Journal of Medical Council of Iran
Year:2011 | Volume:29 | Issue:3|Papers Count:12

Background: Continuous Medical Education (CME) programs are those educational activities held after graduation to ameliorate physician's knowledge, skill and professional practice. This study was conducted to evaluate general practitioner’s educational needs about effectiveness of the CME programs held by Zanjan University of Medical Sciences.Methods: This study was conducted by using questionnaires on 450 general physicians working in Zanjan province who have attended CME programs from Nov 2008 to Feb 2009.Results: The five first priorities proposed by physicians were Radiology (26), Gynecology (26), Emergency 2 (25), Pediatrics 2 (24) and Internal medicine 9 (24). The most useful programs were Emergency 1 (58), Poisoning (56), Practical emergency (46), Headache and low back pain (51), and the least were outpatient centers management (35), and occupational medicine (35).Conclusion: The five first priorities of CME programs for general physicians were determined as Emergencies1&2, Poisoning, Asthma-Allergy, and Radiology.

Background: Because of prevalence of head and neck cancer and extensive surgery in this area, complementary therapies in these patients are of particular importance. One of the most important complementary therapies is head and neck radiation therapy after surgery. Radiation therapy in head and neck can interfere on the thyroid gland function. The aim of this study is to determine the relationship between head and neck cancer radiotherapy and thyroid function after surgery.Methods: This study is an analytical epidemiological study on all patients who admitted for head and neck surgery in Imam Khomini hospital in 2007-2008. These patients candidate for complementary radiotherapy postoperatively. Exclusion criteria include: total for partial thyroidectomy, impaired thyroid function before radiotherapy and patients with a history of thyroid dysfunction. Levels of thyroid hormones (T3, T4, TSH) is recorded before and after radiotherapy. Age, sex, hormone levels before and after radiotherapy and the number of patients with hypothyroidism are reviewed.Results: There was 60 patients, 34 women (56.6%) and 26 male (43.3%). The mean age was 58.5 years, SD was 12.3. Thyroid tests in all patients were reported normal. Average amount of Total T3 before radiation therapy was 2.83±1.2 and after radiation therapy 1.74±0.9. P value level was 0.012. Average Total T4 levels before radiotherapy was 87.5±23.4 and after radiotherapy was 65.3±26.2. P value level was 0.003. Mean TSH levels before radiotherapy was 2.45±1.7 and after radiotherapy was 5.7±3.3. P value level was 0.000 23 patients of 60 patients were hypothyroid (38%).Conclusion: There is a relationship between head and neck radiotherapy and hypothyroidism. We recommended controlling thyroid hormone function before and after treatment and then annually and also treating hypothyroidism if it occurred.

Background: Cerebral Palsy (CP) is a neurodevelopmental disorder caused by non-progressive lesions in single or multiple locations in the immature brain. Lesions of motor cortex and pyramidal tracts can lead to spasticity. Inhibition of spasticity is necessary to increase extremity mobilization, prevent postural abnormalities and provide independence in daily living activities. The purpose of this study was to determine the effects of volar static splint spasticity and range of motion of upper extremity in children with Cerebral palsy in three periods of time.Methods: The design of this study was experimental and repeated measurements. Ten children with Cerebral palsy aging 4-6 years old were non-randomly selected among children referred to occupational therapy Clinic of rehabilitation Faculty of Tehran University of Medical Sciences. Children used dorsal static splint for three months (2 hours a day and 4 hours at night). In this study, Modified Ashworth Scale was used to evaluate spasticity and a Goniometre was used to measure passive range of motion.Results: The results of this study showed significant reduction in the upper limb spasticity after 2 months (p£0.0001) and significant increase in wrist passive range of motion after one, two and three months (p=0.007, p£0.0001 and p£0.0001, respectively) and significant increase in elbow passive range of motion after two (p=0.009) and three (p£0.0001) months.Conclusion: This study shows that use of dorsal static splint in children with Cerebral palsy for 3 months has significant effects on reduction of upper limb spasticity and increasing passive range of motion of the wrist and elbow joints.

Background: In contrast to developed countries mortality rate due to car accidents are very high in Iran. It seems that culture, roads safety, car speed and roads facilities are important in increasing accident- related traumas. This study evaluates the reasons behind high rate of traumas and Low level of driving immunity in Iran.Methods: This study was a deseriptive cross sectional study which performed between September 2008 and 2009 in emergency department of Hafte-Tir Hospital. All traumatized patients were evaluated and data were analyzed ay SPSS.Results: Of 29623 wounded patients in a 1 year period 43% were due to road traffic accidents and 57% due to other reasons. 73% were men. Most were between 20-29 years old. 48% were referred by emergency service (115) 47% of cases needed other medical services after triage and overally 50% of death rate was in first 2 hours after Hospital arrival. The Lowest rate of trauma was in winter months.Conclusion: Development of public transportation, improving ecommunication and medical insurance and public education are the 3 main ways for changing this situation.

