Researcher Bulletin of Medical Sciences
Volume:14 Issue: 2, 2009

To know a smoker’s readiness and motivation for quitting, the motivation test designed and introduced by the recommendation of the English National Health System in 1995. In this study which is the first of its kind in Iran, researchers were interested between the probable relations between the results of this test with success in quitting in the Iranian society so the best time to stop could be recommended to smokers. This cross-sectional study conducted between the years 2006 and 2008, and all attendants for smoking cessation during this period were included. The subjects were evaluated by a single physician and during a 4 session program on a weekly basis, appropriate individualized treatment recommendations including nicotine-containing drugs and others and behavioral therapies were made. In this study, 822 subjects participated including 590 men (72%) with a mean age of 42.5±13 years. Motivation to quit test results were ranked as follows: 339 individuals (44.5%) in the low range (0-9), 378 (50%) in the moderate range (10-15) and 43 (5.5%) in the high range (16-20). 86% of the subjects with a high motivation score succeeded in quitting and this rate was 68% in those with a moderate ranked score and 69% for the low ranking individuals which was not considered statistically significant. Although at follow-up after the first 6 months, 80.5% in the high motivation group compared to 42% in the moderate and 46% in the low motivation group remained abstinent and this was statistically significant (p<0.0001). At follow-up at 12 months, 58% of the highly motivated subjects, 35% of moderately motivated subjects and 36% of those with low motivation remained smoking free and this was also statistically significant (p<0.05). It seems that the best time for starting quit smoking is when smoker is ready to quit with high score of motivational test, but with low score, it might be more focus on treatment.

Considering the key role played by precise data collection on factors affecting the incidence of obesity, this survey aimed at obtaining epidemiologic information and determining the effect of physical activity levels and food consumption pattern on the prevalence of obesity in Tehranian females aged 18-25-years referring to premarriage consultation centers of Tehran in summer 2008. In this cross sectional study, of 926 girls questionnaires were completed for demographic information, anthropometric indicators, and body mass index (BMI) counted. Levels of physical activity were measured by lipid research clinics questionnaire (LRC); and for 104 person with simple random, standard food frequency questionnaire (FFQ) was completed. Prevalence of obesity was determined and the role of food pattern and physical activity was viewed statistically. Mean age and BMI±SD of subjects were 22.4±2.3 year and 21.9±3.6 (kg/m2), respectively. The prevalence of overweight and obesity were 11.9% and 3.1%, respectively, and central obesity based on waist circumference≤80 cm was 13.3%. There was a significant negative relationship between BMI≤25 and educational level (p=0.01) and a significant positive relationship with diabetes among close relatives (p=0.01). Low physical activity had an independent role in predicting overweight and obesity (OR=1.7 with 95% CI: 1.1-2.5)(p=0.03). Regarding fiber intake 21.4% consumed less than the recommended dose (14 g/1000 Kcal); none of the subjects consumed less than 10 g/1000 Kcal. Evaluation of sugar consumption showed that 66.7% had high sugar intakes (>10% of kcal/day). Of samples, 81.7% had low-fat diets, 6.7% were observed to be within the normal range, and 11.5% had high fat intake. Fruits, vegetables and dairy, were consumed at recommended amounts or above by 82, 73, 20 percent of subjects, while these values for grains and meat were 93 and 47%, respectively. Although the prevalence of obesity and central obesity in these Tehranian young females is not prevalent, an intervention in diet pattern with high sugar intake is needed to be implemented, and preventive approaches in order to decrease prevalence of obesity in this transient population is necessary.

