Relationship between smoking and tuberculosis recurrence: A systematic review and meta-analysis.

INTRODUCTION: Of the problems in tuberculosis (TB) control program is the recurrence of this disease. In some studies, smoking has been reported as the most important risk factor. Therefore, the present study aimed at examining the association between smoking and tuberculosis recurrence using meta-analysis. METHODS: To report the findings of this meta-analysis, we used PRISMA. The protocol of this study has been recorded in PROSPERO. The research question has been formulated based on PICO, and the search was performed using both MeSH and non-MeSH keywords. After screening and selecting the articles and evaluating their quality using the NOS checklist, the overall estimate of the odds ratio of tuberculosis recurrence in smokers was assessed with a 95% confidence interval. RESULTS: Fourteen studies met the inclusion criteria. The total number of samples in the group of patients with tuberculosis recurrence was 1988 with 855 (43%) smokers, and in the group of patients affected by tuberculosis without recurrence, it was 27,226 with 7503 (27.56%) smokers. In 13 studies, the odds ratio of tuberculosis recurrence was higher in smokers; this difference was statistically significant in 12 of them. Combining the results of these 14 studies, the odds ratio of tuberculosis recurrence in smokers was 2.10 times higher, using the random effects model (95% CI:1.69, 2.61). CONCLUSION: Based on the results of study present, smoking increases the risk of tuberculosis recurrence. Therefore, to eradicate tuberculosis by 2030, more serious interventions should be taken to quit smoking, which in turn reduces the incidence of tuberculosis.

Comparing Vitamin D Level Between Patients with Psoriasis and Healthy Individuals: A Systematic Review and Meta-Analysis.

BACKGROUND: Psoriasis is nowadays regarded as a systemic inflammatory disorder. Among the topicals, vitamin D derivates are often applied on the skin for their anti-inflammatory and immune-modulatory properties. Vitamin D serum levels in psoriasis (PsO) patients are still debated and an eventual depletion may offer the rational to integrate anti-psoriatic therapies with oral vitamin D. Then, we aimed to perform a systematic review and meta-analysis on the current evidence towards serum vitamin D level in PsO. METHODS: We searched in PubMed, Scopus, Web of Sciences, ScienceDirect and Science Information Database (SID) using the terms "Vitamin D" and "Psoriasis" including manuscripts in English, Italian and Persian. Duplications were excluded using EndNote software and records were screened by title, abstract and full-text. Quality assessment of studies was assessed using Newcastle Ottawa Checklist (NOS). Psoriasis odds ratio (OR) and mean serum vitamin D levels were calculated and displayed in Forest-plots. Heterogeneity indexes were evaluated using I2 and Q. Sensitivity analysis and publication biases were also considered. RESULTS: From 3006 records extracted, after removing duplicates and analyzing full texts we finally included 19 manuscripts involving a total of 1387 PsO cases and 6939 controls. PsO patients exhibited a substantial odds ratio (3.07, 95% CI: 1.56-6.04) for lower serum vitamin D levels compared to the control group. Standardized Mean Difference (SMD) of vitamin D in PsO versus controls was -0.92 (-1.33 to -0.51). CONCLUSION: Psoriatic patients displayed higher risk to have a vitamin D deficiency. Interventional studies to verify the preventive value are mandatory.

Evaluating patients' choice of general and spinal anesthesia for elective cesarean section and associated factors: a descriptive study.

During an elective cesarean section, the choice of method of anesthesia is critical for maternal and fetal outcomes. However, the anesthesiologist's decision is dependent on the patient's desire. This study aimed to determine the choice of general and spinal anesthesia among women undergoing elective cesarean sections and the factors affecting their choice. Methods: In this descriptive study, pregnant women who had the ability to undergo both spinal and general anesthesia were referred to public and private hospitals in (Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences). A questionnaire recorded the patient's demographic data, education and occupation, history of anesthesia, choice of anesthetic method, and reason for selection. Results: A total of 384 women were included in the study, of whom 60% selected general anesthesia and 40% selected spinal anesthesia. Among the reasons for not choosing spinal anesthesia, most common were fear of injury to the spinal cord (64.3%) and fear of seeing and hearing during the surgery (53.3%), and among the reasons for not choosing general anesthesia, most common were fear of not waking (54.3%) and a desire to be alert at the time of infant birth (40.7%). Most of the women with a history of spinal anesthesia selected spinal anesthesia (53%), and 62% of those without a history of spinal anesthesia selected general anesthesia. Factors such as age, nonmedical staff advice, and being employed were significantly correlated with the choice of anesthesia (P<0.005). Conclusion: The rate of general anesthesia selection was higher than spinal anesthesia. More attention and efforts are required to educate patients regarding the method of anesthesia prior to the surgery.

