Hakim Journal
Year:2003 | Volume:6 | Issue:1|Papers Count:24

Protein-energy malnutrition (PEM) is one of the most common nutritional problems among children under 5 years in the country. Based on the national survey in 1999, 15.4% of children under 5 years suffered from moderate and severe stunting, 10.9% were underweight and 4.9% were wasting. Considering the consequences of PEM including decrease in physical and mental performance, increasing the mortality and morbidity among children, prevention and control of malnutrition is one of the priorities of nutritional programs in the Ministry of Health and Medical Education. The main objective was to design an appropriate interventional model to decrease malnutrition among children in rural areas.This study was conducted in rural areas of Ilam, Bardsir and Borazjan from three provinces of Ilam, Kerman and Boushehr, during 1996-1999. The study was carried out in 3 phases included situation analysis, designning intervention and implementation and evaluation. In situation analysis phase, 1703 children 6-35 months old in the rural areas of Ilam (n=659), Borazjan (n=532) and Bardsir (n= 512) were selected by random sampling (systematic). Data were collected in the terms of knowledge, attitude and practice of mothers about child feeding, growth monitoring, family planning, sanitation, safe drinking water, food consumption pattern of households, food production and socioeconomic conditions. Also, anthropometric data for children 6-35 months old included weight and height were collected and  the main causes of malnutrition were determined. Based on the causes, appropriate strategies such as improvement of sanitation, safe drinking water, breast feeding, complementary feeding by demonstration for mothers, growth monitoring, home gardening, income generation, increasing accessibility of foods and illiteracy elimination were implemented. Different sectors like agriculture, education, rural development, social welfare and Literacy Movement Organization co-operated to the program.Three years after intervention, the results showed that the prevalence of underweight decreased from 23 to 11% in Borazjan, from 28 to %14.5 in Bardsir, and from 21 to %10 in Ilam. Stunting also decreased from 25 to %12 in Ilam, from 41 to %13 in Borazjan and from 31 to %14.9 in Bardsir (P<0.0001). This study showed that because of multi-disciplinary character of protein-energy malnutrition, intersectional collaboration, political commitment and community involvement are very important for improving nutritional status of children. By designning an intersectional intervention model, nutritional status of community could be improved.

Renal replacement therapy (RRT) is a general term consists of different modalities that are used in the treatment of end stage renal disease (ESRD) patients and composed of hemodialysis, peritoneal dialysis and allograft kidney transplantation. Coming into existence of the modalities as renal replacement therapy in the second half of 20th century led to save patients’ life and improve their quality of life. In IRAN, these advancements have been occurred in recent 3 decades. Based on available data in "Management Center for Transplantation and Special Diseases", out of 16467 ESRD patients recorded by March, 20th of 2002 (at the end of 1380 solar year) 52% of them were under hemodialysis treatment, 47% were transplanted and 1% were under peritoneal dialysis. The number of known patients was equal to 253 per million population (PMP) that is far from 476 to 1150 PMP in developed countries from the viewpoint of sanitary status. This difference is mainly due to inappropriate case finding. Forty seven percent of these patients were treated with the best modality, kidney transplantation, in the terms of quality of life and medically related costs. This index is compatible with the same one in developed countries, but the percentages of other modalities were different from other countries.Increasing number of new case finding, founding of transplantation units, quality of life improvement and establishment of cadaver organ transplantation organization in the country represent recent advancements in this regard.

