Iranian Red Crescent Medical Journal
Year:2013 | Volume:15 | Issue:5|Papers Count:20

Background: National and international statistics from Iran have indicated that progresses and achievements have been made for most health indicators, but there are differences in some indicators in special groups and at the provincial level.Objectives: Our aim was to assess the main predictors of inequity in seeking Health Care Utilities (HCU) locally.Patients and Methods: Data gathered from the HCU survey, which was conducted in the Markazi province of Iran during 2008, was used in the present study. A systematic sampling method, based on the Iranian household framework, was applied in order to choose 758 households as well as 2711 individuals. The household wealth index constructed by Principle Component Analysis (PCA) and robust login link function in Generalized Estimation Equation (GEE) model were used in order to determine the predictors of inequity.Results: 66.4% of those in need sought outpatient health care from which 97.7% received appropriate services. After adjustment for the clustering effect of household as well as confounding effect of the covariates, GEE model showed that there were inequities in HCU for females (OR=2.44, CI; 1.24- 4.81) and subjects with inpatient need (OR=2.14, CI: 1.23-3.72). Being in the lowest quintile of household wealth index was associated with the lower use of outpatient health services (OR=0.45, CI; 0.23- 0.88).Conclusions: In spite of improvements in the national health indicator, different groups of people use health care services differently, but these inequities in HCU are related to social and individual factors. Also, it is clear that health sector facilities and the accessibility to health services are not the only predictors.

Background: Helicobacter pylori have different virulence factors which are associated with several gastroduodenal diseases; however, this association is variable in different geographical regions. Data of genotypes of Iranian H. pylori isolates are few.Objectives: The aim of the current study was to investigate the cagA/vacA genotypes of Helicobacter pylori isolates and determine the relationship between these genotypes with respect to different gastric disorders in patients of Chaharmahalo Bakhtiarian.Materials and Methods: In this cross-sectional study, gastric biopsies were taken from 200 patients with gastrodoudenal diseases. Histopathological features were recognized by specialist. The samples were subjected to PCR for detection and identification of ureC, cagA and vacA genes.Results: The frequency of the vacA genotypes, sa1/m1, s1a/m1b, s1a/m2, s1b/m1a, s1b/m1b, s1b/m2, s1c/m1a, s1c/m1b, s1c/m2, s2/m1a, s2/m1b and s2/ m2 were 27 (6.6%), 8 (4.3%), 45 (28.04%), 7 (3.7%), 5 (2.5%), 10 (6.1%), 12 (7.4%), 4 (2.5%), 18 (11%), 6 (3.7%), 0 and 22 (13.5%) respectively. The cagA gene was detected in 92% of strains. Based on our findings, it seemed that cagPAI and vacA s1 genotypes were associated with some gastric disorders in patients with H. pylori. In this region, the isolates carrying s1a/m2 were the most prevalent.Conclusions: We found considerable relationship between s1a/m1a, s1a/m2, s2/m2 and s1c/m1a and some gastric disorders. Further studies about the role of H. pylori virulence factors and gastric disorders were recommended.

Background: Hydatidiform moles carry a significant risk for developing persistent gestational trophoblastic disease. Lectins are useful tools to identify cellular glycosylation pattern and changes in glycosylation that occur during growth, development, differentiation and also, during disease states.Objectives: Considering the changes in glycosylation that occur during cell proliferation, differentiation and transformation, the aim of the present study was to evaluate the sugar chain expression in hydatidiform mole by using HRP-conjugated lectins.Materials and Methods: Lectin histochemistry with a panel of HRP-conjugated lectins comprising SBA, PNA, VVA, UEA-1, LTA, GS-I (B4) and WGA were performed in 20 molar (partial & complete moles) formalin-fixed, paraffin-embedded tissue samples.Results: The partial and complete moles generally showed similar reactivity with all used lectins. None of lectins reacted with villous cytotrophoblasts, whereas 4 of 7 lectins comprising WGA, LTA, UEA-I and PNA (after pretreatment with neuraminidase) showed a moderate to strong reactivity with villous syncytiotrophoblasts in both partial and complete hydatidiform moles. The villous stroma reacted with all used lectins except VVA.Conclusions: Our histochemical findings showed a relatively heavy glycosylation of syncytiotrophoblasts of both partial and complete molar tissues, which was prominent in apical portion. This may play a role in their capacity to increase trophoblastic proliferation.

