Professionalism among medical residents in a young second-level university in Iran: A cross-sectional study

Professionalism is a set of behaviors that build trust in physicians� relationships with patients and the public. The aim of this study was to assess professionalism among residents in Kashan University of Medical Sciences, Kashan, Iran. This cross-sectional study was conducted on 139 residents recruited through the census method. Data were collected using the American Board of Internal Medicine Professionalism Questionnaire. The first part of the questionnaire was on residents� personal characteristics, and the second part contained fifteen items in the three domains of professionalism, namely excellence, honor/integrity, and altruism/respect. The mean scores of the questionnaire and its domains were calculated and their relationships with residents� personal characteristics were evaluated. The mean scores (± SD) of professionalism and its excellence, honor/integrity, and altruism/respect domains were 4.93 ± 2.4, 5.92 ± 1.85, 4.94 ± 3.39, and 4.35 ± 3.27, respectively (in a range of 0-10). Professionalism had significant relationships only with residents� specialty and gender. The level of professionalism in residents was low, which requires the attention of educational authorities. Moreover, the mean score of professionalism among residents in surgical specialties was significantly lower than non-surgical specialties. Various factors can be considered in this regard and it cannot be concluded that the lower score means worse professional behavior. © 2019 Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences. All rights reserved

Mesenchymal stem cell-derived exosomes: A new therapeutic approach to osteoarthritis?

Degenerative disorders of joints, especially osteoarthritis (OA), result in persistent pain and disability and high costs to society. Nevertheless, the molecular mechanisms of OA have not yet been fully explained. OA is characterized by destruction of cartilage and loss of extracellular matrix (ECM). It is generally agreed that there is an association between pro-inflammatory cytokines and the development of OA. There is increased expression of matrix metalloproteinase (MMP) and "a disintegrin and metalloproteinase with thrombospondin motifs" (ADAMTS). Mesenchymal stem cells (MSCs) have been explored as a new treatment for OA during the last decade. It has been suggested that paracrine secretion of trophic factors, in which exosomes have a crucial role, contributes to the mechanism of MSC-based treatment of OA. The paracrine secretion of exosomes may play a role in the repair of joint tissue as well as MSC-based treatments for other disorders. Exosomes isolated from various stem cells may contribute to tissue regeneration in the heart, limbs, skin, and other tissues. Recent studies have indicated that exosomes (or similar particles) derived from MSCs may suppress OA development. Herein, for first time, we summarize the recent findings of studies on various exosomes derived from MSCs and their effectiveness in the treatment of OA. Moreover, we highlight the likely mechanisms of actions of exosomes in OA. © 2019 The Author(s)

Symptomatic meckel's diverticulum after appendectomy

Background: Meckel's diverticulum is the most common anomaly of the intestine. It is usually asymptomatic but could also be symptomatic with complications such as bleeding, intestinal obstruction, and inflammation.Case Report: Two weeks after gangrenous appendectomy of a 44 years old man in Shahid Beheshti Hospital in Kashan city, Iran, he complained of abdominal pain, nausea, bilious vomiting and constipation. Considering him as a suspicious case of intestinal obstruction, we performed laparatomy in which torsion of 10 cm. length of Meckel's diverticulum was confirmed. Conclusion: Since the complications of Meckel's diverticulum are rane in adults, this diagnosis is supposed to be considered as one of the probable reasons of acute abdomen surgery. Although, the common place of Meckel's diverticulum is at 40-60 cm away from ileal operculum, it is recommended to assess ileum at a 100 cm distance from it

Evaluation of the relationship between diabetes mellitus and kidney transplantation

Background: Best choice for end stage renal disease (ESRD) is replacement therapy and kidney transplantation. Pre/post transplantation diabetes mellitus (DM) has adverse effects on both the patient and new kidney. In this study the effects of DM before and after the transplantation were compared with complications and outcomes of the procedure in kidney transplanted patients during 2002- 2007. Materials and Methods: In this historical cohort study patients were divided into 3 groups: group I with DM before graft, group II with DM after the transplantation and group III left non diabetic. All information were evaluated based on the delayed function of graft (DGF), rejection possibility, systemic infections, cancer, relapse of renal disease, cardiovascular disease and subsequent death. Results: One hundred five patients were included in this study (35 in each group). Mean age of the group I, II and III were 47, 47.3, and 47.1 respectively. Also, the incidence of outcomes and complications was 82.9, 57.1 and 22.9 respectively. The one year survival of transplanted kidneys in each group was 68.5, 77.1 and 91.4 and the one year survival of patients was 82.8, 88.5 and 97.1 respectively. Conclusion: The prevalence of post transplantation diabetes mellitus (PTDM) in this research was 21. The rate of complications and death in pre transplantation DM patients was higher than that in PTDM patients. Also, this rate was the lowest in non diabetic patients. In conclusion, due to the adverse effects of DM or PTDM, the accurate follow up of patients in terms of blood sugar monitoring and complications is suggested

