Journal of Medical Council of Iran
Year:2019 | Volume:37 | Issue:2|Papers Count:8

Arterial and venous thromboembolism is one of the most common causes of death worldwide. For almost seventy years, heparin, low molecular weight heparin, and vitamin K antagonists have been widely used in the prevention and treatment of thromboembolic disorders. However, many of the limitations of these traditional anticoagulants have led to the search for and attempts to introduce better drug therapies over the past 15 years, and a new group of oral anticoagulants specifically affecting factor X and thrombin have already been introduced and are available. This review study explains the evolution of anticoagulants with a focus on oral anticoagulants and the results of important clinical trials.

Background: Pulmonary Arterial Hypertension (PAH), a fatal orphan disease, is defined as increased mean Pulmonary Arterial Pressure (mPAP) above 25 mm/Hg, Pulmonary Capillary Wedge Pressure (PCWP) below 15 mm/Hg, and pulmonary vascular Resistance over 3 Wood Unit (WU). Although Pulmonary Hypertension (PH) is a relatively prevalent disease, the idiopathic form (iPAH) is a rare disease with a prevalence of 1 to 3 in million population. Methods: The Iranian Registry Program was introduced in 2009 by using its website, www. ipah. ir, for delivery of a standard and national diagnostic protocol to PH patients and also gather patient data in order to provide effective and updated management services to all patients. In this program, the patient data was collected based on guidelines of European Respiratory Society (ERS), European Society of Cardiology (ESC), International Society of Heart and Lung Transplantation (ISHLT), and American College of Cardiology Foundation (ACCF). Moreover, follow up of all patients was possible through the website. Results: 353 PH patients (225 female, 125 male) referred to Masih Daneshvari Hospital Tehran, Iran between 2009-19 and were registered. Among them 182 patients were characterized as iPAH (n=121 female, n= 61 male). The average age of PH patients was 48. 6± 16 years for suffering PH and 48. 2± 15 years for primary idiopathic form. Sparing idiopathic subtype, the aetiology of most PAH patients was Eisen-menger syndrome (43 patients, 12. 2%), collagen vascular (22 patients, 6. 2%), and chronic thromboembolic pulmonary hypertension (95 patients, 26. 9%). Evaluation of functional class based on New York Heart Associated Functional Class (NYHA) showed 15 patients with FC=I (4. 6%), 177 patients with FC=II (50. 7%), 142 patients with FC=III (40. 7%) and 14 patients with FC=IV (4%). Treatment strategy was Tadafil in 209 patients, Bosentan in 230 and Ilomedin in 65. Due to the economic sanctions in the country, we had limited access to standard medications based on guidelines. Conclusion: Diagnosis, management and follow up of PH and certainly iPAH patients under Iranian PAH Registry System (website www. ipah. ir) during 10 years, leads to organized patient care system and management and also provides invaluable data.

Background: AMPK regulation is one of biggest target in T2D and metabolic syndrome research. Therefore, the present study is aimed to investigate The effect of 8 weeks aerobic and Resistance training on AMP-activated protein kinase (AMPK) gene expression in soleus muscle and insulin resistance of STZ-induced diabetic rat. Methods: The research method of present study was experimental. For this purpose, 21 male wistar rat with 200 to 250 g weight and 8 to 10 weeks old were selected. Then the induction of type II diabetes was performed by intraperitoneal injection of Streptozotocin. The samples were randomly allocated to diabetes control, diabetes resistance training and diabetes aerobic training groups. Resistance training was scheduled for 10 repetitions of climbing a ladder carrying a load 100% of body weight, and aerobic training protocol was running on a treadmill with 25 m/min for 40 min and both training continuing for 8 weeks long and 5 day/week. 48 hours after last training session, soleus muscle isolated and AMPK gene expression was measured. For statistical data analysis, independent t-test at P<0. 05 significant level was used. Results: Our study showed that the AMPK gene expression in soleus muscle of aerobic and resistance training group was significantly higher than control group (P value respectively 0. 035 and 0. 019). But there was no significant difference between levels of this factor in aerobic and Resistance training group (P=0. 954). Fasting blood glucose level in aerobic and Resistance training group was significantly lower than control group (P=0. 001). Also insulin and insulin resistance of aerobic and Resistance training group was significantly higher than control group (P<0. 05). Conclusion: This results show that aerobic and resistance training trough increasing gene expression of AMPK can improve blood glucose level in type 2 diabetic rat. So It can be said that aerobic and resistance training activates an noninsulin-dependent pathway and improves insulin resistance in diabetic rats.

