TANAFFOS
Year:2006 | Volume:5 | Issue:3 (19)|Papers Count:10

INTRODUCTION: In this paper we define and classify the health technologies in order to map its range of use in health care. Given the technology impacts on the performance of health systems, it is explored further, highlighting the importance of assessing it before selection, acquisition and use. Examples are presented from the developed countries where they have taken steps for the institutionalization of health technology assessment (HTA). We also assess the new developments in this regard. The Iranian health system is also assessed, emphasising the importance of HTA particularly in the context of health sector reforms.

Background: Common cold is the most frequent illness managed in general practice. Data regarding prevalence of the common cold in communities is confounded by the close similarity between allergy and/or asthma related symptoms and common cold.The purpose of this study was to elucidate possible correlations between self-reported common cold episodes and asthma/allergy related symptoms and some evident risk factors.Materials and Methods: As a part of an ISSAC study in Isfahan , Iran, a randomly selected population of 11666 students aged 6 to 18 years (mean ± SD =12.96±2.99) were studied. The children or parents completed in a questionnaire with both ISSAC, and other supplementary questions regarding the common cold and allergy.Results: 11666 pupils (88.9%) completed the study.Those pupils reporting more than 3 to five episodes of the common cold exhibited a significantly more asthma and/or allergy related symptoms.Conclusion: Persian people with more than 3 to 5 episodes of cold like symptoms per year should be evaluated for allergic conditions.

Background: The laryngeal mask airway (LMA) is a supraglottic airway device that can be used as a substitute for the standard endotracheal tube in emergency and difficult airway managements. However, the use of LMA for elective surgical procedures is still controversial. In most published studies, ETCO2 and SPO2 monitoring was applied to assess the adequacy of LMA placement. However, the most reliable method for evaluating ventilation and oxygenation is the measurement of arterial oxygen partial pressure (PaO2) and arterial carbon dioxide partial pressure (PaCO2) directly from an arterial blood sample. The purpose of this descriptive cross-sectional study was to evaluate ventilation and oxygenation with ProSeal laryngeal mask airway (PLMA) during short-term elective gynecologic surgery in paralyzed anesthetized patients.Materials and Methods: Fifteen ASA (American Society of Anesthesiologists) class I-II women undergoing short-term elective gynecologic operations under general anesthesia were included in the study. After induction of standard general anesthesia an appropriate size ProSeal LMA was inserted and controlled ventilation was established. Position of LMA was detected via auscultation of the lungs and epigastric area. Before the end of surgery, an arterial blood sample was withdrawn for blood gas analysis.Results: First attempted insertion of PLMA was successful in all patients. The position of PLMA was good in 11, acceptable in 2 and suspected in 2 patients. PaO2, PaCO2 and SaO2 were within the normal limits in all situations. Duration of anesthesia (> 30 min and <30 min) had no effect on PaO2. Conclusion: We concluded that ventilation and oxygenation can be maintained through a PLMA during short-term elective gynecologic surgery under general anesthesia.  

Background: This study assessed Helicobacter pylori (HP) seroprevalence in bronchiectatic patients and determined whether there is a potential association between bronchiectasis and H.pylori infection or not.Materials and Methods: This study was conducted on forty consecutive patients (26 men, 14 women; mean age 48.90±16.67 years, range 21-86 years) with bronchiectasis diagnosed by clinical symptoms and high resolution CT-scan. Helicobacter pylori IgG serum levels were measured in serum by enzyme-linked immunosorbent assay. Forty healthy subjects (25 men, 15 women; mean age 55.50±11.91 years, range 16-77 years) were selected as controls with no history of cerebrovascular, ischemic heart or respiratory diseases. Control subjects were matched for age, gender and socioeconomic status.Results: Significant differences were observed in the seroprevalence of H.pylori between the two groups, who had similar age, gender distribution and socioeconomic status (76.0% vs. 54.4 %, p=0.001). Similarly, H.pylori IgG levels were significantly higher in bronchiectatic patients than in control subjects attended the hospital with non-respiratory conditions (1.43± 0.55 and 1.07±0.44 U/ml, respectively; p<0.05).Conclusion: The association between Hp infection and bronchiectasis was confirmed in this study. Additional studies with larger numbers of patients and randomized control studies should be undertaken to assess the relationship and impact of the H.pylori eradication on bronchiectasis.

Background: Use of industry and technology must be based on protection of health as well as the environment. In other words, constant development of technology should fulfil human needs and not pose a health hazard.Silicosis is one of the oldest industry-induced occupational pulmonary diseases which is caused through exposure to particles of crystalline silica in respirable sizes and still is a major health hazard in workers exposed to silica all over the world. Since there is no cure for silicosis and in affected patients the disease may continue to progress even after leaving the workforce, dust control in the working environment is the only way to overcome this disease.Materials and Methods: An analytical cross-sectional study was performed on workers of the 27 stone-cutter factories in Malayer- Azandarian during 2001-2002. Sampling method was un-randomized and considering the type of study, all factory workers who were about 100 individuals entered the study. The study was done via clinical examination, questionnaire, spirometry, and chest x-ray.Results: Study results demonstrated that lung examination was abnormal in 21 workers accompanied by respiratory symptoms as follows:Twelve cases had irritative coughs. Four cases had coughs and dyspnea and 5 complained of exertional dyspnea. In 10 of them a significant change was seen in their chest x-ray. Fourteen cases had an abnormal spirogram curve in evaluation of their respiratory status and only in 4 patients spirometry was abnormal.Most patients with silicosis were under the age of 44 and had almost 5 years of working experience. Six patients were smokers. In conclusion, 10 workers had silicosis (10%) (6 cases of simple silicosis and 4 cases of the complicated type) and the diagnosis was confirmed by chest radiography.

