Beneficial health effects of Menaquinone-7 on body composition, glycemic indices, lipid profile, and endocrine markers in polycystic ovary syndrome patients.

OBJECTIVE: The aim of this study was to investigate the effect of oral vitamin K2 (Menaquinone-7 [MK-7]) on clinical and biochemical parameters in polycystic ovary syndrome (PCOS) patients. METHODS: In this randomized, double-blind, placebo-controlled clinical trial, 84 PCOS patients were randomly assigned into the treatment (90 µg Menaquinone-7 daily for 8 weeks) and placebo groups. Insulin resistance, lipid profile, endocrine biomarkers, and body composition of the participants were measured before and after the intervention. This study was performed in Ghadir Mother & Child Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. RESULTS: Menaquinone-7 supplementation, when compared to placebo, significantly decreased serum fasting insulin (p = .002), homeostasis model of assessment insulin resistance (p = .002), and homeostasis model of assessment ß-cell function (p = .02) in addition to a significant increase in quantitative insulin sensitivity check index (p = .001). Also, MK-7 administration led to significant declines in serum triglyceride (p = .003) and dihydrotestosterone (DHT; p = .03) levels, free androgen index (p < .001), waist circumference (p = .03), and body fat mass (p < .001) as well as significant increases in skeletal muscle (p < .001) and sex hormone binding globulin (SHBG, p < .001). CONCLUSIONS: This study highlights the beneficial effects of MK-7 on insulin resistance, fat mass, skeletal muscle, and serum levels of triglyceride, DHT, and SHBG in PCOS patients. Therefore, it seems that MK-7 supplementation might be an appropriate additive treatment for PCOS patients.

The Correlation Between Bladder Cancer and Obesity, Overweight, Physical Inactivity, and Tobacco Use: An Ecological Study in Asian Countries.

BACKGROUND: Bladder cancer is the ninth most common cancer in the world. OBJECTIVES: This study aimed to determine the correlation between age-standardized incidence rates of bladder cancer and some risk factors in Asian countries through an extensive ecological analysis. METHODS: This ecological study evaluated the correlation between age-standardized incidence rates of bladder cancer and obesity, overweight, physical inactivity, and tobacco use in 30 Asian countries. To determine the factors that were significantly related to age-standardized incidence rate of bladder cancer, a univariate analysis was performed using simple linear regression. In the next step, variables with p-values less than 0.25 were entered into a multivariate linear regression model. RESULTS: The incidence of bladder cancer was higher in countries with higher prevalence of overweight (r2 = 0.36, p < 0.001), obesity (r2 = 0.34, p = 0.001), current daily tobacco use (r2 = 0.17, p = 0.03), and physical inactivity (r2 = 0.13, p = 0.04). The results of multiple regression analysis indicated a direct correlation between the incidence of bladder cancer and overweight (ß = 0.15, p < 0.001) and current daily tobacco use (ß = 0.21, p = 0.001). CONCLUSIONS: There was a significant relationship between the incidence of bladder cancer and overweight and current daily tobacco use. Further epidemiological studies are needed to confirm this relationship.

Factors Affecting Insulin Compliance in Patients with Type 2 Diabetes in South Iran, 2017: We Are Faced with Insulin Phobia.

BACKGROUND: Many patients with type 2 diabetes are uncontrolled on maximum oral treatment. The early introduction of insulin can lower diabetes-related complications. This study aimed to evaluate type 2 diabetes patients' demographic characteristics, clinical factors, and attitude toward insulin therapy initiation. METHODS: In the present cross-sectional study, 457 patients were selected from 12 diabetes clinics in the southern Iranian city of Shiraz in 2017. Adult patients (>30 y) with type 2 diabetes indicated to use insulin for the first time (insulin-naive) were asked to complete a researcher-designed questionnaire. The data were analyzed using SPSS 19. The relationships between insulin and the tendency to use insulin, demographic characteristics, and clinical data were evaluated using the χ2 or t test and logistic regression. The significance level was considered at 0.05. RESULTS: The mean age of the participants was 55.16±8.76 years and 67.4% were female. Despite physician recommendations, 60.2% of the patients were disinclined to use insulin. Those unwilling to initiate insulin therapy had more misconceptions. In the multivariate analysis, the chances of insulin noncompliance were increased by 4.63-fold among the patients without supplementary insurance (P<0.001), by 2.38-fold among those with a nondiabetic diet (P=0.002), and by 6.75-fold among the illiterate ones (P<0.001). CONCLUSION: Based on the results, the factors affecting insulin noncompliance in our insulin-naive patients with type 2 diabetes included insurance coverage, illiteracy, and nondiabetic regimens as well as misconceptions about and irrational fear of insulin injection. Overall, our results indicate the need for further education and financial support for patients and health staff.

