فهرست مطالب

  • Volume:20 Issue: 1, 2017
  • تاریخ انتشار: 1395/11/08
  • تعداد عناوین: 14
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  • Ali Sheidaei, Kimiya Gohari, Amir Kasaeian, Nazila Rezaei, Anita Mansouri, Ardeshir Khosravi, Mahboubeh Parsaeian, Younes Mohammadi, Parinaz Mehdipour, Shadi Rahimzadeh, Farshad Sharifi, Mehdi Varmaghani, Maryam Chegini, Shohreh Naderimagham, Hamid Reza Jamshidi, Farshad Farzadfar* Page 1
    Background
    Causes of death statistics provide crucial health intelligence in national and international communities. An efficient death registration system provides reliable information for health policy system. In many developing countries, death registration systems face a degree of misclassification and incompleteness. There are many impediments to putting an estimate of cause-specific death rates. Addressing those challenges could prevent misleading results.
    Methods
    Our data was collected by Ministry of Health and Medical Education, Tehran and Isfahan cemeteries from 1995 to 2010. After converting ICD codes of Iran’s death registration into GBD codes, 170 underlying causes of deaths were recognized in the available data. A wide range of methods were applied for preparing the data. We used several statistical models to estimate mortality rates in age-sex-province groups for all causes of deaths. The considerable number of combinations for age, sex, cause of death, year, and province variables made further complicated model selection and evaluation of the results.
    Results
    Totally, 58.91% of deaths were related to males. The majority of cases of death were classified as NCDs (77.83%) and injuries (14.80%). We extrapolated 71.76% and 14.71% of causes of death by mixed effect model, spline model with parameter 0.9 and 0.6, respectively.
    Conclusion
    A comprehensive and unique registration system is able to solve many DRS issues. It is necessary to assess the quality and validity of cause of death data. Scientific methods like analyzing mortality level and cause-of-death data are used to provide an overview for better decisions.
    Keywords: Cause of death, international classification of diseases, Iran, misclassification, vital statistics
  • Saeedeh Saeedi Tehrani, Fatemeh Nayeri, Alireza Parsapoor, Ali Jafarian, Ali Labaf, Azim Mirzazadeh, Hamid Emadi Kouchak, Farhad Shahi, Nazafarin Ghasemzadeh, Fariba Asghari * Page 12
    Introduction
    Professional behavior is first learned at the university. One of the necessary considerations in maintaining the professional environment of the university is establishing a set of codes for the behavior of physicians and medical students. This paper describes the process of developing the professional code of conduct in Tehran University of Medical Sciences, Tehran, Iran.
    Methods
    A review of Iranian and international literature was performed to develop the first draft of the guideline. In sessions of group discussion by the authors, the articles of the draft were evaluated for relevancy, clarity, and lack of repetition. The draft was sent for evaluation to all participants, including the medical faculty members, residents, and medical students, four times and necessary corrections were made according to the comments received.
    Results
    The final guideline included 76 behavior codes in 6 categories, including altruism, honor and integrity, responsibility, respect, justice, and excellence. The codes of the guideline cover the physicians’ commitments in the physician-patient, physician-colleague, and instructor-student relationships in order to improve the quality of the services.
    Conclusion
    The Islamic and Iranian culture were taken into consideration in developing the guideline. Accordance with the administrative and educational conditions of the universities was ensured in developing the guideline and its acceptance was ensured through extensive surveys. Thus, it is expected that this guideline will be very effective in enhancing professional commitment in medical universities.
    Keywords: Guideline, Iran, medical professionalism, professional behavior, Tehran university of medical sciences
  • Alireza Jeddian, Ahmad Afzali *, Nazila Jafari Page 16
    Background
    Appropriate admissions and patients’ length of stay are two of the most important indicators of efficient health care delivery in hospitals. Paying due attention to these indicators may lead to optimal use of hospital resources as well as provision of ambulatory services to a larger population of patients. The purpose of the current study is to quantify the rate of inappropriate hospital admissions and days of hospital stay to identify factors affecting them.
