سال:1394 | دوره: | شماره: |تعداد مقالات:6

Medical experts who practice social medicine have a strong ethical approach for their professional positions. Their reports must reflect an objective, independent, high-quality assessment of interactions between health status and the disability of individuals. However, they must simultaneously consider the societal involvement of these individuals when determining the framework of the Statutory Health Insurance and Social Security Systems. Their task is to recommend sociomedical benefits that are tailored to suit personal needs and that respect the individual life situations of the persons involved, thus complementing the efforts of healthcare professionals in clinical settings. The editorial describes the self conception of this medical specialty on behalf of the German Society of Social Medicine and Prevention (DGSMP). Policy makers in social insurances and social security systems generally must respect independent sociomedical recommendations as a crucial point for further realistic development activities.

Background: The analysis of arterial blood gas (ABG) is an invasive procedure that is used frequently in the emergency department (ED) to evaluate the acid-base status of critically-ill patients. However, capnometry is an alternative procedure that has been used in recent years to determine the metabolic status of patients’ blood. Considering the correlation between end-tidal carbon dioxide (ETCO2) and arterial partial pressure of carbon dioxide (PaCO2) identified in the previous studies and the strong correlation between PaCO2 and bicarbonate (HCO3-), we assumed that ETCO2 might be a useful parameter in predicting the presence of metabolic acidosis. The aim of this study was to determine the correlation between ETCO2 and the parameters of ABG in adult patients who were likely present metabolic acid-base disturbances in the Emergency Department of Imam Reza Hospital, the largest academic hospital in Mashhad in northeast Iran.Methods: This was a cross-sectional study conducted during six months on 62 adult patients who presented with suspected metabolic acid-base disorders to the ED. The exclusion criteria were patients with chronic obstructive pulmonary diseases, loss of consciousness, intubated patients, and those who were unable to tolerate capnography. The patients’ demographic information and vital signs were recorded. Also, ABG and ETCO2 results were recorded. The Pearson product moment correlation analysis and linear regression were used to determine the correlation between ETCO2 and ABG parameters.Results: Sixty-four patients were enrolled, consisting of 37 men and 27 women with a mean age of 55.4 ± 22.7 years. The most common complaints presented were nausea and vomiting (n = 24). The average value for ETCO2 was 26.2 ± 6.1. There were significant linear correlations between ETCO2 level, pH (r = 0.368), HCO3 - (r = 0.869), PaCO2 (r = 0.795), and Base Excess (B.E.) (r = 0.346). HCO3 and PaCO2 were the significant predictor values for ETCO2 (linear regression analysis).Conclusion: ETCO2 can be an appropriate indicator to estimate HCO3- and PaCO2 in critical emergency situations, but it cannot be used as an indicator to estimate all ABG variables.

Background: There are various clinical symptoms of thalassemia intermedia, and they lie roughly between those of major and minor forms of the disease. Patients with thalassemia intermedia occasionally require blood transfusions. This renders them susceptible to pulmonary arterial hypertension (PAH) syndrome, which is one of the most significant complications in patients with thalassemia intermedia. PAH is more common in in thalassemia intermedia than in thalassemia major, and it may cause cardiac complications in patients who are older than 30. The objective of this study was to estimate the prevalence of PAH in thalassemia intermedia patients so that they can be referred expeditiously for treatment, thereby preventing the complications that occur later.Methods: This cross sectional study was conducted under the supervision of hematology department of Mashhad Medical University. Forty-one patients with thalassemia intermedia were examined at the Sarvar Thalassemia and Hemophilia Clinic of Mashhad. Electrocardiography, chest radiography, and echocardiography tests were performed for all of the patients by the same pediatric cardiologist. The data were processed by SPSS software, version 11.5, and the results were analyzed using chi-squared, Student’s t, and Mann-Whitney tests.Results: The mean age of the patients was 21.93±8.34. They had been under pediatric heart specialists’ constant examination and treatment since their childhood when they were diagnosed with TI, and continue to receive regular follow-up care. The prevalence of pulmonary hypertension was 24% in our study population. In patients with thalassemia intermedia, the left ventricular (LV) mass indices were about 3-5 times higher than would be expected in a normal population. Patients with higher LV mass indices have a greater risk of developing pulmonary hypertension, and those with serum ferritin levels below 1000 ng/ml are less susceptible to diastolic dysfunction.Conclusion: Pulmonary hypertension is common in patients with thalassemia intermedia. Irregular chelation therapy or absence of this treatment might lead to diastolic dysfunction, and serum ferritin levels below 1000 ng/ml could be an important factor in preventing the development of diastolic dysfunction or slowing down its progression.

