مجله سازمان نظام پزشکی جمهوری اسلامی ایران
سال سی و ششم شماره 3 (پیاپی 143، پاییز 1397)

Despite advances in bone tissue engineering, auto grafts from intra-oral or extra-oral donor sites are still the gold standard for treatment of large craniomaxillofacial defects. Biomaterial development, application of growth factor, and stem cells, open new gateway to bone regeneration studies, but real translation from bench to bedside have not yet happened. In this review article, a number of main approaches that researchers apply to enhance success rate in bone regeneration are described. One of the promising cell source candidates are induced pluripotent stem cells which are a type of stem cells produced by converting differentiated somatic adult cells or non- pluripotent adult stem cells into pluripotent stem cells. Regarding smart scaffolds, addition of bioactive molecules or nanoparticles that can enhance attachment and proliferation of stem cells on the scaffold have been investigated. Moreover, local delivery systems as a device to carry and discharge therapeutic agents including drugs, growth factors such as osteogenic or angiogenic factors and cells into a specific site for a desired period of time, have been introduced. Also, dynamic cell culture methods (namely bioreactors) are used to partially mimic the body’s physiological and mechanical characteristics. Another novel approach termed as Antibody-Mediated Osseous Regeneration (AMOR), is the local or systemic delivery of therapeutic molecules which either activate or inhibit the endogenous factors especially Bone Morphogenetic Proteins  (BMP) signaling. In conclusion, gradual physiologic release of growth factors with the cultured Mesenchymal stem cells (MSCs) in the composite scaffold, dynamic cell culture methods and enhancement of recipient bed, all turn on the light on this future prespective.

Colorectal Cancer (CRC) is the third most common cancer and the second leading cause of cancer-related death all around the world with an estimated 1.2 million new cases and a half million deaths each year. Although some curing methods such as surgery and chemotherapy are used in the early stage of CRC, targeted therapy is one of the principal modes of cancer treatment that could be a reliable and noninvasive strategy. It seems that Mesenchymal Stem Cells (MSCs) which are undifferentiated and multipotent with the ability to self-renew and differentiate into several distinct cell lineages, are emerging as a targeted anticancer agent and exert their biological and therapeutical activity through immune system modulation and release of cytokines and chemokines to the tumor site. These cells also play a significant role as a carrier to delivery drug to the primary site or metastasis of tumors. There are some studies on MSC`s potential to destroy tumors by inhibition of proliferation and induction of apoptosis. In contrast, tumor tendency is one of the most important characteristics of MSCs in which Adipose Derived MSCs (ADSCs) are the cause of tumor growth and metastasis. Furthermore, obesity indicated that increase of adipose tissue and ADSCs are in association with colon and breast cancers. Therefore, the double-edge sword role of MSCs is revealed as a therapeutic agent.

Throughout the life of people, environment can play a crucial role in the process of cognitive, behavioral, and even physical thinking. Thus, the purpose of this study was to identify the focus of attention, loneliness, acceptance and cultural attitude in elderly people located in care centers and independent elderly. The research method was a causal comparison and the statistical population of the study were all elderly women aged 65-75 years without cognitive problems. The sample consisted of 35 elderly people in care centers and 35 independent elderly people who both had normal and healthy cognitive function through non-random available sampling. Cognitive health recognition was performed on the basis of psychologist’s diagnosis and cognitive status index (SPMSQ). They were asked to complete a questionnaire on Marlow and Crown Recognition Scale, Feeling lonely SELSA-S, Focus of Attention Questionnaire (FAQ) and the Hofstede Social Housing Assessment Questionnaire. Data were analyzed using Mann-Whitney Variables Analysis (MANOVA). The results indicate that there is a significant difference in the level of focus of attention, loneliness, acceptance and cultural attitude among elderly people located in care centers and independent elderly (P = 0.01). According to the results of the research, it can generally be concluded that provision of family-based care and the implementation of health-welfare interventions by the relevant organs in the care centers of the elderly can be effective in promoting the general health of the elderly.

