was considered as a significant level.

The mean score of the tachycardia management test after training in the lecture group was 8.6± 9.1 points (out of 13 points). And the mean score of the management test of tachycardia, after training in the model-based workshop group, is equal to 5. It was 6.9±1.00 points (out of 13 marks). According to Mann-Whitney non-parametric test, there was a statistically significant difference in terms of the mean score of the pulse management test after training between the two groups of model-based workshop and lecture group (P = 0.001). Also, the mean score of the rapid-fire management test after training was higher in the model-oriented workshop group.

It seems that the use of model-based method (practical workshop with modeling and clinical scenario) can be more effective on the knowledge of emergency medicine practitioners in the management of common tachycardia before and after training than the lecture method. Therefore, using the model-based method can increase the knowledge of emergency medicine students.

The COVID-19 pandemic is the most significant health challenge humans experienced since World War 2, and its course can be affected by the stringency in undertaking individual and collective protective behavior. In this study, the health belief model structures in adopting the protective behaviors during the COVID-19 pandemic were assessed. A sample of 375 household heads living in the rural areas of Lorestan Province was selected through a multi-stage stratified and random sampling method. Structural equation modeling showed that knowledge, perceived susceptibility, perceived severity, self-efficacy, and cues to action affect the protective behaviors of Iranian rural households during COVID-19. Cues to action and knowledge were the most important predictors of protective behaviors in rural households. The results suggest the necessity to emphasize enhancing knowledge to highlight the negative impacts of COVID-19 and train rural households regarding the proper and effective preventive measures.

Hospital and Pre-hospital emergency staff are the first to experience stressful situations, and this long-term stress leads to burnout. This study aimed to investigate burnout in hospital and pre-hospital emergency departments as a systematic review study.

In this systematic review study, articles published in Persian-language database such as SID, Iranmedex, Magiran, and English-language databases as Science Direct, PubMed, ProQuest, Cochrane Library, Embase, Scopus, and Google Scholar search engine were examined from 2010 to 2022, using keyword such as emergency, emergency medical staff, pre-hospital emergency, emergency department nurses were studied. The quality of the given articles was evaluated using a STROBE checklist.

In this study, 27 articles were used for review. The rate of burnout was divided into three categories: Low, Moderate and High. This study was reported as low in 4 studies, Moderate in 17 studies, and 4 High in 4 studies. The relationship between demographic variables and burnout, the highest relationship between work experience, and burnout was seen in 15 studies.

The results of the present study indicate a significant relationship in most studies between work experience and burnout. Due to the moderate prevalence of burnout in hospital and pre-hospital emergency departments, health planners and policymakers should adopt the appropriate methods and techniques to prevent this phenomenon

BNP increases in certain pathological conditions such as hypertension, renal failure, myocardial infarction, atrial fibrillation, chronic obstructive pulmonary disease (COPD), acute respiratory distress syndrome (ARDS), cirrhosis, etc. Some of them are among the clinical conditions pointing to hypertensive emergency and also its side effects. Therefore, in this study, we aimed to investigate the effeciency of this variable as a diagnostic variable in patients with emergency hypertension.

In this prospective study, 100 patients presenting to the emergency center of Adalatian Hospital, Mashhad, Iran, who had blood pressure equal to or greater than 180/110 mmHg at the time of triage and initial visit were included in the study. In order to evaluate damage to the target organs and the possible diagnosis of emergency hypertension, they were examined by an emergency medicine specialist or resident and the necessary tests were performed. For this purpose, serum levels of blood urea nitrogen (BUN), creatinine (Cr), and TPI/Immune thrombocytopenic purpura (ITP) were checked and a complete neurological examination was performed on patients to determine the presence of focal or generalized neurological defects or the presence of pathology (intracerebral hemorrhage (ICH), ischemia) on brain computed tomography (CT) scan. Patients' eyes were also examined for retinal vascular damage with an ophthalmoscope, and electrocardiogram (ECG) was also taken. Patients were divided into two groups based on the

emergency hypertension and non-emergency hypertension. Meaning, if the criteria for emergency hypertension (target organ damage) were met, they were placed in the end organ dysfunction (EOD) group or hypertensive emergency (HE) group, and otherwise, they were placed in the group without EOD or hypertensive urgency (HU) group. Data analysis was performed using SPSS version 16 and descriptive and inferential statistics tests.

There was no statistically significant difference between the two groups in terms of age and gender (P> 0.05). Based on the tests performed on samples taken from the patients, in the case group BNP level was 6144.81 ± 3052.42 pg/mL and in the control group it was 4835.42 ± 3135.02 pg/mL. The results of T test showed that there was no statistically significant difference between the two groups (P = 0.941). Based on calculations performed, at the cut-off point of 180, BNP can predict kidney damage with 100% sensitivity and 41% specificity. Although specificity and positive predictive value are not high at this cut-off point, but sensitivity and negative predictive value are acceptable, which makes it suitable for screening.

The results of our study showed that BNP test did not have high specificity or positive predictive value, but it had acceptable sensitivity and negative predictive value, which makes it suitable for screening. Therefore, this test can be used as a supplement to other examinations and cardiovascular and renal tests.