Professionalism in residents of physical medicine and rehabilitation in Iran

Professionalism is the foundation of trust on which the doctor-patient relationship is built. This study was performed to measure professionalism in Iranian physical medicine and rehabilitation residents as a baseline assessment tool for future studies. This was a descriptive study. The Persian version of the American Board of Internal Medicine (ABIM) questionnaire was distributed among all the second and third-year residents of the medical state universities of Iran (n=43). Data were summarized as mean (SD), and independent samples t-test was used for comparison of means between genders, and also between the second and third-year residents. Forty questionnaires were analyzed. The mean (± SD) age of respondents was 29.95 (± 2.37) years. The mean score (SD) for the overall score was 115.15 (± 17.36) out of 150, and the mean score (± SD) for all items was 7.67 (± 1.15) out of 10. The respondents averaged 5.88 (± 1.69) for items forming the �excellence� factor, 7.98 (± 1.48) for items in �altruism/respect� and 8.92 (± 1.26) for items in the �honor/integrity� subscale. These data may serve as a baseline for future research in this field. The lowest score pertained to excellence, which needs more focus in future studies. © 2015 Tannaz Ahadi et al.; licensee Tehran Univ. Med. Sci

Effect of hydroxymethylglutaryl-CoA reductase inhibitors on low-density lipoprotein cholesterol, interleukin-6, and high- sensitivity C-reactive protein in end-stage renal disease

Introduction. This study was conducted to determine the effect of statins on the serum levels of interleukin-6 (IL-6), low-density lipoprotein cholesterol (LDLC), and high-sensitivity C-reactive protein (HSCPR). Materials and Methods. This randomized clinical trial was carried out on 95 hemodialysis patients divided into three groups of atorvastatin, 10 mg; simvastatin, 20 mg; and lovastatin, 40 mg, daily, administered for 2 months. Levels of serum HSCRP, IL-6, and LDLC were all measured before and after the study period. Results. At baseline, 59 of the hemodialysis patients presented with elevated HSCRP, 46.3 them had increased IL-6, and 26.3 had an increased LDLC level. The three drugs were capable to lower the level of HSCRP, among which atorvastatin had the highest effect size (41.8 reduction, P=.001). Lovastatin stood in the next (37.6 reduction, P=.02), while HSCRP reduction was not significant in the simvastatin group (25 reduction, P=.14). Neither of the drugs significantly reduced IL-6 levels. Effects of atorvastatin and simvastatin on the LDLC levels were significant, while lovastatin had a marginal effect. Conclusions. Use of statins resulted in CRP reduction in patients on hemodialysis. Atorvastatin was much more effective than lovastatin, while CRP reduction was not significant by simvastatin. However, simvastatin had the greatest impact on LDLC. None of these drugs could reduce IL-6 levels within 2 months

A study about the effect of ultrafiltration's increasing on the clearance of middle molecules in Low-Flux Hemodialysis

Background: Considering the importance of removal of these solutes in chronic renal failure patients, this study was carried out to evaluate the effect of increasing ultrafiltration on clearance of middle molecules in low-flux hemodialysis in Kashan, 2005. Materials and Methods: Twenty one hemodialysis patients, 11 women and 10 men, were enrolled to this clinical before-after study. At the first stage the patients were dialyzed with ultrafiltration equal to their dry body weight. At the second stage two liters was added to the ultrafiltration and clearance of each solute was calculated in both stages. Data were analyzed using SPSS software and square T test. Results: T here was a significant difference in clearance of ß2-microglobulin and vitamin B12 in second stage in comparison with the first one (p<0.03, p<0.001), res pectively. While there was no difference in clearance of small molecules P, BUN, and Cr. (p=0.97, r=0.24, p=0.36). In first hemodialysis KT/V was 1.12 and in the second 1.22. Conclusion: It was shown that in low-flux hemodialysis the increase in ultrafiltration results in increased clearance of middle molecules. Ultrfiltration increase also improve, the adequacy of hemodialysis but it doesn’t affect removal of small molecule

