فهرست مطالب

Archives of Iranian Medicine
Volume:18 Issue: 12, dec 2015

  • تاریخ انتشار: 1394/10/30
  • تعداد عناوین: 13
|
  • *Ali Akbari Sari, Leila Doshmangir, Fereshteh Torabi, Arash Rashidian, Mojtaba Sedaghat, Robabeh Ghomi, Nittita Prasopa, Plaizier Page 811
    Introduction
    Adverse events are relatively common in healthcare, leading to extensive harm to patients and a significant drain on healthcare resources. Identifying the extent, nature and consequences of adverse events is an important step in preventing adverse events and their consequences which is the subject of this study.
    Methods
    This is a retrospective review of medical records randomly selected from patients admitted to4 general hospitals, staying more than 24 hours and discharged between April and September 2012. We randomly selected 1200 records and completed the record review for 1162 of these records. Standard forms (RF1 and RF2) were used to review medical records in two stages by nurses and medical doctors.
    Results
    Eighty-five (7.3%) of the 1162 records had an adverse event during the admission; and in 43 (3.7%) of the 1162 records, the patient was admitted to the hospital due to an adverse event that occurred before the admission. Therefore, a total of 128 (11.0%) adverse events occurred in 126 (10.9) records as two patients had more than one adverse event. Forty-four (34.3%) of these 128 adverse events were considered preventable.
    Conclusions
    This study confirms that adverse events, particularly adverse drug reactions, post-operative infections, bedsore and hospital acquired infections are common and potentially preventable sources of harm to patients in Iranian hospitals.
    Keywords: Adverse events, hospital, incidence, Iran
  • *Khalid M. Almutairi Page 816
    Background
    Diabetes mellitus is a complex disorder that requires continuous management and medical care. The purpose of this review is to identify and summarize the barriers that affect diabetes management in Saudi Arabia.
    Methods
    Studies that have examined the quality of diabetes management in Saudi Arabia were identified through online and manual literature searches. Two researchers independently searched and assessed for inclusion/exclusion criteria. All studies were screened by a specialist for the significance of the review. Studies that were included were evaluated for relevance, methodological rigor, and credibility by giving a quality score based on Russell and Gregory’s criteria.
    Results
    This review presents an overview of the quality of diabetes management and issues and barriers concerning the improvement of diabetes care in Saudi Arabia. The online literature search yielded 11 studies which met the inclusion criteria. Factors affecting the quality of diabetes care can be categorized into patient factors (such as adherence, compliance, attitudes, beliefs, knowledge, financial resources and co-morbidities) and healthcare providers’ factors (including beliefs, attitudes and knowledge, patient – provider interaction and communication).
    Conclusion
    The identified barriers, both from patients and healthcare providers, will help healthcare authorities to improve diabetes management in Saudi Arabia. Improvement of health awareness about disease and disease management should be tailored through continuous patient education. Continuous training and seminars will also expand providers’ knowledge that will ensure quality and effective diabetes management.
    Keywords: Diabetes management_diabetes mellitus_Saudi Arabia_type 2 diabetes
  • Jalal Poorolajal, *Ibrahim Babaee, Reza Yoosefi, Fariba Farnoosh Page 822
    Background
    Rabies post-exposure prophylaxis (PEP) is an effective measure if administered immediately. We evaluated the primary health care provided after animal bite and determined the deviations from rabies PEP protocol.
    Methods
    This 6-year population-based cross-sectional study was conducted in Tehran, the capital of Iran, from April 2006 to March 2012. The study population included people who referred to health centers of Tehran, seeking PEP. The data were extracted from rabies registry databases using a checklist of items according to the context of the health records. All statistical analyses were performed at a significance level of 0.05 using Stata software, version 11.
    Results
    Of 22,766 cases of animal bite, 84.5% were men, 31.9% were aged 21–30 years, and 66.3% lived in urban areas. Most cases were the result of a dog bite (81.7%), mostly at midday (29.9%), and more frequently in spring (27.9%) and summer (27.7). Legs (45.6%) and hands (43.4%) were the most common sites of animal bite. The PEP was associated with a variety of shortcomings as follows. A majority of cases who had indication of receiving a 5-dose vaccination schedule had received only three doses. Most of the cases with a wound in the head and neck and many of cases with deep wounds had not received immunoglobulin. A number of cases needed to receive one-mL dose of vaccine while they had received 0.5-mL doses.
    Conclusions
    According to our results, rabies PEP is not well monitored and the preventive measures are associated with some insufficiencies and deviations from the national PEP protocol which must be taken into consideration by public health authorities to ensure that rabies surveillance is efficient.
    Keywords: Animal bite, Iran, post, exposure prophylaxis, rabies
  • Yulan Chen, Yu Li, Qianqian Jiang, Xinjuan Xu, *Xiangyang Zhang, Zhulepiya Simayi, Hong Ye Page 827
    Objective
    The aim of this study was to analyze the related factors of obstructive sleep apnea hypopnea syndrome (OSAHS) that would affect early kidney injury in patients with hypertension (Hyp).