Association between blood pressure and parameters related to sleep disorders in Tabari cohort population.

BACKGROUND: Insomnia and other sleep disorders can cause an increase in blood pressure, thereby resulting in premature death. Regarding this, the present study was conducted to investigate the relationship between hypertension and parameters related to sleep disorders in Tabari cohort population. METHODS: In this cross-sectional study, the data from the enrollment phase of the Tabari cohort study were adopted. Tabari cohort is a part of the PERSIAN (Prospective Epidemiological Research Studies in Iran) cohort study. Data analysis was performed using descriptive and inferential statistics. RESULTS: Out of 10,255 patients enrolled in the Tabari cohort, 2,281 patients (22.2%) had hypertension. According to the results of univariable logistic regression test, the odds ratio of high blood pressure in patients with insomnia and hypersomnia is 1.22 (95% confidence interval [CI], 1.06-1.40) and 1.22 (95% CI, 1.01-1.47) times higher than normal sleep. This odds ratio was not significant after adjusting the effect of sex, age, body mass index, waist circumference, area residence, high-density lipoprotein cholesterol, triglyceride, and total cholesterol variables with multivariable logistic regression. Frequency of routine hypnotic medication usage (14.6% vs. 5.7%, P < 0.001), involuntary napping (25.3% vs. 19%, P < 0.001), and leg restlessness during sleep (14.8% vs. 11.7%, P < 0.001) was higher in hypertensive individuals than in nonhypertensive cases. CONCLUSIONS: This study showed that sleep disorders prevalence are higher in hypertensive patients than nonhypertensive patients. Also, routine use of hypnotics was significantly higher medication in patients with hypertension compared to that in the nonhypertensive patients.

Atazanavir versus lopinavir on Covid-19 infection: A retrospective protease inhibitors comparative study 2020.

Background: Evaluation of protease inhibitors (PIs) is important in terms of prescribing an effective regimen for reducing mortality and hospitalization in Covid-19. Therefore, follow-up of patients better determines the characteristics of existing regimens. Methods: We retrospectively evaluated the demographic, co-morbidities, gastrointestinal (GI) and liver complications of patients at two teaching hospitals from the first of March to the end of July 2020. All patients received one of two recommended regimens including hydroxychloroquine (HCQ) (400 mg BD on the first day and then 200 mg BD) plus atazanavir/ritonavir (ATV) (300/100 mg daily) or HCQ with the same dose plus lopinavir/ritonavir (Kaletra) (400/100 mg BD) for 5-7 days. Results: We chose 170 cases that received 2 different regimens. In group one, 85(57.6% males) patients received Kaletra and HCQ and group two, 85 (55.3% males) patients received ATV and HCQ. The study of hospitalization in both groups showed no difference in more or less than 5 days hospitalization. (P=0.757) Comparison of mortality rates has not shown a significant difference including 19 (22.4%) deaths in group 1 and 15(17.6%) deaths in group 2 (P=0.443). Nausea followed by diarrhea was the most common side effects in group 1. But no side effects were reported in group 2 (P=0.000). Abnormal liver function tests (LFTs) were seen in both groups. Conclusion: Comparison of hospitalization and mortality were not statistically significant. It seems that a respect to similar effect on mortality and hospitalization. ATV regimen is superior to Kaletra especially for better GI tolerance and less daily pills.

Positive versus negative pressure during removal of endotracheal-tube on prevention of post-extubation atelectasis in ventilated neonates: A randomized controlled trial.