Background: Transthoracic CT-guided percutaneous fine-needle aspiration biopsy (FNAB) has become a well- established diagnostic technique and been useful in differentiating malignant and benign pulmonary lesions.Materials and Methods: 505 patients (311 men and 194 women) aged 7-90 years old (mean age 56.2 years) with pulmonary lesions underwent CT-guided transthoracic fine-needle aspiration biopsy.Cytopathologic evaluation of FNAB samples was performed in all patients. In addition, each case was reviewed for complications, including pneumothorax and hemoptysis. Data were analysed using SPSS software for windows ver. 11.5.Results: FNAB samples were adequate for diagnosis in 410 (81.2%) of 505 patients. Two hundred and forty-nine lesions (60.7%0) were malignant, and 161 (39.3%) were benign or atypical. Thirty-four (6.7%) patients had pneumothorax out of which none of them required thoracostomy tube placement. Additionally, hemoptysis was noted in 9 (1.8%) patients and follow-up was carried out. No further complications were reported.Conclusion: CT-guided FNAB of pulmonary lesions can yield well-established diagnoses and it can be useful in the management of patients with suspected lung cancer.

Background: Based on econometric studies conducted worldwide and in Iran, one of the methods by which the efficiency and effectiveness of an organization is evaluated, is by cost-control methods and economical analyses of therapeutic activities that must be carried out routinely and periodically. It seems that services offered in uni-speciality hospitals are cheaper than general hospitals. This study aims to propose a model by which the provided services can be expanded in a specific field of treatment. Also this study was conducted to analyse and compare the costs of asthma and COPD in two general and uni-speciality hospitals in order to determine the total services costs of these two diseases. Materials and Methods: This cross-sectional retrospective experimental study calculated hospital costs and analysed the data in forms and tables designed especially for this purpose.Also data in regard to capital, current and overhead costs were collected. After calculation, the mean of total costs in both diseases was assessed.Results: In this study, econometric analyses of asthma and COPD demonstrated that the health services cost of asthma in a general hospital was 1.19 times greater than that of a uni-speciality hospital, while the services cost of COPD in a general hospital was 1.36 times that of uni-speciality hospital. The difference in costs includes duration of hospitalization, cost of paraclinical and diagnostic tests, counselling, medical equipments, and overhead costs.Conclusion: As it is observed all over the world, health care personnel pay less attention to the costs of medical equipment and are less aware of the economical aspect of health care services,. Without considering the costs, physicians are always after new equipment. Having knowledge about the costs is not only essential for hospital administrators but also for all medical personnel, since with more cost reduction, a greater number of people can enjoy medical services.

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and is probable to be the third cause of death in the world in 2020.COPD is a highly prevalent, irreversible, and disabling disease with no definite cure which will stay with the patient for life affecting physical, mental and socioeconomic status as well as the quality of life. Therefore, creation of a positive perception of health and preserving the quality of life in these patients are of utmost importance and should be an essential goal in treatment and care of these patients. To reach this goal, first, the quality of life in these patients should be evaluated to assess the effects of mental, social and physical aspects of the disease on the life style of these patients.Materials and Methods: A descriptive case series study was undertaken. The understudy population comprised 80 COPD patients which were selected consecutively. They all filled out the standard respiratory disease questionnaire including: 1) Demographic specifications 2) the St George's Respiratory Questionnaire (SGRQ, includes symptoms, activities, and impact).To collect the data, COPD patients who met the inclusion criteria were selected and questionnaires were filled through interviewing or selfreporting in 20 minutes. The questionnaire was scored from 0 to 100 points. The lower score indicated the better life quality and the higher score indicated deterioration. The collected data were analyzed using Microsoft Excel and SPSS 11.5 software.Results: Mean and standard deviation of the SGRQ total score in understudy patients were 58.31±16.14 (63.09±19.52 for symptoms, 76.35±17.65 for activities and 46.41±17.79 for impact parts). There were no significant differences between the SGRQ total score and sex, age, occupation and level of education. One sided variance analysis and Pearson’s correlation coefficient demonstrated a significant difference between the total score and duration of disease (p=0.01), stages of disease (p=0.02) and also the causes of COPD (p=0.02).Regarding the stages of disease, a significant difference was found between stages 2, 3 and 4 respectively according to SGRQ total score (p=0.02, P=0.04). A significant difference was also seen between smoking and a combination of factors regarding the causes of the disease (p=0.02). Conclusion: According to our study results, quality of life in COPD patients was moderate to low and this would deteriorate with duration of the disease and its severity. Also, high-risk occupations in addition to cigarette smoking deteriorate the quality of life considerably.

Pilomatrix carcinoma is the malignant counterpart of the pilomatrixoma which is a hamartoma of the hair matrix. It is a rare locally aggressive skin tumor with a great tendency for recurrence but its metastatic potential is limited. We report a pilomatrix carcinoma with proven metastases to the lung in a 51-year old man who was admitted to the hospital for respiratory symptoms such as productive cough with green colored sputum and halitosis since one year ago.

Mycobacterium thermoresistibile was first reported in 1981 as a human pathogen. Several studies have reported pulmonary infection and cutaneous lesions due to this type of mycobacterium. A five-year-old boy with cough, fever, and abdominal pain was referred to Masih Daneshvari Hospital. He had been treated with diagnosis of histiocytosis x. Gastric lavage was performed and examined by polymerase chain reaction (PCR) and Mycobacterium thermoresistibile was found. It seems that this case is the first report of an atypical tuberculosis caused by Mycobacterium thermoresistibile in a child.