Iranian Red Crescent Medical Journal
Volume:21 Issue: 12, Dec 2019

Health expenditures in the world undergo increasing growth. According to the WHO Report (2000), health financing is one of the main functions of the health system that has a significant impact on its other functions.

The aim of this study is the systematic review of the changes and shifting of health care financing models and cost burden risk-sharing mechanisms in health systems over the past three decades.
Data Sources: In this systematic review, data sources of studies on health financing realm in different countries were investigated using a series of keywords, including “health financing”, “health expenditure “, “model”, “financing mechanism/arrangement”, and “cost risk-sharing” from the most important databases such as Google Scholar, Web of Science, Scopus, PubMed, and the Iranian databases, such as Magiran, IranMedx, SID, in 1990 - 2019.
Study Selection: According to PRISMA Flow Diagram, with application of inclusion and exclusion criteria (time limitations, language restrictions, lack of related title abstract, full text), among 86,611 documents, 150 studies were selected. Two pairs of review author’s independently extracted data and assessed the risk of bias.

The systematic review of different evidence suggests that with economic growth, since 2001 to 2014, global health expenditure trend was increased from $ 3.8 trillion (in 2001) to $ 9.2 trillion (in 2014) and is estimated to reach $ 24.2 trillion (in 2040). Also, all the evidence indicates a tangible change, a 10% increase in public and pre-payments health expenditures and a 16% reduction in private expenditures, in the global health financing model in the current period up to 2040.

The review of regional and global studies, across countries and during the time, shows that in the last three decades, health financing systems are in a transition towards pervasive (with high financial risk-sharing) public health policies in the world.

Apoptosis is a programmed cell death that occurs due to various factors such as reperfusion ischemia. As a purinergic receptor, A1AR acts as an oxidative stress sensor and an antioxidant during reperfusion ischemia.

The purpose of the present study was to investigate the effect of adenosine injection following cerebral reperfusion ischemia on A1AR gene expression and apoptosis in the brain hippocampal tissue of male Wistar rats.

This experimental study was conducted at Shahid Mirghani Research Institute in Gorgan, Iran, from January 21, 2019, to March 18, 2019. The sample size was determined according to previous studies and a pilot study. Thus, 30 male Wistar rats were divided into three groups by simple random sampling (using a random-number table): Control group (n = 10), Reperfusion ischemia group (n = 10), and Reperfusion ischemia + adenosine group (n = 10). Ischemia was induced in animals by closing the carotid artery for 45 min. Adenosine was injected 24 h after ischemia. We measured A1AR gene expression, SOD protein expression, and apoptosis by real-time PCR, immunohistochemistry, and the TUNEL method, respectively.

The results showed that cerebral reperfusion ischemia significantly increased A1AR gene expression (596%) and apoptosis (378%) and decreased SOD protein expression (72%) compared to the control group (P < 0.001). On the other hand, adenosine significantly reduced A1AR gene expression (46%) and apoptosis (69%) and increased SOD protein expression (94%) compared to the ischemic group (P < 0.001).

Ischemic brain reperfusion causes oxidative stress. Also, adenosine injection seems to be effective in reducing oxidative stress and apoptosis induced by cerebral reperfusion ischemia.

Parkinson’s disease is a progressive nervous system disorder caused by a degenerative loss of dopaminergic neurons of midbrain, from the substantia nigra to the corpus striatum pathway. Quercetin has a neuroprotective effect to prevent the greater loss of substantia nigra dopaminergic neurons in Parkinson’s disease model.

This study aimed to investigate the effect of the flavonoid quercetin on the behavioral test in 1-methyl-4-phenyl,2,3,6-tetrahydropyridine(MPTP)-induced male NMRI mice.

Animals were divided into eight groups (n = 12). Behavioral tests of bar test and treatment with quercetin began one day after inducing the disease and lasted for 35 days. Then, brains were excluded from craniums for histology, immunohistochemistry tyrosine hydroxylase, measurement of TNF-α levels, and gene expression of caspase 3.

