Case reports
Mohammad Eshagh Hosseini; Mohammad Heidary; Seyed Mahmoud Eshagh Hosseini; Samira Alesaedi; Iraj Salehi Abari
Volume 22, Issue 5 , 2020
Abstract
Introduction: Acro-osteolysis is characterized by resorption of distal phalanges of fingers and toes. Plain radiography is the best imaging technique for the detection of acro-osteolysis.
Case Presentation: Our report describes a 38-year- old man with a history of rheumatoid arthritis and ...
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Introduction: Acro-osteolysis is characterized by resorption of distal phalanges of fingers and toes. Plain radiography is the best imaging technique for the detection of acro-osteolysis.
Case Presentation: Our report describes a 38-year- old man with a history of rheumatoid arthritis and celiac disease, who presented with shortness of distal phalanges. Roentgenograms disclosed terminal phalangeal resorption in the ?ngers.
Conclusions: All work-ups were normal from tests and surveys for secondary causes. According to longstanding and poor-controlled celiac disease, after excluding secondary causes, we presume that celiac disease is the leading cause of acro-osteolysis in this patient.
Research articles
Yan Lou; Dan Gao; Qiaoyan Guo; Yixian Zhang; Ping Nie; Wenpeng Cui
Volume 22, Issue 5 , 2020
Abstract
Background: The prevalence of Idiopathic Membranous Nephropathy (IMN) among patients with Primary Glomerular Disease (PGD) has increased in China.
Objectives: This cross-sectional study aimed to investigate changes in the clinicopathological features associated with IMN in northeast China.
Methods: We ...
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Background: The prevalence of Idiopathic Membranous Nephropathy (IMN) among patients with Primary Glomerular Disease (PGD) has increased in China.
Objectives: This cross-sectional study aimed to investigate changes in the clinicopathological features associated with IMN in northeast China.
Methods: We analyzed clinical and pathological data of 1,198 patients with IMN among 4,083 patients hospitalized with PGD undergoing renal biopsy from January 1, 2005, to December 31, 2018 at the Second Hospital of Jilin University in northeast China. Enrollees were divided into two groups: those seen from 2005 to 2011 (Group 1) and those seen from 2012 to 2018 (Group 2). We compared the clinicopathological features between Group 1 and Group 2.
Results: The percentage of patients with IMN among those with PGD increased over the 14 years of the study (P = 0.001). The male-to-female ratio, prevalence of microscopic hematuria, and proteinuria levels were higher in Group 2 than in Group 1 (P < 0.05). Among those with PGD, the percentages of patients with IMN-total, IMN-I, IMN-II, and IMN-III+IV, as well as Tubulointerstitial Lesion (TIL) scores, were higher in Group 2 than in Group 1 (P < 0.05). Finally, age (P < 0.001), degree of proteinuria (P < 0.001), and serum triglyceride level (P = 0.027) were significantly associated with TIL scores among patients with IMN.
Conclusions: Membranous nephropathy is now the leading cause of PGD, with increased TIL scores during the study period. Advanced age, high proteinuria, and serum triglyceride levels represent the independent risk factors for severe TIL among patients with IMN.
Research articles
Zahra Sepehrmanesh; Mehdi Adel; Afshin Ahmadvand; Mojtaba Sehat
Volume 22, Issue 5 , 2020
Abstract
Background: Serotonin and dopamine are involved in the development of obsessive-compulsive disorder (OCD). Approximately 40% of OCD patients do not respond to the first-line therapy of treatment using selective serotonin reuptake inhibitors. Reportedly, the response to the treatment is increased ...
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Background: Serotonin and dopamine are involved in the development of obsessive-compulsive disorder (OCD). Approximately 40% of OCD patients do not respond to the first-line therapy of treatment using selective serotonin reuptake inhibitors. Reportedly, the response to the treatment is increased by enhancing dopamine blockers.
Objectives: The purpose of this study was to evaluate the efficacy and immunogenicity of ondansetron as a booster in the treatment of OCD patients.
Methods: The present double-blind, randomized clinical trial (RCT) was conducted on 40 patients (16 males and 24 females) aged 18 to 60 years who met the DSM-V-TR-based OCD diagnostic criteria and had a minimum score of 16 on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). The patients were randomized to receive standard treatment and ondansetron (8 mg/day) or placebo for 12 weeks. They were examined using Y-BOCS and side-effect checklist at baseline, fourth, eighth, and twelfth weeks.
