HAKIM RESEARCH JOURNAL
Year:2004 | Volume:6 | Issue:4|Papers Count:17

Introduction: Efficiency is one of the most important criteria for resource allocation in all organizations. Measurement of efficiency needs almost complex mathematical and statistical procedures with advanced expertise. The main objectives of this study were establishment of a new and practical method for estimating efficiency in district level and to apply it in Golestan province health centers during 1999-2001.Methods: In order to measure deprivation, input and output four, eight and thirteen indicators were selected, respectively. Data were gathered from routine data sources of district health network including DTARH software, census and statistical forms. Main factors of deprivation, input and output were determined by principle component analysis. Each factor was weighted, based on variances in the model, to build combined indicators for deprivation, input and output, separately. Linear regression analysis was used to determine expected output for a given deprivation and input. Efficiency of each district in any interval could be determined based of absolute difference on observed and expected outputs.Results: Though principle component analysis one indicator was selected for deprivation, three for input and three for output. Gonbad and Minodasht districts had the maximum (2.69) and minimum (-2.84) efficiencies among all Golestan province districts, respectively. Gonbad had the highest efficiency during 1999 and 2000 with 0.06 and 7.04 scores. Agh-ghala illustrated the highest efficiency in 2001 with 0.46 score. Minodasht showed the lowest scores during all of three years with -7.02, -0.87 and 0.41 scores.Conclusion: Trend of efficiency illustrates less variation in 2001 in comparison with 1999. This difference could be explained by appropriate allocation of resources and management that have been performed in recent years. Further studies are necessary to improve model validity for determination of efficiency. These studies could be fulfilled with more districts data and with a wider range of indicators.

Introduction: Marginal zinc (Zn) deficiency due to hyper-zincuria is possible in patients with diabetes mellitus (DM). Zn supplementation, therefore, can be regarded as a suitable "back up" strategy in the management of DM. In this 11-week double-masked clinical trial we investigated the effects of a low-strength Zn sulfate supplement on metabolic control indices in children with type I DM. Methods: Thirty-one 5-15 years children with at least 1.5 year DM history, without any other metabolic condition were randomly divided into Zn-supplemented (10 mg elemental Zn per day) and/or placebo groups after matching for sex, age and DM duration. Twenty-six children fulfilled the study. Weight, fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c), total cholesterol (TC), low density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c) and triglyceride (TG), levels were determined at the beginning and end of trial.Results: In Placebo group, HbA1c, FBS, TC, LDL-c, HDL-c and TG levels changed from 9.7±0.4 to 10±0.5%, 243±26 to 241±22 mg/dl, 160±6 to 154±7 mg/dl, 95±23 to 93±19 mg/dl, 51±4 to 45±2 mg/dl and 68±7 to 85±12 mg/dl, respectively. Corresponding values for Zn supplemented group were 9.9±0.5 to 10±0.5%, 250±23 to 217±36 mg/dl, 176±6 to 161±6 mg/dl, 113±19 to 91±14 mg/dl, 55±5 to 47±3 mg/dl and 88±12 to 95±13 mg/dl, respectively. Only serum LDL-c significantly decreased within Zn supplemented group (P<0.003.(Conclusion: It seems that low-dose Zn supplementation is a safe compensatory strategy for hyper-zincuria in patients with type I DM.

Introduction: Helicobacter pylori (HP) infection is one of the most prevalent human infections. It is the main cause of peptic ulcer disease and one of the predisposing factors for gastric cancer. Reinfection rate after eradication is quite uncommon in adults, but in only study in Iran it has been 19.1% in one year. We have studied the rate of reinfection 3 years after successful eradication.Methods: All patients with Helicobacter pylori eradication 3 years before the beginning the study and negative UBT test one year after eradication have re-called for completion of questionnaire and UBT test. All UBT positive cases underwent endoscopy and antral biopsy was taken for rapid urease test, and biopsies from stomach antrum and body was taken for pathological study.Results: Out of 98 patients enrolled into the study, 20 patients (20.4%) had positive UBT test, of 19 accepted endoscopy, 4 cases had positive rapid unease test (4.1%) and all these patients with another patient had positive Helicobacter pylori pathology (5.1%).There was significant improvement in clinical symptoms (p<0.005) after successful eradication of Helicobacter pylori which had sustained in 3 years of follow up.Conclusion: Reinfection rate 3 year after successful eradication of Helicobacter pylori in our region is 20.4% (@10.2% / year); if we rely on to only one test result (UBT test). If we consider the result of another diagnostic test, this rate declines to 5.1% (@ 2.3% /year).

