[Views of managers, health care providers, and clients about problems in implementation of urban family physician program in Iran: a qualitative study]

Background and Aim: From 2011 to 2013 some efforts had been made in Iran to implement urban family physician program. The aim of this study was to determine the viewpoints of managers, providers, and clients of health care services about the problems in the implementation of urban family physician program in Iran

Materials and Methods: This study was a qualitative study. Data were collected through holding 21 sessions of focus group discussions and 37 individual interviews with managers, providers, and clients of health care services in Alborz, West Azerbaijan, and Kurdistan Provinces in 2014. Data were analyzed by means of content analysis method

Results: According to the results of this study, the problems on the implementation of urban family physician program in Iran can be classified into seven categories including: financial, cultural, educational, motivational, structural, administrative, and contextual problems

Conclusion: We propose definition and stabilization of the financial resources and establishment of appropriate rules for payments to solve financial problems, and also training of general population and staffs and involvement of the mass media in training to solve the cultural problems. In order to solve the educational problems reforms in medical curriculum are recommended. Motivational problems can be solved via encouraging the private sector and experts to take part in the program and also through guaranteeing the continuity of the program. Establishment of appropriate organizations and provision of protocols are recommended to solve the structural problems. Finally, to overcome the contextual problems it is suggested to promote cross-sectoral and inter-sectoral coordination and also attract support from policy-makers

Assessment of skyshine photon dose rates from 9 and 18 MV medical linear accelerators

Background: skyshine describes the radiation scattered by the atmosphere above a LINAC facility to a point on the ground. The aim of this study was to measure the skyshine photon dose rates from two different [9 MV and 18 MV] medical linear accelerators

Materials and Methods: the photon beam was directed upward [180 degree gantry position], with a maximum photon field size [40 × 40 cm2] at the isocenter. Measurements were obtained around the external points selected outside the room facilities at a horizontal distance from the target by the calibrated RDS-110 survey meter at four points around the isocenter

Results: the measured values of the skyshine photon exposure rates at four points for 9 MV and 18 MV were 0.6, 0.5, 0.5, and 0.4 microSv/h, and 0.6, 0.4, 0.4, and 0.5 micro Sv/h, respectively. All the measured skyshine photon exposure rates were lower than the values recommended by NCRP 147

Conclusion: there is a poor agreement between the measured and the calculated values; therefore it seems that caution is needed while using the equations available in NCRP 147 or 151

mRNA expression study on small amount of Theileria annulata lymph node biopsy sample using SMART-cDNA technology

A major issue in many gene expression studies utilizing small amount of biological materials is the limited quantity of RNApurified from clinical samples, which is often used for RT-PCR or standard Northern blot analysis. The SMART cDNA synthesis method and subsequent SMART-cDNA-PCR technique was used to analyse 3 genes in macroschizonts of Theileria annulata in small lymph node biopsy material. The SMART-cDNA of TaSp gene was cloned in pTZ57R/T-vector and sequenced. We focused on genes encoding surface proteins TaSp, TaD and HSP70. Our results showed that SMART cDNA dependably reproduces the expression profile found in messenger RNA. The RT-SMART-PCR showed the amplification of the processed mRNAs. The sequencing analysis showed that the amplified cDNA was coded for TaSp protein in Theileria annulata. It was concluded that the SMART PCR technique is practical for amplification of complete sequence of mRNAs in the form of cDNAs, and therefore for gene expression studies if only small amounts of starting material are available

[Designing a rapid test to diagnose the ovine hydatid cyst]

