ARCHIVES OF IRANIAN MEDICINE
Year:2019 | Volume:22 | Issue:3|Papers Count:10

Background: There is limited evidence about charitable contribution and donation in Iranian healthcare. The main objective of this study was to investigate the factors that influence and encourage Iranian donors to donate money for healthcare facilities. Methods: Data was gathered through semi-structured face-to-face interviews with 36 donors, fund-raisers, and managers of the Iranian health system. Purposive sampling was used to select the participants. The data was analyzed using qualitative content analysis, assisted by MAXQDA 10 software. Results: The factors that affect Iranian donors to donate money for healthcare facilities were (a) feelings of altruism, compassion, concern, pity, sympathy, and obligation; (b) perceptions of difficulties and need in others, similarity with beneficiary, feedback from previous donations, thinking about death, and self-realization; (c) benefits consisted of monetary, social, and psychological benefits; and (d) values including moral, social, and religious values. Conclusion: Better understanding of feelings, perceptions, benefits, and values of donors could improve the fund-raising practices in the Iranian health system.

Background: Iran needs pragmatic screening methods for identifying those with undiagnosed type 2 diabetes or at high risk of developing it. The aim of this study was to assess performance of three non-invasive risk prediction models, i. e. the Finnish Diabetes Risk Score (FINDRISC), the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK), and the American Diabetes Association Risk Score (ADA), for identifying those with undiagnosed type 2 diabetes (prevalent type 2 diabetes at baseline without any treatment) or those who would develop type 2 diabetes within 5 years of follow-up Methods: 3467 participants aged ≥ 30 years without treated type 2 diabetes in the Tehran Lipid and Glucose Study (TLGS) were included in this study. The discrimination power of models was assessed by area under the curve (AUC), their calibrations were assessed by calibration plots and Hosmer– Lemeshow test, and their net benefits were assessed by decision curves. Results: 430 participants had undiagnosed type 2 diabetes at baseline and 203 developed type 2 diabetes during 5 years of follow-up. AUSDRISK had the highest AUC (0. 77) as compared to FINDRISC (0. 75; P value: 0. 014), and the ADA model (0. 73; P value: <0. 001). The original model for AUSDRISK and calibrated versions of FINDRISC and ADA models had acceptable calibration (Hosmer– Lemeshow chi-square <20) and these models were clinically useful in a wide range of risk thresholds as their net benefit was higher than no-screening scenarios. Conclusion: The original AUSDRISK model and recalibrated models for FINDRISC and ADA are valid and effective tools for identifying those with undiagnosed or 5-year incident type 2 diabetes in Iran.

Background: Cancer cells bear various metabolic alterations in order to survive and progress. Neoplastic cells rewire their metabolic pathways for fermentation of glucose and production of more lactate. Microenvironment acidification is a common feature of many neoplastic lesions. In other words, most cancer cells produce energy ineffectively, by aerobic glycolysis, considered as “ Warburg effect” . Mounting on previous evidence, hypoxia also induces tumor stemness, diminished apoptosis, and more invasive behavior as well as angiogenesis. In this study, we aimed to investigate whether more lactate concentration in stereotactic puncture specimen of various brain lesions can be an alarming sign of malignancy and higher grades. The current study aims at providing a rapid prognostic biomarker of higher grades for cystic brain lesions approached stereotactically before the complete pathologic grading report is prepared. Methods: We investigated the biochemical cyst content of 44 patients with astrocytomas, 8 craniopharyngiomas, 1 oligodendroglioma and 2 cases with metastatic lesions after stereotactic surgery (47 patients were enrolled in the study). Cyst fluid was analyzed for pH, total protein concentration, cytology, and lactate. The association of these parameters was explored relative to tumor behavior (e. g., tumor grade, type, and cyst progression). The current study was conducted at Firoozgar hospital, Tehran, Iran. Patients were followed for any possible progression from 2014 to 2017. Results: The analyses revealed a significant and positive correlation between grade and lactate concentration (P ≤ 0. 001); as well as between grade and mean total protein concentration (P = 0. 046). This suggests that more lactate and total protein concentration in stereotactic specimen can be an alarming sign of higher grades and poor outcome in astrocytoma cysts. However, craniopharyngiomas; as benign lesions; had significantly lower lactate (P ≤ 0. 001) and total protein concentrations (P = 0. 018) than astrocytomas. Conclusion: Higher total protein and lactate concentrations in the stereotactic biopsy specimens are alarming signs of poor outcome and higher grades in astrocytomas.