    Methods
    Data were collected regarding admissions and length of stay of 1815 patients admitted to an educational hospital in Tehran, Iran, with a total 12,629 days of hospitalization using the Appropriateness Evaluation Protocol. A qualitative study was conducted using content analysis method by analyzing data from interviews with the hospital personnel about the factors affecting patient's length of stay.
    Results
    The results indicated that the average length of stay in medical and surgical wards was 9.4 to 6.3 days, and 8.5% of admissions and 3.4% of stays were inappropriate. The necessity to receive nursing care and/or to receive medical services and/or the patient's conditions accounted for 57.6% of total hospitalization days, followed by the need to receive nursing care alone (36.6%). Planning/Procedures/ Personnel factors were responsible for 77.3% of inappropriate stays. The qualitative study revealed that in addition to sound in house policy setting, abundance of suitable equipment and facilities at the hospital site had positively affected the appropriateness of hospital stay while incoordination of health care delivery groups, rotation of residents and other wards personnel and lack of a proper complementary patient follow-up system, had a negative impact on the same indicator.
    Conclusion
    Inappropriate admissions and inappropriate stays are influenced by numerous factors, both inside and outside of the hospitals; the results of the current study indicate that structural factors such as techniques adopted in the studied hospital, contributed significantly to decreasing inappropriate stays. Improving and upgrading these techniques will make optimal use of hospital beds possible.
    Keywords: Appropriateness evaluation protocol, inappropriateness admission, inappropriateness hospital stay, inappropriateness length of stay
  • Mahdiyeh Shahrokhi, Mohammad Shafiei, Hamid Galehdari, Gholamreza Shariati* Page 22
    Introduction
    Mitochondrial trifunctional protein (MTP) is a hetero-octamer composed of eight parts (subunits): four α-subunits containing LCEH (long-chain 2,3-enoyl-CoA hydratase) and LCHAD (long-chain 3-hydroxyacyl CoA dehydrogenase) activity, and four β-subunits that possess LCKT (long-chain 3-ketoacyl-CoA thiolase) activity which catalyzes three out of four steps in β-oxidation spiral of long-chain fatty acid. Its deficiency is an autosomal recessive disorder that causes a clinical spectrum of diseases.
    Materials And Methods
    A blood spot was collected from the patient’s original newborn screening card with parental informed consent. A newborn screening test and quantity plasma acylcarnitine profile analysis by MS/MS were performed. After isolation of DNA and Amplification of all exons of the HADHA and HADHB, directly Sequence analyses of all exons and the flanking introns both of genes were performed.
    Results
    Here, we report a novel mutation in a patient with MTP deficiency diagnosed with newborn screening test and quantity plasma acylcarnitine profile analysis by MS/MS and then confirmed by enzyme analysis in cultured fibroblasts and direct sequencing of the HADHA and HADHB genes. Molecular analysis of causative genes showed a missense mutation (p.Q385P) c.1154A > C in exon 14 of HADHB gene.
    Conclusions
    Since this mutation was not found in 50 normal control cases; so it was concluded that c.1154A > C mutation was a causative mutation. Phenotype analysis of this mutation predicted pathogenesis which reduces the stability of the MTP protein complex.
    Keywords: Deficiency, fatty acid oxidation, HADHA, HADHB, mitochondrial trifunctional protein (MTP), novel mutation
  • Fahimeh Agh, Niyaz Mohammadzadeh Honarvar, Mahmoud Djalali, Ebrahim Nematipour, Sanaz Gholamhoseini, Mahnaz Zarei, Samaneh Ansari, Mohammad Hassan Javanbakht* Page 28
    Background
    Omega-3 fatty acids have a protective role against cardiovascular disease and these protective properties are attributed to its anti-inflammatory effects. Myokines have anti-inflammatory properties and thereby reduce low-grade inflammation. Irisin, as a myokine, is considered to be therapeutic for human metabolic diseases. This study was conducted to determine the effects of Omega-3 fatty acids supplementation on serum irisin in men with coronary artery disease (CAD).
