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Context: Several studies have shown that chloroquine can effectively diminish the replication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As such, other studies have also supported this statement, but the psychiatric side effects of chloroquine have not been taken into account. Objectives: The current study aimed to briefly review and discuss the safety of chloroquine. Evidence Acquisition: A narrative literature search on databases was carried out on studies without time limitations. A combination of the two main keywords of "Chloroquine" and "Psychiatric Side Effects" was used to search databases. A manual search was performed to find the relevant articles, and finally, 15 studies were reviewed. Data were shown in the table and then summarized by narrative synthesis. Results: The literature review revealed the pharmaceutical characteristics of chloroquine, the safety of chloroquine, and the management of chloroquine's side effects. Also, the studies showed that chloroquine had psychiatric symptoms varying from insomnia to catatonia, toxic psychosis, and suicidal attempts, as well as behavioral manifestations, including most frequently extreme irritability, restlessness, abusiveness, distractibility, pressured speech, flight of ideas, grandiosity delusion, and auditory and visual hallucinations. Conclusions: Given the probability of a wide range of possible psychiatric symptoms following chloroquine, physicians should cautiously prescribe antiviral agents, and healthcare workers should also notice any psychiatric symptoms after administrating the chloroquine. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to determine the effects of acupressure on the intestinal function of patients undergoing Coronary Artery Bypass Graft (CABG) surgery. Background: Studies indicated that cardiovascular patients are prone to constipation. Acupressure is one of the therapeutic and palliative approaches that can be used by doctors, nurses, and even patients themselves. Methods: The present three-group randomized clinical trial study was conducted on 90 patients undergoing CABG surgery. In the intervention group, 48 hours after surgery the patients received acupressure points LI4 and ST25 twice a day (10 am and 6 pm) for three sequential days. In the sham group, the patients received acupressure at a 1.5 cm distance from the LI4-ST25 points, and the patients in the control group received only the usual care. This research used a demographic and medical information questionnaire, Rome IV scale, Bristol stool scale, symptom registration checklist, and daily excretion assessment checklist. The intestinal function indices were completed 24 hours after surgery (before intervention), 48, 72, 96, and 120 hours after surgery. Results: All three intervention, sham, and control groups were without defecation in 24 hours (before intervention) and 48 hours after surgery. There was a significant difference between the three intervention, sham, and control groups in the number of stools after 72 hours, 96 hours, and 120 hours after the intervention (p<0.001). Also, a significant difference was observed among the three groups in terms of stool consistency 96 hours after the start of the intervention (p=0.032) and 120 hours after the start of the intervention (p<0.001). Conclusion: The results showed that patients had a significant improvement in the number of bowel movements and stool consistency in the intervention group. In acute conditions, acupressure on LI4-ST25 points can positively affect intestinal function when patients are hospitalized in the intensive care unit. [ABSTRACT FROM AUTHOR]

Background: Hemoglobin A1C (HbA1C) test is the best care evaluation measurement due to a strong correlation between the test results and diabetic complications. So, this cross-sectional study aimed to assess whether the level of HbA1C can predict Diabetic Retinopathy (DR) among Type 2 diabetes mellitus (T2DM) in the Iranian population.Method: One hundred sixty-eight diabetic patients were selected via the convenience sampling method. Data were collected by research made questionnaire scale and laboratory test had been done. To estimate the cut off point for some variables statistical tests, formal measures of classification performance, model evaluation criteria and a decision Tree were used.Results: The prevalence of DR was 29.8%. The Receiver Operating Characteristic (ROC) curve and decision tree showed the optimal cut-off point for the HbA1C variable that separates the patient with and without DR is HbA1C = 8.15.Conclusion: Current study showed an appropriate cutoff point for detecting the development of DR among diabetic patients. So, this cutoff point can be used as guide evidence in several clinical judgments on the Iranian population. [ABSTRACT FROM AUTHOR]

Background: Cardiac patients are prone to experiencing constipation. The main purpose of the present study was to assess the effect of acupressure on preventing constipation in patients with acute myocardial infarction (AMI) under primary percutaneous coronary intervention. Methods: The present randomized clinical trial was conducted on 90 patients with AMI (30 patients in each group) who were randomly allocated based on inclusion criteria. The intervention was carried out among the patients with AMI on the acupressure points SJ6, LI4, ST25, and SP6 two times a day (10 am and 6 pm) for three sequential days. Results: On the first and second days of the study, all of the patients had no defecation, and the first defecation occurred on the third day of the study. In the intervention, sham, and control groups, 93.3%, 46.7%, and 50.0% had normal defecation on the third day of the study, respectively. The results of the Chi-square test revealed significant differences among the three groups (P < 0.001). Conclusion: The results of the present study showed that patients with AMI in the intervention group had significant improvement in terms of stool consistency based on the Bristol stool scale. So, acupressure can be used as a nursing intervention in critical care units. [ABSTRACT FROM AUTHOR]

