Medical Journal of The Islamic Republic of Iran
Year:2011 | Volume:25 | Issue:2|Papers Count:9

Medical education in Iran stands to benefit from twenty years of well documented developments: new medical schools, a single Ministry of Health and Medical Education, strong primary care in rural areas, a commitment to evidence based medicine, a priority of social accountability, mandated continuing medical education, and funding from Educational Development Units and research in medical education.Some years back, concerns about rigidity of the national curriculum, both in content and implementation initiated a national process of consultation and renewal, supported by Annual Medical Congresses.

Background: Personality disorders have essential roles in developing and maintaining depressive episodes, though psychotherapies must approach both symptoms and personality problems. This study examined the efficacy of Brief Object Relations Psychotherapy on depression severity and perceived quality of life of women suffer from major depressive disorder comorbid with cluster C personality disorders.Methods: by purposive sampling method, 6 subjects which met the in/exclusion criteria, were participated in a single subject design study randomly. Interventions were arranged based on A/B with follow up design. Each subject completed Beck Depression Inventory (BDI-II) and original McGill Quality of Life Questionnaire (MQOL) every session during 3 baseline, 15 treatment and 3 follow up assessments sessions.Results: Patients totally reached 55% remission in depression severity with mean effect size 1.92 and 43% remission in perceived quality of life with mean effect size 2.08. Gains were maintained in follow up.Conclusion: The efficacy of Brief Object Relations Psychotherapy was statistically and clinically significant. Perceived quality of life reached to normal range, whereas cluster C personality disorders resistance remission from depression.

Background: Research suggests that factors in the environment are major determinants of health behavior for populations. This cross-sectional study used a combination of quantitative and qualitative data collection methods to determine the prevalence of smoking and identify the possible associations between smoking and environmental variables among school pupils in Iran.Methods: A self-reported questionnaire was administrated and collected data from 2200, students15-18 from 100 high schools who agreed to take part in the research. The sample was selected from the Iranian Education System Database using a two-stage cluster sample based on a random sample of schools and pupils as a representative sample of this population. Almost 90% of respondents had completed the questionnaires. Examination of the test-retest answers over all questions among 70 students in two weeks interval revealed reliability coefficient ranges 0.72 to 0.98. The Adjusted Enter Logistic Regression Models were applied to significant variables identified through Chi square tests. In addition, 40 of the sample took part in focus groups exploring the facilitators and barriers to smoking behavior. Content analysis was also used to extract themes from the focus group discussions.Results: The effects of social environment variables including peers', mothers', and sisters' smoking on cigarette consumption among young people were explored in this study. Levels of cigarette availability and exposure, effects of parents' attitudes and supervision, legislation on tobacco control, expanding life opportunities and more options for leisure activities perceived as influencing factors on adolescent smoking were all highlighted in the focus group discussions.Conclusion: The qualitative and quantitative findings revealed the impact of social environment on smoking behavior among young people. This study provides strong evidence to support environmentally oriented smoking prevention programs targeting young people.

Background: The aim of this study was to investigate the various aspects of illness perceptions about breast cancer in affected patients.Methods: A cross-sectional study enrolled 140 patients with breast cancer in their chemotherapy period within 14 months. The revised Illness Perception Questionnaire (revised IPQ) was used to assess the disease representations of breast cancer. The data were analyzed by SPSS v.18 software.Results: The mean age of participants was 49.3±10.3 years. There was no significant correlation among the various items of illness perception of breast cancer in the affected patients with the demographic and clinicopathologic stages of the disease (P>0.05). The present study explored breast cancer to identity component 2.1 (less symptoms attributed to cancer), timeline component 2.86 (encountered to a acute illness), treatment control 3.21 (less therapeutic belief), illness coherence 3.29 (less knowledge about cancer), serious consequences 2.79 (not attributing too much grave results), personal control 3.43 (illness controllable by the personal measures) and emotional representations 2.90 (emotionally good). Also most of our patients attributed stress as the cause of breast cancer (93.6%).The internal consistency of revised IPQ was 0.84 (Cronbach alpha).Conclusion: The patients affected with breast cancer perceived their illness to be short with better personal controllability. They had optimistic views towards the personal, familial and social implications of their illness.Also our patients showed less distress, anger and disappointment while being less optimistic about the treatment modalities and less coherent about their illness.

