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Background: Proper transfer of professional values is an essential part of medical education. Real-life experiences in the educational process are one of the most effective methods for achieving values and assisting the student in developing his/her value framework. This study aimed to develop and characterize the concept of value-rich exposures in medical education to bring this concept closer to the practice.Methods: We used Walker and Avant concept synthesis method. In order to perform the synthesis, a combination of hermeneutic phenomenological method and literature review was used.Results: We defined the concept of value-rich exposure in medical education under five themes while implementing the steps of Walker and Avant's concept synthesis: probing self-inner values, value-rich program, value mentor, value-rich interactions, and value-rich environment. The elements and relationships of the themes were depicted in the form of a conceptual matrix.Conclusions:A value-rich exposure is a type of lived experience that occurs during a student’s professional life, a necessity that, with proper planning, can play an important role in shaping medical students' professional identities.

Exposing medical students to real-world situations and clinical practice experiences during their education years can help them build their professional value frameworks. The COVID-19 pandemic is one of the most challenging conditions that medical students have experienced; however, this pandemic have provided value-rich opportunities assisting in development and enhancement of their professional identity. This commentary aimed to emphasize the importance of medical students’ exposure to clinical practice during the pandemic and the potential that such encounters provide for internalizing values.

INTRODUCTION Long-term pulmonary complications are one of the major long-term consequences of sulfur mustard (SM) exposure. Toll-like receptor 4 (TLR4) involves in the pathogenesis of several pulmonary disorders. Surfactant protein-A (SP-A) regulates LPS-induced TLR4 localization and activation responses. However, the intensity and significance of TLR4 and SP-A expression by lung cells in SM-exposed patients is not clear. METHODS The gene expression of TLR4 (through real-time PCR) and TLR4 and SP-A positive cells and alveolar type II cells, as SP-A producers, (using IHC) were assessed in formalin fixed paraffin embedded (FFPE) specimens from SM-exposed (n = 17), and non-SM exposed individuals (n = 12). RESULTS TLR4 gene expression did not change between study groups. However, its cell surface presentation was significantly reduced in SM-exposed patients and particularly in which with constrictive bronchiolitis compared with the control group (P

Introduction: Over the past few decades, two revolutionary approaches have emerged as a new form of medical education: Electronic Medical Education and Web-based Medical Education. A number of well-known medical institutions, such as Harvard and Johns Hopkins used a wide range of cyberspace capabilities to increase their competitiveness. Researchers have expressed that cyberspace will change health system’s main objective of training physicians and medical education. We conducted this study to identify the health system critical considerations on core issues, involving the development of medical education on cyberspace. Methods: In order to conduct this study, we observed the steps of a critical literature review, combined with the ‘Four-phase method’ adopted by Carnwell and Daly. We focused on particular literature on health and cyber system functions; it was associated with systemic approach. Results: We developed a six-level taxonomy, Cyber level, Governance level, Ministerial level, Organizational level, Program level and Performance level, as a key solution that can be applied for the success of medical education on cyberspace. The results were summarized and appraised in more details. Conclusion: Medical education on cyberspace is a complex interdisciplinary system. It is important that all aspects of the health systems be involved as integral to the development of cyber based medical education; without this convergence, we will be confused by the decisions made by others within the system. Health system should also communicate with those external sectors that are critical to achieving better learning on cyberspace. Integrated planning, governance and management of medical education in cyberspace are pivotal elements for the promotion.

Sulfur mustard (SM) causes late complications in respiratory system of exposed individuals. In this preliminary study, the levels of IL-1α and β, TNF, IL-1Ra, IL-6 and fibrinogen in the spontaneous sputum of SM-exposed individuals were examined 20 years after exposure and the correlation with pulmonary function was tested. The participants were categorized into two major subgroups (hospitalized and non-hospitalized) based on the severity of the clinical complications immediately after exposure. Every participant was visited by a physician; the respiratory functions were checked using spirometry and were categorized as normal, mild, moderate or severe pulmonary complications. The levels of cytokines in the sputum and serum samples were measured using ELISA method. The mean values of TNF, IL-1α and IL-1β were 524.15, 115.15, 1951.33 pg/ml respectively, and the mean levels of IL-1Ra and IL-6 were 6410.52 and 124.44 pg/ml respectively; fibrinogen was 71.59 ng/ml and index of IL-Ra/IL-1β was 7.78. There was more TNF-α and IL-1β and less IL-1Ra and fibrinogen in the sputum of the hospitalized subgroup. The level of TNF-α and IL-1β also increased in moderate and severe pulmonary status comparing with the group with mild disorders, while fibrinogen was lower or decreased significantly in problematic patients. IL-1β and TNF showed positive correlation (r=0.5, and r=0.59, respectively); fibrinogen and IL1Ra/IL-1β have negative correlation with lung function according to the GOLD classification (r=-0.4, and r=-0.61, respectively). It is concluded that sputum cytokines and fibrinogen, reflect the degree of the severity of airway inflammation and the cytokine levels in the sputum might be completely different from the serum fluctuations.

