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Anxiety, Knowledge, and Preventive Behaviors among COVID-19 Survivors: A Cross-Sectional Survey on Coronavirus Concerns 2 2 Introduction: This study aims to examine the interplay between COVID-19-related knowledge, anxiety, and preventive behaviors among individuals who have survived COVID-19. Material & Methods: A descriptive cross-sectional design recruited 230 participants from three public hospitals through simple randomization. Participants completed a questionnaire via email and phone, comprising sections on personal information, the Corona Disease Anxiety Scale (CDAS), and COVID-19 knowledge and preventive behaviors. Data analysis utilized T-tests, ANOVA, and regression models. Results: Out of 230 individuals, 200 responded (an 87% response rate). Education level significantly correlated with COVID-19 knowledge and preventive behaviors. Job status also showed a significant association with participants' understanding and actions regarding COVID-19. Regression analyses revealed that higher levels of knowledge (β=0.5, p=0.001) and anxiety (β=0.182, p=0.001) were linked to increased engagement in preventive behaviors. Conclusion:  This study focused on COVID-19 survivors, finding that anxiety may serve as a motivating factor for engaging in preventive behaviors. These findings hold implications for policymakers in promoting effective preventive measures. 1 9 2023/12/13 1402/9/22 2024/05/6 1403/2/17 Bahare Fallah Bahare Fallah Research Center for Nursing and Midwifery Care, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Iran baharefallah@gmail.com Fatemeh Fathi Fatemeh Fathi Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran Iran fatemeh.fathi1378@gmail.com Mohammad Adham Mohammad Adham Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Iran mohammad.adham1999@gmail.com Melika Moradi Melika Moradi Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Iran melikamoradi3@gmail.com Khadijeh Nasiriani Khadijeh Nasiriani Research Center for Nursing and Midwifery Care, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Iran nasiriani@gmail.com Sara Jambarsang Sara Jambarsang Center for Healthcare Data Modeling, Departments of Biostatistics and Epidemiology, School of public health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Iran s.jambarsang@gmail.com Fatemeh Bakhshi Fatemeh Bakhshi Research Center for Nursing and Midwifery Care, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Iran f.bakhshi@ssu.ac.ir COVID-19 Health Knowledge Preventive Behavior Anxiety Salari M, Bakraei S, Sharifnejad Nemat Abadi MA, Alizadeh N, Mohseni F. Prediction of coronavirus anxiety based on anxiety tolerance and cognitive emotion regulation in employed women. AFTJ 2020;1(4):38-52.##Rahmanian M, Kamali AR, Mosalanezhad H, Foroughian M, Kalani N, Hatami N, et al. A comparative study on anxiety of medical and non-medical staff due to exposure and non-exposure‎ to the novel coronavirus disease. J Arak Uni Med Sci. 2020;23(5):710-23. doi: 10.32598/JAMS.23.COV.3577.3.##Lei L, Huang X, Zhang S, Yang J, Yang L, Xu M. Comparison of prevalence and associated factors of anxiety and depression among people affected by versus people unaffected by quarantine during the COVID-19 epidemic in Southwestern China. Med Sci Monit: international medical journal of experimental and clinical research. 2020;26:e924609-1. doi: 10.12659/MSM.924609.##Rudenstine S, McNeal K, Schulder T, Ettman CK, Hernandez M, Gvozdieva K, Galea S. Depression and anxiety during the COVID‐19 pandemic in an urban, low‐income public university sample. J Trauma Stress. 2021;34(1):12-22. doi: 10.1002/jts.22600##Rayani S, Rayani M, Najafi-Sharjabad F. Correlation between anxiety and resilience of healthcare workers during COVID-19 pandemic in the southwest of Iran. Environ Sci Pollut Res Int. 2022;29(15):21528-21536. doi: 10.1007/s11356-021-17284-x.##Masjoudi M, Aslani A, Seifi M, Khazaeian S, Fathnezhad-Kazemi A. Association between perceived stress, fear and anxiety of COVID 19 with self-care in pregnant women: a cross-sectional study. Psychol Health Med. 2022;27(2):289-300. doi:10.1080/13548506.2021.1894344.##Oliveira ACd, Lucas TC, Iquiapaza RA. What has the covid-19 pandemic taught us about adopting preventive measures?. Texto contexto – enferm. 2020;29.doi: 10.1590/1980-265X-TCE-2020-0106.##Lu HJ, Liu YY, O J, Guo S, Zhu N, Chen BB, et al. Disease history and life history predict behavioral control of the COVID-19 pandemic. Evol Psychol. 2021;19(1). doi: 10.1177/14747049211000714##WHO. Coronavirus. 2021.##Parikh PA, Shah BV, Phatak AG, Vadnerkar AC, Uttekar S, Thacker N, Nimbalkar SM. COVID-19 pandemic: knowledge and perceptions of the public and healthcare professionals. Cureus. 2020;12(5).doi: 10.7759/cureus.8144.##Austrian K, Pinchoff J, Tidwell JB, White C, Abuya T, Kangwana B, et al. COVID-19 related knowledge, attitudes, practices and needs of households in informal settlements in Nairobi, Kenya. SSRN. 2020. doi: 10.2139/ssrn.3576785.##Finset A, Bosworth H, Butow P, Gulbrandsen P, Hulsman RL, Pieterse AH, et al. Effective health communication–a key factor in fighting the COVID-19 pandemic. Patient Educ Couns. 2020;103(5):873.doi: 10.1016/j.pec.2020.03.027.##Moghanibashi-Mansourieh A. Assessing the anxiety level of Iranian general population during COVID-19 outbreak. Asian J Psychiatr. 2020;51:102076.doi: 10.1016/j.ajp.2020.102076.##Hawes MT, Szenczy AK, Klein DN, Hajcak G, Nelson BD. Increases in depression and anxiety symptoms in adolescents and young adults during the COVID-19 pandemic. Psychol Med. 2021:1-9.doi: 10.1017/S0033291720005358.##Fattahi H, Seproo FG, Fattahi A. Effective factors in people’s preventive behaviors during covid-19 pandemic: a systematic review and meta-synthesis. BMC Public Health. 2022;22(1):1-12.doi: 10.1186/s12889-022-13621-y.##Raude J, Lecrique J-M, Lasbeur L, Leon C, Guignard R, Du Roscoät E, Arwidson P. Determinants of preventive behaviors in response to the COVID-19 pandemic in France: Comparing the sociocultural, psychosocial, and social cognitive explanations. Front Psychol. 2020;11:584500.doi: 10.3389/fpsyg.2020.584500.##Mazza MG, De Lorenzo R, Conte C, Poletti S, Vai B, Bollettini I, et al. Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain Behav Immun. 2020;89:594-600.doi: 10.1016/j.bbi.2020.07.037.##Nasirzadeh M, Aligol M. Assessmentof knowledge, attitude, and factors associated with the preventive behaviors of COVID-19 in Qom, Iran, in 2020. Qom Univ Med Sci J. 2020;14(7):50-7.##Hu Y, Ye B, Tan J. Stress of COVID-19, Anxiety, Economic Insecurity, and Mental Health Literacy: A Structural Equation Modeling Approach. . Front Psychol. 2021;12:707079.doi: 10.3389/fpsyg.2021.707079.##Mann FD, Krueger RF, Vohs KD. Personal economic anxiety in response to COVID-19. Pers Individ Dif. 2020;167:110233.doi: 10.1016/j.paid.2020.110233.##Bareket-Bojmel L, Shahar G, Margalit M. COVID-19-related economic anxiety is as high as health anxiety: findings from the USA, the UK, and Israel. Int J Cogn Ther. 2021;14(3):566-74.doi: 10.1007/s41811-020-00078-3.##Peteet JR. COVID-19 anxiety. J Relig Health. 2020;59(5):2203-4.doi: 10.1007/s10943-020-01041-4.##Özdin S, Bayrak Özdin Ş. Levels and predictors of anxiety, depression and health anxiety during COVID-19 pandemic in Turkish society: The importance of gender. Int J Soc Psychiatry. 2020;66(5):504-11.doi: 10.1177/0020764020927051.##Khaleghparast S, Ghanbari B, Maleki M, Zamani F, Peighambari M-M, Niya MHK, et al. Anxiety, Knowledge and Lived Experiences of Families with COVID-19 Patients: A Mixed-Method Multi-Center Study in Iran. Iran J Med Sci. 2022;47(2):131.doi: 10.30476/IJMS.2021.89157.1997.##Borges J, Byrne M. Investigating COVID-19 risk perception and preventive behaviours in third-level students in Ireland. Acta Psychol (Amst). 2022;224:103535.doi: 10.1016/j.actpsy.2022.103535.##Li J-B, Yang A, Dou K, Wang L-X, Zhang M-C, Lin X-Q. Chinese public’s knowledge, perceived severity, and perceived controllability of COVID-19 and their associations with emotional and behavioural reactions, social participation, and precautionary behaviour: A national survey. BMC public health. 2020;20(1):1-14.doi: 10.1186/s12889-020-09695-1.##Pavlatos C, Vita V, editors. Linguistic representation of power system signals. Electricity Distribution; 2016: Springer.##O’Connor AM, Evans AD. Dishonesty during a pandemic: The concealment of COVID-19 information. J Health Psychol. 2022;27(1):236-45.doi: 10.1177/1359105320951603.## ##

