Archives of Iranian Medicine
Volume:15 Issue: 12, Dec 2012

There are different reasons for mergers among higher education institutes. In October 2010 the Iran University of Medical Sciences (IUMS) merged with two other medical universities in Tehran. In this study, we aim to review the literature on academic integrations and university mergers challenges and reasons for the success or failure of university mergers. We searched for studies that pertained to university or college mergers, amalgamation, dissolution, or acquisition in the following DATABASES: PubMed, Emerald, Web of Science, Scopus, and Ovid, without any limitations on country, language, or publication date. Two reviewers selected the search results in a joint meeting. We used content analysis methodology and held three sessions for consensus building on incompatibilities. We reviewed a total of 32 documents. The “merger” phenomenon attracted considerable attention worldwide from the 1970s until the 1990s. The most important reasons for merging were to boost efficiency and effectiveness, deal with organizational fragmentation, broaden student access and implement equity strategies, increase government control on higher education systems, decentralization, and to establish larger organizations. Cultural incompatibility, different academic standards, and geographical distance may prevent a merger. In some countries, geographical distance has caused an increase in existing cultural, social, and academic tensions. The decision and process of a merger is a broad, multi-dimensional change for an academic organization. Managers who are unaware of the fact that mergers are an evolutionary process with different stages may cause challenges and problems during organizational changes. Socio-cultural integration acts as an important stage in the post-merger process. It is possible for newly-formed schools, departments, and research centers to be evaluated as case studies in future research.

Stomach cancer is the most common cancer in Iran. A multi-ethnic population and wide variation in the environmental risk factors may lead to variations in cancer risk within this country. We have designed an ecological study and evaluated geographical variation regarding mortality from stomach cancer and its established risk factors in Iran. We used the Iranian National Causes of Death Registry and estimated the age-standardized mortality rates (ASMR) of stomach cancer in 29 Iranian provinces, stratified by sex and area of residence (rural/urban). The average ASMR of stomach cancer among Iranian males was 15 per 100,000 and for females it was 8.1 per 100,000. The highest and lowest mortality rates were observed in Kurdistan with an ASMR of 29.1 per 100,000 in northwestern Iran and Hormozgan that had an ASMR of 5.0 per 100,000 in southern Iran. Males had approximately a two-fold higher ASMR compared to females, as did rural residents when compared with urban residents. The prevalence of H. pylori infection was about 90% in the province of Ardabil (a high-risk area) and 27% in the province of Sistan-Baluchistan (a low-risk area). The wide geographical variation and high mortality rate of stomach cancer in Iran is likely due to differences in the exposure to the environmental risk factors among people living in the high- and low-risk areas, particularly H. pylori infection, a well-established risk factor of stomach cancer.

Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases encountered in today''s clinic practice. GERD symptoms are troublesome and disruptive to the physical, social and emotional well-being of many patients. This is a cross-sectional study performed on Qashqai nomads of Fars Province in southern Iran to determine the impact of GERD on quality of life. We randomly selected 748 subjects over the age of 25 years. Subjects completed two questionnaires conducted by interviews. The first one consisted of questions on gastroesophageal reflux symptoms. The second questionnaire was the Short Form Health Survey (SF-36), a generic health-related quality of life instrument that consists of 36 items divided into eight dimensions. It has a 0- to 100-point scale where higher scores show better functioning and well-being. Of 748 Qashqai migrating nomads who participated in the study, 717 subjects) mean age: 43 ± 14.2 years) completed the GERD questionnaire and only 371 subjects completed the SF-36 questionnaire due to their busy lifestyles. For all dimensions of SF-36, the mean score was consistently lower in patients with GERD compared to non-GERD subjects (P < 0.001). The dimension most frequently impaired was role-physical (40.9 vs. 77.3) followed by role-emotional (44.7 vs. 77.5), physical functioning (66.9 vs. 84.6), and general health (46.8 vs. 63.8). An association existed between impairment in quality of life and frequency (P < 0.05), but not severity, of GERD symptoms. In this group of Qashqai nomads, all dimensions of health-related quality of life as measured by the SF-36 questionnaire were meaningfully impaired in subjects with symptomatic GERD compared to non-GERD subjects. There was an association between impaired quality of life and frequency, but not severity, of GERD.

