Journal of Inflammatory Diseases
Year:2006 | Volume:10 | Issue:3 (40)|Papers Count:20

Ever-changing needs of society to which the health sector has to respond, makes the health sector reform inevitable for any country around the world. Based on the experiences gained in different countries, it is now possible to determine the driving force, main objectives and principles of reform in the health sector.While such activities began around 2001 in Iran, reform in other countries was enjoying almost two decades of experience. Increasing the efficiency and effectiveness of health services, equity, sustainable financing and management improvement were the main objectives of health sector reform in Iran. Despite conducting some very effective studies, success in finding the answer to some crucial questions and creating a common language among those dealing with the health system, the health sector reform in Iran could not find the opportunity to put its ideas into practice to achieve all its objectives. This stemmed from very poor (if any at all) political commitment. In conclusion, this article recommends both the government and the parliament to be solemnly committed to following health system reform through providing facilities and resources to complete the ongoing project and also implementing the newly developed models in multiple pilot sites.

Background: Regarding the incomplete treatment and occurrence of side effects by chemotherapeutic agents in patients suffering from inflammation, new effective strategies are strongly needed.Objective: To investigate the anti-inflammatory effect of alcoholic extract of Datura stramonium seeds on inflammation.Methods: This was an experimental study carried out in medical school of Shahed university. Induction of acute inflammation was achieved by injecting formalin, xylene and acetic acid into hind paw, ear, and peritoneum of male mice, respectively. The light absorption values of solution (Evince blue dye in circulation) collected from segments with inflammation, considered as data. In chronic inflammation, the data was obtained by weighing of cotton plate implanted into groin region after 7 days. In treatment group the extract (50 mg/kg) was injected (i.p) 20 minutes before the experiments.Findings: The size of inflammation produced by formalin and acetic acid was significantly reduced (52.28±2.2% and 28.8±3.6%), respectively. Comparing the data associated with the weight of implanted cotton plates, the extract showed to have little effect on decreasing the size of  chronic inflammation, yet statistically significant (p<0.05).Conclusion: The data of present study showed that the alcoholic extract of Ds seed is of ability to markedly reduce the amount of inflammation in particular the acute form.

Background: Regarding the increasing number of women suffering from one or more chronic disease-associated risk factors following the cessation of their reproductive cycle, it is necessary to consider their needs over nutrient intake and lifestyle.Objective: To compare the nutrient intakes in menopausal and perimenopausal women.Methods: This was a cross-sectional study in which a total of 96 women (47 in menopausal and 49 in perimenopausal periods), aged 45 and over with no hormone therapy, were enrolled. The study was conducted within the framework of the TLGS, using anthropometric assessments and a 24-hour dietary recall for 2 days. Anthropometric indices were measured, using standard protocols. Mean intakes of nutrients were compared with EAR and DRI recommendations. The mean differences between two groups were analyzed for any statistical significance using a two-tailed unpaired student’s t-test or a Mann-Whitney test whenever the assumption of normality was not met.Findings: Waist to hip ratio for the menopausal women was higher than perimenopausal group (p<0.01). The menopausal group consumed less fat (p<0.01) and more fiber (p<0.05) than did the perimenopausal subjects (28% and 10±1 g/d vs. 32% and 7±2 g/d for fat and fiber, respectively). Mean intake of vitamin C, thiamin, riboflavin, manganese, phosphorus, and potassium were within the optimal ranges for both groups. However, the mean intake of magnesium, copper, zinc, calcium, pyridoxine and vitamin D were lower than recommendations for menopausal and perimenopausal women, respectively (97 and 98% for magnesium, 91 and 92% for copper; 89 and 94% for zinc; 93 and 91% for calcium; 93 and 98% for pyridoxine; 61 and 50% for vitamin D).Conclusion: Menopausal women met the recommendations for the nutrient intakes better than perimenopausal women, although both groups were found to have insufficient nutrient intakes.

