To compare the performance of quanti-feron with the tuberculin skin test for identifying latent tuberculosis infection

Tuberculosis [TB] is an important issue which its control is still unsatisfactory at global level. Traditional diagnostic techniques for active TB diagnosis are inadequate: the diagnostic gold standard is the culturel exam which suffers from lengthy processing and requires highly specialized laboratories. Nowadays more specifie tests hâve been recommended. The aim of this study is to evaluate the performance of Quanti FERON-TB [QFT] Gold In Tube-Test as a substitute for specifie test tuberculin skin test for diagnosis of latent tuberculosis infection in high risk groups. One hundred thirty four [134] individuels who worked in Bo-Ali hospital [Zahedan] enrolled in this study. They had no active tuberculosis. TST and QFT tests were performed. The cut-off point of TST was considered based on 15 [mm] or more indurations as positive. The resuit of QFT was evaluated by manufactured guidelines. Multivariate logistic regression was used to identify the putative risk factors of positive tests. Proportion of employees with latent TB were 1 1 1 [82.8%] were positive by either TST or QFT, and 76[56.7%] were positive by both tests. Agreement between the tests was high [73.8%, k=0.39; 95% E.21-0.44]. Positive family history of Tuberculosis was significant risk factor for both positive tests. This study showed high latent tuberculosis infection prevalence in hospital workers and high agreement between TST and QFT. Decision to select one of the tests will be depended on the population, purpose of study and availability of resources. The results revealed that the QFT can be appropriate alternative test for high risk group

An overview on causation in epidemiology

The relationship between two things if one is another originator or creator, called causality. Although this concept is not specified to Medical Sciences and Epidemiology, the importance of this issue is more highlighted in the field of epidemiology. Causation is the most basic concepts in empirical sciences and is still under discussion because it is dependent on the basis of any scientific laws without acceptance something cease causality is impossible. With the increasing development of science as well as epidemiology, causality has found a broader concept and its application in analytical studies and logical interpretation of the results of this type of study, has a wider dimension. Due to developing new epidemiology courses at medical universities and increase the number of students, it is felt to talk more about the causality concept. In this review causality concepts in the humanities is overviewed, its history is briefly described, the causality of Medical Epidemiology and also Islamic religion is considered, then the causality framework, and models to interpret the conventional causality will be discussed

Turnover intentions and political influence behavior: a test of "fight-or-flight" responses to organizational injustice

We examined the role of organizational frustration as a linking mechanism between the perception of organizational injustice and fight [political influence behavior]/ flight [turnover intentions] responses. The participants were 201 middle-level managers drawn from manufacturing and logistics companies in northern Malaysia. Data were collected by means of a printed questionnaire. Whereas all the three components of injustice-procedural, distributive, and interactional-had significant positive impact on turnover intentions and political influence behavior, only procedural injustice and distributive injustice had such impact on frustration. Interestingly, organizational frustration played a partial mediating role in the relationship of distributive and procedural injustice with turnover intentions and political influence behavior. Implications of the findings for those in managerial roles and directions for future research are suggested

[Passive smoking during pregnancy and obstetric outcomes in pregnant women referring to Rafsanjan Nicknafs hospital]

Inhaling Environmental Tobacco Smoke [ETS], as a world health problem, threats the community especially mothers and newborns. The aim of this study was to determine the effects of passive tobacco smoking during pregnancy on mother and newborns. In this Cross sectional study, in one year, 641 non smoking women who refered to Rafsanjan Nicknafs hospital for bearing a singleton baby, were interviewed at least two hours after delivery using a structured check list. Based on history of exposure to ETS, the study samples were divided into two groups and then maternal and newborn outcomes in the two groups were compared. Exposure to ETS was reported among 25% [161] of respondents. The women exposed to ETS were less educated, multi gravid, had irregular prenatal care, older unemployed, lived in rural and in sum had low socio-economical status. They had higher rates of vaginal delivery [p=0.02], anemia [p=0.048] and preterm delivery [p=0.002]. But mother's exposure to ETS did not show any significant statistical relations with newborn weight, APGAR score, sex, anomaly and preeclampsia and the way of beginning the delivery Exposure to environmental tobacco smoke in pregnancy probably increases the risk of preterm labor and maternal anemia