The most important long-term morbidity problem of sulfur mustard (SM) toxicity is pulmonary complications but the pathogenesis of these complications is not clearly understood. This study evaluates the peripheral blood mononuclear sub-sets and their correlation with pulmonary function in SM exposed civilian cases 20 years post-exposure as gathered in the context of the Sardasht-Iran Cohort Study (SICS). Samples were randomly selected from two groups, SM-exposed (n=372) and control (n=128), with the same ethnicity, culture, and demography. Three color flow cytometry was applied for peripheral blood mononuclear sub-population determination. Results indicated a significant decrease in CD45+/CD3+, CD45+/CD3+/CD4+, and an increase in CD3+/CD16+56+ percentages. It was also found that absolute count of NK cells was highly increased in peripheral blood of exposed cases. There was a significant increase in NK cell count of SM exposed group with pulmonary problems as compared to the same group without pulmonary problems (p-value

The anti-phytoplasma activities of surfactin (derived from Iranian native Bacillus subtilis isolates) and tetracycline towards Candidatus "Phytoplasma aurantifolia", the agent of lime Witches' broom disease, were investigated. HPLC was used to quantify the surfactin production in four previously characterized native surfactin-producing strains, and the one producing the highest amount of surfactin (about 1,500 mg/l) was selected and cultivated following optimized production and extraction protocols. Different combinations of purified surfactin and commercial tetracycline were injected into artificially phytoplasma-infected Mexican lime seedlings using a syringe injection system. An absolute quantitative real-time PCR system was developed to monitor the phytoplasma population shifts in the lime phloem during 3 months following the injections. The results revealed that the injections of surfactin or tetracycline had a significant inhibitory effect on Candidatus "P. aurantifolia". However, the combined treatment with both surfactin and tetracycline (1:1) resulted in the highest inhibition due to a synergic effect, which suppressed the phytoplasma population from about 2×10 5 to less than 10 phytoplasma units/g plant tissue.

IL-10 is an anti-inflammatory cytokine that is important in the regulation of inflammatory processes in different conditions. Sulfur mustard (SM) intoxicated patients are suffering from different inflammatory diseases in their lung, skin and eyes. Physical activity (PA) is reported to control inflammation by reducing pro-inflammatory and inducing anti-inflammatory cytokines. Our previous study revealed lower PA and more sedentary lifestyle among SM exposed population. This study aimed to determine the relationship of PA with IL-10 production in SM exposed subjects. Baseline, mitogen-induced and the serum levels of IL-10 were evaluated. In a historical cohort study, Sardasht-Iran Cohort Study (SICS), 372 SM exposed participants were studied 20 years after exposure and were compared with 128 unexposed control participants. The Global Physical Activity Questionnaire (GPAQ; developed by WHO) was used to obtain a self-reported measure of physical activity. Whole blood culture supernatants and serum samples were used for IL-10 measurement by ELISA technique. In both the control and exposed groups mitogen-induced IL-10 production was significantly elevated with severity of PA intensity (p

Mustard gas was the most extensively used chemical agent in the Iraq-Iran war (1980–1988). It affects many important organs and systems; however, its cardiovascular effects are still unclear. In a historical cohort study, we evaluated the symptoms and signs of mustard gas exposed victims (397 cases) and compared the findings with the control group (132 persons). Typical chest pain was more frequent in the exposed group (11% versus 0%, P = 0.450). In addition, exertional dyspnea was found in 50% of the exposed group versus 30% in the control group (P = 0.162). Chest pain and dyspnea were more frequent in the exposed group and cardiac signs were the same in the two groups. Further studies must be planned for evaluating ischemic and valvular heart diseases, myopathy and other cardiovascular problems in these victims.

