Journal of Medical Council of Iran
Year:2008 | Volume:25 | Issue:4 |Papers Count:20

Diagnosis of dementia in early stages improves treatment outcomes and reduces disease burden. Mini-mental state examination (MMSE) is a widely used instrument for diagnosis and screening of dementia in western countries and many other countries. Aim of this study was to prepare and validate the Farsi version of MMSE (F-MMSE).First, MMSE was translated to Farsi. We made some changes in language-related items to improve face validity of test. F-MMSE was applied to 30 patients with dementia and 200 healthy individuals. F-MMSE score in patients with dementia ranged from 1 to 26 with a mean of 13.6 and standard deviation of 6.17. Range of score in healthy subjects was from 18 to 30 with a mean of 26.3 and standard deviation of 2.79. Based on t-test, there was a significant difference between two groups. Using ROC curve, a cut-off point of 22 showed a sensitivity of 90 and specificity of 93.5 percent. It seems that F-MMSE has acceptable validity and a cut-off point of22 can reliably differentiate patients with dementia from healthy subjects.

Design: Cross-sectional studyMethods: Photographs in anteroposterior, lateral and basal view and anthropometric measurements of the face of 300 Iranian men and women were taken and results were compared with the Cummings canons of the facial proportion.Findings: The Cummings canons of facial proportion were not found to be applicable to most of the Iranian men and women in this study; They were significantly different from the measurements of the Cummings (PV<0.05). Conclusions: These findings support the need for ethnically sensitive facial canons. The proportional relationships found in our subjects might serve as a template.

Background: Irritable Bowel Syndrome (IBS) is one of the most common GI problems and almost one-fourth of all patients who visit a gastroenterologist have this complaint. There are several controlled studies about the effect of some antidepressants on the treatment of IBS compared to placebo. However, few studies have compared the effect of antidepressant drugs with each other. This study compared the effect of amitriptyline and nortriptyline on the treatment of IBS. Methods: A total of 60 patients with diarrhea dominant IBS diagnosed using Rome II questionnaire enrolled in this study. We ruled out organic causes with taking history of diseases for each patient and doing some related lab tests such as celiac tests. We randomly divided these patients into two groups (Group 1; 10 mg amitriptyline, Group2; 10 mg nortriptyline). All the symptoms were recorded at the beginning of the study, after one month and finally after 3 months from beginning of the treatment.Findings: We observed a significant relief of symptoms in both groups at the end of first month and also third month of treatment.The overall symptoms' relief changed from 49% to 9% in amitriptyline group and from 52% to 8% in nortriptyline group at the end of third month.Conclusion: Either amitryptyline or nortriptyline are effective drugs in the treatment of diarrhea dominant IBS and there is no significant difference between their effect on this group of patients.

Background: Student counseling centers in cultural and student affairs are responsible and active in physical, mental and social health of university students. This study aimed to investigate youth health promotion through the study of key stakeholders' opinions about different aspects of these centers for promotion of their activities.Methods: This study was a qualitative study based on grounded theory and use of focus group discussion. Students and key informants of 9 medical universities participated in this study. Data collection and analysis were performed at the same time and codes and themes were drawn out through constant comparative method.Findings: Based on 243 codes and through comparative analysis, 4 categories were determined. These are students' needs for student counseling centers, successes and limits of student counseling centers, service priorities of student counseling centers, and proposal for services promotion.Conclusion: Need of student counseling centers is confirmed and culture making decision and policy and planning with participating of key stakeholders, priority setting of students' needs and use of all potentials would help for more and more use of these centers and better services.

Background: Those who have used drugs and illegal stuff like cannabis during teenage years will have a great chance for early death. Many methods have been performed to decrease illegal drug tendency among students but their consequences have been questionable.Aim: This study was trying to compare effect of different methods about decreasing drugs and illegal stuff tendency in students.Methods: The method of this study was semi examined by selecting three case groups and one control group. Target population included all the students in second grade during school year 84-85 in elementary schools all around the country. Method of selecting samples was clustered and by dividing the country into 5 areas (north, south, east, west and central), selection of provinces was random.Measurement instrument was auto report questionnaire that was adopted with some studying in population information and evaluate view and awareness of drugs and illegal stuff side effects.Findings: The results showed that among sample group of students (2911 persons) with average of 13 years, about 2.2% were using drugs and illegal stuff. In both of attitude and knowledge about drug side effects, there was a significant difference between average scores of control group and case groups. Evaluation of all methods showed that the social educational group had the most negative view and the most knowledge about drug side effects. Conclusion: It seems that using old and traditional methods in order to increase knowledge and to spread information are not effective in the prevention of drug abuse tendency. The best result comes after social skills learning.

