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Background and Purpose: Shortly after the emergence of COVID-19, the World Health Organization declared it a pandemic, which brought numerous challenges to the field of education worldwide. Consequently, this study was conducted to explore the teaching and learning processes of officials during the pandemic. Materials and Methods: This qualitative research study was conducted using a comprehensive content analysis approach from April to November 2023. The participants included 11 officials from Mazandaran University of Medical Sciences, specializing in the teaching and learning process, who were selected purposefully. Data were collected through semi-structured individual interviews and by evaluating documents from the university's directorate and vice-chancellor. To ensure the validity of the qualitative study, four criteria—credibility, confirmability, dependability, and transferability—were employed. Credibility was established through prolonged engagement and sufficient interaction with participants, gathering accurate information, and validating it with participants. Dependability was ensured through peer review by two qualitative research experts, who confirmed the validity of the data analysis process. Confirmability was obtained through the perspectives of the research team colleagues. All research processes were documented and reported in detail to ensure the transferability of the results. Results: From the in-depth analysis of interviews and documents, 520 initial codes were extracted. After reviewing and summarizing the codes multiple times, they were classified based on similarities and correlations. The underlying meanings were identified through analysis and comparison, and the codes were conceptually and abstractly named based on their nature. Ultimately, two main categories, "challenges" and "strategies," emerged from the process of code abstraction. The "challenges" category was derived from three sub-categories: psychosocial pressures, challenges in theoretical teaching, and challenges in clinical education. The "strategies" category evolved from eight sub-categories: strategies to improve virtual teaching of theoretical courses, strategies to improve clinical and practical teaching, the formation of virtual groups for students and enhanced communication with them, managing the physical presence of students and professors according to the pandemic situation, providing facilities for students to access virtual education content, emerging educational strategies, facilitating educational regulations with increased flexibility, and providing the necessary resources to adhere to in-person education protocols. Conclusion: The COVID-19 pandemic introduced various challenges for both professors in adapting their teaching methods and students in adjusting to online learning. However, these challenges also presented opportunities. The pandemic forced changes in educational processes, providing a new experience or opportunity to learn, understand, and adapt to the evolving needs of medical education for all stakeholders. These changes may also have long-term impacts on healthcare. The experiences gained during the pandemic can be used to revise health-related policies, and documenting these experiences can help in better managing future epidemics.

Background and purpose: One of the response areas of Iran's health system in dealing with the COVID-19 pandemic is the area of health and prevention. In many countries of the world, the primary strategy against COVID-19 is prevention and health, and this issue was considered before treatment. Considering that the COVID-19 pandemic was a new event and a new experience for health systems around the world, there is a need to investigate the different effects of this emerging phenomenon in different populations. Therefore, this study was conducted to explain the experiences of the health management of the COVID-19 pandemic in Mazandaran University of Medical Sciences. Materials and methods: This applied research was conducted in terms of the qualitative paradigm and by the method of summative content analysis. In this study, semi-structured interviews and existing documents of university vice-chancellors during the COVID-19 pandemic were used. In this study, interviews were conducted with 16 officials of Mazandaran University of Medical Sciences (The president of the university, vice president of health, health managers, doctors, experts of health centers, and also experts who worked in the university headquarters in the department of health vice) and a three-hour focus group of 15 people. The participants were selected based on the goal of maximum diversity. For the validity and strength of the study, the criteria proposed by Goba and Lincoln were used. The researcher tried to increase the credibility of the research with long-term involvement and sufficient interaction with the participants, collecting valid information and confirming the information by the participants. The researcher tried to increase the reliability of the data by repeating step by step and collecting and analyzing the data, taking advantage of the review by the experts. To increase the data Confirmability criteria, the approval of the associate professors of the project and their supplementary comments were used. To be able to transfer the data of the study, the researcher tried to provide a rich description of the research report to evaluate and applicability of the research in other fields so that other researchers can also be able to understand the data and achieve the same, as well as the participation quotes. The participants were presented in the same way as said. In this study, MAXQDA software was used for data analysis. Results: From the data analysis, two main layers (health challenges, preventive and coping strategies) and eight sub-layers (challenge of lack/delay in receiving health-treatment services, epidemiological challenge, health management challenge, vaccination challenge, strategies Receive health-treatment services on time to promote community health, epidemiological strategies, strategies for implementation of health guidelines, strategies for implementation of COVID-19 vaccination) and twenty-six sub-categories were extracted. Conclusion: Mazandaran University of Medical Sciences faced many challenges during the COVID-19 pandemic, by holding decision-making meetings and coordinating various health units, in line with the policies of the ministry, providing suitable solutions for prevention and countermeasures. The results of this study can be used to teach other university officials to deal with other emerging diseases and the future planning of health policymakers. It is suggested to conduct a study comparing the rate of acceptance of the COVID-19 vaccine in normal people and medical staff and related factors at Mazandaran University of Medical Sciences.

