Religious, cultural, and social beliefs of Iranian rural women about breast cancer: a qualitative study

Background: The purpose of this study was to examine religious, cultural, and social beliefs of healthy women about breast cancer in rural settings in Iran. Methods: In the present study, 16 in-depth interviews with health care leaders, social and religious experts and 11 focus group discussions were conducted with 79 women in the rural areas near the capital city of Tehran, Iran. Grounded theory model was used to analyze the data. Results: Some women believed that religious customs and rituals, such as praying, taking a vow, or going on a pilgrimage to a holy place, might have healing effects if performed in addition to seeking medical care medical care. Many believed that God intervenes in the entire course of any illness, from occurrence to cure. Although few had fatalistic views toward cancer, the majority believed that patients could try to change their destiny. With respect to the relationship between moral behavior and disease, 4 types of opinions were identified; good people suffer, evil people get punished, evil people do not suffer, and everything has a scientific explanation. Participants believed that self-perception, their husbands, deficiencies in the health care system, and financial concerns influence breast cancer outcome. Conclusions: Our study showed that many participants were not aware of any available support in the healthcare system. They generally believed in the healing effect of prayers, only when it is sought in parallel with medical care

[Comparison of the frequency of antinuclear antibodies in patients with pemphigus vulgaris and a control group]

Pemphigus vulgaris [PV] is an autoimmune blistering disease which is specific for skin and mucosal membranes. Its association with connective tissue diseases has already been reported. Considering this association, presence of Anti Nuclear Antibodies [ANAs] in PV patients will not be surprising. The aim of this study was to compare the frequency of ANA positive cases in patients suffering PV with a control group. In this case-control study, the cases were selected from the patients with PV whom were hospitalized at Razi Hospital, Tehran. The controls were chosen from patients who did not have PV. The data were collected using a questionnaire, which was designed for gathering information on participants' age, sex, PV phenotypes, and the result of ANA test. ANA positivity was assessed using indirect immunofluorescence, HEP2. In 8 [26.7%] of 30 PV patients and 3 [10.0%] of 30 controls ANA was positive [P=0.095]. The most common ANA positive patterns among cases and controls were homogeneous and speckled patterns, respectively [P=0.26]. Although in this study the frequency of positive ANA result among controls was similar to what were reported in previous studies, the frequency of this finding among PV patients was different from the previous reports. Differences in the sensitivity of the laboratory kits used in different studies as well as in the threshold for ANA positivity, and differences in the patients' eligibility criteria in different studies may explain the observed discrepancies. Clinical follow up of the PV and requesting an ANA test in the case of appearance of the signs of connective tissue diseases is recommended

Trauma care system in Iran / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to describe the current status of trauma system regarding the components and function.</p><p><b>METHODS</b>The current status of trauma system in all components of a trauma system was described through expert panels and semi-structured interviews with trauma specialists and policy makers.</p><p><b>RESULTS</b>Currently, various organizations are involved in prevention, management and rehabilitation of injuries, but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of public education through media, traffic regulation reinforcement, hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training standards of the front line medical team and continuing education and evaluation are yet to be addressed. Trauma registry has been piloted in some provinces, but as it needs the well-developed infrastructure (regarding staff, maintenance, financial resources), it is not yet established in our system of trauma care.</p><p><b>CONCLUSIONS</b>It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system.</p>

[Pre-hospital delay among patients with acute myocardial infarction]

To determine the prevalence and predictors of patient delay among patients with myocardial infarction. In this cross-sectional study, a sample of 95 admitted patients with confirmed diagnosis of myocardial infarction were included. They were asked about symptoms, the time from presentation to admission and the reason for delay, if any. Delay was defined as arrival to hospital after 3 hours from initiation of symptoms. The mean age of patients was 60.4 +/- 1.1 years and mostly were male [76.8%]. Half of the patients had visited the doctor 9 hours after the pain started or later [median]. About 70 percent of patients had delayed seeking medical care after myocardial infarction. The risk factors for delay in the descending order of importance [OR] were: lacking sweat as a symptom, heart attack at midnight, lacking previous history of heart disease, visiting a general practitioner, gradual onset and lower educational level. Education of the general public especially individuals with lower educational status can lead to better recognition of symptoms and decrease patient delay

