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1.  Epidemiologic analysis of central vein catheter infection in burn patients 
Iranian Journal of Microbiology  2017;9(5):271-276.
Background and Objectives:
Currently, there are no well-defined guidelines or criteria for catheter-site care in burn patients, and there is little information about the epidemiology of central vein catheter (CVC) infection in such patients. This study aimed at addressing the epidemiological aspect of CVC infection in a sample of Iranian burn patients admitted to the largest referral burn center in Iran, Motahari Burn Center.
Materials and Methods:
A total of 191 burn patients were eligible for the study. Catheter related blood stream infection (CRBSI) was diagnosed according to suspected line infection, sepsis or blood culture growing bacteria, which could not have been associated with another site.
Results:
Of the 191 patients in this study, 45 males (23.68%) and 19 females (10%) had positive blood culture, confirming CV line infection. Patients who were burned by gas, gasoline ignition or burning Kerosene had the highest incidence of CV line infection. In contrast, patients burned by alcohol, pitch or thinner had the lower rate of CV line infection. Incidence of CV line infection was higher in patients with delay in presentation to the burn center (55.2%) when compared to those who presented without delay (22.8%). Pseudomonas aeruginosa was the most frequent colonizer of the wound culture (52.4%), the dominant strain of the first catheter tip culture (35%) and the dominant strain of the same day blood samples (53.8%). The mortality rate in patients diagnosed with CRBI was 21.9%.
Conclusion:
One of the important factors related to CV line infection is delay inpresentation to the burn center. The rate of CV line infection was 20.64 in catheter days.
PMCID: PMC5748445
Central Vein Catheter; Infection; Burn wound
2.  Simple Arm Tourniquet as an Adjunct to Double-Cuff Tourniquet in Intravenous Regional Anesthesia 
Background:
Intravenous Regional Anesthesia (IVRA) is a well-known technique for producing analgesia during surgical procedures in the extremities. However, the rapid onset of pain following the deflation of a double-cuff tourniquet during IVRA is a serious disadvantage, leading patient suffering.
Objectives:
The aim of this study was to evaluate the clinical effectiveness of a pneumatic arm tourniquet applied 2 cm above the double-cuff tourniquet in controlling the pain that occurs after its deflation.
Patients and Methods:
Twenty patients undergoing outpatient hand surgery were operated on under IVRA, using 40 - 50 mL of a solution containing 3 mg/kg of lignocaine. A simple pneumatic tourniquet was applied proximal to the double-cuff tourniquet, 3 min before its deflation, while the procedure was being conducted. The severity of pain on the basis of the Numerical Rating Scale (NRS) was assessed throughout the operation, and continued until an hour after the double-cuff tourniquet was removed.
Results:
The mean operation time after the deflation of the double-cuff tourniquet was 20.12 ± 6.1 minutes. Moreover, the mean NRS for the post-deflation time was insignificant (NRS = 2), and only one patient during first 20 minutes received opioids.
Conclusions:
This study showed that a pneumatic arm tourniquet as an adjunct to IVRA provides acceptable analgesia following the deflation of the double- cuff tourniquet for relieving surgical pain.
doi:10.5812/aapm.29316
PMCID: PMC5013696  PMID: 27635387
Analgesia; Lignocaine; Intravenous Regional Anesthesia (IVRA); Double-cuff Tourniquet; Pneumatic Arm Tourniquet; Numerical Rating Scale (NRS)
3.  Temporary Trans-jejunal Hepatic Duct Stenting in Roux-en-y Hepaticojejunostomy for Reconstruction of Iatrogenic Bile Duct Injuries 
Trauma Monthly  2016;21(2):e21115.
Background
Bile Duct Injuries (BDI) during cholecystectomy are now being recognized as major health problems.
Objectives
Herein, we present our experience with handling major BDIs and report long-term outcome of hepaticojejunostomies followed by trans-jejunal hepatic duct stenting performed to reconstruct extra-hepatic biliary tracts.
Materials and Methods
In this case series, we prospectively collected data of 22 patients, who underwent first time biliary reconstruction through Roux-en-y hepaticojejunostomy followed by hepatic duct stenting using a trans-jejunal bifurcated 6F tube drain. The long-term outcome was assessed and defined as excellent (asymptomatic, normal liver enzymes and bilirubin levels), good (asymptomatic, mild abnormality in liver enzyme and bilirubin levels), poor (symptomatic, abnormal liver enzymes and bilirubin level) and failure (requiring reoperation).