Relationship Between Internet Addiction and Sleep Quality in the Students of Ilam University of Medical Sciences in 2023 2 2 Introduction: Today, internet usage has become an integral part of daily life, but excessive use can harm sleep quality. This study aims to explore the relationship between internet addiction and sleep quality among students at Ilam University of Medical Sciences in 2023. Material & Methods: In 2023, 400 students from Ilam University of Medical Sciences participated in this study. They were selected using simple random sampling and met the study criteria. Data were collected through Young's Internet Addiction Test (IAT) and the Pittsburgh Sleep Quality Index (PSQI). Simple and multiple regression analyses were conducted with a significance level of α ≤ 0.05. Results: The findings showed that 320 (80%) of students exhibited mild to severe internet addiction, with an average total sleep quality falling within the poor range (6.30 ± 2.51). Subjective sleep quality was particularly poor (2.03 ± 0.662) compared to other dimensions (p > 0.05). Simple linear regression revealed significant associations between mild (coefficient = 1.03; p = 0.002) and moderate (coefficient = 2.05; p < 0.001) internet addiction and poor total sleep quality, compared to normal individuals. Additionally, graduate students had better sleep quality than undergraduates (coefficient = -1.03; p = 0.016). Multiple regression analysis, adjusted for educational level, confirmed the association between mild (coefficient = 0.98; p = 0.003) and moderate (coefficient = 1.97; p < 0.001) internet addiction and poor total sleep quality. Conclusion:  Internet addiction is linked to poor sleep quality among Ilam University of Medical Sciences students, especially undergraduates. It underscores the need for interventions to raise awareness about internet addiction and its detrimental effects on sleep quality. 10 18 2023/12/132024/02/16 1402/11/27 2024/05/62024/04/30 1403/2/11 Mohsen Jalilian Mohsen Jalilian Department of Public Health, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran Iran jalilian91@yahoo.com Reza Pakzad Reza Pakzad Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran Iran rezapakzad2010@yahoo.com Amin Mirzaei Amin Mirzaei Department of Public Health, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran Iran mirzaei.amin62@gmail.com Malihe Saeedfiroozabadic Malihe Saeedfiroozabadic The Persian Gulf Tropical Medicine Research Center, the Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran Iran s.firoozabadi_m@yahoo.com Hadis Maleki Hadis Maleki Department of Public Health, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran Iran hadsmlk1@gmail.com Parisa Shahbazi Parisa Shahbazi Department of Public Health, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran Iran parisashahbazi755@gmail.com Ali Khorshidi Ali Khorshidi Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran Iran khorshidi-a@medilam.ac.ir Roghayeh Chenary Roghayeh Chenary Department of Public Health, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran Iran chenaryr@yahoo.com Sleep Quality Internet Addiction Students 1. 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Comput Hum Behav Rep. 2015;49:44-9. https://doi.org/10.1016/j.chb.2015.02.043.##26. Massoud EF, ElDeeb AM, Samir SH, Shehata MM. Effect of resistive exercise on insomnia and sleep quality in postmenopausal women: a randomized controlled trial. Bull. Fac. Phys. Ther. 2023;28(1):12. https://doi.org/10.1186/s43161-023-00124-z.##27. Young KS. Internet addiction: The emergence of a new clinical disorder. Cyberpsychol Behav. 1998;1(3):237-44. https://psycnet.apa.org/doi/10.1089/cpb.1998.1.237.##28. Noroozi F, Hassanipour S, Eftekharian F, Eisapareh K, Kaveh MH. Internet Addiction Effect on Quality of Life: A Systematic Review and Meta-Analysis. Sci.World J. 2021;2021:2556679. 10.1155/2021/2556679.##29. Li YY, Sun Y, Meng SQ, Bao YP, Cheng JL, Chang XW, et al. Internet Addiction Increases in the General Population During COVID-19: Evidence From China. Am J Addict. 2021;30(4):389-97. https://doi.org/10.1111/ajad.13156.##30. Zhang MWB, Lim RBC, Lee C, Ho RCM. 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Survival Rates and Associated Factors in Gastric Cancer Patients in Saghez City, Kurdistan Province: A Study From 2010 to 2018 2 2 Introduction: Gastric Cancer ranks as the fourth most common cancer globally, with the second highest mortality rate. Given its significance, this study aims to ascertain and explore the 1-5-year survival rates of patients diagnosed with Gastric Cancer. Material & Methods: This descriptive analytical study examines data from patients diagnosed with Gastric Cancer in Sagheze city, Kurdistan province, spanning from 2010 to 2018. Data from 236 patients with confirmed Gastric Cancer diagnoses, including demographic information, date of diagnosis, tumor morphology, tumor site, and tumor stage, were collected from the Cancer Registry Center at Kurdistan University of Medical Sciences and the Digestion and Liver Research Center at Tohid Hospital in Sanandaj. The data were then analyzed using SPSS 22 software, employing survival analysis based on the Kaplan-Meier method, the Log-rank test statistic, and Cox regression. Results: Of the patients, 159 (67.4%) were male, with a mean age at diagnosis of 68.46±15.50 years. Tumor morphology varied, with 132 (55.9%) categorized as unspecified neoplasms, 39 (16.5%) as invasive types, 35 (14.8%) as adenocarcinomas, 22 (9.3%) as intestinal types, and 8 (3.4%) as diffuse types. Gender (p=0.190), tumor site (p=0.084), and tumor stage (p=0.739) showed no significant relationship with the 1-5-year survival rate. However, age at diagnosis (p>0.001) and tumor morphology (p>0.001) were found to influence survival rates, which were estimated at 43%, 40%, 39%, 39%, and 36% for years 1 to 5, respectively. Conclusion:  Age at diagnosis, tumor site, tumor morphology, tumor differentiation, and treatment type emerge as crucial factors influencing disease prognosis and patient survival. 19 34 2023/12/132024/02/162023/12/4 1402/9/13 2024/05/62024/04/302024/04/29 1403/2/10 Sediq Rostampour Sediq Rostampour Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran Iran srostampour63@gmail.com Khairollah Asadollahi Khairollah Asadollahi Department of Community Medicine, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran Iran Yousef Veisani Yousef Veisani Non-communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran, Ilam, Iran Iran Ghobad Abanagah Ghobad Abanagah Department of Internal Medicine, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran Iran Farshad Sheikh Ismaili Farshad Sheikh Ismaili Department of Internal Medicine, School of MedicineLiver & Digestive Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran Iran Gastric Neoplasms Survival Rate Kaplan-Meier Estimate Tumor Neoplasms Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005 Mar-Apr;55(2):74-108. doi: 10.3322/canjclin.55.2.74.##Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011 Mar-Apr;61(2):69-90. doi: 10.3322/caac.20107.