Abstract Background Miliary tuberculosis (TB) is a lethal hematogenous spread form of mycobacterium tuberculosis with approximately 15–20% mortality rate in children. The present report highlights the clinical manifestations of an unusual presentation of miliary tuberculosis in a 12-year-old girl. Case presentation In this case, extensive lung involvement was presented despite the absence of respiratory symptoms. Also, some central hypo-intense with hyper-intense rim nodules were detected in the brain’s pons, right cerebral peduncles and lentiform nucleus. Conclusion The results of this study showed that severe miliary TB may occur even in a person who received the Bacille Calmette-Guérin (BCG) vaccine.

Abstract Background The present study aimed to respond to clinical question, can prolonged P-R interval predict clinical outcomes in non-ST elevation acute coronary syndrome patients? Methods This descriptive-analytical study was conducted on cardiac patients. All of the non-ST elevation acute coronary syndrome (NSTEACS) including non-ST elevation myocardial infarction (NSTEMI) and unstable angina patients included in the study. Then they divided into two groups: prolonged P-R interval and normal P-R interval. The patients who had a history of digoxin and calcium channel blocker use, using antiarrhythmic drugs, known valvular or congenital heart disease and connective tissue, unreadable P-R interval and cardiac block were excluded. Data were collected using the questionnaire consisted demographic data and clinical outcomes and a follow-up part was completed by one of the researchers. Results Finally, 248 patients completed the study. The results showed both of the two groups had significant differences in terms of the history of myocardial infarction (MI) (p = 0.018), the level of high-density lipoprotein (HDL) (p = 0.004), heart rate (p = 0.042), inverted T wave (p = 0.017), anterior ST- segment depression (p = 0.008), normal report of coronary angiography (CAG) (p = 0.003), three vessels disease (p = 0.043), left main lesion (p = 0.045) and SYNTAX score (p = 0.032) based on the CAG report. The results of six-month follow-up showed although, the frequency of ischemic stroke, coronary artery disease (CAD) and cardiovascular death were higher in prolonged P-R interval groups. The chi-square test showed this difference was statistically non-significant (p > 0.05). The multivariate logistic regression model revealed non-significant relationships between prolonged P-R interval and SYNTAX score, significant CAD, three-vessel disease, inverted T wave, anterior ST depression, heart rate and HDL. Conclusions Based on the results of our study the six-month follow-up showed non-significant outcomes. Further studies are recommended to assess the long-term outcomes.