Sulfur mustard (SM) is an alkylating agent used several times by Iraqi forces as a chemical warfare agent in the Iraq-Iran war (1980–1988). Eyes, skin and respiratory system are the most sensitive organs to SM exposure. This agent has a suppressor effect on the immune system. As we did not find any study on the late rheumatologic complications of SM in the exposed victims in literature, in this study we investigated these complications in Sardasht (Iran) civilians 20 years after exposure. In a cohort study, 370 victims of Sardasht (that divided into two groups: hospitalized, n = 167, and non hospitalized, 203) in comparison to 128 control subjects from Rabat (Iran). The chief rheumatologic complaints, the physical examinations, the most probable clinical diagnosis and the rheumatic laboratory tests were compared between the study groups. The chief complaint was lower extremity pain; the most frequent physical finding was widespread tenderness and the most frequent clinical diagnosis was psychogenic pain. ...

Sulfur mustard was employed as a chemical warfare agent by the Iraqi forces in the borderline regions of Iran during the Iraq-Iran war (1980–1988). The short- and long-term biological effects of sulfur mustard agent have been studied in both basic and clinical aspects. One organ that was primarily affected was the respiratory system. Among the adults, regular physical activity positively affects the respiratory system as well as the individual’s ability to perform important daily tasks. We investigated the self reported physical activity in chemical victims 20 years after sulfur mustard exposure, compared the data with those of the matched counterparts, and explored any potential association with BMI. The exposed group was 357 and the control group was 125 individuals. Physical activity was measured using the global physical activity questionnaire (GPAQ) that evaluates work, recreational, transport and sitting activities. A significant difference was found between the control and exposed groups in terms o...

Sulfur mustard (SM) has widely been used against the military and civilians during the Iraq-Iran war (1980–1988). It mostly affects the respiratory system. A large historical cohort study was designed to evaluate the pulmonary status of non-military victims in Sardasht, Iran, in comparison with a matched control group 20 years after a single massive exposure. The exposed group was divided into two subgroups of hospitalized and non-hospitalized based on the severity of the injuries indicated by hospitalization a few days following exposure. All participants’ respiratory symptoms and signs were evaluated by internists. Dyspnea (n = 261; P = 93.2%) was the most common symptom. Chronic cough, cough severity, sputum, hemoptysis, dyspnea, pattern of dyspnea, severity of dyspnea (P

To describe the long-term health status of Sardasht civilians 20 years after sulfur mustard exposure, a historical cohort study was carried out in Sardasht (Iran) that included 372 exposed and 128 unexposed civilians. Their symptoms, diagnoses, drug use, and general health were compared. The most common complaints were about the respiratory system (93.5%), eyes (52%), skin (94.7%), and anxiety and depression (69.2%). Respiratory (42.5%), skin (75.5%), ophthalmic (19.6%), and mental (62.7%) diseases were diagnosed by specialists and they were more common in the exposed group than the control group (P < 0.001). Most of the exposed group had used drugs (70.6%), which was more than control group (42.8%). It seems that exposure to sulfur mustard caused a lot of health problems in Sardasht. Identifying the pathophysiology of these problems can help them more, but more investigation is needed.

Eyes are very sensitive to sulfur mustard (SM) gas because they have wet surfaces. The severity of ocular damage is related to the dose and duration of exposure to SM, and recovery may take up to several years after the exposure. We conducted a large cohort study to evaluate the ocular signs and symptoms of 367 chemical war victims in Sardasht City, Iran, 20 years after their exposure to mustard gas. The results of these chemical war victims (i.e., the cases) were compared with the results for 128 unaffected civilians (i.e., the controls). Photophobia was the most significant symptom in the cases (36.8%) (compared with 20.3% in the controls) (por = .001). Ocular surface discomfort (burning, itching, and redness) was the second most significant symptom in the cases (29.2%) (compared with 19.5% in the controls) (p = .034). Other symptoms such as foreign-body sensation, tearing, pain, blurring of vision, and dry eye sensation were not significantly different between the 2 groups. In the slit-lamp findings, bulbar conjunctival abnormality was the most significant sign in the cases (9.3%) (compared with 1.6% in the controls) (p = .004). Limbal tissue changes were the second most significant sign in the cases (3.0%) (compared with 0.0% in the controls) (p = .048). Other slit-lamp findings related to tearing and abnormalities in the lids and cornea were not significantly different between the 2 groups. Our findings in the present study showed that photophobia and ocular surface discomfort (burning, itching, and redness) were the most significant symptoms. In addition, bulbar conjunctival abnormalities and limbal tissue changes were the most significant signs among the sulfur mustard chemical war victims.

