مجله سازمان نظام پزشکی جمهوری اسلامی ایران
سال سی و ششم شماره 2 (پیاپی 142، تابستان 1397)

Warfarin sodium as an anticoagulant, is widely used for the prevention and treatment of venous and arterial thrombosis. As a vitamin K antagonist, warfarin effectively decreases the hepatic production of clotting factors II, VII, IX, and X, along with proteins C and S. While anticoagulants such as warfarin have well-established indications, they are also associated with few side effects such as haemorrhage. Many patients receiving vitamin K antagonists have an International Normalized Ratio (INR) higher than the target of 2.0 to 3.0 for over 50% of the time, which is followed with increasing risk of bleeding. In this situation the clinical need for emergency reversal of anticoagulation is necessary. There are a number of potential treatment options for anticoagulant reversal, including administration of vitamin K (oral or intravenous), human plasma products [for example, Fresh Frozen Plasma (FFP)], prothrombin complex concentrates (PCCs); concentrates that contain coagu-lation factors II, VII, IX and X), or single coagulation factors such as activated re-combinant factor VII (rFVIIa). The aim of this paper was to conduct a review of the medical literature and summarize the advantages and risks of the available treatment options for reversing warfarin anticoagulation in patients receiving warfarin. Keywords: Warfarin, Warfarin reversal, Vitamin K, FFP, PCC, rFVIIa

One of the technologies of genetic science is prenatal diagnostic testing. Parents are trying to use their prenatal diagnostic tests to use their legal right about abortion of disabled embryo that is prescribed in Iran according to the Medical Abortion Act in 2005,in England according to the congenital disabilities Act 1976.In this paper,library resources,internet searches were used in order to take advantage of domestic resources,English articles that were difficult or impossible to access from a library. Related materials were collected from various sources,then written by analyzing the content based on the domestic law doctrine,the English legal system.If the physician does not consider the parents' decision to have an abortion of disabled embryo when the conditions are met,the harm that occurs when the child is disabled,the parents can claim the damage.In the UK legal system,according to the fulfillment of civil liability,based on the theory of fault,parents,disabled children can claim additional expenses from the birth of the disabled child. In the legal system of Iran,it is not justified to pay compensation based on Diyah,Arsh,but it is more rational to pay a pension against Diyah,Arsh. However,it seems that there should be a special system of compensation for the lost person.

Lower Urinary Tract Symptoms (LUTS) are problems of patients with neurological bladder including Cerebral Palsy (CP). This study aimed to investigate the effect of Percutaneous Tibial Nerve Stimulation (PTNS) on LUTS in children and adolescents with CP. This study was conducted on 38 children with CP who had LUTS. After collecting demographic information, symptoms of LUTS were recorded. Physiotherapy treatment through PTNS nerve was performed in 12 sessions and results recorded through a daily log for all patients. Sign test, t-test and Fisher's exact test was performed to analyze the data. The values of (p<0/05) were considered statistically significant. The effect of PTNS was significant on urinary frequency (p = 0.001) and stress urinary incontinence (p = 0.008). There was no significant difference between the deviation of the spine and urinary symptoms (p> 0.05). There was no significant correlation between urinary symptoms, muscle tone and walking ability (p> 0.05). In children with normal mental status, the frequency of urination was higher (p = 0.04). The results of this study showed that PTNS is effective in the treatment of some of the symptoms of LUTS in children and adolescents with CP.

Sarcoidosis as chronic granulomatous disease may leave serious effects on function and quality of life. Meanwhile, the emotional intelligence is one of the factors that plays a role in emotional management in difficult situations. Furthermore, personality as the stable and constant characteristics of a person, is related with mortality, morbidity and psychological factors in chronic patients. The goal of the current research was evaluating the correlation between emotional intelligence with personality characteristics in sarcoidosis patients. This was a descriptive – sectional study, in which correlation between emotional intelligence and personality characteristics in sarcoidosis patients was evaluated. The sample group was selected by census method which included 50 patients. The researcher made demographic questionnaire, MMPI-2 and Schutte emotional intelligence questionnaires were applied. The average score of emotional intelligence was higher than average. 10% suffered from depression as a reaction to the disease and aggressive characteristics, 56% had moderate adaptation, and 50% had independency, efficiency, obedience and avoidance from intimate relationships features. Patients with low emotional intelligence had significantly (P= 0.03) higher score in hysteria. Patients had moderate adaptation. Existence of mental pressures and insolvency of patients indicated their good prognosis for treatment. Therefore, paying comprehensive attention to somatic diseases is important for promoting somatic and mental treatment of the patients.