Thrombocytopenia is one of the common AIDS-related blood dyscrasia that is postulated to be in relation with increased viral load and diminished CD+4 Tlymphocytes. We evaluated the rate of Thrombocytopenia (Plt< 100,000) in 170 HIV infected patients from May 2000 until April 2001 in Kermanshah province, Iran. In a cross-sectional study from all HIV positive patients in whom infection had been confirmed by ELISAI, II or western blot test a blood sample was and obtained. The samples were investigated for platelet then, CD+4T-cells were determind by flowcytometry.From 170 patients, 161 cases (94.71%) were male and 9 (5.3%) female. All males and 2 females were drug abusers. The rate of Thrombocytopenia in this study was 20% (34 of 170 patients) of them, three had severe thrombocytopenia (plt<20,000)Although, the prevalence of thrombocytopenia was similar in various stages of HIV infection (18.5%) , the  severe form of thrombocytopenia was found in patients with CD+4 T-cell count of less than 200/ml.There was no associated infection, drug consumption, spleenomegaly or other conditions to cause thrombocytopenia in the patients except for HIV infection. None of the patients developed clinical complications except one for whom spleenectomy was performed with the result of complete recovery.We conclude that mild thrombocytopenia is common in HIV infected patients in the region and the rate of thrombocytopenia is similar in different stages of HIV infection but severe different types are common in advanced phase.

This study was carried out in order to determine visceral leishmaniasis in Azarshahr, East Azarbaijan province, during 2000-2001. The study was descriptive (cross-sectional) and; multi stage sampling has been performed from 10% of children ≤10 years old and the 10% of adults including individuals with kala-azar history. Altogether, 1252 blood specimens were collected to detect anti-leishmania antibodies. The samples were tested by serological procedures included: indirect fluorescence antibody test (IFAT), direct agglutination test (DAT) and in some samples enzyme-linked immuno-sorbent assay (ELISA). Results showed that, by DA test 24(1.9%) of the collected specimens were anti-leishmania antibody positive with ≥1:3200 titers and 15(1.2%) with 1:1600 titers were suspicious. By IFA test, 30 (2.4%) of the specimens with ≥1:160 titers were seropositive and 97(7.7%) of them with 1:80 titers were suspicious.Regarding the findings we recommend that further studies are necessary for isolation and specification of leishmania parasite and determination of the animal reservoir as well as the species of sandfly vectors in this region. This study in comparison with other investigations indicated that visceral leishmaniasis is endemic in Azarshahr district.

In order to assess the preoperative ECG abnormalities on the short – term mortality after operation, a consecutive two series of 52 patients, who were undergoing elective surgery were designed in the setting of shaheed mobasher kashani hospital, Hamedan University of medical sciences.Preoperative characteristic ECG change in 52 patients were analysed by using chi-square test in comparison with a group of normal preoperative ECG data.Main results showed that post operative mortality was occurred in 34 patients (%65.4) but only 7 patients (%13.34) with normal ECG were died. Comparing the risk of death between two groups showed that in those with abnormal ECG. Confidence interval was (%52.38-%78.38) but (%5-%22.46) (p<0.05) in the group with normal ECG.Our results suggest that ECG changes before surgery, apart of other effective indexes, appear to have alespecially high risk of in-hospital mortality after non-cardiac surgery.

To determine the long - term effects of chemical warfare on respiratory system this study was designed.To achieve this goal, 220 victims of imposed war, were studied after 6–13 years of exposure. All patients were physically examined, then radiologic and pulmonary function tests were taken. The results were compared with the findings of 92 healthy male who had applied for employing or those were undertaken a selective operation.The findings of clinical examination, chest radiographs and pulmonary function test (PFT) showed that, the majority of patients had non-specific symptoms such as cough, wheezing and dyspnea. Non-specific changes in chest radiographs were seen in 64% whereas, only 13% had specific changes. Significant clinical symptoms such as hemoptysis and respiratory distress were seen in 5% of patients. PFT was the best diagnostic method with 60% abnormal findings that showing obstructive or restrictive lung diseases. Compared with un-exposed controls, about half of the exposed patients revealed mild to moderate obstructive lung disease which was responsive to bronchodilator only in 30% of cases. These findings show that a long time, after exposure to chemical warfare, obstructive lung disease will be present in a remarkable number of victims with non-specific respiratory symptoms and can be diagnosed by PFT.

