Journal of Iranian Medical Council
Volume:5 Issue: 1, Winter 2022

Depression is one of the most prevalent psychiatric illnesses, leading to increased functional disability and mortality. Current pharmacotherapy is moderately effective, with response rates and remission rates reported at 50% and 15-40% following the first trial with conventional drugs, respectively, and electroconvulsive therapy is beneficial for only half of the refractory patients. A more accurate understanding of pathophysiology and the use of complementary therapies to overcome resistance to treatment have been suggested (1). After serotonergic and then glutamatergic systems, new research in the pathophysiology of depression has turned to the inflammatory mechanism. In this mechanism, cytokines disrupt tryptophan, Brain-Derived Neurotrophic Factor (BDNF), cAMP Response Element-Binding protein (CREB), and tropomyosin receptor kinase B (TrkB) levels balance (2). This mechanism is briefly described in figure 1. Celecoxib, simvastatin, pioglitazone, and dexamethasone are the medications that have had both antidepressant and anti-inflammatory effects in clinical trials (2). Another novel drug is gemfibrozil, which possibly exerts its antidepressant effects on humans through enhancing the BDNF pathway and activating CREB (1).

The rapid spread and high mortality rate of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) have recently received worldwide attention. Understanding the pathologic features and behavior of this new virus can help control its spread. The present study aimed to compare SARS-CoV-2 with other similar viruses.This study is a systematic review of current evidence conducted in September 2020. A search was carried out utilizing the keywords in the online databases, including Google Scholar, PubMed, Scopus, Science Direct, and Web of Science. The original peer-reviewed papers written in English that met the eligibility criteria were included in the final report.In this study, we compared SARS-CoV-2 with similar viruses such as influenza, Zika, Ebola, HIV, SARS-COV, and Middle East Respiratory Syndrome Coronaviruses (MERS-COV) in the features such as envelope structure, risk factors, duration of the disease, common symptoms, and treatments. Moreover, Coronavirus Disease 2019 (COVID-19) has many similarities with the other viruses explained in the present study. However, there are still controversies about the virus’s behavior.Although there are similarities between the abovementioned viruses, the scientific community should also pay special attention to distinct features of SARS-CoV-2, particularly the high probability of transmission in the human population, which causes substantial morbidity and mortality worldwide. Future studies are needed further to explore the biological and epidemiological behavior of this virus.

Polycystic Ovarian Syndrome (PCOS) is a common female gynecological endocrinopathy disorder with ages ranging from 18 to 45 years. PCOS significantly increases the risk of infertility, cardiovascular diseases, and type II diabetes in women. Cinnamon has a strong history of decreasing insulin resistance and treatment of PCOS. Therefore, we aim to review the effects of the cinnamon herb and extract on changes in the serum levels of sex hormones and ovarian tissue, metabolic activity, lipid profile, and insulin resistance.

Coronavirus disease 2019 (COVID-19 disease) is caused by SARS-CoV-2. In December 2019, several outbreaks of severe and life-threatening pneumonia with unknown organism were reported in Wuhan, China and the disease spread rapidly all over the world and caused the biggest pandemic. There was no clear information regarding incidence, morbidity, and mortality rate of COVID-19 disease in kidney transplant recipients or other solid organ transplant recipients. Therefore, we designed a study to evaluate the factors that can have any impact on kidney transplant recipients infected with SARS-Cov2. Our research was a retrospective cross-sectional study. The study population was all adult kidney transplant recipients (> 18 years old) who were hospitalized due to COVID-19 disease according to national guidelines from 1st March, 2020 to 20th April, 2020 in Shariati Hospital, Tehran, Iran. Demographic data, common clinical complaints, vital signs, types and dose of immunosuppressive drugs, comorbidity diseases, and basic laboratory tests were extracted from the medical records using a data collection form. According to the results of our investigation, mortality rate was 69.2% in kidney transplant recipients who were admitted in our hospital. No one died under the age of 47 years, while no one survived over the age of 58 years. As a result, age can be a reliable predictor of survival rate in kidney transplant recipients with COVID-19 pneumonia. All patients in non- survivors’ group were elderly and needed intubation, mechanical ventilation, and renal replacement. In addition to early referral and early start of appropriate and specific treatments of COVID-19 in patients with kidney transplantation, our general advice, is discontinuation of antimetabolite drugs at admission time, dose reduction of calcineurin inhibitors, and even withdrawal of all immunosuppressive drugs except steroids in critical cases.

