Prevalence of behavioral inhibition among preschool aged children in Tehran, Iran

One of the identified risk factors for anxiety disorders in adolescence and adulthood is inhibited behaviors in childhood. The present study sought to examine the relationship between behavioral inhibition with some of the internal [personal] and external [family environment] factors in a sample of preschool children in kindergartens. In a cross sectional study in 2009, data was collected trough a structured questionnaire completed by parents and teachers in day-care centers. A total of 1403 children were assessed. Analysis was performed through complex sample analysis. The results showed that 7.4% [CI95%= 6.1%-9.1%] of children according to parents' and 8.1% [CI95%= 6%- 10.7%] according to teachers' evaluation classified as behaviorally inhibited. The higher levels of behavioral inhibition were shown by girls, first children, single parent families and older children. Birth year before 2004, birth rank, living in a single parent family and maternal level of education were independent predictors for behavioral inhibition in logistic regression modeling. There is relatively high prevalence of inhibited behaviors among Iranian children. Further examination of diagnosed children with behavioral inhibition by experienced psychiatrists is needed. Also establishing consultation centers for behaviorally inhibited children and instructing their parents and teachers are recommended

Inter-observer reproducibility before and after web-based education in the gleason grading of the prostate adenocarcinoma among the Iranian pathologists

This study was aimed at determining intra and inter-observer concordance rates in the Gleason scoring of prostatic adenocarcinoma, before and after a web-based educational course. In this self-controlled study, 150 tissue samples of prostatic adenocarcinoma are re-examined to be scored according to the Gleason scoring system. Then all pathologists attend a free web-based course. Afterwards, the same 150 samples [with different codes compared to the previous ones] are distributed differently among the pathologists to be assigned Gleason scores. After gathering the data, the concordance rate in the first and second reports of pathologists is determined. In the pre web-education, the mean kappa value of Inter observer agreement was 0.25 [fair agreement]. Post web-education significantly improved with the mean kappa value of 0.52 [moderate agreement]. Using weighted kappa values, significant improvement was observed in inter-observer agreement in higher scores of Gleason grade; Score 10 was achieved for the mean kappa value in post web-education was 0.68 [substantial agreement] compared to 0.25 [fair agreement] in pre web-education. Web-based training courses are attractive to pathologists as they do not need to spend much time and money. Therefore, such training courses are strongly recommended for significant pathological issues including the grading of the prostate adenocarcinoma. Through web-based education, pathologists can exchange views and contribute to the rise in the level of reproducibility. Such programs need to be included in post-graduation programs

An Iranian scoring system for diagnosing Buerger's disease

Buerger's disease or thromboangiitis obliterans [TAO] seems to be common in IR Iran, The present study aimed to evaluate an Iranian population with Buerger's disease in order to suggest a diagnostic criterion for Buerger's disease based on the most frequent findings and to compare it with Papa diagnostic criteria. In a cross-sectional study, all patients with resting limb pain, limb ischemic ulcers, intermittent claudication and limb ischemia who referred to the Vascular Clinic of Sina Hospital during 2009-2011 were evaluated. The patients were allocated to Buerger's and non-Buerger's groups; Evaluating 122 patients [61 in each group], according to the model each clinical manifestations and risk factors in the patients with Buerger's disease obtained a score. Absent pulsation, abnormal distal Doppler sonography and ischemic ulcer were respectively present in 58 [95.1%], 58 [95.1%] and 49 [80.3%] individuals with Buerger's disease. Multivariate linear regression analysis and multivariate logistic regression analysis were used for modeling. Considering the model finding findings, diagnostic criteria including age, sex, smoking, Raynaud's phenomenon, abnormal proximal Doppler, diabetes mellitus and hyperlipidemia were suggested [R[2]=0.582]; the sensitivity and specificity of the criteria was respectively 95.1% and 78.7%. Compared with Papa criteria, Kappa coefficient was measured at 0.66 with a P-value<0.001. It seems that the recommended criteria have an acceptable accuracy in diagnosing Buerger's disease, especially in the Iranian population; however, it is necessary to conduct more studies with larger sample sizes to evaluate the criteria, especially in other populations

