A management plan for hospitals and medical centers facing radiation incidents.

BACKGROUND: Nowadays, application of nuclear technology in different industries has largely expanded worldwide. Proportionately, the risk of nuclear incidents and the resulting injuries have, therefore, increased in recent years. Preparedness is an important part of the crisis management cycle; therefore efficient preplanning seems crucial to any crisis management plan. Equipped with facilities and experienced personnel, hospitals naturally engage with the response to disasters. The main purpose of our study was to present a practical management pattern for hospitals and medical centers in case they encounter a nuclear emergency. MATERIALS AND METHODS: In this descriptive qualitative study, data were collected through experimental observations, sources like Safety manuals released by the International Atomic Energy Agency and interviews with experts to gather their ideas along with Delphi method for polling, and brainstorming. In addition, the 45 experts were interviewed on three targeted using brainstorming and Delphi method. RESULTS: We finally proposed a management plan along with a set of practicality standards for hospitals and medical centers to optimally respond to nuclear medical emergencies when a radiation incident happens nearby. CONCLUSION: With respect to the great importance of preparedness against nuclear incidents adoption and regular practice of nuclear crisis management codes for hospitals and medical centers seems quite necessary.

Cognitive-analytical therapy for a patient with functional neurological symptom disorder-conversion disorder (psychogenic myopia): A case study.

Functional neurological symptom disorder commonly presents with symptoms and defects of sensory and motor functions. Therefore, it is often mistaken for a medical condition. It is well known that functional neurological symptom disorder more often caused by psychological factors. There are three main approaches namely analytical, cognitive and biological to manage conversion disorder. Any of such approaches can be applied through short-term treatment programs. In this case, study a 12-year-old boy with the diagnosed functional neurological symptom disorder (psychogenic myopia) was put under a cognitive-analytical treatment. The outcome of this treatment modality was proved successful.

Association of wrist circumference with cardio metabolic risk factors.

OBJECTIVE: The current study aimed to investigate the association of wrist circumference with major cardio metabolic risk factors. METHODS: This study was conducted in 2005-2007 among 3000 first-degree relatives of diabetic patients in Isfahan, Iran. RESULTS: Overall, 1709 (386 males and 1323 females) participants were enrolled in this study. The association of wrist circumference with cardio- metabolic risk factors was significantly positive with waist circumference (p = 0.001), BMI (p = 0.001), and LDL-C (p = 0.01), but significantly inverse with HDL-C (p = 0.001). The corresponding figure was not significant for triglycerides (p = 0.13), total cholesterol (p = 0.13), systolic BP (p = 0.15), diastolic BP (p = 0.6), and HbA1c (p = 0.4). CONCLUSION: Measurement of wrist circumference can serve as an easy-to-detect clinical marker to identify individuals at risk of cardio metabolic disorders, and can be used in large epidemiological studies.

Combination therapy with mitoxantrone and plasma exchange in aggressive relapsing remitting multiple sclerosis: A preliminary clinical study.

BACKGROUND: The efficacy of mitoxantrone induction therapy in rapidly worsening multiple sclerosis (MS) is well established. Plasma exchange is also applied as an adjuvant in exacerbations of relapsing MS. The aim of this study was to compare the efficacy of combination therapy with mitoxantrone and plasma exchange versus mitoxantrone alone in patients with aggressive MS. MATERIALS AND METHODS: Forty patients with aggressive relapsing remitting MS were randomly put into two groups. The first group underwent monthly plasma exchange for three successive months, followed by 12 mg/m(2) mitoxantrone at the end of each course and two more doses of 6 mg/m(2) mitoxantrone in 3-month intervals. The second group received the same doses of mitoxantrone only without plasma exchange. At the end of 8 months treatment course, clinical reassessment and neuroimaging was performed and treatment was continued with interferon-ß. RESULTS: At the end of induction therapy, Expanded Disability Status Scale score was significantly improved in both groups (P < 0.001). Number of demyelinating and gadolinium-enhancing plaques in brain magnetic resonance imaging (MRI) was prominently reduced in group 2(P ≤ 0.05), but the changes were not statistically significant in group 1, except for juxtacortical plaques. CONCLUSION: Administration of mitoxantrone as an induction therapy in patients of aggressive relapsing remitting MS results in significant improvement of their clinical state and MRI activity. However, combination of plasma exchange with mitoxantrone gives no more benefits than mitoxantrone alone and sometimes worsens the situation possibly by reduction of mitoxantrone efficacy as a result of plasma exchange.

