Iranian Red Crescent Medical Journal
Year:2011 | Volume:13 | Issue:5|Papers Count:14

Background: Responsiveness is an indicator by WHO to evaluate the performance of health systems on nonmedical expectations of consumers. This study measures the health system responsiveness and the factors affecting responsiveness in Iran health system.Methods: World Health Survey (WHS) questionnaire was used to collect data on a two-stage cluster sampling in 17th District of Tehran in 2003. Of a sample of 773, 677 and 299 individuals who respectively had outpatient or inpatient services utilization responded to the responsiveness module of WHS questionnaire.Result: More than 90% of respondents believed that responsiveness issues were very important. Performance of outpatient services was better than hospital services in terms of responsiveness. "Prompt attention" and "quality of basic amenities" received low score for outpatient services. Service user variables had no significant effect on responsiveness, while type of centers was significantly related to responsiveness. Principal component analysis found three factors for both outpatient and inpatient services that explained 62% and 61% of total variances respectfully.Conclusion: Iran health system should pay more attention to responding non-medical expectations of service users. It sounds that health system interventions are main determinant of responsiveness score compared to demographic or user variables. Training health staff, allocating more resources and reengineering some processes may play a role in improving responsiveness. Responsiveness domains seems to be tailored based on each society's cultural factors.

Background: Length of Stay (LOS) is an appropriate hospital indicator to evaluate hospital resource utilization rate, efficiency, and quality of services delivered. In this survey, we aimed to study hospital LOS and determine its association with clinical and non-clinical factors in Women Hospital in Tehran.Methods: In this cross-sectional study, we reviewed all 3421 charts of patients admitted in Oncology, Surgery and Obstetrics units in 2008. We used a data collection sheet and conducted interviews to collect the following data: distance from living area, medical insurance coverage types, admission and discharge months, days and times, inpatient units, final diagnoses and the number of diagnostic tests.Results: The overall median of the LOS in the studied hospital was 50.8 hours. The medians were 48.5, 54.4, and 94.2 hours in the Obstetrics, Surgical and Oncology units, respectively. Results showed that the associated factors with the LOS were patient admissions on Thursdays, admitting by residents, the number of performed diagnostic tests (p<0.001), suffering from neoplastic diseases (p=0.005) and spouse jobs.Conclusion: Among the associated factors, policy makers and managers can only change the admission days and the number of diagnostic tests to decrease the LOS. Further researches are needed to find other factors associated with LOS.

Background: Reports on agmatine are controversial showing that it may improve memory, it can deteriorate memory and some did not notice any interference with learning and memory. In the present study, the effect of directly intra-CA1 agmatine microinjection on water maze learning and memory has been assessed.Methods: The cannuls were implanted in hippocampal CA1 regions of rats in a sterotaxic frame after general anesthesia. After one week recovery period, the animals were assessed in the reference memory version of water maze. Agmatine (1, 10, 100 or 200 mg/0.5 ml) or saline were infused 20 minutes before or immediately after training.Results: Agmatine-treated rats did not show any significant difference neither in water maze acquisition nor in consolidation task in comparison with control and sham groups.Conclusion: Agmatine does not affect water maze learning and memory.

Background: Several treatments have been suggested in shingles viral infection caused by Varicella zoster virus that may lead to complications such as PHN (Post-herpetic neuralgia). Intradermal injection of botulinum toxin was shown with few side effects. This study evaluates the efficacy of intradermal injection of botulinum toxin in patients suffering from PHN.Methods: Fifteen patients suffering from PHN for more than1 month were enrolled. Data collected were patients' age, sex, and lesion site, the dermatome involved and the duration and severity of pain by visual analog scale (VAS). Botulinum (15 units /every 10 cm² of body involved) was injected intradermally. The patients were followed 2, 14 and 30 days after injection.Results: Of participants, 6 were males and 9 females. The mean age was 60 years and the mean duration of neuralgia was 6.5 months. The mean VAS on day 2 was 6.4, on day 14 was 7.2 and after 30 days was 7.6. The overall pain after injection decreased but was not significant.Conclusion: It seems that intradermal injection of botulinum toxin decreases pain in PHN patients and this decrease is less prominent by passing time.