    Methods
    This study was an 8-week randomized, double-blind, placebo-controlled trial. Forty-eight CAD male patients (Omega-3, n = 24; control, n = 24) were randomly assigned to either Omega-3 or control groups by permuted block randomization method. Only the participants with more than 50% stenosis in at least one major coronary vessel were included. A total of 3 participants in the control group were excluded from the study. Forty-five participants (Omega-3, n = 24; control, n = 21) completed the study. Participants took Omega-3 fatty acids supplement (720 mg eicosapentaenoic acid plus 480 mg docosahexaenoic acid) or placebo (edible paraffin) for 8 weeks. Serum irisin, high-sensitivity C-reactive protein (hs-CRP), lipid profile and anthropometric indices, body composition, and food intake were assessed before and after intervention. Statistical analyses were performed using SPSS software. Paired t-test was used for evaluating within-group effects from baseline. Variables with normal distribution were compared by independent t-test between 2 groups.
    Results
    Compared to placebo, Omega-3 fatty acids increased serum irisin (P = 0.044) and decreased serum hs-CRP (P = 0.018) and LDL cholesterol (P = 0.031). Omega-3 fatty acids supplementation did not result in any significant changes in anthropometric measurements, blood pressure, serum lipids except for serum LDL, fasting blood glucose, body composition or serum insulin levels (all P > 0.05).
    Conclusion
    Omega-3 fatty acids supplementation could elevate serum irisin in male patients with CAD. Also, these fatty acids may able to decrease serum hs-CRP and LDL cholesterol.
    Keywords: Coronary artery disease (CAD), docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), irisin, myokines, omega, 3 fatty acids
  • Mohammad Reza Fazlollahi, Katayoon Bidad, Raheleh Shokouhi, Raheleh Dashti, Mohammad Nabavi, Masoud Movahedi, Mohammad Hasan Bemanian, Ali Reza Shafiei, Najmoddin Kalantari, Effat Sadat Farboud, Zahra Pourpak *, Mostafa Moin Page 34
    Background
    Unconfirmed beta-lactam allergy is a significant public health problem because of the limitations it imposes in drug selection. In this study, we aimed to evaluate patients referred for beta-lactam allergy to determine the frequency of confirmed beta-lactam allergy and identify some risk factors.
    Methods
    In a prospective cohort study, all referred patients to Immunology, Asthma and Allergy Research Institute in Tehran University of Medical Sciences (between 2007 – 2009) who suspected to have beta-lactam allergy were entered into this study based on having the inclusion criteria. Follow-up was performed 6 – 8 years after the final diagnosis. Diagnosis of beta-lactam allergy relies on thorough history and specific IgE measurements (ImmunoCAP), skin prick testing (SPT), intradermal testing (IDT), patch testing, and oral drug challenge test.
    Results
    Fifty-one patients with mean age of 24.5 (±18.5) years were enrolled in this study. Based on workups, beta-lactam allergy was confirmed in 16 (31.4%) patients, suspicious in 22 (43.1%) patients and ruled out in 13 (25.5%) patients. During the follow-up, 3 patients with suspicious drug allergy consumed the culprit drug with no reaction so allergy was finally ruled out in 16 (31.4%) patients. Age, sex, atopy and family history of drug allergies were not significantly different between the patients with confirmed or ruled-out diagnosis of penicillin and amoxicillin allergy.
    Conclusion
    At least up to one-third of patients with a history of beta-lactam allergy are proven to be safe using the drug. Also, a clear protocol consists of serum sIgE assay and SPT can be helpful to the physicians in the health care system.
    Keywords: Amoxicillin, drug allergy, hypersensitivity, penicillin
  • Pooneh Salari *, Mohammad Abdollahi Page 38
    Introduction
    Recent advances in pharmacy practice have created serious ethical challenges for the pharmacists. Pursuing a new philosophy of practice is required to overcome these challenges and optimize the standard of care. In this regard, the current ethics guideline in the Pharmacy curriculum used in Tehran University of Medical Sciences, does not provide a fully comprehensive understanding of the issue. Therefore, the aim of the present study was to revise the current curriculum based on a needs assessment study.