Hypoparathyroidism is a disorder characterized by hypocalcemia. Premature cataract is one of the signs of hypoparathyroidism, but it is very rare. The present text is a case report of a rare case of a new pattern of bilateral cataracts associated with hypocalcemia secondary to uncontrolled hypoparathyroidism. The patient is a 30-year-old male with a chief complaint of progressive, painless vision loss and tearing in both eyes and photophobia in the left eye for the past 10 months and paresthesia, muscle spasms, and tingling for 2 years before referral. He had a history of hypoparathyroidism disorder that was undertreated with medication. Central posterior subcapsular cataract in both the eyes had been diagnosed. He underwent cataract surgery of the left eye under topical anesthesia. The visual acuity improved from 20/40 to 20/20 postoperatively, and the patient did not have any visual symptoms. This case is the first report of cataract with feathery opacity pattern reported with high-quality imaging from a patient. This feathery opacity pattern may explain the difference in the morphology of this patient's cataracts from others. [ABSTRACT FROM AUTHOR]

Sinus tachycardia and orthostatic hypotension have been so far reported among the negative cardiovascular complications of antipsychotic agents. This study aimed to report a case with bradycardia induced by fluphenazine decanoate administration. The patient was a 29‐year‐old man, admitted to the general teaching hospital in Sari, Iran, with a complaint of abdominal and gastric pain as well as weight loss following 7 months of fasting based on religious delusions. The patient developed bradycardia, 36 hours after fluphenazine decanoate administration. His pulse rate was also 46 beats per min (bpm). The antipsychotic medication was thus held and the patient did not take any drugs. On the 21st day after discontinuing this agent, the pulse rate reached 70 bpm. This case report notifies that much more attention should be paid to all patients before starting fluphenazine decanoate administration, and close cardiac monitoring must be done. [ABSTRACT FROM AUTHOR]

Aim: The main purpose of this study was to assess the levels of anxiety, depression, and stress among healthcare providers in Iran. Methods: This descriptive cross‐sectional survey was performed on healthcare providers selected through the convenience sampling method from April 6 to May 19, 2020, during the COVID‐19 pandemic. To this end, a self‐report web‐based questionnaire made up of a sociodemographic characteristics information form, Depression, Anxiety, and Stress Scale (DASS), and Corona Disease Anxiety Scale (CDAS) was distributed. Descriptive statistics, chi‐square test (χ2), and univariate and multivariate logistic regression models were accordingly practiced to analyze the data using the Statistical Package for Social Sciences (SPSS) software. Results: Of 1343 healthcare providers, 45.8% and 73.0% had moderate physical and psychological anxiety symptoms, respectively. The logistic regression model similarly demonstrated that anxiety caused by COVID‐19 was significantly correlated with the age ranges of 41‐50 (P =.007) and 51‐60 (P =.014) years as well as male participants (P <.001). In addition, the prevalence rates of depression and stress were, respectively, reported by 35.1% and 27.8%. There was correspondingly a significant relationship between depression and age as well as stress and gender. Conclusions: It seems that healthcare managers need to focus more attention on psychological aspects in healthcare providers during this pandemic and plan to teach them about coping strategies. [ABSTRACT FROM AUTHOR]

Different top layer fabrication methods (amine‐first, acid‐first, spin coating), organic phase solvents (hexane, heptane, mixed hexane/heptane), acid acceptors (triethylamine, sodium carbonate, sodium hydroxide), and surfactant sodium dodecyl sulfate concentrations (0, 0.05, and 0.1 wt%) were utilized to fabricate thin film composite polyamide membranes for CO2/N2 separation. The results, according to an L9 orthogonal array of Taguchi approach, showed that employing acid‐first method increases both CO2 permeance and CO2/N2 selectivity of the membranes at a feed gas pressure of 3 bars. On the other hand, sodium hydroxide, and triethylamine should be used, as acid acceptors, to maximize CO2 permeance and CO2/N2 selectivity, respectively. Moreover, the use of hexane solvent and 0 wt% surfactant led to maximum permeance, while, hexane solvent and 0.1 wt% surfactant were needed to reach the highest selectivity. The above level setting of synthesis parameters also resulted in the minimum sensitivity of the fabrication process to the noise factors effects. As shown by the analysis of variance, acid acceptor, and organic solvent types were the most influential parameters on CO2 permeance and CO2/N2 selectivity, respectively. The effects of fabrication method and surfactant concentration, as single factors, on permeation/selectivity responses were also investigated. [ABSTRACT FROM AUTHOR]

