Vol 48 No 12 (2019)

Published: 2019-12-02

Review Article(s)

  • XML | PDF | downloads: 380 | views: 541 | pages: 2116-2123

    At present, the increasing trend of medical disputes has become a serious problem in the work of medical institutions, and directly affects the social stability and orderly development of the institutions. We searched the literature on medical disputes and crisis management in China and Australia within PubMed (2010-2019), China Knowledge Network (CNKI, 2010-2019), and Wanfang Data Knowledge Service Platform (2010-2019). There are several drawbacks in the management of hospital medical disputes in China: 1) the knowledge of crisis is unilateral and not systematic; 2) there are too much stereotype thoughts in crisis management; 3) the crisis attribution is too simple; the crisis impact assessment is insufficient. It is worth learning from Australia’s system, including the legal system, relevant non-governmental organizations, and doctor-patient communication. In view of the malpractice existing in China's medical dispute management, Australia's legal system for handling disputes, doctor-patient communication and other aspects are worthy of our reference. In particular, the construction of third-party supervision and mediation institutions and the prevention of doctor-patient disputes should be optimized.

  • XML | PDF | downloads: 204 | views: 429 | pages: 2124-2132

    Background: In-vitro fertilization (IVF) has been very popular since the birth of the first “test-tube” baby. This method is the last hope and the most serious solution for couples with infertility problems. Although childbearing is a concern of many couples, it must always be noted that any method can also have disadvantages. Thus, many studies have been done on the problems encountered by this method.

    Methods: We searched for relevant articles in Pub Med, Springer, Elsevier, and Google Scholar databases, and studied more than 70 papers. Keywords used included ovarian cancer, in vitro fertilization, gonadotropin hormone, clomiphene citrate, and infertility.

    Results: Due to the large number of studies, high doses of the ovulation-stimulating drugs and their repeated use in this method can increase the risk of the ovarian hyper stimulation syndrome (OHSS), and ovarian cysts, which can lead to ovarian cancer. Also, an increase in the risk of developing ovarian cancer can be due to the increased duration of treatment for up to 12 months and the high doses of medications that are followed by defecation and failure of this treatment.

    Conclusion: Due to the increase in the rates of infertility treatments and the incidence of gynecological cancers, especially ovarian cancer, this method need to be used with caution. IVF clients and candidates should be informed about potential future risks. People should be evaluated genetically for their history of ovarian cancer and be more aware of the importance of “Personalized medicine”.



  • XML | PDF | downloads: 322 | views: 651 | pages: 2133-2139

    Background: Alzheimer's disease is a chronic disease characterized by a progressive decline in mental abilities and quality of life alongside behavioral abnormalities associated with high economic burden. The purpose of this study was to investigate epidemiology and risk factors of Alzheimer’s disease in Iran.

    Methods: In this systematic review study, both Persian and English-language databases including Medline, Google Scholar, PubMed, web of science and Magiran were searched using following keywords: epidemiology, Alzheimer, dementia and Iran without time limit up to 2017. Thirty articles abstract out of 50 studies related to this topics, were reviewed. Of which 12 full text entered into the quality assessment process and finally, four articles were selected for inclusion in this study and their results was extracted.

    Results: The total sample size of the 4 selected studies was 2781. The prevalence of Alzheimer's disease in the current study was estimated to be 2.3% in the population of 67-78 years old. Age, genetics, depression and hypertension were determined as the risk factors for Alzheimer's disease, while daily listening to music, meeting weekly with friends and daily intake of vitamin E were considered as the factors with protective role in this disease.

    Conclusion: Alzheimer's disease is one of the main causes of functional dependence and mortality in the elderly people. Lifestyle changes and multiple mental activities in elderly increases the cognitive ability of these population, which will reduce direct and indirect costs of this disease.

  • XML | PDF | downloads: 232 | views: 461 | pages: 2140-2153

    Background: The scorpions have enjoyed medical importance from ancient times because of their morphological structure and venom. The identification of the species of these arthropods has been more emphasized than any other aspects. The purpose of this study was to determine scorpion’s fauna and mortality rates of their victims as reported in Iran.