Background: The optimal management for patients with concomitant severe coronary artery disease (CAD) and carotid artery stenosis (CAS) remains controversial. We reported our preliminary experience on a synchronous hybrid strategy. Methods: Seven patients with synchronous percutaneous coronary intervention (PCI)/carotid endarterectomy (CEA)/coronary artery bypass grafting (CABG) and 36 patients with synchronous CEA/CABG were enrolled. Then we analyzed the demographics, risk factors and 30-day results of the 2 groups, retrospectively. Results: The 2 groups were comparable in demographics. The operation time was 312. 14 ± 40. 08 minutes for synchronous PCI/CEA/CABG and 294. 58 ± 47. 62 minutes for synchronous CEA/CABG (P = 0. 367). The intraoperative blood loss was 814. 29± 195. 18 mL for synchronous PCI/CEA/CABG and 769. 44 ± 330. 21 mL for synchronous CEA/CABG (P = 0. 731). There was no death in the 2 groups within 30 days. The incidence of primary endpoint [stroke, myocardial infarction (MI) and death] was 14. 29% (1/7) in synchronous PCI/CEA/CABG group and 5. 56% (2/36) in synchronous CEA/CABG group. The difference between the 2 groups was not statistically significant (P = 0. 421). Conclusion: Synchronous PCI, CEA and CABG may be safe and effective in the management of patients with concomitant CAS and complicated multi-vessel CAD. The current data suggested that more studies and randomized controlled trials may be necessary to define whether this strategy is suitable for these patients.

Background: Psoriasis (Ps) is a chronic skin disease that can lead to negative impacts on quality of life (QoL) because of disease-related comorbidities. We aimed to investigate the risk of obstructive sleep apnea syndrome (OSAS) in patients with Ps. Methods: Fifty-seven patients with Ps were included in this study. The patients were evaluated for their demographics, Psoriasis Area Severity Index (PASI), duration of disease, Psoriasis Quality of Life Index (PQLI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and also Berlin questionnaire (BQ), in terms of the risk groups of OSAS. High and low risk groups were compared with above-mentioned parameters. Results: Of the patients studied, 35 (61. 40%) were at high-risk according to BQ. In the high-risk group, body mass index (BMI) was significantly high (P = 0. 009), and they were all obese. The mean values of PASI, disease duration, PQLI and PSQI were significantly higher in the high-risk group compared to the low-risk group (each P < 0. 05). PASI (P = 0. 013), BMI (P = 0. 014), PLQI (P = 0. 012) and hypertension (HT) (P = 0. 030) had significance in prediction of OSAS development, whereas only PASI and BMI showed significant impacts. It was seen that increase in BMI values was slightly more effective than increase in PASI values (1. 25-fold against 1. 07-fold) in development of OSAS. Conclusion: We suggest patients with severe and long-term Ps should be evaluated in terms of OSAS, and OSAS may be accepted as a comorbidity for Ps in the future.