Using a rapid and cost benefote test for diagnosing of hydatidosis, a zoonotic, can be beneficial as a diagnostic. The aim of the present study was to design and assess the performance of a dipstick method for diagnosting of cystic echinococcosis. Hydatid cyst fluid antigens and homogenized antigens of protoscolex were prepared and its electrophoretic pattern was determined by SDS-PAGE. Afterthen, for providing the hyperimmune serum, rabbits were injected by hydatid cyst fluid and protoscolex antigens along with complete freund adjuant and then incomplete freund adjuant. The immune sera were evaluated by dot ELISA. Dipstick was prepared based on nitrocellulose paper as solid phase and coated with antigens which were dotted in the upper surface of the nitrocellulose strip. PBS was used as negative control and rabbit sera noninfected were used as positive control. As a negative control the lower part of the strip was coated by PBS. Each strip was floated in the serum [1:100 dilution] for 7 min, washed for 7 min and floated in the second antibody for 7 min. Afterthen, they were washed and incubated in chromogen/substrate diaminobenzidin for 2 min to show the coloured band at the site of coated antigen. Our findings revealed 15 protein fractions in fluid antigens and 9 protein band in protoscolex antigens at the range of 29-130 kDa and 25-90 kDa, respectively. Meanwhile, the protoscolex antigens at in 1:10 dilution and fluid antigens at in 1:20 dilution showed the best results to diagnose hyper immune serum of 1:10 dilution. This rapid Dipstick assay test can be considered as a suitable immunodiagnostic test for hydatid cyst disease; however further investigations should be done to improve its specificity through preparing highly purified antigens

Micro-implant: a new time saving device for hair transplantation [A Case report]

Hair transplantation is the main therapeutic method for androgenic alopecia. Improvement of the hair transplant techniques with more acceptable appearance of the transplanted hair has made this method more popular. Nowadays, for more acceptable appearance of transplanted hair, every follicle is transplanted separately or in small groups which is a time consuming procedure and exposes the follicles to environmental stressors. The new device that we introduce here can be time saving and decreases the exposure time to stressors. This device was named Micro-implant and we used it for hair transplantation in a 45 years old man with androgenic alopecia. After informed consent and adequate explanations, necessary laboratory tests were performed which their results were normal. Three 10×2 cm grafts were resected from occipital area. The grafts were placed into sterile physiologic buffer rapidly and then divided by a scalpel into small pieces, each containing 1-4 follicles. These graft units were transplanted into the frontal bald area by means of the Micro-implant. Use of this device will reduce transplantation time notably and maintain the viability of the transplanted follicles which ensure success of transplantation

[ unicystic ameloblastoma with ameloblastic fibroma in wall [case report]]

Unicystic ameloblastoma is one type of ameloblastoma with different clinical, radiographic, pathologic and treatment response. The aim of this article is presenting a unicystic ameloblastoma with ameloblastic fibroma in its wall. A 16 year old boy with a painless expansion in the left side of mandible came into a maxillofacial surgery office. Radiographic views showed a unilocular lesion with involvement of mandibular border and root resorption. Aspiration was positive. Differential diagnosis consist of follicular cyst,odontogenic keratocyst and unicystic ameloblastoma. The lesion was removed with an exisional biopsy and curettage. This article reports a collision of unicystic ameloblastoma and ameloblastic fibroma. Treatment was based on exisional biopsy and curettage

[Prevalence of cardiac arrhythmias in dogs referred to Shiraz University Veterinary Teaching Hospital]

Cardiac arrhythmias can cause hypoxia, hypotension disturbance in tissue blood supply and cardiac arrest. Diagnosis of cardiac arrhythmias using electrocardiography is simple and common. The purpose of this study was to review the prevalence of cardiac arrhythmias in dogs brought to the Veterinary Clinic for different reasons. One hundred and seventy six dogs of different age groups [<1, 1-3, 3-5, 5-6,>6 years], and both sexes were included in this study. The survey was carried out for two years. Electrocardiogram of each dog using standard limb leads [1, 11, and Ill] and augmented limb leads [aVR, aVL, and aVF] were taken and investigated for rhythm irregularitieso Results obtained from 1232 traces indicated Sinus arrhythmia [27.9%], sinu5 tachycardia [7.8%], wandering pacemaker [5.1%], ventricular premature beats [3.4%], atrioventricular block type 11[1.2%], and the dogs simultaneously showed two kinds of disrhythmias [11.9%]. From 176 dogs, 68 were males [56.6%] and 33 females [58.9%] showed different types of arrhythmias Results of this study indicated that in spite of referring the dogs merely for check up and vaccination have cardiac arrhythmia that some of which could be dangerous for animal life

