Showing 17 results for ZM
E Razmpa ,
Volume 52, Issue 1 (30 1994)
Abstract
H Borgheie , E Razmpa , F Tabloei ,
Volume 56, Issue 5 (6 1998)
Abstract
57 cases of jaw's SCC who were hospitalized in Imam Khomeini HSP, Amir-Alam HSP & Cancer Institute between the years of 1373 to 1376, were studied. 23 cases of them were female and the rest of them (34 cases) were male. The range of age of patients was between 25 to 85 years. 21 cases (36.8%) have maxillary involvement and 37 cases (64.9%) have mandibular involvement and there was one case (1.7%) of synchronous involvement of both sites. Patients were categorized according to their individual characteristics (sex, age, occupation, birth & living place), etiologic factors (smoking & familial susceptibility), complaints, sites of involvement in each jaw, histopathological characteristics of tumor (stage, grade, lymphatic involvement), rate of bone and soft tissue involvement, type of treatment, and recurrences of previous lesions. According to the results, and apart from late consultation of majority of patients with their physicians, invasive behaviours of tumoral lesions were less than expected rate. And despite of using radical and invasive treatments, considerable percent of patients were facing recurrence of their previous lesions. Besides, patterns of distribution of birth and living places of patients may probably show the role of geographical and environmental factors in making patients susceptible to certain diseases.
E Razmpa ,
Volume 57, Issue 1 (7 1999)
Abstract
The subglot stenosis can be congenital or acquired. The prevalence of this disorder is low but due to seriousness of the disease and lake of an effective treatment it is considered as major issue in otolaryngology. The most important cause of this disorder is trauma due to prolonged intubation of larynx. The aim of this study was to describe the etiologic, clinical manifestation and the therapeutic procedures in patients with subglot stenosis who referred to Imam Khomeini and Amir Alam Hospital during years 1371 through 1376. Sixty-two patients, 44 (71%) men and 18 (29%) women were investigated. The youngest patient was 1.5 years and the oldest was 76 years. The most frequent symptoms were striodor and shorthness of breath. The main etiologic factor was prolonged intubation in younger patients and neoplastic disorder in patients over 40 years. In 62% of subject intubation lasted more than 7 days and the resting less than 7 days. The most frequent endoscopic finding was granulated tissues. Ninety-one percent of subjects had trachestomy. In terms of treatment 44% had been given antibiotics. We conclude that care must be given to these patients to change the graft more frequently and to have antibiotic as a treatment regimen after trachestomy to reduce infection
E Razmpa , M Mohagheghy , P Mansoory ,
Volume 57, Issue 3 (8 1999)
Abstract
Approximately 15% of sogt-tissue sarcomas occur in head neck area and sarcma should be considered in the differential diagnosis of any tumor mass in this anatomic region, especially in younger patient. This was a retrospective study that reviewed all head and neck sarcoma cases registered at Imam Khomeini Hospital and Cancer Institute during the period 1987-1996. Using medical records, relevant informations including demographic, medical and risk factors were collected. Analysis of data on 40 eligible cases revealed, age range of 31-40, yearsmale sex and residence in cities as risk factors. Osteosarcoma was the most frequent pathology and painless mass was the most frequent sign in all histologic subtypes. In 80% of cases the tumors were primary and in 42.5% the disease recurred after treatment.
Zman T, Jalali Ma,
Volume 58, Issue 2 (7 2000)
Abstract
Metabolic alkalosis is characterized by high HCO3- as it is seen in chronic respiratory acidosis, but PH differentiates the two disorders. There is no characteristic symptom or sign. Orthostatic hypotension may be encountered. Weakness and hyporeflexia occur if serum K+ is markerdly low. Tetany and neuromuscular irritability occur rarely. We report the results of retrospective data analysis of metabolic alkalosis in 15463 patients hospitalized Pediatric Medical Center in Tehran during years 1995-1997. We found 50 cases of metabolic alkalosis (rate of 0.32 percent. 64 precent male and 36 percent female). Most of them had growth failure (40% were bellow 3 percentile of height by age, 44% bellow 5 percentile of weight by height). More than 60 percent had hypokalemia, hypocloremia and hyponatremia. The most common cause of Metabolic alkalosis was cystic fibrosis and pyloric stenosis. Fifty percent of cystic fibrosis patients and Bartter cases had metabolic alkalosis. Metabolic alkalosis should be considered in every pediatric patient presented with projectile vomitting.
