Assessing attitudes of medical students towards first contact with patient in Tehran [2016-17]

Background: Early experience of clinical arena as first situations can be effective in selection or refusing medicine as profession is so important that programmers and administrators should consider these settings as one of the most elements in educational programs

Materials and Methods: This study was a cross-sectional study and including presently studying students in medicine field of medical sciences universities. Sample size was estimated for 275 students. Participants were selected from schools of medicine: Iran University [IUMS], Shahid Beheshti University, and Islamic Azad University using stratified random sampling method. Data was collected in March of 2016 by a researcher made questionnaire determined its validity and reliability. Data was analyzed using chi-squared test, t-test, Mann-Whitney and Kruskal-Wallis test

Results: Mean score of medical students' attitude from 15 five-degree scale questions was 51.22 +/- 6.32. The mean scores of attitude in men and women were 51.37 +/- 6.16 and 51.06 +/- 6.53, respectively [p=0.687]. Overall, 13.8 % of students had positive attitude towards first contact with patient, 10.5 % of students had negative attitude and 75.6 % had no opinion. The mean scores of attitude towards first contact with patient in Iran university, Shahid Beheshti university and Islamic Azad university were 50.40 +/- 5.00, 52.71 +/- 5.91 and 46.12 +/- 5.97, respectively [p<0.001]. The mean scores of attitude towards first contact with patient in reformed educational system and old educational system were 52.35 +/- 5.83 and 46.12 +/- 5.97 respectively, with a significant difference between two types of educational system [p<0.001]

Conclusion: As respects more positive attitude of students in reformed educational system in comparison with old educational system, special attention to courses of early contact with patient may contribute to decreasing educational insufficiency and distance between theory and practice and lead to the satisfaction all of beneficiaries

Nephroprotective effects of L-carnitine against contrast-induced nephropathy in patients undergoing percutaneous coronary intervention: a randomized open-labeled clinical trial

Background: L-carnitine may prevent the incidence of AKI by its antioxidant effects and improving circulation in ischemic conditions. The goal of this trial was to evaluate the impact of L-carnitine on contrast-induced nephropathy in patients undergoing elective PCI

Methods: totally, the patients were randomly allocated to 2 groups. The treatment group received 1 g of L-carnitine orally 3 times a day, 24 hours before the procedure [3 g before PCI] and 2 g after PCI, whereas the control group did not receive L-carnitine. In both groups, the plasma level of neutrophil gelatinase-associated lipocalin [NGAL] was measured at baseline and 12 hours after PCI

Results: our study was conducted on 202 patients [including 91 vs. 111 patients in the treatment and the control group; 31 [34.1%] vs 33 [29.7%] female in carnitine and control group; and ages include 62.0 +/- 9.0 vs 57.0 +/- 11.2 years]. The median plasma levels of NGAL were not different between the carnitine and control groups at baseline [57 [IQR: 22 - 255] vs. 54 [IQR: 29 - 324]; p value = 0.155] and 12 hours after PCI [71 [IQR: 52 - 129] vs. 70 [IQR: 46 - 153]; p value = 0.925], but the changes in the plasma NGAL from baseline to 12 hours after PCI were different between the 2 groups [5 [IQR:-147 - 30] vs. 17 [IQR: -21 - 41]; p value = 0.010]

Conclusion: our results showed that oral L-carnitine was able to prevent an increase in NGAL following contrast medium administration in patients undergoing PCI. More studies should be performed to fully elucidate the nephroprotective effects of L-carnitine

Aggression in juvenile delinquents and mental rehabilitation group therapy based on acceptance and commitment

Objective: The most common problem that delinquent children and juveniles deal with at every moment is the lack of sufficient control over their aggression. Accordingly, the aim of this study is to investigate the effects of mental rehabilitation group therapy based on acceptance and commitment on decreasing aggression in juvenile delinquents

Methods: This study employed a quasi-experimental method with a pretest-post-test design and a 2-month follow-up with both the experimental and the control group. To conduct this study, 30 cases of delinquent juveniles were selected by the Buss and Perry Aggression Questionnaire, and randomly assigned to two experimental and control groups. The Experimental group received 8 sessions of acceptance and commitment group therapy