Introduction: Human immunodeficiency virus infection /acquired immunodeficiency syndrome has grown to be one of the world's most momentous pandemics. The present study aimed to explore the effects of stigma on people living with HIV/AIDS (PLWHA) and recommend coping strategies to reduce this phenomenon. Materials and Methods: Using a narrative literature review, the related articles were searched, retrieved, and selected from the databases of Noor Specialized Magazines (Noormags), Elmnet, Scientific Information Database of Academic Center for Education, Culture, and Research (SID), IranMedex, and Magiran via the keywords of "Stigma, Social Stigma, Labeling, Acquired Immunodeficiency Syndrome, AIDS, Human Immunodeficiency Virus, and HIV" in Persian and in the databases of PubMed and Scopus in English. The same procedure was further performed in Google Scholar in both languages. The inclusion criteria were the full-text articles in Persian and English and the exclusion criteria were no access to the full-text articles, while review articles were removed. Results: Considering the inclusion and exclusion criteria and excluding the duplicate studies, 16 articles were recruited in total for review purposes. The effects of stigma on PLWHA consisted of individual and social consequences. As well, the most appropriate coping strategies to reduce stigma were acknowledged as "providing psychosocial support for infected people", "raising awareness in the public and medical staff", "cultivating spirituality and a close relationship with God", "developing and implementing counseling strategies", and "establishing specialty clinics for PLWHA". Conclusion: Given the study findings, it can be suggested that policy-makers and community healthcare managers pay much more attention to the individual and social consequences of HIV/AIDS and make further efforts to increase awareness in the public and medical staffs, strengthen spirituality in PLWHA, and set up specialty clinics for such individuals to cope with stigma. [ABSTRACT FROM AUTHOR]

Objectives: The present study was conducted to assess 3(HCWs) during the COVID‐19 pandemic. Methods: A total number of 7626 HCWs were included in this web‐based cross‐sectional study, via the convenience sampling technique. To collect the required data, the sociodemographic characteristics information form, the Depression Anxiety Stress Scale‐21 (DASS‐21), and the Corona Disease Anxiety Scale (CDAS) were also employed. In addition, data analysis was performed using the SPSS Statistics software (ver. 24), as well as descriptive statistics, Chi‐square test (χ2), and univariate/multivariate logistic regression models. Results: The CDAS results revealed that 47.9% and 70.5% of the HCWs had experienced moderate levels of physical and psychological anxiety, respectively. Based on the DASS results, 44.8%, 43%, and 34.8% of the HCWs had been subjected to depression, anxiety, and stress symptoms during the COVID‐19 pandemic, respectively. The logistic regression models correspondingly showed that depression among the HCWs was significantly correlated with risk factors, such as the age groups of 20–30 years (p =.001), 31–40 years (p =.006), female HCWs (p>.001), history of physical illnesses (p =.004), and history of psychiatric disorders (p>.001). Moreover, factors including the age groups of 20–30 years (p <.001), 31–40 years (p <.001), 41–50 years (p <.001), female HCWs (p>.001), history of physical illnesses (p <.001), and history of psychiatric disorders (p>.001) were assumed as significant predictors of anxiety in these individuals. Besides, factors such as the age groups of 20–30 years (p =.002), 31–40 years (p =.004), female HCWs (p>.001), occupation (p =.016), history of physical illnesses (p <.001), and history of psychiatric disorders (p>.001) could significantly predict the prevalence rate of stress in the HCWs in times of this crisis. Conclusion: Given the importance of mental health status among HCWs during the COVID‐19 pandemic, health administrators and policymakers of the Ministry of Health and Medical Education in Iran are suggested to provide psychological screening and supportive care programs for HCWs with the aim of enhancing their mental health and successful coping with critical circumstances. [ABSTRACT FROM AUTHOR]

