Quality of life in psoriatic patients: a study using the short form-36

Quality of life [QOL] is increasingly recognized as an important outcome measure in dermatology. Psoriasis has a great impact on QOL of patients, and has a strong effect on social relations, psychological status, and daily activities. This study describe and compare the impact of different grades of severity of psoriasis on QOL of patients in north of Iran. This cross-sectional study was performed on 55 patients diagnosed with psoriasis and 55 healthy controls. The patients were selected by consecutive sampling from April to December 2006. The controls were recruited by simple random sampling among patient escorts. After obtaining written informed consent, all the members were included into the study. The Psoriasis Area and Severity Index [PASI] standard questionnaire was used to determine the severity of the disease. In addition, the short-form-36 questionnaire, which is validated for use in Iran, was employed. The gathered data were analyzed using the Stata [V 8.0, SE] [Copyright 1984-2003, Stata Corporation, 4905 Lakeway Drive Special Edition, College Station, Texas 77845 USA] and analyses of covariance [ANCOVA] test. Overall, The mean PASI scores was 5.4 +/- 6.7, total QOL scores had a significant difference between patients and controls [61.1 +/- 17.0 vs. 71.9 +/- 22.4]]P < 0.05], especially in three domains: Role-physical [58.5 +/- 23.3 vs. 70.8 +/- 26.2], general health [43.8 +/- 21.6 vs. 61.5 +/- 27.3], and social functioning [62.7 +/- 26.7 vs. 79.5 +/- 27.5] [P < 0.01]. Physical activities were affected in >50% of the cases. This figure significantly increased with the increasing severity of psoriasis. In addition, social relationships were disrupted in more than half of the patients, but with no significant difference between different grades of severity [P > 0.05]. There is no significant difference between adjusted score of multiple domains of QOL in psoriatic patients according to PASI levels [ANCOVA, P > 0.05]. The physicians' awareness of the importance of patients' QOL in both physical and emotional aspects could improve and enhance the psychological evaluation of the psoriatic patient, which will promote his/her positive outcome. And, PASI

Patterns of care seeking during episodes of childhood diarrhea and its relation to preventive care patterns: national integrated monitoring and evaluation survey [IMES] of family health. Islamic Republic of Iran

In Iran, diarrheal disease is the fourth cause of under five year mortality. Proper care seeking behavior and system based disease management in the national field will have a great effect in reducing morbidity and mortality. This nationwide study was performed on a target population of rural and urban communities; in all 31 provinces of the Islamic Republic of Iran. One lakh three thousand three hundred and thirty one [103331] families were sampled by multi stage stratified random sampling and were interviewed with a standard data collection form. The collected data was entered into the Stata 8.0 software and analyzed by the survey analysis method. Of the 14625 [10.1%] children who were reported to have diarrheal diseases two weeks prior to the interview, 8.8% were cured and 1.5% were not. About 70% of them had at least one visit for health seeking the most of patients were seen by a rural health worker [Behvarz] in the rural and by a general pediatrician in the urban areas. About 62% of the patients in urban and 57% in the rural areas had been treated with antibiotics and these rates for ORS were 51% and 65%, respectively. The factors most related to a care seeking pattern were the level of routine preventive well child care, number of siblings, child age, and living area. According to this national survey, our health system needs to integrate all the levels of prevention, especially the Integrated Management of Child Illnesses [IMCI] programs with a family physician project. Futher more, there is a great need for empowering the referral system and gate keeping in all referral levels, to make efficient national integrated programs

[Effect of dyslipidemia on noise induced hearing loss]

