2023 Impact Factor: 1.3
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pISSN: 2251-6085
eISSN: 2251-6093
Chairman & Editor-in-Chief:
Dariush D. Farhud, MD, Ph.D., MG.
This journal is a member of, and subscribes to the principles of, the Committee on Publication Ethics (COPE). 
Vol 43 No 12 (2014)
Articles
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In recent years, medical and health care consumption has risen, making health risk an important determinant of household spending and welfare. We aimed to examine the determinants of medical and health care expenditure to help policy-makers in the improvement of China's health care system, benefiting the country, society and every household. This paper employs panel data from China's provinces from 2001 to 2011 with all possible economic variations and studies the determinants of medical and healthcare expenditure for urban residents. CPI (consumer price index) of medical services and the resident consumption level of urban residents have positive influence on medical and health care expenditures for urban residents, while the local medical budget, the number of health institutions, the incidence of infectious diseases, the year-end population and the savings of urban residents will not have effect on medical and health care expenditure for urban residents. This paper proposed three relevant policy suggestions for Chinese governments based on the findings of the research.
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Noise-induced hearing loss, which is one of the 10 leading occupational diseases, is a debilitating and irreversible disease. During the recent 15-years period (1997-2012), several studies have investigated the association between noise, hearing damage and other side effects of noise in Iran. The aim of this study was to review systematically the relevant literature related to noise-induced hearing loss, lead to developing noise exposure limits. In this systematic review, two researchers independently extracted the data from 31 past studies that had considered noise-induced hearing loss (including hearing loss, temporary and permanent hearing threshold shift and auditory trauma). The data were then recorded in a modified form and Statistical analyses were performed using SPSS, version 16.0. In analyzed studies the weighted average equivalent sound pressure level [L Aeq ] was 90.29 dB(A) and average hearing loss was 26.44 dB(A). The Highest degree of hearing loss in the right ear was associated at 4000 Hz, and the highest degree of hearing loss in the left ear was associated to 1000 and 4000 Hz. The majority of the reviewed studies have confirmed that exposure to a noise level above 85 dB (A) can lead to an increased chance of hearing loss. Furthermore, the results of the present review indicated that as L Aeq increased up to 85 dB(A), so did the severity of the hearing loss.
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Leviteracetam (LEV) is a novel antiepileptic drug with improved tolerance and safety, while carbamazepine (CBZ) represents classical antiepileptic drugs. So far, a systemic comparison of the efficacy and side effects of these two drugs is lacking. A literature review on the comparison of leviteracetam versus carbamazepine for patients with epilepsy was performed up to September 2013 using PubMed, EMBASE, the Cochrane Library and ISI web of science. Finally, 3 randomized controlled trials (RCT) studies met the criteria on comparing the efficacy of leviteracetam versus carbamazepine for patients with epilepsy were included for meta-analysis. Stata 11.0 was used to analyze and summarize the respective data. Three RCTs met the entry criteria. The relative risk (RR) and 95% and the confidence interval (CI) of leviteracetam versus carbamazepine for 6- and 12-month seizure free intervals were 1.0 (0.91-1.10) and 0.97 (0.84-1.13), respectively, for therapy discontinuation due to adverse events (AEs) were 0.62 (0.48-0.80) and 1.00 (0.94-2.05), respectively, and for withdrawal after 6- and 12-month treatment were 0.8 (0.64-0.99) and 0.87 (0.74-1.03), respectively. The RR and 95% CI for occurrence of headache, fatigue, diarrhea, vertigo, nasopharyngitis, depression, weight gain and rash were 0.88 (0.73-1.06), 1.08(0.63-1.83), 1.23 (0.66-2.28), 0.92 (0.49-1.71), 0.85 (0.59-1.22), 2.15 (1.26-3.68), 0.69 (0.45-1.04), 0.39 (0.23-0.68), respectively. The major outcomes such as rate of seizure freedom were similar between leviteracetam and carbamazepine. However, leviteracetam led to depression more frequently than carbamazepine, while carbamazepine caused rash more frequently. However, the limited numbers of available RCTs studies and included patients in this study made our results less convincing and accurate.
