مجله دانشکده پزشکی اصفهان
پیاپی 421 (هفته اول اردیبهشت 1396)

The present study aimed to study the quality of doctor-patient relationship, and measure the extent of relationship between the dissatisfaction with the doctor-patient relationship and the usage rate of traditional and complementary medicine among the people who visited the non-conventional medical centers in Shiraz city, Iran.
This was an analytical cross-sectional study in which 800 people who visited six non-conventional medical centers in July 2016 were enrolled; having gained their satisfaction, they were studied by method of complete enumeration. The data were collected using a researcher-made questionnaire. Validity and reliability of data were confirmed and analyzed through SPSS software.
Findings: 61 percent of visitors were dissatisfied with the quality of doctor-patient relationship to mediocre extent. There was a significant correlation between the dissatisfaction extent of visitors for doctor-patient relationship and the usage rate of traditional and complementary medicine in that the high dissatisfaction extent was accompanied with the high consumption rate of traditional and complementary medicine.
The usage rate of the traditional and complementary medicine is in relation with the dissatisfaction extent of medical behavior. Thus, providing the doctor-patient relationship is not improved, high dissatisfaction and high consumption of non-conventional medicine will be seen. Therefore, it is to take action to improve the doctor-patient relationship by means of education, and culturalization; in addition, it is to pay more attention to parties’ rights in order to avoid the consequences of excessive and without doctors’ leave usage of traditional and complementary medicine.

Previous studies showed that patients receiving blood transfusion under mechanical ventilation may be encounter to respiratory problems. The aim of this study was to determine the effect of high-dose selenium on maximum inspiratory pressure in critically ill patients who received blood transfusion and under mechanical ventilation in intensive care units (ICUs).
In a clinical trial study, 102 patients with history of blood transfusion in intensive care units of Alzahra hospital, Isfahan, Iran, were randomly divided in three groups of receiving 1000, 500, and 0 µg intravenous selenium. Maximum inspiratory pressure and respiratory parameters were evaluated and compared between the three groups.
Findings: The mean maximum inspiratory pressure in the first time of ventilation was -28.12 ± 2.67, -29.41 ± 2.65, and -28.5 ± 2.16 cmH2O in the three groups of control, and 1000 and 500 µg selenium, respectively, without any statistically difference between the three groups (P = 0.10). The mean maximum inspiratory pressure was -30.29 ± 1.47, -30.12 ± 1.39, and -30.74 ± 1.91 cmH2O at pressure support ventilation (PSV) of 8 cmH2O in mentioned groups, respectively, and no statistically difference were seen between the groups (P = 0.28). At pressure support ventilation 5 cmH2O, the mean maximum inspiratory pressure was -31.82 ± 1.91, -32.53 ± 2.68 and -30.76 ± 5.22 cmH2O in three mentioned groups, respectively, without statistically difference between the groups (P = 0.10).
Different doses of selenium did not decrease airway resistance in patients receiving blood transfusion under mechanical ventilation. Therefore, more studies with larger sample sizes is recommended to determine the role of selenium in improving breathing and ventilation parameters, timing and weaning from mechanical ventilation and other related parameters.

This study aimed to compare the effects of remifentanyl-propofol and remifentasnyl-isoflurane on hemodynamic variables, blood gases, and blood glucose among patients under general anesthesia.
In a clinical trial study, 110 patients under neurosurgeries with general anesthesia were selected and randomly divided in to two groups. Continuing of anesthesia in the first and second groups was done by remifentanyl-propofol and remifentasnyl-isoflurane, respectively. The changes of hemodynamic variables, blood gases, and blood glucose were compared between the two groups.
Findings: The mean blood glucose level in the first hour was significantly more in remifentanyl-propofol group (114.3 ± 44.5 mg/dl) compared to remifentasnyl-isoflurane group (94.7 ± 26.9 mg/dl) (P = 0.006); the mean blood glucose levels in the second and third hours were significantly more in remifentanyl-propofol group, too (P Using remifentanyl isoflurane in patients underwent neurosurgery with general anesthesia led to better blood glucose and blood pressure levels and using this compound is recommended.

