Relationship between Tuberculin Skin Test and COVID-19 Outcomes among Patients with COVID-19 in Zahedan, Iran.

Background: Ecological studies showed that countries with national Bacillus Calmette-Guerin (BCG) vaccination programs for tuberculosis prevention reported lower incidences of severe and fatal COVID-19 than countries without such programs. Several studies have demonstrated that the BCG vaccine can induce long-term trained Immunity in bone marrow progenitor cells. In this study, we tried to evaluate the relationship between tuberculin skin test results, BCG scar, and COVID-19 outcomes among patients with confirmed COVID-19. Materials and Methods: This was a cross-sectional study. Cases included 160 patients with confirmed COVID-19 in Zahedan hospitals (southeast Iran) in 2020, selected by convenient sampling. PPD test was performed for all patients through the intradermal technique. Collected data included demographic information, underlying conditions, PPD test results, and COVID-19 outcome. Analysis was conducted utilizing ANOVA, χ2 test, and multivariate analysis (logistic regression). Results: The univariate analysis showed a positive relationship between older age, having underlying diseases, and positive tuberculin skin test results with the outcome of COVID-19. We also found a lower frequency of BCG scar among patients with death outcomes than recovered ones. In the multivariate analysis by logistic regression through the backward method, only age and underlying diseases remained predictors of death. Conclusion: Tuberculin test results might be dependent on age and underlying conditions. Our study did not show relationship between BCG vaccine and mortality in COVID-19 patients. Further investigations in different settings are required to reveal the efficacy of the BCG vaccine in preventing this devastating disease.

Concept mapping as a tool to improve medical student's learning about rabies surveillance.

CONTEXT: Rabies is a viral zoonotic infection of the central nervous system. Annually more than 59,000 people die of rabies worldwide; human rabies can be prevented by using proper postexposure prophylaxis. A major component of successful rabies surveillance is well-educated medical professional. AIMS: The aim of this study is evaluate the effect of concept mapping as an active teaching method on medical students' knowledge about rabies prophylaxis. SUBJECTS AND METHODS: It was a pre- and post interventional study carried out on 80 medical interns. Our intervention included Group 1 - trained by concept maps - and Group 2: - trained by book reading. Data gathering tool was the researcher-made questionnaire that consisted of seven open-ended questions that assessed the interns' knowledge about animal bite surveillance. STATISTICAL ANALYSIS USED: Students' scores of pre- and posttests have been analyzed with paired t-test and independent t-test. RESULTS: Comparing the pre- and posttest scores of students in two groups by paired t-test showed that interventions have been effective in both the groups; posttest scores of both groups had increased significantly (P < 0.001). Score mean difference in concept map group was significantly higher than book reading group based on independent t-test (P = 0.001). CONCLUSIONS: It seems that concept mapping as a visual training tool for transferring the concepts to medical students is more appropriate than the other traditional ones like book reading, but more research is needed to be sure that active methods are better than traditional ones.

Relationship Between Social Determinants of Health and the Thalassemia Prenatal Diagnosis Test in Zahedan, South Eastern Iran.

Little is known about the social determinants of health (SDH) of taking the prenatal diagnosis (PND) test as a pivotal strategy to prevent occurrences of ß-thalasssemia major (ß-TM). This study sought to evaluate the relationship between socio-demographic characteristics of parents and taking the PND test at Zahedan, Iran from 2015 to 2016. The design of the present study was a case-control. Data on socio-demographic characteristics of parents including age, education, job, ethnicity, and family relationships, kind of marriage as well as pre marriage test status and PND test status, were obtained from registered medical records. The relationship between socio-demographic characteristics and taking the PND test was evaluated using binary logistic regression. The study included 256 ß-thalassemia (ß-thal) carrier couples who were referred to the Zahedan Prenatal Diagnosis Center to take the PND test and 47 ß-thal carrier couples who already had a newborn with ß-TM and had not taken the PND test. Univariate analysis showed that the higher education level of the father, consanguineous parents, official marriages, pre marriage test and consultation, significantly increased the odds of taking the PND test. The significant relationships were not observed in multivariable analysis, however, pre marriage tests and official marriages can be considered as determinants of taking the PND test with odds ratio (OR) [95% confidence interval (95% CI)] of 14.67 (0.64, 334.93) and 3.41 (0.55, 20.94), respectively. Our results provided evidence in which socio-demographic characteristics of the parents may determine their taking the PND test.