Sexual dysfunction (SD) is a common problem among chronic opiate dependents. The purpose of this study is to examine the prevalence of SD and to investigate whether there is a change in SD after six months of methadone maintenance treatment (MMT) compared with baseline. We recruited 30 patients mean age 34.5 years from an MMT center in Damghan, Iran. Patients underwent structured interviews that consisted of the following: (i) socio-demographic characteristics, drug use, and sexual behavior; (ii) the International Index of Erectile Function (IIEF-15) test for SD; (iii) the Zung test for depression; and (iv)analysis of serological status. Overall, 8% of participants reported no SD, 69% reported mild to moderate SD, and 23% reported severe SD upon admission. After completion of the MMT program, these results decreased to 61% and 20%, respectively. In comparison with admission, the mean IIEF-15 score showed moderate improvement from 16.77 ± 7.08 to 21.8 ± 6.40 (P = 0.003). The mean IIEF-15 score for intercourse satisfaction completely improved from12.20 ± 4.55to 15 ± 3.76 (P = 0.001). Slight improvements were noted in the mean IIEF-15 score for sexual desire which increased from 5.10 ± 2.28 to 6.57 ± 2.12 (P = 0.017) and the mean IIEF-15 score for overall satisfaction which increased from 5.10 ± 2.29 to 6.58 ± 2.12 (P = 0.017). However, the mean IIEF-15 score for orgasmic function very slightly decreased from 4.73 ± 4.50 to 4.57 ± 1.92 (P = 0.191), which showed no statistically significant improvement after MMT. There was no relation with depression. The findings of this study reveal a prevalence of SD and improvements in some aspects of SD in patients after six months of MMT. Patients should be screened for SD at the onset of opioid replacement treatment. Future studies on SD should examine the potential benefits of androgen replacement, hormone assay and the role of psychosocial factors.

Waiting time is an important indicator of patient satisfaction and the quality of care. The aim of this study is to determine the waiting time in physician offices in Tehran, Iran. This was a cross-sectional study. The target population of this study consisted of specialist and subspecialist offices in Tehran. We used a census sampling method to study the population. Data of 5475 physicians was extracted from data banks, of which 43.4% were not accessible. Thus 3098 cases were included and analyzed. We conducted telephone interviews to gather data, which was subsequently analyzed using SPSS software. Out of the 3098 physicians interviewed, 2585 were specialists (83.4%); the remaining were subspecialists. The mean waiting time for a patient''s first visit to a specialist was 4.30 days (SD = 8.10) and for subspecialists it was 7.61 days (SD = 13.98). The average waiting time in our study was less than a week for specialists and almost a week for subspecialists. The health system in Iran has not established a complete referral system and with this situation, waiting time may have adverse effects on the health of patients. Thus studying and managing waiting time in some medical specialties or regions is a priority in our country.

Laboratory turnaround time (TAT) is an important determinant of patient stay and quality of care. Our objective is to evaluate laboratory TAT in our emergency department (ED) and to generate a simple model for identifying the primary causes for delay. We measured TATs of hemoglobin, potassium, and prothrombin time tests requested in the ED of a tertiary-care, metropolitan hospital during a consecutive one-week period. The time of different steps (physician order, nurse registration, blood-draw, specimen dispatch from the ED, specimen arrival at the laboratory, and result availability) in the test turnaround process were recorded and the intervals between these steps (order processing, specimen collection, ED waiting, transit, and within-laboratory time) and total TAT were calculated. Median TATs for hemoglobin and potassium were compared with those of the 1990 Q-Probes Study (25 min for hemoglobin and 36 min for potassium) and its recommended goals (45 min for 90% of tests). Intervals were compared according to the proportion of TAT they comprised. Median TATs (170 min for 132 hemoglobin tests, 225 min for 172 potassium tests, and 195.5 min for 128 prothrombin tests) were drastically longer than Q-Probes reported and recommended TATs. The longest intervals were ED waiting time and order processing. Laboratory TAT varies among institutions, and data are sparse in developing countries. In our ED, actions to reduce ED waiting time and order processing are top priorities. We recommend utilization of this model by other institutions in settings with limited resources to identify their own priorities for reducing laboratory TAT.

Annually, around six million patients are admitted to hospitals in Iran. Information about the prevalence of nosocomial infections (NIs) is necessary for both appropriate management and establishment of preventative measures in hospitals. This article is based on the findings of the Nosocomial Infection Surveillance System (NISS) which has been providing information on NIs in Iran since March 2007. NISS covers 95 hospitals throughout Iran, each with over 200 beds. There are four main infections: urinary tract infection (UTI), surgical site infection (SSI), bloodstream infection (BSI) and pneumonia (PNEU) included in NISS. Reports are completed on forms that have been provided based on national guidelines. In all selected hospitals there is one designated nurse who conducts infection control activities and is trained in the detection and reporting of NIs based on NISS guidelines. During March 2007 – March 2008, a total of 1,879,356 patients were admitted to the selected hospitals. The total detected NIs were 10557 with a prevalence of 0.57%. Of these, UTI was the most prevalent infection (32.2%) and BSI was the least (16.3%). Based on gender, females had more UTI, whereas PNEU was the highest in males. Of reported NIs, 9% were detected in children less than five years of age and included BSI (45%), PNEU (20%), SSI (19%) and UTI (16%). There were 26% reported NIs in the age group over 65 years, of which the most prevalent infections were UTI (42%) followed by PNEU (31%), SSI (15%) and BSI (12%). NIs were most often detected in intensive care units (ICUs; 26.7%), followed by surgery wards (12.8%). In comparison with other studies and the World Health Organization (WHO) estimates, the rate of NIs appears to be less according to NISS. NISS has the capability to provide basic information for efficient management and control measures, in addition to indicating variations in NIs based on gender, age and location (hospital ward). In order to have a more realistic estimate of NIs and strengthen NISS, it is advisable to conduct a point prevalence study.

