نشریه طب انتظامی
سال سوم شماره 1 (پیاپی 8، بهار 1393)

Association of anxiety disorders and complex nature of Posttraumatic stress disorder (PTSD) entails examining and applying new treatments therapies. The aim of current study was to determine the effectiveness of cognitive training component in reducing symptoms of PTSD. This quasi-experimental study was conducted with pre-post test and follow- up design using control group from all veterans patients with PTSD who lived in Urmia. For this reason, 40 patients were randomly selected and divided into two equal experimental and control groups. Experimental group experienced 8 sessions of Wells’s metacognitive therapy. While the control group was only followed. Mississipi scale was used as a diagnostic tool and PCL checklist as well as metacognitive test used as evaluation tools in the pre-test, post-test and follow up after two months. The results were recorded. Data were analyzed by multivariate covariance test (ANCOVA) and t-test. Our results indicated that there is a significant difference between mean metacognitive component’s scores of experimental and control groups in post-test and follow up(P<0/01). Experimental group also showed the significant decreas in total scores of general symptoms than the control in post- and follow- up test. These results showed that the metacognitive components in veterans with PTSD are disordered and applying metcognitive model of Wells will be effective on decreasing general symptoms of PTSD.

The final goal of hospitals is improving patient safety and this is requires fundamental changes in processes and positive organizational culture. This study aimed to analysis the relationship between patient safety culture and patient's perception of Healthcare quality in military hospitals in Tehran. This was a descriptive and cross sectional study that performed in military hospitals in Tehran. The study population consisted of 125 staffs of hospitals and 125 patients were selected by using Cochran's formula formed by random stratified sampling. Data collected with use of two questionnairs:1) HSOPSC as a standard tool for patient safety culture assessment and 2) CAHPSHS for patient's perception of Healthcare quality measurement. Descriptive statistics and correlation test were used to analyze the data. The results showed that most employees in this study (%61.81) women and 39.18% of them were male. Based on our achieved results the average scores of overall perceptions of safety was 14.28, actions and expectations of the manager/supervisor in order to promote safety was (12.52), teamwork was (15.33), transparency of communications was (10.34), response to errors without punishing was (8.98), supporting of hospital management from patient safety was (10.6) and the relocation and transfer of patient information was 11.65. Pearson correlation showed that despite the positive correlation between patient safety culture from staff's point of view and patient's perception of Healthcare quality scores (r= %10), this relationship was not statistically significant (P- value= 0.13). With increasing patient's safety culture in hospitals, we can not expect the better perception of quality of care due to health care quality affected by several other factors.

Acute and resistant rise in ICP is a cause of permanent disability in acute traumatic subdural hematoma. The objective of this study is to compare outcomes of two methods of decompressive surgery in acute traumatic subdural hematoma. This study performed from March 2010 to June 2011 in Kamyab Hospital of Mashhad University of Medical Science, and patients who underwent surgical treatment divided to; Craniotomy & Duraplasty (Group I) and Craniotomy & Duraplasty & Lobectomy (Group II). Glascow coma scale (GCS) were assessed in pre- operative evaluation in addition to mortality rate and Glascow Outcome Scale (GOS) at 3 months. Statistical analysis was performed with SPSS18 by Chi- Square and T- student and Mann– Whitney test. 87 patients with acute traumatic subdural hematoma contributed in this study. There were 52 patients in group I and 35 patients in group II There were not any significant relationship in preoperative GCS (p= 0.93), in 3 months postoperative GOS (p= 0.35) and Mortality rate (p= 0.48) between two groups. There were not any statistical relation between preoperative GCS and postoperative GOS in group I (p= 0.15) and group II (p= 0.07). There was a statistical relationship between preoperative GCS and mortality rate in group I (p= 0.04) but not in group II (p= 0.63). Postoperative outcome after 3 months were similar in Craniotomy & Duraplasty and Craniotomy & Duraplasty & Lobectomy operations. Patients after Craniotomy & Duraplasty & Lobectomy operation discharged later from ICU and hospital.