Razmpa E, Sadeghi Hasanabadi. M, Asefi N, Arabi M,
Volume 65, Issue 2 (8 2008)
Abstract
Background: Thyroid cancer is a rare disease which includes less than 1%
percent of all human cancers. The aim of this study is to evaluate the
demographic characteristics and risk factors among patients with thyroid
malignancy at the Cancer institute and Imam Khomeini hospital in Tehran
Iran.
Methods: This is a retrospective descriptive study of the charts of 320
patients admitted with the diagnosis of thyroid malignancy based on
pathologic reports in the above- mentioned hospitals from 1992 to 2002.
Results: From the 320 patients diagnosed with thyroid malignancy 68.1%
were papillary cancer, 10.9% were follicular cancer, 10.6% were anaplastic
cancer, 9.06% were medullary cancer and 1.2% were lymphoma.
The average of the patients was 50.2 years, ranging from 12 to 98 years
60.6% were female and 39.4 %were male 22.8% of the patients had
histories of thyroid nodule and 5% had received radiation therapy.
From the anatomic point of view 57.5% of the cancers were in the right lobe
of thyroid, 38.1% were in left lobe and 4.4% in the isthmus. None of the
patients had positive family history of thyroid malignancy.
Conclusion:
Thyroid malignancy is more prevalent in the fifth decade of life and more
common among females. Therefore, among patients in this group, alarming
symptoms, such as anterior neck mass, thyroid nodule and voice change,
should be evaluated more seriously.
Razmpa E, Azimi C, Soltan Sanjarei M, Nazari H, Ghasempoure A, Yousefi M,
Volume 66, Issue 7 (6 2008)
Abstract
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Background: A high percentage of the patients at ENT or plastic
surgery clinics have ENT abnormalities, either congenital or those developing
later in life. Some are life threatening, while others cause disability and
esthetic problems, with profound consequences for the affected child and the
family. In addition, ENT abnormalities usually place stress on interpersonal
relationships, causing social isolation, unhappiness and depression. The
majority of these abnormalities is genetic and follows autosomal recessive pattern
of inheritance. Geneticists believe that there is a higher frequency of autosomal
recessive disorders among the offspring of consanguineous parents. The aim of
this study was to find the frequency of ENT abnormalities among children born of consanguineous parents.
Methods: We studied 3503 files (pedigrees) of patients referred for genetic
counseling at the Department of Genetics at Imam
Khomeini Hospital,
Tehran, Iran, from 1999 to 2000. We studied these
cases according to degree of parental consanguinity, patterns of inheritance
and gender using SPSS v.15.
Results: Of all 3503 files, 206 had ENT abnormalities, of which 157 had consangui-neous
marriages. Among these 157 pedigrees, 496 cases had consanguineous parents. Out of the 496 cases, the
four most frequent ENT abnormalities were: 115 cases (23.2%) of deafness,
53
cases (10.7%) of hearing loss, 12 cases (2.4%) of cleft lip and palate, and 5 cases (1%) of cleft
palate.
Conclusion: This high frequency of ENT abnormalities
indicates that consanguineous marriage should be discouraged by Iranian policy
makers in order to reduce the burden of these disorders on society. Further
research into the cultural problems that encourage consanguineous marriage and
ways of resolving these problems is recommended.
Azmoudeh Ardalan F, Saleki S, Eftekhari Hr,
Volume 66, Issue 12 (5 2009)
Abstract
Background: The postmortem diagnosis of early myocardial infarction is a perplexing affair in forensic pathology. The routine evaluations of autopsied hearts including macroscopic examination and study of H&E stained sections are often not contributory. Some other methods like electron microscopy need sophisticated equipments which are not available in all pathology laboratories.
Methods: In an attempt to find a more reliable and less labor- intensive method, we have studied the diagnostic value of cardiac troponin- T by an optimized immunohistochemical method on 67 autopsied hearts in Legal Medicine Organization of Iran. The cases were divided into three groups: the positive group composed of cases with the definite diagnosis of myocardial infarction (MI) as the cause of death the non-cardiac death group and finally the suspicious group which consisted of cases with high probability of early myocardial infarction, however without definite evidence of MI on the routine histopathologic studies. In stained sections, the degree of troponin T depletion was scored.