[Oral care in ICU patients: a review of research evidence]

Considering the importance of oral care in the ICU and the lack of comprehensive protocols for oral care, the present study was conducted to review the available literature on oral care and to present an evidence-based protocol for oral care in ICU patients. Fifty-four full-texts original articles, systematic reviews and metaanalysis papers on mouth care in ICU patients published from 2001 to the end of 2010 in English and indexed in the Pubmed, Ovid, Elsevier, and ProQuest databases were searched by using the relative key-words [e.g. oral care, mouth care, critical care, and intensive care] in the title or abstract and then evaluated. ICU patients are prone to dental plaque and VAP due to conditions such as impaired immunological deficiency, the presence of an endotracheal tube, drug side effects, and difficulty with swallowing food and fluids. Due to the lack of a standard protocol for oral care in ICU, oral cares haven't properly done in ICU wards. Studies have shown that some oral care interventions [e.g. tooth brushing with toothpaste, brushing all surfaces of teeth, tongue and palate, and also the use of chlorhexidine solution] have largely reduced the incidence of VAP in ICU patients. The results revealed that the oral hygiene may reduce the incidence of VAP. Hence assessing patients, implementing mechanical and pharmaceutical interventions are important in oral care and applying the protocol presented in this study can improve the oral health of patients in the ICU

Outcome and factors associated with hospital mortality in patients with impaired left ventricular function undergoing coronary artery bypass grafting: where do we stand?

Impaired ventricular function is a known risk factor for mortality after coronary artery bypass grafting however increasingly more patients with impaired ventricular function are referred for surgery. Currently no large data is available from Pakistan regarding this aspect of coronary surgery. Our objectives were to find out the hospital mortality and mid term functional improvement in patients with impaired ventricular function undergoing coronary artery by pass grafting and identify the risk factors for mortality. Retrospective analysis of preoperative, operative and postoperative variables of patients with impaired ventricular function who were operated for isolated first time coronary artery bypass between October 2006 to April 2009. Total 190 patients with impaired ventricular function underwent isolated first time coronary artery bypass grafting during this period with a male predominance [82.6%]. Mean ejection fraction of the group was 25.4 +/- 5.3%. Mean predicted mortality on logistic Euro score was 10.9 +/- 2.7%. Actual in hospital mortality of the group was 4.7% which is comparable to contemporary published results. Multivariate analysis identified use of intra aortic balloon pump, non use of internal mammary artery and preoperative NYHA functional class as factors associated with mortality. Coronary artery bypass grafting can be performed in patients with impaired ventricular function with acceptable hospital mortality and mid term functional improvement

[Does fear of childbirth predict emergency cesarean section in primiparous women?]

Effect of women's psychological status on delivery processes is proven. Studies showed that women who experience severe anxiety were more vulnerable for getting emergency cesarean, and physical and psychological complications. Cesarean section is a surgery in which a lot of complications may occur. As primiparous women experience more fear than the other women and also delivery outcomes in first delivery affect later deliveries; this study aimed to study the relationship between fears from vaginal delivery with the occurrence of emergency cesarean in primiparous women. In this cross-sectional study, 243 primiparous women were recruited randomly from Nicknafs hospital during a six months period in 2004. Data were gathered through face-to-face interviewing with the respondents using a structured questionnaire. This questionnaire was included demographic information, reasons for fear from vaginal delivery, and method of delivery. Data were analyzed using ?2 test in SPSS. Seven percent of the respondents stated that they did not fear from Normal Vaginal Delivery [NVD]. Most of the respondents [44.4%] reported that they slightly fear from NVD and 26.3% said that they fear much from vaginal delivery. A relatively high percent of women [22.3%] stated that they extremely fear from NVD. The most mentioned reasons by the women for fear were pain [68/3%], and fetal injury [30%]. There was a significant relationship between fear and method of delivery [P < 0.001]. It is essential that midwives consider the fear from NVD in their routine cares

