Journal of Iranian Medical Council
Volume:5 Issue: 4, Autumn 2022

Major depression is a common disabling disorder that affects about 280 million people worldwide (1-3) and is predicted to become the main contributor to global Disability-Adjusted Life Years (DALY) by 2030 (4). The costs imposed by depression and its complications in the United States reach more than 200 billion annually - considering occupational problems and suicide of patients (5). There are effective treatments for depression, but about one-third of patients are resistant to treatment. In addition, Electroconvulsive Therapy (ECT) has been reported to be beneficial for only half of refractory patients (4,6). A better understanding of the neuropathophysiology of the disorder, which leads to more appropriate and useful classifications, preventions, and treatments, seems to be a solution. After the monoaminergic system, the glutamatergic system and, recently, the neuroinflammation hypothesis have been proposed in the pathophysiology of major depression. Inflammation disrupts the regulation of the Hypothalamus-Pituitary-Adrenal (HPA) axis and the production of neurons in the hippocampus (7). Inflammatory cytokines disrupt the serotonin production pathway by decreasing Brain-Derived Neurotrophic Factor (BDNF) expression and increasing tryptophan oxidation (8). Decreased levels of BDNF and decreased signaling between it and its receptor in the hippocampus and prefrontal cortex cause depression (9). The result of the oxidation of tryptophan is kynurenine, whose compositions have agonistic and antagonistic effects on the N-methyl-d-aspartate (NMDA) receptor, a major player in the glutamatergic system (8,10). In general, the evidence shows the complexity and overlap of systems in the pathoetiology of inflammatory depression. Regarding this, even a subtype called Inflammatory Cytokine-Associated Depression (ICAD) has been suggested so that different treatment approaches can be considered for these patients (10). There is clinical evidence for these proposed mechanisms. An imbalance in the levels of kynurenine metabolites in patients with depression and an increase in the levels of pro-inflammatory cytokines in patients with resistant depression have been reported. Another suggester is its higher prevalence in patients with chronic autoimmune connective tissue disorders and exacerbated activation times of the innate immune system (11). The administration of cytokine and interferon for the treatment of cancer and hepatitis C, respectively, has led to depression in patients (7,10,11). Moreover, anti-inflammatory compounds such as celecoxib, simvastatin, pioglitazone, and dexamethasone have shown antidepressant effects in various trials (8). Blood levels of Interleukin-6 (IL-6) and C-Reactive Protein (CRP) are associated with depression, so that inflammation measured through these two predicts future depression (13). The levels of peripheral inflammatory cytokines have also been helpful in predicting patients’ responses to antidepressant treatment. Specifically, lower baseline IL-8 levels have been reported to lead to a better response to antidepressants. Additionally, antidepressant responders had a significant reduction in Tumor Necrosis Factor-α (TNF-α) (10,12). It seems that any primary neuroinflammation of the brain and any chronic inflammatory condition that produces markers crossing the blood-brain barrier and even chronic stress on the vessels can cause depression (7). Also, genetics, cellular damage, obesity, stress, diet, and gut microbiome can fuel chronic inflammation (10). Considering that inflammation predicts future depression and depression is a predictor of IL-6, it is possible to suggest a bidirectional relationship between inflammation and depression. The evidence promises an important therapeutic target for major depression treatment approaches. Also, more research is necessary to investigate the possibility of using inflammatory cytokines as biomarkers of response to pharmacological treatment and even other treatments.

Adaptation is a process in which a person is actively involved for a period of time and uses different strategies. Roy’s adaptation model sees individuals as an adaptive system in a stable interaction with internal and external environment; therefore, they constantly change and try to adapt. When the individual does not make the desired adaptation and hence ineffective responses, nurses learn about it. The present study aimed to systematically review the studies conducted in Iran on the Roy’s adaptation model.

This is a systematic review study, and it has been done purposefully by focusing on research purpose. A computerized search was performed systematically with no time limitation till October 2021, by using keywords: Roy’s adaptation model, Nursing and Iran in Web of Sciences, PubMed, Scopus, Google Scholar, IranDoc, SID and Magiran databases. The articles were evaluated using the Consort checklist. A total of 235 articles were found, and the systematic review of the articles was performed based on PRISMA. Finally, full text of 34 suitable articles were selected and analyzed after several steps of evaluation.

