پرستو کریمی علی آبادی

The process by which family physicians refer patients to specialized levels of the healthcare system is presented. In other words, the referral system can assure us that the clients of health care services are optimally allocated at the specialized level of services. In addition to providing proper time and providing proper health care for health benefits. The referral process is a specialized outpatient consulting process that determines the course and communication of the individual in three levels of the health system to provide the integrity and continuity of services this study aimed to determine the quality of referral and feedback forms in the medical family physician of Mazandaran province in 2019.

This descriptive cross-sectional study was conducted to examine the form of insurance referral of social security insurance by physicians of urban families and feedback from experts. After receiving the code of ethics and obtaining permission from the relevant organization the researcher paid the social security organization 1397 issued by the physicians in the province. The statistical population consisted of all forms of reference and the feedback from experts to the social security insurance organization to get the right According the report of the department of medical record department of the social security insurance organization of Mazandaran province in1397 has been handed over to that organization in a total of 151075 reference sheets completed to obtain the right of the specialists. the collected data were entered into Excel software for statistical analysis was performed in descriptive statistics using central dices (mean, median, mode) and dispersion index(variance, standard deviation, range of changes, coefficients of variation ) for quantitative variables, and index, percentage, and prevalence for qualitative data. The data were analyzed by using spss-25 software.

The study of 3200 cases of referral and referral forms of family physicians and specialists showed that among the Physicians 2321(72.5) were male and 879(27.5) were female. The patient's records in 586(%18.3) were incomplete. Clinical findings Were found in 98(2.7%) cases and paraclinical findings were incomplete in 22 cases (0.7%) and complete in 171 cases (5.3%). in 884 cases (27.6%) the papers were illegible the cause of referral was written in 560(17.5%). the reason for further referral in 187 cases (5.8%) was written by experts. In addition, 1454 cases (45.4%) of the return sheets completed by specialists were illegible.

The results obtained in this study show that the status of the quality of completion of the referral form by the family doctors and also the status of providing feedback by the specialist doctors are not suitable. to improve this situation the implementation of face-to-face and non-face-to-face training programs for both groups and using electronic referral forms can be put on the agenda.

Vaccination is a highly effective medical intervention in the COVID-19 pandemic. Systemic Capillary Leakage Syndrome (SCLS) is a severe and rare condition that can occur following COVID-19 vaccination, leading to recurrent shock episodes in patients. This report highlights a case where a patient experienced leakage syndrome after receiving the AstraZeneca vaccine. The 31-year-old female patient experienced shortness of breath, blood pressure drops, edema, and limb coldness 48 hours after receiving the COVID-19 vaccine. The clinical assessments identified low blood pressure, rapid heart rate, and reduced breath sounds at the bases of the lungs. Bilateral pleural effusion was observed in a chest CT scan, and pericardial effusion of moderate severity was seen in echocardiography. Laboratory tests showed leukocytosis, hyponatremia, hypoalbuminemia, hypocalcemia, and transudative pleural fluid. The remaining observations fell within standard parameters. Measures such as fluid restriction, correction of electrolyte imbalances, prescription of corticosteroids, and antibiotic therapy were applied. These interventions resulted in an improvement in the patient's overall condition, leading to the resolution of her symptoms. Since the symptoms of leakage syndrome are non-specific, and its diagnosis is based on excluding other causes, and considering that no paraneoplastic evidence was found in the studied patient, the diagnosis of leakage syndrome was attributed to the individual.For individuals exhibiting hypovolemic shock and edema linked to pleural effusion or ascites, and upon excluding conditions such as nephrotic syndrome, hypercoagulability syndromes, sepsis, and connective tissue vascular diseases, attention should be directed towards the possibility of leakage syndrome. Supportive care is the mainstay of treatment in these patients, and fluid restriction is a key component of management. Awareness of the symptoms and signs of this syndrome, as well as factors that may trigger its recurrence, is essential for physicians to make appropriate decisions for timely diagnosis and treatment in similar cases

Metabolic syndrome is characterized by a cluster of symptoms including insulin resistance, blood pressure, abdominal obesity, defects in glucose metabolism, and dyslipidemia. Considering the increasing prevalence of cardiovascular diseases and metabolic syndrome, the aim of the present study was to investigate the relationship between metabolic syndrome and its criteria with cardiovascular diseases.

