فصلنامه کومش
سال بیست و چهارم شماره 5 (پیاپی 91، مهر و آبان 1401)

Undoubtedly, vaccination can be one of the promising approaches to control infectious diseases such as the COVID-19 pandemic. Inactivated viral vaccines have a history of "vaccine-induced enhanced disease", which may occur when neutralizing antibodies bind to viral antigens without blocking or clearing the infection. This can cause additional inflammation through the mechanisms described for other respiratory pathogens and lead to acute respiratory distress syndrome. Since the structure and function of SARS-CoV-2 glycoproteins are well known, vaccine manufacturers appear to be careful when inactivating the virus to completely inactivate and maintain the viral epitopes necessary for protective immune induction. It seems that caution should be taken in the usage of inactivated vaccines in children to ensure they are safe and efficacious, vaccinated children should be well monitored and any symptoms should be reported immediately.

In 2019, a new coronavirus (COVID-19) was discovered in Wuhan, China, which soon spread all over the world. The main hallmark of the disease includes fever, diarrhea, vomiting, and dry cough with dyspnea in half of the patients and acute respiratory distress syndrome (ARDS). Currently, no definitive treatment or prevention therapy exists for COVID-19 but scientists and researchers all over the world are relentlessly working to understand COVID-19 to discover novel therapeutic tools and vaccines. Today, photodynamic therapy (PDT) has been investigated as a noninvasive therapy for the treatment of this pandemic and was able to increase the healing process with the help of appropriate photosensitizers by targeting the pathogen inside the patient's body.

The respiratory system affects the motor control and stability of the body, especially in the elderly. The present study aimed to determine the effect of diaphragmatic breathing practice on respiratory function, balance, and quality of life in elderly women.

Forty elderly women with a mean age of 72.40 years participated in this study voluntarily. Subjects were randomly divided into diaphragmatic breathing practice (DBP) (n=20) and control (n=20) groups. The experimental group performed diaphragmatic breathing exercises for 6 weeks, 3 sessions per week under the supervision of an instructor, and 3 sessions in the form of exercises at home in 3 sets. Respiratory function with respiration rate per minute and breath-holding time tests, static with sharpened Romberg test, and dynamic balance timed-get up and go and quality of life with Lipad 31-statement QOL questionnaire were assessed in both groups before and after exercise. Data analysis was performed with repeated measures ANOVA at a significance level of P<0.05.

The number of breaths was reduced (23%) significantly in the experimental group (P<0.001). duration of confinement in the deep-breath position (25%) and duration of breath-holding in the deep-exhalation position (42%) increased significantly in the experimental group (P<0.001). Additionally, static (P=0.002) and dynamic (P<0.001) balance indexes were improved significantly in the experimental group after diaphragmatic breathing exercises. Diaphragmatic breathing exercises have also significant effects on the quality of life of elderly women (P=0.005).

Diaphragmatic breathing exercises can significantly improve respiratory function; the number of breaths, holding the breath, and exhalations; static balance, dynamic balance, and quality of life in older women. Therefore, using these exercises for courses of prevention, performance improvement, and Rehabilitation is recommended for different people and ages.

Type 2 diabetes, as a complex disorder, is one of the most prevalent endocrine disorders.  Importantly, the extent of familial aggregation and heritability in Iran is unknown. The aim of the present study was to determine type 2 diabetes heritability in the Tehran families.

The current research comprises 1691 diabetic and 12050 non-diabetic individuals over 20 years who are participants in the Tehran Cardiometabolic Genetic Study (TCGS). In this research, the BGLR, gap, and S.A.G.E tools were used to conduct familial aggregation, family-based heritability, and segregation analysis.

Out of 13741 subjects, 45% were female, and 55% were male in 2594 constituent pedigrees. The results of intra-family correlation showed that there is a higher correlation among siblings (ICCbrother-sister = 0.26, ICCbrother-brother =0.16, ICCsister-sister =0.14) than mother-offspring (ICCmother-offsprings = 0.13) followed by father-son (ICCfather-son = 0.05). Besides, the results of logistic regression showed that the chances of developing diabetes are higher in people whose at least one parent had diabetes (OR=4.16). The heritability rate in this population was about 65% (SE=0.034). The segregation analysis showed that type 2 diabetes in this community follows a polygenic pattern.

The heritability of type 2 diabetes with a polygenic pattern in Iran is higher than the global average. Type 2 diabetes is transmitted equally to siblings, and in terms of family history, parents are the most important risk factor for the disease. According to the findings of this research, it is recommended to shift the level of prevention from the individual to the family level in society when making health-system policy decisions.

