فهرست مطالب

Medical Council - Volume:2 Issue: 5, 2019
  • Volume:2 Issue: 5, 2019
  • تاریخ انتشار: 1398/04/10
  • تعداد عناوین: 9
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  • Ali Asadollahi amin* Pages 110-111
  • Mohammadreza Shalbafan, Sonia Donboli, Razieh Salehian * Pages 112-119
    Background

    Substance use disorders are among the most common psychiatric disorders worldwide, including Iran, and according to the latest studies, 2.8% of people have been affected in Iran. Sexual dysfunction is one of the most serious and most troublesome problems associated with substance use.

    Methods

    Research has been conducted on reliable and credible Persian and English databases regarding correlation between substance use and sexual dysfunction. By reviewing the Persian and English scientific bases, this article has been written.

    Results

    The effects of substance abuse on sexual function are different in terms of both the duration of use and the person’s gender; for example, opiates such as opium, which are also found in narcotic pain medications, initially prolong the period of excitement and improve sexual activity in some individuals; however, for long term effects, they can reduce sexual desire and make erectile dysfunction. In addition, the use of stimulants and cannabinoids is mainly associated with the improvement and increased sexual desire. However, chronic and long-term use of these substances reduces desire and impairs the function. Similar cases about alcohol use are also evident.

    Conclusion

    Substance abuse positively correlates with sexual dysfunction with a variety of manifestations, and prevention or treatment of this commonly occurring disorder can lead to improved sexual health.

    Keywords: alcohol, opiates, Sexual behavior, sexual health, Substance-related disorders
  • Ali Mohammadi *, Koorosh Kamali Pages 120-127
    Background
    Physician empathy toward patient is an important factor and humanistic aspect of patient -centered cares and effective therapeutic consultation. The aim of the present study was to evaluate inpatients perceptions of physician empathy and their level of satisfaction regarding medical care besides evaluating the association of the variables with the decision of the inpatients in recommending physician to friends and relatives.
    Methods
    This cross-sectional study was carried out at teaching hospitals of Zanjan city in 2018. The participants included 285 inpatients. The Jefferson Scale of Patient’s Perceptions of Physician Empathy (JSPPPE) was used for the data collection. Data analysis was performed using descriptive statistics and multivariate analyses to describe empathy relations with personal characteristics. Pearson correlation coefficient was used to examine the relationship between inpatients’ satisfaction and perception of empathy with the decision of recommending physician to their relatives.
    Results
    The factor analysis on five items of JSPPPE led to one prominent factor. Items-total empathy score correlations ranged from 0.7 to 0.81. Correlation coefficient between JSPPPE scores with inpatients’ satisfaction was statistically significant (r=0.69, p<0.001). Overall score of the JSPPPE was strongly correlated with recommendation of physician to relatives and friends (r=0.56, p<0.001). More than half of inpatients (57.1%) were satisfied with medical care and consultations. Only a quarter of inpatients said that they knew their physicians well beforehand. Observed difference in mean scores of the overall satisfaction and personal trust to physician and recommending physician to relatives was statistically significant on the base of age characteristic (p<0.5).
    Conclusion
    The results of the study showed that there is significant positive association between perceptions of physician empathy with patient’s satisfaction and recommending physician to relatives and friends.
    Keywords: Empathy, Inpatients, Personal satisfaction, physicians
  • Aidin Yaghoobi Notash, Fezzeh Elyasinia, Behnam Molavi * Pages 128-133
    Background
    Atherosclerosis is a systemic disease of large- and medium-sized arteries in which the diameter of the artery is narrowed due to accumulation of fat and fibrous materials between the intima and medial layers of the vessels. Atherosclerosis of non-cardiac arteries is called Peripheral Artery Disease (PAD). Although endovascular treatments demonstrated high success rates, treatment failure is still regarded as a great concern. Therefore, the purpose of this study was to evaluate the success rates and risk factors of Percutaneous Transluminal Angioplasty (PTA) in patients with PAD.
    Methods
    In this retrospective cohort study, the medical records of all the patients referring to Shariati Hospital and Tehran Heart Center with complaints of severe claudication, treated via PTA during 2007-13 were collected from the archives. Required data were extracted from the records and then were analyzed by SPSS software V24.
    Results
    Of the 111 patients included in this study, 2 underwent PTA three times. Two PTAs were performed on 17 subjects and the rest only had one PTA. Based on the results, the first PTA in 96 patients (86.5%) was successful, in 12 subjects (10.8%) was acceptable and in three cases was unsuccessful. Considering the acceptable results as successful, a success rate of 97.3% was calculated. It was revealed that 17 subjects needed a second PTA which is indicative of a 15.7% re-stenosis rate. According to the analysis performed to identify the risk factors of treatment failure, the differences regarding length of the lesion (p<0.001) and serum HDL level (p=0.005) were statistically significant.
    Conclusion
    The success rate of PTA for treatment of PAD was found to be considerably high which promotes its application as the treatment of choice. However, the risk factors identified in this study seem to be accidental findings due to a small sample size of patients in one of our comparison groups.
    Keywords: Percutaneous transluminal angioplasty, Peripheral artery disease, risk factors
  • Solmaz Bazrafshan, Mehrdad Eftekhar Ardebili, Nazila Karim Zad, Shabnam Nohe Sara, Malihe Ranjbar, Homa Mohammadsadeghi * Pages 134-142
    Background

