فهرست مطالب
Journal of Analytical Research in Clinical Medicine
Volume:5 Issue: 3, Summer 2017
- تاریخ انتشار: 1396/07/11
- تعداد عناوین: 7
-
Pages 75-77Shared decision making (SDM) is a systematic procedure by which patients and health care professionals collaborate to make informed value-congruent decisions. During the procedure, patients are empowered to make decisions based on accurate evidence-based information and what matters most to them. In spite of its importance and proven benefits in different countries, its implementation in Iran is absent. Here, I will give a brief introduction on SDM with some directions for its implementation in Iran.Keywords: Shared decision-making, Patient engagement, Patient Empowerment, Evidence-based medicine, Iran
-
Pages 76-81IntroductionLower limb amputation in patients with diabetes is one of its major complications. Therefor understanding the prevalence and causes of this problem has great importance. The aim of this study was to evaluate lower limb amputation in patients with diabetes.MethodsDuring this observational cross-sectional study, 350 patients with diabetes mellitus admitted to Shahid Modarres Hospital, Tehran, Iran, from March 2012 to March 2017 were studied and incidence of lower limb amputation was observed.ResultsAbout 64% of patients suffered from some degree of amputation. Important factors in these patients were delay in referral to surgeon, ineffective debridement and longtime impaired distal blood flow.ConclusionThe frequency of lower limb amputation in patients with diabetes is high and therefore there is a great need to find and reduce its underlying problems.Keywords: Diabetes Mellitus, Amputation, Lower Extremity
-
Pages 82-85IntroductionBehcet's disease (BD) is a chronic systemic inflammatory disease affecting multiple organs and systems such as mucosa, skin, eye, joints and cardiovascular, nervous and gastrointestinal systems. Various criteria are proposed for the assessment of BD. This study was designed to compare performance of two internationally collaborated criteria for diagnosis of BD, namely International Study Group (ISG) criteria and International Criteria for Behcet's Disease (ICBD) in the Azeri population of Iran.MethodsIn a descriptive analytical study, 859 consecutive patients with one of the major clinical manifestations of BD were included. All patients were examined and evaluated by an expert rheumatologist and diagnosis was confirmed clinically. All patients were assessed by ISG and ICBD criteria. Finally, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of both criteria were calculated.ResultsWe included 859 patients in this study. BD was diagnosed in 211 patients. Sensitivity, specificity and accuracy of ISG criteria were 64.9%, 100%, and 91.4%, respectively. Sensitivity, specificity and accuracy of ICBD criteria were 94.7%, 99.6% and 98.5%, respectively.ConclusionBased on the finding of the present study, sensitivity and accuracy of ICBD criteria for diagnosis of BD in Azeri population are higher than ISG criteria. So we propose to use ICBD criteria for the evaluation of patients with suspected BD to decrease the rate of missed diagnosis.Keywords: Behcet's Disease, International Study Group Criteria, International Criteria for Behcet's Disease, Azeri Population
-
Pages 86-90IntroductionHelicobacter pylori (H. pylori) infection is common in developing countries. There are various invasive and non-invasive methods for diagnosing H. pylori infection. Stool antigen test is a new non-invasive method to diagnose H. pylori infection. In this study we evaluated the diagnostic accuracy of HpSA for H. pylori infection in patients with gastrointestinal (GI) complaints.MethodsSixty patients including 28 men and 32 women with mean age of 49.2 ± 19.8 years undergoing diagnostic endoscopy with 30 positive and 30 negative rapid urease test (RUT) and histology results for H. pylori infection were evaluated. H. pylori stool antigen test (HpSA) was measured in these patients and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for HpSA were calculated.ResultsAmong 31 positive HpSA results, 2 were negative in RUT and histology and among 29 negative HpSA results, 1 was positive in RUT and histology results. Sensitivity, specificity, PPV, NPV and accuracy for HpSA in diagnosing H. pylori infection were 96.67%, 93.33%, 93.55%, 96.55% and 95%, respectively.ConclusionAlthough the sensitivity and specificity of the HpSA are evaluated in a relatively small sample size, these results showed that HpSA is a useful test in diagnosing H. pylori infection in patients with upper GI complaints.Keywords: Helicobacter pylor, Infection, Stool Antigen Test, Accuracy
-
