مجله دانشکده پزشکی اصفهان
پیاپی 208 (هفته دوم آذر 1391)

Continuous evaluation of screening programs in different parts of the country can provide appropriate feedbacks for the health system to adopt training programs and modify existing protocols. We studied the current status of cervical cancer screening in women referred to health centers in Isfahan, Iran.

This cross-sectional study was conducted in women aged 35 to 60 years old covered by health centers in Isfahan city for one year starting from the beginning of 2011. Patients were selected by clustered random sampling method. Data were gathered by telephone or in-person interviews and also by the review of medical records.

From 324 patients studied, 284 patients (87.7%) had at least one Pap smear test, of whom, 10.5% had one test and 89.4% had several tests (38.7% had the test done every three years and 50.7% irregularly). The associations of age and education with performing Pap smear test was not statistically significant (P = 0.062), but being employed outside home was associated with less frequent Pap smear tests (P < 0.001). No relationship was found between the family history of cancer and the frequency of Pap smear tests (P = 0.288).

Based on our results, there is a need to improve women's participation rates in cervical cancer screening by primary health care providers. Promoting awareness through high schools and higher education institutions seems necessary.

Many people want to know about complementary and alternative medicine and its effectiveness. People tend to use such methods, especially the Iranian traditional medicine (ITM) due to various reasons and cultural backgrounds. One way to evaluate the effectiveness of ITM is to assess patients’ satisfaction. In this cross-sectional study, 256 patients who had attended the ITM service providers in Isfahan, Iran for more than three sessions were included. The subjects’ complaints and satisfactions from alternative and complementary medicine, practitioners’ skills, and effectiveness in improving symptoms were collected by a questionnaire. The mean age of patients was 37.9 ± 11.8 years. Women constituted 65.2% of the whole population. Back pain was their most common complain (73.4%). Underweight had the highest recovery rate (50%). Herbal medicine (84%) and cupping (77.5%) had been used more than other alternative medicine methods. The mean satisfaction scores from alternative medicine, practitioners’ skills, and effectiveness of the treatment were 29.1 ± 3.48 (out of 40), 32.58 ± 6.77 (out of 45) and 34.8 ± 3.24 (out of 50). The findings of this study showed good satisfaction of patients from traditional medicine. Therefore, better planning and research in this field may result in even higher satisfaction rates. Alternative medicine can also be recommended as complementary to the routine medical care.

Anterior and posterior vaginal repair are common surgeries for women with prolapse of pelvic organs. Tissue damage during these surgeries causes postoperative pain. Since pain management after surgery is of high importance, we evaluated the preventive effects of pudendal nerve block on postoperative pain in anterior and posterior vaginal wall repair. In a double-blind clinical trial study, 58 female candidates of anterior and posterior vaginal repair were randomly assigned to two groups. Using a nerve stimulator, pudendal nerve tracks of the intervention group were injected with 0.3 cc/kg bupivacaine 0.25%. Similar injections with normal saline were performed for the control group. A visual analogue scale was used to measure pain during the first 48 hours after the surgery. Data was analyzed by repeated measures analysis of variance (ANOVA). Compared to the intervention group, the control group experienced greater pain during rest and walking. There were significant differences between the two groups from the first postoperative hour (P = 0.003) until 48 hours after the operation (P = 0.021). However, the mean ± SD values of pain in sitting position was not significantly different the two groups (P = 0.340). Pudendal nerve block can reduce postoperative pain scores in anterior and posterior vaginal wall repair.

Thyroid disorders are common among women in Iran. Moreover, many of the affected women in reproductive age are unaware of their disease. Infertility or recurrent abortion may happen in women with hypothyroidism. Therefore, the diagnosis and treatment of them are very important. This survey was carried out to realize the proportion of the hypothyroidism in pregnant women and underline the necessity of screening of this group for thyroid disorders. This survey was a descriptive study conducted in Shahid Beheshti University Hospital (Iran) from October 2010 to September 2011. During the time course of the study, a total of 1102 pregnant women who had referred to this medical center for receiving prenatal care, were studied for the level of thyroid-stimulating hormone. The prevalence of hypothyroidism in our study was 36.9% (407 women); of whom, 43 individuals (10.6%) were diagnosed as having thyroid disorders. No significant relationship was found between hypothyroidism and age, history of abortion, level of education, and the amount of fish they ate. Regarding the fact that the serious consequences of hypothyroidism for the fetus cannot be neglected, it is essential to screen the women seeking prenatal care by thyroid-stimulating hormone test as one of their routine evaluations.

After recognition of sequences of different genomes, the next logical step is the discovery of their function and regulation. To classify genes in the laboratory, factors such as the behavior of genes, gene expression control and protein interactions have been reviewed. It is expected that genes with similar regulation mechanisms have the same expression patterns.

In this paper, we introduce a special way of clustering, called biclustering, for microarray data obtained from multiple sclerosis (MS) patients. From a biological perspective, gene regulatory modules consist of genes that have similar behaviors at different points of time under several conditions. By identifying these modules, the recognition of the regulatory mechanisms that are the common causes of genes behaviors might be conceivable.

We used a modified format of iterative signature algorithm (ISA) to extract co-expressed gene profiles from microarray data. The combination of K-nearest neighbor (KNN) algorithm and ISA provides a helpful algorithm which results in an outstanding and optimum way to obtain similar genes in microarray data.

The algorithm was performed on a synthetic as well as a real database (MS patients’ data), and showed a pronounced difference between the extracted modules in contrast to ISA. Although we showed our method’s efficiency over synthetic and MS data, it will be usable for any other kinds of data. In other words, our method is based on a series of logical and statistical methods rather than data-based methods.

The World Health Organization suggested that the prevalence of different types of arthritis was between 0.7 and 4.01 in every 1000 children in 2003. With regard to this fact, the present study was aimed to review available evidence on anti-tumor necrosis factor (Anti-TNF) drugs which are prescribed to treat patients suffering from debilitating pain and physical limitations of various forms of arthritis. A database search of the Cochrane Library was conducted from the beginning of the year 2009 to October 2011. Only the secondary studies that used drug safety, efficacy and cost-effectiveness criteria for comparing biologic agents for the treatment of the most common forms of arthritis were considered in this review. Results were analyzed using qualitative methods. Using a specific search query, 34 hints were retrieved. After eliminating the irrelevant studies and duplications, 12 articles were entered into the review, based on predetermined criteria. Findings of the 12 selected articles, published between 2009 and 2011, were categorized into safety (3 articles), effectiveness (6 articles), and economic evaluations (3 articles). Anti-TNF drugs can safely provide rapid, significant, and sustained benefits in patients with active rheumatoid arthritis, according to different studies. However, their long-term complications including tuberculosis reactivation, serious infection and chronic heart failure need further investigation. Anti-TNF drugs, particularly etanercept, were effective in treating rheumatoid arthritis, psoriatic arthritis, and psoriatic plaque and efficacious in alleviating the signs and symptoms of early and severe rheumatoid arthritis. Because of the lack of sound and long-term economic data, evidence is insufficient to draw firm conclusions about the comparative cost-effectiveness of these biologics; nevertheless, this review suggests that etanercept is cost-effective in treating the three aforementioned forms of arthritis.