##Veisani Y, Delpisheh A, Sayehmiri K, Rahimi E. Survival rate estimation and its associated factors in patients with Gastric Cancer in Tohid Hospital in Sanandaj. Sci J Kurdistan Univ Med Sci. 2013;18(2):1-8.##Etemad K,Gooya MM. National report on registered cancer cases in 2009. Tehran, Iran: Cancer Office,Centre for Disease Control, Deputy for Health, Ministry of Health and Medical Education:2009(persian).##Sadjadi A, Malekzadeh R, Derakhshan MH, Sepehr A,Nouraie M, Sotoudeh M, et al. Cancer occurrence in Ardabil: results of a population-based cancer registry from Iran. Int J Cancer. 2003; 107: 113 – 118##Adami H-O, Hunter D, Tricoploulos D. Textbook of cancer epidemiology.2002. 162-87 p.##Gunderson LL, Sosin H. 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Spa typing of Methicillin-Resistant Staphylococcus aureus Isolated From Clinical Samples of Hospitalized Patients, a Study in the Wasit Province of Iraq 2 2 Introduction: Since its discovery in 1961, methicillin-resistant Staphylococcus aureus (MRSA) has been recognized as a significant healthcare-associated pathogen (HA-MRSA) and a notorious 'superbug'. Typing is crucial for surveillance, epidemiology analysis, infection control of MRSA and sequencing of the spa gene is one of the most common methods used for determining the origin of this bacterium in humans and animals. This research aimed to determine the antibiotic resistance and spa type of S. aureus strains collected from outpatients in two hospitals in the Wasit province of Iraq. Material & Methods: The study analyzed 200 outpatient MRSA isolates by collecting nasal and sputum samples from patients. Standard biochemical and molecular methods based on the nuc gene were used to identify S. aureus bacteria and amplify the mecA and spa genes. The Kirby-Bauer disc diffusion method was employed to determine the antibiotic sensitivity of the isolates using penicillin, cefoxitin, vancomycin, gentamicin, erythromycin, tetracycline, imipenem, clindamycin, chloramphenicol and rifampicin. Results: Thirty-five (17.5%) out of 200 isolates were identified as S. aureus by biochemical and molecular methods. The prevalence of MRSA was more common in women than in men. Antibiogram results showed that most of the isolates were resistant to penicillin (94.2%) and sensitive to imipenem (100%), clindamycin (100%), and chloramphenicol (100%). Of these 35 isolates, 30 (87.5%) and 26 strains (74.3%) were positive for the mecA and spa genes. Typing based on spa gene sequencing revealed four different patterns: t386, t3579, t10002 and t10234. Conclusion:  Variations in the spa gene among different S. aureus isolates may be of clinical importance when treating staphylococcal infections. In this study, spa typing revealed four different patterns in Iraq, representing diagnostic and therapeutic implications 35 45 2023/12/132024/02/162023/12/42024/02/13 1402/11/24 2024/05/62024/04/302024/04/292024/05/21 1403/3/1 Karar Alhakeem Karar Alhakeem MSc Student, Department of Microbiology, Faculty of Veterinary Sciences, Ilam University, Ilam-Iran Iran Mostafa Nemati Mostafa Nemati Associate Prof., Department of Microbiology, Faculty of Veterinary Sciences, Ilam University, Ilam-Iran Iran m.nemati@ilam.ac.ir Fazel Pourahmad Fazel Pourahmad Associate Prof., Department of Microbiology, Faculty of Veterinary Sciences, Ilam University, Ilam-Iran Iran f.pourahmad@ilam.ac.ir Hussam Sami Alshimry Hussam Sami Alshimry Doctor of Veterinary Medicine, Wasit- Iraq Iraq Husamshaft@gmail.com : Staphylococcus aureus MRSA PCR mecA spa typing M, Shah PP, Carugati M, et al. MethicilliTurner NA, Sharma-Kuinkel BK, Maskarinec SA, Eichenberger En-resistant Staphylococcus aureus: an overview of basic and clinical research. Nat Rev Microbiol. 2019;17(4):203-18.##Diekema DJ, Hsueh PR, Mendes RE, Pfaller MA, Rolston KV, Sader HS, Jones RN. The microbiology of bloodstream infection: 20-year trends from the SENTRY antimicrobial surveillance program. Antimicrob Agents Chemother. 2019;63(7):10-128.##Robinson DA, Enright MC. Multilocus sequence typing and the evolution of methicillin-resistant Staphylococcus aureus. Clin Microbiol Infect. 2004;10(2):92-7.##Lee AS, Huttner BD, Catho G, Harbarth S. Methicillin-resistant Staphylococcus aureus: an update on prevention and control in acute care settings. Infect Dis Clin. 2021;35(4):931-52.##Jones SU, Chua KH, Chew CH, Yeo CC, Abdullah FH, Othman N, et al. spa diversity of methicillin-resistant and-susceptible Staphylococcus aureus in clinical strains from Malaysia: a high prevalence of invasive European spa-type t032. Peer J. 2021;8;9:e11195.##Mazi W, Sangal V, Sandstrom G, Saeed A, Yu J. Evaluation of spa-typing of methicillin-resistant Staphylococcus aureus using high-resolution melting analysis. Int J Infect Dis. 2015;38:125-8.##Harmsen D, Claus H, Witte W, Rothganger J, Claus H, Turnwald D, Vogel U. Typing of methicillin-resistant Staphylococcus aureus in a university hospital setting by using novel software for spa repeat determination and database management. J Clin Microbiol. 2003;41(12):5442-8.##Kavanagh KT. Control of MSSA and MRSA in the United States: protocols, policies, risk adjustment and excuses. Antimicrob Resist Infect Control. 2019;8(1):1-8.##Thaker HC, Brahmbhatt MN, Nayak JB, Thaker HC. Isolation and identification of Staphylococcus aureus from milk and milk products and their drug resistance patterns in Anand, Gujarat. Vet World. 2013;6(1):10-3. https://doi:10.5455/vetworld.2013.10-13.##Flayhart D, Lema C, Borek A, Carroll KC. Comparison of the BBL CHROMagar Staph aureus agar medium to conventional media for detection of Staphylococcus aureus in respiratory samples. J Clin Microbiol. 2004;42(8):3566-9.##Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; 28th informational supplement, M100-S8. Clinical and Laboratory Standards Institute, Wayne, PA. 2018.##Kateete DP, Kimani CN, Katabazi FA, Okeng A, Okee MS, Nanteza A, Joloba ML, Najjuka FC. Identification of Staphylococcus aureus: DNase and Mannitol salt agar improve the efficiency of the tube coagulase test. Ann. Clin Microbiol Antimicrob. 2010;9:1-7.##Al-Talib H, Yean CY, Al-Khateeb A, Hassan H, Singh KK, Al-Jashamy K, Ravichandran M. A pentaplex PCR assay for the rapid detection of methicillin-resistant Staphylococcus aureus and Panton-Valentine Leucocidin. BMC Microbiology. 2009;9:1-8. doi.org/10.1186/1471-2180-9-113##Wichelhaus TA, Hunfeld KP, Böddinghaus B, Kraiczy P, Schafer V, Brade V. Rapid molecular typing of methicillin-resistant Staphylococcus aureus by PCR-RFLP. Infection Control & Hospital Epidemiology. 2001;22(5):294-8.##Al-Mayahi A, Srhan F. A preliminary study of Aminoglycoside Modifying Enzymes (AMEs) of Multiple Antibiotic Resistance of Methicillin-resistant Staphylococcus aureus (MRSA) isolated from clinical specimens in Al-Diwaniya/Iraq. Jordan J Biol Sci. 2021;14(4).733-41.##Saleh NT, Alsammak eg. spa typing and virulence genes variation in Methicillin -resistant Staphylococcus aureus isolated from Mosul, Iraq. Biochem Cell Arch. 2022;22(1). connectjournals.com/03896.2022.22.2163.##Al-Charrakh AH, Al-Hassnawi HH, Al-Khafaji JK. Molecular characteristics of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) isolates from clinical specimens in Iraq. Br Microbiol Res J. 2015;5(3):227.##Hallabjaiy RM, Darogha SN, Hamad PA. Vancomycin resistance among methicillin-resistant Staphylococcus aureus isolated from clinical samples in Erbil City-Iraq. Medical Journal of Islamic World Acad Sci. 2014;22(4):168-74.##János D, Viorel H, Ionica I, Corina P, Tiana F, Roxana D. Carriage of multidrug resistance staphylococci in shelter dogs in Timisoara, Romania. Antibiotics. 2021;10(7):801.