Shared Decision-Making and Its Correlation with Demographic Characteristics of Iranian Patients.

Aims: To evaluate relationship between patient age, location and their preference toward partnership in clinical decision making Place and Duration: A university-based clinic, Tabriz University of medical sciences, Tabriz, Iran from March to September Methods: In a cross-sectional study, 200 patients were randomly selected for the study. Patients’ demographic indicators and attitude toward partnership with their doctor was assessed by the use of an author-developed questionnaire containing 12 questions. Validity of this questionnaire was previously confirmed. The data was finally collected and analyzed. Results: Fifty three percent (53%) of patients were male and 47% was female. Mean age was 33.88 (SD=11.35). Of the 200 patients, 66% had tendency toward shared decision making (SDM). There was a positive correlation between higher level of education and SDM in Iranian patients. Conclusion: We found a trend toward shared decision making among patients. We conclude that raising literacy could change the culture of patient-physician relationship within the country.

Age related secretary pattern of growth hormone, iansulin-like growth factor-I & insulin-like growth factor binding protein-3 in postmenopausal women.

Background & objectives: After menopause in women, loss of bone density increases rapidly with estrogen deficiency. Evidence has revealed that this deficiency may be directly correlated with growth hormone (GH) level declining with age. The present study was designed to evaluate the age dependant patterns of GH, insulin-like growth factor-1 (IGF1-1) and insulin-like growth factor binding protein-3 (IGFBP-3) endogenous secretion in postmenopausal women. Methods: During this prospective study in a 12-month period, 150 postmenopausal women were enrolled who were referred to the densitometry unit of bone research centre of Tabriz University of Medical Sciences for assessing bone mineral density. Serum levels of basal and clonidine stimulated GH were measured using radioimmunoassay while IGF-1 and IGFBP-3 were measured by ELISA. Post stimulation over 3 to 6 fold increase in GH over the baseline level was considered normal response and less increase was considered abnormal. Results: There were no significant differences in the mean levels of GH0, GH60 and GH90 in different age groups of postmenopausal women. No significant difference in the mean IGFBP-3 and IGF-1 levels was seen in different age groups of postmenopausal women. The number of postmenopausal women with abnormal response to stimulation by clonidine in 61-70 and > 70 yr age groups was higher than in other groups (P<0.05). Interpretation & conclusions: Despite the higher rate of abnormal response to stimulation by clonidine in women aged more than 60 yr, the current study showed no significant correlation between age, and the basal and stimulated GH secretion rate and serum levels of IGF-1 and IGFBP-3 in postmenopausal women.

Comparison of laparoscopy-assisted hysterectomies with conventional hysterectomies

To compare operative and early postoperative outcomes of laparoscopic-assisted vaginal hysterectomy [LAVH] and laparoscopy assisted supracervical hysterectomy [LASH] with conventional hysterectomy by laparotomy or vaginally, including patients undergoing total or subtotal hysterectomy for benign gynecologic disease. Three different methods of hysterectomies: laparoscopic, vaginal, and abdominal, were compared at the Department of Obstetrics and Gynecology of Tabriz University of Medical Sciences, Tabriz, Iran, including all patients with indication of uterus removal for benign uterine disease from January 2005 to December 2007. The regional medical research ethics committee approved the study. A total of 288 hysterectomies were performed: 165 [57.3%] abdominal hysterectomy, 85 [29.5%] vaginal hysterectomy, and 38 [13.2%] laparoscopic-assisted hysterectomy. Laparoscopy assisted hysterectomy [LAVH, LASH] was associated with significantly lower early postoperative pain scores and complication rates, less blood loss, short hospital stay, and resulted in lower hospital charge with reusable devices statistically [p=0.03]. Laparoscopy is preferred to abdominal hysterectomy by laparotomy and to vaginal hysterectomy. Though vaginal hysterectomy had less complications and rapid recovery and patient satisfaction as compared with abdominal, but it was limited for multiparous patients with some degree of pelvic organ prolapse

Comparison of the effect of gonadotropin-releasing hormone agonist and dopamine receptor agonist on uterine myoma growth. Histologic, sonographic, and intra-operative changes

To investigate the effect of 2 medications; Diphereline and Cabergoline, on uterine leiomyoma growth, and its histologic, sonographic, and intra-operative changes. In an effort to treat large uterine leiomyoma in symptomatic patients in the Gynecology Clinics of the Alzahra Teaching Hospital of Tabriz University of Medical Sciences, Tabriz, Iran, from September 2007 to November 2008, 60 candidates randomized to receive Diphereline 3.75 mg, 4 times every 28 days [group I], and Cabergoline 0.5 mg, once a week for 6 weeks [group II], were included in this study. Clinical symptoms, feasibility of intra-operative dissection, intraoperative complications, sonographic, and pathologic characteristics of the tumor were evaluated. Thirteen patients from group I, and 10 patients from group II underwent surgery. There was a significant difference between the groups in the rate of lymphocyte infiltration [p=0.003], but not in other pathologic features. In both groups, the mitotic index was between 0-10. While there was no significant difference between the groups in the number [p=0.30], and volume of leiomyomas [p=0.65], however, changes in the uterine artery circulation was significant [p=0.001 [group I], p=0.026 [group II]]. In addition, there was a significant difference between the groups for intra-operative hemorrhage and adhesion of leiomyomas to the uterine wall. This study found that Cabergoline is as effective as Diphereline in the shrinkage of myomas, accompanied by improvement in the sonographic, clinical, and intra-operative outcomes without any adverse pathological changes, and could be a good medical regimen as an adjunct to surgical management

Comparison study on the effect of prenatal administration of high dose and low dose folic acid

To evaluate the effect of high dose and low dose folic acid on the levels of hemocysteine Hcy concentration during the first trimester of pregnancy and at delivery, and to examine the association of Hcy serum levels and preeclampsia. In a single blinded randomized clinical trial, which was conducted in Tabriz, Iran, from 2005-2008, 246 nulliparous pregnant women in 2 similar groups, received folic acid daily from early pregnancy until delivery 5 mg/day in group one and 0.5 mg/ day in group 2. The incidence of hypertension and laboratory changes in the levels of serum Hcy, lactate dehydrogenase, and uric acid in addition to the levels of urine creatinine and protein were compared between the groups. There was no presence of any type of hypertension in each group. The systolic blood pressures BP mm Hg at the first trimester were 114.01 +/- 8.78 for group one, 114.16 +/- 9.05 for group 2, and at delivery, 117.24 +/- 6.91 for group one, and 117.23 +/- 11.48 for group 2 p = 0.32. The diastolic BP at the first trimester were 74.90 +/- 7.45 for group one, 73.30 +/- 8.90 for group 2, and at delivery 76.46 +/- 5.58 for group one, and 76.69 +/- 8.62 for group 2 p = 0.42. Although the level of Hcy umol/L decreased significantly at the delivery time in group one 11.81 +/- 3.85 decreased to 6.44 +/- 1.88, and 2 9.08 +/- 3.24, decreased to 7.44 +/- 2.99, this decrement was more significant in the first group p < 0.001. The results show that folic acid supplement throughout pregnancy, irrespective of the dosage, could eliminate hypertensive disorders, and decreases serum level of Hcy, although it is reduced more significant in the first group