The Position of E-Health in Reshaping Doctor/Patient Communications

Accessibility to all levels of information technology has experienced rapid progress in recent years, particularly in the health sector. Rapid penetration into this technology has led to changes in lifestyles and changes in the working procedures of institutions. In 2014, the number of Internet users reached 3 billion, and this number is predicted to exceed 8 billion in 2018. Statistics estimate the number of Iranian users of the Internet to be about 45 million. In 2014, more than 80% of Internet users searched for health information. Today, the Internet plays a vital role in providing such health services as education, disease management, support, basic medical treatment decisions, and doctor-patient communication

Ischemic Toes after Venous Thromboembolism: A Difficult Differential Diagnosis with Good Response to Combination Therapy—A Case Report

The obliteration of the arterial vascular system of toes is considered as a potentially catastrophic event in clinical practices. In most instances, the cessation of arterial blood flow heralds a serious underlying pathology. A definite classification of some cases is somehow difficult and subject to diagnostic challenges. The aim of the present case study is to share and discuss potentially complex and multifactorial mechanisms of some acute vascular events. In this report, we deal with a 46-year-old man with a rather gradual-onset ischemia of his toe who responded favorably to a combination of pulsed glucocorticoid and anticoagulation within a week

Efficacy of Elaeagnus angustifolia extract in the treatment of knee osteoarthritis: a randomized controlled trial

Osteoarthritis (OA) is one of the most common musculoskeletal disorders all over the world. Available antiarthritic medications have only partial efficacy and their long-term use is associated with adverse events. Elaeagnus Angustifolia (EA) is a medicinal plant with analgesic and anti-inflammatory properties. The present study evaluated the impact of two doses of EA extract compared with ibuprofen on the severity of disease in patients with knee OA. This study was designed as a randomized, double blind, active-controlled and parallel group trial. Patients with OA were randomized to receive 300 mg/day (n=33) or 600 mg/day (n=32) of EA aqueous extract, or 800 mg/day ibuprofen (n=32) for 7 weeks. EA extract contained 0.21 % (w/w) kaempferol according to HPLC. Efficacy of treatment was assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Scale (VAS) of pain, Lequesne’s Pain-Function Index (LPFI), and patient’s global assessment (PGA) index. The amount of kaempferol in the extract was determined by HPLC method to be 0.21 % w/w. There were significant reductions in WOMAC, VAS, LPFI and PGA scores by the end of trial with all three interventions. Comparison of the changes in WOMAC, VAS and LPFI scores among the treatment groups did not reveal any significant difference between EA and ibuprofen, and between low and high doses of EA. EA was safe and well tolerated during the course of trial and no adverse event was reported. The present results suggest beneficial effects of aqueous EA extract in reducing the symptoms of OA with an efficacy comparable to that of ibuprofen

The cut-off point of dual energy X-ray and laser (DXL) of calcaneus osteoporosis diagnosis in postmenopausal women

Background: Dual X-Ray Absorptiometry (DXA) is a method which can extensively be used for bone mineral densitometry (BMD). Another more recent method is DXL, which associate with dual X ray absorptiometry, assisted by laser measure heel thickness. In this study the cut off points for DXL of calcaneus in the diagnosis of osteoporosis in different bone regions in postmenopausal women had been determined. Materials and Methods: In 268 postmenopausal women, BMD of the spinal and femoral regions was measured by DXA, and the value for the calcaneous was measured by DXL. The agreement of the two methods in the diagnosis of osteoporosis and optimal cut-off point for DXL in defining osteoporosis was obtained. What obtained was the agreement of the two methods in the diagnosis of osteoporosis, as well as the optimal cut-off point for DXL in defining osteoporosis. Results: DXA showed osteoporosis in 40.7 of cases with 35.2 in L2-L4, 16.2 in the femoral neck, and 11.7 for the femoral total region. The DXL found osteoporosis, considering -2.5 SD as a threshold, in 26.1 of cases. Agreement of the two methods in the diagnosis of osteoporosis (Kappa score) was 0.443 for the lumbar region, 0.464 for the neck, and, 0.421 for total femur regions (all P values were significant). Using Receiver Operating Characteristic (ROC ) curves, it was found that a T-score of -2.1, -2.6 and -2.4 as the optimal cut-off point of DXL in the diagnosis of osteoporosis in the lumbar spine, the neck and total region of femur, respectively. Conclusion: The results of this study sh owed a moderate agreement between the two methods in the diagnosis of osteoporosis. It seems that the DXL cannot be used as a substitute for the DXA method, but it can be used as a screening method to find (to diagnose) osteoporosis