Objectives: Despite the noticeable advances in sexual dysfunction (SD) research in the menopausal period, scientific literature showed different reports on the prevalence of SD in the menopausal stages. The primary objective of this study was to systematically review and meta-analysis the prevalence of SD in the different menopausal stages and then meta-analysis the included studies in domains of SD separately. Methods: In this systematic review and meta-analysis, keywords were retrieved through MeSH strategy and databases such as PubMed/MEDLINE, PsycINFO, Web of Science (ISI), Scopus, ScienceDirect, SID (Scientific Information Database), Magiran, and Google scholar were searched. Manual review of retrieved citations identified additional citations. The quality of the included studies was assessed using The Newcastle-Ottawa Scale. The main outcome measure in this study was the prevalence of SD in three stages of menopause such as pre, peri, and postmenopause. Results: Of 54 included studies 81,227 menopausal aged women from different menopause stages participated and the sample sizes varied from 49 to 31,581 individuals. The articles from 17 countries worldwide were included in this study. The prevalence of SD in premenopausal aged women was ranged between 22.7% and 72.2%, in perimenopausal aged women, was 37.3–78.2% and also in postmenopausal aged women was extremely reported a wide variety of prevalence ranges and was estimated between 8.7% and 89.01%. The premenopausal women had a lower prevalence of SD compared to other stages of the menopausal period. Conclusion: The results indicated that the prevalence of SD and also domains of SD in different studies were reported much widely. This study can be used as a good resource for obstetricians to understand the high possibility of recurrence of SD and assess the sexual activity of menopausal aged women in the menopause clinic. However, based on the systematic review, more standard and high-quality studies are needed to perform regarding the prevalence of SD in menopausal periods. [ABSTRACT FROM AUTHOR]

Background: Due to the fear of childbirth (FOC) and failure to provide painless delivery in Iran, the prevalence rate of elective cesarean section (C-section) performed on request by pregnant women is on the rise. However, no systematic review assessing the results of studies in this respect has been thus far developed. Objective: To systematically review published psychological intervention research reflecting on FOC in Iran. Materials and Methods: In this systematic review, the databases of PubMed, MEDLINE, PsycINFO, Wiley, ISI Web of Science, Scopus, Science Direct, Cochrane Library, Google Scholar, and Scientific Information Database were searched to retrieve the relevant studies. Manual searches were performed to find the relevant articles and finally 21 intervention studies were reviewed. Results: Based on the modified Jadad Scale, a methodological quality (risk of bias) assessment tool, 14 and 7 studies had acceptable or good and low quality, respectively. The included articles covered fear, fear of childbirth, pregnancy, and psychological intervention in Iran. Cognitive behavioral therapy, relaxation techniques, psychological counseling, childbirth preparation classes (CPCs), mindfulness programs, and psychoeducation had been also practiced as the main types of psychological interventions for reducing FOC in pregnant women. Conclusion: There was no clear evidence to establish the most effective method for minimizing levels of FOC in pregnant women. Based on the assessment tool and since most of the studies had moderate or low quality, conducting standard and high-quality randomized controlled trials focusing on FOC in pregnant women is of most importance in Iranian population. [ABSTRACT FROM AUTHOR]

Background: Hemodialysis patients are faced with challenges in carrying out their daily activities. Self-efficacy is a social cognitive concept that can affect behavioral control in these patients. Hence, the purpose of the present study was to investigate the effects of exercise training on physical performance and self-efficacy in hemodialysis patients. Materials and Methods: This randomized controlled clinical trial was conducted on 60 hemodialysis patients who visited hospitals affiliated to Mazandaran University of Medical Sciences in Sari, Iran. The participants were randomly divided into two groups. The patients in the intervention/exercise group received the 8-week exercise program. Patients in the control group received routine care. The Six-Minute Walk Test (6MWT) was used to assess the patients' functional ability and the Exercise Self-Efficacy Scale (ESES) and Chronic Disease Self-Efficacy Scale (CDSES) were used to assess their self-efficacy before and 2 and 8 weeks after the intervention. For statistical analysis, independent t-test and paired t-test were used. Results: The comparison of self-efficacy between the exercise group and control group after 8 weeks of intervention showed a significant difference between the groups in terms of the CDSES (F1,43 = 22.92, p < 0.001) and ESES (F1,38 = 10.84, p < 0.001) results. Moreover, the comparison of mean distance walked based on the 6MWT showed significant changes in this variable (F1 = 2.05, p = 0.015). Conclusions: The designed exercise program can improve self-efficacy and physical performance in hemodialysis patients. This intervention is recommended for hemodialysis patients due to its effectiveness, simplicity, and uncomplicated characteristics [ABSTRACT FROM AUTHOR]

