hojjat torkmandi

Due to the wide variety of cervical vertebral congenital anomalies, knowledge of their types and related clinical conditions can prove to be helpful for physicians and surgeons in the diagnosis and treatment of patients. The aim of this study is to report on a rare case of unstable cervical vertebral congenital anomaly in which the patient had a defect in the body of the C3 vertebra in addition to defects in the posterior arch of C1 and posterior element of C2. This type of anomaly has not been reported so far in the literature. To reduce the patient’s related neurological disorders, our treatment choice for this patient was occipitocervical fusion (OCF) surgery. At the 3-year postoperative follow-up, all sensory and motor problems related to this anomaly affecting the patient's upper and lower limbs and causing shoulder and neck pain were eliminated. In this rare type of anomaly, OCF surgery seems to be an effective choice in relieving the patient's neurological symptoms.

One of the legal and ethical issues related to the medical profession and health centers is patients’ uncertainty regarding the type and quality of clinical care provided and the extent to which the health care providers comply with the necessary criteria in delivering health care. This study investigated the civil, criminal, and ethical aspects of using cameras in the operating room by describing a case that a legal complaint had filed regarding this issue and a review of the literature.

The study was a case report and narrative review. First, we introduce a case that found out that the patient admitted for brain tumor surgery did not operate on him and requested to review the videos of the operating room. Then, we investigated this issue in the literature.

The purpose and outcome of using Closed-Circuit Television (CCTV) in the Operating Room (OR), may vary depending on the goals, needs, and expectations of different stakeholders. Some countries may use CCTV in the OR primarily for educational, research, or quality improvement purposes. In contrast, others may use CCTV in the OR mainly for security, surveillance, or legal purposes. 

The suggestion of recording the events done in the operating room environment using a CCTV can be an acceptable solution and as a legal document and evidence.

Professionalism means understanding a profession and introducing it to the society through professional behaviors. In particular in clinical settings, constructive feedback is provided in education to create professional behaviors.

This study aimed to investigate giving feedback on professionalism in clinical education.

A narrative review was conducted in PubMed and Google Scholar on the publications over the last 10 years. Eight hundred twenty-six articles were found in the first step, among which 30 were handed over to the expert panel. Fifteen of 30 articles were finally selected.

The data of the studies were in four categories: feedback techniques, feedback in. curriculum, the scope of feedback, and feedback outcome. Feedback on professionalism was mostly presented through online services, portfolio, video-based systems, by a preceptor or peers, longitudinally in internship courses, and Multi Source Feedback (360 degree). In a study, feedback on professionalism was considered formally in the curriculum. Educational experts give both formative and summative feedback (most of which were formative). Based on the literature, feedback can enhance learning professionalism, curriculum reforms, system support, student comfort, evaluations, and efficacy of professionalism.

Multi-Source feedback assessment was the most used tool for giving feedback in professionalism, and the most popular form was informal-formative feedback. Since professionalism is a multidimensional concept related to personal communication, multi-source tools have been the most commonly used in the literature.

Pyrexia and shivering are the most popular side effects of postpartum administration of misoprostol, but other side effects of this drug are very rare. A 27-year-old pregnant female patient was admitted to Ayatollah Mousavi hospital (Zanjan, Iran), complaining about severe headache and the primary diagnosis of cerebral venous thrombosis. Treatment was successful after primary investigations and planed therapy for Cerebral Venous Thrombosis (CVT). Following the decision on terminating the pregnancy, five tablets of Sublingual misoprostol (200 mg) was used once evacuation of pregnancy remnants was done. About thirty minutes after the administration of misoprostol, onset of severe shivering and tachycardia (201/min) with high fever (about 41°C) and hypertension (182/123 mmHg) was observed. National Adverse Drug Reaction (ADR) form was completed. All of symptoms were alleviated 30 minutes after administration of Paracetamol 1gram (Intravenous infusion) followed by Metoprolol 50 mg (orally). According to the literature, we listed the various side effects of misoprostol. Even though the side effects of misoprostol are diverse and rare, the simultaneous occurrence of these side effects is not cited till date. These incidents are reported to the authorities as per ADR policy; nonetheless, no preventive measures are implemented. This necessitates medical educational policies to be taken into consideration to educate healthcare providers throughout their professional career as well as research.