Hearing is one the most important senses of human. Hearing loss is one of the greatest chronic disabilities. Noise induced hearing loss [NIHL] is a common occupational disorder and several factors affect its intensity. One of these factors is individual differences. The aim of present study is the assessment of dyslipidemia's effect on NIHL. This study was conducted to evaluate association between dyslipidemia and noise induced hearing loss. This was an analytic-descriptive study which was conducted in 2010. The factory workers of Rasht industrial city with the following inclusion criteria were selected: environmental noise above 85dB, age below 55 years, no otologic disease or surgery, and no history of usage of ototoxic drugs. A total of 298 workers were assessed. After physical examination and audiometry, we measured the level of serum cholesterol, triglyceride, high and low density lipoprotein of participants. The results were analyzed with the SPSS version 17.0. The p value < 0.05 is considered significant statistically. In this study, 250 men and 48 women were assessed. The mean age of participants was 35.8 years. The participants had high noise exposure of 11 years on average [1-26years]. Ninty five of them had NIHL [31.8%]. The frequency of serum cholesterol, triglyceride, high and low density of this group were 31.5%, 10.8%, 53.2% and 14.3%, respectively. These levels in the group without NIHL [203 workers] were 38.9%, 12.6%, 58.9% and 21.1%, respectively. There was no statistical significance between these levels in the two groups. By backward logistic regression method, we observed that the duration of employment and gender increased the hearing threshold of 4 KHz frequency in the NIHL group. The odd ratio of hearing loss in male gender was 3.36 [95% confidence interval: 1.61-8.95, p= 0.004]. The other effective factors on the hearing threshold of 4 KHz frequency had statistical, but no clinical significant difference in two groups. We observed no statistical significance of dyslipidemia frequency between two groups. In addition to duration of employment, male gender was the other observed related factor with hearing loss in the two groups. This effect may be due to protective effect of estrogen on the hearing level. Studies with more sensitive approaches on a larger sample is advised

influence of lateral and supine position on bacterial colonization of endotracheal tube in neonates admitted to neonatal intensive care unit

Recent data suggest that during mechanical ventilation, lateral patient position [in which the endotracheal tube is horizontal] decreases the incidence of bacterial colonization of ventilated neonates. The objective of this study was to evaluate the influence of lateral and supine position on bacterial colonization of endotracheal tube in neonates. We conducted a prospective, randomized, clinical trial with 31 intubated neonates [intubated within 48 hours after birth]; sixteen neonates were positioned supine [supine group], and fifteen were maintained in the lateral position [lateral group].Tracheal aspirates were cultured in second and fifth days of mechanical ventilation. Data were analyzed with SPSS version 16. In the second day of ventilation, positive cultures were recognized in 6.2% of supine group and 6.7% of lateral group. After 5 days, tracheal cultures were positive in 25% [4 neonates] of supine group and 13.3% [2 neonates] of lateral group that wasn't statistically significant [P=0.9 in second day and P=0.9 in the fifth day]. The most common organisms isolated from tracheal aspirates were Gram-negative rods [Klebsiella]. Since respiratory contamination is very common among ventilated neonates and the effect of lateral position on bacterial colonization of endotracheal tubes of intubated neonates wasn't established in our study, further studies are required to suggest ways to decrease bacterial colonization of intubated neonates

Vascular access and survival in hemodialysis patients in Rasht, Iran

Arteriovenous fistulas and grafts are two common permanent access methods for hemodialysis. Selection of an appropriate access, appropriate surgical techniques, and treatment of complications are basic principles of long-term maintenance of vascular access. We aimed to assess the survival of arteriovenous fistulas and grafts in our dialysis center. A total of 200 cases of vascular access placement in 155 patients were reviewed. Data on the type of access and the duration of a functional access were collected for survival analysis. The median duration of dialysis was 70.6 months. Among different methods of vascular access, elbows' wrinkle arteriovenous fistulas [57.0%] were the most frequently used vascular access. The longest mean survival period based on the anatomical location was seen in patients with the arteriovenous fistulas of the wrist [100.2 months]; however, there were no significant relationships between anatomical location and durability of vascular access. The mean survival of vascular access was 96.4 months in men and 104.9 months in women. The mean vascular access survival in diabetic patients was 78.8 months as compared with 101.6 months in nondiabetics. Antecubital arteriovenous fistulas were the most common forms of vascular access among our hemodialysis patients; however, arteriovenous fistulas of the wrist provided a better survival. Monitoring of the arteriovenous access and early diagnosis of its insufficiency can guarantee timely intervention and a better survival time

