Journal of Iranian Medical Council
Volume:6 Issue: 2, Spring 2023

More than three years after the all-society-inclusive outbreak of coronavirus disease 2019 (COVID-19) that quickly turned into a pandemic, situations have considerably improved, and public concerns have subsided. Nevertheless, about 800 million confirmed cases of COVID-19 and about seven million deaths have been reported to the World Health Organization (WHO) so far, and this pandemic is still far from over (1). However, now public awareness has increased, the virus is more predictable, communities are better prepared, the crisis has been contained, and in short, the disease and its subsequent concerns have been brought under control. But what led to this [imperfect] success? Certainly, this was beyond the power of one person, country, and discipline. It was a collaboration, a comprehensive collaboration of researchers and experts in basic and clinical sciences and medical specialties worldwide. The interdisciplinary approach has influenced the sciences more and more over time, aiming to overcome problems beyond the ability of a single science (2). This growing trend, which has rapidly been spreading over the last decades, is the solution to overcome crises like the COVID-19 pandemic. Interdisciplinary approaches in this era led to disease management, vaccine development, and better societal decisions. Basic science, with its curiosity-driven focus on understanding phenomena, served as a bridge connecting the laboratory to the clinic and the community and society to reach applied sciences, although it seems insufficient for the desired technological and medical applications. Indeed, basic sciences provided the necessary knowledge and understanding for further studies and applications. Current advances in clinical science are rooted in basic science research, so that without a background in basic research, applied science perspectives are incomplete and unstable (3). Bioinformatics and machine learning were two of the most important fields used to assess the situation, develop strategies, and decide on the appropriate response. In addition, physicists, chemists, and engineers developed protective and safety equipment, and biological scientists’ knowledge and science-centric research led to the development of diagnostic tools and vaccines (4,5). The production of effective vaccines, of which more than 13 billion doses have been injected worldwide, is one of the most prominent results of medical biotechnology collaborations (1,5). Collaboration and integration of science within medical specialties also caused beneficial results; the nature of COVID-19 with the involvement of different organs of the human body, including the respiratory system, the cardiovascular system, the digestive system, the nervous system, etc. (6), provoked and accelerated interdisciplinary collaborations. Interdisciplinary research clarified the mechanism of the disease being a multi-organ aggressor and proposed possible treatments, including anti-infective agents, organ-specific therapies, and complementary therapies to improve nutritional, inflammatory, and metabolic status (4,6,7). In the COVID-19 era, social scientists have modified social restrictions by considering the psychological and psychiatric effects, economists have explained resilience policies, and policymakers made their decisions by considering medical, economic, and social components (4,5). Although it may seem that the medical sciences have received most of the credit and prestige for overcoming the COVID-19 crisis, the role of other fields toward reducing their harms (3) and collaborating in this relative success is quite evident (8-10). It can be said that collaborations with an interdisciplinary approach in the pandemic era have led to pandemic collaborations and have produced an evidence-based, multidisciplinary science that can be used in crises.

Trauma is one of the most important causes of death in. Therefore, proper management and treatment of these patients can be very beneficial. Therefore, the aim of this literature was to investigate the extent, scope and nature of researches on the effect of insulin therapy on the treatment efficacy of traumatic patients.

This study is a scoping review of research that was conducted by searching in Scopus, PubMed, Embase and ScienceDirect databases with keywords related to insulin therapy and trauma. In this study, all reports with human and animals as well as cohort and clinical trial studies were reviewed.

Of the 4365 studies, 73 studies met the inclusion criteria and were evaluated, most studies examining the effect of insulin on traumatic brain injury and immune system and the fewest were in trunk trauma patients, especially chest trauma. The findings of this study showed the effect of insulin therapy on decreasing levels of IL-6, IL-8, IL-10 and TNF-α thus decreasing the inflammatory response in trauma patients. Insulin therapy can reduce the risk of infection in patients with trauma and burns thereby reducing the number of days spent in intensive care units and dependence on ventilation.

Insulin therapy can be useful in treating trauma patients but increases the rate of hypoglycemic episodes that require careful monitoring of patients’ blood glucose which can have a negative impact on treatment outcomes.

