Hakim Journal
Year:2003 | Volume:5 | Issue:4|Papers Count:15

There has not been organized any studies to investigate TB status and the related treatment among Afghan refugees in Iran.A descriptive – analytical study was conducted on all adult TB cases (over 15 years) referring to the National Research Institute of Tuberculosis and Lung Disease (NRITLD) from March 1998 – to March 2000.A total of 1028 TB cases, 68.3% Iranian and 31.7% Afghan were studied. The mean age was 32.8 and 49.0 years among Afghans and Iranians, respectively (P<0.0001). Out of 712 patients with positive smear, grade of sputum smear of 689 cases were recorded. The minimum and maximum smear grades were +1 (43.6%) and +3 (37.5%) among Iranians, whereas, they were 32.1% and 44.3% among Afghans, respectively (P<0.05). Sputum smear was negative among 77.4% (260 cases) of Iranians and 63.3% (93 cases) of Afghans at the end of the second month of treatment (P=0.001). About 49% of Afghans with smear positive pulmonary TB left before the end of treatment whereas this rate was 32.4% among Iranians (P=0.001).The present study showed that Afghan TB patients were younger than Iranians and developed more severe forms of the disease compared to Iranians. Afghan refugees play an important role in the transmission of tuberculosis in Iran, therefore, detecting TB in  Afghan refugees and the need to follow up patients, while being treated, should be taken into special consideration.

To conduct this research, 104 questionnaires were distributed among managers and matrons of 53 teaching hospitals located in the city of Tehran (N=104). The hospitals were affiliated with Iran, Tehran and Shahid Beheshti Universities of Medical Sciences. Total of 88 persons participated in this survey (43 managers and 45 matrons(.The findings revealed that 31.34% of the investigated subjects experienced high level of stress. The rates were 19.51% and 43.18% for the managers and the matrons, respectively. By ranking managers and matrons' sources of stress, 13 items were shown to be stressful for managers and 20 for matrons. Out of these items seven were job-related factors for the managers and eight for the matrons.The results also indicated that stress had reduced the managers "works’ quality" and had a negative impact on their ability to make decision effectively at work. Negative impact of stress on mental health of the managers and matrons was also observed in this study. These findings were more serious for the matrons.

Psychoneuroimmunology is referred to an interfiled in science that studies the psychological, neurological and immunological factors causing various diseases.Present inquiry tries to study, within the domain of psychoneuroimmunology, the personality types and mental health, somatic symptoms, anxiety, depression, and social dysfunction in patients suffering from systemic lupus erythematosus (SLE) and Rheumatoid Arthritis (RA) which are Autoimmune diseases with unknown causes.This research is a post facto and it is performed on a statistical sample of 150 women including 50 persons suffering from SLE, 50 persons with RA and a control group of 50 non-patients. Both of the patient groups have been randomly selected from Tehran and Shiraz residents who referred to the clinics. Research instruments are three questionnaires. Eysenck questionnaire, Bortner personality type A and B questionnaires and the general health questionnaire (GHQ).The inquiry results showed a significant relation between personality type C and the two Autoimmune diseases, SLE and RA, (P=0.0001) and those affected, were less mentally healthy with more anxiety, depression and physical symptoms in comparison with those in the control group. There was not a significant relation between the patients and control group in social dysfunction.This research also revealed that individuals tending towards personality type A as compared to those of type B were less mentally healthy with more anxiety, depression, and physical symptoms.

Deliberate self- burning is very common in some Middle Eastern, Asian and African cultures. About 1.39 to 40 percent of committing suicides had been reported to be self- immolation in different parts of Iran. In a prospective descriptive study, all cases had attempted suicide by burning who referred to the burn center of Mazandaran province have been evaluated to find out psychiatric and physical disorders and medications tionsused.Three hundred and eighteen cases had been identified in three years (264 women and 54 men) and in 74.6% of females and 72.2% of males death resulted. Thirty percent of the cases had important physical disorders that the majority of them were chronic, and 39.1% of the cases were using medications that most of which were psychotropic (27%). About ninety five percent of the cases had one or more psychiatric disorders, the most common of them were: adjustment disorders, nicotine dependence, major depressive disorder, dysthymic disorder and anxiety disorders. Psychoses had been noticed in only 9.6% of all. The prevalence of psychiatric disorders were most common in comparison to western studies, but depression and specially psychoses and other drugs abuse and dependence were less common in both cases of suicide and parasuicide through deliberate self- burning .Regarding the high prevalence of adjustment disorders (42% of parasuicidal cases and 39.8% of suicides), it is necessary to pay special attention to environmental precipitating factors; and it is suggested that the diagnostic category of "adjustment disorder with suicidal ideas" should be pointed out again.  

In most studies the validities of different methods for student assessment have independently been evaluated from each other. In this descriptive-analytical research, 1372 medical students were asked by the three types of questions, so that the result of each method can be compared to that of the other two for each student. Nine classes from different curricula were randomly selected and in each of the them, 30 questions for 10 selected topics were distributed, to a total of 270 questions.The analysis of the students' scores after excluding questions with a discrimination index of less than 0.3, showed that the most valid assessment method was the short-answer question (r=0.685). The kappa coefficients of the short-answer method and the other two methods are in the "fair" range of agreement. The highest coefficient of contingency is between the multiple-choice and true-false questions (0.402). The percentage of correct answers is the lowest in short-answer questions (53%) and the highest in true-false questions (65%). The higher percentage of incorrect answers in multiple-choice (32%) compared to the true-false (26%) questions can be the result of the students being confronted with alternative choices in multiple-choice questions, which apparently encourages them to choose one without using the relevant knowledge.In conclusion, it is recommended to use short-answer and true-false questions as the main components of examinations, instead of only multiple-choice questions, so that students’ learning and recall are tested and they are not misled.

