Iranian Red Crescent Medical Journal
Year:2014 | Volume:16 | Issue:4|Papers Count:15

Background: Ankylosing spondylitis (AS) is a chronic destructive and inflammatory disease of the axial skeleton manifested by back pain and progressive stiffness of the spine.Objectives: The aim of the present cross-sectional study was to evaluate and identify factors leading to delayed diagnosis of AS in Iranian patients.Patients and Methods: Sixty patients, (53 male, 7 female) with a diagnosis of AS according to the modified New York criteria were recruited. Diagnosis delay was defined as the interval between a patient's first spondyloarthritic symptoms [inflammatory back pain (IBP), inflammatory arthritis, enthesopathy and uveitis] and a correct diagnosis of AS.Results: The average age of patients at diagnosis of AS was 36.4±4.5 years and the average of delay in diagnosis was 6.2±3.5 years. The most common diagnosis at the first visit was disc herniation (68.3%). Delay in diagnosis of Human Leukocyte Antigen (HLA-B27) positive and negative patients were 4.6±2.2 years and 10.1±3.2 years, respectively (P=0.0001). Diagnosis delay in patients with morning stiffness and IBP were significantly shorter than that of patients without these symptoms (P=0.0001 and P=0.001 respectively). Patients with uveitis had the shortest diagnosis delay (P=0.02). The Bath Ankylosing spondylitis disease activity index (BASDAI) was not significantly different in early (<3years) and late (>3years) diagnosis (3.3±0.9 and 3.6±0.7 respectively) (P=0.18), but the Both ankylosing spondylitis functional index (BASFI) was significantly different between them (3.3±1.0 and 4.1±0.7 respectively) (P=0.001).Conclusions: In this study, delay in diagnosis was similar to other studies. Educating physicians to careful history taking especially in the case of IBP, non-musculoskeletal symptoms such as uveitis and precise physical examination are important in early diagnosis.

Background: CCR5 is a receptor for CCL3 (MIP-1 a), CCL4 (MIP-1 a) and CCL5 (regulated on activation normal T cell expressed and secreted (RANTES)) and play important roles in recruitment of NK cells to the HBV infected liver.Objectives: The main purpose of this study was to investigate the expression levels of CCR5 on the NK cells and also serum levels of RANTES in chronic HBV infected (CHI) patients.Materials and Methods: In this descriptive study 63 CHI patients and 96 healthy controls were evaluated regarding CCR5 expression on the NK cells and serum levels of RANTES using flow cytometry and ELISA techniques, respectively. Real-Time PCR technique also was used for HBV-DNA quantification.Results: The results revealed that CCR5 expressing NK cells and serum levels of RANTES were decreased significantly in the CHI patients in compare to healthy control.Conclusions: Based on the results it can be concluded that NK cells of Iranian CHI patients are unable to express adequate levels of CCR5 and expression levels of RANTES by immune cells also are defected in CHI patients, hence, the migration of NK cells to the infected hepatocytes and HBV eradication from the cells is interrupted.

Background: Hospitals are the most costly operational and really important units of health system because they consume about 50%-89% of total health resources. Therefore efficient use of resources could help in saving and reallocating the financial and physical resources.Objectives: The aim of this study was to obtain an overview of hospitals' performance status by applying different techniques, to compare similarities and differences between these methods and suggest the most comprehensive and practical method of appraisal for managers and policy makers.Patients and Methods: This is a cross sectional study conducted in all hospitals of Ahvaz (eight hospitals affiliated with Jundishapur University of Medical Sciences and eight non-affiliated hospitals) during 2007 to 2011.Two kinds of data were collected through separate special checklists. Excel 2007 and Windeap 2.1 software were applied for data analysis.Results: The present findings show that the average of bed occupancy rate (BOR) in the studied hospitals was about 65.91±1.16. The maximum number of inefficient hospitals in the present study happened in the years 2007, 2008 and 2010 (four hospitals) but there were two hospitals in the third part of the present graph which had maximum level of efficiency and optimal level of productivity in the years 2007 and 2009. Data Envelopment Analysis (DEA) showed that the mean score of technical efficiency for the studied hospitals is 0.924±0.105 with the minimum of 0.585±0.905 for hospital number 1. Furthermore It shows that only five hospitals (31.25%) reach complete technical efficiency (TE) scores across all five years of 2007-11 (TE=1).Conclusions: Results of the present and similar studies should be considered for the future planning and resource allocation of Iranian public hospitals. At the same time it is very important to consider need assessment results for each region according to its potentials, population under the coverage and other geographical and cultural indices. Furthermore because of potential limitations of each of the above models it is highly recommended to apply different methods of performance evaluation to reach a complete and real l status view of the hospitals for future planning.