Statement of the Problem: Oral mucositis (OM) is a common inflammatory complication consequent to chemotherapy or radiotherapy in cancer patients that affects their quality of life. Therefore, finding an effective treatment for OM is always imperative. Purpose: The purpose of this experimental study was to measure the stereological, antiinflammatory and antioxidant markers of hydro-alcoholic extract of Pistacia Atlantica (P. atlantica) leaves, Trachyspermum Ammi (T. ammi) fruits and their mixture on induced OM in hamsters. Materials and Method: In Experimental study, OM was generated by the method employed by Tanideh et al., in 90 hamsters, by 5-FU (5-fluorouracil 65 mg/kg, IP). All the animals were divided into 5 groups: control, topical gel base, hydro-alcoholic extract 3% of P. atlantica, hydro-alcoholic extract 1% of T. ammi, and a mixture of the extracts of the two plants. On days 13, 15, and 17, the cheek pouch samples were harvested. Stereological scores and the levels of malondialdehyde (MDA), Superoxide dismutase (SOD), myeloperoxidase (MPO), and interleukin-1B (IL-1B) in the pouch tissue were measured. Results: Lower levels of MPO, MDA, and IL-1B and an increase of SOD level were discovered in the mixture-treated group in comparison with other groups. As an aspect of MDA, no significant differences were detected between the topical gel form of P. atlantica and T. ammi groups on days 13 (p= 0.648), 15 (p= 0.981) and 17 (p= 0.540). No variations of MPO were detected among P. atlantica and T. ammi groups on days 13 (p= 0.159) and 15 (p= 0.694); however, the MPO activity of the T. ammi group was significantly lower than the P. atlantica group on day 17 (5.57±0.56 vs. 6.48±0.35 U/ml, p< .001). The volume density of the epithelium increased in the mixture- treated group (p< 0.05). Conclusion: The results of this study indicated that the mixture of P. atlantica leaves and T. Ammi fruits might be effective in the treatment of OM. [ABSTRACT FROM AUTHOR]

This paper aims to examine the effect of cellulose nanocrystals (CNC) on the hydration, transport behavior, and microstructure of cement mixtures. The addition of CNC delayed hydration at an early age but improved hydration at later ages. A small increase in the electrical resistivity of the cement mixtures with CNC was observed. Statistical nanoindentation showed a small tendency to a larger volume fraction of high density calcium-silicate-hydrate (C-S-H) and a smaller volume fraction of low-density C-S-H in the mixture with CNC. [ABSTRACT FROM AUTHOR]

This paper examines the hydration and microstructure evaluation of cement pastes modified with two types of glass powders with a fine size distribution and a class F fly ash. Hydration was investigated by measuring the heat of hydration, chemical shrinkage and setting time at early age and non-evaporable water content at late ages. Pozzolanic behavior was studied using thermogravimetric analysis and X-ray diffraction. The microstructure was evaluated by the electrical resistivity measurement and image analysis. Based on the findings of this study for the glass powders and fly ash used, glass powders were shown to enhance the early hydration of cement and fly ash demonstrated a small delaying effect. Glass powders were found to possess pozzolanic behavior and to improve the hydration of cement paste at later ages. Microstructure evaluation indicated pore refinement in the microstructure of cement pastes modified with glass powders. It was concluded that glass powders with a microscale size distribution can be used as a pozzolan in cement-based materials. [ABSTRACT FROM AUTHOR]

This paper examines the mechanical strength and durability behavior of cementitious materials modified with two types of glass powders and a class F fly ash at various levels of cement replacement. Mechanical strengths were evaluated via compressive strength and flexural strength tests, and durability characteristics studied included alkali-silica-reactivity, electrical resistivity, chloride permeability and porosity. The findings from this study indicated that cementitious materials modified with glass powders showed an improvement in compressive and flexural strengths compared to the control concrete at late ages of curing. It was found that the addition of glass powders decreased alkali-silica reaction expansions of the modified cementitious materials when mixed with reactive sands and enhanced resistance to chloride permeability and electrical resistivity of cementitious materials. The improvement in the mechanical strength and durability of the cementitious materials modified with glass powders can be attributed to microstructure improvement arising from the pozzolanic property of the glass powders. [ABSTRACT FROM AUTHOR]