    Borderline Personality Disorder (BPD) is a relatively common disorder affecting nearly 1-2 % of individuals. In this study, an attempt was made to assess the course and severity of symptoms of BPD in a one year follow up and to investigate the factors associated with the severity of symptoms over time.

    Methods

    In this cohort study which is conducted at Iran Psychiatry Hospital in 2016-17, BPD patients were assessed in the time of admission and 6 and 12 months afterwards. Demographic information along with comorbid disorders, suicidal and self-harm thoughts and attempts, other high risk behaviors, substance use, psychotic symptoms and DASS (Depression Anxiety Stress Scale with 40 questions) and Spilberger Inventory (Anger assessment with 10 questions) were investigated at first interview and each followup.

    Results

    In this study, 68 patients were enrolled. Forty two and then 38 patients were followed for 6 months and 12 months. Based on repeated measures analysis, the severity of borderline symptoms and DASS (p = 0.033) and Spielberger (p=0.019) scores significantly decreased within 12 months. Cox regression showed that there was only significant association between psychotic symptoms and BPD severity (p=0.002). There was no significant association between the type of therapy and the reduction of BPD severity (p=0.755).

    Conclusion

    Decreasing the symptoms severity over time seems to be related to time duration as an effective factor. It is probable that frequent contacts for follow up and therapeutic alliance might have contributed to reduction of symptoms severity. However, it should be kept in mind that a variety of other factors might have also induced such effects.

    Keywords: borderline personality disorder, Prognosis, Suicide
  • Seyed Ali Javad Moosavi, Bijan Dabaghian, Mahdis Vakili, Hanieh Raji * Pages 143-147
    Background
    The lung can be the target of the harmful effects of alcohol, and to date, data on this matter are insufficient. The aim of this study was to evaluate the effects of alcohol on airway resistance in healthy individuals.
    Methods
    This was a cross sectional study conducted with 24 cases and 26 controls. The cases were alcohol consumers of more than 4 years with no comorbidity or disease. Pulmonary function tests and body plethysmography were performed to determine FEV1, FVC, TLC, RV and FEV1/FVC and participant’s response to bronchodilators. The amount of alcohol consumption and its duration were measured by visual scales and portion size album.
    Results
    The mean values of FVC, FEV1, TLC, and RV did not differ significantly between the two groups. In the case group, FEV1 and age were significantly correlated (r=-0.460, p=0.049). There was an insignificant correlation value of -0.06 (p=0.752) between FEV1 and age in the control group. Also, there was no significant correlation between age and FVC, TLC or RV in both groups.
    Conclusion
    Overall, there was a strong, negative correlation between FEV1 and age in the case group of this study, and it appears that alcohol slightly enhanced the effect of age on pulmonary function tests.
    Keywords: alcohol, Airway resistance, Pulmonary function
  • Pasha Mosaed, Pouria Tavakkolian *, Mahdi Hosseini, Akefeh Ahmadiafshar, Giti Gholami, MohammadEhsan Motaghi Pages 148-155
    Background

    Sudden cardiac death occurs with higher prevalence in competitive athletes than general population. Thus, the purpose of this study was to evaluate the Electrocardiographic (ECG) patterns among 6 – 17 year-old competitive athletes in Zanjan city.

    Methods

    241 competitive athletes aged 6-17 years old were enrolled in this cross sectional study. ECG was performed for all study participants. Information including age, sex, height, weight, medical history and medications was collected.  Heart axis, QRS pattern, PR interval and QTC interval were evaluated.