Burnout is relatively frequent among medical students and has a major impact on mental health. We aimed to determine the prevalence of burnout among medical students of Tehran University of Medical Sciences (TUMS).  It was a cross-sectional study conducted at TUMS. All medical students at the university entrance (first semester), beginning of the clerkship, beginning of the internship, and end of the internship (graduation time) were enrolled. Maslach`s Burnout Inventory for Students (MBI-SS) was used to assess the prevalence of burnout. Chi-square test and Kendal tau_c test were utilized to compare subscales and curricular phases. 668 students participated in the study. The prevalence of burnout was 24.1% which was significantly higher at the end of their internship. 65% of the students had high emotional exhaustion, 75.4% had high cynicism, and 37% had low academic efficacy. There was no association between gender and burnout. The prevalence of burnout among medical students was slightly higher than expected, and interns faced burnout more frequently. Further studies to assess the potential predisposing factors of burnout and appropriate strategies to reduce its burden seem to be mandatory.

Sleep disorder is one of the main complaints of patients with cancer that could affect their quality of life and clinical outcomes. We aimed to investigate major contributors of poor quality sleep in patients with cancer that underwent treatment.  We performed a cross-sectional study on 250 patients with cancer referred to the oncology department of Shohaday-e-Haftome-Tir Hospital, Tehran, Iran. Sleep quality as the main outcome of the study was evaluated using the Persian version of the self-report PSQI questionnaire. Global PSQI score >5 was categorized as the poor quality sleep. We also collected demographic and clinical data and physical performance status based on ECOG scale which grading is from 0:Fully active to 12:Death. Collecting the data regarding each patient was performed through medical records and face-to-face interviews. Mean age (±SD) of the study participants was 52.8 (±11.9) and 177 (70.8%) patients were female. The overall proportion of poor quality sleep was 66.8%. Sleep disorders were observed more frequent in patients with partial (OR=2.0, 95% CI=1.0, 3.8) and complete (OR=7.4, 95% CI=1.5, 36.4) physical dysfunction (p-value<0.05). There was also a strong association between a history of sleep disorder and cancer-related insomnia (OR=4.4, 95% CI=1.9, 10.1). No association was found between age, marital status, metastasis status, and cancer location with poor quality sleep. Poor sleep quality had a high prevalence among our patients. Patients with physical functional impairment and those with psychiatric disorders (mood disorder) and pre-existing insomnia were the main groups of patients with a higher likelihood of cancer-related insomnia.

Sleep has a well-recognized impact on human immunity. COVID-19 infectivity and severity depend on the immune system of the host. Medical interns are at risk for the development of this disease and have poor sleep quality. In this study, the association between sleep quality and COVID-19 infection development and severity in medical students was evaluated. In the current study, 50 medical students were enrolled. Demographic and subjective sleep parameters were documented and compared with COVID-19 infection history and development of dyspnea. Chronotype was assessed by the reduced Morningness-Eveningness Questionnaire (rMEQ). The total sleep time in infected medical intern were 68.14 minutes shorter than non-infected one (p=0.048). The wake time was one hour and twelve minutes earlier in the group which developed dyspnea (p=0.020). Age, gender, rMEQ score and Body Mass Index (BMI) are significantly associated with neither COVID-19 infection history nor dyspnea. Short sleep time and early morning awakening are bound up with the prevalence and severity of COVID-19 in medical interns.

