مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و نهم شماره 5 (پیاپی 245، امرداد 1400)

Breast cancer is one of the most common types of cancer in women. Screening mammography is a low‑dose X‑ray examination of breasts, which is conducted to detect breast cancer at early stages when the cancerous tumor is too small to be felt as a lump. Screening mammography is conducted for women with no symptoms of breast cancer, for early detection of cancer when the cancer is most treatable and consequently greatly reduce the death rate from the breast cancer. Screening mammography should be performed every year for women age 45-54, and every two years for women age 55 and older who are in good health. A mammogram is read by a radiologist to diagnose cancer. To assist radiologists in reading mammograms, computer-aided detection (CAD) systems have been developed which can identify suspicious lesions on mammograms. CADs can improve the accuracy and confidence level of radiologists in decision making and have been approved by FDA for clinical use. Traditional CAD systems work based on conventional machine learning (ML) and image processing algorithms. With recent advances in software and hardware resources, a great breakthrough in deep learning (DL) algorithms was followed, which revolutionized various engineering areas including medical technologies. Recently, DL models have been applied in CAD systems in mammograms and achieved outstanding performance. In contrast to conventional ML, DL algorithms eliminate the need for the tedious task of human-designed feature engineering, as they are capable of learning useful features automatically from the raw data (mammogram). One of the most common DL frameworks is the convolutional neural network (CNN). To localize lesions in a mammogram, a CNN should be applied in region‑based algorithms such as R‑CNN, Fast R‑CNN, Faster R‑CNN, and YOLO. Proper training of a DL‑based CAD requires a large amount of annotated mammogram data, where cancerous lesions have been marked by an experienced radiologist. This highlights the importance of establishing a large, annotated mammogram dataset for the development of a reliable CAD system. This article provides a brief review of the state‑of‑the‑art techniques for DL‑based CAD in mammography.

Heart failure is one of the most common cardiovascular disorders and is considered a chronic, progressive and debilitating disorder. The medical treatment of this disease is accompanied by many problems. Today, stem cells are being used increasingly to reduce the problems of heart failure treatments. Since pro-inflammatory cytokines play an important role in the prognosis and progression of cardiovascular disease, the present study aimed to investigate the effect of intravenous injection of human amniotic membrane mesenchymal stem cells on the levels of interleukins 4 and 12 in the serum of male rats in the heart failure model.

This is an experimental study that was conducted from October 2018 to May 2019 in the Physiology Research Center of Iran University of Medical Sciences. In this study, 28 male wistar rats (180-200 gr) were randomly divided into four groups: control group, heart failure group, heart failure group that received culture medium and heart failure group that received mesenchymal stem cells by intravenous injection. After 30 days, echocardiography was done and then serum levels of interleukin 4 and 12 were measured in these groups by Elisa test.

The results of this study showed that intravenous injection of human amniotic membrane mesenchymal stem cells into male rats with heart failure, improved echocardiographic parameters such as ejection fraction (EF) and fractional shortening (FS) in the cell injection group compared to the heart failure group (P<0.05). Also, the levels of inflammatory cytokines IL-4 and IL-12 were significantly reduced in the cell injection group compared to rats with the heart failure group (P<0.05).

Due to the improvement of cardiac parameters and the reduction level of inflammatory cytokines in this study, it seems that human amniotic membrane mesenchymal stem cells play an important role in improving heart failure by reducing the level of inflammation.

One of the most empirical subjects particularly in substantial operations for example in surgeries involving the vertebral column, are the implication of sedatives in a manner which would create the least complications such as changes in the hemodynamic parameters. Two such drugs that are widely used in this capacity in clinical settings are midazolam and dexmedetomidine. Hemodynamic stability is particularly important in surgical operations, especially during spinal surgery. One of the ways to prevent hemodynamic changes during surgery is the use of drugs such as midazolam and dexmedetomidine.

