Using 360-degree multi-source feedback to evaluate professionalism in surgery departments: an Iranian perspective

Background: Medical professionalism helps physicians adopt a proper and good healing action for the patients based on their particular circumstance. This study was conducted to assess professionalism in surgical residents, using a 360-degree evaluation technique in several teaching hospitals in Tehran, Iran. Methods: This study was conducted on all the second and third year surgery residents from three university teaching hospitals in Tehran. Multi-source feedback questionnaire contained 10 questions on the residents’ professional behavior and was completed by the faculty and staff members (nurses, operation room staff, and medical assistants) as well as other surgery residents, interns and patients to evaluate each resident. Response rates were used to determine feasibility for each of the respondent groups and the mean and standard deviation score for each question was computed to determine the viability of the items. Reliability was assessed using alpha Cronbach coefficient for each respondent group. The correlation between these scores and the residents’ final and OSCE grade was also assessed. Results: The internal consistency reliability for 360-degree rating was 0.889. There was no significant difference in the residents’ score in different hospitals. While male residents obtained higher total score, there was no significant difference between them. The residents, however, obtained lower scores compared to the staff. The highest score was recorded for question 6, suggesting that the residents treated the patients regardless of their socioeconomic status. Conclusion: This study revealed a strong agreement between the results gathered from different respondents, confirming the reliability of the questionnaire and the respondents’ unbiased response. It also revealed that the residents did well in the whole test, showing they were conscientious and learning to become medical professionals

The relationship between anthropometric parameters and bone mineral density in an Iranian referral population

Osteoporosis is a common health concern in both developed and developing countries. In this study the association between anthropometric measures and osteoporosis was investigated in 3630 males and females visiting BMD clinic of Shariati Hospital, Tehran, Iran, a teaching hospital and referral center for osteoporosis affiliated to the Tehran University of Medical Sciences. Anthropometric measurements obtained and also Bone Mineral Density (BMD) measurement was done using a Lunar DPXMD densitometer. Data were analyzed using SPSS with Chi-square and ANOVA with post-hoc tests. Results showed that the weight, BMI and age had the strongest correlation with the BMD values in the studied people. While age is negatively correlated with BMD in all the studied people, a positive association was noted between weight, height and BMI and BMD parameters (P<0.01). It was concluded that certain anthropometric parameters (BMI and weight) can considerably affect one's risk of developing osteoporosis. Further research on the effect of these variables on the association of weight and BMD is needed

Dual energy X-ray absorptiometry diagnostic discordance between Z scores and T scores in a young Iranian population

Background: Dual-energy X-ray Absorptiometry (DXA) is considered the gold standard for non-invasive measurement of bone mass. T-scores and Z-scores are used to present the results of bone mass. The present study was designed to evaluate the discordance between T-scores and Z-scores calculated at a same level and its relation with age, gender and body mass index (BMI) in a representative sample of normal population. Methods: This cross-sectional study was conducted as a part of a comprehensive survey, Iranian Multicenter Osteoporosis Study (IMOS), designed to assess bone health among healthy adults. Each individual underwent both L1–L4 antero-posterior lumbar spine and hip DXA scan. The difference between the T- and Z-scores measured at each of the four skeletal sites was then calculated. Results: A -1.21 to 1.21 point difference was noted in the Z- and T- scores measured at each site. While the difference between the T- and Z-scores was less than 0.5 SD in most of the cases, the difference was higher than 1 SD in about 5% of the subjects. Conclusion: Standardization of Z-score definition and calculation techniques as well as developing an ethnicity-matched reference population is needed to improve the reliability of DXA-generated Z-scores

Numerical simulation of a multi-inlet microfluidic device for biosensing purposes in osteoporosis management

Objectives In this paper, the effect of the position of the inlet and outlet microchannels on the flow profile and the geometry of the recognition chamber for sample pre-treatment in an electrochemical biosensor to be used in osteoporosis management were investigated. Methods All numerical computation presented in this work were performed using COMSOL Multiphysics and Fluent. Simulation was performed for a three-dimensional, incompressible Navier-Stokes flow and so explicit biphasic volume of fluid (VOF) equations were used. Results In the designed microfluidic system, a pressure-driven laminar flow with no-slip boundary condition was responsible for fluid actuation through microchannels in a reproducible approach. Based on the simulation results, the number of outlets was increased and the angel through which the inlets and outlets were attached to the microchamber was changed so that the dead volume would be eliminated and the fluid flow trajectory, the velocity field and pressure were evenly distributed across the chamber. The Re number in the inlets was equal to 4.41, suggesting a laminar flow at this site. Conclusion The simulation results along with the fact that the design change was tested using laser ablated tape and a color dye at different steps provided the researchers with the opportunity to study the changes in a fast and accurate but cheap method. The absence of backflow helps with the cross-talk concern in the channels and the lack of bubbles and complete coverage of the chamber helps with a better surface modification and thus better sensing performance

