مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هشتاد و یکم شماره 1 (پیاپی 264، فروردین 1402)

Stem cells play an important role in tissue regeneration and treatment of diseases. This study aimed to investigate the awareness, knowledge and attitudes regarding stem cell donation among different people in the community.

In this systematic review study, Persian keywords and English keywords such as awareness, knowledge, stem cells, embryonic stem cells, adult stem cells, cord blood stem cells and donation were selected according to MeSH database and then these selected keywords have been searched in the academic databases such as PubMed, Scopus, OVID, Science Direct, Iran Medex and SID. In addition, these selected keywords have been searched in the search engines such as Google Scholar, between January 2010 to December 2021.

The results of this study found a total of twenty-five articles related to the awareness, knowledge and attitudes regarding stem cell donation among different people in the community. They were selected. In this study there were 10 cross-sectional studies, 2 descriptive-cross-sectional studies, 5 descriptive studies, 1 mixed method study, 1 semi-experimental study, 1 intervention study, 1 survey study, 1 review study, and the study type was not mentioned in three studies. Most of the studies were conducted in countries such as India, Saudi Arabia, and then United States (USA) and Turkey. Only one article was found in Iran. The results of studies have shown that the level of awareness and attitude of the majority of different people in the community towards the donation and use of stem cells is medium and low. However, most people have a good and positive attitude towards the donation and use of stem cells and mention the use of stem cells as an effective way to treat diseases.

Considering the importance and application of stem cells, it is suggested that managers and planners provide the necessary conditions to implement educational programs to raise the level of awareness and attitude of different people in the community towards stem cell donation.

Syncope is a temporary loss of consciousness with a loss of postural tone. Medicinal treatment of reflex syncope has shown to have no significant effect in reducing the recurrence of syncope. A 36-month follow-up of our pilot cohort showed that non-pharmacological treatments alone were effective in reducing relapse rates. The purpose of this study is to investigate long-term results and 8-year follow-up of previous patients.

The current study is a continuation of a prospective pilot cohort which was done between August 2013 and 2014 in two academic hospitals in Isfahan (Dr. Chamran heart center and Imam Hossein children hospitals). This current study examines the 8-year follow-up results of children with reflex syncope who were treated with non-pharmacological treatments alone or with drugs. Therefore, the patients who participated in the pilot study were enrolled (30 patients in the pharmacologic group and 40 patients non-pharmacological group). Finally, on 26 patients in the pharmacologic group and 31 patients in the non-pharmacological group (after applying the exclusion criteria), the incidence of syncope and pre-syncope attacks was compared between these two groups of patients using the Chi-square test.

Our study showed that within 5 years after the last follow-up, the incidence of syncope and pre-syncope in patients with a history of vasovagal syncope who did not continue the diet or tilt exercises was different between the two groups of patients (without medication and drug recipient) was not significantly different, even the incidence of presyncope increased significantly again in both groups. The incidence of syncope in the period of 5 years after the last follow-up from the previous study was slightly increased in the group of patients without medication compared to the previous periods, but in the group of patients receiving medication, this incidence decreased slightly.

In order to prevent recurrence, the use of non-pharmacological methods is effective, but for the stability of this recovery, follow-up and continuation of these methods is necessary.

Osteoarthritis (OA) is the most common form of arthritis characterized by progressive loss of articular cartilage, causing pain and loss of articular function. High glucose is a crucial inflammatory factor playing a pivotal role in the pathogenesis of OA that induces ROS production. Since most of the current therapies for OA are short-term benefits, hence, there is high demand for finding novel therapeutic agents for OA treatment. Recent studies have demonstrated that mesenchymal stem cells secrete important therapeutic factors that protect chondrocytes. In the current study, we investigated the protective potential of Adipose-derived stem cell conditioned medium (CM-ADSC) as an alternative to cell therapy in high glucose-mediated oxidative stress in C28I2 human chondrocytes.