Introduction: Diagnosis of tuberculous meningitis is one of the most complex issues in medicine. Early diagnosis decreases the mortality rate and neurological deficits of the disease. Current methods of diagnosis of TB meningitis are either expensive (e.g. PCR) and limited to reference research centers (e.g. gas liquid chromatography) or have low sensitivity in cerebrospinal fluid (CSF). Also, like other Mycobacteria, culture could take a long time to give results. The aim of this case- control study was to determine the importance of different levels of adenosine deaminase (ADA) enzyme in early diagnosis of the disease by measuring its different levels in CSF which is a relatively cheap and fast method. Also, it was intended to determine the best cut off point in comparison to other studies. Methods: Seventy-one admitted patients with diagnosis of meningitis were divided into two groups: 15 patients us TB and 56 patients as non TB group. The level of ADA and routine tests on CSF of all the patients has been performed in one laboratory. HIV positive patients were excluded from the study.Results: The ADA mean in the first group was 20.8 IU/L (± 13.24) and 9.75 IU/L (± 5.85) in the second group, which showed a significant difference in the two groups (p=0.001). None of the variables like glucose, protein level, white blood cells count and lymphocyte's percentage in the CSF result were confounding factors. The sensitivity and specificity in the cut off point >11 IU/L for the ADA enzyme in diagnosis of TB meningitis was 73% and 66%, respectively.Conclusion: The results of some studies show that the cut off point in Spain, Chile, India and Malaysia are lower than that of ours. Therefore, the sole measurement of this enzyme is not useful and it is necessary to take other factors into account for early diagnosis.

Introduction: Factor XIII deficiency is a very rare bleeding disorder. Its prevalence is estimated to be 1 in 1-2 million. This study was carried out to measure the prevalence of deficiency and its clinical picture in Sistan and Baluchestan province with a population of 1.5 million and a very high rate of consanguinity.Methods: During 1997-2002 all patients admitted in or referred to our hospital (which is the only center in the province with sub-specialty for bleeding disorders) with bleeding complaints, delayed wound healing, delayed umbilical bleeding or recurrent abortions and had normal routine coagulation tests, were screened by clot solubility test (1% monochloroacetic acid). Since 2001 the diagnosis has confirmed by measurement of plasma factor XIII levels.Results: We were able to detect 44 patients with abnormal clot solubility tests; among them, we performed factor XIII level measurement in 13 patients, which all had low factor XIII levels. Most common symptoms were delayed umbilical bleeding (84%) echymosis and hematoma (69%) and delayed wound healing (66%). Intracranial bleeding occurred in 4 patients with abnormal clot solubility, resulted in 1 case of death and another case of hemiplegia. There was no patient referred for recurrent abortions.Conclusion: The prevalence of factor XIII deficiency is very high in this area and is the second most common congenital bleeding disorder related to coagulation factor deficiencies in this province (17%). DNA analysis studies are needed to explain this finding.

Introduction: Relationship between psychiatric disorder and immune system has been the center of interest among researchers for years. Recent findings concerning the impairment of immunity in depressed patients has provided valuable clues for further research and understanding the multiple aspects of psychiatric disorders. But, there is almost lack of evidence about immunity in bipolar disorders. In this study, our aim was to evaluate the immune system of patients with bipolar I disorder (during manic episode) compared with normal subjects.Methods: Twenty-four manic patients (15 male, 9 female) and 26 normal subjects (15 male, 11 female) aged 15-50 were clinically interviewed by authors and underwent the study. At entry (before treatment with lithium and haloprideol) a blood sample was taken from all subjects and the function status of cellular immunity was evaluated by measuring lymphocyte transformation test (LTT) against PHA Mitogen and indices of T cell function including: CD4, CD8, CD3 and CD4/CD8 ratio as well as CD56; an index of natural killer cells. The measurement was repeated for all subjects 2 months, after clinical remission of patients.Results: T- test and Levene’s test showed a significant difference between patients and control subjects in LTT but not in other indices. The proliferation of the patients’ lymphocytes was lower in comparison to the subject group, but regarding variables such as CD4, CD8, CD3, CD4/CD8, CD56 there was no significant difference.Conclusion: The results are an evidence for impairment in cellular immune system of bipolar I patients (manic phase) and show that the proliferation of immune cells against mitogen was lower than the control group but it needs more research about this issue. 

