Journal of Medical Council of Iran
Year:2008 | Volume:26 | Issue:1|Papers Count:21

Background: There are different ways to present patients in teaching hospitals, one of which is bedside case presentation. Some studies suggest that using this style may provoke stress in patients. The present study investigated some aspects of bedside case presentation which may need change or improvement.Methods: A descriptive study was conducted to assess opinions of 120 patients on bedside case presentation in eight medical wards of a large teaching hospital in Tehran, using purposive sampling. The study questionnaire was derived from the literature, and an observational study and a panel of experts reviewed the items. Data were analyzed descriptively.Findings: With regard to privacy, 37% of patients stated that loud case-presentation in the presence of other patients was distressing; and 63% indicated that during bedside presentation, physicians spent most of the time discussing scientific matters. Using medical terminology was found to be the source of a considerable anxiety (47%). Finally, concerning patient-physician relationship, it was found that 37% of patients believed that physicians did not understand them.Conclusion: The study findings indicate that bedside case presentation might breach privacy, provoke anxiety and impair patient-physician relationship and thus, it needs redesigning and improvement.

Background: This study was performed to evaluate the quality of diabetes care for the first time in Iran.Methods: In this cross- sectional study, diabetic patients (aged 18- 75 years) were evaluated from 25 provinces of Iran. Data on treatment method, education, evaluation for diabetes complications and glucose and lipid measurment results in the last year, were collected by interview and patients’ healthcare files and laboratory records. The quality of care was assessed using the National Diabetes Quality Improvement Alliance (NDQIA) measures.Findings: A total of 2456 patients with a mean age of 57.2 ± 0.2 years were studied. The majority of patients (68.7%) were treated with oral antidiabetic drugs (OAD) and 7.6% with insulin (exclusively or in combination with OAD). The measurment of weight and blood presure and foot examination had been performed only in 9.2% of the patients wihin the 6 months before the study. The annual measurement of HbA1c, cholesterol, triglyceride and dilated eye examination, 24-hour urine collection and diabetesrelated educations were 6.4, 57.9, 55, 29.9, 4.4 and 22.9 percent, respectively. Target cholesterol (<200 mg/dl) and triglyceride (<150 mg/dl) levels were observed in 36.9% and 29.1% of patients, respectively. The blood pressure values below 140/80 mmHg were found in 20% of patients.Conclusion: This study shows a huge gap between the quality of diabetes care in Iran and the standard control criteria. New efforts to enhance the quality of diabetes management are essential in order to prevent chronic diabetic complications in Iranian diabetic patients.

Background: Many factors influence donation rate, such as social factors, religion, familial relations, level of knowledge and attitude. Level of knowledge and attitude toward organ and tissue donation and transplantation plays an important role in willingness to donate organ and tissue after death. Increasing the public awareness can reform the incorrect beliefs and myths about donation and transplantation. This study investigated knowledge and attitude of donor card holders in relation to organ and tissue donation and transplantation.Methods: This case-control study was carried out in Iranian Tissue Bank during 1385. A total of 178 donor card holders and an equal number of control group completed a questionnaire including 23 questions and demographic information.Findings: Knowledge and attitude toward donation and transplantation in card holders were significantly higher than control group (P< 0.05). There was a reverse correlation between age and a positive attitude toward donation and transplantation in card holders.Conclusion: This investigation suggests that the main reasons for refusal to donate organ and tissue are insufficient knowledge and negative attitude due to misinformation regarding donation and transplantation. We believe that educating and motivating the public with mass media can increase the rate of consent for organ and tissue donation and transplantation.