Out of the reviewed articles, 23.52% were published in international journals in English and 76.47% were published in Iranian journals in Persian and English. All the articles were original researches and intervention studies that 5.88, 47.05, 41.17, and 5.88% of them were experimental, quasi-experimental, clinical trial, and randomized controlled trials, respectively. Also, in all the studies pre-test and post-test were used, 5.88, 88.23, and 5.88% of them utilized random, availability, and block sampling, respectively.

Application of care program based on the Roy’s adaptation model increased physical and psychological adaptive (healthy) behaviors in patients with chronic diseases, which might improve the patients’ psychological adaptation to the disease, proper disease control, reduction of complications, and quality of nursing care.

 The prevalence of negative act behaviors among medical residents has not yet been assessed in our country. Present study aimed at evaluating the prevalence and impact of negative act behaviors among residents of four academic hospitals in Iran.

 This cross-sectional survey was conducted on medical residents in two educational hospitals affiliated to Iran University of Medical Sciences. An online electronic questionnaire was distributed to all clinical residents in these hospitals via WhatsApp. We used an online electronic four-part questionnaire including demographic data, Negative Act Questionnaire-Revised (NAQ-R), some questions on negative behaviors causes and effects, and General Health Questionnaire 12 (GHQ-12).

 In total, 254 completed questionnaires were received, with an overall response rate of 71%. Ninety five percent of participants had experienced negative act behaviors once or more during the last six months, whereas 91% of responders had witnessed negative act behaviors during this time. The most common source of these behaviors were senior residents (73.8% of those bullied, n=178). There was a significant positive correlation between the GHQ score and the NAQ-R score assays.

 This study, as the first study on the prevalence of bullying and negative acts in Iranian medical residents, showed that the medical education atmosphere in residency is not optimal. Therefore, there is a need for certain interventions in the medical education environment. We recommend better education of residents and faculty members, strong policy making, situation assessment and feedback regulations as essential steps towards diminishing bullying and negative behaviors in resident training centers.

 The present study aimed to investigate the relationship between patients’ demographic/clinical factors and readmission.

 This retrospective cohort study was conducted on all patients admitted to Iran psychiatric hospital and the Psychiatric Ward of Rasoul-e-Akram Hospital in Tehran in 2011. The study variable and post-discharge readmission status in a 7-years period until 2018 were collected by reviewing patients’ clinical charts, making telephone calls or studying patients’ records at Roozbeh Hospital. Thereafter, clinical factors such as Length of Hospital Stay (LOS), diagnosis, and medication compliance were evaluated by using statistical tests, including Meier-Kaplan survival analysis, Logrank test, and Cox regression analysis and SPSS software.

 The present study was conducted on 1410 inpatients, 434 women (30.8%) and 976 men (62.9%), whose most common disorder was mood disorder. The diagnoses of the patients were recorded based on DSM-IV-TR. Among the patients readmitted, the mean time to readmission was 24.94 months. Among the demographic and clinical factors, the longer length of stay, more previous hospitalizations, inpatient physical restraint, lack of therapeutic compliance, and diagnosis of psychotic disorders has increased the odds of readmission (all p<0.01).

 To reduce the readmission rate among these patients, we need to use some methods to reduce readmission such as psychoeducation regarding nature of the disease, importance of medication adherence, and identifying warning signs that indicate the possibility of recurrence of the disease, especially more severe such as psychotic disorders. It is also recommended to avoid physical restraint, a factor of readmission risk, during hospitalization as much as possible.

 Ovarian tumors are mostly detected in advanced stages. Early diagnosis of malignant ovarian germ cell tumors is so vital to keep life and fertility of the patients. We aimed to find out different presentations of malignant ovarian germ cell tumors based on age, parity and histology to help early diagnosis of the tumors. 

 In this study, malignant ovarian germ cell tumors admitted in a referral center of gynecology oncology were studied 2001-2018. The symptoms and signs of the patients were collected and analyzed according to age, parity and specific histology. 