Results: Results were analyzed using ANOVA, and showed that the experimental group demonstrated a significant reduction in aggression and its aspects [physical aggression, verbal aggression, anger and hostility] compared with the control group. This difference was also maintained in the follow-up phase [P< 0.001]

Discussion: The results showed that acceptance and commitment group therapy can effectively reduce overall aggression and its dimension [physical aggression, verbal aggression, anger and hostility], and that the results last to the follow-up phase

Platelet rich plasma: review of literature

Objective: At present, growth factor-containing products such as enamel matrix derivatives, recombinant bone morphogenetic protein [rh-BMP], recombinant platelet derived growth factor and platelet rich plasma [PRP] have gained increasing attention. PRP is an autologous source of platelet growth factors used to enhance healing of soft and hard tissues. PRP has gained popularity due to its autologous nature, easy procurement and low cost

Review of Literatures: This study focuses on procurement and clinical applications of PRP

Conclusion: Controversy exists regarding the efficacy and applications of PRP and longitudinal studies are required to further elucidate this subject

Insulin refusal in Iranian patients with poorly controlled type 2 diabetes mellitus

To achieve tight glycemic control in diabetic patients, it may be necessary to introduce insulin therapy much earlier in the disease course. Poor glycemic control is a risk factor for the development of diabetic complications. Many patients require insulin therapy after several years of disease in order to maintain good glycemic control and prevent complications. But many patients do not receive insulin therapy in a timely manner because of a negative appraisal of this treatment. Understanding the cause of this negative attitudes is necessary for better evaluation to overcome for this problem. The purpose of this study was to evaluate the reasons for insulin refusal among patients with type 2 diabetes. This is a descriptive crosssectional study from Yazd Diabetes Research Center. 400 patients with type 2 diabetes who had an HbA1c >/= 8.0% despite optimal oral therapy were identified that participated in this study. Data were obtained by patient interview using validated questionnaires. This study showed that Insulin refusal was common. 77% of participant reported being unwilling to take insulin if prescribed. Fear of injection is an important cause for insulin refusal among patients. Insulin refusal is an important problem among our patients with type 2 diabetes mellitus. Findings of this study suggest that interventions aimed at increasing insulin use should focus on injection-related concerns, education and correction of misconceptions.

Review of simulation and optimization of autonomous and grid-connected hybrid renewable energy systems as micro-grids

Micro Grid [MG] systems show great promise for integrating large numbers of distributed energy resource [DER] systems into power networks. The MG concept has been researched and implemented intensively by many experts.The interest in MG is growing due to its potential benefits in providing reliable, safe, efficient and sustainable electricity from renewable energy sources [RES]. This paper reviews the simulation and optimization approaches to the use of hybrid renewable energy resources as micro grid in two modes, standalone and gridconnected.

Peri-implant soft tissue management through use of cultured gingival graft: a case report

Tissue-engineered gingival graft was used for regenerating facial gingiva around an implant at lower left first premolar area with insufficient attached gingiva. Engineered gingival graft was produced by mixing 250 ml bovine skin collagen with 250 ml nutritional medium containing human gingival fibroblasts [2x10[5]]. 3 months post-surgery, there were gains in the attached gingiva compared to pre-surgery. The histological examination revealed a keratinized tissue on the treated site. Based on the result of this investigation, this graft was safe and capable of generating keratinized gingiva

Advances and considerations in attention-deficit/hyperactivity disorder pharmacotherapy

Attention-deficit/hyperactivity disorder [ADHD] is a highly heritable neuropsychiatric disorder associated with significant impairments in occupational, academic, neuropsychological, and social functioning. Central nervous system [CNS] stimulants are recommended as first-line medication therapy for children. CNS stimulants include formulations of methylphenidate and amphetamine derivatives and are available in a large variety of immediate-and extended-release preparations. Extended-release preparations are often preferred to limit drug administration during school or work and may help to limit side effects associated with rapid fluctuations in serum concentration. Stimulant medication is by far the most commonly used treatment in managing children with ADHD, 10-20% of those who take such medication do now show clinically significant improvements in their primary ADHD symptom. Even when a favorable response is obtained, some children experience side effects that are of sufficient occurrence and severity to prevent continued use of stimulant medication. In such instances or when families are unwilling to consider a stimulant, non-stimulant medications may be appealing. This review focuses on etiology, assessment and treatment of ADHD with various stimulant and non-stimulant agents

