سال:1392 | دوره: | شماره: |تعداد مقالات:17

Context: The tendency to use advanced technology in healthcare and the governmental policies have put forward electronic prescription. Electronic prescription is considered as the main solution to overcome the major drawbacks of the paper-based medication prescription, such as transcription errors. This study aims to provide practical information concerning electronic prescription system to a variety of stakeholders.Evidence Acquisition: In this review study, PubMed, ISI Web of Science, Scopus, EMBASE databases, Iranian National Library of Medicine (INLM) portal, Google Scholar, Google and Yahoo were searched for relevant English publications concerning the problems of paper-based prescription, and concept, features, levels, benefits, stakeholders and standards of electronic prescription system.Results: There are many problems with the paper prescription system which, according to studies have jeopardized patients’ safety and negatively affected the outcomes of medication therapy. All of these problems are remedied through the implementation of e-prescriptions.Conclusions: The sophistication of electronic prescription and integration with EHR will become a reality, if all its stakeholders collaborate in developing fast and secure electronic prescription systems. It is plausible that the required infrastructure should be provided for implementation of the national integrated electronic prescription systems in countries without the system. Given the barriers to the implementation and use, policymakers should consider multiple strategies and offer incentives to encourage e-prescription initiatives. This will result in widespread adoption of the system.

Background: Mental retardation/Developmental delay (MR/DD) is present in 1 - 3% of the general population (1, 2). MR is defined as a significant impairment of both cognitive (IQ<70) and social adaptive functions, with onset before 18 years of age. Objectives: The purpose was to determine the results of subtelomeric screening by the Multiplex Ligation Dependent Probe Amplification (MLPA) Technique in 100 selected patients with idiopathic mental retardation (IMR) in Iran.Materials and Methods: A number of 100 patients with IMR, normal karyotypes and negative fragile-X and metabolic tests were screened for subtelomeric abnormalities using MLPA technique.Results: Nine of 100 patients showed subtelomeric abnormalities with at least one of the two MLPA kits. Deletion in a single region was found in 3 patients, and in two different subtelomeric regions in 1 patient. Duplication was only single and was present in 2 patients. Three patients were found to have both a deletion and duplication.MLPA testing in the parental samples of 7 patients which was accessible showed that 4 patients were de novo, 2 patients had inherited from a clinically normal mother, and one had inherited from a clinically normal father. Screening with the two MLPA kits (SALSA P036 and SALSA P070) proved abnormality in only five of the 9 patients.Conclusions: So, the prevalence rate of abnormal subtelomeres using MLPA technique in patients with idiopathic MR in our study was 5 - 9%, the higher limit referring to the positive results of one of the two MLPA kits, and the lower limit representing the results of positive double-checking with the two MLPA kits.

Background: One of the known complications of diabetes mellitus is vascular dysfunction. Inability of the coronary vascular response to cardiac hyperactivity might cause a higher incidence of ischemic heart disease in diabetic subjects. It has been indicated that regular exercise training and antioxidants could prevent diabetic cardiovascular problems enhanced by vascular damage.Objectives: The aim of this study was to determine the effects of grape seed extract (as antioxidant), with and without exercise training on coronary vascular function in streptozotocin induced diabetic rats.Materials and Methods: Fifty male Wistar rats weighing 200-232 grams were randomly divided into five groups of 10 rats each: sedentary control, sedentary diabetic, trained diabetic, grape seed extract (200 mg/kg) treated sedentary diabetic and, grape seed extract treated trained diabetic. Diabetes was induced by one intraperitoneal injection of streptozotocin. After eight weeks, coronary vascular responses to vasoactive agents were determined.Results: The endothelium dependent vasorelaxation to acetylcholine was reduced significantly in diabetic animals, exercise training or grape seed extract administration partially improves this response. However, exercise training in combination with grape seed extract restores endothelial function completely. The endothelium independent vasorelaxation to sodium nitroprusside was improved by combination of exercise training and grape seed extract. On the other hand, the basal perfusion pressure and vasoconstrictive response to phenylephrine did not change significantly.Conclusions: The data indicated that co-administration of grape seed extract and exercise training had more significant effects than exercise training or grape seed extract alone, this may constitute a convenient and inexpensive therapeutic approach to diabetic vascular complications.

