Iranian Red Crescent Medical Journal
Year:2011 | Volume:13 | Issue:3|Papers Count:15

In the past two decades, the international health efforts have been focused on the control of infectious diseases in developing countries with noncommunicable diseases (NCDs) given a lower priority.However, the incidence of NCDs including chronic kidney disease (CKD) is increasing in developing countries where primary care intervention for CKD is often inadequate. The main international focus is now on NCDs including diabetes mellitus (DM), hypertension, obesity and chronic airway obstruction.Most of the NCDs share common risk factors which are potentially amenable to behavioral modifications including smoking, unhealthy diet, physical inactivity and stress. These diseases can usually be detected by simple tests which are available in primary care settings even in low and middle income countries. CKD which is often caused by underlying diseases such as DM and hypertension can be effectively prevented by detection and treatment of these diseases.

Background: Since 2005, pediculosis is one of the obligatory reportable diseases from community to the Center of Disease Control. This study is the first nationwide survey on the prevalence of pediculosis and some associated risk factors in Iranian children and adolescents.Methods: National data of the Ministry of Health and Medical Education were gathered in 2005 through school screening programs and obligatory reports from the country health centers.Results: 12, 359, 448 Iranian children and adolescents were screened in 2005. Overall, 213, 450 students, consisting of 198, 947 girls and 14, 320 boys were reported to have pediculosis. The prevalence of pediculosis was 581 per 100, 000 population that varied from 1/100 000 to 8, 303/100, 000. In general, the highest prevalence of pediculosis was documented in south-eastern cities. The prevalence of pediculosis was significantly higher in girls than in boys (93% vs.7%, respectively, p<0.0001). In both genders, the highest prevalence of pediculosis was documented in the 6-10- year age group. Of those infected, 62% lived in rural areas, and 32% of those infected with pediculosis had a previous history of this infection. Most (99.37%) infected individuals had head lice, the rest had body and pubic pediculosis.Conclusion: The prevalence of pediculosis is low in Iranian children and adolescents, but this infestation is still a health problem in some south-eastern cities with warm climate and low to middle socioeconomic status.

Background: Coronary artery bypass graft (CABG) is a treatment strategy to relieve the symptoms of coronary artery disease (CAD). Based on determining the long term outcome of CABG using SF-36 Health Related Quality Of Life (HRQOL) questionnaire, the present study was conducted in our center to determine the CABG results one-year after the operation.Methods: Between March 2005 and August 2009, 112 patients with coronary heart disease (CHD) who underwent coronary artery bypass graft (CABG) were enrolled. Patients completed SF-36 HRQOL general health status questionnaire. Stepwise multiple linear regression models were used to detect independent variables predicting changes in each eight subscales of SF-36 questionnaire.Results: The mean age of patients was 61.4±0.9 years and most of them were male with three vessel diseases that were on pump CABG. The mean physical and mental component summary scores were 59.5±0.9 and 60.2±0.9, respectively. Physical functioning (PF) and role physical (RP) improved in males. Regression models showed that there were some statistical models with low R-square to predict role emotional (RE), general health (GH), PF and RP according to ejection fraction after surgery, diabetes, pump type of CABG and male gender.Conclusion: CABG has led to higher and more satisfactory outcomes for PF, RP and RE but lower in other scales comparing with normative data of the society and one-year post-operative scores of other studies. It could mostly be attributed to unmodified risk factors and progression of existing comorbidities.

Background: Reamed interlocking intramedullary nailing is considered the gold standard treatment for complex fractures of the femoral and tibial shaft. There has been some controversies about dynamization of statically locked nails, and some authors recommended routine dynamization for promotion of healing. This study aims to evaluate treatment of complex fractures in tibia and femur with static interlocking intramedullary nail method.Methods: In a retrospective study from January 2003 to April 2008, 173 patients with femoral and tibial shaft fracture that were treated with this method were enrolled. No rod was dynamized in our patients.Results: All patients with tibial fractures achieved union without any need for dynamization during 12-18 weeks (mean; 13.4 weeks). Four patients developed delayed union but all achieved union without any intervention. In femoral fracture, all but one patient achieved complete union during 10-30 weeks (mean: 18.3 weeks). One patient developed non-union who was treated by an exchange nailing and iliac bone graft method. No significant complication was observed in our patients.Conclusion: It is not necessary to routinely dynamize nails in tibial and femoral shaft fractures as all fractures united in acceptable alignment without any complication.