##El-Adawy H, Ahmed M, Hotzel H, Monecke S, Schulz J, Hartung J, Ehricht R, Neubauer H, Hafez HM. Characterization of methicillin-resistant Staphylococcus aureus isolated from healthy turkeys and broilers using DNA microarrays. Front Microbiol. 2016;19;7:2019.##Hiramatsu K, Hanaki H, Ino T, Yabuta K, Oguri T, Tenover FC. Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility. J Antimicrob Chemother. 1997;40(1):135-6.##Liu J, Gao Y, Wang X, Qian Z, Chen J, Huang Y, Meng Z, Lu X, Deng G, Liu F, Zhang Z. Culture-positive spontaneous ascitic infection in patients with acute decompensated cirrhosis: multidrug-resistant pathogens and antibiotic strategies. Yonsei Med J. 2020;61(2):145-53.##Mwansa TN, Kamvuma K, Mulemena JA, Phiri CN, Chanda W. Antibiotic susceptibility patterns of pathogens isolated from laboratory specimens at Livingstone Central Hospital in Zambia. PLoS One. 2022;2(9):e0000623.##Yehia HM, Al-Masoud AH, Alarjani KM, Alamri MS. Prevalence of methicillin-resistant (mecA gene) and heat-resistant Staphylococcus aureus strains in pasteurized camel milk. J Dairy Sci. 2020;103(7):5947-63.##Goering RV, Swartzendruber EA, Obradovich AE, Tickler IA, Tenover FC. Emergence of oxacillin resistance in stealth methicillin-resistant Staphylococcus aureus due to mecA sequence instability. Antimicrob Agents Chemother. 2019;63(8):10-128.##Jannati E, Arzanlou M, Habibzadeh S, Mohammadi S, Ahadi P, Mohammadi-Ghalehbin B, Dogaheh HP, Dibah S, Kazemi E. Nasal colonization of mecA-positive, oxacillin-susceptible, methicillin-resistant Staphylococcus aureus isolates among nursing staff in an Iranian teaching hospital. Am J Infect Control. 2013;41(11):1122-4.##Chung M, Kim CK, Conceiçao T, Aires-De-Sousa M, De Lencastre H, Tomasz A. Heterogeneous oxacillin-resistant phenotypes and production of PBP2A by oxacillin-susceptible/mecA-positive MRSA strains from Africa. J Antimicrob Chemother. 2016;71(10):2804-9.##Duarte FC, Danelli T, Tavares ER, Morguette AE, Kerbauy G, Grion CM, Yamauchi LM, Perugini MR, Yamada-Ogatta SF. Fatal sepsis caused by mecA-positive oxacillin-susceptible Staphylococcus aureus: first report in a tertiary hospital of southern Brazil. J Infect Chemother. 2019;25(4):293-7.##Gargis AS, Yoo BB, Lonsway DR, Anderson K, Campbell D, Ewing TO, Lawsin A, Machado MJ, Yamamoto N, Halpin AL, Lutgring JD. Difficult-to-detect Staphylococcus aureus: mecA-positive isolates associated with oxacillin and cefoxitin false-susceptible results. J. Clin Microbiol. 2020;58(4):10-128. https://journals.asm.org/doi/pdf/10.1128/jcm.02038-19.##Baddour MM, AbuElKheir MM, Fatani AJ. Comparison of mecA polymerase chain reaction with phenotypic methods for the detection of methicillin-resistant Staphylococcus aureus. Curr Microbiol. 2007;55: 473-9.##H Al-Hassnawi H, H Al-Charrakh A, Al-Khafaj J. Antibiotic resistance patterns of community acquired methicillin resistance Staphylococcus aureus (CA-MRSA) in Al-Hilla/Iraq. Karbala J Pharmaceut Sci. 2013;4(4):91-102.##Ba X, Harrison EM, Edwards GF, Holden MT, Larsen AR, Petersen A, Skov RL, Peacock SJ, Parkhill J, Paterson GK, Holmes MA. Novel mutations in penicillin-binding protein genes in clinical Staphylococcus aureus isolates that are methicillin resistant on susceptibility testing, but lack the mec gene. J Antimicrob Chemother. 2014;69(3):594-7.##Keener AB, Thurlow LT, Kang S, Spidale NA, Clarke SH, Cunnion KM, Tisch R, Richardson AR, Vilen BJ. Staphylococcus aureus protein A disrupts immunity mediated by long-lived plasma cells. J Immunol. 2017 1;198(3):1263-73.##Tahoun A, Elnafarawy HK, El-Sharkawy H, Rizk AM, Alorabi M, El-Shehawi AM, Youssef MA, Ibrahim HM, El-Khodery S. The prevalence and molecular biology of Staphylococcus aureus isolated from healthy and diseased equine eyes in Egypt. Antibiotics. 2022;10;11(2):221.##Shakeri F, Shojai A, Golalipour M, Rahimi Alang S, Vaez H, Ghaemi EA. Spa Diversity among MRSA and MSSA Strains of Staphylococcus aureus in North of Iran. Int J Microbiol. 2010; 2010:1-5.##Al-Kadmy IM. A genetic study to differential HC/AC MRSA isolated from clinical cases in Iraq hospitals. Mintage J Pharm Med Sci. 2013; 2:57-62.##Craft KM, Nguyen JM, Berg LJ, Townsend SD. Methicillin-resistant Staphylococcus aureus (MRSA): antibiotic-resistance and the biofilm phenotype. Med Chem Comm. 2019;10(8):1231-41.##Kareem SM, Aljubori SS, Ali MR. Novel determination of spa gene diversity and its molecular typing among Staphylococcus aureus Iraqi isolates obtained from different clinical samples. New Microbes New Infect. 2020; 34:100653.##Adwan G, Shaheen H, Adwan K, Barakat A. Molecular characterization of methicillin resistant Staphylococcus aureus isolated from hospitals environments and patients in Northern Palestine. Epidemiol Biostat Public Health. 2015;12(3).##Aqel AA, Alzoubi HM, Vickers A, Pichon B, Kearns AM. Molecular epidemiology of nasal isolates of methicillin-resistant Staphylococcus aureus from Jordan. J Infect Public Health. 2015;8(1):90-7.##Harastani HH, Araj GF, Tokajian ST. Molecular characteristics of Staphylococcus aureus isolated from a major hospital in Lebanon. Int J Infect Dis. 2014; 19:33-8.##Goudarzi M, Fazeli M, Goudarzi H, Azad M, Seyedjavadi SS. spa typing of Staphylococcus aureus strains isolated from clinical specimens of patients with nosocomial infections in Tehran, Iran. Jundishapur J Microbiol. 2016; 9 (7): 1-9.##Udo EE, Boswihi SS, Al-Sweih N. High prevalence of toxic shock syndrome toxin–producing epidemic methicillin-resistant Staphylococcus aureus 15 (EMRSA-15) strains in Kuwait hospitals. New Microbes New Infect. 2016;12: 24-30.##Hashemizadeh Z, Hadi N, Mohebi S, Kalantar-Neyestanaki D, Bazargani A. Characterization of SCCmec, spa types and Multi Drug Resistant of methicillin-resistant Staphylococcus aureus isolates among inpatients and outpatients in a referral hospital in Shiraz, Iran. BMC Res Notes. 2019;12(1):1-6.##M, Shah PP, Carugati M, et al. MethicilliTurner NA, Sharma-Kuinkel BK, Maskarinec SA, Eichenberger En-resistant Staphylococcus aureus: an overview of basic and clinical research. Nat Rev Microbiol. 2019;17(4):203-18.##Diekema DJ, Hsueh PR, Mendes RE, Pfaller MA, Rolston KV, Sader HS, Jones RN. The microbiology of bloodstream infection: 20-year trends from the SENTRY antimicrobial surveillance program. Antimicrob Agents Chemother. 2019;63(7):10-128.##Robinson DA, Enright MC. Multilocus sequence typing and the evolution of methicillin-resistant Staphylococcus aureus. Clin Microbiol Infect. 2004;10(2):92-7.##Lee AS, Huttner BD, Catho G, Harbarth S. Methicillin-resistant Staphylococcus aureus: an update on prevention and control in acute care settings. Infect Dis Clin. 2021;35(4):931-52.##Jones SU, Chua KH, Chew CH, Yeo CC, Abdullah FH, Othman N, et al. spa diversity of methicillin-resistant and-susceptible Staphylococcus aureus in clinical strains from Malaysia: a high prevalence of invasive European spa-type t032. Peer J. 2021;8;9:e11195.##Mazi W, Sangal V, Sandstrom G, Saeed A, Yu J. Evaluation of spa-typing of methicillin-resistant Staphylococcus aureus using high-resolution melting analysis. Int J Infect Dis. 2015;38:125-8.##Harmsen D, Claus H, Witte W, Rothganger J, Claus H, Turnwald D, Vogel U. Typing of methicillin-resistant Staphylococcus aureus in a university hospital setting by using novel software for spa repeat determination and database management. J Clin Microbiol. 2003;41(12):5442-8.##Kavanagh KT. Control of MSSA and MRSA in the United States: protocols, policies, risk adjustment and excuses. Antimicrob Resist Infect Control. 2019;8(1):1-8.##Thaker HC, Brahmbhatt MN, Nayak JB, Thaker HC. Isolation and identification of Staphylococcus aureus from milk and milk products and their drug resistance patterns in Anand, Gujarat. Vet World. 2013;6(1):10-3. https://doi:10.5455/vetworld.2013.10-13.