Hakim Journal
Year:2005 | Volume:8 | Issue:3|Papers Count:12

Introduction: About 10-15% of adult population experience degrees of tinnitus in their life. The purpose of present study was to determine the effectiveness of AES on tinnitus improvement and associated psychological complaints. Methods: Completing a standard tinnitus questionnaire, otolaryngological, comprehensive audiological and psycho acoustical tinnitus assessment in patients was made before and after AES. The patients received AES with a Nucleous Promontory Stimulation system. Patients received bipolar square waves fewer than 400 Hz pulses (often 50 Hz) with duration of 0.5 sec. during the seven sessions of 30 min. In an attempt to measure the effects of tinnitus before and after AES, we used the Persian Tinnitus Questionnaire (TQ), designed to assess the dimensions of tinnitus complaints. The patients of our study had been unsuccessfully treated by many medical methods and gave their written consent to participate in the study, which was approved by the department & Research Center of Otolaryngology, Head & Neck Surgery, Iran University of Medical Sciences. Results: We used extratympanic auditory electrical stimulation (EAES) to treat 42 patients with persistent tinnitus. For each patient the standard tinnitus questionnaire (TQ) was filled before and after intervention of AES. In the group of patients in whom tinnitus was improved (n = 28), the global score of TQ decreased significantly (P=0.0001), whereas the same dimension of TQ showed no remarkable changes (P=0.064) in the "unimproved" group (n = 14). The decrease in the loudness of tinnitus was significant (P=0.002), but in the unimproved group the difference in the loudness was not significant (P=0.336). Conclusion: The TQ is an instrument which provides a broad description from both factor analysis and clinical evidence. Our findings indicate that the dimensions of psychological complaints due to tinnitus from before to after treatment with AES were significantly decreased. In conclusion, EAES reduces the effects of the tinnitus but presents limitations, mainly due to the short duration of the electrical residual inhibition of the tinnitus. It seems that the continuous use of the electrical stimulation by external electrical stimulation produces a progressive inhibition of the tinnitus in distressing tinnitus patients.  

Introduction: Erudite people immigration and its epidemic form, known as brain drain, is a well-known phenomenon worldwide, especially in the developing world. This form of immigration, when occurs in the health care professionals can damage the health care system of any country. Iran has faced a wave of brain drain in health professionals, as well as other professionals, during the last years. The aim of study was to find the inclination to immigration and the related factors among Iranian physicians. Methods: This is a mail survey conducted on random sample, sized 5482 physicians, from registered physician roster at the Medical Council of Islamic Republic of Iran. The questionnaire included items on inclination toward immigration and the perceived causes of it. The final analysis was based on the 2789 returned questionnaires. Results: When measured on a scale from zero to 100, the mean inclination toward immigration among Iranian physicians is 53.3 (95% CI: 51.9 - 54.7). This inclination was slightly more in men than in women (54.6 vs. 50.0) and moderately more in single than in married physicians (61.8 vs. 51.0). The most stated reasons for this inclination were low income from medical jobs, low earnings in the face of inflation and high living costs, current discriminations, need for occupational promotion, and relative absence or poor living facilities in Iran. Iranian physicians rated their mean capability for immigration in the same scale as 30.85 (95% CI 30.52 - 31.18). They addressed financial problems, family bounds, and the imposed restrictions in the destination countries as the main obstacles facing with. Conclusion: More than half of Iranian physicians have more than moderate inclination toward immigration. This is in part due to their financial, occupational, and social problems.        

Introduction: Most patients with coronary heart disease are overweight or obese. An increased accumulation of fat in the intra abdominal cavity, is highly correlated with adverse coronary risk profiles. Many studies in cardiac rehabilitation setting show that patients who exercise, present an improvement in coronary risk profile, further research is needed to define better program for weight loss and risk improvement in CAD patients. The aim of this study was to determine the effect of cardiac rehabilitation program on body composition and body fat distribution in CAD population. Methods: The study investigated 118 CAD patients (27 females and 91 males) aged 53.83±8.01 years (mean± SD) before and after 2, 6 and 12 months of cardiac rehabilitation program. Outcome variables included weight, body mass index, body fat distribution indices such as waist circumference and waist to hip ratio (WHR). Results: Weight, waist circumference, W/H ratio and BMI significantly decreased after 2 months (supervised program p<0.001) but hip circumference had not significant change. All of measurements did not show significant changes in the end of program (after 12 months).Conclusions: A 2-month supervised cardiac rehabilitation program was associated with good improvements in body composition and body fat distribution. Men improved to a greater extent than the female patients. The effects of non supervised program were minimal and it needs to be reviewed.      