Background: Hot flashes (HF) are a common symptom during the menopausal transition. It is therefore important to identify effective drugs that can alleviate HF. This study aimed to systematically review published clinical trials on the efficacy and safety of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) in the treatment of HF in healthy menopausal women. Methods: In this systematic review, articles published during 2003-2019 in PubMed, MEDLINE, Web of Science, Scopus, Science Direct, PsycINFO, CINAHL, the Cochrane Central Register of Controlled Trials, and Google Scholar as well as Iranian databases such as SID, and Magiran were searched. The quality of the selected articles was assessed using the Jadad score calculation. Results: Thirty-six articles on randomized controlled trials were included in this study, out of which 27 articles had acceptable, and nine had weak methodological quality. Findings on SSRIs class of drugs indicated that escitalopram, paroxetine, and fluoxetine have higher efficacy and safety in the treatment of menopausal HF than other drugs. Studies on the effectiveness of sertraline, citalopram, and fluvoxamine are limited in number or show inconsistent results. Therefore, further high-quality studies are required to confirm their effectiveness in alleviating HF. Within the SNRIs class, venlafaxine and desvenlafaxine showed significant efficacy in the treatment of menopausal HF. However, studies on the effectiveness of duloxetine are also limited, which requires further research. Conclusion: Most studies have indicated the efficacy and safety of some antidepressants, such as SSRIs and SNRIs, in decreasing the frequency and severity of HF. These drugs are therefore recommended for the treatment of menopausal HF. [ABSTRACT FROM AUTHOR]

Calcium-silicate-hydrate (CSH)/polymer nanocomposites were synthesized with the layer-by-layer (LBL) method, and their morphology and mechanical properties were investigated using atomic force microscopy (AFM) imaging and AFM nanoindentation. Different sets of polymers were used to produce CSH/polymer nanocomposites. The effect of different factors including dipping time, calcium to silicate ratios (C/S ratios) and pH on morphology was investigated. CSH/polymer nanocomposites made with different sets of polymers showed variation in morphologies. However, the Young’s modulus did not seem to reveal significant differences between the nanocomposites studied here. In nanocomposites containing graphene oxide (GO) nanosheet, an increase in the density of CSH particles was observed on the GO nanosheet compared to areas away from the GO nanosheet, providing evidence for improved nucleation of CSH in the presence of GO nanosheets. An increase in roughness and a reduction in the packing density in nanocomposites containing GO nanosheets was observed. [ABSTRACT FROM AUTHOR]

Background: Physician empathy is one of the fundamental factors involved in patient care and it can enhance the therapeutic effects of patient-clinician relationships. Attachment is defined as the tendency of human beings to make strong affectional bonds with some specific people. Objectives: This study are aimed to examine the possible relationship between secure and insecure attachment style with physician empathy among medical students. Methods: A cross-sectional study was conducted on 268 medical students and residents at Mazandaran University of Medical Sciences, Iran in 2015. All participants voluntarily participated in this study and an informed consent was obtained. Data analysis was done through completing two questionnaires, including the Jefferson Scale of Physician Empathy-Health Professionals Version (JSPE-HP) and the Revised Adult Attachment Scale (RAAS). Data was analyzed using Pearson correlation coefficient and stepwise regression analysis and analyzed in SPSS (v. 18). Results: The highest frequency (n = 137; 51%) was related to individuals in the age range of 21 - 25 years. The empathy score of all students was 99.99. Among 268 participants, 76 (28.4%) and 192 (71.6%) students represented secure and insecure attachment styles, respectively. Married students had higher empathy scores than single students (P = 0.056). Nostatistically significant difference was found in the mean empathy scores by gender (P = 0.305) and different years of studying (P = 0.883). The mean±standard deviation of empathy score in psychiatry residents was 113.4 ± 16.24, which was higher than the residents of other fields. Also, our results revealed no significant difference between the empathy scores in individuals with secure and insecure attachment styles (P = 0.945; 95% CI: -3.883 - 3.620). Conclusions: Evaluating empathy in the educational courses of medical students, as future physicians, can offer valuable guidelines to improve the mental health of students and help them have a good relationship with patients. [ABSTRACT FROM AUTHOR]

