Medical Journal of The Islamic Republic of Iran (MJIRI)

---

Metabolic acidosis and severe hypotension are the main causes of irreversibility during hemorrhagic shock. The influence of these two factors on durations of shock period and survival time were studied in four groups of anesthetized cats. In group I the animals were made hypotensive by reducing mean arterial blood pressure (Pa) to 45 mmHg with concurrent metabolic acidosis. [n group II the same level of hypotension was produced, along with an intravenous infusion of 12% sodium bicarbonate solution (0.25 ml/kg/min.) thus metabolic acidosis was prevented and arterial blood pH (pHa) was kept within its normal range. In group III the Pa was kept at 50 mmHg in the presence of metabolic acidosis, and in group IV, the Pa was kept at 50 mmHg (the same as group Ill) but acidosis was prevented. Durations of shock period and survival times of all groups were compared. The results of this study show that I) preventing metabolic acidosis increased survival time by 400%, 2) keeping the Pa at 50 mmHg increased survival time by 800 percent, and 3) prevention of metabolic acidosis at a Pa of 50 mmHg still augmented survival time by more than 250 percent. We therefore conclude that control of pHa and prevention of severe hypotension may increase survival rates in patients suffering from hemorrhage.

---

Experiments were carried out on anesthetized adult New Zealand rabbits. Acute joint inflammation was achieved by intra-articular injection of 2% carrageenan. Radiolabelled microspheres were used to measure the effect of acute inflammation on blood flow in the knee joint and establish whether neural influences on blood vessel caliber were affected. Surgical exposure of the posterior joint "capsule" increased blood flow in the control knee, but subsequent section of the posterior articular nerve (PAN) supplying the knee produced no further increase. In the inflamed knee, blood flow declined progressively with ea<.:h procedure. Electrical stimulation of PAN reduced blood flow in the posterior region of both knees, with somewhat less effects in the inflamed knee.

---

  Background: Intra-operative radiation therapy (IORT) is the transfer of a single large radiation dose to the tumor bed during surgery with the final goal of improving regional tumor control. This study aimed to investigate the safety, effectiveness and economic evaluation of intra-operative radiation therapy.

  Methods : The scientific literature was searched in the main biomedical databases (Centre for Reviews and Dissemination, Cochrane Library and PubMed) up to March 2014. Two independent reviewers selected the papers based on pre-established inclusion criteria, with any disagreements being resolved by consensus. Data were then extracted and summarized in a structured form. Results from studies were analyzed and discussed within a descriptive synthesis.

  Results : Sixteen studies met the inclusion criteria. It seems that outcomes from using intra-operative radiation therapy can be considered in various kinds of cancers like breast, pancreatic and colorectal cancers. The application of this method may provide significant survival increase only for colorectal cancer, but this increase was not significant for other types of cancer. This technology had low complications and it is relatively safe. Using intra-operative radiation therapy could potentially be accounted as a cost-effective strategy for controlling and managing breast cancer.

  Conclusion : According to the existing evidences, that are the highest medical evidences for using intra-operative radiation therapy, one can generally conclude that intra-operative radiation therapy is considered as a relatively safe and cost-effective method for managing early-stage breast cancer and it can significantly increase the survival of patients with colorectal cancer. Also, the results of this study have policy implications with respect to the reimbursement of this technology.

  

---

Background: Respecting patients’ privacy is an essential professional responsibility for physicians and other health team members. In this regard, this study investigates medical students’ knowledge and attitude about confidentiality and disclosure of patients’ information.
   Methods: In this cross-sectional study, 160 medical students of Iran University of Medical Sciences participated who were selected using stratified random sampling. Data were gathered using a valid and reliable self-report questionnaire. Student's knowledge and attitude toward medical confidentiality were assessed using self-administered and researcher-made questionnaires. Cronbach's alpha coefficients for knowledge and attitude levels were 79.7 and 82.2, respectively.
   Results: The average of medical students' responses to knowledge and attitude questions were 56.6% (9.6/ 17) and 55.3% (9.4 out of 17), respectively. On average, females had an acceptable attitude about 57.5% of the questions, whereas this was 50.9% for males. On average, females had an acceptable knowledge about 59.5% of the questions, whereas this was 50.6% for males. Therefore, female’s attitudes and knowledge were more correct than their male counterparts (p<0.001).
   Conclusion: The low level of knowledge and attitude of medical students towards medical confidentiality indicates that revision of Iranian medical education curriculum to reinforce attention and knowledge of medical students on this issue to render appropriate care to patients is a necessity. Medical students’ knowledge and attitude towards patient’s confidentiality rights is not fulfilling.
 
 

---

Background: A few studies have been done regarding the validity and reliability of the Mini-Peer Assessment Tool across various specialties. This study was conducted to determine the reliability, content and construct validity of Mini-Peer Assessment Tool to assess the competency of emergency medicine residents.
   Methods: This study was carried out to investigate the psychometric properties of the mini-PAT tool to evaluate the professional competencies of emergency medicine residents in educational hospitals affiliated to Tehran University of Medical Sciences. The initial Mini-Peer Assessment Tool was translated into Persian. After that, the content validity index and content validity ratio determined by consulting 12 professors of emergency medicine. The construct validity was determined with exploratory factor analysis and investigation of the correlation coefficient on 31 self and 248 peer assessment cases.
The reliability of the mini peer assessment tool was determined by internal consistency and item deletion by using Cronbach’s alpha coefficient. Reliability was also assessed by determining the agreement between the two tools of self-assessment and peer assessment by using the diagram Bland and Altman.
   Results: The results showed content validity ratio (CVR) of the items ranged from 0.56 to 0.83, and the content validity index (CVI) of the items ranged from 0.72 to 0.90. The reliability of the self-assessment and peer-assessment tools were 0.83 and 0.95 respectively and there was a relative agreement between the self-assessment method and the peer assessment method. Finally, the tool underwent exploratory factor analysis resulting extraction into two factors namely ‘clinical competencies’ and ‘human interactions’ in the peer assessment tool. In the self-assessment tool, the factors of ‘good practice’ and ‘technical competence’ were extracted.
  Conclusion: The results of the present study provided evidence of the adequacy of content validity, reliability of the contextually customized mini-peer assessment tool in assessing the competencies of emergency medicine residents.
 

---

Background: Depression is a prevalent illness in the world. Given the importance of mental disorders, many researchers have investigated the effects of different variables on average depression scores. In this study, we decided to investigate the effect of some explanatory variables on the average depression score.
Methods: The data were obtained from the second phase of the cohort of the Kerman Coronary Artery Diseases Risk Factors study (KERCADRS), which was performed in 2014-2018. We used the cluster-wise linear regression model to find more accurate relationships between depression scores and predictor variables. 
Results: The total number of the subjects in this study was 9811, out of whom 2144 were allocated to cluster 1, 4540 to cluster 2, and 3127 to cluster 3. The average depression score was 13.76 7.6 in cluster 1, 4.39  4.7 in cluster 2, and 10.83  6.7 in cluster 3. However, the average depression score for all the data was 8.5  7.2. In all the clusters, the average depression score of females was significantly greater than that of men (p-value<0.0001). In cluster 1, the age category of 35-54, in cluster 2, the age category of 55-80, and in cluster 3, the age category of 15-34 had a maximum average depression score.
Discussion:  we can name the three clusters to low ( cluster 2), medium ( cluster 3 ), and high (cluster 1) depression score with respect to age group with the maximum ADS in each cluster. that they are 55-80 years old, 15-34 years old and 35-54 years old in cluster 2 ( low), cluster 3 ( medium) and cluster 1( high) respectively.