Pachymeningitis in a Patient With Granulomatosis With Polyangiitis; A Case Report

Inrtoduction: Granulomatosis with polyangiitis (GPA) is a systematic and necrotizing vasculitis with positive autoimmune antibodies. Some studies have reported the prevalence of eye involvement between 40%-50% of cases. Retro orbital granuloma is a rare complication of GPA which should be treated by surgical involvements, while pachymeningitis can be diagnosed by MRI and treated by medical management. In this study, we tried to present a case of GPA with optic neuritis and typical central nervous system (CNS) involvement, while there were no definite features of sinusitis or kidney injuries. Case Presentation: A 15-year-old girl was admitted because of blurred vision in her left eye. She was a known case of GPA three years ago with initial features, including left facial nerve paresis due to pan-sinusitis and pulmonary cavity. Neurologic evaluations, including sensory and motor features, were normal, too. Ophthalmologic examinations showed that visual acuity of the right eye was good, while the visual acuity in the left eye decreased to the point of finger counting at a distance of 20 cm. The left eye Marcus gunn test was positive (3+); anterior and posterior eye segments were normal. The patient was evaluated by brain MRI with gadolinium and a pathologic enhancement in the left cavernous was seen which had a pressure effect on the optic nerve. She was treated by intravenous methylprednisolone followed by rituximab. Conclusion: Reporting orbital mass in a patient who had GPA can be supposed as granuloma which needs a biopsy to confirm a diagnosis. In our case, the imaging manifestation was heterodox for granuloma, while neurosurgical consultation recommended drug treatment for pachymeningitis

Bilateral Facial Paralysis and Otitis Media as the First Presentations of Wegener’s Granulomatosis: A Case Report

Introduction: Cranial nerve palsy in Wegener’s granulomatosis is a curious incident, particularly if it occurs without kidney or lung involvement. In a review of medical articles, only 1 case of Wegener’s granulomatosis with bilateral facial nerve palsy was found. Case Presentation: The patient was a 16-year-old female who presented with pain and hearing loss in both ears and reduced muscle tone in the right side of her face. After myringotomy and ventilation tube embedding in both ears, she gradually developed infectious otorrhea in both ears. Despite antibiotic and antifungal therapy for 2 weeks after surgery, the patient developed paresis in the left facial nerve and gag reflex disorder. Both magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) tests were normal, but the C-anti-neutrophil cytoplasmic antibody (CANCA) test result was about forty times higher than normal, and a sinus biopsy also verified Wegener’s granulomatosis. The patient was then treated with pulse corticosteroid and cyclophosphamide therapy. Her gag reflex healed and the ear secretions stopped, but the facial nerve palsy continued. Conclusion: Although cranial nerve involvement in Wegener’s granulomatosis is an unusual incidence, it may occur in some cases. In the current case, otitis media and cranial nerve paresis without kidney or lung disorders were the only signs of disease onset; of course, computerized tomography (CT) scan revealed a right mandibular sinus disorder without any clinical signs. Another important point in this case is that other identified Wegener’s patients were in their fourth or fifth decade of life; thus, Wegener’s was the last choice for a diagnosis in the current case

Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in IRAN: A single center study.