Results
A total of 22 patients including four males (18.1%) and 18 females (81.8%) were evaluated. The mean age was 42.71 (range: 23 - 74) years. Twelve patients had undergone open cholecystectomy (54.5%) and the rest had a history of laparoscopic cholecystectomy. The mean interval between the primary operation and reconstruction was 92.71 days. The mean follow-up period after biliary reconstruction was 42.33 (range: 1 - 96) months. No instance of anastomotic leakage or stenosis, biliary sepsis, thromboembolic event, or respiratory infection was noted in the long-term follow-up. The outcome was excellent in all patients. No case with poor or failure of result was noticed.
Conclusions
Although a devastating complication iatrogenic major bile duct injuries can be corrected surgically with a high rate of success. Temporary trans-jejunal stenting of the hepatic ducts can help in maintaining the integrity of anastomosis without stenosis or biliary sepsis.
doi:10.5812/traumamon.21115
PMCID: PMC5003501  PMID: 27626003
Biliary Tract; Reconstruction; Treatment Outcome, Bile Duct; Iatrogenic
4.  Studying the Effectiveness of One Type of Iranian Traditional Massage on Lumbar Radiculopathy 
Background:
Low-back pain is one of the most common human morbidities worldwide, which is damaging individually, socially and economically. Recent studies have shown that its prevalence is rising. Most of the low-back pains are non-specific though specific ones need more complicated and more expensive treatments. Sciatica or lumbar radiculopathy is one of these specific low-back pains and is explained in Iranian traditional medicine textbooks in detail. Massage is one of the therapeutic modalities, advised for sciatica. Due to different aspects of sciatica in modern medicine, massage is not indicated as treatment, but it is advised in Iranian traditional medicine. In Iran, many patients resort to traditional massage for sciatica and are satisfied. Thus, the effectiveness of one type of Iranian traditional massage “Kermanshahi family” and conventional treatment were compared based on three outcomes of pain, disability, and quality of life score.
Methods:
A total of 50 patients were observed in two groups (25 per group) of case (massage) and control (classic treatment) in a non-randomized controlled clinical trial. Patients suffering from lumbar radicular pain for 8 weeks or longer, before referring to each center (neurosurgery or traditional massage clinic), were enrolled continuously. In the case group, patients underwent traditional massage sessions whereas in the control group they were prescribed as routine. Three outcomes were observed during three periods of before intervention, 1-month, and 3-month after intervention.
Results:
The mean difference of pain severity decrease in both groups was meaningful (P=0/007). The mean difference of disability decrease in both groups was meaningful (P=0/003). However, the mean difference of quality of life increase in both groups was not meaningful.
Conclusion:
Iranian traditional massage may be useful for the treatment of non-acute sciatica, but more studies are required to confirm and clarify the protocols.
PMCID: PMC4955298  PMID: 27516646
Medicine; Traditional; Musculoskeletal Manipulations; Massage
5.  Studying the Effectiveness of One Type of Iranian Traditional Massage on Lumbar Radiculopathy 
Iranian Journal of Medical Sciences  2016;41(3 Suppl):S11.
Background:
Low-back pain is one of the most common human morbidities worldwide, which is damaging individually, socially and economically. Recent studies have shown that its prevalence is rising. Most of the low-back pains are non-specific though specific ones need more complicated and more expensive treatments. Sciatica or lumbar radiculopathy is one of these specific low-back pains and is explained in Iranian traditional medicine textbooks in detail. Massage is one of the therapeutic modalities, advised for sciatica. Due to different aspects of sciatica in modern medicine, massage is not indicated as treatment, but it is advised in Iranian traditional medicine. In Iran, many patients resort to traditional massage for sciatica and are satisfied. Thus, the effectiveness of one type of Iranian traditional massage “Kermanshahi family” and conventional treatment were compared based on three outcomes of pain, disability, and quality of life score.
Methods:
A total of 50 patients were observed in two groups (25 per group) of case (massage) and control (classic treatment) in a non-randomized controlled clinical trial. Patients suffering from lumbar radicular pain for 8 weeks or longer, before referring to each center (neurosurgery or traditional massage clinic), were enrolled continuously. In the case group, patients underwent traditional massage sessions whereas in the control group they were prescribed as routine. Three outcomes were observed during three periods of before intervention, 1-month, and 3-month after intervention.