Nowadays, the attention to the combination of Substance Use Disorders (SUD) and anxiety disorders in women is increasing; therefore, the aim of this study was to investigate the prevalence of anxiety disorders in women substance users and epidemiological features of this population. In a cross-sectional study, 48 female outpatients with SUD referred to the Iran psychiatric hospital substance use clinic with a range of 18 to 65 years, were involved in the study. All participants referred to the substance use clinic of Iran psychiatric center to follow up on the comorbidities and psychiatric disorders, were involved in the study. The Structured Clinical Interview for DSM-5 (SCID) was used to anxiety disorders and SUD diagnoses. The SCID is a semi-structured interview guide for making the major DSM-5 diagnoses. It is administered by a clinician who is familiar with the DSM-5 classification and diagnostic criteria. Finally, gathered data were analyzed by SPSS-22. Totally, 48 patients enrolled to this study. The mean age of patients was 34.2±9.4. Crystal (60.4%) and alcohol (50%) were the most commonly used substances. Of the 48 substance users, 47.9% had at least one type of anxiety disorders. The most common anxiety disorders in substance users were generalized anxiety disorder (37.5%), social anxiety disorder (18.8%), and agoraphobia and panic disorder (12.5%). A statistically significant correlation was found between agoraphobia and opium (p=0.04), generalized anxiety disorders and benzodiazepines (p=0.02). In the present study, it was shown that anxiety disorders co-occur with SUD at a high rate. Generalized anxiety disorders and social anxiety disorder were the two most prevalent conditions among substance users. Analysis showed a statistically significant correlation between agoraphobia and opium, general anxiety disorders and benzodiazepines.

Diabetes Mellitus is one of the chronic diseases of childhood that needs long-term care and follow-up. The participation of the family, especially mothers, in caring for their child seems essential. This study aimed to investigate the challenges of Iranian mothers in caring for their children with Type 1 diabetes mellitus during the outbreak of COVID-19. This qualitative study was conducted on 22 participants who engaged in taking care of children with diabetes mellitus. Purposeful and snowball sampling were used to select the participants. The main theme of “diabetes control in the shadow of the COVID-19” and three categories emerged from data analysis. Lack of taking the child to the doctor during the COVID-19 the pandemic impacted the management of diabetes in their child. Therefore, having a virtual communication channel between the family of diabetic children and the health care professionals could be helpful for managing the children’s disease.

Hesperidin is a secondary metabolite of the flavonoid group. Due to its antioxidant, anti-inflammatory and anti-viral properties, it can be helpful as a treatment option for patients with COVID 19. This study was conducted as a clinical trial in Masih Daneshvari Hospital in Tehran. After providing complete explanations and obtaining written consent, patients with new coronavirus (COVID-19) were included in the study if they met the inclusion criteria.  20 patients with the new coronavirus (COVID-19) were included in the study. Patients were then randomly divided into hesperidin and control groups. Patients in the hesperidin group received 1 mg of hesperidin orally intravenously every 6 hours for 5 days, whereas in the control group, they did not. Then, the desired variables were measured during the research period. Patients were monitored for adverse drug reactions based on clinical symptoms and signs. The results were evaluated with regard to the design of the questionnaire and its completion using t-test and SPSS16 software. Patients with equal gender ratio were studied and diabetes mellitus with a prevalence of 60% had the highest prevalence among patients. On the other hand, 85% of these patients presented with bilateral lung involvement. Using hesperidin decreased lymphocytes, CRP, ESR, LDH, D-dimer, and IL-6 and increased WBC, Hb and Plt. None of the mentioned changes were significant (p>0.05). Utilizing hesperidin could not cause significant changes in the level of immunological and inflammatory factors in patients with COVID 19.

Considerable advances in medical science and modern biotechnology have caused an increasing need for discussing the ethical issues and decision making in the patients. Thus, this is considered as an essential element in medical education. In order to fill this scientific gap, the teachers should be able to investigate the thinking of learners in moral reasoning prior to graduation, thus they can develop the necessary skills in the analysis of clinical situations. This study was designed with an aim to explain the metacognition in moral reasoning in medical departments and based on the Islamic Society of Iran. The current study was a qualitative content analysis with a conventional approach where the information was acquired from in-depth personal interviews with 17 clinical professors and students in the medical, nursing, and midwifery majors from Isfahan University of Medical Sciences and Bushehr University of Medical Sciences. 25 sub-categories, 6 categories, and 3 themes were extracted from the qualitative data. Three themes, including basics of metacognition in moral reasoning, metacognitive process in moral reasoning, and metacognitive responsiveness in moral reasoning, were extracted from the qualitative data. Then, based on the results of the qualitative data, the concept of metacognition was explained in moral reasoning. Metacognition in moral reasoning in medical departments is a mental process where the medical team uses their knowledge, skills, and experience in observance of the principles and a scientific and reliable process to have the necessary and sufficient responsiveness in their ethical decisions.