As a serious social problem in Iran that leads to many social damages and deviations, Addiction requires primary and secondary preventions. Therefore, present study has been conducted with the aim of assessing primary prevention approaches and relapse prevention from the view of patient admitted to treatment center in Ahvaz during 2012- 2013. In this cross-sectional descriptive research, 200 of addicts referred to 8 treatments centers were selected by random- cluster sampling in a six month period. Data were collected by structured interviews and a 3 part researcher designed questionnaire (included demographic data, primary prevention approaches and relapse prevention) and analyzed with SPSS19. The mean age of participants in the research was 32.19 + 9.40 years, the mean age of onset for drug abus was 20. 7 + 7.37 years and the mean of addiction was 10.84 + 8.30. In the field of primary prevention approaches, familial, educational, social and economic approaches and in the field of relapse prevention, educational, familial and socioeconomic approaches were respectively as the most important approaches from patient perspective. According to achieved results, in all programs of primary and relapse prevention of addiction, in addition to considering individual approaches, familial, educational, social and economic approaches should be included with regard to their importance to achieve the most efficacy.

Programmed cell death or apoptosis is one of the most important physiological processes involved in development and homeostasis maintenance of multicellular organisms. Every defect in apoptosis regulation leads to wide variety of genetic disorders, autoimmune diseases and cancers. Apoptosis is an essential process in both health and diseases. Apoptosis is defined as morphological changes in a cell undergoing programmed cell death. These changes lead to cell shrinkage, nuclear condensation, membrane intrusion, plasma membrane fractionation and their conversion to apoptotic bodies and changes in cell surface membrane which cause phagocytosis of the cell bearing apoptosis. Apaf-1 gene is mutated using PCR and then transfected into HEK293T cells by lipofectamin. 24 h transfected cells exposed to doxorubicin and caspase 3/7 activity was measured over different times. Caspase 3/7 activity was observed obviousely in transfected cells, which was 3 fold greater than those of controls. This data demonstrates the increase in caspase 3/7 activity in HEK293T cells. Based on our observation, the terminus domain in Apaf-1 is probably play a role in releasing the caspases. The results of this study indicated that terminal domain of Apaf-1 has pivotal role in caspase regulation and it is possible to design a biosensor for screening the anticancer drugs by removing terminal domain of this protein.

Perineal trauma is a common problem during operational conflicts that is a surgical emergency. Case report: In this case report, a 25-year-old man was referred to our hospital because of penetrating trauma caused by gunshot. The patient had severe pain, decline of hemoglobin and decreased blood pressure. An emergency surgery was performed immediately. During surgery, a complete destruction of the right testis, cutting the root of the penis and urethra, bladder large rupture, the rupture of the ileum and approximately two liters of blood in the peritoneal space was observed. Resection and the anastomosis of bowel were done, and abdominal vascular and bladder rupture were also repaired. His penis and urinary tract were repaired, as well. Right testis was removed and the cystostomy drain was fixed and the wall was repaired. The patient did not have urinary problems and his erection was normal during follow-up period. This report showed that the multidisciplinary emergency surgery during the least possible time can lead to complete repair of extensive injury to the pelvis and genitalia following gunshot trauma, and the patient had normal and stable condition without any urinary and sexual disorder in seven months follow-up.

The aim of this study is to investigate the trends of incidence rate of morbidity and mortality from traffic accident in urban and suburban areas of Isfahan. This descriptive cross-sectional analytic study conducted with use of data achieved from the National Statistics, according to the Chief of Police (Traffic Police) and recorded in accidents nationwide program in Isfahan province. Incidence rates of injuries and deaths resulting from traffic accidents calculated per 100 thousand of population, based on the occurrence areas of the accidents. Overall, 128477 patients injured from traffic accidents during the study period, that 6392 patients (5%) died. It was found that 99,463 (77.4%) cases of injury (injuries and deaths) occurred in urban and 29014 cases (22.6%) happened in suburban areas. Trend of mortality incidence during the study was ascending, that changes from 4.9 to 26.58 per 100000 person of population. In this study 47.7% of traffic accidents occurred in motorcycle riders, 34.2% in the motorcar and 18.4% in pedestrians. In Isfahan province during 2002– 2010 the incidence of traffic accidents, deaths and injuries were found in ascending trend. Urban areas include the larger proportion of accidents and injuries– and- suburban areas, a greater proportion of deaths. In Urban areas larger proportion of deaths occurred in pedestrians. Motorcycle is the biggest cause of traffic accidents.