Background: In osteoporotic patients, inferior mandibular cortex undergoes resorption which its manifestations can be detected on dental panoramic radiographs as a simple and available method. The aim of this study was to evaluate the correlation between width and morphology of mandibular inferior cortex in digital panoramic radiography and postmenopausal osteoporosis.Methods: Bone mineral density (BMD) of lumbar vertebrae and femural neck of 119 postmenopause women was assessed using DXA. Width [cortical index (CI)] and morphology [mandibular cortical index (MCI)] of inferior mandibular cortex were measured and the correlations between BMD and width and shape of the inferior mandibular cortex were evaluated.Results: The specificity and sensitivity in identifying women with low BMD of lumbar vertebrae by visual cortical estimation (normal or eroded) were 69.4% and 80.7% respectively. These results in identifying women with low BMD of femural neck were 67.7% and 81.5% respectively. For both sides, the threshold value that provided the highest validity (minimal false negative and false positive results) corresponded to cortical width of 4.29 mm. This threshold in lumbar vertebrae or femural neck provided a sensitivity of 81.4% (95% CI=69.1%-90.3%), specificity of 58.3% (95% CI=44.9%-70.9%), positive predictive value of 65.8% and likelihood ratio of 1.95. There were significant associations between BMD and CI and MCI.Conclusion: Postmenopausal women with thin or eroded mandibular inferior cortex may have an increased risk for low BMD or osteoporosis.

Background: The combination of cisplatin and 5-fluorouracil (PF) is currently considered a standard and effective regimen for the treatment of advanced head and neck carcinomas. The aim of this study was to evaluate the efficacy and safety of docetaxel, cisplatin and 5-fluorouracil (TPF) in patients with unresectable head and neck carcinomas.Methods: Forty-six patients with previously untreated non-metastatic stage IV head and neck carcinomas were enrolled.All patients received three cycles of induction chemotherapy with docetaxel (75 mg/m2), cisplatin (40 mg/m2) (days 1-2), and 5-FU (500 mg/m2, days 1-3), repeated every 21 days. Following induction chemotherapy, all patients underwent concurrent chemoradiotherapy using weekly cisplatin (30 mg/m2) and a median total dose of 70 Gy was delivered. Clinical response rate and toxicity were the primary and secondary end-points of the study.Results: There were 31 men and 15 women. All patients had non-metastatic stage IV (T2-3N2-3 or T4N0-3) of disease. Overall and complete response rates were 74% and 24% respectively. Advanced T4 classification was associated with poorer response rate (p value=0.042). The major (grade 3-4) treatment-related toxicities were myelosuppression (78%), anorexia (13%), diarrhea (7%), emesis (11%) and stomatitis/pharyngitis (24%).Conclusion: In comparison with the data of historical published trials of the PF regimen, the TPF regimen was more effective. However, the TPF regimen appears to be associated with a higher incidence of major toxicities.Therefore, our limited findings support the TPF regimen as an alternative chemotherapeutic regimen for advanced head and neck carcinomas.

Background: The age in menopause and frequency of menopausal symptoms differ in different societies. This study evaluates the distribution of age at normal menopause, the frequency of menopausal symptoms and the associated factors in Babol, Northern Iran.Methods: In a community based study, the Symptom Score Card was used to assess the frequency and severity of menopausal symptoms. Data from 1, 397 women around 45-63 years old in Babol, northern Iran were enrolled.Subjects were selected using the standard cluster sampling techniques.Results: In urban areas, the median age at menopause was 48 years. The five most prevalent symptoms were irritabilities (72.1%), joint pains (70.6%), backache (61.2%), hot flushes (49.3%) and headache (49.2%) during the previous two weeks. More than 60% of women experienced hot flushes. Low educational level (OR=0.70; 95% CI=0.54, 0.90), early age at menarche (OR=0.76; 95% CI=0.59, 0.99) and oral contraceptive use (OR=0.76; 95% CI=0.54, 0.97) were significantly associated with hot flushes.Conclusion: It could be beneficial to provide evidences to manage menopausal women in Primary Health Care centers as a cost effective method. Emphasis should be placed on practical education of women to raise their knowledge on menopausal symptoms and ways of increasing their understanding on midlife experiences.