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The intensity of the conflict such as war is one of the determinants of the flow of migrants and refuges with consequence of introducing infectious disease to other countries. This paper investigates the relationship between malaria incidence and forced immigration due to war from neighboring countries in Dezful district, southwestern Iran. All available data and accessible archived documentary records on malaria cases in the period 1988-2011 in Dezful Health Centers were reviewed. Retrospective analysis of routine surveillance data from the Health authority of Dezful district was conducted to assess the trend of malaria incidence and prevalence in the last two decades. Malaria transmission dynamics was described using surveillance indicators viz, Annual Parasite Incidence (API), Slide Positivity Rate (SPR), Annual Blood Examination Rate (ABER) and based on personal information of patients. Two peaks of malaria incidence occurred during past two decades. The first one arisen by Iran-Iraq war due to residential instability in Dezful while the API reached to 8 per 1000. The second peak happened after to civil war of Afghanistan began which caused large immigrates moved into the study area. During the second peak, API reached 1.7 per 1000 at maximum and the majority of patients were immigrants. This study describes the linkage between incidence and prevalence of malaria and immigration due to civil conflict. Therefore, malaria screening of immigrants and early warning programme are effective to prevent outbreak of disease in a potential risk area such Dezful.
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Hypothermia generates potentially severe complications in operating or recovery room. Forced air warmer is effective to maintain body temperature. Extremely low frequency electromagnetic field (ELF-EMF) is harmful to human body and mainly produced by electronic equipment including convective air warming system. We investigated ELF-EMF from convective air warming device on various temperature selection and distance for guideline to protect medical personnel and patients.The intensity of ELF-EMF was measured as two-second interval for five minutes on various distance (0.1, 0.2, 0.3, 0.5 and 1meter) and temperature selection (high, medium, low and ambient). All of electrical devices were off including lamp, computer and air conditioner. Groups were compared using one-way ANOVA. P<0.05 was considered significant.Mean values of ELF-EMF on the distance of 30 cm were 18.63, 18.44, 18.23 and 17.92 milligauss (mG) respectively (high, medium, low and ambient temperature set). ELF-EMF of high temperature set was higher than data of medium, low and ambient set in all the distances.ELF-EMF from convective air warming system is higher in condition of more close location and higher temperature. ELF-EMF within thirty centimeters exceeds 2mG recommended by Swedish TCO guideline.
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Liberalization and decentralization of public sector has been triggered in some developing countries and in Iran by the Ministry of Health and Medical Education (MOHME) that granted autonomy to 54 public hospitals. However, establishment of such a complex organizational reform was rather unsuccessful. We aimed to explore the obstacles and barriers caused such a failure and their mechanisms.Using a qualitative approach in 2013, we consulted key informants at the autonomous hospitals and their affiliating universities. Data collection was done within two phases: (i) 276 unstructured questionnaires asking respondents of barriers, and (ii) 23 semi-structured interviews from the first phase's key respondents. The first phase data were analyzed using thematic analysis and the second's by framework approach based on the frame shaped at the first phase.Nine obstacles were recognized including "autonomous hospitals' board composition", "delay in announcing autonomous hospitals' charges by the MOHME", "lack of financing by the committed organizations", "poor follow up for implementation of the reform", "irregular board meetings", "lack of an external overseer", "shortage of full-time physicians", "lack of management stability", and "health insurance organizations' delayed payments".The MOHME and insurance organizations did not pay the reform expenses. There were some competing motives as well to slow the reform or to shut it down. The stages of policy formulation and implementation were done separately in Iran, so this big organizational reform encountered serious obstacles.
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Vitamin D deficiency is prevalent in diabetes type 2 and this vitamin may be related to insulin action. This randomized controlled trial study was done to evaluate the effect of vitamin D supplementation on glucose control and insulin resistance in patients with diabetes type 2.Participants of this randomized clinical trial study consisted of 28 patients with type 2 diabetes who received 100 microgram (4000 IU) vitamin D and 30 diabetic patients who received placebo for 2 months between September 2012 and February 2013. The effect of vitamin D on glucose control was assessed by measuring HbA1c and insulin resistance as HOMA-IR at the baseline and the end of the intervention.The results showed a significant decrease in HbA1c (from 7.29 ± 0.22 % to 6.76 ± 0.18 %, P<0.001) and insulin concentration (from 8.24 ± 0.97 μIU/mL to 6.55 ± 0.28 μIU/mL, P=0.048), but a non-significant decrease in HOMA-IR in vitamin D group. Also, HDL-C level increased significantly in both of vitamin D (P=0.046) and placebo groups (P=0.028).It seems that vitamin D supplementation has beneficial effects on glucose homeostasis and can increases insulin sensitivity in diabetic 2 patients.
