Galen Medical journal
Volume:5 Issue: 1, 2016

For many reasons, the elderly population in Iran is considered a growing phenomenon. An accelerated decline in birth rate in the past two decades, medical-health advances, and increased life expectancy are among the major reasons. Based on the definitions of the Country’s Population Index, Iran''s elderly population, with a growth rate of 3.9% compared to the total population growth (2.29%) between 2007 and 2012 has reached to the elderly population of 8.26% in 2012, which puts Iran among countries with aging populations. Now, Iran''s elderly population is 6205998 people, including approximately 48.70% aged men and 51.30% aged women. Iran, based on the age criteria of the population structure, is now faced with the aging phenomenon, and since this phenomenon encompasses health, economic and social consequences, as well as service requirements, elderly population of Iran should be comprehensively and continuously evaluated so that the health and medical officials could deal with the incident with proper planning and meet the needs of this group of the society.

Restless leg syndrome (RLS), fatigue and daytime sleepiness are three known co-morbidities in patients with multiple sclerosis (MS). The aim of this study was to evaluate the frequency of RLS in patients with MS and its effect on the frequency of fatigue and daytime sleepiness in these patients.
Material and One hundred twenty patients who referred to the Inpatients Neurology Ward of Chamran hospital, affiliated with the Shiraz University of Medical Sciences, from June 2014 to March 2015, were selected as the study participants. The patients with clinically definite MS, according to the 2010 Revised Mc-Donald criteria, and expanded disability status scale (EDSS) ≤5.5 were included. RLS, fatigue and daytime sleepiness were assessed by the criteria of the International RLS study group (IRLSSG), fatigue severity scale (FSS) and Epworth sleepiness scale (ESS) respectively and the related statistical analyzes were conducted.
Seventy eight patients (65%) met all the four IRLSSG criteria, 77 patients (64.1%) suffered from fatigue and only 36 patients (30%) had excessive daytime sleepiness. RLS was not significantly linked to mean age, sex, MS duration, and daytime sleepiness of the studied MS patients, but fatigue was more frequent in MS patients with RLS, which was statistically significant (P=0.018).
The main result of this study is that RLS is a common comorbidity in MS and the patients with MS, who also suffer from RLS. They have frequently experienced higher fatigue symptoms than those without RLS. Therefore, the appropriate diagnosis and management of RLS may improve both RLS and fatigue in these patients.

Several methods are used for the prevention or decreasing the incidence of spinal anesthesia hemodynamic complications. Ondansetron is a 5HT3 receptor antagonist with known efficacy on preventing nausea and vomiting and probably on intrathecal opioid-induced pruritus. The present study aims to evaluate the effects of intravenous Ondansetron on the attenuation of blood pressure and heart rate, by 5HT3 blocking in vagal nerve endings and effect on Bezold Jarish reflex.
Material and One hundred and two candidates for elective cesarean section were randomized into 2 groups of 51 cases, the Ondansetron group received 4mg Ondansetron intravenously before performing spinal anesthesia, and placebo group received 2cc sterile water. Hypotension was defined: Systolic blood pressure less than 100 MmHg or fall more than 20% from primary BP which was treated by administration of Ephedrine in case of any. In both groups, Ondansetron effect was studied on hypotension occurrence, bradycardia, consumed Ephedrine amount, pruritus, nausea and vomiting.
There were no statistically significant differences in systolic/diastolic blood pressure, Mean Arterial Pressure, heart rate and pruritus in both groups (P=0.081).Nausea and vomiting in the first 10 minutes after spinal anesthesia were lesser in Ondansetron group (P= 0.001). Mean consumed Ephedrine was significantly lesser in Ondansetron group (5.8 mg in Ondansetron and 10.7 mg in placebo group, P=0.009).
Ondansetron given intravenously with antiemetic dose (4 mg) decreases mean consumed Ephedrine and nausea and vomiting after spinal anesthesia, but does not have an influence on blood pressure, heart rate and pruritus.