Background: Psychologically traumatic events can affect anybody, but consequences of psychological birth trauma for the mother are very profound, extensive and unforgettable. Furthermore, the mother’s response not only touches the mother, but also affects the child, the father and the society. The objective of this study was to explore the mothers’ response to psychological birth trauma.Objectives: Psychological birth trauma is a complex matter as the length of a women’s life and mother’s responds can be present through different psychological and physical ways. In this regard, the mothers suffer from its consequences, but they do not know what is going on? Mothers are getting worse every day by “the silent effects of the psychological phenomena.Materials&Methods: This qualitative study was conducted on 23 mothers with psychological birth trauma experience, who were recruited from health centers of the capital and one of the metropolises of Iran. Their interviews were transcribed verbatim and analyzed by the content analysis method.Results: Three themes were extracted from the data: impact on health, changes in mother’s roles, and changes decision making ability. Several categories and sub-categories also emerged from the data (physical and psychological problems, bonding with the child, and relationship with husband, social role, cesarean request and psychological inability to have another child).Conclusions: By considering the mothers’ responses to traumatic labor, which endangers the health of the child as well as that of the mother and impairs their familial and social relationships, midwives should notice the consequences of psychological birth trauma in order to plan supportive and timely interventions.

Background: Serious health problems and socioeconomic consequences of the illicit use of opiates have been proved in both developed and developing societies.Objectives: We aimed to evaluate "The effects of opiate addiction through different administration routes on pulmonary inflammation and its severity."Materials and Methods: Our experiments were performed on eighteen adult male Syrian golden hamsters which were allocated to one of the three groups (n=6): control group which did not receive opiate, the first study group were administered oral opiate via stomach tube, and another study group were administered inhaled opiate. After four weeks, all hamsters were anesthetized with diethyl ether and their lung tissues were isolated for pathological assessment.Results: Severe perivascular inflammation was detected in 33.3% of the samples with oral opiate dependence and 20% of the cases addicted to opiate through inhalation. Also, severe peribronchial inflammation was observed in only 20% of the samples addicted to inhaled opiate and was not found in the other groups. No significant differences were found in the severity of perivascular and peribronchial inflammation across the three groups. Although the mean of total inflammation scale in the subjects with oral opiate dependence (3.00±1.79) was numerically higher than that in the inhaled dependence group (1.40±2.60) and the controls (2.25±1.26), this difference was not statistically significant.Conclusions: Administration did not influence the appearance or severity of pulmonary inflammation in animal models addicted to opiate.

Hospitals constitute the most important centers which accept people during disasters such as earthquakes, wars and flood. Hospitals have sophisticated organizations due to their direct contact with human health and diseases; therefore the level of service quality in such organizations is of utmost importance (1, 2). The critical conditions resulting from disasters pose great problems for hospitals. In order to enhance efficiency in critical conditions of disaster, hospitals need to have a pre-organized operational plan, lack of which will cause chaos and confusion at the time of crisis (3)…  