Background: Untrained fingertip palpation has been shown to be unable to adjust endotracheal tube (ET) cuff pressure in most intubated patients.Objective: We determined the impact of a training course of ETT cuff adjustment by palpation in attaining a safe cuff inflation pressure.Patients and Methods: Twenty-five nurses were asked to adjust the ETT cuff pressure to 25 cmH2O by palpation on three different patients in seven sessions (S1-S7): before training, two hours and two days after first training session, and two hours, two days, one week, and eight months after second training session.Results: Before training, 41.3% of the cuff pressures were adjusted to the safe range of 21-35 cmH2O. The pressures obtained in S2-S7 were lower and less variable than S1 (P=0.02 to<0.0001). After the first training session, all the ETT cuff pressures in the high range (36-50 cmH2O) and 87.5% in the very high range (>50 cmH2O) changed to the safe range.Conclusions: Using trained fingertip adjustment of the ETT cuff pressure throughout the nursing shift with protocols for the adjustment of out of range pressures at the beginning of each shift by cuff manometer could decrease the rate of ETT cuff over- and under-inflation.

Background: A variety of surgical treatment methods for carpal tunnel syndrome are introduced recently, including open surgery, endoscopic and the Knifelight. It is hypothesized that Knifelight method could decrease scar tenderness and time before return to daily activities for patients and is accompanied with less disturbance to fine sensory nerves.Objectives: To compare the Knifelight instrument and open carpal tunnel release with respect to scar length, operation duration, recovery time needed before return to work and amount of pain three weeks after surgery in patients with neurophysiologically confirmed carpal tunnel syndrome.Patients and Methods: Fifty nine patients with indication for carpal tunnel release randomly assigned into two groups: open (n=30) or Knifelight (n=29). The patients compared regarding scar length, operation duration, time to return to daily activities and amount of pain at three weeks after operation based on Visual Analog Scale.Results: There was no significant differences regarding age and sex in the two groups. The scar length, operation duration and time before return to daily activities were significantly lower in the Knifelight group. Although the mean visual analogue scale of Knifelight group found to be lower than the other, it was not statistically significant.Conclusions: The Knifelight technique is accompanied with advantages over the open surgery regarding operation time, scar length and time to return to daily activities. The pain relieve based on Visual Analog Scale was not statistically different from conventional open surgery.

Background: The burn wound represents a susceptible site for opportunistic colonization by organisms of endogenous and exogenous origin. Diminishing appetite is known to occur in patients with burn infection, yet its underlying reason is not fully understood. We have examined the levels of nesfatin 1, a protein that we consider to be a potential new treatment target for the solution of appetite and nutrition problem in patients with burn infection.Objectives: The aim of the present study was therefore to examine nesfatin levels in patients with burn infection.Material and Methods: Laboratory values, medication and dietary records, and patient notes with diagnostic information of burn wounds patients who were admitted to the Division of Burn Treatment Center were obtained from the Erzurum Region Education and Research Hospital electronic database. Post-burn wound infection was objectively assessed by culturing wound homogenates from skin tissue. The main immediate inflammatory stress response parameters assessed were serum CRP concentrations, WBC counts, and blood nesfatin concentrations.Results: Scalding was the predominant cause of burns in both categories of patients. In 19 (61.3%) burn wound infection patients, the burns were due to a scald. A significant difference was found for the nesfatin, CRP, and WBC levels between the patients and the control group (P= 0.000). A significant difference was also determined between the nesfatin, CRP, and WBC figures at the time of hospitalization and at discharge from the hospital (P=0.000). The most predominant bacterial isolate was Pseudomonas aeruginosa 16 (51.6%) followed by Methicilline resistant Staphylococcus aureus (MRSA) 7 (22.6%).Conclusions: We showed that the serum nesfatin 1 level was significantly lower in the patients with burn than in the control group in our study. We considered that the central nesfatin 1 system should be taken into consideration, rather than the peripheric nesfatin 1 system, when considering the regulation of appetite in patients with burns and particularly those accompanied by infection. In other explanation of the observed negative correlation between nesfatin 1 and burn wound infection suggests that nesfatin 1 may indicate the possible contribution of nesfatin 1 to the energy homeostasis.