    Methods: In this review, published documents during 1966–2018 related to medically important scorpions and mortality reports due to scorpionism were searched in the data bases such as Web of Science, PubMed, Scopus, Google Scholar and etc., using key words including scorpion, species, classification, Iran, family, species, and the names of all 31 provinces of Iran.

    Results: Overall, 169 sources were found. Based on the STROBE checklist, the quality of the documents was also considered, and ultimately, 95 sources were selected. Sixty-four species of scorpions have been identified in Iran and 86% of the species belong to the Buthidae family, and the rest (9.5%, 4.5%) belong to the Hemiscorpiidae and Scorpionidae families, respectively. These species live mostly in tropical regions of Iran. The dangerous scorpions and their mortality reports are often recorded from southern regions such as Khuzestan and Hormozgan provinces.

    Conclusion: Due to the significant increase in the abundance of scorpions in Iran over the past 30 years, it is expected that this trend will continue by researchers, and the fauna of scorpions is regularly reconsidered.

  • XML | PDF | downloads: 179 | views: 339 | pages: 2154-2164

    Opiates are the second most prevalent abused illicit sub­stance after cannabis in the world. The latest United Nations Office on Drugs and Crime (UNODC) report estimated 30% increment in opium cultivation worldwide. High prevalence of opium consumption in eastern countries may be due to the high availability and traditional misconceptions. Opium consumption has been linked to hypertension, diabetes mellitus, dyslipidemia, and coronary artery diseases (CAD). In this review, we will review the association between opium use, cardiovascular diseases, and clinical outcomes. The present evidence suggests that chronic opiate consumption may increase the risk of cardiovascular diseases and related mortality.

  • XML | PDF | downloads: 128 | views: 216 | pages: 2165-2176

    Background: Urinary tract infection (UTI) is a major complication in patients who receive the kidney transplant. We aimed to evaluate the prevalence and antimicrobial resistance of bacterial uropathogens isolated from Iranian kidney transplant recipients.

    Methods: We searched according to Prisma protocol for UTI infection, prevalence, occurrence and distribution of bacteria and their pattern of antibiotic resistance among Iranian patients who receive kidney transplant through online electronic databases with MeSh terms and text words in published references in both Persian and English languages during 1990-2017. Data analysis was performed using Comprehensive meta-analysis software (CMA) by Cochrane Q and I2 Random Effects Model.

    Results: Eleven studies met the eligible inclusion criteria. The prevalence of UTI among kidney transplant patients varied from 11.7% to 67.5%. The combined prevalence of UTI was 32.6%. Among Gram-negative pathogens causing UTI, E. coli was the most dominant followed by Klebsiella pneumonia with prevalence 41.3% and 11.9%, respectively. Also, amongst Gram-positive bacteria, the highest prevalence belonged to Enterococcus spp. (9.8%) and coagulase-negative Staphylococci (9.4%). Also in Gram-negative pathogens, the most resistance was to ampicillin (91.2%), followed by ceftazidime (89.5%).  The minimum resistance was against imipenem with prevalence 14.3%.

    Conclusion: The combined prevalence of UTI was 32.6%. Gram-negative pathogens especially E. coli were the most agents of UTI in Iranian patients who receive kidney transplant. Also, in gram-negative pathogens, the most resistance was to ampicillin that it needs a new strategy for prophylaxis and treatment of UTI after the kidney transplant.

Original Article(s)

  • XML | PDF | downloads: 168 | views: 224 | pages: 2177-2186

    Background: We aimed to explore the significance of procalcitonin (PCT), C-reactive protein (CRP) and neutrophil ratio (N%) in the early diagnosis, treatment, and prognosis of severe acute pancreatitis (SAP).

    Methods: A total of 104 patients with SAP (SAP group) and 101 patients with mild acute pancreatitis (MAP) (MAP group) admitted to Affiliated Hospital of Jining Medical University, Jining, China were enrolled. The PCT and CRP in serum were detected by a full-automatic biochemical analyzer, and N% in peripheral blood was measured by a hemocyte analyzer.

    Results: The peripheral blood PCT, CRP, and N% in the SAP group were significantly higher than those in the MAP group (P<0.001). Multivariate Logistic regression analysis showed that acute physiology and chronic health evaluation II (APACHE II) score, Ranson score, PCT, CRP, and N% were independent risk factors for SAP. The receiver operating characteristic (ROC) curve showed that the area under curve (AUC) of PCT, CRP, and N% in diagnosing SAP were 0.906, 0.840, and 0.834 respectively, while that of combined detection was 0.972. The AUC of PCT, CRP, and N% in diagnosing SAP death were 0.907, 0.900, and 0.894, respectively.

