مجله دانشکده پزشکی اصفهان
پیاپی 530 (هفته دوم امرداد 1398)

Nowadays, radiological findings help to diagnose emergency in patients with trauma, and the radiologic demands of these patients are very high. The aim of this study was to evaluate the amount of received radiation by patients with trauma within 48 hours of admission in the hospital. In this cross-sectional study, 200 patients with trauma who were referred to the emergency department of Alzahra hospital in Isfahan city, Iran, during 2017-2018 were followed up by type and amount of radiation. For each patient, data including radiographs and computed tomography (CT) scans were collected during the first 48 hours. Radiation rate due to radiography and CT scan was recorded in mSv. The mean total requested x-rays and CT scans in patients were 5.96 ± 1.93 and 1.05 ± 0.50, respectively. The highest mean of radiation due to radiology was in total spine, and the highest mean of radiation due to CT scan was in thoracic and spine CT. The mean of total radiation due to radiology and CT scan was 0.57 ± 0.34 and 4.90 ± 2.28 mSv, respectively. The mean total radiation dose in the patients was 5.38 ± 2.62 mSv. The mean of radiation in men was significantly higher than in women (P < 0.001). Due to the numerous side effects of inappropriate imaging procedures, necessary imaging can reduce the cost of patient and hospitalization, as well as physical complications.

Asthma is the most common chronic respiratory tract disorder, and so far, numerous methods for controlling asthma attacks have been presented. The aim of this study was to compare the effect of the use of the budesonide (Pulmicort) clinical guide with the current standard treatment of acute asthma attacks. In this randomized clinical trial study, 90 patients with history or presentation of acute asthma attack were selected, and randomly divided into two groups of 45. The intervention group received 0.5 mg inhaled budesonide for one time plus standard protocol, and the control group received standard protocol only. The standard protocol consisted of 5 mg of salbutamol (4-10 puff) in 3 doses (with an interval of 20 minutes) via nebulizer, 0.5 mg of ipratropium in 3 doses (with an interval of 20 minutes) via inhalation, and 50 mg of prednisolone orally. Then, the peak expiratory flow rate (PEFR), forced expiratory volume in one second (FEV1), and hemodynamic parameters at 20th, 40th, and 60th minutes were measured and compared between the two groups. In intervention and control groups, the mean PEFR was 180.04 ± 8.51 and 175.17 ± 6.25 liter/minute (P = 0.003), 225.88 ± 13.34 and 219.68 ± 13.21 liter/minute (P = 0.029), and 424.02 ± 86.8 and 361.64 ± 75.44 liter/minute (P < 0.001) at 20th, 40th, and 60th minutes, respectively. It seems that budesonide (Pulmicort) protocol appears to be effective in accelerating the treatment process in acute asthma attacks.

The breaking bad news (BBN) is one of the most difficult duties of physicians, which can be very stressful and, as a result, has adverse effects on relationship between the physician and the patient. As the stress of BBN to the patient can disrupt the physician's performance, in this study, we aimed to investigate the stress of faculty members and residents of Isfahan University of Medical Sciences (IUMS), Iran, regarding the BBN to the patients and stress coping strategies. In this cross-sectional study, 334 faculty members and residents of IUMS were investigated. Demographic and occupational data and perceived stress levels were collected using a researcher-made questionnaire. Furthermore, the investigation of stress coping strategies was performed using the Endler and Parker questionnaire. During the BBN, 76 participants (22.8%) experienced sweating, 64 subjects (19.2%) tremor, and 159 (47.6%) faced palpitations. The mean score of perceived stress in women (2.96 ± 1.05) was significantly higher than men (2.64 ± 1.10) (P = 0.006). Regarding stress coping strategies during BBN to patients, 107 participants (32%) used the problem-focused coping, 48 (14.4%) used meaning-focused coping, and 179 subjects (53.6%) used the emotion-focused coping. Many physicians get stress during BBN to patients, which most common associated symptom is palpitations. Regarding stress coping strategies, management of stressful situations using the emotion-focused coping is the most commonly used strategy by physicians during BBN to patients that is also associated with less stress.

Women's orgasm is a biopsychosocial experience that causes a woman to experience sincere communication and pleasure, and possibly pregnancy. To date, limited studies conducted for evaluation of the efficacy of drugs on sexual function in women with anorgasmia. Therefore, the purpose of this study was to evaluate the efficacy of bupropion on the sexual function of a group of Iranian women with orgasmic disorders. This was a pilot randomized clinical trial study on 32 women with orgasm disorders, who referred to the psychosexual clinic of Khorshid hospital, Isfahan, Iran. Patients were selected by simple sampling method, and randomly divided into equal intervention and control groups. In intervention group, bupropion was started at a dose of 75 mg, and increased weekly to 300 mg; the control group received a placebo. Scores of sexual satisfaction and sexual function of participants were evaluated using the Persian version of the Larsson Sexual Satisfaction Questionnaire and the Female Sexual Function Index (FSFI) before the intervention and 2, 4, 6, and 8 weeks after the onset of intervention. The data were analyzed using Mann-Whitney U and Friedman tests. There was a significant difference in desire subscale between the two experimental and control groups from the second week, and in mental arousal and vaginal lubrication from the fourth week of the trial. This significant difference was observed in orgasm, sexual satisfaction, and pain only at the sixth and eighth weeks, and between experimental and control groups in the total scores of sexual satisfaction from the second week (P < 0.010 for all). Bupropion caused improvement in sexual satisfaction of women with orgasmic disorders and these changes occurred in all subscales of sexual performance. Further studies are warranted with greater sample sizes and more extended periods.

Prostate cancer is the second most frequent cancer and the fifth leading cause of cancer death in men. Many patients with metastatic prostate cancer die due to lack of effective treatment. Therefore, new therapeutic strategies are needed. Due to the local expression of prostate cancer antigens, evaluation of their existence in cancerous tissues would probably result in introducing new biomarkers for diagnosis and prognosis, as well as treatment of prostate cancer. Hence, specific immunotherapy against the new biomarkers may be a new way to treat and improve the management of prostate cancer. Immunotoxin therapies are novel targeted cancer therapies in which a toxin is a fusion of a monoclonal antibody. Immunotoxins selectively operate against the target cell due to the specific antibody, and kill cells through bacterial or plant toxin. So, immunotoxin is a promising candidate for therapeutic applications in patients with prostate cancer. Considering the importance of immunotoxins in the treatment of patients with prostate cancer, the purpose of this study was to review various immunotoxins used in prostate cancer in previous preclinical studies and finally, we made suggestions for the advancement of future studies.