Shiraz Emedical Journal
Volume:24 Issue: 7, Jul 2023

Context:

 Salivary cortisol could be a good marker for temporomandibular joint disorders. This article aimed to study the association between salivary cortisol and temporomandibular joint disorders (TMD).

 PubMed, Web of Science, Scopus, and Embase were searched according to the PRISMA guidelines without restricting the publication start date until October 2022. Only case-control studies were included in the study. The critical appraisal checklist of the Joanna Briggs Institute was utilized to appraise the selected articles.

 Of 1173 articles found, 23 studies were eligible, and 18 were meta-analyzed. A total of 696 TMD patients and 785 controls were included. Meta-analysis showed that salivary cortisol was significantly higher in patients with TMD than the controls. Meta-regression showed that the difference in mean salivary cortisol decreased significantly between the two groups with increasing age.

 The salivary cortisol in patients with TMD is significantly higher than in the controls. As the heterogeneity among the studies was high, more studies are required to verify this association.

 Exercise stress test (EST) is commonly performed to diagnose cardiovascular diseases. Patients undergoing EST usually experience anxiety and stress mainly because they lack knowledge about the test.

 The present double-blinded randomized controlled trial aimed to compare the effects of education via face-to-face, interactive multimedia, and short messaging service (SMS) methods on anxiety level (main outcome) and vital signs (secondary outcomes) in candidates for EST.

 Candidates of EST with moderate to severe anxiety were allocated randomly (block size of 6) to receive education via the face-to-face routine method (control, n = 47), multimedia (n = 48), or SMS (n = 49). The educational content was similar in the groups and focused on EST methods, preparations, and potential adverse effects. Anxiety was assessed at baseline and one week after education. The patients’ blood pressure and pulse rate were measured at baseline, before, and after the EST.

 One-hundred-forty-four patients completed the study. The post-intervention anxiety reduced significantly in the SMS group compared to the control group (P < 0.001, Cohen’s d = -1.09) and in the SMS group compared to the multimedia group (P < 0.001, Cohen’s d = -0.83). The anxiety score was not significantly different between the multimedia and control groups (P = 0.454, Cohen’s d = -0.26), although within-group comparison showed a significant decrease in the multimedia and SMS groups. Patients who received education via SMS also experienced lower pulse rates than those in the control group.

 Because of the effectiveness of education via SMS in decreasing patients’ anxiety scores, we recommend using this method to prevent anxiety before EST, especially in developing and low-income countries.

 Hospitals are the front line of dealing with Incidents. Chemical, biological, radiological, and nuclear (CBRN) incidents are alarming for governments' healthcare providers and the public. Therefore, they must make the necessary preparations to deal with these incidents.

 This study aimed to evaluate the preparedness of hospitals against chemical, biological, radiological, and nuclear incidents and the related influential factors.

 The present study was a cross-sectional survey in northwest Iran, 2020-2022. The statistical population was the hospitals of West Azerbaijan province. The inclusion criteria were that hospitals must be university or therapeutic affiliated with the West Azerbaijan University of Medical Sciences, and at least one year had to be passed since the hospital’s operation. Also, the exclusion criteria were that the hospitals were on the verge of closing or changing their use. In this way, 26 hospitals in West Azerbaijan were studied. The "Canadian Center for Emergency Preparedness" evaluation checklist research tool was used to determine the level of preparedness of the studied hospitals in CBRN incidents. The data was collected for 5 months, from January to May 2021. Cronbach's alpha score for this checklist was 0.94. Descriptive and analytical statistics indicators were used for data analysis using SPSS 20 software.

 The study showed that the hospitals lacked the preparation, capacities, and abilities to deal with CBRN incidents. In the single-variable mode, in the chemical dimension, the number of morgues of the deceased (P = 0.006); in the biological aspect, per capita educational factors in the biological domain (P = 0.03), the number of facility personnel (P = 0.04), the number of infectious disease specialists (P = 0.02), the number of equipment with optimal laboratory capabilities (P = 0.04), and the number of morgues of the deceased (P = 0.006); in the radiological and nuclear dimensions per capita of nuclear education (P = 0.01) and dosimeter (P = 0.03), and the general dimension the CBRN training per capita (P = 0.004), the number of personnel (P = 0.015), and laboratory equipment (P = 0.006) had a significant relationship with the preparedness of hospitals against CBRN incidents (P < 0.05).

 Overall, this study's results showed that hospitals' preparedness against CBRN incidents was unsatisfactory, and appropriate policies needed to be adopted to improve it.

 This study presents the legal obligations set for the main stakeholders in the establishment and implementation of electronic health (e-health) records in Iran and investigates the fulfillment of these obligations.

 This qualitative study was conducted using document analysis. The research population comprised all the documents, laws, reports, and policies of the establishment and utilization of electronic health records in Iran. Sampling was purposive, and all the internal documents of Iran were included until the end of May 2022. A data extraction form was used to collect the data, and Scott's criterion was used to select the documents. Descriptive analysis was used to analyze the data.

 Based on the documents, 56% of the sentences were implemented, and 22% were not enforced according to the assigned tasks. The status of the execution of tasks by the main players was also extracted. The most important of these included the drafting of the electronic health security and privacy regulations, not providing the conditions for receiving electronic copies in the e-records, creating internal automation for the Ministry of Health and Medical Education instead of the e-health records system, instability of the integrated portal for exchanging health information and disconnection of the majority of service centers, eliminating the extension of the validity of paper booklets, operationalizing the online entitlement system, using the first phase of the electronic prescription project, not inserting nursing notes in the records, recording financial and administrative information instead of clinical ones, refusal of numerous doctors to write electronic prescriptions, using an alternative method of two-step verification instead of electronic signature, the progress of coding and drug authenticity, and the non-implementation of medical equipment coding.

 Reviewing the status of the enforcement of approvals also revealed that the format of actions since 2018 has ended with a positive result. The main achievement so far has been electronic prescription, while it should be noted that prescription is only part of the electronic health record project.

 Brachial plexus variations have been observed in some people. The median nerve is one of the branches of this plexus, formed by the union of the medial and lateral cords. The median nerve usually does not have a branch in the arm region and innervates the forearm and hand muscles.

 During the dissection of the right axillary cavity of a 74-year-old male donor for medical students, the variation in the innervation of arm muscles was observed. Unexpectedly, the biceps brachii and brachialis muscles were innervated by the branches of the median nerve. The median nerve normally does not have a branch in the arm region and innervates the forearm and hand muscles. The musculocutaneous nerve (C5-7) is a terminal branch of the lateral cord and innervates the three muscles of the anterior compartment of the arm, namely coracobrachialis, biceps brachii, and brachialis muscles.

 The innervation of the arm's anterior compartment muscles by the median nerve is a rare variation that has never been seen in this country. Awareness of such anatomical variations is necessary for physicians and clinicians. These variations should be taken into consideration during axillary region surgeries.