##Flayhart D, Lema C, Borek A, Carroll KC. Comparison of the BBL CHROMagar Staph aureus agar medium to conventional media for detection of Staphylococcus aureus in respiratory samples. J Clin Microbiol. 2004;42(8):3566-9.##Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; 28th informational supplement, M100-S8. Clinical and Laboratory Standards Institute, Wayne, PA. 2018.##Kateete DP, Kimani CN, Katabazi FA, Okeng A, Okee MS, Nanteza A, Joloba ML, Najjuka FC. Identification of Staphylococcus aureus: DNase and Mannitol salt agar improve the efficiency of the tube coagulase test. Ann. Clin Microbiol Antimicrob. 2010;9:1-7.##Al-Talib H, Yean CY, Al-Khateeb A, Hassan H, Singh KK, Al-Jashamy K, Ravichandran M. A pentaplex PCR assay for the rapid detection of methicillin-resistant Staphylococcus aureus and Panton-Valentine Leucocidin. BMC Microbiology. 2009;9:1-8. doi.org/10.1186/1471-2180-9-113##Wichelhaus TA, Hunfeld KP, Böddinghaus B, Kraiczy P, Schafer V, Brade V. Rapid molecular typing of methicillin-resistant Staphylococcus aureus by PCR-RFLP. Infection Control & Hospital Epidemiology. 2001;22(5):294-8.##Al-Mayahi A, Srhan F. A preliminary study of Aminoglycoside Modifying Enzymes (AMEs) of Multiple Antibiotic Resistance of Methicillin-resistant Staphylococcus aureus (MRSA) isolated from clinical specimens in Al-Diwaniya/Iraq. Jordan J Biol Sci. 2021;14(4).733-41.##Saleh NT, Alsammak eg. spa typing and virulence genes variation in Methicillin -resistant Staphylococcus aureus isolated from Mosul, Iraq. Biochem Cell Arch. 2022;22(1). connectjournals.com/03896.2022.22.2163.##Al-Charrakh AH, Al-Hassnawi HH, Al-Khafaji JK. Molecular characteristics of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) isolates from clinical specimens in Iraq. Br Microbiol Res J. 2015;5(3):227.##Hallabjaiy RM, Darogha SN, Hamad PA. Vancomycin resistance among methicillin-resistant Staphylococcus aureus isolated from clinical samples in Erbil City-Iraq. Medical Journal of Islamic World Acad Sci. 2014;22(4):168-74.##János D, Viorel H, Ionica I, Corina P, Tiana F, Roxana D. Carriage of multidrug resistance staphylococci in shelter dogs in Timisoara, Romania. Antibiotics. 2021;10(7):801.##El-Adawy H, Ahmed M, Hotzel H, Monecke S, Schulz J, Hartung J, Ehricht R, Neubauer H, Hafez HM. Characterization of methicillin-resistant Staphylococcus aureus isolated from healthy turkeys and broilers using DNA microarrays. Front Microbiol. 2016;19;7:2019.##Hiramatsu K, Hanaki H, Ino T, Yabuta K, Oguri T, Tenover FC. Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility. J Antimicrob Chemother. 1997;40(1):135-6.##Liu J, Gao Y, Wang X, Qian Z, Chen J, Huang Y, Meng Z, Lu X, Deng G, Liu F, Zhang Z. Culture-positive spontaneous ascitic infection in patients with acute decompensated cirrhosis: multidrug-resistant pathogens and antibiotic strategies. Yonsei Med J. 2020;61(2):145-53.##Mwansa TN, Kamvuma K, Mulemena JA, Phiri CN, Chanda W. Antibiotic susceptibility patterns of pathogens isolated from laboratory specimens at Livingstone Central Hospital in Zambia. PLoS One. 2022;2(9):e0000623.##Yehia HM, Al-Masoud AH, Alarjani KM, Alamri MS. Prevalence of methicillin-resistant (mecA gene) and heat-resistant Staphylococcus aureus strains in pasteurized camel milk. J Dairy Sci. 2020;103(7):5947-63.##Goering RV, Swartzendruber EA, Obradovich AE, Tickler IA, Tenover FC. Emergence of oxacillin resistance in stealth methicillin-resistant Staphylococcus aureus due to mecA sequence instability. Antimicrob Agents Chemother. 2019;63(8):10-128.##Jannati E, Arzanlou M, Habibzadeh S, Mohammadi S, Ahadi P, Mohammadi-Ghalehbin B, Dogaheh HP, Dibah S, Kazemi E. Nasal colonization of mecA-positive, oxacillin-susceptible, methicillin-resistant Staphylococcus aureus isolates among nursing staff in an Iranian teaching hospital. Am J Infect Control. 2013;41(11):1122-4.##Chung M, Kim CK, Conceiçao T, Aires-De-Sousa M, De Lencastre H, Tomasz A. Heterogeneous oxacillin-resistant phenotypes and production of PBP2A by oxacillin-susceptible/mecA-positive MRSA strains from Africa. J Antimicrob Chemother. 2016;71(10):2804-9.##Duarte FC, Danelli T, Tavares ER, Morguette AE, Kerbauy G, Grion CM, Yamauchi LM, Perugini MR, Yamada-Ogatta SF. Fatal sepsis caused by mecA-positive oxacillin-susceptible Staphylococcus aureus: first report in a tertiary hospital of southern Brazil. J Infect Chemother. 2019;25(4):293-7.##Gargis AS, Yoo BB, Lonsway DR, Anderson K, Campbell D, Ewing TO, Lawsin A, Machado MJ, Yamamoto N, Halpin AL, Lutgring JD. Difficult-to-detect Staphylococcus aureus: mecA-positive isolates associated with oxacillin and cefoxitin false-susceptible results. J. Clin Microbiol. 2020;58(4):10-128. https://journals.asm.org/doi/pdf/10.1128/jcm.02038-19.##Baddour MM, AbuElKheir MM, Fatani AJ. Comparison of mecA polymerase chain reaction with phenotypic methods for the detection of methicillin-resistant Staphylococcus aureus. Curr Microbiol. 2007;55: 473-9.##H Al-Hassnawi H, H Al-Charrakh A, Al-Khafaj J. Antibiotic resistance patterns of community acquired methicillin resistance Staphylococcus aureus (CA-MRSA) in Al-Hilla/Iraq. Karbala J Pharmaceut Sci. 2013;4(4):91-102.##Ba X, Harrison EM, Edwards GF, Holden MT, Larsen AR, Petersen A, Skov RL, Peacock SJ, Parkhill J, Paterson GK, Holmes MA. Novel mutations in penicillin-binding protein genes in clinical Staphylococcus aureus isolates that are methicillin resistant on susceptibility testing, but lack the mec gene. J Antimicrob Chemother. 2014;69(3):594-7.##Keener AB, Thurlow LT, Kang S, Spidale NA, Clarke SH, Cunnion KM, Tisch R, Richardson AR, Vilen BJ. Staphylococcus aureus protein A disrupts immunity mediated by long-lived plasma cells. J Immunol. 2017 1;198(3):1263-73.##Tahoun A, Elnafarawy HK, El-Sharkawy H, Rizk AM, Alorabi M, El-Shehawi AM, Youssef MA, Ibrahim HM, El-Khodery S. The prevalence and molecular biology of Staphylococcus aureus isolated from healthy and diseased equine eyes in Egypt. Antibiotics. 2022;10;11(2):221.##Shakeri F, Shojai A, Golalipour M, Rahimi Alang S, Vaez H, Ghaemi EA. Spa Diversity among MRSA and MSSA Strains of Staphylococcus aureus in North of Iran. Int J Microbiol. 2010; 2010:1-5.##Al-Kadmy IM. A genetic study to differential HC/AC MRSA isolated from clinical cases in Iraq hospitals. Mintage J Pharm Med Sci. 2013; 2:57-62.##Craft KM, Nguyen JM, Berg LJ, Townsend SD. Methicillin-resistant Staphylococcus aureus (MRSA): antibiotic-resistance and the biofilm phenotype. Med Chem Comm. 2019;10(8):1231-41.##Kareem SM, Aljubori SS, Ali MR. Novel determination of spa gene diversity and its molecular typing among Staphylococcus aureus Iraqi isolates obtained from different clinical samples. New Microbes New Infect. 2020; 34:100653.##Adwan G, Shaheen H, Adwan K, Barakat A. Molecular characterization of methicillin resistant Staphylococcus aureus isolated from hospitals environments and patients in Northern Palestine. Epidemiol Biostat Public Health. 2015;12(3).##Aqel AA, Alzoubi HM, Vickers A, Pichon B, Kearns AM. Molecular epidemiology of nasal isolates of methicillin-resistant Staphylococcus aureus from Jordan. J Infect Public Health. 2015;8(1):90-7.##Harastani HH, Araj GF, Tokajian ST. Molecular characteristics of Staphylococcus aureus isolated from a major hospital in Lebanon. Int J Infect Dis. 2014; 19:33-8.##Goudarzi M, Fazeli M, Goudarzi H, Azad M, Seyedjavadi SS. spa typing of Staphylococcus aureus strains isolated from clinical specimens of patients with nosocomial infections in Tehran, Iran. Jundishapur J Microbiol. 2016; 9 (7): 1-9.##Udo EE, Boswihi SS, Al-Sweih N. High prevalence of toxic shock syndrome toxin–producing epidemic methicillin-resistant Staphylococcus aureus 15 (EMRSA-15) strains in Kuwait hospitals. New Microbes New Infect. 2016;12: 24-30.##Hashemizadeh Z, Hadi N, Mohebi S, Kalantar-Neyestanaki D, Bazargani A. Characterization of SCCmec, spa types and Multi Drug Resistant of methicillin-resistant Staphylococcus aureus isolates among inpatients and outpatients in a referral hospital in Shiraz, Iran. BMC Res Notes. 2019;12(1):1-6.## ##