Effects of intrathecal opioids use in cesarean section on breastfeeding and newborns’ weight gaining

Objective: To assess the association between intrapartum intrathecal opioid use and breastfeeding and weight gain following cesarean section. Materials and methods: The prospective double-blinded study was conducted on term pregnant women, undergoing elective cesarean section under spinal anesthesia. They divided into two groups. In the first group, intrathecal Morphine was used to achieve analgesia during or after the operation. The remainder divided into two subgroups, those who did not receive any opioid or those received systemic opioids. Following labor breastfeeding accessed in a follow-up, two month latter. Results: There was no difference between the demographic variables of the mothers and newborns APGAR score and weight at the time of birth. Breastfeeding rate was similar in intrathecal group in compare with other patents (P value = 0.518). While, the infants’ weight at the end of second month was lower in spinal opioid group (P value = 0.036). Conclusion: The present study was the first to suggest that spinal (intrathecal) opioids do not have any impact on breastfeeding. However the relationship between spinal anesthesia on weight gaining needs more investigation

Magnetic resonance spectroscopy in the management of tophaceous gout: A case report

Development of chronic tophaceous arthritis with marked joint impairment may follow repeated acute attacks. We present a 60 year-old man with huge urate deposits and severe gouty arthropathy with underlying hypothyroidism. During the past years, he had undergone several surgeries with different degrees of amputation to remove the tophus. Magnetic resonance spectroscopy (MRS) of foot finger revealed high peak of lactate, suggesting that high lactate levels is linked with chronic gout and frequent attacks. The patient was treated with levothyroxine along with gout medication, and his thyroid-stimulating hormone (TSH) and urate levels were soon normal, suggesting that the underlying hypothyroidism had aggravated his gout condition

New horizons in treatment of osteoporosis

BACKGROUND: Prevalence of osteoporosis is increasing both in developed and developing countries. Due to rapid growth in the burden and cost of osteoporosis, worldwide, it seems reasonable to focus on the reduction of fractures as the main goal of treatment. Although, efficient pharmacological agents are available for the treatment of osteoporosis, there still remains a need to more specific drugs with less adverse effects. MAIN BODY: This review article provides a brief update on the pathogenesis, presenting current pharmacological products approved by the US Food and Drug Administration (FDA) or Europe, and also newer therapeutic agents to treat osteoporosis according to the clinical trial data available at PubMed, UpToDate, International Osteoporosis Foundation (IOF), and clinical practice guidelines. As well, the effect of combination therapy and recommendations for future research will be further discussed. SHORT CONCLUSION: The use of current antiresorptive and anabolic agents alone or in combinations for the treatment of osteoporosis entails several limitations. Mainly, their efficacy on non-vertebral fracture reduction is lower than that observed on vertebral fracture. In addition, they have potential adverse events on long time usage. Development of newer agents such as cathepsin k inhibitor and strontium ranelate not only have increased the available options for treating osteoporosis, but also have opened doors of opportunity to improvements in the effective treatment. However, the high cost of new agents have restricted their usage in selective patients who are at high risk of fracture or whom failed response to first line treatment options. Thus, personalized medicine should be considered for future evaluation of genetic risk score and also for environmental exposure assessment. In addition to permanent attention to early diagnosis of osteoporosis and understanding of the pathophysiology of osteoporosis for novel approach in drug discovery, there seems a need to more well-designed clinical trials with larger sample sizes and longer duration on current as well as on newer agents. Also, continuous research on plant-derived components as the source of discovering new agents, and conducting more clinical trials with combination of two or more synthetic drugs, plants, or drug-plant for the treatment of osteoporosis are recommended. GRAPHICAL ABSTRACT: Summary of treatment modalities for osteoporosis. [Image: see text

The Effect of Hibiscus Sabdariffa on Lipid Profile, Creatinine, and Serum Electrolytes: A Randomized Clinical Trial

Background. Hibiscus Sabdariffa L. (HS), a member of malvaceae family, is a medicinal plant with a worldwide fame. Its effect on reducing serum lipids is mentioned in several studies. The purpose of this study was to assess the efficacy of this plant in reducing the serum's lipids in hypertensive patients. Materials and Methods. Ninety hypertensive patients were randomly assigned to receive Hibiscus Sabdariffa (HS) tea or black tea for 15 days. The patients were asked to drink the tea within 20 minutes following its preparation. This process had to be repeated two times, daily. Patient's FBS and lipid profile were collected at the first visit day (day 0) and on the day 30. Results. There was no significant differences between pre and post experiment values within the two groups. An upward trend in total cholesterol, HDL, and LDL cholesterol was evident in both groups. The increase in total and HDL cholesterol in both groups relative to their initial values were significant. Conclusion. Hibiscus Sabdariffa is probably a safe medicinal plant. No significant harmful changes in cholesterol, triglyceride, BUN, serum creatinine, Na and K levels were observed within 15 days after the discontinuation of the medication