Assessing the effective dose of warfarin in treatment course of the patients referring to Kashan Heart Clinic

Background: The major problem in prescribing the therapeutic dose of warfarin, the most clinically used anticoagulant, is achieving its optimal International Normalized Ratio (INR). This study was designed to determine the mean dose of warfarin among the patients admitted to Kashan Heart Clinic in 2008. Materials and Methods: In this cross-sectional study, the medical documents of all patients receiving warfarin in any medical indications were studied for demographic specification, INR results, smoking, other used drugs and the underlying diseases. The warfarin dose attained (INR equal to 2.4-2.6 for 3 consecutive test results) was regarded as the optimal dose. All unqualified cases in terms of INR criteria were excluded. Statistical analysis was done using ANOVA, Pearson, Spearman and T-tests.Results: Seventy one out of 86 patients were included in the study. The mean daily dose of warfarin was 3.97±1.38 mg. Fourty six, 13, 11 and one patient(s) received warfarin for atrial fibrillation, prosthetic valve, congestive heart failure and embolic cerebrovascular accident, respectively. While warfarin dose had an inverse relation to age (P=0.01), it had no significant relation with sex (P=0.7), underlying diseases (P>0.07), smoking (P=0.2), other used drugs (P=0.07) and the patient weight (P=0.1). The results showed that warfarin dose was higher among the patients with prosthetic valve (P=0.008). Conclusion: The obtained effective daily and weekly dose of warfarin i.e. 3.97±1.38 and 27.83±9.77 mg, respectively could be used as a therapeutic clue for prescribing the appropriate dose and optimum INR

Effect of single injection of platelet-rich plasma in comparison with corticosteroid on knee osteoarthritis: A double-blind randomized clinical trial

BACKGROUND: Evidence on the effect of platelet-rich plasma (PRP) in treating osteoarthritis (OA) is insufficient. Therefore, the present study compares the effects of a one-time injection of PRP and corticosteroid (CS). METHODS: In the present randomized double blind clinical trial, the participants who suffered from knee osteoarthritis (Grades II/III), were randomly divided into two groups: intra articular injection of PRP and CS. Knee injury and osteoarthritis outcome score (KOOS), the 20-Meter- Walk Test (20MW), active and passive ranges of motions (ROM), flexion contracture, and pain intensity based on Visual Analog Scale (VAS) were assessed before, 2-months, and 6-months after interventions. RESULTS: Forty-one participants (48 knees) were involved in the research (66.7 women; average age of 61.1±7.0 years old). Compared to the group treated with corticosteroid, pain relief (df: 6, 35; F=11.0; P=0.007), symptom free (df:6, 35; F=23.0; P0.05). CONCLUSIONS: Our study demonstrated that one shot of PRP injection, decreased joint pain more and longer-term, alleviated the symptoms, and enhanced the activity of daily living and quality of life in short-term duration in comparison with CS. © 2015 EDIZIONI MINERVA MEDICA

Effect of assisted hatching on pregnancy rate in IVF patients

Background: Assisted hatching techniques are utilized to facilitate the embryo escape out of the zona pellucida and increase the pregnancy rates in IVF centers. The objective of this study was to evaluate if assisted hatching improved the rates of pregnancy for in-vitro fertilization, in Isfahan Infertility Center. Materials and methods: This case-control study was carried out on 296 infertile patients. Patients with assisted hatching were 131 (case group) and non-treated patients were 165 (control group). Patients' age, number of oocytes aspirated, number of oocytes fertilized, and numbers of embryos transferred were matched. The pregnancy was determined by positive β -HCG, 14 days after transfer and implantation was defined as presence of gestational sac in uterus on sonography. Statistical analysis was done with the student t-test and χ 2 test. A P-value of less than 0.05 was considered statistically significant. Results: No significant difference was noted in the mean age of patients, the number of oocytes aspirated, the number of oocytes fertilized, and the number of embryos transferred between the case and control groups. In addition, no significant difference was observed in the rates of pregnancy between the hatched and control groups (22.9 versus 20.6, respectively). Conclusion: Assisted hatching has no significant impact on pregnancy rates in the patients population studied. Further data are needed to determine if assisted hatching has beneficial effect on pregnancy rate