Background & Aims:

Accidental hypothermia is a common complication in trauma patients. Hospitalization of these patients in the Operating Room (OR) can greatly affect the prevalence of inadvertent hypothermia. Due to the negative patient's outcomes, the aim of this study was to investigate its prevalence and related risk factors among trauma patients in the OR.

This prospective observational study was conducted on trauma patients who underwent surgery in the OR department of the Educational and Treatment Center of Mousavi in Zanjan. In this study, 59 eligible patients were selected using convenience sampling method in December 2017. Individual, clinical, environmental and care variables related to hypothermia were collected by a researcher and recorded in a researcher-made data sheet.

The majority of patients (66.1%) were men. The mean and standard deviation of their age was 46.8 (17.7) years. The most common mechanism of trauma was blunt trauma (66.1%) and the main cause of trauma was motor vehicle crash (45.8%). The prevalence of accidental hypothermia in the OR was 67.8%. Eighteen independent variables were entered into the logistic regression model as factors related to accidental hypothermia, and in the final step of the model, low systolic blood pressure (OR=1.141, P=0.022), low blood oxygen saturation (OR=2.229, P=0.009), and inadequate clothing and coverage of patients (OR=8.354, P=0.039) were identified as risk factors. High OR ambient temperature (OR=0.126, P=0.035) and short duration of surgery (OR=0.086, P=0.016) also acted as protective factors.

In the current study, a significant part of surgical patients was hypothermic during operation and factors such as surgery time, systolic blood pressure, blood oxygen saturation, ambient temperature of the OR, and the condition of the patients' clothing were found to be effective in its development. This study has aimed to emphasize the need for early identification of hypothermia and effective management of related factors in order to prevent unwanted consequences.

Anabolic-androgenic steroids (AAS) are one of the ingredients of herbal and dietary supplements that are popular among sports trainers. AAS abuse predisposes everyone to several complications. Reviews of the literature on AAS users have shown mainly skin, renal, and hepatic complications. In this case report, we presented a case with simultaneous complications, including diffuse alveolar hemorrhage (DAH), acute respiratory distress syndrome (ARDS), pericardial effusion, gastrointestinal bleeding (GIB), and acute kidney injury (AKI). Given the potential for lethal complications and the consequences of ethical, civil, and criminal law, it seems that specific policies will be considered for the use of bodybuilding drugs. It is also suggested that this approach be added as a new part of the medical curriculum. Also, ARDS and DAH are unreported side effects in other studies, which is suggested to be considered by specialists.

Hydatid cysts can be caused by Echinococcus species in various tissues. Skeletal cystic lesions are very rare and may be neglected. Here, we report a case of pathologic fracture following primary hydatid cystic lesions in the proximal and femoral shaft bone. A 62-year-old man suffered a sudden fracture followed by swelling of the thigh. Intramedullary femoral fixation was made and during the surgery, numerous cystic lesions of the hydatid cysts were observed. After  the surgery ultrasound and CT-Scans of the abdomen, lung, spine, and brain did not confirm any sign of mass or cyst elsewhere. The patient was followed up for one year. During this period, the union was not yet completely established and the patient was stillreceiving treatment. Orthopedic surgeons need to be aware of this parasitic complication in bones and joints and provide the best outcome for the patients with proper treatment. Surgery along with albendazole and/or mebendazole  therapy remains the treatment of choice. For this purpose, it is recommended that attention be paid to long-term follow-up in continuous professional development courses.

