Iranian Journal of Medical Sciences
Volume:45 Issue: 6, Nov 2020

The present review focuses on identifying factors contributing to health service utilization (HSU) among the general adult population according to Anderson’s behavioral model.

Published articles in English on factors related to HSU were identified by systematically probing the Web of Science, MEDLINE (via PubMed research engine), and Scopus databases between January 2008 and July 2018, in accordance with the PRISMA guidelines. The search terms related to HSU were combined with terms for determinants by Boolean operators AND and OR. The database search yielded 2530 papers. Furthermore, we could find 13 additional studies following a manual search we carried out on the relevant reference lists.

Thirty-seven eligible studies were included in this review, and the determinants of HSU were categorized as predisposing, enabling, and need factors according to Andersen’s model of HSU. The results demonstrated that all predisposing, enabling, and need factors influence HSU. In most studies, the female gender, being married, older age, and being unemployed were positively correlated with increased HSU. However, evidence was found regarding the associations between education levels, regions of residence, and HSU. Several studies reported that a higher education level was related to HSU. Higher incomes and being insured, also, significantly increased the likelihood of HSU.

This review has identified the importance of predisposing, enabling, and need factors, which influence outpatient HSU. The prediction of prospective demands is a major component of planning in health services since, through this measure, we make sure that the existing resources are provided in the most efficient and effective way.

The assessment of narrative skills in young children is essential for early identification of potential learning and literacy-related difficulties. The present study aimed to develop a validated and reliable test for consecutive assessment of narrative skills in Iranian school-age children.

To elicit story retelling by the children, 14 pictures (each a discrete test) were developed based on which 14 stories were scripted in accordance with the Stein and Glenn model. The pictures were presented to 50 typically developing (TD) children and seven children with autism spectrum disorder (ASD) in Kerman, Iran, 2018. The recorded audio of retold stories by the children was transcribed and analyzed using the monitoring indicator of scholarly language (MISL) instrument. The SPSS software (Version: 18.0) was used to analyze the data with the significance level set at 0.05.

A high correlation between the total MISL score of each test and each MISL item (r>0.5) confirmed the construct validity of our test. A comparison of the mean total MISL score between the TD and ASD groups showed significant differences (p 0.7 between all the MISL items and the intraclass correlation coefficient between the test and retest scores was >0.96 for all pictures. The repeated measures ANOVA did not indicate significant differences (P=0.15) between the total MISL scores of the pictures.

The validity and reliability of the developed test were confirmed, suggesting it can be used for consecutive assessment and monitoring of the narrative skills in school-aged children.

The knee outcome survey-activities of daily living (KOS-ADL) scale is a self-reported measure to determine knee function and symptoms in individuals suffering from a variety of knee disorders. The present study aimed to assess the validity, reliability, and cross-cultural adaptation of the Persian version of the KOS-ADL scale.

In this cross-sectional and psychometric study, 130 patients (14 men and 116 women) with different grades of knee osteoarthritis were recruited. The construct validity of the scale was examined through the correlation between the domains of KOS-ADL and the subclasses of the knee injury and osteoarthritis outcome score (KOOS). To assess the test-retest reliability, 40 of the participants were requested to fill in the questionnaire again with an 8-day interval. The internal consistency of the questionnaire and its subclasses was evaluated with Cronbach’s alpha coefficient. To evaluate construct validity, concurrent construct validity was examined with a correlation matrix using Pearson’s correlation coefficients between the KOS-ADL domains and KOOS total score and subclasses. The test-retest reliability was analyzed using the intra-class correlation coefficient (ICC). The Kappa coefficient was used to determine the intra-rater agreement.

The Persian version of the KOS-ADL scale had good reliability (ICC=0.79) and internal consistency (α=0.92). There was a good correlation between the KOS-ADL total score and KOOS subclasses (r≥0.71, P≤0.001).

The Persian version of the KOS-ADL scale is a valid and reliable instrument to evaluate the symptoms and functional status of people suffering from knee osteoarthritis.

Burn wound infection and sepsis are serious medical conditions requiring prompt intervention. Plants are a good natural source for the development of novel, safe, and cost-effective antibacterial agents. The objective of the present study was to assess the antibacterial potential of aqueous, chloroform, and methanol extracts of the Prunus scoparia (P. scoparia) root against the most common burn wound pathogens.