Background: Hospitals are the most costly and important components of any health care system, so it is important to know their economic values, pay attention to their efficiency and consider factors affecting them.Objective: The aim of this study was to assess the technical scale and economic efficiency of hospitals in the West Azerbaijan province of Iran, for which Data Envelopment Analysis (DEA) was used to propose a model for operational budgeting.Materials and Methods: This study was a descriptive-analysis that was conducted in 2009 and had three inputs and two outputs. Deap2, 1 software was used for data analysis. Slack and radial movements and surplus of inputs were calculated for selected hospitals. Finally, a model was proposed for performance-based budgeting of hospitals and health sectors using the DEA technique.Results: The average scores of technical efficiency, pure technical efficiency (managerial efficiency) and scale efficiency of hospitals were 0.584, 0.782 and 0.771, respectively. In other words the capacity of efficiency promotion in hospitals without any increase in costs and with the same amount of inputs was about 41.5%. Only four hospitals among all hospitals had the maximum level of technical efficiency. Moreover, surplus production factors were evident in these hospitals.Conclusions: Reduction of surplus production factors through comprehensive planning based on the results of the Data Envelopment Analysis can play a major role in cost reduction of hospitals and health sectors. In hospitals with a technical efficiency score of less than one, the original and projected values of inputs were different; resulting in a surplus. Hence, these hospitals should reduce their values of inputs to achieve maximum efficiency and optimal performance. The results of this method was applied to hospitals a benchmark for making decisions about resource allocation; linking budgets to performance results; and controlling and improving hospitals performance.

Background: Although, melasma is most prevalent among Asian young women, and also darkly pigmented individuals are particularly prone to developing post inflammatory hyperpigmentation, to the best of our knowledge, there are rare or no studies about the association of melasma and Post inflammatory hyperpigmentation.Objectives: The aim of this study was to investigate how likely is a melasma patient to developed post inflammatory hyperpigmentation when compared to patients with inflammatory acne lesions who do not have melasma.Patients and Methods: This comparative study was conducted on 400 participants, 200 subjects involved with pigmented lesions of melasma and inflammatory acne lesions and200 involved only with inflammatory Acne lesions without melasma. Melasma, acne and post inflammatory hyper pigmentation, if existed, were assessed by a dermatologist, and pigmentation depth was assessed by wood's lamp. Multivariate logistic regression analysis suitable for study design was used to assess the association between melasma and post-acne pigmentation.Results: We found out that 24.1% of patients without melasma had post-acne pigmentation compared to 66.8% in melasma group (P<0.001). The likelihood of observing post-acne pigmentation was found to be nearly six times more in melasma patients versus those without melasma. Association existed after controlling for possible confounders such as melanin score and time length of self-reported sun exposure, and acne severity score.Conclusions: Melasma appears to increase the likelihood of post-acne pigmentation.

Background: The quality of life (QOL) is an important indicator for disease-severity classification and outcome measurement in obtaining treatment sinonasal diseases. The sinonasal outcome test 22 (SNOT 22) questionnaire has been introduced as the best specific sinonasal instrument for QOL measurement.Objectives: To prepare a valid and reliable Persian language version of SNOT 22 questionnaire.Patients and Methods: After forward and backward translation of the original version of SNOT 22 questionnaire from English to Persian, a group of patients with nasal septal deviation who need septal surgery and another group of healthy volunteers answered the Persian version of the questionnaire. The responsiveness rate, validity (Pearson correlations and differential validity) and reliability (internal consistency and test-retest reliability) of the 22 items of the questionnaire was calculated. P value<0.05 was considered significant.Results: Thirty adults with nasal septal deviation need surgical correction and 30 healthy volunteers were included (mean age 30.4±7.1 vs. 33±6.7, P value=0.148). The questionnaire was introduced to subjects two times with a two-week-period gap. Total responsiveness rate for 22 items was more than 97%. The total Cronbach's Alfa coefficient was 0.898 (ranging 0.890-0.903). The Pearson correlations were 0.85 and 0.96 for patients and healthy volunteers, respectively. The mean total score were 25.6±13.3 (range 6-52) and 7.6±9.1 (range 0-45) in patients and healthy volunteers, respectively (P<0.0001). The subscales scores were also significantly different between two groups.Conclusions: The Persian version of SNOT 22 questionnaire is a valid and reliable instrument for accessing sinonasal diseases in Persian speaking people.