Results:
The mean difference of pain severity decrease in both groups was meaningful (P=0/007). The mean difference of disability decrease in both groups was meaningful (P=0/003). However, the mean difference of quality of life increase in both groups was not meaningful.
Conclusion:
Iranian traditional massage may be useful for the treatment of non-acute sciatica, but more studies are required to confirm and clarify the protocols.
PMCID: PMC5103516  PMID: 27840477
Medicine; Traditional; Musculoskeletal Manipulations; Massage
6.  Undergraduate medical education programme renewal: a longitudinal context, input, process and product evaluation study 
The purpose of this study was to utilize the Context, Input, Process and Product (CIPP) evaluation model as a comprehensive framework to guide initiating, planning, implementing and evaluating a revised undergraduate medical education programme. The eight-year longitudinal evaluation study consisted of four phases compatible with the four components of the CIPP model. In the first phase, we explored the strengths and weaknesses of the traditional programme as well as contextual needs, assets, and resources. For the second phase, we proposed a model for the programme considering contextual features. During the process phase, we provided formative information for revisions and adjustments. Finally, in the fourth phase, we evaluated the outcomes of the new undergraduate medical education programme in the basic sciences phase. Information was collected from different sources such as medical students, faculty members, administrators, and graduates, using various qualitative and quantitative methods including focus groups, questionnaires, and performance measures. The CIPP model has the potential to guide policy makers to systematically collect evaluation data and to manage stakeholders’ reactions at each stage of the reform in order to make informed decisions. However, the model may result in evaluation burden and fail to address some unplanned evaluation questions.
doi:10.1007/s40037-015-0243-3
PMCID: PMC4754210  PMID: 26820748
Undergraduate Medical Education programme; CIPP model; Curriculum reform
7.  Typical Absence Seizure Similarity to “Shokhous” in Iranian Traditional Medicine 
doi:10.5812/ircmj.21048
PMCID: PMC4752727  PMID: 26889388
Absence Seizure; Iranian Traditional Medicine; Shokhous
8.  Psychosocial Status of Liver Transplant Candidates in Iran and Its Correlation with Health-Related Quality of Life and Depression and Anxiety 
Journal of Transplantation  2015;2015:329615.
Objectives. The study was aimed at providing a psychosocial profile for Iranian liver transplant candidates referred to an established liver transplantation program. Material and Methods. Patients assessed for liver transplant candidacy in Imam Khomeini Hospital (Tehran, Iran) between March 2013 and September 2014 were included. The following battery of tests were administered: Psychosocial Assessment of Candidates for Transplant (PACT), the Short-Form health survey (SF-36), and Hospital Anxiety and Depression Scale (HADS). Results. Psychosocial assessment in 205 liver transplant candidates revealed significant impairments in several SF-36 domains; social functioning was the least and physical functioning was the most impaired domains. The prevalence of cases with probable anxiety and depressive disorders, according to HADS, was 13.8% and 5.6%, respectively. According to PACT, 24.3% of the assessed individuals were considered good or excellent candidates. In 11.2%, transplantation seemed poor candidate due to at least one major psychosocial or lifestyle risk factor. Poor candidate quality was associated with impaired health-related quality of life and higher scores on anxiety and depression scales (p < 0.05). Conclusions. Transplant programs could implement specific intervention programs based on normative databases to address the psychosocial issues in patients in order to improve patient care, quality of life, and transplant outcomes.
doi:10.1155/2015/329615
PMCID: PMC4662971  PMID: 26649189
9.  Surgical infrainguinal revascularization for peripheral arterial disease: factors affecting patency rate 
Background: Peripheral arterial disease is a source of morbidity and mortality. Surgical vascular reconstruction is a treatment option but probability of failure and complications are important concerns. In this study, we evaluated outcome of surgical infrainguinal reconstruction and factors affecting graft patency for a period of one year.
Methods: In this cohort study, 85 consecutive patients with chronic ischemia who underwent lower extremity surgical vascular reconstruction (including 52 femoropopliteal and 25 femorofemoral bypass) from March 2007 to Feb 2009 were recruited. Graft patency was evaluated before discharge from hospital and one year after the surgical operation using duplex ultrasonography. Association between possible risk factors and graft patency were evaluated.
Results: In general, 71% (37 patients) of femoropopliteal and 52% (13 patients) of femorofemoral reconstructions were patent during the follow up period. Diabetes mellitus, hypertension, smoking, opium use and ischemic heart disease were significantly associated with decreased rate of patency (p<0.05).
