Medical Journal Of the Islamic Republic of Iran
Volume:25 Issue: 1, Spring 2011

This debate article highlights the challenges of health situation in Iran and some influencing or relevant factors such as health sector, welfare system and social protection, social exclusion and civil society from the viewpoint of an international partner. Some advanced experiences in Iranian health system and the manner of system for international cooperation have also been discussed.

The most important and complex phenomenon of respiratory function of the nose is related to different nasal anatomy. The differences in facial anatomic structure between different races may also be reflected in nasal resistance and airflow. Caucasians has different facial anatomic structure which is the reflection of intranasal resistance or consequence of airflow. The active anterior rhinomanometric (AAR) is recommended for objective assessment of nasal airway resistance (NAR) in inspiration and expiration which can be calculated via nasal airflow. This study designed to evaluate the resistance of the nasal airway in Iranian samples and comparing with the standard methods. An epidemiologic case series cross sectional study was designed for 100 Iranian adult volunteer without nasal breathing problems and with AAR inclusion criteria. All subjects had to undergo a primary assessment of relevant symptoms of nasal disease and nasal examination before undergoing AAR assessment. The mean values of total nasal airway resistance sere 0/38±0/17 pa/cm2/s in inspiration and 0/41±0/27 pa/cm2/s in expiration at 150 pas pressure point. Unilateral nasal resistance in right and left in inspiration were respectively 0.88±0.69pa/cm2/s and 0.90±0.57at 150 pa/cm2/s pas pressure point. Also unilateral nasal resistance in right and left in expiration were respectively 0.95±0.72 pa/cm2/s and 0.95±0.57 pa/cm2/s at 150 pas pressure point. The study concluded that nasal airway resistance had the same range as the standard in different races and also no correlation exist between nasal resistance and sex, age, height, weight and smoking. Our suggestion is more epidemiologic studies if there are any queries in Iranian's airway resistance in larger sample size and wider areas.

The aim of study was to compare the effect of Kangaroo mother care (KMC) and conventional methods of care (CMC) in low birth weight babies less than 2000 grams. One hundred babies with birth weight less than 2000 grams and without clinical problem were randomized in two groups; the intervention group (N=50) who received Kangaroo mother care and the control group (N=50) with conventional care. Two groups were compared in daily weight gaining, self confidence of mother, duration of hospitalization, clinical cyanosis and nosocomial infection. Collected data was analyzed by SPSS 11.5 software. Irct ID: IRCT201101091162N16. The KMC babies had better daily weight gaining average [18.31±7.57gm vs. 4.8±16.57gm (P< 0.001)] CMC: and also, self confidence of mother in KMC group was significantly higher than CMC group (p<0.001). A significantly longer duration of hospitalization observed in CMC group [27.18±12.07 day vs. 16.24±10.04 day (P<0.001)]. There was no significant difference between the two groups for clinical cyanosis and nosocomial infection (both P>0.05). In this study Kangaroo mother care had better effect on daily weight gaining, mother

Lead toxicity is caused by ingestion, inhalation, or contact with particles or vapors containing lead. It can present with nonspecific signs and symptoms such as abdominal pain, constipation, irritability, difficulty concentrating, and anemia. In this study, we have tried to find a relationship between lead poisoning and drug abuse. In a cross sectional study, drug addicts presenting with abdominal pain referring to GI center of Imam Khomeini hospital in 2008 were observed. Patients having occupational contact with lead were excluded from the study. Required data included age, sex, clinical findings, Para clinic results and blood lead level. Results were analyzed through SPSS-15 software. 42 patients (all male) with average age of 46.9 ± 10.1 years were included in the study. Average blood lead level was 51.17±27.96µg/dl. 22 patients (52.6%) had lead toxicity. A significant relation was found between lead toxicity and mode of opium drug use; however relation between lead toxicity and duration of addiction was not significant. Similarly, a meaningful relation was found between lead toxicity and abnormal liver function test, urine tests, ECG, presence of basophilic stippling and hyperuricemia. There seems to be a significant relation between opium drug abuse and lead toxicity. Further

Fractures of the tibia are important for their commonness and controversy in their management. Both conservative and surgical techniques have been introduced in an effort to speed time to union while minimizing the occurrence of complications. Standard treatment for low-energy tibial shaft fractures includes closed reduction and cast immobilization. The purpose of our study was to analyze retention of reduction after cast immobilization of simple isolated closed tibial fractures. All cases of the diagnosed isolated closed tibial shaft fracture treated non-surgically at Shafa Yahyaeian Hospital, between 2006 and 2009 were retrieved from medical records. We reviewed all medical records and radiographs of these patients to inquire about the patients’ demographic data used to analyze the outcomes of the non-surgical treatment. Of the 26 patients examined, males were more commonly affected. The mean age was 27.46 (SD=7.58). The most common causes of injury were direct blow and motorcycle to pedestrian accident. Followup duration for each patient had an average of 9.12 months (SD=2.36). Using AO/OTA classification, distributed as 38.5% A1.1, 26.9% A2.1 and 34.6% A3.1 fractures. Most fractures were sustained in the lower third of the tibia (53.85%). All fractures eventually healed in an average of 13.7 weeks (SD=3.24). There was one case of delayed union in the 22nd week. In 92.3% of patients, shortening of bone was less than 1 cm, while in 7.7% patients, was more than 1.5 cm. We observed an anterior or posterior angulation > 10 ° in 2 (7.69%) patients. Moreover, in 4 (15.38%) patients we found varus angulation > 5°. Therefore, final deformity was observed in 8 (30.77%) patients. No patient had non-union, rotational malalignment of more than 10 degrees, an infection, or a compartment syndrome. Our non-surgical treatment’s outcomes were not satisfactory, despite applying all principles for conservative treatment and selecting patients satisfying restricted criteria. Moreover, considering long-term physical disability with longer follow-up period, it seems that there still is a controversy in the treatment selection even for the simple tibial fractures.