Weight status of the first-degree relatives of patients with type 2 diabetes based on the glucose tolerance test.

BACKGROUND: This study aimed to compare different body mass index (BMI) categories in individuals with diabetes, prediabetes and normal glucose tolerance among the first degree relatives of type 2 diabetic patients. MATERIALS AND METHODS: A cross-sectional study was conducted during 2005-2007 in Isfahan, Iran. It evaluated 3323 first-degree relatives of diabetic patients selected by consecutive convenient sampling method. Participants were classified as diabetic, prediabetic, and normal glucose tolerance test groups according to the results of 75 g oral glucose tolerance test (OGTT). The analysis of variance (ANOVA) was used for comparison of quantitative variables, and chi square test for comparison of categorical parameters. RESULTS: The study population consisted of 3323 individuals including 306 diabetics (98 males and 208 females), 1309 prediabetics (337 males and 972 females), and 1708 normal subjects (430 males and 1278 females). Among diabetic patients, the prevalence of obesity was 48.5% in women and 27.6% in men. Among prediabetics, the corresponding figures were 45.6% and 27.3%, respectively. CONCLUSIONS: Our findings suggest that men are diagnosed with T2DM at lower BMI than women. Moreover, the alarming high prevalence of overweight and obesity among females necessitates preventing and controlling this underlying problem among females.

The Webometric Status of Isfahan University of Medical Sciences, Iran.

BACKGROUND: Webometrics refers to the quantitative study of science production, application, structure and technology in the cyber environment. Impact analysis, website collaboration, and recognition of core websites are regarded as the most practical advantages of webometrics. Furthermore, webometrics is applied in ranking studies for universities and academic institutes. This serves as an internationally approved means of academic ranking worldwide. Our study aimed to evaluate the webometric status of Isfahan University of Medical Sciences (IUMS) and its place in the Webometric Ranking of World Universities. We also tried to comment on how to improve the university's webometric rank at national, regional, and international levels. MATERIAL AND METHODS: This was a descriptive cross-sectional study including all websites of Iranian universities. Census sampling was applied to cover all Iranian university websites. Then the websites were evaluated according to the latest criteria for the international webometric ranking methodology (Cyberometric Lab, July 2012) and their webometric rank at the international level as well as the changes in the rank between July 2012 and January 2013 were analyzed. The webometric rank of IUMS was compared with other medical universities at different levels as well. FINDINGS: According to the findings, from July 2012 to January 2013, IUMS webometric rank improved by 707, 5 and 2 at international, national and ministerial levels, respectively. Moreover, the rank of IUMS for openness rose from 4477 to 193 during the mentioned period (∆ 4284). In excellence, the university rank did not change sensibly (1537 /1538). In the same period, the rank in presence shifted from 1137 to 1091. Meanwhile, growth in website impact was negative as the university impact rank declined from 3369 to 3393. CONCLUSION: It seems that impact as the most influential ranking indicator fails to grow proportionately as other factors of IUMS website. This is potentially due to the content language (Farsi) which is an important barrier to easy retrieval of information by non-Farsi speakers. However, the scientific content and SEO (Search Engine Optimization) standards of the website need serious improvement.

Protein-energy Malnutrition in Goitrous Schoolchildren of Isfahan, Iran.