Results: With our proposed cut off, this test showed positive results in 19 out of 22 cases in MI group (86.4%), none of the 17 cases of non-cardiac death (100% specificity), and 15 out of 28 cases of suspicious group (53.6%).
Conclusions: This relatively easy method may increase the sensitivity of routine histopathologic methods in postmortem detection of early myocardial infarction. Additionally, this method does not require a particular preparation and can be done very easily on the archival paraffin blocks available in pathology departments whenever further evaluation is deemed necessary by the pathologist.
Soltan Dallal Mm, Yazdi Mh, Hassan Zm, Holakuyee M, Abedi Mohtasab Tp, Aminharaty F, Agha Amiri S, Mahdavi M,
Volume 67, Issue 11 (4 2010)
Abstract
Background: In according to immunomodulatory effect of probiotics and effect of these bacteria on the effectiveness of immune responses, at the present work we proposed the evaluation of oral administration of L.acidophilus on the immune statues in BALB/c mice bearing breast cancer.
Methods: A total of 30 In-bred BALB/c mices aged from six to eight weeks weighting 25-30g were randomly enrolled in our study, in two groups each consist of 15 mices. The L.acidophilus ATCC4356 strain used in this study was inoculated in MRS broth and cultivated for a day at 37°C under anaerobic conditions, collected by centrifugation and resuspend in Phosphate Buffer Saline (PBS). After preparation of proper amount of these suspensions it was orally administered to the mice with a gastric feeding, Control mices received an equal volume of PBS in duration of study.
Results: Results showed the increase in production of IFnγ (p<0.005), and decrease in production of Th2 cytokines such as IL4 (p=0.347) in the L.acidophilus administered mice in comparison to control group of mice. In addition the proliferation of immune cells in probiotic group was significantly higher than controls, and most importantly probiotic administered mice showed an increase in survival rate of this group compared to control mice (p<0.001).
Conclusion: Results of our study suggested that daily consumption of Lactobacillus acidophilus can regulate immune responses skewed Th1 balance that is needed against tumor, further studies is needed to investigate the other mechanisms of this effect.
Aghili M, Babaei M, Azmoodeh Ardalan F, Farhan F, Hadad P, Ghanjalikhani M,
Volume 68, Issue 7 (7 2010)
Abstract
Background: Colorectal cancer is the third common cancer world wide and the forth in Iran. Neoadjuvant chemoradiotherapy is the standard treatment for locally advanced rectal cancer. In this study we evaluate the efficacy a cox-2 inhibitor on pathologic response, sphincter preservation and acute toxicity during neoadjuvant chemoradiation.
Methods: Thirty-six patients that have adenocarcinoma of rectum was enrolled (up to 15 cm of anal verge). The patients were undergone Endometrial Ultrasound (EUS), abdomino-pelvic and chest CT for staging. Then received neoadjuvant concurrent chemo radiation (xeloda 825 mg/m2 bid in combination with celecoxib 100 mg qid and 50-50.4Gy/25-28f). Surgery was done 4-8 weeks after chemoradiation. During the chemoradiation the patients was observed for the probable complication one year. Tumor regression grade was reported.
Results: From 36 surgery patients, Total Mesorectal Excision (TME) was done in 30 patients. Pathologic complete response was seen in eight of 30 patients (26.7%). Tumor regression grade was calculated in three and five grade system: in three grade system 17 patients had grade 1 (60.7%), eight patients had grade 2 (28.6%) and three patients had grade 3 (10.7%). In five grade system of tumor regression eight patients had grade 1 (28.6%), nine patients had grade 2 (32.1%), eight patients grade 3 (28.6%), three patients had grade 4 (10.7%). T down staging was 43.3%. N downstaging was 30.8%. No patient had skin reaction or cardio-vascular complication.
Conclusion: Based on our study results, Celecoxib in combination with neoadjuvant chemoradiation is safe and is associated with low complications. This combination can promote pathologic complete response, TRG and T and N downstaging in Rectal adenocarcinoma.
