Search

Background: The topical application of boron has been significantly associated with intensifying wound healing. Using 3% boric acid in deep wounds significantly contributes to wound healing and reduces the duration of hospitalization in the intensive care. The objective of this study was to assess the therapeutic impact of a topical gel containing sodium pentaborate pentahydrate on the management of wounds resulting from grade 1 to 3 hemorrhoids. Methods: In this randomized double-blind placebo-controlled trial, we applied a topical gel consisting of sodium pentaborate pentahydrate 3% on 206 eligible patients with the diagnosis of grade 1, 2, and 3 hemorrhoid diseases. Then patients were randomly allocated to two groups of sodium pentaborate pentahydrate or placebo gel with a ratio of 1:1 and received the allocated gel for four weeks. Patient hemorrhoid symptoms severity, hemorrhoid degree, and anoscopy findings were compared before and after the trial. Results: Before the intervention, symptom severity (p > 0.05) and anoscopy findings (p = 0.815) were similar between the two groups. Subsequent to the intervention, a majority of patients in the intervention group experienced a reduction in anal itching compared to the placebo group [adjusted mean difference (aMD) 95% CI: -1.98 (−2.2 to −1.8), p = 0.007]. Moreover, resting pain [aMD (95% CI): -1.37 (−1.6 to −1.1), p = 0.015], pain during defecation [aMD (95% CI): -2.19 (−2.4 to −2.0), p = 0.005], feeling a lump in the anus (aMD (95% CI): -0.71 (−1.2 to −0.2), p = 0.011), bleeding during defecation (41.7% vs. 66.9%, p = 0.027), and hemorrhoid degree (p

Abstract Introduction The relationship between cardiovascular disorders and nonalcoholic fatty liver disease (NAFLD) has been extensively studied. To better pool this data and make a more definite conclusion, we performed a meta‐analysis to evaluate the association between NAFLD and the thickness of media and intima of carotid artery (CIMT) and cardiovascular disorders. Methods We searched PubMed, Ovid, Scopus, ProQuest, Web of Science, and the Cochrane Library, and analyzed the pooled data using R studio and the “metafor” package. Results The final analysis included a total of 59 studies with 16,179 cases and 26,120 control individuals. NAFLD was shown to be associated with an increase of 0.1231 mm (20.6%) in carotid artery intima‐media thickness (CIMT) (p = 0.002, 95% confidence interval [CI]: 0.0462–0.2000) in individuals with NAFLD. The prevalence of atherosclerotic plaques in the carotid arteries and the occurrence of NAFLD are significantly correlated, according to a meta‐analysis based on 17 distinct studies (p = 0.001, 1.28–1.43, 95% CI, odds ratio = 1.356). Conclusion Patients with increased CIMT are considerably more likely to have NAFLD. Large prospective investigations are required to corroborate these findings and their prognostic significance, along with the effectiveness of the available interventions.

Background: The association between the severity of coronary atherosclerosis and histopathologic findings in patients with non-alcoholic fatty liver disease (NAFLD) is not entirely understood. Considering the gold standard method, this study evaluates the histopathologic association between the severity of NAFLD and the grades of coronary atherosclerosis. Methods: In this descriptive-analytical study, data from 205 cadavers who were referred to an Iranian (Tabriz) forensic medicine organization between 2015 and 2017 and underwent simultaneous liver and coronary artery biopsies were examined. Finally, 168 cases were entered based on the inclusion criteria. First, pathological slides of these cadavers were extracted from the forensic medicine archive and re-examined. Then, the selected cases’ blocks were extracted from the tissue block bank, and again, after preparing a new slide, they were stained with trichrome for accurate estimation of liver fibrosis. Results: The assessment of NAFLD histological status in the studied cases revealed that 75.6% of the cases were classified as severity I, 18.4% as severity II, and 6% as severity III. Most cases with coronary atherosclerosis were classified as American Heart Association staging (AHA), type V (19.6%), and normal (19.6%). There was no statistically significant relationship between the severity of simple steatosis, steatohepatitis, and NAFLD, with coronary atherosclerosis. In subjects with higher severity of coronary atherosclerosis, the liver fibrosis rate is also higher, but no statistically significant difference was observed. Conclusion: The present study revealed no significant histopathological association between NAFLD and coronary artery atherosclerosis grade.