[ comparison of mallampati test in supine and sitting position in traditional approach and during phonation for predicting of difficult laryngoscopy and intubation]

Inadequate ventilation, esophageal intubation and difficult intubation are the most common adverse respiratory outcomes in patient undergoing anesthesia .The aim of this study was to compare Mallampati test in supine and sitting positions in traditional approach and during phonation for predicting difficult laryngoscopy and intubation. In this study performed in Imam Khomeini Hospital in Tehran, Iran, Mallampati test was performed on 661 patients who met the inclusion criteria for the study. The test was done in supine and sitting positions with and without phonation by a rater who was blind to Mallampati test. Subsequently, laryngoscopy view and difficult intubation were evaluated in the four aforesaid positions by Mallampati test for predicting difficult laryngoscopy and intubation. For each situations, sensitivity, specificity, positive and negative predictive values and accuracy were calculated. Overall, 28 [4.2%] patients had difficult laryngoscopy and 9 [1.4%] patients had difficult intubation. The highest sensitivity for Mallampati test in predicting difficult laryngoscopy and intubation was in supine and sitting positions without phonation, and the highest specificity was seen in sitting position with phonation. Negative predictive values were more than 95% in all different positions for Mallampati tests and the highest positive predictive value was seen in supine position with phonation. According to our findings, the highest correlation between Mallampati test and different positions in predicting difficult laryngoscopy and intubation was seen in supine position with phonation. Phonation improved Mallampati score in supine rather than sitting position

[ prevalence of abdominal aortic aneurysm in Iranian male population over 65 years old]

Prevalence of Abdominal Aortic Aneurysm [AAA], estimated by various studies, ranged from 4.1% to 14.2% in men older than 60 years. Most cases of AAA are asymptomatic and often discovered incidentally. Approximately the initial presentation in 12% of cases of AAA is sudden rupture with subsequent high mortality. This study was performed to evaluate the prevalence and screening necessity of AAA among Iranian men older than 65 years old. In this cross-sectional study, men older than 65 years, who referred for ultrasound examination to three different centers in Tehran, Iran at the year 2008 were included for evaluation of size of the abdominal aorta and presence of AAA. A total of 240 men older than 65 years enrolled in this study. AAA was found in 24 of the participants with prevalence rate of 10% in the studied population. Mean diameter of detected aneurysms was 3.93-1.435 cm. In 4 [1.7%] subjects, aneurysms greater than 5.5 cm in diameter were detected. One of these four subjects had the history of coronary artery disease and one was cigarette smoker. Three out of four had history of hypertension. Considering the estimated prevalence rate of AAA by the current study and the population of Iranian men older than 65, implementing of mass screening for AAA in this group would detect 986 asymptomatic cases each year. Therefore, the authors recommend further studies about the cost-effectiveness of mass screening for AAA among Iranian men above 65 years

Prevalence of attention-deficit/hyperactivity disorder symptoms in preschool-aged Iranian children

The aim of this study was to determine the prevalence of attention-deficit/hyperactivity disorder [ADHD] symptoms in Iranian preschool children based on evaluations by parents and teachers because a thorough understanding of epidemiologic features of ADHD symptoms in preschool children is important for prevention and management. Children between the ages of three and six attending kindergarten participated in this study. For the survey, 37 kindergartens were selected by multistage [stratified cluster random] sampling, consisting of 2213 children with a design effect equal to 1.5. A 19-item observer-rating questionnaire was generated to assess ADHD symptoms in children within the last 6 months. This questionnaire was used by both teachers and parents to assess ADHD behavior in participating children. Of 1403 children aged 3-6 years, 362 were classified as having ADHD symptoms according to their parent evaluation [25.8% [23.6-28.1%]] and 239 according to their teachers evaluation [17% [14.1-20.4%]]. Child rank among siblings, mother's education level, and interest in aggressive television programs were all independent explanatory variables according to parents' evaluation. Gender, parent education, child rank, single parent and interest in aggressive television programs were all independent explanatory variables according to teachers' evaluation. Our findings reveal a large discrepancy in the prevalence of ADHD symptoms in preschool children based on evaluation by parents and teachers. Thus, it seems that the ADHD screening should be performed in multiple settings in order to identify children who need further investigations