Environment and health, challenges of the new millennium

More than a century after John Snow identified a hand pump in Broad Street, London as the Primary source of cholera epidemic, then raging through the areas, supply of safe water and providing human excreta disposal facilities to all, still remain illusive targets in most communities in India, particularly in rural areas. Today the urban population of the country is at the interface of the process of development and environmental degradation, concurrently the rural population continues to suffer from lack of sanitation and safe drinking water, malnutrition and ecological insecurity. Ecological degradation brings in its wake, poverty and ill health and they combine to jeopardize the productivity of the country. Unfortunately, however, the costs of their health impact were never considered seriously by the economic planners

[Preference method of delivery and it's relevant causes in view of pregnant women referring to public and private clinics in Rafsanjan city]

While it's widely accepted that vaginal delivery is the best method of parturition, in most countries the cesarean rate has been growing over the past decades and in most cases it's performed only based on the women demand. Finding the reasons of women's tendency toward cesarean may help to diminsh the rate of this delivery method. Therefor in the present study we tried to investigate the preference method of delivery and its relevant causes in view of pregnant women referring to public and private clinics in Rafsanjan. In this cross-sectional study, 256 pregnant women were continuously interviewed and their method of choice for delivery and their reasons were also investigated using a qustionnaire. Data were analyzed by t test, one way Analysis of Variance and X[2] test. The results showed that 31.25% and 68.75% of the participants choose Cesarean Section [C/S] and Normal Vaginal Delivery [NVD] respectively as a method of choice for parturition. 52.6% of those who have chosen C/S, believed that NVD is a painful and stressful method which cannot be tolerated whereas 42% of the second group believed C/S could be a high-risk and invasive method. Of the knowledge qustions, 45.5% were correctly answered by the participants. The most important reasons for choosing C/S among the participants were fear of severe pain during vaginal delivery and lack of knowledge about the complications of cesarean. In addition, it should be important for the health - policy makers to develop an awareness concerning the C/S complications and the advantages of NVD. Applying of pharmaceutical and non - pharmaceutial pain-relief methods may also change the attitude of women in favour of NVD

[ effect of Ramadan fasting on psychological health and depression in Sirjan Azad university students [2004]]

Fasting improves both spiritual and physical aspects of individual's performance. In other words, fasting has many advantages in improving human health and elimination of abnormal behavior. In general, the advantages of fasting include psychological, physical and spiritual benefits. In this study, the effect of Ramadan fasting on psychological health and depression among university students has been evaluated. Three hundred and sixty one students were randomly selected and their demographic information was collected. Psychological health and depression scores were examined by Ferrell 12-item scale and standard Beck depression test, respectively. The data were collected in two different occasions 10 days before and 10 days after Ramadan. Mean scores of psychological health and depression of students in these two occasions were compared. The mean score of psychological health of participants before Ramadan was 33.94 +/- 8.55 [Mean +/- SE] that increased to 34.5 +/- 8.2 after Ramadan. Mean score of depression before Ramadan was 14.45 +/- 10.33 that decreased to 11.88 +/- 10.38 after Ramadan. These differences were statistically significant. Our findings confirmed that Ramadan fasting could be an important factor for improving mental health and elimination of depression in university students

Patterns of malignant tumors of the brain and spinal cord in Bahrain: Fifty two year period

To review malignant neoplasms of the brain and spinal cord in Bahrain, and to compare the incidence with other parts of the world. A retrospective study. All Histopathology Departments in Bahrain. Data relating to all malignant CNS neoplasms which were diagnosed histologically in Bahrain were extracted from the relevant patient medical records. All tumors were histologically diagnosed in Bahrain between 1952 and 2004. There were 103 malignant CNS tumors representing 1.4% of all malignancies histologically reported during the same period. Of the 103 patients, 77 [74.8%] were Bahraini. Of the Bahraini patients, thirty-one [40.3%] were female and the male: female ratio was 1.48:1. Sixty-two of the 77 Bahraini tumors [80.5%] were primary brain tumors, nine [11.7%] were primary spinal cord tumors, and six [7.8%] were secondary tumors. Astrocytoma and medulloblastoma were the commonest primary malignant CNS neoplasms in both adults and children. The apparent incidence of malignant brain and spinal cord neoplasms in Bahrain is very low. The small Bahraini population, inefficient registration of cancers, and the lack of routine hospital autopsies are contributory factors for the low numbers observed

