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Fatema Ahmed Ali,1 Ghufran Jassim,2 Zahra Khalaf,3 Manaf Yusuf,4 Sara Ali,5 Nada Husain,6 Fatema Ebrahim6 1Department of Internal Medicine, South West Acute Hospital, Western Health and Social Care Trust, Enniskillen, Northern Ireland, UK; 2Family Medicine Department, Royal College of Surgeons in Ireland — Medical University of Bahrain (RCSI Bahrain), Busaiteen, Kingdom of Bahrain; 3Department of Postgraduate Studies, Royal College of Surgeons in Ireland, Dublin, Ireland; 4Children’s & Adolescent Services, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK; 5Ministry of Health Bahrain, COVID-19 National Team, Sanabis, Kingdom of Bahrain; 6Department of Internal Medicine, Private Health Sector, Manama, Kingdom of BahrainCorrespondence: Ghufran Jassim, Family Medicine Department, Royal College of Surgeons in Ireland — Medical University of Bahrain (RCSI Bahrain), Busaiteen, Kingdom of Bahrain, Email gjassim@rcsi-mub.comObjective: This study aims to explore the prevalence of anosmia and dysgeusia and their impact on COVID-19 patients.Methods: This is a cross-sectional study. Patients diagnosed with COVID-19 between 1st October 2020 and 30th June 2021 were randomly selected from a national COVID-19 registry. COVID-19 cases were diagnosed using molecular testing method which measured the viral E gene. The Anosmia Reporting Tool, and a brief version of the questionnaire on olfactory disorders were used to measure the outcomes via telephone interviews. Data were analysed using SPSS 27 statistics software.Results: A total of 405 COVID-19 adults were included in this study, 220 (54.3%) were males and 185 (45.8%) were females. The mean±SD age of participants was 38.2 ± 11.3 years. Alterations in the sense of smell and taste were reported by 206 (50.9%), and 195 (48.1%) of the patients, respectively. Sex and nationality of participants were significantly associated with anosmia and dysgeusia (p < 0.001) and (p-value=0.001) respectively. Among patients who experienced anosmia and dysgeusia, alterations in eating habits (64.2%), impact on mental wellbeing (38.9%), concerns that the alterations were permanent (35.4%), and physical implications and difficulty performing activities of daily living (34%) were reported.Conclusion: Anosmia and dysgeusia are prevalent symptoms of COVID-19 disease, especially among females. Although transient, anosmia and dysgeusia had considerable impact on patient’s life. Neuropsychological implications of COVID-19 in acute infection phase and prognosis of anosmia and dysgeusia in COVID-19 are areas for further exploration.Keywords: anosmia, taste, smell, COVID-19, dysgeusia, quality of life

Alok Prasad, Aamer Mughal, Imran Ahmed, Farheen Ebrahim, Syed Mustafa Ali AhmadFaculty of Medicine, Imperial College – London, London, UKWe note with great interest the article by Deane and Murphy1 exploring the learning drivers and strategies of medical students in a clinical rotation in obstetrics and gynecology. The article highlights key points about the motivation of medical students, and we strongly agree that extrinsic motivators, such as obtaining a good ranking to stand a better chance when applying for future jobs, are key learning drivers. We lament the relative unimportance of intrinsic motivators and we commend the authors’ suggestion of considering strategies to foster more intrinsic drivers of student learning. We believe, however, that this will be difficult to implement with the intense competition prevalent at every stage of a medical career, with students’ motivations more likely to be of the extrinsic nature. Furthermore, from a practical standpoint, aspirations relating to future careers are often volatile or, more commonly, uncertain. This creates an environment wherein intrinsic motivators may not be applicable, and so we would argue that medical educators should focus more on aiding students to find their given area of interest, allowing the intrinsic motivation to develop naturally.View the orignal paper by Deane and Murphy.