Background: Nausea and vomiting after middle ear surgery as one of the most common complications after surgery is considered to become the ground for the incidence of other adverse consequences. The aim of this study was to evaluate the effect of 16 mg prophylactic intravenous dexamethasone on postoperative nausea and vomiting after stapedectomy.Methods: In a randomized double-blind controlled trial study, 70 patients candidate for stapedectomy divided into two equal groups, using the same sedation by single surgeon. While the case group received 16 mg Dexamethasone half an hour before surgery, the control group received 4ml intravenous saline as a placebo. Patients controlled 1-24 hours after the surgery in terms of nausea and vomiting and dependent variables such as vertigo and tinnitus.Results: 70 patients (38 females and 32 males) were enrolled in this study. The rate of postoperative Nausea and vomiting in Case group was 31.4% (equal to 11 paticents), and in control group was 60% (equal to 21 patients). The different was statisticall significant (p=3%).Conclusion: The prophylactic use of 16 mg intravenous dexamethasone half an hour before surgery can significantly reduce incidence of nausea and vomiting after stapedectomy.

Background: Various infectious agents like Helicobacter pylori and Chlamydia pneumoniae have been suggested for the development of atherosclerosis. The seroepidemiological association between Chlamydia pneumonia infection and coronary artery disease is still controversial. The purpose of this study is to investigate the association between anti-chlamydia pneumoniae antibodies (IgG and IgA) and acute coronary syndrome.Methods: 87 patients and 87 controls (matched by age and sex) were recruited into this case-control study from February 2009 to January 2010. Sampling was done and anti-Chlamydia pneumonia antibodies were measured using micro immunofluorescence method. Characteristics of population were recorded and statistical analysis was performed using SPSS software.Results: The overall prevalence of anti-Chlamydia pneumoniae IgG and IgA were 43% and 10%,respectively.38 (43.7%) patients and 38 (43.7%) controls were positive for IgG (OR=1). 8 (9.2%) patients and 11 (12.6%) controls were positive for IgA (OR=0.69). There was no statistically significant difference between patients and controls in seropositivity of Chlamydia pneumoniae in uni- and multi-variate analysis.Conclusion: There is no association between Chlamydia pneumoniae seropositivity and acute coronary syndrome in this case-control study. More investigations are suggested because of controversial results.

True approach and appropriate behavior to the child with loss of consciousness whom referred to emergency room is one of the important skills of every physician. If there is defined diagnostic and therapeutic algorithm in the emergency room for managing these children, it helps physicians not to be confused and save golden time for survival of the patients.After describing the history taking, physical and neurologic exams’ skills in children with loss of consciousness, this article explain the etiological factors which are classified into traumatic and nontraumatic agents. Infectious encephalopathies and applied classification of them are more evaluated and emphasized in our paper.

Abnormal accumulation of lymph in subcutaneous tissue is called lymphedema, which in turn, is due to lymph drainage disorder. It can be primary (congenital), or secondary (acquired). Primary lymphedema may be present at birth, and may spread to one or more extremity, face or external genital organs. Praecox lymphedema is the most common form of primary lymphedema (94%), it commonly presents in females, (male/female: 10/1). The disorder appears in adolescence. Edema usually presents in the affected foot or leg. Conversely, the tardive form, presents after 35 years of age. The early stages of the disease may partly respond to conservative therapies such as CDT (complex decongestive therapy), or limb elevation or antibiotic prophylaxis, but when the disorder progresses toward the advanced stages, the effectiveness of above treatments are minimal and temporary. To date current researches in regenerative medicine, exhibits that, stem cell therapy-induced angiogenesis, may provide new approaches for these patients.This study is an experimental study. A case of praecox lymphedema which wasn’t responsive to medical conservative therapies was the candidate for autologous stem cell transplantation. Recombinant human GCSF was injected subcutaneously, (5 mg/kg body weight) to mobilize stem/progenitor cells from bone marrow to the circulation. After reaching the WBC count to about 25000 cells per ml, MNCs were separated from peripheral blood, then concentrated and injected along the lower limb lymphatic pathway.As a result, this study shows that autologous stem cell transplantation, in the case of primary lower limb lymphedema, is a new optional treatment to improve lymph drainage and subsequent alleviation of signs and symptoms and improvement in the patient’s quality of life.