Antibiotic prophylaxis in clean surgery

This study was performed to compare the use of perioperative prophylactic antibioctics in reducing wound infection in clean elective general surgery operations with no use of antibiotics in these operations. It was an experimental prospective study. The study was conducted at Combined Military Hospital [CMH] Multan from June 2002 to December 2002. Hundred patients were included in the study. Convenience sampling technique was used for the selection of patients. Only those patients undergoing clean elective general surgery operations were included. Patients were divided into two equal Groups [Group A and Group B]. Those in Group A were given injection cephradine 1g IV 8 hourly and injection gentamicin 80 mg IV 8 hourly 30 minutes before operation and continued for 24 hours postoperatively. Patients of group B did not receive any antibiotics. Surgical technique employed was similar. Patients from both groups were observed for the presence of wound infection. It was observed that in Group-A [with chemoprophylaxis] one patient [2%] developed postoperative wound infection and in Group-B [without chemo-prophylaxis] three patients [6%] developed postoperative wound infection. The low frequency of postoperative wound infection seen in Group-A as compared to Group-B [1/50 Vs 3/50] was not statistically significant by Chi-Square test. This study concludes that routine perioperative antibiotic prophylaxis doesn't significantly reduce the incidence of postoperative wound infections in clean elective general surgery operations

[Study of the anatomic characteristics of perforating branches of middle cerebral artery in left and right hemisphere in human brian]

Many arteries are responsible for nutrition of brain tissue that one of them is themiddle cerebral artery with its branches [perforating arteries]. The collapse or injury in each ofthese branches lead to brain stroke or pathologic injury in brain so perforating arteries has anatomicimportance and also it is necessary to recognize these arteries therefore we decided to measurelength, outer diameter and number of these vessels in middle cerebral artery.In this descriptive study 26 Brains [21 male and 5 female] of people whowere dead by non brain problems causes were surveyed using usual dissection method. The brainswere taken out in Kerman forensic medical center and dissection of the brains wereperformed inDepartment of anatomy, Kerman faculty of medicine.The length, diameter and number of perforations were measured in middle cerebral artery [MCA].Data were analysed by t-test.Results showed that the main number of perforating artery branches was 6.03 in right and6.57 in left the differences between two parts were not significant. The mean length was 13.61 +/- 0.05in right and 13.72 +/- 0.51 in left that were not significantly different. The mean outer diameter was0.49 +/- 0.01 in right and 0.58 +/- 0.03 in left the difference was significant [p<0.05].This study showedthat the outer diameter of perforating arteries in MCA weresignificantly differentein right and left brain, but the other variables were not significantly differentin right and left brain

[Factors relevant to sleeping disturbances in hospitalized medical-surgical wards patients of ail Ebne Abitaleb teaching hospital of Rafsanjan]

Sleep has always been considered as one of the most essential needs of humans. Patients need sleeping more than healthy individuals. Results of recent studies indicate that disease and hospitalization have close relationship with sleeping disturbances. This study is an attempt to assess the sleep disturbance-related factors in patients admitted to Medical-Surgical wards of Ali Ebne Abitaleb Teaching hospital of Rafsanjan.Using questionnaire, this descriptive study was performed. Sampling was target based and sample size was determined by use of volume assigning. Considering the probability of the out breaking at 80%, the sample size of 245 patients was determined. Samples were selected equally from medical and surgical wards. The collected data in the form of descriptive statistics were analyzed by using SPSS software. Furthermore, for determining the relationship between the demographic characters and the type of ward, based on the patients' out look, non parametric statistics was used.51.2% of the samples were male and 48.8% were female and most of them [33.9%] were under 25 years old. 49.1% of the patients claimed that the quality of their sleep had been decreased. The comparison of factors affecting the sleep disturbances showed statistically significant differences [p<0.001]. The most effective factors were personal, environmental and attentive factors, respectively. Having pain and restlessness were the most frequent personal factors. Moaning and other patients, crying, quality of hospital beds, room temperature and the noise caused by hospital equipments were the most effective environmental factors. Among attentive factors, being awake for receiving medicine or serum taking was the most important one.Half of the studied patients complained from sleeping disturbances and according to their opinion, controlling or removing the above-mentioned factors can be suggested