QOM UNIVERSITY OF MEDICAL SCIENCES JOURNAL
Year:2007 | Volume:1 | Issue:3|Papers Count:8

Background and objectives: Endoscopic retrograde cholangiopancreatography (ERCP) has been used as the method of choice in assessment of obstructive jaundice for a long time. Recently, the development of endoscopic ultrasonography (EUS) has attracted the attention of clinicians as an alternative accurate, safe and cheap method to replace the ERCP procedures performed only for diagnostic purposes.Methods: In this study, 100 patients underwent endoscopic ultrasonography in Digestive Disease Research Center, Shariati Hospital. The patients were divided into two groups: 1) those with operable periampullary tumors who were referred to the surgeons, 2) other patients. The final diagnosis made after ERCP and operative removal of the mass was considered as the gold standard and was compared with accuracy of endoscopic ultrasonography.Results: The overall accuracy of endoscopic ultrasonography in the diagnosis of obstructive cholestasis was 92.0%. Sensitivity and specificity of this method in diagnosis of choledocholithiasis were 95.2% and 96.4% respectively. The corresponding values for diagnosis of periampullary tumors were 96.2% and 95.8%.Conclusion: In this study the accuracy of EUS in diagnosis of obstructive jaundice and its sensitivity and specificity for diagnosis of choledocholithiasis and periampullary tumors were high. Therefore, it could be concluded that endoscopic ultrasonography is a reliable diagnostic tool for extrahepatic cholestasis.

Background and objectives: This study aimed to validate the West Haven-Yale Multidimensional Pain Inventory (WHYMPI) for Iranian patients with chronic pain.Methods: 585 patients with chronic pain in legs, back, hands, neck and shoulders were entered into this study. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI) was used for assessment of pain in these patients. For validation of this inventory the results were compared with those obtained from Brief Pain Inventory (BPI), Beck Depression Inventory (BDI), State Trait Anxiety Questionnaire and Enrich marriage inventory.Results: Using Cronbach's alpha, validity of the first section of WHYMPI was 0.86, the second section was 0.78, and the third section was 0.75. The Test-retest correlation was 0.95. Also, the correlation of each individual section with the whole inventory was positive and significant.Conclusion: The results indicate that modified form of the West Haven-Yale Multidimensional Pain Inventory (WHYMPI) can be used in Iran.

Background and objectives: The immunobead binding test (IBT) and the mixed agglutination reaction (MAR) are the most commonly used methods for detection of antisperm antibodies (ASA). The detection of ASA by flow cytometry (FCM) was first described by Haas and Cunningham. Both assays can be performed as direct or indirect methods. In this study, indirect FCM was compared with the direct MAR for detection of ASA. Methods: Semen samples were obtained from 80 men (infertile couples) in Isfahan Fertility and Infertility Center. Seminal plasma samples were incubated with ASA-negative donor sperm. Then, surface-bound antibody was detected with FITC-labeled antihuman immunoglobulin directed against IgA and IgG in the indirect FCM assay. ASAs bound to the surface of patients’ sperm were detected by direct MAR test. Results: The indirect FCM correlates with direct MAR for detection of IgA antisperm antibodies (r=0.55 and P=0.006). The indirect FCM, however, does not correlate with direct MAR for the detection of IgG antisperm antibodies (r=0.25 and P=0.25). Conclusion: Some of the ASAs in seminal fluid bind to spermatozoa. Therefore, indirect tests to detect ASAs in seminal plasma are likely to miss the presence of IgG antisperm antibodies while they effectively detect IgA antisperm antibodies.

Background and objectives: Education and management are considered two integrated and non-separable requirements of an emergency department (ED). Despite the emphasis on teaching of essentials of approaching and management of critical patients, medical students do not acquire the necessary knowledge to handle these patients during their rotation in different specialties other than emergency medicine (EM). This study aims to evaluate the changes in EM knowledge of interns during their one month rotation in ED of Rasoul Akram Hospital.Methods: In a 15-month period, 226 interns were entered into this study. A pretest was taken at the beginning of their one-month internship period. Then, the interns were provided with a handbook, which was prepared and revised according to the approved curriculum of Ministry of Health and Medical Education of Iran and latest emergency medicine textbooks. The interns were taught by several lecture and practical sessions. At the end of their EM internship period, a post-test was taken and the change of their emergency medical knowledge was assessed by comparison of pre-and post-test results.Results: The results showed a significant increase of mean post-test scores compared with the pretest scores. Also, there was a significant difference between the scores obtained by males and those obtained by females (P<0.001).Conclusion: The one-month EM training significantly improved the level of interns’ knowledge.

