مجله دانشکده پزشکی اصفهان
پیاپی 496 (هفته چهارم آبان ماه 1397)

Pemphigus vulgaris is an autoimmune disorder, which appears as a mucosal intracutaneous blister. The disease prevalence is different in various countries and regions. Therefore, identification of the prevalence and characteristics of patients with this disease in different climates can be useful in initiating early treatment and management, and reducing the mortality. So, the aim of this study was to evaluate the epidemiology of Pemphigus vulgaris in Isfahan City, Iran during a ten-year period. In this descriptive retrospective study, 114 patients with Pemphigus vulgaris who were admitted in Alzahra hospital in Isfahan during the years of 2006-2017 were studied. Demographic, clinical, and paraclinical data were recorded, and the results were reported using SPSS software. Findings: Of 114 patients, 78 (68.4%) were women and (31.6%) 36 were men, with a mean age of 49.15 ± 12.55 years. Type of the lesion was mucosal and vegetative in 14.9%, cutaneous in 24.4%, and both mucosal and cutaneous in 60.5%. In addition, the prevalence of this disease in the spring and summer was 31.6% and 27.2%, respectively. Most patients were treated with prednisolone and Azaram drugs, which were associated with complications in 17.8%; but eventually all patients recovered and no mortality occurred during this assessment. According to the results of the study, the prevalence of this disease in women was more than men, and most of them appeared in spring and summer as cutaneous-mucosal manifestations. Therefore, it seems that more research is needed on the prevalence of this disease and its manifestations, the season of more prevalence, and successful treatments.

This study compared the effect of escitalopram on depression and quality of life in patients with breast cancer and mastectomy with placebo. In a randomized, double-blind clinical trial study, 72 patients were enrolled. After considering the inclusion and exclusion criteria, 64 eligible people, from women aged 18-65 years, diagnosed with breast cancer with modified radical mastectomy were randomly assigned into two groups of intervention (32 subjects) and control (32 people). In the escitalopram group, the drug started at a dose of 10 mg daily, and after one week, reached 20 mg daily, and continued until the 12 weeks. The evaluation of patients was done using Depression Anxiety Stress Scales (DASS) questionnaire and World Health Organization Quality of Life-Brief (WHOQOL-BREF) questionnaire at weeks 0, 2, 8, and 12. Findings: In assessing the quality of life, the subscales of psychological health, social relations, environmental health, and general health in the assessment of weeks 2, 8, and 12 were significantly higher than the control group (P < 0.05). Moreover, in intra-group analysis in intervention group, the difference between the mean values of the subscales of physical health, psychological health, social relations, environmental health, and general health was reported to be statistically significant (P < 0.01). The onset of escitalopram with a daily dose of 10 mg and a gradual increase of it to 20 mg daily in patients with breast cancer and without diabetes mellitus, and with mastectomy, may be effective in controlling and preventing depression symptoms, and improving quality of life.

Due to the insufficiency of resources in the intensive care unit (ICU), different ranking and evaluation systems are presented in order to predict the prognosis and mortality rates of patients in ICU. Two of these evaluation systems are Acute Physiology and Chronic Health Evaluation (APACHE) and Sequential Organ Failure Assessment (SOFA). So far, these two systems have not been compared. So we aimed to compare SOFA and APACHE III. This cross-sectional study was performed in 2016 in Alzahra hospital, Isfahan, Iran. We studied a total number of 100 non-traumatic ICU patients, and APACHE and SOFA scores were evaluated for each of them. Data were then collected and analyzed using SPSS software. Findings: Of the total 100 patients, 21% of them died. Both APACHE III and SOFA had an accuracy rate of 95.20% for those patients who were going to die. On the other hand, SOFA system had an accuracy rate of 26.08% for prediction of those patients who were going to live, which was 36.36% for APACHE III in same patients (P < 0.001). Our results indicate that APACHE III and SOFA have the same value in prediction of mortality rate in patients admitted to ICU; but for negative predictive values, APACHE III has a better preference

Recently, chronic renal failure (CRF) has increased worldwide. CRF is a major risk factor to end-stage renal diseases. The incidence of metabolic syndrome (MS) and its cardiovascular complications is common in patients CRF, too. In this study, we compared renal function in patients with CRF and with or without metabolic syndrome. This study was conducted in 2017 among 100 patient with CRF with glomerular filtration rate (GFR) of 15-60 ml/min/1.73m2, 50 patients with and 50 without metabolic syndrome. Metabolic syndrome criteria, as well as serum creatinine were measured in all the patients each 3 months till 1 year. Findings: 42 patients were women and 58 were men. The mean GFR was not significantly different among the patients with or without metabolic syndrome (P = 0.322) in 1-year follow up. In 3-month follow ups, only there was a significant association between systolic blood pressure and GFR with metabolic syndrome (P = 0.028, P = 0.030, P = 0.020, and P = 0.15 in 1st, 2nd, 3rd, and 4th 3-month follow up). In 1-year follow up, there was no significant association between other metabolic syndrome criteria and GFR in patients with metabolic syndrome [P = 0.214, P = 0.061, P = 0.409, P = 0.315, and P = 0.284 for abdominal obesity, diastolic blood pressure, triglyceride, high-density lipoprotein (HDL), and fasting blood sugar (FBS)]. Metabolic syndrome does not any effect on renal function in patients with CRF. We recommend further studies with longer follow-up period

Changing the approach form professional education to interprofessional education is one of the new methods in health science education. The aim of this study was to evaluate improvement of learning and professional competency among postgraduate students through designing and implementation of interprofessional education (IPE). This method was started from 1st semester of educational year of 2016-2017. First, the Readiness for Interprofessional Learning Scale (RIPLS) questionnaire was completed by 80 postgraduate students. Then, IPE method was implemented through lecture/group discussion and practical/laboratory workshops with attendance of students/staffs from different disciplines. For evaluation of implementation, we used Interdisciplinary Education Perception Scale (IPES). Findings: Score of RIPLS questionnaire in four domains including team work and collaboration, negative professional identity, positive professional identity, and roles and responsibilities were more than average. In IEPS questionnaire, before and after implementation, the score improved in four fields of competency and autonomy (33.55 ± 0.5 vs. 38.84 ± 4.5), perceived needs for cooperation (7.50 ± 1.97 vs. 9.07 ± 2.32), perception of actual cooperation (18.20 ± 5.39 vs. 24.53 ± 2.60), and understanding others value (11.20 ± 3.11 vs. 14.84 ± 1.67); and the most improvement was observed in field of perception of actual cooperation. Using education strategy based on IPE can improve health, as well as the responsibility in health system in our country.