مجله سازمان نظام پزشکی جمهوری اسلامی ایران
سال سی و سوم شماره 1 (پیاپی 129، بهار 1394)

communications and information technology revolution has a remarkable effect on economic, social, politic and security of all the world. using of information technology in medicine has many advantages such as improve the quality and effectiveness of care, reduce medical errors, enhance the management of acute and chronic disease, access to updated information, and help to medical decision-making. This study was aimed to determine the status of using information technology in the private clinics of general physicians as well as to find the reasons for unwillingness to use of that.

This is a descriptive and applied study done in 1393–94 (2015). The population included general physicians’ clinic in Ahvaz (344 clinics) . A questionnaire and a check list were applied to obtain the required information. A test- retest with two weeks interval was used to find out the instruments reliability (r= 0.94) and their validity were confirmed by experts.

71.42% and 28.57% out of respondents were male and female respectively. The results showed that 7.2% out of  the participants used of information technology. The physicians believed that the lack of knowledge about how to use of information technology in medical care is an important reason for reluctance to use of information technology.

Although, the practitioners agreed with the use of information technology in medicine, but they still have not accepted the technology in their clinics.

Providing high quality and equal healthcare services is one of the most important objectives for any healthcare system. For achieving this goal the human resources is an important influencing factor. Because of individual, social and economic incentives many of physicians prefer dual paracticing and this lead to concerns between health policy makers and planners. Regarding to this, national policymakers and planners designed and approved an action entitled to:” Banning dualparacticing Action within frame of I.R.I 5th Development Plan Action. So this paper aimed to assessing this action by using the health and medical experts and consultants.

We applied a qualitative design throug a Questionnaire and Discussion Groups method with 15 participants which have met the required study crteria. We recognize Three Thematic including: the possible benefits or harms of implementing the action, the feasability of action and finally the probable challenges of implementing this action.

According to experts opinion implementing this Action have benefits for health systems but subject to generating some reforms and condition, which including: improving the managerial and structural infrastuctures, allocating adequate budget, revising of current healthcare services tarriffing and reimbursement mechanisms, pilot and stage to stage impelementing of Action, improving the quality of services by public hospitals, and confidence-building between physicians and planners are usefull for efficient and effective implementation of Action.

Rice farming need physical activity and can cause musculoskeletal disorders (MSD) among farmers. Most of previous studies were focused on prevalence of MSD in other body regions such as lumbar region so this study had been performed for assessment of MSD prevalence in lower limbs of Iranian rice farmers.

This prospective study had been performed between March and October 2013 on 75 rice farmers and 75 non rice farmers of Babol city. Rice farming had been determined as exposure and MSD prevalence was assessed at three follow-up points in two, four and six months.

During six months follow-up, 47 farmer from exposure and 26 farmer from unexposed groups had been reported MSD at their lower limbs region. At two and fourth months after beginning the study, MSD prevalence in exposed group were significantly higher than unexposed group. At six months after follow up, MSD prevalence in lower limbs had non-significant differences between two groups.

Rice farming was known as one of the risk factors for development of MSD on lower limbs of Iranian rice farmers.

Iron deficiency anemia (IDA) is the most common malnutrition worldwide. While this disease is preventable, about half of women and children in developing countries and more than 30 percent of Iranian women are suffering from that. So, this study was designed to evaluate knowledge level of mothers about preventive methods of Iron deficiency anemia.

In this cross sectional descriptive study, 336 female students were evaluated in 8 primary and middle schools in Tehran’s east. Knowledge level of them about Iron deficiency anemia and its preventive methods were evaluated with questionnaire which its validity and reliability was provided. Sample acquisition was done as cluster random sampling. SPSS 16 statistical software was used for data analysis and effect of underlying variations on knowledge level.

47% of mothers had inadequate knowledge about causes, complications and preventive methods of Iron deficiency anemia and only 8.3% of them had enough knowledge. The mean of knowledge scores which had been acquired by mothers was 8.05 ± 3 from 20. This demonstrates weak knowledge of them about Iron deficiency anemia. There were positive correlation between mother’s age (p=0.005), father’s age (p=0.048), mother’s and father’s educational level (p<0.001 and p<0.001 respectively) and children educational level (p<0.008) with mother’s knowledge level. There wasn’t any significant association between mother’s and father’s occupation and child number with mother’s knowledge level (p>0.05).

In spite of significant prevalence of iron deficiency and its subsequent anemia and preventability of this health problem, most of the people don’t have enough knowledge about that.