Background: Post-extubation-atelectasis (PEA) is a common problem after the removal of an endotracheal tube in neonates which increases the rate of extubation failure. Different techniques have been introduced for the prevention of PEA. One technique is the removal of the endotracheal tube by negative or positive gradients of pressure. No RCT has yet been done to compare the use of these two methods in neonates. So this study aimed to compare the role of positive and negative pressure during extubation of neonates on the prevention of PEA. Materials and methods: We enrolled 100 newborns in this RCT that required at least 24 h of mechanical ventilation. The endotracheal tube in one group was removed by a T-Piece resuscitator at a PEEP level of 5 CmH2o while in another group extubation was done applying suction pressure of 100 mmHg by random selection. Prevalence of PEA in CXRs after extubation was compared between the two groups. Results: The prevalence of PEA in the extubation of the positive pressure group (24%) was significantly lower than that of the negative pressure group (46%) (p = 0.024). Extubation failure was found to be lower in the positive pressure group (6% versus 20% P = 0.037). No significant difference was observed between the two groups in the prevalence of apnea, pneumothorax, and death at 3 days after extubation. Conclusion: The use of positive pressure during removal of the endotracheal tube in newborn infants reduced the rate of PEA compared with the negative pressure so extubation by a positive pressure is recommended in neonates.

Comparative evaluation of ultrasonography and lateral radiography in nasal fractures diagnosis.

BACKGROUND: Nasal fractures are the most common type of trauma fracture. Conventional radiography is the primary method of choice. Ultrasonography is used as a new and non-invasive method for this purpose. The aim of this study is to compare the diagnostic values of ultrasonography with nasal X-ray. METHODS: This was a prospective study which was conducted during 2018-2019 at Bouali hospital, Sari, northern Iran. 130 patients who met our criteria enrolled our study. All patients underwent nasal X-ray and ultrasonography on a day of trauma. The physical examination during the reduction in operation room considered as gold standard for nasal bone fracture. The sensitivity, specificity, precision, positive predictive values, and negative predictive values, along with 95% confidence intervals, were determined by SPSS. RESULTS: The sensitivity, specificity, positive predictive values, negative predictive values, and precision of nasal X-ray were all reported to be 100% when compared to physical examination (the gold standard). Ultrasonography had a sensitivity of 78.13%, a specificity of 100%, a PPV of 100%, an NPV of 61.82%, and a precision of 83.85% in comparison to physical examination (the gold standard). CONCLUSION: The findings of this study suggest that ultrasonography can be utilized as a main diagnostic tool in the identification of nasal bone fractures in the vast majority of cases, avoiding the unwanted dangers and problems of X-rays. This is especially critical for expecting mothers and children.

Obtaining informed consent from patients hospitalized in the surgical wards as a major legal challenge.

BACKGROUND AND OBJECTIVES: Informed consent (IC) is the process of establishing communication between the physician and the patient or an alternative decision that leads to the agreement or rejection of the patient and/or their legal representative to perform specific medical procedures. In this study, we evaluated the level of awareness and patient participation in IC in the surgical wards of the general hospital in northern Iran in the 2019-2020 years. PATIENTS AND METHODS: This study is cross-sectional research that was performed during the 2019-2020 years. The statistical population includes patients admitted to the surgical wards of the general hospital in northern Iran in 2019-2020. The Cochran's formula was used to determine the sample size and the statistical sample size was 385 patients. The sampling method is stratified random. The method of data collection was through questionnaire tools. The software used was SPSS 21 with an independent t-test and one-way ANOVA. RESULTS: Our data showed that the frequency of men was significantly higher (P < 0.001). Individuals with a higher education group have a significantly higher level of awareness (P < 0.001). The Pearson's Correlation (PC) test showed that there was no significant correlation between age and patients' awareness score (PC = -0.007, P = 0.887). CONCLUSION: The current study showed that individuals with higher education had a significantly higher level of awareness, and there was no significant correlation between age and patients' awareness score. Therefore, senior university administrators are suggested to improve IC processes in accordance with the patients' rights charter and internationally accredited standards, and assist health care providers with legal implications in the courts.

The Effect of Oral Simvastatin on the Clinical Outcome of Patients with Severe Traumatic Brain Injury: A Randomized Clinical Trial.