How do parents think about the effect of food and alternative medicine on their epileptic children?

Parents of epileptic children are willing to know if specific foods precipitate or aggravate their kids' seizures. Nonetheless conclusive data are limited. Alternative medicine has become a popular approach to many diseases in the world and there are limited data about this approach to epilepsy in Iran. We tried to evaluate attitude of parents of epileptic children to food-epilepsy relationship and alternative therapeutic approach to epilepsy. We carried out a cross-sectional study with analytic aspect at Children's Medical Center, Tehran, Iran in 2008, by asking the parents of epileptic children to fill out a valid and excellently reliable questionnaire. We collected parents attitude and analyzed it using SPSS software. One-hundred and fifty one families participated in the study. Fifty-nine of participants [39.1%] believed that foods had no effect on epilepsy. Fifty one cases [33.8%] said that foods might have negative or positive effect on epilepsy and 27.1% [41 cases] had no idea. Higher percent of parents believed in food-epilepsy relation in cases that fathers had educational levels above high school graduation. Sixteen cases [10.6%] said that alternative medicine might improve epilepsy and 55% had no idea about efficacy of this approach to epilepsy. Compared with previous published study from Iran, parents of epileptic children believed less in food-epilepsy relation. Majority of parents either believed that foods had no effect on epilepsy or had no idea. More than half of parents had no idea about efficacy of alternative medicine to epilepsy. Only a few of them believed in ameliorating effects of alternative medicine on epilepsy

Trend of smear positive pulmonary tuberculosis in Sistan and Baluchestan province [2005-2008]

According to the World Health Organization [WHO] report in 2008, incidence of tuberculosis in Iran is 25-49/100,000 cases per year. Based on the guidelines of the Ministry of Health, case detection index for smear positive pulmonary tuberculosis [SPP-TB] has reported to be 11/100,000 in Iran in the year 2006. Sistan and Baluchestan Province has the highest rate of SPP-TB in Iran. This study aimed to evaluate the trend of incidence of SPP TB from 2005 to 2008, taking into consideration the interventions [started in the beginning of 2006] implemented by the Zahedan University of Medical Sciences to reinforce the screening system and evaluate the case detection index in this province. The understudy population comprised of the whole community under medical coverage of Zahedan University of Medical Sciences. Screening was mainly conducted passively till the end of 2005. Since the early 2006, some interventions have been conducted to reinforce the active screening system. All the information regarding the new cases of SPP-TB from 2005 to 2008 was collected from the Center for Disease Control of Sistan and Baluchestan Province. Changes in trend of SPP-TB incidence were analyzed by using Time Series analysis considering the interventions and related effective factors. As a result of interventions aiming at reinforcing active screening since 2006, there has been a significant increase in both the incidence rate and case detection index. However, the incidence rate decreased in 2007.By using "Time Series Analysis for evaluation of the trend of incidence during the study period, the incidence of TB was estimated to be 22.88 cases in 100,000 in 2009. If we overcome the existing shortcomings regarding the screening system of SPP TB, successful case detection index should be higher than 22.88 in 100,000

Effect of incisional site infiltration of Bupivacaine on postoperative pain and meperidine consumption after midline laparotomy