Introduction: Botulinum toxin type A (BTX-A) has been reported to be effective for the therapy for migraine. The purpose of this study was to investigate the effect of BTX-A on the immunoreactive levels of calcitonin gene-related peptide (CGRP) and substance P (SP) in the jugular plasma and medulla oblongata of migraine in rats induced by nitroglycerin (NTG), and then to evaluate and compare the effectiveness of fixed (muscle)-sites and acupoint-sites injection of BTX-A for migraine therapy of patients in a randomly controlled trial extending over four months.Materials and Methods: Rats with NTG-induced migraine were subcutaneously injected with vehicle or BTX-A (5 U/kg or 10 U/kg bodyweight). CGRP-and SP-like immunoreactivity (CGRP-LI and SP-LI) were determined by radioimmunoassay. In clinical trials, sixty patients respectively received BTX-A (2.5 U each site, 25 U per patient) at fixed-sites (group F, n=30) including occipitofrontalis, corrugator supercili, temporalis and trapezius or at acupoint-sites (group A, n=30) including EX-HN3, EX-HN5, GV20, GB8, GB20 and BL10.Results: Local BTX-A injection suppressed NTG-induced CGRP-LI and SP-LI levels in jugular plasma and oblongata. BTX-A injection for both groups with migraine significantly reduced the attack frequency, intensity, duration and associated symptoms. The efficacy of BTX-A for migraine in group A (93% improvement) was more significant than that in group F (83% improvement) (P<0.01).Conclusions: The evidence that BTX-A decreases NTG-induced CGRP-LI and SP-LI levels in trigeminovascular system suggests that BTX-A attenuates migraine by suppression of neuropeptide release. BTX-A injections for migraine at acupoint-sites and fixed-sites are effective. Acupoint-sites BTX-A administration shows more efficacy for migraine than fixed-sites application.

Background: Calcaneus has the most fracture prevalence among tarsal bones. About 3/4 of calcaneal fractures are intra-articular fractures with displacement. The majority of calcaneal fractures occur in 21 - 35 year old young men, and that are mostly active people, these fractures cause complete disability for 15 months. Moreover, inappropriate treatment leads to lots of social and economic damages.Objectives: In this study we compared the incidence and the severity of peroneal tenosynovitis as a complication of non-operative and operative treatment of intra-articular calcaneal fractures. In this study, some other complications of this fracture were also analyzed and the prevalence of the complication was higher in non-operated patients. Patients and Methods: A total of 140 patients with intra-articular calcaneal fracture were analyzed prospectively. These patients were divided into 2 groups: operated group and non-operated group.Results: In non-operated group (56 patients), 22 patients were complicated by peroneal tenosynovitis. In operated group (84 patients), 8 patients had the same complication. Statistical analysis revealed that the prevalence, and the severity of this complication in the mentioned groups had a meaningful difference. The results in operated group were much better than the non-operated one.Conclusions: Although some of the orthopedic surgeons are not interested to manage these fractures surgically and most of them treat these cases conservatively (casting, etc.), in most displaced intra-articular calcaneal fractures, surgical treatment is the method of choice. Moreover, in non-surgical treatment the prevalence of these complications among the patients is more and as a result, inevitable social, occupational and familial damages occur.

Background: In the contemporary orthodontics, the number of people who demand orthodontic treatment to improve their psychosocial issues related to facial esthetic is constantly increasing. Even in treatment plans, appearance and esthetic gain more attention.Objectives: The purpose of this study was to determine the need for orthodontic treatment on the basis of the dental aesthetic index (DAI) in the Iranian students of Ahvaz city.Material and Methods: This cross sectional study was performed on 900 students aged between 11-14 years (450 boys, 450 girls). Schools were selected based on random cluster sampling from different parts of the city. Students\ who had or were having orthodontic treatment including those on interceptive orthodontics, were excluded from the study. Two questionnaires were used, the first one included different DAI criteria, and the second one included two questions about orthodontic treatment need and satisfaction of personal dental appearance. The results were analyzed by Chi-Square and T test.Results: In 70.9% of the students, DAI score was 13-25, 19.2% of the samples had a DAI score of 26-30, the DAI score of 7.8% was 31-35, and in 2.1% the DAI score was greater than 35. The association between the DAI score and sex was not statistically significant (P=0.778). In relation to orthodontic treatment need, 44.8% of students answered positively, while in 55.2% the answer was negative. In relation to satisfaction with appearance, 21% of the students were satisfied with their appearance, 59% were relatively satisfied, and 19.9% were not satisfied with their appearance. The association between DAI score and the need for orthodontic treatment and satisfaction of dental appearance was significant (P=0.000).Conclusion: In comparison to other studies, the students in Iran (Ahvaz) have a better dental appearance and less need for orthodontic treatment. Significantly positive correlations were found between the DAI and satisfaction of dental appearance, orthodontic treatment need and student’s perception.