    Conclusions: Peripheral blood PCT, CRP, and N% contribute to the diagnosis and prognosis of SAP.

  • XML | PDF | downloads: 202 | views: 296 | pages: 2187-2195

    Background: Climate change is an alarming challenge for humanity at large due to its mediating role in emergence and spread of infectious diseases like cholera and malaria. This study was conducted to examine the effect of climate change and some socio-economic factors on incidence of infectious diseases.

    Methods: We used country level panel data over the 1990-2017 period using panel ARDL-PMG technique on highly affected countries from climate change.

    Results: There is a long run co-integrating relationship among climate change, socio-economic factors and prevalence of infectious diseases. Climate change, as measured by the temperature, is contributing to the spread of infectious diseases.

    Conclusion: This is the first study giving evidence of the impact of climate change on incidence of infectious diseases as can be seen from highly vulnerable countries to climate change. It is recommended to improve the level of education along with public health and town planning to reduce the incidence of infectious diseases.

  • XML | PDF | downloads: 128 | views: 226 | pages: 2196-2204

    Background: We aimed to investigate the effect of PI3K/Akt signaling pathway on PRAS40Thr246 phosphorylation in gastric cancer cells.

    Methods: The study was conducted from April 2017 to January 2018 in Zhongshan Hospital, Xiamen University, Xiamen, China. Gastric cancer cells were divided into three groups: gastric cancer cell group, LY294002 group and MK-2206 group. Specific tests were conducted accordingly.  

    Results: Inhibition of PI3K/Akt signaling pathway activation and PRAS40Thr246 phosphorylation could inhibit proliferation and invasion and promote apoptosis of gastric cancer cells, and PRAS40Thr246 phosphorylation could activate PI3K/Akt signaling pathway.

    Conclusion: The levels of PI3K/Akt signaling pathway related proteins and p-PRAS40Thr246 were significantly increased in gastric cancer cells. p-PRAS40-Thr246 was able to reflect the activation of the PI3K/Akt signaling pathway, reflecting the sensitivity of the PI3K/AKT signaling pathway to inhibitors.

  • XML | PDF | downloads: 118 | views: 223 | pages: 2205-2209

    Background: The discourse of HIV and AIDS determinants is dominated and developed by international institutions through WHO, UNICEF, and donor institutions. We aimed to look at the discourse in the HIV and AIDS prevention discourse by the elite. This research was conducted in 2019 in Palu City, Central Sulawesi, Indonesia in Palu City, Central Sulawesi, Indonesia.

    Methods: We used qualitative research aiming to obtain a full picture of a matter according to the human perspective studied.

    Results: There was a pressure from various groups so that all people who have the potential to increase the HIV and AIDS trends must be dealt with explicitly, even religious leaders urged to immediately close down the main source of the disease, namely prostitution, LGBT activities that are considered very contrary to culture and any religion.

    Conclusion: The discourse in the HIV and AIDS prevention discourse in Palu city has not yet occurred in the discourse synergy developed by the elite, even the program policies are domination and hegemony.

  • XML | PDF | downloads: 116 | views: 187 | pages: 2210-2215

    Background: To identify serum nonylphenol (NP) and glucolipid metabolism-related proteins in Type 2 diabetes (T2D) patients.

    Methods: We performed a hospital-based, case-control study in patients admitted to the Department of Endocrinology, Hospital of Zunyi Medical University, Zunyi City, China from Mar to Nov of 2014. The study included 112 T2D cases diagnosed in accordance with the 2013 WHO Expert Committee Diabetes Diagnosing Criteria, and 125 healthy individuals with normal fasting blood glucose (FBG) when receiving physical examination in the same period in the Municipal Physical Examination Center. Blood samples from subjects in the 2 groups underwent detection of biochemical indices, including FBG, blood fat, and NP. Glucolipid metabolism-related proteins, including estrogen receptor (ER), sterol regulatory element-binding protein-1c (SREBP-1c), wingless-type MMTV integration site family member 5a (Wnt5a), and peroxisome proliferator-activated receptor-γ (PPAR­-γ). These indices were compared between the 2 groups to analyze the correlation between serum NP levels and glucolipid metabolic proteins.

