Vol 45 No 3 (2016)

Review Article(s)

  • XML | PDF | downloads: 116 | views: 444 | pages: 278-288

    Background: Physician dual practice is a common phenomenon in almost all countries throughout the world, which could potential impacts on access, equity and quality of services. This paper aims to review studies in physician dual practice and categorize them in order to their main objectives and purposes.

    Methods: Comprehensive literature searches were undertaken in order to obtain main papers and documents in the field of physician dual practice. Systematic searches in Medline and Embase from 1960 to 2013, and general searches in some popular search engines were carried out in this way. After that, descriptive mapping review methods were utilized to categorize eligible studies in this area.

    Results: The searches obtained 404 titles, of which 81 full texts were assessed. Finally, 24 studies were eligible for inclusion in our review. These studies were categorized into four groups - "motivation and forces behind dual practice", "consequences of dual practice", "dual practice Policies and their impacts", and "other studies" - based on their main objectives. Our findings showed a dearth of scientifically reliable literature in some areas of dual practice, like the prevalence of the phenomenon, the real consequences of it, and the impacts of the implemented policy measures.

    Conclusion: Rigorous empirical and evaluative studies should be designed to detect the real consequences of DP and assess the effects of interventions and regulations, which governments have implemented in this field.



Original Article(s)

  • XML | PDF | downloads: 76 | views: 378 | pages: 289-296

    Background: To analyse time trends in self-rated health in older people by gender and age and examine disability in the time trends of self-rated health.

    Methods: The data used come from the Spanish National Health Surveys conducted in 2001, 2003, 2006 and 2011-12. Samples of adults aged 16 yr and older were selected. Multivariate logistic regression was used to assess the association between age, gender, socio-economic status, marital status, disability and self-rated health across period study.

    Results: Women exhibited lower (higher) prevalence of good self-rated health (disability) compared to men. The multivariate analysis for time trends found that good self-rated health increased from 2001 to 2012. Overall, variables associated with a lower likelihood of good self-rated health were: being married or living with a partner, lower educational level, and disability.

    Conclusion: Trends of good self-rated health differ by gender according to socio-demographic factors and the prevalence of disability.


  • XML | PDF | downloads: 87 | views: 366 | pages: 297-304

    Background: To examine the effect of nutritional education on children’s breakfast patterns

    Methods: A kindergarten based nutrition intervention was started in September 2001 among 8 kindergartens in Hefei with a total of 2,012 children aged 4-6 years and their parent pairs.

    Results: Monthly nutrition education sessions were held over two semesters in kindergartens part of the intervention arm.  The approach in education and the content of other activities were uniform across all the kindergartens. A validated questionnaire was used to record breakfast behavior over 7 days including at least one weekend. The parents recorded the children’s breakfast pattern (frequency, time, and food selection) at baseline, middle, and end of the study. After intervention, there were significant differences at the final stage, but none at the baseline before intervention. There were changes not only in breakfast frequency, but also in the breakfast selection

    Conclusion: The breakfast pattern of Chinese children can be modified through nutrition education after a long term intervention.


  • XML | PDF | downloads: 111 | views: 351 | pages: 305-313

    Background: Tuberculosis (TB) is one of the main health issues in Turkey. Extrapulmonary TB cases have significant proportion comparing pulmonary TB cases. The aim of the study was to evaluate the extrapulmonary tuberculosis (EPTB) cases in two regions of Turkey, which have different demographic and socioeconomic characteristics.

    Methods: In this retrospective cohort study, EPTB cases between 2000 and 2005 in Van and Izmir Provinces of Turkey were analyzed and compared for symptoms, age groups, vaccination status, diagnostic procedures and social-economical conditions within two provinces. Descriptive analytic methods were used.