Determining endemic values of cutaneous leishmaniasis in Iranian Fars province by retrospectively detected clusters and receiver operating characteristic curve analysis

To determine the endemic values of cutaneous leishmaniasis in different cities of Fars province, Iran. Methods: Totally, 29201 cases registered from 2010 to 2015 in Iranian Fars province were selected, and the endemic values of cutaneous leishmaniasis were determined by retrospective clusters derived from spatiotemporal permutation modeling on a time-series design. The accuracy of the values was assessed using receiver operating characteristic (ROC) curve. SPSS version 22, ArcGIS, and ITSM 2002 software tools were used for analysis. Results: Nine statistically significant retrospective clusters (P<0.05) resulted in finding seven significant and accurate endemic values (P<0.1). These valid endemic scores were generalized to the other 18 cities based on 6 different climates in the province. Conclusions: Retrospectively detected clusters with the help of ROC curve analysis could help determine cutaneous leishmaniasis endemic values which are essential for future prediction and prevention policies in the area.

Establishment of an early warning system for cutaneous leishmaniasis in Fars province, Iran

Objective: To establish an early warning system for cutaneous leishmaniasis in Fars province, Iran in 2016. Methods: Time-series data were recorded from 29201 cutaneous leishmaniasis cases in 25 cities of Fars province from 2010 to 2015 and were used to fit and predict the cases using time-series models. Different models were compared via Akaike information criterion/Bayesian information criterion statistics, residual analysis, autocorrelation function, and partial autocorrelation function sample/model. To decide on an outbreak, four endemic scores were evaluated including mean, median, mean + 2 standard deviations, and median + interquartile range of the past five years. Patients whose symptoms of cutaneous leishmaniasis began from 1 January 2010 to 31 December 2015 were included, and there were no exclusion criteria. Results: Regarding four statistically significant endemic values, four different cutaneous leishmaniasis space-time outbreaks were detected in 2016. The accuracy of all four endemic values was statistically significant (P<0.05). Conclusions: This study presents a protocol to set early warning systems regarding time and space features of cutaneous leishmaniasis in four steps: (i) to define endemic values based on which we could verify if there is an outbreak, (ii) to set different time-series models to forecast cutaneous leishmaniasis in future, (iii) to compare the forecasts with endemic values and decide on space-time outbreaks, and (iv) to set an alarm to health managers.

Data on health risk assessment to the nitrate in drinking water of rural areas in the Khash city, Iran.

The main objective of this data was determination of the nitrate concentration and its health risk assessment in the drinking water resources. In the aim of this data article a number of 30 samples of nitrate concentration in drinking water resources were collected from villages of the Khash city, Sistan and Baluchistan province, Iran. The nitrate concentration was measured using a Spectrophotometer accordance standard methods for examination of water and wastewater. Data indicated that nitrate concentration in drinking water ranged from 6 to 35 mg/L (average 16.083 mg/L). The mean EDI values for nitrate in different groups of infants, children, teenagers and adults were 0.1287, 0.9114, 0.6433 and 0.5155 mg/Kg, respectively. The findings of data showed that HQ value was less than 1 in 96% of samples in age groups of infants, children, teenagers and adults.

Does prospective permutation scan statistics work well with cutaneous leishmaniais as a high-frequency or malaria as a low-frequency infection in Fars province, Iran?

