فهرست مطالب

Archives of Iranian Medicine
Volume:20 Issue: 9, Sep 2017

  • تاریخ انتشار: 1396/08/10
  • تعداد عناوین: 10
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  • Hadigheh Kazemijaliseh, Fahimeh Ramezani Tehrani *, Samira Behboudi-Gandevani, Davood Khalili, Farhad Hosseinpanah, Fereidoun Azizi Page 558
    Background
    Abnormal uterine bleeding (AUB) is one of the most common gynecologic complaints among reproductive-age women. The purpose of this study was to investigate the prevalence of AUB and its related factors among reproductive age Iranian women.
    Methods
    A population-based cross-sectional study was conducted on 1393 women aged 15 – 45 years who participated in the Tehran Lipid and Glucose Study in 2009 – 2012. FIGO terminology and previous definitions were used for classification of AUB. Logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals to check the association between AUB and the women’s demographic characteristics. P
    Results
    A total of 35.8% (95% CI: 31.5% – 40.2%) of the participants suffered from one or more types of AUB. About 10.6% (95% CI: 6.3% – 12.5%) of them had disturbances of regularity and 23.8% (95% CI: 18.4% – 26.1%) reported experiencing disturbances of frequency. Also, disturbances of heaviness of flow and duration of flow were reported in 16% (95% CI: 12.7% – 19.2%) and 11.5% (95% CI: 8% – 15.4%), respectively. About 4.3% of the women (95% CI: 2.1% – 10.5%) reported irregular non-menstrual bleeding.
    According to previous definitions, the prevalence of heavy periods, metrorrhagia, polymenorrhea, oligomenorrhea, amenorrhea and inter-menstrual bleeding in reproductive aged women was 15.2%, 18.9%, 10.6%, 15.2%, 2.2%, and 4.3%, respectively.
    In addition, the proportions of women with AUB rose in the early and late reproductive years. After adjustment of confounders, logistic regression analysis showed that age (adjusted OR = 1.08, 95% CI: 1.07 – 3.97, P = 0.03) and BMI (adjusted OR = 1.05, 95% CI: 1.02 – 3.04, P = 0.04) had statistically significant associations with AUB.
    Conclusion
    The prevalence of AUB as a possible clinical indicator of underlying disorders was high among Iranian reproductive age women. Healthcare providers and policy makers are required to acknowledge these disorders and provide education and counseling opportunities for the public to inform them when and how to seek medical advice.
    Keywords: Abnormal uterine bleeding, Iran, population-based study, prevalence
  • Hamideh Javadinasab, Rajabali Daroudi, Hamideh Salimzadeh, Alireza Delavari *, Payam Vezvaie, Reza Malekzadeh Page 564
    Background
    Colorectal cancer (CRC) is the fourth most common cancer among men and the second among women in Iran. First-Degree Relatives (FDRs) of patients with CRC are known to be at higher risk of CRC. The aim of this study was to identify the most cost-effective strategy for CRC screening in Iranian high risk individuals.
    Methods
    A Markov model was developed to assess the cost-effectiveness of six colonoscopy screening strategies for individuals at increased risk of CRC because of positive history of the disease in at least one first-degree relative in their family. Our strategies included five-yearly or ten-yearly colonoscopy starting from the age of 40 or 50 and colonoscopy once at 50 or 55 years. Data were extracted from the published literature, Globocan 2012 database, and national cancer registry reports. The Markov model contained 11 mutually exclusive health states. Time horizon of model was life time and cycle duration was 1 year. Outcomes included life year gains, Quality Adjusted Life Years (QALYs) and costs. The TreeAge Pro software was used for data modeling.
    Results
    All six screening strategies increased the life expectancy and QALY and were costlier than no screening. The incremental cost per QALY gained for CRC screening varied from $489 for one colonoscopy screening per lifetime at 55 years to $3,135 for colonoscopy screening every five years starting at the age of 40, compared with no screening. When strategies were compared with the next best strategy, dominated strategies were removed from analysis, one colonoscopy screening per lifetime at 55 years old; or every ten years starting at the age 40; or every five years starting at age 40 remained with incremental cost effective ratios of $489, $2,505, and $26,080 per QALY gained, respectively.
    Conclusions
    CRC colonoscopy screening in high-risk individuals is cost-effective in Iran. Colonoscopy screening every 10 years starting at the age of 40 was the most cost-effective strategy.
    Keywords: Colonoscopy, colorectal cancer, cost-effectiveness, first degree relative, screening
  • Mutlu Demirel, GUl GUrsoy *, Mehmet Yi, Ldi, Z Page 572
    Objective
    Thyroid hormone has well recognized effects on the cardiovascular system. The purpose of this study was to define the influence of treatment of either hypothyroidism and hyperthyroidism on the values and circadial variations of arterial blood pressure measured by ambulatory blood pressure monitoring.