The present experimental study was conducted at Shiraz University of Medical Sciences (Shiraz, Iran) during 2018-2019. The antibacterial activity of the total plant extract was assayed using the broth microdilution method. Fractionation was performed using a separation funnel and solvents with different polarities. Broth microdilution and agar well diffusion assays were performed to determine the antibacterial potential of the obtained fractions. Quantitative and qualitative phytochemical analyses were performed to confirm the presence of secondary metabolites in both the total extract and the fractions.

Methanolic extract of P. scoparia root exhibited antibacterial activity against all tested bacterial strains, especially against Methicillin-resistant Staphylococcus aureus (MRSA) isolates. This extract, compared to the aqueous and chloroformic extracts, exhibited the presence of active antibacterial compounds. The quantitative and qualitative results of phytochemical screening showed that phenols and flavonoids were the main antibacterial compounds in the methanolic extract of the plant.

For the first time, we demonstrated the antibacterial activity of the P. scoparia root against MRSA isolates and other common burn wound pathogens.

The movement system impairment (MSI) model is a clinical model that can be used for the classification, diagnosis, and treatment of knee impairments. By using the partitioning around medoids (PAM) clustering method, patients can be easily clustered in homogeneous groups through the determination of the most discriminative variables. The present study aimed to reduce the number of clinical examination variables, determine the important variables, and simplify the MSI model using the PAM clustering method.

The present cross-sectional study was performed in Shiraz, Iran, during February-December 2018. A total of 209 patients with knee pain were recruited. Patients’ knee, femoral and tibial movement impairments, and the perceived pain level were examined in quiet standing, sitting, walking, partial squatting, single-leg stance (both sides), sit-to-stand transfer, and stair ambulation. The tests were repeated after correction for impairments. Both the pain pattern and the types of impairment were subsequently used in the PAM clustering analysis.

PAM clustering analysis categorized the patients in two main clusters (valgus and non-valgus) based on the presence or absence of valgus impairment. Secondary analysis of the valgus cluster identified two sub-clusters based on the presence of hypomobility. Analysis of the non-valgus cluster showed four sub-clusters with different characteristics. PAM clustering organized important variables in each analysis and showed that only 23 out of the 41 variables were essential in the sub-clustering of patients with knee pain.

A new direct knee examination method is introduced for the organization of important discriminative tests, which requires fewer clinical examination variables.

Efflux pumps such as MexEF-OprN and mexXY-OprM play an important role in the resistance of Pseudomonas aeruginosa (P. aeruginosa) to antibiotics. The present study aimed to assess the reduced expression of efflux pump genes of P. aeruginosa with Satureja khuzistanica essential oil (SKEO). The present cross-sectional study was conducted in 2016 at the Microbiology Laboratory of Baqiyatallah University of Medical Sciences, Tehran, Iran. The disk diffusion method was used for susceptibility testing of gentamicin and norfloxacin. Minimum inhibitory concentration (MIC) was determined for gentamicin and norfloxacin. The antibacterial efficacy of SKEO was defined by determining the MIC values using the microdilution method. In vitro, the synergistic interaction of SKEO combined with gentamicin or norfloxacin was examined via checkerboard assay and defined as a fractional inhibitory concentration index. The reverse transcription-polymerase chain reaction technique was used to measure changes in the expression of the efflux pump genes. The data were analyzed using SPSS software version 16.0, and p The MIC values of SKEO were in the range of 6 to 12 µg/mL. In the presence of sub-inhibitory concentrations (1.16 to 2 MIC) of SKEO, synergistic effects were revealed using the checkerboard method. The effect of norfloxacin and gentamicin increased up to 8-fold. The expression of mexY and mexE was reduced after treatment with SKEO. SKEO reduced the expression of efflux pumps and the MIC values of norfloxacin and gentamicin in vitro.

Cervical conization is a standard diagnostic method for precancerous lesions. However, its results could be negative despite an initially positive punch biopsy. The present study aimed to re-evaluate pathological biopsies with Ki-67 and p16 immunostaining to assess the diagnostic accuracy of punch biopsies.

