Iranian Red Crescent Medical Journal
Year:2011 | Volume:13 | Issue:8|Papers Count:15

Japan has been the victim of the worst two nuclear disasters in the world. In the first event, on Monday, August 6th 1945 (just 66 years ago), Hiroshima was bombarded by an American B-29 plane dropping the first atomic bomb on a civilian target. The damage was incredible. Recent estimates of death toll in Hiroshima bombing indicates between 90,000 up to 166,000 deaths most of them occurred in the first day of bombing of this city with a resident civilian population of 340, 000. Roughly near 70% of the city's buildings were completely destroyed and another 7% were severely damaged.

Background: Currently, accidents are the second highest cause of death in most societies. Traffic accidents account for the largest proportion of accidental deaths. The aim of this report was to identify the accidents that cause casualties on the roads around Mashhad.Patients and Methods: This study was a case-control study, where the cases were drivers who had accidents resulted in casualties, and the controls were drivers who had accidents in the same locations without casualties. Variables included age, sex, seatbelt use, spontaneous combustion, entrapment within the vehicle, ejection from the vehicle, music playing in the vehicle at the time of the accident, use of cell phone, smoking at the time of the accident, the direction of the accident, the time of day, and the model of the vehicle.Results: Interviews were conducted with the 90% of the cases and the 93% of the controls who consented to being interviewed.Females accounted for 16.2% of the case group and 23.4% of the control group, and males comprised 83.8% of the cases and 76.6% of the controls. The average age of the case group was 35.5±10.5 and of the control group was 39.4±9.8. The use of a seatbelt as a safety factor was significantly greater in the control group (OR=0.44). Combustion occurred in approximately 21% of the accidents in the case group, but in only 1.3% of the accidents in the control group.Being trapped in and being ejected from the vehicle were significantly more prevalent in the case group.Conclusions: According to the results of this study, the fastening of seatbelts had a significantly positive effect on reducing the injuries caused by an accident. Age was another significant indicator influencing the outcome of road accidents education through media seem to play agreat role in reducing mortality and morbidity due to road accident.

Background: Metabolic syndrome (MetS) is a clustering of risk factors for cardiovascular disease (CVD), which includes obesity, hypertension, diabetes, dyslipidemia, and unhealthy lifestyle. A combination of these risk factors has been shown to predict type 2 diabetes and CVD. To examine the association between socioeconomic determinants and smoking behavior in a population-based sample of Iranians with MetS.Patients and Methods: This cross-sectional survey comprised 12, 600 randomly selected men and women aged³19 years living in 3 counties in the central part of Iran. These subjects had participated in the baseline survey of a communitybased program for CVD prevention, entitled “Isfahan Healthy Heart Program,” conducted in 2000-2001.Subjects with MetS were selected on the basis of the National Centers for Environmental Prediction-Adult Treatment Panel III (NCEP- ATPIII) criteria. Data for demographic factors, medical history, medication use, and lifestyle behaviors were obtained using questionnaires, and physical examination and fasting blood sampling were performed to measure blood pressure, obesity indices, and serum lipid levels. Smokers were defined as persons smoking at least 1 cigarette per day at the time of the study. Five social determinants were used: education, income, marital status, place of residency, and car ownership.Logistic regression analysis was performed to assess the association between socioeconomic determinants and smoking habits and other health-related behaviors.Results: The mean age of subjects with MetS was significantly higher than that of subjects without MetS. In both MetS and non-MetS groups, the mean ages of smokers were higher than those of non-smokers. However, smokers in both groups showed lower waist circumference (WC) and waist-hip ratio (WHR). Our data showed that marital status, age category, and residency were not significantly different in smokers and non-smokers with MetS. Smoking was more common (12.4%) in the group with intermediate educational level (6-12 years of education), the same as the high percentage of smokers (12.3%) in the middle economic group by the income category (Quartile 1-3). MetS is significantly related to age, sex, and education. On the basis of the results of logistic regression analysis, middle-aged and elderly smokers were at approximately 4-5 times higher risk of developing MetS than nonsmokers. Low levels of education decreased the risk of MetS by 0.48; similarly, in non-smokers, 6-12 years of education decreased the risk of MetS by 0.72 (ranging between 0.63-0.82).Conclusions: This study showed that the 3 dimensions of socioeconomic status, i.e., education, occupation, and income, were associated with MetS in smokers. It is assumed that. Awareness of the effect of smoking on health is increased with a higher level of education.more educated people also have better practice, control and treatment related to their wealth. Therefore, we recommend prevention efforts against smoking in the lower social strata of the Iranian population.