Background: Due to the interruption of the EHC pathway in NAFLD patients, we hypothesized that parenteral vitamin D supplementation is superior to oral in vitamin D insufficient patients with NAFLD. Therefore, this study aimed to compare the efficacy of oral and parenteral routes of vitamin D supplementation on serum 25(OH) vitamin D levels in patients with NAFLD. Methods: In this prospective randomized trial, 66 NAFLD cases with vitamin D deficiency were studied. For 33 cases, oral vitamin D was supplemented, whereas the other 33 patients were given an intramuscular injection of vitamin D. Laboratory tests and liver ultrasound were performed at the beginning and the end of the trial for each subject. Results: Regardless of the drug administration route, at the end of this trial the mean of serum 25-hydroxy vitamin D level increased from 8.74±2.47 to 33.16±17.61 (P=0.00), and the mean±SD for serum triglyceride decreased from 191.46±92.79 to 166.00±68.30 (P=0.02), both were statistically significant. Liver ultrasound reported statistically significant changes in the grade of fatty liver disease (P=0.003). In the comparison between the two groups, serum 25-hydroxy vitamin D level changes were not statistically significant (P=0.788). Conclusion: The intramuscular method of supplementation was not better than the oral route in improving serum 25(OH) vitamin D levels in NAFLD patients. In this study, the impaired EHC and vitamin D absorption inhibitor factors in NAFLD patients did not affect the final result of serum vitamin D levels significantly.

Background: Non-alcoholic fatty liver disease (NAFLD) is one of the important health issues with high prevalence worldwide. However, there is no approved medication for that. As one of the indicators of metabolic syndrome, uric acid might play a role in the pathogenesis of NAFLD. In this study, we aimed to determine the correlation between serum uric acid level, liver enzymes, and ultrasonographic grading of NAFLD. Methods: This cross-sectional study included patients aged 18-65 with NAFLD. Patients with other metabolic disorders and a history of using alcohol or medications that alter uric acid levels were excluded. The patients' serum uric acid, alanine aminotransferase (ALT), aspartate aminotransferase (AST) levels, and ultrasonographic grading of NAFLD at baseline, third month, and sixth month were collected. Results: Of the 3000 patients, 500 patients met the eligibility criteria. The results showed that there is a significant positive relationship between ALT and serum uric acid level at the first (P = .01), third (P = .01), and sixth month (P = .01). Furthermore, there was a significant positive correlation between AST and serum uric acid level at the sixth month (P = 0.001). The comparison of 249 patients' ultrasonographic grading showed no significant correlation with serum uric acid levels. Conclusion: To conclude, the serum uric acid level significantly correlates with ALT and AST over six months but not with the ultrasonographic grading. Further studies are required to determine the role of uric acid-lowering agents in the treatment of NAFLD.

Abstract Objective Uncoupling protein 2 (UCP2) plays a crucial role in energy homeostasis via insulin secretion regulation, free fatty acid concentrations, and lipid metabolism. This study aimed to investigate the association of 45-bp ins/del polymorphism of UCP2 with susceptibility to NAFLD (Non-Alcoholic Fatty Liver Disease) and T2DM (Type 2 Diabetes Mellitus). DNA was extracted from the white blood cells of the subjects, and the gene polymorphism was determined using polymerase chain reaction (PCR). In this study, 72 patients with NAFLD, 71 healthy individuals as control, 80 patients with T2DM, and 77 healthy controls were enrolled in the study. Results A higher prevalence of insertion/insertion genotype was observed in T2DM patients compared to the controls (p- value˂ 0.05). There was no difference in genotype distribution between NAFLD patients and controls (p-value > 0.05). NAFLD patients with D/D, D/I genotype had higher triglyceride, ALT, and AST levels; however, their HDL levels were lower than healthy controls. Patients with T2DM with D/D or D/I genotype also had significantly higher fasting serum glucose (FSG). While we found an association between the 45 bp I/D polymorphism in 3ʹUTR of UCP2 and T2DM, no correlation between this polymorphism and NAFLD was identified.

