Researcher Bulletin of Medical Sciences
Volume:15 Issue: 4, 2010

Helicobacter pylori (H. pylori) is an important pathogen and carcinogen. Generally, pathogenicity of H. pylori is related to cag Patogenicity Island. The famous genes in this region are cagA and cagE. The aim of this study was to evaluate the relation between cagE or cagA and clinical features of Iranian patients. The H. pylori was cultured and detected by glmM gene. Polymerase chain reaction was performed to detect cagA and cagE. Among 311 studied patients, 231 were reported as H. pylori positive including 154 (%66.7) patients with cagA and 90 (%39) patients with cagE. There was no significant relation between clinical outcomes (including gastritis, peptic ulcer and gastric cancer) and cagE or cagA. ‍ CagA and cagE were not found as suitable markers for diagnosis of gastric disorders. The mentioned result was similar to pervious researches in Iran. In addition, cagA was found to be a better marker compared to cagE.

Diversity and complexity of health related issues along with the limitation of resources make research priorities setting inevitable. In this article we report the method, problems, limitations, barriers and outcomes of the project of setting research priority in Shahid Beheahti University of Medical Sciences.

This study involved 91 departments of eight schools and 830 stakeholders in 2009-10. There were five basic principles including stakeholders’ participation, situation analysis and need assessment, defining research priority topics, scoring according to the criteria, and defining priorities based on the most agreed topics. This was a modified version of the proposed model of “The Council on Health Research for Development” (COHRED).

The research priorities of 91 educational departments from schools of medicine, dentistry, pharmacy, nursery and midwifery, public health, nutrition, paramedical sciences, and rehabilitation were determined. 610 faculty members and 220 other health system stakeholders and health related persons outside the university were involved in this project. Finally 841 research fields and about 1900 sub-fields were defined as the research priorities. ‍

It seems that the COHRED model is suitable for setting research priority in educational departments. We hope that research priorities lead researchers to design their proposals in accordance with the priorities and also act as a tool for policy makers to effectively manage limited resources.

Studies have shown that breast cancer patients who have estrogen receptor (ER) or progesterone receptor (PR) positive tumors have lower risks of mortality and better response to treatment compared to women with ER and/ or PR negative breast tumors. However, few studies have been performed about these factors and their relation with demographic or clinical characteristics in Iran. So we decided to evaluate the correlation between ER, PR and Human epidermal growth factor 2 (HER-2) with age, tumor size, tumor histological grade and lymph node metastasis as prognostic factors in breast cancer. In this cross sectional study, 138 patients with invasive ductal breast carcinoma who were admitted in Shohadaye Tajrish hospital during 2004-2005 were studied and all information was gathered from patients’ medical records. Statistically significant correlation between ER, PR, and HER-2 receptors with age, tumor size and lymph node metastasis was not observed. Also correlation between ER, PR and HER-2 receptors with tumor grade was not significant. But there was significant correlation between HER-2 receptors and tumor grade (P<0/05). Correlation between ER and PR with HER-2 receptors was not significant. Also there was not a significant correlation between Triple Negative tumors and age, tumor size, tumor grade, and lymph node involvement. ‍ It seems that patients with HER2 positive tumors tend to face higher grade tumors and metastasis; besides, maybe they face an increased risk of mortality.

Ventilator Associated pneumonia (VAP) occurs 48 hours or later after initiation of mechanical ventilation. VAP is the second most common nosocomial infection in neonatal intensive care unit (NICU). Therefore, it is necessary to determine the rate, characteristics, risk factors and outcome of VAP in NICU patients. A prospective cohort study was conducted at the Mahdiyeh Hospital over a period of 1 year on all neonates who were admitted to NICU and required mechanical ventilation for more than 48 hours. Diagnosis of VAP was made according to the definition of nosocomial pneumonias for patients younger than 12 months by CDC (center for disease control and prevention). Risk factors for developing VAP such as birth weight, gestational age, gender, duration of mechanical ventilation, length of hospital stay and drugs were studied. The significant risk factors in univariate analysis were subjected to multivariate regression to determine independent predictor of VAP and mortality. VAP occurred in 14 of 81 neonates (17.3%). The rate of VAP was 9 per 1000 ventilator days. The most common bacteria isolated from endotracheal aspirate were gram negative organisms (Ecoli (21.4%), Klebsiella (21.4%) and Pseudomonas (14.1%)). By multivariate analysis, duration of mechanical ventilation (B odd's ratio= 0.07, P=0.001) and anti-acid therapy (OR= 0.22, P=0.098) were two single independent risk factors for VAP. Two neonates with VAP died (14.3%) and multivariate analysis revealed that duration of mechanical ventilation (B odd's rate= -0.04, P=0.01), low birth weight (B odd's ratio= 0.002, P<0.001) and purulent sputum (hazard risk= 0.25, P=0.006) were independent predictor of mortality. Patients with VAP also had prolonged stay in NICU (59 vs 27 days). ‍ VAP occurred at significant rate among mechanically ventilated NICU patients. Additional studies are needed to investigate how to prevent VAP and interventions needed.