Teaching the necessary knowledge and skills in the emergency department has always faced challenges due to its importance, unique features and multidisciplinary expertise. Today, advances in information and communication technology have also revolutionized education. The purpose of this article is to investigate the feasibility and experiences of using virtual reality and augmented reality technologies in the education of the emergency department by reviewing the studies conducted in the world.

This research is based on a systematic review in which the quality of the articles was evaluated using the STROBE standard checklist. The primary studies carried out, through articles on the educational capacities of augmented and virtual reality technology in the emergency department; in Persian language databases; SID, Magiran and English language databases; Science Direct, PubMed, Scopus and Google Scholar search engine were done until the end of September 2022. Farsi keywords; Emergency, medical emergencies, education, virtual reality, augmented reality and mixed reality were used as a combination of words; Also, Boolean search methods and OR operators and Mesh keywords including: Emergency, Education, Virtual Augmented, Virtual Reality, Mixed Reality, EMS, MR, VR, AR were used.

Among the 9 reviewed studies, the largest number of extracted studies, i.e. three articles, were conducted in China. Other articles were from America, Germany, Iran and Netherlands. The research method used in 8 articles was intervention, and only one article was tool design and content analysis using the Delphi method. The types of tools used in these studies were: a wearable module on the head with two categories of movement and operation, playing virtual reality simulation videos with the help of television and virtual reality glasses, a wearable headset and two hand controllers with triggers that make hand movements. Such as grasping, pushing and turning, virtual simulated scenes, an immersive room-scale multi-user virtual reality 3D simulation environment with a virtual emergency scenario, wearable modules and mouse and keyboard prototypes, and an interactive training module. The results of the studies also showed the improvement of educational performance, enthusiasm for learning, educational satisfaction, increased skills, improved response capacity, effectiveness of education and control of emotions in emergency situations.

The results of this study clarified several issues: 1- The volume of studies in the field of emergency department training with the help of virtual world tools is very small. 2- Augmented reality and mixed reality tools have not yet entered the field of medical education in the emergency department. 3- These tools can cause complications and challenges in using them. 4- Most of the studies have been conducted in the last 3 years, which show that this field of educational tools to promote and improve performance due to continuous evaluations is at the beginning.

Advances in the field of technology in the field of virtualization today have led to the creation of tools that can easily evoke the presence of the patient in a more attractive situation than the current situation or by adding information to the real world to deepen the understanding of reality. Make Virtual reality and augmented reality technology has seriously entered the field of medicine for two decades. The emergency department has also been able to use this tool with its special features; therefore, the current research tries to have a systematic review of the therapeutic use of augmented and virtual reality technology in the emergency department.

This research is based on a systematic review in which the quality of the articles was evaluated using the STROBE standard checklist. The primary studies carried out, through articles on the use of virtual reality and augmented reality therapy in the emergency department; in Persian language databases; SID, Iranmedex, Magiran and English language databases; Science Direct, PubMed, Scopus and Google Scholar search engines were conducted until the end of September 2022. Keywords of Emergency, Augmented Reality, Virtual Reality, Mixed Reality, Treatment, Cure, Therapy, Medical, EMS, MR, VR, and AR were considered as a combination of words.

Among the 14 reviewed studies, the largest number of extracted studies with 4 articles were conducted in Canada; and mostly it was a randomized and controlled prospective intervention method. Most of the studies with 10 articles were in the field of providing emergency services to children and adolescents under 18 years of age, and the effective components of virtualization technology were: reducing pain, managing anxiety and distress, improving hemodynamic parameters, and controlling fear and anger. Among the reviewed articles, none of the studies used augmented reality or mixed reality tools.

The results of the collected studies on the use of virtualization therapy show that so far this tool has had significant effects on controlling emotions and improving hemodynamic parameters. Analyzing the mechanism of the effect of virtual reality in different groups can help to establish a cause and effect relationship and the targeted use of these tools. It is also necessary to design these tools in such a way that their use does not prevent the normal procedures in the emergency department.

COVID-19 has affected the pattern of referral to medical centers and quarantine against COVID-19 might delay referral and management of surgical emergencies. This study aimed to compare the pooledevent rate of pediatric perforated appendicitis before and during the COVID-19 pandemic.

This wasa systematic review and meta-analysis study based on the PRISMA guidelines. Scopus, Web of Sciences, andPubMed databases were searched for studies reporting the rate of perforated appendicitis based on the post-appendectomy observations or imaging methods. The Egger bias test and funnel plot were used to detect anddepict publication bias. Statistical analysis was performed in Comprehensive Meta-analysis package version 3.

Twelve studies were eligible for inclusion in our study. The pooled prevalence of pediatric perforatedappendicitis in the pre-COVID era was 28.5% (CI95%: 28.3 to 28.7%) with a heterogeneity of 99%. In the COVIDera, the event rate proportion was 39.4% (CI95%: 36.6 to 42.3%) with a heterogeneity of 99%. There was a sig-nificant difference in the subgroup analysis within the pre-COVID and COVID era (P<0.001), showing a higherperforation rate in the COVID era.

Our study showed that during the COVID-19 pandemic, the rateof perforated appendicitis has significantly increased in comparison to before the COVID-19 pandemic.