Gaeini Aa, Khaledi N, Fayazmilani R, Ravasi A, Sedghroohi G, Arabkari V,
Volume 71, Issue 1 (4 2013)
Abstract
Background: Alpha-actinins are located in the skeletal muscle Z-line and form actin–actin cross-links. It belongs to a highly conserved family of actin-binding proteins- the spectrin superfamily, which also contains the spectrins and dystrophin. Mammalian skeletal muscle has two isoforms: alpha-actinins-2 and alpha-actinins-3. However, the response of alpha-actinins to exercise training is little understood. This study examined the effects of 8 weeks of resistance training on muscle mass, ACTN3 (alpha-actinins-3) gene expression levels and fiber type composition in the flexor hallucis longus (FHL) muscle.
Methods: Forty five female Sprague-Dawley rats (Initial body mass: 169.25±9gr age: 3 month) were obtained and assigned to a control (C n=18) or exercise training (T n=22) and pilot (P n=5) groups. The resistance training consisted of climbing a ladder carry-ing a load suspended from the tail and the weight increased progressively. Real-time PCR and Immunohistochemistry techniques were used to measure gene expression leve-ls and myosin heavy chain (MyHC) composition, respectively.
Results: Following 8 weeks of training, we observed significant increase in absolute muscle mass in FHL (P=0.01). Results showed that no significant difference was found in ACTN3 gene expression levels between training and control groups (P=0.852 respecti-vely). Also, Pearson coefficient didn't indicated any significant relationships in gene expression and Fiber type IIX in response to resistance training in FHL (r=0.12).
Conclusion: However, resistance training effects on sarcomeric proteins development, these results showed no effect of resistance training on alpha-actinins-3 levels. Althou-gh alpha-actinins-3 has an important function to produce and progress of force in sarco-mere, but didn't changed significantly in response to resistance training.
Nasrin Moghadami Tabrizi , Khadijeh Adabi , Azra Azmoodeh , Sepideh Nekuei, Babak Dabirashrafi, Kamyar Dabirashrafi, Batool Ghorbani Yekta,
Volume 71, Issue 4 (July 2013)
Abstract
Background: Endometrioma of ovary is one of the common diseases during reproductive age and the effect of laparoscopic cystectomy of endometrioma on infertility is still matter of debate. We designed this case control study to evaluate the ovarian response to controlled ovarian hyperstimulation during IVF (In vitro fertilization) cycle following laparoscopic unilateral cystectomy of endometrioma.
Methods: In a case control study, we enrolled 30 women with history of unilateral laparoscopic cystectomy of ovarian endometrioma in stripping method who underwent IVF cycle in women Hospital, 2009-2012. The numbers of follicles in response to controlled ovarian hyperstimulation during IVF cycle in the ovary with history of unilateral laparoscopic cystectomy of endometrioma were compared with those from the contralateral ovary.
Results: The mean age (±SD) of patients was 32.3 (±3.4). The mean (±SD) diameter of excised ovarian endometrioma was 42.4 (±10.4) mm. Interval since ovarian surgery to induction ovulation was 2.7 (±2.6) years. Mean number of follicles in the ovary with history of unilateral laparoscopic cystectomy of endometrioma was 2.5 (±1.2) with the range of 1 to 5 and in the control ovary 3.9 (±1.4) with the range of 1 to 6. There was significant difference in the number of follicles in the ovary with laparascopic cystectomy of endometrioma compared with opposite one (P<0.001).
Conclusion: Laparoscopic cystectomy for unilateral endometrioma is associated with a reduced ovarian response to controlled ovarian hyperstimulation during IVF cycle. We did not find any statistically significant difference in reduced ovarian response with regard to patients age, body mass index, size and location of the cyst, and time duration since ovarian cystectomy.
Mahdiye Bazmi, Mitra Haghayeghi , Roya Lari , Nasser Mahdavi Shahri , Morteza Behnam Rasouli,
Volume 73, Issue 4 (July 2015)
Abstract
Background: Bone is a hard and dynamic tissue, which continually undergoes remodeling process. Longitudinal growth of bone is mediated by growth plate that is a cartilage structure at the end of long bones. During puberty, along with the closure (ossification) of growth plate, the longitudinal growth of bone will stop. Diazinon is one of the widely used organophosphorus pesticides that have been known to cause damage to the cells and tissues of the body by enhancing oxidative stress. Due to the dynamism and active process, bone and growth plate tissues are suitable models to investigate the effect of diazinon on bone development and bone growth. The aim of this study was to investigate the effects of diazinon on the epiphyseal growth plate width (including the proliferating cells zone and hypertrophy cells zone) of immature rat.