Results: The patients in both groups were homogeneous and comparable in terms of age, marital sex status, type of obsession, anxiety, depression, age at the onset of disease, and the duration of disease. The Y-BOCS scores in the intervention and placebo groups were 27.15 ± 3.94 vs. 26.15 ± 4.94 at baseline, 25.40 ± 3.75 vs. 25.00 ± 4.79 in the fourth week, 20.85 ± 3.69 vs. 24.05 ± 4.97 (P = 0.026) in the eighth week, and 17.95 ± 3.43 vs. 21.65 ± 4.85 (P = 0.008) in the twelfth week, respectively. Significant changes occurred between the two groups at weeks 8 and 12; the difference between the two groups was significant (P = 0.015), whereas no significant difference was observed between the two groups before week 8.
Conclusions: This 12-week, double-blind, and randomized clinical trial showed that ondansetron was a booster agent with a significant effect on patients with moderate to severe OCD. This study also showed that ondansetron is generally well tolerated by OCD patients. The response to the treatment also increased from the eighth week of treatment onwards. The severity of the disease was decreased at the end of the ondansetron intervention. The adjunct ondansetron treatment was recommended for OCD patients
Case reports
Zhenzhu liu; Dajun Yuan; Xiangpeng Kong; Peng Qu; Hongyan Wang
Volume 22, Issue 5 , 2020
Abstract
Introduction: ?-blockers and angiotensin receptor blocker (ARB)/angiotensin-converting enzyme inhibitors (ACEI) are well known as critical therapies for improving the prognosis in patients with acute myocardial infarction, however, their use in some case may be limited. We believe that in such cases ...
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Introduction: ?-blockers and angiotensin receptor blocker (ARB)/angiotensin-converting enzyme inhibitors (ACEI) are well known as critical therapies for improving the prognosis in patients with acute myocardial infarction, however, their use in some case may be limited. We believe that in such cases as when ?-blockers and ARB/ACEI use is limited, ivabradine plays a potential role in the improvement of individual prognoses.
Case Presentation: A 49-year-old man from Dalian, China. He was diagnosed with acute inferior myocardial infarction in Feb, 2016. And he still experienced palpitations and heart failure after drug treatment and percutaneous coronary intervention (PCI). We used metoprolol at a low dose, although the symptoms were not relieved, ?-blockers could not be used or increase dose because of his hypotension. Finally, we chose ivabradine to alleviate the symptoms of the patient related to heart rate and palpitations without affecting blood pressure so as to promote the recovery of heart function. We witnessed a gradual reduction in heart rate (HR) and a gradual increase in blood pressure. Finally, we administered an ARB and increased via titration the dose of ARB and ?-blocker.
Conclusions: When there are limitations to the use of ARB/ACEI and ?-blockers, we can use ivabradine, which reduces HR without affecting blood pressure. Ivabradine can help with the titration of the dose of ARB/ACEI or ?-blockers.
Research articles
Behrouz Beiranvand; Ebrahim Hajizadeh; Aliakbar Rasekhi; Abdollah Amirfarhangi; Javad Nasseryan
Volume 22, Issue 5 , 2020
Abstract
Background: Restenosis after coronary angioplasty can have serious complications such as coronary artery bypass graft, myocardial infarction, and death.
Objectives: The present study aimed at investigating the factors affecting the recurrence of coronary artery stenosis in patients undergoing ...
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Background: Restenosis after coronary angioplasty can have serious complications such as coronary artery bypass graft, myocardial infarction, and death.
Objectives: The present study aimed at investigating the factors affecting the recurrence of coronary artery stenosis in patients undergoing angioplasty using the recurrent event data analysis.
Methods: A cohort study was performed on patients undergoing coronary angioplasty from March 23, 2009, to January 21, 2011. All patients were followed up from angioplasty to January 21, 2015. First, each of the independent variables was entered into the univariate Cox model with a frailty component. Then, variables with p-values of less than 0.2 were entered into the multivariate analysis. The statistical analysis was done using R software, version 3.6, at the significance level of 0.05.
Results: The present study was conducted on 1,000 patients who underwent coronary angioplasty. We found that 441 patients experienced restenosis at least once in the study period. The mean survival time to the first event of restenosis was 44.08 ± 1.06 months. Patients with a history of diabetes, unstable angina, and myocardial infarction had a significantly higher hazard of restenosis compared to other patients (P < 0.05).
Conclusions: The results of the recurrent event survival analysis confirmed the significant role of risk factors such as a history of diabetes, unstable angina, and myocardial infarction. Therefore, training to enhance the patients awareness and attitude seems necessary to prevent them from exposing whit known risk factors. The periodic follow-up of patients with risk factors and more ongoing care are also necessary.
Research articles
Ali Akhavan Behbahani; Irvan Masoudiasl; Somayeh Hessam; Mohesn Najafikhah
Volume 22, Issue 5 , 2020
Abstract
Background: Health legislation provides a framework to implement various health policies. Participatory democracy in healthcare is inevitable. Citizens and health professionals should participate in participatory democracy, and health laws should be the result of a process in which participatory ...