Background: Our country is considered to be one of the countries with the widest drug usage and we face several problems such as lack or insufficiency of some drug preparations. The aim of this study was to evaluate self-medication and its related factors among the elderly of Tehran.Methods: 385 elderly individuals were selected and studied in a cross-sectional descriptive study. Using an informative form which contained 32 questions in 2 parts, demographic and specific information, the required data was collected. Data was analyzed using SPSS statistical software, Mann-Whitney, and Chi-Square tests.Findings: Mean age of subjects was 67±4.33 years. 76.9% were male and 23.1% female. Results showed that 72% of study subjects kept un-used drugs at home. The most important factor to keep drugs at home was drug storage (48.7%). Most stored drugs were analgesics (44.4%). Likewise, 57.7% of persons had self-medication over the previous three months. Furthermore, the most important factors for self-medication were previous prescription of a drug and recurrence of a disease or exacerbation of similar symptoms (25.6%). There was a statistically significant association between self-medication and marital status (p=0.020), educational level (p=0.008) and number of children (p=0.001).Conclusion: This study shows that rate of self-medication among Tehran elderly is less than the rate in general population which has been reported in previous studies, though still higher than developed countries. This problem demands for establishing suitable, efficient solutions and programs.

Background: The aim of this study was to evaluate addiction in women distinctly and to assess its etiology and effective factors in the society.Methods: In a descriptive cross-sectional study covering the years 1384 and 1385, data was collected using checklists spread in the detoxification centers in the capital of Tehran and the gathered data was subsequently analyzed.Findings: Study subjects comprised 2100 women referred to detoxification centers, of which 60 percent resided in Tehran and 40 percent in other provinces. The average age of subjects was 32 years and the mean age at the time of addiction onset was 20 years. The most common cause of drug use among our subjects was fun and recreation in parties, with a relative being the first person who offered the drug.Conclusion: This study shows that because of the special cultural texture of Iran, addiction in women is more hidden than men. This fact asks for more attention, such as establishment of special centers for women, as well as prevention measures with particular attention to addiction therapy.

Background-Surgical wound infection is one of the most important hospital infection The objective of the study was determination of infection rate in general surgical wards and the related risk factors. Methods-In this prospective study, 2860 patients were selected during 2 years in general surgical wards of two university hospitals. The surgical site infection rate during admission in hospital and frequency of risk factors were measured. Seven hundreds and fifty patients were selected randomly and followed up for one month after surgery.Findings-The frequencies of surgical site infections was 2.2% In univariate analysis, higher age, more than one anatomical surgical site, increased duration of surgery, longer surgical wound, surgery because of malignancy or perforation of organs, in surgical wound, history of high blood pressure, history of diabetes mellitus, daily smoking, drug and alcohol abuse, recently steroid therapy, recently chemotherapy, lower serum hemoglobin and albumin levels were related with surgical site infection.In multivariate analysis, only increased duration of surgery, deran usage, drug abuse, recently steroid therapy, lower serum hemoglobin levels and surgery because of perforation of organs were related with surgical wound infection.Conclusion-Risk factors in iranian population is similar as others, but addiction to opium was a specific risk factors in our patients.

Background: Exercise training has assumed a major role in cardiac rehabilitation, mostly because of its positive effects on myocardial perfusion in patients with coronary artery disease. The mechanism involved in mediating this key effect has long been debated: both improvement of peripheral vascular system and myocardial contractile function have been suggested as potential adaptations. The purpose of this study was to determine the effect of concurrent training on left ventricular contractile function in patient with coronary artery disease.Methods: Twenty four patients with coronary artery disease (mean age of 60±6 yrs; mean weight 74±12 kg; and mean body mass index 26±4) were randomly divided to two subgroups, experimental (n=12) and control (n=12) groups. The experimental group participated in 3 months concurrent training, 3 times/week for 60 to 80 minutes at 70% to 85% of maximum heart rate (MHR) and 40% to 60% of one repetition maximum (IRM). Investigation variables were assessed at baseline and at the end of the protocol by the impedance cardiography method.Findings: A significant training effect was documented by a decrease in heart rate and blood pressure at rest. Acceleration index (ACI) increased from 0.49±0.14 to 0.78±0.24 sec2 (P<0.05). Velocity index (VI) increased from 36±9 to 47±8 msec (P<0.05). Left cardiac work (LCW) increased from 5±1 to 7±2 kg m (P<0.05). Left cardiac work index (LCWI) increased from 3±1 to 4±1 kgm/m2 (P<0.05). Pre-ejection period (PEP) decreased from 91±12 to 68±12 msec (P<0.05). Systolic time ratio (STR) decreased from 28±5 to 21±6 (P<0.05). The left ventricular ejection time (LVET) did not change.Conclusion: We conclude that concurrent training may improve myocardial contractile function in some patients with CAD.