Methods: This is an experimental study. This study was performed on 12 immature male in Ferdowsi University of Mashhad in May 2014, Wistar rats that randomly divided into 2 groups: control group and diazinon group. All treatments were done by oral gavage during 28 days. The animals were sacrificed on day 28 and left femur bones were removed for histomorphometric studies of epiphyseal growth plate width. Assessments were done by ImageJ software, version 1.40g (Wayne Rasband, NIH, USA) and the significance of the results were performed by ANOVA analysis and Tukey’s test.
Results: Epiphyseal growth plate width of diazinon group was significantly reduced (P=0.0126) in compared to control group. This reduction was associated with reduced of width of the proliferating zone (P=0.0001) and increased width of the hypertrophy zone (P=0.0166).
Conclusion: Diazinon leads to reduction in the Epiphyseal growth plate width of immature male rats. Therefore it could be a factor in the impairment of bone longitudinal growth and premature closure of the growth plate.
Fatemeh Masaebi , Farid Zayeri , Malihe Nasiri , Mehdi Azizmohammad Looha ,
Volume 76, Issue 11 (February 2019)
Abstract
Considering the advancement of medical sciences, diagnostic tests have been developed to distinguish patients from healthy population. Therefore, Determining and evaluation of the diagnostic accuracy tests is of great importance. The accuracy of a test under evaluation is determined through the amount of agreement between its results with the results of the gold standard, and this test accuracy can be defined based on sensitivity, specificity, positive predictive value, negative predictive value and the area under the receiver operative characteristic curve (AUC). Gold standard is an accurate and error- free method to determine the presence or absence of disease of interest and classify patients, which is not available in some diseases and situations as this method is costly or invasive. In these cases, reference standard is a best available replacement method to be used by physicians to diagnostic disease. However, in some situation, the acceptable reference standard is invasive or costly and does not exist or unreliable. It can be imperfect and results of the reference standard method are not necessarily error- free and cannot be applied to everyone in the study; all these cases point to the conditions in which the gold standard is not available. The use of reference standard including error causes to incorrect separation of patients from healthy population and thus, it cannot be a comparing measure for other diagnostic tests and its results are inaccurate. Therefore, other alternatives methods are needed for evaluation and determine the diagnostic accuracy tests when the gold standard does not exist. Imputation method, correct imperfect reference standard method, the construct reference standard method, latent class models, differential verification, composite reference standard and discrepant analysis are of these alternative methods. Each of these methods, considering its features, advantages, and limitations can be used to evaluate the accuracy of diagnostic test in the absence of gold standard. The present study gave an overview of methods to evaluation of diagnostic accuracy tests when there is no gold standard and the focus of this study was on explain the concept of these solutions, review and compare them and their strengths and weaknesses.
Ali Salehi , Mohammad-Ali Abtahi , Seyed-Hossein Abtahi , Hasan Razmjou , Mohammad Tohidi , Mojtaba Akbari , Hamidreza Jahanbani-Ardakani ,
Volume 77, Issue 5 (August 2019)
Abstract
Background: Retinal vein occlusions are one of the most common form of retinal vascular disorders and could lead to vision loss due to macular edema, macular ischemia and sequelae from neovascularization. Anti-venous endothelial growth factor (anti-VEGF) treatment is the choice strategy of treatment for patients with macular edema secondary to central retinal vein occlusion (CRVO). There is an evidence of body with the controversies regarding increment of choroidal thickness in CRVO condition. The current study was designed to determine whether baseline subfoveal choroidal thickness may be an indicator for visual and anatomical outcome of bevacizumab in patients with CRVO macular edema.
Methods: This study was a prospective clinical cohort study that enrolled in 23 new cases of treatment-naïve central retinal vein occlusion (CRVO) from February to July 2017 who were visited in Feiz Eye Hospital, Isfahan, Iran. Patients received a single injection of bevacizumab and were followed for 30 days. Ratio of subfoveal choroidal thickness (SFCT) was measured using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT). Ratio of SFCT of the CRVO eye to the fellow healthy eye (SFCT1/F) was taken as independent variable. Changes of best-corrected visual acuity (BCVA) in LogMAR (ΔBCVA, functional response) and secondary to baseline central macular thickness ratio (CMT2/1, anatomical response) in the CRVO eyes were taken for comparative and correlative analytics.