Neonatal sepsis is still one of the main issues with unspecific signs and symptoms with high mortality and morbidity rates to assess Mean Platelet Volume (MPV) as a laboratory value for predicting neonatal sepsis. In this cross-sectional study, we recruited 72 term and late preterm newborns diagnosed with sepsis who were admitted into the neonatal ward of the children’s medical center of Tehran University of Medical Sciences (TUMS) from March 2016 to May 2017 case group. The control group consisted of 50 healthy term infants (mean age: 5.46±3.59 days). The blood test was performed at the time of admission. Hematologic markers including MPV, White Blood Cell (WBC), and C-Reactive Protein (CRP) were compared between two groups.  There were statistically significant differences between WBC (p=0.019), CRP (Mean Difference: 9.38, 95% CI: 4.19 to 14.58, p=0.001) and MPV (Mean Difference: 0.56, 95% CI: 0.25 to 0.86, p<0.001) in case group in comparison with the control group. The area under the curve was 68.71 for MPV. Diagnostic cut-off levels with sensitivity (80.56%) and specificity (52%) were found to be MPV> 9.2 fL. There was no significant association between MPV and disease status (case group: 9.80 ±0.88 vs. control group: 9.24 ±0.75). Despite higher MPV during neonatal sepsis, the MPV values’ sensitivity and specificity were inadequate to be used as diagnostic tests.  CRP is still a better marker for early suspicion of neonatal sepsis. MPV may be used in combination with CRP for identifying neonatal sepsis.

Vaccination is likely to be the final solution to stop the COVID-19 pandemic which has been considered as a global public health emergency. Influenza and coronavirus have previously demonstrated antigenic cross-reactivity.

This cross-sectional study was aimed to evaluate the transmission rate and the severity of coronavirus infection among health care workers with history of previous influenza vaccination. Subjects of the study were asked about their demographics, influenza vaccination history prior to pandemic, infection with COVID-19, and the severity indicators of the disease.

Influenza vaccination has correlation neither with the prevalence of COVID-19 infection rate nor with the severity of the disease process among those who received flu vaccines and those who were not vaccinated. Vaccinated and unvaccinated subjects were equal in terms of sex, age, and comorbidities.Asthma has not been demonstrated to contribute to the severity of the disease. 

Influenza vaccination regardless of the evidence on its antigenic cross reactivity with coronavirus, is not associated with lesser involvement by or any contribution to the severity of the 2019 novel SARS-COV2 disease.

Failure of cannulation due to the unavailability of deep veins is one of the complicated problems for chronic hemodialysis patients. By using superficialization, the veins with larger caliber and intact intima will be available for continuing the dialysis process. Brachio-Basilic superficialization with Minimal Incision (BBMI) is a proposed method that its patency and results are explored in the current study. Thirty hemodialysis patients with two-step superficialization indication were evaluated. For BBMI, first by using sonography, basilic vein pathway was marked and with three small incisions matured basilic vein explored and transected near pervious anastomosis and transposed from new subcutaneous tunneling and re-anastomosed the vein. In a definitive time period up to 6 months, the study variables were evaluated. There were 11 females and 19 males. The minimum and maximum ages were 29 and 92. Technical success was 100%. After passing several successful dialysis sessions from the superficialized vein, 2 patients (6.7%) encountered unsuccessful cannulation due to thrombosis, and one of thrombosis events was due to hypotension. These cases were whom with the shortest interruption between surgery and dialysis initiation (18 and 25 days; mean±SD=28.63 ±7.36 days). There were no cases of infection and pseudoaneurysm. Furthermore, 1 case (3%) experienced wound dehiscence that managed using proper wound care. BBMI could be utilized safely with a high patency. This method has the lowest complications. The minimal side effects are affected by predisposing factors that should be clarified precisely in future studies and by gathering more evidence.

