Journal of Medical Council of Iran
Year:2023 | Volume:41 | Issue:1|Papers Count:8

At least one third of adults around the world suffer from chronic pain. These types of pain have a great impact on physical activity, wellbeing, sleep, depression, social isolation, and the quality of life in people suffering from it. Various treatments are available to treat chronic pain. One of them is the use of antidepressants. Recently, a network meta-analysis has examined the effectiveness of these drugs. In this commentary, we have discussed the importance of the subject and the investigation of the claim of this study and the evaluation of its method.

Substance Use Disorders (SUDs) are common worldly wide and are one of the leading causes of mortality and morbidity worldwide. World Health Organization (WHO) has estimated that the burden of disease attributable to SUDs is approximately 1.5% of the global burden of disease in the world. In response to this global problem, different countries have used different policies and frameworks over past years. The National SUDs Treatment Framework proved to be a framework through which service providers can ensure that people affected by illicit drug use have access to a range of integrated options tailored to their needs. The most important strategies that have been used in the world for years to solve the problem of substance abuse are War on Drugs (WOD) and Harm Reduction (HR).

Background: Fatigue is common after chronic stroke, which may cause upper extremity sensory-motor dysfunction, as well as decreased independence in activities of daily living (ADLs) and participation. This study aimed to investigate the effects of upper extremity exercises based on fatigue prediction on sensory-motor functions and ADLs in subjects with chronic stroke. Methods: This is a pilot study. Twenty subjects with chronic stroke (11 male and 9 female) with mean age of 56±14.09 years and mean time since the stroke of 71.05±53.5 months were randomly assigned to either the control group (receiving conventional rehabilitation) or intervention group (receiving unimanual exercises based on fatigue prediction) using the Kinect Upper extremity motor function. Fine and gross manual dexterity, grip strength, shoulder and elbow proprioception, independence in ADLs, participation, and fatigue severity were assessed before the interventions, after the interventions (6 week, each weak 3 session, for 45 minute) and 6 weeks following the completion of the interventions (i.e. follow up).  Result: In both control and intervention groups, a significant improvement was observed in all assessments (P≤0.05), except for independence in ADLs. Moreover, the decrease in fatigue severity and improvement in fine manual dexterity was significantly greater in the intervention group compared with the control group (P≤0.05).  Conclusion: The results of this study indicated that upper extremity exercises based on fatigue prediction led to an improvement in upper extremity sensory-motor functions, manual dexterity, and participation as well as a decrease in fatigue severity in subjects with chronic stroke.

Background: Common anti-depressant drugs have various and sometimes serious side effects that can cause intolerance and arbitrary discontinuation of the drug by the patient. In this research, the anti-depressant effects of rosmarinic acid were investigated in mice and in groups of seven members using the forced swimming test (FST) and tail suspension test (TST). Methods: For this purpose, intraperitoneal injection of rosmarinic acid with doses of 50, 20, 10, and 5 mg/kg in 5 groups of rats, as well as gavage of citalopram suspension with doses of 15 mg/kg in 2 groups and injection of normal saline in the control group for 7 days and then the FST and TST tests were performed. The mean ± standard error of the data obtained from each group was analyzed separately by one-way ANOVA test and P<0.05 was considered significant in each test. Results: Rosmarinic acid in doses of 5, 10, and 20 mg/kg in both FST and TST tests had significant antidepressant effects compared to the group receiving normal saline (P<0.05) and also in the group receiving citalopram 15 mg/kg along with 50 mg/kg. Rosmarinic acid showed a significant difference in antidepressant effects compared to the group receiving normal saline (P<0.01). The dose of 50 mg/kg of rosmarinic acid did not have significant antidepressant effects compared to the control group. Conclusion: The findings indicate that rosmarinic acid in low and medium doses has obvious and significant antidepressant effects compared to the normal saline control group, but it does not have an obvious superiority compared to citalopram. An antidepressant effect was not observed in the high dose of rosmarinic acid, which could be due to the predominance of its sedative effects. Therefore, it can be concluded that the antidepressant effects of this agent are not dose-dependent and follows a U-shaped dose-response curve.