Endoscopy is animportant procedure for diagnosis of lesions in upper gastrointestinal tract. Zoom or magnifying endoscopy is a new development in fiberoptic technology providing the possibility for observation of mucosal lesions with much higher magnifications than usual. Gastric mucosal atrophy, a consequence of chronic gastritis, is considered as a high risk condition and a possible precancerous lesion for gastric adenocarcinoma by many authorities.The objective of the study was determination of the efficacy of zoom versus routine endoscopy for diagnosis of gastric mucosal atrophy.Digital pictures taken from gastric mucosa by both routine and zoom video endoscope were independently examined by an experienced gastroenterologist for presence and severity of mucosal atrophy. Biopsy specimens taken from the same sites were blindly observed by a pathologist and reported accordingly.Pathologic examination of 178 satisfactory specimens showed 30% atrophic changes in the antrum and 18.8% in the body. Sensitivity and specificity of zoom endoscopy for diagnosis of gastric mucosal atrophy were 45 and 87%, respectively. The figures were 12 and 93% for routine endoscopy. Likelihood ratio showed to be 3.4 for zoom and 1.7 for routine endoscopy.According to the results, zoom endoscopy showed to be more efficient for diagnosis of gastric mucosal atrophy in this study. Further studies are suggested to ensure reproducibility of the results and proposing better visual criteria for better diagnosis of different mucosal lesions by zoom endoscope. This will certainly help for finding the representative site for biopsy and pathologic confirmation of the endoscopic diagnoses.

There is no agreement about the effect of temporary hyperprolactinemia on the day of ovum pick up (OPU) on pregnancy rate in assisted reproductive treatments. In order to determine the association of serum prolactin on the day of OPU with pregnancy rate in IVF/ICSI methods, this study was carried out on infertile women, admitted to Valie-Asr Hospital through the years of 1998-1999.In 151 eligible women, stimulation was conducted according to the Long Protocol. Then, serum prolactin was measured on the day of HCG injection and OPU.The results of the study showed that serum prolactin was ≤25 ng/ml in 91 patients (group I) and >25ng/ml in 60 patients (group II). There wasn't any statistically significant differences between two groups regarding maternal age, kind and cause of infertility, the number of mature follicles (>13 mm) and mature oocytes. The number of embryo and their cleavage rate was similar in both groups. There was a significant difference between two groups regarding the maturation rate of embryos. Grade A (suitable cell maturation) was seen in 90% of group II and 77% in group I (P=0.019). The pregnancy rate was significantly higher in group II than group I (28.3% versus 3.3%, P=0.00001).In logistic regression model the serum prolactin (P=0.0150) and quality of embryo (P=0.140) had a significant association with pregnancy rate.

Anesthesiology has been known as a stressful specialty with unique characteristics since its appearance. Stressful environment and availability of opioids and sedatives as well as the necessity of a vigilant anesthesiologist to catch up the dangerous fatal moments and immediate action, emphasize the importance of mental health of anesthesiologists. This study was aimed at primary evaluation and determination of problems threatening mental health and performing an easy and reliable method for the assessment of mental status in anesthesiologists and residents.Thirty-nine year-one residents before beginnig the residency (group A) and 85 year-one to-three residents who had passed at least three month (group B) answered SCL-90-R screening test questionnaire. Answers to 90 questions of the test ranked 0 to 4 and averaged within 9 subscales. Then, the score of each subscale was compared with the norm of Iranian students.Scores of all subscales in group A were higher than group B. There was inequality in scores of men and women. Sensitivity and obssessive-compulsive subscales were ranked the highest in groups A and B, respectively. Phobia and psychotism were ranked the lowest in both groups.Exposure to anesthesiology produces some changes in the subscales of residents mental test. Moreover, respecting obssession-compulsion as one end of depression spectrum, the risk of depression in anesthesiology residents is serious. This study remarkes the importance of anesthesiology derived mental conflicts and emphasizes the necessity of performing screening test for residents and anesthesiologists in different time sections.