Kidney transplant recipients are among vulnerable individuals with increased risk of developing COVID-19. Long-term immunosuppression and multiple co-morbidities might affect clinical characteristics of COVID-19 in such patients. In this study, we describe clinical presentations and the incidence of Acute Kidney Injury (AKI) in 9 kidney transplant patients with COVID-19.

This retrospective case series was conducted on 9 kidney transplant recipients with COVID-19 who were admitted in Imam Khomeini Hospital Complex during the first wave of the disease in Iran from February 20 to 20th April 2020. The diagnosis of COVID-19 infection was confirmed by either positive results of quantitative RT-PCR on nasopharyngeal swabs or typical findings in chest CT scanning. 

The median age of patients was 51 years and the graft was functional in all cases before COVID-19 infection. Most patients complained of fever (8 cases), followed by cough (7 cases) and shortness of breath (5 cases). Eight cases had lymphopenia, and leukopenia was reported in 4 cases. AKI occurred in 8 cases. The increase in serum creatinine level resolved partially in most cases, but those who required renal replacement therapy had worse prognosis. Those who survived the acute illness are still alive after more than 16 months with functioning graft.

It was shown in our study that similar to general population, fever and respiratory symptoms are presenting features of COVID-19 in kidney transplant recipients. Lymphopenia is more prominent and the course of COVID-19 infection is more likely to be complicated by AKI in such patients.

Recent evidence suggests a connection between celiac disease and dilated cardiomyopathy. Herein, we serologically screened for celiac in dilated cardiomyopathy patients and investigated its correlation with ejection fraction. We selected 123 cardiomyopathy patients. Patients were screened for celiac, using anti-tissue transglutaminase (ATA), anti-gliadin (AGA), and anti-endomysial (EMA) immunoglobulin type A (IgA) antibodies. Total IgA levels were also measured.  Of 123 patients, 3 were EMA positive (2.4%), 4 were AGA positive (3.3%) and 5 were ATA positive (4.1%). EMA positive patients had significantly lower EF values compared to EMA negative patients (35±5 vs. 46.52±9.21, p-value: 0.034). Similar results were observed for AGA (32.5±14.34 vs. 46.7±8.8, p-value: 0.002), but not for either ATA positivity (40±10 vs. 46.5±9.21, p-value:  0.126) or IgA deficiency (50±5 vs. 46.14±9.37, p-value:  0.480). No significant difference was observed in the age and gender of seropositive patients compared to seronegative. We observed a higher prevalence of celiac seropositivity among dilated cardiomyopathy patients compared to the general population. EMA and AGA positive patients had significantly lower ejection fractions compared to their negative counterparts.

Taking care of a patient with COVID-19 can have a significant psychological burden. This study aimed at determining the levels of stress, anxiety and depression symptoms among family caregivers of Covid-19 patients.  This cross-sectional study was conducted on 236 main caregivers of coronavirus patients in Zanjan, Iran in 2020. The data measurement tool was the DASS-21 electronic questionnaire which was designed using the Porsline platform and was sent to the participants via SMS and WhatsApp messages. Descriptive statistics and Pearson’s R, Student’s T test and analysis of variance were performed to analyze the data in SPSS version 25. The mean age of participants was 34.72±9.52 years. Of the participants, 57.21, 70.77 and 55.09% had symptoms of depression, anxiety and stress, respectively. Females experienced higher levels of stress than males (p=0.049). Additionally, the mean score of depression sub-scale was significantly different between categories of employment status (p=0.029), as self-employed workers had significantly higher depression sub-scale scores (10.97±10.85) compared to the other two groups. No significant associations were found between age and depression, anxiety, and stress of the participants. Moreover, the mean scores of depressions, anxiety, and stress sub-scales were not significantly different between categories of marital status and levels of education. The majority of family caregivers experienced depression, anxiety, and stress symptoms. This significant prevalence of psychological burden among these individuals underscores the need for supportive measures by policy makers and communities to prevent further severe consequences and help them reduce these symptoms.