Class B beta-lactamases, termed metallo-beta-lactamases (MBLs) such as VIM, IMP and SPM are an increasingly serious clinical problems. They have a very broad substrate profile that includes penicillins, expanded spectrum cephalosporins, and carbapenems, except for monobactames such as aztreonam. MBLs producing Pseudomonas aeruginosa isolates have been responsible for several nosocomial outbreaks. In this study we determined prevalence of blaIMP-1, blaVIM-1 and blaSPM-1 MBL genes among imipenem resistant P. aeruginosa isolated from Imam Khomeini hospital (Tehran, Iran). A total of 243 P. aeruginosa isolates were collected from different clinical samples from Imam Khomeini hospital. After determination of Minimum Inhibitory Concentration (MIC) to imipenem, isolates with MIC≥4 µg/ml were screened for MBLs producing strains by DDST using imipenem-EDTA discs. PCR assay for detection of blaIMP-1, blaVIM-1 and blaSPM-1 MBL genes was performed by specific primer. Among all studied isolates, 28 isolates with MIC≥4 µg/ml to imipenem were selected to DDST with EDTA and PCR assay. Results of this study showed that 22 of these 28 isolates were positive by DDST and 15 isolates harbored blaVIM-1 gene. All these strains were susceptible to colistin and polimixin B. No other MBL studied genes were observed. Our data showed that blaVIM-1 MBL gene is the most frequent gene among clinical P. aeruginosa isolates in this research. According to importance of MBL producing isolates in prolonged nosocomial outbreaks it is necessary to rapid detection and concern seriously for infection control management.

Acute brucellosis among household members of Brucella patients has been reported. The aim of this study was to determine the effectiveness of active serological screening in detecting additional unrecognized cases among people who were in contact with patients suffering from acute brucellosis. This descriptive study was conducted among people who were in contact with Brucella patients (contact cases) in two provinces (Tehran and Lorestan) of Iran, between years 2005 to 2007. Five mL of venous blood samples were taken from Brucella patients (index cases) and contact cases and evaluated by using Brucella ELISA IgM, IgG, IgA assay kits. 36 Index cases with the mean number of contact cases (4.5±2.5) with 117 contact cases [59 (50.5%) men, 58 (49.5%) women] were screened. Positive IgM, IgA, IgG ELISA titers were detected in 7 (6%), 25 (21.5%), 31 (26.5%) of contact cases, respectively. The seroprevalence rate was detected in 40 (34.2%) among contact cases. 38 (32.5%) of contact cases manifested various symptoms. Among 40 contact cases with positive seroprevalence, 14 (35%) cases had complaint, but among 77 contact cases with negative seroprevalence, 24 (31%) cases had complaint. There was not a significant correlation between positive seroprevalence with clinical complaint. The high seroprevalence rate (34.2%) and symptomatic individuals among contact cases (35%) in this study showed that the household members are not the single most important identifiable risk group and screening of other contact cases is necessary. Screening all contact cases provides an effective means for their early diagnosis.

The emergency room is the most critical and important ward in hospitals. Increasing industrialization in the developing world has contributed to an epidemiological transition in disease pattern from infectious diseases to trauma. The aim of this study was to evaluate the emergency rooms in hospitals affiliated to Shahid Beheshti University of Medical Sciences. This cross-sectional study was conducted in February 2008 on emergency rooms in hospitals affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran. We used the standards of "Ministry of Health and Medical Education" as a check list in our query. The authors evaluated 18 items viz. physical structure, triage, physical examination room, resuscitation room, operating room, nursing station, isolated room, and other important parts and characters in emergency wards. This study carried out in seven emergency rooms of seven university-affiliated hospitals. The most important problems were related to physical structure, operating room and isolated room. In regards to triage and resuscitation rooms the optimum score was related to 4 and 5 hospitals, respectively. The other criteria had optimum score in most of the hospitals. The emergency rooms in university-affiliated hospitals were in acceptable situation though, they showed some problems which need to be improved.