Background: Despite recent promising pharmacological and technological advances in neurosurgical intensive care, the overall TBI-related mortality and morbidity remain high and still pose a major clinical problem. The aim of this study was to evaluate the effect of oral simvastatin on the clinical outcome of patients with severe TBI. Methods: In a double-blind placebo-controlled randomized clinical trial a total of 98 patients with severe TBI in Imam Khomeini Hospital in Sari, Iran, were evaluated. Patients who meet the inclusion criteria were randomly allocated into two groups (n=49). In addition to supportive therapies, the intervention group received oral simvastatin (40 mg, daily) for 10 days, and the control group received the placebo (10 days). Patients' Glasgow coma scale (GCS) score, in hospital mortality, duration of mechanical ventilation and length of ICU and neurosurgery ward stay were evaluated during three-time intervals (T1: admission, T2: discharge and T3: one month after discharge). Results: The percentage of conscious patients was 18.9% (7 cases) in the simvastatin group and 3.1% (1 case) in controls (P=0.06) at T2. One month after discharge (T3) the proportion of conscious patients significantly increased in the simvastatin group compared to control group (64.9 % versus 28.1 %; P=0.002). There was no significant difference for the mean of GCS score between the simvastatin group and control group at T1 (6.41 ± 1.30 versus 6.41 ± 1.28, respectively; P = 0.98). However, the mean score of GCS in patients who received simvastatin was significantly greater than controls at T2 and T3 (p<0.05). There was no significant differences between two group in-terms of length of mechanical ventilation, ICU and neurosurgery ward stay. Conclusion: According to the results of this study it seems that using simvastatin may be an effective and promising therapeutic modality for improving GCS score during TBI recovery.

Evaluation of sleep quality and duration in pregnancy and risk of gestational diabetes mellitus: A prospective follow-up study.

BACKGROUND AND OBJECTIVES: Sleep disorders during pregnancy may be linked an increase risk of adverse pregnancy outcomes. This study aimed to evaluate the relationship between sleep quality and duration in pregnancy and risk of gestational diabetes mellitus (GDM). MATERIALS AND METHODS: This prospective follow-up study was performed on 240 pregnant women with a gestational age between 20 to 24 weeks, who were referred to Imam Khomeini Hospital in Sari from 2018 to 2019 for prenatal care. The sleep quality of all eligible women were evaluated with the Pittsburgh Sleep Quality Index (PSQI). During the 26 to 28 weeks of gestation, 1-hour and 2-hour oral glucose tolerance test (OGTT) was done for all women. RESULTS: The results showed that women with poor sleep quality had a significantly higher mean BMI and 1-hour and 2-hour OGTT results (P < 0.05). Compared to women with good sleep quality, women with poor sleep quality (PSQI >5) had a greater risk of developing GDM (OR = 2.99, 95% CI 1.77 to 5.06). In women with sleep duration of less than 7 and more than 9 hours, the frequency of GDM was significantly higher than women with the 7-9 hour sleep duration (P < 0.05). Also, the frequency of GDM in women with three or more than three times of snoring in a week (63.44%) was significantly higher than women with once a week (30.61%) (P-value <0.001). CONCLUSION: It seems that sleep disorders and poor sleep quality can be a risk factor in developing GDM. Therefore, sleep characteristics should be considered in pregnancy care; especially in women with higher risk of GDM.

Investigating the relationship between carotid intima-media thickness, flow-mediated dilatation in brachial artery and nuclear heart scan in patients with rheumatoid arthritis for evaluation of asymptomatic cardiac ischemia and atherosclerotic changes.

BACKGROUND: Cardiovascular disease is the most common cause of death worldwide. In order to prevent and treat heart diseases, we need to estimate the trend of non-cardiac diseases with the cardiovascular system. Arthritis Rheumatoid is a chronic immune/inflammatory process which leads to subclinical atherosclerosis and increases cardiovascular disease. We examined the patients who referred to our nuclear medicine center for MPI and correlated their findings with flow-mediated dilatation (FMD) of the brachial artery and carotid intima-media thickness (CIMT) in arthritis rheumatoid patients. MATERIAL AND METHODS: A total 30 known cases with arthritis rheumatoid were referred to our department for MPI and the single-photon emission computed tomography (SPECT) imaging were visually and quantitatively evaluated by two nuclear medicine physicians and the correlation of the measured FMD and CIMT were evaluated and compared with ultrasonography data. Demographic information such as gender, age and sex and medical history (risk factors, cardiovascular sign and symptoms, lab findings, medication etc…) were recorded in questionnaire sheets and were analyzed by SPSS.20. Chi-square and student t-test were used for further analysis. RESULTS: The mean CIMT (R = 0.452 ± 0.07, L = 0.447 ± 0.08) and %FMD (R = 7.22 ± 8.66, L = 6.42 ± 11.88) were measured for all subjects. Age was the only parameter correlated with both right and left CIMT (P = 0.033 and P = 0.024, respectively). Among the patients, 26.7% had mild ischemia (SSS < 8) and 3 of them suffered from active arthritis rheumatoid. All patients with RA showed normal ventricular ejection fraction and normal volumes and among them, 93.3% had normal functional performance (normal wall motion…). Moreover, the mean CIMT and %FMD were not significantly different in ischemic and non-ischemic patients. Among ischemic patients, just the course of the disease was associated with CIMT and none of the parameters was correlated with FMD. CONCLUSIONS: There is no significant statistical difference between ischemic and non-ischemic patients and also the functional performance with values of CIMT and FMD. Among all populations, the parameter of age, and in ischemic group, the course of disease were found as the only variable correlated with CIMT.