Background: Several studies have investigated the effects of acupressure in patients with known diabetes. However, no studies have investigated the effects of acupressure on women with prediabetes.Objectives: The present study aimed to investigate the effects of self-administered acupressure on fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c), and anxiety levels in prediabetic women.Methods: This randomized controlled trial was carried out on 50 women with prediabetes who referred to the Diabetes Clinic of Mazandaran University of Medical Sciences, Sari, Iran, from September 4, 2021, to February 20, 2023. Participants were randomly assigned to two groups of 25 to receive either metformin and self-administered acupressure or metformin and sham point pressure. FBS, HbA1c, and anxiety levels were measured in both groups before and 12 weeks after the intervention. All patients also received routine training. Data were analyzed using chi-square test and Fisher's exact test, independent samples t-test and analysis of covariance (ANCOVA).Results: The two groups did not differ significantly in their mean baseline FBS and HbA1c values. However, the mean baseline anxiety was significantly higher in the control group (P=0.009). After the intervention, the mean FBS, HbA1c, and anxiety were significantly lower in the intervention group (P

Objective: This study evaluated the occupational burnout (OB) and spiritual well-being (SWB) of emergencynurses as well as the associations between these variables.Method: This cross-sectional study was conducted in six hospitals and emergency medical centers affiliated withArdebil 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±6.4years. The mean of existential well-being and religious well-being was 40.3±8.7 and 41.0±9.2, respectively. Theresults indicated that moderate (P=0.007) and severe (P

Background and purpose: The diagnosis and treatment of cancer is stressful and perceived stress and concerns during the treatment period can add to this stress and affect the recovery of patients with gastrointestinal cancer. The aim of this study was to investigate the relationship between illness perception and coping styles, and perceived stress in patients with gastrointestinal cancer. Materials and methods: The present cross-sectional correlational study was conducted in 110 patients with gastrointestinal cancer in Sari Imam Khomeini Hospital, Iran 2022, selected by convenience sampling. Data were collected using a demographic questionnaire, The Brief Illness Perception Questionnaire (Brief IPQ), Billings and Moos Coping Styles Questionnaire, and Perceived Stress Scale (PSS). Finally, the data were analyzed applying descriptive statistics and Chi-square, independent t-test, Pearson's coefficient correlation, and ANOVA. Results: Most of the participants were females (50.9%), with a medium income level (59.1%), living in the city (91.8%), suffering from colon cancer (40.9%), and undergoing treatment (90.0%). Findings showed that most of the patients had a high level of perceived stress (57.3%), moderate levels of illness perception (71.8%), and moderate coping styles (71.8%). We observed an inverse relationship between perceived stress and illness perception (P

Background & Objective: Learners prefer to use a system for learning that improves their interaction; therefore, self-regulated learning is important. The present study aimed to determine online self-regulated learning (OSRL) and its related factors among medical science students during the COVID-19 pandemic, 2021. Materials & Methods: This cross-sectional study was conducted on 249 students affiliated with Mazandaran University of Medical Sciences, Mazandaran, Iran, using a non-randomized quota sampling method. The required data were collected using a demographic form, an Online Self-Regulated Learning Questionnaire, and a researcher-made questionnaire of related factors of OSRL based on a literature review. The data were analyzed using descriptive and inferential statistical methods, such as ANOVA, t-test, Pearson, and multivariate linear regression using the Enter method. Results: The mean of the total score of self-regulated learning was 80.2±15.5 and in a good range. Among the related factors, students' gender (β=-0.239), marital status (β=-0.210), age (β=0.195), and time management (β=-0.125) explored 16.5% of the variance OSRL. The other variables had no significant relationship with OSRL. Conclusion: In the present study, marital status, gender, age, and time management significantly correlated with the variance of OSRL. Different studies are necessary to investigate the variables that explore OSRL so that educational managers can provide a better virtual learning environment for students by considering these variables.

Background: Rabies is a fatal and often neglected disease leading to encephalomyelitis following a bite by an infected mammal. According to the necessity of rabies disease in Iran, we present four cases of rabies virus infection. Case Presentation: We presented 4 cases of rabies virus infection hospitalized in different hospitals in Iran in 2021-2022. Three patients were male. The youngest patient was 6 years old and the oldest was 81 years old. In all 4 cases, RT-PCR detected the positive virus infection. Three cases received rabies immunoglobulin. All of them received at least one dose of rabies vaccination; but, unfortunately, all patients died. Conclusions: The present case series showed the necessity of early rabies vaccination and also the early organization of stray dogs in the community. Unfortunately, two cases were lost to follow-up. So, the population education and follow-up of suspected rabies patients must be taken seriously by healthcare facilities.