Helicobacter pylori (H. Pylori) is a common infection in children, especially in the developing countries. The infection is usually asymptomatic but it may cause gastrointestinal diseases. In children, the symptoms include abdominal pain, vomiting and anemia. Recurrent abdominal pain (RAP) is a common cause of children’s referral. But, whether H. Pylori causes RAP in children has to be scrutinized to prevent further complications by proper diagnosis and treatment. However, there is still controversy in the literature regarding this issue. Therefore, we aimed to assess the association between H. Pylori and RAP in children.
In this case-control study, the children with RAP aged 2-10 years who referred to a private pediatric clinic in Marvdasht, Iran, were compared to other children without RAP, during 2015. The sample size was calculated to be 70 for each case and the control group. The patients were visited by a gastro-enterologist who recorded the demographic data of all the patients and the findings of stool test for H. Pylori. To assess the association of RAP with H. Pylori, the odds ratio was calculated. The statistical analysis was performed using SPSS 20.0 software. The P-values less than 0.05 were considered as statistically significant.
The mean age of the participants was 7.35±3.11 (with a range of 2-10). In the case group, 41/70 and 69/70 of the control group were girls. H. Pylori was found positive in 37 cases (52.9%) of the case group and 11 (15.7%) in the control group (P There was a statistically significant correlation between H. Pylori and RAP.

Analysis of costs and incomes and analyzing the relationship between current and capital expenditures, attention to cost recovery and changes in investment patterns are of utmost importance in the economy of hospitals. The effective use of financial variables and subsequently performance evaluation of hospitals would help to facilitate the continuation of activities which provides the ground for the economic administration of hospital industry. The purpose of this study was to evaluate the viewpoints of executive administrators of hospitals in Iran to evaluate the feasibility of using financial variables of health in hospitals.
Material and The present study was an applied research which is conducted using AHP (Analytical Hierarchy Process) technique. After extracting the evaluation variables, the financial performance of hospitals was evaluated using the questionnaire which was confirmed by Cronbach’s Alpha equal to 0.85. Moreover, the group of experts in this study included 62 Iranian hospital administrators.
Global indices for the economic evaluation of hospitals were identified which were categorized into 9 domains/factors using AHP (Analytical Hierarchy Process); furthermore, they were prioritized regarding the importance and feasibility in hospitals.
Utilizing financial variables in evaluating the economic performance of hospitals can determine their economic growth. Moreover, analysis of the current status of hospitals can be used to make strategic decisions and provides a basis for comparisons between hospitals and their rankings.

The most important criterion for healthcare success is customers’ satisfaction. The number of patients leaving the hospital on their own decision or Against Medical Advice (AMA) can be a sign of their discontent and a problem with considerable importance. In this regard¡ the present study was designed aiming at evaluating the causes of AMA discharges at a hospital affiliated with Shiraz University of Medical Sciences.
This is a qualitative study on all patients who were discharged AMA from the studied hospital during 3 months in 2012 (March 21 – June 21). Data were collected through telephone interviews. All interviews were written by the researcher and analyzed using grounded theory with thematic method.
The most frequent reasons for discharge AMA were classified into 3 general themes: issues related to hospital status¡ the staff and the patients. Additionally¡ the most frequent reasons causing discharge AMA were as follows; 1. Sense of recovery; 2. Failure to register discharge order despite verbal order¡ 3. Physicians and nurses’ inadequate care (technically); 4. Lack of informing the patients and their relatives as to the patient’s condition properly; 5. Crowded wards; 6. Lack of attention to patients by the staff (emotionally).
It seems that if hospital managers want to reduce discharge AMA¡ it is better to consider the causes. Based on such causes¡ effective intervention can be implemented which may differ in terms of resource-consuming.

Combined factor V and factor VIII deficiency (F5F8D, OMIM 227300) is a rare autosomal recessive bleeding disorder. It seems more common among Jews and Iranians, particularly in regions with frequent consanguineous marriages.
Case Report: We describe a 5-yearold girl born out of consanguineous marriage with a complaint of prolonged bleeding after dental extraction. There were no history of spontaneous bleeding and other coagulation defect symptoms.
In frequent consanguineous marriage regions, inherited deficiency of factor V and VIII should be considered in patients with coagulation defect symptoms.