مجله سازمان نظام پزشکی جمهوری اسلامی ایران
سال سی و هشتم شماره 3 (پیاپی 151، پاییز 1399)

In reviewing the laboratory studies on humans and animals, we observe that use of certain drugs with specified applications inhibit the immune reactions in the body. Selective Serotonin Reuptake Inhibitors (SSRIs) are among these drugs. The goal of the current research is evaluating the effectiveness of one kind of SSRIs namely fluvoxamine on the cytokine level of COVID-19 patients.

The current study was approved in the ethical committee. The sample of current research included 80 patients with COVID-19, hospitalized in ICU of Massih Daneshvari Hospital. They entered the research by accessible method of sampling and were divided in to two groups randomly. The experimental group underwent the treatment with fluvoxamine, while the control group did not receive fluvoxamine. The IL-6 and CRP levels were measured both before the onset of fluvoxamine treatment and when discharged from the hospital in all members of the sample group.

The IL-6 was increased and CRP level was decreased significantly in experimental group (P= 0.01). Meanwhile in women receiving fluvoxamine, the IL-6 and CRP levels were increased and decreased, respectively as compared to men.

Considering the effectiveness of fluvoxamine on two important cytokines in COVID-19 patients it can be concluded that it is possible to use this drug to help treat COVID-19 patients, ultimately improving both mental and physical status of the patients and leaving the COVID-19 pandemic behind with less pathology.

Social Security Organization with more than 40 million insured people, supplies therapeutic services to nearly fifty percent of the country’s population. This volume of service needs a good update and on line planning, organizing, coordination, staffing, and budgeting. Electronic health is improving day to day and is a good tool in helping the Social Security Organization in conducting its managerial tasks quickly, accurately and appropriately. This study aimed to design a model for electronic health management in Social Security Organization.

This study was conducted in terms of applied and descriptive – analytical method. Based on literature review and searching scientific articles published in the field of electronic health and conducting a comparative study between selected countries including Turkey, India, Sweden, England, Estonia and Pakistan, a conceptual model for electronic health management was designed for Islamic Republic of Iran Social Security Organization. Then, a questionnaire was developed based on these studies. Validity and reliability of the questionnaire were calculated and was completed by 557 experts in Social Security Organization in the health section. For confirmation and fitting of the factors, exploratory and confirmatory factor analysis were done.  

Model fit indices such as Kaiser-Meyer-Olkin evaluation and Bartlett test indicate the appropriateness and sufficient number of samples and the existence of correlations between items in the questionnaire (22 items). Based on the result, after performing the Varimax rotation, 5 factors with special values ​​greater than one were selected, which indicates that the items of this tool were loaded on these 5 factors in the analysis. The first factor alone explains about 23%, the second factor 15%, the third factor 14%, the fourth factor about 11% and the third factor about 9% of the total variance. And in total 5 identified factors explain 72.57% of the total variance of the sample. Indicators, comparative comparators and Tucker-Lewis index are acceptable in the range greater than 0.9. The average square root of the approximation error and the remainder of the standard square root must be less than 0.80. This is the case in Model 5. Of course, the SRMR value is 9,000ths of a percent higher. Also, a model with a smaller value is more appropriate than a model with a lower five-factor index. In general, according to the results, the model with 5 factors is the most suitable model. This model contains 20 items out of 22 items.

Based on the results and the study of factors and its relationship with items, 20 items had significant relationship with the related factors. As a result, the obtained model will be able to be implemented in the Social Security Organization. If this model is implemented, future studies for evaluation and monitoring will be necessary to improve the model.

The special role of health service providers in coping with the crisis is undeniable. However, there is lack of a research studying the crisis management of the operating rooms. The aim of this study was to evaluate the situation of crisis management in operating rooms of hospitals affiliated to Tehran University of Medical Sciences.

In this descriptive cross-sectional study, thirty –seven of operating rooms, affiliated to Tehran, Iran and Shahid Beheshti University of Medical Sciences were evaluated through observation and ask question based on WHO‏/PAHO standard checklist. All data were analyzed by SPSS software using descriptive and analytical statistical tests (Chi-square, Shapiro Wilk, and ANOVA).

According to the results of this study, the average score of structural status, non-structural factors and functional and managerial ability were 16.19± 3.49, 66.32± 15.98, 41.12 ±19.04, respectively, which reflect the medium level of preparedness for disaster management in the operating rooms of hospitals studied. The results of comparison between all three dimensions of crisis management showed that the highest average score of managerial safety and performance was related to operating room of hospitals affiliated to Shahid Beheshti University of Medical Sciences (P <0.05). There was not a significant difference in structural and non-structural dimensions among hospitals that were studied (P >0.05).

Based on the results of this study the disaster preparedness of operating rooms are moderate (medium) in structural, non-structural, and managerial-functional domains; thus necessary appropriate measures should be taken to enhance the preparedness of hospital operating rooms in these aspects of crisis management.

Carpal tunnel syndrome (CTS) is the most common type of mononeuropathy. Although CTS patients usually have sensory and motor latency in the EMG-NCV or EDX, a significant percentage (10-25%) of patients have a normal routine study. And if more complete diagnostic tests are not performed, it will not be diagnosed. We decided to identify this group of patients by calculating other methods.

