International Journal of Travel Medicine and Global Health
Volume:3 Issue: 1, Winter 2015

Upper limb fractures are prevalent injuries. An essential element of fracture healing is to maintain the bones alignment. However there are lots of complications associated with traditional ways of treatment, such as compartment syndrome and stiffness due to immobility for long time. Also evaluation and observation of the limb under the casts for potential infections and skin issues are not possible. By this article an invention of puzzle shaped cast for upper limb is introduced. This novel cast is made up of different parts that they complete each other and join as pieces of a puzzle to shape a cast. By this mean physical examination during the healing process is possible and the complications could be less.

There has been significant growth in international tourism from South-East Asia. Travel medicine services are still quite limited in this region. Few data exists on the knowledge, attitudes and practices of travelers from South-East Asia regarding the prevention of travel-related health risks. The present study aimed to characterize the travel trends and risk reduction strategies of international travelers departing from a major Malaysian airport.
We conducted a cross-sectional survey among international travelers at the Kuala Lumpur International Airport. A questionnaire recorded data on the demographic profile, travel patterns, travel health protective measures, sources of pre-travel health advice, personal perception of travel-related risk, and barriers to seeking health advice, travel vaccinations and malaria chemoprophylaxis.
36.8% of respondents had sought pre-travel health advice, mostly (64.7%) from their doctor. 23.6% of the travelers had received travel vaccinations. 40% of travelers were uninsured and over 50% did not know how to access medical care overseas. The survey revealed deficiencies in the risk perception of travelers regarding endemic infectious diseases such as malaria, dengue, and rabies. A minority of the travelers reported an intention to avoid unsafe food and water, inform themselves of local disease outbreaks, pack a first-aid kit, and protect themselves from animal and mosquito bites.
This study highlights areas of concern in relation to the knowledge and behavior of the travelers surveyed and points to the need for raising public awareness in South-East Asia of the risks associated with international travel and the most efficient means of mitigating those risks.

Higher levels of pro-inflammatory cytokines in schizophrenia have suggested that dysfunctions of the immune system may play a role in this disabling condition. The current study was performed to discover if low dose celecoxib combined with clozapine may improve symptoms of schizophrenia or not.
In a double-blind randomized clinical trial, 40 patients with non- treatment resistance schizophrenia were allocated into two groups. The experimental group received flexible and low dose clozapine plus 200 mg/day of celecoxib for 4 weeks, while the control group received clozapine plus placebo. Experimental and control groups were similar in terms of age, gender, clozapine mean dosage and severity of schizophrenic symptoms at baseline. Main outcomes were severity of schizophrenia symptoms measured by the Positive and Negative Syndrome Scale (PANSS) at baseline followed by the second and fourth weeks.
Although both groups experienced significant improvement in all PANSS sub-scales in the second and fourth weeks (P<0.001), the differences between the two groups did not reach significance (P>0.05).
Our findings did not support the findings of prior studies that report a significant effect for celecoxib combined with atypical antipsychotics. Such inconsistency may be due to statistical power, drug interactions between clozapine and celecoxib, and the low dose of celecoxib used in this study. Future research is needed on the role of anti-inflammatory medications as adds-on treatments for schizophrenia.

Hepatitis B virus (HBV) infection is a global public health problem. Serum HBV DNA measurement is a non-invasive test that predicts the liver disease progression. The aim of this study was to determine the HBV DNA level and look for a relation between the HBV DNA level and liver histology.
This was a cross sectional study on chronic hepatitis B infected patients in Tehran Hepatitis Center from 2006 to 2010. Percutaneus liver biopsy was performed in all patients. Patients with a history of any treatment and co-infection of HCV, HDV and HIV were excluded.
301 patients were included in this study. The mean age was 34.63±13.25 years. Mean serum HBV DNA level was 1.35* 108 ± 10.5*109 copies/ml.  Mean inflammatory score (grade) was 5.54±3.26 and fibrosis (stage) was 1.93±1.56. There wasn’t any significant relation between age and sex with liver histology. No significant relation was seen between liver histology and the HBV DNA level. HBe Ag positive patients had a higher serum HBV DNA level.
There wasn’t any significant relation between liver histology and the HBV DNA level. We suggest using liver biopsy as a golden standard. In addition we need more studies in this field.

Children, who work or live at streets, are one of the HIV high risk groups in Iran, with no comprehensive preventive programs. This study intended to assess substance use among street children in Tehran, Capital of Iran.
This paper is a part of comprehensive rapid assessment and response (RAR) research on street children in Tehran in 2012-13. Data were collected by interview using questionnaires. Two hundred and seventy 289 street children were selected by time-location sampling in Tehran.
From the total of 259 street children, 59.4% were Iranian and 74% were boys. Prevalence of drug use among street children was 25.6%.  The prevalence of smoking, drug abuse and also drinking alcohol were 8.9% among boys and 1.4% among girls.20.8%, 17.3% and 6.9% of the street children had at least used cigarette, alcohol and drugs once in their lives respectively. There was a significant relationship between consumption of alcohol and other substances among street children with higher age, type of occupation and leaving home experience.
Comprehensive preventive programs targeting street children is recommended to be started at lower ages, with the main focus on young boys among street children. In addition family intervention and improvement of children’s lifestyle could be a main strategy for drug use prevention among this population.

The nature of the Alzheimer’s disease gradually makes patients dependent to persistent care. This may have a large negative effect on the caregivers’ quality of life and predisposes them to psychological distress. Spirituality, however, may act as a buffer and enhance their adaptability with stressful conditions. This study aimed to evaluate the association between spirituality and symptoms of anxiety and depression in a sample of caregivers of patients with Alzheimer’s disease. In this cross-sectional study, 209 outpatients with moderate Alzheimer’s disease (using DSM-IV criteria and MMSE test) and their caregivers were selected. Patients’ and caregivers’ demographic data were recorded. The Spiritual Intelligence Questionnaire and Hospital Anxiety-Depression Scale were completed by caregivers. Spirituality was negatively correlated with depressive symptoms. Spirituality, however, had a positive but non-significant correlation with anxiety symptoms. Although symptoms of anxiety and depression are highly prevalent in Alzheimer caregivers, only depressive symptoms are directly linked to spirituality. Spiritually-based approach may be a component of therapeutic interventions, in order to enhance caregivers’ adaptability.

Service quality is a judgment that the customer compares his/her expectations by this judgment, with the perception of the received services. The purpose of this study was to compare service quality in teaching hospitals with non-teaching hospitals in Kerman city.
This cross-sectional study has been done on 166 hospitalized patients and the standard SERVQUAL questionnaire with an approved validity and reliability was used. Data analysis was performed using SPSS software version 19.
The results show that the service quality from the patients’ perception in non-teaching hospitals is more than the teaching hospitals (p=0.002). Most of the service quality gap is in the tangibility dimensions and also in providing amenities for patients and their companions.
Teaching setting of the hospital typically can cause poor subjectivity in patients about the quality of services provided and it is recommended that authorities identify factors causing these kind of thinking and solve them. Also the negative scores indicate a need for improvement in all aspects, especially the tangibility dimensions having the maximum gap.