This experimental study was performed in the Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran from May 2018 to August 2020. Adipose-derived stem cells were cultured until they reached 90% confluence then washed with PBS and cultured in a FBS-free medium for 48 hours. The conditioned medium was collected and centrifuged. The protective effect of the concentration of conditioned medium on high glucose (75mM)-induced oxidative stress in C28I2 cell viability was evaluated by WST-1 assay. Total RNA was isolated from the treated and untreated cells with TRIzol reagent. The mRNA expression of antioxidant enzymes including, glutathione S-transferase-P1 (GSTP1), catalase (CAT), and superoxide dismutase1 (SOD1) was evaluated by reverse transcription-polymerase chain reaction in treatment and non-treatment groups.

Adipose-derived stem cell conditioned medium pretreatment remarkably protected C28I2 cells against high glucose. The expression of mRNA of CAT, GSTP1, and SOD1 significantly increased following treatment with the conditioned medium (50%) for 24 hours in high glucose-exposed cells as compared to the control.

Present study indicates that the Adipose-derived stem cell conditioned medium can reduce oxidative stress. It seems that the conditioned medium may protect cartilage in the progression of osteoarthritis.

Improving the quality of life of patients is the main goal of therapeutic interventions in chronic diseases. One way to achieve this is to decrease the severity of symptoms. The aim of this study was to investigate the effect of curcumin capsule on quality of life and symptoms of patients with irritable bowel.

This clinical trial study was performed on 60 patients with irritable bowel syndrome referred to Amir al-Momenin Hospital in Arak city from April to September 2018, using convenience sampling and Extra-intestinal symptoms severity scale and WHOQOL_BREF tools. The patients were divided into two groups of intervention and control, curcumin capsules were used in the first one, and in the second one, placebo capsules were used twice a day after lunch and dinner for four weeks. All patients were examined at the beginning of the study, the fourth week and three months later, in terms of quality of life, severity and frequency of symptoms and possible complications. During this period, the patients were followed up on a monthly basis through phone calls, and the contact number of the researcher was provided to the patients to call in case of any problems or questions.

The average age of the curcumin group was 35 years and for the placebo group was 36.43 years. There was no significant difference in the quality of life between the curcumin and placebo groups after the intervention (P>0.05). Significant were found between the curcumin and placebo groups after the intervention (P<0.05).

The results of this study showed that there was a significant difference between curcumin and placebo in improving the clinical symptoms of patients, but the quality of life of patients in both curcumin and placebo groups did not change significantly after the intervention.

Nowadays, beauty practices have attracted the attention of people following the change in lifestyle and social values. Therefore, the present study was conducted with the aim of examining the opinion of experts regarding the challenges and management solutions of the aforementioned practices in Iran.

This qualitative study was conducted through interviews with 26 policymakers and cosmetic surgery service providers in Tehran from April to September 2022. Sampling was purposeful and snowball. The interviews were semi-structured and thematic analysis was used to analyze the data obtained from the interviews. The inclusion criteria for the interviewees' entry were knowledge and experience in the subject and willingness to participate.

Challenges under the four categories of service providers (improper education, non-specialist providers, moral hazards, deficiencies in the way laws are written, and the ineffectiveness of the complaint handling process), service receivers (being influenced by deceptive advertisements, low level of public health literacy and lack of mental health), the place of providing services (performing surgeries in non-standard places and non-integrated information system) and medicines, products and medical equipment (insufficient control over supply, distribution and use and price fluctuations) were categorized. Experts considered the major part of the challenges to be related to the service providers. In the category of service recipients, "being influenced by deceptive advertisements" was the main problem mentioned by the experts. Performing surgeries in non-standard places, including limited surgery centers, non-sterile places, and unauthorized places, is among the unsolved problems regarding the place of providing services. In relation to medicines, products, and medical equipment, the main problem was insufficient supply, distribution, and use supervision.

The main effective measure to solve the challenges is to strengthen the supervision of the health system administrator with internal and external coordination and cooperation. In this regard, it is recommended to develop educational, ethical, and legal frameworks, regulate regulatory laws, public awareness, clinical interviews and psychological counseling, especially before cosmetic surgery, and the establishment of an integrated electronic health record system.

Patient satisfaction is considered as one of the most important elements of the evaluation of healthcare centers. In this research, the level of satisfaction of infertile patients was evaluated.