 Technologies can predict various aspects of COVID-19, such as early prediction of cases and those ‎at higher risks of severe disease. Predictions will yield numerous benefits and can result in a lower number of cases ‎and deaths. Herein, we aimed to review the published models and techniques that predict various ‎COVID-19 outcomes and identify their role in the management of the COVID-19.‎ 

 This study was a review identifying the prediction models and techniques for management of the COVID-19. Web of Science, Scopus, and PubMed were searched from December 2019 until ‎September 4th, 2021. In addition, Google Scholar was also searched.‎ 

 We have reviewed 59 studies. The authors reviewed prediction techniques in COVID-19 disease ‎management. Studies in these articles have shown that in the section medical setting, most of the subjects were ‎inpatients. In the purpose of the prediction section, mortality was also the most item. In the type of data/predict ‎section, basic patient information, demographic, and laboratory values were the most cases. Also, in the type of ‎technique section, logistic regression was the most item used. Training, internal and external validation, and cross-validation were among the issues raised in the type of validation section.‎ 

 Artificial intelligence and machine learning methods were found to be useful in disease control and ‎prevention. They accelerate the process of diagnosis and move toward great progress in emergency ‎circumstances like the COVID-19 pandemic.‎

 Smoking is considered to be one of the main risk factors that may affect the severity of coronavirus disease 2019 (COVID-19). Previously, several meta-analyses with a limited or small sample size and insufficient methodology have been conducted investigating the impact of smoking on disease severity. Here, we use a more accurate method to identify the effect of smoking on COVID-19 disease severity.

 BMC, PubMed, Science Direct, Wiley, Springer, and Google Scholar websites were used to search for and select reliable articles to be included in the current analysis. Research articles that mentioned the relationship between smoking and COVID-19 severity were included. 

 Twenty-six research articles detailing 15,713 confirmed COVID-19 cases comprising patients who smoke were selected to be included in this analysis. The analysis showed a relationship between smoking, severe COVID-19, and non-severe COVID-19 (OR=0:11; 95%CI: 0.10–0.11; p<0.00001). Only 15% (2407) of the smokers suffered severe COVID-19, with the other 85% (13306) of smokers experiencing non-severe COVID-19.

 The current analysis found that only 15% of severe COVID-19 cases were smokers. Therefore, smoking is not significantly correlated with severe covid19.

 Intrinsic features of COVID-19 disease, including the severity of the virus transmission and mortality rates, make it difficult to provide obstetric care to pregnant women. In this regard, telemedicine can provide comprehensive midwifery care relying on new technologies, such as virtual clinic, telehealth, tele-monitoring, m-Health, wearable sensors, and the internet of medical things. The objective of this study is to identify the application and requirements of a telehealth system for midwifery care.

 We conducted a literature search from 2019/12/1 to 2022/10/1 using the following electronic scientific databases: Web of Science, Scopus, PubMed, Science Direct, and Google Scholar. We carried out hand searches from the reference lists of retrieved studies of journals.

 We showed that, during COVID-19 pandemic, prenatal care via telehealth increased and telehealth is a good strategy for prenatal and post-partum disease managements. Mental health services are also feasible via telehealth. These new technologies also reduce the risks associated with interpersonal contacts in COVID-19 pandemic.

 With the COVID-19 pandemic, telehealth became the norm. The future of medical services will be built around this technology and that is a great opportunity to move toward a great evolution.

 Education Development Center (EDC) of the IRAN Ministry of Health conducted a national webinar and evaluated it to know what it achieved, compared to an in-person conference.

 The evaluation was arranged with mixed method design in two quantitative and qualitative parts. In quantitative part, the data was collected through an electronic survey with census sampling. The number and distribution of participants was calculated, the quality of each lecture was rated on a 5-point Likert scale and the cost-effectiveness was estimated by calculating the actual cost. Data collection was done in the qualitative part with formal and informal interviews based on convenience sampling and content analyzed.

 High accessibility, synchronous communication, and wide coverage with convenient diversity indicate proper publicity and well acceptance of the seminar. Increasing awareness, inspiring a new attitude, resolving some ambiguities and 82% satisfaction rate show the overall success of the seminar. Temporal constraints, limited interaction, delay in communication or disconnection and ambiguity of sound were things that aroused dissatisfaction of audience. 0.8% cost of the webinar compare with a hypothetical in-person conference shows acceptable cost -effectiveness. 