This double-blind randomized clinical trial recruited 105 patients undergoing laminectomy spinal surgery under spinal anesthesia at Al-Zahra Hospital, Isfahan between 21 April 2019 till 1 September 2019. Patients were randomly divided into 3 groups: First was the midazolam group, second the dexmedetomidine group and the third was the control group. Data were presented as mean±standard deviation and percentages. In order for the evaluation of differences to be performed between all groups, an evaluation using the one-way analysis of variance was utilized. Statistical analysis was done by means of the SPSS software version 23 (IBM Corporation, Armonk, New York, USA). The P-value which was accepted as significant was P less than 0.05. (P<0.05)

There differences in age and gender were not statistically significant among the studied groups (p>0.05). Results from the ANOVA test showed that the effects when taking into consideration time (P<0.001) and group (P<0.001) were statistically significant on Mean of Arterial Pressure, Systole Blood Pressure and Diastole Blood Pressure. However, Heart Rate and oxygen saturation (SPO2) were not significantly different inter-group as well as intra-group over time (before, during, and after the operation) (P=0.12).  Furthermore, the mean of the hemorrhage amount and duration of recovery stay had significant differences over time between all three groups (P<0.05).

The incidence of complications during surgery in the dexmedetomidine group was less than the midazolam group. Additionally, the frequency of complications in the subjects given midazolam was higher than the dexmedetomidine group during recovery.

Normal vaginal delivery causes sexual dysfunction as well as urinary and fecal incontinence, which can threaten a personchr('39')s quality of life. It is believed that pelvic floor muscle strength is the most important factor in improving sexual satisfaction and function and urinary control. Therefore, This study aimed to investigate the role of physiotherapy and pelvic floor exercises in reducing sexual dysfunction and incontinence in primiparous women.

This study was performed as a prospective randomized clinical trial on primiparous women who were referred to Al-Zahra and Shahid Beheshti educational hospitals in Isfahan between march 2019-Mars 2020. In this study, after obtaining ethics approval from the Medical Ethics Committee of Isfahan University of Medical Sciences, patients were divided into control (n=57) and intervention (n=57) groups. In the control group, no intervention was performed and only routine postpartum recommendations (multivitamin tablets and 500 mg calcium tablets once daily for two months) were prescribed. For the intervention group the pelvic floor physiotherapy was performed Sexual function and urinary and fecal incontinence were assessed in both groups at 8 and 16 weeks postpartum by completing two questionnaires.

In two groups of intervention and control; Mean maternal age, body mass index, and birth weight were not significant (P>0.05) In the intervention group, at the 8th and 16th weeks after delivery, the mean score of total sexual function, and the total score of female urinary and fecal incontinence was a significant difference. (P<0.05). Compared between the groups, the mean sexual function and pelvic floor irritation at 16 weeks postpartum were significantly different between the two groups. Physiotherapy and pelvic floor exercise intervention reduce pelvic floor irritation and improve sexual function.

it seems that simultaneous performance of physiotherapy (biofeedback) and pelvic floor exercises by strengthening the strength of the pelvic floor muscles increases sexual function as well as a relative improvement of pelvic floor irritation in the postpartum period.

Inlet patch (IP) lesion is the presence of gastric columnar epithelial tissue outside of the stomach. Symptoms such as a lump in the throat, chronic cough, laryngitis, or other mouth-throat symptoms may be IP-related only and have no other abnormalities. This study aimed to determine the relationship between globus sensation and structural disorder of Inlet Patch in patients with gastroesophageal reflux disease

The case-control study was performed in patients who were referred to the endoscopy ward of Sina Hospital in Tehran from October 2016 to October 2017. Inclusion criteria were diagnosis of gastroesophageal reflux and endoscopic indications. Patients who had endoscopic indications and underwent endoscopy were evaluated. Information on reflux esophagitis and inlet patch structural disorder were determined. Symptoms of reflux, including a lump in the throat, were identified and recorded. Then the frequency of globus sensation in patients with inlet patch structural disorder (patient group) and without it (control group) was compared.

A total of 100 patients with gastric reflux participated in this study. Patients included 42 men (42%) and 58 women (58%). The mean age of patients was 41.17±10.35 years (18-77 years). The severity of mild reflux was 57%, moderate reflux was 27% and severe reflux was 16%. 28% of patients had a lump in the throat and 12 patients had an inlet patch. There was a statistically significant relationship between inlet patch and globus sensation (p=0.001). All patients with inlet patch had globus sensation. 81.8% of patients without inlet patch did not feel a lump in the throat. The results showed a statistically significant difference between the two groups with and without inlet patch in terms of globus sensation in general and in terms of different clinical variables (p=0.001).

The findings of the study showed that inlet patch had a significant relationship with the feeling of a lump in the throat and all patients with inlet patch felt Globus sensation.As the result, to diagnose a patient with an inlet patch, other causes such as esophagitis, hernia, heartburn and metabolic syndrome should be ruled out.