Ethics and law studies examine several issues in the field of medicine, one of which is the legal aspects related to patients living with mental disability. In a previous article, we introduced a 24-year-old female patient living with mental disability, diagnosed with large tumor growth in her right breast. Inadequate self-care as well as lack of breast self-examination were the causes of delayed referral and late diagnosis. The patient's family stated that no periodic breast examination was performed by the family or health centers. The patient's family did not have sufficient knowledge about caring for patients with mental disabilities. The question that will then arise under such circumstances is, will the legal system protect the incapacitated individuals if they or their family cannot provide for themselves? In this article, we discuss this issue and the existing legal vacuum.

Cerebral venous sinus thrombosis is a rare and infrequent condition in pregnant women. Hemorrhagic infarction can occur in early stages of cerebral venous thrombosis. This article reports a rare case of cerebral transverse sinus thrombosis presenting in pregnant women with unidentified secondary hypoparathyroidism, highlighting the difficulties in identifying this rare case from common diagnosis like preeclampsia. According to the differential diagnoses for this case, it can be a good exercise to strengthen clinical reasoning in students and medical teachers to improve the quality of clinical education.

Substance abuse has a reciprocal association with the individualschr('39') general health; and its incidence among medical students is highly variable over time.

The present study aimed to investigate the factors involved in the substance abuse and its association with medical studentschr('39') general health.

The present mixed-method study was conducted on the medical students of Azad University of Tabriz in 2018 with Stratified Random Sampling. Data were collected using the General Health Questionnaire-28 (GHQ-28) and a researcher-made substance abuse questionnaire and then was analyzed through tests, chi-square, ANOVA, post hoc Howell Games and Multivariate regression models were using the SPSS16.

150 medical students with a mean age of 26.98±3.46 are participating in the present study. 17.3% of students were substance abusers. The highest rate of abuse was related to Ritalin. The mean scores of the general health of addicted and non-addicted students were 42.65±11.95 and 23.62±16.83 respectively, and it was statistically significant (p= 0.012). Academic pressure was the main reason for Substance Abuse. Anxiety and insomnia were the most essential predictors decreasing general health among students with substance abuse.

The prevalence of substance abuse among medical students was unexpected. Medical students are at risk of addiction due to the inadequate distribution of academic pressure and other predisposing factors. The implementation of practical strategies in training environments, families, and society is very important to prevent and improve the current status.

Fazio-Londe disease is a genetic rare disorder manifesting by acute respiratory distress. This article is a case report of Fazio-Londe syndrome, its comparison with other case reports in the literature, and its patient-centered nursing care. 

In this study, we reported a case with Fazio-Londe syndrome with respiratory distress, bulbar palsy, muscle weakness, and other symptoms. 
Management and outcome: The patient was treated with oral riboflavin (100 mg/day), ribavirin (200 mg/day), and intramuscular Vit-B12 (1000 mg/day). She was managed using a patient-centered nursing care model. 

Health care providers should be aware of the new and constant symptoms of this rare disease. A patient-centered nursing care model is suggested to manage the disease.

Substance abuse as a major social and medical problem can be job-dependent.

Among various occupations, medical personnel have greater access to narcotic drugs, leading to mood, behavior, and occupational disorders and ultimately death due to lack of control.

The present study reported a death of medical personnel with migraines owing to colleagues' inattention to substance abuse.

The case was a 44-year-old man with 24 years of clinical experience, good social relationship, no symptoms of psychiatric disorder, an expert in the field of anesthesiology, and a popular manager among hospital colleagues. Diagnosed with migraine headaches one year ago, he worked for several treatment centers. According to some reports, he showed ataxia in some cases due to the exacerbated headache. Additionally, ataxia and drowsiness after a headache attack were not considered the cause of drug abuse so that they were always attributed to the disease. Eventually, in a shift, he had a respiratory failure and then died of the overdose or non-control of fentanyl abuse.