Background and objectives: In chronopharmacology the biological rhythm variations caused by drug administration is assessed. Evaluation of the time of drug administration and the qualitative and quantitative effects of reactions to drugs is called chronopharmacodynamics. In this study, we assessed the chronopharmacodynamics of intrathecal co-administration of sufentanyl and bupivacaine in surgical operations of lower extremities.Methods: In 2006, patients aged 20-50 with ASA physical status of I and II, who underwent surgical operation of lower extremities were entered into this prospective study. The patients received a slow intrathecal injection of 10mg sufentanyl and 15 mg bupivacaine into subarachnoid of third and fourth lumbar spaces in 30 seconds. After the operation, the time of first pain sensation and the visual analogue scale (VAS) score, as the measure of severity of pain, were recorded.Results: 115 patients were studied in this project. The pain-free interval was considered as the time between injection and patient’s demand for pain relief. This interval was 746 (± 322) minutes. The average score of pain severity on VAS at the time of demand for pain relief was 24.7 (± 9.3). The average pain-free duration in patients injected about noon or at midnight was significantly longer than the pain-free interval of other patients.Conclusion: The results show that intrathecal co-administration of sufentanyl and bupivacaine at noon or midnight (conforming to the circadian rhythm) causes better pain-relief with longer duration in comparison with other times of the day or night.

Background and objectives: The number of hemodialysis patients has been increasing in recent years. Accumulation of metabolic waste products due to nonobservance of the proper diet is one of the mechanisms that threaten the health of these patients. In this study, the effects of lecture and handbook education methods have been evaluated on changes of body weight, serum sodium, potassium, blood urea nitrogen, creatinine and phosphorus in hemodialysis patients.Methods: In this clinical trial study, 113 hemodialysis patients were divided into three groups including control, lecture education, and handbook education groups. The indices were measured monthly, starting 3 months before and continuing for 3 months after the intervention. A comparison was made between the mean of each index measured before and after the intervention, using One-way ANOVA, followed by the Tukey’s post-hoc test.Results: Except sodium concentration, all other indices showed a significant reduction in both lecture and handbook education groups in comparison with controls (P<0.05). Although, in lecture education group the reduction of indices was higher than handbook education group, the reduction was not significant except for the serum blood urea nitrogen.Conclusion: Education can effectively help hemodialysis patients to reduce their weight and serum indices and it seems that education by lecture is more effective than by handbook.

Background and objectives: Occupational health is a very important issue in all sectors, and particularly, agriculture. Agriculture is a potentially hazardous industry associated with many occupational injuries and illnesses. Knowledge and practice of farmers and their educational needs is essential for preparation of a suitable educational package. This study aims to determine the level of knowledge and practice of farmers in regards to the occupational health in Qom agriculture industry.Methods: Two hundred Qom farmers were randomly entered into this cross-sectional study. A questionnaire was designed for data collection and the farmers were interviewed. SPSS 11.5 was used for data analysis.Results: We found that farmers have a low level of knowledge (10%) in regard to occupational respiratory, gastrointestinal and renal disorders. The lowest level of knowledge was related to the preventive measures including not blowing the nozzle of the pesticide sprayer (18%), noise reduction measures (18.5%), and application of sunscreen (20%). The most undesirable practices observed were wearing of filter mask (8%) and observance of safety measures for tractors’ driver cabin.Conclusion: Present findings suggest that farmers have inadequate knowledge in regard to occupational disorders. Therefore, effective interventions to increase their level of knowledge and safety of their occupational behavior are recommended.

Background and objectives: The primary goal of therapy in patients with chronic hepatitis B is durable suppression of HBV DNA to the lowest possible level. The threshold of HBV DNA level to initiate therapy is ³105 copies /ml for patients with HBe antigen–positive and ³104 copies /ml for patients with HBe antigen-negative chronic hepatitis B. Interferon a2b, lamivudine and adefovir dipivoxil are FDA-approved and could all be used as an initial first-line therapy in chronic hepatitis B. It was shown that adding lamivudine to either conventional interferon or peg-interferon did not increase the efficacy of treatment. Also, addition of lamivudine to adefovir had no additional effect in compensated patients. Response rate is about 30-40% with first-line drugs. Peg-interferon, which recently received FDA approval, was associated with an increased response rate. Further long-term studies are required in order to use Peg-interferon as a wide-scale first-line treatment. Treatment strategy is changing towards using prolonged combination therapy with evolving nucleoside analogues with or without an immunomodulatory agent, aiming to eradicate cccDNA.