Comparing effects of continuous insulin infusion with or without subcutaneous glargine insulin on glycemic control in diabetic patients undergoing coronary artery bypass graft [CABG]

Hyperglycemia is associated with increased morbidity and mortality in diabetic patients following coronary artery bypass grafting. Tight glycemic control in perioperative period can reduce these events. The goal of this study was to determine whether combination of continuous infusion and subcutaneous glargine as a basal insulin could improve glycemic control. Diabetic patients who were candidate for CABG were randomized to receive continuous insulin infusion with or without subcutaneous Glargine insulin for at least 72 hours which started 24 hours before surgery and continued for 48 hours after surgery. A total 84 subjects were required. In group A [n=45] continuous insulin infusion was used for glycemic control and in group B [n=39] we used continuous infusion with subcutaneous glargine insulin. Blood glucose level was significantly better in desirable range in group B in comparison to group A. Total mean blood glucose level in group A was 186.1 mg/dl and in group B was 174.3 mg/dl [P=0.008]. Frequency of hypoglycemia [blood glucose <70 mg/dl] was 0.66% in group A and 0.5% in group B that was similar [P=0.530]. The mean length of stay in the hospital was not different between two groups [P=0.288]. We found out that a combination of continuous insulin infusion and glargine insulin as main basal insulin can improve glycemic control in diabetic patients undergoing coronary artery bypass grafting

Comparison of the effects of sodium metavanadate and zinc sulfate supplementation on lipid and glucose in patients with type 2 diabetes

Type 2 diabetes mellitus is a chronic illness causing considerable morbidity and mortality. Enormous advances have been made in medical care but more people are still having tendency to use herbal or alternative remedies. This study is a randomized, controlled trial on type 2 diabetic patients. The subject consisted of 60 patients divided randomly into three groups and supplemented daily with 100 mg sodium metavanadate and 660 mg zinc sulfate or placebo for six weeks. The following were checked at baseline of the study and after six weeks: Body Mass Index [BMI], Blood Pressure [BP], Fasting Blood Sugar [FBS], 2-h postprandial glucose [2hpp], Glycated hemoglobin [HbA1c], Triglyceride [TG], Total Cholesterol [TC], Low-Density Lipoproteins, and High-Density Lipoproteins. Also HbA1c, BMI and BP were measured after 12 weeks to evaluate the long-term effects of drugs. Statistical analysis was performed using SPSS 11.5. Data of continuous variables are expressed as means +/- standard deviation. Differences between groups were assessed by the paired T-test. Comparison between three groups was done by Post Hoc Tests. Mean age of patients was 51.39 +/- 8.60 years. The results of this study show a significant decrease in TG [P=0.01] and BMI [P=0.03]. After 12 weeks, there was a significant decrease in BMI [P=0.01] in Sodium metavanadate group. Due to zinc sulfate administration, significant decrease was seen in TG [P=0.005], TC [P=0.02], LDL [P=0.01] and systolic blood pressure [P=0.02]. After 12 weeks, there was a significant decrease in HbA1c [P=0.04] with zinc sulfate consumption. Consumption of zinc sulfate in type 2 diabetic patients could be effective in lipid profile. It is recommended to use another vanadium compound to achieve better results

Effect of Sodium Metavanadate Supplementation on Lipid and Glucose Metabolism Biomarkers in Type 2 Diabetic Patients