Data showed that orally taking quercetin for 35 days improved the behavioral test of bar tests in Parkinson’s disease. Cell density in TH staining was counted and showed considerable decreases in the substantia nigra in Parkinson’s disease group (83.67 ± 12.811) while it was higher in quercetin-treated groups PD + Q1 (103.67 ± 8.090) and PD + Q2 (145.33 ± 13.908) than in Parkinson’s disease group (P < 0.05). Quercetin decreased inflammation due to MPTP in the substantia nigra in PD + Q1 (1395.73 ± 1.058) and PD + Q2 (1250.66 ± 1.95), and corpus striatum in PD + Q1 (1207.033 ± 2.228) and PD + Q2 (1187.44 ± 1.64) and TNF-α protein levels in the quercetin-treated group (P < 0.05). Parkinson’s disease decreased gene expression of caspase 3 (0.35 ± 0.019) and increased it in quercetin-treated groups PD + Q1 (1.26 ± 0.062) and PD+Q2 (2.27 ± 0.144) (P < 0.0001).

Quercetin is a natural flavonoid with neuroprotection effect and antioxidant, anti-inflammatory, and anti-apoptosis properties preventing the loss of dopaminergic neurons in mice with Parkinson’s disease.

The present study was conducted to compare the effect of gargling normal saline mixed with honey and cold normal saline on postoperative pain relief in children undergoing tonsillectomy or adenotonsillectomy during 2018.

This clinical trial was performed on 105 children aged 5 - 14 years. The participants were randomly allocated to three 35-member groups, viz. normal saline mixed with honey, cold normal saline, and the control. The patients underwent general anesthesia and then were operated by a single surgeon. Gargle was administered in the first and second groups every six hours up to 48 hours following the surgery. There was no intervention in the control group. The pain was recorded by the Wong-Baker FACES Pain Rating Scale (WBS) at the recovery time and 6, 12, 18, 24, 36, 48 hours and 7 days after the surgery. Data were analyzed using repeated measures ANOVA.

Among the participants, 47 subjects (44.8%) were males and the rest were females, with a mean age of 8.6 ± 2.5 years. The three groups were similar in terms of sex, weight, duration of surgery, and bleeding during surgery. The pain at the site of surgery during both resting and swallowing was different at 6, 12, 18, 24, 36, 48 hours, and 7 days following the surgery (P < 0.001).

Gargling cold normal saline and normal saline mixed with honey led to reduced pain after tonsillectomy or adenotonsillectomy; however, the latter had a higher effect on the postoperative pain relief.

Various studies have reported that the pelvic girdle and lumbar spine are reflexively stabilized and braced prior to the initiation of extremity movements.

The present study aimed to assess the reliability of the diaphragm muscle thickness and excursion measured by rehabilitative ultrasound imaging (RUSI).

This is a cross-sectional study that was done in the physiotherapy department of the Faculty of Rehabilitation at the Shahid Beheshti University of Medical Sciences (Tehran, Iran) in 2019. Images of diaphragm thickness were taken using RUSI in the intercostal space between the 7th and 8th, or 8th and 9th ribs, at which the diaphragm was more easily visualized. The diaphragm motion assessment was performed by applying the transducer on the abdomen at the right midclavicular line. Imaging was conducted in 10 participants with pelvic girdle pain (PGP) and 10 asymptomatic women and men aged 20 - 44 years. Images were obtained by one examiner, muscle thickness was measured using B mode RUSI, and the motion was assessed using M mode RUSI. All assessments were performed in quiet breathing and deep breathing states. Intraclass correlation coefficients (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were used for reliability assessment.

The ICC, SEM, and MDC values revealed an excellent intrarater reliability for RUSI in both groups to measure the diaphragm thickness (ICC between 0.88 to 0.92). Measurement of diaphragm excursion demonstrated excellent reliability in the asymptomatic group (ICC between 0.80 to 0.90) and less reliability, between good and excellent, in the PGP group (ICC between 0.74 to 0.79).

The method of RUSI employed in the present study is recommended for measuring diaphragm thickness and motion in patients with PGP.

Multiple sclerosis (MS) is a progressive central nervous system disease that has an enormous effect on a patient’s quality of life due to physical complications and psychological problems.

The purpose of this study is to investigate the effect of self-care education program based on Health-Promoting Self-Care Behaviors System Model on quality of life, resilience, and sense of coherence in patients with MS.

In this randomized controlled clinical trial, 80 patients with MS referred to hospitals for special diseases in Kerman were enrolled using systematic sampling method and then randomly assigned to the intervention and control groups. The main research instruments, including demographic information checklist, Multiple Sclerosis Quality of Life (MSQOL-54), Connor-Davidson scale, Resilience Scale and Sense of Coherence Scale were completed by subjects in both intervention and control groups. The intervention group participated in 18 training sessions that addressed the needs of patients. The two groups completed the questionnaires one week and two months after intervention again. Generalized Estimating Equations (GEE) (GEE) test was used for data analysis.