Aamer Mughal, Alok Prasad, Imran Ahmed, Farheen Ebrahim, Syed Mustafa Ali Ahmad Faculty of Medicine, Imperial College London, London, UK We note with great interest the work of Kötter and Niebuhr,1 with regard to reducing examination-related stress in medical students through short-term coaching. We highly commend their efforts to provide an evidence base for techniques that have been suggested in the literature. We would however argue that the use of coaching such as wingwave® may perhaps be too impractical and expensive to be used on a regular basis, and that the long-term efficacy of the approach is unclear. We would encourage further work into other methods and would specifically welcome trials comparing these techniques to the coaching described by Kötter and Niebuhr. View the original paper by Kötter and Niebuhr.

Aim: The incidence of thyroid cancer has increased dramatically in recent decades. Multifocality is considered a poor prognostic factor for papillary thyroid carcinoma (PTC). Patients with multifocal PTC (MPTC) are at high risk for local recurrence, as well as lymphatic and distal metastases. This study examined the features and outcomes of MPTC. Material and Methods: This retrospective study was conducted on 300 patients with PTC. Patients were classified into a multifocal group and a unifocal group. The pathological features of the PTC and the patients’ outcomes were analyzed and compared. Results: The multifocal group included 146 patients (48.7%), while the unifocal group included 154 patients (51.3%). The occurrence of multifocality was higher in females than in males (Odds ratio, OR: 2.37, 95% confidence interval, CI: 1.20-4.67, p=0.015). Tumor size of >1 cm in the multifocal group was larger than in the unifocal group (2.5 and 2.2 cm, respectively, p=0.021). Moreover, in multifocal group higher moderate risk of recurrence was detected than in the unifocal group (OR: 1.63, 95% CI: 1.01-2.60, p=0.044). At follow-up after treatment, MPTC patients had higher lymph node metastasis (OR: 2.89, 95% CI: 1.23-6.80, p=0.014). In addition, significantly higher thyroglobulin plasma levels (p=0.026) and disease recurrence (OR: 2.41, 95% CI: 1.05-5.52, p=0.037) were found in the multifocal group compared to the unifocal group. Conclusion: Patients with MPTC had a higher risk of disease recurrence, and multifocality was concluded to be an independent prognostic factor for overall disease recurrence.

Aim: The late elderly, are the leading group of non-survivors infected with the coronavirus disease 2019 (COVID-19). Computed tomography (CT) imaging has been recognized as an important diagnostic method for COVID-19. This study aimed to determine the prognostic performance of CT imaging in patients above 75 years old. Material and Methods: After meeting the inclusion and exclusion criteria 56 elderly patients, 28 male, and 28 female were included in the study. Two radiologists interpreted CT imaging and a third experienced radiologist was in charge of reviewing the data and imaging findings in the controversial and disagreement cases. The lung score was determined for each patient, and radiologic signs were also examined. Results: The mean age of the patients was 81.4±5.0 years. Thirty-six patients survived, and 20 did not. 28 (50.0%) patients had central involvement, while 25 (44.6%) patients had diffuse involvement. Radiologic signs such as consolidation and air bronchogram were more common among non-survivors than survivors (both p=0.001). The mean lung score for the survivors was 8.75±6.21 and 13.45±6.41 for non-survivors, and the difference between the two groups was statistically significant (p=0.010). The area under the receiver operating characteristic curve for a cut-off score of 12 was 0.714 (95% CI, 0.577 to 0.827, p=0.003). Conclusion: It seems that using lung scores can play a very important role in predicting the condition of hospitalized patients over 75 years old.