Type 2 diabetes mellitus is a chronic, progressive illness that causes considerable morbidity and premature mortality. Vanadium is a trace mineral that has been claimed to be effective in controlling blood glucose levels in diabetic patients. A randomised placebo-controlled study was conducted to evaluate the effect of sodium metavanadate on selected biochemical markers in type 2 diabetic patients. Forty patients were enrolled and half of them received 100 mg sodium metavanadate daily for 6 weeks while the other half were placebo subjects. The mean age of the patients was 53.1 ± 8.5 years. Body mass index (BMI), blood pressure(BP), fasting blood sugar (FBS), 2-h postprandial glucose, glycated hemoglobin (HbA1C), triglyceride(TG), total cholesterol (TC), low-density lipoproteins (LDL), high-density lipoproteins (HDL) were determined before the start and at the end of the study. Levels of FBS, HbA1C, TC and LDL in the diabetic subjects decreased after six weeks on sodium metavanadate, but the differences were not statistically significant on comparing between pre- and posttrial levels. Based on the results, this study did not find sodium metavanadate of beneficial use as a form of vanadium supplementation among patients with type 2 diabetes.

comparative scanning electron microscope investigation of cleanliness of root canals using hand K-Flexofiles, rotary RaCe and K3 instruments

The most important aims of root canal preparation are the removal of vital pulp tissue, remaining necrotic debris and infected dentin, eliminating the bulk of bacteria present in the root canal system. The aim of this study was to compare the cleaning efficacy of hand K-Flexofiles and rotary RaCe and K3 instruments in root canal preparation. A total of 60 single rooted teeth with maximum curvature of <20§ were selected and divided into three groups of 20 teeth each. Canals were prepared with KFlexofiles, K3 and RaCe instruments using crown down preparation technique, up to size #30. After instrumentation, the root canals were flushed with 5 mL of 2.5% NaOCl solution. The amount of debris and smear layer was quantified on the basis of Hulsmann method using a scanning electron microscope. The data were statistically analyzed with one-way ANOVA test at a significance level of P<0.05. None of the three groups achieved completely debrided root canals.. In general, KFlexofiles were able to achieve cleaner canals compared to K3 and RaCe instruments [P<0.05]. There were no significant differences between three groups in smear layer removal throughout the root canal walls [P<0.05]. K-Flexofiles group had less remained debris when compared to K3 and RaCe instruments

Effects of cisapride on QTc interval in children

Cisapride is a prokinetic drug with different reports on its cardiac side effects. As there might be a genetic susceptibility for the effects of this drug, we studied its effects on QTc interval of children in our region. This semi-experimental study was performed on children aged over one month, who attended Amirkola Children's Hospital from October 2004 to March 2005 and needed to be treated with Cisapride. Patients with risk factors such as cardiac disease, electrolyte disturbance and drug usage interfering with Cisapride metabolism were excluded from the study. Cisapride was prescribed orally 0.6mg/kg/day in 3 doses. ECG was taken in lead II before drug administration and after one week. QTc intervals before and after treatment were compared. P-value >0.05 was considered significant. Among 135 admitted children needing Cisapride, 118 cases fulfilled inclusion criteria and were enrolled in the study. Their mean age was 14.1 [1.5] months. The mean QTc intervals before and after treatment were 377 [20] msec and 380 [22] msec, respectively [P=0.1]. No child had a QTc interval more than 450 msec. Cisapride [0.6mg/kg/day] did not cause a significant prolonged QTc interval in children with no risk factor

Clinical and visual outcome of transsphenoidal surgery in nonfunctioning pituitary adenomas

The aim of this study was to evaluate the outcome of patients with nonfunctioning pituitary adenoma treated with transsphenoidal surgery, with special emphasis on the visual status and complications associated with the technique. From 1994 to 2004, 47 patients underwent transsphenoidal surgery for treatment of pituitary adenomas unassociated with clinical or biochemical evidence of hormonal overproduction. Transsphenoidal surgery using the surgical microscope and the television radiofluoroscope was performed in all cases. Visual field and acuity assessments were done before and a few weeks after surgery in both eyes. Of 94 patient's eyes assessed preoperatively, 86 [91.48%] had visual acuity and 66 [70.21%] had visual field problems. Incidence of optic atrophy in our patients' eyes was 33%. In our series, postoperative visual results were not influenced by the presence of optic atrophy. There was no statistically Significant difference between postoperative visual acuity improvement and the severity of visual acuity problems, but postoperative visual outcome was better in patients with quadranopsia or hemianopsia than patients with blindness [p < 0.05]. The mean postoperative hospitalization was 9.8 +/- 7.9 days. The percentage of surgically related complications was 19.14% and deaths was 2.12%. There were 4 instances of permanent diabetes insipidus, 2 of cerebrospinal fluid rhinorrhea, 2 of ophthalmoplegia, and one of postoperative haematoma. This low rate of postoperative complications and excellent outcome which our study showed, makes transsphenoidal surgery an attractive procedure for patients with nonfunctioning pituitary adenomas