Background: Irritable Bowel Syndrome (IBS) is a common gastrointestinal (GI) disorder and is the most frequent cause of patients’ referral to GI clinics. Similarly, lactose intolerance is also another prevalent disorder which presents with some clinical manifestations mimicking IBS. So, diagnosis and differentiation of these entities are so important and play a main role in the treatment of patients.Methods: The study was conducted on patients who had been diagnosed to have IBS based on Rome II criteria, visited in a GI clinic. All patients were assessed for lactase deficiency with H2 breath test and consequently divided into 3 subgroups of negative, borderline and positive.Then, regarding their clinical symptoms and H2 breath test results, they experienced 3 different management protocols of lactose free diet, antibiotic therapy and observation for 2 weeks. At the end of this period, they were evaluated for their symptoms again.Findings: Ninety-four eligible patients (39.4% males and 60.6% females with an age range of 24-49 years) were enrolled in this study during 2 years. 35.0% and 27.0% of patients were diagnosed to have lactase deficiency and intestinal bacterial overgrowth, respectively. The other 38.0% were normal. After undergoing management protocols, abdominal distension and gas passing decreased significantly.Conclusion: Intestinal lactase deficiency and bacterial overgrowth could accompany IBS. Given the feasibility and simplicity of H2 breath test for the diagnosis of these disorders, this test is strongly recommended for the evaluation of IBS patients.

Background: Informed consent is a process through which patients or their surrogate decision makers understand and agree to medical procedures. This study examined the informed consent process from the perspective of patients admitted to Shariati Hospital in Tehran.Methods: We conducted a cross-sectional prospective study on obtaining informed consent from patients admitted to the surgery department of Shariati Hospital during the first trimester of 2007. Data was gathered through a piloted questionnaire, interview, and medical records. The collected data was analyzed using SPSS software.Findings: From 254 participants, 158 (62.2%) were male and 96 (37.8%) were female. The mean age was 48.01±19.04 years. Only about half of the patients had taken their knowledge from their physicians. Rate of patients' information about various aspects of informed consent is described as follows, success of surgery: 44.5%, probable complications: 54.3%, substitute treatments: 61.4%, and feeling free: 67.3%. About 69.7% of participants declared that their answers would not change after treatment. If a complication would occur, the patients believed their doctors did absolute or relative medical malpractices (5.9% and 57.1%, respectively).Conclusions: According to the results, the rate of acceptable knowledge and information is relatively weak. On the other hand, most patients believed their physicians must be respectively responsible in case of complications. Thus, it is necessary to emphasize and highlight the importance of obtaining informed consent.

Background: Jejunostomy feeding is an acceptable enteral feeding for patients with neurologic disorders and those who need long term nutritional support. However, several studies have reported catastrophic complications for this method. The purpose of this study was to evaluate complications of feeding via jejunostomy.Methods: Patients who were candidate for nutritional support by this method between years 2002 and 2006 were enrolled in this study. Roux-en-Y jejunostomy was performed for all the patients.Findings: Feeding jejunostomy was performed for 12 patients during the study period. Electrolytes did not reduce during our study and remained in the normal limits afterwards. Intra-peritoneal leak (2 patients), abdominal distention (2 patients) and diarrhea were the only reported complications in this study and were all treated nonoperatively. Mortality secondary to the complications of operation was not reported in the current study.Conclusion: Jejunostomy feeding is not associated with any significant complications or mortality.

Background: Tuberculosis has been one of the greatest murderers of human being during history and it is still expanding now. In accordance with its respiratory transmission, it is much more dangerous rather than other infectious diseases, say, AIDS. One of the prevention methods of this disease is B.C.G vaccine and its resulted scar can be used as a suitable criterion for its vaccine influence. The purpose of this investigation was to determine the scar situation after injection of B.C.G vaccine in infants and to assess parental awareness regarding this matter.Methods: The studied sample were all the infants (4-12 months) who were injected B.C.G vaccine in the first days at birth and who were referred to three health centers in north of Tehran. This study was accomplished in six months during 2004. The necessary data was collected via completing questionnaires, observation and evaluation of scars, and interviewing parents. Findings: 94% of infants had scar due to B.C.G vaccine. 44% of mothers had high, 29% moderate, and 27% low knowledge about B.C.G vaccine. There was a meaningful relation between mothers’ education and their level of knowledge regarding B.C.G vaccine (p<0.01). Also, there was a meaningful relation between B.C.G. scar existence and gestational age of infants at birth (p<0.01). Conclusion: In 6% of infants, no B.C.G. scar was noted which was associated with their low gestational age at birth.