Results: A total of 46 eyes from 23 patients with the mean age of 64.60±10.19 years were included in this study. Baseline SFCT was higher in CRVO eyes (251.91±46.09 µm) in comparison to the fellow eye (206.95±26.62, P<0.0001). Also central macular thickness in CRVO eyes were significantly higher in CRVO eyes in comparison with fellow eye (531.04±38.22 vs 303.30±33.59, respectively, P<0.05). SFCT1/F, correlated moderately with anatomical (CMT2/1) and strongly with functional response (ΔBCVA).
Conclusion: Bilateral evaluation of SFCT by EDI-OCT in all newly diagnosed CRVO cases is recommended to determine if there is a relative increase in choroidal thickness. This may help predict short-term response to anti-VEGF therapy.
Hatef Ghasemi Hamidabadi , Maryam Nazm Bojnordi , Nourrelah Rezaie, Mojtaba Hajihoseini, Ali Delbari ,
Volume 79, Issue 1 (April 2021)
Abstract
Background: Understanding hand structures is necessary to diagnose its diseases and injuries. Several methods have been used to teach the anatomy of this body part. In this article, we introduce a new educational tool and examine the impact of its use in learning anatomy.
Methods: Color images of different layers of hand structures were connected with a spring. On each page, the desired structure was cut and that part could be turned from another direction so that the tool was beyond a booklet and could create a three-dimensional image of the region. In this way, a multi-layered structure was made that looking at each part of it and going to the next part was equivalent to removing a layer from the palm of the hand and observing the layer beneath. After making the educational tool, 280 students who participated in the study were divided into two groups: control (A) and experimental (B). Both groups participated in a pre-test. After teaching the theory of hand anatomy for both groups, the control group received practical training using the traditional method and the experimental group using the proposed educational tool, and both groups participated in a post-test and the scores of the pre and post-test groups were compared. Data were analyzed using SPSS 24 statistical software using Mann-Whitney and Wilcoxon tests.
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Results: The pre-test scores of groups A and B were 3.48±1.197 and 3.49±1.481, respectively. The post-test scores of groups A and B were 6.97±1.504 and 10.54±1.303, respectively. Therefore, although the pre-test scores of groups A and B were not much different (P>0.05), the post-test scores of the two groups showed a significant difference (P<0.001). Students also expressed that using this educational tool has made learning hand anatomy more interesting for them.
Conclusion: The results of this study showed that the proposed educational tool is effective in the field of hand anatomy education.
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Elham Bazmi , Shekofeh Sanaie, Amir Hossein Behnoush, Mehdi Forouzesh, Abdolrazagh Barzegar, Behnam Behnoush,
Volume 79, Issue 9 (December 2021)
Abstract
Background: Today, despite the efforts of the medical community and health staff, the rate of dissatisfaction and complaints among patients is increasing and this highlights the importance of evaluating its related factors. The aim of this study was to analytically investigate complaints against ophthalmologists which were referred to the Legal Medicine Organization of Iran in Tehran during 2017-2019.
Methods: In this cross-sectional (analytical-descriptive) study, the demographic data of patients and physicians including age, gender, marital status and academic degree, type of treatment measures leading to complaints, last decision of the medical commission, characteristics of protesting of patients and vote of revision commissions for all the complaints of ophthalmology were recorded and analyzed.
Results: During 3 years, 176 complaints were recorded in the field of ophthalmology. Of these, 90(51.1%) complaints were from medical interventions which took place in university or government hospitals and clinics. Also, 27(15.3%) cases of malpractice were reported, among which negligent was the most common type, with 22 cases (81.5%). The highest number of complaints was for cataract surgery and the most frequent treatments with malpractice of the physicians were cornea transplantation. Although the most protests to the first decision were from the patients, the effectiveness of physicians’ protest was significantly higher (P<0.001).
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Conclusion: Nowadays, with advances in treatment methods and technologies in ophthalmology and enhancement in the knowledge of patients about their rights, their expectations from medical staff have changed. The findings of the present study suggest that due to the rise in the number of complaints in ophthalmological treatment while a decrease in malpractice rate, applying intervention actions such as good communication between physicians and patients and patient’s right perception of treatment and possible side effects can lead to less number of complaints. In addition, due to different opinions in consecutive commissions, utilizing a single approach based on new information and evidence seems necessary.
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