Prevalence of mood disorders in Iran

To study the prevalence and demographic characteristics of mood disorders among Iranian adults. In this cross-sectional population-based epidemiological study [age 18] in Iran, 25180 individuals were selected through a randomized cluster sampling method for a diagnosis using the Schedule for Affective Disorders and Schizophrenia [SADS]. They were then interviewed at home by 250 trained clinical psychologists. The estimated lifetime prevalence of Major Depressive Disorder [MOD] and Minor Depressive Disorder [mDD] were 3.1% and 0.3% respectively. Also, the estimated lifetime prevalence of Bipolar Mood disorder [BMD] type I and type II were 0.1% and 0.7% respectively. The current prevalence of MDD, mDD, BMD-I and BMD-II were 1.8%. 0.2%, 0.04%, and 0.3% respectively. Mood disorders were associated with female gender, lower education, being married, being middle-aged, living in cities, and not being a homemaker. The prevalence of mood disorders was lower among Iranian adults than reported in Western studies, and a number of demographic associations differed from those reported in Western studies: Important cultural differences in the nature or manifestation of depression are implied by these results

[Report of 54 cases of diastematomyelia treated in Shohadaye Tajrish, Mehrad and Mofid Hospitals]

Diastematomyelia is a congenital anomaly of the spinal cord which is usually associated with other CNS, skeletal and skin abnormalities. In this study, 54 cases treated with surgical or medical routes have been surveyed. Average age was 35 months and female/male ratio was 1811. Two thirds of the patients were found to have neurological deficit, with gait problem being the most predominant whereas skin and orthopedic anomalies ranked next. Tethered cord was detected in about half of them and spurs found in two third. Two thirds of cases underwent surgery out of which 114 had transient postoperative complications with complication rate of 25%. There was no postoperative mortality. Post-operative improvement of neurological deficit occurred in 14% of cases and same percentage had deterioration, while others had no change in their neurological status

[In vitro study between antibacterial and cytotoxic effects of chlorhexidine and persica mouthrinses]

The use of mouth rinses as antiseptics to prepare surgical site is highly recommended by surgical principles and they are used even after doing surgery. Chlorhexidine has been considered as an effective antibacterial mouth rinse but as its well known side effects are potentially harmful, Persica mouth rinse which is supposed to be as effective as Chlorhexidine with less side effects, due to its herbal origin, was compared with Chlorhexidine mouthrinse. The aim of this study was to compare the antibacterial and cytotoxic effects of Chlorhexidine and Persica mouthrinses. In this in vitro experimental study Streptococcus Mutans, Streptococcus Sanguis and Lactobacillus Kasei were exposed to Persica [absolute and 50%] and Chlorhexidine concentrations [0.01% ,0.02% ,0.1% ,0.2%] for 2 ,10 , 30 minutes. The growth of microorganisms were evaluated after 24hr incubation. The human oral carcinoma cell line KB, the human osteosarcoma cell line Saos-2 , the mouse macrophage cell line J774A.1 and human gingival fibroblast cell line MRF were exposed to Persica [0.1% , 0.5% , 1% , 5%] and Chlorhexidine concentrations [0.0001%, 0.001%, 0.01%, 0.03%] for 1 hr. Following drug exposure the cells were washed and cultured for another 48-72 hrs, then, cell growth was assessed by MTT assay. All concentrations of Chlorhexidine prevented the growth of microorganisms but Persica mouthwash had a weak antibacterial effect. Chlorohexidine concentrations of higher than 0.001% had significant cytotoxicity in all cell lines and concentrations of higher than 0.1% of Persica also exerted a very significant cytotoxic effect on all cell lines. Persica mouth rinse is not a reliable antiseptic for preparation of oral cavity prior to oral surgery since it doesn't bear enough antibacterial properties. Both mouth rinses are cytotoxic, so that, using them for wound care, specially for oral wounds which heal by secondary intention is not recommended