Investigating the Impact of Online Gamification on Nursing Students' Knowledge of Lung Diseases, Lung Sounds, and Self-Efficacy 2 2 Introduction: Diagnosing and performing timely treatment for lung diseases is crucial for saving patients' lives. This study aims to investigate the effect of online gamification on nursing students' learning of lung diseases, lung sounds, and self-efficacy. Material & Methods: This semi-experimental study involved 68 sixth-semester nursing students, selected through convenient sampling and randomly allocated to control and intervention groups using dice throws. Over three weekly sessions, the intervention group received training on lung diseases and lung sounds via the Storyline platform and gamification through Kahoot, while the control group received the same content through lectures by the same instructor. Questionnaires assessing demographics, learning outcomes, and self-efficacy were administered before and two weeks after the intervention. Data were analyzed using Chi-square, independent t-tests, paired t-tests, and Kolmogorov-Smirnov tests in SPSS v.16, with a significance level of 0.05. Results: The participants had a mean age of 22.73 ± 1.29 years, and 63% were male. There were no significant differences between the two groups in learning assessment and self-efficacy before the intervention (P=0.193 and P=0.167, respectively). After the intervention, the intervention group showed a statistically significant improvement in learning assessment scores (P=0.031, 16.55±2.57) compared to the control group (P=0.086, 9.11±1.01). Similarly, self-efficacy scores in the intervention group (P=0.023, 65.29±3.97) were significantly higher than in the control group (P=0.084, 48.18±5.36). Conclusion:  Online gamification significantly improves the learning of lung diseases, lung sounds, and self-efficacy in nursing students 46 55 2023/12/132024/02/162023/12/42024/02/132024/04/17 1403/1/29 2024/05/62024/04/302024/04/292024/05/212024/05/19 1403/2/30 Fatemeh Najafi Fatemeh Najafi 1 Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran Iran najafi-f@medilam.ac.ir Mosayeb Mozafari Mosayeb Mozafari Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran Iran mazafaric@yahoo.com Masoumeh Shohani Masoumeh Shohani Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran Iran msh28200@gmil.com Maryam Pakseresht Maryam Pakseresht Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran Iran paksereshtmaryam@yahoo.com Fakhredin Taghinezhad Fakhredin Taghinezhad Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran Iran ftaghinezhad@modares.ac.ir Reza Pakzad Reza Pakzad Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran Iran rezapakzad2010@yahoo.com Amirreza Bazhdan Amirreza Bazhdan Student Research Committee, Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran Iran amirreza.bazhdan80@gmail.com Alireza Vasiee Alireza Vasiee Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran Iran rezawest10@gmail.com Gamification Lung diseases Self-Efficacy Nursing Lang C, Jaksch P, Hoda MA, Lang G, Staudinger T, Tschernko E, et al. Lung transplantation for COVID-19-associated acute respiratory distress syndrome in a PCR-positive patient. Lancet Respir Med. 2020;8(10):1057-60.##Chen W, Ware LB. Prognostic factors in the acute respiratory distress syndrome. Clin Transl Med. 2015;4:1-9.##Bradford C, Martin D, K JL, Robertson N, Carne A, Skidmore N, et al. The impact of sport on the physical, psychological and social wellbeing of people with chronic breathlessness: A mixed-methods systematic review. Clin Rehabil. 2023;37(12):1611-36. doi: 10.1177/02692155231190770.##Bordon J, Slomka M, Gupta R, Furmanek S, Cavallazzi R, Sethi S, et al. Hospitalization due to community-acquired pneumonia in patients with chronic obstructive pulmonary disease: incidence, epidemiology and outcomes. Clin Microbiol Infect. 2020;26(2):220-6.##Jones I, Johnson M. What is the role of the coronary care nurse? A review of the literature. Eur J Cardiovasc Nurs. 2008;7(3):163-70.##Glen S. E-learning in nursing education: Lessons learnt? Nurs Educ Today. 2005;25(6):415-8.##Garrison DR, Kanuka H. Blended learning: Uncovering its transformative potential in higher education. Internt High Educ. 2004;7(2):95-105.##Babamohamdi H, Khalili H. Comparison of critical thinking skills in students of nursing in continuous and interrupted BS sections of Semnan University of Medical Sciences. J Med Educ. 2005;6(2).##Aghapour SA, Vakili MA, Karbasi M, Badeli R. Comparison the Effect of Student-Based Group Discussion and Lecture Methods Teaching on Midwifery Student's Learning Level. Edu-Str-Med-Sci. 2015;8(5):281-6.##Marek MW, Chew CS, Wu W-cV. Teacher experiences in converting classes to distance learning in the COVID-19 pandemic. IJDET. 2021;19(1):89-109.##Nabolsi M, Abu-Moghli F, Khalaf I, Zumot A, Suliman W. Nursing faculty experience with online distance education during COVID-19 crisis: A qualitative study. J Prof Nurs. 2021;37(5):828-35.##Gentry SV, Gauthier A, L'Estrade Ehrstrom B, Wortley D, Lilienthal A, Tudor Car L, et al. Serious Gaming and Gamification Education in Health Professions: Systematic Review. J Med Internet Res. 2019;21(3):e12994. doi: 10.2196/12994.##Ghasemzadeh I, Aghamolaei T, Hosseini-Parandar F. Evaluation of medical students of teacher-based and student-based teaching methods in infectious diseases course. JML. 2015;8(Spec Iss 3):113.##Landers RN, Landers AK. An empirical test of the theory of gamified learning: The effect of leaderboards on time-on-task and academic performance. S&G. 2014;45(6):769-85.##Erfani N. Predict Self Beliefs Based on Self-Regulation Strategies in Students in Bu-Ali Sina University. J-Nurs-Edu. 2018;7(2):45-52.##Ozyilmaz A, Erdogan B, Karaeminogullari A. Trust in organization as a moderator of the relationship between self‐efficacy and workplace outcomes: A social cognitive theory‐based examination. 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Sex Transm Infec. 2001;77(5):376-80.##Orujlu S, Hemmati Maslakpak M. Assessing the relationship between critical thinking and self-efficacy of nursing student. J Nurs Educ. 2017;5(6):11-7.##Inangil D, Dincer B, Kabuk A. Effectiveness of the Use of Animation and Gamification in Online Distance Education During Pandemic. CIN. 2022;40(5):335.##Antit S, Zairi I, Bellakhal S, Mzoughi K, Ouali S, Mghaieth F, et al. Evaluation of students' motivation during the gamification of electrocardiogram interpretation learning. Tunis Med. 2020;98(11):776-82.##Ghezelghash A AS, Alavi MH, yaghmaei F. Comparing methods of lecturing, problem solving and self-learning via internet to learn proper interpretation of electrocardiogram among nursing student. IJNR. 2008;3(10):7-14.##El-Beheiry M, McCreery G, Schlachta CM. A serious game skills competition increases voluntary usage and proficiency of a virtual reality laparoscopic simulator during first-year surgical residents' simulation curriculum. 