مجله علمی پزشکی جندی شاپور
سال بیست و دوم شماره 1 (پیاپی 142، فروردین و اردیبهشت 1402)

Background and Objectives One of the most important proteins of the SARS-COV-2 virus is S protein, which consists of S1 and S2 subunits. The most important region insubunit S1 is the receptor binding region (RBD), which plays a key role in binding toACE receptors. The RBD is a conserved region in S protein that is the target of theimmune system and the production of antibodies against the virus. Due to theimportance of this region in the production of neutralizing antibodies, it can be a goodcandidate for vaccine development and production of diagnostic kits. Therefore, thepresent study aimed to assess the response rate of antibodies in the serum ofrecovered COVID-19 cases using recombinant RBD protein produced in the prokaryoticexpression system as an inexpensive expression system.Subjects and Methods In this study, the recombinant PET22b-RBD construct wastransformed to the Escherichia coli (BL21) host, and the bacterial cells were culturedin a culture medium; thereafter, protein expression was induced using isopropyl beta-D-thiogalactoside (IPTG). The expression of recombinant RBD protein was confirmedby acrylamide gel (SDS-PAGE) and Western blotting. Finally, the desired protein wasextracted using a Ni-NTA column and applied in an indirect ELISA.Results In comparison with the serum of healthy individuals (cut off: 0.412), nosignificant increase was observed in the response of 30 serum samples to therecombinant RBD protein.Conclusion The recombinant RBD protein produced in the prokaryotic host did notrespond significantly to the antibodies in the serum of recovered COVID-19 patientsand cannot be used for diagnostic purposes.

Background and Objectives The COVID-19 pandemic, with its impact on the educational systems, led to the closure of face-to-face courses and the transition of universities to virtual education. This study was conducted to examine the strengths and weaknesses of virtual education based on measuring the satisfaction of medical externs and the quality of clinical education during the COVID-19 epidemic at the Shahrekord University of Medical Sciences, Shahrekord, Iran. Subjects and Methods This cross-sectional descriptive-correlation study was conducted on all 160 medical interns by census. The required data were collected using a three-part questionnaire consisting of demographic variables, the quality of clinical education, and the e-learning acceptance scale. Data analysis was done in SPSS software version 22. Results The results of the present study showed that the mean score of students' satisfaction with virtual education was 41.67±15.33. It was found that the lowest level of student satisfaction was related to the area of interaction and feedback between students and instructors and the lowest quality from the students' perspective was related to monitoring and evaluation. Moreover, there was a positive and significant correlation between satisfaction with virtual education and parents' job, place of residence, and economic status of students as well as between the quality of clinical education and students' satisfaction with virtual education. Conclusion According to the present study, the level of students' satisfaction with virtual education and clinical quality was not at the desired level. Considering the importance of virtual education in various aspects in the current era, it is highly important to recognize the strengths and weaknesses of this type of education and its related challenges and resolve them.

Background and Objectives Acute gastroenteritis is among the leading causes of mortality in developing countries. The present study aimed to compare zinc levels in children with and without acute gastroenteritis. Subjects and Methods This case-control study was conducted on children with acute gastroenteritis and age and gender-matched control group without gastroenteritis. A total of 80 children with acute gastroenteritis and 80 children without gastroenteritis were included. The control group was selected from among patients admitted to the pediatric surgery ward for a minor surgery. The case and control groups were matched regarding age and gender. The inclusion criteria for the control group were as follows: onset of diarrhea less than 48 hours, the age range of 6-12 years old, and clinical manifestation of diarrhea. On the other hand, evidence of chronic disease, zinc supplementation within three months before hospitalization, and duration of diarrhea more than seven were considered the exclusion criteria. This study was approved by the ethical committee of the university. Results Out of 160 participants (80 cases and 80 control), 89(55.6%) cases were male, and 71(44.4%) subjects were female. The mean age of the participants was 3.35±2.21 years (aged 1-10 years). There was no difference between case and control groups in terms of age and gender. The mean zinc level was significantly lower in cases (72.76±26.39) than in controls (91.15±17.76). Zinc level in children aged < 5 years was significantly less in the case group compared to that in the control group, while in children aged > 5 years, no significant difference was observed(P=0.85). Conclusion As evidenced by the obtained results, serum zinc level was significantly lower in children with gastroenteritis compared to that in their counterparts without this problem.