Enrolment Phase Results of the Tabari Cohort Study: Comparing Family History, Lipids and Anthropometric Profiles Among Diabetic Patients.

OBJECTIVES: Different factors are responsible for the silent epidemic of diabetes mellitus in developing and developed countries. This study aimed to determine the role of demographic factors, lipid profile, family history (the estimation of genetic association) and anthropometric factors on diabetes onset. METHODS: Data from the enrolment phase of the Tabari Cohort study was applied for this study and included 10,255 participants aged between 35-70 years. Anthropometric variables were measured by trained staff using standard tools. Blood specimens were collected for lipid profile and blood glucose measurements. Data analyses were performed using SPSS version 24, with univariate and multivariate logistic regression. RESULTS: The prevalence of diabetes mellitus was estimated to be 17.2% in the cohort population, 15.6% in men, and 18.3% in women. The adjusted odds ratios (95% confidence intervals) for age groups 40-49, 50-59 and over 60 were 2.58 (2.20-3.69), 5.80 (4.51-7.48) and 8.72 (6.67-11.39), respectively. In addition, the odds ratios (95% confidence intervals) for 2 (or more), and 1 affected family member were 4.12 (3.55-4.90) and 2.34 (2.07-2.65), respectively. Triglyceride concentrations more than 500, and abnormal high-density lipoprotein levels increased the odds of diabetes mellitus by 3.29- and 1.18-fold, respectively. CONCLUSION: The current study showed that old age and a family history were strong predictors for diabetes mellitus.

The Effect of Adding Low-Dose Naloxone to Intrathecal Morphine on Postoperative Pain and Morphine Related Side Effects after Cesarean Section: A Double-Blind, Randomized, Clinical Trial.

BACKGROUND: Nowadays, spinal anaesthesia is a suitable choice for most elective and emergency cesarean section (C-section) deliveries. AIM: This study aimed to determine the effect of adding low-dose naloxone to intrathecal morphine on postoperative pain and morphine related side effects after C-section. MATERIAL AND METHODS: In the present double-blind, randomised clinical trial, 70 women aged over 18 years, who were candidates for elective medical C-section under spinal anaesthesia were selected and randomly assigned to either the study group or the control group. For spinal anaesthesia, 10 mg of Bupivacaine plus 100 µg of morphine was administered for all patients. However, patients in the study group received 20 µg of naloxone intrathecally; but the patients in the control group only received normal saline as a placebo. After surgery, patient-controlled analgesia (PCA) pump with paracetamol (Apotel®) was connected to each patient. The intensity of postoperative pain in the patients was evaluated and recorded using Visual Acuity Screening (VAS) at 2, 4, 6 and 24 hours after the surgery. The patients were also examined for postoperative nausea and pruritus. RESULTS: Regardless of the groups to which the patients were assigned, a significant difference in pain intensity was observed during the study period (time effect; p < 0.001). Although the intensity of pain was lower in the study group, the difference was not statistically significant (group effect; p = 0.84). Also, there was no group time interaction between pain intensity and the times studied (p = 0.61). The incidence rates of postoperative nausea and pruritus were significantly lower in the study group compared to the control group (p < 0.001). CONCLUSION: According to the results of this study, adding low dose naloxone to intrathecal morphine did not significantly change postoperative pain intensity in the patients undergone elective C-section using spinal anaesthesia; however, significantly decreased the severity of postoperative nausea and pruritus.

Comparing Hemodynamic Responses to Diazepam, Propofol and Etomidate During Anesthesia Induction in Patients with Left Ventricular Dysfunction Undergoing Coronary Artery Bypass Graft Surgery: a Double-blind, Randomized Clinical Trial.