Hodgkin's disease with hyperferritinemia, hepatic and heart failure

Diffuse hepatic infiltration is an unusual form of Hodgkin's disease [HD]. Its manifestation as progressive hepatitis or with hepatic failure is even rarer and can be difficult to diagnose. We aim to describe an unusual case of liver failure due to HD. A middle-aged woman with a 10 month history of daily febrile episodes, constitutional symptoms and strikingly high levels of serum ferritin was admitted to our hospital with pancytopenia and jaundice. The patient rapidly deteriorated, and developed hepatic and heart failure. A liver biopsy revealed infiltration of the liver with mixed cellularity type HD that was confirmed by lymph node biopsy. HD must be considered in the differential diagnosis of obstructive jaundice in adults. Liver biopsy early in the course of liver dysfunction may establish this diagnosis without a higher risk of bleeding complications seen once liver failure sets in

[Evaluation of HBV_DNA level distribution and related factors in chronic hepatitis B patients]

Hepatitis B is still a major health problem in many parts of the world. In some developing countries the most common cause of chronic hepatitis and liver cirrhosis is hepatitis B virus [HBV]. The progression of chronic hepatitis B to cirrhosis and hepatocellular carcinoma [HCC] include such viral factors as genotype C and high levels of serum HBV DNA in addition to host factors such as older age, male gender, obesity and diabetes. Other factors that influence progression to cirrhosis and HCC are simultaneous alcohol use, and co-infections with HIV, HDV and HCV. The present study aims to determine the correlations between serum HBV DNA viral load and related factors. In this study, new HBV DNA and ALT levels that enable better separation between different stages of this disease are presented. Materials and Chronic hepatitis B patients who presented to the Liver Clinic at Imam Khomeini Hospital in 1388 who were HBsAg positive for more than six months were enrolled in this study. Patients who had previously been treated or those with concurrent HIV, HCV and HDV infections as well as those with autoimmune hepatitis and fatty liver were excluded. Patients' data, HbeAg state, demographics, liver enzymes, HBV DNA level, smoking history, cirrhosis and disease stage were recorded. In order to better differentiation between non-replicative and reactive chronic hepatitis B patients, statistical analysis was done to distinguish between their HBV DNA levels. Evaluation of the relationships between HBV DNA level and the above mentioned variables was performed. High Levels of HBV DNA correlated with HBeAg positive state, smoking [p=0.005] and elevated liver enzymes [p=0.002]. The cut-off value for ALT level that separated HbeAg-positive group [immunoclearance and immunotolerance phases] was set at 42 U/l on the roc curve[r=0.889 area under curve] with 100% sensitivity and 67.7% specificity. The cut-off value for serum HBV DNA levels that differentiated between the Hbe Ag-negative group [non-replicative and reactive phases] was set at 3000 IU/ml on the roc curve [r=0.987 area under curve] with 97% sensitivity and 92% specificity. The present study determined that serum HBV DNA at a level of 3000 IU/ml was a better level for classification of HBeAg-negative patients into the non-replicative and reactive groups

Adverse events of trivalent influenza vaccine among health care workers in Iran

To assess the frequency and type of adverse events after influenza vaccination in Iranian adults. Health care workers in 7 medical centers received the influenza vaccine from October 2006 to February 2007 and followed by phone regarding symptoms experienced after vaccination. Of 897 adults who participated in the study, local and systemic reactions were reported by 187 [20.8%] and 98 [22.1%] persons, respectively. The most common local reaction was pain [20.2%], while myalgia [15.8%] was the most common systemic reaction. One case of Guillain-barre syndrome was reported. Inactivated influenza vaccine administration did not result in potential adverse events in healthy adults

First report of Dermatophilus congolensis dermatitis in dairy cows in Shiraz, southern Iran

Skin lesions were found in two 3-4-year-old Holstein cows in a dairy farm in Shiraz. Lesions were distributed mostly around the neck, forelimbs, hindlimbs, and bilateral of midline portion and varied from nodule-like structure to patch with extensive accumulation of crust. Skin scraping samples were taken from each animal and direct smears were prepared, stained with Giemsa and observed under a light microscope. Some scabs were cultured and incubated both aerobically and anaerobically. Cultured smears were Gram stained and the morphology of isolates were studied. The diagnosis of dermatophilosis was made on the basis of clinical signs, skin lesions and morphological characteristics of the isolates. In this study, the infection could be related to insect population density during the outbreak and exposure to ticks which were observed in the animal environment. Rain scald in the region, especially in the late August and September could be a predisposing factor for flare-up of the infection. This is the first report of dermatophilosis in cattle in Shiraz, southern Iran