Conclusion: Assessing risk factors that predict perioperative mortality and graft patency is essential for selecting patients that would benefit from surgery. Omitting surgical reconstruction and endovascular intervention may be preferable especially when multiple risk factors are present or in the absence of critical limb ischemia.
PMCID: PMC4715410  PMID: 26793669
Outcome; Surgical reconstruction; Peripheral vascular disease; Infrainguinal bypass
10.  Inferior Epigastric Artery Pseudoaneurysm Following Paracentesis in a Liver Graft Recipient: A Case Report 
Iranian Journal of Radiology  2015;12(3):e15517.
Pseudoaneurysm happens when the artery wall is injured and the blood is contained by the surrounding tissues with eventual formation of a fibrous sac communicating with the artery. We report a case of a 39-year-old man with inferior epigastric artery (IEA) pseudoaneurysm after paracentesis. The pseudoaneurysm was diagnosed by Doppler ultrasound and treated by surgical intervention regarding the patient’s underlying comorbidity. IEA false aneurysm must be included in the differential diagnosis during investigation of the cause of any swelling after paracentesis. Cirrhotic patients may be more prone to this complication because of thin rectus muscle that could not confine the hematoma.
doi:10.5812/iranjradiol.15517v2
PMCID: PMC4632133  PMID: 26557270
Diagnosis; Epigastric Arteries; Paracentesis; Pseudoaneurysm; Cirrhosis
11.  Correlation of Histopathologic Findings of Non-Graft Threatening Preservation/Reperfusion Injury in Time-Zero Liver Needle Biopsies With Short-Term Post-transplantation Laboratory Alterations 
Hepatitis Monthly  2015;15(6):e30008.
Background:
Early post-transplantation alterations in liver tests are caused by a variety of etiologies including rejection, biliary or vascular complications, and preservation/reperfusion injury (PRI).
Objectives:
The aim of this study was to show the correlation between histopathologic changes of PRI and the alterations in liver tests in the early post-transplantation period.
Materials and Methods:
Between April 2013 and August 2014, histopathologic findings of protocol, time-zero, Tru-Cut, liver needle biopsies were evaluated in 94 cases of cadaveric liver transplantation. The histopathologic changes included ballooning degeneration, micro- and macro-vesicular steatosis, bilirubinostasis, apoptotic cells, bile plugs and neutrophilic infiltration. These histopathologic changes were compared with the early (15 days) post-transplantation liver laboratory findings.
Results:
Clinico-pathologic evaluation of all 94 cases was done by assessment of PRI findings in time-zero biopsies and possible causes of allograft injury were appraised. In 21 patients, a specific cause for allograft injury was found including rejection and/or surgical complications. In the remaining 73 cases, there was no specific cause for allograft injury and histopathologic findings of time-zero liver needle biopsies supported PRI. We classified liver laboratory tests alterations as: hepatocellular damage (elevation of transaminases and lactate dehydrogenase), cholestatic damage (elevation of alkaline phosphatase and total bilirubin) and mixed. Hepatocellular and cholestatic alterations in liver function tests were associated with the presence of marked apoptotic bodies and neutrophilic aggregates in time zero biopsies, respectively. On the other hand, macrovesicular steatosis was dominantly associated with mixed (hepatocellular and cholestatic) laboratory alterations of liver tests.
Conclusions:
Any discrepancy between histopathologic changes in time-zero biopsies and pattern of early liver laboratory alterations may be considered as a warning for causes other than PRI.
doi:10.5812/hepatmon.30008v2
PMCID: PMC4532786  PMID: 26288638
Ischemia Reperfusion Injury; Liver Function Tests; Pathology; Liver Transplantation
12.  The Effect of Intra-Articular Meperidine and Bupivacaine 0.5% on Postoperative Pain of Arthroscopic Knee Surgery; a Randomized Double Blind Clinical Trial 
Background:
Arthroscopic knee surgeries have a painful postoperative course, which often necessitates acute pain management. Among different analgesia techniques, Intra-articular injection is the technique of choice for many pain specialists, based on its confined effect to the surgical site (knee), lack of systemic effects and promotion of safe early ambulation.
Objectives:
The aim of this study was to compare analgesic effects of intra-articular meperidine, bupivacaine 0.5% or their combination after knee arthroscopic surgery.