Background: In some works, a correlation between the percentage of meals-derived energy intake and the prevalence rate of obesity has been found.Objectives: To explore any possible correlation between body mass index (BMI) and dietary energy, macronutrients intakes and also contribution of meals to energy intake.Methods: This was a cross-sectional study in which 348 male high school students aged 14-16 from Zarrin-shahr district, Isfahan, were investigated. The selection procedure was based on stratified random sampling from all high schools in the region followed by calculation of BMI (Weight/height2) for each individual. Data on food and nutrient intakes were gathered using a 24-hr dietary recall method. Obesity, overweight and thinness were defined on the basis of CDC 2000.Findings: The data showed that 9% of adolescents were thin, 6% overweight and 5% obese. While there was a positive correlation between total energy intake and BMI (r=0.31; p<0.03), no relationship was found between BMI and protein, fat or carbohydrate intakes. In all age groups, overweight/obese students had lower energy intake from breakfast. The adolescents aged 14 and 15 had higher energy intake from lunch (23.9±5.1% vs. 18.9±4.2% and 27.2±4.0% vs. 19.2±3.9%), respectively (p<0.01).Conclusion: There was a significant correlation between total energy intakes and BMI, and also between the latter and the energy share of different meals which may have important implications in designing nutrition education programs to prevent overweight or obesity in school adolescents.

Background: Management of pain after cesarean section not only brings comfort for patients but reduces the cost and duration of hospitalization.Objective: This study was performed to compare post-cesarean pain between two techniques of closure and non-closure of parietal peritoneum.Methods: This was a double blind clinical trial in which 160 pregnant women visited in Kosar hospital during the period from October 2003 to May 2004 were selected. All cases were operated under spinal anesthesia. A pfannenstiel incision of skin and lower segment of uterus was employed in all cases. The patients were randomly divided into two equal groups. In one group, parietal peritoneum was closed using a continuous chromic suture and in second group this layer was left unsutured. The analgesic requirement and the degree of pain over the first 24 hours following the surgery were further assessed. Two groups were compared by t-test and chi-square test.Findings: Two groups were similar in terms of age, weight, parity, and cause of cesarean. In non-closure group, the mean use of analgesic over 24 hours was 90.8 mg of Voltaren and 1.16 capsules of mefenamic acid whereas in closure group it was 112.9 mg of Voltaren and 2 capsules of mefenamic acid and the difference was found significant, statistically (p=0/000). The mean VAS in closure and non-closure groups over 24 hours was 5.5 and 4.24, respectively. The difference between two groups was also shown to be statistically significant (p=0/000).Conclusion: Non-closure of parietal peritoneum in cesarean section produces a significant reduction in post operative pain and analgesic use.

Background: Aawareness during anesthesia causes many psychological problems for the patients and the society.Objective: To compare the prevalence rate of awareness during cesarean section with three anesthetic techniques.Methods: Through a prospective clinical trial, 178 patients were randomly divided into three sets as group a (101), group B (50), and group C (27) based on the type of drug received. The induction of anesthesia was carried out using  thiopental 5 mg/kg in group A and propofol 2-2.5mg/kg in groups B and C. Maintenance of anesthesia was accomplished using halotan and N2O in groups A and B and propofol infusion and N2O in Group C. Following the extraction of neonate, only fentanyl (1.5 mg/kg) was administered for groups A and B while in Group C fentanyl (1.5 mg/kg) plus midazolan (2 mg) was used. Muscle relaxant used in three Groups was the same. During the time between inductions of anesthesia to extubation of tracheal tube, a tape containing part of Quran was played. Eight hours after wakefulness and using a questionnaire, the patients were asked about feeling of pain during surgery, remembering of Quran voice or accidents during surgery. The data were analyzed using chi-square test.Findings: Among 178 patients under the study, 7 cases (3.9%) had awareness of grade I during anesthesia in which 2 patients were the members of group A (2%), 3 patients of group B (6%) and 2 patients of Group C (7.4%). The differences found in the study were not significant from a statistical point of view (p>0.05). There was no direct relationship between the age, educational status and indication of CS with the prevalence of awareness during anesthesia.Conclusion: The prevalence of awareness during anesthesia in CS by three different anesthetic techniques (Thiopental-halotan, propofol-halotan, and propofol-midazolam) was almost equal.