Background and Objectives Medical errors are harmful and unintended events that lead to complications, morbidity, and potential consequences. This can be potentially prevented by adhesion to strict medical standards. Descriptive data collection for awareness of involved medical staff can enhance the standards of care and restriction for medical error occurrence. Subjects and Methods The present survey was established as a descriptive-analytical cross-sectional epidemiological study. It aimed to determine the viewpoints of 300 interns and new residents regarding the causes and disclosure of medical errors in teaching hospitals of Ahvaz Jundishapur University of Medical Sciences in 2018-2019. The obtained data were analyzed. Results The mean prevalence of medical errors in interns in the investigated areas was moderate. There was a significant relationship between assistants and interns based on the prevalence of medical errors due to the specific characteristics of each patient and disease (P=0.008) The attitude of interns and assistants towards the causes of medical errors was moderate. There was no significant relationship between residents and interns based on their general attitudes toward the causes of medical errors (P> 0.05). Conclusion As evidenced by the results of this study, the most common cause of medical errors for missed diagnosis is related to the specific characteristics of each patient and the disease. It is suggested to reduce the occurrence of medical errors by creating electronic infrastructures for the systematic recording of data from the history and examinations and creating a process for the availability of the patient's past medical records. Furthermore, increasing the number of medical staff per shift should be noted.

Background and Objectives Hypertension is one of the causes of cardiovascular diseases. The existence of a correlation between hypertension and some factors, such as diabetes, body mass index, and age, has been proven in past studies. The risk of contracting such diseases is higher due to the issues in the lives of refugees in each society. So far, no serious attention has been paid to this issue; therefore, this study aimed to investigate the relationship between hypertension and some factors, such as gender, age, migration period, occupation, marriage, and ethnicity, were conducted on Afghan refugees living in Isfahan. Subjects and Methods This study was conducted on 4,165 Afghan refugees (1,525 men and 2,640 women), over 30 years old, living in Isfahan in the form of screening in Zainbiye, Isfahan, from February 2020 to July 2020. The required data were collected using a demographic form and measuring blood pressure in two stages at Zainbiye Health Center. Data was analyzed by SPSS software (version 20). Results According to the results, the average prevalence of hypertension was 30.7%. The results of the correlation test showed that gender, age, migration period, occupation, marriage, and ethnicity were related to the average blood pressure of refugees. The results of the correlation coefficient test did not show a significant relationship between hypertension and such factors as smoking, history of hypertension in the family, and education level. Conclusion The findings showed that an increase in the age of the refugees, their longer period of migration, the death of a spouse or separation, occupation, and ethnicity had a significant relationship with their high blood pressure, highlighting the need for more reflection and attention by the officials of the refugee organization.

Background and Objectives In recent years, access to rehabilitation services has been limited due to the COVID-19 pandemic; therefore, Telehealth is suggested as a solution for providing physical therapy services. The present study aimed to examine the validity and reliability of online postural assessment of the cervical spine and shoulder region in people with chronic neck pain. Subjects and Methods A total of 23 participants with neck pain were recruited. The presence of shoulder symmetry, kyphosis, anterior and lateral head tilt, and relative scapula position were assessed using face-to-face and online methods. The satisfaction of participants with the online assessment was recorded. Each participant underwent online-based and conventional FTF assessments randomly in a single session. Results Online assessment of different scapula positions demonstrated poor to moderate agreement with face-to-face assessment. Online assessment indicators of head-neck angle, head tilt in the sagittal and frontal plane, shoulder alignment, and kyphosis had a high correlation coefficient with the face-to-face method. Furthermore, the percentage of agreement and intra-examiner reproducibility of this method was excellent for all indicators. Most participants displayed a good level of satisfaction with the online method. Conclusion Online postural assessment of the cervical spine is valid and reliable for measuring shoulder symmetry, kyphosis, anterior and lateral head tilt angle, and craniocervical angle in neck pain patients who do not have access to physical therapy services.