Sepsis is a critical condition witch is mostly by bacterial infection with high rate of mortality. Prognosis of Sepsis depends on early diagnose and treatment by proper antibiotics. Since definite diagnosis of sepsis is a positive blood culture and this test needs a long time to determined, other biochemical markers like procalcitonin (PCT) has been scrutinized. In this study we tried to scrutinize sensitivity and specificity of PCT in diagnosis of neonatal sepsis. 76 infants with clinical suspicion of neonatal sepsis were included in this cross-sectional and prospective study. After taking detailed history and physical examination, serum PCT concentrations were measured by a semi quantitative method, and the results of PCT test were compared with blood cultures results to determine sensitivity and specificity of PCT assay in diagnosis of neonatal sepsis. In 8 infants (10.5%) blood cultures were positive and 45 infants (59.2%) had positive PCT test (PCT>0.5 ng/mL). Sensitivity and specificity of PCT in all infants were 75% and 42.6%, respectively. In infants aged 48 hours and younger, sensitivity and specificity of the test were 100% and 22.5%, respectively. In infants aged older than 48 hours, both the sensitivity and specificity of the test were 71.4%. ‍ PCT is a useful marker as a part of evaluations for diagnosis of neonatal sepsis. It is an easy method for the work-up of sepsis, but it is not sufficient as a sole marker of diagnosis of sepsis. Studies with larger sample sizes are required to establish value of PCT.

The aggravating role of Staphylococcus aureus superantigens is well known in atopic dermatitis but has not yet been proven in psoriasis. The role of Staphylococcus aureus is emphasized in the initiation, maintenance and complications of psoriasis. We investigated the frequency of nasal, axillary, and perineal carriage of Staphylococcus aureus (S. aureus) in patients with psoriasis and its possible influence on the severity of the disease. One hundred patients with the clinical diagnosis of psoriasis participated in the study. Cultures of the bacterial flora were obtained from the right and left axilla and nasal nares and perineum, inoculated on standard bacterial medium (blood agar), and incubated at 37°C degrees for 48 h. one hundred patients with the clinical diagnosis of psoriasis (42% female and 58% male) comprised the study group. Mean age of the patients was 41.1±17.1 years. 42% of the patients carried S. aureus; of these, 32% were from the nose, 13% from axilla, and 11% from the perineum. Three patients were carrier in 3 sites. There was no significant difference in the severity of the disease between the carriers and non-carriers measured by the psoriasis area and severity index (PASI) Score. It seems that the severity of psoriasis is not influenced by staphylococcal carrier state.

According to increased trend for rapid intubations of trachea on one hand and need for importance of muscle relaxation during intubations process on the other hand, we conduct this research to evaluate using priming method by usual dose of Atracurium with Succinylcholine. One hundred participants by age ranged between 15 to 55 years old underwent in doubled blind clinical trial research. They had no anatomical troubles in their tracheal air way. They were assigned randomly in two groups named group (S) which stands for Succinylcholine, and group (P) which stands for priming. As premedication, both groups received 0.5-1.5 mg dose of Midazolam and 2 µg/kg dose of Fentanyl intravenously, and also group (P) received 0.05 mg/kg dose of Atracurium while group (S) nothing but 0.5 cc of normal saline. Both groups were oxygenized for three minutes followed by anesthetic induction by using some drugs such as 5-6 mg/kg dose of thiopental and 1.5 mg/kg of lidocaine. During induction, group (S) received 1.5 mg/kg Succinylcholine while group (P) received 0.55 mg/kg of atracurium. All participants in research in both groups were intubated by an expert anesthesiologist after 60 seconds. Muscle relaxation was recorded based on applying single twitch neurostimulator (ST) that to determine it we assign three numbers which includes 0, 1, and 2. Zero was for nonexistence of it, 1 for moderate and 2 for complete relaxation, and also it was based on other clinical criteria such as mandibular relaxation (0, 1), openness of vocal cord (0, 1) and not bucking (0, 1 and 2). Subjects were considered completely relaxed when the sum of scores was 4, and relatively relaxed when it was 3. The effects of these approaches were judged based on muscle relaxation associated with evaluation of clinical examination and ST by using key do and fisher test. Data showed that none of the subjects got 2 or less than it from the sum of scores of the degree of muscle relaxation and clinical evaluation, and also it showed that 16% of control group and 8% of experimental group got relatively relaxed (not significant). Based on ST, there were No. 1 or zero grades in all patients in control group vs. relatively relaxation in 64% of patients in experimental one (p<0.000001). New priming method is as same as method which we use Succinylcholine at least in clinical respect. We recommend using the mentioned method in patients who are candidates for contraindication of using Succinylcholine. We suggest a more complete research with evaluating Train of Four (TOF).