One of the major tasks of medical workforce planning system is establishing a balance between physician supply and demand throughout the country. There are different methods for estimating of specialist demand, one of them is estimation of future demand based on current demand. In this study, attendance to specialists during two weeks and/or hospitalization during one year before initiating the study had been considered as a criterion for demand estimation. Ten thousands urban families (45518 people) in 400 clusters (each containing 25 families) were studied in 17 districts. According to the results, it is predicted that there will be a physician oversupply in pediatrics, OB/GYN, and general surgery specialties until the years 2003-2004.  

There are many pollutants in welding process and surveying their effects on human health is very important. During welding operation many pollutants are produced; various gases such as CO2, CO, O3 and nitrogen oxides and also metal fumes like Fe, Mn, Pb, Cr, and Zn which are the most important and can cause several diseases in welding workers.This study was conducted on 152 welders as the case group and 86 workers who were not exposed to welding as the controls. All of the workers were interviewed and examined, then a spirometry and chest radiography were obtained to investigate probable diseases.Problems including abnormal breathing, cough, sputum, wheezing and also reduction in pulmonary function were the most common findings in some of the welders. Statistical analysis revealed lesser pulmonary functions in the case group than in the control group (p<0.05).The most diminished parameter was observed in FEV1 though it was decreased from 4.4 liters in the controls to 3.7 liters in the case group.Some cases of lung cancer due to presence of chromium-6 have been reported through similar studies. But in this survey, looking forward to cancer was not as the main purpose of the study, although no patient with cancer was seen based on their medical records and it seems necessary that more investigation should be done in this regard.

The aim of this descriptive study was to determine the prevalence of consuming formula milk in urban and rural areas of Takestan. In winter 1998, two different sampling methods were used in the urban and rural areas and finally 480 and 720 children (aged under 2 years) were chosen, respectively, from these areas. Results show that 7.7% of children in urban area (95% CI, 5.3% - 10.1%) and 6.5% in rural area (95% CI, 4.7% - 8.3%) are fed by formula milk. Z-test indicated that these prevalences are not significantly different.  We also found out that the mentioned prevalence for girls and boys in urban area were 8.2% and 7.1% while in rural area were 5.8% and 7.2%, respectively.The logistic regression model showed that in urban area two factors "age" and "employment" of mother is significantly related to the probability of an infant being fed by formula milk. This model also indicated that infant whose mothers have a job are 4.4 times more at risk of being fed by formula milk than by breast feeding.  

Cyclic neutropenia is a rare disorder often presents at childhood and characterized by recurrent infections in regular three-week intervals associated with short course of neutropenia.In this article, we report two cases; one with early diagnosis and another diagnosed at age of 25. Details of pathogenesis, diagnosis and treatment are also discussed.

Better understanding of etiology and pathogenesis of chronic viral hepatitis and new methods for controlling or eradication of pathogenic viruses in recent years, mandates early diagnosis of the disease. An appropriate scoring system is also a necessity for grading the severity of necroinflammatory process and progress of disease. Reproducibility of a scoring system is a basic and important issue for selecting and using such a system. The purpose of this study is to estimate the degree of agreement and correlation between two pathologists using the modified Hepatitis Activity Index.One hundred and fifty series of liver needle biopsy slides obtained from the patients with viral hepatitis were reviewed in a double-blind order by two pathologists who were quite experienced in the interpretation of liver biopsy. Data was analyzed by kappa weighted value statistical method.Interface hepatitis showed the highest point of agreement whereas, this concurrence in grading severity of lesion was moderate. With respect to grading, the two observers had less than 2 scores difference in 63.3% of cases. Since the accuracy and clinical correlation of this system have already been proved by previous studies, this difference probably suggests lack of adequate and required agreement in using histologic criteria for HAI system by our patologists. Holding discussions and workshops will help pathologists to come to a better diagnostic accordance with this respect. In addition, further studies in order to suggest more effective and reproducible histologic criteria for the scoring systems would be necessary.

Even half century after the first use of sulfur mustard as a chemical weapon, it is still being used occasionally in regional and international conflicts. Sulfur mustard is a non-selective alkylating agent, which has been used as chemical warfare many times in last decades. It has devastating effects on numerous tissues and biomolecules and could cause painful death after exposure to its lethal doses. One of the most important enzymes which may be affected by sulfur mustard is acetylcholine esterase (AchE), enzyme responsible for cleavage of acetylcholine and termination of its effect in cholinergic nerve system. The enzyme is the main target for organophosphate and carbamate pesticides.To evaluate the effects of sublethal doses of sulfur mustard on AchE, 500 microlitter of purified serum AchE in phosphate buffer incubated with different concentrations of sulfur mustard at 25°C for 10 min. Determination of enzyme showed a significant reduction of enzyme activity. Also to evaluate effect of oximes on recovery of sulfur mustard inhibited AchE, pralidoxime has been used both before and after incubation. Intraperitonal injections of 5 and 10 mg/kg of sulfur mustard significantly reduced AchE activity in serum, muscles and RBCs. However, the reduction of AchE activity in the liver and brain was not significant. The results of the study indicate that sulfur mustard even in sublethal doses significantly inhibits AchE. However, mechanism of inhibition is different from that of organophosphate pesticides.