We evaluated 131 patients with CTS and 34 persons from the asymptomatic group as controls (297 hands in total). Individuals were then divided into 4 groups: asymptomatic, mild, moderate, and severe based on the severity of the disease. Calculated electrophysiological parameters were measured using nerve conduction studies. For each group, we calculated the sensitivity and specificity of 4 indicators separately including terminal latency index (TLI), residual latency (RL), modified F-wave latency ratio (MFR), difference of the minimal F-wave latencies between the median and ulnar nerves (F-diff M-U), and finally obtained the best parameter according to the total sensitivity and specificity. We also determined the cutting point for each parameter.

RL index (90.7%) has the highest sensitivity for diagnosing mild cases and F-diff M-U index (50%) has the highest specificity. TLI and MFR indices have the highest sensitivity for diagnosing moderate cases and RL index (84.6%) has the highest specificity. RL index (94.6%) has the highest sensitivity for diagnosing severe cases and MFR index (86.5%) has the highest specificity.

The best indicator for distinguishing CTS from normal cases, as well as determining its severity, is RI.

The Structure of Health System affects quality of care in family physician program. This study aimed to explore the required structures of Family Physician Program for achieving service quality dimensions in Primary Health care through analyzing country experiences. These structures will be useful in achievement of quality health care in family physician system.

In this systematic review, 15 electronic databases and search engines were searched by appropriate keywords in the time span of 2000-19. English or Persian articles on the health issue were discussed, and their quality was evaluated using the CASP checklist.

Out of 3067 identified articles, 67 articles with title, abstract, and text were included in the study. Based on the findings of this study the main structure and executive components in Multi-Country Study for family physician program were Insurance, Monitoring and Control,  Payment,  Provider, Quality, Financial support and  Cultural structures.

Quality improvement in primary health care requires attention to executive structures. Use of executive experiences of other countries will be useful in achievement of quality health care in family physician system.

In order to assess the symptoms of bipolar disorder and to construct an inventory, this study was performed on 108 people from two sample groups (53 non-clinical participants) (55 participants with bipolar disorder) who were selected by a purposive sampling method.

In order to evaluate the reliability of this 74-item of the inventory, the method of internal consistency and temporal stability was used. Factor analysis and content, structure and convergent validity of the bipolar disorder symptom inventory were also examined.

Cronbach’s alpha coefficient was 0.91 (N = 55, in the bipolar sample) and 0.83 (N = 53, in the non-clinical sample), respectively, and P<0.05, which indicated the appropriate internal consistency of this instrument. Also, to evaluate the temporal stability of the inventory, 35 participants (a combination of both non-clinical groups and participants with bipolar disorder) were randomly selected from 108 participants and the inventory for the second time and seven weeks after the first time was filled. The correlation coefficient of the total scores of the inventory between the first and second time was r = 0.91, P <0.01, which indicates a very good stability of this inventory. The convergent validity of this inventory was assessed with the Career Problems Inventory–Bipolar Disorder form (CPI-BD) and the correlation of the total score of the career problems inventory–bipolar disorder form with the total score of the Bipolar Disorder Symptoms Inventory (BDSI) in non-clinical sample and bipolar sample, respectively was (r = 66), P <0.0001, N = 53 and (r = 66, P <0.0001, N = 53). In factor analysis of the inventory using varimex rotation, eight subscales were extracted, which include: communication problems, neuroticism, change seeking, instability, restlessness, euphoria, dysfunctional problem perception and depressive thoughts.

The bipolar disorder symptom inventory is a valid and reliable tool to assess and diagnose bipolar disorder symptoms.

Coronary artery disease is one of the most common causes of death in the world. With the increase in the incidence of these diseases, surgical and non-surgical interventions followed by cardiovascular rehabilitation programs have become more important. The process of angiogenesis and improvement of blood flow is considered as one of the therapeutic goals in these patients, and vascular endothelial growth factor (VEGF) is known as the most important stimulus and endostatin is known as its most important inhibitory agent. The aim of this study was to investigate the effect of eight-week Cardiac Rehabilitation Program based on combined training on VEGF/Endostatin gene expression ratio in acute coronary syndrome (ACS) patients with Coronary Artery Bypass Graft (CABG).

30 middle-aged CABG men were selected using purposive sampling based on inclusion criteria. Participants were randomly divided into two groups of control and training. Quantitative Real-time PCR was used to measure VEGF and endostatin gene expression levels. The eight-week combined exercise training was conducted in three sessions in a week, with the supervision of cardiac rehabilitation physician. Dependent t-test and independent t-test were used to data analysis.

Significant increase was observed after eight weeks of combined training on VEGF gene expression in CABG patients (P=0.001), but it was not significant on Endostatin gene expression (p=0.38) and VEGF/Endostatin ratio (P=0.62).

Eight-week combined cardiac rehabilitation training- as the protocol used in this research- increased the expression of VEGF gene in CABG patients, but there were not any significant changes in Endostatin gene expression and VEGF/Endostatin ratio by this method.Therefore, it can be stated that increase in VEGF gene is one of the results of adaptation to combined exercise activity used in this study, and it seems that physical activity is an important and effective factor in the process of angiogenesis and can play an important role in prevention cardiovascular diseases.