Anemia has a very high prevalence across the world. Microcytic anemia is the most common nutritional disorder and a major health problem in infants and children associated with inadequate growth and development. Diagnosing anemia at the birth can be difficult. Due to the fact that conditions such as thalassemia and iron deficiency are causative factors of microcytic anemia are prevalent in Iran, early diagnosing and treating these diseases can prevent excessive costs and further complications. Therefore, recognizing the practical factors with this complication is an effective step in controlling and preventing it. Therefore, the present study was performed to determine the prevalence of microcytic anemia in newborns in Baharloo Hospital in Tehran, Iran.

This cross-sectional study was performed on 210 infants, which were newly born on Baharloo Hospital from march2018 to march2019. 2.5 cc cord blood sample was extracted from each infant, and microcytic anemia were diagnosed according to factors such as Hb, MCV and others parameters.

in this study, we demonstrated that there is a significant association between MCH and microcytic anemia. Our results showed that the rates of newborn infants with anemia disease (Hb<13ml/dl) were 14.3% and the rates of microcytic anemia were 9.5%. There were not any significant differences between motherchr('39')s age, neonatal weight and height, type of parturition, pregnancy age and parental ratio with the incidence of microcytic anemia.

Anemia has a relatively high prevalence in the center of Baharloo Hospital, Tehran, Iran. So screening and further investigation for anemia and related factors are critical. According to the results of our investigation, studies showed that anemia is a multifactorial disease that depends on different factors. The existence of variable results in different studies requires evaluating more parameters that affect the incidence of microcytic anemia, such as iron deficiency, eating habits, level of parental education, and use of iron supplements in pregnancy. Management of this disease requires screening and early diagnosis for more effective treatment and reduction of its potential complications.

Medical malpractice is a serious problem in the health care system. This study aimed to review the medical negligence in Iran.

Based on the PRISMA checklist, a search for scientific records was done separately by two researchers. All the articles that had selection criteria were evaluated in terms of methodological quality. Medical malpractice was assessed in four main divisions including negligence, Lack of skill, Carelessness and non-compliance with government regulations). The bias test was performed using the Egger’s test. Revman software was used to analyze the data.

In the present study, 25 studies that examined the countrychr('39')s medical malpractice from April 1994 to March 2018 were included in the meta-analysis. Negligence has been implicated in 1,105 cases of the 2,068 claims. Lack of skill in 255 out of 2068 cases, 432 cases of carelessness and 244 cases of non-compliance with government regulations Were recorded the results of the meta-analysis showed that OR negligence was 0.76 (CI 95%: 0.66-0.87), lack of skill was 0.61 (CI 95%: 0.49-0.76), carelessness was 0.62 (CI 95%: 0.50-0.76) and non-compliance with government regulations was 0.66 (95% CI: 0.60-0.73). In the review of the confirmed negligence ratio of the registered complaint files, only 19 studies mentioned this ratio. The results of the meta-analysis of these 19 studies showed that the OR ratio of the confirmed negligence of complaints was 0.6 (95% CI: 0.41-0.86). From all claims, General surgeons had OR of confirmed medical malpractices, equal to 0.47 (CI 95%: 0.37-0.60), gynecologists with OR equal to 0.49 (CI 95%: 0.36-0.66), general practitioners with OR equal to 0.43 (CI 95%: 0.30-0.63) and orthopedic specialists with an OR of 0.44 (CI 95%: 0.32-0.61).

The results of this study help to understand the current position of medical negligence studies in the country to identify the cause of the malpractice and develop new studies for the future.

This study aimed to evaluate the effect of intravenous Ibuprofen Apotel analgesia in comparison with intravenous Morphine alone regimen in patients undergoing lubmar disc surgery.

This study was a double-blind clinical trial that was performed on patients with moderate to severe lumbar disc pain (VAS score or Visual analog scale more than 4) in August 2019 at Shohada Tajrish hospital. Patients in the Ibuprofen-Apotel group (group A) recieved intravenous Ibuprofen (800 mg) in 100 cc Normal saline in the first 30 minutes of Recovery, then 400 mg in 100 cc Normal saline every 6 hours (48 hours after surgery), plus 30 mg Apotel for each kilogram in100 cc Normal saline in 15 minutes every 8 hours. In group B, Morphine has injected with 70 µg/kg bolus and then 20µg/kg/h infused with a PCA pump with a Maximum Rate of 1mg/hr. Then 60 minutes after surgery, patientschr('39') pain was measured using an analog scale.
The primary outcome was defined as a reduction in pain intensity of 3 or more VAS units (which was considered as therapeutic success) and the incidence of side effects was considered as secondary outcomes.