Introduction: Lithium as a first choice drug for controlling the acute phase of mania is widely used and relatively safe, but it has a major drawback which is the occasional of adverse effects in some patients with even low plasma concentrations. Therefore, there is an increasing need for a precise method able to predict the accuracy of adverse effects.Methods: This descriptive- analytic study was undertaken on a group of patients with bipolar I disorder (manic phase). The relationship between lithium induced adverse effects and three laboratory indices were assessed; the indices included plasma lithium concentration, lithium concentration in red blood cells (RBCs) and the RBC/ plasma concentration ratio. Changes in Extrapyramidal Symptoms Rating Scale (ESRS), Abnormal Involuntary Movement Scale (AIMS) and Mini Mental Status Examination (MMSE) scores and clinical evaluation of tandem walk, rapid alternative movement, tremor, myoclonus and muscle force were considered as measures for adverse effects. After six weeks of treatment the association of each adverse effect with lithium concentrations was assessed using statistical tests. Results: The findings show that adverse effects such as dystonia, dyskinesia, and cerebellar signs were correlated.Conclusion: Measurement of lithium concentration in RBCs, could be of value in prediction of some neurological adverse effects of lithium.

Introduction: Tracheal extubation may be accompanied by cardiovascular alterations such as hypertension, tachycardia, etc which can be dangerous in high-risk patients. In this study the effects of oral clonidine, as premeditation, on the reduction of cardiovascular complications following tracheal extubation was evaluated.Methods: In a double-blind clinical trial, 99 patients candidated for elective upper extremity surgery at the end of general anesthesia were divided into 3 groups. Patients received premedication 0.2 mg oral clonidine (group 1), 0.4 mg clonidine (group 2) and vitamin B6 as a placebo (group 3). Alterations in blood pressure and heart rate five minutes pre- and post- extubation and during extubation were recorded.Results: Homodynamic instability was reduced in groups receiving oral clonidine in comparison with control group. Conclusions: There was no significant difference between the two groups of 0.2 mg versus 0.4 mg oral clonidine in blunting deleterious hemodynamic effects during extubation. We recommended the use of 0.2mg oral clonidine in patients who are at risk of cardiovascular disease.

Introduction: Mortuary service employees are subjected to daily stressful events such as bereavement rituals, the death issue, and undesirable social attitudes concerning their business.  These sources of stress may affect mental health of this population. The present study was designed to investigate the possible relationships between mental health, and job satisfaction of a group of mortuary institute employees.Methods: 250 employees out of 500 total personnel of Behsht-Zahra mortuary service of Tehran were studied. All corpse bathers (n=42), all grave yard personnel (n=29), and a group of systematically randomized selection of other works were requested to take part in the study.  Those who had high-school education (12 years of formal education) completed a demographic and job satisfaction questionnaire and General Health Questionnaire (GHQ-28) as self-report, while those who had lower education the questionnaires were completed with the help of a trained interviewer.Results: Findings revealed that those with higher education had more psychological problems in contrast to their counterpart colleagues.  About 38.1% of the corpse bathing personnels and 29% of the office workers suffer from a psychiatric problem. Highest job satisfaction was relevant to peer relationship and lowest was for negative social cognition about this carrier. The office workers and corpse bathers had the highest and lowest job dissatisfaction, respectively. There were positive and significant correlations between aspects of job dissatisfaction and decrement in mental health state of the personnels.Conclusion: The results suggest that people working in mortuary services are more prone to psychiatric illnesses.  Job satisfaction is highly relates to mental health in the mortuary service personnel.

Introduction: Exact diagnosis of bacterial agents in soft tissue abscesses is an important value in antibiotic therapy. This study was performed on 110 patients with soft tissue abscesses to evaluate the causative agents and, their antibiotic response, in vitro.Methods: Samples were collected from 110 patients with skin and soft tissue abscesses which were refered to clinical laboratories in Kerman city and then the samples were cultured by routine microbiological methods for isolation of microbial agents. The antibiogram disc agar diffusion technique was used to evaluate the sensitivity of microbial agents to antibiotic.Results: The aerobic microbial agents of soft tissue abscesses included Staphylococcus aureus (51.8%), β-hemolytic Streptococcus spp (12.7%), Pseudomonas spp (10%), Klebsiella (8.2%), coagulase negative Staphylococci (6.4%), Escherichia coli (6.4%), Enterobacter (4.5%). The highest rate of bacterial sensitivity belonged to ciprofloxacin (95%). After that, erythromycin (79.6%) and gentamicin (61.4%) were the most efficacious antibiotics for aerobic microbial treatment in soft tissue abscesses, respectively. The highest rate of microbial resistance belonged to penicillin G (78.3%) and amoxicillin (65.4%), respectively. Conclusion: This study shows that Staphylococcus aureus is the most common etiologic agent in soft tissue abscesses, and regarding the emergence of microbial resistant to current antibiotic therapy, it is recommended that culture and arteriogram must be performed to choose appropriate antibiotics.  

