مجله دانشکده پزشکی اصفهان
پیاپی 161 (هفته اول دی1390)

Complaints from medical doctors have created problems for both physicians and patients. As a result, patients find it hard to trust their physicians and doctors feel more stressed. The purpose of this search was to evaluate all complaints in all specialized fields and to identify the subjects at risk. It also tried to assess the effects of characteristics of plaintiffs (patients) and defendants (physicians) on the final verdict. This was a retrospective cross-sectional study. The statistical population consisted of all records of the malpractice complaints in different specialized fields adjudicated in Isfahan Department of Legal Medicine, during 2009-2010. Demographic characteristics of physicians and patients, the place at which the physician worked, type of medical negligence, conviction rate, and complaint outcome were evaluated. In the 123 studied cases, the mean age of patients was 37.8 ± 7.8. Moreover, 64.5% were men and 53% had a high school diploma or a higher educational level. The mean age of physicians was 43.29 ± 9.64. In addition, 81% were men, 45.9% were highly experienced and 65.3% were specialists (surgery, orthopedics, gynecology, and anesthesia). Most complaints were from non-academic governmental centers. While 50.8% of physicians were charged with an average of 35.2 ± 34.1 percent error, the most common error type was imprudence. The final verdict was associated with education and gender of the patient. The percent error was associated with type of disease, education and gender of the patient, and the final injury and disease status. Patients may complain from physicians due to increased awareness and expectations. Specialists, particularly surgeons, are more at risk. Although many complaints of severe injuries, such as death, have been made, the percentage of failure has been determined to be higher in minor injuries or financial losses. Therefore, considering the high rate of fault in judgment commissions, more teaching and counseling centers are required.

Cutaneous leishmaniasis (CL) is an endemic disease in Iran. Pentavalent antimonial drugs have been the first line of therapy in CL for many years. However, the cure rate of these agents is still not favorable. This study was carried out to compare the efficacy of intralesional glucantime and topical trichloroacetic acid 50% in combination with non-ablative radiofrequency heat therapy on cutaneous leishmaniasis. A total of 30 patients with 38 lesions were treated with intralesional injection of meglumine antimoniate (Glucantime) (Sanofi-Aventis, France) as Group 1. An equal number of 38 lesions in the remaining 30 patients were treated with the combination of non-ablative radiofrequency and topical trichloroacetic acid 50% as Group 2. Complete cure rate besides changes in lesion size and size of scars were assessed and compared between the two groups. Data was then analyzed by SPSS. Complete cure at after 4 months of treatment was significantly more in Group 1 than the other group (P = 0.01). However, the complete cure rate at the 6th month was not significantly different between the two groups (P = 0.06). This study showed that intralesional glucantime has significantly higher cure rate of cutaneous leishmaniasis in shorter time than trichloroacetic acid 50% in combination with non-ablative radiofrequency. Moreover, it could significantly induce efficient size reduction of more than 50% in most of lesions. The analyses revealed that intralesional glucantime still has the superiority to be the first line of therapy in cutaneous leishmaniasis.

The world population is aging rapidly. Therefore, the social, financial and health consequences of increasing longevity cannot be ignored. In addition to increased age-related physical illnesses, this demographic change will also lead to an increased number of mental health problems. Thus, any health promotion approach that could facilitate introduction of effective primary, secondary and even tertiary prevention strategies in old age psychiatry would be of significant importance. This paper explored physical activity as one of the possible health promotion strategies with positive effects on mental health in later life. In this quasi-experimental study, 372 male and female individuals aged 60 years and older were randomly allocated into case and control groups. An exercise program (two 30-45 minute sessions weekly for 2 months) was assigned to the case group. However, some practical problems divided the subjects in the case group into two subgroups of individual physical activity (n = 96) and group physical activity (n = 85). The 28-item general health questionnaire (GHQ-28) was administered in order to obtain information on mental health. The questionnaire was completed before, immediately and 3 months after the intervention. The data was analyzed by chi-square test, paired t-test and independent t-test in SPSS11.5. In the case group, the mean of GHQ total scores decreased immediately after the intervention (8 ± 5.5 vs. 5.6 ± 5.1). The changes remained significant after 3 months (the mean after 3 months = 5.6; P <. 001). The scores of GHQ subscales including somatization, anxiety, social dysfunction and depression decreased in the case group and all changes remained significant after 3 months. In addition, there were significant differences in mental health benefits between subjects with group physical activity and those with individual physical activity, i.e. doing exercise with a group was determined to be more effective. This study showed physical activity as an effective intervention which significantly improved mental health in older adults. However, performing physical activity in a group of individuals with the same age would have more benefits.

APC is a tumor-suppressor protein. To evaluate the correlation between APC expression and pathogenesis of colorectal cancer, we investigated the expression of this protein in cancerous and normal colorectal tissues. APC expression was evaluated in 50 pairs of primary colorectal cancers and corresponding normal colorectal tissues using immunohistochemical staining on paraffin-embedded sections. APC was expressed in all tissues. It was down-regulated in the colorectal cancer specimens compared with the matched normal tissues (P < 0.001). APC expression may be a favorable biologic marker and a useful prognostic indicator in patients with colorectal cancer.

Migraine and allergic rhinitis (AR) are two common causes of headache and facial pain in which inflammatory mediators with vasoactive function play important roles. This study aimed to determine the frequency of migraine in AR patients. In a case-control study performed from June to December 2010 in patients referred to ear, nose and throat (ENT) clinic of a university hospital in Rasht, Iran, 46 AR patients with positive skin prick tests were compared with 60 subjects without AR signs and symptoms and negative skin tests. In both groups, history of migraine was assessed according to IHS (International Headache Society) criteria. Data was analyzed by chi-square and Fisher's exact tests in SPSS17. The case group included 14 male and 32 female patients with a mean age of 31.17 ± 8.31 years. In addition, 23 male and 37 female individuals with a mean age of 37.58 ± 12.63 years constituted the control group. The prevalence of migraine in the case and control groups was 37% and 5%, respectively. The differences in the prevalence of migraine and migraine without aura between cases and controls were significant (P = 0.001 for both conditions, odds ratio for migraine = 11.244,95% CI: 2.428-53.76). In contrast to individuals over 40 years old, in subjects younger than 30 and those between 30-39 years old, the difference in the prevalence of migraine (with and without aura) was not significant. The prevalence of migraine, especially without aura, in allergic patients is higher than non-allergic subjects and this correlation is more significant with increasing age.

Pilonidal disease is a painful condition usually occurring in the intergluteal region. The most common procedure for surgical treatment of pilonidal disease in Alzahra Hospital (Isfahan, Iran) is excision and primary closure. However, this method could be complicated by creating a dead space at the surgical site. In this clinical trial, we compared two techniques to minimize complications following surgery. This clinical controlled trial was performed in Alzahra Hospital (Isfahan, Iran) during 2007-2008. Patients were randomized into either tie over technique group (group A, n = 54) or closed suction drainage group (group B, n = 54). The incidence of complications was evaluated by means of a specific questionnaire at the time of surgery and during follow-up visits. Data was analyzed using SPSS13. This study included 108 patients (94.4% males and 5.6% females). The mean age of subjects was 25.08 ± 3.6 years. The prevalence of complications (disease recurrence, surgical wound infection, wound dehiscence, and seroma collection) did not significantly differ between the two groups. Duration of operation in group A was significantly longer than group B (P < 0.001). Based on our data, there were no differences between the outcomes of tie over and closed suction drainage techniques for surgical management of sacrococcygeal pilonidal sinus disease.