The present study was a case-control study that utilized the results of the enrollment phase of the Tabari cohort study. The case group (304 individuals) was randomly selected from participants with cardiovascular diseases (564 individuals). The control group (304 individuals) was randomly selected from among other participants who were matched by age and sex. The comparison of variables between the two groups was done using the chi-square test. Logistic regression test was used to adjust the effect of confounding variables.

Patients with metabolic syndrome were 69.1% (210) in the case group and 55.6% (169) in the control group (P=0.001). The results of the univariate regression test showed that the chance of developing metabolic syndrome in people with cardiovascular diseases was 1.755 times more than people without cardiovascular diseases (95% CI: 1.280-2.418, and P=0.01). Among the diagnostic criteria of metabolic syndrome, the chances of high blood pressure, high triglyceride levels, and decreased HDL were significantly higher in the case group compared to the control group.

The risk of metabolic syndrome is significantly higher in people with cardiovascular diseases compared to the ones without cardiovascular diseases. After adjusting for confounding factors, we found a significant difference between triglyceride level and blood pressure in the two groups.

Increased urbanization in developing countries has led to increase in non-communicable diseases such as cardiovascular disease. Primary prevention of atherosclerotic vascular disease could be achieved by promoting healthy lifestyle throughout life. Team care approach is an effective strategy to prevent cardiovascular disease. Physicians should consider social factors affecting health to make appropriate treatment decisions. The present study will provide a brief overview of the latest clinical guidelines for treatment of lipid disorders in primary prevention of cardiovascular disease in adults.

In this narrative review, a comprehensive search of electronic databases (pubmed, scopus, google scholar, uptodate, and Embace) was done using the following keywords: primary prevention, cardiovascular disease, LDL cholesterol, and guideline. The goal of this study was to review the latest guidelines for lipid treatment in prevention of cardiovascular disease from 2015 onwards. Six articles were obtained in this field.

To prevent cardiovascular disease in diabetic patients aged 40-75 years, a moderate dose of statin is recommended. In non-diabetic patients, high-dose statin should be given for LDL levels ≥ 190 mg/dL. Also, 10-year risk of atherosclerotic heart disease should be calculated in non-diabetic patients aged 40-75 years old with LDL levels of 70-190 mg/dL to make treatment decisions.

According to access to the latest clinical guidelines, depending on patient's condition and type of disorder, therapeutic interventions in lipid disorders are recommended for primary prevention of cardiovascular disease.

Every year, 20-60% of older people experience a fall at least once. Falls account for 40% of all injury deaths at the age of 85 years and older. Medical costs and the need for traumatic ICU care in this population are three times higher than younger patients. The aim of this study was to determine the prevalence and factors associated with falls in older people living in Qaemshahr, north of Iran 2019.

In this descriptive-analytical study, five health centers were selected by simple random sampling and 450 older people (last clients) were selected via convenience sampling. Data were collected using a researcher-made questionnaire, interviewing the participants, and reviewing electronic health records. The validity of the scale was confirmed by five experts. Descriptive statistics and inferential statistics (correlation and multiple regression) were used to analyze the data.

The participants aged 60-93 years. The prevalence of falls was 44.7% (n= 198) and 12.5% (n= 58) experienced more than one fall. The incidence of falls was significantly higher in older people with lower educational backgrounds, walking aids, diabetes, myocardial infarction, and those on medication (especially aspirin, metformin, glibenclamide, gemfibrozil) (P<0.001).

There is growing population of older people in Iran who experience dangerous complications and high costs of fall injuries, therefore, appropriate strategies are needed to prevent falls in this population.

Social capital is one of the factors affecting the health of diabetic patients which will also affect their quality of life. The purpose of this study was to investigate the relationship between social capital, psychological well-being, and quality of life in diabetes patients.

A cross-sectional study was conducted in 275 diabetic patients attending Qaemshahr Razi Hospital in north of Iran. They were selected via convenience sampling. Data were collected using a demographic checklist, the Social Capital Questionnaire (SCQ), Diabetes Quality of Life questionnaire (DQOL), and World Health Organization Well-Being Index. Data were analyzed in SPSS V22.

The mean values for social capital, psychological well-being, and quality of life were 103.74 ± 19.56, 13.19 ± 5.47, and 43.59 ± 7.2, respectively. The study showed that social capital was positively and significantly associated with psychological well-being and quality of life (P<0.05). In this study, psychological well-being, social capital, more children, and higher educational backgrounds explained 34% of the variance in quality of life of diabetic patients.

Appropriate interventions on psychological well-being and social capital are needed to improve the quality of life of diabetes patients.