Introduction: Clinical reasoning as a critical and high level of clinicalcompetency should be acquired during medical education, and medicaleducators should attempt to assess this ability in medical students. Nowadays,there are several ways to evaluate medical students’ clinical reasoningability in different countries worldwide. There are some well-known clinicalreasoning tests such as Key Feature (KF), Clinical Reasoning Problem(CRP), Script Concordance Test (SCT), and Comprehensive IntegrativePuzzle (CIP). Each of these tests has its advantages and disadvantages. In thisstudy, we evaluated the reliability of combination of clinical reasoning testsSCT, KF, CIP, and CRP in one national exam and the correlation between thesubtest scores of these tests together with the total score of the exam.Methods: A total of 339 high ranked medical students from 60 medicalschools in Iran participated in a national exam named “Medical Olympiad”.The ninth Medical Olympiad was held in Shahid Beheshti University ofMedical Sciences, Tehran, Iran, under the direct supervision of the Ministryof Health and Medical Education in summer 2017. The expert groupdesigned a combination of four types of clinical reasoning tests to assessboth analytical and non-analytical clinical reasoning. Mean scores of SCT,CRP, KF, and CIP were measured using descriptive statistics. Reliabilitywas calculated for each test and the combination of tests using Cronbach’salpha. Spearman’s correlation coefficient was used to evaluate the correlationbetween the score of each subtest and the total score. SPSS version 21 wasused for data analysis and the level of significance was considered Results: The reliability of the combination of tests was 0.815. The reliability ofKF was 0.81 and 0.76, 0.80, and 0.92 for SCT, CRP, and CIP, respectively. Themean total score was 169.921±41.54 from 240. All correlations between eachclinical reasoning test and total score were significant (Pcorrelation (0.887) was seen between CIP score and total score.Conclusion: The study showed that combining different clinical reasoningtests can be a reliable way of measuring this ability.

BACKGROUND Pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP), which may lead to death. The purpose of this study was to evaluate the preventive effect of aggressive fluid therapy on the incidence of post-ERCP pancreatitis. METHODS In double-blind controlled condition, 240 patients were selected and divided into two groups. The treatment of the intervention group (n = 120) included a dose of 20 mL/kg of ringer lactate infusion within 90 minutes before ERCP and 3 mL/kg/h during ERCP followed by 3 mL/kg/h up to 8 hours. The treatment of the control group (n = 120) included a dose of 1.5 mL/kg of ringer lactate infusion during ERCP up to 8 hours later. Firstly, the patients were evaluated in terms of excessive fluid and serum amylase and pain level, and then they were re-evaluated 2, 8, and 24 hours after ERCP. RESULTS The mean age of the patients was 51.57 ± 13.5 years. Most of the patients were female (54.5%). Pancreatitis was developed in 26 patients including 5.83% of the patients in the intervention group and 15.83% of the patients in the control group (p = 0.013). Pancreatic pain was seen in 7.5% of the patients in the intervention group and in 27.5% of the control group (p < 0.005). Hyperamylasemia was seen in 20.83% of the patients in the intervention group and in 35% of the control group (p = 0.014). The mean days of hospital admission was 1.308 ± 0.807 in the intervention group and 1.425 ± 0.876 in the control group (p = 0.275). CONCLUSION Aggressive fluid therapy with ringer lactate solution before ERCP can effectively prevent post- ERCP pancreatitis, pancreatic pain, and hyperamylasemia.