Nowadays the burden of psychiatric disorders has been identified in developed countries by screening questionnaires and standard clinical interviews at a high level, but there has been conducted few investigation to study the epidemiology of psychiatric disorders in our country, comprehensively.The aim of this survey was to estimate the prevalence of psychiatric disorders in the individuals of 18 years and above in urban and rural areas of Iran.For this purpose, 25180 individuals were selected through a randomized systematic and clustered sampling method among the families of the country. Schedule for Affective Disorders and Schizophrenia (SADS) with 904 questions was accomplished on them by 256 clinical psychologists throughout the country in the year 2001 as well.The results of this study showed that the prevalence of total psychiatric disorders was 17.10 percent. The prevalence rate in the women was 23.4 percents and in men was 10.86 percent. Anxiety and mood disorders, respectively, with 8.31 and 4.35 percents were the most common psychiatric disorders. The prevalence of psychotic disorders in this study was 0.89 percent, neuro-cognitive disorders 2.78 percent and dissociative disorders was 0.77 percent. In the group of mood disorders, the major depression with 2.98 percent and in the group of anxiety disorders, the phobic disorder with 2.05 percent had higher prevalence. In this study 10.87 percent of individuals suffered from one of the psychiatric disorders. The prevalence of psychiatric disorders among the individuals between the ages of 41-55 years with 12.62 percent, divorced and separated persons with 22.31 percent, the residents of urban areas with 11.77 percent, illiterate individuals with 13.80 percent, housewives with 14.48 percent and unemployed individuals with 12.33 percent was more than other individuals in the sample.Being aware of the status, reveals the responsibility of health policy makers and programmer and the role of prevention, treatment and medical education more than before in relation to prepare natinal plans for mental health.

Job stress has been recognized as one of the important factors for human well-being. Job stress is more important among women than other groups, because of their key roles in the household. It has a negative effect on their health status and other family members, and reduce their quality of life.The aim of this investigation was to study the women’s job stress and dissatisfaction, and to determine the main stressors in their working places.This study was carried out on 700 employed women aged 24 to 65 years living in Ahwaz. Information was collected by a self-completed questionnaire. To determine job stress, the Karasek’s job strain model was employed. Responses were categorized and scored as "always", "often", "sometimes", and "never". The job stress indicators were; fire, anxiety, psychological pressures, have a boring job, dissatisfaction of work time, lack of enough rest, lack of correspondence to educational level/experience, and lack of enough independence. All 7 stress- items were scored on a scale of 1 to 4 ranged between 7 to 28. Those above and those below the median value (16) were signified as more and less job stress, respectively.The mean age for the women was 40.8± 10.0 years. Overall, 24.3% and 54.2% of women were dissatisfy of their job and reported job stress, respectively. Job dissatisfaction was more common among low educated and unskilled workers (P<0.001). Job stress was also more common among high-educated responders (P<0.001). Teachers compared to others reported the most job stress (66.7%, P<0.001). Lack of enough rest (96.9%), dissatisfaction of work time (91.9%), and psychological pressures (88.7%) were the most common stressors at women’s work. In conclusion, more attention on job satisfaction and reduction of work-time, particularly for those who are more at risk of job stress, increase the women’s health level and their family. Furthermore, this may increase their work production and prevent the occupational accidents. Since many women’s job stressors are related to management programs, managers should have the most attentions to these issues.

French-American-British (FAB) classification of acute leukemia is based on the morphologic examination of bone marrow smears and cytochemical staining of blast cells. New therapeutic measures however, mandate the use of flowcytometric immunophenotyping of acute leukemia.Comparison of the results of FAB classification and flowcytometric immunophenotyping confirms the value of immunophenotyping since, many distinct types of leukemia are known to warrant specific therapy and carry predictable prognoses.In this study cytomorphology, cytochemical staining characteristics and immunophenotyping of 420 new cases of acute leukemia were analyzed.Flowcytometric immunophenotyping showed 280 (66.7%) acute lymphoblastic (ALL), 135 (32.1%) acute myeloid (AML), 3(0.7%) biphenotypic and 2(0.5%) unclassified cases. Of 280 cases designated as lymphoid by flowcytometry, 257 were diagnosed as such by cytochemistry/morphology. Thus, the sensitivity and specificity of the latter for diagnosis of ALL was 91% and 82%, respectively. Of 135 immunophenotypically proved acute myeloid leukemia, 115 cases were diagnosed as such by cytochemistry /morphology. Hence, the sensitivity of the test for diagnosis of AML was 85% and specificity 92%.The results show the importance of immunophenotyping in routine diagnosis of new cases of acute leukemia for selection of appropriate treatment protocols.