Patients and Methods:
Sixty ASA class I-II patients’ candidates for arthroscopy knee surgery enrolled in a randomized double blind study to receive either 20 mL of bupivacaine 0.5%; 100 mg meperidine (diluted in normal saline) or bupivacaine 0.5% along with 100 mg meperidine. A written informed consent was obtained from all patients. Postoperative analgesia duration, VAS at 2, 6, 12 and 24 hours, the first analgesic request time, total fentanyl consumption in first 24 hours, patients’ satisfaction and adverse effects were recorded.
Results:
The bupivacaine-meperidine group had better duration of postoperative analgesia (P = 0.001), latter first analgesic request (P ≤ 0.001), lower total fentanyl consumption in first 24 hours after the operation (P = 0.001), less mean VAS at 2 hours (P = 0.001) and more patients’ overall satisfaction (P = 0.01) compared with each medication alone. VAS at 6, 12 and 24 postoperative hours were not different between the groups of study. No adverse effects were observed.
Conclusions:
Although postoperative intra-articular meperidine is a better alternative for bupivacaine, their combination could improve their analgesic effects compared with each other alone.
doi:10.5812/aapm.27470
PMCID: PMC4363738  PMID: 25830119
Intra-Articular Injection; Pain; Meperidine; Bupivacaine
13.  NAFLD Prevalence in a Young Cadaveric Organ Donor Population 
Hepatitis Monthly  2014;14(10):e21574.
Background:
Liver transplantation is a critical survival point for patients with end stage liver diseases. It can dramatically increase patients’ survival if the donor liver is intact. One aspect of liver health is absence of steatosis. Nonalcoholic Steato Hepatitis (NASH) and Nonalcoholic Fatty Liver Disease (NAFLD) are increasing among young adults and patients living with chronic liver diseases.
Objectives:
In this study, we determined the prevalence of NALFD in livers of brain-dead donors in Imam-Khomeini hospital Complex, Tehran, Iran. We assumed that the calculated prevalence would represent NAFLD prevalence in Iranian population in the age range of 20-60 years.
Materials and Methods:
All eligible brain dead liver transplant donors were enrolled in the survey from March 21, 2011 to March 21, 2013 in Imam-Khomeini hospital Complex. Eligible participants were donors aged 20 to 60 years without any obvious history of liver disease. Liver needle biopsy was performed at the end of the transplant operation; time zero biopsy. We calculated the prevalence of NAFLD among brain-dead donors. Moreover, the frequency of NASH was calculated based on the NAS (NAFLD Activity Score).
Results:
Among 116 cases, two were diagnosed as probable NASH. There was a significant association between NAFLD and male gender (P = 0.04). Moreover, we found a higher steatosis level in male gender. There was a significant association between NAFLD and BMI (P = 0.05). Those with BMI more than 27 had severe steatosis.
Conclusions:
Our comprehensive literature review showed that our study was the first investigation in Iran and the region, which determined the prevalence of NAFLD based on tissue diagnosis. We believe that the prevalence of NAFLD/NASH in our donors can represent the overall prevalence in this age group in Iran.
doi:10.5812/hepatmon.21574
PMCID: PMC4238153  PMID: 25419218
Steatosis; NASH; NAFLD; Prevalence; Cadaver
14.  Clinical Pharmacokinetics of Tacrolimus in Iranian Liver Transplant Recipients 
Tacrolimus, a cornerstone of immunosuppressive therapy in solid organ transplantation, has a narrow therapeutic range with considerable inter-individual and intra-individual pharmacokinetic variability. To date, there is no information on the pharmacokinetics of tacrolimus in Iranian liver transplant recipients. This study was designed to determine pharmacokinetic properties of orally administered tacrolimus in Iranian adult liver transplant recipients.
Tacrolimus doses and steady state whole blood trough concentrations as well as patient demographic and clinical data were obtained retrospectively using the 30 included patients’ medical records. Pharmacokinetic parameters were estimated by using a nonlinear mixed effect model program (Monolix version 3.1). Absorption rate constant was fixed at two hours-1. Drug apparent clearance (CL/F), apparent volume of distribution (Vd/F), and elimination half life (t½β) were calculated.
The administered dose of tacrolimus to the patients ranged from 0.02 to 0.14 mg/Kg/day. Tacrolimus blood trough concentrations varied widely within the range of 1.8 to 30 ng/mL. The mean values of CL/F, Vd/F, and t½β were found to be 9.3 ± 0.96 L/h, 101 ± 29 L, and 7.5 hours, respectively.
