فهرست مطالب

  • Volume:14 Issue: 5, 2012
  • تاریخ انتشار: 1391/01/31
  • تعداد عناوین: 12
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  • M. Nejabat, B. Maleki, M. Nimrouzi, A. Mahbodi, Ar Salehi Page 265
    Background
    Physicians in ancient Persia played an important role in the development of medicine in the medieval era. One of the most influential figures of this era was Abu Ali Sina or Ibn Sina, known as Avicenna in the western world. The author of more than 200 books on medicine and philosophy, Avicenna followed and further expanded on the tradition of western philosophy and medicine introduced by Aristotle, Hippocrates and Galen. Few researchers have looked into the different medical issues in his best known work, the Canon of Medicine, particularly with regard to ophthalmology. In this analysis, Avicenna’s views on and contributions to the diagnosis and treatment of cataracts in his Canon were elucidated..
    Methods
    We first reviewed an electronic copy of the Canon and then reviewed other important sources in traditional medicine including the Kamel-al-Sanaeh, Al-Havi (Continents) and Zakhireh-kharazmshahi, available in the Avicenna Special Traditional Medicine Library of Shiraz University of Medical Sciences. We also searched Medline, Embase, Scopus, Iranmedex and Science Iranian Database (SID) with these keywords: “traditional medicine,” “Avicenna,” “cataract”, “Canon”, “history “ophthalmology” and “eye disorders”..
    Results
    According to the Canon, nozul-al-maa or cataract is an obstructive disease in which external moisture accumulates between the aqueous humor and the corneal membrane and prevents images from entering the eye. Avicenna classified cataracts on the basis of size, density and color. According to size, he identified two types of cataracts including complete and partial obstruction. According to the Canon, surgical intervention was necessary only for certain indications. Avicenna believed that opacity in the initial stages of cataract could be diminished by medicines and foods, and described several medicines for cataracts. He believed that surgery should be postponed until the liquid accumulation stopped, and the cataract reached its mature state. After surgery, according to Avicenna, the patient should avoid headache-inducing situations because headaches could lead to edema of the layers of the eye. He further emphasized that the patient’s psychological status played an important role in the success of surgery..
    Conclusion
    An important aspect of Avicenna’s contribution to the medical management of cataracts was that he believed they could be cured by medication and nutrition in their early stages without the need for surgery. He also considered the patient’s mental status as an important factor contributing to the postoperative prognosis. Our review of Avicenna’s writings on eye disorders in the Canon of Medicine suggests that he had a rigorous approach to the diagnosis and management of patients suffering from eye disorders.
    Keywords: Avicenna, Cataract, Traditional medicine, Canon, History, Ophthalmology, Eye disorders
  • A. Ebrahimi, Mh Kalantar Motamedi, N. Nejadsarvari, E. Shams Koushki Page 271
    Background
    Reconstruction of nasal skin after tumor resection is imperative for full patient rehabilitation; and use of similar skin is necessary to achieve best esthetic and functional results..
    Methods
    This clinical series study represent management of patients with large nasal defects (up to 4x7 cm) using subcutaneous pedicle island paramedian forehead flap, during a period of 2007-2009, 8 patients with large nasal defects were repaired with this flap, among them 5 patients were male and 3 patients were female with mean age of 53 years, all cases were reconstructed with island pedicle flap in a single stage..
    Results
    Good and satisfying results were achieved in all cases except for one case that was operated again for debulking of flap..
    Conclusion
    Island paramedian forehead flap provides esthetic and functional results in a single stage reconstruction of defects with various sizes and locations. This variation of forehead flap is a good choice especially for those patients that have problems with cost or problem with multistage reconstruction of nasal defects.
    Keywords: Surgical flaps, Esthetic, Forehead, Basal cell carcinoma, Reconstruction
  • A. Karbasfrushan, K. Farhadi, J. Amini, Saman, S. Bazargan, Hejazi, A. Ahmadi Page 276
    Background
    The benzodiazepines are used primarily for anxiolysis, amnesia and sedation. However, recent investigations have shown that some forms of this group of drugs have also direct effect on pain. This study aims to determine the effect of midazolam in reducing the severity of pain in women scheduled for elective cesarean section..
    Methods
    In a prospective, double blind randomized controlled trial, two groups parallel study, was conducted in Imam Reza/Moatazedi Hospital, an affiliate of Kermanshah University of Medical Sciences. Parturient women who met study inclusion criteria were consecutively assigned into either experimental (n=62) or control groups (n=62). Women in the experimental group received bupivacaine (10 mg) plus intrathecal midazolam (2 mg/ml) (BM) and those in the control group received bupivacaine plus normal saline (BNS). The outcome pain severity was measured by Verbal Numerical Rating Scale..