Background: The status of hepatitis A virus (HAV) among health care workers has not been studied yet in Iran.Objectives: This study aimed to evaluate the HAV seropositivity among the healthcare personnel in Ayatollah Rohani Hospital, Babol, Iran, according to age, number of working years, and other demographic data.Patients and Methods: This cross sectional study was performed on all nurses, nurses' aid, and paramedical technicians at Ayatollah Rohani Hospital, Babol, from March 2011 to March 2012. Blood was obtained from all cases (466) and the sera were separated. All serum samples were tested for anti-HAV antibodies (IgG) by enzyme-linked immunosorbent assay (ELISA). Data were analyzed by logistic regression analysis using SPSS software, version 18.Results: 330 out of 466 (71%) persons were positive for anti-HAV antibodies (IgG) with no significant difference between females (71.5%) and males (70%) (P=0.89, 95% CI. 0.533-2.083). The lowest sero-prevalence rate was observed in the 20-29 year age group (57.8%). Seropositivity for HAV significantly increased with age (P<0.000, 95% CI. 1.626-3.262), 77.4% for 30-39 years and 85.3% for more than 40 years. The seropositivity rate also increased significantly in accordance with the number of working years (P=0.012, 95%CI. 1.098-2.170).110 out of 353 (31.2%) cases were seronegative among those with less than 5 years of working time. An obvious decrease of seronegative rate of HAV was seen in those with 5-10 years (27%) and more than 10 years (14.3%) of working time.Conclusions: These findings indicate relatively high prevalence rate of HA infection among nurses and paramedical personnel at this hospital. Nevertheless, 30% of the health workers have been seronegative and are still at risk of HA infection development. Considering that the disease has more severe course as age increases, improvement of standard hygiene and prevention strategies are recommended. Furthermore, vaccination may play a significant role in the occupational health policy to protect the susceptible health care workers population in the future.

Background: It is known that cardiopulmonary bypass causes an inflammatory reaction with associated morbidity and mortality. Several anti-inflammatory strategies have been implemented to reduce this response, including leukocyte removal from the circulation using specialized filters.Objectives: The aim of this randomized clinical study was to assess the impact of arterial-line systemic leukocyte filtration on the postoperative outcome of adult patients undergoing elective cardiac surgery.Patients and Methods: 114 patients undergoing CABG or valve replacement in Baqiyatallah hospital, Tehran, Iran from May to August 2011 were randomly assigned to two groups: with and without leukocyte filtration and their outcomes were compared.Results: The postoperative intubation time was significantly shorter in patients with leukocyte filters (0.014). There was no significant difference between two groups regarding other outcome relatedvariables.Conclusions: Systemic arterial leukocyte filtration reduces the intubation time but has no other beneficial effect on the outcome of patients undergoing CABG or valve surgery.

Background: Hypertension is considered as a major public health problem in most countries due to its association with ischemic heart disease which causes cerebrovascular disease and death.Objectives: The purpose of the present study was to study factors affecting Blood Pressure (BP).Patients and Methods: The data were extracted from annual observation of the workers who worked in Polyacryl Iran Corporation (PIC) between 1998 and 2010. In this research, we assessed the effect of Body Mass Index (BMI), age, sex, job status, marital status, job schedule type, and education level on Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) using Bayesian multilevel modeling with skew t distribution using WinBUGS software.Results: Totally 3965 persons participated in this study, 75 (1.9%) female and 3890 (98.1%) male. In this study age, sex, BMI, job status, marital status, and education level had statistical association with SBP. The result for DBP was similar to SBP except the education level which had no statistical association.Conclusions: Treating obesity, increasing physical activity and quality of married life are proposed as practical solutions to reduce BP.

Objectives: The purpose of this study was to compare remifentanil versus propofol effect on pain and homodynamic in patients undergoing phacoemulsification with topical anesthesia.Materials and Methods: A double blind clinical trial was conducted to research following the approval of the ethical committee research of the university. One hundred volunteer subjects were randomly assigned into two equal groups (n=50). The subjects in the propofol group received 3mg/kg/hr while the patients in the remifentanil drug received 3 mg/kg/hr of this medication. Phaco time, blood pressure and heart rate before and after surgery, respiratory depression (O2 sat<90%) and vomiting, pain scores, ophthalmologist satisfaction and demographic data were recorded.Results: The results of analysis showed that there were no significant differences between the age, sex, and duration of operation of the two treatment groups. Systolic, diastolic blood pressure and heart rate were significantly lower in the propofol group. The propofol group complained of pain than the remifentanil group (P=0.001) while the surgeon satisfaction was higher for the remifentanil condition (P=0.01). No significant differences were found between the two groups with respect to respiratory depression.No patient suffered from nausea and vomiting.Conclusions: The results of this study indicated that using appropriate dose of remifentanil instead of propofol results in less pain, more stable homodynamic condition, and satisfaction of surgeon without no respiratory depression or perioperative nausea and vomiting.