Based on the results of this study, the mean age of the subjects was 33.28±12.48 years. Also, the mean age in the group of Ibuprofen-Apotel and Morphine alone were 35.4±13.6 and 31.16±11.75 years. So, there is not a significant difference between the groups. 77.14% of the subjects (54 people) were male and 22.86% (16 people) were women. In comparing the frequency distribution of individuals in terms of gender and the method of creating analgesia, no significant difference was observed between the groups studied.According to the results, after the intervention, the highest pain intensity in both groups was significantly decreased. However, no significant difference was observed between the two groups.

The study indicated that Ibuprofen can be effective in controlling postoperative pain.

Hospital accreditation is a systematic external evaluation of a hospitalchr('39')s structures, processes, and outcomes by an independent professional accreditation body using published optimum, evidence‐based, and achievable standards. Accreditation is a strategy for ensuring the quality, safety, and productivity of hospital services. Implementing accreditation standards imposes a high cost on hospitals. Therefore, this cost should be offset by increased hospital efficiency. Hence, this study aimed to examine the relationship between the Iranian public hospitals’ efficiency and their accreditation status.

This descriptive and cross-sectional study was conducted in May 2019. The efficiency of general hospitals in Iran was assessed using the Pabon Lasso chart and three performance indicators of bed occupancy rate, average patient length of stay and hospital bed turnover. Then, the relationship between the efficiency of hospitals and their accreditation grade was examined. Descriptive statistics and ANOVA tests were used for data analysis using SPSS software.

There were 834 general hospitals with 108,275 active beds in Iran in 2018. The Iranian general hospitals had an average bed occupancy of 62.8%, an average patient length of stay of 2.6 days, and an average bed turnover of 93.4 times. Almost 15.3% of the hospitals performed well and were located in area 3 of the Pabon Lasso chart. About 36.1% and 48.6% of the hospitals had moderate and low efficiency, respectively. Approximately, 74% and 21% of hospitals had the accreditation status of 1 and 2, respectively. There was a significant relationship between the degree of accreditation of hospitals with their bed occupancy, bed turnover and bed turnover interval.

The efficiency of public hospitals is low. A hospital accreditation grade is related to some of its efficiency indicators. Low efficiency and waste of resources will reduce the effectiveness of hospital and, consequently, its accreditation grade. Accordingly, the hospitalchr('39')s revenue will decrease and therefore, the hospitalchr('39')s productivity and accreditation grade will decrease and the hospital will be in a vicious cycle. Strengthening hospital accreditation standards and their proper implementation will increase the efficiency of hospitals.

Hypoglycemia can cause permanent damage to the brain or lead to death. That is why it is very important to prevent or quickly correct hypoglycemia to save life for the treatment of hypoglycemia following the use of Sulfonylureas, taking oral nutrition for the patient or administration of injectable hypertonic glucose is recommanded. But recurrence and resistance to treatment are common in sulfonylurea poisoning. Due to the vulnerability of the brain to long-term hypoglycemia, plasma glucose concentrations should be returned to normal as soon as possible and recurrences of hypoglycemic attacks should be prevented. Because Octreotide is of particular importance in the control of hypoglycemia, this study aimed to use Octreotide to treat recurrent and refractory hypoglycemia due to Glibenclamide use.

In this study, four patients with an average age of 30.75 years and an age range of 18-40 years were evaluated and managed. Following suicide with a high dose of Glibenclamide, they had refractory hypoglycemic attacks So for these patients, Octreotide was started at a dose of 50 μg every 6 hours, and all of them responded to Octreotide therapy, and the hypoglycemic attacks were greatly reduced. All patients were treated with Dextrose 50% at the time of admission. However, their blood glucose dropped significantly and did not respond to the dextrose diet. However, receiving the first dose of Octreotide with a significant increase in patientschr('39') blood glucose showed a favorable effect of Octreotide in this study.

In hypoglycemia caused by Sulfonylureas, Octreotide is used temporarily. Octreotide is a somatostatin analogue that inhibits insulin secretion. In this study, it was found that in cases of recurrent hypoglycemia and resistance to common therapies, the use of Octreotide at a dose of 50 μg every 6 hours is desirable and the patient can be discharged with appropriate blood sugar So that the use of Octreotide played an important role in controlling recurrent and refractory hypoglycemia in patients with glibenclamide poisoning