The purpose of the current study was to determine whether infiltration of bupivacaine in the incision site of midline laparotomy reduces postoperative pain and opioid consumption. Fifty-six, 30-60 year-old patients who were undergoing midline laparotomy were enrolled in the present study. The patients were randomly assigned into two groups of control [group C, n = 28] or bupivacaine [group B, n= 28]. Just before suturing, the incision sites were infiltrated by 20 ml epineprinated bupivacaine 0.25% [group B] or 20 ml normal saline as placebo [group C]. The patients were asked to score their pain at 6, 24, and 48 hours after surgery. Demographic characteristics of the patients were similar in the two groups. There was no significant difference in the mean of visual analogue scale pain scores measured over time between the two groups. There was a significant difference in post operative meperidine consumption between the two groups, and in the bupivacaine group, meperidine request was less [90.53 +/- 13.36 mg in bupivacaine group v127.5 +/- 23.14 mg in the control group, P < 0.05]. After midline laparotomy, incisional site infiltration with 20 ml epineprinated bupivacaine 0.25% causes a significant decrease in postoperative meperidine consumption

Sexual dysfunction in Epileptic men

The aim of this study was to evaluate the frequency of sexual dysfunction among epileptic patients. Eighty married men between 22 and 50 years with a confirmed diagnosis of epilepsy were enrolled in this study. Patients with other neurological diseases, hypertension, cardiovascular diseases, diabetes mellitus, underlying urogenital diseases, and impaired general health status were excluded. Furthermore, those with mental health problems were identified by the standardized General Health Questionnaire-28 and were excluded. Demographic and clinical characteristics of the disease were evaluated, and sexual function was assessed by the self-administered questionnaire of the International Index of Erectile Function-15 [IIEF-15]. Of 80 patients, 34 [42.5%] had erectile dysfunction. There were no differences between the patients in the 3 age groups [>30 years, 30 to 40 years, and > 40 years] in the IIEF scores. Type of seizure had a significant correlation with erectile function score [P=.008]. None of the IIEF domains scores were different between the patients with controlled epilepsy and those with uncontrolled epilepsy during the previous 6 months. However, frequency of epileptic seizures [before treatment] correlated with the scores for erectile function [r=0.31; P=.005], orgasmic function [r=0.23; P=.04], and sexual desire [r=0.24'P=.03]. It seems that the main aspects of sexual activity such as erectile function, orgasmic function, and sexual desire are frequently impaired in epileptic patients. Our findings were also indicative of a higher risk of sexual dysfunction in patients with partial seizures

Comparison of mortality and morbidity rates among Iranian pilgrims in Hajj 2004 and 2005

We compared the incidence of common diseases and accidents among Iranian pilgrims during Hajj 2004 and 2005, and determined the factors affecting the prevalence of each disease. We conducted this comparative study on 30037 Iranian pilgrims during Hajj 2004 and 75676 pilgrims during Hajj 2005, in Mecca and Medina in the Kingdom of Saudi Arabia. In this study, 23 types of common illnesses, 8 types of accidents, some important demographic variables, and some probable related factors were investigated. Two-sample tests of proportions in STATA Statistical Software version 8 was used for the data analysis. The most common diseases during the 2 journeys were respiratory diseases and the incidence of these diseases in Hajj 2005 was twice more in the year 2004. The prevalence of cardiovascular diseases among pilgrims in Hajj 2005 was 142 per 10,000 and it was significantly lower than in Hajj 2004 [288 per 10,000]. There was no significant difference among gastrointestinal, gynecological, psychological, and other important diseases, in the 2 journeys. Among the 8 types of accidents, the incidence of head and eye injuries during Ramy [one of the components of Hajj rites] in the year 2005, was significantly lower in 2004 [22 per 10,000 against 125 per 10,000]. Furthermore, the mortality rate in the year 2005 with 24 deaths per 100000, was significantly lower than the deaths in 2004 [47 per 100000]. The findings of this study may guide the Hajj managers to estimate the needs of drugs, equipment, manpower, and educational needs for the pilgrims, also to identify and eliminate casual factors of diseases and accidents