    Results

    In this study, out of 241 patients, 49 (20.3%) of them had at least one abnormality in their electrocardiogram, and 5 had two abnormalities at the same time. Abnormal axis deviations (right or left) were the most common abnormal patterns and were seen among 35 (14.5%)   participants. QRS complex abnormality, prolonged QTC interval, rhythm abnormality (Non-sinus rhythm), and prolonged PR interval were seen in 34 (14.1%), 26 (10.8), 5 (2.1%), and 2 (0.8%) of participants, respectively. Frequency of electrocardiogram abnormalities in athletes over 13 years old was 28.1% (n=25) and in athletes under 13 years old was 15.8% (n=24), (p=0.022). This frequency was 18.2% (n=28) among boys and 24.2% (n=21) among girls. Finally, the frequency of electrocardiogram abnormalities was 23.8% (n=37) among athletes performing dynamic exercises and 14% (n=12) among athletes performing static exercises.

    Conclusion

    Our study showed that about one fifth of the studied athletes showed some type of electrocardiographic disorder. Abnormal heart axis, QRS complex abnormalities, prolonged QTc interval, sinus rhythm abnormalities, and prolonged PR interval were the most common electrocardiographic findings among our study population, respectively. According to the results of the study, age and electrocardiographic abnormalities had a significant relationship. Given the greater frequency of ECG disorders among athletes aged 6-17, it is recommended to use ECG as a routine screening tool in the same community (athletes 6-17 years old).

    Keywords: Athletes, Electrocardiography (ECG), sudden cardiac death
  • Abdullatif Amini, Fereshteh Ahmadzadeh, Narges Jokar, Majid Assadi * Pages 156-160
    Background

    According to the World Health Organization (WHO), cardiovascular disease is the significant leading cause of mortality in adults. Some studies demonstrated that rest Myocardial Perfusion Imaging (rMPI) is a reliable test for ruling out myocardial ischemia/infarction in patients with inconclusive diagnostic data including non-diagnostic or normal Electrocardiogram (ECG) and troponin test result.

    Methods

    Patients who presented to the emergency department with chest pain underwent evaluation assay including inquiry about history, having abnormal ECG, troponin test result and physical examination. The patients with normal or non-diagnostic ECG and normal troponin were enrolled in our study. Then, they were referred to the department of nuclear medicine for rMPI. The patients with abnormal rMPI were asked to perform coronary angiography and the patients with normal rMPI were followed up for average of 12.8 months.

    Results

    In this study, 20 patients with mean age of 46.15±12.7 including 7 males and 13 felames were enrolled. Among 20 patients, 14 (70%) patients had normal rMPI and 6 (30%) were abnormal. All patients with abnormal rMPI showed coronary disorders in angiography. Rest of them with normal rMPI were followed up and no cases with cardiac events were found among them. Sensitivity, specificity, positive and negative predictive value for MPI was 100%.

    Conclusion

    According to the data of this study, MPI has a good sensitivity and specificity for diagnosis of myocardial ischemia/infraction and the acute coronary syndrome that prevents unnesseray hospitalization. So, it can be included in the diagnostic protocol in emergency departments of developing countries.

    Keywords: Acute coronary syndrome, Emergency departments, Chest pain, Myocardial perfusion imaging, Single-photon emission computed tomography (SPECT)
  • Fariba Shirvani *, Abdollah Karimi, Fereshteh Karbasian, Anahita Sanaei Dashti Pages 161-166
    Background
    Acute parvovirus infection may cause different complications and comorbidity in Pediatric Intensive Care Unit (PICU) patients. This study was conducted to investigate the effect of parvovirus infection on death, Hb, WBC count, and liver function tests in patients admitted to Mofid Children Hospital PICU from September 2015 to September 2016.
    Methods
    66 children admitted to Mofid Children Hospital PICU were selected. Data on age, sex, underlying disease, anti-parvovirus IgG and IgM antibody, death, Hb, WBC count, AST, and ALT were gathered by questionnaire and data analysis was performed by the SPSS 21.
    Results
    Age range of children was 1-156 [Mean: 36.5(±41.3 SD)] months. Underlying diseases were gastrointestinal disease (13 cases), respiratory tract illnesses (14 cases), urinary tract diseases (6 cases), nervous system diseases (3 cases), hematological and oncological diseases (7 cases) and other diseases (3 cases). Quantitative results on IgG and IgM were analyzed. IgG and IgM were not significantly associated with Hb and WBC count. ALT over 12.5 IU was more significant in IgM positive cases and AST over 67 IU in IgG positive cases. IgM positivity was significantly associated with death (p<0.05).
    Conclusion
    Parvovirus serologic antibody can be an important measure in PICU patients because it can be associated with anemia, neutropenia, and LFT tests.
    Keywords: Child, Intensive Care Units, Parvoviridae infections, Pediatric