Background and Objectives This study aimed to determine the frequency of erythrasma, a superficial mycosis in outpatients referring to Iran-Zamin Medical Diagnostic Laboratory in Ahvaz, the provincial capital of Khuzestan, over eleven years (2003-2014). Subjects and Methods The investigation was carried out by direct testing on patients. Shaved skin from the infected areas, including the inguinal, axillary, interdigital space, and inframammary, was tested directly using 20% potassium hydroxide (KOH). Samples were stained with 2.5% methylene blue. Results A total of 25,643 patients were referred to Iran-Zemin Medical Diagnostic Laboratory from various parts of Khuzestan province. Among this population, 942 (3.67%) subjects were suffering from erythrasma, with 625 (66.4%) males and 317 (33.6%) females, ranging in age from 1 to 67 years. Erythrasma was found in 942 of the suspected patients. Therefore, 715 inguinal areas (75.9%), 133 axillary areas (14.1%), 58 interdigital regions (6.2%), and 36 inframammary regions (3.8%) were all positive for erythrasma disease. As a result, the results of the present study can be useful in providing accurate information on the prevalence of erythrasma in Khuzestan province. Regarding this, management, control, and monitoring of the spread of this disease are essential. Conclusion The findings of the present study confirmed the frequency of erythrasma in the region and should be considered in the differential diagnosis. The most commonly affected part was the groin and its frequency was higher in males.

Background and Objectives Stress urinary incontinence is a common disorder, especially in women. According to studies, low back pain is also highly prevalent in this group. Since postural stability has been reported to be associated with low back pain, this study aimed to investigate the relationship between the severity of stress incontinence and dynamic postural stability indices and functional disability due to low back pain in women with stress incontinence. Subjects and Methods This cross-sectional analytical study was conducted on 28 female participants in the age group of 20 to 55 years. It was found that 14 participants had mild stress incontinence and 14 the severe type. Dynamic postural stability and limit of stability tests were performed by the Biodex Balance System with empty and full bladders. The measurement of functional disability due to low back pain was performed using the Oswestry questionnaire. Results When the bladder was full, there was a significant difference in the overall and anterior-posterior stability indices between the two groups, while with an empty bladder, there was a difference in the overall and medial-lateral stability indices. The magnitude of functional disability due to low back pain was higher in the group with severe incontinence than in the mild type. Conclusion The existence of compensatory strategies during pelvic floor muscle dysfunction leads to different synergy patterns of trunk muscles when perturbations occur. Increased anterior-posterior postural stability index in women with urinary incontinence in the present study may be related to increased abdominal muscle activity, especially the external oblique muscles.

Background and Objectives Menopause is associated with cardiovascularcomplications. The present study aimed to determine the effect of eight weeks ofaerobic exercise and soybean consumption on cardiovascular function inpostmenopausal women.Subjects and Methods In this semi-experimental research, 60 postmenopausalwomen living in Andimshek City, Khuzestan province, Iran, were selected bypurposeful sampling and then randomly divided into four groups: 1) soy (n=15), 2)exercise (n=15), 3) combined (exercise+soy, n=15), and 4) control (n=15 people). Theexercise intervention consisted of eight weeks of exercises, three sessions per weekwith an intensity of 50-70% of heart rate reserve. Soy consumption was 80 g ofsoybeans daily. Paired sample t-tests and covariance analysis were used for statisticalanalysis, and the significance level was considered p ≥ 0.05.Results A significant decrease in systolic blood pressure, diastolic blood pressure, andresting heart rate was observed in the aerobic and combined exercise groupscompared to the control group (P<0.01). A significant decrease in systolic bloodpressure was also observed in the soy group compared to the control group (P<0.001).Moreover, the decrease in resting heart rate was significantly higher in the aerobic andcombined exercise groups than in the soy group (P<0.001).Conclusion According to the results, it can be said that aerobic exercises and theconsumption of nuts have positive effects on improving cardiovascular function inpostmenopausal women, and the use of both boosts effectiveness in cardiovascularprotection.

