مجله سازمان نظام پزشکی جمهوری اسلامی ایران
سال سی و نهم شماره 3 (پیاپی 155، پاییز 1400)

For more than one year, the SARS-CoV-2 has severely affected human health and all the people around the world are involved in social and economic problems. In less than 18 months, it has adversely affected individual and social relations, reduced global average GDP by five and two tenths, and has killed about 4 million people so far. Numerous ways have been tried to find solutions to overcome this global problem, but using the IT platform and the World Wide Web, which bring together the three elements of the patient, therapist, and health system, is perhaps the most effective. The solution is to overcome the pandemic reign of the “crown virus” at the beginning of the 21st century. In this article, while presenting the general concepts and principles of telemedicine, we will discuss its applications in the management of pandemics and widespread epidemics, especially in the field of infectious diseases. In this regard, the effective role of telemedicine in public education, prevention, epidemic control and management of social behaviors, remote therapy, and virtual visits, especially in remote areas deprived of advanced health services, as well as research during infectious pandemics has been studied.

Prostate cancer is one of the most common cancers in Iranian men. PSA(prostate specific antigen) screening is a controversial issue because PSA screening leads to diagnose of patients with low risk prostate cancer who not only do not benefit from treatment but also suffer from complication caused by treatment. On the other hand, without prostate cancer screening, the rate of metastatic prostate cancer will increase. This article is a narrative review article on PSA screening, reviewing clinical trial articles in the PubMed.

We searched PubMed using keywords: “PSA, Prostate Cancer and  Screen” and English as well as full text articles were included. Only clinical trial studies were included. Case studies, cohort studies and review articles were excluded. 301 articles were found. Our emphasis was on four questions on benefits and harms of PSA screening and benefits and harms of prostate cancer treatment for localized prostate cancer were reviewed. Finally 15 articles were included. References from included studies were manually reviewed to identify additional studies of interest.

PLCO AND CAP studies showed that PSA screening does not lead to decreased prostate cancer mortality but ERSPC study showed 21% decrease in prostate cancer mortality among people who screen for prostate cancer. The most problem in prostate cancer screening is over diagnosis. These studies revealed over diagnosis in 20.7% to 50.4% of patients who were screened with PSA. Pivot and PROTECT studies revealed radical prostatectomy for patients with localized prostate cancer detected with PSA screening, does not significantly increase the survival of prostate cancer, however; SPCG-4 study showed that radical prostatectomy significantly increased survival of localized prostate cancer.

Active surveillance of low-risk prostate cancer or supplemental tests such as PHI (prostate health index) and Multiparametric MRI in cases where PSA is slightly higher than normal is recommended for PSA screening.

One of the major challenges in road safety is the occurrence of sudden disability attacks while driving. An important point about the occupational health of drivers who have patients who have the potential for sudden disability attacks is to estimate the likelihood and consequences of the attacks. In other words, how likely is an accident to follow a sudden disability while driving? Understanding the types of medical conditions that can cause sudden attacks and whether or not these diseases give the driver ample opportunity to drive safely on the side of the road is important in assessing drivers’ job fit. In this study, in order to answer the question that it is possible to drive a car along the road following the occurrence of sudden disability in drivers, research has been done in the reputable databases of Embase, UpToDate, PubMed, Medline (Ovid), Scopus and Web of Science. A variety of diseases such as heart disease (such as myocardial infarction, arrhythmia, etc.), stroke, epilepsy, diabetes, etc., are associated with sudden disability attacks even while driving. But in most cases, the driver has enough opportunity to drive the car to the side of the road. However, some medical conditions such as syncope, etc. do not provide this opportunity for the driver and can have unfortunate consequences for drivers following these attacks.

Acute bronchiolitis is the most common cause of lower respiratory tract infection and hospitalization due to respiratory disease during infancy. The disease is mainly diagnosed based on history and clinical examination, with paraclinical investigation being of little value in the diagnosis. The present study aimed to determine the role of paraclinical tests in the management and treatment of children with acute bronchiolitis.

In this retrospective cross-sectional study, the medical records of infants aged 1-24 months admitted to Bahrami Children’s Hospital with initial diagnosis of bronchiolitis were reviewed. Demographic, clinical and laboratory data as well as data related to disease management were reported and the relationship between tests’ results and treatment, prognosis and length of hospital stay was analyzed by statistical methods.