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Background: Health legislation provides a framework to implement various health policies. Participatory democracy in healthcare is inevitable. Citizens and health professionals should participate in participatory democracy, and health laws should be the result of a process in which participatory instruments and techniques have a prominent role. Health democracy can be achieved through the expansion of mechanisms for citizens participation in the legislative process. The health democracy enables citizens to participate in the decision-making process and to have equal access to services provided by the public health system.
Objectives: The current study aims to assess participatory mechanisms used by selected countries to participate their citizens in legislative processes.
Methods: The current study is a comparative study of the legislative processes of selected countries. To select countries, four issues were evaluated: (a) overall legal system; (b) how laws enforce; (c) legislative backgrounds; and (d) health system basic model.
Results: The number of legislative chambers, legislative initiatives, legislative authorities and institutions, legislative commissions, and citizens participation in the legislative process were analyzed in the selected countries. An analysis of the factors affecting public participation in healthcare legislation shows that participation in the legislative process is a complex phenomenon influenced by social, legal, cultural, political, and sovereignty factors. This phenomenon cannot be analyzed isolated from these factors. However, the way should be paved for citizens' participation. The selected countries use different methods for citizens participation, depending on their legal systems.
Conclusions: Research results show that there are various public participation mechanisms. In Iran, there is a huge potential for public participation, and members of the parliament can easily interact with the interest groups and relevant individuals. These conditions provide a golden opportunity for expert health legislation.
Research articles
Khanali Mohammadi; Sedigheh Sadat Tavafian
Volume 22, Issue 5 , 2020
Abstract
Background: Addiction in Afghanistan, as the largest opium producer in the world, is relatively high, and limited studies have indicated that the youth, especially students are the majority of the addicted cases in this country.
Objectives: This quasi-experimental study aimed at designing ...
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Background: Addiction in Afghanistan, as the largest opium producer in the world, is relatively high, and limited studies have indicated that the youth, especially students are the majority of the addicted cases in this country.
Objectives: This quasi-experimental study aimed at designing and evaluating the effect of educational intervention based on the Health Belief Model (HBM) on drug abuse prevention among the students of Khatam Al-Nabieen University in Afghanistan.
Methods: In this quasi-experimental study, 120 students of Khatam Al-Nabieen University residing in Ghazni city, Afghanistan, were randomly divided into two groups of the intervention and control (60 students per group). The HBM-based educational intervention was performed for the intervention group. The data in both groups were collected and evaluated at four time points, including before intervention, and immediately, 3, and 6 months after the intervention using a valid researcher-made questionnaire.
Results: Although there was no significant difference between the mean score of the HBM constructs (P > 0.05) before the intervention, the results of repeated measures ANOVA showed significant differences in the intervention group in HBM constructs and also intention toward substance abuse preventive behavior (P < 0.001). There were significant inter- and intra-group differences, as well as the group-time interaction in all HBM constructs mean scores (P < 0.001). Also, as the valuable finding, the preventive behavioral intention significantly (P < 0.001) improved following a 3- and 6-month follow-up in the intervention group (17.63 ± 1.34 and 17.66 ± 1.42, respectively) compared with the control group (10.95 ± 1.33 and 10.87 ± 1.22, respectively).
Conclusions: The results showed that the HBM-based educational program by preventing substance abuse can help students adopt proper behaviors.
Research articles
Babak Jamshidi; Mansour Rezaei; Farid Najafi; Azad Sheikhi
Volume 22, Issue 5 , 2020
Abstract
Background: Over 150,000 confirmed cases, around 140 countries, and about 6,000 death occurred owing to coronavirus disease 2019 (COVID-19) pandemic in China, Italy, Iran, and South Korea. Iran reported its first confirmed cases of COVID-19 in Qom City on 19 February 2020 and has the third-highest ...
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Background: Over 150,000 confirmed cases, around 140 countries, and about 6,000 death occurred owing to coronavirus disease 2019 (COVID-19) pandemic in China, Italy, Iran, and South Korea. Iran reported its first confirmed cases of COVID-19 in Qom City on 19 February 2020 and has the third-highest number of COVID-19 deaths after China and Italy and the highest in Western Asia.
Methods: We applied a two-part model of time series to predict the spread of COVID-19 in Iran through addressing the daily relative increments. All of the calculations, simulations, and results in our paper were carried out by using MatLab R2015b software. The average, upper bound, and lower bound were calculated through 100 simulations of the fitted models.
Results: According to the prediction, it is expected that by 15 April 2020, the relative increment (RI) falls to the interval 1.5% to 3.6% (average equal to 2.5%). During the last three days, the RI belonged to the interval of 12% to 15%. It is expected that the reported cumulative number of confirmed cases reaches 71,000 by 15 April, 2020. Moreover, 80% confidence interval was calculated as 35K and 133K.