Pages 91-96IntroductionTuberculosis has become a chronic debilitating disease in developing countries, particularly after the emergence of multidrug resistant tuberculosis (MDR-TB). Second line treatments for the disease which were subsequently developed were associated with psychiatric disorders among patients. Psychiatric disorder can either be induced by treatment regiments or psychosocial factors. Cycloserine administration is frequently reported to be associated with psychiatric disorders. In this study, we examined the prevalence and characteristics of psychiatric disorders among MDR-TB patients in Sardjito Hospital, Yogyakarta, Indonesia.MethodsIn this descriptive study, we studied medical records of MDR-TB patients admitted for MDR-TB treatments to Sardjito Hospital from January 2014 to July 2016 and screened for psychiatric disorders.ResultsWe found that 32.8% of the patients had psychiatric disorders, some of which had multiple psychiatric diagnoses (14.1%). The diagnoses were medication induced delirium, substance/medication induced psychotic disorder, substance/medication use depressive disorder, depressive type schizoaffective disorder, bipolar I disorder current episode severe manic with psychotic features, mild depression, moderate depression, major depression without psychotic features, major depression with psychotic features, adjustment disorders with mixed anxiety and depressed mood, adjustment disorder with anxiety, acute stress disorder, and insomnia. Psychiatric disorders were significantly associated with cycloserine dose and sex. Psychotic symptoms were significantly associated with sex and level of education.ConclusionThe presence of psychiatric disorders might disturb MDR-TB treatment resulting in poor outcomes. Precaution and prompt managements are required for psychiatric disorders in patients receiving MDR-TB treatment regiments.Keywords: Tuberculosis, Multi drug resistant, Psychiatric disorders, Cycloserine
-
Pages 97-102IntroductionCervical cancer is the third most common cancer and the second most frequent cause of mortality from malignancies of genital organs in women, which can be prevented by diagnosis of pre-neoplastic changes in cervix. This study aimed to evaluate the p16INK4a biomarker in different grades of cervical intraepithelial neoplasia (CIN) using immunohistochemistry (IHC) method.MethodsThe present cross-sectional study was carried out on the paraffin-embedded blocks of cervical tissue of 100 women with previous histopathological diagnosis of CIN referred to Al-Zahra Hospital, Tabriz, Iran, during 2015-2016. The samples were divided into 4 groups, 31 with normal cervical finding, 30 with low-grade CIN (CIN I), and 39 with high-grade CIN (16 CIN II and 23 CIN III). p16INK4a was investigated on the samples using IHC technique. Data was analyzed by SPSS using chi-square and Mann-Whitney U tests.ResultsThirteen out of 30 (43%), 12 out of 16 (75%) and 23 out of 23 (100%) of the CIN I, CIN II, CIN III were positive for p16INK4a, respectively. None of the normal samples were positive for p16INK4a. Sensitivity of p16INK4a for detection of CIN I, CIN II, CIN III was calculated as 63%, 80% and 100%, respectively. The overall sensitivity of the biomarker for detection of CIN lesions was 76.6% and the specificity was 100% for all CIN grades.ConclusionThe p16INK4A biomarker is a suitable diagnostic tool for high-grade CIN, yet for low-grade ones it has lower sensitivity. p16INK4a can be a helpful tool beside histopathology for diagnosis of CIN lesions.Keywords: p16INK4A, Dysplasia, Neoplasia, Cancer, Cervix
-
Pages 103-109IntroductionTuberculosis is a major public health problem in the world. The aim of the present study was to determine the incidence rate of tuberculosis through modeling and predict the disease incidence rate using spatio-temporal Kriging method in three endemic regions (Kashmar, Khalilabad and Bardeskan) in the northeast of Iran.MethodsThis cross-sectional study was conducted during 2007-2012. The diagnosis of tuberculosis in patients who had signs and symptoms of infection was confirmed using sputum smear test. According to fitted variogram function and Kriging method, we predicted tuberculosis incidence for all spatial and temporal points of regions in the study area.ResultsBetween 2007 and 2012, 155 cases of tuberculosis were observed. Among all patients, 70 (45.0%) were men and 94.0% were rural residents. Mean age of patients with tuberculosis was 64 years and 151 (97.5%) of patients were 55 years old and above. Based on the geographical coordinates, we identified the place of residence for each patient.ConclusionOur study showed that the downward trend of the incidence rate of tuberculosis indicates good but inadequate progress with tuberculosis control. The findings of this study can be used for planning and evaluating interventions by considering the risk factors of tuberculosis infection in the northeast of Iran.Keywords: Tuberculosis, Geography, Iran, Spatio-temporal analysis