Postgraduate Trainees’ Perception of the Clinical Learning Environment at an Iranian Medical Sciences University

AbstractBACKGROUND and PURPOSE: Clinical learning environment is an influential component of the educational experience. This study measures the learning environment across all of resident physicians at Guilan University of Medical Sciences (GUMS) in Iran by using Postgraduate Hospital Educational Environment Measure (PHEEM), and identifies areas for change to enhance residents experiences. METHODS: This cross-sectional study was conducted at GUMS during summer 2011. The 40-item PHEEM is an evaluation tool consisting of a validated questionnaire with 3 subscales: perceptions of autonomy, social support and teaching which are factors perceived to be influencing the educational environment. The questionnaire was distributed to all residents in clinical wards of university hospitals at GUMS. Collected data were analyzed by using SPSS18 software. RESULTS: Trainees’ perception of clinical learning environment was more positive than negative. There were differences in perceptions of the learning environment between the junior and senior trainees but no significant difference between male and female Trainees in educational environment subscales. CONCLUSIONS: The results revealed that the educational climate was generally perceived positively by trainees and trainees were happy with their teaching, their supports and the work they did. The study also showed problematic components of learning environment in our university hospitals which enabled us to adopt some remedial measures

Comparison of the therapeutic effect of melatonin, metformin and vitamin E in patients with non-alcoholic fatty liver disease under a diet program

Introduction and objectives: Understanding the best treatment for non-alcoholic fatty liver (NAFLD) as its prevalence growing is necessary. In this study we evaluated and compared the therapeutic effects of three drugs metformin, vitamin E and melatonin in patients with NAFLD. Materials and methods: This double blinded randomized clinical trial conducted on 3 groups contain 30 patients with NAFLD. For all patients we administrated same diet regimen and changing the life style by increasing the activity time of the day. Drugs administrated randomly and patients followed for 3 months. Metformin 500 mg per day, Vitamin E 400 IU per day and melatonin 3mg per day was administered. At the beginning and the end of the study, the weight of patients,BMI, liver aminotransferases, lipid factors and fasting blood glucose were evaluated. Data were analyzed by SPSS software version 20. Results: Metformin, vitamin E and melatonin all of them were able to significantly reduce the level of aminotransferases (P <0.05). In compare of the groups, ALT, AST, cholesterol and LDL levels were significantly different between the two groups of metformin and melatonin (P <0.05). It was also observed that weight lost can independently improve disease condition. Conclusion: Melatonin can improve the hepatic injury factors and lipid metabolism and also fasting the repairing process. Metformin also do so but especially more powerful in improving the lipid factors. Vitamin E can reduce the hepatic injury factors remarkably

Endometrial Carcinoma Metastatic to the Clitoris: A Case Report and Review of the Literature

Endometrial cancer generally carries a good prognosis. Endometrial carcinoma more frequently metastasizes to the pelvic and para-aortic nodes. Visceral metastases usually occur in the vagina and ovaries. Distant metastases involve lungs and occur as a terminal event. This case report describes vulvalar metastasis of endometrial cancer to the clitoris. Metastatic tumors of the vulva are rare. Moreover, in the presence of metastatic endometrial carcinoma to the vulva, it is necessary to verify if other visceral metastases are present. Endometrial cancer can extend through direct dermatogens and lymphatic spread. We report a clitoral metastasis of an endometrial carcinoma and discuss whether the possible mechanism is vascular spreading or direct seeding

Central nervous system metastasis in epithelial ovarian carcinoma: a case report and literature review.

Objective:To report involvement of the central nervous system (CNS) following epithelial ovarian cancer is rare. Advances in management of ovarian cancer by use of primary surgery including abdominal hysterectomy, bilateral salpingo'oophorectomy should attain as complete a cytoreduction as possible and effective platinum-based chemotherapy have prolonged survival. Case report:We present a case involving a 35-year-old Iranian woman diagnosed and treated for primary ovarian cancer in 2002. She underwent optimal cytoreductive surgery and chemotherapy treatment. Eight months after the initiation of therapy, multiple brain metastases without intraperitoneal lesions were found and treated with combination chemotherapy and whole brain radiotherapy (WBRT), without evidence of recurrent disease. The patient died from disease in December 2005. Conclusion:In a patient suffering from neoplasm that rarely metastasizes to CNS, a careful clinical examination and proper therapeutic approach including chemotherapy may lead to prolong survival

Mushroom Poisoning in the Southwest Region of the Caspian Sea, Iran: A Retrospective Study

Background: Mushroom poisoning as a medical emergency can be a challengingproblem for physicians. Despite the vast resources of poisonous mushrooms inIran, few studies have been done in this regard, especially in the southwest regionof the Caspian Sea that is very suitable for mushroom growth. Therefore, the aimof this study was to evaluate our experience with mushroom poisoning in thisregion.Methods: This retrospective study reviewed the records of 102 patients who wereadmitted to the Emergency Department of Razi Hospital of Rasht, the only referraldepartment in this region, from May 2006 to May 2011. Data were analyzed byChi-square test, ANOVA, and student’s t-test.Results: The patients’ age ranged from 13 to 75 years and 47 of them were maleand the rest 55 were female. Overall, 57.8% of mushroom poisoning casesoccurred in patients from urban areas. Most incidences were reported betweenSeptember and October, the rainy season in Guilan. Except for four patients withtachycardia, others had stable vital signs. The most frequent symptoms (86.4%)were nausea and vomiting. Complete blood cell count revealed that 28.4% of thepatients had leukocytosis but all of them had platelet counts of less than 100000.Conclusions: This study showed that all cases had mild to moderate symptomsthat were treated by simple supportive therapies. This suggested that mushroomspecies in our region are less dangerous but further studies need to establish whattoxins and species are responsible for mushroom toxicity