Objective: To determine whether permutation scan statistics was more efficient in finding prospective spatial-temporal outbreaks for cutaneous leishmaniasis (CL) or for malaria in Fars province, Iran in 2016.Methods: Using time-series data including 29177 CL cases recorded during 2010-2015 and 357 malaria cases recorded during 2010-2015, CL and malaria cases were predicted in 2016. Predicted cases were used to verify if they followed uniform distribution over time and space using space-time analysis. To testify the uniformity of distributions, permutation scan statistics was applied prospectively to detect statistically significant and non-significant outbreaks. Finally, the findings were compared to determine whether permutation scan statistics worked better for CL or for malaria in the area. Prospective permutation scan modeling was performed using SatScan software.Results: A total of 5359 CL and 23 malaria cases were predicted in 2016 using time-series models. Applied time-series models were well-fitted regarding auto correlation function, partial auto correlation function sample/model, and residual analysis criteria (Pv was set to 0.1). The results indicated two significant prospective spatial-temporal outbreaks for CL (P<0.5) including Most Likely Clusters, and one non-significant outbreak for malaria (P>0.5) in the area.Conclusions: Both CL and malaria follow a space-time trend in the area, but prospective permutation scan modeling works better for detecting CL spatial-temporal outbreaks. It is not far away from expectation since clusters are defined as accumulation of cases in specified times and places. Although this method seems to work better with finding the outbreaks of a high-frequency disease;i.e., CL, it is able to find non-significant outbreaks. This is clinically important for both high- and low-frequency infections;i.e., CL and malaria.

Study on nutritional monitoring of Persian malnourished school students: A check on reproducibility and validity of questionnaire.

AIM: To develop a nutritional screening tool and examine its reliability and validity in elementary school children with malnutrition based on PRECEDE-PROCEED model, in Shiraz, Iran. METHODS: A questionnaire was designed and its reproducibility was analysed via test-retest design among students with malnutrition. The students were in the fourth to sixth grades. Validity was assessed using face validity, content validity, construct validity, item difficulty and item discrimination. Reliability was measured by Cronbach's alpha (internal consistency), the intra-class correlation coefficient (ICC) and κ statistics (test-retest reliability). RESULTS: A total of 165 primary school students (mean age of 11.21 ± 1.08 years, 65.5% females) participated in the study. The PRECEDE-PROCEED theoretical model for health education was adapted for this questionnaire. The questionnaire was divided into four main sections: predisposing, reinforcing, enabling factors and behaviour. Coefficient α reliability estimate was above 0.9 for most scales. The ICCs for different scales of the questionnaire were within the range of 0.402-0.800. Values for κ ranged from 0.412 to 0.785 for most scales. CONCLUSIONS: The results showed reasonable validity, excellent reliability and moderate to substantial reproducibility for all scales of the questionnaire except two questions for κ statistics. The present study is of great importance, as there are no psychometrically evaluated tools (based on health behaviour models) with accepted validity and reliability for the evaluation of such factors in children with malnutrition. The questionnaire developed in the present study can be used to assess the effect of intervention among primary school students with malnutrition.

Metabolic syndrome in Iranian adolescents with polycystic ovary syndrome.

