Etiologic Agents of Otomycosis in the North-Western Area of Iran

Background: Otomycosis is a superfcial fungal infection often involves the pinna and external auditory canal. It is a pathologic condition, with Candida and Aspergillus, the most common fungal species. It is common worldwide but more prevalent in tropical and subtropical countries Objectives: The aim of this study was to determine the etiologic agents and local epidemiologic pattern of otomycosis in northwest Iran. Patients and Methods: A series of 140 patients with clinically symptomatic otomycosis were studied in 21 cities, towns, and villages throughout northwest Iran between 2009 and 2011. Clinical samples were collected by swabs and then assessed by mycological investigation. Results: Otomycosis was diagnosed in 129 cases (92%, 76 male, 53 female) with the highest prevalence of cases occurring in males between 21 - 40 years of age. From an etiological point of view, 116 patients (90%, 21 - 40 years old) were infected by saprophytic mold and 9 patients (7%) were infected by yeast. Three cases (2%) involved dermatophytes, and in one case (1%) the subject was infected with Eurotium (the perfect stage of Aspergillus fumigatus). Aspergillus niger was the most common mold that was isolated, followed by A. flavus, A. fumigatus, Penicillium spp., Fusarium spp., and Rhizopus spp. A total of 2 yeasts belonging to genus Candida, C. albicans and C. tropicalis, were isolated. Conclusions:Our study showed a high prevalence of otomycosis in the northwestern area of Iran. As such, proper diagnosis and treatment by aseptic techniques for this disease is urgently needed

Medical Environment, Patient and Bad News

Background & Objective: Patients have the right to be informed about their own health condition including bad news and sometimes, medical staff has no choice but to give the patients such information that makes them feel bad and is that’s when it’s evaluated as "bad news". Unfortunately such kind of news is enormously found in medical environment, for medical staff, patients and their companies. The responsibility of telling patients the bad news is one of the hardest tasks in medical career. Patients and their companies’ illogical expectation and inappropriate behavior add to its difficulty while in this situation medical staff is also responsible for calming others. Conclusion : The difficult part of telling bad news is due to physicians’ previous lack of skill, even the ones with a proven track record, for facing the situation of transferring bad news and further management and consequences which may end in bringing it out of control and causes patients’ and their companies’ mistrust in staff or hospital environment. This ends in discontinue of future and useful necessary plans. This situation causes a faulty circle of unwanted events which are against the medical affairs. So a thoughtful bad news transfer to patients and their companies may cause them a relief and makes the control of present and future consequences easier. This important factor will be gained by practicing and applying the smart strategy of SPIKES by the professional physician. Keywords: Bad news, Medical environment, Patient, Medical ethics