[Microbiological study and antimicrobial susceptibilities of brucella isolates in serologic diagnosed cases]

Brucellosis is a zoonotic disease with worldwide distribution that is endemic in Iran. Worldwide, brucellosis remains a major cause of morbidity in humans and domesticated animals. The disease has a wide spectrum of clinical manifestation and can affect a variety of organs and systems. This study focused on blood culture of serologic diagnosed brucellosis and antimicrobial susceptibility test. In this cross sectional study, microbiologic survey was done on a total of 30 serum samples with STA titer of 1:160 or greater and 2ME titer of 1:40 or greater, which were presumptive for brucellosis. Blood cultures were done by lysis centrifugation and antimicrobial susceptibility test, against 9 antimicrobial agents by disk method. The data was analyzed by stata V8.0 software. At the end this study, the blood culture isolation rate was 23.3% [7 cases out of 30 patients] and all of the isolates were brucella melitensis. Antimicrobial susceptibility tests showed high in vitro activity of ofloxacin, ciprofloxacin and doxycycline and also, low in vitro activity of streptomycin and cotrimoxazole. Brucellosis is endemic in Iran. Brucella melitensis was the most common strain of brucella in our patients. Except cotrimoxazole and streptomycin, high in vitro activity was found with other antibrucella agents, especially with ofloxacin, ciprofloxacin and doxycycline

Glomerular filtration rate estimates based on serum creatinine level in healthy people: conventional Jaffe method versus calibrated Jaffe method at laboratories in Rasht

Conventional Jaffe method of serum creatinine measurement is influenced by several drugs and components of blood as well as the expertise of laboratory staffs. We obtained blood samples of 22 healthy volunteers and sent them to 23 laboratories in Rasht, Iran, in which the conventional Jaffe method would be used for serum creatinine measurement. Also, we tested the samples in 1 reference laboratory with the calibrated Jaffe method. Glomerular filtration rates were calculated using the abbreviated equation of the Modification of Diet in Renal Disease study. Eight of 23 laboratories [34.7%] reported significantly different mean serum creatinine levels from the mean values yielded in the reference laboratory. Seven of 23 laboratories [30.4%] had significantly different estimated glomerular filtration rates in comparison to those calculated in the reference laboratory. Different results for creatinine lead to wrong interpretation of patients' kidney function, and rectifications of this divergence are of utmost importance

Prevalence of hematuria and proteinuria in healthy 4 to 6 year children in daycare centers of Rasht [northern Iran]

Screening of kidney diseases by urinalysis in preschool children was approved in many parts of the world with inexpensive tools such as urinary dipsticks. In this study the researchers investigate the prevalence of hematuria and proteniuria in 4 to 6-year-old children in daycare centers of Rasht [Iran]. The researchers examined proteinuria and hematuria in 1520 healthy children in daycare centers of Rasht. Urine strips were employed to examine the urine which was already collected from the subjects. Another urine sample was collected from those children with abnormal findings in the first samples with dipstick of the same brand a month later. If any positive result was found again, the urine was analyzed with dipstick and microscope concurrently. In the first dipstick samples, the prevalence was 3.2% for hematuria, 5.8% for proteinuria, and 0.13% for a mixture of proteinuria and hematuria. In the second urinalysis in patients with positive findings, hematuria, proteinuria as well as mixed proteinuria and hematuria were 20.4%, 52.0%, and 2.0% correspondingly. In the third analysis of samples, the abnormal findings in all patients were 13 [0.85%] isolated hematuria, 24 [1.57%] isolated proteinuria and one [0.06%] mixed hematuria and proteiuria. This study showed that the prevalence of proteinuria and hematuria during pre-school period [4 to 6 year-olds] may reveal relatively similar frequencies of some other studies

[Isolation and serotyping of endemic leptospires of eastern part of flat area of Guilan province, Iran]