BACKGROUND: Some studies have shown the possible role of protein-energy malnutrition (PEM) in persistence of endemic goiter in iodine replenished areas. The present study was conducted to assess the association between PEM and goiter in schoolchildren of Isfahan, Iran. METHODS: In a cross-sectional study using multistage cluster random-sampling, 2331 schoolchildren with age ranged from 6-13 years old with a female to male ratio of 1.60 were enrolled. Thyroid size was examined by two endocrinologists for goiter detection. Children were considered goitrous if they had palpable or visible goiters according to World Health Organization (WHO)/United Nations children's Fund/International Council for the Control of Iodine Deficiency criteria. Weight and standing height were measured using the standard tools and anthropometric indices were calculated using the WHO AnthroPlus software developed by the World Health Organization. Height-for-age Z-scores (HAZ), weight-for-age Z-scores (WAZ) and body mass index (BMI) for age were calculated for each child. Children with a HAZ, WAZ or BMI-for-age of Z-score < -2.0 were classified as stunted, underweight or thin, respectively. Blood samples were drowned to measure serum thyroid hormones. RESULTS: Overall, 32.9% of subjects were classified as goitrous. Weight, height, BMI, WAZ and BMI-for-age Z-score were significantly lower in children with goiter than in children who did not have goiter (P < 0.05). The prevalence of goiter in thin children was higher than that in non-thin ones (48.4 vs. 31.6%, odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.52-2.69, P < 0.001). Although 33.4% of non-stunted children were goitrous, 31% of stunted ones had goiter (P = 0.5). According to the logistic regression model taking sex and age as covariates, the only significant parameter affecting palpable goiter detection was thinness (OR = 2.13, 95% CI: 1.22-3.69, P < 0.001). CONCLUSIONS: In the present study, we found a high prevalence of goiter in children who were malnourished. It seems that PEM may play a role in the still high prevalence of goiter in this region.

Serum uric acid level in patients with relapsing-remitting multiple sclerosis.

Uric acid (UA) is a hydrophilic antioxidant product associated with multiple sclerosis (MS). We conducted a randomized case-control study to evaluate the serum level of UA in different phases of MS in comparison with levels in a healthy control population. Serum UA was checked in 130 patients with relapsing-remitting MS (85 patients in remitting and 45 patients in relapsing phase) and 50 age-matched controls using a quantitative enzyme-linked immunosorbent assay (ELISA). The mean concentrations of UA in serum was 6.41(±3.18)mg/dL in patients with remitting MS, 4.76(±1.66)mg/dL in patients with relapsing MS and 6.33(±2.94)mg/dL in controls. There was a significant difference between mean UA concentration in relapsing MS and remitting MS (p<0.001), and between patients with relapsing MS and controls (p=0.002); however, the difference between levels for patients in the remitting phase of MS and the control group was not significant (p=0.87). It seems probable that UA has a role in the prevention of disease activity in MS.

Urbach-wiethe syndrome and the ophthalmologist: review of the literature and introduction of the first instance of bilateral uveitis.

Patients suffering from Urbach-Wiethe syndrome (UWS), also known as lipoid proteinosis or hyalinosis cutis et mucosae, may have an ophthalmologist involved in the diagnosis and management of their disease. Along with moniliform blepharosis as a pathognomonic feature of the disease, an ophthalmologist may encounter other manifestations of UWS in any part of the eye such as cornea; conjunctiva; sclera; trabecular meshwork; iris/pupil; lens and zonular fibers; retina; nasolacrimal duct. This paper provides a review on the pathogenesis and the diverse ocular manifestations seen in UWS patients. Uncommon complications are discussed in this paper (glaucoma; dry eye and epiphora; complications of lens, retina, cornea; iris/pupil and conjunctiva). Moreover, a 27-year-old male UWS patient is described with bilateral diffuse anterior stromal iris atrophy, diffuse keratic precipitates; posterior subcapsular cataract; 1 + vitreous cell in anterior vitreous examination. This case was thought to be the first instance of bilateral uveitis associated with UWS. Overall, ophthalmologists may encounter diverse ocular complications accompanying this syndrome. They should be familiar with well-established ophthalmologic manifestations leading them to cooperate with other specialists in diagnosis and management of the disease.