Background: Perinatal assessment tests such as non-stress test is required to decrease fetus and infant morbidity and mortality rate. It is a type of screening test for fetal surveillance. There are several factors including the maternal position which affect the results of non-stress test. Objective: To evaluate the relationship between maternal position and the results of non-stress test in high risk pregnant women. Methods: This was a clinical trial, carried out on 150 patients, hospitalized in Alzahra medical center, Tabriz, Iran, in 2003. The cases were singleton pregnant women with gestation period between 32 to 42 weeks. The first patient was randomly assigned to a "sitting first" (semi-Fowler position) or "supine first" (left lateral position) and then the position was alternated. Fetal heart rate monitoring was performed for ten minutes. A non-probability purposive method was used for sampling. Data were collected using check lists and sample select forms. The data were further analyzed using both descriptive (means, standard deviation) and analytical statistics (chi-squared test, McNemar test).Findings: The average maternal gestational age was 36.67 weeks and the majority of mothers were nuliparous (51.3%). There were no significant correlations between both demographic characteristic and maternal positions (Semi-Fowler and Left lateral positions) with results of non-stress test.Conclusion: According to the results of present study, either of position could be used while performing a non-stress test.

Background: Proteinuria is the most important factor in dignosis and management of preeclamptic patients. The use of a method providing rapid diagnosis of preeclampsia is of prime importance and critical to immediate treatment.Objective: To measure the protein content of a 24-hour urine samples by determining protein/creatinine ratio in a random urine sample obtained from a pregnant woman suspected of preeclampsia.Methods: This was a cross-sectional study carried out in Kosar hospital, Qazvin, Iran, during 2003-2004. The subjects were 50 pregnant women with gestationl age³ 20 weeks and blood pressure³140/90. Following admission, the protein content of a 24-hour urine sample was measured and later, a random urine sample collected for determination of protein/creatinine ratio. Correlation coefficient between 24-hour proteinuria and protein/creatinine ratio was further calculated. Findings: Among 50 pregnant women, 12 cases had a proteinuria>300mg/day and 38 with proteinuria<300mg/day. Regarding the results of our study, a protein/creatinine ratio of £0.25 was compatible with 24-hour proteinuria<300mg and similarly, a protein/creatinine ratio of >0.25 with 24-hour proteinuria>300mg (r=0/99, p<0/001). Sensitivity, specificity, and the positive/negative predictive value for this ratio was 98% with an accuracy of 96%.Conclusion: Determination of protein/creatinine ratio of a random urine sample could predict significant proteinuria (>300mg/24h).

Background: Rapid urease test is increasingly used as a cheap and quick procedure with high specificity for clinical detection of Helicobacter pylori worldwide.Objectives: To evaluate the functionality of a rapid urease kit manufactured by Pasteur institute of Iran in 2002, with some modifications compared with other common kits. During a clinical trial in Baghiatallah hospital, Tehran, the sensitivity, specificity and accuracy of the kit was investigated.Methods: This was an experimental study in which 91 patients suspected of having H pylori infection were examined. Following collection of history and clinical symptoms, the endoscopic signs of all patients were also recorded. Each endoscopic specimen was carefully examined in three ways with no previous knowledge of operator as follows: 1. Detection of urease test using modified rapid urease kit. 2. Detection of urease test using certified commercial kit. 3. Pathologic examination as the gold standard method.Findings: Regarding the results of present study, employing modified rapid urease kit produced positive results on 78.8% of pathologically positive samples. When negative pathologic samples were tested with modified kit, 89.7 % of samples found to be negative. The differences observed between the results of two tests were statistically significant (p=0.001). Using modified rapid urease kit also produced a false positive rate of 4.4%.Conclusion: Based on our data, it was shown that the sensitivity, specificity and accuracy of the modified kit were 78.8%, 89.7% and of 83.5%, respectively.