Background: Many nurses have reported experiencing high levels of occupational stress in their work environment. Stress, as an outcome of stressful workplaces and tasks, affects nursing behavior in hospital wards. The objectives of this research were to determine the prevalence of occupational stress and mental health problems in nurses in the intensive care unit (ICU) at Shahid Mohammadi Hospital in Bandar Abbas in 2013 and to determine the relationship between occupational stress and mental health.Methods: This cross-sectional study was conducted in 2013 on all of the nurses working in ICU at Shahid Mohammadi Hospital located in Bandar Abbas, Iran. Seventy-two nurses were selected as the population for this study, and all of them were female. Two questionnaires were used in this study, i.e., General Health Questionnaire-28 (GHQ-28) for assessing mental health and an occupational stress test for assessing job stress. Furthermore, the relationship between occupational stress and mental health was examined. One-way analysis of variance (ANOVA), independent samples t-test, and Pearson's product-moment correlation test were used to analyze the data.Results: High and moderate levels of occupational stress were experienced by 83.9% and 10.7% of ICU nurses, respectively. The prevalence of mental disorders, somatic symptoms, anxiety, social dysfunction, and depression were 58.9, 60.7, 62.5, 71.4, and 10.7%, respectively. The findings of the independent samples t-test showed that somatic symptoms had significant relationships with age and working experience (p = 0.01). According to the independent samples t-test, there were no significant differences between somatic symptoms and working different shifts (p > 0.05).Conclusions: There was a high prevalence of occupational stress among ICU nurses. There was a significant relationship between occupational stress and mental health. Future interventions are needed to codify a comprehensive health program in this field to reduce occupational stress and enhance nurses’ levels of mental health.

Background: Low-grade gliomas (LGGs) are the second most prevalent type of primary brain tumors in adults. The prognosis for LGGs can differ according to the clinical-pathological prognostic factors determined during diagnosis and treatment. The purpose of this study was to identify 10-year, disease-free survival (DFS), 10-year overall survival (OS), and related clinical-pathological prognostic factors of adult patients with supratentorial, low-grade gliomas who were treated with or without surgery and radiation therapy.Methods: The study included 110 patients who were confirmed to have low-grade, supratentorial gliomas and who had received surgery and adjuvant radiation therapy or salvage radiotherapy as part of their treatment. These patients were followed by the radiation-oncology ward at Shohada-e-Tajrish Hospital in Tehran, Iran, between 2002 and 2012. The log-rank test (univariate) and the Cox proportional hazards model (multivariate) were used to examine the 10-year DFS and OS and to assess the strengths of various histo-clinical factors relative to 10-year DFS and OS.Results: The study included 110 patients for whom 10-year DFS and OS were found to be 23 and 28%, respectively. Favorable prognostic factors in the univariate analysis using the Kaplan-Meier 10-year OS analysis were the following: age below 40, karnofsky performance status (KPS) more than 70, the presence of oligodendroglioma, tumor size of < 5 cm, and gross-total resection (p=0.02, p=0.01, p=0.03, p=0.01, p=0.02, respectively). Good prognostic factors in multivariate analysis using the Cox regression model were as follows: age below 40, the presence of oligodendroglioma, tumor size< 5 cm, and gross total resection in10-year OS (p=0.01, p=0.03, p=0.00, p=0.02, respectively).Conclusions: Gross-total resection, tumor size < 5 cm, age below 40, and the presence of oligodendroglioma had better 10-year DFS and OS rates. We recommend that all patients with LGG tumors be referred to neurooncology centers that have sufficient experience to achieve the best results of treatment.

Background: Noise-induced hearing loss (NIHL) is usually one of the main problems in industrial settings. The aim of this study was to determine whether changes in the signal-to-noise ratio (SNR) in different DPOAE are caused by exposure to different levels of noise at different time intervals among workers exposed to noise.Methods: This case-control study was conducted in the autumn of 2014 on 45 workers at Gol Gohar Mining and Industrial Company, which is located in Sirjan in southeast Iran. The workers were divided into three groups based on their noise exposure, i.e., 1) 15 office workers as a control group with exposure to low levels of noise, 2) 15 workers from manufacturing departments who were exposed to a medium level of noise, and 3) 15 workers from manufacturing departments who were exposed to high levels of noise. The SNRs at the frequencies of 1000, 2000, 3000, 4000, and 6000 Hz were measured in both ears at three different time intervals during the shift work. SNRs of 6 or greater were considered as inclusion criterion. Repeated measures, the Spearman rank-order correlation test, and paired t-test analyses were used with α = 0.05 being the level of significance.Results: For all frequencies in the right and left ears, the SNR values were more than 6, thus all SNR values were considered as acceptable responses. The effects of time and sound pressure level (SPL) on SNR were significant for the right and left ears (p = 0.027 and < 0.001, respectively). There was a statistically significant correlation between the SNR values in the right and left ears for the time intervals 7:30-8:00 A.M. and 13:30–14:00 P.M., which implied that an increase in the duration of exposure led to reduced SNR values (p = 0.024, r = 0.948).Conclusions: The comparison of the SNR values in the right and left ears (for all frequencies and the three different SPLs) indicated that the values decreased during the shift work.