    Results: Total of 397 EPTB cases were reviewed retrospectively in Izmir and Van provinces. Pleural TB was most often seen EPTB form (47.6% vs. 32.6%) and female/male ratio was similar in both groups. Patients were in older ages in Izmir Province. Chest pain (20% vs. 32%), cough (33% vs. 26%) and night sweatiness (29% vs. 36%) were leading complaints. Low BCG vaccination rate and higher childhood EPTB were found in Van group, in contrary elderly EPTB was more often in of Izmir group.

    Conclusion: Frequency of severe forms of EPTB is more often in younger ages in lower social economical condition areas.


  • XML | PDF | downloads: 96 | views: 378 | pages: 314-321

    Background: Anxiety, depression, and other adverse psychological reactions are often observed in elderly hypertensive patients. Appropriate exercise is a safe form of adjuvant therapy without causing side effects among these patients, with consistent effects on patients’ mental health. In this study, a collective exercise intervention experiment was conducted to evaluate the mental health of elderly hypertensive patients and to verify the effect of the psychological intervention of collective exercise.

    Method: A total of 115 elderly hypertensive patients aged 60–70 years old were selected as study subjects from May 2012 to January 2015 in Fuzhou City, Fujian Province, China. A total of 57 patients were included in the control group and 58 patients were assigned in the experimental group. Patients in the experimental group participated in a 12 weeks exercise intervention, while patients in the control group didn’t participate in any regular physical exercise.

    Results: After intervention, the Symptom Checklist-90 (SCL-90), total score, somatization, obsessive-compulsive symptom, interpersonal sensitivity, depression, anxiety, hostility, and paranoia scores of the experimental group were significantly lower than those of the control group (P < 0.05). The positive coping style score of the experimental group was significantly higher than that of the control group (P<0.05); by contrast, the negative coping style score of the experimental group was significantly lower than that of the control group (P < 0.05).

    Conclusion: The mental health level and coping ability of elderly hypertensive patients can be effectively improved with the proposed treatment.



  • XML | PDF | downloads: 79 | views: 333 | pages: 322-328

    Background: Candida parapsilosis is an emergent agent of invasive fungal infections. This yeast is one of the five most widespread yeasts concerned in invasive candidiasis.
    C. parapsilosis stands out as the second most common yeast species isolated from patients with bloodstream infections especially in neonates with catheter.
    Recently several reports suggested that its reduced susceptibility to azoles and polyene might become a cause for clinical concern, although C. parapsilosis is not believed to be intensely prone to the development of antifungal resistance.

    Methods: In the present report, One hundred and twenty clinical isolates of C. parapsilosis complex were identified and differentiated by using PCR-RFLP analysis. The isolates were then analyzed to determine their susceptibility profile to fluconazole (FLU), itraconazole (ITC) and amphotericin B. The minimum inhibitory concentration (MIC) results were analyzed according to the standard CLSI guide.

    Results: All of isolates were identified as C. parapsilosis. No C. metapsilosis and C. orthopsilosis strains were found. Evaluation of the antifungal susceptibility profile showed that only three (2.5%) C. parapsilosis were resistant to fluconazole, three (2.5%) C. parapsilosis were resistant to itraconazole and two (1.7%) C. parapsilosis were amphotericin B resistant.

    Conclusion: Profiles in clinical isolates of C. parapsilosis can provide important information for the control of antifungal resistance as well as distribution and susceptibility profiles in populations.


  • XML | PDF | downloads: 92 | views: 351 | pages: 329-339

    Background: Familial hypertrophic cardiomyopathy (HCM) is caused by mutations in genes encoding cardiac sarcomere proteins. Nowadays genetic testing of HCM plays an important role in clinical practice by contributing to the diagnosis, prognosis, and screening of high-risk individuals. The aim of this study was developing a reliable testing strategy for HCM based on linkage analysis and appropriate for Iranian population.

    Methods: Six panels of four microsatellite markers surrounding MYH7, MYBPC3, TNNT2, TNNI3, TPM1, and MYL2 genes (24 markers in total) were selected for multiplex PCR and fragment length analysis. Characteristics of markers and informativeness of the panels were evaluated in 50 unrelated Iranians. The efficacy of the strategy was verified in a family with HCM.

