[ survey of Knowledge, Attitude and Practice of Physicians Related to Evidence-Based Medicine in Hakim and 22 Bahman Hospitals of Neyshabur]

Introduction and Aims: evidence based medicine aids the delivery of effective service to patients, diagnosing and treating. According to Clinical guidelines of evidence-based medicine, it's possible to change clinical decision, improve treatment and promote the patients´ health. The purpose of this study is to survey knowledge, attitudes and performance about evidence-based medicine among physicians

Materials and Methods: all of the physicians in educational hospitals of medical faculty of Neyshabur, were entered in this cross-descriptive study by convenience sampling method. The questionnaire included demographic information and also information about knowledge, attitudes and obstacles of evidence-based medicine. Data were analyzed by SPSS v.16 software and descriptive statistics

Results: results showed that 88 % of physicians had little familiarity with evidence-based medicine and its resources. 47.8 % of them employed evidence-based medicine in their treatment decisions and 60.4 % knew the significance of evidence based medicine for medical teams. Overloud of information were reported by 55.1 % of participants as preventive factor in use of evidence-based medicine

Conclusion: according to low level of knowledge and performance in evidence-based medicine among physicians, promoting awareness and practice is needed

Association of haptoglobin phenotypes with serum levels of IgE and IgA in allergic rhinitis patients

Allergic rhinitis [AR] is an allergic disorder of the nasal tissue that underlies diseases such as sinusitis, otits and asthma. Different predisposing factors including immunological and non-immunological factors contribute to the disease pathogenesis. To investigate association of haptoglobin [Hp] phenotypes [Hp1-1, 2-1 and 2-2] with serum immunoglobulins A and E levels in patients suffering from AR in comparison with healthy individuals. Two hundred and forty patients and 240 healthy individual entered in this case-control study. Serum levels of IgE and IgA were measured and haptoglobulin phenotypes were determined by electrophoresis. The results were evaluated by chi[2] statistical test using SPSS software. Serum electrophoresis showed that the distribution of haptoglobin phenotypes of Hp1-1, Hp2-1 and Hp2-2 among 240 patients were 11.3%, 37.9% and 50.8%, respectively. The distribution of different haptoglobin phenotypes in healthy controls were 88.7%, 36.6% and 54.7%, respectively. However, the difference between patients and controls was not statistically significant [p=0.136]. The mean of IgE level was significantly higher in patients than controls in association with all three phenotypes [p<0.001]. Mean of IgA serum level was also significantly different between case and control groups for Hp1-1 [p<0.048] and Hp2-2 phenotypes [p<0.027]. We conclude that there is an association of all three haptoglobin phenotypes with IgE level. Hp1-1 and Hp2-2 phenotypes showed association with IgA in allergic rhinitis, as well. However, we cannot solely attribute these associations to the pathogenesis of allergic rhinitis

prophylactic effect of rectal acetaminophen on postoperative pain and opioid requirements after adenotonsillectomy in children

Postoperative pain in children is common after adenotonsillectomy. Rectal acetaminophen has been used effectively for postoperative pain management in small children. The aim of this randomized double blind study was to evaluate the prophylactic effect of rectal acetaminophen on postoperative pain management and opioid requirements in children undergoing adenotonsillectomy. 104 children, 7 to 15 yr, ASA I or II scheduled for elective adenotonsillectomy were recruited for the study. Patients were randomized to receive either rectal acetaminophen 40 mg/kg or nothing after induction of standard anesthesia. The postoperative pain was assessed using visual analog scale [VAS] every 2 hours for the first 6 hours. The need for rescue analgesic, intravenous pethedine of 0.5 mg/kg, was recorded at 24 hours after surgery. Pain scores were significantly lower in acetaminophen group at different times [p<0.001] and needed less rescue analgesic [p<0.001]. We conclude that prophylactic rectal acetaminophen is effective in reducing pain after adenotonsillectomy and postoperative analgesic requirement

[Incidence of hearing abnormality in neonate hospitalized in neonate intensive care unit]

Risk factors including asphyxia, meningitis, form of delivery, etc may cause hearing loss in neonates results in speech and language deprivation, emotional and educational problems. The aim of this study was to determine the prevalence of hearing loss and its relationship with risk factors among neonates hospitalized in neonate intensive care unit [NICU]. It was a cross-sectional study on 234 NICU hospitalized neonates in Ghaem and Imam-Reza hospitals of Mashhad. Epidemiologic and pathologic information were obtained. Otoacoustic emissions were done in all of neonates. Patients referred to the second otoacoustic emissions [OAEs] and patients failed in the second test controlled by auditory brainstem response [ABR]. Hearing abnormality was found in 11 neonates [4.7%] including 2 girls and 9 boys. [1 neonate with mild, 2 with mild to moderate, 2 with moderate to severe, 1 with sever to profound hearing loss and 4 with auditory neuropathy]. Hearing abnormality has a significant greater incidence in group with apgar 5, so, a comprehensive hearing screening program must be applied for early identification and intervention

Vaccine immunotherapy for a deadly disease like malignant melanoma: where do we stand?

The incidence of cancer and its related morbidity and mortality remain on the increase in both developing and developed countries. Cancer remains a huge burden on the health and social welfare sectors worldwide and its prevention and cure remain two golden goals that science strives to achieve. Among the treatment options for cancer that have emerged in the past one hundred years, cancer vaccine immunotherapy seems to present a promising and relatively safer approach as compared to chemotherapy and radiotherapy. The identification of different tumor antigens in the last fifteen years using a variety of techniques, together with the molecular cloning of cytotoxic T lymphocytes [CTLs]-and tumor infiltrating lymphocytes [TILs]-defined tumor antigens allowed more refining of the cancer vaccines that are currently used in different clinical trials. In a proportion of treated patients, some of these vaccines have resulted in partial or complete tumor regression, while they have increased the disease-free survival rate in others. These outcomes a re more evident now in patients suffering fro m melanoma. This review provides an update on melanoma vaccine immunotherapy. Different cancer antigens are reviewed with a detailed description of the melanoma antigens discovered so far. The review also summarizes clinical trials and individual clinical cases in which some of the old and current methods to vaccinate against or treat melanoma were used. These include vaccines made of autologous or allogenic melanoma tumor cells, melanoma peptides, recombinant bacterial or viral vectors, or dendritic cells