Background: Care, treatment and the necessity of extensive research in burn patients is an important priority for health systems. The aim of this study is to analyze the epidemiology of burn patients who admitted to intensive care unit (ICU) of Shahid Motahari hospital in Tehran during 2008-2013. Methods: This descriptive-analytical study was performed on patients with burns which were admitted to the ICUof Shahid Motahary Burn Center from April 2008 to April 2013. Demographic and clinical data including gender, age, length of hospital stay, total body surface area (TBSA), grading of burn, site of burn, type of patient’ s insurance and surgical procedures have gathered from medical records. Data were analyzed by SPSS. 16 software and by means of X2 and ANOVA test. Results: In study period 976 patients were admitted in ICU, which 70. 6% of them were male. Their mean age was 34. 72± 20. 26 years old and mean hospital stay was 17. 09± 14. 05 days. The main manner of burns was due to accidental burn (87%). The main site of burn was in more than three sites of body in 89. 7% of patients. 80. 3% of patients had grade 3 burn and the main cause of burns in our patients was due to flame (77. 1%). Inhalation injures were seen in 20% of samples. There was significant relationship between burn outcome and gender, degree of burn, percentage of burn, location of injuries, burn infection, cause of burns and inhalation injury. Conclusions: High mortality rate in patients with more than 40% burn of total body surface area and effect of flame (fossile feuls) and hot water as a main cuase of burn in adults patients and younger samples respectively indicative for need of increasing necessary training in order to increase awareness of population in the context of the common causes of burns and reduction strategies in community events.

Background: Studies on hemodynamic changes in brain death are in vitro and in animal studies. And very few studies have been done on the hemodynamic changes of brain death. The aim of this study was to use advanced hemodynamic monitoring with echocardiography for evaluation of donated heart and to evaluate the moment by moment brain death patients with advanced hemodynamic monitoring tools and its effect on organ donation outcome. Methods: This cross-sectional analytical study was performed on the patients with brain death who were candidates for organ donation in Dr. Masih Daneshvari Hospital between 2017 and 2019. Forty-two patients with brain death who were candidate for heart donation were evaluated using purposive sampling. After echocardiography and initial evaluation, these patients were evaluated using advanced hemodynamic monitoring tools and the required data were collected and recorded. Results: In echocardiography, Left Ventricle Size (LVS) was normal in 100% of patients and Left Ventricle Function (LVF) in 87. 5%. Left Ventricle Ejection Fraction (LVEF) was less than 50% in 12. 5% and in 87. 5% it was more than 50%. In 50% of patients at baseline, peripheral vascular resistance (Systemic Vascular Resistance-SVR) was lower than 1200 and at the end of study it raised to 54. 4%. Cardiac Index (CI) was lower than 2. 4 in 16. 7% of patients at baseline and 25% at the end of study. Decreased CI and decreased vascular resistance in patients with Ejection Fraction (EF) less than 50% were also significantly higher than in patients with EF above 50%. Conclusion: Due to the extensive pathological changes that brain death has on the cardiovascular system, advanced hemodynamic monitoring can continuously manage inotropic drugs in these patients, decide to manage intravascular volume and ultimately stabilize hemodynamic and prevent destruction.

Background: Identification of variables with substantial effect on providing health care insurance can lead to detect the major health indicators, which help improving the mental health care system of Iran. This study aimed to design and validate a health insurance management questionnaire to improve the care for those with mental disorders. Methods: This research was a survey-analytical study. Books, articles and similar questionnaires were studied and a researcher-made questionnaire was developed containing 6 fields. The questionnaire was evaluated by 10 experts from relevant fields using a Delphi method. The content validity of the questionnaire was assessed using CVR and CVI indices. In 2018 a survey was conducted on 470 participants from different fields of governmental, private insurance providers and experts from the mental health fields. This was to evaluate the validity of the questionnaire. We had used alpha Cronbach coefficient to analyze the result of the survey. Results: The findings showed that the CVR value for all questions was more than 0. 62 and the total CVI of the questionnaire was 0. 89. The reliability of the researcher tool was 0. 931. Conclusion: We are able to claim that the validity and reliability of our questionnaire was successfull and approved. We conclude that a researcher-made questionnaire can be used to improve health services and enhance the level of satisfaction of patients with mental disorders, if it uses the variables that affect health insurance management of those individuals.

Background: Colorectal cancer is one of the most common malignant tumors, Human guts harbor abundant microbes that adjust many aspects of host physiology. Increasing studies show that gut microbiota plays a significant role in the incidence and expansion of CRC, as a result of virulence factors, bacterial metabolites, or inflammatory pathways. Materials and Methods: In this study, viability of HT29 cells, treated by different time of microbiota metabolits (3, 6, 12, 18h), was assessed by MTT assay respectively. Results: Treated cells with microbiota metabolits showed increased viability and proliferation, in time-dependent analysis by MTT assay. Conclusion: Considering that microbial metabolits is able to induce proliferation and increase cell viability, it seems microbial metabolites imbalance or dysbiosis in the gut due to the dietary or environmental changes or lifestyle risk factors may cause colorectal cancer.