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Shigella species are among the common causes of bacterial diarrhoeal diseases. Traditional detection methods are time-consuming resulting in delay in treatment and control of Shigella infections thus there is a need to develop molecular methods for rapid and simultaneous detection of Shigella spp. In this study a rapid multiplex PCR were developed for simultaneous detection of three pathogenic Shigella species.For detection of Shigella spp., a pair of primers was used to replicate a chromosomal sequence. Three other sets of primers were also designed to amplify the target genes of three most common species of Shigella in Iran including S. sonnei, S. flexneri and S. boydii. The multiplex PCR assay was optimized for simultaneous detection and differentiation of three pathogenic Shigella species. The assay specificity was investigated by testing different strains of Shigella and other additional strains belonging to non Shigella species, but responsible for foodborne diseases.The Shigella genus specific PCR yielded the expected DNA band of 159 bp in all tested strains belonging to four Shigella species. The standard and multiplex PCR assays also produced the expected fragments of 248 bp, 503 bp, and 314 bp, for S. boydii, S. sonnei and S. flexneri, respectively. Each species-specific primer pair did not show any cross-reactivity.Both standard and multiplex PCR protocols had a good specificity. They can provide a valuable tool for the rapid and simultaneous detection and differentiation of three most prevalent Shigella species in Iran.
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Fluoride is an essential element for human health. However, excess fluoride in drinking water may cause dental and/or skeletal fluorosis. Drinking water is the main route of fluoride intake. The aim of the present study was to measure fluoride levels in human breast milk collected from two regions of Golestan Province, northern Iran with different amount of fluoride concentration of drinking water in Bandar Gaz and Nokande cities and to correlate it with fluoride concentrations in drinking water used by mothers living in these two areas.Twenty samples of water were collected from seven drinking water wells during 2012 from Bandar Gaz and Nokande in Iran during 2012. Fluoride concentration of water samples was measured using SPADNS method. Sixty breast milk samples were collected from lactating mothers of Bandar Gaz and Nokande cities. Content in breast milk was determined using standard F ion-selective electrode. Spearman's rho correlation analysis was used to assess any possible relationship between fluoride levels in breast milk and in drinking water.The means and standard deviation for F concentration in breast milk and drinking water were 0.002188±0.00026224 ppm and 0.5850±0.22542 ppm, respectively. Analysis of data showed that the variables were not normally distributed so the Spearman correlation coefficient between two variables calculated (ρ S = 0.65) and it was significant (P=0.002).Fluoride concentration in water can directly act on its concentration in breast milk. We speculate that modifying F concentration in water can affect accessibility of fluoride for infants.
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A surveillance system helps to detect epidemics and the pattern of the incidence of the problems in the community and is important for evidence based decision making. This study was conducted to determine the feasibility of the Pregnancy Risk Assessment Monitoring System (PRAMS) in Iran.PRAMS feasibility was assessed in a cross-sectional study in the city of Shahriar, located in the west of Tehran in 2013. In this study, 811 women within 2 to 6 months postpartum who had a live or still birth were selected from thyroid screening forms and hospital records through a systematic simple random sampling method. Trained interviewers collected the data via calling mothers from health centers or through home visits. The outcome was tested on the "TELOS" model including technical, economic, legal, operational and schedule feasibility components.Thirty-seven health volunteers collected the data in this study. Many prevalence estimates were comparable with national and Tehran data (technical feasibility). A home based completed questionnaire cost 2.45 and a phone cost 1.89 USD (economic feasibility). The project was consistent with legal requirements (legal feasibility). The participation rate was 92.8% (95%CI: 92.7-95.3) for home visits and 90.9% (95% CI: 87.3-93.6) for the phonemethod. Over 80% of different sections of the questionnaire were completed (operational feasibility). All data collection processes took 35 days (schedule feasibility).The adapted PRAMS could be considered feasible in Iran. Its widespread and periodic implementation can provide valuable maternal and child health information in the country.
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Amelogenesis Imperfecta (AI) is a disorder of tooth development where there is an abnormal formation of enamel or the external layer of teeth. The aim of this study was to screen mutations in the four most important candidate genes, ENAM, KLK4, MMP20 and FAM83H responsible for amelogenesis imperfect.Geneomic DNA was isolated from five Iranian families with 22 members affected with enamel malformations. The PCR amplifications were typically carried out for amplification the coding regions for AI patients and unaffected family members. The PCR products were subjected to direct sequencing. The pedigree analysis was performed using Cyrillic software.One family had four affected members with autosomal dominant hypocalcified amelogenesis imperfecta (ADHPCAI); pedigree analysis revealed four consanguineous families with 18 patients with autosomal recessive hypoplastic amelogenesis imperfecta (ARHPAI). One non-synonymous single-nucleotide substitution, c.1150T>A, p. Ser 342Thr was identified in the FAM83H, which resulted in ADHCAI. Furthermore, different polymorphisms or unclassified variants were detected in MMP20, ENAM and KLK4.Our results are consistent with other studies and provide further evidence for pathogenic mutations of FAM83H gene. These findings suggest different loci and genes could be implicated in the pathogenesis of AI.