Medical personnel with migraine are at high risk of substance abuse in therapeutic settings. Therefore, it is suggested that periodic and intangible examinations be conducted for medical personnel, especially those with migraines in the field of substance abuse, and preventive counseling be provided.

Changes of body image following breast cancer is one of the factors affecting the quality of life of women with this disease.

Thus, the factors affecting the body image need to be identified to improve their quality of life. Therefore, this study aimed to investigate the factors affecting the body image in Iranian women diagnosed with breast cancer.

In this cross-sectional study, 200 breast cancer women were participated using convenience sampling method during April to January, 2018. The data were collected using a demographic questionnaire and body image questionnaires after breast cancer (BIBCQ). The data were analyzed using Univariate and Multivariate linear regression in SPSS25 at a significance level of 0.05.

The mean age of participants was 48.43 (SD=10.53). The results showed that the variables such as type of treatment (p=0.002), physical health (β=-0.49, p<0.001), economic status (β=-0.62, p<0.001), and quality of life (β=-0.41, p=0.003) had the predictability potential of the body image in those under mastectomy. Educational level (β= 0.22, p=0.02) and physical health (β=-0.25, p=0.01) factors could predict body image in people with no mastectomy.

The results of the study indicated that the improvement of the economic status has a positive effect on the body image of breast cancer. In addition, this factor can improve the quality of life in women who survive breast cancer.

Hypothermia is likely to cause enormous dangers for patients undergoing cesarean section.

This study aims to comparison between the effect of using two different temperatures of IV fluids (37.5°C versus 21-22°C) in body temperature drop and the post-operative pain.

This experimental study was double-blind clinical trial, conducted in 2017 (April, 2017 to January, 2018). The method of sampling was simple random sampling. The randomly selected mothers, undergoing cesarean section, were assigned into two groups of equal number (the hexagonal blocks of A and B) in this clinical trial. The experimental and control group participants received IV fluid at the operation room temperature (25°C) and the IV fluid of 37.5°C, respectively. The core intraoperative body temperature was measured by Microlife Infrared Tympanic-IR100 thermometer. Severity of the experimental and control group patients’ post-operative pain was also measured and compared for 24 hours (since when the patients were discharged from the recovery ward) by the VAS (0-10).

A total of 80 patients underwent this study. The demographic information of the two group members showed no difference of significance (p>0.05). The average intraoperative body temperature of the experimental group participants was higher in the level (p=0.001) of significance than that of the control group members. There was no difference of significance (p=0.41) between the mean severity of pain of both groups’ participants in the first 24 hours.

The intraoperative IV fluid warming seems not to have any tranquilizing effect in the post-surgery pain.

BackgroundPregnant women and newborns are at risk of vitamin D deficiency. This study aimed to determine the vitamin D status in pregnant women andtheir newborns in Karaj, Iran.
Materials and MethodsThis cross-sectional study was conducted from March 2014 to October 2015. A total of 151 pregnant women and 154 newborns (three twin cases) were included in the study. After obtaining 5 ml venous blood samples from mothers and 5 ml blood from the umbilical cord of newborns, 25-hydroxy vitamin D [25(OH)D] was measured by ELISA method. Serum level of 25(OH)D below 20 ng/ml was considered deficiency, 21-29 ng/ml was considered insufficient and 30-100 ng/ml was considered sufficient. Data were analyzed using SPSS software version 20.0.
ResultsThe prevalence of vitamin D deficiency and its insufficiency was 93.5% and 6.5% for pregnant women, 94.2% and 3.9% for newborns, respectively. The mean 25(OH)D concentration in pregnant women and newborns was estimated to be 10.649±5.967 ng/ml and 10.574±6.280 ng/ml, respectively. There was a significant correlation between the mean 25(OH)D concentration in mothers and their newborns (r=0.913 and pConclusionThe results of this study showed that overall prevalence of vitamin D deficiencies (levels