BACKGROUND: Anesthesia induction is often accompanied by a period of hemodynamic instability, which could be deleterious in patients with coronary artery disease (CAD) and left ventricular dysfunction undergoing coronary artery bypass graft (CABG) surgery. The aim of this study was to compare the hemodynamic responses to propofol, etomidate, and diazepam following anesthesia induction, laryngoscopy and intubation in CABG surgery patients with low ejection fraction (EF). METHODS: A double-blind randomized, clinical study was performed on 150 patients with CAD and left ventricular dysfunction (EF≤35%) scheduled for elective CABG surgery with Cardiopulmonary bypass (CPB). Patients were randomly allocated to three groups A, B, and C. These patients received propofol, etomidate or diazepam at induction of anesthesia, respectively. Hemodynamic variables (systolic and diastolic blood pressure [SBP, DBP], mean arterial pressure [MAP] and heart rate [HR]) were measured and recorded at baseline, immediately before laryngoscopy and tracheal intubation and one and three minutes after intubation. RESULT: One minute after induction and before laryngoscopy, there was a statistically significant decrease from the baseline in SBP, DBP and MAP in all three groups, but these variables in each hemodynamic parameters in diazepam group were less than other two groups (p<0.001). Moreover, the mean HR decreased in patients receiving propofol and etomidate one minute after induction and before laryngoscopy, but did not decreased in the diazepam group (p=0.005). CONCLUSION: The present study showed that in patients undergoing CABG surgery with low EF, diazepam is more favorable in terms of hemodynamic stability compared to propofol and etomidate and this drug can be used safely for induction of anesthesia in patients with impaired ventricular function.

Bolus administration of intravenous lidocaine reduces pain after an elective caesarean section: Findings from a randomised, double-blind, placebo-controlled trial.

We conducted a randomised double-blind, placebo-controlled trial to assess whether a bolus dose of lidocaine during the induction of general anaesthesia would reduce postoperative pain over 24 h. Level of satisfaction with pain control at 48 h after surgery and Apgar score were also examined. A total of 100 women aged 20-35 years, who were candidates for elective caesarean section (CS) were randomised to receive either 1.5 mg/kg lidocaine or placebo during the induction of general anaesthesia. Results showed that lidocaine decreased pain intensity over 24 h after surgery (p < .001), and decreased postoperative morphine consumption from median (range) of 3.79 (0-9) mg in the placebo group to 0 (0-12) mg and in the lidocaine group (p <.001). Lidocaine was not associated with postoperative nausea and vomiting or any side effects in women and newborn babies. We conclude that a small bolus dose of lidocaine attenuates postoperative pain, thus reducing the requirement for opioid consumption in the postoperative period. Impact statement • With its anti-inflammatory, anti-hyperalgesic and analgesic properties, intravenous perioperative lidocaine infusion (IVLI) has been used for optimal postoperative care in different surgeries. Limited evidence suggests that IVLI may be a useful adjuvant during general anaesthesia. There is a report of a positive effect on several outcomes after surgery including postoperative pain over 24 h after laparoscopic abdominal surgery or open abdominal surgery. However, there was a paucity of information regarding the efficacy of a bolus dose of lidocaine in patients undergoing caesarean section (CS). In this randomized, placebo-controlled trial the use of a bolus dose of 1.5 mg/kg lidocaine 2%, compared with placebo, during the induction of general anaesthesia for elective CS resulted in a significant decrease in postoperative pain score as well as decreased postoperative morphine consumption over 24 h. Lidocaine use was not associated with any side effect in participants and newborns. • This study provides the first evidence that a bolus dose of lidocaine may be a safe and simple alternative therapeutic intervention for enhanced postoperative recovery in terms of pain and postoperative opioid consumption. Future studies are needed to examine pain reducing effect of perioperative bolus dose of lidocaine after CS under spinal or epidural anesthesia.

Study of Scientific Production of Community Medicines' Department Indexed in ISI Citation Databases.

