Vol 46 No 12 (2017)

Review Article(s)

  • XML | PDF | downloads: 407 | views: 588 | pages: 1603-1610

    Background: The elderly population following the improvement in health status and life expectancy in developing countries is increasing. Malnutrition causes decreased quality of life and increased mortality in elderly. This study aimed to review systematically and meta-analysis of studies assessing the prevalence of malnutrition among Iranian elderly people over 60 yr of age using Mini Nutritional Assessment (MNA).

    Methods: This systematic review and meta-analysis was conducted in 2016 to estimate the overall malnutrition prevalence. Data were collected using the following keywords: prevalence, elderly, aging, malnutrition, nutrition, nutritional assessment, nutritional status, health status, mini nutritional assessment, MNA and Iran in PubMed, Scopus, Google Scholar, Iranmedex, Magiran, and SID. Computer software CMA: Two were applied to estimate the overall prevalence of malnutrition.

    Results: Seventeen of 811 articles were included in our analyses. The overall estimated prevalence of malnutrition among elderly based on the random effect model was 12.2% (95% CI 8-18.5). In subgroups, the prevalence of malnutrition among elderly living in home based on the fixed effect model was 9.2% (95% CI 7.1-11.9) and prevalence of malnutrition among elderly residents of nursing homes based on the random effect model was 21.6% (95% CI 12-38.6).

    Conclusion: Given the increase in the elderly population in future and the prevalence rate of malnutrition among them as well as the higher prevalence of malnutrition in elderly care centers, more attention to this population group is a matter of necessity.


  • XML | PDF | downloads: 257 | views: 470 | pages: 1611-1622

    Background: Using dexmedetomidine (Dex) as a sedative agent may benefit the clinical outcomes of post-surgery patients. We reviewed randomized controlled trials (RCTs) to assess whether use of a Dex could improve the outcomes in post-surgery critically ill adults.

    Methods: We searched Medline, Embase, PubMed, and the Cochrane databases for RCTs comparing Dex with propofol or a placebo in post-operative patients, all included RCTs should be published in English before Jul 2016. Citations meeting inclusion criteria were full screened, and trial available data were abstracted independently and the Cochrane risk of bias tool was used for quality assessment.

    Results: Sixteen RCTs involving 2568 patients were subject to this meta-analysis. The use of a Dex sedative regimen was associated with a reduce delirium prevalence [odd ratio (OR):0.33, 95% confidence intervals (CI): 0.24–0.45, I2= 5%, P<0.001], a shorter the length of ICU stay [mean difference (MD): -0.60, 95%CI: -0.69 to -0.50, I2=40%, P<0.001] and the length of hospital stay [MD: -0.68, 95%CI: -1.21 to -0.16, I2=0%, P=0.01]. However, using of Dex could not shorter the duration of mechanical ventilation [MD: -10.18. 95%CI: -31.08–10.72, I2=99%, P=0.34], but could shorter the time to extubation in post-surgery patients [MD: -47.46, 95%CI: -84.63–10.67, I2=98%, P=0.01].

    Conclusion: The use of a Dex sedative regimen was associated with a reduce delirium prevalence, a shorter the length of ICU and hospital stay, and a shorter time to extubation in post-surgery critical ill patients.


Original Article(s)

  • XML | PDF | downloads: 268 | views: 369 | pages: 1632-1638

     Background: This study was designed to explore the correlation of connective tissue growth factor (CTGF), heme oxygenase (HO-1), neurotrophic factors (NT-3) with type 2 diabetic peripheral neuropathy, as well as the changes after immune cytokine alone and combined with cattleencephalon glycoside and ignotin treatment.

    Methods: Seventy-six patients with type 2 diabetes and peripheral neuropathy charged into People’s Hospital of Rizhaolanshan, China from 2014-2016 were selected. The severity of neuropathy was evaluated by TCSS. Pearson analysis was used to analyze the correlation between the degree of neuropathy and CTGF, HO-1 and NT-3. The patients were randomly divided into control group and observation group, n=38. The control group accepted TGF-β1 treatment on the basis of controlling diet and blood sugar, while the observation group was treated with cattle encephalon glycoside and ignotin injection on the basis of control group. CTGF、HO-1, NT-3 concentration in the blood and nerve conductive velocity (NCV) were detected and analyzed before and after treatment.