Aim: This study was conducted to determine the frequency of anxiety and depression and its related factors among hyperandrogenic women in a private clinic in north of Tehran. Methods: In this descriptive analytical cross-sectional study, 55 women (16-38 years old) with high serum levels of testosterone and/or and rostenedione and/or clinical signs of hirsutism, visited in a private clinic between June 2000 and June 2001, were studied. Data were collected using written questionnaires for demographic characteristics, Spielberg State-Trait Anxiety Inventory and Beck Depression Inventory. Data were analysed using Student t-test and one-way analysis of variance.Results: The mean of state anxiety, trait anxiety and depression was 44.35, 47.25 and 20.22, respectively. Significant relationships were found between state anxiety and infertility status; trait anxiety and gravidity and infertility status (p<0.05 & less). In addition, there were significant relationships between depression and age, literacy, infertility status, occupation and physical activity (p<0.05 & less).Conclusion: The rate of anxiety and depression was high in these women. Physical activity and other techniques for reducing anxiety and depression are therefore recommended.

Background and aim: Due to the important role of dentists in plaque control programs, the present study evaluated the knowledge of general dentists about plaque control in the city of Isfahan during 2003.Methods: This descriptive, cross-sectional study included 165 general dentists holding private practice in Isfahan. The response rate of the study was 91.6% and questionnaire included items about demographic data, basis of plaque control, toothbrush types, dental flosses, mouthwashes and toothpastes. Questionnaires were distributed among dentists and each correct answer received 1 score while no score was given to incorrect or blank answers. Subjects who answered 0-5 questions correctly were classified as the weak group; those who answered 6-11 items correctly were classified as the average group, and dentists who correctly answered 12-15 items were considered as the good group. Data were analyzed by descriptive statistics using chi-square test.Findings: Among participants, 29.7% were female and 70.3% were male. 72.1% had average knowledge and 27.9% exhibited good knowledge, while no dentist was classified as having a poor level of knowledge. Knowledge source was reported internet in 3.6%, scientific articles in 35.8%, congresses in 55.2% and miscellaneous in 5.4%. In the study group, 7.9% graduated from Shaheed Beheshti University, 13.3%,52.1%, 7.9%, 5.5% and 13.3% graduated from Tehran, Isfahan, Shiraz, abroad and other universities, respectively. The mean duration from graduation was 12.3 years. No significant differences were found between knowledge and gender, information source and university, but a significant difference was observed between knowledge and work experience (P<0.001). Conclusion: It appears that knowledge of Isfahan general dentists regarding plaque control is at a satisfactory level.

Background: Oxidative stress has been suggested to playa key role in accelerated atherosclerosis and to be involved in cardiovascular diseases of dialysis patients.Method: In this prospective study, we enrolled 34 (21 hemodialysis (HD) and 13 peritoneal dialysis (PD)) patients. All of the subjects had received dialysis for at least 3 month. We also enrolled 18 normal controls (Ne). Serum levels ofmalondialdehyde (MDA) and thiobarbituric acid-reactive substances (TBARS) were used for measuring lipid peroxide levels. Also, commercial test kits were applied to estimate serum total antioxidant status. Results: MDA levels were significantly elevated in HD patients compared with NC group, 1.36 (0.00- 2.17) versus 0.00 (0.00-1.41) respectively (P=0.005); while there was not a significant difference with regard to MDA between PD patients 0.88 (0.00-14.8) and NC group. Also, there were significant differences in serum TAS between RD, PD patients and NC group (1.44(1.09-1.63), 1.31(1.08- 1.54) and 1.17(1.06-1.43), respectively, (p=0.001)). In addition, we found that TAS concentration was significantly correlated with serum MDA level in HD and PD patients (r= 0.443, P<0.001). Conclusion: The results of our study showed that in spite of elevated serum levels of TAS, the susceptibility to oxidative stress is related to MDA levels.

Ulcerative colitis is one of the inflammatory bowel diseases with unknown etiology which presents as recurrent inflammatory attacks in mucosal and submocosal layers of the large bowel. Based upon our current understanding of the pathogenesis of these disorders, new therapies have focused on the enteric immune response and inflammatory process, but conventional therapies such as aminosalicylates and corticosteroids continue to be widely used. Newer agents in these classes (e.g. mesal amine) hold promise for enhanced efficacy and/or tolerability. lmmunomodulators have become more effective for clinicians in the management of ulcerative colitis over the past several decades. The recent introduction of biological therapies (such as infliximab) offers potential for additional therapeutic options. None of the currently available therapies, however, is ideal. Continued efforts in search of more superior drugs are still needed. 

Introduction: Celiac Disease (CD) is an autoimmune disease that occurs in 1% of the general population. Diarrhea and iron deficiency anemia or osteopromalacia may be the presentation of the disease. Arthritis is commonly found in patients with CD and this disease may predispose patients to secondary hypertrophic osteoarthropathy (HOA) which is characterized by clubbing and periosteal reaction of long bones and arthritis.Case: Our patient was a 22 year old man with a known history of CD for 10 years. He had arthritis of both knees and ankles since 1.5 years ago and in physical examination he had pachydermoperiostosis and clubbing of fingers and linear periosteal reaction in his long bones.Discussion: This is an unusual case of CD accompanied by pachydermoperiostosis, a common feature of primary HOA.