During the past few decades, the pharmaceutical industry, as against "fast moving consumer goods" (FMCG) industries, has given little weight and value to branding and has had little success in promoting its products in spite of the allotment of large sums of money to do so. As for the Iranian pharmaceutical industry, where most of the companies rely on the government for both local and foreign exchange support, the situation is graver, particularly because of the allocation of production quotas to them. However, some environmental factors, the most significant of which is the change in governmental policies and regulations, have provided local pharmaceutical companies with opportunities to strive to create differentiation and competitive advantage to be able to survive and meet the challenges of the changing environment. There is the need in this regard to conduct a deeper survey of the present status of the pharmaceutical industry (so far as the branding is concerned) to be able to set up and implement appropriate strategies and policies. This study aims at surveying the "feasibility of the utilization of branding in the pharmaceutical industry in Iran". Attempts have been made to present status of the country's pharmaceutical industry in regard to "branding" along with recommended strategies to pave the ground for the success of the local pharmaceutical companies in an effort to create a brand and resultant brand equity for their products. In order to access to above mentioned object, relevant literature have been reviewed, expert views heard, and the method of case study with the model proposed by Wong and Merrilees (2005) has been used. Based on the interviews conducted with the management (both senior managers and executive ones), personnel, and pharmaceutical representatives of the selected companies, it may be stated that they are all sufficiently aware of the significance of marketing and that this awareness is being intensified as competition in the pharmaceutical industries of Iran shapes up and the importance of marketing become more perceptible. However, none of them (at the time of the interview) perceived branding as competitive leverage for the sale of their pharmaceutical products. They could not differentiate the products of one company from those of the other, either. It could be roughly concluded that, given the criteria for the assessment of brand-marketing performance, also considering the variety of the views received, the brand names of neither Company A nor Company B have attained the desired degree of achievement. To put it all in a nutshell, it may be said that the chief decision markers of the companies (that is, the senior management and the executive managers) did not know much about the processes of the utilization of brand name for their products and the prerequisites required for such utilization, though they understood the benefits of it. However, this understanding was never reflected in their macro strategies, organizational structure, and, above all, their manpower planning.

Coronary artery disease (CAD) is the most common cause of mortality worldwide. The most frequent symptom of CAD is angina pectoris. The aim of this study was to compare scientific and applicable difference of two kinds of sublingual nitroglycerin, made by G. Pohl-Boskamp (Germany) and Zahravi (Iran) Pharmaceutical Companies on hemodynamic indices in coronary angiography. We evaluated left ventricular systolic pressure, left ventricular end diastolic pressure, aortic systolic, diastolic and mean pressures before and 5 min after consumption of two 0.4 mg sublingual nitroglycerin pearls made by Zahravi Company, and one 0.8 mg sublingual nitroglycerin pearl made by G. Pohl-Boskamp Company in 30 and 31 patients, respectively. Primary hemodynamic data did not show significant statistics differences (p>0.05). Both sublingual nitroglycerin pearls induced significant reduction of all hemodynamic indices (p<0.001), with no statistical difference in both groups (p>0.05). In this study we showed that Zahravi-made sublingual nitroglycerin pearl has similar hemodynamic effects in patients underwent coronary angiography as compared with the G. Pohl-Boskamp one.