Unprotected sexual activity is an important reason for the currently growing incidence of HIV infection in Iran. Recognizing barriers to safe sexual practice and affordance of behavioral changes can improve planning for condom promotion. The main objective of our study is to evaluate the opinions of HIV-positive men on condom use. Our study was performed at three behavioral disease consultation clinics (HIV care clinics) in Tehran, Iran. Participants were initially selected among HIV-positive male patients by convenience sampling and narrowed-down by maximum diversity sampling in order to obtain the number of patients that would express various viewpoints regarding barriers and benefits to condom use. Data were collected using in-depth semi-structured individual interviews. All interviews were recorded and transcribed, and the codes were extracted after reviewing them several times. In this study, 22 HIV-positive men with a mean age of 37.5 ± 7.3 years were interviewed. Participants mentioned the prevention of HIV and sexually transmitted diseases as a benefit of condom use. However, most named decreased sexual satisfaction as the most important reason for not using condom. Because of decreased sexual satisfaction and unpleasantness, 9% of participants had not used condom during sexual intercourse.The most important reason for not using condom was decreased sexual satisfaction. This study has indicated a need for consultations with HIV-positive and at risk populations to change their attitudes towards condom use and demonstrate the advantages of condom. To achieve this, government programs and media should be utilized.

Liver transplantation (LTx) is the treatment of choice for patients with end-stage liver disease (ESLD). Improvement in outcomes (allograft and patient survival) has led to widespread use of LTx worldwide. However, new problems that include severe organ shortage, recurrence of primary disease, opportunistic infections, and development of de novo malignancies are the major problems affecting further implementation of LTx.

Osteoid osteoma is a benign، bone-forming tumor that rarely involves the carpal bones. We report a case of osteoid osteoma of the trapezoid carpal bone with extension to the adjacent second metacarpal bone. Chronic wrist pain and local tenderness were the major clinical signs and symptoms. In chronic wrist pain osteoid osteoma and the possibility of extension to the adjacent bones should be considered.

Chorea-acanthocythosis (ChAc) is an inherited neurodegenerative disorder characterized by movement disorders, neuropsychiatric disturbances, neuropathy, myopathy, seizures and acanthocytosis accompanied by an elevated serum creatine kinase (CK) level. Its causative gene (VPS13A) produces chorein which is absent in ChAc patients as evaluated by Western blot assay. We report the first three Iranian patients whose disease has been confirmed by chorein Western blot. Our cases presented with heterogeneous courses of ChAc. A high sense of clinical awareness in approaching patients with deteriorating and/or multiple abnormal movements that are accompanied by other neurological signs such as neuropathy, myopathy, seizures and high serum CK level will support an early diagnosis of this disease. We also emphasize on the presence of axial flexion/extension spasms as a good clinical sign for narrowing differential diagnosis.

Avicenna, a renowned Persian Muslim scientist has written numerous scientific papers and valuable medical books that are respected worldwide. For centuries his masterpiece, the «Canon of Medicine», has been used as a major medical reference. The Canon, as a prime encyclopedia on medicine is comprised of five books. In the introduction to the Canon, Avicenna has described the purpose of medicine as the preservation of health if it is already attained and its restoration when it is lost. He defines health as a trait or state, which results in the normal functioning of the human body and presumes that health is a steady state, whilst disease is more of a variable concept. Thus whenever we depart from a healthy state, we approach disease. A comparison of current views regarding definitions of health, disease and their components as defined by Avicenna could open new horizons for ancient, traditional medicine. The Canon contains numerous implications concerning the infrastructures of public health-related issues. For example the specifications of healthy water and air are well described in the «Canon of Medicine». To enable a better understanding of Avicenna''s viewpoints about public health, we have briefly reviewed his perspective on the topics of health, disease, and environmental sanitation concerning water and air.