 Both in the corona virus pandemic or the post-pandemic era, if the purpose of the educational program is to inform, increasing awareness and motivate the audience, conducting such a national webinar is optimal and recommended and increase equitable access to national experts.

 Twin pregnancies have a higher risk of preterm labor than singletons. Otherwise, progesterone using to reduce the risk of preterm labor in twin pregnancies remains controversial. Therefore, this study evaluated the effect of intramuscular progesterone to prevent preterm labor in complicated monochorionic diamniotic twin pregnancies after Radiofrequency Ablation (RFA) of one fetus.

 Pregnant women with monochorionic diamniotic twin pregnancies of 16 to 26 weeks of gestational age in an academic center were randomly assigned to receive intramuscular 17-hydroxy progesterone caproate weekly until 36 weeks of gestational age after RFA of one fetus and a control group who did not receive intervention after RFA. Demographic and obstetrical characteristics, as well as maternal, fetal and neonatal outcomes were compared between groups. 

 In total, 79 participants were recruited in the study. The mean±SD of gestational age at delivery in case and control groups were 34.6±3.8 and 34.6±5.1 with no significant difference (p=0.967). Neonatal outcomes including birth weight (p=0.870), intensive care unit admission (p=0.415), premature preterm rupture of membrane (p=0.115) and pregnancy outcome (live birth, fetal demise or neonatal death) (p=0.524) were not different either. Indeed, gestational age at delivery was inversely related to cervical length at the time of procedure and maternal body mass index, but these differences were not statistically significant. Also, there was no significant difference in terms of gestational diabetes, which was a worrying complication of 17-hydroxy progesterone caproate. 

 Although 17-hydroxy progesterone caproate seems to be safe with no apparent maternal and neonatal side effects, it does not prolong pregnancy after RFA. Further studies with longer follow up and larger sample size are suggested.

 Cardiovascular disease, which itself can lead to liver disorders, is known as the most common cause of death in many countries, including Iran. Elevated liver enzymes can increase mortality risk after transplantation in most heart surgeries. This study aimed to investigate the effect of elevated liver enzymes before and after transplantation on the risk of perioperative mortality in heart transplant patients.

 The information of this historical cohort study was prepared using patients’ hospital records from 2014 to 2019. The data belonged to demographic information, medical history, and laboratory data of 203 patients admitted to Dr. Masih Daneshvari Hospital. More than three times normal institutional ranges defined elevated liver enzymes. Also, the number of deaths within 30 days after transplantation was considered to determine perioperative mortality. The Chi-square test and regression method were used to analyze the data using SPSS software.   

 Mortality of patients with elevated liver enzymes before and on the first, second, and third days after heart transplantation was 4.08, 3.95, 3.75, and 4.89 times higher than those with normal liver enzymes, respectively. Increasing the Model for End-Stage Liver Disease (MELD) score was associated with a significantly increased risk of death (p<0.001).

 Elevated liver enzymes before or three days after heart transplantation are significantly associated with perioperative transplant death. Optimization of liver function before transplantation can play an important role in preventing mortality.

 The current evaluation was planned to study the effect of vitamin D on improving bacterial vaginosis in premenopausal women with vitamin D deficiency.

 This study was an open-label clinical trial. Forty premenopausal vitamin D deficient women with bacterial vaginosis enrolled in this study. Patients received metronidazole tablet 500 mg twice daily for seven days in both groups. In the vitamin D group, patients also received 50000 IU per day for five days.

 Fourteen days after completion of the study, the number of patients complaining of malodor vaginal discharge, vaginal itching, and discharge discoloration was significantly lower than that in the control group. Regarding the laboratory results, in the vitamin D group, the numbers of Gardnerella vaginalis, gram-negative bacilli, and clue cells in the smear of vaginal secretions were significantly less than in the control group (p<0.05). Furthermore, none of the patients had a positive whiff test after treatment in the vitamin D group (p<0.05). Fourteen days after the completion of the study, the plasma level of 25-OH vitamin D in the vitamin D group was significantly higher than that in the control group. However, the short course of high-dose vitamin D therapy did not increase the plasma concentration of 25-OH vitamin D to the average level.

