Journal of Iranian Medical Council
Volume:2 Issue: 4, Spring 2019

The musculoskeletal (MSK) system includes bone, cartilage, fat, muscles, blood vessels, neural tissue, and other connective tissues. As aging occurs, the incidence of musculoskeletal disorders increases. Benign bone and soft tissue pathologies are more common than malignant ones. Although some MSK abnormalities can be self-limited, in the cases of severe defects or impairment of the potential restoration, intervention by novel methods such as radiation therapy may be required along with the main treatment, which is surgery in most cases. Radiation is categorized as non-ionizing and ionizing. Non-ionizing radiation is longer wavelength, lower frequency, and lower energy, while ionizing radiation is short wavelength, high frequency, and higher energy that able to destroy the cells. Utilizing these methods can have both symptom-relieving and curative effects. One of the non-ionizing radiation types comes in the form of Low Level Laser Therapy (LLLT), which is a non-aggressive, non-ionizing, monochromatic and electromagnetic high-concentrated beam. LLLT has an essential role in ATP production, reducing inflammation, pain relief, wound healing, and muscle function. The development of ionization radiation therapy by radionuclides as a targeted therapy in nuclear medicine, boron capture neutron therapy and proton therapy as external radiation therapy can play a critical role in treating bone and soft tissue malignancies, especially in pediatric oncology. The purpose of this paper is to review the efficiency of LLLT, bone-seeking radiopharmaceuticals, proton, and boron capture neutron therapy for the treatment of bone and soft tissue pathologies and malignancies.

Patent Ductus Arteriosus (PDA) is a common congenital heart disease (CHD) that can lead to infant mortality. This study compared the impact of two treatment approaches (i.e. intravenous acetaminophen and ibuprofen) on the closure rate of PDA. In this randomized controlled trial, 30 infants with PDA were divided into two groups based on the applied treatment approaches (IV acetaminophen and IV ibuprofen). The two groups were compared with each other in terms of primary outcomes including post-intervention PDA grades, length of stay, duration of mechanical ventilation, and patient outcomes (i.e. death or discharge). Based on the results, none of the participants had a moderate or large-sized PDA after the intervention. The post-intervention PDA closure rates in the acetaminophen and ibuprofen groups were 87.5% and 92.1%, respectively (p = 0.626). The mortality rate in the acetaminophen and ibuprofen groups were 12.5% and 14.3%, respectively (p = 0.886). In addition, no significant difference was found between the two groups in terms of the length of stay and duration of mechanical ventilation (P-value > 0.05). The results showed that the efficacy of IV acetaminophen was similar to that of IV ibuprofen in the treatment of PDA. However, authors recommend conducting randomized multicenter clinical trials with larger sample sizes to confirm the replacement of IV ibuprofen by acetaminophen.

Suicide victims frequently have had contact with the mental health services before they died. In this study, the rate of mental health care system contact during the last year before suicide commission was evaluated.

Utilization of mental health care facilities during the last 12 months of 231 individuals who committed suicide was assessed by the questionnaire.

Of the suicide victims, 62% had been used mental health services at least once. The mean age of the patients was 29.7 years (SD = 4/11). There wasn’t Significant difference in age between men and women who had used mental health services (P = 0.077). There was a significant relation-ship between the two groups using and not using of mental health services and suicide more than once (P = 0.008). There was also a significant relationship between psychiatric illness and mental health services use. (P <0.0001).

Increasing utilization of mental health care facilities should be considered a particularly profound suicide risk assessment and post discharge treatment planning. Continued and more serious follow-up of these patients with strategies such as social workers or through methods such as telemedicine (Continuous and right communication through phone, email, etc.) is necessary for preventing suicide.

Gastroesophageal reflux disease is one of the most common diseases in adults. Ultrasonography (US) is a noninvasive and reliable diagnostic tool for the disease at least in infants but the diagnostic value in adults has not been evaluated well. A total of 72 patients complaining form gastroesophageal reflux disease symptoms who have undergone upper endoscopy were recruited for this study. In abdominal sonography, the following variables were measured or observed: esophageal wall thickness at gastroesophageal junction, AP diameter of esophagus at hiatus and gastroesophageal junction, abdominal esophagus length, funnel shape esophagus and presence of reflux after drinking a glass of water. Among all variables, only the presence of reflux in sonography was significantly related to the positive endoscopic findings with a sensitivity of 45% and specificity of 86%. Sonography can predict induced esophagitis by gastroesophageal reflux disease induced.

Children with cyanotic Congenital Heart Disease (CHD) are at higher risk for delay in their growth and development due to more energy consumption during their activities. In addition, they are more prone to respiratory infection and hospitalization. Due to the nature of disease, these patients suffer from a chronic hypoxia and its impact on growth and development is not well investigated. This study was designed to find out which physical growth and neurodevelopmental parameters of these patients are affected by chronic hypoxia in comparison with acyanotic disease. 81 children with CHD (34 cyanotic and 47 acyanotic), aged between 6 months to 3 years from Children’s Medical Center affiliated to Tehran University of Medical Sciences in Tehran were recruited from January 2013 to January 2014. Growth parameters including weight, height, and head circumference were checked and then these indices were categorized into three groups of Failure To Thrive (FTT). Functional development was assessed by using modified Denver Developmental Screening Test (DDST II). In acyanotic group, Ventricular Septal Defect (VSD) and in the cyanotic group, tetralogy of fallot (TOF) were the most prevalent disorders. Growth indices were low in 52% of patients (70% of cyanotic and 38.2% acyanotic), and also weight and height parameters were significantly lower in the cyanotic group (p= 0.009 and p= 0.05). 62% of cyanotic patients and 17% of acyanotic patients had delay at least in one of their neurological development indices (Gross motor, fine motor, speech or psychosocial behavior). This study also demonstrates an association between neurodevelopment delay and FTT in cyanotic patients, but not in acyanotic ones. Results in this study suggest that children with cyanotic CHD are more prone to delay in their development besides their growth possibly due to the nature of their disease. Therefore, chronic hypoxia can be a risk factor influencing neurodevelopment of the patients and appropriate intervention is required to gain better outcome.