Background: Type2 diabetes is a metabolic disease that is rapidly increasing in the world. GLUT4 and RBP4 are factors that play a role in glucose uptake. This study aimed to investigate the effect of moderate-intensity continuous training on RBP4 and GLUT4 gene expression of soleus muscle in STZ induced diabetic rats. Methods: This experimental study was conducted between May and September 2016 at Baqiyatallah University of Medical Sciences. In this study, there were 48 8-week-old male Wistar rats (mean weight 250±20) that were randomly divided into four groups: basic control, 12-week control, diabetes, diabetes and moderate continuous training. Diabetes was induced by injection of streptozotocin solution. The training protocol consisted of continuous aerobic training for 12 weeks, five sessions per week in the form of running on a treadmill. After sampling, real-time PCR expression was used to measure gene expression. Statistical analysis was performed by SPSS software, version 22 (IBM SPSS, Armonk, NY, USA) and graphs were drawn using GraphPad Prism, version 8, (GraphPad Software, USA). Results: According to the results, there was a significant increase in RBP4 in the diabetic group compared to other groups. compared to the two groups of diabetes and diabetes, along with moderate continuous training, RBP4 gene expression was less expressed in diabetic training. Regarding GLUT4, there was a significant difference between diabetes and diabetes groups with training. Also, the expression of the GLUT4 gene in the diabetic group with training was higher than the other groups. According to this study, it was shown that moderate-intensity continuous training somehow reduces the negative effects of diabetes on metabolism and health by activating various cellular and molecular pathways and mechanisms. Conclusion: the present study showed the effect of moderate-intensity continuous training on the expression of RBP4 and GLUT4 genes in soleus muscle which can be effective in glucose uptake. It was also shown that moderate-intensity continuous training can minimize the complications of diabetes by reducing RBP4 gene expression.

Background: Multiple risk factors are supposed to progress oral cavity carcinoma and among them, the role of neither bacterial nor viral infections should be underestimated. Despite relentless efforts, the accelerating effects of human papillomavirus (HPV), Epstein–Barr virus (EBV), and Porphyromonas gingivalis (P. gingivalis) on oral cancer has not yet been recognized successfully. Taking advantage of these facts, in this study we evaluated the prevalence of HPV, EBV, and P. gingivalis in oral cavity carcinoma. Materials and Methods: A total of 43 oral cavity cancerous tissues and 29 healthy oral ones were collected from Loghman Hospital, Tehran, Iran, between 2016 and 2018. After DNA extraction, the prevalence of HPV, EBV, and P. gingivalis was evaluated by PCR. Results: There were 53.5 well-differentiated (15 male, 9 female), 41.8% moderate (10 male, 5 female), and 4.7% poor (1 male, 3 female) adenocarcinoma paraffin-embedded tissue samples. PCR analysis has shown that there were 1 HPV (age: 46; moderate adenocarcinoma) and 1 EBV (age: 62; moderate adenocarcinoma) positive in different samples. No P. gingivalis was found and there was not any infected tissue with both EBV and HPV. In 31% of control tissues, blisters were observed and in 51.7% there was no mucus. We did not find any association between age, sex, and HPV, EBV positive samples. Conclusion: As sample size can affect the results of epidemiological and clinical study, and due to the low number of positive samples in this study, we concluded that HPV, EBV, and P. gingivalis may not have a detrimental effect on the progression of oral cancer, but further studies are needed.

Background: Myocardial infarction is a daily challenging emergency. Proper diagnosis and intervention in a timely manner is crucial. The aim of the work: We aimed to detect the impact of primary percutaneous coronary intervention [PPCI] on the development and severity of mitral valve regurgitation in patients presenting with acute myocardial infarction with ST-segment elevation [STEMI]. Patients and Methods: This was a cross-sectional comparative study that was conducted from January 2018 to November 2019 at the Department of Cardiology, Al-Azhar University Hospital, Damietta, Egypt. Patients were divided into four groups; Group I: STEMI patients with PPCI and single-vessel disease; Group II: STEMI patients with PPCI of culprit vessel and staged PCI with in-hospital admission; Group III: STEMI patients with streptokinase and pharmaco-invasive PCI of the single vessel; Group IV: STEMI patients with streptokinase and multi-vessel PCI at the same session. Results: One-hundred and five patients were included in this study. Patients in group I showed a significant improvement after six months of follow-up in terms of ejection fraction [p