Extremity fractures in children: a hospital based study in Tehran / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Although long bone fracture in children is not life-threatening, it may cause major disability, loss of working days and severe psychological distress. We conducted this study to determine the pattern of extremity fracture due to trauma in children.</p><p><b>METHODS</b>During one year in six general hospitals in Tehran, trauma patients who were hospitalized for more than 24 hours and sustained injuries within seven days before admission were included in the study. The records of children (< or = 16 years old) hospitalized in six general hospitals in Tehran due to trauma were reviewed prospectively.</p><p><b>RESULTS</b>During the study period, 1 274 children had sustained extremity fractures. Male to female ratio was 3.6/1, with the mean age of (10.3+/-4.2) years. Falls and traffic crashes were the main causes of injuries, with the percentages of 57.3% and 37.1%, respectively. Simple fall (falling on the ground) consisted 60% of patients that sustained fall-related injuries. Pedestrians and bicycle riders comprised most of the cases that were injured due to traffic crashes. Of our cases, 56.8% sustained fractures in the upper extremities and 43.2% in the lower extremities. Forearm was the most common fracture site (34.1%). Comparing our results in preschool and school-age children, falls were the main cause of injuries in both groups, but fractures of lower extremities were significantly more common in preschool children.</p><p><b>CONCLUSIONS</b>Improvement of physical condition of sidewalks and crossings in roads will be necessary for prevention of injuries. More attention to safety of home environment should be paid for control of preschools'injury at home. Education of children and adults is necessary to reduce injuries resulting from road traffic crashes.</p>

Seat belt use during pregnancy in Iran: attitudes and practices / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Seat belt use during pregnancy reduces injury to the mother and her fetus. During recent years, the use of seat belts has been mandated by law in Iran. The purpose of this study was to determine the attitudes and practices of pregnant women regarding seat belt use.</p><p><b>METHODS</b>In this cross-sectional study, we asked 335 pregnant women at a hospital-based prenatal care clinic on the use of safety belt before and during pregnancy. SPSS version 13.0 was used for data analysis.</p><p><b>RESULTS</b>The mean age of study subjects was 27.3 years ± 5.3 years with the median of 27 years. Compared with the seat belt use before pregnancy, no change was detected in 48.7% of the women; seat belt use had increased in 17.5 % of them and decreased in 33.8 %. Eighty-one percent of women knew the correct placing of both lap belt and shoulder belt. Only 4% of women had received education on proper restraint use during pregnancy.</p><p><b>CONCLUSIONS</b>The prevalence of seat belt use during pregnancy is lower than reports which are mostly from developed nations. The fact that about one-third of women have decreased their seat belt usage during pregnancy highlights the importance of education of mothers on this topic.</p>

Violence against nurses in non-psychiatry emergency wards

Violence against health staff is a widespread problem occurring in different ways and has multiple consequences on health personnel, health systems and even patient care. Emergency Department [ED] personnel especially nursing staff have a higher risk of being exposed to violence, but due to the lack of any recording and reporting system of such incidents, the history of related studies in our country is limited. This exploratory study was conducted in EDs of three major hospitals of Tehran University of medical sciences in 2004, in order to determine the frequency of violence against nursing staff. Data of this cross sectional study were retrieved by questionnaire from 136 nurses working in the ED of three hospitals, Imam-Khomeini, Shariati and Sina. The questionnaire consisted of questions on socio-demographics, previous experience of different types of violence and its reporting. Data were analyzed using statistical software [SPSS] version 11.5. Of study participants, 66.9% were female and 31.6% were male. The overall experience of violence was rather high [98.6%]: 97.8% verbal violence, 39.7% physical violence and 86% other types of violence. Reporting of physical violence was more than the other types. The reasons of underreporting of violence according to the participants were belief in inefficacy of any actions in this regard and their intentions for not magnifying the incident in the workplace. Most of the nurses believed that the possible explanations for the violence incidents they faced were prolonged waiting time in ED, high direct costs, inadequate health insurance, and finally inadequate number of personnel in ED. A majority of nurses had worries about being assaulted in the ER in the future [91.1%]. Exposure to violence especially verbal violence among nurses working in EDs is high, but despite the high prevalence of worrying about reoccurrence of violence, most of the cases remain unreported and don't result in a legal action. It seems that arrangement of systematic educational courses concerning prevention of violence and conflict resolution for ER staff, empowerment of security systems like guards, adoption of strategies to support assaulted staff and take effective legislative actions against aggression and violence in the health systems may be effective to reduce the burden problem