Background: This research was conducted with the aim of investigating the design of the human resource empowerment model with a digital approach in the organization of the medical system. Methods: It is an applied research and part of mixed methods, which uses qualitative and quantitative methods. In the qualitative research method, thematic analysis method is used. The statistical community of this department includes top managers of the medical system who had more than two years of management experience in the medical system organization and the professors of the university, whose education was a specialized doctorate in management and had the scientific rank of assistant professor, formed a sufficient number of 20 people. After collecting the data, the data was coded in thematic analysis method, and the obtained indicators and components were used to design a quantitative questionnaire based on the 5-option Likert scale, and descriptive survey method was used in the quantitative method. Finally, the final model was presented using structural equations. In the qualitative part, face and content validity was examined, and the reliability of the qualitative part was examined using the Kappa coefficient index. In the quantitative part, the validity and reliability of the questionnaire was checked with Cronbach's alpha coefficient, CVR and CVI, and then, for statistical analysis, the Kolmogorov-Smirnov test was used to check and test the measurement model, diagnostic reliability, convergent validity and divergent validity. Findings: The results of the research showed that the factors affecting the empowerment of human resources with a digital approach in the organization of the medical system include: strategic planning, development of organizational communication, development of cultural and social factors, training and empowerment of human resources with a digital approach, development of management factors, development of individual characteristics, development of financial and economic resources, development of organizational factors and identification of the challenges of advancing the empowerment of human resources in the medical system. Conclusion: Finally, the obtained results indicate that in order to develop and empower human resources with a digital approach, the challenges ahead must be identified and resolved.

Background: Rheumatoid Arthritis (RA) is an inflammatory autoimmune disease, affecting multiple joints. Temporomandibular joint disorders (TMD) are common in these patients. Also, parafunctional habits can lead to signs and symptoms of TMD. The purpose of this study was to determine the prevalence of TMD and parafunctional habits in patients with RA. Methods: Forty patients with RA (according to ACR-1987 criteria) participated in this cross-sectional study. The patients’ information was collected by clinical examination and questionnaire. The DAS-28 criteria were employed to determine the disease severity. Thereafter, the TMD (according to RDC/TMD criteria) and parafunctional habits were compared to the control group (n=40). Results: 85% of RA patients had at least one sign or symptom of TMD. The prevalence of joint sound and jaw deviation in patients with RA were 75 and 27.5%, respectively. These values were significantly higher than the values in the control group. A comparison between parafunctional habits demonstrated that both groups had the same frequency for bruxism and clenching. The masticatory muscle tenderness was reported in 32.5% of RA patients. Conclusion: The prevalence of TMD in patients with RA is considerably higher than in healthy group. Unlike patient’s expressions, more tooth wear and muscle tenderness may indicate the probability of prevalence of bruxism and clenching in these patients.

Background: Autism spectrum disorder (ASD) is one of the neurodevelopmental disorders and the most common progressive developmental disorder associated with motor deficits, social relations, stereotyped behaviors, and movement disorders. According to the increasing statistics of autism, the problems and burden that this disorder causes for the child, family, and society, and also the necessity of providing a comprehensive rehabilitation exercise program to improve the developmental disorders of these children from childhood and elementary school ages, this issue has gained importance. Therefore, the present research aims to determine the effect of the selected rehabilitation exercise program on the motor development of autistic children. Methods: In this semi-experimental study, autistic children (girls and boys) aged 8 to 12 years from the rehabilitation center of Tehran were selected based on HFA and IQ (70-90). After completing the consent form, the parents voluntarily participated in the research. After the pre-test, they were selected for rehabilitation exercises for 8 weeks (24 sessions) of 60 minutes.  We used the single-subject research method to increase the accuracy and effectiveness of the selected training program. In the end a post-test was taken. The Bruninks-Oseretsky test was used to evaluate the results of the training program on the motor development of gross and fine skills. Results: The findings showed that selected rehabilitation exercises were an effective measure in improving the development of motor skills (gross and fine) in children with autism. Also, both subjects showed significant growth in all subtests of gross motor skills (speed, running, and, agility), balance, bilateral coordination, strength, and fine motor skills (upper limb coordination, response speed, motor vision control, upper limb speed, and agility). Conclusion: It seems that performing 8 weeks of selected rehabilitation exercises by improving the physiological function of muscles and the central nervous system and improving psychological abilities, increases movement skills (gross and fine) in autistic children.