 128 cases of malignant germ cell tumors were detected. The primary symptoms included abdominal distension (45%), acute pain (40.95%), chronic pain (23.95%), menstrual irregularity (14.7%), sense of abdominal firmness and mass (7.72%), nausea (5.4%), fever (5.4%), lack of appetite (4.63%), virilization (3.1%), depletion of weight (3.1%), and 9.27% detected incidentally. Abdominal distension, and acute pain decreased after 24. Menstrual disorders and incidental detection in multiparas were significantly more than nulliparous (p<0.05). Abdominal distension was the prominent sign in dysgerminomas (50%). Almost 45% of immature, yolk sac, and mixed tumors referred with acute abdominal pain. The data showed that 85% of the patients had been suffering from some discomforts for days to months prior to the diagnosis. 

 The majority of cases are symptomatic for a long time before the first visit although aging and parity can lessen their severity. Late diagnosis can lead to acute abdomen in some histology types. Young women and health providers should be warned about concerned presentations of ovarian tumors.

Background: 

Mindfulness-Based Cognitive Therapy (MBCT) is a short-term and structured intervention approach that has a favorable research background. The aim of this study was to evaluate the effectiveness of MBCT on negative automatic thought, psychological symptoms, severity of pain and quality of life in female patients with fibromyalgia. 

Methods:

 In a randomized controlled trial, from February to October 2021, 20 patients with fibromyalgia were selected using purposive sampling method and assigned into two experimental and control groups through block randomization. MBCT was presented to the participants in the experimental group in eight sessions and the control group was placed on a waiting list. Quality of Life Questionnaire (WHOQOL-BREF), Pain Intensity Questionnaire (PIS), Psychological Symptoms Questionnaire (anxiety, stress and depression) (DASS), and Automatic Negative Thoughts Questionnaire (QNS) were completed by the participants in two stages (pre-test and post-test). Data were analyzed using multivariate analysis of covariance in SPSS version 26. 

Results:

 Preliminary results showed that MBCT had a significant effect on the severity of pain index and psychological symptoms (all’s <0.05). Secondary results also indicated that this therapeutic intervention was effective in reducing negative automatic thought and improving the quality of life (all’s<0.05). 

Conclusion: 

Findings of this study in line with the research background showed the effectiveness of this therapeutic approach on psychological indices in female patients with fibromyalgia, although additional studies in this field are suggested.

 Neurofibromatosis type 1 (NF1), a genetic condition most commonly characterized by the presence of dermal neurofibromas and café au lait macules, has a significant impact upon the Quality of Life (QoL). The purpose of this study is to predict the QoL with Dermatology Life Quality Index (DLQI) in Iranian patients with neurofibromatosis type  .1

 This cross-sectional study was conducted on 223 patients with neurofibromatosis type 1 using available sampling. Data collection tools were demographic information form, SF-36 and DLQI questionnaires. Quality of life was predicted by DLQI. Linear and multiple regression tests were utilized to analyze the data. 

  Predicting the quality of life by dermatology quality of life showed that the physical function by the variable “work and school” and treatment, role limitations due to physical health by the variable of work and school, the role limitations due to emotional problems by the variable of treatment, emotional well-being by the variable of interpersonal relationships, pain by the variable of symptoms and feelings, daily activities, and personal relationships were predictable. Finally, social function, general health and fatigue cannot be predicted by any variable.

 The results of this study indicated that the quality of dermatology life is able to predict some aspects of quality of life. These findings can be used to provide better health services to this group of patients and improve their quality of life.

The present study aimed to investigate the prevalence of substance use disorder in Iranian children and adolescents and its relationship with demographic characteristics and psychiatric comorbidities.

The data were taken from a national survey on the prevalence of psychiatric disorders in Iranian children and adolescents. The national survey was conducted on 30,532 children and adolescents aged 6-18 years which were selected using multistage cluster sampling. The psychiatric disorders were assessed by employing k-SADS-PL questionnaire and interviews carried out by 240 clinical psychologists with the participants and their parents. Data were analyzed by Chi-square test and logistic regression.

A total of 277 (0.97%) were diagnosed as people with substance use disorder that were further studied for comorbid disorders. Among the various types of drugs, hypnotic/sedative/anti-anxiety drugs were abused by 84 people (46.15%), cannabis by 68 (37.36%) and stimulants by 43 (23.63%). The variables of gender, place of residence, and father’s occupation and parents’ education level were identified as predictors of substance use disorder in children and adolescents. At the same time, 42.50% substances and alcohol abusing people had at least one comorbid psychiatric disorder and the highest comorbidity was observed in oppositional defiant disorder, attention deficit and hyperactivity disorder and separation anxiety disorder (p≤0.05).

