مجله سازمان نظام پزشکی جمهوری اسلامی ایران
سال سی و ششم شماره 4 (پیاپی 144، زمستان 1397)

Although screening, finding and treatment of active cases of tuberculosis is very important for control of disease in the community, for reaching to the goals planed by world health organization and approaching to elimination of the disease, it is necessary to find and treat persons with latent infection. Concerning to high prevalence of latent TB in developing countries and resource limitations, priorities should be assigned to infected persons with higher probability for conversion to active disease. These high risk groups are: close contacts of active TB, HIV infected persons, patients under treatment of anti-TNF drugs, candidates of organ transplantation, under dialysis patients, and cases of silicosis. In this article we review definitions, indications and details about diagnosis and treatment of latent TB in Iran in accordance to national TB program.

Chronic Thromboembolic Pulmonary Hypertension (CTEPH) results from the obstruction of predominantly major pulmonary vessels by organized blood clots and is one of the causes of pulmonary hypertension. The disease is still underdiagnosed and the true prevalence is not clear. The objective of this study was to determine the clinical characteristics and current management of patients with CTEPH. This cross sectional study was conducted in 2011till 2017 on 70 patients with CTEPH at Masih Daneshvari Hospital. World Health Organization (WHO) functional class, six minute walking test (6MWT), pulmonary artery pressure (PAP) and plasma NT-ProBNP level were measured, before, during and after treatment. Results showed that in Patients which were treated with prostanoids, Endothelin receptor antagonist (ERAs), phosphodiesterase type 5 inhibitors (PDE-5i) and soluble guanylate cyclase (sGC) stimulators, NYHA score, PAP, NT-ProBNP and the distance walked in 6MWD significantly improved. our results suggest that drug therapy in patients with CTEPH leads to a reduction in the functional class and pulmonary arterial pressure and prevents progression of the disease of the patients during the course of treatment.

The purpose of this study was to determine the effectiveness of Dialectical Behavioral Therapy (DBT) on emotion regulation, positive and negative affection, aggressive behavior and self-harm in female students. The research method was experimental with pretest-post-test design with experimental and control groups. The statistical population of the study included all 13- to 16-year-old female students from the first level high schools in Karaj city in 2017. Among the study population, using the purposeful sampling method, based on the positive and negative affects questionnaire, Buss & Perry, self-injury inventory questionnaire and the emotional adjustment questionnaire Gross at the forefront, 30 people who had entry criteria formed our statistical sample. The 30 subjects were chosen completely in 2 groups of 15 subjects (experimental and control groups). The experimental group received DBT, while the control group was on the waiting list and did not receive any treatment. To analyze the data, multivariate covariance analysis (MANCOVA) was used to accelerate the results of the SPSS-21 software. The findings revealed that after being treated by DBT in the experimental group, post-test scores increased significantly in emotion regulation and positive affect variables of the experimental group (P<0.001) compared to the control group (respectively from 30.43 and 30.93 in the control group to 46.27 and 32.80 in the experimental group). Post-test scores also decreased significantly in negative affect, aggressive behavior and self-injury variables after being treated by DBT (P <0.001) (from 29.32, 100.66 and 29.14, respectively, in the control group to 13.19 and 74.43 and 21.33 in the experimental group). According to the findings of this study, DBT is effective in reducing negative affect, aggressive and self-injury behavior and increasing emotion regulation and positive affect.

Postpartum depression is a serious and persistent psychological disorder that sometimes causes disability in the daily functioning and activity of the individual. The aim of this study was to evaluate the rate of depression in both normal and selective delivery cesarean groups and their neonatal outcomes. The present study was a two-stage, descriptive-analytic study. A simple random sampling was available with satisfaction from 80 pregnant nursing mothers, single term pregnancies, without history of drug use and history of chronic disease and complications of pregnancy. Demographic questionnaire and standard Beck questionnaire were used to collect data. Data analysis was performed at the significant level of p <0.05 using SPSS software version 20. The mean depression score in the selected cesarean section (8.09) was higher than the normal delivery group (7.70). This difference was not significant significantly. No significant relationship was found between demographic characteristics and depression. There was a significant relationship between mean depression score and physical activity during pregnancy (p <0.05). Although the mean postpartum depression in the two groups did not differ significantly, the high mean depression score in our cesarean section led us to physical exercises, giving the mother the opportunity to initiate spontaneous pain and normal delivery. We will also see improvement in fetal weights.