Fatty liver disease is rising as the most common liver disease in recent years. One of the new approaches to manage the disease is the use of intelligent systems. The recommender system is increasingly utilized in managing chronic conditions. This study was performed to identify the common data elements and features of a recommender system for people living with fatty liver. This study was a narrative review exploring the minimum data set for a recommender system in fatty liver disease. We aimed to review the current literature evidence to comprehend the specific requirements of the related knowledge. The search was carried out in November 2020 using PubMed, Scopus, Science Direct, and Web of Science databases. We searched the keywords including fatty liver, liver disease, nonalcoholic fatty liver disease, intelligent, smart system, recommender system, minimum data set, data element, and data requirements. A review of the articles showed that the most common data elements of the administrative category were sex/gender (n=22), age (n=22), and ethnic group/race (n=8). We also identified the clinical data elements and technical features of a recommender system for people living with fatty liver. Based on the findings of this study, “diabetes and glucose status” (n=18), “AST” (n=15), “BMI” (n=13), and “ALT” (n=13) were the most frequent data elements of clinical category. Furthermore, “predicting and identifying” (n=8) was the most common technical feature mentioned in the reviewed articles.‎ We determined the common elements and features of a recommender system in ‎three different categories: clinical data elements, demographic data elements, and technical ‎capabilities. Using these requirements, it is possible to structure data gathering, medication ‎adherence, and communication with healthcare providers in a standard manner. It is ‎suggested that appropriate policies and national grants be adopted to identify and prioritize a ‎minimum data set to support the healthcare services of people living with chronic conditions.

The most common etiology for patients with acute abdominal pain presenting in emergency departments is acute appendicitis. This study aimed to evaluate the effectiveness of liver enzymes in early diagnosis of acute appendicitis and prediction of its complications. 176 patients with the chief complaint of abdominal pain presented in the emergency departments were enrolled in this study. All included patients underwent standard approach for acute abdomen with target focus for appendicitis. Samples for serum levels of ALT and AST on arrival have been arranged for all included. Patients were evaluated for appendicitis and diagnosis confirmed by histopathology. AST, ALT variables and confirmed diagnosis of acute appendicitis, and related complications have been evaluated for any correlations using Kruskal-Wallis test. Based on the results, 67 simple, 24 complicated appendicitis, and 85 cases of normal appendix were evaluated. The mean AST was significantly different in normal, simple appendicitis, and complicated groups (p=0.019), but the mean ALT failed to show a significant difference. The differential test showed that there was a significant difference between the two appendicitis groups and the normal group in AST (p<0.05), but not between the two appendicitis groups. The p-values of AST and ALT were 0.17 and 0.2, respectively.  According to the results of this study, it seems that increased AST may be increased in simple/complicated appendicitis in contrast to normal group, but regarding AUC curve data, AST and ALT fail to have the necessary diagnostic accuracy and efficiency to diagnose acute appendicitis and predict its complications.

Our goal was to compare two common methods including auscultation and Fiber-Optic Bronchoscopy (FOB) in confirming the correct placement of Double-Lumen Tube (DLT). Seventy six patients were enrolled. After DLT insertion, clinical verification was made by auscultation, then FOB was applied. At lateral decubitus, the position of DLT was rechecked by auscultation, and then by FOB. The incorrect position including malposition and misplacement were compared between two routine methods of auscultation and FOB. After blind intubation, 21.1% of DLTs were considered to be in an incorrect position. Meanwhile, FOB showed that 46.1% of DLTs were not placed correctly. Among all the patients, 53.9% of DLTs were in the optimal position. Misplacement was diagnosed in 35.5% and malposition in 10.5% of the patients. After positioning to the lateral decubitus, using auscultation, we found that 5.3% of tubes were dislocated, but according to FOB, it was 10.5%. The agreement coefficient between auscultation and FOB was 0.42 in the supine position and 0.64 in lateral position. Our results showed that although FOB needs more time to check the position of DLT, it should be used to confirm the exact position of DLT.