Toxoplasma gondii (T.gondii) is an obligate intracellular protozoan parasite that can infect a wide range of hosts including humans. Humans are infected through raw or undercooked meat containing tissue cysts and ingesting oocysts through contaminated food, water supplies and gardening. Infection with T. gondii is characterized by acute and chronic phases, which are distinct with regards to the developmental stage of the parasite and the sites of parasite persistence (1). However, Toxoplasma infection is mostly asymptomatic in immunocompetent individuals but it may be life threatening in immunocompromised cases (2). There is some evidence that chronic renal failure patients undergoing hemodialysis are susceptible to acquire various infections (3). This study aimed to illustrate the clinical manifestations of toxoplasmosis in haemodialysis patients and seroconversion rates of T. gondii.

Background: The development of antibiotic resistance among Streptococcus pneumoniae strains has caused significant health problems worldwide.Objectives: The aim of this study was to determine antibiotic resistance pattern and serotypes distribution of Streptococcus pneumonia strains isolated from clinical specimens.Material and Methods: A total of fifty Streptococcus pneumoniae strains were isolated from Tehran Hospital’s laboratory from 2008 to 2012. Antimicrobial susceptibility testing was performed using broth microdilution method and minimum inhibitory concentration (MIC) of each strain was determined. to verify the resistant strains and demonstrate the presence of antibiotic resistant genes, the PCR was performed.Results: The study showed that three strains (6%) and six strains (12%) indicated intermediate resistance and complete resistance to penicillin, respectively, 58% strains were susceptible to ceftazidime, two ones (4%) indicated resistance to ciprofloxacin, one (2%) indicated intermediate resistance to ceftriaxone , two strains (4%) indicated complete resistance and four (8%) strains indicated resistance to vancomycin.Conclusions: The emergence of Streptococcus pneumoniae strains with multiple resistance needs permanent monitoring of antibiotic susceptibility patterns of clinical isolates. We have found that ceftazidime is not a suitable drug for choosing the treatment of pneumococcal Infections.

Background: The prevalence of unintended pregnancy and associated risks are higher in late reproductive years. Limited studies have focused on contraceptive choices in these women. The aim of the study was to identify contraceptive choices and their related factors in women 35 years or older attending health centers of Khuzestan province.Objectives: Additionally, several line of evidence indicated relationship between increasing maternal age and poor pregnancy outcomes (1, 2). Pregnancies above the age of 35 are accompanied with more risks for complication related to pregnancy as compared to younger women (3-5). Risk of spontaneous abortion is 74.4% in mothers aged 45 years or more.Patients and Methods: In a cross-sectional study 1584 women aged 35 years and older attending public health centers of four cities of Khuzestan were studied. We used an interviewer-administered questionnaire for data collection. Women investigators were recruited for interview and filling the questionnaire. Participants were assured of the confidentiality of their responses.Results: The mean age of women was 39.8±4.2 years. The most popular contraceptive methods used in this age group were oral contraceptive pills (31.4%), condom (28.1%), and tubal ligation (14.8%). Less effective contraceptive methods were used in 41.5% of women. Significant associations were found between the use of effective methods and literacy of husband (OR=0.80, 95% CI: 0.75, 0.91), city of residence (OR=0, 92, 95%CI: 0.87-0.97), women age (OR=0.97, 95% CI, 0.94-0.99), and women education (OR=0.87, 95%CI: 0.76-0.99) (P<0.01).Conclusions: In spite of risk of pregnancy and unintended pregnancy in this age group, about a half of them used less effective contraceptive methods, hence family planning education, and counseling to older women should be a priority in health centers.