Pyridostigmine bromide (PB) is a reversible cholinesterase inhibitor. The aim of this study was to determine the effect of orally administration of single dose sustained-released tablet of pyridostigmine bromide (PBSR) on the frequency domain indices of heart rate variability (HRV). Thirty-two healthy young men were participated in this study. They were divided into 2 groups; the pyridostigmine group (n = 22) and the placebo group (n = 10). Electrocardiogram (ECG) was recorded at 10, 30, 60, 90, 120, 150, 180, 210, 240, 300 and 420 min after PBSR administration. At each time, simultaneously, a blood sample was prepared and PB plasma concentration was measured by high-performance liquid chromatography (HPLC) method. Statistical analysis showed that in different indices of HRV, there is a significant increase in low frequency (LF) band at 300 min, but no difference in high frequency band (HF). It also showed significant decreases in normalized high frequency band (Hfnu), normalized low frequency band (Lfnu) and LF/HF ratio at 120, 240 and 300 min after PBSR administration. Maximum plasma concentration of PB was 150 min after the administration. In conclusion, administration of a single dose PBSR can enhance the frequency domains indices of HRV and improvesympathovagal balance.

The selectins (L, P and E) are carbohydrate-binding membrane glycoproteins acting as adhesion molecules involved in the development of different inflammatory reactions. Various eye, skin and lung diseases are associated with induction of soluble selectins. In this study serum levels of soluble forms of selectins (sL-selectin, sP-selectin and sE-selectin) were evaluated in the sulfur mustard (SM) exposed and the control groups using ELISA method. sL-selectin was significantly lower in the SM exposed group compared to the control group (1131.5+/-16.3 and 1205.7+/-26.9 pg/ml respectively; p=0.021). The serum levels of sP-Selectin was significantly reduced in the SM exposed group in comparison to the control group (149.35+/-2.61 and 170.25+/-5.16 pg/ml respectively; p

The serum levels of four important and well characterized inflammatory chemokines including MCP-1/CCL2, RANTES/CCL5, IL-8/CXCL8 and Fractalkine/CX3CL1 were evaluated in sulfur mustard (SM) exposed Iranian population 20 years after exposure. In this historical cohort study 372 SM exposed participants from Sardasht, and 128 unexposed participants as controls were studied. The serum concentrations of chemokines were measured by a sandwich ELISA technique. The serum concentrations in the exposed comparing to the control group were 201.86 vs 180.60 pg/ml (p = 0.002), for MCP-1/CCL2, 1182.6 vs 1393.1 pg/ml (p = 0.021) for RANTES/CCL5, 12.61 vs 15 pg/ml (p = 0.002) for IL-8/CXCL8 and 0.696 vs 0.0648 (p = 0.413) for Fractalkine/CX3CL1. In conclusion, elevated levels of MCP-1/CCL2 may suggest an anti inflammatory response and decreased levels of IL-8/CXCL8 and RANTES/CCL5 may represent a different pathophysiology and diverse molecular mechanisms involved in long term clinical manifestations of SM exposure. However, further prospect into their role in the pathogenesis of SM remains to be done.

Background and purpose: Active learning, combined with computer-assisted instruction, can enhance medical students’ performance and learning. This article is an attempt to introduce a new web-based approach to information technology instruction for medical students.Methods: Eight topics were selected to be instructed in Web-based workshops. PHPBB Forum was used for web-based collaborative learning. One oral lecture session was held to make the students familiar with the Forum and their duties. For each topic, groups of 6-9 students had to search the Web, based on a search strategy to find answers for the questions. The students could discuss theirfindings in their group Forum under the supervision of a tutor.Results: Direct (face-to-face) and indirect (Web-based) interactions among students was considerably increased. The students showed greater interest in participating in class activities. Students’ attitude toward Web-based learning was improved.Conclusion: Adding collaborative learning to computer-assisted instruction, along with constant supervision by the tutor, can enhance students’ learning, since they can have free discussion and express their opinionsKey word: SMALL GROUP, INFORMATION TECHNOLOGY, WEB-BASED LEARNING