[ survey of unmet health needs and the related barriers to access them]

Introduction: Unmet needs are defined as the difference between services judged necessary to deal appropriately with health problems and services actually received. Unmet needs are considered as simple tools in monitoring the accessibility and the extent of inequity in access and use of health care

Methods: This is a cross-section health survey. The sample consists of 792 households living in Tehran. Data were collected by the WHO [households] questionnaire in 2012, and were analyzed using Logistic Model and STATA12 software

Results: The outcomes show that economical problems, lack of time, self-treatment, long distance to reach health facilities, deprivation of insurance coverage, and lack of adequate information about the locations of health care centres are all factors affecting patients' willingness to refer to these centres. The socio-economic factors which can enhance the probability of fulfilment of health care needs were found to be settlement ownership and poverty reduction

Conclusion: Unmet needs can cause detrimental effects, such as worsening health situation and quality of life, increasing the risk of mortality and causing mental and psychosomatic disorders; therefore, policy makers should give high priority to eliminating socio-economic barriers, as lack of insurance coverage, as well as reducing the costs and economic inequalities, and payment systems reform

Prevalence of zinc deficiency in 3-18 years old children in Shiraz-Iran

Zinc is an essential trace element with a prominent role in human nutrition. Zinc deficiency has been linked to growth retardation, hypogonadism in males, and lack of sexual development in females. It ranges from 50% in sub-Saharan Africa to 5% in high income countries. The aim of this study is to evaluate the prevalence of zinc deficiency in healthy children in Shiraz, Southern Iran. In this study, 902 children aged 3-18 years old were randomly sampled for serum zinc level. Age, sex, weight, height, BMI, stunting and wasting indices were also recorded. With atomic absorption spectrophotometry method, the serum level of zinc less than 70 micro g/dL was considered as deficient. Mean serum level of zinc was 122.3 +/- 55 micro g/dL. The prevalence of zinc deficiency was 7.9%. There was no relationship among serum zinc level and age, sex, height, weight or BMI, but mild wasting [weight for age] and mild stunting [height for age] were significantly more prevalent among zinc deficient children compared to children with normal or high level of zinc. Zinc deficiency in Shiraz is not as prevalent as other areas of Iran. It was significantly more frequent among stunted and wasted [malnourished] children. Difference in soil zinc level, recent wide prescription of zinc supplements by pediatricians and especial pattern of nutrition, considered as possible factors responsible for lower prevalence of zinc deficiency in Shiraz, deserve more investigations

[Study of LDL receptor gene mutations in patients with familial hypercholesterolemia in Chaharmahal va Bakhtiari province]

Familial hypercholesterolemia is an autosomal dominant inherited disorder, characterized by increased level of low-density lipoprotein cholesterol and lipid accumulation in tendons and arteries. It can cause premature atherosclerosis and increased risk of coronary heart disease [CHD]. Familial hypercholesterolemia is caused mainly by mutations in low-density lipoprotein receptor [LDLR] gene. The aim of this study was to analyze the LDLR gene mutations in a group of patients from Chaharmahal va Bakhtiari province. In this descriptive-lab based study, 57 suspected FH patients were screened for mutations in promoter and exons 1,3,5,11,13,15,16,17 and 18 of LDLR gene using PCR-SSCP strategy. Two different LDLR gene variations, including heterozygote mutation 283T>A and polymorphism 1959T>C, were identified in 1 and 9 FH Families studied, respectively. We conclude that LDLR gene mutation may not be the major cause of FH in the population studied and the cause of FH in Chaharmahal va Bakhtiari province remains to be detected in other loci or genes

[DFNB59 gene mutations screening in non syndromic deaf subjects in Chaharmahal va Bakhtiari province]