The possible consequences of a sharp decline in fertility, has forced the community leaders and policy makers to revise policies in regard to encouraging the population to give birth to children. The aim of this study was to determine the satisfaction of the people from childbearing government policies in recent years. This descriptive cross-sectional study was performed on 300 women in the reproductive age (18-45 years) referring to Karaj health centers in 2012 using cluster random sampling method. Data were collected using a questionnaire and data analysis using Chi-square test (P = 0.05) and SPSS software (version 20). Of the 300 women with a mean age 35 years, 62% of women (186) did not agree to limit their access to contraceptives. 48% of women (144) reported inadequate information in regard to contraception. Intelligence sources in 37% of patients were families (111) and only 9% (27) were medical staff. Economic problems in 83% of patients are considered to be the greatest cause of unwillingness to have a children. Satisfaction with education, age, marriage age, family income and level of unwanted pregnancy correlated (p<0/05) and had no significant relationship with contraception method (p>0/05). Dissatisfaction with family planning policies has been seen in almost half of the women and the lack of awareness and gaining information from invalid sources still exist among Iranian women. In order to encourage the birth growth rate, it is necessary to create the welfare infrastructure first and then, with proper education, allow families to increase their awareness in raising their children.

Fertility care, pre-pregnancy, pregnancy period and postpartum care play a very important role in the early diagnosis and timely and effective treatment of pregnancy and postpartum complications. This study was conducted to assess the effect of health transform plan on satisfaction of waiting time and continuation of receiving maternal health services in clients of community health centers of Iran University of Medical Sciences in 2017. This study was conducted as a case-control design. The study was done in community health centers of Iran University of Medical Sciences and samples were chosen by simple random method. 126 women referring to these centers entered the study as study samples. Data gathering was done using researcher made questionnaire after obtaining the approval of reliability and validity. Data was analyzed using descriptive and analytical approach by SPSS 22nd version and Wilcoxon and McNemar and Fisher tests. Out of 126 participating women, 63.4% were housewife and unemployed and most of them were in less than 35 years old age group. firstly, the ratio of service recipients was earned. Then compare the ratios in two steps before and after the transformation plan which was obtained according to the results. The rate of continuation of mothers’ referral after the development plan was more than before the transformation plan (P> 0.05). Mothers’ satisfaction with waiting time for receiving health services before and after the development of health system was significant (P <0.05). The mean score of mothers’ satisfaction before and after the design change was 2.72 and 3.36, respectively. The average satisfaction score after the change was more than before. Satisfaction of waiting time and continuation of receiving maternal health services increased after health transform plan. Utilization of maternal health services can improve infant and maternal health indicators for better health outcome and access to both qualitative and quantitative manners.

Poor adherence is one of causes of inadequate response in patients under treatment with levothyroxine. The aim of present study was to evaluate the effect of individualized patients’ education and giving a pamphlet regarding the proper usage of levothyroxine on patient’s adherence. A total number of 200 patients who consumed levothyroxine were included to evaluate their adherence to levothyroxine consumption based on Morisky questionnaire. Hundred patients received levothyroxine as routine without any instruction on proper use and 100 patients were educated and received a pamphlet on proper use of levothyroxine. There were no differences in two groups regarding sex distribution, mean age, levothyroxine use duration, number of medications and having a job. In patients who did not receive education demonstrated 52, 8 and 10% poor, moderate and good adherence, respectively. Patients who received education showed 26, 34 and 40% poor, moderate and good adherence, respectively. Chi square analysis showed that there was a significant difference between adherence of patients who received pamphlet and education in comparison to patients who did not (p= 0.001). Using education and giving pamphlet regarding the importance and proper use of levothyroxine in Iranian hypothyroid patients will lead to better adherence to medication use.

Endoscopic evaluation of a 51 year old woman, who had referred with a 6-months complaint of epigastric pain and fullness in the upper abdomen, demonstrated a large polyp in the greater curvature of the middle third of the stomach. The size of the pedunculated polyp was about 25 mm. Polypectomy was done by snar base and diluted epinephrine was injected submucosally and in to the stem and polyp removed completely. The initial endoscopic diagnosis was hyperplastic polyp without any significant complication. However, histological evaluation confirmed the final diagnosis of Gastritis cystica polyposa.