Background: Rapid detection of H. pylori is important for determining of resistant are susceptible strains to clarithromycin and recovery of patients will be acelerated, if clarithromycin is added to therapeutic protocol.Objective: Rapid detection of susceptible or resistant strains of Helicobacter pylori to clarithromycin in patients with dyspeptic ulcers by FISH technique and also comparison of FISH results with E-test technique. Methods: Frozen sections of gastric biopsies from 50 patients with dyspeptic ulcers were hybridized in situ with 5 fluorescent oligonucleotide probes (FISH). Following staining with DAPI, the slides were examined using fluorescent microscopy. Also, susceptibility and resistance of isolated strains of H. pylori to clarithromycin was determined by E-test. The results obtained from both E-test and FISH techniques were compared.Findings: Twenty five out of 50 examined gastric biopsy samples were positive for H. pylori by FISH. Out of 25 H. pylori strains, 17 strains (68%) were susceptible, 6 strains (24%) resistant and 2 strains (8%) showed intermediate response to clarithromycin. This study showed that there was no significant difference between FISH and E-test results in terms of the number of susceptible or resistance strains.Conclusion: Regarding the results of this study, it sems that the FISH technique to be a suitable method to determine the susceptibility are H. pylori to clarithromycin, especially when a quickly decision is necessary for treating of dyspeptic patients. 

Background: Approximal caries is detected by clinical examination supplemented by bite wing radiography. Objective: In vitro comparison of diagnostic accuracy in detecting approximal caries of two dental X-ray films named as Kodak Ektaspeed and Agfa Dentus M2.Methods: In an experimental study, sixty-four unrestored extracted premolar and molar with approximal caries were arranged in a way to simulate a bite wing examination followed by radiography under standardized condition using Dentus M2 (Agfa-Gevaert) and Ektaspeed (Kodak Eastman). The films were processed automatically. Three observers assessed radiographs using the following rating measures: R0=sound; R1= enamel lesion; R2= lesion reaching the dentioenamel junction; R3= dentinal lesion. True caries depth was determined by histological examination. True caries depth was compared using the values given by observers and further an analysis of kappa was performed. The null hypothesis was rejected when p<0.001.Findings: The interobservers' agreement on two films was high and revealed no significant disagreement (p<0.001). Kappa value was 0.52 to 0.62. This value corresponded with moderate to high strength of agreement. There was no significant difference between two films and the standard (p>0.001).Conclusion: Both films produced similar results in terms of diagnostic accuracy for approximal caries.

Background: Optimal glycemic control is generally believed to be essential in patients with diabetes to minimize the long term complications associated with the disease. Measuring the level of glycated hemoglobin is usually performed to assess long term control while evaluation of short term control is achieved by determining the levels of plasma proteins or fructosamine. Regarding the shorter half life of plasma proteins, it is believed that fructosamine test is more sensitive in responding to variations in glycemic condition.Objective: To compare fructosamine and glycated hemoglobin tests in assessing glycemic control.Methods: This method evaluation study carried out in Yazd center for diabetes in 2003. The study group consisted of 50 diabetic patients who were tested for plasma fructosmine and glycatd hemoglobim levels during two months. Two measurements for fructosamine level (once each month) and one assay for glycatd hemoglobim level (at the end of two months) were performed. Ion exchange chromatography and chlorometric method based on nitro blue tetrazulium reduction were used to measure glycated hemoglobin and fructosamine, respectively.Findings: The results were indicative of a highly significant correlation between fructosamine and glycated hemoglobin (r=0.94; p<0.001). Variation coefficient among series and days of fructosamine measurement were 2.7 and 5.1 with recovery rate of 96.8%. Conclusion: Based on data found in our study and also in view of lower price, easy performance, high accuracy and precision, it seems that fructosanine to have a high capacity in assessing diabetes control.