    Results: The subjects in the diabetes group had higher triglycerides (TG), total cholesterol (TC), NP, ER, SREBP-1c, Wnt5a, FBG, and TG levels than the healthy group, but lower levels of low-density lipoprotein cholesterol (LDL-C) and PPAR­-γ than the healthy group. No significant differences in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were found between the two groups. The serum NP levels were shown to be positively correlated with SREBP-1c but negatively correlated with PPAR­-γ.

    Conclusion: The serum NP levels of T2D patients is higher than the levels in healthy controls, and its levels correlate with SREBP-1c and PPAR­-γ levels.

  • XML | PDF | downloads: 166 | views: 499 | pages: 2216-2223

    Background: The incidence and mortality from prostate cancer in most native Asian populations remain low although a gradual increase is observed over the last years.

    Methods: The statistical analysis of official data on prostate cancer mortality and morbidity was performed for the whole country and for Pavlodar Region.

    Results: The increase in the incidence of prostate cancer among the population of Kazakhstan is observed, which may be attributed to the introduction of screening program based on serum PSA. Still, the crude incidence rates in Kazakhstan are below world indices. Over the last few years, the decreasing prostate cancer mortality is observed that might be influenced by early diagnosis. The age-standardized incidence rates show that the majority of prostate cancer cases occur in advanced ages (70 years and older).

    Conclusion: More research is needed to determine the risk factors for prostate cancer, as well as ethnic and geographical trends for the population of Kazakhstan.

  • XML | PDF | downloads: 138 | views: 227 | pages: 2224-2231

    Background: A number of anthropometric indices have been used in different world populations as markers to estimate obesity and its related health risks. The present study is large population based study dealing with five anthropometric obesity scales; Body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), basal adiposity index (BAI), and Visceral adiposity index (VAI) to identify common adiposity trait(s) that best predict obesity and associated health complication(s).

    Methods: A total of 4000 subjects including 1000 in each category of BMI from four provinces (Punjab, Sindh, Kahyber pakhtoonkha and Balochistan) of Pakistan from 2012-2017 were collected. Complete anthropometric measurementswere obtained and blood samples were collected and Biochemical profiling was performed. Descriptive statistics, linear regression, binary and multiple regression analysis was done.

    Results: Our data analysis explored the relationships of obesity five indices; BMI, WC, WHR, BAI, and VAI with common metabolic health complications. Effect size analysis clearly indicates that a unit increase in BMI significant raised all anthropometric and clinical parameters. General and sex specific association analysis of adiposity traits with risk phenotypes (hypertension, hyperglycemia and dyslipidemia) indicated significant associations of WC with all three metabolic risks. Varying degrees of correlations of other adiposity traits with metabolic risks were observed. Frequency of different obesity classes among obese population group were as follows; 55.7% class I, 28.50% Class II and 15.80% Class III.

    Conclusion: WC is the strong predictor of obesity associated metabolic health issues in Pakistani populations. While BMI has significant increasing effect on other obesity indices like WHR, VAI and BAI.

  • XML | PDF | downloads: 192 | views: 279 | pages: 2232-2239

    Background: We aimed to investigate the cystic echinococcosis (CE) epidemiology in Karaman Province from 2010 to 2017 using data from the provincial state hospital.

    Methods: Overall, 482 cases were determined from Karaman State Hospital, Karaman Province, Turkey from 2010 to 2017. Records were investigated in terms of year, gender, age, cyst location, rural and urban households and duration of hospital stay.

    Results: The CE incidence was 22.40 per 100 000 people after final diagnosis with focused abdominal ultrasound. Totally, 482 people including 166 (34.4%) male and 316 (65.6%) female were with CE. The mean age of patients was 50.3±17.48 yr. More CE cases were reported in the age group of 51-60 yr than in the other age groups. CE was mostly seen in liver (470, 97.5%). Moreover, 28.4% of patients were resided in rural areas. The observed frequencies of demographic features of female gender, infected liver, residence in provincial centers, referral to general surgery policlinic and no hospitalization were significantly higher than expected frequencies (P<0.05). Sixty (12.4%) patients with CE had been hospitalized. There was a statistically significant positive relationship between age of hospitalized patients and duration of hospitalization (P<0.05). Of the patients 73.2% were admitted to general surgery.

