HAKIM RESEARCH JOURNAL
Year:2006 | Volume:9 | Issue:2|Papers Count:14

Introduction: Hepatitis B is a common problem in many countries. Due to high efficacy, safety and low cost of vaccine, mass immunization has become a favorite strategy to improve population health. In this study, we tried to estimate marginal effectiveness of adolescents’ immunization program in Iran.Methods: Epidemiologic data about of hepatitis B in Iran was gathered through literature review, expert opinion, existing resources of data and synthesis by modeling of other data. In a state transition model, different stages of disease were simulated in 15 to 100 year old individuals. Comparing the results of burden of hepatitis B with and without immunization revealed an estimate of avoidable burden of disease with intervention. Monte Carlo simulation and sensitivity analyses were done for uncertainty analysis of results.Results: Immunization of around one million 15- year. old males and females prevents 2071 of male and 581 of female premature deaths due to acute hepatitis B, cirrhosis and hepatocellular carcinoma annually. Moreover, it prevents loss of about 52 and 36 percent of YLL (years of life lost) due to hepatitis B complications in males and females respectively. On average, it avoids loss of Disability Adjusted Life Years (DALY) of 0.012 and 0.006 years, according to present value of life. Monte Carlo simulation of populations showed that effectiveness of the intervention is quite significant and about half of males and one third of females with disability, equal to at least one year of full health, will be free. With sensitivity analyses, results were standing in acceptable limit of values in both bivariate and probabilistic calculations.Conclusion: Our study showed that effectiveness of adolescents’ immunization against hepatitis B is quite significant. Calculation using basic estimates of cost of intervention program implies that this intervention is possibly very cost effective. For final judgment, results should be combined with cost effectiveness analysis, and compared to other interventions.

Introduction: Labor pain is considered as one of the most important causes of stress for the parturient. The aim of this study was to compare the effects of subcutaneous injection of 1% lidocaine with normal saline in the lumbosacral region on labor pain reduction and their complications. Methods: Seventy para 2, term ASA I parturient were enrolled in a randomized clinical trial and randomly allocated to lidocaine group (injection of 0.5 ml 1% lidocaine or control group (injection of 0.5 ml normal saline). Drugs were injected subcutaneously at 4 points in lumbosacral region (Michaelis' rhomboid) by an insulin syringe. Labor pain was assessed by visual analogue scale 15, 40 and 60 minutes after injections.Results: There were no significant differences among age, systolic and diastolic blood pressures and fetal or maternal age between groups. The pain intensities in lidocaine group were significantly lower 15, 40 and 60 minutes after injections compared with normal saline group. There was no significant difference between normal saline pain intensity after injection compared with before injection but in lidocaine group all the post-injection pain intensities were significantly lower compared to pre-injection. There were no cases of hemodynamic instability or fetal complications.  Conclusion: Subcutaneous injection of 1% lidocaine in the Michaelis' rhomboid region is accompanied by minimal homodynamic changes or complications and significant reduction in labor pain.

Introduction: Foot and knee deformities are among common complaints of patients referred to the orthopedic centers. Most of naturally occurring lower limb deformities in children, which are rather common, would be corrected with further normal growth. However, a small percentage of these problems remain unresolved and may cause complications in the future. Methods: The purpose of this descriptive study was to determine the prevalence of foot and knee deformities (such as, genovarus, genovalgus, flat foot, …) among one thousand female high-school students in of Tehran District No.5. Also relationships of deformities with age, familial and personal history and severity of clinical symptoms were studied. To indicate the severity of symptoms of genovarus and genovalgus, bilateral medial femorocondylar distance and bimalleolar distance were measured respectively. Severity of hallux valgus was determined by measuring the angle formed by medial border of foot and medial border of great toe. Also clinical observance of patient's sole while standing was used to evaluate whether the patient had the pescavus or flat foot.Results: 30.4% of the studid subjects had knee abnormalities, of which 27.5% were classified as genovarus and 2.9% as genovalgus. 11.2% suffered from foot anomalies, of which 0.2% had pescavus and 11% had flat foot. Prevalence of hallux valgus was 12.7%. Meaningful relationships were observed between foot and knee deformities and other variables such as age, birth order and severity of clinical symptoms. There was a significant association between foot deformities and familial or personal history. No significant association was detected between knee deformities and familial or personal history.Conclusion: These findings point to the importance of proper physical examination, early diagnosis and on-time treatment of foot and knee deformities in children.