Thoracic injury: a review of 276 cases / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Chest injury, one of the most important aspects of trauma, directly accounts for 25% of all trauma-related deaths and plays a major contributing role in another 25% of trauma deaths. This paper aimed to explore the spectrum and outcome of thoracic injuries seen in a multi centric study of trauma patients.</p><p><b>METHODS</b>A total of 276 consecutive trauma patients in 6 general hospitals were analyzed. The feature of injury, injury severity score (ISS), clinical treatment and mortality were recorded in a prospective manner and analyzed retrospectively. Multiple logistic regression analysis was used to determine the independent predictors of mortality following the chest trauma.</p><p><b>RESULTS</b>There were 246 males (89.1%) and 30 females (10.9%) ranging from 3 to 80 years with a mean age of (34+/-17) years. Road traffic accident was the main cause of injury, especially for pedestrians, followed by stab wound (89 cases, 32.1%) and falling injuries (32 cases, 11.6%), respectively. Haemothorax or pneumothorax (50.4%) and rib fracture (38.6%) were the most common types of chest injury. Extremity fracture was the most common associated injury with the rate of 37% ( 85/230), followed by head injury (25.2%) and abdominal trauma (19.6%). These injuries contributed significantly to the morbidity and mortality of trauma patients.</p><p><b>CONCLUSIONS</b>According to the results, most patients with chest injury can be treated conservatively with close observation and tube thoracostomy. The presence of blunt trauma, head injury and abdominal injury independently adversely affect mortality after chest trauma. It is necessary to investigate the causes and patterns of injuries resulting from stab wound for effective prevention.</p>

[ relation between thiopurine methyl transferase activity and efficacy and side effects of azathioprine in patients with pemphigus vulgaris]

Azathioprine is the most widely used immunosuppressive agent as an adjunct to corticosteroids in the treatment of pemphigus vulgaris [PV]. Thiopurine methyl transferase [TPMT] is a key enzyme in azathioprine metabolism and a genetic polymorphism controls its activity in human tissue. TPMT activity can provide a rational basis to determine suitable dose of azathioprine, theoretically. The aim of this study was to evaluate the clinical relevancy of this hypothesis in PV patients. In this cross sectional study in Razi Hospital, the activity of TPMT in the red blood cells of 52 PV patients who received azathioprine for at least 12 months and 29 PV patients who did not receive this drug was measured and correlated to the clinical response and side effects observed. The mean of TPMT activity was not significantly different in patients with unfavourable response, comparing to patients with favorable response to azathioprine [P=0.087]. No relationship was observed between total dose of corticosteroid and TPMT activity [r=0.089, P=0.583]. There was no difference between the mean of TPMT activity in patients receiving azathioprine and those not receiving this drug [P=0.36]. A direct relationship was not observed between TPMT activity and clinical efficacy and side effects in PV patients under treatment with azathioprine. Larger prospective studies in more homogenous patients are needed to evaluate the clinical relevance of TPMT polymorphism and to determine accurate azathioprine dosing guidelines based on TPMT activity

Chest injury in victims of Bam earthquake / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To analyze the data of trauma patients with thoracic injury in the earthquake of Bam admitted to hospitals of Tehran University of Medical Science (TUMS) for better understanding the type and consequence of thoracic injuries in a major earthquake.</p><p><b>METHODS</b>After Bam earthquake registering 6.5 on the Richter scale, 526 trauma patients were admitted to hospitals of TUMS. Among them, 53 patients sustained thoracic injury.</p><p><b>RESULTS</b>This group was composed of 21 females (39.6%) and 32 males (60.4%). Fifteen patients (28.3%) had isolated chest injuries. Rib fracture (36.4%) was the most common injury in our patients and haemo/pneumothorax (25.5%) followed. Superficial injury was the most common accompanying injury. Multiple-trauma patients with chest injury had higher injury severity score (ISS) versus patients with isolated chest injury (P=0.003).</p><p><b>CONCLUSIONS</b>Chest wall injuries and haemo/pneumothorax comprise a considerable number of injuries in survival victims of earthquakes. Consequently, the majority of these patients can be treated with observation or tube thoracostomy. We should train and equip the health workers and members of rescue teams to treat and manage these patients in the field.</p>