Leptospirosis is a zoonosis that is more common in tropical and semitropical regions and is endemic in Guilan province. In endemic region, only a limited number of pathogenic serovars are common, characterization of them is very important step in detecting the main reservoir [s] of the disease. This study was performed to isolate leptospires from rice farms, irrigation canals and rivers of eastern part of flat area of Guilan province to detect main endemic serotypes of leptospirosis. In this descriptive and cross - sectional study samples were taken from 8 cities of the area of Guilan province, Noth of Iran between May to September of 2007. Two ml of any processed water sample was inoculated in liquid EMJH medium with 200 micro g/ml 5-flurouracil after filtration, were incubated in 30°C for 3 monthes, and were checked by darkfiel microscopy every two weeks. All positive samples were serotyped by using 30 type antisera which were main representative of serogroups. 47 of 320 specimens were positive and 273 samples were negative. One saprophytic specie [Biflexa] including two serogroups [Andamana, and Semaranga] and three pathogenic species [Interrogans, Kireshnerii, and Boirgpetersenii] including 6 serogroups were detected Icterohaemorrhagiae, Pomona, and canicola of interrogans, Hardjobovis and Sejroea of Borgpeterseni pecie, Grippotyphosa of KircshnerL Non-pathogenic serogroups were found from surface water, but the pathogenic serogroup were detected only from rice farm water. The high incidence of leptospirosis in rual area concide with seasonal rice cultivation, which can be due to trafic of domestic animal in rice farms and elevation temprature, and activity of rice farm water with subsequent presence of pathogenic type and serotypes in rice farm

Epidemiologic assessment of Leptospira serotypes in Caspian littoral

Leptospirosis is a widespread zoonosis in the world with more prevalence in tropical and subtropical regions. The disease is very common in flat area of Gilan, northern Iran, where the climate is humid and temperate and rice farming is main agricultural activity in rural areas. We performed this study in 2004 by taking blood samples from 465 hospitalized patients who were suspected of leptospirosis based on their clinical presentation, to find positive cases and analysis their signs, symptoms, and epidemiological data, and also to determine the most common clinical features of the disease in the area. All sera were examined by microscopic agglutination test. Renal failure was most common symptoms [4.5%]. Icterhaemorrhagia had highest titers in 57.0% of patients. In Gilan province, some of the farmers get leptospirosis each year near the end of spring and summer at the time of rice harvesting. Better recognition of the disease and diagnosing it at proper time can improve the quality of life and health state of the farmers

[Evaluation an in-house IgM-ELISA for the diagnosis of human leptospirosis]

Leptospirosisis a very common zoonosis in the world. Culture is low sensitive with high rate false negative. So, serological assays are best alternative way for its diagnosis. Microscopic agglutination test [MAT] is gold standard but performing it requires a panel of some standard strains and need periodic subculturing of them, and also requires double sera with at least two weeks interval to investigate seroconversion. Furthermore, other serological methods should be investigated. The aim of this study was to evaluate an in-house IgM-ELISA developed by using antigen extracted from endemic isolates. 14 endemic isolates belonged to the serogroups: Icterohaemorrahgia, Pomona, Hardjo, and Gripotyphosa, were inoculated in EMJH to take well grown cultures. Whole antigen was extracted from each culture by Freezing-Thawing method in distilled water. Same amount of extraction of each culture with same OD number in 550nm were mixed together and were used for coating Elisa plates. Antihuman IgM conjugated with alkaline phosphatase were used in this assay. We used a commercial quantitative IgM-ELISA [SERION ELISA classic] for cut off determination. MAT was used for confirmation positive and negative cases. Sera with titer >/= 1:100 in MAT and positive criteria in commercial quantitative IgM-ELISA were considered as positive cases. 98 positive cases and 54 negative cases were chosen by screening 200 sera of patients suspected to leptospirosis by using MAT and commercial quantitative IgM-ELISA. We also used 30 sera of patients affected by hepatitis B, salmonelosis, and brucellosis as control cases. 88 of 98 positive cases were positive [false negative=10], 1 of 54 negative and all control case were negative [false positive =1] in the test. Sensitivity, specificity, PPV, NPV, and accuracy of the test were evaluated :99.0%, 89.1%, 90.75, 98.8%, and 94.25, respectively. ELISA for measuring specific IgM to leptospires antigen[s] could be a good alternative to MAT, which is not a routine diagnostic assay to perform in clinical diagnostic laboratories and only is reliable when there is paired sera. Sensitivity and specificity of the assay is dependent to several factors, especially to the type of antigen coated on plates, quality of assay materials, and also to the time of sampling. Sera of days >/= 6 of the disease has enough antibodies to measure and a common antigen extracted from several common pathogenic leptospires, especially from endemic isolates, could be more helpful to increase accuracy of the assay