Pre-intervention results revealed that intervention and control groups were not significantly different in the mean scores of most dimensions of quality of life and sense of coherence (P > 0.05). However, intervention and control groups were significantly different in mean scores of all dimensions of quality of life, resilience and sense of coherence one week and (P < 0.05) and two months (P < 0.05) after the intervention. The results of GEE test also reflected a meaningful difference in the intervention group in terms of increased mean scores in all dimensions of quality of life (P < 0.05), resilience (69.60 ± 6.62) (P < 0.05) and sense of coherence (74.50 ± 3.52) (P < 0.05) one week and two months after the intervention compared to the baseline. However, this improvement was not observed in the controls (P > 0.05).

Teaching health-promoting self-care behaviors system model improves the quality of life, resilience, and sense of coherence in patients with MS. Therefore, it is recommended to plan and implement self-care training interventions in accordance with this model for all patients with MS.

Carbamazepine (CBZ) is a drug used in the treatment of neurological and psychiatric disorders. Intoxication with CBZ is a serious condition that can result in coma, hemodynamic instability and death. Urgent management of CBZ intoxication is life saving and extracorporeal methods are used for removal of CBZ. It is also known that CBZ is highly protein-bound and charcoal hemoperfusion is the most effective extracorporeal elimination. We know that hemodialysis is also a technique for management of this drug.

We present two cases of CBZ intoxication, treated with two different methods, charcoal hemoperfusion and high-flux hemodialysis. The first patient who was receiving CBZ treatment for anxiety disorder was admitted to Bakırköy Dr. Sadi Konuk Educational and Research Hospital, Istanbul, Turkey on 11th of December 2017, with complaints of dizziness and blurred vision. Vital signs were stable. Laboratory tests were normal. Serum CBZ level was 56 μg/mL (reference 4 - 12 μg/mL). The CBZ level was 15.6 μg/mL after charcoal hemoperfusion for 3 hours. The second patient was admitted to the emergency room on the 5th of February 2015, with blurred consciousness. The patient had taken CBZ for suicide. The CBZ level was 33 μg/mL and was 14.86 μg/mL after hemodialysis with high-flux membrane for 4 hours. Serum CBZ level decreased by 73% in the first patient who received charcoal hemoperfusion and by 55% in the second patient who received high-flux hemodialysis.

In presenting these cases, we aimed to show the decrease of CBZ serum levels by using two different hemodialysis modalities in CBZ intoxication.

Bee sting to the cornea is a relatively rare environmental injury that can result in vision loss of different degrees. This study aimed to review the clinical features, pathogenesis, and management of keratopathy caused by corneal bee sting and present a case of keratitis with hypopyon and iridocyclitis secondary to bee sting injury without a retained stinger.

A 47-year-old man was presented for eyelid edema, severe pain, redness, and impaired vision following a corneal bee sting. On examination, we observed striate keratitis, focal infiltration with diffuse corneal edema, and iridocyclitis under the slit lamp. We also noted trace cells and empyema in the anterior chamber prompted by infection. No retained stinger was detected. A treatment strategy with corticosteroids in combination with broad-spectrum topical antibiotics started and the symptoms resolved significantly. At a three-week follow-up, the cornea restored transparency without complications and visual acuity maintained 20/20.

Following bee sting injury, it is crucial to monitor the progression, manifestations, and development of inflammation and infection. Individual timing, symptoms, severity, and complications vary in each case due to various compositions of bee venom. Therefore, assessment and careful follow-up of evolving manifestations may lead to better therapeutic decisions.

Extramedullary plasmacytomas (EMPs) can arise from organs other than bones. The majority of EMPs occur in the upper respiratory tract. The thyroid gland is a rare site for EMPs.

We report a case of primary plasmacytoma of the thyroid in a 42-year-old man who referred to the outpatient clinic of Namazi Hospital, a governmental hospital affiliated to the Shiraz University of Medical Sciences, Shiraz, Iran, in January 2018. The diagnosis of plasmacytoma was made by fine-needle aspiration of thyroid.

Primary plasmacytoma of the thyroid is a rare disease and its diagnosis can be made by cytology or pathology after ruling out benign conditions like Hashimoto thyroiditis by an appropriate workup. The prognosis of this disease is favorable, but the clinical follow-up of patients is mandatory because it can progress to multiple myeloma in some cases.