 Vitamin D supplementation can improve the therapeutic response to metronidazole in vitamin D deficient women with BV. However, large-scale double-blind, randomized clinical trials must confirm this finding.

 Allergic rhinitis is a very common disease which its clinical symptoms can reduce the patient’s quality of life. This study aimed to compare the effects and side effects of desloratadine with fexofenadine on allergic rhinitis.

 The present study is a clinical trial on 68 patients with allergic rhinitis who were randomly divided into two groups named A and B. In the A group, patients used 120 mg of fexofenadine for 4 weeks and in the B group, patients received 5 mg of desloratadine for 4 weeks. After two weeks of rest, patients in the A group received desloratadine, and patients in the B group received fexofenadine for 4 weeks. Then, the clinical conditions and efficiency of the drugs in both groups were compared.

 The severity of symptoms significantly decreased in the A and B groups before and after the treatment (p<0.001 and p=0.007, respectively). The severity of symptoms after taking the first and second drugs in the A group was lower than in the B group. In the A group, the changes in symptom severity after taking the first and second drugs were significantly greater than in the B group. Other symptoms were not significantly different between the two treatment groups (p>0.05 in all cases(. 

 In patients with allergic rhinitis, the use of fexofenadine compared to desloratadine can more effectively reduce the severity of the symptoms of the disease and can be prescribed as a suitable treatment option for these patients.

 Dental caries is an infectious disease caused by bacterial colonization and biofilm formation. Streptococcus mutans (S. mutans) is mainly responsible for dental caries development. Considering the side effects of synthetic antibacterial agents, attempts are ongoing to find antimicrobial agents with minimal or no side effects for preventing dental caries. Based on the reported antibacterial activity of chitosan, this in vitro study aimed to assess the antibacterial and anti-biofilm effects of chitosan nanoparticles on S. mutans clinical isolates. 

 S. mutans isolates were isolated from supragingival plaque and carious lesions of patients by standard biochemical tests and Polymerase Chain Reaction (PCR) of the gtfB gene. The antibacterial activity and Minimum Inhibitory Concentration (MIC), Minimum Bactericidal Concentration (MBC) of chitosan nanoparticles against S. mutans was evaluated by the agar well-plate and broth micro-dilution test, respectively. Also, the effect of chitosan nanoparticles on biofilm formation was evaluated using micro-titer plate method. Data were analyzed using ANOVA.

 Fifteen S. mutans isolates were collected from patients. The chitosan nanoparticles synthesized had a diameter of 20–30 nm. The chitosan nanoparticles showed antibacterial activity against S. mutans isolates. MICs and MBCs ranged from 0.625-2.5 µg/ml and 1.25-5 µg/ml, respectively. All isolates evaluated in this study were biofilm-forming and 5 of these produced a strong biofilm. The chitosan nanoparticles inhibited biofilm formation at 0.75 µg/ml concentration. 

 Chitosan nanoparticles had antibacterial and anti-biofilm activity on S. mutans clinical isolates. This study suggests the potential of chitosan nanoparticles as antimicrobial agents against cariogenic Streptococci.

 This study aimed to determine the distance between the hard palate and the tongue and its relationship with Nasal Septal Deviation (NSD).

 This descriptive-analytical study was conducted on patients aged 18 to 60 years referred to the ENT clinic of Milad and Masih Daneshvari Hospitals. Patients were also divided into two groups (patients with and without NSD). Coronal CT scan was taken in all patients in the same position. In this regard, these pictures were taken vertically from the highest point of the hard palate to the tongue, the transverse distance between the two upper third molars of the upper jaw, and the ratio of these two distances.

 The mean age of patients with and without NSD was 35.82±12.49, and 33.99±12.78 years old (p=0.66). The distance of hard palate to tongue in patients with and without NSD was 13.05±4.52, and 12.26±4.68 mm, respectively (p=0.32). The intermolar distance in these patients was 34.2±3.50, and 34.40±3.31 mm (p=0.78), respectively. This ratio in the two groups was 0.38±0.13, and 0.34±0.11, respectively (p=0.16).