    Conclusion: CE is of great importance to public health considerations in the Karaman Province and we advocate the implementation of eradication programs to decrease the CE cases number.

  • XML | PDF | downloads: 129 | views: 251 | pages: 2240-2248

    Background: Accurate estimation of active general practitioners (GPs) is a concern for health authorities to estimate requirements. This study aimed to accurately estimate GPs active supply in Iran using three sources capture-recapture (CRC) method.

    Methods: This cross-sectional study collected data during 2015-2016, targeting all GPs registered in three independent data sources; a national survey from all hospitals, database of human resource management office at health ministry and physicians' offices databank. Variables including medical council codes, GP names, surnames and national ID codes were used for data linkage among the three sources. Three sources CRC method was applied using log-linear models to estimate the total number of active GPs in STATA software.

    Results: Overall, 27,048 GPs were identified after removing the duplicate records. Based on CRC three sources data, the total number of GPs were 53,630 in 2015-2016. Distribution of GPs per 1,000 population among the provinces indicates that provinces of Kohgiluyeh & Boyer Ahmad, Mazandaran, Golestan and Yazd with ratios of 1.28, 1.28, 1.21 and 1.17 physicians rank the highest proportion of GPs and the provinces of Sistan & Baluchestan, Ilam, Zanjan, Alborz, North Khorasan with corresponding ratios of 0.24, 0.40, 0.40, 0.43 and 0.45 GPs ranked the lowest.

    Conclusion: CRC method is known to be the best and rapidest method to estimate active GP due to its compatibility for the current situation of databanks in Iran. Therefore, this method is a good application in human resource distribution and planning.

  • XML | PDF | downloads: 108 | views: 214 | pages: 2249-2259

    Background: Breast cancer is the first non-cutaneous malignancy in women and the second cause of death due to cancer all over the world. There are situations where researchers are interested in dynamic prediction of survival of patients where traditional models might fail to achieve this goal. We aimed to use a dynamic prediction model in analyzing survival of breast cancer patients.

    Methods:  We used a data set originates from a retrospective cohort (registry-based) study conducted in 2014 in Tehran, Iran, information of 550 patients were available analyzed. A method of landmarking was utilized for dynamic prediction of survival of the patients. The criteria of time-dependent area under the curve and prediction error curve were used to evaluate the performance of the model.

    Results: An index of risk score (prognostic index) was calculated according to the available covariates based on Cox proportional hazards. Therefore, hazard of dying for a high-risk patient with breast cancer within the next five years was 2.69 to 3.04 times of that for a low-risk patient. The value of the dynamic C-index was 0.89 using prognostic index as covariate.

    Conclusion: Generally, the landmark model showed promising performance in predicting survival or probability of dying for breast cancer patients in this study in a predefined window. Therefore, this model can be used in other studies as a useful model for investigating the survival of breast cancer patients.

  • XML | PDF | downloads: 103 | views: 182 | pages: 2260-2269

    Background: The goal of this study was to determine hazard rate of death rate and the causes of death in Iranian patients with Traumatic spinal cord injury (TSCI).

    Methods: Overall, 1024 patients with chronic traumatic spinal cord injury referred to Brain and Spinal Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran from Jan 2013-2017 were enrolled. Epidemiological and neurological data, along with secondary complications were recorded for all participants. In the case of death, the cause, and the date of death were recorded. The Kaplan–Meier method was used for survival analysis. A log-rank test was carried out to compare survival due to different risk factors. Risk factors and relative risk estimates associated with death were assessed by means of a Cox regression model.

    Results: Nineteen percent were lost to follow up. During the follow-up period, 22 out of 830 remaining cases (2.6%) died. Deaths were only observed in patients with cervical injuries (59% in C1-C4 level and 41% in C5-C7 level). Kaplan–Meier Log-rank test showed that probability of survival was significantly less in females, complete injury cases, patients with cervical spine injury, depression, and ADR (Autonomic dysreflexia). Controlling for age, sex and education level, Cox regression model showed that hazard rate of death was significantly affected by the categorical variables such as level of injury (HR=0.2, 95% CI=0.12-0.39), severe ADR.