Background Gastrointestinal cancers in Iran are among the major non-communicable diseases with a considerable burden on the health system. Changes in lifestyles as well as environmental factors have resulted in the emergence of these cancers. Objective To elicit and quantitatively verify experts’ opinions regarding the potential public health impact, feasibility, economic impact, and budgetary impact of gastrointestinal cancer prevention policies in Iran. Methods Sixteen experts from Iran were recruited in an email-based, two-round Delphi study. In each round, a questionnaire of policy options for preventing gastrointestinal cancers, which adhered to the new policy framework of the World Cancer Research Fund International, was given to participants. In the first round, experts were asked to provide opinions for and against the policy options. The second round evaluated the policy options for their public health impact, feasibility, economic impact, and budgetary impact. Results A total of 32 policy options were organized based on three domains: health-enhancing environments, system changes, and behavior change communications. Of the 32 policy options, there were consensus in 31 (96%) and 30 (93%) options for public health impact and feasibility, respectively. On study completion, experts reached a consensus in 29 of 32 (90%) policy options for economic impact; only on 26 (81%) of these policy options did participants reached consensus for budgetary impact. Conclusion Findings indicated that although nearly all policy options reached a consensus for their public health impact, some options are not feasible or do not appear to have an economic rationale for being implemented. Moreover, it is crucial to take into account the inter-sectoral collaboration between health and non-health sectors. Findings from this study can be helpful for health policymakers in identifying support for evidence-informed approaches regarding gastrointestinal cancer prevention.

This qualitative systematic review was conducted to summarize the policies for prevention of common gastrointestinal cancers worldwide. This study was conducted using PubMed, Web of Science, SCOPUS, and ProQuest databases. Two independent reviewers assessed included studies for methodological quality and extracted data by using standardized tools from Joanna Briggs Institute (JBI). Primary study findings were read and reread to identify the strategies or policies used in the studies for prevention of gastrointestinal cancers. The extracted findings were categorized on the basis of their similarity in meaning. These categories were then subjected to a meta-synthesis. The final synthesized findings were graded according to the ConQual approach for establishing confidence in the output of qualitative research synthesis. From the nine included studies in this review, 39 findings were extracted and based on their relevance in meaning were aggregated into 12 categories. Four synthesized findings were developed from these categories. We used World Health Organization report on 2000 for synthesizing the findings. The four synthesized findings were “service provision”, “resource generation”, “financing”, and “stewardship”. In order to reach a comprehensive evidence informed policy package for the prevention of gastrointestinal cancers, there should be a great communication among the interventions conducted directly on patients, health system infrastructures, and resources.

Objective: Nonalcoholic fatty liver disease (NAFLD) is a chronic disease linked to insulin resistance and fatty acid synthesis. Insulin resistance plays an important role in the pathogenesis of NAFLD causing multiple lipid metabolism disorders. Supplementing probiotics and prebiotics is a complementary therapy in obesity-related disorders, including dyslipidemia and insulin resistance. The objective of this study was to evaluate the effect of probiotic and prebiotic supplementation on serum lipid profile and insulin resistance in patients with NAFLD. Materials and Methods: In this study, 84 subjects were divided into 4 groups. The first group received probiotic capsules (B.L and L.A: 2*107 CFU/d) and placebo of prebiotic (maltodextrin powder), the second group received prebiotic as sachet (inulin HP: 10 g/d) and placebo of probiotic (fat- and lactose-free milk capsules), the third group received probiotic and prebiotic, and the fourth group received a placebo of probiotic and prebiotic, for 3 months. Anthropometric characteristics, insulin resistance biomarkers and lipid profile were measured for all patients before and after the intervention. The primary outcome of the study was the Homeostasis model of assessment insulin resistance (HOMA-IR) level. The remaining variables (i.e., glucose, insulin, TC, TG, HDL, LDL, weight and BMI changes) were considered represent secondary outcomes. Results: Results showed that probiotic consumption was able to decrease BMI and weight in all the intervention groups in comparison to the placebo group. The serum levels of HDL and LDL differed significantly in the probiotic and pro- and prebiotic groups in comparison to the placebo group. In addition, there were no statistically significant reduction in TC, glucose, insulin levels and HOMA-IR in the intervention groups in comparison to the placebo group. Based on the analysis of covariance (ANCOVA) test, there were significant differences in HDL (P = 0.005) and LDL (P = 0.028) serum levels between the groups at the end of the study. Conclusion: Probiotic and prebiotic supplementation may be effective in improving serum lipid profile and insulin resistance markers in patients diagnosed with NAFLD.