Background Metabolic syndrome (MS) in adolescents is a risk factor for type 2 diabetes and cardiovascular diseases. Objective The present study aimed to determine the prevalence of MS in 14-18-year-old girls. Methods This analytical case-control study was conducted on 3200 high school students with polycystic ovarian syndrome (PCOS). PCOS was confirmed by an endocrinologist after detection of clinical hyperandrogenism (acne, hirsutism and alopecia) and oligomenorrhea, rejection of hypothyroidism and hyperprolactinemia and performance of abdominal sonography. In the second stage, the prevalence of MS was compared between 70 girls with PCOS and 45 healthy girls using the ATPIII, Cooki and Ferranti scales. The study data were collected using a demographic questionnaire, body mass index (BMI) graph, the WC graph and standard blood pressure graph in adolescents. Then, the data were analyzed using the t-test and the χ2-test. Results Based on the Ferranti scale, the prevalence of MS was 10.4% and 0% in the case and control groups, respectively. The highest prevalence was related to hyperandrogenism and polycystic ovaries phenotype (11.6% vs. 0%, p = 0.05). Based on the Cooki and ATPIII scales, the prevalence of this disorder was 4.1% in the case group and 0.67% in the control group, with the highest rate being related to hyperandrogenism, oligomenorrhea and polycystic ovaries phenotype (7.5% vs. 0%, p = 0.28). Conclusion In comparison to the control group, the prevalence of MS in the patients with PCOS was 10-fold higher according to the Ferranti scale and nearly 3.5-fold higher based on the Cooki and ATPIII scales. Thus, long-term follow-up is suggested in these patients.

Spatiotemporal clustering of cutaneous leishmaniasis in Fars province,Iran

Objective: To assess the spatiotemporal trait of cutaneous leishmaniasis (CL) in Fars province, Iran. Methods: Spatiotemporal cluster analysis was conducted retrospectively to find spatio-temporal clusters of CL cases.Time-series data were recorded from 29 201 cases in Fars province,Iran from 2010 to 2015,which were used to verify if the cases were distributed randomly over time and place. Then, subgroup analysis was applied to find significant sub-clusters within large clusters.Spatiotemporal permutation scans statistics in addition to subgroup analysis were implemented using SaTScan software. Results: This study resulted in statistically significant spatiotemporal clusters of CL (P<0.05).The most likely cluster contained 350 cases from 1 July 2010 to 30 November 2010. Besides, 5 secondary clusters were detected in different periods of time. Finally, statistically significant sub-clusters were found within the three large clusters(P<0.05). Conclusions: Transmission of CL followed spatiotemporal pattern in Fars province, Iran.This can have an important effect on future studies on prediction and prevention of CL.

Inter-Segmental Coordination Pattern in Patients with Anterior Cruciate Ligament Deficiency during a Single-Step Descent.

Anterior cruciate ligament injury is a debilitating pathology which may alter lower limb coordination pattern in both intact and affected lower extremities during activities of daily living. Emerging evidence supports the notion that kinematic variables may not be a good indicator to differentiate patients with anterior cruciate ligament deficiency during step descent task. The aim of the present study was to examine alterations in kinematics as well as coordination patterns and coordination variability of both limbs of these patients during a single step descent task. Continuous relative phase technique was used to measure coordination pattern and coordination variability between a group of anterior cruciate ligament deficient (n = 23) and a healthy control group (n = 23). A third order polynomial Curve fitting was utilized to provide a curve that best fitted to the data points of coordination pattern and coordination variability of the healthy control group. This was considered as a reference to compare to that of patient group using nonlinear regression analysis. The results of the present study demonstrated an altered coordination pattern of the supporting shank-thigh and the stepping foot-shank couplings in anterior cruciate ligament deficient subjects. It was further noticed that there was an increased coordination variability in foot-shank and shank-thigh couplings of both supporting and stepping legs. There was no significant difference in the hip, knee and ankle joints kinematics in either side of these patients. Anterior cruciate ligament deficient individuals showed altered strategies in both intact and affected legs, with increased coordination variability. Kinematic data did not indicate any significant difference between the two groups. It could be concluded that more sophisticated dynamic approach such as continuous relative phase would uncover discrepancies between the healthy and anterior cruciate ligament deficient individuals.

Investigation of outliers of evaluation scores among school of health instructors using outlier - determination indices.