Background: It has been demonstrated that noscapine, an antitussive opioid alkaloid, could antagonize bradykinin- induced responses such as bradykinin effects in guinea-pig ileum, cough induced by bradykinin receptor agonist and angiotensin converting enzyme inhibitors, and brain damage after brain edema both in neonatal rat model and in patients with stroke. In the present study, the effect of noscapine on bradykinin-induced constriction of human umbilical artery was investigated.Methods: Segments of human umbilical cords were obtained from women with normal full term pregnancies. Concentration-response curves for bradykinin (1-1000 nM) were constructed in the absence and presence of noscapine (1-1000 nM). To show the specificity of noscapine for bradykinin-induced constriction in the tissue, the effect of noscapine (10 pM) on vasoconstriction produced by histamine were also examined.Results: The results showed that noscapine could antagonize the constriction produced by bradykinin in human umbilical artery. It was also demonstrated that noscapine was capable of reducing histamine-induced contractile response.Conclusion: It is concluded that noscapine can antagonize bradykinin-induced constriction of human umbilical artery in a nonspecific manner. Thus, noscapine is likely to find a clinical application in pathologic conditions accompanied by higher vascular sensitivity to bradykinin in pregnancy.

Background: Unstable Pelvic fracture, a result of high energy antero-posterior compression injury, has been managed based on internal fixation and open reduction. The mode of fixation in Unstable Pelvic fracture has, however, been a subject of controversy and some authors have proposed a need to address the issue of partial breach of the pelvic ring elements in these injuries. This study was performed to evaluate the functional and radiological results of treatment of pelvic ring fractures by open reduction, internal fixation.Methods: Thirty eight patients with unstable pelvic fractures, treated from 2002 to2008 were retrospectively reviewed. The mean age of patients’ was 37 years old (range 20 to 67). Twenty six patients were men and 12 women. The most common cause was a road traffic accident (N=37, 97%). There were 11 type-C and 27 type-B fractures according to Tile’s classification. Thirty six patients sustained additional injuries. The most prevalent additional injuries were lower extremity fractures. Open reduction, internal fixation as a definite management was applied for all patients. Quality of reduction was graded according to the grades proposed by Matta and Majeed’s score was used to assess the clinical outcome. The mean period of follow-up was 25 months (ranged from 6 to 109 months). About 81.6% of patients had either good or excellent radiological reduction.Results: The functional outcome was excellent in 66%, good in 15%, fair in 11% and poor in 7% of the patients. There were 4 postoperative infections. No sexual function problem was reported. Nerve deficits recovered completely in 2 and partially in 3 of 11 patients with preoperative neurologic deficiency. There was no significant relation between functional outcome and the site of fractureConclusion: Unstable pelvic ring fracture injuries should be managed surgically by rigid stabilization that must be carried out as soon as the general condition of the patient permits, and even up to two weeks.

Background: Morning report is an integral component of medical training programs. It is conducted as "evidence based" or "problem based". It takes an efficient time of all members of the medical team in teaching hospitals, it seems necessary to evaluate its role in the education. Because of the importance of morning report in education, we evaluated the current and ideal conditions of morning report according to the opinions of medical teams in teaching children’s hospitals.Methods: A cross- sectional descriptive study conducted in three children’s teaching hospitals in Tehran in 2005. The opinion and perception of 358 participants, including faculties, residents, fellows, interns, and medical students, were collected by a questionnaire regarding the importance and structure of morning report. The data were presented as frequency and percentage.Results: 78% of respondents expected a high educational role for morning report. Although 317 (88.54%) had a regular attendance in morning report, only 34.1% were satisfied from current condition. The majority believed that faculty had better to lead the sessions, and voted for case presentation to be selected by senior resident on call, despite the prominent current leadership of the faculty. Most of the participants (88.6%) preferred complicated and unusual cases for presentation.Current morning reports predominantly based on the presentation of the interesting or complicated cases were admitted on the previous day. A few number of cases were reintroduced after achieving the final diagnosis. In addition out-patients and those under observation in emergency room were usually ignored in the meetings.Conclusion: Regarding the educational role of morning report, there is a far distance between the present and ideal condition. Unattractiveness of presentations and poor participation in discussion might have negative impact on achieving the goals.

Traumatic descending thoracic aorta pseudo aneurysms have been treated traditionally with open surgery in the past, which have had noticeable rates of mortality and morbidity. A safer method of treatment for this disease is made possible with recent progress in endovascular treatment techniques. In this article, we present three cases of Traumatic descending thoracic aorta pseudo aneurysms that were treated with Thoracic endovascular aortic repair (TEVAR) and discharged from our clinic without any complication.

Patella is a relative uncommon site for chondroblastoma. Most of cases of chondroblastoma in patella reported in literature are treated with patellectomy. We treated a large chondroblastic lesion in patella of an 18- year-old male with curettage, burring & bone graft and the result was satisfactory after 3 years post operation.