    Results: All markers were highly polymorphic. The panels were informative in 96-100% of samples. Multipoint linkage analysis excluded the linkage between the disease and all six genes by obtaining maximum LOD score ≤-2.

    Conclusion: This study suggests a reliable genetic testing method based on linkage analysis between 6 sarcomere genes and familial HCM. It could be applied for diagnostic, predictive, or screening testing in clinical setting.



  • XML | PDF | downloads: 103 | views: 453 | pages: 340-345

    Background: Diabetes is a major cause of death. Oxidative stress mainly caused by hyperglycemia is the primary reason of related complications. Omega-3 fatty acids are prescribed in diabetes but the effect on antioxidant defense is controversial. This study investigated effects of omega-3 supplementation on antioxidant enzymes activity in type 2 diabetic patients.

    Methods: A randomized, placebo controlled, double blind clinical trial was performed on 90 type2 diabetic patients. The treatment group took, daily, three capsules of omega-3 for two mo, which totally provided 2714mg omega-3 (EPA=1548 mg, DHA=828 mg and 338 mg of other omega=3 fatty acids). Placebo contained 2100 mg sunflower oil (12% SFA, 65% linoleic acid, 23% MUFA), which is the main oil used in the study population. Food intakes, anthropometric and demographic characteristics, and therapeutic regimen data were recorded before and after the intervention. Fasting blood samples were taken before and after the intervention to measure super oxide dismutase, glutathione peroxidase, glutathione reductase, catalase and total antioxidant capacity in erythrocytes.

    Results: A total of 81 subjects completed the study. Two study groups were similar as regards duration of diabetes, age and the enzymes at baseline. Energy and macro- and micronutrients intakes, weight and hypoglycemic agent consumption were similar in the two groups at baseline and did not change. Supplementation had no effect on antioxidant enzyme status. Glycated hemoglobin showed a significant reduction by supplementation.

    Conclusion: Daily supplementation of 2714 mg mega-3 for two mo results in a significant reduction in HbA1c level in type2 diabetic patients with no effects on antioxidant enzymes activity.



  • XML | PDF | downloads: 90 | views: 328 | pages: 346-352

    Background: Previous studies have shown that leukemogenic chromosomal translocations, including fusions between Break point Cluster Region (BCR) and Abelson (ABL) are present in the peripheral blood of healthy individuals. The aim of this study was to gain insights into the genetic alterations other than BCR-Abl translocation in molecular level, which cause chronic myeloid leukemia (CML).

    Methods: We performed whole-exome sequencing on four cases representative of BCR-ABL positive CML in chronic phase of the disease.

    Results: We did not identify any pathogenic mutation in all known genes involved in CML or other cancers in our subjects. Nevertheless, we identified polymorphisms in related genes.

    Conclusion: It is the first report of exome sequencing in Philadelphia chromosome positive CML patients. We did not identify any pathogenic mutation in known cancer genes in our patients who can be due to CML pathogenesis or technical limitations.



  • XML | PDF | downloads: 119 | views: 472 | pages: 353-361

    Background: The aim of this study was to assess the associations between nutrition and dental caries in permanent dentition among schoolchildren.

    Methods: A cross-sectional survey was undertaken on 698 schoolchildren aged 10 to 12 yr from a random sample of primary schools in Kermanshah, western Iran, in 2014. The study was based on the data obtained from the questionnaire containing information on nutritional habits and the outcome of decayed/missing/filled teeth (DMFT) index. The association between predictors and dental caries was modeled using the Zero Inflated Generalized Poisson (ZIGP) regression model.

    Results: Fourteen percent of the children were caries free. The model was shown that in female children, the odds of being in a caries susceptible sub-group was 1.23(95% CI: 1.08-1.51) times more likely than boys (P=0.041). Additionally, mean caries count in children who consumed the fizzy soft beverages and sweet biscuits more than once daily was 1.41(95% CI: 1.19-1.63) and 1.27 (95% CI: 1.18-1.37) times more than children that were in category of less than 3 times a week or never, respectively.