Background: To identify the association of total diet and individual meals with gastroesophageal reflux disease (GERD). Methods: This age- and sex-matched case-control study was carried out among 217 subjects (106 cases and 111 controls). Data were collected using a demographic questionnaire and a GERD checklist and a 3-day food record. Results: Cases consumed more fat (median: 26.3 [3.2-71.5] g vs. 21.8 [4.3-58.1] g; P=0.04)and more energy percent form carbohydrates (median: 72.5 [0-100] vs. 69.0 [0-100]; P=0.02)at lunch, and less energy (median: 129.5 kcal [0-617.6] vs. 170.5 kcal [0-615.7]; P=0.01) and protein (2.4 [0-19.4] g vs. 3.1 [0-21.8] g; P=0.01) at evening snack, compared to controls.The volume of food was significantly different between the two group only at lunch (median:516 [161-1292] g vs. 468 [198-1060] g; P=0.02). The percentage of energy from total dietary protein showed a significant association with GERD after adjusting for confounders (odds ratio[OR]=0.89; 95% CI: 0.81-0.98). Regarding the individual meals, amount of fat consumed at lunch (OR=1.02; 95% CI: 1.00-1.05), and amount of protein intake at evening snack (OR=0.92;95% CI: 0.85-1.00) were significantly associated with GERD. Meanwhile, caloric density and meal frequency did not differ significantly between the two groups. Conclusion: Amount of fat consumed at lunch is positively associated with GERD, whereas the percentage of energy from total protein and amount of protein intake at evening snack are more likely to be inversely associated with GERD.

BACKGROUND: Any prediction of a person's ability to succeed in a motor skill depends on the detection and accurate measurement of the basic abilities for the performance of that skill. Task analysis is needed to determine the psychomotor skills and abilities required to perform an action. This study aimed to determine the components of psychomotor abilities for diagnostic upper gastrointestinal (GI) endoscopy through procedural task analysis (PTA) and expert review. MATERIAL AND METHODS: A multisource, multimethod task analysis was conducted in six metropolitan teaching hospitals affiliated with the adult gastroenterology and hepatology training centers in the Islamic Republic of Iran in 2019. Observation, video-recording, and think-aloud protocols were used while diagnostic upper GI endoscopy was performed. To confirm the accuracy of the PTA, the incorporated the views of the adult gastroenterology and hepatology subspecialty experts through the checklist of PTA assessment criteria. Finally, to determine the psychomotor abilities for each stage of the procedure, the study incorporated a panel of experts from occupational therapy, physical education, physical medicine, and adult gastroenterology and hepatology subspecialty. RESULTS: Of the 15 psychomotor abilities examined, 11 were determined for upper GI endoscopy procedure, of which six cases (including visuospatial and perceptual abilities, hand–eye coordination, multilimb coordination, finger dexterity, arm–hand steadiness, and manual dexterity) were the most frequent. CONCLUSIONS: PTA techniques and subsequent expert review were used to identify the components of psychomotor abilities for diagnostic upper GI endoscopy. It is suggested that PTA is performed for other procedures, and after psychomotor abilities are specified, proportional tests are developed.

Objective: Acute mesenteric ischemia (IMA) is a vascular emergency with broad variability of clinical presentations and non-specific laboratory findings. Therefore, there is a significant need for reliable serological markers of ischemia. Various laboratory studies may be performed for suspected AMI, but in general, such studies will not establish the diagnosis. Methods: In a prospective, non-interventional study, from October 2012 to October 2013, we investigated 70 patients with probable diagnosis of AMI. Blood samples were taken from patients and analyzed for complete blood count (CBC), prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), urea, creatinine (Cr), sodium (Na), potassium (K), D-dimer, lactate, amylase, PH, partial pressure of carbon dioxide (PCO2 ), and bicarbonate (HCO3 ). Finally the results were compared with AMI diagnosis confirmed by computed tomography (CT) angiography. Results: Seventy patients with acute severe abdominal pain were studied. Thirty-nine patients (55.7%) were male and 31 patients (44.3%) were female. The average age was 68.01±14.67 (±SD). Based on CT-angiography results, 27 (38.6%) patients had AMI and 43 (61.4%) patients did not have AMI. Chi-squire test showed P values of 0.606 and 0.986 for relations between sex and risk factors with AMI correspondingly. One-sample Kolmogorov-Smirnov revealed white blood cell (WBC), hemoglobin (Hb), platelets (Plt), urea, Cr, Na, K, PCO2 and HCO3 as normally distributed parameters (P>0.05). Moreover PT, PTT, INR, D-dimer, lactate, amylase, and PH were non-normally distributed (P