Background: Port catheter is a new generation of central venous catheter used in patients with cancer to prescribe chemotherapy drugs. There are various methods for inserting this catheter, and the aim of present study was to evaluate the complications of catheter insertion via subclavian or external jugular vein cut-down. Methods: The study was performed on 80 patients with malignancy requiring port catheter insertion. External jugular vein cut-down and Seldinger method via subclavian vein was used for vein access in groups A and B, respectively. To implant the port chamber, a cavity was created in the subcutaneous tissue below the clavicle. Then, a tunnel was made between the cavities and puncture site for the bypass catheter, and the catheter tip was attached to the port compartment. All patients were evaluated for intraoperative complications such as pneumothorax, hemorrhage, artery rupture, inappropriate port catheter place, and embolism, as well as late complications such as infection, thrombosis, extravasation, catheter rupture, and pulmonary embolism. Findings: Early complications such as pneumothorax (12.5% vs. 0.0%) and hematoma (15.0% vs. 2.5%) were more common in group B (P < 0.050). Moreover, delayed complications such as infection (9 vs. 2 cases), venous thrombosis (7 vs. 1 patients), catheter obstruction (8 vs. 2 cases), and cellulitis (8 vs. 2 patients) were more common in group B, too (P < 0.050). Conclusion: Despite higher insertion time, port catheter insertion via subclavian vein was a better method than external jugular vein due to lower incidence of early and late complications.

Background & objectives: The purpose of this study was to determine the bacterial bioaerosols in indoor air of Ardabil universities and to investigate the factors affecting their concentration in Ardabil city. Methods: Air sampling was performed using Andersen single-stage sampler at a flow rate of 28.3 liters per minute and a respiratory range of 10 min. In this study, trypticase soy agar containing cycloheximide antibiotic was used for bacterial culture. Biochemical tests such as DNase, catalase, oxidase, coagulase, bile esculin hydrolysis test, urease, citrate test, antibiotic resistance to novobiocin, bacitracin and optochin were used for identification and differentiation of isolates. Result: The mean bacterial concentration in Ardabil university of medical sciences in the open air, outside the college, the halls, the classrooms and the staff rooms was 18, 88.4, 76.6, 77.4 CFU/m3 , respectively. The concentration of bacteria in Islamic Azad university of Ardabil in the open air, outside the college, the halls, the classrooms and the staff rooms was 103, 97, 124, 132 CFU/m3, respectively. The dominant species of bacteria in indoor air were Staphylococcus aureus, Staphylococcus epidermidis, Actinomycetes and Bacillus, respectively. Conclusion: According to the results of this study, it is found that the concentration of bacterial bioaerosols in indoor air is not more than standard, but the abundance of bacterial species can cause lung, intestinal and other diseases in academic personnel, staff and students in the long-term.

Background and Aim: Viral infections in the intensive care units (ICUs) often involve the central nervous system or respiratory tract. These infections can cause significant morbidity and mortality. Science the fact that there is effective treatment against some viruses, knowing the viruses that cause infections in ICU can be a great help in managing these patients. Hence, the study reviewed the major viruses in the ICU. Materials and Methods: We searched published articles on trends of viral infections in the intensive care units (ICUs). The articles were retrieved from databases of PubMed, Scopus, Google Scholar, and MEDLINE. Conclusion: Due to the significant outbreak of viruses in the ICU and the presence of effective treatments against some viruses, knowing the important viruses in this area and rapid diagnosing and treatment can be important