Background: Constitutional delay of growth and puberty (CDGP) is one of the most common problems in pediatrics. It causes a lot of psychological and social disorders in families. Currently, there are a variety of therapies including administration of testosterone enantate, oxandrolone and growth hormone available.The aim of this study, which has been performed for the first time in Iran and the second in the world, was to compare the effect of oral iron in combination with vitamin A with that of oxandrolone in promoting height growth and bone age of children with CDGP. HSDS, WSDS, BMI, SMR, bone age and serum IGF-1 levels were used as milestones of such improvement in this study.Methods: This clinical trial was performed on 85 CDGP boys. After registration of personal identities and taking blood, urine and stool specimens, to rule out probable underlying diseases and interfering factors, children were divided into three groups including a control group, those treated with oxandrolone and those treated with oral iron and vitamin A. Data were transferred to SPSS program where the results were analyzed by paired T-, ANOVA, Tukey, and Wilkakson – Krueskwalis tests.Findings: There was no significant difference between the treated groups in HSDS (p= 0.56), WSDS (p = 0.08) and BMI (p= 0.51). On the other hand, there was a significant difference in SMR (p< 0.001) and bone age (p< 0.001) between groups. Eventually, no significant difference was found in serum IGF-1 levels between the two treated groups (p= 0.98).Conclusion: Iron and vitamin A can be used instead of oxandrolone in CDGP children with the same therapeutic effects and without the adverse effects seen with oxandrolone administration. In addition, this new therapeutic method has no significant effect on SMR and bone age promotion in contrast with oxandrolone therapy.

Background: Weight retention after delivery is a public health problem as it can cause overweight in prolonged time and is accompanied by cardiac risks. Numerous factors are correlated with postpartum weight loss. This study was performed to evaluate the correlation between delivery mode (vaginal or cesarean) and postpartum weight loss.Methods: This was an analytical cross sectional study on two groups of 100 women with vaginal or cesarean delivery in Javaheri Hospital (Tehran, Iran) during 1385. Mother's weight at the time of delivery, one week and one month after delivery was measured in this two groups. Statistical analysis was performed by SPSS software using independent t-test.Findings: There was no significant difference between mean weight at delivery and mean weight gain during pregnancy in the two groups. Percentage of weight loss one week and one month after delivery in cesarean section group was more than that in vaginal delivery group, and this difference was statistically significant. Also, fraction of weight loss in multiparous women was lower than nulliparous women.Conclusion: Vaginal delivery has a better result for pregnant women with regard to early returning to pre-pregnancy weight as compared to women undergoing cesarean section. Mode of delivery is effective in decreasing weight over the first month after delivery, but other factors are more important in the long run.

Background: The use of dialysis in patients with end stage renal disease (ESRD) remains one of the most resourceconsuming and hence expensive therapeutic interventions. The purpose of this study was to assess the cost of hmodialysis in Iran.Methods: This study was conducted in the nephrology department of Imam Khomeini Hospital, Tehran University of Medical Sciences (Iran), between 2006 and 2007. Patients with ESRD on chronic hemodialysis were recruited in the study. Relevant data was collected using interviews and questionnaires. Analyzed costs included transportation plus absence from work, treatment instruments, drugs and other medical procedures, dietary, staff, equipment and building support services, non-medical supplies, depreciation of installations and equipment, depreciation of reverse osmosis (RO), and building rent.Findings: A total of 63 patients (47.7% males and 52.3% females) with a mean age of 47±12 years were studied. The direct cost of each hemodialysis per session was about 74 US dollars through which an annual cost of 11549 US dollars was estimated. Transportation and work leaves (28.9%), staff costs and salaries (21.5%), and treatment instruments (21.1%) were among the greatest expenses.Conclusion: The annual cost of dialysis in Iran is similar to other developing countries, but significantly less than developed countries.