Oxytocin is excreted from the posterior pituitary gland and has many physiological properties like uterine contraction and consequently facilitating labour. This peptide amide is prepared by chemical synthetic means and has pharmaceutical applications in human and domestic animals. There are two methods of preparation of peptides, solution and solid phase; the latter being used in this study.The resin selected was Rink Amide MBHA and the alpha – amino acid, Fmoc-Gly-OH, was bonded to the resin followed by deprotection of Fmoc group by 20% piperidine. The next amino acid was added and this was continued till the chain was completed. The synthesized peptide was detached from the resin under acidic condition and then precipitated. The disulphide bridge between Cysteine 1 and 6 was achieved using iodine. The purified product was analyzed with respect to its purity, amino acids and biological activity.The results obtained were compared with the standard sample. The purity of the product was 95% and amino acid analysis showed the presence of all amino acids in the hormone. Biological activity was 467.05 unit per milligram.

Introducing the most suitable method to obtain useful materials and reapplication and multiple- use of materials and natural resources is one of the most effective methods for preserving environment. Tannin, one of the most important substances in oak tree, has various applications in pharmaceutical, ink, leather, oil well drilling, wood coating, and wood glue industries. This study was conducted to achieve the most suitable method of tannin extraction from the fruit of oak.Out of 36 species and sub-species, 10 species and sub-species which cover a more extended area of Iranian woods in north Alborz, Arasbaran region and the west region of Zagros Mountains, were selected in term of their dispersion and then, 5 samples of each specie were taken. The tannins of the samples were extracted and measured through the four methods of maceration, decoction, percolation and soxhlet extractor.The results of the study reveals that Quercus brantii belangri has the most amount of tanin with 9.7 percent and this rate for other 9 species and sub-species which cover a more extended area of Iranian woods is between 3.2 and 7.5 percent.

Endoscopy is an-important procedure for diagnosis of lesions in upper gastrointestinal tract. Zoom or magnifying endoscopY is a new development in fiberoptic technology providing the possibility for observation of mucosal lesions with much higher magnificationsthan usual. Gastric mucosal atrophy, a consequence of chronic gastritis, is considered a high risk condition and a possible precancerous lesion for gastric adenocarcinoma by many authorities.Determination of efficacy of zoom versus routine   ndoscopy for diagnosis of gastric mucosal atrophy.Digital pictures taken from gastric mucosaby both routine and zoom videoendoscope were independentlyexamined by an experienced gastroenterologist for presence andseverity of mucosal atrophy. Biopsy specimens from the same sites wereblindly examined by a pathologist and reported accordingly.Pathologic examination of 178 satisfactory specimenssho wed 30% atrophic changes in antrum and 18.8% in body. Sensitivity and specificity of zoom endoscopy for diagnosis of gastric mucosalatrophy were 45% and 47% respectively. The figures were 12% and 93%for routine endoscop.Likelihood ratio showed to be 3.4 for zoom and 1.7 for routine endoscopy.According to the results, zoom endoscopy showed to be more efficient for diagnosis of gastric mucosal atrophy in this study. Further studies are suggested to ensure reproducibility of the results and proposing better visual criteria for better diagnosis of different mucosal lesions by zoom endoscope. This will certainly help for finding the representative site for biopsy and pathologic confirmation of the endoscopic diagnoses.