Introduction: Lipopolysaccharide (LPS) of Brucella abortus is important in brucellosis diagnosis and as one of the components for developing a subunit vaccine against brucellosis. Comparision of LPS extraction methods and evaluation of B. abortus LPS toxicity have been considered as the goal of this research.Methods: Brucella abortus LPS was extracted by n-butanol and hot phenol method, in E.coli by hot phenol, then they were purified by ultracentrifugation. B. abortus LPS was detoxified by alkaline treatment. LPS SDS-PAGE was performed with polyacrylamide gels and stained with silver stain. Results: Purified LPS from B.abortus by butanol extraction was shown to have less than 2% (wt/wt) contamination by protein and less than 1%(wt/wt) contamination by nucleic acids. In addition, purified LPS from B.abortus and E.coli extracted by phenol were shown to have below 4% (wt/wt) contamination by protein and below 1.5% contamination by nucleic acids. The electrophoresis pattern of B.abortus LPS and E.coli LPS was the same as the former studies. Pyrogenicity test of B.abortus LPS (10 μg/ml) and E.coli LPS (0.5 μg/ml) was positive, but D-LPS (10, 50μg/ml) was negative. In LAL test, 10 ng/ml of D-LPS was negative, but 0.04ng/ml of B.abortus LPS was positive and endotoxin unit of B.abortus LPS was less than E.coli LPS.Conclusion: Results show that the amount of LPS of extracted by phenol method is higher, and protein, nucleic acids contamination rate in butanol method is very low. In addition, D-LPS toxicity is severely decreased, hence, we can use several as many as B.abortus LPS for stimulating immune system. Besides, ability of B.abortus LPS is likely much less than the LPS from E.coli to evoke endotoxic shock, and it can be used as immunogen directly.

Introduction: One of the most important factors influencing research development is the ease and rate of different resources such as data banks. OVID, a well known electronic resource containing various set of databases is one of them. This survey was carried out to evaluate usage of OVID by academic members.Methods: Data was collected via Office of Statistics and Computer Services, Deputy for Research, Ministry of Health and Medical Education. The number of academic member of each university was determined as an index to define variables as follow: daily use of academic members, use of database per capita and daily use of database per capita for Journals@ Ovid, MEDLINE, EBMR, Pre Medline databases. Data collection period was 6 months.Results: On average each academic member search was 12.56 phrases in 125.56 minutes in 5.23 sessions for 182 days. The daily use of all academic members was searching 15 phrases in 167 minutes in 7 sessions.Discussion: Prominent low usage of OVID raises hypothesis as low tendency for research, inappropriate facilities provided, use of other resources and poor information system performance of universities. KAP study performance is recommended for investigating causes of low usage among academic members.

Introduction: This study has been done to investigate the effect of group counseling on the quality of life of the patients suffering from myocardial infarction.Methods: A number of 62 patients with myocardial infarction were referred to Imam Khomeini and Shariati Hospitals were assigned to two groups: intervention and no intervention groups. Some factors such as age, sex, education level and the number of heart attacks were matched in the above groups. For 31 of the patients in the intervention group, 6 to 7 group counseling session were performed 2 days a week, each session would last 1 hour. However, no counseling was done for the control group. The quality of life in both groups was assessed by Mac New QLMI questionnaire, before the counseling program, and one month after that, and the quality of life in both group were compared. Data were analyzed using SPSS, Windows version.Results: Independent t-test showed that the quality of life score before the group counseling had not a significant difference between the two groups (p=0.99). Meanwhile, after the group counseling the same test with P= 0.001 indicated a significant difference between the two groups. Paired t-test revealed that the quality of life score before and after the group counseling in the intervention group with P<0.001 has a significant difference. Pearson correlation coefficient test with P= 0.002 revealed that there was a significant correlation between the duration of suffering from myocardial infarction, and the quality of life score. The effectiveness of the designed counseling program on the quality of life according to the growth test was assessed as 24.08.Conclusion: Considering the results, it is recommended that group counseling program should be used to increase the quality of life of the patients suffering from myocardial infarction.