    Results
    In comparison with the BNS group, mothers in the BM group reported a significant relief in pain (15 min and 120 min) after the surgery. There were no significant differences between the groups regarding the intensity of pain 5, 30, 60 and 240 min after the surgery. The average time until the first dose of additional analgesic, per mother’s request was 142.18±55.19 min in the BNS vs 178.06±77.33 min in the BM group..
    Conclusion
    Combination of bupivacaine plus intrathecal midazolam was an effective anesthetic technique to provide improvement in pain. The onset of sedation was faster in the BM group compared with the BNS group. The duration of effective analgesia, and the time for regression of sensory analgesia was the same in both groups in our study. However, incidence of nausea and vomiting was higher in the experimental group.
    Keywords: Intrathecal, Bupivacaine, Midazolam, Cesarean Section, Pain
  • M. Salehi, Sm Alavian, Sv Tabatabaei, Sh Izadi, E. Sanei Moghaddam, S. Amini Kafi, Abad, A. Gharehbaghian, S. Khosravi, H. Abolghasemi Page 283
    Background
    Hepatitis B virus (HBV) infection is a major risk factor of cirrhosis and hepatocellular carcinoma affecting billions of people globally. Since information on its prevalence in general population is mandatory for formulating effective policies, this population based serological survey was conducted in Sistan and Baluchistan, where no previous epidemiological data were available..
    Methods
    Using random cluster sampling 3989 healthy subjects were selected from 9 districts of Sistan and Baluchistan Province in southeastern Iran. The subjects’ age ranged from 6 to 65 years old. Serum samples were tested for HBcAb, HBsAg. Screening tests were carried out by the third generation of ELISA. Various risk factors were recorded and multivariate analysis was performed..
    Results
    The prevalence of HBsAg and HBcAb in Sistan and Baluchistan was 3.38% (95% CI 2.85; 3.98) and 23.58% (95% CI 22.29; 24.93) respectively. We found 8 cases of positive anti-HDV antibody. Predictors of HBsAg or HBcAb in multivariate analysis were age, marital status and addiction..
    Conclusion
    The rate of HBV infection in Sistan and Baluchistan was higher than other parts of Iran. Approximately 25% of general population in this province had previous exposure to HBV and 3% were HBsAg carriers. Intrafamilial and addiction were major routes of HBV transmission in this province.
    Keywords: Epidemiology, Hepatitis, HBV, Iran
  • B. Fatholahzadeh, A. Bahador, M. Haghighi Hasanabad, F. Bazarjani, F. Haghighi Page 289
    Background
    There are more than 30 different sexually transmissible agents while the most common one is Chlamydia trachomatis. In this prospective study, we decided to compare the prevalence of infection in symptomatic and asymptomatic females..
    Methods
    Two hundred sixty urine samples of women in two groups (symptomatic and asymptomatic) were collected from patients attending Mehrad Hospital in Tehran, Iran and tested by polymerase chain reaction..
    Results
    Thirty nine women in both groups were infected (14.99%), while 27/130 subjects were in symptomatic group (20.76%), compared with 12/130 person in asymptomatic group (9.23%). No statistically significant difference was found between two groups. Data analysis showed infection with C. trachomatis in symptomatic women to be significantly associated with history of sexually transmitted infections, white blood cells in urine and epithelial cells in urine..
    Conclusion
    The present study recommends that targeted screening programs in high risk sexually active women (like as individuals who had a history of STIs) are needed as part of case-finding strategies and treatment.
    Keywords: Chlamydia trachomatis, Prevalence, Women, PCR, Iran
  • Sh Yektatalab, Mh Kaveh, F. Sharif, M. Fallahi Khoshknab, P. Petramfar Page 294
    Background
    Due to the increase in the number of Alzheimer’s patients in Iran and also the limitation of cultural knowledge about caring of these patients, this study was designed to explore the perceptions of Iranian caregivers about caring Alzheimer patients in the elderly care homes..
    Methods
    A qualitative content analysis method was conducted on two elderly care homes of Shiraz/Iran, during 2009-2011. Fourteen key informants (10 women and 4 men, between 25-35 years of age), who had been working in elderly care homes caring for the elderly with Alzheimer disease for about 1-11 years (Mean=30 months) were selected by purposive sampling method. The caring experience and ability of transferring their experience to others were the main criteria for selection of the participants. They were participated in 2 focus groups and 4 interviews..
    Results
    Nearly, 800 initial codes were extracted and categorized into 3 groups of "multidimensional care", "going along with the patients" and "need to be professional" and 12 subcategories. Although several aspects of care were mentioned by the participants but the main aspect was physical care. Infantilizing the patients was the main feature of care and caring personality was an important characteristic of caregivers..