Background: Perforated appendicitis is one of the most common causes of acute abdomen requiring emergent surgery for immediate appendectomy and peritoneal cavity irrigation, however, the efficacy of irrigation with antibiotic solutions is controversial.Objectives: The aim of this study was to assess the efficacy of imipenem solution irrigation on post-operative surgical site infections (SSIs), hospital length of stay, and hospital costs. We hypothesized that there would be lower rate of SSIs, a shorter hospital stay, and lower hospital cost in patients with perforated appendicitis who received peritoneal cavity irrigation with imipenem solution in comparison to their counterparts who received irrigation with normal saline.Patients and Methods: In this randomized single-blind parallel-group clinical trial, we enrolled 90 patients with perforated appendicitis with 12-50 years of age and randomly allocated them into experimental group (n=45) and control group (n=45). The control group received peritoneal irrigation with normal saline (0.9%) and experimental group underwent peritoneal irrigation with imipenem solution (1 mg/mL). All surgical procedures were performed in Imam Reza Hospital of Kermanshah University of Medical Sciences. The study primary outcome was surgical site infections (including wound infection and abdominal abscess) and the secondary outcomes were length of hospital stay and hospital cost. Chi-squared and t-tests were used to analyze the study data.Results: Imipenem solution irrigation was associated with significant clinical improvement at one-month follow-up. The experimental group presented with significantly lower rate of SSIs and shorter length of hospital stay. The experimental group had lower rate of SSIs compared to the control group (4.4% vs.22.2%, respectively) (p=0.013). The duration of hospital stay was nearly one day longer in control group (5.84±2.58 days) vs. experimental group (4.91±1.29 days) (P=0.034), and hospital costs were $50 lower in experimental group ($500±$292) vs. control group ($450±$170) (P=0.281).Conclusions: The study findings revealed that peritoneal lavage with imipenem solution (1 mg/mL) decreases the rate of post-operative SSIs in patients with perforated appendicitis in comparison to patients irrigated with normal saline alone. These patients also had shorter hospital stay, and lower hospital costs.

Background: To determine if the GlideScopeâ videolaryngoscope (GVL) could attenuate the hemodynamic responses to orotracheal intubation compared with conventional Macintosh laryngoscope.Objectives: The aim of this relatively large randomized trial was to compare the hemodynamic stress responses during laryngoscopy and tracheal intubation using GVL versus MCL amongst healthy adult individuals receiving general anesthesia for elective surgeries.Patients and Methods: Ninety five healthy adult patients with American Society of Anesthesiologists physical status class I or II that were scheduled for elective surgery under general anesthesia were randomly allocated to either Macintosh or GlideScope arms. All patients received a standardized protocol of general anesthesia. Hemodynamic changes associated with intubation were recorded before and at 1, 3 and 5 minutes after the intubation. The time taken to perform endotracheal intubation was also noted in both groups.Results: Immediately before laryngoscopy (pre-laryngoscopy), the values of all hemodynamic variables did not differ significantly between the two groups (All P values>0.05). Blood pressures and HR values changed significantly over time within the groups. Time to intubation was significantly longer in the GlideScope (15.9±6.7 seconds) than in the Macintosh group (7.8±3.7 sec) (P<0.001). However, there were no significant differences between the two groups in hemodynamic responses at all time points.Conclusions: The longer intubation time using GVL suggests that the benefit of GVL could become apparent if the time taken for orotracheal intubation could be decreased in GlideScope group.