Background: Implementation of economical analyses for optimal allocation and effective utilization of hospital resources is of prime importance.Objective: To estimate the production function of hospitals affiliated to Qazvin University of Medical Sciences during 1998-2004.Methods: This was a cross-sectional study conducted in 4 university hospitals. The data were collected using information forms and further analyzed by SPSS software and regression method. Cobb-Douglas was the method of choice for production function in present study. Findings: The results indicated that the production elasticity of physicians, nurses, active beds and other personnel-associated factors were 0.55, 0.29, 0.81 and 0.73, respectively. Also, the marginal product rate of physicians, nurses, active beds and other personnel-associated factors were 114, 38.6, 54 and 37 patient admissions, respectively. The production function coefficient in target hospitals was 1.28 with an obvious economy of scale shown in our study.Conclusion: All production factors were in the economic region of production. Hence, increasing production factors except for physicians to boost total product and also decreasing product cost is recommended.

Background: The opinion of students towards future career affects the quality of education and there are different factors influencing a person's attitude on future career.Objective: To determine the opinion of medical students studying at different levels (basic sciences, physiopathology and clinical section) towards future career.Methods: The present descriptive study was carried out in Qazvin during the academic year of 2000-2001. A questionnaire was used to collect the data. A total number of 339 students participated in the study by filling the questionnaires. The data were further analyzed using chi-square statistical test.Findings: The results indicated that 78% of the students were eager to continue their education in speciality courses. Among students, the most important reason for field selection was self-satisfaction. From scientific, social, and economical points of view, the field was evaluated as "very well" by 43%, 17.7%, and 5.3%, respectively. There was a significant relationship between the educational levels and the points (0-10) given by students to medical course compared to other professions (p<0.001). The students of physiopathology level gave the highest score (9). There was also a significant relationship between the educational level and the present opinion of the students as compared with the beginning of the course (p<0.001). A negative opinion was found to be higher among the medical stagers compared with those of other levels.Conclusion: A negative attitude into future career was more obvious among the students of higher levels. Perhaps it could be concluded that, although the field of medicine was mainly chosen based on personal interest, nevertheless, the majority of students believed that their future economic prosperity is unlikely to be met by being qualified as GPs.

Background: Studying problems and daily hassles in young children can provide models and frames for stress and also the ways stress could be coped with.Objective: To recognize and classify the stress and the ways of coping with 3- year old children in Qazvin.Methods: The present study was basic in nature, and developmental. The study population consisted of 115, 3-year old children of Qazvin. Assessment instrument was a problem check list and demographic questions along with the main test, which included 4 pictorial stories in 4 stages. Results were interpreted both qualitatively and quantitatively.Findings: Although the children used simple and ordinary responses, they also could use problem solving methods. Children's inappropriate and wrong responses could be considered as predisposing element of later disorders; an important subject to study, yet has gained little attention. The children's coping responses were frequently classified as non-effective however these are called positive responses spent upon developmental ones and proposed in the frame of adaptive strategies. Conclusion: Finding a suitable model for stress and coping with children requires more thorough investigations.

In some cases, pregnancy is complicated by anomalies of the reproductive tract. Uterine dysfunction and uterine rupture are serious hazards in these abnormalities. This case was a 22 years old lady with acute abdomen signs in her first pregnancy with a gestational age of 14 weeks. In our evaluation, she had a unicornuate uterus with a right rudimentary horn. The pregnancy occurred at this rudimentary horn causing uterine rupture and internal hemorrhage.

The aim of this study was to determine disturbed sleep quality among nurses.The results indicated that the majority of sleep disorders were associated with insomnia (66% difficulty in falling sleep , 37% difficulty in staying asleep, 55% waking early and unable to return to sleep, and also 68% of respondents reported to suffer from fatigue following getting up).The data obtained in our study suggest that the nurses, who work in night shifts, need further education on how to cope with overnight shifts and also change of their lifestyle.