Background: Colorectal cancer (CRC) is the third and a second common cancer in men and women respectively in the world and about 1.4 million new cases diagnosed in 2012. The normal gut microflora consists of bacterial species. One group of them is probiotics, which confer a health benefit to the host. Lactobacillus reuteri (L.reuteri) is known as a probiotic, which lead to the prevention of colorectal cancer. The aim of this study was to assess the inhibitory effects of Lactobacillus reuteri’s cell wall on cell proliferation in the colorectal cancer HCT-116 cell line.Materials and Methods: The cells of HCT-116 cell line were grown at 37ᵒC, 5% CO2. L.reuteri was obtained from the Iranian Biological Resource Center and cultured in the MRS Broth at 37ᵒC for 48h anaerobically. The cell wall was prepared by the freezing-thawing procedure. So the inhibitory effect of L.reuteri on the growth and proliferation of HCT-116 cells was assessed by MTT assay.Results: The cell wall from L.reuteri inhibited cell proliferation on colorectal cancer HCT-116 cell line. It showed dose- and –time dependent inhibition.Conclusion: These results demonstrated that cell wall of L.reuteri inhibits cell proliferation of HCT-116 cell line.

Background and Objectives: Adherence to low-sodium diet is an important aspect of self-care behaviors, which plays a role in improving the quality of life, and in reducing readmission rate, mortality, and healthcare costs. This study aimed to investigate the correlation between type D personality and adherence to low-sodium diet in patients with systolic heart failure. Methods: This descriptive-correlational study was conducted on 100 patients with heart failure with at least one year history and ejection fraction below 40% hospitalized in the internal ward of Alborz Social Security Hospitals of Karaj and Shahriar in 2013, who were selected by convenience sampling. Demographic characteristics form, type-D personality questionnaire, and adherence to low-sodium diet, were completed by interview. The data were analyzed using descriptive statistics, t-test, ANOVA, and Pearson correlation coefficient. Results: In this study, there was a poor significant positive correlation between adherence to low-sodium diet and dimensions of depression/anxiety (p=0.032), social inhibition (p=0.008), and total score of type D personality (p=0.023). Conclusion: The results of this study showed that heart failure patients with type D personality had lower adherence to low-sodium diet. Hence, screening and evaluation of heart failure patients in terms of type D personality, referring patients for consultation, and use of appropriate therapies, can help to improve adherence to low-sodium diet and quality of life in heart failure patients.

Introduction: Surveying the viewpoints of students and graduates is one of the important steps in determining the aspects of a curriculum that require revision. The purpose of this study was to assess the opinions of students of nutrition sciences about the credits of basic courses in Iranian medical universities 2014-15. Methods: This cross-sectional study was conducted on 185 MSc and final-semester BSc students who were selected from all Iranian medical universities through convenience sampling census. Data collection tool was a valid and reliable researcher-made questionnaire. The proportion of course credits to content, interest in each course, proportion to community needs, and relation to the field nutrition were assessed. Data were analyzed by means of descriptive statistics. Results: As to basic nutrition 2, pharmacology, pathophysiology, principles of meal planning, diet therapy 1, diet therapy 2, nutrition for special groups, nutrition physiology and diet therapy apprenticeship, 49.8, 61.3, 61, 63.6, 66.2, 68, 56.2, 62.5, 56.2 percent of the participants respectively stated that the credits of these courses were inadequate relative to their contents. Most of the students believed that the courses metabolism biochemistry, basic nutrition 1, basic nutrition 2, pharmacology, pathophysiology, English for nutrition students and principles of meal planning were highly related to the field nutrition. Most students also believed that 5 new courses should be added to the curriculum. 84.8% and 93.7% of the students respectively believed that an internship in the field course and an internship program during theory courses should be created. Also, 58.6% of them believed that the length of the program should be more than 4 years and as a PhD program. Conclusion: According to the findings of this study, revision of the curriculum of nutrition sciences BSc program by taking students’ opinions into account seems necessary.