Introduction: Systemic sclerosis is a chronic multisystem disease. Many patients with limited scleroderma do not meet the criteria of the American College of Rheumatology (ACR), although they clearly have skin changes. There is no information regarding the sensitivity and specificity of manifestations of scleroderma. The aim of this study was to determine the sensitivity and specificity of the vascular and skin signs in patients with limited scleroderma. Methods: Forty patients with limited scleroderma according to the ACR criteria, 40 patients with other collagen vascular diseases, and forty healthy persons were selected for this study. Ten parameters (acrocyanosis, acro-osteolysis, gangrene, Raynaud's phenomenon, pitting ulcer, more than 5 facial and palmar telangectasia, hyper- and hypopigmentation, vertical and horizontal mouth diameter, and the number of radial furrowing around the mouth) were evaluated in them. Results: The mean age for both groups of scleroderma and healthy persons was the same (40 years). The patients with collagen vascular disease had a mean age of 36 years old. More than 95% of patients in each group were female. The mean duration of the disease at onset was 7.6 years in the scleroderma patients. Raynaud's phenomenon and pitting ulcers had the highest sensitivity (97.5% and 82.5%, respectively). Acrocyanosis, acro-osteolysis, gangrene, pitting ulcer, hypo and hyper pigmentation, more than 5facial and palmar telangiectasia had 100% specificity. Receiver-operator curve (ROC) was used to determine the best cut-off point for vertical and horizontal mouth diameter and the number of radial furrowing around the mouth. The number of the radial furrowing around the mouth had the largest area under the curve with 80% sensitivity and 87.5% specificity for 5folds or more. Discussion: Raynaud's phenomenon is the best and the first sign to rule in or out the disease because it has the most positive likelihood ratio (39) and the least negative likelihood ratio (0.02). The 100% specificity of the skin signs may be due to the lack of dermatologic patients in the control group. It is therefore recommended to design studies with patients in their early onset of the disease and control groups consisting of patients with skin diseases.      

Introduction: Patient satisfaction is one of the basic points in quality improvement systems. One of the services delivered to the patients is admission and its related aspects. The patient satisfaction from admission has a great impact on their satisfaction from the succeeding services they receive during the hospitalization. Patient satisfaction has different aspects including the personnel behavior, the waiting time for hospitalization, medical staff behavior, financial problems and hospitalization in the ward without problems. This study aimed to evaluate the above mentioned points in TUMS (Tehran University of Medical Sciences) hospitals. Methods: To obtain data, patients were interviewed at the time of discharge. Hence, 1378 patients were interviewed during two consequent months. The data was analyzed using descriptive and analytic models employing version 10 of SPSS software. Results: The findings are as follows: 66.6% didn't have any waiting time for hospitalization but 26.8% did. For 56.3% of patient, the length of time between coming into the emergency room and entering the proper ward wasn't long whereas 11. 7% of patients weren't satisfied of the admission personnel behavior and 4.7% weren't satisfied. The rate of contact satisfaction with admission's employees was 82.4%. 91.3% of patients have found the wards immediately after the admission. 80.5% of patients have said they would come back for treatment to the same facility again (if necessary) while 13.6% didn't show any tendency to the same place again. 78.7% of patients would recommend the center to their relatives while 14.1% wouldn't do so. The patient overall satisfaction of the admission process was: 76% satisfied, 14.6% partially satisfied and 9.4% dissatisfied. There was a significant relation between educational level of the patients (p=0.007) the waiting time for hospitalization (p=0.004) and to have insurance notebook (p= 0.046) others as sex, age and marital status had no effect on the satisfaction rate.Conclusion: We conclude that some hospitals have greater satisfaction rate than the others. It can be used benchmarking method to increase this rate. Other processes of admission should be improved; including decrease of waiting admission time and increase of social insurance coverage.

Introduction: It is essential for the management of the pregnant patients with a recent rash or in contact with a rubelliform illness that differential diagnosis of primary rubella infection from reinfection could be accomplished. The presence of rubella specific IgM has been taken in the past as a reliable indicator of primary infection, but in some cases the presence of IgM can be due to other causes. In this study, 'considering the fact that IgG avidity in primary rubella is much lower than in reinfection, the main objective was to use a convenient serological method for rubella IgG Avidity assay. Method: For this purpose 72 serum samples from measles negative exanthematous patients were investigated. These samples were divided in two categories of A and B according to the serological markers (HI test results and IgM detection) and also the age of patients, presence of low avidity IgG for group A and high avidity IgG for group B was expected. An avidity IgG EL/SA test was performed by elution method for each group using Radim commercial kit and 6M urea (a mild protein denaturant) and avidity index was calculated. Results: Using Splus software CART method (classification and regression tree), the borderline achieved for separation the high avidity IgG from low avidity one was 47.5% and using Roc curve in SPSS software specificity and sensitivity of the test were calculated. Conclusion: The results show that, this method is suitable for differential diagnosis of primary rubella infection from reinfection.        