The findings can be used in the prevention and treatment of substance use disorder and promotion of mental health in children and adolescents by focusing on the psychiatric comorbidities of people with substance use disorder.

 Determining the exact location of mandibular foramen is an important factor prior to Inferior Alveolar Nerve (IAN) block injection. The aim of this study is to assess the position of Mandibular Foramen (MF) and its variations using Cone-Beam Computed Tomography (CBCT).

 This study was conducted on CBCT images of 80 females and 80 males (18 to 68 years). The distance between the MF and the anterior border of ramus (A), inferior border of mandible (B), superior border of mandible (C), and occlusal plane was measured. Data were analyzed by the student t-test, bivariate correlation analysis, paired sample t-test, and Pearson’s correlation coefficient. 

 The mean amount of A, B and C distances, and the mean distance from the occlusal plane to the center of MF were 13.76, 24.24, 12.32, and 7.59 mm, respectively, with no significant difference between the right and left sides (p>0.05). The mean B and C distances were significantly smaller in females than males (p<0.05). The mean size of the measured angle was 43.2°. Significant correlations were noted between aging and decreased A distance, and reduction in the angle between the contralateral premolars and MF (p<0.05). 

 Knowledge about the position of MF can enhance the surgical procedures in this region. Using a 21-25 mm needle would be associated with lower risk of needle fracture during IAN block injection. Also, needle insertion angle <45-degrees is optimal for the samples assessed in this study.

 Management of patients with Gastrointestinal Bleeding (GIB) based on chronicity and severity of it can vary from outpatient medical therapy to intensive caring in life-threatening cases. Initial clinical management decision in patients presenting to emergency department with acute GIB is often based on identifying high- and low-risk patients. Patients with high risks of adverse outcomes, such as death or re-bleeding, are more likely to benefit from early, aggressive management, whereas patients with lower risks may be considered for early hospital discharge or even outpatient management. Serum lactate level is generally an indicator of the overall adequacy of peripheral oxygenation. In severe cases of acute GIB, the hemodynamic of the patients disturbs. In this study, we are evaluating whether higher serum lactate level is potentially a biomarker for predicting the future need for special management considerations.

 168 patients with confirmed acute GIB have entered this study. The serum lactate level of participants was measured and documented as well as their demographic data and their medical history. The participants’ need for ICU admission, blood transfusion, emergent endoscopy, and mortality rate were documented and assessed prospectively.

 Patients with higher levels of serum lactate levels were more admitted to the intensive care unit in the upcoming days. Anticoagulant use and abdominal pain prevalence were also significantly different in the study groups (p>0.05). Other assessments were not statistically significant.

 Higher levels of serum lactate predict a higher probability of ICU admission in patients with acute GIB.

 It is necessary to identify unidentified or less- concentrated issues in professionalism and anesthesiology through an extended study. This study is done to identify different dimensions of professionalism in anesthesiology among quantitative and qualitative research.

 The present meta-synthesis study is done through a systematic review. The main criteria were to use quantitative and qualitative professionalism studies in which their participants were anesthesiologists. All the published and indexed articles related to professionalism in anesthesiology in PubMed and Google Scholar databases from February 2000 to December 2020 were scrutinized. Search in these databases was done using key words “Professionalism” and “anesthesiology”. The abstracts were screened for relevance and full articles were located, and 54 articles were chosen. Data analysis was performed using qualitative content analysis.

 Generally, concepts extracted from professionalism in anesthesiology dimension are classified in six main categories including: promoting professionalism, accountability, legal issues, self-regulation, physician well-being threats and social media as well as 19 sub-categories.

 In this meta-synthesis study, there was an effort to present a new interpretation of the previous studies. This study helped attain a more comprehensive and deeper knowledge about professionalism in anesthesiology and reveal its different aspects, which are not assessed in the past. The results revealed issues such as well-being and burnout needs more effort.

The corona pandemic has created many unpredictable challenges for the medical staff and students. In almost all countries, changes have been made in the medical education programs at all levels. The anesthesiology assistants are among the most affected groups due to the role of this specialty in the management of COVID patients. 

