Socioeconomic status and satisfaction with public healthcare system in Iran

Background: The users' satisfaction is a method for evaluating the efficacy of healthcare system. We aimed to evaluate the association between the users' socioeconomic status [SES] and satisfaction with the healthcare system in Shiraz, Iran

Methods: This cross-sectional study was conducted from December, 2013 to March, 2014, in Shiraz, Iran. 3400 households were recruited by multi-stage cluster random sampling. Information about demographic, insurance status, and users' satisfaction was derived from face-to-face interviews. Satisfaction with healthcare system was assessed by using 5-point Likert scale statements, which ranged from "very dissatisfied" to "very satisfied". All statistical analyses were performed using SPSS-21

Results: Overall, 1.6% [55] of the respondents were very satisfied, while 6% [203] were very dissatisfied with healthcare system. Participants were classified into high SES [26.3%], middle SES [47.9%] and low SES [25.8%]. It was discovered that the better the SES, the more frequent were the respondents dissatisfied with healthcare system [P<0.001]. Also, dissatisfied respondents were significantly older [P=0.036]. Moreover, women were more dissatisfied with healthcare system [P=0.005]. Also, dissatisfied respondents had significantly a higher level of education than satisfied ones [P<0.001]. Furthermore, logistic regression revealed that age [P=0.04], marital status [P=0.01], insurance status [P<0.001], SES [P<0.001], and having supplemental insurance [P=0.02] were determinant factors of satisfaction with healthcare system

Conclusion: This study demonstrated that users' sex, age, educational level, and SES were related to dissatisfaction with healthcare system. Meanwhile, clients' age, SES, insurance status and marital status were recognized as determinant factors

Age at Natural Menopause and Related Factors in Isfahan, Iran

OBJECTIVE: This study was aimed to evaluate the age at natural menopause and related factors among women in a population based study in 2015 in Isfahan, Islamic Republic of Iran. METHODS: In this cross-sectional study 960 menopausal women were selected by cluster sampling. Demographic, socioeconomic, lifestyle behavior and reproductive history aspects were collected using a structured questionnaire. Woman and her husband's educational level and occupation with family income were the variables to construct socioeconomic status using principal component analysis. RESULTS: Mean and median of natural menopause age were 48.66 and 48 years, respectively. Women body mass index (BMI) more than 30 kg/m2 had significantly higher menopausal age than women with lower BMI (P value = 0.022). The mean of menopausal age was not statistically significant in regard to marital status, physical activity, smoking status, menarche age, age at first pregnancy and history of abortion. Menopause age with pregnancy numbers and age at last pregnancy had a significant positive association. Women with better socioeconomic status had significantly higher natural menopause age. Multiple linear regression shows significant relationship between lower age at menopause with higher age at marriage, higher number of pregnancy and lower socioeconomic status. CONCLUSION: Age at menopause in our studied sample is similar to previous estimates reported for other Iranian populations. Age at marriage, higher number of pregnancy and lower socioeconomic status were the significant factors in relations to age at menopause.

P-glycoprotein a gene expression in glucantime-resistant and sensitive leishmania major [MRHO/IR/75/ER]

Leishmaniasis is a parasitic disease caused by different species of Leishmania parasites with a wide range of clinical manifestations. Antimonial compounds such as meglumine antimoniate [glucantime] are the first line drugs for the treat-ment of leishmaniasis. However, according to reports of the drug resistance of parasites, the efficacy of antimonial compounds is low. The ATP-binding cassette [ABC] proteins are present in all organisms and mediate the transport of vital elements through biological membranes. One of the important mechanisms of resistance in Leishmania parasites is the overexpression of ABC efflux pumps. P-glycoprotein A [pgpA] is a related gene for ABC transporter in Leishmania species. The aim of this study was to compare the pgpA expression in laboratory-induced resistant L. major [MRHO/IR/75/ER] and sensitive parasites. RNA extraction of promastigotes of sensitive and resistant clones was performed and total RNA was reverse transcribed. The real-time quantitative polymerase chain reaction [PCR] was used to assess RNA expression profiles and the expression levels were calculated using 2-deltaCt method. The mean expression level of pgpA mRNA was 2.70 +/- 0.51 in in sensitive Leishmania clone and 6.08 +/- 1.50 in resistant Leishmania clone [P = 0.021]. The expression of pgpA gene in resistant strains of L. major was almost fivefold higher than those in susceptible strains. Therefore, this can be used in field isolates, i.e. overexpression of the gene can prove resistance in wild type field isolates