    Conclusion: Probability of survival is lower in female individuals, cases with complete injuries, patients with cervical spine injury, individuals wi-th depression (BDI>10), and clients who experience ADR.

  • XML | PDF | downloads: 114 | views: 221 | pages: 2270-2276

    Background: Asymptomatic nasal colonization of Methicillin-Resistant Staphylococcus aureus is common in Multiple Sclerosis patients. SCCmec types I to III are mainly attributed to HA-MRSA strains whereas SCCmec types IV and V have commonly been reported in CA-MRSA infections. Here, we assessed the frequency of nasal carriage of MRSA in MS patients. This study aimed to evaluate MRSA SCCmec typing in MS nasal carriage.

    Methods: A cross-sectional descriptive study was conducted from Feb and Jun 2017 in MS Research Center, Tehran University of Medical Sciences (TUMS), Iran. Overall, 620 nasal swabs were collected (325 from MS patients and 295 from control group). Antimicrobial susceptibility test was performed using the disk diffusion and E-test method. Presence of mecA gene was confirmed by PCR assay and multiplex PCR was performed for SCCmec typing of MRSA isolates.

    Results: The frequency of MRSA among the MS patients and control group was almost equal (9.2% and 10.1%, respectively). SCCmec typing detected only types III, IV and V in both groups and type IV was the most predominant type in MS patients and control group. SCCmec type III was more prevalent in control group than MS patients (40% vs. 20%). Moreover, the frequency of SCCmec type V in MS patients was significantly higher than control group (36.7% vs. 3.3%).

    Conclusion: Although most MRSA isolates were collected from inpatients, interestingly there is a high frequency of SCCmec types IV and V in MS group. Moreover, MRSA isolates were not resistant to more antibiotics in SCCmec type III than types IV-V.

  • XML | PDF | downloads: 175 | views: 306 | pages: 2277-2284

    Background: Sex is one of the major social classes in any society. Gender identity as the most fundamental element of human life from beginning to end. While most people with behavior and attitudes appropriate to their physiological gender, but among them are also those sexual behaviors with their physical sex does not match, that say to this group transsexual people. The aim of this study was to investigate happiness and mental health in transsexual individuals before surgery and after surgery.

    Methods: This quasi-experimental study, consisted of 42 patients before surgery and after surgery inside Iran in 2016-2017. Snowball sampling method was selected. The instrument was Oxford Happiness Questionnaire (OHQ) and Symptom Check List (SCL25). Data were analyzed using SPSS, t-test independent groups and one-way ANOVA.

    Results: There was significant difference between transsexual individuals before surgery and after surgery in mean score of happiness (P<0.01) (t=-4/84). Moreover, there was significant difference between the two groups in mean score of mental health (P<0.01) (f=19/13).

    Conclusion: Transsexual individuals after surgery experienced more happiness and mental health than those before surgery.

Short Communication(s)

  • XML | PDF | downloads: 141 | views: 232 | pages: 2285-2292

    Background: The aims of the current study were to determined present status of CL in Shiraz City, identify the causative species of Leishmania and conduct phylogenetic evaluations in detected parasites

    Methods: This study was conducted on 70 individuals with suspected CL that referred to the major health centers of Shiraz (Valfajr), Fars province, Iran, from Sep 2016 to Jul 2017. DNA was extracted from cultured Leishmania promastigotes and PCR-RFLP were performed using ITS1-rDNA gene.

    Results: Overall, 39 male (55.70%) and 31 (44.30%) female were found to be positive microscopically. All of direct examined positive samples were confirmed to be positive for Leishmania spp. DNA. Based upon the PCR-RFLP patterns and phylogenetic analysis, 46 (65.72%), 17 (24.28%) and 7 (10%) isolates were clearly identified as L. major, L. tropica and C. fasciculata, respectively.

    Conclusion: The dominat detected species in Shiraz City was L. major and L. tropica, respectively. CL has high prevalence in Shiraz City; therefore, more studies on leishmaniasis in the natural vectors and also reservoirs infection in this region is exceedingly recommended. Skin leisons due to C. fasciculata, was described for the first time in Iran (Shiraz City).

Letter to the Editor