Asthma is a heterogeneous disease, in which asthmatic patients present with different clinical phenotypes, variable endotypes, and different response to asthma medicines. Thus, we are faced with an asthma paradox; asthma is diagnosed subjectively by clinical history and treated with biologically active drugs. To solve this paradox, we need objective airway biomarkers to tailor the proper medications to the proper patient. Biomarkers should have one or more of the following characteristics: 1) could differentiate poor symptoms perceivers from over-perceivers, 2) could predict disease activity and hence disease outcome, 3) could clarify asthma phenotype responders from non-responders, and finally 4) could characterize different clinical asthma phenotypes. Therefore, we have conducted a review of literature trying to apply those four parameters to different airway inflammatory biomarkers. We found that FeNO fulfilled the four proposed clinical parameters of airway inflammatory biomarkers whereas; serum periostin was the single best systemic biomarker of airway luminal and tissue eosinophilia in severe uncontrolled TH2 asthma phenotype. Thus, this may be considered a trial towards tailoring the proper medication to the proper patient. However, application of biomarkers in clinical practice requires easier and cheaper techniques together with standardized methods for sample collection and analysis.

Dear editor, A 52-year-old man was admitted to a hospital with the chief complaint of palpitation. Electrocardiography revealed right ventricular outflow tract (RVOT) ventricular tachycardia, which was subsequently treated by direct-current shock after no responses to amiodarone infusion. Selective coronary angiography demonstrated a normal coronary artery. The patient was referred to our tertiary referral center for further evaluation. . .

BACKGROUND AND OBJECTIVE: Infective endocarditis is a disease that causes vegetation on heart valves. Special form of that occurs by intravenous drug abuse and most of patients are young men. Crescentic glomerulonephritis is a rare complication of infective endocarditis that progresses to renal failure during few weeks to few months. CASE: A 40 year old man referred with edema, nausea, vomiting and dyspnea. Due to severe renal failure and hyperkalemia, acute hemodialysis was performed. With regard to fever and heart murmur, an echocardiography was done and a large vegetation on tricuspid valve was appeared. A kidney biopsy was done for determining the cause of renal failure. After a while it was determined that he was an intravenous drug abuser. Pathological report showed many fibrotic crescents and hemodialysis were started. CONCLUSION: With regard to glomerular lesions occurs in 22% of cases with infective endocarditis and since crescentic glomerulonephritis is the most uncommon and has the worst renal prognosis, a high clinical suspicion for renal involvement can help us for a better care of this organ.

Keeping the patients secrets has always been a kind of right and has been considered as an obligation for the doctor. Even though, confidentiality is not an absolute matter and under conflicting circumstances the doctor might have to violet confidentiality. This study was carried out with the purpose of assessment of the basis of doctor’civil responsibility if the secrets of the patient have been disclosed. A thorough study in the documents and laws reveals that other than exceptional cases, disclosure of medical secrets is not ethical and allowed and it will cause the doctor to take the responsibility of compensating for the damages and harms that the patient has sustained. Civil responsibility of a doctor for compensating the harms has not been mentioned clearly in Iranian law and legislations, but after it has been proofed in the court that there has been financial and mental harm and there has been causal link between the illegal act of the doctor and the hatms done to the patient, according to the article 1 of the civil liability law, the court will bound the doctor to compensate the damages. Eventually what guaranties the compensation of the harms done to the patient is the professional civil liability insurance of the doctor.

Background and objectives: Patient’s awareness about their rights in addition to increase the service quality and health care and reduce medical expenses (cost), can cause the medical staff also take responsibility of protection of patients’ rights. Therefore, this investigation was conducted in order to determine awareness from patient right patent and its consideration (observance) from hospitalized patients’ viewpoint.Material & Methods: This cross-sectional study was conducted through available sampling on 384 hospitalized patients referred to Zahedan Medical University hospitals in 1390. Information collecting tolls were including: demographic information check list and two questionnaires regard patients awareness and observance about patient right patent. Data were analyzed by Pearson’s test of correlation, two-sample t-test and one-way ANOVA, and Through SPSS software version 16.0.Results: Results showed that average score of patients awareness about their rights patent was 6.48 (SD=1.3) (in weak level) and average of observance of right patent from patients viewpoint was 6.28 (SD=1.02) (in adverse level).Also analysis of the seventh realms related to awareness and patient’s right patent observance showed that minimum and maximum average score were related to objection and complaint right (0.15±0.85 and 0.25±0.05) and awareness right and get information (2.1±0.55 and 2.8±0.68), respectively.There was a significant relationship between awareness of patients about their rights and patient’s right patent observance (P<0.05).Conclusion: According to the obtained results, it is necessary that hospitals managers must adopt some measures to make qualifications in order to awareness of patients about their rights and execution of the laws related to observance of patient’s rights.