Fish and egg specific immunoglobin E in multiple sclerosis patients

The effect of nutrition in the course of multiple sclerosis [MS] is a topic of great interest. The present study was aimed to evaluate the immunoglobin E [IgE] against egg and fish in MS patients compared to healthy controls. Between March 2012 and July 2012, 48 MS patients were selected and compared with 48 healthy subjects to assess the frequency of IgE against egg and fish in MS patients compared to healthy control. Fish and Egg specific IgE was determined by Immuno CAP. Sex and the frequency of specific IgE were compared between study groups by Chi-square test. Total of 96 subjects was assessed [22% male and 78% female]. The mean age of the study subjects was 30.8 +/- 6.6 years. Mean age of case and control groups was 30.7 [ +/- 6.9] versus 30.9 +/- 6.3, respectively [P = 0.83]. There were no detection of egg and fish specific IgE in serum of MS patients and healthy subjects. IgE allergy against fish and egg may be very unlikely to affect MS course

estimation of direct medical costs of treating patients with chronic hepatitis B and C in Iran

The objective of this study is to estimate the average diagnosis and treatment costs of chronic hepatitis B and C, with respect to different therapeutic strategies in Iran. This is a descriptive, analytical, and cross sectional study carried out on patients with hepatitis B and C, who were referred to the Liver Disease Research Center for Prevention and Treatment of Hepatitis, Isfahan University of Medical Sciences, in 2011. We have estimated the direct medical costs including doctors' fees, cost of para clinical tests, medical treatments, and liver biopsy, in different treatment strategies. The results of this study showed that the total cost of diagnostic services for hepatitis B virus [HBV] and hepatitis C virus [HCV] patients, with state medical tariffs, was US$ 1499.07 and US$ 2084.89, respectively. The patients' profiles showed that there were currently seven therapeutic strategies available to treat HBV patients. The total cost of treatment strategies varied significantly from US$ 73 to US$ 8256. There were also four main strategies for HCV patients, each of these could be applied in two periods of time. The total cost of these treatment strategies showed a high disc repancy from US$ 242 t o US$ 8256. The results confirmed that the total direct medical cost for an HBV patient in Iran exceeded US$ 5.5 Milliard in 2011. The results implied that the market price of direct medical cost of HBV and HCV patients in Iran is much higher than the estimated state costs. These costs would likely be saved or reduced by effective disease management and early prevention

Late-onset multiple sclerosis in Isfahan, Iran

Multiple sclerosis [MS] typically affects young adults; however, the first symptoms can occur after age 50 and is classified as late-onset MS [LOMS]. In this retrospective study, we extracted the records of 3522 MS patients [2716 females and 806 males] registered in the Isfahan MS Society [IMSS] from 2003 to 2010. Next, we searched for LOMS cases. We aimed to compare these cases with 1698 non-LOMS subjects also extracted from the IMSS database. We found 48 LOMS patients [28 females and 20 males], which gave a crude frequency of 1.36%. The frequency by sex of LOMS in males [2.4%] was significantly greater than in females [1.0%, P = 0.002]. The mean age at onset was 55.1 +/- 4.3 years. The female to male ratio of 1.4:1 in these patients was significantly lower than in non-LOMS subjects [3.37:1, P= 0.003]. The leading pattern of MS was relapsing-remitting [RR] in 62.5%, followed by primary progressive [PP] in 27.1%, and secondary progressive [SP] in 10.4%. Predominant presenting symptoms and signs were motor disturbances [35.4%], followed by brainstem [25%], optic neuritis [22.9%], and sensory related deficits [18.7%]. The mean progression index [PI] in LOMS patients [0.88 +/- 0.48] was significantly higher than in non-LOMS cases, 0.37 +/- 0.17 [P< 0.0001]. In comparing LOMS patients with the non-LOMS cohort, there was a higher frequency of the PP pattern and a higher PI in the LOMS group. In comparing other high-risk populations with the Isfahan cohort, LOMS formed a lower percentage of the total Isfahan MS population

25 Hydroxyvitamin D concentrations in patients with optic neuritis as a clinically isolated syndrome and healthy controls