    Methods
    A total of 457 Hyp patients with nocturnal snoring were selected for polysomnography (PSG). The patients were divided into four groups according to the apnea hypopnea index (AHI), and the related factors that would impact blood urea, creatinine, 24 hr urinary protein (24 hr UTP), 24 h urinary microalbuminuria and serum cystatin C (Cyst C) were analyzed in the groups.
    Results
    Severe OSAHS (OR = 4.880, 95% CI = 1.577~15.099) was the influencing factor for 24 hr UTP; blood pressure control (OR = 2.335, 95% CI = 1.326~4.112) and Obesity (OR = 2.072, 95% CI = 1.236~3.474) were the influencing factors for 24 hr urinary microalbuminuria; age (OR = 1.996, 95% CI = 1.366~2.917), blood pressure control (OR = 2.895, 95% CI = 1.267~6.615) and severe OSAHS (OR = 6.093, 95% CI = 1.267~29.303) were the influencing factors for Cyst C. As for the Hyp patients associated with OSAHS, severe OSAHS were the influencing factors for 24 hr UTP; blood pressure control and Obesity were the influencing factors for 24 hr urinary microalbuminuria; age, blood pressure control and severe OSAHS were the influencing factors for Cyst C.
    Conclusions
    OSAHS is a risk factor of early kidney injury.
    Keywords: Hypertension, kidney injury, obstructive sleep apnea hypopnea syndrome
  • Maryam Salavatifar, *Sedigheh Zakeri, Akram Abouie Mehrizi, Sedigheh Mirkazemi, Navid Dinparast Djadid Page 834
    Background
    Acquired antibody responses following natural infection provide valuable information for selection of candidate antigens for malaria vaccines. Apical membrane antigen-1 of Plasmodium vivax (PvAMA-1) has potential as a component of a subunit vaccine for vivax malaria. In addition, genetic diversity in this antigen is responsible for challenges in the development of an effective PvAMA-1 based vaccine. Therefore, the main aim of this study was to determine whether allelic polymorphisms in pvama-1 influence the recognition of naturally occurring antibodies. Also, the profile of IgG isotypes to two sequence types of PvAMA-1 antigen was evaluated among subjects exposed to P. vivax in areas of low and unstable transmission.
    Methods
    For this purpose, the two variant forms of PvAMA-1 (PvAMA-1A and B) were expressed in Escherichia coli M15-pQE30 system using genomic DNA from Iranian individuals with patent P. vivax infection. Anti-AMA-1 response and isotype composition to two variant forms were measured in target P. vivax-infected individuals (n = 110, 2 to 65 years old) using Enzyme-linked immunosorbent assay.
    Results
    The results showed that 65.5% of the studied individuals had positive IgG responses to two PvAMA-1 variants, and the prevalence of responders did not differ significantly (P = 0.32). Also, a marked isotype switching to cytophilic (IgG1 /IgG3) antibodies was evident with increasing age, and adults responded more frequently to these antigens than did younger children.
    Conclusion
    In conclusion, the presence of mature, protective isotype antibodies and equal immune responses to two genetically distinct variant forms of antigens in individuals from low transmission areas implicates that one of these forms could be used in a universal blood-stage vaccine based on PvAMA-1 antigen.
    Keywords: Apical membrane antigen, 1, immuno, epidemiology, malaria, naturally acquired antibody, Plasmodium vivax
  • *Mojgan Akbarzadeh, Jahromi, Golsa Shekarkhar, Fatemeh Sari Aslani, Negar Azarpira, Mina Heidari Esfahani, Mozhdeh Momtahan Page 844
    Background
    The present study aims to assess the prevalence and histological characteristics of endometriosis in different types of ovarian surface epithelial tumors.
    Methods
    Microscopic slides of 110 ovarian tumors (89 malignant and 21 borderlines) were reviewed from 2008 to 2013 in two major gynecological centers affiliated with the Shiraz University of Medical Sciences, Shiraz, Iran. The presence or absence of endometriosis and transitions from atypical endometriosis to carcinoma were also histologically evaluated. Chi-square and t-test were used to compare the study groups.
    Results
    The mean age of the patients was 49.93 ± 9.36 years in the Endometriosis-Associated Ovarian Carcinomas (EAOC) group and 50.18 ± 12.8 years in the non-EAOC group. Among the 110 patients, 28 (25.4%) had endometriosis. According to ovarian cancer subtype 67% (4/6) of clear cell adenocarcinoma, 65% (11/17) of endometrioid adenocarcinoma, 28% (7/25) of low grade serous adenocarcinoma, 4% (1/25) of high grade serous adenocarcinoma, 30% (4/13) of borderline serous tumor, and 25% (1/4) of mixed carcinoma had endometriosis. None of the mucinous borderline tumors and mucinous adenocarcinoma cases had endometriosis. Moreover, 23 cases had typical endometriosis, while 14 had atypical endometriosis. On the other hand, 19 cases had both typical and atypical endometriosis. Furthermore, transition from atypical endometriosis to carcinoma was seen in 11 cases.