Considering the important role of rest and absence of tension in working environment and consequently promotion of working efficiency, finding ways with the best choices to reduce job stress, seems necessary. Municipality of Tehran with a huge number of employees and with the aim to reduce stress and promote work efficiency is studying this matter seriously. The aim of the present study was to evaluate and compare the level of job stress among fixed and shift workers of regional municipalities 18 and 20 of Tehran city. Data population of this research included building security officers of Tehran municipality. From 22 municipality regions of Tehran, two groups (88 persons from region 18 and 72 persons from region 20) were chosen randomly for exam from full time shift ( 24 hrs work, 24 hrs rest ), day-shift and night-shift workers. Osipow’s job stress test was used to determine demographic variables. The differences of job stress and mini-factors of workload role, insufficiency role, ambiguity role, limitation of role, responsibility and physical environment of security officers considering their age groups, educational level, marital status, job background, shift work and region of duty were assessed. Data were analyzed by SPSS software and processed by a professional test, MANOVA. Relation between age variable and scores obtained in Ospiow’s test in regard to workload role and insufficiency role in examiners was significant with confidence 95% (p<0.05); however significant difference was not seen with other mini-factors. Also there was no statistically difference between level of job stress and other mini-factors, considering educational grade, marital status and job background of examiners. Relation between scores in job stress and mini-factors of insufficiency role, and ambiguity role while considering work shifts in confidence 95% were statistically significant (p<0.05), however significant difference was not seen with other mini-factors. At the end, relation between scores in mini-factors of role limitation and responsibility while considering job regions in confidence 95% were statistically significant (p<0.05); however significant difference was not seen with other mini-factors and the same variable. This survey determined that stress decreased with increasing age. Also work shift had important role in the amount of stress. Therefore, the lowest level of stress was among night-shift workers and the highest stress level was among day-shift workers and 24-24 group was in between. Also, the municipality region of workers was related with job stress. It seems that level of stress, at least in two mini-factors, in region 18 was less than region 20.

The aim of this study was to examine the effectiveness of Behavioral Activation (BA) on psychological well-being and psychological flexibility in girl students in Tehran city. In a pretest-post-test test and follow-up with a control group, 30 girl students from Tehran city were selected through Multi-stage cluster and randomly divided to either BA (n=15) and  control group (n=15). The case group underwent 10-weeks BA session. The Reef Psychological Well-Being test (RSPWB) Inventory, and the Acceptance and Action Questionnaire-ᴨ (AAQ-II) were used as outcome measures, before and after the intervention. Data were analyzed with multivariate analysis of covariance. The result of this study showed that BA approach on psychological well-being and psychological flexibility was significantly effective as compared to control group ( P<0/05, F= 7.838). According to these finding we can conclude that BA could be beneficial for mental health, raising the quality of life and education of students, and it is suggested to use this approach in schools and student counseling centers.

Intrauterine Devices (IUDs) are used as an efficient and inexpensive method of contracep tion. Contraceptive efficacy depends on the intrauterine location of IUD and intrauterine displacement of the IUD leads to decreased contraceptive efficacy. Expulsion of IUD and its penetration into myometrium is one of the complications of IUD. In cases where IUDs are not detected by ultrasound method, in addition to expulsion of IUD, risk of displacement or improper placement of the IUD arises.
In the present case, following cesarean section IUD was inserted. However, due to ambiguous observation of the IUD in the cervical canal and in the uterus cavity on two-dimensional ultrasound, three-dimensional ultrasound was performed.  By using this method, expulsion of IUD from the previous cesarean section scar was visible. This finding was confirmed by laparoscopy.
Three-dimensional ultrasound is recommended for precise assessment and tracking the placement of the IUD into the uterine cavity, particularly in cases where there is a history of cesarean delivery, especially if IUD is not visible in the uterine cavity or when it is displaced. Three-dimensional ultrasound has more accuracy as compared to two-dimensional ultrasound in determination of the location of IUD and it is not an invasive method such as laparoscopy. Also as three-dimensional ultrasound provides images in coronal plane; it is more efficient in detecting IUDs expelled through cesarean section scars.