Background: Missing data is a common problem in cancer research.Although simple methods, such as complete-case (C-C) analysis, are commonly employed to deal with this problem, several studies have shown that such methods lead to biased estimates. The aim of this study was to address the issues encountered in the development of a prognostic model when missing data exist.Patients and Methods: A total of 310 breast cancer patients were recruited.Initially, the patients with missing data for any of the 4 candidate variables were excluded. Then, the missing data were imputed 10 times. Cox regression model was fitted to the C-C and imputed data. The results were compared in terms of the variables retained in the model, discrimination ability, and goodness of fit.Results: In the C-C analysis, some variables lost their significance because of a loss in power, but after imputation of the missing data, these variables reached significant level. The discrimination ability and goodness of fit of the imputed data sets model was higher than those of the C-C model (C-index, 76% versus 72%; likelihood ratio test result, 51.19 versus 32.44).Conclusions: The results indicate the inappropriateness of an ad hoc C-C analysis. This approach leads to loss in power of the variables and imprecise estimates. Application of multiple imputation techniques is recommended for avoiding such problems.

Background: The quality of life of children with leukemia is reduced by the fear and anxiety of their parents after diagnosis and a lack of information about the disease, treatments, and care of the child.Patients and Methods: In this interventional study, 60 parents of Acute lymphoblastic leukemia (ALL) children who met the inclusion criteria were selected using simple random sampling and assigned to experimental and control groups.The study tool included a valid and reliable questionnaire (TNO-AZL) that was completed through interviews with the parents before and 2 months after the intervention for both groups. The first part of the questionnaire included demographic items, and the second part (7 dimensions, each with 8 sections) contained questions related to quality of life. The scores could range between 56 and 280; higher scores represented a better quality of life. The intervention included 3 1-hour classes that were composed of a lecture and question-answer sessions, which were held for groups of 4-6 participants, accompanied by a booklet.Results: Before the intervention, the quality-of-life score in the experimental and control groups was 180.83±14.43 and 174.28±20/72, respectively; after the intervention, these values changed to 226.±11/76 and 174.41±20/42, respectively.By paired-sample t-test, quality of life increased significantly in the experimental group.Conclusions: Parental education successfully increased the quality of life of leukemic children; therefore, parental consultation sessions and educational programs are recommended.

Background: One of the most widely used methods to detect tuberculosis (TB) infection is the tuberculin skin test (TST).full Sequencing of the Mycobacterium tuberculosis (M.tb) genome has led to the identification of several antigens that can be utilized for accurate diagnosis and control of TB. The aim of this study is to produce and purify several specific recombinant M.tb antigens in order to evaluate their potential use in the diagnosis of TB.Materials and Methods: The recombinant secretory antigens ESAT-6, CFP-10, and ESAT-6/CFP-10 were produced through PCR and cloning methods. To investigate the antigen-specific responses of these recombinant antigens in the detection of TB, ex vivo enzyme-linked immunospot (ELISPOT) tests were performed on samples of 30 clinically diagnosed TB patients.Results: Throughout this study, the selected M.tb antigens were cloned, expressed, and purified in Escherichia coli (BL21).The ELISPOT assays for the detection of TB showed sensitivity values of 93%, 90%, and 100% for recombinant ESAT-6, CFP-10, and ESAT-6/CFP-10 proteins, respectively, which were significantly higher than the values obtained in conventional tuberculin skin test (TST).Conclusions: Our results show that these recombinant antigens can be used as an accurate detecting TB test for Iranian Patients.