The Ethical and Legal Aspects of Fee Splitting in Healthcare

Imposing unnecessary medical and healthcare costs upon patients is in direct contrast with patient rights and the spiritual and historical values of medical practice and it seriously undermines the honor regarding doctors and healthcare teams. All medical oaths and affidavits have repeatedly emphasized on the fact that medical teams and staff must take precedence over the patient’s rights and gains rather than their own. Such oaths clearly state that healthcare imposers must fulfill their duty regarding the patient’s physical and mental comfort. In the event of fee splitting, the medical staff not only neglect and undermine the medical affidavits but also seriously damage the hard gained doctor-patient trust and the historical honor of their profession. Within the law and justice system in practice in the Islamic Republic of Iran, fee splitting in considered unacceptable and illegal and fee splitters may be pursued by law. The same is true in different societies and most medical councils and accepted ethical codes and guidelines. It is clearly stated in the fifth paragraph of the medical affidavit vowed by all Iranian medical students and doctors that fee splitting is considered amoral and even illegal and that healthcare and medical practices are not to be used as a means of gathering wealth for oneself. All Islamic religious leaders have also questioned the lawfulness of money and wealth earned by fee splitting. The act of fee splitting is also recognized as unethical and unlawful in the guidelines and codes affected by universal medicine societies. تحمیل هزینه‌های غیر ضروری بر بیمار هم با حقوق اولیه بیماران و هم با شأن و شرافت ذاتـی و تاریخــی علم پزشکی و کادر پزشکی منافات دارد و همچنین همه سوگندنامه‌ها، پندنامه‌ها، منشورهای اخلاقی پزشکی و ... در طول تاریخ کادر پزشکی را ملتزم نموده‌اند که منافع بیمار را بر منافع خود مقدم بدارند و در تیمار و تسکین آلام بیماران حداکثر مساعی خود را به کار گیرند. در پدیده سهم‌خواری، متأسفانه پزشک و یا کادر پزشکی سهم خوار، برخلاف اصول بنیادین همه سوگندنامه‌های پزشکی از یک طرف و از طرف دیگر بر خلاف شأن و شرافت ذاتی حرفه پزشکی، به ضرر بیمار و به نفع خود، به سودجویی غیر اخلاقی می‌پردازد و اساس اعتماد پزشک ـ بیمار را به شدت مخدوش می‌نماید. مطابق نظامات دولتی و مقررات نظام پزشکی جمهوری اسلامی ایران نیز سهم‌خواری جزء موارد روشن قصور پزشکی بوده و قابل پیگرد سازمانی و حقوقی است، همچنانکه در بسیاری از کدهای اخلاقی ناظر بر عملکرد جامعه پزشکی و در اساسنامه انجمن‌های پزشکی و قوانین نظام پزشکی در جوامع مختلف نیز موضوع سهم‌خواری، رفتاری غیراخلاقی و بعضاً غیرقانونی در نظر گرفته شده و در پاراگراف پنجم سوگندنامه دانشجویان و پزشکان ایرانی هم بر پرهیز از آزمندی و نگاهبانی دانش پزشکی از سیم و زر تأکید شده است. فتاوی فقهی مراجع تقلید نیز وجوه حاصل از سهم‌خواری را غیرمشروع می‌دانند.در اساسنامه انجمن جهانی پزشکی در قسمت مربوط به تعارض منافع از سهم‌خواری یاد شده و این پدیده مذموم شمرده شده است

مقایسه حقوق بیمار در پندنامه علی بن عباس مجوسی اهوازی با اخلاق پزشکی نوین

One of the known Iranian physicians in the period after Islam advent was Ali Ebn Abbas Majusi-e-Ahvazi who, in his famous book (Kamel-al sanae) one chapter to medical ethics, and his written a affidavit that is more comprehensive than Boghrat oaths. It seems that Ahvazi added principals according to Islamic to this book. These teaching have been a more perfect over time. The aim of present analytical-review article is to compare Ali Ebn Majusi-e-Ahvazi affidavits to patient rights prisms from ministry of health of Islamic republic of Iran. In this article in order to achieving comprehensive comparison, we divided to seven approaches (physicians characteristics and behavior, giving health services and physicians decision for treatment, giving information and patients decision, secrecy, privacy policy, medical emergency, physicians up to date information) and has been investigated. Major part of affidavit and prism topics are identical but other cases which are noticed in affidavit, but not in prism are more relevant to topics such as personal behavior and medic his owns personality.از پزشکان معروف ایران در دوران بعد از اسلام علی بن عباس مجوسی اهوازی است که در اثر معروف خود کامل الصناعه بابی را به اخلاق پزشکی اختصاص داده و پندنامه‌ای را به نگارش درآورده که از سوگندنامه بقراط جامع‌تر است و به نظر می‌رسد که اهوازی با توجه به تعالی اسلامی، اصولی به آن افزوده است. این تعالیم به مرور زمان کامل‌تر شده و امروزه به صورت منشور حقوق بیماران مطرح است. هدف مطالعه مروری و تحلیلی حاضر، مقایسه پندنامه علی بن مجوسی اهوازی با منشور حقوق بیماران ابلاغ‌شده از سوی وزارت بهداشت و درمان جمهوری اسلامی ایران به مراکز درمانی است. در این مقاله به منظور مقایسه‌ای جامع،هفت رویکرد (ویژگی‌ها و نحوه رفتار پزشک، ارائه خدمات و تصمیم‌گیری پزشک برای درمان، ارائه اطلاعات و تصمیم‌گیری بیمار، رازداری، حریم خصوصی، موارد حاد پزشکی و اطلاعات کامل و به‌روز پزشک) در نظر گرفته شده که بر اساس این رویکردها ارزیابی و مقایسه انجام شده است. قسمت عمده موضوعات پندنامه و منشور با همدیگر همخوانی دارد اما مطالب دیگری که در پندنامه به آن‌ها اشاره‌شده ولی در منشور ذکر نشده بیشتر مسائلی از قبیل رفتار شخصی و ویژگی‌های شخصیتی خود پزشک هستند. همچنين مطالب جامع و با جزئیات بیشتر منشور هم که در پندنامه وجود ندارد، در مورد مسائلی است که به اقتضای زمان کامل تر و جامع‌تر شده است