The aim of our study was to assess factors associated with residents’ perceived competency regarding female pelvic medicine and reconstruction surgery (FPMRS). We conducted an Internet-based cross-sectional survey. Obstetrics and gynecology residents’ self-perceived competence in clinical skills for management of pelvic floor disorders were questioned. Competency in different aspects was analyzed concerning the availability of fellowship-trained professor, rotation, and fellowship training program. 1168 residents of four levels of residency participated in this study. 760 (65.06 %) of residents were not trained by a fellowship-trained attendant. Of 409 (35.01%) responders who were trained by board-certified fellowship, 334 had FPMRS rotation in their residency program. Senior residents were significantly more confident than residents in the first and second years. 695 (59.50 %) of residents reported participating in the pelvic floor surgeries; however, only 15.3 % were served as primary surgeons. Where pelvic floor education had been provided by a fellowship-trained attendant, more perceived competency was evident in all fields of clinical skills except performance as primary surgeon and management of emergency cases. Among residents trained by board-certified FPMRS attendants, there were no significant differences regarding FPMRS rotation or fellowship training programs. 88.69 % of residents declared that a comprehensive course in the field of FPMRS is needed in the residency curriculum. This study demonstrates that being trained by board-certified FPMRS attendants has significant effect on residents’ self-perceived competency. Residency education was not compromised by fellowship training program.

Emerging from general anesthesia remains a passive process. Recent studies show the importance of dopaminergic pathways in sleep–wake cycles. The effect of caffeine in increasing the level of consciousness and cognitive function has been well documented. The purpose of the current study was to evaluate the effect of intravenous caffeine, a dopamine receptor stimulant, on accelerating recovery from Total Intravenous Anesthesia (TIVA) with propofol.  

Fifty patients, aged between 20 to 50 years old scheduled for elective laparoscopic cholecystectomy, were enrolled in this double-blind clinical trial, and forty-eight were analyzed.  The study group, consisting of 24 patients, received 500 mg IV caffeine infusion 15 minutes before the end of the surgery. The control group, comprising 24 patients, received an equal volume of saline infusion.  Emergence profile was evaluated and compared in two groups. The depth of anesthesia was determined by Bispectral Index (BIS) monitoring.

Our research demonstrated that in the study group, the time intervals for increasing BIS values from 60 to 80, endotracheal extubation, eye-opening on verbal command, and achieving an Aldrete’s discharge score ≥ 8 were significantly less than the control group.  Short Orientation Memory Concentration Score (SOMCT) was lower in the control group as well. Incidence of nausea, vomiting and, shivering had no significant difference between the two groups.

Since emergence from general anesthesia is a passive process, caffeine may be used as a measure for active reverse of general anesthesia at clinical practice.

Since the initiation of the new coronavirus (COVID-19) in February 2020 in Wuhan, the Health Care System (HCS) has tolerated a lot of morbidities and mortalities all around the world. While the COVID -19 is spreading out the whole world, HCS carries almost all the burden as the first line. However, countries like Iran suffer from a lack of infected Health Care Workers (HCW) population data and statistics, especially the major hospitals for COVID-19 referrals. 

In this single-center cross sectional study, we studied the healthcare personnel infected by COVID-19, from February 2020 to August 2020, in a major tertiary hospital of Tehran, Iran.

Of total 1595 HCW working in Sina hospital, 389 (24%) with the mean age of 35.43 ± 8.2 years were infected by COVID-19, almost one fourth. 238 (61.2%) were women, though 92.5% of the population used Personal Protective Equipment (PPE). 140 (36%) of them were personnel of the wards assigned to the COVID-19, Personnel went on sick leave for 7.76 ± 4.64 days. 51(13.1%)  personnel had an exacerbation of symptoms, and only one of the personnel experienced COVID-19 almost twice in four months.

COVID-19 infection risk is considered to be very low for HCWs in case suitable PPE and social distancing are regarded. In our study, more than 92% of the infected personnel utilized PPE, which indicates that they might have failed to use PPE properly or might not have taken hand-hygienic precautions well. It is necessary to limit working hours and prevent excessive workload so that the staff could adhere more to hygienic precautions in hospitals or in society.