Introduction: The Nationwide Medical Sciences Students purpose of the Olympiad is to discover student’s talents and encourage them to study. It seems that holding regional Olympiad exams to select students for the National Olympiad can help us to maintain fairness. The aim of this study is Management of Holding and Evaluating Clinical Reasoning Exams Using a Comprehensive System of Electronic Clinical Reasoning Exams. Methods: Study was carried out in 2013 at the University of Medical Sciences on 750 students, 250 question designers, 37 responsibles. The nationwide universities held regional exams for the Student Olympiad in the area of clinical reasoning on specific dates and times. A quality review of the exams was done to study the strengths and weaknesses and to eliminate shortcomings and problems. Therefore, a researcher created a questionnaire with a reliability of R= 0.86 and validity was confirmed by experts, which was then loaded into the system. The collected data were analyzed using SPSS and descriptive statistics (Percent, Average, standard deviation). Results: The multimedia educational quality of the system, with an average of 69.36 ±22.79, the students and faculty members evaluated as good, with averages of 64.30 ±23.48 and 67.28 ± 22.43, respectively. The quality of the exam was evaluated as excellent by faculty members, with an average of 94.63 ±16.60 and 59.52 ±27.46, by the students. Conclusion: Evaluating the quality of the system’s performance and its ability to assess students will lead to a clarification of its strengths and weaknesses. Finally, result in the creation of a high quality evaluation system.

Abstract Background: After many years of teaching, both the efficiency and efficacy of communication skills programs are under question because patients’ dissatisfaction with doctors’ communication behavior is at the top of the complaint lists. It is assumed that finding the specific role of different determinants of doctors’ communication behavior, instructional designers can plan more effective training programs. This study aims to explore the predictive value of interns’ knowledge and self-efficacy in building effective relationship with patients and determine the causal relationship between interns’ knowledge and self-efficacy about effective doctor-patient relationship. Methods: In this cross-sectional study, PRECEDE model was applied and the analyzed content from semistructured interviews with 7 interns and 14 faculty members was combined with the items from literature review. All the emerged items were categorized under eight constructs of social cognitive theory. The validity and reliability of the items of the research questionnaire were examined by 40 interns and an expert panel of 14 faculty members. The questionnaires were completed by 203 medical interns and confirmatory factor analysis (CFA) was done on the items. The data were analyzed by SPSS.21 and LISREL 8.80. Results: CFA indicated a good fit to the data. Knowledge and self-efficacy, together, explained 23 percent of the variance in interns’ communicative behavior. 53 percent of the changes in interns’ selfefficacy were attributed to the changes in interns’ knowledge. Conclusion: Improving the interns’ shared vision can increase the quality of their knowledge and instructional designs based on learning facts, and gaining insights about effective doctor-patient relationship can increase the interns’ self-efficacy and consequently improve the interns’ communication skills.

Background: Pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP) and may cause significant morbidity and even death. There is no effective prophylactic intervention for patients with average risk yet. This study aims to investigate preventive effect of aggressive hydration for post-ERCP pancreatitis. Materials and Methods: In a double-blind controlled setting, 150 patient were randomly assigned to receive either aggressive hydration with lactated Ringer′s solution (3 mL/kg/h during ERCP, followed by a 20 mL/kg bolus and 3 mL/kg/h for 8 h after the procedure, n = 75) or standard amount of hydration (1.5 mL/kg/h during and for 8 h after ERCP, n = 75). Patients were observed for volume overload as well as pancreatic pain and serum levels of amylase at baseline and 2, 8, and 24 h after ERCP. Post-ERCP pancreatitis was defined as hyperamylasemia (level of amylase >300) and pancreatic pain during the 24 h follow-up. Hyperamylasemia and pancreatic pain were the secondary end points. Results: Mean age of the patients was 50.8 ± 13.5 years. Most of the patients were female (66%). Pancreatitis developed in 21 patients, including 22.7% of patients receiving standard hydration and 5.3% patients receiving aggressive hydration (P = 0.002). Hyperamylasemia was detected in 44.0% of patients receiving standard hydration and 22.7% of patients aggressive hydration (P = 0.006). The pancreatic pain was reported by 5.3% of patients receiving aggressive hydration and 37.3% of patients receiving standard hydration (P ≤ 0.005). Conclusion: Aggressive hydration with lactated Ringer′s solution may effectively prevent post-ERCP pancreatitis as well as hyperamylasemia and pancreatic pain in patients with average risk.