Delayed muscle soreness occurs after resistance activity or training involving an eccentric component, and nutrition can affect the extent of muscle injury by playing a role in both protein synthesis and catabolism. The objective of this study was to evaluate the effect of using glutamine supplementation in 3 days on injury indices after a session of eccentric resistance exercise In a double-blind study, 20 voluntary non-athlete male subjects [age 21.1 ± 2.3 yr., height 177 ± 3 cm, weight 77.1 ± 6.2 kg, Body Mass Index (BMI) 24 ± 1.9 kg/m2, body fat 14.8 ± 4.5%] were divided randomly into 2 groups with 10 member supplement (glutamine) and placebo (maltodextrin). Serum creatine kinase was measured by photometric method and muscle pain was determined by using a standard scale of PAS in 24, 48 and 72 hours after resistance test which involved leg press. Three subsequent days of using glutamine amino acid did not demonstrate significant difference in decreasing injury indices after eccentric leg press (p>0.05). It seems that this dose of supplement is not sufficient in regard to the number of days administered and in order to show the positive effects of amino acid, it should be used for more number of the days. So, to clarify the effects of glutamine supplement, there is need to conduct further studies with more accurate control and more data collection times.

Celiac disease is a chronic digestive disorder that occurs in people genetically susceptible due to the use of gluten protein in wheat, barley, and rye. One of the genes that is increasing in the inflammatory pathway of the disease is the NFkB1 gene. Therefore, the purpose of this study was to design a specific primer pair to examine the expression of NF-kB1 gene in patients with celiac disease under gluten-free diet compared with healthy subjects. In this case-control study, biopsy samples were collected from 10 approved celiac disease patients and 10 healthy individuals. The gene specific primer pairs were designed and temperature and specificity of the gene was verified by Blast software. Then, a cDNA was constructed to quantitate the expression of NF-kB1 gene which was investigated by Real-Time PCR. In this study, case group consisted of 3 (30%) women and 7 (70%) men with mean age of 34. 11 ± 34.80 year, and 4 (40%) women and 6 (60%) men were in the control group with an average age of 38.12 ± 4.50 yr. As all patients with celiac disease were under a gluten-free diet for more than 1 year, the expression of NF-kB1 in patients with diet was reduced compared with healthy subjects (P: 0.45). The results of this study indicate that observing a gluten-free diet for more than a year has the potential effect to reduce inflammatory gene expression levels, including NF-kB1, in patients with celiac disease.

Gifted students are recognized as important human capital in the world. It is very important to study the factors that affect the thinking style of this subject. So, the aim of this study was to determine the role of emotional creativity and neuropsychological functions in prediction of critical thinking of gifted students. The research method was descriptive-correlational. The statistical population of this study was all students of the second grade in secondary schools of Rasht city in the academic year of 2018-19. 120 subjects were selected through the sampling method. Emotional Creativity Questionnaire, Wisconsin Test, Wechsler IQ Scale for Children and Critical Thinking Questionnaire were used to gather information. The collected data were analyzed using Pearson correlation coefficient and Multiple regression tests. The results showed a positive and significant relationship between emotional creativity (and its components) and neuropsychological functions (performance in the Wisconsin test, vocabulary and multiplication of cultivars) with critical thinking in gifted students (p <0.01). The results of multiple regression showed that emotional creativity and neuropsychological functions had the ability to predict the variance of critical thinking skills of 37% of students. These results emphasize the need to provide educational programs based on emotional creativity and non-psychological functions to enhance critical thinking.