Introduction: The high quality and saniety of ingredients as well as what we use daily is very important. The necessity of analysis the high and low density polyethylene (HDPE and WPE) compositions as the primitive granoul and used disposable food containers lead us to start this research. The present study, therefore, aims to evaluate mutagenicity and carcinogenicity effect of the compositions. Methods: The method is based on Ames test applying Salmonella typhimurium strains TA100,TA104 which received directly from Professor Ames. In the first stage, these strains for property purity of mutation were confirmed. Then, polyethylenes compositions have been added separately to minimal agar medium contain fresh overnight culture (TA100, TA104) and compared to positive control (index of mutagen sodium azide and bacteria) and negative control (index of distilled water and bacteria). In the other stage rat liver tissues microsmes produced under sterile conditions had been added separately to minimal agar medium with polyethylene compositions and it was measured the effect of the carcinogen material and bacteria status affected by reverse mutation and histidin produced. Results: There was a specific mutation in the histidine synthesis gene that made these strains (TA100,TA104) become an external source of histidine for theirs growth. These strains upon exposure to an external mutagen undergo a reverse mutagenecity in theirs mutated histidine synthesis operon and these strains then can grow in a histidine free medium. In this research considering to colony numbers and comparison with negative control index containing several colonies produced by spontaneous mutation approved materials mutagenicity and compared. The result, also showed that the HDPE grades as the raw material and their products made in the forms of disposable glasses and containers, drinking bottles and milk bags don't possess the mutagenicity property, but plastics bags made from LDPE caused reverse mutation of S.typhimurium of these products. If these products coated by liquid or solid oils were found to have much more affects on mutagenicity of the films. Conclusion: Considering the above results, it seems that polyethylene is a safe element. The only reason, then for mutation or carcinogenicity of the PE thin bags is the presence of some very active elements added to polyethylene or involved in its formation. This critical case makes us have more care and control on the mechanism of plastics bags production.  

Introduction: Aflatoxins are secondary hazardous fungal metabolites that are produced by toxigenic strains of some Aspergillus species on food and feedstuffi. These toxins are mutagenic and carcinogenic compounds, and are capable of causing health hazard in human and animals. Prevention of aflatoxin production and their elimination from food products is a matter of importance for many researchers in the last decades. Neem plant is known as an inhibitor of aflatoxin biosynthesis in producing fungi. In this communication, we studied the effect of incubation time as an important parameter on growth and aflatoxin production by Aspergillus parasiticus in presence of different concentrations of Neem aqueous leaf extracts. Materials and Methods: The toxigenic fungus (Aspergillus parasiticus NRRL 2999) was cultured on sucrose low salts (SLS) medium in presence of various concentrations of aqueous neem leaf extracts (0.2%, 0.8%, 3.12%, 12.5% and 50% v/v). After shaking incubation of culture for 2,4,6,8, 10 and 12 days at 280C, the fungal mycelia were collected and processed for determination of dry weight. A known amount of mycelia and also culture media were processed for aflatoxin BI (AFBI) determination by thin layer chromatography (TLC) method. Results: The neem leaf extracts had not any obvious effect on fungal growth rate at different periods of time. APBI production in the control samples (without neem extract) increased to the maximum level in the 8th day of culture, and then remained in a constant status till 12th day. The inhibition of aflatoxin synthesis by aqueous neem extracts was found to be time- and dose-dependent with maximum of 80-90% in presence of 50% concentration. After 2 days, there wasn't any change in APBI production in neem treated mycelia as compared with control samples. In the 4th day, at 12.5% and 50% concentrations, toxin production was reduced and this reduction at 50% concentration was significant after comparing with control samples (P<0.05). Conclusion: The obtained results clearly show that inhibitory effects of aqueous neem leaf extracts on aflatoxin synthesis reported in this study is time-dependent without any obvious effect on fungal growth rate. Aflatoxin inhibition is mainly occurred in primary stages of fungal growth where the genes involved in aflatoxin biosynthesis have the maximum activity within the fungal cells.