The relationship between identity styles and addiction vulnerability: A cross-sectional study among medical students in Zahedan, South Eastern Iran.

Very little research done on the relationship between identity styles and addiction vulnerability among university students. This study aims to evaluate the extent to which identity styles can influence addiction vulnerability among medical students in Zahedan, Iran. The present cross-sectional study being conducted at Zahedan University of Medical Sciences from 2015 to 2016. The study sample consisted of 205 pre-clinical medical students (60% Female, 40% male) recruited. Berzonsky's Identity Style Questionnaire and Addiction Potential questionnaire, respectively measured "Identity Styles and addiction vulnerability". The multivariate linear analysis was conducted applying backward stepwise selection method. The female students shown more normative oriented than the male ones (p = 0.01). Students living in own house had significantly higher scores for diffuse avoidant style and addiction vulnerability compared with other types of accommodation (p â€¯≤  0.01). Multivariable regression analysis demonstrated that the final model included accommodation, admission qouta, normative, diffuse-avoidant and commitment styles, as addiction vulnerability may be higher as the results of lower normative style indicated (ß = -0.54; 95% confidence interval: -1.00 to -0.08), higher diffuse-avoidant (0.41; 0.09 to 0.74) and lower commitment style (-0.79; -1.22 to -0.37). The study provides direct evidence of potential role of identity formation on the addiction vulnerability among medical students.

A local equation for differential diagnosis of ß-thalassemia trait and iron deficiency anemia by logistic regression analysis in Southeast Iran.

The most common differential diagnosis of ß-thalassemia (ß-thal) trait is iron deficiency anemia. Several red blood cell equations were introduced during different studies for differential diagnosis between ß-thal trait and iron deficiency anemia. Due to genetic variations in different regions, these equations cannot be useful in all population. The aim of this study was to determine a native equation with high accuracy for differential diagnosis of ß-thal trait and iron deficiency anemia for the Sistan and Baluchestan population by logistic regression analysis. We selected 77 iron deficiency anemia and 100 ß-thal trait cases. We used binary logistic regression analysis and determined best equations for probability prediction of ß-thal trait against iron deficiency anemia in our population. We compared diagnostic values and receiver operative characteristic (ROC) curve related to this equation and another 10 published equations in discriminating ß-thal trait and iron deficiency anemia. The binary logistic regression analysis determined the best equation for best probability prediction of ß-thal trait against iron deficiency anemia with area under curve (AUC) 0.998. Based on ROC curves and AUC, Green & King, England & Frazer, and then Sirdah indices, respectively, had the most accuracy after our equation. We suggest that to get the best equation and cut-off in each region, one needs to evaluate specific information of each region, specifically in areas where populations are homogeneous, to provide a specific formula for differentiating between ß-thal trait and iron deficiency anemia.

Cut off Determination of Discrimination Indices in Differential Diagnosis between Iron Deficiency Anemia and ß- Thalassemia Minor.

OBJECTIVE: The two most frequent hypochromic microcytic anemias are ß- thalassemia minor (BTM) and iron deficiency anemia (IDA). Several discrimination indices have been proposed to quickly discriminate these similar entities via parameters obtained from automated blood count analyzers. The aim of this study to evaluate the diagnostic reliability of ten discrimination indices in the differentiation of Iron deficiency anemia (IDA) from ß Thalassemia Minor (BTM). METHODS: This study was conducted on 100 BTM and 70 cases with IDA in southern Iran. This evaluation was conducted through calculation sensitivity, specificity, positive and negative predictive value, Likelihood ratio positive, likelihood ratio negative and also we recalculated cut-off values for every formulas in our population and determination of Area Under Curve related to receiver operative characteristic (ROC) curves. RESULTS: ROC for each discrimination indices show that, the highest diagnostic value based on the area under the ROC curve are related to the Green & King, England & Frazer and then Sirdah formulas (0.909, 0.907, 0.904, respectively) in South-east of Iran, and relatively different cut-off values for every formula. CONCLUSION: The spectrum ß thalassemia mutations in each population can affect on various RBC indices, therefore, it is suggested to determine cut-off value for every formula in different populations.