Abstract 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 Background The outbreak of the COVID-19 pandemic has thus far disrupted clinical nursing education (CNE) around the world and in Iran; which has encountered numerous challenges to this point for students and clinical educators. Therefore, this qualitative study was conducted to identify the perspectives of nursing students and clinical educators during the COVID-19 pandemic. Methods In this qualitative descriptive study, 15 participants, including nursing students and clinical educators, were selected through the purposive sampling method. The data were collected from March to September 2021 in nursing school through in-depth semi-structured interviews, and then analyzed based on the Graneheim and Lundman method. Results Two main themes, “CNE in the shadows of threats and opportunities” and “CNE recovery” and five themes (Injured CNE, CNE under fear, Lessons from the COVID-19 crisis, Providing optimal CNE by eradicating COVID-19, and Adapting CNE to existing conditions) were extracted from the data analysis. Conclusions The results of this qualitative study demonstrated that the COVID-19 pandemic had led the participants to experience new conditions, also referred to as “combined threats and opportunities”. Based on this, nursing managers and planners are advised to take great steps towards the development and improvement of CNE by considering and applying these results in their plans to overcome the challenge of CNE with effective and useful actions in the COVID-19 pandemic.

Background and purpose: Kawasaki is an acute childhood vasculitis of unknown cause that if left untreated can cause coronary aneurysms in 25% of cases. The disease is reported as the leading cause of acquired heart disease in children in developed countries. The purpose of this study was to investigate the epidemiological and clinical features of Kawasaki disease in northern Iran. Materials and methods: In this descriptive-analytic review study, all registered cases of Kawasaki disease in Mazandaran province between 2007 and 2019 were investigated. Epidemiological, demographic, clinical, periodical tests, risk factors, disease burden, complications, and follow-up information were collected. Data analysis was done applying descriptive statistics, Chi-square test, and logistic regression. Results: The data of 136 children with Kawasaki disease were assessed. Clinical symptoms were found to be significantly different between children with complete and incomplete Kawasaki disease (P0.05). Multivariate regression analysis showed that fever for more than 5 days is a predictor of coronary artery involvement (P= 0.001). Conclusion: The study showed that fever for more than 5 days is a risk factor for heart and coronary artery involvement as one of the complications leading to death in these children. Therefore, accurate control of fever and heart examinations are important in children with symptoms of

Abstract 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 Background and aim Health care workers (HCWs), mostly frontliners, are encountering numerous physical and psychosocial stressors, and even managing some conflicts over the course of the novel coronavirus disease 2019 (COVID-19). In this respect, the present study was to investigate the prevalence rate of occupational burnout (OB) in such workers during this pandemic. Materials and methods This cross-sectional study was conducted between April 6 and May 30, 2020, via an online survey in 31 provinces of Iran, on HCWs selected based on convenience sampling method. For data collection, a socio-demographic information form and the Maslach Burnout Inventory (MBI) was utilized. Descriptive statistics, Chi-square test, and multivariate regression analysis were also applied to test the research hypotheses. Results In total, 7626 HCWs participated in the present study. Accordingly, 73.2 and 26.8% of the workers were female and male, respectively. As well, 57.8% of the respondents were nurses and 14.4% of the cases were clinicians. Moreover, 44.8% of the participants had thus far worked in isolation wards and 40.3% of these individuals reported working for 4–8 hours with COVID-19 patients. The prevalence rate of OB was 18.3%. Besides, 34.2, 48.7, and 56.1% of the respondents had severe levels of emotional exhaustion (EE), higher depersonalization (DP), and decreased sense of personal accomplishment (PA), respectively. Besides, the HCWs at the age range of 20 to 30, having female gender, no children, and a bachelor’s degree, and working in isolation wards showed the higher levels of OB with reference to the Chi-square test results (p

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.

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 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