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Use of herbal extracts and essences as natural antibacterial compounds has become increasingly popular for the control of oral infectious diseases. Therefore, finding natural antimicrobial products with the lowest side effects seems necessary. The present study sought to assess the effect of Punica granatum L. water extract on five oral bacteria and bacterial biofilm formation on orthodontic wire.Antibacterial property of P. granatum L. water extract was primarily evaluated in brain heart infusion agar medium using well-plate method. The minimum inhibitory concentration and minimum bactericidal concentration were determined by macro-dilution method. The inhibitory effect on orthodontic wire bacterial biofilm formation was evaluated using viable cell count in biofilm medium. At the final phase, samples were fixed and analyzed by Scanning Electron Microscopy.The growth inhibition zone diameter was proportional to the extract concentration. The water extract demonstrated the maximum antibacterial effect on Streptococcus sanguinis ATCC 10556 with a minimum inhibitory concentration of 6.25 mg/ml and maximum bactericidal effect on S. sanguinis ATCC 10556 and S. sobrinus ATCC 27607 with minimum bactericidal concentration of 25 mg/ml. The water extract decreased bacterial biofilm formation by S. sanguinis, S. sobrinus, S. salivarius, S. mutans ATCC 35608 and E. faecalis CIP 55142 by 93.7-100%, 40.6-99.9%, 85.2-86.5%, 66.4-84.4% and 35.5-56.3% respectively.Punica granatum L. water extract had significant antibacterial properties against 5 oral bacteria and prevented orthodontic wire bacterial biofilm formation. However, further investigations are required to generalize these results to the clinical setting.
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In the Republic of Kazakhstan, the State screening program for early detection of Arterial Hypertension (AH) and other cardiovascular diseases (CVD) for the target age groups was established in 2008.The results of cross-sectional survey conducted at 8 primary health care facilities of Almaty city and Almaty region of Kazakhstan from September 2012 until May 2013 was used. A multistage sampling approach was used to select patients with diagnosed arterial hypertension between 18 to 64 years of age residing in a city (n=405, 50.6%) or village (n=395, 49.4%). Data collection was done via face-to-face interviews using a semi-structured questionnaire.Rural residents (62.7%) mainly were "no-screened". These patients get treatment in policlinics only in case of serious health problems. At younger ages of 18 and 39 years, AH is diagnosed less often among rural than among urban residents (P<0.05). In addition, 71% of the rural residents have incomes below the national average, which has a significant impact on their ability to purchase quality medicines and food and to engage in sports; 16.3% of the rural respondents do not follow doctor's prescriptions due to the lack of money to buy medications.The screening for AH and the dissemination of information about screening in rural areas needs a lot of improvement, and that it is necessary to reconsider and improve the public policy for the distribution of free medications.
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We report an unusual case of hemimegalencephaly (HMG) associated with ipsilateral congenital-infiltrating lipomatosis of the face in a five-month-old boy. Hemimegalencephaly is a rare but unique malformation characterized by enlargement of all or parts of a cerebral hemisphere. The affected hemisphere may have focal or diffuse neuronal migration defects, with areas of polymicrogyria, pachygyria and heterotopia. Our aim was to investigate morphologic abnormalities occurring on the affected hemisphere by Magnetic Resonance Imaging (MRI), but some MRI findings were also noted outside of the affected hemicerebrum. There are a few case reports that have described various other abnormalities accompanying this condition, such as enlargement of ipsilateral brainstem, cerebellum and left lateral ventricle. MRI may be the most useful method demonstrating features of hemimegalencephaly with infiltrating lipomatosis of the face. However, studies using electroencephalogram (EEG) and brain single photon emission computerized tomography (SPECT) can show distinct variants of discharges and brain-perfusion anomalies.
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Mutations in the GJB2 gene are the most common known cause of hereditary congenital hearing loss. Rapid genomic DNA extraction (RGDE) method was used for genomic DNA extraction. After amplification of coding region of CX26 gene with specific primers, expected PCR products with 724bp length were subjected to direct sequencing in both directions. We describe here a novel heterozygous -T to -C transition at codon 202 (TGC→CGC) of the GJB2 gene in a patient, 40-year-old Iranian woman, which replaces a cysteine with an arginine residue (C202R). The dominant mutation C202R associated with non-syndromic sensorineural hearing loss. This mutation has not previously been described in affected or control samples from other populations investigated for GJB2 mutations, indicating that it is a rare substitution. This dominant mutation was recorded in NCBI GenBank with accession number KF 638275.
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