Background: One of the main challenges of healthcare systems of developing countries is health inequality. Health inequality means inequality in individuals’ ability and proper functioning, resulting in inequality in social status and living conditions, which thwarts social interventions implemented by the government.Objectives: This study aimed to determine and prioritize the social determinants of health inequality in Iran.Materials and Methods: This was a mixed method study with two phases of qualitative and quantitative research. The study population consisted of experts dealing with social determinants of health. A purposive, stratified and non-random sampling method was used. Semi-structured interviews were conducted to collect qualitative data along with a multiple attribute decision making method for the quantitative phase of the research in which the TOPSIS technique was employed for prioritization. The qualitative findings were entered into NVivo for analysis, as were the quantitative data entered into MATLAB software.Results: The results approved the suitability of the conceptual framework of social determinants of health suggested by the WHO (world health organization) for studying social determinants of health inequality, however, this framework general and theoretical rather than a guideline for practice. Thus, in this study, 15 themes and 31 sub-themes were determined as social determinants of social health inequality in Iran. Based on the findings of the quantitative phase of our research, socioeconomic status, living facilities such as housing, and social integrity had the greatest effect on decreasing health inequality.Conclusions: A major part of the inequality in health distribution is avoidable because they are mostly caused by adjustable factors like economic conditions, educational conditions, employment, living facilities, etc. As in the majority of developing countries the living and health conditions are the same as Iran, the findings of this study may be applicable for other developing countries.

Background: Suicidal behavior is one the most significant mental health problems in the military. Militaries are closed systems that operate in particular situations. Military service is associated with certain stressful conditions. On this basis, there is likely of trauma in the military environment. Measures of suicidal behavior are pathologically complex. A range of biological, psychological, social, and institutional factors are involved in the incidence and prevalence of these behaviors.Objectives: One of the underlying factors in suicidal behavior is individuals' personality.Patients and Methods: The study population comprised of the Iranian Armed Forces. To recruit the sample of the research, 1659 soldiers were selected by multistage sampling. Data were collected using the Beck Scale for Suicide Ideation (BSSI) and NEO-Five Factor Inventory.Results: There was a significant positive correlation (r=0.323) between neuroticism and suicide ideation, however, significant negative correlations existed between three other personality traits --extraversion [r=-0.306], agreeableness [r=-0.227], and conscientiousness [r=-0.271] and suicidal ideation. Unlike neuroticism, extraversion and conscientiousness personality factors could reduce significantly (as much 14% as are predicted) levels of suicidal ideation.Conclusions: Based on these results, neuroticism might increase suicide, but extraversion and conscientiousness personality traits are associated with a reduced risk of suicide.

Background: Taxi drivers are exposed to various risk factors such as work overload, stress, an irregular diet, and a sedentary lifestyle, which make these individuals vulnerable to many diseases. This study was designed to assess the health status of this occupational group.Objectives: The objective was to explore the health status, the intention to seek health examination, and participation in health education among taxi drivers in Jinan, China.Patients and Methods: The sample-size was determined scientifically. The systematic sampling procedure was used for selecting the sample. Four hundred taxi drivers were randomly selected from several taxi companies in Jinan. In total, 396 valid questionnaires (from 370 males and 26 females) were returned. Health status, intention to seek health examination, and participation in health education were assessed by a self-designed questionnaire. Other personal information including sex, age, ethnicity, marital status, years of employment as a taxi driver, education level, and habits were also collected.Results: This survey revealed that 54.8% of taxi drivers reported illness in the last two weeks and 44.7% of participants reported chronic diseases. The prevalence rates of hypertension, diabetes mellitus, gastroenteritis, arthritis, and heart disease were 18.2%, 8.8%, 26%, 18.4%, and 4.8% of questioned taxi drivers, respectively. Significant self-reported symptoms included fatigue, waist and back pain, headache, dyspepsia, and dry throat affecting 49.7%, 26.2%, 23.5%, 26%, and 27% of participants, respectively. In total, 90.1% of subjects thought that it was necessary to receive a regular health examination. Only 17.9% of subjects had been given information about health education, and significantly, more than 87% of subjects who had been given information about health education reported that the information had been helpful.Conclusions: Taxi drivers’ health was poor in our survey. Thus, using health education interventions to improve knowledge and change in behaviors are necessary and effective programs that improve the health of individuals in this special occupational group are needed.