Background and Objectives Metformin is increasingly used as an effective treatment for gestational diabetes (GDM). However, the impact of metformin treatment on maternal and neonatal outcomes is not well known. The aim of this study was to evaluate the frequency of maternal and fetal outcomes in women with gestational diabetes treated with metformin in Ahvaz. Subjects and Methods This retrospective study was conducted on 314 women with gestational diabetes treated with metformin in the outpatient department of Imam Khomeini Hospital in Ahvaz during 1397-98. The women were followed up until delivery and maternal and neonatal outcomes were assessed. Results The result of this study showed that 32 patients (10.2%) had preterm labor, 2 patients (0.6%) had preeclampsia 6 patients (1.9%), had low birth weight (LBW), 1 patient (0.3%) had macrosomia, and 6 patients (1.9%) had neonatal hypoglycemia. Abnormal blood glucose 6 weeks after delivery was observed in 13 cases (4.1%). In all but 8 (2.5%) women with GDM, optimal glycemic control (HbA1C<6.5) was achieved with metformin alone. There was no significant association between maternal and neonatal outcomes and baseline characteristics of metformin-treated women with GDM. Conclusion Our study shows that metformin is effective and safe in the treatment of GDM. It is not associated with an increased risk of adverse maternal-fetal complications and can be used as a useful treatment in the management of gestational diabetes to reduce the costs associated with gestational diabetes.

Background and Objectives Anesthesia is one of the major risks of cesarean surgery, and the decision to choose the type of anesthesia depends on various reasons. This study aimed to identify Reasons for using different methods of anesthesia in cesarean section in selected teaching hospitals located in Khuzestan province. Subjects and Methods The present qualitative research was conducted using the content analysis method. The research population included all doctors and anesthesiologists working in two teaching hospitals located in two cities. The necessary information was obtained through a semi-structured interview with a purposeful sampling method until the theoretical saturation of the data. The data were analyzed using the qualitative content analysis method. Results To choose the type of anesthesia, two main themes of preference from the doctor and preference from the organization were obtained, which preference from the doctor includes the priority of the type of service (patient and surgeon preference) and specialized reasons (fewer side effects, scientific and technical) and priority from the side of the organization, they include hospital routine (majority choice) and time management (better control of operating room time). Conclusion The preferred method of the anesthesiologist for the health of the patient is determined in addition to scientific and technical reasons according to the priorities of the surgeon and the patient as well as the desired priorities of the organization. It is necessary to establish training courses for anesthesiologists and create platforms for informed choice by providing about the complications and benefits of the chosen method for the patient.

Snakebite is considered a major health threat in Iran, mostly caused by pit vipers(Crotalidae species). A bite by a viper snake causes the release of plasma and blood tothe tissue around the bite inflammation and tissue damage. The occurrence ofepididymitis in the absence of a bite in the scrotal area is an unusual phenomenon. Inthis case report study, we reported epididymitis in a 16-year-old patient who wasbitten by a viper on the right leg. This patient initially experienced local bleeding,reversible coagulopathy (thrombocytopenia and increased prothrombin time andinternational normalized ratio), leukocytosis, and neutrophilia. Due to the occurrenceof a new organic complication, re-administration of five vials of snake antidotepolyvalent serum along with corticosteroid, pain reliever, and antihistamine alleviatedepididymitis and the patient was discharged consequently with full recovery. In thisarticle, the details of the relevant diagnostic and treatment for this young person areprovided.