Mental Disorders Diagnosed by Psychiatrist’s Clinical Interviews and Results of the Thematic Apperception Test Conducted by Psychologists

Background: One of the most important issues to diagnose mental disorders is the use of independent tools with similar results. Documented history is an important tool to diagnose diseases at each stage. The first and fundamental step in diagnosis is a comprehensive clinical interview. Objectives: The current study aimed to investigate the concordance of mental disorders diagnosed by psychiatrist’s clinical interviews and results of thematic apperception test (TAT) conducted by psychologists. Methods: It was a cross sectional descriptive-analytical study. The study population included the patients (male and female) admitted in psychiatry section of Dr. Fatemi hospital in Ardabil, Iran, during 2009-2010. Data were collected from the archive of Ardebil Dr. Fatemi hospital and about 1200 patients were studied. Demographic data of participants including age, gender, marital status, admission date, discharge date and type of insurance were gathered from the recorded documents. The initial diagnosis of psychologist using TAT test was compared with the final diagnosis recorded for the patient attended by physicians. Data were analyzed using SPSS software, ver. 16. Results: Out of 1,200 participants, 660 (55%) were male and 540 (45%) female; 150 (12.5%) subjects were under 25 years old and 284(23.66%) were over 45 years old. Also, 650 subjects were illiterate and the rest were literate. The results of Chi-square test showed a significant difference between diagnoses of psychiatrist’s clinical interviews with TAT results conducted by psychologists (P <0.045). In spite of this difference, the results of TAT test were in relative concordance with psychiatrists’ diagnoses for schizophrenia, depression, bipolar depression and anxiety disease. Conclusions: The findings showed a relative concordance between psychiatric interviews and psychological assessments in the clinical diagnosis of mental illness. Keywords: Mental Disorders, Psychological Interview, Thematic Apperception Tes

Evaluation of the Prevalence of Congenital Cytomegalovirus Infection and its Clinical Outcomes in Neonates Born in Vali-e-Asr Hospital of Birjand, Iran

Background Cytomegalovirus (CMV) has been known as the most common cause for congenital infections worldwide which can lead to death in fetus and neonates as well as neuropsychiatric deficits. The aim of this study was to determine the prevalence of congenital CMV infection in newly born neonates and to evaluate the medical outcomes. Materials and Methods In this cross-sectional study, 868 neonates were selected using unconditional random sampling in 2017. Neonatal saliva was given on the first or second day of birth using a Dacron swab and tested by PCR for the presence of CMV DNA. All infants with positive CMV infection went through further tests and examinations to evaluate the clinical outcomes. Results: 787 (90.67%) and 81 (9.33%) births were term and preterm respectively. The PCR test was positive results only in 14 term neonates (1.61%). Thus, the prevalence of CMV infection in term neonates (n=14, 1.61%) was higher than that of preterm infants (n=0), although there was no statistically significant difference (P>0.05). The most common abnormalities were neutropenia (50%, n=4) followed by anemia (37.5%, n=3). Conclusion The prevalence of CMV infection in this study (1.61%) was within the global range and there was no association between CMV infection and birth weight, infant gender, and as well ae neonatal type. The frequency of symptomatic neonates at birth in this study was higher than the average global range, but almost the same as in developing countries

Quebec Decision Rule in Determining the Need for Radiography in Reduction of Shoulder Dislocation; a Diagnostic Accuracy Study

Introduction: The Quebec Decision Rule (QDR) has been developed for deciding on the necessity of radiography for patients with shoulder dislocation. This study aimed to investigate the diagnostic value of QDR in this regard. Method: This diagnostic accuracy study was conducted on patients with shoulder dislocation visiting the emergency department. After filling out the QDR-based checklist for all patients, they underwent radiography and the obtained radiography results were compared to QDR-based clinical diagnostic findings. Results: ‌ 143 patients with the mean age of 32.1±12 years were evaluated (88.8% males). Sensitivity, specificity, and positive and negative predictive values of QDR were 50%, 58.2%, 3.3%, and 97.6%, respectively. The sensitivity and specificity were 100% and 50% in patients >40 years old, and 33.3% and 59.8% in those <40 years old. These indices were 33.3% and 60.4%, respectively, in the male sex and 100% and 40% in the female sex. Conclusion: ‌ Quebec decision rule holds promise to diagnose concomitant fractures in patients over the age of 40 with 100% sensitivity, thereby reducing the number of radiographies by 50% without causing diagnostic errors. In contrast, this criterion proved inefficient in patients younger than 40. â€

Treatment of Osteopenic Menopause Women as a Public Health Problem with Nasal Calcitonin; an Original Study on Follow up Markers

Introduction: Various therapeutic options such as Calcitonin are suggested for patients with low bone density. However, the efficacy remains uncertain in all patients. C-telopeptide of type I collagen (CTx) is the authentic bone marker which is recently used to assess the bone turnover. This study aimed at revealing the therapeutic effects of Calcitonin on osteopenic women via serum CTx and assessment of other biochemical markers. Methods: we conducted a before-after clinical trial on menopause women with low bone mineral density (bone mineral density score less than 1.5 SD of peak bone mass) attending Baqiyatallah hospital clinic. They received 200 IU Calcitonin nasal spray, calcium (1000 mg) and vitamin D (400 IU). Then the serum CTx and other laboratory parameters were compared after a 6 months treatment. The data was analyzed using SPSS ver.16, paired T-test and regression model. Results: The study population included 115 menopause women with the mean age of 58.75 ± 8.15 years. The CTx amount decreased significantly compared with that of the baseline level (3.203 ± 2.24 vs. 2.497 ± 1.657 Pmol/lit, P 0.05). Conclusion: Nasal spray of Calcitonin could be effective on the progression of osteoporosis by decreasing bone tissue turnover and improving the bone density. Further controlled-studies with a larger sample size and a longer duration of follow up are recommended