There are many risk factors for osteoporosis which can help to decide whether a person needs bone densitometry or not. For reducing the cost of mass screening of osteoporosis, numerous risk assessment methods have been created, from which Simple Calculated Osteoporosis Risk Estimation (SCORE), Osteoporosis Risk Assessment Instrument and Osteoporosis Self Assessment Tool (OST) are the most recognized ones. The objective of this study was to compare SCORE and OST in osteoporotic and high risk women. SCORE and OST were calculated for 210 postmenopausal women in Loghman Hospital. After bone densitometry the women were categorized as healthy, osteoporotic (T-score< -2.5), or high risk (T-score<-2). The sensitivity, specificity, predictive value, likelihood ratio (LR), positive predictive value (PPV) and negative predictive value (NPV) of the tests were determined. Then their true positive, true negative, false positive and false negative were assessed by chi2 test. The mean age of the patients was 57.3 y. 43 (20.3%) had osteoporosis and 88 (41.7%) were at risk. The PPV and NPV of OST was 39.2% and 91.6%, respectively, while they were 34.2% and 97.8% for SCORE, respectively. The sensitivity of SCORE was higher in osteoporotic and high risk women (95% and 88.2%, respectively). In addition, it’s NPV and diagnostic odds ratio was higher. The specificity of OST was higher in osteoporotic and high risk women (71.4% and 75.4%, respectively). In addition, it’s LR was higher. ‍ Considering the area under the curve for ROC in 95% CI, the difference between two methods was not statistically significant; however, SCORE can exclude low risk population with higher sensitivity and NPV, while OST is useful for detecting high risk population with its better specificity and PPV.

Brain death is an irreversible loss of brain and brainstem activities and these patients are the main organ donors. However, in Iran many families refuse to donate brain dead organs. Here, we report causes of brain death and the results of these patient's follow-up in Shahid Beheshti University Organ Procurement Unit (OPU).

This descriptive study was carried out in one of the organ procurement units of Tehran that covers one third of Tehran population in 2009-2010. Suspected brain dead patients were detected and evaluated for the signs of brain death and suitability of the organs. If the patient was a suitable donor, their family was approached by the coordinator and social workers. Upon family consent, the patient was transferred to the OPU ICU of Masih Daneshvari Hospital and the organs were retrieved after confirmation of brain death.

From 467 detected patients, 373 were diagnosed as brain dead. 29 patients (8%) were 15 y old or younger (mean: 10 y) and 344 were older (mean: 47 y). In both age groups car accident was the most common cause of brain death (55% and 33% in younger and older than 15y, respectively). Brain tumor was the second cause in younger and intracranial hemorrhage and CVA were the second and third causes in the other group. 184 patients had suitable organs and 160 families were approached. 117 (73%) of the families refused to donate. 2 patients died before donation and organ donation was carried out in 41 patient (26%). In spite of more suitable organs, family refusal was higher in traumatic patients (74%) compared with other causes of brain death. ‍

This study showed that the most common cause of brain death in both children and adults was trauma. Unfortunately, in spite of more suitable organs in traumatic patients, the rate of family refusal was dramatically high. Thus, improvement of society cultural level about brain death and organ donation is necessary.

Considering the increasing number of musculoskeletal disorders, insufficiency of current assessment tools, and successful reports about SMFA (short musculoskeletal function assessment) questionnaire in evaluating and assessing these disorders, this study was designed.

The original questionnaire was in English. At first, SMFA was translated to Farsi and then back to English. Then the questionnaire was evaluated for validity and reliability, regarding content validity, visual validity and concurrent validity. For concurrent validity, the SF-36 health survey which had been translated to Farsi and had been adapted to Iranian culture was used.

326 patients (56.77% male) with mean age of 51±16 years contributed in this study. The translation to Farsi and back to English was done successfully. The content validity was assessed by 20 orthopedic surgeons and was approved. Simplicity and clearance was evaluated by physicians and patients and was confirmed. Also visual validity was confirmed by the same group. Concurrent validity was 0.91 and in subscales was 0.89-0.93 (p<0.001). ‍

A reliable and valid Farsi version of the SMFA was developed. It will facilitate assessing functional performance within a large patient population and allows cross-cultural comparisons.

Mazandaran province has the highest patient population ratio for thalassemia major in the country (1 to 1000) and 11% of people living in Mazandaran province carry the disease gene. This study was performed to identify the clinical and laboratory status of the thalassemia patients referred to the largest therapeutic center of Mazandaran province. This cross sectional study was performed by reviewing of the patient's documents from May 2007 until May 2009. Demographic and clinical characteristics were extracted and analyzed by SPSS11, using descriptive statistics. From 1010 patient's records, 53% were male. 84.2% of patients had thalassemia major and 15.8% had thalassemia intermedia. Mean age of patients was 23±8 years. 93 patients were married and 60 had children. The average of three last ferritin measurements was 1000-2000 in about 40% of the patients; 22% patients had ferritin level more than 3000. Cardiac MRI T2 was performed in 160 patients and 34% had severe iron storage. 81 patients (8%) had diabetes mellitus and age of diagnosis was 20 ± 7 years. 28 patients were treated for heart failure. Hepatitis C infection occurred in 73 patients. Each month, 23,000 deferoxamine vial and 12,000 deferiprone tablets were used. Thirty patients received free Osveral. ‍ The age distribution of the patients indicates that prenatal screening has been successful. On the other hand, increased life expectancy of patients was due to medical care. Most of the patients are continuing their physical growth. So their need for blood and iron chalator drugs is increasing in following years.