There is little evidence of access to health services among people with disabilities (PWD) in low- and middle-income countries. This study aimed to examine access to physical rehabilitation services among PWD in Iran.

A population-based cross-sectional survey of 2177 PWD was conducted in all provinces of Iran using a multistage cluster sampling method in 2019. The number of sample zones was determined by dividing the country into four socioeconomic zones and considering the share of the population in each zone. Data were obtained by a valid self-administrated questionnaire and analyzed.

The frequency of need for physical rehabilitation services among PWD is %16.6. Among the types of physical rehabilitation services, the highest frequency of needs was related to physiotherapy services. About 28.1% of PWD did not have access to the required rehabilitation services. The third zone has more need and less access to required rehabilitation services. Lack of access to information and financial inability were the most common reasons for lack of access to services. Basic health insurance coverage, low disability rate, high level of education, and socioeconomic status were the determinants of access to rehabilitation services.

Given the gaps in the fair access of PWD to physical rehabilitation services, it is suggested that policies and programs be designed to increase the coverage of rehabilitation services and their costs to achieve the goal of universal health coverage in Iran. The implementation of these policies should be evaluated.

According to studies, children are often kept fasting in intervals longer than the standard fasting time, which can lead to complications for them. So, there was little and contradictory evidence about fasting time and its complications, this study aimed to investigate the relationship between preoperative fasting time with vital signs and the type and dose of analgesic in pediatrics.

In this cross-sectional research, 192 children aged between 6-36 months were surveyed in a specialized center for children. Children were examined through a researcher-made form in terms of preoperative fasting time, the type and dose of analgesic, as well as post-operative respiratory rate, pulse rate, and temperature through observation, pulse oximetry, and tympanic thermometer.

The mean fasting time was 8.09 hours. Fasting time was higher in children who took Apotel (P=0.03). The fasting time was significantly and directly related to the dose of Apotel and also to the total dose of the three drugs (P<0.001 and P<0.001, respectively). The mean body temperature of children who fasted for more than six hours was significantly lower than other children (P<0.001).

The fasting time of children was more than standard times. Using a higher dose of Apotel and the total higher dose of three analgesic drugs suggests the existence of more pain in patients with longer fasting times. Moreover, increased fasting time led to a decrease in the temperature in pediatric patients. Therefore, it is necessary to reduce the fasting time of children to prevent the complications associated with it.

Due to incomplete development of coping skills in children, they usually cannot cope with stressful situations like dental appointments. The present study aims to evaluate the effect of intranasal midazolam with/without inhalation sedation (N2O/O2) in children with high levels of dental anxiety.

This crossover double-blinded clinical trial was conducted on 14 uncooperative children aged 3‒6, who required at least two similar dental treatment visits. Children were randomly sedated by the combination of intranasal midazolam (0.5 mg/kg) and nasal drops of lidocaine hydrochloride (2%) with or without inhalation sedation (N2O/O2) during each visit. Houpt’s scale for sedation was used to evaluate the patient`s behavior and efficacy of the sedation by an independent pediatric dentist.

The combination of midazolam and inhalation sedation was significantly more effective in overall behavior after 15 minutes and at the end of the treatment (P<0.05), but not at the time of onset and discharge (P>0.05).

To manage the behavior of the children with high levels of dental anxiety, the combination of inhalation sedation with intranasal midazolam can be efficiently used.

Students with specific language impairment (SLI) have many difficulties in producing coherent written texts The goal of this study was to investigate and compare the management of cohesion in the written production of individuals with SLI and their normal peers in terms of density and diversity of connectives, the density of punctuation marks (periods and commas) and density and diversity of anaphors.

24 students with SLI as an experimental group and 24 normal developing students as a control group was asked to write stories about contentious situations situated at school. Then, their written productions were transcribed and analyzed linguistically based on the density and the diversity of three cohesive devices: connectives, punctuation marks, and anaphors.

The findings of the study showed that in the SLI group, the density (P=0.005), and the diversity of (P=0.005), and in the normally developing group the diversity of connectives (P=0.02) have significantly increased with increasing age.  The density (P=0.03) of the connectives used by the SLI group and their diversity (P=0.02) was significantly lower than the density and the diversity of those used by the normal developing students. In the normally developing group, the density of comma increased significantly with increasing age (P=0.001). The density of commas used by normal developing students was significantly higher than the density of that in SLI students. The density of anaphors was significantly increased with increasing age in the SLI group (P=0.001). In contrast, the diversity of anaphors significantly increased with increasing age (P=0.02) in the normally developing group. The differences between the SLI group and the normal developing students were significant only in children (P=0.01).