Background: To investigate pulp response to the application of two types adhesive systems (total-etch and self-etch) in human premolar teeth.Materials and Methods: Cavities limited to enamel walls in all margins with 2.5 mm depth were prepared on buccal surfaces of thirty three human premolars. The cavities were treated with the following adhesive. Single Bond (SB) and Prompt L-Pop (PLP). The teeth were extracted after 30 days and prepared due to histological technique.Results: Pulp responses were evaluated in three field including inflammatory cell response, pulp tissue disorganization and restorative dentin formation. There were no differences in histological response of the pulp tissue (P>0.05).Conclusion: Both adhesive systems showed good biological compatibility.

Background: Stabilization of fractures with an intramedullary nail is a widespread technique in the treatment of femoral shaft fractures in adults; however, to ream or not to ream is still being debated.Objectives: The primary objective of this study was to determine clinical results following unreamed versus ream intramedullary nailing of femoral fractures.Patients and Methods: Between January 2008 and August 2009, 50 patients with femoral shaft fractures were treated with unreamed or reamed femoral nails in our clinic. From this prospective single centre study, 16 patients were excluded due to insufficient follow-up data. According to the AO classification, fractures in this study were either type A or B. Dynamic proximal locking was performed in all cases. The remaining 34 patients were divided into two groups of 17 with ream or unream nailing. During and after the operation, we evaluated some variables in whole series.Results: After statistical analyzes, we found that there were no differences in radiologic union time (P=1) or full weight bearing time (P=0.73) between ream and unream nailing. Nail breakage or iatrogenic fractures during nail insertion did not occur and we did not have any fat emboli in both groups but one secondary loss of reduction occurred in the unream group. Superficial infection after the operation was seen in one case which was treated successfully with antibiotics. In the ream group surgical time was about thirty minutes longer and differences were significant (P=0.000). Patients had to pay more for ream nailing but the difference was not significant. We found no statistical difference between union time with or without reaming; on the other hand, there was significant increased operation length, blood loss and systemic changes in BP or So2 in the ream group versus the unream group.Conclusions: We advocate that unream nailing in traumatic femoral shaft fractures is a simple, safe and effective procedure with significant advantages, especially in multitrauma patients.

Nocardiosis has been reported increasingly in recent two decades, probably due to improvement in isolation of the organism and increased burden of immune compromised patients. Nocardia occasionally has been reported in healthy people. A case series of definitive Nocardiosis (2002 to 2010), clinical characteristics, underlying diseases, immune status and in-patient outcome were studied in a tertiary referral center. Twenty one patients with definite diagnosis of Nocardiosis were studied. 17 cases (81%) had an underlying disease (diabetes mellitus, corticosteroid therapy, and chronic granulomatous disease and collagen vascular diseases). Four patients (19%) were immune-competent without any predisposing disease. In 17 patients (81%), Nocardiosis was limited to respiratory tract and in 4 cases (19%) it was disseminated with multi organ involvement. Two cases (9.5%) died in hospital.

Dear Editor, Studies showed that Iranian pregnant women did not take enough calcium and dairy products such as milk (1). Adequate milk consumption is crucial during pregnancy to meet calcium needs (2). Various factors such as attitudes, beliefs, habit, sensory and expectations are determinants of the consumption of milk (3).

Dear Editors, Most intra-abdominal adhesions result from peritoneal injuries caused by presurgical procedures or intraabdominal infections. Adhesions were reported during postmortem examinations in 67% patients who had undergone presurgical procedures and in 28% patients with a history of intra-abdominal infections.

Dear Editor, The present research is a quasi-experimental study with two groups (before and after training). This study compared the two methods of lecturing training and education by the multimedia software.

Dear Editor, Scorpion sting is a major public health problem in many parts of the world. High prevalence, severity of symptoms and difficulty of treatment are problems of scorpion sting (1).