Background: Transcranial direct current stimulation (tDCS) is a non-invasive method that improves learning and memory. In this study, the effect of tDCS on streptozotocin (STZ) induced amnesia in the presence or absence of SCH23390 (D1 dopamine receptor antagonist) and sulpiride (dopamine D2 receptor antagonist) has been investigated in male Wistar rats. Methods: Passive avoidance memory, locomotor activity and pain perception have been assessed by step-through, open-field and hot-plate instruments, respectively. Anodal and cathodal tDCS were exerted on the left frontal cortex with an intensity of 0. 2 milliamps for 20 minutes twice a day in 2 successive days. Results: Our study showed that STZ at doses of 30 and 60 mg/ml/kg caused amnesia, while they did not alter locomotor activity and a higher dose of STZ induced analgesia 14 days after injection. SCH23390 (0. 001 mg/mL/kg) and sulpiride (0. 1 mg/mL/kg) did not alter memory formation by themselves and amnesia induced by STZ (30 and 60 mg/mL/kg), while SCH23390 restored the analgesia induced by STZ (60 mg/mL/kg). Moreover, left frontal anodal and cathodal tDCS restored memory impairment induced by STZ (30 and 60 mg/mL/kg). Also, SCH23390 and sulpiride could prohibit the anodic stimulating effect on memory impairment induced by a dose of 60 mg/ml/kg, but they did not hinder the effect of the cathodal stimulation on this phenomenon. Conclusion: The study showed that D1 and D2 dopamine receptors are involved in the restoration effect of left frontal anodal-but not cathodal-tDCS in STZ-induced amnesia.

Ordinary linear regression (OLR) is one of the most common statistical techniques used in determining the association between the outcome variable and its related factors. This method determines the association that is assumed to be true for the whole study area – a global association. In the field of public health and social sciences, this assumption is not always true, especially when it is known that the relationship between variables varies across the study area. Therefore, in such a scenario, an OLR should be calibrated in a way to account for this spatial variability. In this paper, we demonstrate use of the geographically weighted regression (GWR) method to account for spatial heterogeneity. In GWR, local models are reported in which association varies according to the location accounting for the local variation in variables. This technique utilizes geographical weights in determining association between the outcome variable and its related factors. These geographical weights are relatively large (i. e. close to 1) for observations located near regression point than for the observations located farther from the regression point. In this paper, we demonstrated the application of GWR and its comparison with OLR using demographic and health survey (DHS) data from Tanzania. Here we have focused on determining the association between percentages of acute respiratory infection (ARI) in children with its related factors. From OLR, we found that the percentage of female with higher education had the largest significant association with ARI (P = 0. 027). On the other hand, result from the GWR returned coefficients varying from-0. 15 to-0. 01 (P < 0. 001) over the study area in contrast to the global coefficient from OLR model. We advocate that identifying significant spatially-varying association will help policymaker to recognize the local areas of interest and design targeted interventions.

The aim of the presentation of this case is to discuss whether there is an association with eosinophilic granulomatosis with polyangiitis (EGPA) and the use of montelukast, and clarithromycin and to discuss a successful treatment course. A 4-year-old girl with a preceding history of asthma attacks and increased eosinophil counts was admitted. She had been using clarithromycin for five days and montelucast for a month. She was eventually diagnosed with EGPA with detailed examination. Clinicians should remember EGPA in children with asthma and hypereosinophilia. Patients receiving leukotriene receptor antagonists and/or macrolides should be monitored for developing a multisystem disease. Treatment with immunosuppressive agents may be required to ensure a good prognosis.

Dear Editor, I read with great interest the article by Ghelichkhani et al1 regarding cigarette and hookah inequality in Iran. The authors used the Blinder-Oaxaca decomposition method to determine the associated factors with inequality. As a researcher who first introduced this method in Iran. 2-10 I noticed some critiques in using this method as listed below. . . .

In response to Dr. Emamian’ s comments about our published article, 1 we feel obligated to clarify some points. First, I should point out that the phrase, “ As a researcher who first introduced this method in Iran” in Emamian’ s letter seems to be technically incorrect since only the developer of a technique or model can make such a bold claim. Merely applying an existing statistical model on some datasets does not provide anyone the right to refer to themselves as the introducer. . . .