The pharmacokinetics of tacrolimus was highly variable among our patients. CL/F, Vd/F, and t½β of tacrolimus in this study were comparable to reported values from Italian heart transplant patients but somewhat different from reported ones from other solid organ transplant populations.
PMCID: PMC3985261  PMID: 24734081
Liver transplantation; Pharmacokinetics; Tacrolimus
15.  Imaging and Imaging-Guided Interventions in the Diagnosis and Management of Hepatocellular Carcinoma (HCC)-Review of Evidence 
Iranian Journal of Radiology  2012;9(4):167-177.
The imaging of hepatocellular carcinoma (HCC) is challenging and plays a crucial role in the diagnosis and staging of the disease. A variety of imaging modalities, such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine are currently used in evaluating patients with HCC. Although the best option for the treatment of these cases is hepatic resection or transplantation, only 20% of HCCs are surgically treatable. In those patients who are not eligible for surgical treatment, interventional therapies such as transcatheter arterial chemoembolization (TACE), percutaneous ethanol injection (PEI), radio-frequency ablation (RFA), percutaneous microwave coagulation therapy (PMC), laser ablation or cryoablation, and acetic acid injection are indicated. In this paper, we aimed to review the evidence regarding imaging modalities and therapeutic interventions of HCC.
doi:10.5812/iranjradiol.8242
PMCID: PMC3569547  PMID: 23407596
Carcinoma, Hepatocellular; Radiology, Interventional; Chemoembolization, Therapeutic; Iran; Risk Factors
16.  Organ Allocation for Liver Transplantation According to the Public Opinion 
Hepatitis Monthly  2012;12(8):e6183.
Background
Although liver transplantation is the last resort for treating end stage liver diseases, this medical procedure is not available for all needful patients because of inadequate organ supply. Therefore, guidelines have been developed by medical experts to regulate the process. Some professionals believe that medical criteria are inadequate for organ allocation in all situations and may not secure fairness of organ allocation.
Objectives
The current study has been designed to identify decision criteria about allocation of donated liver to potential recipients from public points of view.
Patients and Methods
This is a qualitative study that was conducted through individual interviews and Focus Group Discussions. Individual interviews were conducted among patients’ companions and nurses in one of the two liver transplant centers in Iran. Group discussions were conducted among groups of ordinary people who had not dealt previously with the subject. Data was analyzed by Thematic Analysis method.
Results
Most of the participants in this study believe that in equal medical conditions, some individual and societal criteria could be used to prioritize patients for receiving donated livers. The criteria include psychological acceptance, ability to pay post-operative care costs, being breadwinner of the family, family support, being socially valued, ability to be instructed, lack of mental disorders, young age of the recipient, being on waiting list for a long time, lack of patient’s role in causing the illness, first time transplant recipient, critical medical condition, high success rate of transplantation, lack of concurrent medical illnesses, not being an inmate at the time of receiving transplant, and bearing Iranian nationality.
Conclusions
Taking public opinion into consideration may smooth the process of organ allocation to needful patients with equal medical conditions. It seems that considering these viewpoints in drafting organ allocation guidelines may increase confidence of the society to the equity of organ allocation in the country. This strategy may also persuade people to donate organs particularly after death.
doi:10.5812/hepatmon.6183
PMCID: PMC3475021  PMID: 23087752
Liver Transplantation; Resource Allocation; Decision Making; Public Opinion
17.  Reform in medical ethics curriculum: a step by step approach based on available resources 
In this project, we aimed to revise the medical ethics curriculum at the School of Medicine, Tehran University of Medical Sciences, in order to promote the level of students’ ethical awareness and enable them to make ethical decisions.
Ideal and long term educational objectives were set to determine directions for future reforms and to provide a baseline for future evaluation of the project. However, based on limited available recourses, the first stage of the reform was planned and implemented with a 3 years scope. In revising the curriculum, which was done according to the Harden’s ten questions, we focused on moral attitude and ethical reasoning skill in addition to academic knowledge base by using methods such as case discussions, portfolio, and clinical ethics rounds. The revised curriculum was implemented during the first semester of the 2006–2007 academic year for the first time.
The student feedback indicated that the new curriculum was successful in increasing the students’ awareness of ethical issues and enabled them to understand and accept their professional obligations.