    Results: CTGF(r=-0.865), HO-1(r=-0.706), NT-3(r=-0.587) was negatively correlated with TCSS scores. After treatment, the concentrations of CTGF、HO-1and NT-3 in the observation group were higher than the control group (P<0.05). In moderate and severe lesions, the concentrations of CTGF, HO-1and NT-3 in the observation group were higher than the control group (P<0.05). The conduction velocity of nerve increased with the increase of CTGF, HO-1 and NT-3 concentrations. The obvious effective rate and total effective rate of observation group were both higher than the control group.

    Conclusion:  Immune cytokine TGF-β1 combined with cattle encephalon glycoside and ignotin injection could improve the contents of CTGF, HO-1 and NT-3, and be better to treat the peripheral neuropathy of type 2 diabetes.



  • XML | PDF | downloads: 354 | views: 559 | pages: 1639-1645

    Background: By considering innovation as a new project in hospitals, all the project management’s standard steps should be followed in execution. This study investigated the validation of a new set of measures in terms of providing a procedure for knowledge management-oriented innovation that enriches the hospital management system.

    Methods: The relation between innovation and all the knowledge management areas, as the main constructs of project management, was illustrated by referring to project management standard steps and previous studies. Through consultations and meetings with a committee of professional project managers, a questionnaire was developed to measure ten knowledge management areas in hospital’s innovation process. Additionally, a group of experts from hospital managers were invited to comment on the applicability of the questionnaires by considering if the items are measurable in hospitals practically.

    Results: A close-ended, Likert-type scale items, consisted of ten sections, were developed based on project management body of knowledge thorough Delphi technique. It enables the managers to evaluate hospitals’ situation to be aware whether the organization follows the knowledge management standards in innovation process or not. By pilot study, confirmatory factor analysis and exploratory factor analysis were conducted to ensure the validity and reliability of the measurement items.

    Conclusion: The developed items seem to have a potential to help hospital managers and subsequently delivering new products/services successfully based on the standard procedures in their organization. In all innovation processes, the knowledge management areas and their standard steps help hospital managers by a new tool as questionnaire format.



  • XML | PDF | downloads: 265 | views: 423 | pages: 1646-1651

    Background: We aimed to evaluate the effect of high-quality nursing on improvement of anxiety and depression of patients with acute stroke in magnetic resonance imaging (MRI) examination.

    Methods: A total of 120 patients diagnosed as acute stroke for the first time were enrolled in Liaocheng People’s Hospital from 2016-2017 and randomly divided into control group (n=60) and observation group (n=60). All patients received cerebral MRI examination at 6h and 24h after admission and before discharge. The control group was treated with routine nursing, while the observation group was treated with high-quality nursing, and the specific nursing measures included the establishment of high-quality nursing group, full evaluation of the severity of disease, timely solving of difficulties in MRI examination, understanding of the patient's anxiety and depression, establishment of personal information files before discharge, etc. The completion rate and average duration of examination, the improvement of anxiety and depression and the nursing satisfaction were compared between the two groups.

    Results: In observation group, the completion rate of MRI examination was significantly increased (P=0.035), the average duration was shortened (P=0.011), the anxiety and depression scores (self-rating anxiety scale (SAS) and self-rating depression scale (SDS)) were improved obviously (P=0.006 and 0.009), and the nursing satisfaction score and rate was increased (P=0.000 and 0.027); the differences were statistically significant (P<0.05).

    Conclusion: High-quality nursing can significantly improve the anxiety and depression of patients with acute stroke in MRI examination, which has a better application value in increasing the completion rate of examination, shortening the duration of examination and improving the nursing satisfaction.



  • XML | PDF | downloads: 391 | views: 323 | pages: 1652-1658

    Background: The recognition of patient safety is now occupying a prominent place on the health policy agenda since medical errors can result in adverse events. The existence of confusing drug names is one of the most common causes of medication errors. In Iran, the General Office of Trademarks Registry (GOTR), for four years (2010-2014) was responsible for approving drug proprietary names. This study aimed to investigate the performance of the GOTR in terms of drug names orthographic similarity using the SOLAR model.

    Methods: First, 100 names were randomly selected from the GOTR’s database. Then, each name was searched through pharmaceutical websites including Martindale (the Complete Drug Reference published by Pharmaceutical Press), Drugs.com and Medicines Complete. Pair of drugs whose names look orthographically similar with different indications were identified. Then, the SOLAR model was utilized to determine orthographic similarity between all pair of drug names.

    Results: The mean of match values of these 100 pairs of drug was 77% indicating the high risk of similarity. The match value for most of the reviewed pairs (92%) was high (≥66%). This value was medium (≥ 33% and <66%) just for 8% of the pairs of drug. These results indicate high risk of confusion due to similarity of drug names.