Background: The recently developed policy of the family practice program in rural regions of Iran faced some challenges such as inefficient referral system. The health insurance organizations (purchaser) and health policy makers are concerned about the high rate of patient referrals from family physicians to specialists due to imposing unnecessary services and costs.Objectives: This study examined utility of the theory of planned behavior to explain intention of Iranian family physicians to reduce referral rate of patients with respiratory diseases to medical specialist.Patients and Methods: An exploratory cross-sectional study, employing a correlational design directed by the theory of planned behavior was conducted. A questionnaire was developed based on an eliciting study and review of literature. One hundred and seventy-four family physicians working at primary care centers in two provinces of Iran completed the questionnaire (response rate of 86%).Results: The finding revealed that intention of family physicians to reduce referral rate of patients to specialists was significantly related to two theory-based variables of subjective norms (r=0.38, P<0.001) and perceived behavioral control (r=0.43, P<0.001), and not to attitudes. A stepwise regression entering direct measures of the theory variables explained 35% of the variance on the intention, with perceived behavioral control being the strongest predictor. Adding background variables to the model achieved further 5% by variables of practice size and past referral rate behavior.Conclusions: The results indicated that psychological variables of the theory of planned behavior could explain a noticeable proportion of variance in family physician's intention to decrease the rate of referring patients with respiratory diseases to medical specialists. The intention is primarily influenced by normative and control considerations. These findings contribute to a better understanding of referral decisions by family physicians and are of great value in developing interventions to reduce the variation in referral rate of patients to medical specialists at primary care health centers.

Background: In spite of the pivotal role of clinical governance in enhancing quality of services provided by hospitals across the country, a scientific framework with specific criteria for evaluating hospitals has not been developed so far.Objectives: This study was conducted with the aim to identify the challenges involved in evaluating systems of clinical governance in Iran.Materials and Methods: For the purposes of this qualitative study, 15 semi-structured interviews with experts in the field were conducted in 2011 and the data were analyzed using framework analysis method.Results: Five major challenges in evaluating clinical governance include managing human resources, improving clinical quality, managing development, organizing clinical governance, and providing patient-oriented healthcare system.Conclusions: Healthcare system in Iran requires a clinical governance program which has a patient-oriented approach in philosophy, operation, and effectiveness in order to meet the challenges ahead.

Background: Several lines of evidence demonstrating that innate and adaptive immunity play important roles in the defense against visceral leishmaniasis (VL). A polymorphism within the FcgRIIIB gene can lead to the expression of three variants of NA1, NA2, and the combined one (NA1/NA2) which alters affinity of IgG to its receptor.Objectives: The main aim of this study was to evaluate the FcgRIIIB-NA1/NA2 polymorphism in the FcgRIIIB gene of VL patients in comparison to healthy controls.Patients and Methods: In this cross-sectional study, three groups, 54 seropositive patients with clinical presentation of VL (group 1), 104 seropositive patients without clinical presentation (group 2), and 104 healthy controls (group 3) were evaluated with respect to the FcgRIIIB-NA1/NA2 polymorphism using a PCR-SSP method. The titration of anti-leishmania antibodies was analyzed using an immunoflorescence technique.Results: Our results indicated that polymorphisms within the FcγRIIIB gene (that lead to the expression of the NA1/NA2 isoforms) are significantly associated with VL. The results demonstrated that the genotype heterozygotic for FcgRIIIB-NA1/NA2 expression was significantly increased in VL patients, group 1 when compared to groups 2 and 3. Conversely, there is a decrease in homozygous NA1 and NA2 genotypes in VL patients, however, the overall frequency of NA1 and NA2 alleles appear similar across the three cohorts examined.Conclusions: According to our results, it is likely that the increased frequency of the FcgRIIIB-NA1/NA2 genotype is associated with impaired immune responses against VL and its subsequent clearance from the patient.