Revising the curriculum and its evaluation should be considered as an ongoing process. The present project was a successful experience that motivated faculty members to pursue the next steps of improving the curriculum on medical ethics and proved to be convincing for the authorities and policy makers to support it.
PMCID: PMC3713913  PMID: 23908750
Curriculum; Medical ethics; Undergraduate medical education
19.  A Survey of the Complaints Entering the Medical Council Organization of Tehran in Three Time Periods: The Years Ending on 20 March 1992, 20 March 1997 and 20 March 2002 
One of the most important occupational tensions a physician encounters in his/her practice is the complaints lodged against him/her by the patients. The purpose of this study is examining the complaints against physicians and dentists entering the Medical Council Organization of Tehran in the years ending on 20 March 1992, 20 March 1997 and 20 March 2002 from the viewpoint of number, dispersion and inducing factors.
The present study was performed as a descriptive and retrospective one with the aid of a questionnaire containing concerned data. Filling in the questionnaire or studying the file was accomplished by a trustee expert of the Medical Council Organization and the data obtained were analyzed after classification.
During a 3-year period, 832 complaints were lodged against physicians and dentists. The complaints against physicians in the years ending on 20 March 1997 and 20 March 2002 were 70% more than that in the year ending on 20 March 1992. 83.1% of the physicians and dentists of Tehran that were sued had not been convicted until the date of the performance of the study, on the basis of the contents of the files, and had no malpractice from the vantage point of the Medical Council Organization. The most common causes of complaints from the viewpoint of complainers were therapeutic errors (38%), neglect (30.2%), financial affairs (25.4%) and the physicians’ lack of skill (17.7%). On the basis of this study, with the increase of the doctor’s practice track record and experience more than 15–20 years, the number of the complaints decreases and most of the complaints are against the middle-aged doctors/dentists with 10–20 years of experience.
Most physicians and dentists of Tehran having been sued have not committed any wrong from the vantage point of the Medical Council Organization experts and a large part of the complaints are a consequence of doctor-patient inconvenient interactions. A behavior based on professional commitment of the physician/dentist vis-à-vis the patient can hinder a major part of complaints.
PMCID: PMC3713705  PMID: 23908723
Medical error; Patients’ rights; Malpractice
20.  Retroperitoneal cystic lymphangioma 
The Indian Journal of Surgery  2008;70(3):150-151.
doi:10.1007/s12262-008-0043-7
PMCID: PMC3452452  PMID: 23133047
21.  Abdominal surgical site infections: incidence and risk factors at an Iranian teaching hospital 
BMC Surgery  2005;5:2.
Background
Abdominal surgical site infections are among the most common complications of inpatient admissions and have serious consequences for outcomes and costs. Different risk factors may be involved, including age, sex, nutrition and immunity, prophylactic antibiotics, operation type and duration, type of shaving, and secondary infections. This study aimed to determine the risk factors affecting abdominal surgical site infections and their incidence at Imam Khomeini, a major referral teaching hospital in Iran.
Methods
Patients (n = 802) who had undergone abdominal surgery were studied and the relationships among variables were analyzed by Student's t and Chi-square tests. The subjects were followed for 30 days and by a 20-item questionnaire. Data were collected through pre- and post-operative examinations and telephone follow-ups.
Results
Of the 802 patients, 139 suffered from SSI (17.4%). In 40.8% of the cases, the wound was dirty infected. The average age for the patients was 46.7 years. The operations were elective in 75.7% of the cases and 24.7% were urgent. The average duration of the operation was 2.24 hours, the average duration of pre-operative hospital stay 4.31 days and the average length of (pre- and post-operation) hospital stay 11.2 days. Three quarters of the cases were shaved 12 hours before the operation. The increased operation time, increased bed stay, electivity of the operation, septicity of the wound, type of incision, the administration of prophylactic antibiotic, type of operation, background disease, and the increased time lapse between shaving and operation all significantly associated with SSI with a p-value less than 0.001.
Conclusion
In view of the high rate of SSI reported here (17.4% compared with the 14% quoted in literature), this study suggests that by reducing the average operation time to less than 2 hours, the average preoperative stay to 4 days and the overall stay to less than 11 days, and approximating the timing of shaving to the operation and substituting cefazolin for cefaluthin when prophylactic antibiotic is to be administered, the SSI may be reduced to a more acceptable level.
doi:10.1186/1471-2482-5-2
PMCID: PMC555554  PMID: 15733323

Results 1-21 (21)