[Serum digoxin level among patients referred to Kashan cardiovascular clinic during 2009-10]

Considering that the Digoxin's therapeutic level is very close to its toxic level, it is important to determine the digoxin dose. Digoxin serum level is affected by multiple pharmacokinetic factors. Therefore, this study aimed to evaluate the serum digoxin level and its relation with the initial dose and other related factors in patients referred to Kashan cardiovascular clinic. This cross-sectional study was carried out on 125 patients for whom digoxin was prescribed for at least one month. The patients were excluded in the case of having simultaneous history of thyroid disease and other antiarrhythmic drugs. Serum digoxin, creatinine and potassium level and also the demographic characteristics of the patients for the first time were checked out. The mean age of patients was 63.7 +/- 13.42 years. Sixty-six [52.8%] cases were male. The most common reason for drug implication was systolic dysfunction [63.2%] and the most common cause of systolic dysfunction the coronary artery disease [56.61%]. Most patients [70.4%] had a glomerular filtration rate [GFR] between 30-90 ml/min. Moreover, Fifty-nine patients [47.2%] with the highest frequency in treatment group were treated with 3.5 tablets per week. Serum digoxin level was significantly associated with the age and GFR [P=0.001 and P=0.008, respectively], but not with gender, potassium level and the reason for drug use and left ventricular ejection fraction. The main factor in determining the digoxin dose is the patient's GFR that includes all pharmacokinetic variables of drug plasma level

[Serum zinc level in children with acute gastroenteritis admitted to Kashan Shahid Beheshti hospital]

Zinc is an essential micronutrient for growth and proper immune function. Zinc deficiency may contribute to the incidence, prevalence and severity of diarrhea and can also cause failure to thrive in children. The purpose of this study was to evaluate the serum zinc level in children with diarrhea. This cross-sectional study was performed on 105 children with acute watery diarrhea referred to Kashan Shahid Beheshti hospital during 2008-9. To test the serum zink level, a sample of venous blood [5-cc] was taken. In addition, the age, sex, the duration of diarrhea, the length of hospitalization and FTT were evaluated. Data were analyzed using Chi-square, T-test and ANOVA. Among the 105 children, 48.6% were male and half of them aged more than 12 months. The results showed that the mean serum zinc level in hospitalized children and diarrhea duration more than 3 days was lower than the other children [P=0.023 and P=0.004, respectively]. Moreover, the mean serum zinc level in children with FTT was lower than the children without FTT [P<0.001]. Duration of diarrhea, the length of hospitalization and FTT in children with low serum zinc levels was more than the other children

Epidemiology of attempted suicide in Kashan during 2003-8

Background: Suicide is a major public health problem in developing countries which depending on geographical area, several factors have been associated with its prevalence and incidence. This study was conducted to evaluate the prevalence of attempted suicide and its related factors in Kashan during 2003-8

Materials and Methods: This cross-sectional study was performed on all suicide attempters referred to Kashan health centers during 2003-8. Patient's demographic information, manner, outcome and a previous history of suicide attempts were recorded on a questionnaire by interviewing patients or their families

Results: There were 2867 suicide cases during the study period. Most of them were in age range of 25-35 years. Fifty-nine percent of patients were female and 56% married. Drug abuse was the most common method of suicide [79%]. So, an overall attempted suicide rate was 119 per 100000 people in Kashan during 2003-8 and there were only 29 cases [1.1%] of successful suicide

Conclusion: Although the rate of attempted suicide are high in this city, the rate for successful suicide is very low. Therefore, this problem and its related factors need to be considered by health managers

[Occupational and non-occupational risk factors in occupational hand injuries]

Hand injuries are the most common bodily traumas sustained at work and are always preventable. Different occupational and non-occupational risk factors may predispose to these grave events; identification and modifying them has a critical role in prevention of the accidents. This study was carried out to evaluate the association between these factors and hand injuries. In this case control study 82 industrial workers with occupational hand injuries from Tehran nearby factories were compared with eighty-three controls. Working circumstances were assessed using a detailed occupational and non-occupational [individual and socio-psychological factors] questionnaire. Data were analyzed with chisquare and t-test. Rotational shift work [P=0.027], lack of a close relationship between the workers, lack of training, availability and using safety equipments are statistically significant risk factors related to hand injuries [P=0.006]. There is no significant relationship between individual and familial factors and hand injuries. Availability of safety equipments and their proper use are the most important preventive factors for hand injury. Lack of close relationship between workers can also be regarded as a significant risk factor

Economic burden of inappropriate antibiotic use for prophylactic purpose in Shiraz, Iran