An innovative method to assess clinical reasoning skills: Clinical reasoning tests in the second national medical science Olympiad in Iran

BACKGROUND: Clinical reasoning plays a major role in the ability of doctors to make a diagnosis and reach treatment decisions. This paper describes the use of four clinical reasoning tests in the second National Medical Science Olympiad in Iran: key features (KF), script concordance (SCT), clinical reasoning problems (CRP) and comprehensive integrative puzzles (CIP). The purpose of the study was to design a multi instrument for multiple roles approach in clinical reasoning field based on the theoretical framework, KF was used to measure data gathering, CRP was used to measure hypothesis formation, SCT and CIP were used to measure hypothesis evaluation and investigating the combined use of these tests in the Olympiad. A bank of clinical reasoning test items was developed for emergency medicine by a scientific expert committee representing all the medical schools in the country. These items were pretested by a reference group and the results were analyzed to select items that could be omitted. Then 135 top-ranked medical students from 45 medical universities in Iran participated in the clinical domain of the Olympiad. The reliability of each test was calculated by Cronbach's alpha. Item difficulty and the correlation between each item and the total score were measured. The correlation between the students' final grade and each of the clinical reasoning tests was calculated, as was the correlation between final grades and another measure of knowledge, i.e., the students' grade point average. RESULTS: The combined reliability for all four clinical reasoning tests was 0.91. Of the four clinical reasoning tests we compared, reliability was highest for CIP (0.91). The reliability was 0.83 for KF, 0.78 for SCT and 0.71 for CRP. Most of the tests had an acceptable item difficulty level between 0.2 and 0.8. The correlation between the score for each item and the total test score for each of the four tests was positive. The correlations between scores for each test and total score were highest for KF and CIP. The correlation between scores for each test and grade point average was low to intermediate for all four of the tests. CONCLUSION: The combination of these four clinical reasoning tests is a reliable evaluation tool that can be implemented to assess clinical reasoning skills in talented undergraduate medical students, however these data may not generalizable to whole medical students population. The CIP and KF tests showed the greatest potential to measure clinical reasoning skills. Grade point averages did not necessarily predict performance in the clinical domain of the national competitive examination for medical school students

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Nosocomial infections and related factors in southern khorasan hospitals

Background and Aim: Nosocomial infections are defined as infections occurring during a patient's stay at hospital (48-72h after admission).Nosocomial infections are one of the important problems of health. This study aimed was determine the prevalence of nosocomial infections, and related factors in hospitals with more than 100 beds in south Khorasan Province. Materials and Methods: In this crass-sectional study, an investigator-administered questionnaire was completed for each patient with nosocomial infections diagnosis in hospitals with more than 100 beds in South Khorasan. This questionnaire conation demographic characteristic of patients, department, duration of admission, kind of pathogen and risk factors that was designed according to standard questionnaire of Iranian Nasocomial infections surveillance system (INIS) of Center for communicable Disease Control, Ministry of Health. Data were analyzed with SPSS 16 software. Results and discussion: Number of patients with nosocomial infection was 358. The incidence of nosocomial infection was 0.9%. ICU had the highest incidence rate (17.3%). The most common nosocomial infection was pneumonia (43%), and urinary tract infection (UTI) (15.1%). In 33.5% culture result were negative. In other cases, culture results showed klebsiella spp. (12.8%) and Pseudomonas aeruginosa (9.8%) were the most prevalent bacteria. Most factors associated with nosocomial infection in patients were urinary catheters (70.4%), suction (66.8%) and tracheal tube (54.2%). 24% of patients expired. The results showed lower ratio of nosocomial infection, that the main reason is failure to detection and reporting of actual cases of nosocomial infection. Promoting detection and reporting system for Prevention and control of nosocomial infection was recommende

Galactocele in the Axillary Accessory Breast Mimicking Suspicious Solid Mass on Ultrasound

Galactoceles are the most common benign breast lesions during breastfeeding period that can mimic carcinomas. We report a galactocele with malignant appearance on ultrasound in the accessory breast. The patient was a 32-year-old lactating woman presented to our hospital for considerable swelling in the left axilla. Ultrasound examination revealed a hypoechoic mass with heterogeneous echogenicity and irregular shape and margins. Sonography-guided aspiration was performed. Aspiration of milky fluid and resolution of the axillary lump after aspiration confirmed the diagnosis of galactocele. Galactocele can present as a suspicious tumoral lesion in the axillary accessory breast and diagnostic aspiration can help in correct diagnosis of this rare lesion in the accessory breast

A man with disabling low back pain: Echinococcus of the sacrum

Bone involvement in hydatid disease is rare, and when it does occur, the most common sites of involvement are the spine and pelvis. A case of bone hydatid disease involving the sacrum is reported here