This study is a cross-sectional descriptive study. The research population is infertile patients who referred to the infertility clinic (at least 4 visits) and hospitalized in four hospitals affiliated with the Tehran University of Medical Sciences. The satisfaction questionnaire was valid researcher-made which included 56 questions in 9 areas, and were collected from May 2021 to September 2022. In order to comply with the ethical principles in research, hospitals were named 1-4.The results were analyzed using the chi-square test or Fisher's exact test for qualitative variables and analysis of variance for quantitative variables in SPSS software, version 24 (SPSS Inc., Chicago, IL, US).

Results:

 Three hundred–four infertile women in four hospitals were studied. The mean age of the participants was 33.8 years, with a standard deviation of 5.8 years. The average satisfaction with admission and discharge services, medical services, nutrition, accounting, and insurance services in the number-1 Hospital had the highest score, and the average satisfaction with nursing or midwifery services, diagnostic and therapeutic services (radiology/laboratory), hospital services, charter patient rights, management services, paid expenses in Hospital 4 received the most points. The mean score of satisfaction was the highest among those who visited the infertility clinic of Hospital 3 (161.54±21.41). Average satisfaction with admission and discharge services, medical services, nutrition, accounting, and insurance services in Hospital No. 1 had the highest score, and average satisfaction with nursing or midwifery services, medical diagnostic services (radiology/laboratory), hospital services, respecting the patient's rights, management services, paid expenses in hospital number 4 got the most points. The average of nursing or midwifery services, respecting the patient's rights, and hotelling in all hospitals received the highest score, respectively, and nutrition services and paid expenses received the lowest points (most dissatisfaction) (P<0.05).

The level of satisfaction of women referring to the infertility clinic in 35.9% of cases was considered to be at an appropriate and exceptional level, in 49.3% of cases it was at a partially appropriate level, and in 14.8% at an inappropriate level.

Some negative psychological factors such as depression, anxiety, and stress have been identified as serious risk factors for the final adverse outcome of ischemic heart disease. Given the high prevalence of psychiatric disorders, in this study, we aimed to determine the relationship between the severity of depression, anxiety, and stress, with nuclear scan results in patients referred to Imam Khomeini Hospital in Urmia.

In this cross-sectional-analytical study, 163 patients with the possibility of ischemic heart disease from various clinics and medical centers referred to Imam Khomeini Hospital in Urmia for nuclear heart scanning from April to July 1400, were assessed by the DASS-21 questionnaire in terms of depression, anxiety, and stress scores. Finally, the data obtained from the DASS-21 questionnaire, nuclear scan, and demographic characteristics were analyzed with SPSS20 software.

According to the results, the mean age of the patients was 54.78±11.54 years, 73% of whom were women. The prevalence of depression, anxiety, and stress was high (72.4, 80.3, and 59.5%, respectively). Although the prevalence of depression, anxiety, and stress in patients with a negative report of ischemia was higher and evaluated as 73.2, 78.7, and 58.3% respectively, there was not a significant difference with the subjects whose heart scan results were positive (P>0.05). Moreover, a weak positive correlation was observed between the severity of depression, anxiety, and stress with the severity of cardiac ischemia in study patients.

The results of this study revealed that the depressive, anxiety, and stress symptoms in patients before a cardiac nuclear scan are often moderate to mild. Likewise, among the different demographic characteristics of patients, only gender played an important role in these disorders. Regardless of the negative nuclear scan results in most patients (77.9%), the prevalence of these psychological symptoms in the studied patients was high. Therefore, considering the possibility of psychological disorders with clinical manifestations mimicking cardiovascular can prevent additional costs for diagnostic and therapeutic procedures in these patients.

The rate of exclusive breastfeeding in Iran at the ages of 3 and 6 months is estimated to be 44% and 27%, respectively, which is still far from the optimal index of the World Health Organization until 2030 (70% in the first six months). In order to monitor breastfeeding counseling centers, which have been set up with the aim of promoting breastfeeding and supporting mothers who have problems with breastfeeding.