    Conclusion: The stewardship of the GOTR in patient safety considerations is fundamentally problematic. Thus, as a best practice, we recommend that proprietary names of drugs be evaluated by an entity within the health system. While an entity within the health system should address patient safety considerations, the GOTR is responsible for intellectual property rights.



  • XML | PDF | downloads: 411 | views: 454 | pages: 1659-1668

    Background: At present, the mental health of rural left-behind children is a major social problem in China. Internet addiction, social anxiety, and loneliness are common psychological and behavioral problems among rural left-behind children, but the relationships among these issues have not been clearly identified.

    Methods: A total of 432 junior year 1 to senior year 3 students were randomly selected from 2 rural middle schools in Hunan Province of China as the research subjects. The Internet Addiction Disorder Diagnostic Scale, Social Anxiety Subscale of the Self-Consciousness Scale (SASS-CS), and University of California Los Angeles Loneliness Scale were employed to measure the degree of Internet addiction, feelings of social fear, social avoidance behavior, and the level of loneliness among the research subjects.

    Results: The rate of Internet addiction among rural left-behind middle school students was 18.27%, and was correlated with the length of time their parents spent at home as well as whether one or both parents migrated for work. Positive correlations were found among Internet addiction, social anxiety, and loneliness. Loneliness was found to play a mediating role in the relationship between social anxiety and Internet addiction among rural left-behind middle school students.

    Conclusion: Social anxiety and loneliness both increase the likelihood of Internet addiction in rural left-behind middle school students and social anxiety can affect Internet addiction through loneliness, implying an urgent need to strengthen care for rural left-behind children, reduce their loneliness, and thereby effectively alleviate the problem of Internet addiction among rural left-behind middle school students.



  • XML | PDF | downloads: 335 | views: 457 | pages: 1669-1678

    Background: Adolescence is a developmental stage associated with many behavioural fluctuations and health risks behaviours. In this study, various health risk behaviours among Government school students in Jordan were assessed.

    Methods: This cross-sectional descriptive study recruited 1256 students from 20 secondary schools all over the country. Students completed the Global School-based Student Health Survey (GSHS, 2009-2012). The study was conducted in the period between Feb 2016 and Aug 2016. Chi-square (x2) was used to examine differences among the demographic variables.

    Results: Students scored low in eating breakfast, eating fruit, vegetables, and milk products. However, students scored moderately in hand and mouth hygiene. Students showed minimal incidences of physical attack and physical fight. Although suicidal attempts were not significantly reported, complaining from worries, feeling of sadness and hopelessness were moderately scored. The majority of physical activities were reported from walking or riding bicycles. However, three hours per day was the average of time spent on sitting activities. Students scored lowest in school absenteeism and the majority described their classmates as kind and helpful. Parental control on students' home activities was regarded.

    Conclusion: In comparison with 2004 and 2007 statistics, students revealed improvements in physical activity, and reduced physical attacks and injuries. Future researchers are encouraged to discover factors associated with these changes.


  • XML | PDF | downloads: 265 | views: 2432 | pages: 1679-1689


    Background: Compared to the rigid image registration task, the non-rigid image registration task faces much more challenges due to its high degree of freedom and inherent requirement of smoothness in the deformation field. The purpose was to propose an efficient coarse-to-fine non-rigid medical image registration algorithm based on a multi-level deformable model.

    Methods: In this paper, a robust and efficient coarse-to-fine non-rigid medical image registration algorithm is proposed. It contains three level deformation models, i.e., the global homography model, the local mesh-level homography model, and the local B-spline FFD (Free-Form Deformation) model. The coarse registration is achieved by the first two level models. In the global homography model, a robust algorithm for simultaneous outliers (error matched feature points) removal and model estimation is applied. In the local mesh-level homography model, a new similarity measure is proposed to improve the robustness and accuracy of local mesh based registration. In the fine registration, a local B-spline FFD model with normalized mutual information gradient is employed.

    Results: We verified the effectiveness of each stage of the proposed registration algorithm with many non-rigid transformation image pairs, and quantitatively compared our proposed registration algorithm with the HBFFD method which is based on the control points of multi-resolution. The experimental results show that our algorithm is more accurate than the hierarchical local B-spline FFD method.

    Conclusion: Our algorithm can achieve high precision registration by coarse-to-fine process based on multi-level deformable model, which ourperforms the state-of-the-art methods.