Albucasis: pioneer of the modern anorectal surgery

Albucasis is one of the world’s pioneers in surgery. In his book, “Al-Tasrif”, he described the surgical procedures and tools, as well as post-operative care in detail. He introduced colorectal surgeries in detail and used topical substances to accelerate recovery. Albucasis considered different approaches for anorectal surgeries and used them according to the complexity of the cases. Many of these methods were first invented by him and the effect of his ideas on modern surgical methods is evident. In this article, we discuss anorectal diseases treated by Albucasis using surgical procedures. Resumo: Albucasis foi um dos pioneiros do mundo todo em cirurgia. Em seu livro “Al-Tasrif”, ele descreveu os procedimentos e ferramentas cirúrgicas, bem como os cuidados pós-operatórios em detalhes. Ele incluiu cirurgias colorretais em detalhes e também utilizou substâncias tópicas para acelerar a recuperação. Albucasis considerou diferentes abordagens para cirurgias anorretais e as utilizou de acordo com a complexidade dos casos. Muitos desses métodos foram inventados por ele e o efeito de suas ideias nos métodos cirúrgicos modernos é evidente. Neste artigo, discutimos doenças anorretais tratadas por Albucasis utilizando procedimentos cirúrgicos

Crisis Management Aspects of Bam Catastrophic Earthquake: Review Article

Background: Bam earthquake was the most catastrophic natural disasters in recent years. The aim of this study was to review different aspects of crisis manage­ment during and after the catastrophic earthquake in Bam City, Iran.Methods: Data needed for this systematic review were collected through search­ing PubMed, EMBASE and SID databases, for the period from 2003 to 2011. Keywords included earthquake, Iran and Bam earthquake. The data were summarized and were analyzed using Content Analysis.Results: Out of 422 articles, 25 articles were included in the study. Crisis Manage­ment aspects and existing pitfalls were classified into seven categories including planning and organization, human resource management, management of logistics, international humanitarian aids, field performance of the military and security forces, health and medical service provision, and information manage­ment. Positive aspects and major pitfalls of crisis management have been introduced in all the mentioned categories. Conclusion: The available evidence indicated poor crisis management during Bam earthquake that resulted in aggravating the losses as well as diminishing the effect of interventions. Thus, concerning the importance of different aspects of the crisis management and the high prevalence of disasters in Iran, the observed vulnerability in disaster management process should be addressed

Characterisation and expression of phospholipases B from the opportunistic fungus Aspergillus fumigatus

International audienceThe phospholipase B family (PLB) are enzymes sharing phospholipase (PL), lysophospholipase (LPL) and lysophospholipase-transacylase (LPTA) activities. They have been shown to be important virulence factors in several human fungal pathogens including Candida albicans and Cryptococcus neoformans. Aspergillus fumigatus, a human opportunistic fungal pathogen leading to a high rate of mortality in immunosuppressed patients is known to possess an extracellular phospholipase B activity. In this paper, we report the molecular characterisation of three PLB genes from A. fumigatus (afplb) using degenerate primers in PCR amplification and data from the A. fumigatus genome project. They are expressed at 37 °C, and two of them (afplb1 and afplb3) are induced by lecithin. They encode proteins of 633, 588 and 630 amino acids, respectively, presenting together a T-Coffee score of 81. They also possess the amino acid triad responsible for enzymatic activity in the mammalian cytosolic PLA 2 and other fungal PLBs. AfPLB1 and afPLB3 are secreted with a cleaved signal peptide. The complete cDNA sequences were obtained by RACE-PCR for the two secreted afPLBs and probably account for the extracellular phospholipase activity previously reported in the culture media of A. fumigatus