    Methods
    In this study, a two-part questionnaire was presented to pharmacists to obtain their views on the importance of topics in their daily routine practice. Part one of the questionnaire consisted of demographic data and part two of 23 topics in pharmacy ethics.
    Results
    Out of a total of 200 questionnaires, 158 questionnaires were returned. We reached consensus on 24 topics, of which 8 topics gained a score of higher than 4 (the highest score was considered to be 5) and the rest obtained a score of 3 and higher. The highest score pertained to the pharmacists’ relationship with patients, awareness of the rules and regulations, and medication error.
    Conclusion
    Based on the results, a revised curriculum was designed for ethics in pharmacy. It seems that the designed curriculum is context-based and will develop appropriate educational material regarding pharmacists’ requirements in daily practice. Consideration of interactive methods for teaching the curriculum is highly recommended.
    Keywords: Needs assessment, pharmacy ethics, pharmacy ethics education
  • Marzieh Katibeh *, Zhale Rajavi, Mehdi Yaseri, Simin Hosseini, Sara Hosseini, Shadi Akbarian, Mojtaba Sehat Page 43
    Backgrounds
    To assess the role of socio-economic inequality in visual impairment (VI) in Varamin district, Iran.
    Patients and
    Methods
    Using multistage cluster sampling method, 60 clusters (each with 50 subjects) were recruited and underwent clinical eye examinations. Socio-economic status (SES) was identified based on education, occupation, family assets and housing conditions that were measured at the participants’ households using a semi-structured questionnaire and a two-step cluster analysis model. In addition, principal component analysis and the concentration index were used to identify the gap between high and low SES groups.
    Results
    Participants were categorized in high (522, 24.4%), moderate (974, 43.1%) and low (763, 33.7%) socio-economic levels. In these levels, the prevalence of VI was 5.9% (95% CI: 3.3 to 8.6), 10.4% (95% CI: 8.4 to 12.4), and 12.6% (95% CI: 10.1 to 15.1), respectively. The prevalence of VI in people with low SES was significantly greater than those in high SES level. The proportions of avoidable causes were relatively high in all SES levels (more than 80%) with no significant difference between different levels.
    Conclusions
    There is significant inequality in VI prevalence in Varamin district. Avoidable causes are high in all SES groups. Therefore, community-based modalities and preventive programs with a specific notice to poorer SES groups are recommended to improve eye health in this district.
    Keywords: Iran, population, based study, socio, economic status, visual impairment
  • Hasanali Karimpour, Kamran Vafaii, Maryam Chalechale, Saeed Mohammadi, Rasool Kaviannezhad* Page 49
    Background
    Tracheostomy is considered the airway management of choice for patients who need prolonged mechanical ventilation support. Percutaneous Dilatational Tracheotomy (PDT) is a technique that can be performed easily and rapidly at bedside and is particularly useful in the intensive care setting. The Griggs percutaneous tracheotomy is unique in its utilization of a guide wire dilator forceps.
    Objective
    We aimed to describe the early perioperative and late postoperative complications of PDT using the Griggs technique in patients in the intensive care unit (ICU).
    Patients and
    Methods
    This cross-sectional study was conducted on all patients who underwent tracheostomy in the ICU of the Imam Reza Hospital of Kermanshah, Iran, from June 2011 to June 2015. PDT was performed in 184 patients with the Griggs technique. Demographic variables, as well as perioperative and late postoperative complications were recorded.
    Results
    The mean age of patients was 57.3 ± 15.37 years. The most common primary causes of tracheostomy were hypoxic brain damage disorders (43.2%) and pneumonia (14.8%). Perioperative and early complications occurred in 16.7 % of procedures, of which 9.3% were bleedings (minor, significant and major). Furthermore, the incidence of late complications was 8.6%, including: stomal infection, difficult replace tracheostomy tube, tracheoesophageal fistula, tracheal stenosis, and tracheomalacia.