INTRODUCTION: Teacher evaluation, as an important strategy for improving the quality of education, has been considered by universities and leads to a better understanding of the strengths and weaknesses of education. Analysis of instructors' scores is one of the main fields of educational research. Since outliers affect analysis and interpretation of information processes both structurally and conceptually, understanding the methods of detecting outliers in collected data can be helpful for scholars, data analysts, and researchers. The present study aimed to present and compare the available techniques for detecting outliers. METHODS: In this cross-sectional study, the statistical population included the evaluation forms of instructors completed by the students of Shiraz School of Health in the first and second semesters of the academic year 2012-2013. All the forms related to these years (N=1317) were entered into analysis through census. Then, four methods (Dixon, Gauss, Grubb, and Graphical methods) were used for determining outliers. Kappa coefficient was also used to determine the agreement among the methods. RESULTS: In this study 1317 forms were completed by 203 undergraduate and 1114 postgraduate students. The mean scores given by undergraduates and postgraduates were 17.24±3.04 and 18.90±1.82, respectively. The results showed that Dixon and Grubb were the most appropriate methods to determine the outliers of evaluation scores in small samples, because they had appropriate agreement. On the other hand, NPP and QQ plot were the most appropriate methods in large samples. CONCLUSION: The results showed that each of the studied methods could help us, in some way, determine outliers. Researchers and analysts who intend to select and use the methods must first review the observations with the help of descriptive information and overview of the distribution. Determination of outliers is important in evaluation of instructors, because by determining the outliers and removing the data that might have been recorded incorrectly, more accurate and reliable results can be obtained.

Factors associated with extubation time in coronary artery bypass grafting patients.

Background and Objectives. Cardiovascular diseases are the leading cause of death worldwide, with coronary artery disease being the most common. With increasing numbers of patients, Coronary Artery Bypass Grafting (CABG) has become the most common operation in the world. Respiratory disorder is one of the most prevalent complications of CABG. Thus, weaning off the mechanical ventilation and extubation are of great clinical importance for these patients. Some post-operative problems also relate to the tracheal tube and mechanical ventilation. Therefore, an increase in this leads to an increase in the number of complications, length of hospital stay, and treatment costs. Since a large number of factors affect the post-operative period, the present study aims to identify the predictors of extubation time in CABG patients using casualty network analysis. Method. This longitudinal study was conducted on 800 over 18 year old patients who had undergone CABG surgery in three treatment centers affiliated to Shiraz University of Medical Sciences. The patients' information, including pre-operative, peri-operative, and post-operative variables, was retrospectively extracted from their medical records. Then, the data was comprehensively analyzed through path analysis using MPLUS-7.1 software. Results. The mean of extubation time was 10.27 + 4.39 h. Moreover, extubation time was significantly affected by packed cells during the Cardiopulmonary Bypass (CPB), packed cells after CPB, inotrope use on arrival at ICU, mean arterial pressure 1st ICU, packed cells 1st ICU, platelets 1st ICU, Blood Urea Nitrogen 1st ICU, and hematocrit 1st ICU. Conclusion. Considering all of the factors under investigation, some peri-operative and post-operative factors had significant effects. Therefore, considering the post-operative factors is important for designing a treatment plan and evaluating patients' prognosis.

Spatio-Temporal Pattern of Tuberculosis in the Regions Supervised by Shiraz University of Medical Sciences 2006-2012.

BACKGROUND: The present study aimed to identify the spatial distribution of tuberculosis and determine the TB control program parameters in the regions supervised by Shiraz University of Medical Sciences in 2006-2012. METHODS: The present ecological study was performed on 1797 TB patients in Shiraz University in 2006-2012 which were recorded by health centers using TB Register software. The study data were collected through over-counting and analyzed using the SPSS statistical software (ver. 19). Besides, the maps were drawn by ArcGIS, version 10. RESULTS: The incidence rate of TB was 4.8 in 100,000 at the end of 2012. Success in treatment was adequate only in 2012 (89.7%). However, recovery of pulmonary TB was not adequate in any of the study years. In our study, the majority of the patients belonged to the 25-34 years age group that constitutes the active faction of the society. Moreover, the maps provided by GIS showed a high incidence rate of extra pulmonary TB in Firozabad Township during 7 years (2.7 in 100000 populations). CONCLUSION: Incidence of TB in the regions supervised by Shiraz University of Medical Sciences follows a specific pattern, which requires exclusive studies for further evaluation of the incidence determinatives in various environmental and social conditions.