Introduction: Electronic Health Record is a comprehensive and organized electronic set of clinical, social and financial data that it document given care to one person. Access to information and data of patient is one of the positive features of EHR but this facility of access increase risk of relevance of confidentiality. So far, many solutions were given for preservation of the patient’s rights.Method: This paper with purpose of giving the solutions of preservation of the patient’s rights in EHR systems begin to review information of valid database for example AHIMA and, Pub med and site of valid organization standard such asASTM, HL7 and ISO and related texts 2000-2008.Result: To preserve of patient’s rights about confidentiality of their information in EHR system is applied by establishment of standards that they provide access users to information and in other hand it should supply security methods. Reading, writing and arrangement of information by users should control and in this case, controlling access devices and level of access, encrypting, decrypting, labeling and identifier would help us.Authentication that means attestation of information is done by digital signature and standards and guidelines should be establish in this field and if EHR is going to use both of patients and clinicians and it would accept in legal court as a records, its necessary to aspects of medico legal.Conclusion and discussion: Because EHR is source of information patient and it have been used for purpose of education, research and treatment in different levels and by users, It should design in that way it don’t hurt to security and confidentiality of information and just authenticated persons. Formulation of standard and guideline is the most necessary solution of the preservation patient’s rights because it would moderate the problem of variety of systems and would ensure the integrity of EHR systems. With consideration to this paper, the most important domain of standardization includes identifier, privacy guidelines, confidentiality, access, prescription management, authority and credit of users, modification and authentication of health information, internet and intranet health care guideline and security of systems. Security and privacy of exchanging data is also significant field. Finally we should pay attention to this point that cultural and structural restrictions effect on privacy and confidentiality of information.

Introduction: Arbitration has a contractual nature and is subject to the sovereignty of the will of the parties, but in some cases, the legislator imposed the referral of claims to arbitration on the will of the parties and caused the contractual nature of the arbitration clause to disappear or be limited. By doing this, he has placed the arbitration outside the will of the parties. This issue causes some moral conflicts in the discussion of compulsory arbitration. Therefore, this research has been done with the purpose of examining the position of compulsory arbitration in Iran's legal system and the ethical challenges in it with a descriptive-analytical approach. Material and Methods: The research was a review method, in order to achieve the goal of the research, in addition to electronic education books and virtual education in this field, articles related to the research keywords from 2004 to 2022 from the databases of Civilica, Magiran, Sid, Researchgate, Science direct, was reviewed Conclusion: Based on the findings of the research, it can be concluded that compulsory arbitration in Iran has ethical challenges in the field of implementation and interpretation, the most important of which is the issue of the right to action and judicial justice. In the context of ambiguities in mandatory arbitration, even if the method of arbitration becomes ambiguous, the arbitrator has the duty to find out the will of the legislator with the principles and rules of interpretation, which creates a moral conflict for the arbitrator.

Background: Upper extremity intermittent ischemia due to non-aneurysmal, not occluded aberrant right subclavian artery (ARSA) is rare. Case presentation: We describe a 30-year-old male who suffered from PFO and nonaneurysmal, not occluded ARSA, and presented by intermittent right upper extremity ischemia. He was treated by right carotid subclavian transposition for ARSA and antiplatelet medication for PFO. Conclusion: Authors assume that intermittent limb ischemia can occur secondary to anatomical changes in a patient without aneurysmal degeneration or occluded ARSA and the existence of pure PFO without any evidence of venous thrombosis is not enough to prove the paradoxical emboli scenario.