 According to these findings, no significant difference was observed between the patients with and without NSD regarding the distance between the hard palate and tongue, intermolar distance, and its ratio, but the distance of hard palate to tongue, and the ratio in the patients with NSD was slightly higher than patients without NSD. Further studies using coronal CT scan in larger samples are needed to clarify the role of the distance of hard palate and the tongue in NSD.

 Due to the lack of definitive treatments for corona disease and the use of various medications in protocols around the world, it is necessary to conduct more epidemiological studies exploring the effect of different available therapeutic regimes; therefore, the present study aimed to explore the current effective drugs for the treatment of hospitalized COVID-19 patients.

 The present study is a descriptive-analytical study that was conducted between August and September of 2021 at Khalkhal University of Medical Sciences. A convenient sampling method was employed to retrieve the data from the available hospital records, including 252 documents from COVID-19 hospitalized patients. A researcher-made checklist was used to record the data. Data were analyzed using SPSS 26 software.

 The findings showed that Hypertension and Hypotension (n=47,18.7%) are the most common underlying diseases in the study sample. The most therapeutic regimen was the combination of Remdesivir and Dexametason (n=137,54.4%) in hospitalized COVID-19 patients. There are a variety of organ involvements and presentations to the COVID-19; however, most patients experience a mild-to-moderate, self-limited disease; even though, the disease could progress to more fatal cases and lead to death. 

 The main pathology exists in the lungs which are caused by an inappropriate immune response that leads to a severe inflammatory response. Therefore, antiviral and anti-inflammatory drugs are currently the first-line therapy for hospitalized patients.

 Acute Appendicitis (AA) is a common cause of emergency room visits among children.  Non-specific symptoms of appendicitis may pose a major challenge. Due to the lack of access to imaging modalities in all facilities and its high cost, the evaluation of clinical symptoms and examination results is important in diagnosing acute appendicitis.    

 This study is a retrospective cross-sectional study. Patients admitted to our emergency department and were suspected of having acute appendicitis by pediatric residents, and underwent an appendectomy during 2013-2018 were included. A checklist of the patients’ clinical signs and symptoms, and laboratory results and imaging findings completed from the records of these patients.

 We reviewed the files of 300 patients with a clinical diagnosis of acute appendicitis and having an appendectomy. Leukocytosis was found in 248 (82.7%), neutrophilia in 240 (80%) and CRP level equal or above 12 mg/L was observed in 107 (35.7%) patients. Ultrasound was performed in 283 patients (94.33%); of which 228 (80.56%) were reported as acute appendicitis. Abdominal CT scan was performed in 19 patients (6.33%); of which acute appendicitis was reported in 17 patients (89.47%).   

 The results of this research showed that RLQ tenderness, and nausea/vomiting are the most common signs and symptoms, and leukocytosis is the most common laboratory finding in children with acute appendicitis. It can be suggested that relying just on the clinical presentation of AA (RLQ tenderness, fever, nausea/vomiting, anorexia and leukocytosis), can lead to the correct diagnosis of 78% of the suspected patients.

 To investigate the effects of the COVID-19 pandemic on the patients’ attendance/distribution patterns within different departments and the perception of the dental team providing dental services during the COVID-19 outbreak in a private dental clinic. Moreover, the impact of SARS-CoV-2 on dental professionals next to the role of personal protective equipment in the prevention of infection in the corresponding teams was simultaneously investigated.

A clinic located in the northern part of Tehran was selected. Forty-four dentists with 48 staff members were involved in treatment teams. Preventive strategies, i.e., personnel/operator/patient management comprising full Personal Protective Equipment (PPE), high–volume evacuation suctions, primary screening questions, pulse oximetry, the patient’s body temperature measurement as well as administrative controls, e.g. disinfection of surfaces and using stairs instead of lifts, were implemented to manage the prevalence of disease and analyze the impact of COVID-19 on the distribution/attendance patterns of patients. 