This is a descriptive-retrospective study and all the mothers who were referred to the Health and Treatment Center No. 2 in Mashhad between April 2019 and March 2019 were examined. This health center has two active counseling clinics and the collection of information is based on documents registered in offices and computers. The inclusion criteria for study were not having breast diseases, having an infant child, being able to read and write and living in Mashhad city. The exclusion criteria were also the unwillingness to participate in the study and the newborn suffering from diseases that are incompatible with breastfeeding. Therefore, census sampling was done. The data were analyzed using SPSS 16 software and the significance level was less than 0.05.

In 42.8% of cases, mothers had started feeding combined formula with breast milk before visiting, and in 28.1% of cases, when referring to counseling milk clinics, it was reported that the baby was fed only with formula. After breastfeeding consultations and follow-ups at the end of six months, the rate of exclusive breastfeeding is 34.1% (12% increase compared to the initial reference) and combined formula feeding with breastmilk is 27.8% (a 22% decrease compared to the first visit). And feeding with powdered milk alone was calculated to be 36.5% (an increase of 8.4% compared to the first visit).

The positive role of breastfeeding counseling center in reducing the cases of artificial feeding is clear, and it is recommended to prepare written instructions based on the challenges in breastfeeding for breastfeeding counseling in the first month after delivery.

Medical Laboratories have a great impact on patient safety and 80-90% of medical diagnoses are based on the results of laboratory tests. Medical procedures from the initial diagnostic steps such as a test or a simple injection to specialized treatment steps may be erroneous. The aim of this study was to determine the type and rate of human error, equipment, materials and procedures in all stages including before analysis, during analysis and after analysis to analyze the causes and find logical solutions to reduce of them.

This cross-sectional descriptive study was performed in a medical center in Tehran, Iran during the years 1400-1401. Data collection was considered in accordance with the instructions of the Laboratory Affairs Department of the Ministry of Health and Medical Education regarding the type of errors in the field of job description in each of the technical and non-technical sections. Data was analyzed by IBM SPSS software, version 22 (SPSS Inc., Chicago, IL, USA) software.

During the period of study, the number of  referred patients was about 45,000 and the number of tests 594,000. The total number of errors was 837. The ratio of errors to the patients was 1.9% and to the tests 0.15%. The 37 types of errors were identified and reported in this study. Of these, 11 types of errors were in the pre-analysis, 14 types during the analysis and 12 types of errors in the post-analysis stage. The frequency of errors in the three stages was 180(21.5%), 312(37.3%) and 345(41.2%), respectively that the errors rate did not have a normal distribution and a significant difference was observed (P<0.05, df=2).

Due to the variety of reported errors and the importance of their role in other stages of diagnosis and treatment, it is necessary that all human, equipment and process errors in all stages of laboratory analysis be carefully recorded and corrective and preventive measures be taken to minimize them.

By examining the comprehensive system for evaluating the academic progress of general medical students, often the objectives of the cognitive domain and the form of cumulative evaluation were used, and the tests were not used much for feedback to the students. The aim of the study is to develop a model that fits the levels of Miller's evaluation pyramid in formative-cumulative forms.

The search was started in Iranian and international databases, magazines, curriculum of prestigious universities in the world. To find out about the latest events in the field of assessment, AMEE international virtual conferences in August 2021 and the summary booklet of medical education articles of Shahid Motahari 1400 (the 22nd national conference of medical education) were reviewed. Data analysis was done by Beredy's adaptive model. The search and analysis lasted for 11 months. Finally, a model was developed according to Miller's evaluation pyramid. Its validation was done in the focus group meeting in two ways, in person at Mashhad Medical School and virtual.

According to the extracted data, the approach of assessment is towards formative assessment format and improvement of traditional methods along with modern methods, which was clearly observed in the study of the curriculum of Harvard-Stanford University in America and Oxford University in England. Integrating the results with Miller's evaluation levels, and the formative and cumulative evaluation format, led to the formulation of a model with the most favorable opinions of experts. In addition, the majority of opinions and suggestions of experts were related to the change in the way of executive policies of universities and providing a context for the emergence of new idea.

A model including measurement methods according to the levels of Miller's evaluation pyramid was developed in formative-cumulative. It is suggested that the model be reviewed by the relevant experts and notified by taking into account the implementation conditions for the correct evaluation process.