Comparison of the Effect of Vaginal Zataria multiflora Cream and Oral Metronidazole Pill on Results of Treatments for Vaginal Infections including Trichomoniasis and Bacterial Vaginosis in Women of Reproductive Age.

Effect of Zataria multiflora on bacterial vaginosis and Trichomonas vaginalis is shown in vivo and in vitro. We compare the effectiveness of Zataria multiflora cream and oral metronidazole pill on results of treatment for vaginal infections including Trichomonas and bacterial vaginosis; these infections occur simultaneously. The study included 420 women with bacterial vaginosis, Trichomonas vaginalis, or both infections together, who were randomly divided into six groups. Criteria for diagnosis were wet smear and Gram stain. Vaginal Zataria multiflora cream and placebo pill were administered to the experiment groups; the control group received oral metronidazole pill and vaginal placebo cream. Comparison of the clinical symptoms showed no significant difference in all three vaginitis groups receiving metronidazole pill and vaginal Zataria multiflora cream. However, comparison of the wet smear test results was significant in patients with trichomoniasis and bacterial vaginosis associated with trichomoniasis in the two treatment groups (p = 0.001 and p = 0.01). Vaginal Zataria multiflora cream had the same effect of oral metronidazole tablets in improving clinical symptoms of all three vaginitis groups, as well as the treatment for bacterial vaginosis. It can be used as a drug for treatment of bacterial vaginosis and elimination of clinical symptoms of Trichomonas vaginitis.

Spatial analysis of common gastrointestinal tract cancers in counties of Iran.

BACKGROUND: Gastrointestinal tract cancers are among the most common cancers in Iran and comprise approximately 38% of all the reported cases of cancer. This study aimed to describe the epidemiology and to investigate spatial clustering of common cancers of the gastrointestinal tract across the counties of Iran using full Bayesian smoothing and Moran I Index statistics. MATERIALS AND METHODS: The data of the national registry cancer were used in this study. Besides, indirect standardized rates were calculated for 371 counties of Iranand smoothed using Winbug 1.4 software with a full Bayesian method. Global Moran I and local Moran I were also used to investigate clustering. RESULTS: According to the results, 75,644 new cases of cancer were nationally registered in Iran among which 18,019 cases (23.8%) were esophagus, gastric, colorectal, and liver cancers. The results of Global Moran's I test were 0.60 (P=0.001), 0.47 (P=0.001), 0.29 (P=0.001), and 0.40 (P=0.001) for esophagus, gastric, colorectal, and liver cancers, respectively. This shows clustering of the four studied cancers in Iran at the national level. CONCLUSIONS: High level clustering of the cases was seen in northern, northwestern, western, and northeastern areas for esophagus, gastric, and colorectal cancers. Considering liver cancer, high clustering was observed in some counties in central, northeastern, and southern areas.

Pathological profile of patients with breast diseases in Shiraz.

BACKGROUND: Around 200,000 breast disorders are annually diagnosed all over the world. Fibrocystic changes are the most common breast disorder and fibroadenoma is the most prevalent benign breast tumor. The present study aimed to determine the spectrum, type and prevalence of breast masses in women referred to Shiraz University of Medical Sciences between 2004 and 2012 . MATERIALS AND METHODS: A cross-sectional study was conducted on the diagnostic reports data. RESULTS: A total of 640 samples were studied. Most 57.3% of masses were detected in the left breast, 65%, 28.2% and 6.1% of cases presenting with benign, malignant, and inflammatory lesions, respectively. Among all the samples the most prevalent diagnosis (37.7%) was fibroadenoma and fibrocystic lesions (17%). 174 samples (96% of the malignant cases) were invasive. 6.5% of the benign, and 37% of the malignant cases occurred in post menopause women and the differences were statistically significant. Among those with malignant tumors lymph nodes were involved in 25.6% of menopausal women and 44.2% of non-menopausal ones, and the difference was statistically significant. CONCLUSIONS: Regular clinical breast examination beside mammographic follow-ups, especially during menopause, should be carried out as a priority and a national organized program should be designed for screening breast disorders.