 During 6 months, a 26% reduction in the number of patients was observed after the pandemic; however, men’s and women’s distributions were not affected. The department of orthodontics reported a 6% increase in new cases whereas the department of pediatric dentistry revealed the least changes in the number of patients. In the departments of operative dentistry, prosthodontics, oral/maxillofacial surgery, and periodontics, the number of patients was reduced by 10-30%. In addition, three dentists and four staff members were affected by COVID-19 during the mentioned period.

 It seems that the potential for COVID-19 transmission in dental clinics is relatively low.

We conducted this study to determine the safety and evidence of effectiveness of SeptimebTM among patients with COVID-19.

An uncontrolled phase II clinical trial with SeptimebTM was implemented in Imam Khomeini Hospital as a before-and-after trial during May to October 2020. Considering the inclusion and exclusion criteria, 33 patients with COVID-19 were treated using SeptimebTM. The patients received the anti-inflammatory drug 150 mg /10 ml /IV infusion SeptimebTM on the first day and then 300 mg /20 ml / IV infusion from the second day onwards for at least 2 days and up to 13 days based on the improvement of clinical symptoms and laboratory findings in addition to treatment which were selected according to the national protocol. The patients were then evaluated for the treatment efficacy and side effects. Adherence to treatment, clinical observations, and side effects were recorded before and after the treatment.

The herbal drug SeptimebTM was injected in phase two of an uncontrolled clinical trial on 33 patients with COVID-19 in Imam Khomeini Hospital in Tehran as a before-and-after trial. The number of new cases admitted to the Intensive Care Unit (ICU) and the new need to Non-Invasive Ventilation (NIV) ecreased compared to before the treatment. Also, blood oxygen saturation and platelet count increased. Conversely, CRP, ESR, and ferritin levels decreased (p<0.05). Besides, SeptimebTM did not show any serious side effects except recurrent thrombophlebitis during the treatment.

We found some evidence regarding the efficacy of this drug and its low amount of short term side effects. The investigators recommend conducting the third phase of the clinical trial.

 The aim of the study was to determine the anatomical variations of the sphenoid sinus and its adjacent critical structures using Cone-Beam Computed Tomography (CBCT). 

 This cross-sectional study was conducted on CBCT scans of 67 females and 84 males between 18 to 67 years. Presence/absence of intersphenoid septa, sphenoid sinus pneumatization and its type (conchal, presellar, sellar, and postsellar a and b), protrusion of the optic canal and carotid canal into the sphenoid sinus, optic canal and carotid canal dehiscence, and Anterior Clinoid Process (ACP) pneumatization was evaluated on CBCT scans, and their prevalence and correlation were calculated. Data were analyzed by the Chi-square test (alpha=0.05).   

 The prevalence of intersphenoid septa was 98.68%. Postsellar type a was the most common type of sphenoid sinus pneumatization with a prevalence of 41.3%. The prevalence of conchal, presellar, sellar and postsellar b types was 0, 11, 30, and 17.7%, respectively. The prevalence of optic canal and carotid canal protrusion into the sphenoid sinus was 50 and 52.7%, respectively. The prevalence of optic canal and carotid canal dehiscence was 48.3 and 40.3%, respectively. The prevalence of ACP pneumatization was 45%. Optic canal and carotid canal protrusion had a significant correlation with ACP pneumatization (p<0.001). Also, carotid canal and optic canal protrusion and dehiscence were significantly correlated with degree of sphenoid sinus pneumatization (p<0.001). 

 Sphenoid sinus pneumatization significantly increases the likelihood of carotid canal, optic canal protrusion into the sphenoid sinus and their dehiscence, therefore, a preoperative 3D imaging is strongly recommended prior to trans-sphenoidal surgical procedures.

 Following the outbreak of coronavirus and its impact on the educational process of medical students, attention was paid to e-learning due to the importance of education and research. The aim of the present study is an evaluation of virtual and actual education models on the learning of internal interns during the COVID-19 pandemic. 

 The present study is a trial that was performed on 112 internal interns of hospitals from January to December 2020. Each participant was randomly assigned to one of the actual or virtual educational model groups with personal consent. Educational method was case-based discussion in both groups. The learning outcomes of the interns of these two groups were compared in 9 areas with 95% confidence level and 5% random error. Data about age, sex, type of residence (home or dormitory), pre-internship score (≤150 or >150) and entrance exam rank (≤300 or >300) were collected. Data were analyzed using SPSS Version 20.