The incidence of pre-lingual deafness is about 1 in 1000 neonates from which more than 60% of cases are inherited. Deafness is a heterogeneous disorder and may be due to genetic or environmental cause or both. Mutations in the DFNB59 gene encoding pejvakin protein has been very recently shown to cause neural deafness. In the present study, we have conducted type and frequency of the DFNB59 gene mutations in a cohort of 100 non syndromic deaf subjects in Chaharmahal va Bakhtiari province. In this descriptive-lab based study we investigated the frequency of DFNB59 gene mutations in the entire coding exons of the gene. DNA was extracted from the peripheral blood samples following the standard phenol chloroform procedure. DFNB59 gene mutations were investigated using PCR-SSCP/ Heteroduplex Analysis [HA]. The results of PCRSSCP/HA were confirmed by sequencing of exon 7, nested PCR and PCR-RFLP of 3 known DFNB59 mutations. Altogether 3 different gene polymorphisms [793C>G, 793C>T and 874G>A] and one mutation [988delG] were detected in 7, 5, 2 and 1 subjects respectively. Based on our data from the present study and previous study, we conclude that DFNB59 gene mutations have a very low contribution to deafness in patients in Chaharmahal va Bakhtiari province and are not of great clinical importance in this region

Assessment of breast cancer risk factors in asymptomatic hospital staff women aged 32-59: a descriptive report

Iranian breast cancer patients are relatively younger than their Western counterparts. The objective of the present study was to investigate risk factors for breast cancer in Iranian women and compare it with other data driven from other studies. A study was conducted in April 2008 in Tehran, Iran. Demographical data and risk factor related information, including data from their mammograms were collected using a questionnaire. In all, 109 participants were interviewed. The mean age of participants was 40.48 +/- 0.56 years. 1.8% of women were unmarried, while 78% were married and 20.2% were divorced/widowed. The mean age for menarche was 13.34 +/- 1.47 years and 46.89 +/- 4.98 for the menopause, respectively. The mean parity time was 2.36 +/- 1.13 and breastfeeding in women was 23.27 +/- 14.16 months. About 5.5% of the participants used oral contraceptive as a method for contraception. 8.3% of women experienced menopause, at the mean age of 46.89 +/- 4.98. 33.3% of menopaused women, used Hormone Replace Therapy [HRT]. Moreover, 8.3% of women had a positive history of breast cancer in their family. Of those women on whom mammography was done, 10.1% had breast mass in radiological findings, mostly in favour of fibrocystic change. In 20.2% of participants, further investigation was advised. The findings of the present study were in accordance with other studies done in Iran and in some aspects in tune with other studies about breast cancer in other countries. However, more multicentric larger scale studies should be conducted in Iran to determine a pattern for breast cancer in Iranian women

17 years old girls with Kikuchi-Fujimoto disease [KFD] and severe leukopenia

Kikuchi-Fujimoto disease [KFD] is an enigmatic, benign and self-limited syndrome characterized by regional lymphadenopathy with tenderness, usually accompanied by mild fever and night sweats. A 17 years old girl admitted in infectious diseases ward with chief complaint of fever and cervical lymphadenopathy since one week ago. Her problems started with fever and pharyngitis. Three days later, she developed one cervical lymphadenopathy. Blood sample revealed a WBC count of 1700 cells/mm[3], platelets count of 137000/mm[3]. IgG-anti EBV antibody [VCA] level was 98.7 [upper limit of normal 20] and IgM-anti EBV antibody level was 52.7 [upper limit of normal 40]. In hospital course her leucopenia became worse and reached 700cells/mm[3]. After two weeks WBC count recovered, and reached 5100 cells/mm[3]. Lymph node biopsy was achieved and showed necrotizing lymphadenitis with histiocytic reaction consistent with Kikuchi disease. Kikuchi-Fujimoto disease must be considered in differential diagnosis of patients with acute severe neutropenia

[Baclofen and clonidine in opioid detoxification]

Objectives: This study was conducted to evaluate the efficacy and side effects of baclofen and clonidine treatments in opioid detoxification

Method: 66 subjects from an outpatient setting diagnosed with opium dependency [based on DSM-IV] took part in a double blind study. Randomly 32 and 34 subjects were assigned to take respectively baclofen and clonidine for 14 days

Findings: Both drugs showed similar efficacy in regards to physical and mental symptoms of withdrawal syndrome. No significant difference was noted between the two groups on depression and anxiety scales. The side effect profiles of the two groups were more or less the same except for "vomiting" and "euphoria" which were more significantly evident in the baclofen group

Results: Baclofen can be invariably considered as an equivalent of clonidine, in opium detoxification