BACKGROUND: In the scientometric, the main criterion in determining the scientific position and ranking of the scientific centers, particularly the universities, is the rate of scientific production and innovation, and in all participations in the global scientific development. One of the subjects more involved in repeatedly dealt with science and technology and effective on the improvement of health is medical science fields. In this research using scientometric and citation analysis, we studied the rate of scientific productions in the field of community medicine, which is the numbers of articles published and indexed in ISI database from 2000 to 2010. METHODS: This study is scientometric using the survey and analytical citation. The study samples included all of the articles in the ISI database from 2000 to 2010. For the data collection, the advance method of searching was used at the ISI database. The ISI analyses software and descriptive statistics were used for data analysis. RESULTS: Results showed that among the five top universities in producing documents, Tehran University of Medical Sciences with 88 (22.22%) documents are allocated to the first rank of scientific products. M. Askarian with 36 (90/9%) published documents; most of the scientific outputs in Community medicine, in the international arena is the most active author in this field. In collaboration with other writers, Iranian departments of Community Medicine with 27 published articles have the greatest participation with scholars of English authors. In the process of scientific outputs, the results showed that the scientific process was in its lowest in the years 2000 to 2004, and while the department of Community medicine in 2009 allocated most of the production process to itself. Iranian Journal of Public Health and Saudi Medical Journal each of them had 16 articles which had most participation rate in the publishing of community medicine's department. On the type of carrier, community medicine's department by presentation of 340(85.86%) articles had presented most of their scientific productions in the format of article, also in the field of community medicine outputs, article entitled: "Iron loading and erythrophagocytosis increase ferroportin 1 (FPN1) expression in J774 macrophages"(1) with 81 citations ranked first in cited articles. Subject areas of occupational health with 70 articles and subject areas of general medicine with 69 articles ranked the most active research areas in the Production of community medicine's department. CONCLUSION: the obtained data showed the much growth of scientific production. The Tehran University of medical Sciences ranked the first in publishing articles in community medicine's department and with most collaboration with community medicine department of England writers in this field and most writers will present their works in paper format.

Sexual dysfunction in women with type 2 diabetes mellitus.

BACKGROUND: Sexual dysfunction (SD) is one of the important problems in diabetic patients. The present study aimed to determine the prevalence of sexual problems in Iranian women with type 2 diabetes mellitus. METHODS: A cross-sectional study was conducted among type 2 diabetic women who visited two outpatient endocrine clinics, namely Imam Hospital and Tuba clinic (Sari, Iran) in 2012. Patients were asked to complete two validated questionnaires: Female Sexual Function Index (FSFI) and The Hospital Anxiety and Depression Scale (HADS) as well as a demographic questionnaire. Analysis was performed using descriptive and analytical tests. P<0.05 was considered to be significant. RESULTS: One hundred and fifty women with type 2 diabetes were investigated. Most of the cases aged 40-44 years old. The mean of the total score of the FSFI questionnaire was 22. The prevalence of sexual dysfunction was 78.7% (CI: 71.4-84.4); among these, 58% (CI: 50.0-65.6) reported problems in lubrication, 50% (CI: 42.1-57.9) complained of decreased sexual desire, 50% (CI: 42.1-57.9) had problems with arousal, 47.3% (CI: 39.5-55.3) had dyspareunia, 32.7% (CI: 25.7-40.5) complained of orgasmic dysfunction and 42.7% (CI: 35.0-50.7) reported problems in sexual satisfaction. With regard to the results of the HADS questionnaire, 58.7% (CI: 50.7-66.2) of the patients had depression and 96.7% (CI: 92.4-98.6) had anxiety. CONCLUSION: This study showed the high prevalence of sexual dysfunction in diabetic women, especially among those complaining of depression. Health care professionals dealing with diabetic patients should be aware of possible presence of sexual dysfunction in female patients.

Public and private hospital nurses' perceptions of the ethical climate in their work settings, sari city, 2011.