Context: Cancer diagnosis and its therapeutic methods can lead to considerable psychological problems and decrease the levels of hope in patients. Due to the considerably important multidimensional effects of hope on the life of patients with cancer, this study aimed to assess the effect of psycho-socio-spiritual strategies on the hope level of patients with cancer. Evidence Acquisition: In this narrative review, electronic databases were searched including Google Scholar, Scientific Information Database, Magiran, PubMed, ScienceDirect, Web of Science (ISI), Ovid, and Scopus. Those articles published between 1978 and 2020 were retrieved and assessed through the abstract and full-text appraisal. Finally, 74 articles were included in this study. Results: Psycho-socio-spiritual strategies for affecting the hope level of patients with cancer were classified as follows: (1) psychological interventions (psychotherapy, counseling, coping skills training, stress management training, crisis management, individual or group supporting therapy, hope therapy, and psychoeducational interventions); (2) social interventions (social and family support intervention); and (3) spiritual interventions (logotherapy, religion therapy, and praying). Conclusions: Due to the chronic nature of cancer disease, in addition to the important role of pharmacological treatment such as chemotherapy and radiotherapy, considering non-pharmacological approaches such as hope-fostering interventions for these patients is essential and can lead to a better quality of life. [ABSTRACT FROM AUTHOR]

Abstract: Immune activation and inflammation play critical roles in the development of heart failure (HF). Human leukocyte antigen–G (HLA-G) is a nonclassical, major histocompatibility complex class I (MHC–I) protein, upregulated in the context of transplantation, malignancy, and inflammation, and has been correlated with various clinical outcomes. We sought to evaluate the utility of plasma HLA-G in identifying patients with HF. We conducted a single-center, cross-sectional pilot study involving 82 patients diagnosed with HF and 10 healthy controls. Concentrations of circulating HLA-G and inflammatory markers were detected with specific enzyme-linked immunosorbent assay kits and quantified according to purified protein standards. The mean age of the patients was 49.1 ± 12.0 years and 62.2% were male. The median and interquartile range of HLA-G levels (U/ml) were significantly higher (p < 0.001) in HF patients (63, 36–98) compared with controls (28, 22–40). Moreover, HLA-G levels that were similarly (p = 0.766) upregulated across all New York Heart Association functional classes. There was no significant correlation between serum HLA-G and other biomarkers. In conclusion, HLA-G is upregulated in patients diagnosed with HF. Its marked elevation even in New York Heart Association class I patients might indicate that serum HLA-G is a more sensitive marker than other classical HF biomarkers. [Copyright &y& Elsevier]

Objective: This study evaluated the occupational burnout (OB) and spiritual well-being (SWB) of emergency nurses as well as the associations between these variables., Method: This cross-sectional study was conducted in six hospitals and emergency medical centers affiliated with Ardebil University of Medical Sciences (Ardebil, Iran), in 2020. Data were collected via socio-demographic, Spiritual Well-Being Scale (SWBS), and Maslach Burnout Inventory (MBI) questionnaires., Results: This study included 239 emergency department nurses. The mean age of the participants was 34.4±6.4 years. The mean of existential well-being and religious well-being was 40.3±8.7 and 41.0±9.2, respectively. The results indicated that moderate (P=0.007) and severe (P<0.001) personal accomplishment was a positive and significant predictor of the SWB in emergency department nurses., Conclusion: Proper planning and provision of suitable educational programs in the dimension of the SWB of nurses prevent the creation and continuation of OB and increase the self-efficacy and job satisfaction of emergency medical staff, resulting in better patient care., Competing Interests: None declared.

Background: The function of healthcare workers, particularly nursing staff, in taking care of coronavirus disease 2019 (COVID-19) patients, cannot be overemphasized. As the pandemic lasts, burnout among the nursing staff needs to be considered as an important challenge. This was aimed to assess the nurses' burnout and factors affecting this variable., Materials and Methods: In this cross-sectional study, Maslach Burnout Inventory was completed by 261 nurses in Shiraz hospitals (Iran) in April 2020. This questionnaire addresses different aspects, including emotional exhaustion, personal achievement, and depersonalization, to determine the intensity of perceived burnout among nurses during the outbreak., Results: Our data demonstrated that the nurses' burnout in Shiraz hospitals during the COVID-19 pandemic was high (64.6%). Emotional exhaustion and depersonalization were observed in 63.6 and 53.3 percent of the participants, respectively. Moreover, the rate of successful personal achievement among these nurses was >97%. Work experience <10 years (P=0.016), hospital ward (P=0.044), the number of deaths observed by nurses during the COVID-19 pandemic (P<0.001), and the total number of shifts during the COVID-19 pandemic (P=0.006) had a positive correlation with emotional exhaustion., Conclusion: Workload and stress resulting from the COVID-19 outbreak seem to be one of the major causes of emotional exhaustion in nurses. The emotional exhaustion among nurses must be considered in epidemics, such as COVID-19., (Copyright© 2020, Galen Medical Journal.)