    Conclusion
    An appropriate schedule of care considering main categories and subcategories of this research based on cultural context should be prepared. Moreover, consistent promotion of the schedule, employment of trained staff and plans for continued education for them can improve the quality of care and patient's life in elderly care homes.
    Keywords: Alzheimer disease, Elderly care home, Perception, Care
  • Mj Moradian, B. Rastegarfar, R. Salahi, Hr Abbasi, Sh Paydar, Mr Rastegar, M. Dehghani, S. Mousavi, E. Shirzad, M. Khorrami, M. Esnaashar, Sh Bolandparvaz Page 300
    Background
    Considering the limited available resources, high cost of the helicopter emergency medical service (HEMS), and high load of trauma patients especially in our centers, a careful assessment of HEMS in our center seemed to be necessary for trauma patients.
    Methods
    From April 2001 to September 2007, the data of all patients transferred by HEMS were extracted including: Annual number of services, clinical category, number of proper or improper services, and rescue time for HEMS and ground ambulance. The criteria for the properly transferred group included: Death or being operated in the first 24 hours of admission, admission in ICU care units, and transfer of more than three patients in one mission. Others were considered as improper group..
    Results
    In this period through 185 flights, 225 victims were transferred. The most common reason of HEMS dispatching was trauma. The most difference of rescue time between ground ambulance and HEMS was recorded in Lamerd that was transferring patients with HEMS needed 3 hours less than ground ambulance. However, in Sarvestan, Dashte-Arjan, and Marvdasht, transferred patients with ground ambulance needed less time than air transfer. Most of transferred patients were from Kazeroon, Nourabad and Lamerd respectively while 46.3% of patients were in the proper group, and the rest were considered as improper group..
    Conclusion
    Our study revealed that helicopter dispatch to the cities like Lamerd, Lar, Khonj, Abadeh can be more effective, whereas, for the towns like Marvdasht, Dashte-Arjan, Sarvestan, Sepidan, Saadatshar, Tang Abolhayat use of HEMS should be limited to specific conditions. Our study showed inclusion of physicians in the decision making team increased the number of transferred cases.
    Keywords: Iran, Helicopter, Ambulance, Air transfer, Trauma
  • A. Tol, Gr Sharifirad, Ag Pourreza, A. Rahimi, D. Shojaeezadeh, Mr Mohajeritehrani, F. Alhani Page 305
    Background
    Patient empowerment can enhance the outcomes of care such as metabolic control as well as quality of their life. This study evaluates the Iranian version for development of a valid and reliable diabetes empowerment scale..
    Methods
    Validity and reliability of Iranian version of Diabetes Empowerment Scale (DES-LF) were measured through a cross-sectional study. DES-LF was evaluated through a qualitative and quantitative study by 160 type 2 diabetic patients..
    Results
    Reliability and validity of the scale and its 3 subscales, namely, managing the psychosocial aspects of diabetes (a=0.94), assessing dissatisfaction and readiness to change (a=0.96), and setting and achieving diabetes goals (a=0.96) were approved by a psychometric analysis..
    Conclusion
    Findings approved the reliability and validity of the Iranian version of DES-LF for patient education and psychosocial interventions among Iranian people with type 2 diabetes.
    Keywords: Empowerment_Type 2 diabetes_Reliability_Validity_Iran
  • M. Nematollahi, N. Khalesi, H. Moghaddasi, M. Askarian Page 309
    Background
    For the purpose of minimizing the HIV/AIDS epidemic effects, one of the programs is the promotion of scientific methods and setting of the suitable surveillance systems. The present research was conducted to design the HIV/AIDS surveillance system in Iran applying WHO recommendations and the experience of some countries..
    Methods
    In 2009, based on the country's requirements, the HIV/AIDS surveillance system was proposed and designed for Iran. The Delphi technique was utilized to find the views of experts. Data analysis was conducted based on a comparison of the attributes of the HIV/AIDS surveillance systems in the countries under consideration using a descriptive and theoretical analysis..
    Results
    The model was approved obtaining the final score of 36.3 out of 44, viz 82.5%..
    Conclusion
    Designing and performing of the HIV/AIDS surveillance pattern in the direction of “second generation of HIV/AIDS surveillance” can be considered as an important step in the improvement of the patient’s control and precaution of HIV/AIDS.
    Keywords: HIV, AIDS, Surveillance system, Iran
  • B. Geramizadeh, Mr Farzaneh, M. Ramzi, Or Momenzadeh Page 313
  • M. Entezari Asl, Kh Isazadehfar, G. Akhavanakbari, M. Khoshbaten Page 316
  • O. Ogenler, G. Yapici, B. Tasdelen, T. Akca Page 318