The results of the study showed that children with SLI have difficulties in the management of cohesion in the written texts.

Propofol is one of the most common anesthetic drugs. Painful injection with a reported prevalence of 28 to 90% in various studies is one of the problems of taking Propofol. The present study investigated the effect of performing the Valsalva maneuver and tourniquet twisting on pain intensity and hemodynamic changes.

This clinical trial was performed on 105 patients under general anesthesia with propofol that was randomly divided into three groups Valsalva, tourniquet, and control. Pain caused by propofol injection was evaluated using the withdrawal response score from 0 (painless) to 3. Hemodynamic parameters including blood pressure (systolic, diastolic, mean arterial), heart rate, and oxygen saturation level have been measured too.

Statistical analysis showed that there was no significant relationship between the distribution of pain intensity among the three groups, however the frequency of people with moderate pain intensity and painless in the tourniquet and Valsalva groups increased significantly compared to the control group. There was also a significant correlation between blood pressure systolic, diastolic, mean arterial (P=0.0001), and heart rate (P=0.013) in the three groups, and no significant difference was observed between oxygen saturation levels in the three groups (P=0.102). Mean blood pressure in the Valsalva group and heart rate in the tourniquet group is higher than in other groups.

Valsalva maneuvering and tourniquet twisting reduce the pain caused by propofol injection, with the difference that the mean blood pressure in the Valsalva group is greater than that in the tourniquet group

Chronic hepatitis B (CHB) leads to liver fibrosis, its failure, and death in the long term. The stage of fibrosis in CHB patients can also be detected based on the biochemical markers. The aim of this study was to predict the state of liver fibrosis in CHB patients and determine the possibility of patients shifting from a given state to another one.

This study is a cross-sectional study conducted in 2021. Age, blood platelet count, AST, and ALT enzymes were used as the input variable to create predictive models. Predictive models were Decision Tree (DT), Naïve Bayes, Support Vector Machine (SVM), and Neural Network (NN). The probability of a patient shifting from a given stage of fibrosis to another was calculated using the transition matrix. The 10-fold cross-validation was used to ensure the generalization of predictive models.

The DT had the best precision, recall, and accuracy (100%) among developed algorithms to predict the stage of fibrosis in CHB patients. The NN was the second most efficient algorithm. Its accuracy and mean square error was 99.35±0.60 and 0.058±0.025, respectively. Besides, SVM had the lowest recall, precision, and accuracy values. Based on the transition matrix results, there is a very low probability that the patients with non-significant fibrosis state shifted to the cirrhosis state.

Computational approaches like machine learning algorithms are the non-invasive way to predict the fibrosis state in CHB patients efficiently.

The aim of this research was a comparison of the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) and Transcranial direct-current Stimulation (tDCS) in worry, Emotion Regulation, and their subcomponents in fibromyalgia patients.

The study was a semi-experimental pretest-posttest with two experimental and one Sham group. 36 people were selected by the available sampling method from Fibromyalgia patients who were referred to rheumatologists in Tehran during 1399 and randomly classified into three MBCT, tDCS, and sham groups. The members of these groups were asked to complete the Penn State Worry Questionnaire (PSWQ) and The Cognitive Emotion Regulation Questionnaire (CERQ) before and after the intervention.

Multivariate Covariance analysis showed that in terms of worry variable, both treatments were effective in comparison with the Sham group, Also the MBCT was significantly more effective than tDCS (P<0.05). In terms of emotion regulation components, a significant difference between tDCS and the Sham group was seen in negative emotion. However, the MBCT method was significantly more effective than the sham group in both negative and positive emotion components of emotion regulation (P<0.05).

Based on the results of this study, it is recommended to employ both MBCT and tDCS to treat fibromyalgia patients.

It is necessary to improve the educational performance of faculty members continuously. However, achieving such a goal will not happen unless efficient tools and processes are available to evaluate. Therefore, the current study aimed to develop a questionnaire to evaluate the educational performance of faculty members in medical universities.

The present study undertook an integrative methodological approach to reach the aim. Reviewing the literature, interviewing the experts, and using the protocols to develop and standardize a questionnaire were implemented. The identified items were categorized according to valid scientific sources. Ten well-experienced experts with an academic degree in medical education or educational management evaluated the face and content validity of the designed questionnaire. Finally, a flowchart was presented to show the difficulties and solutions of the evaluation of the faculty members in medical universities.