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The Impact of Specific Physical Training on FGF-2 and VEGF-A Expression in Patients Post-Coronary Artery Bypass Surgery 2 2 Introduction:  Coronary artery bypass surgery (CABG) is a common procedure for patients with coronary artery disease. This study aimed to investigate the effect of selected physical exercises on the expression of FGF-2 and VEGF-A in patients post-CABG. Material & Methods: In this semi-experimental study, 20 male patients from Afshar Hospital (Yazd City) who had undergone CABG were selected and randomly divided into two groups: a combined training group and a control group. The combined training group performed an 8-week program consisting of endurance training (15-20 minutes at 50-60% of HRmax) and resistance training (10-20 minutes, including three upper limb and two lower limb movements, each with three sets of 10 repetitions at 30-60% of 1RM), conducted three times per week. Gene expression of Fibroblast Growth Factor 2 (FGF-2) and Vascular Endothelial Growth Factor A (VEGF-A) was measured using Real-Time PCR. Data were analyzed using paired t-tests and one-way ANOVA with a significance level set at P<0.05. Results: An increase in the expression of VEGF and FGF-2 genes was observed in the combined training group post-test compared to pre-test (p=0.019). Additionally, there was a significant difference in VEGF gene expression between the control and training groups (p=0.016). Significant differences were also found in FGF-2 expression between the combined exercise group and both the healthy control and patient control groups (p=0.001 for both).   Conclusion: The results suggest that combined exercises may enhance physiological adaptations and improve the functional capacity of the heart and vessels in CABG patients by increasing growth factor expression.   56 65 2023/12/132024/02/162023/12/42024/02/132024/04/172023/05/30 1402/3/9 2024/05/62024/04/302024/04/292024/05/212024/05/192023/06/8 1402/3/18 Maryam Monjezi Maryam Monjezi Department of Sport Physiology, Ayatollah Amoli Branch, IslamicAzad University, Amol, Iran Iran marya731@yahoo.com Alireza Barari Alireza Barari 1 Department of Sport Physiology, Ayatollah Amoli Branch, Islamic Azad University, Amol, Iran Iran alireza54.barari@gmail.com Ahmad Abdi Ahmad Abdi Department of Sport Physiology Ayatollah Amoli Branch Islamic Azad University Amol, Iran Iran a.abdi58@gmail.com The results suggest that combined exercises may enhance physiological adaptations and improve the functional capacity of the heart and vessels in CABG patients by increasing growth factor expression. Jannati M, Attar A. Analgesia and sedation postcoronary artery bypass graft surgery: a review of the literature. Ther Clin Risk Manag. 2019;15:773.doi: 10.2147/TCRM.S195267.##Giorgini JC, Rubio M, Baldi J, David M, Higa C, Borracci RA, et al. Short-Term Outcomes of Isolated and Combined Coronary Artery Bypass Graft Surgery in Women. Rev Argent Cardiol. 2020;88(5):448-53.doi: 10.1136/openhrt-2015-000386.##Balakrishnan, Sheeja, and Senthil Kumar B. “Correlation of serum vascular endothelial growth factor and cardiovascular risk factors on collateral formation in patients with acute coronary artery syndrome. Clin Anat. 2022 Jul;35(5):673-678. doi: 10.1002/ca.23890.##Gilani N, Kazemnejad A, Zayeri F, Hadaegh F, Azizi F, Khalili D. Anthropometric indices as predictors of coronary heart disease risk: Joint modeling of longitudinal measurements and time to event. Iran J Public Health. 2017;46(11):1546.##Scioli, M.G.; Storti, G.; D’Amico, F.; Rodríguez Guzmán, R.; Centofanti, F.; Doldo, et al. Oxidative Stress and New Pathogenetic Mechanisms in Endothelial Dysfunction: Potential Diagnostic Biomarkers and Therapeutic Targets. J. Clin. Med. 2020, 9, 1995.doi: 10.3390/jcm9061995.##Zhou Y, Zhu X, Cui H, Shi J, Yuan G, Shi S, Hu Y. The Role of the VEGF Family in Coronary Heart Disease. Front Cardiovasc Med. 2021; 8:738325. doi: 10.3389/fcvm.2021.738325.##Podemska-Jedrzejczak Z, Malinska A, SujkaKordowska P, Nowicki M, Puslecki M, Jemielity M, et al. Vascular restenosis in coronary artery bypass grafting might be associated with VEGF-C/VEGFR-3 signaling pathway. Heart Vessels. 2018;33(9):1106- 20. doi: 10.1007/s00380-018-1158-9.##Zangi L, Lui KO, Von Gise A, Ma Q, Ebina W, Ptaszek LM, et al. Modified mRNA directs the fate of heart progenitor cells and induces vascular regeneration after myocardial infarction. Nat Biotechnol. 2013;31(10):898-907.doi: 10.1038/nbt.2682.##Hamidi A, Rashidlamir A, Khajei R, Zarei M, Zendedel A. The Effect of Aerobic-resistance Training on Plasma Levels of bFGF in Coronary Artery Disease After CABG. J Arak Uni Med Sci 2020; 23 (3) :314-325##Cavalcante SL, Lopes S, Bohn L, Cavero-Redondo I, Álvarez-Bueno C, Viamonte S, Santos M, Oliveira J, Ribeiro F. Effects of exercise on endothelial progenitor cells in patients with cardiovascular disease: A systematic review and meta-analysis of randomized controlled trials. Rev Port Cardiol (Engl Ed). 2019 Nov;38(11):817-827. English, Portuguese. doi: 10.1016/j.repc.2019.02.016.##Ghorbanzadeh V, Mohammadi M, Dariushnejad H, Chodari L, Mohaddes G. Effects of crocin and voluntary exercise, alone or combined, on heart VEGF-A and HOMA-IR of HFD/STZ induced type 2 diabetic rats. J Endocrinol Invest. 2016 Oct;39(10):1179-86. doi: 10.1007/s40618-016-0456-2.##Danzig V, Míková B, Kuchynka P, Benáková H, Zima T, Kittnar O, et al. Levels of circulating biomarkers at rest and after exercise in coronary artery disease patients. Physiol Res. 2010;59(3):385-392. doi: 10.33549/physiolres.931764.##Hoier B, Nordsborg N, Andersen S, Jensen L, Nybo L, Bangsbo J, et al. Pro- and anti-angiogenic factors in human skeletal muscle in response to acute exercise and training. J Physiol. 2012 1;590(3):595-606. doi: 10.1113/jphysiol.2011.216135##Paluch AE, Boyer WR, Franklin BA, Laddu D, Lobelo F, Lee DC, et al A; on behalf the American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Epidemiology and Prevention; and Council on Peripheral Vascular Disease. Resistance Exercise Training in Individuals With and Without Cardiovascular Disease: 2023 Update: A Scientific Statement From the American Heart Association. Circulation. 2024 Jan 16;149(3):e217-e231. doi: 10.1161/CIR.0000000000001189.##Vuorio T, Jauhiainen S, Ylä-Herttuala S. Pro- and anti-angiogenic therapy and atherosclerosis with special emphasis on vascular endothelial growth factors. Expert Opin Biol Ther. 2012;12(1):79-92. doi: 10.1517/14712598.2012.641011.##Burton PB, Owen VJ, Hafizi S, Barton PJ, Carr-White G, Koh T, De Souza A, Yacoub MH, Pepper JR. Vascular endothelial growth factor release following coronary artery bypass surgery: extracorporeal circulation versus 'beating heart' surgery. Eur Heart J. 2000;21(20):1708-13. doi: 10.1053/euhj.2000.2177.##Sun Z, Shen Y, Lu L, Zhang RY, Pu LJ, Zhang Q, et al. Increased serum level of soluble vascular endothelial growth factor receptor-1 is associated with poor coronary collateralization in patients with stable coronary artery disease. Circ J. 2014;78(5):1191-6. doi: 10.1253/circj.cj-13-1143.##Nelken NA, Coughlin SR, Gordon D, Wilcox JN. Monocyte chemoattractant protein-1 in human atheromatous plaques. J Clin Invest. 1991 Oct;88(4):1121-7. doi: 10.1172/JCI115411.##Braile M, Marcella S, Cristinziano L, Galdiero MR, Modestino L, Ferrara AL, et al. VEGF-A in Cardiomyocytes and Heart Diseases. Int J Mol Sci. 2020 Jul 26;21(15):5294. doi: 10.3390/ijms21155294.##Abdi H, Shamsaei N, Jafari M. [The role of aerobic training in protein expression of stromal cell-derived factor-alpha and apoptotic death of cardiomyocyte after experimental myocardial infarction]. Journal of Practical Studies of Biosciences in Sport. 2019; 7(14): 103-15. DOI: 10.22077/JPSBS.2017.489.1190##1. Ellison GM, Waring CD, Vicinanza C, Torella D. Physiological cardiac remodelling in response to endurance exercise training: cellular and molecular mechanisms. Heart. 2012; 98(1): 5- 10. DOI: 10.1136/heartjnl-2011-300639##Yang X, Chrisman H, Weijer CJ. PDGF signalling controls the migration of mesoderm cells during chick gastrulation by regulating N-cadherin expression. Development. 2008; 135(21): 3521-30. DOI: 10.1242/dev.023416##Samsa LA, Yang B, Liu J. Embryonic cardiac chamber maturation: Trabeculation, conduction, and cardiomyocyte proliferation. Am J Med Genet C Semin Med Genet. 2013 Aug; 163C(3): 157-68. DOI:10.1002/ajmg.c.31366##Gaeini AA, Sattarifard S, CafiZadeh S, Nejatian M. [The comparison of eight weeks of combined and aerobic training on functional capacity, body composition and strength in postcoronary artery bypass graft cardiac patients]. Cardiovasc Nurs. 2013; 2(1): 34-41. [Article in Persian].## ##