Low Back Pain (LBP) is still a medical problem in 21 st century. Having back pain and being disabled by it are not the same thing. It is common to come across with patients who have simple back pain but surprisingly totally disabled and vice versa. In clinical practice, it is important to have a proper evaluation of disability and making a clear distinction between pain and disability. During the past two decades several selfreport measures and questionnaires have been developed to evaluate disability in LBP patients, however most of these questionnaire were designed in English language and based on European or American studies. The aim of this study was to develop and validate a translated and culturally adapt “Pain Disability Index (PDI)” and “Pain Disability Questionnaire (PDQ)” among Iranian patients with low back pain. The Persian versions of the PDI, PDQ were created through systematic translation and crosscultural adaptation of the original questionnaires. The Oswestry Disability Index and Visual Analogue Scale were used for validation studies. Patients were asked to complete these questionnaires initially and also at 7 days later as retest. A total of 304 patients with acute and chronic LBP completed the Persian versions of PDI, PDQ, “Oswestry Disability Index” (ODI) and “Visual Analogue Scale” (VAS). Among patients 111 patients participated for retest after seven days. The Cronbach’s alpha (coefficient of reliability) for the PDI and PDQ was satisfactory. The PDI and PDQ showed high and very high test-retest reliability (ICC=0.8 and 0.92 respectively). The Pearson correlation coefficient among PDI, PDQ with ODI was 0.64 and 0.72, and for PDI, PDQ, ODI with VAS was 0.36, 0.47 and 0.57, respectively (P<0.001). The Persian version of the PDI and PDQ questionnaires are reliable and valid instruments to evaluate generic perceived disability in Persian-speaking patients with LBP. It is shown that PDI and PDQ are capable of measuring the disability in LBP patients. They could be used in clinical and research encounters with acceptable confidence.

Leukemia is one of the mostcommon cancers in children, comprising more than a third of all childhood cancers. Newly affected patients in USA are estimated as 10100cases, and if these cases are diagnosed late or proper treatment is not applied, then it can be mortal. Because rapid and proper diagnosis of leukemia based on clinical or medicinal findings (without biopsy) is impossible, we decided to apply artificial neural network for rapid leukemia diagnosis. For this aim we used clinical and medical parameters taken from 131 patients of Sina hospital of Hamadan. We carried out independent sample T-test with SPSS software for 38 parameters. With regard to the results of this analysis we selected 8 parameters that had lowest sig for ANN analysis (among parameters, whose sig were less than 0.05). Selected parameters of 131 patients were applied for training network with Levenberg-Marquardt learning algorithm, with learning rate of 0.1. Performance of learning was 0.094. The Relationship between the output of trained network for test data and real results of test data was high and the area under ROC curve was 0.967. With these results we can conclude that training process was done successfully and accurately. Therefore we can use artificial neural network for rapid and reliable leukemia recognition.

Although, different studies on end-to-side nerve repair, results are controversial. The importance of this method in case is unavailability of proximal nerve. In this method, donor nerves also remain intact and without injury. In compare to other classic procedures, end-to-side repair is not much time consuming and needs less dissection. Overall, the previous studies in this field have just evaluated nerve recovery by non functional or functional parameters. As it has proven, the results of functional and non functional studies are not always matched. Therefore, this study was designed to evaluate this method by functional (Sciatic function index) and non functional parameters (histochemical study). In this experimental study, forty adult male Wistar rats (200-250g) were used their left proneal nerve was cut and divided into four groups: 1- control group (n=10). In this group, nerve was exposed and cut and implanted onto adductor muscles, 2- end-to-end anastomosis (n=10). In this group, peroneal nerve cut and two segments were anastomosed end-to-end, 3- end-to-side anastomosis with window (n=10). In this group, peroneal nerve was cut and anastomosed with window to tibial nerve, 4- end-to-side anastomosis without window (n=10). In this group, peroneal nerve was cut and anastomosed without window to tibial nerve. After 1, 8 and 16 weeks, functional (Sciatic function index) and after 16 weeks non functional studies (histochemical study) were performed and the results compared. All experimental groups (group 2, 3, 4) motor recovery at 8th, 16 th week were not statistically different (p>0.05). In histological study axons count in end -to-side with window anastomosis were higher than other experimental groups (p<0.05). According to our findings, the authors believe that end to side neuroraphy leads to axon growth and comparable functional recovery with end to end neuroraphy in rat model. Due to the fact that the diameter of nerves and muscles which might be neurotised in human are much bigger and not comparable with rat, it is suggested to set up some set of experiments on the bigger size animals such as primates in further studies for generalization of results to human being.

Mammary tissue, skeletal muscle, and spleen are less frequently affected by mycobacterium tuberculosis (TB). The most common age for breast TB is between 50 and 70. On this article, we are reporting a 72-year-old woman who presented with chronic cough, lobar consolidation in right middle lobe (RML) on the CXR, and a mass in her right breast revealed on the physical examination. Biopsy from the breast lesion showed granulomatous changes and acid fast bacilli were detected by bronchoalveolar lavage. Treatment for TB was begun and the patient showed significant improvement.Based on the patient’s age, breast carcinoma was suspected first. Sinus formation was found on her breast ultrasound.This is a common finding and not diagnostic for TB. Our report is a reminder that although breast masses in older women tend to be more malignant, tuberculosis should be considered in differential diagnosis, especially in postmenopausal women. Moreover, breast TB can present with insidious growth without any symptoms.