Background: Women with recurrent and severe symptoms are diagnosed as having premenstrual syndrome (PMS), and if they suffer from severe affective symptoms, a diagnosis of premenstrual dysphoric disorder (PMDD) is made. The purpose of this study was to determine the association of work stress with PMS and PMDD.Methods: Fifty-five female medical students in their internship program (ten 24-hour shifts per month) and 38 third-year female medical students without any shift duties were asked to participate in this study. A questionnaire was used to record demographic information and a self-report inventory was used to measure 13 symptoms relevant to PMS and PMDD according to DSM-IV criteria. All participants were asked to complete the inventory every night around midnight for those on shifts or before going to bed at home for 60 consecutive nights.Results: Out of 55 volunteers in the shift-work group, 31 (56%) fulfilled the diagnostic criteria for PMS in contrast to 12 (32%) in the control group. The frequency of PMDD was 12 (22%) in the intern group and 5 (13%) in the control group. Twenty one students (55%) from the control group did not have PMS or PMDD, compared to 12 (22%) students from the shift workers. Decreased energy (70.9%) and irritability (65.4%) were the most frequent symptoms during the luteal phase in the shift-work group.Conclusion: Work stress and an increase in responsibility may produce or exacerbate PMS. Self-help approaches to induce self-awareness, along with psychological and psychiatric interventions, may help susceptible women to overcome this cyclic condition in order to increase their productivity as well as their quality of life.

Background: One of the features of Mission Based Management is measuring the activities of faculty members and departments and their contributions to the school's mission. As it is important to assess the school's readiness for such a system, in this study we assessed the viewpoints of Tehran Medical School's department chairs about faculty members’ activities.Methods: We used focus group technique to identify participants' viewpoints. We divided 30 department chairs into homogenous groups of 4-6. After a brief introduction, the moderator presented questions to determine the participants' idea and a secretary recorded them. We categorized viewpoints into main themes and subthemes.Results: Ninety three percent of chairs participated in the sessions. Department chairs' viewpoints were categorized into 3 main themes: "system is effective and important", "system is effective and important but some challenges should be considered" and "system is ineffective and should not be implemented". Subthemes included chairs' concerns, views, fears and reasons.Conclusions: The results of the study provided reliable information about department chairs' concerns and reactions to this system. Finally, we determined points of strengths and anticipated threats for developing a faculty member activity measurement system.

Mucormycosis is a rare fungal infection caused by organisms of the order Mucorales often occurring in diabetics or immunologically compromised patients. To date, only one case of primary mucormycosis of breast has been reported in the English literature. We describe a further case of mucormycosis that was localized to the breast in a patient with no underlying disease and was successfully treated with a simple mastectomy and intravenous antifungal therapy.

A 26-year-old lady with the diagnosis of multiple sclerosis who had received interferon beta1-b for eleven months was visited in MS clinic of our hospital because of icter and fatigue. Laboratory tests showed anemia, indirect hyperbillirubinemia, increased LDH, positive direct and indirect coomb’s tests, and increased reticulocyte count and percentage. Other causes of autoimmune hemolytic anemia (AHA) and pre-existing AHA in the patient were ruled out. After INF discontinuation, symptoms disappeared, hemoglobin increased, and indirect coomb’s test became negative. We concluded that autoimmune hemolytic anemia should be considered in all MS patients who receive interferon beta1-b and present with symptoms and signs of anemia.

Gasoline burn is one of the major causes of thermal burns even in the developed countries. Lack of understanding on explosive nature of gasoline has resulted into its inappropriate and unsafe use. In order to determine the frequency and outcomes of gasoline burns in our center in Tehran, Iran, we reviewed the hospital records of all acute gasoline burns during the last year.Patient’s age groups and their jobs, the mechanism of burn, Total Body Surface Area (TBSA), total hospitalization days, frequency of inhalation injury and mortality during their hospital admission were determined.

The colorectal cancer is the forth prevalent cancer worldwide. The incidence and mortality of colorectal cancer (CRC) in men and women has been estimated more than 1.233 million cases and nearly 610000 deaths annually respectively. It is also the forth prevalent cancer in Iran. The CRC occurrence is correlated with genetic and non-genetic factors such as missense and non-missense mutations in a tumor suppressor P53 gene.3 It is known that most of point mutations happen in exons 5 to 8 of the P53 gene with different prevalence in different regions.

About one out of three patients referred to dental clinics have a medical problem with most common being cardiac, respiratory, and cerebrovascular diseases.As a health care provider, dentists must be prepared for prevention, diagnosis and treatment of medical emergencies (MEs) in dental office, by means of basic recommended emergency equipment’s, emergency drugs and an appropriate knowledge. To assess the knowledge and preparedness of Mashhad (in north east of Iran) general dentists about common MEs in dental settings, a cross sectional, analytical study was performed using a self-stablished questionnaire.

We present a case of non-fatal poisoning with oleander decoction in a 24-year-old pregnant woman.Nerium oleander, an evergreen ornamental plant, native in the Mediterranean, is cultivated worldwide particularly in warm temperate and subtropical areas.Elsewhere, where the shrub is not frost-tolerant, e.g.in Central and Western Europe, it may be grown as a conservatory plant.1 The plant is grown throughout Iran and is more common in eastern and southern provinces. Application of oleander as a pharmaceutical product, rodenticide, and insecticide has been widely recognized.