Background: Colonization of nasopharynx by Streptococcus pneumoniae can lead to pneumococcal diseases.This study was performed to determine the carriage rate of nasopharyngeal S. pneumoniae in adolescents, antibiotic susceptibility and serotype prevalence in Zahedan, Iran.Methods: Nasopharyngeal specimens from 865 adolescents (age range: 10-19 years old) attending eight schools in Zahedan, Iran, were collected and assessed by standard procedures to recover S. pneumoniae. The serotyping was carried out by latex agglutination test and the minimum inhibitory concentrations (MIC) of penicillin as well as other commonly used antibiotics were determined by a broth dilution method.Results: Pneumococci were recovered from 15.7% (136/865, 95% confidence interval (CI) 12.3-18.9) of total samples which 119 isolates were typable with the available antisera.1, 19A, 15C, 9V, 11A and 19F were found as the most frequent serotypes. Ninety three pneumococcal isolates were sensitive to penicillin. The MIC values of antibiotics tested were (mg/ml): penicillin 0.01-4, cefotaxime 0.01-4, ceftriaxone 0.02-128, chloramphenicol 0.08-32, ciprofloxacin 0.06-16, erythromycin 0.01-128, tetracycline 0.08-128 and vancomycin 0.02-1.Conclusion: A clear diversity was seen in the serotype distribution of the S. pneumoniae isolates and most of the antibiotic resistant strains belonged to few serotypes. Healthy adolescents in Zahedan, Iran commonly show pneumococcal carriage and antibiotic resistance.

Background: Effective reproductive number (Re) is an index which considers the proportion of susceptible people in a community. There are different methods for calculation of basic reproductive number. The aim of this study was to evaluate the reproductive number using data from H1N1 patients in Fars Province, southern Iran.Methods: According to the data obtained, 233 cases were confirmed between July 15th and December 3rd, 2009.Two waves were observed during this period with a peak in October 21st in Fars Province.Results: In the first wave, the highest amount of R0 was 3.22 and the lowest amount was 2.12 and in the second wave, the highest and lowest amounts of R0 were 3.42 and 2.42, respectively.Conclusion: Effective reproductive number could not be more than 1.54. Thus in order to maintain R0 below 1, using preventive measures like vaccination, only 70% of population should be immune. As 54.9% of Fars population were immune against H1N1 if only 15.1 of them take part in vaccination program, the disease will not reach an epidemic level.

Background: Following the production of Syrian gel, the scientists from Atomic Energy Commission of Syria, researchers in Yazd Atomic Energy Commission Radiation Processing Center in Iran, have manufactured a hydrogel wound dressing. This study was conducted to evaluate and compare the efficacy of these two hydrogels.Methods: In this study, 32 male Wistar rats underwent a full thickness circular skin wound on the dorsum under light anesthesia. Animals were divided into two groups. Wounds in the 1st group were dressed by the Syrian hydrogel and in the 2nd group by Iranian gel. Wound contraction rate was determined on days 1, 3, 7 and 12 for comparing the wound healing rate in two groups. Laboratory investigation of blood samples, skin tensile strength and histopathology of repaired skins were also evaluated.Results: Wound contraction ratio on 7th and 12th days in Iranian gel was significantly greater than Syrian gel group.According to histopathological evaluations, wound repair in 63.6% of specimens in Iranian gel group was excellent and in 35.5% good while in Syrian gel group, 54.5% of repaired wounds were graded as excellent and 1 case showed to be in a weak repairing state. A significant difference was noticed in wound repair patterns between the two groups. The differences in skin tensile strength in two groups on days 15 and 30 were not significant.Conclusion: According to our findings Iranian and Syrian hydrogels did not show any adverse effects on wound healing in rats and could be easily removed from the wound area without any trauma. However Iranian hydrogel dressings were more effective in wound repair regarding wound contraction rate and histopathological evaluation of the skin specimens in the region of healed wounds.