Recently Grapefruit juice is known to enhance the bioavailability of several clinically important drugs such as nifedipine, terfenadine, cyclosporine, ethinylestradiole, midazolam, and triazolam. Cyclosporine is an immunosuppressive agent that used in transplantation for preventation of chronic rejection. Grapefruit increase in Cmax and AUC of drug mediated by suppression of Cyp3A4 in small intestine wall.

This study has been performed by twenty Allogenic bone marrow transplant recipients at shariati hospital in Tehran. Subjects were coadministration oral cyclosporine and grapefruit juice and water as a placebo, simultaneously and two hours later.
Blood samples were collected at 3.5 and 11.5 hours following drug administrations.Blood concentration analyzed by specific monoclonal radiomimmunoassay (RIA) technique.

Grapefruit juice has significantly increase, about %42 in cyclosporin Cmax (3.5h), compared with placebo, (p=0.001). However the blood level obtained at (11.5h) Cmin was only increased about %20, (p=0.316). The average systolic and diastolic blood pressure, decreased significantly in grapefruit juice group compared with placebo, respectively (p=0.001, p=0.012).

This study demonstrated that administration of grapefruit juice had increased the cyclosporin Cmax (%42) at Iranian bone marrow transplant recipients.
Because grapefruit juice may be a safe and effective instrument to enhance absorption of many therapeutic agents, it is an appropriate means in terms of reducing dosing requirements of many Cyp3A4 substrates such as cyclosporin.

Caustic or corrosive caustic substance is a chemical substance that damages the tissue with which it comes to contact. These materials include domestic and industrial caustic. Treatment of chemical burns of the esophagus and stomach is one of the greatest problems in surgery; the studies to date have not proved specific results despite various medical and surgical procedures

Due to some previous convincing results of stenting, in this survey we studied the patients who presented to Loghman Hospital from 2000 to 2010 complaining of caustic ingestion and underwent stenting. The patients were followed for a period of 1 year.

Among the 35 patients, 18 patients (51.4%) didn’t have any stenosis on imaging or examination, 5 cases (14.3%) developed Gastric Outlet Obstraction(GOO), in 2 patients (5.7%) we diagnosed esophageal stricture, unfortunately 6 patients (17.1%) died, and we did not find anything about the fate of 4 (11.4%).

In this review we concluded that the use of stents in patients with esophageal caustic burns, especially in those with endoscopic Grade 2A burns, is effective the incidence of Esophagus stenosis.

Despite the introduction of several new classes of antidepressants, tricyclic antidepressants )TCA( have remained as a prominent choice for management of depressive disorders in the geriatrics due to wealth of evidence in relevant literature and the feasibility of their therapeutic drug monitoring in clinical practice. TCAs with tertiary amine structure are associated with much more frequent and severe adverse reactions compared to those with secondary amine structure. Regarding its effectiveness against a wide range of late-life depressive disorders along with favorable safety profile and specified as well as defined therapeutic window, nortriptyline has been considered as a gold standard TCA in the elderly by most researchersand clinicians. Although the overall clinical efficacy of TCA in geriatrics is believed to be comparable to that observed in younger subjects, but their onset of response appear to be somewhat slower in the elderly compare to younger adults )9-12 versus 6 weeks, respectively(. Geriatrics is generally more vulnerable to adverse reactions of TCA due to age-related physiologic alterations in pharmacodynamics and pharmacokinetics. Therefore, the elderly in comparison to young adults usually need lower doses of TCAs to achieve favorable response and minimize adverse reactions. Treatment with TCAs in geriatrics should be initiated with the least tolerable dose and dose increments should be made gradually based on the patient tolerability. To avoid withdrawal syndrome, TCAs should be tapered by 10%-25% every 1-2 weeks. A comprehensive medical assessment such as the presence of cardiac diseases )especially conduction defects(, glaucoma, and prostate hypertrophy is crucial before starting TCAs in geriatrics. During the TCA treatment, the elderlyshould be closely monitored regarding orthostatic blood pressure, electrocardiogram, electrolytes, serum creatinine, liver function tests, and its blood level after any dose change or adding a new medication with potential pharmacokinetics interactions. Due to the plausible aggravation of their co-morbid diseases, administration of TCAs is considered contraindicated in geriatric patients with Alzheimer’s disease, ischemic heart disease, cardiac conduction abnormality, congestive heart failure, and angle-closure glaucoma.