The onset of multiple sclerosis in the majority of the cases occurs as a clinically isolated syndrome [CIS]. We sought to assess serum levels of 25-hydroxyvitamin D [25-OHD] in CIS patients and healthy controls. In this cross-sectional study 40 patients [36 women and 4 men] with CIS manifesting as a single isolated optic neuritis and 40 Age- and sex-matched healthy controls [35 women and 5 men] were enrolled between late October 2010 and early March 2011. General vitamin D deficiency was defined as serum 25-OHD levels of lower than 20 ng/ml and was classified as mild [15 < 25-OHD <20 ng/ml], moderate [8 < 25-OHD <15 ng/ml], and severe [25- OHD <8 ng/ml]. We found no difference in the median interquartile range [IQR] between CIS patients and controls [17.95 [10.40- 29.13] vs. 17.00 [12.25-31.00]; P=0.57]. However, when stratified by the levels of deficiency, among CIS patients a significantly higher proportion had severe vitamin D deficiency in comparison to healthy controls [20% vs. 2.5%; P=0.034]. Nevertheless, the frequency of general [62.5% vs. 60%, P=0.82], mild [25% vs. 30%, P=0.80], and moderate [17.5% vs. 27.5%, P=0.42] vitamin D deficiency were not different between the two groups. Our findings do not indicate any significant difference of serum 25-OHD between CIS patients and healthy controls. However, in our series severe vitamin D deficiency was more frequent among CIS patients.

Anti-aquaporin-4 IgG in patients presenting with unilateral optic neuritis: a cohort study

Optic neuritis [ON] can be the first presentation of multiple sclerosis [MS] or neuromyelitis optica [NMO]. Anti-aquaporin-4 IgG [AQP4 IgG] is a highly specific and moderately sensitive biomarker for NMO. This study was designed to assess the rate of seropositivity for AQP4 IgG, and the short-term outcome of patients presenting with single isolated ON [SION]. A cohort of 41 consecutive patients experiencing severe [< 20 / 200] SION [not fulfilling the diagnostic criteria for MS or NMO], was prospectively recruited. Blood sampling was carried out immediately after the diagnosis of ON, and AQP4 IgG was tested qualitatively, using an indirect immunofluorescence kit. After clinical and paraclinical investigations, all the patients were followed up for a short-term period of at least 18 months. The seroprevalence among the initial ON patients was 9.7% [4 / 41]. The short-term conversion rate to MS and NMO was estimated to be about 7.3 and 4.9%, respectively. The conversion rate to NMO in initially seropositive patients was greater than that for the whole cohort [2/4 [50%] vs. 2/41 [4.9%]; P = 0.035; Odds ratio: 19.5, 95% confidence interval: 1.73 to 219.50]. AQP4 IgG seropositive SION patients were more likely to develop NMO in comparison to the total SION population. Further studies, with a longer follow-up period and larger sample sizes are warranted to assess the clinical and prognostic value of assessing AQP4 IgG in SION

Comparative study of two silicone hydrogel contact lenses used as bandage contact lenses after photorefractive keratectomy

Silicon hydrogel bandage contact lenses are used to enhance epithelial healing, control surface-generated pain, and prevent epithelial erosions after refractive surgery. Considering the importance of faster reepithelialization in preventing complications of photorefractive keratectomy [PRK] and the fact that the features and specifications of these commercially-available lenses are different and their performance as a postoperative bandage lenses would be different also, the aim of this study was comparison the efficacy of senofilcon A and lotrafilcon A after PRK. In this prospective study, 44 patients with PRK in both eyes randomly received a silicon hydrogel contact lens of senofilcon A in one eye and lotrafilcon A in other eye. Then the epithelial defect size, visual acuity and subjective level of pain and discomfort were measured for both eyes and compared on day 1, 3 and 5 postoperatively. There was no statistical difference in rate of reepithelialization between senofilcon A and lotrafilcon A [P > 0.05]. The mean pain and discomfort index was significantly lower in eyes with senofilcon A [P < 0.05]. The mean subjective visual scores were similar with both bandage contact lenses [BCLs] [P > 0.05]. Silicon hydrogel BCLs are safe and effective for corneal reepithelialization and have great therapeutic outcome on visual outcomes after PRK. But, senofilcon A had better effect on postoperative pain and discomfort which made it superior than lotrafilcon A. However for more conclusive results, it is recommended to study larger sample size with evaluation the possible factors responsible for the obtained findings regarding postoperative pain and discomfort

Prevalence of hepatitis C virus, hepatitis B virus, human immunodeficiency virus and related risk factors among hemophilia and thalassemia patients In Iran