Background: Measurement of central venous pressure (CVP) is a reliable method for evaluating intravascular volume status and cardiac function; however it is an invasive and expensive method that may result in some complications such as arterial puncture, pneumothorax and development of infections. This study was performed to compare CVP measurements between central and peripheral catheters in infant and children with congenital heart disease.Methods: The CVP and peripheral venous pressure (PVP) were measured simultaneously in 30 patients within 10 consecutive hours.Results: The mean difference between CVP and PVP was 1.48±0.98 mmHg. The linear regression equation showed that CVP was 0.374+0.774 PVP (r2=0.725).Conclusion: PVP measured from a peripheral intravenous catheter in infants and children with congenital heart disease is an accurate estimation of CVP and its changes has good concordance with CVP over a long period of time.

Hydatid cyst of adrenal gland is rare and usually incidentally found as a part of disseminated disease. Herein we report a rare case of primary adrenal hydatid cyst who presented with unusual symptom of arterial hypertension from an endemic country.

In endemic regions, visceral leishmaniasis is one of the most common opportunistic infections in HIV positive patients. Simultaneous infection with Leishmania and HIV has been reported in some countries but this is the first report of such a case in Iran. Our patient was a 27 years old man with intermittent night fever, abdominal pain, loss of appetite, vomiting, watery diarrhea and severe weight loss for 6 months. He had low socio-economic status with an imprisonment history. The patient was quite cachectic and had low grade fever. Physical exam and upper GI endoscopy revealed oropharyngeal candidiasis. Microscopic evaluation of duodenal biopsy material showed Leishmania amastigotes in macrophages of lamina propria. Leishman bodies were also observed in bone marrow aspiration specimen. Serologic tests were positive for Leishmania infantum. HIV antibody was also positive with a CD4+cell count of 80/ml. The diagnosis was acquired immunodeficiency syndrome with simultaneous visceral leishmaniasis involving intestinal mucosa.

Considering the severe outcome of undiagnosed ophthalmic brucellosis, the timely recognition of this form of disease could prevent its further complications. The first case of ophthalmic brucellosis was reported by Lemaire in 1924. The eye involvement in brucellosis occurs in different forms including dacryoadenitis, conjunctivitis, episcleritis, keratitis, iritis, iridocyclitis, neuroretinitis, retinitis, chorioiditis, panuveitis, pars planitis, and hyalitis. The clinical manifestations of ophthalmic brucellosis include injection, blurred vision, eye pain, tearing, diplopia, foreign body sensation, cotton-wool lesions, exudative retinal detachment, and retinal hemorrhage

Early enteral feeding is a standard of care in many intensive care units (ICU) around the world. The use of enteral route is facilitated by the development of highly flexible nasogastric tubes (NGT). Although the insertion of nasogastric tubes has been described as being easy, but can produce unexpected complications.The insertion of a feeding tube into the lower airway is an uncommon complication which is more likely to occur in obtunded or intubated patients.

Beta Thalassemia major is a genetic disease with an autosomal recessive pattern and is differentiated by severe microcytic hypochromic hemolytic anemia with hepatosplenomegaly, ineffective erythropoiesis and bone marrow expansion.1 The b-globin (HBB) gene coding for b-chain expression is located on a 50 kb globin gene cluster on the short arm of chromosome 11, whose mutation mediated inactivation is usually responsive for the outcome of disease. Beta thalassemia occurs frequently in the coastline areas of the world.

Oral lesions may be as a manifestation of mucocutaneous or systemic disease or a side effect of treatmentincluding laceration, erosion, vesicle, traumatic lesions (such as cheek biting, denture induced lesions), infections (candidiasis, warts,..), chemical or heat burn lesions, drug complications, radiotherapy effects and specific lesions in pemphigus vulgaris, lichen planus and aphtus stomatitis.