Background: Human breast milk, the sole source of nutrition during the early neonatal period, is rich in nutrients, hormones, growth factors, and immunoactive molecules, which influence the growth, development, and immune status of the newborn infant. It had long been thought that breast milk is an adequate source of anthracitic activity for the newborns and growing child.Objective: Human milk is a complex biologic fluid which contains nutritional and protective factors such as Osteoprotegerin (OPG), at levels 1000-fold higher than normal human serum. Since OPG and Receptor activator of nuclear factor-kappa B ligand (RANKL) system are tightly involved in bone remodeling and immune activity, the study was designated to evaluate the effect of breastfeeding on serum soluble receptor activator of nuclear factor-kappa B ligand (sRANKL) /OPG ratio in full term neonates in comparison with those of formula feeding full term neonates.Materials and Methods: In this cross-sectional study serum levels of OPG and sRANKL in 45 breastfed infants were compared to those of 44 formula-fed full term infants. The levels of serum OPG, sRANKL, and Tumor necrosis factor alpha (TNFa) were determined by standard techniques using enzyme-linked immunosorbent assay kits.Results: The serum levels of OPG were significantly higher (P<0.001), and the concentrations of TNFα was markedly lower (P=0.024) in breastfed infants than those of formula-fed infants. No marked differences were observed between the serum levels of sRANKL in the two study groups (P=0.8).Conclusions: High OPG and low TNFα levels in serum of breastfed infants are important factors involved in remodeling of bone, and immune activity may prove superiority of breastfeeding over formula feeding during infancy.

Background: While tocolytic therapy can halt the process of delivery, some patients return before the 37th week of pregnancy with recurrence of preterm labor signs.Objectives: This study was designed to evaluate the efficacy of progesterone in the prolonging of gestation and reduction of neonatal complications.Material and Methods: In a clinical trial in 2010, 110 singleton pregnant women admitted at Imam Reza Hospital, Mashhad, Iran, with the diagnosis of preterm labor were divided into three groups: 400 mg/d vaginal progesterone suppositories, 250 mg/w 17-alpha-hydroxyl-progestrone-caproate, and a control group with no additional treatment. After delivery, we assessed the duration between the first phases of labor to the recurrence of preterm labor. The neonatal complications, apgar score, birth weight, need for admission to NICU, and congenital malformations were compared between groups.Results: The mean gestational age was 34±3 weeks in the first, 33.5±3 weeks in the second and 32.5±2 weeks in the control group. The duration of first phase of labor was 31±17 days in the first, 36±14 days in the second and 26±22 days in the control group. The difference between study groups and the control group was significant (P<0.005). The complications were lower in progesterone-receiving group in comparison to the control group.Discussion: This study reveals that progesterone can significant reduce the rate of recurrent preterm labor and the several possible neonatal complications among women who had treated with tocolytics to suppress the acute phase.

Background: Premature ejaculation (PE) is the most common sexual disorder in men and studies reported prevalence up to 30% (1, 2). PE is not a life-threatening medical condition but it influences the quality of life (QoL).Objective: The aim of this study was to compare the efficiency, and safety of alpha blocker drugs in the treatment of patients with premature ejaculation (PE). Additionally we investigated the quality of life (QoL) in patients with PE who were treated with alpha blocker drugs.Materials and Methods: This study was a pilot clinical trial. Prospectively documented 108 patients with PE were treated and were followed-up in urology outpatient clinic. All patients were divided into 5 groups according to used alpha blocker agents which were determined by simple randomization. Silodosin 4mg (Group 1, n=21), tamsulosin hydrochloride 0.4mg (Group 2, n=23), alfuzosin 10mg (Group 3,n=22), terazosin 5mg (Group 4, n=21), doksazosin mesylate 4mg (Group5, n=21), were used for treatment. The demographic parameters of patients, pre and post treatment intravaginal ejaculation latency time (IELT), PE Profile (PEP), and QoL index were recorded and evaluated. Effectiveness of treatment was evaluated by measuring IELT. Additionally, side effects of drugs were recorded. P<0.05 was considered statistically significant.Results: All alpha blocker drugs were statistically effective for preventing PE. Notably, silodosin seemed to be more effective for preventing PE than other alpha blockers (P<0.05). However all alpha blockers provided development in QoL scores, silodosin was a little better than other drugs in statistical analyses. Furthermore statistical increase in IELT and decrease in PEP were provided more in Group 1 than other groups (P<0.05).Conclusions: Silodosin seems to be able to even more prevent PE. Silodosin may provide development in QoL than other alpha blocker agents. Additionally, lower systemic adverse events and more effectivity are the prominent features of silodosin in PE.This study was a pilot clinical trial. Prospectively documented 108 patients with PE were treated and were followed-up in urology outpatient clinic. All patients were divided into 5 groups according to used alpha blocker agents which were determined by simple randomization. Silodosin 4mg (Group 1, n=21), tamsulosin hydrochloride 0.4mg (Group 2, n=23), alfuzosin 10mg (Group 3, n=22), terazosin 5mg (Group 4, n=21), doksazosin mesylate 4mg (Group5, n=21), were used for treatment. The demographic parameters of patients, pre and post treatment intravaginal ejaculation latency time (IELT), PE Profile (PEP), and QoL index were recorded and evaluated. Effectiveness of treatment was evaluated by measuring IELT. Additionally, side effects of drugs were recorded. P<0.05 was considered statistically significant.