[ sight of nurses about training to patients]

Introduction: The importance of training to patient has been not considered as a dimension of nursing science. Positive sight to patient training can affect on their suitable operation in this case. So the goal of this search is determination of amount of nurses sight

Method: In this profile search 186 nurses were selected basis of classification sampling from Hospitals of Ardebil. The information was collected by singly particulars form and Redman questionnaire

Results: The Findings show the 47/8 of nurses had positive sight and 52/2 had negative sight. 91/4 said that training to patients helps them to confirm better the disease. Although all nurses [100%] believed training to patient is necessary but 37/6 believed this work is in era of Doctor's act. The result of data analysis of search shows meaningful relation between nurses sight and changes of service, sex and marriage position. [P=0/50]

Discussion: the results of this search show the nurses sight to act the training role of them to patients

[Analysis of Iran's mental health research over 3 decades: a scientometric study]

Objective: To describe the characteristics of Iran’s mental health research articles that are published over a 30-year period

Method: The articles include those concerned with psychiatry, psychology, and neuroscience that were published in the national as well as international scientific journals. These articles were drawn from a national database of published research in psychiatry, psychology as well as neuroscience [IranPsych]. For this study, articles were limited to those published in a 30-year period of 1973-2002 [1352-1381 in Persian calendar]

Results: Of a total of 3031 articles published in the 30-year period, 19.8% were published in the international journals. The publication trends showed a marked increase in number over item, especially in the last 5 years. Among research areas, psychology, clinical sciences, and the neurosciences constituted the largest proportions [52.8%, 31.6%, and 13.5%, respectively]. The trend of research areas revealed an upward trajectory for the proportion of neuroscience research and a decline in the proportion of mental health service research. The topic of 38.6% of all articles was in the category of mental disorders, with pharmacotherapy and psychotherapy researches constituting 14.5% and 5.7% of the articles, respectively. Among mental disorders, the largest proportions of the published research were about mood disorders, substance use related disorders, and anxiety disorders. The most commonly used research method was cross-sectional, with experimental designs comprising 15.9% and prospective research accounting for 1%. The preferred places for data collection included hospitals, schools and universities. In more than 90% of the articles there were no references to the funding sources and only 2.1% of the articles were carried out with international collaboration of the authors

Conclusion: The rising trend of mental health research publications shows the significant contribution of nation’s mental health researchers. The results of this study could provide an empirical basis for policy making and strategic planning in mental health research

[Attitudes of opioid dependents and their families in bam toward the effects of addiction on losses and injuries caused by the earthquake]

Objective: In the final days of the year 2003, the earthquake in the Iranian city of Bam, led to the death of more than 30000 of the 200000 inhabitants. The rate of opium abuse, which had been already high among the population in this city caused problems after the earthquake. The objectives of this rapid qualitative study were to assess drug abuse situation and the attitude of drug dependents and their families toward the effects of drug dependency on the injuries and losses imposed by the earthquake

Method: The study was carried out in the city of Bam, one of its nearby villages and 8 hospitals in Tehran and Kerman admitting earthquake victims. A group of 159 people were interviewed, including opioid dependents, their family members, people living in Bam, and service providers

Results: According to more than half of the opioid dependent interviewees, opioid dependency had decreased and according to one third it had increased the effects of injuries and losses due to the earthquake. Half of their relatives believed that opioid dependency had increased injuries and another half believed that it had no effect on their losses and injuries

Conclusion: Considering a great risk of worsening of drug abuse situation in Bam after the earthquake, and the existence of positive and even neutral attitudes toward drugs, it can be anticipated that drug abuse would begin or continue among the survivors. Therefore, there is a great need for interventions that affect peoples’ attitudes toward drugs to achieve prevention and control of substance abuse