Myositis is not a common finding in patients diagnosed with COVID-19. Up to now, a few cases of COVID-19 associated with myositis have been reported.A 26-year-old man was referred to the hematology clinic due to leukocytosis and bicytopenia in his lab tests. The patient had no symptoms at the visit session. Following the evaluation, he was hospitalized with the diagnosis of pre-B cell Acute Lymphoblastic Leukemia (ALL) and was considered a chemotherapy regimen consisting of vincristine, methotrexate, cytarabine, and prednisolone. Prior to initiating the treatment, he was diagnosed with COVID-19 with manifestations of fever and dyspnea on the 20th day of hospitalization. The positive Polymerase Chain Reaction (PCR) test confirmed the diagnosis. On the 8th day of COVID-19 related clinical and paraclinical manifestations, the patient was complaining about a vague severe pain in the pelvic region predominantly around his hips. A pelvic MRI was performed to rule out critical etiologies and perimuscular and intramuscular edema was revealed. Creatine Phosphokinase (CPK) and Lactate Dehydrogenase (LDH) were elevated in the lab tests. His pain was diminished in few days spontaneously and diagnosis of myositis was confirmed. Myositis can be one of the extra-pulmonary manifestations of COVID-19. Therefore, finding out the association between myositis and COVID-19 can be beneficial for the early diagnosis and prevention of misleading.

Ectopic eruption of teeth is a rare phenomenon, when teeth are found outside their regular site of eruption. This condition is quite rare in non-dentate regions such as maxillary sinus, nasal septum, mandibular condyle, coronoid process and the palate. The most typical symptomatic presentation of this condition is facial pain. Most of the reported cases of ectopic eruption are permanent third molars and only few cases of ectopic deciduous tooth have been reported in the literature. The purpose of this study is to report a case of ectopic deciduous molar tooth in maxillary sinus in a 13-year-old patient with no related signs and symptoms.

Novel COVID-19 has caused a deathful pandemic since 2019 with more than 2.5 million deaths reported around the world by February 2021. Although best known for its effects on respiratory system, it can be responsible for multiple organ damage. Cardiovascular complications are not uncommon meanwhile. However, some cardiac manifestations are also reported, namely: palpitations and chest pain. Acute myocarditis, acute heart failure, acute coronary syndrome, cardiac arrhythmias and thromboembolic events have been the most common cardiovascular complications reported. Meanwhile, more deaths occurred as a result of aortic dissection. Herein, we want to report a silent death in a patient with COVID-19.

Estimates show that medical errors are one of the most significant causes of death and should be included in the list of the most important causes of death in the world (1). Medical errors are inevitable and occur occasionally. Mistakes are sometimes very small and harmless, but sometimes they become extremely serious and dangerous that they can endanger patients’ lives, which is the third leading cause of death in the United States and a major issue among people in the European Union (2).

Modern medical education in Iran initiated after the establishment of Tehran University School of Medicine in 1934 (1). During the last three decades, more emphasis has been placed on the successful upgrading of medical training, the educational programs, and curriculum (2). Moreover, great strides have been made in teaching and practicing biomedical ethics, especially in the field of education (3). In order to continue this path, the authors, as young medical faculties in Iran, have discovered that some uncivil behavior could negatively affect the medical training atmosphere, especially in the residency training period. Uncivil behavior such as bullying, harassment and undermining is a widespread issue which is not limited to certain countries or specific educational programs (4). Bullying and harassment impact negatively on patient care and safety, medical education, medical students’ psychological health and well-being, and organizational costs (5). In Iran, several rules and policies have been established with respect to some negative workplace behaviors such as sexual harassment, physical violence and aggressive communication, but those grey areas such as bullying and harassment have not yet been appropriately considered. Previous studies have recommended that training medical students, residents, and faculty members regarding uncivil behavior and their negative effects could raise awareness besides providing a desired atmosphere for eliminating or at least decreasing uncivil behavior.