Introduction: Regarding to the importance of students Olympiads, and the need for evaluation of quality of questions, the aim of this study was to analyze questions (indices of difficulty coefficient and discrimination coefficient) of Fourth Olympiad examination among Iranian medical sciences students in the area of scientific thinking in basic science. Methods: This study was descriptive-analytical study and was conducted in 2013 in the Tabriz University of Medical Sciences (Tabriz, Iran). The individual phase of this period, comprised from four phase and six parts included: designing conceptual map (CM) (three part designing CM, summarizing CM, and designing three questions), hypothesis generating, selecting variables, and analyzing the findings. Data analyzed using descriptive statistics and statistical tests in SPSS for Windows. Results: According to difficulty coefficient of selecting variable (82%) and making hypothesis was the easiest part (46%). And according to discriminate coefficient, analyzing the findings had the highest discriminate coefficient (83%), and selecting materials had the lowest discriminate coefficient (34%). Difficulty coefficient of the test was estimated about 63%, and discriminate coefficient was 66%. The results of Spearman correlation coefficient test showed that the correlation between scores related to designing CM with generating hypothesis equals to 85%, with selecting variable was 36% and with analyzing the results equals to 71%. Conclusion: Based on the result of this study, it is necessary for a designer of test to focus on selecting variable part of the test for improvement of quality and validity of the test. Furthermore, regarding to effectiveness of CM, it seems logical to pay more attention to their use.

Introduction: The present study aimed to determine the educational and research needs of faculty members of Tabriz University of Medical Sciences, Tabriz, Iran so that educational priorities can be found and presented to the authorities for the purpose of educational planning.Methods: This cross-sectional descriptive study was conducted in 2013 at aforementioned University. Overall, 250 faculty members were randomly selected from 10 faculties and recruited. Research tool, a researcher-made questionnaire whose validity had been confirmed by a number of experts, was distributed in person, and eventually 230 were completed. Data were analyzed in SPSS-21 software using descriptive statistical tests. Results: Faculty members of the University declared student assessment as their first educational priority. They also considered the following as their educational needs: teaching and learning, writing scientific articles, educational needs assessment, research in education and health systems, teaching methods and techniques, educational planning, program evaluation, educational guidance and counseling, professional ethics, and computer application in education, respectively. Conclusion: This study investigated the educational needs of faculty members in three areas and 50 subjects and prioritized these needs according to each area. Based on these needs, educational planning authorities of faculty members, by appropriate educational planning, can take an effective step in improving scientific knowledge of professors and play an important role in enhancing the overall quality of education.

Background: We tested whether hepatic haemodynamics assessed by Doppler ultrasonography can be a predictor of response to therapy in patients with non-alcoholic fatty liver disease (NAFLD) to prevent further unnecessary diagnostic tests and interventions. Methods: Forty eight consecutive patients affected by NAFLD, who refered to some clinics in Tabriz, Iran between 2009 and 2011 were included in the study. Response to therapy was assessed by decrease in liver enzyme levels. Three liver Doppler parameters (hepatic artery resistance index [RI], hepatic artery pulsatility index [PI] and portal vein waveform [PVW]) were analysed in all subjects who showed a decrease in liver function tests results. Wilcoxon and paired student′s t-test were used for analysis. Results: Forty eight subjects with NAFLD were included in the study during 21 months, out of which 22 (39.1% male - mean age: 37.6 ± 8.3) responded to the treatment and formed the basis of this study. Mean hepatic artery RI increased significantly from 0.60 ± 0.07 to 0.83 ± 0.27before and after treatment, however, there was no significant differences between hepatic artery PI or PVW. Conclusions: Increase in hepatic artery RI assessed by Doppler ultrasound may provide information on improvement of NAFLD in patients during the course of therapy.