The final questionnaire had 74 items divided into five divisions: educational goals, educational content, teaching-learning process, educational evaluation, and clinical / laboratory education. The highest number of items was assigned to the teaching-learning process (34 items) and the least number was allocated to the educational goals (6 items). According to the CVR and CVI (92% and 89% sequentially), the experts were strongly in agreement regarding the content validity of the questionnaire. The research team obtained the perspectives of the experts qualitatively to assess and enhance the face validity of the questionnaire. The reliability of the questionnaire was confirmed based on the internal consistency (Cronbach’s alpha = 0.781).

The present study indicated that the questionnaire had considerable comprehensiveness and acceptability. The research team hopes that the use of this questionnaire along with the presented flowchart would help universities to evaluate and improve the educational performance of their faculty members comprehensively and accurately.

In response to the increasing demand for improving the professional competencies of medical graduates, significant changes have been made in learning strategies in medical education. A four-component instructional design as one of the task-oriented models emphasizes a set of actual learning tasks that physicians face. The implementation of this method can be effective in promoting professional competencies in medical education by eliminating the gap between theoretical and practical knowledge along with experiencing authentic learning tasks. Therefore, this study as a new experience was conducted to evaluate the effect of a four-component educational design on the learning, attitude, and practice of radiologists.

This experimental study was performed in the second semester of the 2019-2020 academic year on 50 specialized assistants in radiology who were randomly divided into two experimental (n=25) and comparison groups (n=25). Relatively, the data were collected using three tools to measure learners' attitudes toward learning, as well as the levels of learning and practice.

The results of this study as a new experience showed a significant difference between the experimental and comparison groups regarding the posttest scores after the implementation of the educational intervention. Moreover, the learners in the experimental group had more positive attitudes toward the learning environment and showed higher levels of learning and better practice than the comparison group.

The findings of this study showed that the educational intervention based on the four-component educational design led to the effectiveness and promotion of assistants' performance due to its realistic learning assignments in the clinical learning environment. Therefore, the use of this method is recommended in medical education.

Acute gastroenteritis is a typical disorder that accounts for 8-12% of pediatric outpatient visits. Campylobacter and Salmonella infections account for about 8.4% and 11% of global diarrhea cases. Due to the importance of these bacteria in pediatric diseases, the aim of this study was to determine the infectious rate of Salmonella and Campylobacter species and also the frequency of the gene encoding Cytholethal distending toxin in children with community-acquired diarrhea.

Stool samples of children under 5 years of age with diarrhea were collected. The samples were related to children referred to hospitals in Hamadan, Ardabil, Bandar Abbas and two hospitals in Tehran. DNA was extracted from the samples using a DNA extraction kit from stool. The presence of Campylobacter in the studied samples was detected by polymerase chain reaction using specific primers. A control stool sample was spiked with 10-fold dilution of C. jejuni suspension for LOD (detection limit determination) measurement.

In this study, PCR results showed a LOD of 100 CFU per gram in the spiked feces sample. Accordingly, out of 144 fecal samples of children with acute diarrhea, one case was positive for Campylobacter jejuni; this sample was also positive for the presence of cdtB gene. Presence of Salmonella was confirmed in two samples of the patients (1.4%).

Low prevalence of Campylobacter and Salmonella was detected in symptomatic children under 5 years of age during the Covid-19 pandemic. Examination of these samples for viruses and other microbial agents can clarify the etiology of diarrhea in children referred to the hospitals.

Ginger in Iranian traditional medicine is known as an effective plant in reducing menopausal symptoms and treating osteoporosis. Therefore, in this study, the effects of ginger on the skeletal system in the fetus and the level of bone formation factors in the mice were investigated.

In this study, 40 pregnant Balb/c mice were equally divided into four groups 1) control group 2) group receiving 100 mg/kg ginger hydroalcoholic extract orally, 3) group receiving 500 mg/kg ginger hydroalcoholic extract orally and 4) group receiving 1000 mg/kg ginger hydroalcoholic extract orally. Alizarin Red S and Alcian Blue staining methods were used to examine the embryo skeletal system. Osteogenesis length and bony area of femur and tibia as well as the length, width, and height of the skull in the embryos were measured. Blood samples were taken on the 19th day of pregnancy to evaluate bone formation factors in pregnant mice and biochemical factors were measured in blood samples.

Evaluations showed that the length of femur and tibia and osteogenesis index in the treated groups relatively increased compared to the control group. Biochemical studies showed a significant increase in calcium, magnesium, and alkaline phosphatase levels in the group receiving 1000 mg/kg ginger hydroalcoholic extract compared to the control group.

The results of this study showed that ginger hydroalcoholic extract can be effective in increasing osteogenesis in the embryos and reducing the risk of osteoporosis in mothers.