    Conclusion
    PDT via Griggs technique is a safe, quick, and effective method. The low incidence of complications indicates that bedside percutaneous tracheostomy can be performed safely as a routine procedure for daily care implemented in the ICU.
    Keywords: Complications, critical care, percutaneous, tracheostomy
  • Yahya Salimi, Akbar Fotouhi, Kazem Mohammad, Nasrin Mansournia, Mohammad Ali Mansournia* Page 55
    Background
    In the presence of non-adherence, intention-to-treat analysis preserves randomization, but does not lead to a valid comparison of outcome between the assigned groups. Using a reanalysis of Diabetes Prevention Program, this study aimed to estimate the causal effect of treatment with intensive lifestyle intervention or metformin vs. placebo on blood pressure and lipid profile using G-estimation after accounting for non-adherence.
    Methods
    The Diabetes Prevention Program randomized 3,052 pre-diabetic individuals to metformin (N = 1015), placebo (N = 1014), or an intensive lifestyle intervention (N = 1023). G-estimation was used to estimate the causal effect of intensive lifestyle intervention or metformin vs. placebo on blood pressure and lipid profile in 2,973 patients who had adherence data. For comparison, we also performed the standard intention-to-treat analysis.
    Results
    The G-estimation results showed that intensive lifestyle substantially improves systolic and diastolic blood pressure and lipid profile. The G-estimates of the effects of metformin vs. placebo as well as intensive lifestyle intervention vs. metformin on blood pressure and lipid profile were also stronger than the intention-to-treat effect estimates.
    Conclusion
    G-estimation suggests that intensive lifestyle modification improves known risk factors for cardiovascular disease, including systolic blood pressure, diastolic blood pressure, triglyceride, and HDL levels more than what standard ITT analysis suggests. Adherence to the assigned treatment should be measured in all randomized trials, and G-estimation should be the standard analysis of randomized trials with substantial non-adherence.
    Keywords: Cardiovascular disease, G, estimation, intensive lifestyle intervention, metformin, pre, diabetes
  • Andisheh Maneshi, Saeedeh Ravi, Mohammad Reza Salehi, Maliheh Hasannezhad, Hossein Khalili * Page 60
    A 23-year-old man was admitted to the hospital with chief complaints of pain, edema and spasm of the left lower limb, as well as mottling of dorsal and plantar aspects of the foot. One week before the current admission, he was treated with oral co–amoxiclav and intramuscular penicillin 6.3.3. Immediately after the third injection, he experienced burning and yellowish discoloration at the site of the injection which then progressed to his leg and foot. Pain, significant edema, spasm and mottling occurred within 30 minutes of the injection. The patient was referred to the hospital after 36 hours from the beginning of symptoms. Color Doppler sonography revealed no impairment in the lower extremity flow and the common femoral artery, superficial femoral, popliteal, dorsalis pedis and posterior tibialis arteries were normal. Superficial probe sonography detected mild effusion in the left ankle without collection.
    Keywords: Intramuscular injection, nicolua syndrome, penicillin
  • Moeinadin Safavi *, Sima Safari Page 65
  • Pedzisai Mazengenya *, Rashid Bhikha Page 67
    Ibn Sina (1037 AD), also known as Avicenna in the West, is recognized as one of the forefathers of modern medicine. He was widely accepted as an influential and leading scientific figure of the medieval ages. His book the “Canon of Medicine” collected all aspects of medical knowledge available from ancient Greek and Muslim sources and also added his own. The medical information he collected ranged from basic medical sciences to applied and specialized medical fields.
    In the current vignette, we present an analysis of the basic anatomy of the brain, spinal cord and some sense organs as presented in the Canon of medicine and compare their relevance in modern medical practice and human anatomy knowledge.
    Keywords: Avicenna, brain, ear, eye, nervous system, spinal cord
  • Saeideh Babashahy, Abdolvahab Baghbanian* Page 71