  • XML | PDF | downloads: 262 | views: 342 | pages: 1690-1696

    Background: The most common serological assay to measure anti-influenza antibodies is hemagglutination inhibition (HI) assay. Recently, neutralizing antibodies against influenza virus infection or vaccination can also be detected using microneutralization assays and occasionally, have greater sensitivity than the standard HI assays. The study aimed to compare the sensitivity and specificity of ELISA-based microneutralization (microNT-ELISA) and conventional HI assays in order to detect influenza H1N1 virus antibodies.

    Methods: MicroNT-ELISA was set up according to the WHO Manual on Influenza Diagnosis and Surveillance in Virology Department of Tehran University of Medical Sciences for the detection of neutralizing antibodies against H1N1 influenza virus in 2013. Fifty serum samples were analyzed with both HI and microNT-ELISA assays. Correlation between methods was calculated by linear regression analysis.

    Results: The linear correlation coefficient squares, R2, of microNT-ELISA and HI test was 0.61 (P<0.0001) and we observed a high index of coincidence between the two tests. According to McNemar's test, there was no statistically significant difference between these two assays (P>0.05).

    Conclusion: The sensitivity and specificity of microNT-ELISA assay were high (87% and 73%, respectively) and closely related to gold standard test results. Therefore, microNT-ELISA is recommended as an alternative or complementary test to conventional HI assay for serological and epidemiological purposes.


  • XML | PDF | downloads: 256 | views: 270 | pages: 1697-1703

    Background: Microsporidia have been reported as the cause of opportunistic infections in immunocompromised patients in Iran and other countries. There is no data on prevalence of intestinal microsporidia in healthy population of Iran. This study aimed to provide preliminary data on the present status of microsporidia infection in the local healthy population in Jiroft, Kerman Province from southeastern Iran in 2013-2014.

    Methods: Fresh stool samples were randomly collected from 418 residents in rural 209 (50%) and urban 209 (50%) areas of Jiroft. All of the collected samples were concentrated with conventional formalin-ether, stained with Ryan blue. Microscopic examination was performed with high magnification on each sample separately for the demonstration of microsporidia spores.

    Results: Microsporidial spores were identified in 41 out of 418 (9.8%) samples including 16.41(39%) from rural areas and 25.41(61%) from urban areas. In general, there was no significant difference between sex, age, job, education, and contact with soil and livestock, water supply, gastrointestinal disorders and microsporidia infection among general population in Jiroft.

    Conclusion: Intestinal microsporidia infection without clinical manifestations is prevalent in general population resident in southeastern Iran. Appropriate molecular methods are needed for microsporidia species identification.


  • XML | PDF | downloads: 196 | views: 282 | pages: 1704-1711

    Background: Pain and its opioid treatments are complex measurable traits. Responses to morphine in terms of pain control is likely to be determined by many factors, including the underlying pain sensitivity of the patient, along with nature and extent of the painful process, concomitant medications, genetic and other clinical and environmental factors. This study investigated genetic polymorphisms implicated in the inter-individual pain response variability to opioid treatment in the Tunisian population.

    Methods: This prospective association study investigated seven variations in the OPRM1, OPRK1 and COMT gene, which encode Mu and KAPPA opioid receptors, and Catechol-O-methyltransferase enzyme respectively, in a cohort of 129 Tunisian cancer pain patients under oral morphine treatment. Genotyping was performed by simple probe probes on Light Cyler for rs17174629, rs1799972, rs1799971, rs1051659, rs1051660 and rs4680 and by PCR assay for the indel in the promoter region of OPRK1 (rs35566036). A statistical associations study between dose (continuous), dose escalation (yes/no) and SNP or haplotypes were investigated using linear multiple regressions and logistic regressions respectively adjusted on metastases and pain covariates in the R software.

    Results: We detected significant association of the rs1051660 adjusted on metastasis and pain (P=0.02), no other association has been detected between the 7 polymorphisms screened and the dose of morphine needed for pain relief.

    Conclusion: This can be explained by the strong genetic heterogeneity in the cosmopolitan areas where our patients were recruited for this study, compared to more homegenous population recruited in other studies.



  • XML | PDF | downloads: 245 | views: 295 | pages: 1712-1719

    Background: Trichinellosis is an important and neglected foodborne zoonotic infectious disease in worldwide. The most human outbreaks in recent years have been related to consumption of wild boar meat. This cross-sectional study determined the prevalence of Trichinella spp. infections in hunted wild boars in northern Iran.