This retrospective study performed in Motahhari Clinic and Shahid Faghihi Hospital, (Shiraz, Iran). 88 punch and cone biopsy slides from 2007-2016 were re-evaluated by two pathologists, and the results were compared with the original diagnoses. Agreement between the initial diagnoses and re-evaluations and between our pathologists were assessed with the kappa coefficient. Twenty-two negative conization results after positive punch biopsy were re-sectioned and evaluated with Ki-67 and p16 immunostaining.

The overall agreement (kappa) between the primary punch diagnoses by the original pathologists and those made in the present study (by the first and second pathologists) before immunohistochemical (IHC) staining was 0.33 and 0.43, respectively. The kappa coefficient between punch biopsy diagnoses by the first and second pathologists before IHC staining was 0.73, while it increased to one after IHC staining with Ki-67 and p16. Out of the 22 specimens with the positive punch and negative cone biopsies on initial diagnosis, cervical intraepithelial neoplasia (CIN) was not confirmed in 11 specimens by our pathologists after IHC staining with Ki-67 and p16. These cases were reclassified as transitional metaplasia or acute/chronic cervicitis.

Punch biopsy can be misdiagnosed as CIN positive, leading to unnecessary conization. The use of Ki-67 and p16 markers as appropriate ancillary tests are recommended.

Leptin and leptin receptor (Ob-R) are associated with worse prognosis, distant metastasis, and poor survival of breast cancer. We investigated the cytotoxic effect of silibinin and curcumin, individually and combined, on Ob-R expression in MCF-7 cells.

This study was performed from October 2017 to April 2018 at the Department of Clinical Biochemistry, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. The cytotoxic effect of silibinin and curcumin, individually and combined, and their corresponding half-maximal inhibitory concentration (IC50) values were determined using the methylthiazolyldiphenyl-tetrazolium bromide (MTT) assay. The cells were treated with different concentrations of silibinin (50-400 μM), curcumin (10-35 μM), and their combinations for 24 and 48 hours. The expression of Ob-R was measured using the Western blot analysis by treating the cells with different concentrations of curcumin (10-25 μM), silibinin (50-250 μM), and their respective combinations. The difference in mean cell viability between the groups was calculated using one-way ANOVA followed by Tukey’s post hoc test.

Silibinin and curcumin exerted time- and dose-dependent cytotoxic effect on MCF-7 cells. After treatment with silibinin, the IC50 values were about 250 and 50 μM at 24 and 48 hours, respectively. In terms of treatment with curcumin, the IC50 values were about 25 and 15 μM at 24 and 48 hours, respectively. Following treatment with silibinin, the Western blot analysis showed that Ob-R expression significantly decreased at 150 μM (P=0.031) and 200 μM (P=0.023) concentrations. Curcumin did not significantly decrease the Ob-R expression, however, the expression significantly decreased (P=0.004) when it was combined with silibinin.

The combination of silibinin and curcumin significantly reduced Ob-R expression in MCF-7 cells compared with their individual effects.

Posterior reversible encephalopathy syndrome (PRES) is a clinico-neuroradiological entity that is manifested by characteristic magnetic resonance imaging (MRI) depictions of subcortical/cortical hyperintensities in the parieto-occipital lobes. Paroxysmal hypertension, headache, and palpitation are the most common clinical manifestations of pheochromocytoma, which are catecholamine-secreting enterochromaffin tumors. PRES is a rare complication of pheochromocytoma. Herein, we describe a 44-year-old woman who presented with postoperative confusion and headache. MRI images showed multiple asymmetrical hyperintensities with surrounding edema and contrast enhancement, predominantly in the right parietal lobe, left cerebellar hemisphere, and dentate nuclei, in favor of hemorrhagic metastases. The results of further investigations, including abdominopelvic computed tomography and the 24-hour urine test for metanephrine and normetanephrine, were in favor of a pheochromocytoma. The patient was scheduled for adrenalectomy and histopathologic examination of the tissue, which confirmed the diagnosis. Surprisingly, her symptoms and neuroimaging abnormalities improved significantly without any treatment during the follow-up period. Based on these findings, the diagnosis of PRES was considered, and the patient was followed. She was symptom-free at 3 years’ follow-up. The literature contains only four case reports of PRES as a complication of pheochromocytoma; however, all these cases had bilateral symmetrical hemispheric involvement and occurred during childhood and adolescence.