Computed tomography (CT) is one of the most used imaging modalities and is one of the main sources of population exposure. Recently, patient doses are estimated through CT dose index (CTDI) phantoms as a reference to calculate CTDI volume (CTDIvol) values followed by calculating equilibrium dose (Deq). This study aimed to improve measurement methods for equilibrium dose and the effective dose using the American Association of Physicists in Medicine-Task Group Report No. 111 (AAPM-TG111).
Using standard phantom of polymethylmethacrylate (PMMA) and pencil ionization chamber, the values of CTDI100 and ε(CTDI100), and DL(0) were calculated followed by calculating equilibrium dose, hence obtaining the total effective dose.
Findings: The average equilibrium dose in according to the CTDI100 and CTDIvol was found to be 26.11 and 58.99, respectively; which was based on the value of 19.4 and 42.4 mGy recorded by CT console. Differences between CTDIvol and Deq were 34.58% and 39.12% based on the experiments setting up by the CT-weighted and volume dose index, respectively.
Differences between values of CTDIvol and Deq were consistent with the literature results. Overall, weighted dose index of CT systems is not sufficient to determine patient’s dose and using new recommended indices are required.

Obesity has always been considered as a major health problem but most studies survey the comorbidities of obesity on patients and due to the influence of culture and ethnicity factors on quality of life, other studies cannot be used for our society. The aim of this study was designing a questionnaire to evaluate quality of life among patients with obesity according to cultural and ethnicity factors.
Cases were asked to fill open-ended questions about quality of life affected by obesity and initial closed questionennaire containing 58 questions was designed and 36 patients were asked to fill it. The results were analyzed and the content validity and relevance were determined. The initial questionnaire was modified and the questionnaire with 54 questions completed by 114 cases and its validity and reliability were evaluated. We used descriptive statistical methods, confirmatory factor analysis, reliability, correlation analysis and modeling of 6-factors questionnaire in this article.
Findings: For the initial 58-questions questionnaire, Cronbach's alpha was 0.870, which indicated the proper validation and according to it, the 54-questions questionnaire was designed. Sampling sufficiency test and Bartlett's test showed the adequacy of sample size and factor analysis used to identify the structure factor model, respectively. The final questionnaire had a reliability coefficient of 0.913 according to Cronbach's alpha.
Thist study, by designing a quality of life questionnaire for patients with obesity via reviewing and approving the six-factor model, provides an instrument for evaluating quality of life and functional status among these patients based on ethnicity and cultural factors.

In this survey, the protective effect of Prosopis farcta seed hydro-alcoholic extract against acute hepatotoxicity induced by thioacetamide in rat was studied.
30 male rats were equally divided to 3 groups. The first group received normal saline orally. The second and third group received thioacetamid (50 mg/kg intraperitoneally) three times at an interval of 24 hours. Rats in the third group received hydro-alcoholic extract of Prosopis fracta seed extract (100 mg/kg orally) for 3 weeks. Serum liver enzymes and malondialdehyde (MDA) levels were assayed. After tissue processing, histopathological changes of liver were examined under light microscopy. Data were compared using one-way ANOVA and Tukey tests at the significance level of P Findings: Intraperitoneal injection of thioacetamide significantly increased liver enzymes in rats (P These results showed the protective effect of Prosopis farcta hydro-alcoholic extract on acute liver injury in rats.

This study aimed to determine the diagnostic values of frozen section compared with permanent pathology results for detection of characteristic of head and neck tumors.
In a cross-sectional study, 88 patients suffered from head and neck tumors and operated during 2010-2015 in Alzahra hospital, Isfahan, Iran, were enrolled. The results of frozen section and permanent pathology were extracted from hospital records and sensitivity, specificity, false negative, false positive, and negative and positive predictive values were calculated for frozen section.
Findings: Sensitivity, specificity, false negative, false positive, positive predictive value, and negative predictive value were as 89.8%, 94.4%, 5.6%, 10.2%, 95.7%, and 87.2%, respectively; and the accuracy of frozen section was 91.8%.
Frozen section test during surgeries is a good and valuable method for detection of characteristic of head and neck tumors. But, enough pathologist experience and precision of sampling by surgeon can lead to increase the accuracy rate of frozen section which finally leads to decrease of reoperation and relapse of disease, and better prognosis.