Background: Angioaccess is one of the main treatment procedures for surgeons considering dialysis patients. End stage renal disease patients have to spend most of their lives under dialysis; therefore, given the high expenditure of angioaccess surgeries, this study was conducted to evaluate the patency rate and complications of arteriovenous access operations.Methods: In this prospective study, 169 patients underwent 311 access surgeries for hemodialysis. Data was collected through questionnaires and analyzed by SPSS.Findings: Life table analysis showed that of 169 patients with fistulas, 84.9% of cases were patent after 2 months, and 80.5% and 73% were patent after 4 and 6 months, respectively. There was no significant difference between diabetic and non-diabetic patients patency rate in cubital access, but the patency rate in distal fistulas was significantly lower in diabetics. Different complications were recorded in 48.6% of patients, mainly heart failure and mild edema.Conclusion: Diabetes was higher among our cases than normal population which can be due to poor screening programs and low information on risks and correct follow-up of patients. In diabetic patients, cubital fistulas should be considered prior to distal accesses. Complication rate in our study was higher than those reported. Since complications are significantly surgeon dependent, more attention to residential education and participating in related workshops can be helpful.

Aim: To determine childbirth self efficacy among the pregnant women referred to a prenatal care clinic.Background: Self-efficacy – certainly of concern during labor – involves an individual’s evaluation of her/his capabilities to cope with stressful situations and perform required behaviors. Before any event, self efficacy predicts how much one attempts for coping with labor and how long continues his/her effort. Researchers have indicated that women with low self efficacy assume normal delivery as an inaccessible event, and experience high level of fear during their pregnancy. Considering the importance of self efficacy in choosing normal vaginal delivery and coping with childbirth fear, it is necessary to determine the level of self efficacy among pregnant women. This can provide basic knowledge for suitable educational interventions to promote childbirth self efficacy.Methods: The present cross-sectional study was carried out on 176 pregnant women admitted to some OB/GYN clinics. These clinics were randomly selected from teaching and governmental OB/GYN hospitals. To establish construct validity of the CBSEI, exploratory factor analysis (EFA) was performed. To test reliability, internal consistency was assessed by Cronbach's alpha coefficient.Findings: Results indicated that childbirth self efficacy has a high internal consistency of about 0.84-0.91. There were statistically significant differences between the outcome-AL and efficacy-AL for active labor (t (171) = 7.543, 95% CI = 12.63-21.58, P<0.001), and between the outcome-SS and efficacy-SS for second stage of labor (t (167) =8, 7681, 95% CI = 16.12 - 25.49, P<0.001).Conclusion: This study confirms the role of childbirth self efficacy as an important factor in coping with the pain of labor.

Erythema multiforme is a skin condition considered to be a hypersensitivity reaction to infections or drugs. It consists of a polymorphous eruption of macules, papules, and characteristic "target" lesions that are symmetrically scattered with a tendency to the distal extremities. There is minimal mucosal involvement.Management involves treating the presented infections or withdrawing the contributory drug. Mild cases resolve without any complications and do not necessitate treatment. Recurrent cases have been prevented with continuous acyclovir. Patients who have no response to acyclovir may respond to valacyclovir or famciclovir, which have better oral bioavailability and more suitable dosing.Patients with recurrent erythema multiforme despite suppressive antiviral therapy should be referred to a dermatologist for additional treatment.

There are very few reports concerning intracranial and spinal lesions due to extramedullary hematopoiesis. These reported cases occur as pure extradural masses or rarely within some of the intracranial tumors such as meningioma, hemangioblastoma or pilocytic astrocytoma. The patients often present some kind of hematologic disorders like thalassemia major, myelodysplastic syndromes, acute myeloblastic leukemia and myelofibrosis. In this paper, we report a patient who developed extramedullary hematopoiesis as compressive lesions of the spine followed by cranial involvement. In this report, the clinical presentations of the patient, radiologic and pathological findings along with therapeutic measures and follow up results are presented in detail.

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 (Group1; 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 sympto ms 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.