Association between major depressive disorder and serum cholesterol level

Nowadays, depression is one of the most prevalent psychological disorders and is a prevalent mood disorder. Recently researches about depression etiology, show that in addition to different neurotransmitters and life events, internal stressors such as serum cholesterol, triglyceride and some coagulation factors can have an effect. This study was focused on the relationship between major depressive disorder and serum cholesterol level. This research is a case control study that was performed in the year 2006. Case group were 62 patients referred to Hashemi Senejani psychiatric medical center and control group were chosen from ENT ward patients of Amir-Kabir hospital. Both groups were paired match for age, gender and education. In order to determine serum cholesterol level, 5[cc] blood sample was taken of each person from both groups. Data was analyzed using K-S and Mann-Witheny U tests. The mean age of samples was 35.5 +/- 9.9 years. 77% were female, 67.2% married, 25.8% single and 6.5% divorced. Average serum cholesterol level in case group [215.6 +/- 47.6 mg/dl] in comparison to control group [183.1 +/- 31.2 mg/dl] was significantly higher [p<0.05]. Regarding the results, it seems that serum cholesterol is an internal stressor for depressive disorder so everyone with high serum cholesterol level must be evaluated for depressive disorder

Epidemiology and risk factors of 377 AIDS [HIV infected] patients

Oral manifestations of HIV infection are common and include oral lesions and novel presentations of previously known opportunistic diseases. Some risk factors are significantly contributed to probability of developing opportunistic infection of oral candidiasis. We have performed the current survey to evaluate their role in Iranian patients with HIV infection. Totally, 377 documented HIV infected patients were included. Oral candidiasis was investigated with clinical observation, direct smear, and culture. Meanwhile, CD4 count was determined at the first visit and following antiretroviral therapy. The study population included 316 males and 60 females with a mean age of 36.5 +/- 8.7 years. Patients were diagnosed for a mean duration of 2.9 years. The most common route of infection transmission was shared needles [117 cases or 31%]. In serologic tests, 11 cases [2.9%] were positive for HBsAg, 206 cases [71.5%] for HCV nucleic acid and 53 cases [14.1%] for tuberculosis infection. At the first visit 52 cases [13.9%] and following HAART 31 cases [8.2%] were revealed to have oral candidiasis. Mean CD4 count in patients with oral candidiasis was significantly less than other patients [193.8 vs. 349.7 cells, P=0.0001]; however, the difference was not significant at follow up. Prompt diagnosis and treatment of HIV infection may have a significant role in prognosis and clinical course of patients with HIV infection and could decrease the rate of opportunistic infections

Synthesis, activity and thermal stability of gold nanoparticle on modified NH[4]-Y type zeolite for cooxidation

Gold nanoparticle is the active catalyst for CO oxidation at low temperature. This feature of gold base catalysts is suitable to overcome the problem of cold-start problem of automobile exhaust TWC converters. In this study gold nanoparticle were deposited on modified NH[4]-Y type zeolite. The activity of synthesized catalyst was measured in a fixed-bed quartz-tubular reactor [7mm i.d.] under atmospheric pressure. In order to investigate the catalytic activities toward CO oxidation reaction, 31mL/min of air and 0.155mL/min of carbon monoxide were mixed and then passed through the reactor. It was found that activity of Au/Y catalyst was 100% at 20°C. The thermal stability of Au/Y catalyst was measured at 400°C for 4h. The activity of the catalyst was decreased to 65% at 20°C after thermal stability test. Results of Energy Dispersive Analysis by X-rays before and after thermal stability have showed that Au content of these samples were 3.89% and 1.76, respectively. It was found that the amount of Au content decreased after thermal stability process. Fourier Transform Infrared [FT-IR] spectra showed no changes in framework structure of zeolite during thermal stabilization process of the catalyst

Factors associated with the nutritional status of adolescent girls based on body mass index in Sari, Iran