We prepared a questionnaire including demographic information, as well as 20 questions associated with work and educational issues. The questionnaire was sent to all anesthesia assistants via SMS and the answers were collected within 5 days. The 20 main questions were designed in the form of multiple-choice questions with 5 standard options.

Responses were immediately reported after categorization. Chi-square test was used to compare the answers among the subgroups, such as male and female, single and married and at different levels. 66 anesthesia assistants out of total amount of 71 at four different levels (92.9%) answered the questions. The results showed that the majority of assistants have experienced a higher level of stress during corona pandemic and the negative effects of the pandemic on their medical education were obvious. 

According to the responses received in this study, the amount of stress in male assistants was less than females and also married assistants experienced less stress in comparison to singles.

Kell Ag, the main antigen of kell system has the greatest antigenicity after Rh antigen and the associated antibodies are very important. These antibodies are mainly of the Ig G class and can cause side effects like Hemolytic disease of the Fetus and Newborn (HDFN) or Hemolytic Transfusion Reaction (HTR), especially in patients with chronic blood transfusions such as thalassemia patients. The aim of this study was to evaluate Kell antigen in pregnant women with thalassemia minor and intermedia and to determine the appropriate strategy for transfusion in this group of patients

This study is a cross-sectional study on pregnant women with thalassemia minor or intermedia. The samples were taken from patients of Shahid Motahari clinic and those with positive antigen were selected and statistically analyzed.

The results showed that from the 64 patients who entered this study, the results of kell ag of 58 patients were negative and 6 were positive. Therefore, 91% of the pregnant women with beta thalassemia minor or intermedia were negative for ag kell and 9% were positive.

In summary, the results of this study indicated that a large percentage of pregnant women with beta-thalassemia minor or intermediate are Kell-negative, and due to the complications of alloimmunization, screening of pack cells and pregnant patients is very important.

Spirometry procedure is known to be an efficient test for evaluating lung function. Nevertheless, the ventilatory function indexes acquired by spirometry seem to have been affected by several factors, some of which are demographic and anthropometric parameters. Hence, our study aimed to address the effect of some specific features of Hamedani individuals in Iran on spirometric characteristics.

We assessed the spirometric parameters, including Forced Vital Capacity (FVC), forced expiratory volume in the first second (FEV1), maximal mid-expiratory flow rate (FEF25-75), and FEV1/FVC ratio, obtained from normal spirometry test of 1483 individuals between the ages of 16 and 89 years.

FVC, FEV1, FEV1/FVC ratio, and FEF25-75 were different between the two genders significantly (p<0.001). Even though there was a higher FVC, FEV1, and FEF25-75 in males, FEV1/FVC ratios for males were significantly lower than the ratios for females at the same ages (total mean of 82.09±6.78 in males versus 84.94±6.49 for females). In addition, FEV1/FVC ratio and FEF25-75 were not significantly different between tall males and females with a height of >170 cm. Finally, age and stature influenced the ventilatory function values with a correlation strength of <0.001. 

Albeit men, mostly because of their particular anatomic and physiologic feature of respiratory muscles, had larger FVC and FEV1, those who were tall showed no significant change in FEV1/FVC ratio and FEF25-75, in comparison with females. Irrespective of their height, men found a higher FEF25-75 as well.

Sacroiliac Joint (SIJ) dysfunction, a common etiology of Low Back Pain (LBP), is a challenging diagnosis. There is controversy over the efficacy of prolotherapy and corticosteroid injections in relieving SIJ dysfunction. Inconsistent success rates reported in previous studies can be due to heterogeneity in selecting the patients and procedures between studies. This study was conducted to compare the efficacy of local injection of dextrose prolotherapy and corticosteroid in treating the SIJ dysfunction.

This 36-week, double-blind, Randomized Controlled Trial (RCT) included 40 patients with SIJ dysfunction. The clinical impression was confirmed by the use of a diagnostic injection of local anesthetic inside SIJ. Participants received a single injection of either hypertonic dextrose solution or triamcinolone under Ultrasound (US) guidance. The primary outcome measurement tools, including the Visual Analog Scale (VAS) for pain and the Dallas Pain Questionnaire (DPQ), were evaluated initially and after 2, 8, and 36 weeks.