The records of 193 patients (55.4% male, mean age 3.88 ± 5.17 months) were reviewed. Complete Blood cells (CBC), C-reactive protein (CRP) and serum electrolytes (sodium and potassium) were measured in more than 90% of patients, blood culture and urine culture were performed in 50% and blood gas analysis in 65%. Serum electrolytes were in the normal range in all infants. Blood culture was negative in all patients. Active urine analysis was reported in 2.1% which revealed negative results on urine culture. One-third of patients received at least one type of antibiotic and 92.7% received ventolin. The majority (93.3%) of patients were discharged with a final diagnosis of bronchiolitis and the mean length of hospital stay was 2.6 days. There was no statistically significant relationship between laboratory results and PICU admission and length of hospital stay.

The findings of this study showed that laboratory tests and treatments incompatible with pediatric guidelines are widely used in bronchiolitis and do not play a decisive role in the prognosis and management of the disease

Silver nanocrystalline dressings have recently received a great deal of attention due to their effect on various bacteria present in wound infections. The most important factor in choosing a dressing is the effect of disinfection, its effect on epithelium and its ability to control wound infection. In addition, it reduces the use of painkillers and narcotics and reduces the stress of changing the dressing by 50%. All of these solutions require optimization to achieve the best conditions with the least amount of time and cost.

In this study, the preparation of silver nanoparticles, the study of silver fabrics in terms of sterility, the design of experiments using the Taguchi method and the study of silver fabrics in terms of microbial effectiveness have been performed.     

The best state predicted by the software includes 45 grams per liter of silver nitrate, 14 grams per liter of glucose, 280 microliters of sodium hydroxide, 60 seconds mixing time and 4 hours drying time. In this case, the average diameter of the growth inhibition halo was predicted to be 4.5 cm. In the laboratory, the average diameter of the no-growth halo in this case was equal to 4.25.

Obtaining a solution for optimizing of silver nanocrystalline dressing production as well as obtaining the diameter of the non-growth halo, which indicates the more effective performance of this dressing, is of particular importance.

Stroke is the second leading cause of death in the world and has irreversible consequences. Cerebral ischemia/reperfusion (I/R) through production of oxidants and inflammatory markers causes apoptosis of brain neurons. On the other hand, in various studies, the antioxidant and anti-inflammatory effects of the Malva neglecta have been proven. Therefore, in this study, we investigated the protective effect of hydroalcoholic extract of Malva neglecta leaf on pyramidal neurons in the CA1 region of the hippocampus of male Wistar rats following ischemia-reperfusion.

In this experimental study, we divided 24 Wistar rats weighting 350-300 gr randomly into four groups (n=6) as control, Ischemia/reperfusion (I/R), I/R+ hydroalcoholic extract of Malva neglecta leaf was injected intraperitoneally (300 &600 mg/kg 0-24-48-72 hour after the ischemia). The ischemic model was performed by clamping the bilateral common carotid arteries (BCCA) for 20 minutes to induce ischemic injury. After 4 days all groups were sacrificed and brain sections were stained by Nissl and evaluated by light microscope. P<0.05 was assumed as statistically significant.

The results showed that ischemia / reperfusion in the brain for 20 minutes caused degeneration of pyramidal cells in the CA1 region of the hippocampus and the ischemia group showed a significant decrease (P <0.05) compared to the control group. Malva neglecta injection at a dose of 600 mg / kg largely preserved the neurons and was not significantly different from the control group (P = 0.107).

The use of hydroalcoholic extract of Malva neglecta leaf at a dose of 600 mg / kg prevents the reduction and death of neurons in the CA1 region of the hippocampus following ischemia-reperfusion in the brain of Wistar rat. Malva neglecta extract can be used as an effective agent in preventing or reducing the complications of stroke alone or with other drugs.

There are various questionnaires in the world to assess the level of knowledge and attitudes of people about Alzheimer’s disease. Dementia Knowledge Assessment Scale (DKAS) and Dementia Attitude Scale (DAS) questionnaires are two well-known questionnaires in this field, respectively. The purpose of this study is translation and psychometrics evaluation of two questionnaires DKAS and DASS and appropriating it with the culture of Iranian society.

Initially, the questionnaires were translated. The content validity of the questionnaires was assessed by 10 experts. To measure content validity, inter-rater agreement (IRA), relevancy and clarity of each of the items and the tool as a whole and comprehensiveness were calculated.  Reliability was measured with Cronbach’s alpha and intra -cluster correlation.

The Inter Rater Agreement to relevancy and clarity of the tool was 94% and 76%, respectively. The overall relevancy and clarity of the tool calculated through the mean, was 99.2% and 96%, respectively. Eventually its comprehensiveness was 100%. Overall Cronbach’s alpha in knowledge and attitude scale was 0.71 and 0.76, respectively. The highest ICC value was 0.97 and the lowest was 0.81 in the knowledge tool and 0.97 in the attitude tool in both areas.

The results of this study show that the tools used to measure the level of knowledge and attitudes of health care providers about Alzheimer’s disease have good content validity and reliability.