BACKGROUND: Nurses' perceptions of ethical climate patterns have certain undeniable effects on hospitals. There is little evidence of possible differences in this element between public and private hospitals and contributing factors. OBJECTIVES: This study investigated whether the perceptions of the ethical climate in nurses' working in public hospitals differ from that of nurses in private hospitals, and which factors may affect nurses' perceptions. MATERIALS AND METHODS: A cross-sectional study of randomly selected registered nurses (n = 235), working in four public hospitals affiliated to Mazandaran University of Medical Sciences, and three private hospitals, was conducted in Sari City, Iran. A self-administered questionnaire, containing demographic characteristics and the Hospital Ethical Climate Survey (HECS), were used to assess registered nurses' perceptions of public and private hospitals ethical climate. An independent t-test and one-way ANOVA were used to analyze the data. RESULTS: Across the five factors of HECS, the highest and lowest mean scores pertained to managers and physicians, respectively, in both public and private hospitals. Nurses who had a conditional employment situation and those working in pediatric intensive care units showed significantly more positive perceptions of the ethical work climate when compared to their peers (P < 0.05). Although the mean score of ethical work climate in private hospitals (3.82 ± 0.61) was higher than that in public hospitals (3.76 ± 0.54), no significant difference was found (P = 0.44). CONCLUSIONS: Hospital managers need to discover better ways to promote safety and health programs for their staff according to nurses' area of work and their type of units. They should also encourage greater levels of participation in safety-enhancing initiatives in the hospital's ethical climate, especially in the areas of nurses' perceptions of their physician colleagues, and for nurses with a conditional employment situation.

Comparison of brain white matter hyperintensities in methamphetamine and methadone dependent patients and healthy controls.

BACKGROUND: Previous studies have proven the development of white matter hyperintensities (WMH) in methamphetamine and opioid users. Opiates and methamphetamines (MA) are the most common addictive agents in Iran. The adverse effects of drugs on the CNS is of concern to specialists and researchers, and given that the neurotoxicity associated with methamphetamine is greater than opioids, it is hypothesized that the severity of WMH in patients with methamphetamine dependence is more than opioid drug-dependent individuals. OBJECTIVES: To our knowledge, this is the first research comparing the effect of methamphetamine and methadone (M) on the brain. PATIENTS AND METHODS: In a historical cohort study, we compared WMH in the brain MRI of 50 methamphetamine-dependent patients, 50 methadone-dependent patients and 50 healthy volunteers who were matched for age, sex and dominant hand. RESULTS: WMH was detected in 18 methamphetamine users, in 12 methadone users and in seven controls (P = 0.038). The site of brain lesions in MA users was mostly in the frontal lobe in 17 cases, in M users in the frontal lobe in 12 cases and in the control group, it was in the parietal lobe in four cases (P=0.001). The frontal lobes were the predominant locations of WMH in MA and M groups (P = 0.001). The frequency of brain lesions was mostly in the deep WM in 18 cases in MA users, in 12 cases in M users and in two cases in the control group (P=0.007). Hyper-signal foci of deep WM in the MA group were grade I (punctuate) in 12 cases, grade II (beginning confluence) in five cases and grade III (large confluent) in four cases. In the M group, there were six cases in grade I, three cases in grade II and one case in grade III. In the control group, there were three grade I cases, two grade II cases, and no grade III cases. Except for periventricular WMH (P = 0.13), there were statistical significant differences in the deep WMH (P = 0.007) and subcortex WMH (P = 0.01) between the three groups. The history of using other drugs and the duration of MA and M consumption were similar. The prevalence of brain lesions was generally higher in both drug user groups compared with the healthy controls. Increased WMH in the MA group was higher than the M group. CONCLUSIONS: A greater number of blood flow defects and ischemic lesions in the brain of MA users compared to opiate users may explain the prevalence of psychiatric disorders in these patients.

Patients discharged against medical advice from a psychiatric hospital in Iran: a prospective study.

AIM: Self- discharged patients are at high risk for readmission and ultimately higher cost for care.We intended to find the proportion of patients who leave hospital against medical advice and explore some of their characteristics. METHODS: This prospective study of discharge against medical advice was conducted in psychiatric wards of Zare hospital in Iran, 2011. A psychologist recorded some information on a checklist based on the documented information about the patient who wanted to leave against medical advice. The psychologist interviewed these patients and recorded the reasons for discharge against medical advice. Descriptive statistics were calculated for the variables. RESULTS: The rate of premature discharge was 34.4%. Compared to patients with regular discharges, patients with premature discharge were significantly more likely to be male, self-employed, to have co morbid substance abuse and first admission and positive family history of psychiatric disorder. Disappearance of symptoms was the most frequent reason for premature discharge. CONCLUSION: The 34.4% rate of premature discharge observed in our study is higher than rate reported in other studies. One possible explanation is our teaching hospital serves a low-income urban area and most patients had low socioeconomic status. Further studies are needed to compare teaching and non-teaching hospital about the rate of premature discharge and the reasons of patients who want to leave against medical advice.