It is now hypothesized that anti-asthmatic agents such as bronchodilators can reduce residual capacity and Residual Volume (RV) along with inducing no change in Total Lung Capacity (TLC). In the present study, an attempt was made to assess RV following administration of salbutamol inhaled in patients with Chronic Obstructive Pulmonary Disease (COPD).

This prospective interventional case series was conducted on 119 patients with COPD who referred to Rasoul-e-Akram Hospital in Tehran, Iran in 2015. At the beginning of the study, the patients were assessed using spirometer and plethysmograph (BodyBox) and RV was measured. Then, inhaled 400 µg salbutamol (Four puffs) was administered and the RV, TLC and the ratio of RV to TLC (RV/TLC) was measured again 15 min later.

Regarding the change in parameters of lung volumes after salbutamol administration, although Forced Expiratory Volume in one second (FEV1) and FEV1/FVC (Forced Vital Capacity-FVC) ratio is significantly increased, the deduction of RV and TLC would be much more. RV decreased from 217.02±123.72% before intervention to 167.50±30.91% after that (p<0.001). There was also no difference between men and women in the change of RV (142.99±52.30% vs. 37.78±36.99%, p=0.37). Compared to smokers, nonsmokers had experienced more reduction in RV (142.50±60.06% vs. 57.79±11.20% p=0.01). The change in RV was adversely associated with age. There was no relation between COPD severity and the change in RV and also RV to TLC.

The use of salbutamol inhaled in COPD patients even 15 min after administration leads to significant decrease in RV and RV to TLC ratio even more than increment in FEV1 and FEV1/FVC ratio.

One of the useful methods in heart surgery is Coronary Artery Bypass Graft (CABG). Nevertheless, hospitalization and surgery are accompanied by a large amount of stress and anxiety for patients. Resilience is one of the related variables with threatening experiences and stressors. The aim of the present research was determining and comparing resilience in patients undergoing CABG and healthy subjects based on personal and hospital factors. In this descriptive cross-sectional study, the statistical population included all patients undergoing CABG admitted to hospitals in Tehran in 2018. The research sample included 85 patients with CABG and 85 healthy subjects (total of 170 subjects), who were selected from Hazrat-e Rasoul-e Akram Hospital and Imam Khomeini Hospital. The Conner-Davidson Resilience Scale and a personal and hospital factors checklist were used to collect the data. In this study, it was found that there was not a statistically meaningful difference between resilience distribution in CABG patients and healthy subjects (p≥0/05). Moreover, there was meaningful relationship between personal factors (age and occupation) and patients’ resilience; also, there was no meaningful relationship between hospital factors and patients’ resilience andin healthy subjects, the relationship between age and resilience was negative and meaningful, and between education and resilience was positive and meaningful. Resilience is a capacity and skill which can be trained and learned. Based on the results, people who are more knowledgeable have more chance to improve their resilience. Therefore, concentrating and emphasizing on patients’ resilience deserves more attention.

Intramuscular Hemangiomas (IHs) are benign vascular neoplasms usually arising within the striated muscle of the trunk and extremities. These account for less than 1% of all hemangiomas. IH in the distal thigh with extension to knee joint is rarely reported, and may be confused with other lesions. A case of cavernous intramuscular hemangioma that involved distal third of left thigh with extension to knee joint in a 10-year-old girl is reported in this paper. The girl initially presented with sclerotic bony changes in imaging and slow growth during 4 years which at firt was misdiagnosed as osteoid osteoma for a long time. The patient’s parents refused the recommended biopsy of the lesion. Four years later, after the onset of the patient’s complaints of pain and swelling in the distal thigh, another survey with Doppler ultrasound and MRI was done. The tumor was finally diagnosed as hemangioma, and was completely resected. Histopathology confirmed a cavernous hemangioma with free margins. Our case was both an educational and clinical case with radiological presentations like articular involvement of this extra articular hemangioma and there was delay in diagnosis.

Dear Editor; It was reported that the First Vice President of the Islamic Republic of Iran had emphasized public trust beyond economic solutions in implementing economic programs and emphasized the role of the elite in raising social capital.(1) Trust is an essential component of social capital.(2) There are different views on the relationship between social capital and the economic situation.(3) (4) Due to its unique circumstances, Iran has always witnessed the economic impact of the situation over the past few decades.(5) In one of the latest academic studies in Iran, the amount of social capital and trust in Iran was above average.(6) High level of trust and enormous social capital during the imposed war, the formation of bonding and bridging social capital during the post-war construction period, and high participation in natural disaster relief are examples. In the current period when Iran is under severe economic sanctions, what has played a role in the historical memory of the Iranian people, the existence of public trust and social capital and other components to cope with the difficult livelihoods of the country and to come up with solutions to exit the situation. Trust and social capital is something that has been the focus of policymakers and government officials in the historical context of our country and expressing and expanding its meaning is one of the duties of the country's health authorities.