Background: While tocolytic therapy can halt the process of delivery, some patients return before the 37th week of pregnancy with recurrence of preterm labor signs.Objectives: This study was designed to evaluate the efficacy of progesterone in the prolonging of gestation and reduction of neonatal complications.Material and Methods: In a clinical trial in 2010, 110 singleton pregnant women admitted at Imam Reza Hospital, Mashhad, Iran, with the diagnosis of preterm labor were divided into three groups: 400 mg/d vaginal progesterone suppositories, 250 mg/w 17-alpha-hydroxyl-progestrone-caproate, and a control group with no additional treatment. After delivery, we assessed the duration between the first phases of labor to the recurrence of preterm labor. The neonatal complications, apgar score, birth weight, need for admission to NICU, and congenital malformations were compared between groups.Results: The mean gestational age was 34±3 weeks in the first, 33.5±3 weeks in the second and 32.5±2 weeks in the control group. The duration of first phase of labor was 31±17 days in the first, 36±14 days in the second and 26±22 days in the control group. The difference between study groups and the control group was significant (P<0.005). The complications were lower in progesterone-receiving group in comparison to the control group.Discussion: This study reveals that progesterone can significant reduce the rate of recurrent preterm labor and the several possible neonatal complications among women who had treated with tocolytics to suppress the acute phase.

Background: To investigate the prevalence and characteristics of osteoarthritis (OA) in Mongolian middle-aged and senior residents of the Inner Mongolia autonomous region compared with the prevalence of OA in different regions, to understand the OA-associated factors and provide theoretical evidences for intervention and prevention.Objectives: Thereby the prevalence, distribution characteristics and correlative factors of OA in Mongolian middle-aged and senior residents in the Inner Mongolia autonomous region were investigated in this study.Materials and Methods: Rural and urban residents in Hohhot, Baotou and Erdos were selected using stratified, multi-stage and cluster random sampling. 2000 residents aging over 45 filled out questionnaires underwent specialized physical and X-ray examinations. The factors affecting OA were analyzed by the multivariate unconditional logistic regression.Results: Obtained total of 1877 questionnaires were completed. 93% of the residents were unaware of OA-related issues. The prevalence of radiological OA and clinical OA (neck OA: 36.72%; waist OA: 44.02%; knee OA: 12.43%; hand OA: 6.83%) were 62.17% and 56.15%, respectively. Urban residents were more subjected to cervical spine (χ2=8.92, P=0.005) and less to lumbar spine disease (χ2=10.32, P=0.004) compared to rural ones. The prevalence of OA in knees and hands of females (χ2=8.65, P=0.003) was significantly higher than males (χ2=4.37, P=0.042). The prevalence of OA in postmenopausal females was slightly higher than males (χ2=3.86, P=0.052), with no statically significant difference. The risks of OA obviously increased with age. The residents with hypertension, diabetes and atherosclerosis were more subjected to OA.Conclusions: The prevalence of OA in Mongolian middle-aged and senior residents in part of the Inner Mongolia autonomous region was similar to the other ethnic groups. The prevalence of OA was affected by age, gender, location, hypertension, diabetes, atherosclerosis and osteoporosis. The residents need further educations about OA prevention and treatment.