    MATERIAL AND
    Methods
    The study was carried out on 30 hypothyroidic and 30 hyperthyroidic patients without hypertension and 46 healthy participants. First, all the parameters of the groups, then blood pressure values obtained by ambulatory blood pressure monitoring before and after treatment (thyroid hormone replacement with levothyroxine and antithyroid treatment either with propylthyrouracil or metimazole) were compared. For statistical examinations, Shapiro-Wilk, one-way analysis of variance, Kruskal Wallis, post-hoc Tukey, and Wilcoxon Sign tests were used.
    Results
    In the hypothyroid group, 24-hour mean and diastolic blood pressure, daytime diastolic blood pressure, nighttime mean, systolic and diastolic blood pressures were higher than the control group (P
    Conclusion
    Throughout 24 hours, in hypothyroidic patients especially higher diastolic and in hyperthyroidics especially higher systolic blood pressures were exhibited than euthyroid subjects. After treatment of these diseases, ambulatory blood pressure values decreased. Early control of thyroid dysfunctions may help to protect cardiovascular system from hazardous effects of thyroid dysfunctions and lower mortality and morbidity in these patients.
    Keywords: Ambulatory blood pressure monitoring, hyperthyroidism, hypothyroidism
  • Zainab Eydipour, Gholamhassan Vaezi, Mohammad Nasehi *, Seyed-Ali Haeri-Rouhani, Mohammad-Reza Zarrindast * Page 581
    Background
    Serotonin receptors such as 5-HT3 plays critical role in regulation of sleep, wake cycle and cognitive process. Thus, we investigated the role of CA1 5-HT3 serotonin receptors in memory acquisition deficit induced by total sleep deprivation (TSD; for 24 hour) and REM sleep deprivation (RSD; for 24 hour). Pain perception and locomotor activity were also assessed as factors that may affect the memory process.
    Methods
    Modified water box and multi-platform apparatus were used to induce TSD or RSD, respectively. Passive avoidance, hot plate and open field devices were used for assessment of memory acquisition, pain and locomotor activity, respectively.
    Results
    Totally, 152 male Wistar rats were used in the study. Pre-training, intra-CA1 injection of 5HT3 receptor agonist Chlorophenylbiguanide (Mchl; 0.01 and 0.001 µg/rat; P
    Conclusion
    Based on the above data, CA1 5HT3 receptors seem to play a critical role in cognitive and non-cognitive behaviors induced by TSD and RSD.
    Keywords: 5-HT3, CA1, hippocampus, memory, pain, sleep deprivation
  • Leila Doshmangir, Mohammad Bazyar, Parinaz Doshmangir, Hakimeh Mostafavi, Amirhossein Takian Page 589
    Introduction
    Following the implementation of Family Physician (FP) Program in rural areas and cities with populations under 20000 in 2005, the Iranian Ministry of Health and Medical Education in 2012 decided to implement urban FP in large cities with populations more than 20000. Along with the development and implementation of urban FP in Iran, local websites and newspapers reflected the viewpoints of experts in various levels of health system regarding the various stages of Family Medicine (FM) development (from agenda setting to initial stages of implementation). This study aimed to explore the major infrastructures perceived to be required to achieve desirable implementation of urban FP through analyzing experts’ viewpoints reflected in the media and interviews.
    Methods
    In a qualitative study, we analyzed the contents of health related national websites as well as transcribed interviews with key informants. Documents were collected from December 2011 to January 2014 and interviews were conducted from February 2014 to June 2015. We used mixed thematic approach (inductive and deductive) for analysis that was assisted by MAXQDA 12 software.
    Results
    Infrastructures needed for the implementation of FP were categorized in five main themes and 23 subthemes. The themes are: ‘Stewardship/governance’, ‘Actors and stakeholders’, ‘structural infrastructure’, ‘technical infrastructure and needed resources’, and ‘information and communication infrastructure’.
    Conclusions
    Expansion of FP program to urban settings needs appropriate attention to the principles of policy implementation as well as provision of robust infrastructures. Well-defined stewardship, revised approach to financial regulation and payment system, stakeholder’s commitment to collaboration, policy for conflict resolution, and universal insurance coverage are pivotal for the expansion of family physician program to the urban settings in Iran.
    Keywords: Family physician, family practice, health system, infrastructure, policy implementation, urban areas
  • Roya Farzanegan, Mansoureh Feizabadi, Fariba Ghorbani, Masoud Movassaghi, Esmaeil Vaziri, Mahdi Zangi, Seyed Amirmohammad Lajevardi, Mohammad Behgam Shadmehr Page 598
    Background
    Tracheal stenosis remains a challenge in the thoracic surgery field. Recognizing the hot topics and major concepts in this area would help the health policy makers to determine their own priorities and design the effective research plans. The present study analyzed and mapped the topics and trends of tracheal stenosis studies over time as well as authors’ and countries’ contributions.