 The mean ±SD age of the participants was 24.9±2.3 years, 46% of participants were men and 54% of them lived in dormitories. The results of the study show that the difference in pre-test and post-test scores with actual and virtual education models in the male and female is significantly different (p-value=0.020). Virtual education for men and actual education for women have resulted in higher difference scores in pre-test and post-test. Actual and virtual education models were not different in academic achievements of the participants. Thus, the scores obtained in 9 areas did not make a significant difference between the two types of educational models.

The comparison of virtual and actual education demonstrated that there is no significant difference between these two methods in student output. Given the conditions that have been created by COVID-19 in the world, it seems that the use of virtual education can be a good alternative to educating medical students so that education does not stop.

 The purpose of this study was to assess the presence of Disaster Medical Assistance Team (DMAT) members at the site of disasters and related factors.

 This quasi-experimental study was conducted on all 178 DMAT members in Iran in 2020. A researcher-made questionnaire was used to collect data, which consisted of 20 questions. On a pre-appointed time, DMAT members were called for disaster by receiving a text message and asked to come to a pre-appointed place. Data analysis was performed using descriptive and inferential statistics, included chi-square test. 

 Only 29% of the members responded to the call and showed up at the place. There were significant relationships between being a clinical member, membership in similar organizations, experience of work in disasters, worries about the health of the child, responsibility for taking care of an old family member, believing the disaster site’s safety and security and the availability of personal protective equipment in the disaster site with the status of response to disaster call.

 Overall, the response rate to call was very low, which indicates the need to take measures to improve it. Continuing training and providing safety at disaster areas and support for family members will increase the presence at work in disasters.

 Since the risk factors for miscarriage vary in different societies, the present study was conducted to investigate the effect of the related factors on miscarriage in the west of Iran (Zanjan city). We aimed to determine the modifiable and non-modifiable predictors of miscarriage.

 In this case-control study, 219 cases and 420 controls were selected among those living in the Zanjan (a city located in western Iran) in 2019. Data were collected by a 25-item checklist of medical records available in the comprehensive urban health service center. For assessing the effects of explanatory variables on miscarriage, the multiple logistic regression model was used at a 95% confidence interval. All analysis was conducted by Stata 14 software. 

 Short birth interval (less than 36 months) (OR=2.4, p<0.001) and ectopic pregnancy (OR=3.5, p<0.011) increase the odds of miscarriage. In other words, high education reduced the odds of miscarriage (OR:0.07,p<0.001).

 In the present study, increasing age, low education level, history of previous coagulation, previous spontaneous abortion, history of previous ectopic pregnancy and short birth intervals (less than 36 month) were associated directly with miscarriage.  

 Breast cancer, the most common cancer in women, has a significant challenge in the early diagnosis of medicine. This study aimed to evaluate the diagnostic value of the neutrophil-to-lymphocyte ratio in differentiating benign and malignant breast masses by an economical and straightforward test of Complete Blood Count (CBC).

 This study was a retrospective cross-sectional that was performed on 75 patients with breast masse (40 had benign breast mass and 35 had malignant mass). Data was obtained from the patient’s hospital sheets with health ministry ethics permission. This information was demographic data including CBC, CBC diff, neutrophil/lymphocyte ratio, BMI, and pathologic results of biopsies. Data were analyzed by chi-square, Mann-Whitney, fisher’s exact tests, t-test, and ROC maps in SPSS version 16 software.

 The diagnostic power of neutrophil-to-lymphocyte ratio in the diagnosis of malignant tumor or benign according to the cut-off point was 1.74, and significant. Sensitivity and specificity were 85.71 and 45%, respectively, and their positive and negative predictive value was also found to be 57.76 and 78.26%, respectively, and the overall accuracy of the test was 64%.

 The neutrophil-to-lymphocyte ratio has high sensitivity and low specificity that can help identify positive malignant breast masses. Due to the low specificity, the negative results, however, cannot detect the nature of breast masses with high precision. Therefore, this test is considered a preliminary method that is complementary to other more explicit tests used for the identification of malignant breast masses.