In both prolotherapy and corticosteroid groups, VAS significantly declined within 36-weeks of follow-up. However, there was no remarkable difference between the two groups at any follow-up timepoints. Similarly, DPQ revealed a remarkable improvement in the corticosteroid group while it did not show any meaningful change in the prolotherapy group.

Both local injections of dextrose and corticosteroids can successfully reduce pain in patients with SIJ dysfunction without significant superiority between the two treatments. However, corticosteroid injection was slightly more effective in terms of improvement of functional status. Further investigations are required to extend these results to SIJ dysfunction treatment more reliably.

Changes in auditory function have been noted in post-menopausal women attributed in part to the lower levels of ovarian hormones. Decreased levels of ovarian hormones may alter auditory neurotransmission time, as evaluated by Auditory Brainstem Responses (ABR). Thus, objective of this study was comparison of mean inter-peak ABR latencies in post-menopausal women compared to non-menopausal women.

In this cross-sectional study, research sample consisted of 60 women as case group in the age range of 45-55 years, who were post-menopausal and had normal hearing. The control group with similar characteristics were non-menopausal. Two groups were estimated by ABR and then the means of the variables that had a normal distribution were compared with each other by independent t-test.  

All differences between two groups were not significant, as follows; Mean I-III inter-peak ABR latencies (p-value=0.714), mean III-V inter-peak ABR latencies (p-value=0.691) and mean I-V inter-peak ABR latencies (p-value=0.483).

Menopause does not cause abnormal results in auditory brainstem responses.

Changes in auditory function have been noted in post-menopausal women attributed in part to the lower levels of ovarian hormones. Decreased levels of ovarian hormones may alter auditory neurotransmission time, as evaluated by Auditory Brainstem Responses (ABR). Thus, the objective of this study was to compare the mean inter-peak ABR latencies and post-menopausal women compared to non-menopausal women.

In this cross-sectional study, research sample consisted of 60 women as case group in the age range of 45-55 years, who were post-menopausal and had normal hearing. The control group with similar characteristics were non-menopausal. Two groups were estimated by ABR and then the means of the variables that had a normal distribution were compared with each other by independent t-test.  

All differences between two groups were not significant, as follows; Mean I-III inter-peak ABR latencies (p-value=0.714), mean III-V inter-peak ABR latencies (p-value=0.691) and mean I-V inter-peak ABR latencies (p-value=0.483).

Menopause does not cause abnormal results in auditory brainstem responses.

The Persian Handwriting Assessment Tool (PHAT) evaluates speed and legibility in copying and dictation domains. The aim of the present study was to determine psychometric validation and diagnostic accuracy features of the PHAT for students with specific learning disorder.

In this cross-sectional study, handwriting of 120 participants (typically developing students, N= 60; students with specific learning disorder, N= 60; mean age (SD): 9.23 ± 0.53 years and 9.13±0.56 years, respectively) were assessed with PHAT. Receiver Operating Characteristics (ROC) curve analysis was carried out to derive validity parameters and Area Under the Curve (AUC) for diagnostic accuracy. Discriminative validity, internal consistency, test-retest reliability and absolute reliability were examined.

The PHAT had significant ability to discriminate typically developing students from students with specific learning disorder in formation, spacing and alignment (AUC= 0.78-0.95) and moderate accuracy (AUC= 0.61-0.66) in text slant in both domains. Acceptable discriminative validity (P< 0.01), internal consistency (copying: α= 0.80-0.98; dictation: α= 0.83-0.98), and test-retest reliability (copying: ICC2,1= 0.75-0.98; dictation: ICC2,1= 0.78-0.98) were also obtained.

The current study suggests that the PHAT has satisfactory reliability, validity and high to acceptable diagnostic accuracy for students with specific learning disorder.

Bariatric surgery leads to weight loss and body fat percentage reduction, but patients are prone to lean tissue loss which itself reduces the quality of life, and increases the risk of deatand h. This study evaluated the effects of bariatric surgery and changes in Fat Mass (FM) and Fat-Free Mass (FFM) on the respiratory and skeletal muscles’ strength three months after bariatric surgery.

After obtaining demographic information, anthropometric measurements and body composition analysis, including Body Mass Index (BMI), FM, FFM,  Percent Body Fat (PBF), handgrip isometric force, respiratory muscle forces and spirometry volumes, were assessed before and three months after bariatric surgery in 50 men and women undergoing this surgery.