Background: Prostate brachytherapy has become an increasingly popular treatment for localized prostate cancer. A steep dose gradient between the prostate and organs at risk (rectum and bladder) is ideal in this treatment modality, so prostate displacement and deformation due to bladder filling and rectal distension play an important role in critical organs post-implant dose. The purpose of this study was to evaluate the interrelationship between normal rectal distension, bladder filling, and their movements. The study also aimed to quantify total prostate displacement and deformation due to physiologic organ filling measured by using magnetic resonance imaging (MRI) based shifts and estimate the precision with which the shifts were made in supine and left decubitus positions.Patients and Methods: 3 patients who were referred for transrectal prostatic biopsy (Shahid Faghihi hospital, Shiraz, Iran) with different prostate sizes were selected for this study. A 1.5-Tesla MRI system (Avanto, Siemens, Germany) and an ultrasound system (Logiq 500, GE medical systems, USA) were used to collect images of the patients’ prostates at different stages of bladder and rectum fullness.Results: The mean displacement of the prostate after bladder filling in the supine and left decubitus positions along the anterior-posterior (AP) axis was posterior by 3.5 mm (range=0.7 mm to 6.3 mm) and along the superior-inferior (SI) axis was inferior by 3.4 mm (range=1.4 mm to 5 mm). Prostate displacement in the left-right (LR) axis was negligible.The mean prostate displacement after rectal distension was anterior by 7.1 mm in the supine position, 5.1 mm anterior in the left decubitus position, and along the SI axis was inferior by 2.9 mm in the supine and left decubitus positions.The maximum prostate deformation due to rectal distension and bladder filling in the supine position was as large as 3.2 mm, 1.9 mm, and 1.2 mm in the AP, SI, and LR directions, respectively. While in the left decubitus position, maximum prostate deformation was 2.6 mm, 1.2 mm, and 1.3 mm in the AP, LR, and SI directions, respectively.Conclusions: It is probably important to evaluate the influence of the changes in the shape and location of the prostate due to bladder filling, rectal distension, and patient position in post-implant brachytherapy dosimetry. Using images of patients in the left decubitus position with a full bladder and distended rectum is suggested in planning for treatment.

Background: Islamic Republic of Iran has the strategic socioeconomic plans since 20 years ago in 5 year terms. It is important to know the concordance of performance in the health sector with this strategic plan.Materials and Methods: To evaluate the performance of the program implemented on the basis of a 5-year socioeconomic strategic plan, healthcare indicators in the Islamic Republic of Iran at the end the 4th year of the program (2008) were evaluated and compared with the same indicators from the 1st year (2004). Indicators were selected using the Delphi technique from published indicators. Data were gathered from the current health information system.Results: Trends for calculated indicators at 2 time points were evaluated at both 41 individual universities and on average at the country level.Conclusions: An increasing trend of significant indicators in all medical universities was observed; however, healthcare indicators in the less-developed provinces need to be improved at an accelerated pace.

Background: Amblyopia is a major cause of visual impairment in children. The goal of our study was to compare the patching method with atropine penalization as a treatment for moderate amblyopia in children between 4 and 10 years of age.Patients and Methods: This prospective, randomized clinical trial included 120 patients between 4 and 10 years of age suffering from moderate amblyopia in the range of 20/40 and 20/100 between 2004 and 2007.Subjects were randomly divided into equal-sized groups and received either the patch therapy or twice-weekly atropine penalization, and were followed for 2 years. Successful treatment was defined as an increase of 2 or more lines of visual acuity or a final visual acuity of 20/25 or better.Results: By the end of the follow-up period, visual acuity in the amblyopic eye had improved from baseline by a mean of 3.8 lines in the patching group and 3.7 lines in the atropine group. The average visual acuity in both groups was 0.5 Log MAR acuity, which increased to 0.18 in the patching group and 0.2 in the atropine group.Conclusions: Twice-weekly atropine penalization and patching resulted in similar levels of visual acuity improvement in patients between the age of 4 and 10 years treated for moderate amblyopia.