    Materials And Methods
    Search results were obtained employing Bibexcel. To determine cold and hot topics, co-occurrence analysis was applied using three international databases 'Web of Science', 'PubMed' and 'Scopus'. Appropriately, different categories in the articles such as keywords, authors, and countries were explored via VOSviewer and NetDraw. Afterward, the trends of research topics were depicted in four time-intervals from 1945 to 2015 by ten co-occurrence terms.
    Results
    The majority of articles were limited to case series and retrospective studies. The studies had been conducted less frequently on prevention, risk factors and incidence determination but extensively on treatment and procedures. Based on the articles indexed in WOS, 45 countries and 8,260 authors have contributed to scientific progress in this field. The highest degree of cooperation occurred between the USA and England with 15 common papers.
    Conclusions
    Most of the published literature in tracheal stenosis research field was about surgical and non-surgical treatments. Conducting the screening and prevention studies would diminish the burden of this disease on the health system as well as the patients and their families’ well-being.
    Keywords: Intubation, scientometric, tracheal stenosis, visualization
  • Shirin Djalalinia, Mitra Modirian, Ali Sheidaei, Moein Yoosefi, Hossein Zokaiee, Bahman Damirchilu, Zohreh Mahmoudi, Negar Mahmoudi, Mohammad Javad Hajipour, Niloofar Peykari, Nazila Rezaei, Rosa Haghshenas, Mohammad Hossein Mohammadi, Alireza Delavari, Farshad Farzadfar * Page 608
    Introduction
    The rise in non–communicable diseases (NCDs) has gained increasing attention. There is a great need for reliable data to address such problems. Here, we describe the development of a comprehensive set of executive and scientific protocols and instructions of STEPs 2016.
    METHODS/DESIGN: This is a large–scale cross–sectional study of Surveillance of Risk Factors of NCDs in Iran. Through systematic proportional to size cluster random sampling, 31,050 participants enrolled in three sequential processes, of completing questionnaires; physical measurements, and lab assessment.
    Results
    Out of 429 districts, samples were taken from urban and rural areas of 389 districts. After applying sampling weight to the samples, comparing the distribution of population and samples, compared classification was determined in accordance with the age and sex groups. Out of 31,050 expected participants, 30,541 participant completed questionnaires (52.31% female). For physical measurements and lab assessment, the cases included 30,042 (52.38% female) and 19,778 (54.04% female), respectively.
    Discussion
    There is an urgent need to focus on reviewing trend analyses of NCDs.To the best of our knowledge, the present study is the first comprehensive experience on systematic electronic national survey. The results could be also used for future complementary studies.
    Keywords: Design, Iran, non–communicable diseases, protocol, risk factors, STEPs
  • Masoud Edizadeh, Raheleh Vazehan, Fatemeh Javadi, Shima Dehdahsi, Mahsa Fadaee, Mehrshid Faraji Zonooz, Elham Parsimehr, Fatemeh Ahangari, Ayda Abolhassani, Zahra Kalhor, Zohreh Fattahi, Ariana Kariminejad, Hossein Najmabadi *, Shahriar Nafissi * Page 617
    The calcium channel, voltage-dependent, L-type, alpha 1S subunit (CACNA1S) gene encodes a skeletal Ca2 channel which is involved in calcium-dependent processes such as muscle contraction and neurotransmitter release. Mutations in this gene have been accompanied by hypo- and normokalemic periodic paralysis, thyrotoxic periodic paralysis, and susceptibility to malignant hyperthermia. We report the clinical and genetic findings in a patient diagnosed with metabolic myopathy who had episodic attacks of muscle pain and weakness but with no family background of the disease. Next-generation sequencing (NGS) using a panel targeting metabolic myopathy and myotonia genes identified a de novo heterozygous pathogenic variant c.3724A>G, p.Arg1242Gly, in exon 30 of CACNA1S. As the second report of this variant, this case may broaden the CACNA1S-related disease spectrum to include normokalemic periodic paralysis.
    Keywords: CACNA1S, channelopathies, next-generation sequencing, normokalemic, periodic paralysis
  • Mahnaz Pejman Sani, Keivan Gohari Moghadam, Mahbube Ebrahimpur * Page 621
  • Seyyed Alireza Golshani *, Ziba Ghafouri, Mohammad Ebrahim Zohalinezhad Page 623
    The popularity of the science of medicine in the Gurkani Court of India relied on the presence and scientific work of Iranian scholars. Iranian women, like men, enjoyed this area of science and were also actively involved in social issues. The remarkable participation of Iranian female physicians in some medical fields, such as issues and care in pregnancy, child-bearing, and baby care, is among their scientific contributions to the changes and growing trends in medicine. These affairs were monopolized by women who held this knowledge for centuries. One of the women who was considerably successful in this field was Zat-on-Nessa Amoli, titled Kheyr-on-Nessa, a seventeenth-century female Iranian physician. This research aimed to study the contributions and scientific life of this poet and Iranian physician based on historical documents and texts, considering the research on the science and knowledge of medicine.
    Keywords: Gurkani era, Kheyr-on-Nessa, India, Iran, Safavid era