Introduction: Rheumatoid arthritis (RA) is one of the most common chronic inflammatory disorders. Genes and environmental factors contribute to RA. Epstein–Barr Virus (EBV) has been considered as one the RA pathogeneses. The aim of this study was to detect of the EBV genome in patients with RA. Methods: In this cross-sectional study, 50 samples of synovial fluid were obtained from patients with RA from 2010–2012. Using a standard of the EBV genome and EBNA-1-specific primers, the method of PCR was set up. Then, all of the samples of synovial fluids separately were subjected to DNA extraction and Polymerase Chain Reaction (PCR) amplification. Data were analyzed using SPSS version 18.0. The statistical analysis was performed by the t-test. Results: The demographic and laboratory characteristic assay revealed that the mean age of patients was 49, and the patients were 60% males and 40% females. In addition, in all cases, the mean rheumatoid factor (RF) levels of the patients were below the normal level. The results of this study showed that the PCR was able to detect EBV DNA in > 60% of the cases. Conclusion: The results of this study indicated that EBV was frequently detected in the synovial fluid of RA patients. Thus, EBV may be a strong candidate that can act at several levels of the pathophysiology of RA. However, these findings also indicated that EBV may play a role in the pathogenesis of RA. However, the possible relationship between RA and EBV must be determined by further research.

Introduction: Brucella spp. are gram-negative, facultative intracellular bacteria pathogens responsible for brucellosis, a zoonotic disease that can cause abortion, fetal death, and genital infections in animals and undulant fever in humans. Lipopolysaccharide (LPS) is known as a major virulence factor of Brucella spp. The wboA gene is capable of encoding a glycosyltransferase that appears to play a major role in LPS biosynthesis. Hence, the characterization of this gene can help in the clarification of the pathogenicity of Brucella spp. Methods: This study was carried out at Razi Vaccine and Serum Research Institute in 2011. Briefly, the wboA gene in B. abortus biovar 3 and B. melitensis biovar 1, the predominant biovars in Iran, were amplified by using two pairs of specific primers. Polymerase chain reaction (PCR) products were cloned into a thymine–adenine (TA) cloning vector and transformed into an E. coli DH5α before being sequenced. Multiple alignments of identified sequences were performed, with all wboA sequences deposited in the GenBank sequence database. Results: This study showed that a mismatch has occurred in B. melitensis biovar 1; this biovar is predominant in Iran. In contrast, the wboA gene from B. abortus biovar 3 was similar to that of other B. abortus variations. Conclusion: The comparison and alignment of the wboA gene of native Brucella strains in Iran to all wboA sequences deposited in GenBank revealed that the wboA gene has changed in the long term; hence, because of its unique nucleotide pattern, the gene can be used for specific diagnosis of B. abortus and B. canis.

Background: We sought to determine the clinical characteristics of pediatric esophagitis in southern Iran. Methods: This cross-sectional study was conducted over a 4-year period, from 2005 to 2009, in Nemazee Hospital, a tertiary healthcare center in Shiraz, southern Iran. We consecutively included all pediatric patients (

Introduction: Changes in science, technology and life style, and the role of nutrition in the pathogenesis of chronic diseases have propounded the need to revise the outline and content of nutrition course in medical education. The objective was to determine the opinion of medical students in Lorestan University of Medical Sciences (LUMS) about the outline of nutrition course and obtain their suggestions concerning adding new topics to this course in 2004. Methods: In this descriptive study, a valid and reliable questionnaire which asked about the current outline of this course, the time specified for it, and the necessity for learning nutrition, was designed. Also, the topics physicians faced the most but not considered in the course, were put in the questionnaire. The questionnaires were sent to 56 interns and filled by them. The statistical analysis was performed by SPSS softwere. Results: The respondents believed that the nutrition course outline should be divided and presented in three stages of basic sciences, introduction to clinical medicine, and clerkship. They also suggested new nutrition topics such as hospital diets, tube feeding, total parenteral nutrition, and diet and diabetes for the medical education curriculum. In total, they considered 55.9% of the nutrition course, applied and in accordance with their professional needs. Conclusion: This study suggested that the current nutrition course which is taught in Iranian medical schools does not have the required application for a physician and should be revised. These revisions include, adding new topics, presenting the course in an appropriate stage of studying medicine, and adding the number of credits concerning nutrition and diet therapy.