Polymorphism of the Testis-Specific Serine/Threonine Kinase 6 (TSSK6) Gene in Spermatozoa of Asthenozoospermia Patients at Institut Pasteur of Côte d'Ivoire 2 2 Introduction:Phosphorylation reactions highlight the essential role of protein kinases in sperm motility. TSSK6 protein is thought to play a crucial role in this process. Indeed, sperm obtained from mice with the Tssk6-/- genotype are unable to carry out fertilization and exhibit decreased motility. This leads us to investigate the causes of asthenozoospermia by searching for polymorphisms in the TSSK6 gene. Therefore, the objective of this study is to identify polymorphisms in the TSSK6 gene in men affected by asthenozoospermia. Material & Methods: The methodology involved direct sequencing of spermatozoa DNA. Thirty ejaculates were analyzed, including 20 from asthenozoospermic men and 10 from normozoospermic men. Spermograms were performed according to WHO procedures. DNA extraction was carried out using the phenol/chloroform method followed by conventional PCR. The amplicons were sequenced using the Sanger method, and the sequences were analyzed with BioEdit software. The data were analyzed using Fisher and Mann-Whitney tests. Results: The results revealed mutations in the TSSK6 gene in both normospermic and asthenozoospermic ejaculates. The synonymous mutations c.690T>C (p.Tyr230Tyr) and c.372C>A (p.Arg124Arg) were the most frequent, occurring at rates of 50% and 33.33%, respectively. Analysis of the mutations using PolyPhen-2 indicated that all mutations observed in normozoospermic samples are benign and would not affect sperm quality. However, only the mutations described in asthenozoospermic samples are predicted to be damaging to the protein. Conclusion: In conclusion, mutations in the TSSK6 gene were observed in infertile men. Deleterious mutations in the TSSK6 protein are associated with asthenozoospermia   66 72 2023/12/132024/02/162023/12/42024/02/132024/04/172023/05/302024/02/9 1402/11/20 2024/05/62024/04/302024/04/292024/05/212024/05/192023/06/82024/06/2 1403/3/13 Konan Guy Sylvère N'zi Konan Guy Sylvère N'zi Alassane Ouattara University, Department of Science and Technology, Côte d’Ivoire Côte d’Ivoire guysylverenzi@yahoo.fr Jules Eric Hermann Ayekoue Jules Eric Hermann Ayekoue Alassane Ouattara University, Department of Science and Technology, Côte d’Ivoire Côte d’Ivoire ayekouejuleseric@gmail.com Marie Florence N'guessan Marie Florence N'guessan Institut Pasteur of Côte d’Ivoire Côte d’Ivoire miflo2@yahoo.fr Founzégué Amadou Coulibaly Founzégué Amadou Coulibaly University of San Pedro, UFR Agriculture, fisheries resources and agro-industry, Côte d’Ivoire Côte d’Ivoire founzegue@yahoo.fr Allico Joseph Djaman Allico Joseph Djaman Alassane Ouattara University, Department of Science and Technology, Côte d’Ivoire Côte d’Ivoire djamanj@yahoo.fr Infertility Male Gene Protein Mutation TSSK6 World Health Organization. Laboratory manual for the examination and processing of human semen, 5th ed. Geneva, Switzerland; 2010. P. 271.##Drissi J, Drissi M, Koutaini A, Rhrab B, Fehati D, El Hamzaoui S. Les facteurs influençant la fertilité masculine. Int j of innov and sci res. 2015; 15(1):15-26.##Ayékoué JEH, N’zi KGS, Yayé YG, Coulibaly FA, N’guessan MF, Bahi GA, et al. The asthenozoospermia as a major sperm abnormality in males assessed for semen analysis in Institut Pasteur of Cote d’Ivoire. JAMSAT. 2018; 4:7-12.##Luconi M, Forti G, Baldi E. Pathophysiology of sperm motility. Front Biosci. 2006; 1(11):1433-47. doi: 10.2741/1894.##Debby I, Maya F, Haim B. Mechanism of sperm capacitation and the acrosome reaction: role of protein kinases. Asian J Androl. 2012; 14(6):816-21. doi: 10.1038/aja.2012.81.##Baldi E, Luconi M, Bonaccorsi L, Muratori M, Forti G. Intracellular events and signaling pathways involved in sperm acquisition of fertilizing capacity and acrosome reaction. Front Biosci. 2000; 1:5:E110-23. doi: 10.2741/baldi.##Pereira R, Sá R, Barros A, Sousa M. Major regulatory mechanisms involved in sperm motility. Asian J Androl. 2017; 19(1):5-14. doi: 10.4103/1008-682x.167716.##Li Y., Sosnik J, Brassard L, Reese M, Spiridonov NA, Bates TC, et al. Expression and localization of five members of the testis-specific serine kinase (Tssk) family in mouse and human sperm and testis. Mol Hum Reprod. 2011; 17(1):42-56. doi.org/10.1093/molehr/gaq071.##Spiridonov NA, Wong L, Zerfas PM, Starost MF, Pack SD, Paweletz CP, et al. Identification and characterization of SSTK, a serine/ threonine protein kinase essential for male fertility. Mol Cell Biol. 25(10):4250-61. doi.org/10.1128/mcb.25.10.4250-4261.2005.##Su D, Wei Z, Yuan Y, Hao Z, Yun-Qiang L, Gang B, et al. c.822+126T>G/C: a novel triallelic polymorphism of the TSSK6 gene associated with spermatogenic impairment in a Chinese population. 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Statistical Modeling of COVID-19 Mortality Trends in Iran 2 2 Introduction:: The proliferation of the COVID-19 virus has become a significant global public health concern. Iran was among the countries severely affected by this virus, facing considerable challenges in managing and treating COVID-19 infections. To implement more efficient care and prevention strategies, it is critical to understand the progression of the illness and the mortality rate of those affected. This study focuses on analyzing the mortality trends of COVID-19 patients in Iran. The primary aim is to apply statistical models to characterize and predict fatalities caused by COVID-19 in Iran. Material & Methods : Data on COVID-19-related deaths in Iran were analyzed, encompassing the daily number of new cases and the cumulative number of cases reported between February 19, 2020, and May 15, 2022. The data were divided into six periods to develop more accurate models. Ten time series and regression models were fitted to the data, with the best model for each variable in each period identified using the coefficient of determination (R²) index. The significance of the models was assessed using the F-test. Results:Throughout the study period, the ARIMA (4,1,4) model and the cubic regression model were the time series models that best fit the mortality data. The cubic model provided the best fit during the first, second, third, fourth, and fifth periods, while the quadratic model was the best fit during the sixth period. For the cumulative death data, the cubic model was the most accurate.  Conclusion: The study's findings demonstrate that time series and regression statistical models can effectively model and forecast COVID-19 mortality data on both a daily and cumulative basis.   73 83 2023/12/132024/02/162023/12/42024/02/132024/04/172023/05/302024/02/92024/02/7 1402/11/18 2024/05/62024/04/302024/04/292024/05/212024/05/192023/06/82024/06/22024/06/12 1403/3/23 Ehsan Ghasemi Ehsan Ghasemi 1 School of Health, biostatistics department, Ilam University of Medical Sciences, Ilam, Iran Iran ehsanghasemi.k@gmail.com Ali Khorshidi Ali Khorshidi Health and Environment Research Center, Ilam university of medical sciences, Ilam, Iran-Health and Environment Re Iran ali_482002@yahoo.com Mehdi Omidi Mehdi Omidi Department of mathematics, Ilam University, Ilam, Iran Iran omidi_280@yahoo.com Kourosh Sayehmiri Kourosh Sayehmiri Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran Iran kourosh86@gmail.com Keywords: COVID-19 Forecasting best fit regression models Time Series Studies 1. 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