Breast cancer risk factors in women participating in a breast screening program: a study on 11,850 Iranian females.

The incidence rate of breast cancer in developed countries is almost three-fold higher than in developing countries. Iran has had one of the lowest incidence rates for breast cancer in the world, but during the recent decades a marked increase has been seen. The purpose of this study was to investigate some established risk factors of breast cancer in Iranian women. A study of 11,850 women participating in abreast screening program was conducted. The 197 women diagnosed with breast cancer and 11,653 healthy women were compared. Logistic regression was performed to investigate associations of reproductive and anthropometric factors with breast cancer risk. Family history of breast cancer (OR=1.94 , 95%CI=1.35-2.78), occupation (OR= 1.65,95%CI=1.20- 2.25), education level (OR=0.50,95%CI=0.28-0.91), parity (OR=0.27, 95%CI=0.12-0.59), menopausal status (OR=3.15, 95%CI=2.35-4.21), age at menarche (OR=0.33, 95%CI=0.15-0.70), and age at the first pregnancy (OR=4.10 , 95%CI=1.13-14.77) were related to the risk of breast cancer. Decrease in parity may to some extent explain the rising trend of incidence of breast cancer incidence in Iranian women.

A model for decision making for intensive care unit admission in source limited hospitals.

BACKGROUND: Demand for ICU beds is exceeding its supply. Since the sources are limited in some centers, it is necessary to design a model to identify the patients who benefit more from ICU beds. OBJECTIVES: The present study aimed to develop a model to prioritize adult patients according to their clinical indications by a three rounded Delphi method study. PATIENTS AND METHODS: In this study, 22 physicians who practiced in a source limited hospital in southern Iran were invited to participate in a three phase Delphi survey. RESULTS: At first, the panelists recommended 30 indications. The indications in the first checklist plus those obtained by literature review formed the second checklist which contained 36 items. The items were scored from 0 to 10 by the panelists. According to the scores, the indications were categorized into three priority levels, which were confirmed by the panelists in the third round. CONCLUSIONS: This simple checklist contains the indications for ICU admission categorized into three priority levels. This checklist can be considered as a guide for physicians who practice in hospitals with limited number of ICU beds.

Epidemiologic characteristics of HIV-positive patients referring to behavioral diseases consultation center in Shiraz, Iran.

BACKGROUND: Acquired immune deficiency syndrome (AIDS) was firstly reported from California and soon became a pandemic in the world. This disease poses serious threats to humans' health. In this study, we intended to examine the characteristics of HIV-positive patients who referred to the Behavioral Diseases Consultation Center (BDCC) in Shiraz, Iran. METHODS: This was a cross-sectional descriptive study. HIV-positive patients, referring toBDCC of Shiraz University of Medical Scienceswere the population under the study. The data, collected through a checklist, were encoded and entered in to the SPSS 19. Then descriptive statistics such as mean, median, standard deviation and range were used to describe the variables. Also, the relationships between the variables were tested using X2 test. RESULTS: The mean and median age of the HIV-positive patients were 39 + 8.7 and 38years, respectively.Nearly327 (65.4%) of the studied population were male and 173 (34.6%) were female. With respect to marital status, 225 (45%) participants were married, 133 (27%) were single, 91 (18.2%) were divorced and 49 (9.8%) were widowed. Also, 265(53%) of the participants were infected through injection drug use, 198 (39.6%) through sexual route, 7 (1.4%) through blood and blood products, 6 (1.2%) through tattoos and 21 (4.2%) by other routes. Most of the participants had a HIV-positive history in their family, and 145 (29%) mentioned that their wives were HIV-positive. Moreover, 320 (62.7%) of the participants had a positive history of drug use, 176 (35.2%) did not have a history of drug abuse, and the status of 10 (2%) participants was not recognized. CONCLUSION: Although the results of this study highlighted that injection addiction remains the major transmission route inIran, the role of sexual transmission should be acknowledged in the future.