    Conclusions: Girls were at a higher risk of caries than boys were. Since our study showed that nutritional status may have significant effect on caries in permanent teeth, we recommend that health promotion activities in school should be emphasized on healthful eating practices; especially limiting beverages containing sugar to only occasionally between meals.



  • XML | PDF | downloads: 218 | views: 549 | pages: 362-369

    Background: Hospitals are the central entity of each health care system and Health Promoting Hospitals (HPH) was launched by WHO in 1988. However, there has not been any accurate and detailed model for establishing a HPH in Iran up to now. Therefore, this study aimed to determine factors affecting the establishment of a health promoting hospital in Iran using factor analysis method.

    Methods: This applied, cross-sectional and descriptive-analytical study was conducted in Iran in four steps. Confirmatory Factor Analysis (CFA) was used for determining factors affecting the establishment of a HPH.

    Results: Society (0.97) and Policy (0.74) had the highest regression weights (effects) and management had the lowest one.

    Conclusion: Community assessment was the most important dimension of proposed conceptual model for establishing a HPH.


Case Report(s)

  • XML | PDF | downloads: 124 | views: 341 | pages: 370-375


    Mendelian susceptibility to mycobacterial diseases (MSMD) is a rare inheritance syndrome, characterized by a disseminated infection with mycobacterium in children following BCG vaccination at birth. Regarding the vaccination program in Iran, it may consider as a public health problem. The pathogenesis of MSMD is dependent on either insufficient production of IFN-gamma (γ) or inadequate response to it. Here, we want to introduce three cases including two siblings and one girl from two unrelated families with severe mycobacterial infections referred to Immunology, Asthma and Allergy Research Institute (IAARI), from 2013 to 2015; their MSMD was confirmed by both cytokine assessment and genetic analysis. Regarding the clinical features of the patients, cell proliferation against a mitogen and BCG antigen was ordered in a lymphocyte transformation test (LTT) setting. ELISA was performed for the measurement of IL-12p70 and IFN- γ in whole blood samples activated by BCG + recombinant human IFN-γ and BCG + recombinant human IL-12, respectively. In contrast to mitogen, the antigen-dependent proliferation activity of the patients’ leukocytes was significantly lower than that in normal range. We identified a homozygous mutation in IL12RB1 gene for two kindred who had a homozygous mutation affecting an essential splice site. For the third patient, a novel frameshift deletion in IL12RB1 gene was found. The genetic study results confirmed the impaired function of stimulated lymphocytes to release IFN-γ following stimulation with BCG+IL-12 while the response to rhIFN-γ for IL-12p70 production was relatively intact. Our findings show that cellular and molecular assessments are needed for precise identification of immunodeficiency disorders especially those without clear-cut diagnostic criteria.



  • XML | PDF | downloads: 99 | views: 356 | pages: 376-380

    The interpretation of supernumerary chromosome is important for genetic counseling and prognosis. Here, we used SNP array and conventional karyotyping method to identify a denovo marker chromosome originated from chromosome 22 and 11 in a newborn transferred to the Neonatal Intensive Care Unit of Shahid Sadoughi Hospital in 2015.  Clinical abnormalities identified in the newborn were dysmorphic face, intrauterine growth retardation, atrial septal defect (ASD), the hypoplasia of corpus callosum and septum pellucidum. These clinical abnormalities can be related to this marker, and it may help genetic counselor for predicting abnormality risk in susceptible individuals as well as prenatal diagnosis. 


  • XML | PDF | downloads: 83 | views: 319 | pages: 381-386

    This case of a female patient, 14 yr old with association of the two anomalies, which we came across with in 2014, is rarely met in the specialty practice. The impacted canines are part of the group of dental anomalies of position, while the agenesis is part of the group of dental number anomalies. The orthodontic treatment in the two arches has to be differentiated, the therapeutic objectives being, also different in the two arches.



Letter to the Editor