This study was conducted to assess the prevalence of Hepatitis C virus [HCV], Hepatitis B virus [HBV] and Human immunodeficiency virus [HIV] among hemophilia and thalassemia patients. Present study was conducted from October 2008 to December 2010 in Isfahan, Iran. One thousand one hundred and sixty adult multi-transfused patients [822 males, 338 females, mean age 22.7 +/- 11.5 years] suffering from beta-thalassemia [n = 545] and hemophilia [n=615] were enrolled in the study. Blood samples were obtained from the patients and were tested for HBs Ag, Anti-HCV Ag and Anti- HIV Ab. HCV positive patients underwent genotype determination. Of 545 thalassemia patients, 312[57.2%] were male and 233 [42.8%] were female. From 615 hemophilia patients, 511[83%] were male and 104 [17%] were female. Chronic hepatitis was detected in 505[82.1%] hemophilia patients of which 495 [98%] were HCV Ab positive and 10 [2%] had HBsAg positive. The prevalence of HCV Ab positive and HBsAg positive in 56 [11%] thalassemia patients with chronic hepatitis was 50 [89.2%] and 6 [10.8%] respectively. None of the thalassemia and hemophilia patients were positive for HIV Ab. History of hepatitis in family is the major risk factors and HCV genotype 1 was the major genotype in our patients. HCV is the major virus of concern in multi-transfused patients. The strategies for prevention of HCV, HBV and HIV and safety of blood products in this respect have indeed been successful

Comparison of impulse osillometry system and spirometry for diagnosis of obstructive lung disorders

Obstructive lung disease is a growing health problem, especially in developed countries. This study aimed to compare Impulse Osillometry System [IOS] and Spirometry for evaluation of Chronic Obstructive Pulmonary Disease and asthma. The study groups contained 87 healthy people, 87 asthmatic patients and 56 COPD patients. Spirometry [FVC, FEV1, FEV1/FVC] and IOS [R5, R20, X5] measurements were performed for all the healthy subjects and patients. The results of IOS were compared with spirometric results. Significant differences were detected among the 3 groups [control, COPD and asthma] in terms of all the spirometric parameters [FVC, FEV1, FEV1/FVC] and some parameters of IOS [R5,R20,X5] measurements [p<0.05]. Among COPD patients, sensitivity for X5 [the best value of IOS measurements in the COPD group] was 76%. Also, in asthmatic patients, sensitivity for R20 [the best value of IOS measurements in the asthma group] was 77%. We found a correlation between R5, R20 and X5 with FEV1 in asthmatic patients, but only R5 had this correlation with FEV1 in COPD patients. We concluded that IOS can be an alternative for spirometry in the diagnosis of obstructive lung disease in patients with minimal cooperation. R5 can represent COPD severity

Evaluation of the effect of donepezil on cerebral blood flow velocity in Alzheimer's disease

To evaluate the effect of Donepezil on cerebral blood flow velocity using non-invasive transcranial Doppler [TCD] sonography. This clinical trial was carried out in the Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran from March 2008 to July 2009, on Alzheimer's disease [AD] patients in 2 groups of case and control, each consisting of 11 patients. The case group who received Donepezil medication was examined by TCD before [baseline], after 4 weeks of oral treatment with 5mg per day Donepezil, and a further 4 weeks of 10mg per day Donepezil, orally. The control group comprised AD patients who did not receive any medications, and were examined by TCD only once. Peak systolic [PSV], end-diastolic [EDV], and mean flow [MFV] velocities of the posterior cerebral artery [PCA] and the middle cerebral artery [MCA] was assessed by TCD. Also, mini-mental state examination [MMSE] was carried out. There were no significant differences between the case and control groups, in terms of age and gender. In the case group, the mean MMSE score reached 20.2 +/- 2.8 from a baseline value of 15.8 +/- 3.3 after 4 weeks of oral treatment with 5mg/d Donepezil, and reached 20.6 +/- 3.9 after 4 more weeks at 10mg/d Donepezil. In the MCA, the difference in PSV and MFV values after 4 weeks of treatment with 10mg/d Donepezil was statistically significant compared with the baseline values. In PCA, the values of MFV and EDV after 4 weeks of treatment with 10mg/d Donepezil were statistically significant in comparison with the baseline value. Donepezil [10mg/d] increased cerebral blood flow velocity and MMSE score in our AD patients, but more extensive trials are recommended