Background/Aim: Previous studies have shown the association of some genetic factors, such as Plasminogen activator inhibitor type-1 (PAI-1) 4G/5G polymorphism, with the development of inflammatory bowel disease (IBD). We aimed to study this polymorphism as a risk factor in IBD patients in this cohort. Patients and Methods: One hundred and fifteen IBD patients and 95 healthy controls were selected from Iranian Azeri Turks and -6754G/5G polymorphism of PAI-1 gene was tested by polymerase chain reaction using allele-specific primers confirmed by sequencing. Results: There was no significant difference of PAI-1 polymorphism between IBD patients and the control group (P > 0.05). Furthermore, these data showed no significant difference between Crohn′s disease and ulcerative colitis patients. However, 4G/4G homozygotes have reduced probability to progression of loss of appetite, whereas 5G/5G genotypes have increased risk for development of chronic diarrhea without blood, nausea, and loss of appetite. Conclusions: Although our study showed no significant association of PAI-1 polymorphism between patients and control group, the carriers of 4G/4G genotype and 4G allele had reduced risk for the progression of IBD features in this cohort.

Background/Aim: Multidrug resistance 1 (MDR1) gene encodes for P-glycoprotein (P-gp), a transmembrane efflux pump transferring both exogenous and endogenous substrate from the cells. In the human gastrointestinal tract, P-gp is found in high concentrations on the epithelial cells of the colon and small intestine. It is hypothesized that the expression level of MDR1 gene is related to susceptibility of both forms of inflammatory bowel disease (IBD). The aim of this study was to investigate the association of C3435T Single Nucleotide Polymorphism in IBD patients with/without clinical symptoms in Iranian Azeri Turks. Settings and Design: A total of 116 patients with IBD and 92 healthy subjects were analyzed. Materials and Methods: We investigated the distribution of MDR1 C3435T polymorphism via polymerase chain reaction - Restriction Fragment Length Polymorphism technique. Statistical Analysis Used: All statistical analyses were calculated with the SPSS for Windows 16.0. The Fisher exact test was used to test for departure from Hardy-Weinberg equilibrium of the genotype frequencies ( P > 0.05). Results: The data showed that IBD patient with homozygous variant carrying MDR1 3435 T/T genotype has elevated risk for development of routine IBD clinical symptoms like Abdominal pain ( P = 0.005) and chronic Diarrhea ( P = 0.013) compared with MDR1 3435 C/C homozygotes who has reduced risk for development of IBD symptoms. Conclusions: Our data showed that patients with MDR1 3435 T/T are more susceptible to the development of some routine IBD clinical symptoms ( P < 0.05). This study suggests a protective role for the MDR1 3435 C/C versus MDR1 3435 T/Tgenotype and C versus T allele for the progression of IBD in this cohort.

This randomized double-blind placebo-controlled trial was conducted on 41 patients with non-alcoholic fatty liver disease. Patients in intervention group received 100 mg/day coenzyme Q10 (CoQ10) for four weeks. There was a significant reduction in waist circumference and aspartate aminotransferase concentrations after CoQ10 supplementation (p

In this paper, a 63-year-old woman was reported with recurrent abdominal pain after cholecystectomy. A retained surgical towel was seen by CT-scan in the peritoneal cavity, where it migrated across duodenum wall toward pre-pyloric region of the stomach. Endoscopic removal of the large retained gauze in size of 40 cm x 40 cm was successfully performed without laparotomy and with no complication. In the last years, the main method for removal of retained foreign objects has been open laparotomy or laparoscopy. We claimed that removal of large retained surgical long gauze is actually possible using upper GI endoscopy by expert endoscopists, and, therefore, there is no need for anesthesia or surgery as well as no occurrence of complication and laceration.