Background: The incidence of fistulas found during surgery for chronic otitis media with cholesteatoma has been reported to vary widely in different geographical areas. To identify the prevalence of labyrinthine fistula in the south of Iran.Patients and Methods: This was a prospective cross-sectional study of 787 consecutive tympanoplasty surgeries with or without mastoidectomy for chronic otitis media (504 ears in 462 patients). The preoperative clinical data, preoperative and postoperative hearing status, and intraoperative findings were analyzed.Results: A labyrinthine fistula was found at surgery in 24 (4.7%) of 504 ears in the 462 patients undergoing surgery for chronic otitis media. The location of the fistula was the lateral semicircular canal in 23 ears, posterior semicircular canal in 1 ear, and promontory in one ear. There was a statistically significant difference in preoperative and postoperative Air Conduction (AC) threshold in 500–3000 Hz frequency and Air-Bone Gap ABG) 500–3000 Hz, but there were no statistically significant differences in the other variables.Conclusions: There is no universal method of reporting hearing outcomes in labyrinthine fistula surgery. Hearing evaluation methods in the literature are poorly comparable due to the usage of different methodologies.

We report the case of a 23-year-old man and 3 members of his family with Hb J-Iran confirmed by electrophoresis, chain separation by high-performance liquid chromatography, and sequencing. Alpha thalassemia was also confirmed in two family members. The substitution at b 77 leads to a higher negative charge of the b J-Iran subunit, which enhances its electrostatic attraction for the normally positively charged a subunit.Therefore, more Hb J-Iran than Hb A forms in the red blood cells of heterozygotes. In a -thalassemia, the more attractive b J-Iran subunit out-competes b A subunits in forming assemblies with deficient a subunits, so even more Hb J-Iran is formed.

Foot infections are one of the main causes of hospitalization and the leading cause of morbidity in patients with diabetes. Diabetic foot lesions may manifest as ulceration, gangrene, Charcot’s joint, or fracture, and if not treated promptly, may necessitate amputation.The proper management of these infections requires early recognition, selection of the appropriate antibiotic, and quick initiation of the antibiotic therapy on the basis of the results of culturing and antimicrobial susceptibility testing. The aim of this study was to determine the relative frequency of bacterial isolates cultured from diabetic foot infection.We also performed antimicrobial susceptibility testing with commonly used antimicrobial agents to assess the prevalence of antimicrobial resistance patterns in the bacterial isolates.

Cardiovascular-related diseases are the most common causes of cardiac arrest in the adult population. The reported survival of this serious condition is 2% to 24%, despite rigorous attempts during cardiopulmonary resuscitation Because of the poor clinical yield with epinephrine, studies have focused on possible alternative pharmacological agents. Vasopressin was considered a remedy, based on observations of the implied high concentration of this endogenous vasopressin during cardiac arrest. Several clinical trials were also performed in various settings with supportive and contradictory results.

High zinc levels may cause rejection of allograft organs by promoting the immune system. So, it seems that limiting zinc supplements and all foods and drugs with a high amount of zinc may be effective in the prevention of allograft organ rejection after transplantation. Zinc is an essential micronutrient for human growth, development, and immune function. Zinc deficiency accompanied by the quality and functional insufficiency of Tcell-mediated immunity and by the diminished phagocytic activity of neutrophils.

Indeed, cystic tumors of the pancreas are rare and account for 10%–15% of pancreatic neoplasms. There are four main categories of pancreatic cystic tumors:1-Mucinous cystic tumors (MCTs);2-Serous cystic tumors (SCTs);3-Intraductal papillary cystic tumors (IPCTs); and4-Papillary cystic tumors.Mucinous cystic neoplasm of the pancreas is an uncommon tumor characterized by an inner mucin-producing columnar epithelium layer and an outer dense cellular ovarian-type stromal layer. These tumors are typically localized in the body and tail of the pancreas and do not communicate with the pancreatic ductal system.