Because economic data on the prophylactic usage of antibiotic in Iran are scant, we have conducted a cross-sectional study with provider perspective to measure costs and appropriate use of antibiotics in surgical wards of 6 training hospitals affiliated to Shiraz University of Medical Sciences [SUMS], Iran. Over a six-month period 1,000 consecutive patients undergoing surgical operation were enrolled and information on prophylactic antibiotic administration was collected. The information included basic patient's demographic data, types of surgery, category of antibiotic, dosage, dosage intervals, route of administration, number of doses, initiation times and duration of administration. In order to determine the agreement between prescribed antibiotics and medical indication, the American Society of Health-System Pharmacists [ASHP] guidelines were applied. Nine hundred and ninety three out of 1,000 patients [99.3%] had received at least one antibiotic and 908 patients [91.4%] received antibiotics because of a medical indication. Five out of 913 patients who had indications for antibiotic prophylaxis did not receive any antibiotic. Antibiotics were prescribed for 85 out of 87 [98%] procedures in which an antibiotic was not indicated. The average cost of antibiotic prescription per surgical procedure was 786,936 Iranian Rials [corresponding to 99.60 USD or Eng. pound 82.90]. The most frequent prescribed antibiotic was cefazoline adding 53.3% of the total cost of antibiotics. In total, 36,516,190 Iranian Rials [corresponding to 4,622.95 USD or Eng. pound 3,845.20] were spent for cefazoline alone. The results of this study showed that all surgical patients received at least one antibiotic as prophylaxis for any infection in the surgical site. Our results indicate over- and misuse of antibiotics in Iran leading to a great amount of economic burden, since in 98% of all procedures, antibiotics were used inappropriately

[Survival analysis of gastric cancer patients refering to Emam-Khomeini hospital using Weibull cure model]

Due to its high prevalence, the survey on gastric cancer survival in Iran seems too important. In the case of relative long-term survival of the cases, using standard models is not conventional. So cure models are used to estimate the proportion of the cured patients that will never experience the event of interest and also to evaluate the survival function of susceptible individuals who may experience the event and effective factors. This study was carried out to determine the five-year survival rate of gastric cancer patients who have undergone surgical treatment. Three hundred and thirty gastric cancer operated patients with a maximum 10-year survival were enrolled in the study. The patients' life expectancy after surgery and cure fraction and their relationships with some variables were evaluated. Kaplan-Meier and Weibull Cure models were utilized for analyses. The five-year survival rate and the median life expectancy were 24% and 19.9 months, respectively. Univariate analysis using the Weibull model showed that age, existence/site of metastasis and stage of disease influenced on the probability of curing [P<0.05]. On assessing the simultaneous effect of different variables the age and stage of disease proved to be effective on curing [P<0.05], but none of the variables affected the life expectancy of patients [P>0.05]. Using the cure models is beneficial in situations which the population under study suggests the presence of subpopulation. The cure/immune model methodology may separeltery identify the sets of covariates related to the cured proportion and also the failure time distribution of uncured one

[Assessing the effective dose of warfarin in treatment course of the patients referring to Kashan heart clinic]

The major problem in prescribing the therapeutic dose of warfarin, the most clinically used anticoagulant, is achieving its optimal International Normalized Ratio [INR]. This study was designed to determine the mean dose of warfarin among the patients admitted to Kashan Heart Clinic in 2008. In this cross-sectional study, the medical documents of all patients receiving warfarin in any medical indications were studied for demographic specification, INR results, smoking, other used drugs and the underlying diseases. The warfarin dose attained [INR equal to 2.4-2.6 for 3 consecutive test results] was regarded as the optimal dose. All unqualified cases in terms of INR criteria were excluded. Statistical analysis was done using ANOVA, Pearson, Spearman and t-tests. Seventy one out of 86 patients were included in the study. The mean daily dose of warfarin was 3.97 +/- 1.38 mg. Fourty six, 13, 11 and one patient[s] received warfarin for atrial fibrillation, prosthetic valve, congestive heart failure and embolic cerebrovascular accident, respectively. While warfarin dose had an inverse relation to age [P=0.01], it had no significant relation with sex [P=0.7], underlying diseases [P>0.07], smoking [P=0.2], other used drugs [P=0.07] and the patient weight [P=0.1]. The results showed that warfarin dose was higher among the patients with prosthetic valve [P=0.008]. The obtained effective daily and weekly dose of warfarin i.e. 3.97 +/- 1.38 and 27.83 +/- 9.77 mg, respectively could be used as a therapeutic clue for prescribing the appropriate dose and optimum INR