The third and the last stage in human growth and development is adolescence. Adequate nutrition of adolescent girls, these future mothers, is very important. The purpose of this survey was to determine association of such variables as age, age of menarche, nutritional awareness, physical activity, and family size, with the body mass index [BMI] in 14-18 year-old adolescent high school girls' in Sari, north of Iran. The sample size was 240. Weight and height were measured, and BMI was calculated and compared with the 2000 US Centers for Disease Control and Prevention [CDC] standards. Nutritional status was determined based on BMI, the categories being underweight, normal, at-risk-of-overweight, and overweight. Information on the nutritional knowledge, physical activity, age, family size, and age of menarche were obtained using questionnaires. ANOVA and Post Hoc were used to determine differences between the variables. The nutritional status of adolescent girls had no significant association with the age of menarche, nutritional knowledge, or physical activity. However, significant relationships with family size and girls' age were found. The results of this survey showed that in Iran, a developing country, family size has a considerable effect on the nutritional status of adolescent girls; furthermore, age was assessed to be an important factor influencing the nutritional status of adolescent girls

Haematological manifestations of brucellosis

Brucellosis is a major health problem in many parts of the world, particularly in the Mediterranean and Middle East. Very few data on the frequency and diversity of haematological abnormalities occurring in brucellosis have been reported. In the present study 85 patients with brucellosis in Imam Khomeini Hospital during 1997-2002 were investigated retrospectively to determine the haematological changes during the active course of this infection. Inclusion criteria included a compatible clinical picture with either a positive blood culture or bone marrow culture for brucella organism or a brucella antibody titre of 1/80 [Wright agglutination test], and 2MB [2-mercaptoethanol] of 1/40 or coomb's Wright with any titre. Anemia was detected in 43.5% patients, leukopenia in 13.6%, thrombocytopenia in 12.5% and pancytopenia in 2.4% of patients. Unusual complications were detected in two patients, one with mouth bleedings, the other with purpuric skin lesions of the lower extremities, both patients had endocarditis. As brucellosis is common in our region it may be considered in patients whose blood picture reveals haemolytic anemia, leukopenia, thrombocytopenia or pancytopenia, particularly when the disease is epidemiologically suspected

Diagnosis of brucellosis by use of BACTEC blood culture and confirmation by PCR

Brucellosis is one of the most common zoonotic diseases in Iran. Growth of Brucella is slow and blood cultures of these bacteria are time-consuming via classical methods. We try to evaluate BACTEC 9120 system capacity in order to detect of bacteremia due to Brucella spp and to confirm isolated bacteria by PCR. Blood culture sample of 102 suspected patients evaluated by BACTEC 9120 system. They were subcultured when the machine detected their growth; if not; blind subcultures were performed on days 7, 14, 21 and 28. Forty-one of 102 suspected patients showed bactermia. Isolation rate of Brucellawas 40.2%. All patients were detected by BACTEC 9120 system. All positive blood culture was detected via BACTEC 9120 and blind subcultures. No positive blood culture bottles were missed by the system. Our data obtained by using the BACTEC 9120 system indicates a more rapid detection of Brucella than conventional methods

[Community-acquired pneumonia: a comparison between elderly and nonelderly patients]

Community-acquired pneumonia could be a life-threatening condition especially in elderly patients. The factors influencing the outcome in elderly patients are thought to be different from those in young adults. We compared the clinical and paraclinical profiles in elderly and nonelderly patients with community-acquired pneumonias. In this cross-sectional study, seventy nine patients who were hospitalized with community acquired pneumonia over a period of one year were included. Patients' medical records were reviewed; and data related to comorbid conditions, signs and symptoms, laboratory and radiographic findings were gathered using a checklist. The clinical features, laboratory parameters and complications from pneumonia were almost similar in 41 elderly [group I, age

Direct urease test and acridine orange staining on bactec blood culture for rapid presumptive diagnosis of brucellosis

Brucellosis is one of the most common zoonotic diseases in Iran and human brucellosis is endemic in all parts of the country. Growth of Brucella is slow and blood culture of these bacteria by use of classical methods is time-consuming. Furthermore, in endemic area culture is required for definitive diagnosis. In the present study, direct urease test and acridine orange staining were tried on the BACTEC blood culture broths for early presumptive identification of Brucella growth. Blood cultures were attempted in 102 seropositive patients. In the forty one blood cultures positive for Brucella, coccobacilli were seen in broth smears stained with acridine orange stain, and also were urease test positive, thus providing presumptive identification of Brucella growth. Urease test was negative and bacteria were not seen in the broth smears of the remaining 61 broths negative for Brucella growth. Because of simplicity, reliability and reproducibility, these tests can be routinely incorporated in the laboratory for diagnosis of brucellosis