    Methods: Thirty-five hunted wild boars were subjected in this study in 2015. All samples were examined by conventional artificial digestion method to detect of muscle larvae. Genomic DNA was extracted by phenol-chloroform method from isolated larvae. To identify the Trichinella species, a PCR-based method was applied using the internal transcribed spacer 2 (ITS2) and mitochondrial small-subunit ribosomal RNA (rRNA) gene sequences.

    Results: The overall prevalence of Trichinella spp. infection was 5.7% (2/35, 95%CI= 0-13.4). The mean larval burdens in two positive samples were 0.05 and 6 larvae per gr tissue muscle, respectively. The PCR reaction, using specific primers, yielded two 367 bp and 195 bp bands on agarose gel for ITS 2 and rrnS, respectively.

    Conclusion: There is a hidden burden of Trichinella spp. infection in wild boar population in Iran. Moreover, T. britovi is the prevalent species circulating in wild boars of Iran. Therefore, education of the hunters and other consumers should be performed about the risk of consumption of raw or undercooked meat and meat products from wild boars.



  • XML | PDF | downloads: 233 | views: 338 | pages: 1720-1725

    Background: Reduction of inappropriate use of health services can decrease health care costs without harming the quality of services. This study aimed to investigate inappropriate admission and hospitalization at Afzalipour Hospital of Kerman, Iran.

    Methods: Inappropriate admission and hospitalization were assessed via a cross-sectional study on 400 patients in Kerman Afzalipour Hospital, Kerman, Iran in 2015. The Iranian version of the Appropriateness Assessment Protocol was used for data collection. Chi-square tests and logistic regression were used to analyze the data.

    Results: The rate of inappropriate admissions and hospitalization were 7.6% and 9% respectively. There was no significant relationship between inappropriate admissions and any of the studied variables; however, there was a significant relationship between inappropriate hospitalization and age, length of stay and hospital departments.

    Conclusion: If standard measures of admission and hospitalization execute correctly, unnecessary hospitalization rate can be reduced, so more patients can be treated and cost and workload of hospital personnel can be moderated.



  • XML | PDF | downloads: 280 | views: 342 | pages: 1726-1736

    Background: Shiraz University of Medical Sciences, Iran has developed a new version of health urban posts called Urban Community Health Center (UCHC) with primary aim of improving primary health care (PHC) in urban areas. The aim of present study was to evaluate this newly developed model of UCHC in Ghaleno, a suburban region of Shiraz, Iran in 2014.

    Methods: Besides descriptive analysis of foregoing model and considering its goal, plan, and dimensions, a qualitative study was carried out using in-depth interview with four managers of this model in Ghaleo region as well as the family physicians (FPs) of the model. Data were analyzed using conventional content analysis.

    Results: Evaluation of this model in 7-month period after implementation, showed that population coverage was raised from 23% to 84%, a remarkable and increasing achievement of 61%. The universal package is a protocol for providing healthcare services based on PHC.
    The descriptive study of the model based on physicians view, explored real FP, population's satisfaction, importance of physician's assistant, and payment system reform in the model.

    Conclusion: Ghaleno model has unique objectives in providing healthcare services in urban areas. The findings of this study call for further evaluation, specifically in quality care services. The success and continuation of this model demand the support of policy makers.




National Report

  • XML | PDF | downloads: 300 | views: 336 | pages: 1623-1631

    Background: Cystic Echinococcosis (CE) is a serious zoonotic parasitic disease in Iran. This study aimed to show the trend of the confirmed disease from 1995 to 2014 and to describe some of epidemiological aspects of the disease in Iran.

    Methods: This retrospective study has been designed based on data collected from 8518 cases of CE among various geographical locations of Iran.

    Results: The average annual number of human cases of CE was 274.8. Among 31 provinces of Iran, Razavi Khorasan from northeast part of Iran was the highest human CE infected province with the 1801 cases and Hormozgan Province in south part of the country showed the lowest the disease with the only one case of CE in 2009. Liver and lungs with the infection rate of 61% and 20%, respectively are the most infected organs, 53% of patients had one cyst in the bodies and the number of cysts in 8% of cases was more than 3 cysts. Altogether, 41% of CE cases were treated by surgery, 11% with chemotherapy and 48 % with mixed surgery and chemotherapy.

    Conclusion: Human CE is a major health problem in Iran and it is necessary to establish basic control programs. It is crucial to setting up standard diagnostic methods for early diagnosis, effective treatment, plan educational schedule for different social levels and control the disease in both definitive and intermediate hosts.



Letter to the Editor