OBJECTIVE. The objective of our study was to determine the accuracy of ultrasound (US) and CT in diagnosing appendicitis at our institution while taking into account the number of indeterminate examinations in accordance with the Standards for Reporting Diagnostic Accuracy (STARD) guidelines. MATERIALS AND METHODS. We retrospectively evaluated 790 patients who underwent US, CT, or both for evaluation of suspected appendicitis between May 1, 2013, and April 30, 2015. Patient characteristics and US and CT examination results were recorded. The reference standard was histopathology or 3 months of medical record follow-up if surgery was not performed; 3 × 2 tables were generated, and sensitivity, specificity, overall test yield, and accuracy were calculated according to STARD guidelines. For surgical cases, time to surgery (one-way ANOVA) was compared among patients who underwent US alone, CT alone, or both US and CT. RESULTS. A total of 473 of 562 US examinations had indeterminate findings (overall test yield, 15.8%); sensitivity and specificity in the 89 diagnostic examinations were 98.5% and 54.2%, respectively. Thirteen of 522 CT examinations were indeterminate (overall test yield, 97.5%); sensitivity and specificity in the remaining 509 CT examinations were 98.9% and 97.2%, respectively. Taking indeterminate studies into account, the accuracy was 13.7% for US and 95.6% for CT. The negative appendectomy rates were 17.7% (11/62) for US and 3.3% (9/276) for CT ( p = 0.0002). Time to surgery was longer for patients who underwent US and CT (mean ± SD, 17.7 ± 8.9 hours) than US alone (12.9 ± 6.4 hours; p = 0.002) but was not longer for patients who underwent CT alone (16.3 ± 8.4 hours; p = 0.45). CONCLUSION. At our institution, a large proportion of US examinations are indeterminate for appendicitis. CT is the preferred first-line imaging test for evaluating appendicitis in nonobstetric adult patients.

Background: Cisplatin is a cytotoxic agent in cancer therapy. Nephrotoxicity is considered as a side effect of cisplatin usage. Using rate models, we studied the possible protective impact of corn-silk (CS) extract against cisplatin-induced nephrotoxicity., Materials and Methods: Thirty-five experimental rats were divided into five groups (n=7 per each group) as follow: C1: Control received distilled water only; C2: received one dose of cisplatin, and CS: received 300 mg/kg/day of CS. Both CS1 and CS2 received 200 and 300 mg/kg/day of the CS extract orally, individually, for eight consecutive days. CS1 and CS2 received a single dose of cisplatin on the first day only. The specific biochemical markers and histopathological alterations were evaluated., Result: According to our results, cisplatin administration could have induced severe degeneration in all parts of the nephron tubules and liver. Pre-treatment with CS exhibited a significant decrease in the malondialdehyde (MDA) levels as compared to the values obtained after treatment with cisplatin alone (P<0.01). Moreover, the CS extract with 200 mg dose showed significant (P<0.01) protection against the cisplatin-induced elevation of blood urea nitrogen. Further, the serum levels of alanine transaminase and aspartate transaminase were higher in the cisplatin-treated groups, when compared to the control group (P<0.05). Furthermore, the hepatic function was also improved in cisplatin-treated animals, which were pre-treated with CS., Conclusion: CS has the potential to attenuate nephrotoxicity and lipid peroxidation induced by cisplatin in rats., Competing Interests: All authors declare there is no any conflict of interest in presenting the current work., (Copyright© 2018, Galen Medical Journal.)

Background: One of the major problems of the aged women or older than 35 is getting pregnant in the late fertility life. Fertility rates begin to decline gradually at the age of 30, more so at 35, and markedly at 40. Even with fertility treatments such as in vitro fertilization, women have more difficulty in getting pregnant or may deliver abnormal fetus. The purpose of this study was to assess the effects of flax seed hydroalcoholic extract on the fetal brain of aged mice and its comparison with young mice., Methods: In this experimental study, 32 aged and 32 young mice were divided into 4 groups. Controls received no special treatment. The experimental mice groups, 3 weeks before mating, were fed with flax seed hydroalcoholic extract by oral gavages. After giving birth, the brains of the fetus were removed. Data analysis was performed by statistical test ANOVA using SPSS version 18 (P<0.05)., Results: The mean fetus brain weight of aged mother groups compared to the control group was increased significantly (P<0.05)., Conclusion: This study showed that flax seed hydroalcoholic extract could improve fetal brain weights in the aged groups.