Disclosure of cancer information in iran: a perspective of patients, family members, and health professionals

In the last decades cancer has become one of the important causes of death in Iran .This study examined perspective of a group of Iranian health professionals, patients and patients' family members regarding their view on disclosure of cancer information at a university hospital in Tehran, Iran. The method of study was qualitative semi-structured focused group content analysis. Two group leaders [psychologist and psychiatrist] run the focus groups. Oncologists, nurses, patients and family members participated in separate focus groups. Five group sessions were held to sum up the participants views in four major topics related to disclosure of cancer information to patients and families. Most of physicians and nurses believed that disclosure of cancer diagnosis is a mistake. Family members think that it should be delivered gradually during stages of therapy based on patient's psychological state, but most of the patients consider truth telling as a patient right. All physicians, most of nurses and all the patients see the physician as a person responsible to break the diagnostic disclosure. All patients wanted the physicians to take the total control of decisionmaking process for their treatment. Iranian physicians and nurses hesitate to disclose cancer diagnosis compared to patients, who want to know the truth. Patients, nurses and physicians consider the physician to be the person responsible for delivering the information of cancer diagnosis .Development and implementation of a protocol based on Iranian culture is a necessity

Comparison between diazepam and phenobarbital in prevention of febrile seizure: clinical trial

Febrile convulsions [FC] are the most common convulsive events in childhood, occurring in 2-5% of children. About one third of these children will have a recurrence during a subsequent febrile infection. This sudden neurologic problem is extremely frightening and emotionally traumatic for parents so some physicians try to prevent recurrence of FC by prescribing different drugs. This is a randomized clinical trial in 85 healthy children, aged 6 months to 5 years, who were not treated before. These children received randomly either oral diazepam [0.33 mg/kg/TDS for two days during febrile illness] or continuous oral Phenobarbital [3-5mg/kg /24 h]. Ultimately 64 patients completed the study and were followed up for an average of 13 months [12-18 months]. The rate of recurrence of febrile seizure was 18.2% in diazepam group and 32.3% in Phenobarbital group; the difference is not statistically significant [p=0.16]. There was no significant difference between intermittent oral diazepam and continuous oral Phenobarbital for FC prevention

[Unprecedented rise in Cushing's syndrome in addicts in Tehran]

Despite the widespread medical use of glucocorticoids, reports of factitious administration of these hormones have been uncommon. We herein report an unprecedented rise in outbreak of Cushing's syndrome in Tehran among addicts using Tamgesic [a brand of Buprenorphine] to help them through the narcotic withdrawal stage, without knowledge of the glucocorticoid content of the black-market drug. Case histories of 19 patients with a final diagnosis of iatrogenic Cushing syndrome were reviewed. Liquid chromatography/mass spectrometry [LC-Mass] method was used to evaluate glucocorticoid existence in the brand. No Buprenorphine was present in the vials. Each Tamgesic vial contained 0.4 mg of Dexamethasone disodium phosphate and some amount of heroin. The duration of injection abuse and the number of vials used per day was 4.5 [1-18] months and 6.5 [2-20], respectively. Physical findings of the cases were not different from those of the classic endogenous Cushing's syndrome but their serum cortisol and urinary free cortisol were suppressed. Severe life-threatening complications were demonstrated in five cases. Surreptitious use of steroids resulting in Cushing's syndrome may be more common in opium addicts; a high degree of suspicion is needed to uncover this disorder. Whenever facing a Cushingoid appearance in addicts, the possibility of using black market drugs with corticosteroid contents should be kept in mind

[Treatment of pedophilia, bipolar mood disorder, and mental retardation; a case report]

Among legally identified cases of paraphilias, pedophilia is most common. Psychiatric disorders frequently coexist with pedophilia. Unfortunately, pedophilia is extremely difficult to treat. The authors report a patient with pedophilia, bipolar mood disorder and mental retardation who was treated with combination of carbamazepine and spironolactone

[Hearing function of children with meningitis by auditory brainstem response]

Sensorineural hearing loss is one of the most important complications' of meningitis, however, it can be neglected during the acute course of the disease. By early detection and medical intervention, the retardation of lingual development can be avoided. The hearing function of 40 children with meningitis was evaluated at 24- 72 hours after diagnosis [acute period] and 24 hours before discharging from hospital [recovery period] with auditory brainstem responses [ABR]. During the acute period, ABR test revealed normal hearing in 35 patients [87.5%] and severe to profound sensorineural hearing loss in 5 patients [12.5%]. The same results were obtained in re-evaluation in the recovery period. There were significant differences between the female gender, positive culture of cerebrospinal fluid, the age below 2 years of old and hearing loss. [P value = 0.03, 0.02, 0.02, respectively]. ABR can be used for early detection of hearing loss during the acute and recovery period of meningitis

[Comparison between diazepam and phenobarbital in prevention of febrile seizure]

Febrile seizures are the most common convulsive events in childhood, occurring in 2-5% of children. About one third of these children will have a recurrence during a subsequent febrile infection. This is a randomized clinical trial in 85 healthy children, aged 6 months to 5 years, who were not treated before. These children received randomly either oral diazepam [0.33 mg/kg/tds for two days during febrile illness] or continuous oral Phenobarbital [3-5mg/kg /24 h]. Ultimately 64 patients completed the study and were followed up for an average of 13 months [12-18 months]. The rate of recurrence of febrile seizure was 18.2% in diazepam group and 32.3% in phenobarbital group; the difference is not statistically significant [p=0.16]. There was no significant difference between intermittent oral diazepam or continuous oral phenobarbital

Psychiatric consultation in Taleghani hospital in 2002

Mental disorders may interfere, aggravate or mimic medical conditions. Treatment of such disorders may improve the course of the underlying disease and promote patient's quality of life. This study was carried out to evaluate the characteristics of psychiatric referrals during one year [2002], in Taleghani hospital.The study was performed by weekly analysis of all psychiatric consultations. Initial data including sex, age, referral ward, underlying disease, and cause of psychiatric consultation were gathered.A total of 201 consecutive patients [1.6% of all admitted subjects to the hospital] referred for consultation. They were mainly referred from the Endocrinology [15%], CCU [13.6%], and Cardiology [12.6%] wards. The most frequent reasons of referral were: current psychiatric symptom [55%], presence of psychiatric history [15%], and aggression [10%]. Main diagnosis turned out to be depression [36%], adjustment disorder [16.5%] and delirium [15%].These results highlight the role and functioning of consultation in a general hospital, but further studies are required to evaluate the importance of such a service to improve patient care and psychiatric education in various medical wards