Percutaneous nephrolithotomy with and without retrograde pyelography: Preliminary results of a randomized controlled trial

Since the introduction of percutaneous nephrolithotomy [PNL], many modifications to entering the pyelocalyceal system have been made. One alternative is to insert a needle pointed to an opaque stone as a landmark. The aim of this study was to compare the outcomes of managing kidney calculi by PNL with and without retrograde pyelography. In this randomized controlled trial, 55 candidates for PNL with a single opaque kidney calculus in the calyx alone, the pelvis alone, or both the calyx and the pelvis were assigned into 2 groups. Twenty-seven patients underwent PNL with a ureteral catheter, and 28 patients underwent PNL without a ureteral catheter. Clinical outcomes were compared between the 2 groups using plain radiographs taken on the first day after the procedure. Patients had similar distributions regarding sex, age, operative time, hospital stay, past surgical history on the kidneys, and stone size. There was a significantly greater decrease in postoperative hemoglobin level in patients having PNL with a ureteral catheter [P<0.001] than in those having the procedure without a ureteral catheter. No differences were seen among patients in the 2 groups in terms of stone-free rate, and number of patients with insignificant residue, and those needing extracorporeal shock wave lithotripsy, a second PNL procedure, or transurethral lithotripsy. Percutaneous nephrolithotomy without ureteral catheterization has specific benefits: urine leakage is lower and there is no need to perform cystoscopy. Patients with a single kidney calculus are good candidates for PNL without previous ureteral catheter insertion

Synchronous surgical removal of suspicious ovarian metastases from colorectal cancer

Metastatic ovarian cancers occur in 3-8 percent of women undergoing surgical resection of a primary colorectal cancer. In this study we examined the characteristics of women with colorectal cancer for whom synchronous oophorectomy had been performed.In this cross-sectional study, records of patients with colorectal cancer from April 1991 through October 1999 who had undergone surgery for both colorectal cancer resection and oophorectomy for suspicious ovarian metastasis in the Cancer Institute, Imam Khomeini Medical Center, were reviewed. SPSS version 10 was used for statistical analysis.The studied cases [n= 82] comprised 44.1 percent of all recorded cases of women with colorectal cancer during this period [N= 186]. The mean age of our cases was 52.19 years. 54.9% of the studied women were in stage C of colorectal cancer. The commonest pathology of tumors was adenocarcinoma [89%]. Well differentiated carcinoma was observed in 43.9%, followed by moderately differentiated carcinoma in 37.8%, poorly differentiated in 12.2% and unspecified in 6.1%. 22 of our patients [26.8%] had gross abnormalities of ovaries at operation. In 13 cases [15.8% of our 82 studied cases and 6.99% of all 186 women with colorectal cancer], tumoral involvement of ovaries was proven through pathologic examination. 10 out of these 13 cases were among those with gross abnormalities of ovaries at operation [p= 0.048]. Among the 13 patients with ovarian metastasis, 11 cases [84.6%] were in stage C at operation [p= 0.02] and 7 [53.8%] had well differentiated carcinoma [p= 0.04].Patients with ovarian metastases of colorectal origin are generally peri- or post-menopausal. Like similar studies, in our setting, about 7 percent of all recorded female cases with colorectal cancer turned out to have ovarian metastases in surgical pathologic examination in fact, 15.8% of our 82 cases sustaining surgery for [[colorectal cancer and suspicious ovarian metastases]] proved to have ovarian metastases. We recommend that prophylactic oophorectomy be performed in postmenopausal women with advanced stage colorectal cancer or any other women with colorectal cancer with gross abnormality of the ovarian at operation