    Conclusion
    Clear cell and endometrioid carcinoma are the most common types of EACO. Atypical endometriosis was more commonly seen in endometrioid and clear cell carcinomas which are included in type I ovarian cancer. Thus, it can be concluded that atypical endometriosis is a precursor for type I ovarian cancer.
    Keywords: Atypical endometriosis, endometriosis, ovarian cancer
  • Gholamreza Heydari, *Arezoo Ebn Ahmady, Harry A. Lando, Fahimeh Chamyani, Mohammadreza Masjedi, Mohammad B. Shadmehr, Lida Fadaizadeh Page 849
    The implementation of 5 of the 6 WHO MPOWER program in Iran is satisfactory; the only notable shortcoming is the lack of tobacco taxation increases. This study was designed to increase key policy maker's awareness of tobacco taxation effectiveness through a sensitization program in Iran. This analytical and semi-experimental study in 2014 included 110 tobacco control key policy makers, who were trained and received educational materials on the importance of tobacco taxation. A valid and reliable questionnaire was completed before and three months after intervention. Data were analyzed using mean (SD), t-Test and analysis of variance. The mean (SD) scores at pre- and post-test were 2.7 ± 3 and 8.8 ± 1 out of 10, respectively. Paired t-tests demonstrated a significant difference in the pre- post-test knowledge scores. Increasing knowledge and promoting favorable attitudes of policy makers can lead to greater attention which could in turn change tobacco taxation policies.
    Keywords: Control, tax, tobacco
  • Nahid Rafie, Sahar Golpour Hamedani, Reza Ghiasvand, *Maryam Miraghajani Page 852
    Some studies have suggested chemopreventive effects of kefir, a fermented milk product, on carcinogenesis. The aim of this review study was to evaluate the scientific evidence for effects of kefir on cancer prevention and treatment. We systematically searched for all relevant studies published before June 2015, using PubMed, Google scholar, Cochrane and Science Direct, SID, MedLib and Srlst databases. Relevant studies were reviewed based on systematic review (PRISMA) guidelines. From a total of 2208 papers obtained at the initial database search, 11 publications including 7in vitro and 4 experimental studies were eligible. In vitro studies on breast, colon, skin and gastric cancers and leukemia cell lines and experimental studies on different sarcomas consistently showed beneficial effects of kefir on cancer prevention and treatment. The results of this systematic review suggest that kefir may be associated with cancer prevention and it also has beneficial effects in cancer treatment. This protection may be associated with kefir bioactive components including peptides, polysaccharides and sphingolipids.
    Keywords: Cancer, fermented milk products, kefir, systematic review
  • *Mahsa Kalantari, Parviz Deyhimi, Parisa Kalantari Page 858
    Primitive neuroectodermal tumors (PNETs) are a family of highly malignant soft tissue neoplasms mostly occurring in children and young adults. PNETs usually develop in the thoracopulmonary region, abdomen, pelvis, and rarely in the head and neck region. Here, a case of PNET located in the parotid gland is reported.
    Keywords: Head, neck cancer, parotid gland, primitive neuroectodermal tumor
  • Mohammad Samadian, *Mehrdad Hosseinzadeh Bakhtevari, Armin Jahangiri Babadi, Naveed Nabizadeh, Omidvar Rezaei Page 861
    Congenital absence of posterior elements of the lumbar column is an extremely uncommon anomaly and we found no any reported cases of incomplete congenital absence of the posterior elements of lumbar vertebra in the literature. Here, we present a case with congenital absence of posterior elements of lumbar vertebra. The patient was a 51-year-old man with a history of 20 years of back pain. Imaging of the lumbar spine revealed instability in L2 and L3 and there was evidence of retrolisthesis, agenesis of pars interarticularis, spinous processes, lamina, transverse processes and facets at L2 and L3. The patient underwent lumbar discectomy and posterior spinal fixation and instrumentation was then done using pedicle screw fixation. Four pedicle screws, two rods, and one cross link were employed to bilaterally fix the L2 and L3 and then we used autograft and allograft bone for interbody fusion, substitutes from iliac crest for posterior fusion. There were no postoperative complications, and at 6, 12 and 24 months of follow-up, his leg and back pain had improved, and the patient did not need any analgesic for pain relief.Complete congenital absence of the lumbar posterior element has been rarely reported in the literature. Patients whose congenital anomalies lead to segmental instability are surgical fusion candidates, but if these anomalies occur in pars interarticularis such as spondylolysis isthmus, fixation and inter segmental fusion techniques are useful.
    Keywords: Agenesis, Congenital anomalies, Instability, Lumbar vertebra