Introduction: One of the most toxic effects of organophosphate (OP) poisoning has been the paralysis of skeletal muscles that can lead to paralysis of respiratory muscles and death. However, oximes are the only antidotes available to reverse or prevent such toxic effects of OP insecticides and nerve chemical warfare agents.Methods: In the present study, the effect of different concentrations of paraoxon (as an OP) on the function of skeletal muscle and reversal or prevention of these effects by an oxime (pralidoxime, 2-PAM) were studied in chicken biventer cervices nerve-muscle preparation using twitch tension recording technique. For this purpose, twitches of the biventer cervices were evoked by stimulating the motor nerve at 0.1 Hz with pulses of 0.2 msec duration and a voltage of greater than that required to produce maximum response. Twitches and contractures were recorded isotonic ally using Narco Biosystems.Results: The results showed that paraoxon (0.1 µM) induced a great increase (more than 100%) in the twitch amplitude, while higher concentrations (0.3 and 1 µM) could induce partial or total contractures. In this study, paraoxon at a concentration of 0.1 µM was used to examine the capability of pralidoxime to reverse or prevent its effects. Pralidoxime at doses of 300 and 100 µM almost fully reversed (when it was used as post treatment) or prevented (when it was used as pretreatment or at the same time as toxin) the effect of paraoxon. hile oxime at doses of 30 and 10 µM could only reverse or reduce this effect to about 25 and 75% respectively, pralidoxime alone had no significant effect on the function of the muscle.Conclusion: These results suggest that this method is of high value in studying the functional effects of OPs on skeletal muscle tissues and the reversal effects of antidotes, and pralidoxime by itself can fully reverse such effects.

Introduction: In medical history of different nations, there are numerous documents concerning cancer. The present study is an investigation in ancient books to determine the part that Iranian medicine has played in the recognition of cancer.Methods: 30 Iranian medical books mostly from 3rd to 13th centuries A.H. in a library search study were examined.Results: The findings showed that cancer in ancient medical books of Iran has been categorized under "swellings" and classified as "solid tumor" and "cold swelling". Like other diseases, the etiology of cancer has been related to four humours. Also the role of nutrition in cancer development has not been neglected. Concerning clinical manifestations, it has been discussed that cancer in early stages lacks clinical manifestations but with its progression gradually its symptoms and signs appear. Cancer was found to be more common in women and the most common organs involved were indicated as breast and uterus in women and pharynx, larynx, gut and genitalia in men. Cancer outbreak was reported in autumn. To differentiate cancer from other swellings, it has been recommended that all swellings must be viewed using clinical and physical examination. Concerning the prognosis of cancer, there was an agreement on its poor prognosis but some factors were considered important. Concerning the treatment of cancer, it was believed that although there is no complete cure, the treatment of cancer (medical management, surgery, diet) should be considered in its early stages.Conclusion: The findings from this study indicate that in ancient Iranian medical books cancer has been thoroughly investigated from different perspectives, some of which still have maintained their scientific merits.

Introduction: Breast cancer is the most common cancer and the second most common cancer of cancer death in Iranian women after gastric carcinoma; although it is the second most common cancer in the western women after lung cancer. Its survival depends on multiple factors, which are very important to identify in order to understand natural history of the disease in Iran.Methods: In the present study, 154 patients with T1-T2-T3-N0-N1-M0 breast cancer participated between March 1996 and March 1998 after surgery followed by adjuvant chemotherapy and/or radiation therapy and/or tamoxifen and were followed up for at least 5 years. Different factors might be effective on survival evaluation. Data was analyzed by SPSS, using chi-square and Kaplan Mayer method for survival analysis.Results: 5 year survival was 76.5% .It decreased by lymph node involvement (72.9% versus 88.9%, p=0.034) and increased in estrogen receptor positive tumors (84.3% versus 62.5,p=0.024). Left breast cancer patients survived more than right ones (87.5% versus 76.5%, p=0.004). Tumor size, type of pathology, age, type of surgery (breast conservative surgery or mastectomy) progesterone receptors, HER-2 proto- oncogene and type of chemotherapy had no effect on survival.Conclusion: There is high survival by adjuvant therapy in Iran when breast cancers is detected at an early stage without lymph node involvement and receive appropriate therapy. The other factors should be studied more by future researches.