Conclusions: The screening of suspected people, using their electronic health files, helps isolate the patients in their earlier stage, which in turn helps decrease the period of transmissibility of the patients. Considering all issues, the best way is to apply the model with no modification to model the probable increasing or decreasing acceleration of spreading.
Research articles
Seyyed Mohammad Miri; Mohammad Ajalloueyan
Volume 22, Issue 5 , 2020
Abstract
Introduction: The pandemic coronavirus disease 2019 or COVID-19 is infecting as fast as possible in more than 200 countries and creating the most horrible domino-like demolition ever seen. From its beginning in Wuhan, China, the SARS-CoV-2 infected the similar groups of 100,000 patients in 67, 11, ...
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Introduction: The pandemic coronavirus disease 2019 or COVID-19 is infecting as fast as possible in more than 200 countries and creating the most horrible domino-like demolition ever seen. From its beginning in Wuhan, China, the SARS-CoV-2 infected the similar groups of 100,000 patients in 67, 11, 4, and 2 days. Healthcare workers are in the frontline of attacking by SARS-CoV-2, especially those who are in close contact with upper respiratory mucosa like otolaryngologists.
Objectives: To describe ear pain as one of the first clinical manifestations of COVID-19, we present two cases of a family (a mother and her daughter) with a positive RT-PCR test for COVID-19 who presented earache as their first symptoms.
Case Presentation: The first case was a 32 years old female patient (stewardess of an international airline, Tehran, Iran) was labeled as at risk due to her air flight to China in Dec 2019. She was first admitted for moderate ear pain in her left ear with mild itching of the external ear to an otolaryngology outpatient clinic by a general practitioner. After 7 days, her test for RT-PCR against COVID-19 was positive. No lung involvement was reported by high-resolution computed tomography (HRCT) of the thorax. Another case was her mother who were in close contact with each other and experienced severe ear pain after 7 days. She acquired mild COVID-19 symptoms with anosmia was a positive test result for COVID-19.
Conclusions: The earache must be considered as their first clinical symptoms during the early phase of the coronavirus outbreak. It seems that local and international scientific groups of otolaryngologists must prepare their national guidelines to protect their practitioners against COVID-19 based on practical strategies. Using personal protective equipment is of utmost importance in reducing the risk of nosocomial infection among otolaryngologists.
Research articles
Mohammad Taghi Taghavifard; Yohan Yousefzadeh
Volume 22, Issue 5 , 2020
Abstract
Background: After the end of an emergency period and through setting up emergency settlement camps, humanitarian agents will take action to improve livelihood and health conditions of those suffering from the disaster through sending livelihood and health packages with standard contents and based ...
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Background: After the end of an emergency period and through setting up emergency settlement camps, humanitarian agents will take action to improve livelihood and health conditions of those suffering from the disaster through sending livelihood and health packages with standard contents and based on peoples requirements. However, the problem is that the packages are prepared for normal people, and they would be no use for infants, children, and the elderly or patient family members. Cash-based Assistance (CBA) instead of in-kind donations would result in observing the human dignity of victims during the post-emergency period, as well as families and economic recovery of the affected region. There are many toolkits and process models provided by international humanitarian agencies, but because of special conditions of Iran (sanctions/economy) and a large number of natural disasters, we need a localized process model on CBA for victims of natural disasters based on Information Technology (IT), which would lead to speed, accuracy, and transparency.
Methods: The research was performed in two phases. Through a systematic review in the first phase, we studied international models/toolkits and proposed a process model for CBA in Iran. In the second phase, the localized model was customized using Delphi based on experts opinions. The statistical population in the first phase was the international publications in addition to operational reports provided by local/international organizations/agencies from 2004 to 2019. In the second part, the statistical population included the executive managers of rescue and relief agencies and university professors in critical management from whom, 14 individuals were selected through targeted sampling and participated in Delphi rounds.
Results: In the first stage, by a systematic review, based on five well known international toolkits/models, researcher experiences, and experts, a process model was developed with five steps and 27 processes. In the first round of Delphi, four processes were rejected, and four new processes were added by experts. In the second and third rounds, the experts agreed with all of the items. The calculated Kendalls Coefficient of Concordance (KCC) value of 0.724 evidenced a good expert agreement on the obtained localized CBA model.
Conclusions: The localized process model on CBA for victims of natural disasters based on IT included 27 processes in five steps: (1) preparedness, (2) assessment, (3) response analysis, (4) implementation, and (5) monitoring, evaluation, and exit. These are localized processes agreed on by the Delphi panel expert, emphasizing hardware for e-transactions; victims, retailers, and wholesalers training in the fourth step; and program quality assurance and report to donors in the fifth step. The achieved theoretical process model would be a fundamental model to develop a process-based software application system for use in the future in Iran.