Quality of life in chronic hepatitis B and C patients

Chronic hepatitis B and C are prevalent diseases, especially in developing countries. In many of the patients they cause limitations in physical and mental functions and finally cause reduction in their life quality. We wanted to assess the quality of life in these patients. This research was done on 74 chronic hepatitis B and C patients of Rasht which their diseases were confirmed by serologic and histologic methods and their hepatic enzymes including AST and ALT was two times more than normal range for at least 6 months. Cross-sectional questionnaire survey performed in October 2003 till Jully 2004 in Gastrointestinal and Liver Diseases Research Center of Rasht [north city of Iran], Razi hospital. The questionnaires consisted of 29 questions that were given to the patients and they were let free to complete it. The individuals under survey consisted of 15 [20.27%] chronic hepatitis B patients and 59 [79.72%] chronic hepatitis C patients. 54 [72.79%] ones were male and 20 [27.02%] were female. Total adjusted score [up to 100 points] of life quality was 54.4 +/- 22.5. No meaningful difference was seen between two sexes based on total score of life quality. Also, in different fields of life quality no significant difference was seen between two genders, except the systemic signs that the average of adjusted score of females [43 +/- 28] was less than males [63 +/- 27] that means meaningful statistical difference [P < 0.007]. Generally, it seems that chronic hepatitis B and C have untoward life qualities which could result from concern of decrease of social support or fear of society or decrease in patronage of the family or friends and it is mandate to be concerned when furnishing services to these patients

comparison between suppository diclofenac and pethidine in post-cesarean section pain relief: a randomized controlled clinical trial

Narcotic drugs are usually used for postoperative pain control which could cause several complications such as respiratory depression and apnea. Therefore, replacement of these drugs with safer analgesics is recommended. The aim of this study was to compare the analgesic effects of suppository diclofenac and pethidine in post-cesarean section [C/S] patients. In this clinical trial, pregnant women who were admitted to Alzahrah Hospital, Isfahan, Iran, between August and February 2004 and met the inclusion criteria were recruited. After obtaining informed consent, the patients were randomly assigned [block randomization] to two groups. In group A, 100 mg rectal suppository diclofenac was used after operation at four time points: at the end of operation and 8, 16 and 24 hours after the operation. Group B received pethidine 1 mg/kg intramuscularly at similar time points. The pain scores were assessed at 2, 10, 18 and 26 hours after C/S using the Visual Analogue Scale [VAS]. Age, gestational age, parity, history of previous abortion, C/S and abdominal surgery, level of education, pain score, side effects and satisfaction level were assessed. Analysis was carried out with ANCOVA model and X[2] Mantel Haenszel tests by SPSS.10 software. P<0.05 was considered significant. Two hundred forty patients met inclusion criteria. Age, parity, history of previous abortion, history of previous C/S and abdominal surgery, level of education and satisfaction level were similar in the two groups [P>0.05]. There was no significant difference between side effects in the two groups except for dizziness in 11 cases in group B. There were significant statistical difference between pain intensity in 10, 18 and 26 hours after C/S in group A and group B [2.05 +/- 2.07, 1.4 +/- 1.6 and 0.5 +/- 1.1 vs. 2.6 +/- 2.2, 2.3 +/- 2.2 and 1.3 +/- 1.9] respectively. The results of the present study showed that the use of suppository diclofenac is an appropriate replacement therapy for pain relief after C/S