Introduction: Detection of H. pylori, the widely distributed etiologic agent of gastro-duodenal inflammation, peptic ulcer and gastric cancer, is easy and available.Methods: In this study, 100 patients who visited endoscopy section of Imam Khomeini Hospital or private clinic in 2001 were studied for gastric cytology (brushing and touch preparation) and biopsy.Results: Of 100 studied patients, 31 patients (31%) had abnormal endoscopy, including gastritis in 78%. Brushing was positive in 43 (43%) patients, touch preparation in 52 (52%), rapid urease test (RUT) in 53% and biopsy in 54(54%) of patients. Sensitivity of brush and touch cytology were 79.6% and 96.3%, respectively.Conclusion: Agreement between brush and touch cytology was 78.1%. According to of Mc-Nemar test they had no concordance. Sensitivity of RUT was 98.1%. Agreement between touch cytology and biopsy was 96% and according to Mc-Nemar test they showed concordance.

Introduction: Nitinol (NiTi) is the most interesting smart material used in orthopedic surgery and production of artificial muscles. Considering its medical applications, Nitinol biocompatibility is, therefore, quite important. This issue is discussed in this paper.Methods: Nitinol alloy experimentally produced by melting and casting under vacuum, plus imported commercial AO samples were implanted in limb tissue of a number of male rats. Twenty one days after the implantation, fibroblast and fibrosis formation in the tissues around the alloy were studied.Results: The amount of the alloy that was corroded under the experimental invitro conditions was acceptable. The biocompatibility of the experimentally made alloy implanted in limb tissue was nearly similar to that of the imported alloy.Conclusion: According to the results obtained, utilization of Nitinol in medicine is scientifically justifiable. Possibilities of its wide industrial and medical applications favorably support the mass production of the alloy in the country, and its biocompatible parallels that of the imported material.

Introduction: With the increased awareness regarding transfusion- related complications, blood transfusion therapy has become an issue of increasing concern.Methods: In this survey, the rate of blood transfusion was evaluated among children between the ages of 1 month to 14 years who were admitted to the pediatric intensive care unit (PICU) of the Children's Medical Center. Children with chronic diseases and malignancy were excluded.Results: Among 262 patients who were eligible to participate in this study, 116 (44.3%) had history of blood transfusion during PICU admission. Most of them were infants under the age of one year (56.1%). The rate of blood transfusion, volume of blood sampling, oxygenation, need for mechanical ventilation, and the mortality rate were compared between the children who had received blood transfusion with the group without blood transfusion. The differences between these two groups (with and without blood transfusion) with regard to oxygen saturation or assisted ventilation did not show significant differences, but the mean volume of blood sampling and length of PICU stay were significantly different (p<0.0001). Blood transfusion did not cause any changes in the mortality rate )9 patients with blood transfusion died in comparison to 5 patients in the other group). Conclusion: Although anemia is very common in the critical care setting, it seems that blood transfusion has no significant effect in improving oxygenation, or mortality rate.

Introduction: Psychological debriefing is a way for prevention and reduction of post- traumatic stress disorder (PTSD) symptoms. Many studies have shown the efficacy of cognitive- behavioral therapy in treatment of post- traumatic stress disorder. Only some evidence is available about using these techniques in large scale disasters. This study was done to evaluate the efficacy of psychological debriefing and cognitive- behavioral group therapy combination on Bam earthquake related PTSD symptoms.Methods: In a before-after trial, we evaluated the effect of single session psychological debriefing and three sessions of group cognitive-behavioral therapy on PTSD symptoms of Bam earthquake survivors Individuals with severe PTSD or other psychiatric disorders needing pharmacological interventions were excluded. Before, immediately and 3 months after interventions, we evaluated PTSD symptoms by clinically- administered PTSD scale for DSM-IV and analyzed them.Results: 95 persons were included in the study; 11 and 25 people were excluded during the first month of interventions and the 3 month follow- up period, respectively, because of migration. The frequency of  PTSD symptoms and the frequency, intensity and severity of avoidance symptoms reduced during 3 month period of study which was statistically significant (p<0.05). No effect was observed regarding the frequency, intensity and severity of hyper- arousal, re-experience and the intensity and severity of total PTSD symptoms.Conclusion: Psychological debriefing and group cognitive- behavioral therapy may be effective on avoidance and the frequency of total PTSD symptoms.