Background: Diabetes is the most common metabolic disorder which is required to be taken under control. According to some studies, the impact of self-regulation on health has been considered as a monitoring strategy to achieve individual’s goals.Objectives: This study, which was performed in 2012, aimed at determining the consequences of self-regulation on controlling type 2 diabetes.Patients and Methods: In this double-blind clinical trial, 60 patients with type 2 diabetes - who were referred to Diabetes Clinic of Bisto-Dou Bahman Hospital in Gonabad, Iran - were divided randomly into case and control groups. Self-regulation questionnaire, nutritional information and physical activity checklists were completed by both groups once at the beginning and once at end of the training. Fasting blood sugar (FBS) of both groups were measured as well. Case group was trained for a month, whereas the control group received no special training. Data were analyzed by SPSS version 19 software, K-square and paired t-tests.Results: Comparing the case with the control group before and after the training showed that teaching patients self-regulatory strategies had significant impact on lowering blood sugar (-16.50 vs. -2.47, P<0.001), observing dietary behaviors (5.97 vs. -0.87, P<0.001) and increasing physical activities (6.2 vs. -0.73, P<0.001) of the former group.Conclusions: Learning self-regulations has a role to play in controlling type 2 diabetes. Therefore, it is suggested to professionals in healthcare centers to educate patients about self-regulatory techniques and use them as auxiliary methods for keeping type 2 diabetes under control.

Introduction: The use of traditional medicine has been emerged in the treatment of BPS (bladder pain syndrome) due to its high prevalence and expenses and its insufficient treatment by conventional therapies. Iranian traditional medicine has discussed such diseases. Considering the signs and symptoms of BPS and "reeh", the proposed mechanism of flatulency as casualty of recurrent circulating pains seems to be a proper diagnose. So, as a preliminary study the authors administered Horse Mint as one of effective traditional herbs on flatulent pain in a patient with BPS.Case Presentation: A 60-year-old female was referred with the diagnosis of BPS. Six clinical visits with 2-week intervals were performed for patient, and the NIH-ICSI (National Institutes of Health Interstitial Cystitis Symptom Index) was completed, which was used as a pretreatment symptom quantifier and post-treatment outcome tool. Horse mint (Mentha longifolia) was prescribed twice a day for 12 weeks.Discussion: Clinical visits showed alleviation of signs, symptoms, and changes in the patient's NIH-ICSI score, suggesting further studies on this field.

Background: Regardless of numerous advances in surgical techniques, selection of the best technique to sew up wounds and the best suture material are still controversial. Several postoperative complications, including wound infection, stitched wound, chronic incision pain, wound dehiscence and hernia stitches result from many factors such as used suture material.Objectives: The aim of the present study was to investigate the complications of pfannenstiel incision and nylon/ polyglactin 910 sutures utilization in patients undergoing c-section cesarean.Patients and Methods: This clinical trial was conducted on 120 women who underwent caesarean section at Imam-Ali hospital in Zabol, Iran. In this study, patients were equally divided into two groups of 60 people (50% in nylon suture and 50% in polyglactin 910 sutures). Patients of the two groups were investigated by a gynecologist 24-48 hours after the operation, a week later and on the sixth month of surgery. Moreover, time of wound dehiscence and treatment duration, the level of sinus infection, chronic incision pain and incision hernia were studied. The results were analyzed by SPSS software. P£0.05 was considered as statistically significant.Results: One hundred and twenty patients undergoing a cesarean section at Imam-Ali hospital in Zabol were recruited into the study, 60 in the Nylon group and 60 in Polyglactin 910group. Our data demonstrated a statistically higher incidence of suture sinus and chronic incision pain in the nylon group (P<0.05). No statistically significant difference in wound stitch and incision hernia was demonstrated between the suture groups.Conclusions: The results of our trial did not demonstrate a significant difference between absorbing polyglactin 910 (PDS) and nylon regarding incision hernia, wound infection and wound dehiscence. However, subjects sutured with PDS were less likely to experience chronic incision pain and wound stitch. Therefore, PDS appears to be the optimal choice for fascial closure after cesarean section.

Introduction: Aortic dissection is a rare condition in young women and usually related with congenital anomalies of aorta and connective tissue disorders. We reported a 34-year-old postpartum woman with aortic dissection.Case presentations: The patient complained of respiratory distress and weakness with no abdominal pain or chest pain 20 days after delivery and had no history of hypertension during pregnancy and perinatal or prior heart disease. Postpartum cardiomyopathy and left ventricular dysfunction were diagnosed by imaging study and cardiac enzyme level. Finally, CT-scan was performed and showed aortic dissection. The patient underwent surgery and after surgery, she was alive without any problem.Conclusions: Patients with peripartum cardiomyopathy and aortic dissection could be cured with good medical care.