BackgroundAn outbreak of COVID-19 in Iran has spread throughout the country. Identifying the epidemiological characteristics of this disease will help to make appropriate decisions and thus control the epidemic. The aim of this study was characterization of the epidemiological features of COVID-19 in Iran.MethodsIn this retrospective study, data related to the epidemiological characteristics of COVID-19 patients admitted to Baqiyatallah Hospital in Tehran, Iran, from 19 February 2020 to 15 April 2020 have been analyzed and reported. Patient characteristics including age, gender and underlying diseases were investigated. Data were collected through patient records. Sex ratio, Case Fatality Rate (CFR) and daily trend of cases were also determined. A multiple logistic regression analysis was also performed to assess affecting factors on mortality.ResultsFrom February 19, 2020 to April 15, 2020, 12870 patients referred to the hospital emergency department, of which 2968 were hospitalized with COVID-19 diagnosis. The majority of cases were in the age group of 50 to 60 years of old. The male-to-female ratio was 1.93:1. A total of 239 deaths occurred among all cases for an overall CFR of 1.85% based on the total number of patients (both outpatient and inpatient) and 8.06% among hospitalized patients. Out of all patients 10.89% had comorbidity. Diabetes, chronic respiratory diseases, hypertension, cardiovascular diseases, chronic Kidney diseases and cancer were the most common comorbidities with 3.81, 2.02 , 1.99 , 1.25, 0.60 and 0.57 %, respectively. Male gender (OR=1.45, 95% CI: 1.08-1.96), older age (OR=1.05, 95% CI: 1.04-1.06) and having underlying diseases (OR=1.53, 95% CI: 1.04-2.24) were significantly associated with mortality.ConclusionsThe results of this study showed that Male gender, older age and having comorbidities were significantly associated with the risk of death among COVID-19 patients. It is important to pay special attention to male elderly patients with underlying diseases

Assessment of Factors Affecting the Establishment of Hospitals in Iran

Background: It is important to set up hospitals, since they play a key role in providing health care services based on the budget allocated to the health sector. Objective:  This study evaluated factors militating against the establishment of hospitals in Iran. It also emphasized the importance of health care services. Methods: This cross-sectional study was conducted in 2012 using a qualitative approach. The study sample consisted of 22 people, officials, administrators and health experts who were recruited by purposeful selection. In order to collect data, a semi-structured interview was conducted. Data was analyzed using an Atlas-Ti software. Results: Analysis of the interviews suggest that the issue of providing services in terms of ease of access and equity in the allocation of health services is also the focus of particular attention. The socio-economic status of regions were examined in terms of the need for poverty alleviation, equity in health and well-being of interest to industry participants. The survey interviews revealed that the issue of financing and human resources for provincial hospitals, were the key challenges raised by participants in the study. Conclusion: According to the findings of this study, feasibility studies and evidence-based management optimal decisions were adopted in order to build and operate hospitals in the provinces

Screening for amyloid deposition by subcutaneous fat tissue aspiration technique in rheumatoid arthritic patients and investigating its clinical significance in Iran

Aim: This study examined the frequency of secondary amyloidosis in Iranian patients with rheumatoid arthritis (RA) in order to determine its clinical significance. Methods: A total of 220 RA patients (167 female, 53 male), with minimum disease duration of 5 years, were included in this prospective study over a period of about 2 years. Abdominal subcutaneous fat-pad aspiration (ASFA) method was used in obtaining specimens from all subjects. All of the specimens were examined for apple-green birefringence under polarized light microscope. Amyloid deposits were graded from 1+ to 3+. Clinical, radiological, and laboratory characteristics of the patients were assessed and recorded. Results: Amyloid deposition was detected in 11 (5) of the fat smears stained with Congo red stain. All of the samples had minimal (1+) amyloid deposits. In this study, amyloid-positive cases showed clinically significant symptoms; six of the patients (55) presented with proteinuria, and seven other cases (64) presented with severe constipation. Conclusion: Abdominal fat amyloid deposition was found to be uncommon in adult Iranian RA patients. In up to half of the patients the deposits were subclinical. A longer follow-up and larger multicentric collaborative study is needed to determine the significance of subclinical amyloid deposits. © 2007 Asia Pacific League of Associations for Rheumatology and Blackwell Publishing Asia Pty Ltd