Weight, BMI, FM, PBF and FFM isometric muscle force were decreased significantly. In contrast, respiratory muscle forces and respiratory volumes were increased significantly three months after the surgery. Reduction in FFM 3 months after the surgery did not lead to a change in respiratory muscle strength (p-values≥0.05).

According to our findings, FM and FFM along with weight and BMI decrease significantly after bariatric surgery. These alternations were accompanied by a significant increase in respiratory muscle strength but were not correlated with handgrip muscle force changes.

Pulmonary arterial hypertension is a progressive disease of the lung vascular system which causes patients’ functional limitations and reduces their Health-Related Quality of Life (HRQoL). This study was aimed at determining the effectiveness of Macitentan on the HRQoL of Iranian PAH patients by the emphasis 10 questionnaire. 

31 idiopathic class I pulmonary hypertension patients were enrolled in this cohort study. Patients completed the emphasis 10 questionnaire at baseline and 6 months after Macitentan consumption. The absolute changes in emphasis 10 scores were calculated. The effect of Macitentan on functional activity and paraclinical indexes was assessed. 

The mean quality of life scores before and after the Macitentan, were 25.83 (±11.80 SD) and 16.93 (±10.36 SD), respectively (p-value=0.001). Besides, administration of Macitentan increased the mean distance in the 6-minute walk test, from 227.00±(87.275 SD) to 263.67 (±115.855 SD) (p-value=0.044), led to a reduction in the mean hospitalization days from 2.23 (±4.049 SD) to 0.33 (±1.322 SD), (p-value=0.015) and reduction in times of hospitalization from 0.57(0.93) to 0.10(0.30), (p-value=0.017). Although it had a positive effect on mean PAP (81 to 68), O2 saturation at the beginning of 6MW (90 to 91%), final O2 Saturation in 6MW (81 to 85%), and pro-BNP (907 to 412), this effect was not statistically significant. 

Treatment with Macitentan significantly improved patient functional activity and reduced the mean hospitalization days. Thus, due to the low side effects and high efficacy, it can be advised as the first line of treatment.

Esophageal spasm is a common problem after Foreign Body Ingestion (FBI) and causes difficulties for foreign bodies’ removal by endoscopic intervention. Sometimes, medication may help relieve spasms and facilitate the removal of a foreign body. In the current study, we introduce a patient with esophageal spasm due to FBI for whom intravenous nitroglycerin was used to treat the spasm. 

The patient was a 48-year-old man who was admitted to emergency department of Shohadaye Tajrish academic Hospital, Tehran, Iran due to FBI and following sever mid-anterior neck pain, nausea and drooling. His vital signs were normal and during endoscopic procedure, we noticed a sharp object attached to the wall of the upper third of the esophagus, causing severe spasm. After trying for an hour to remove the glass under general anesthesia, we were not able to remove it. Finally, intravenous nitroglycerin was used to relieve the spasm and it was easily removed after 2 minutes.

Due to inconsistencies in the clinical results of nitroglycerin, and as notable lack of studies are investigating the effectiveness of the intravenous method, we aimed to share our successful experience.

Introduction Following two decades of efforts by the Ministry of Health and Medical Education (MOHME) to develop a nationwide electronic health record system, Iran has made e-prescribing mandatory as of December 22, 2021. However, these regulations have sparked significant concerns among both health care providers and authorities of professional bodies, such as the Iranian council of medicine, concerning patient privacy and confidentiality, which we shall analyze from an ethico-legal perspective in this paper.  An Electronic Health Record (EHR) is “an electronic record of health-related information of an individual that conforms to nationally recognized interoperability standards and can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization” (1). E-health has drawn the attention of policymakers in Iran since 2000. In 2001, the MOHME approved the TAKFAB project in Iran as the first pilot project for creating an e-health system. SEPAS project was another e-health project supported by the MOHME that was run in Iran from 2007 to 2018 (2).  By allowing access to patients’ medical records, increasing the accuracy of medical decision-making, saving costs, reducing medical errors, promoting clinical research and education, and providing effective communication between health care providers, EHR improves the quality of care (1,2). It can also play a crucial role in the sustainability of health systems, as it facilitates structural reforms and policy-making processes (2).