Classification of health structural indicators using scalogram model in golestan province, Northern Iran

One of the main and basic pillars of health system promotion is the equitable distribution of health facilities in order to ensure fair access of people in the community to the health services. The goal of this study was to classify the health structural indicators in Golestan Province using Scalogram analysis model. A descriptive study was conducted in 2010. Data related to indicators in 3 categories of institutional, human resources and rural health and their indicators were collected using statistical yearbook. Data analysis was done using SPSS software and scalogram analysis model. There is large gap between health structural indicators in cities of Golestan Province. Aq Qala City with 97 score and Azad Shahr City with 41 score were the most and lowest scores respectively from enjoyment of health structural indicators. Generally, 18% of cities were in less developed level and only 27% of cities were developed level. To achieve a fair and balanced healthcare status in different provinces based on their state of development, plans should be arranged in order to reduce the gap in the access to healthcare facilities

Common challenges in laboratory diagnosis and management of tuberculosis

The history of tuberculosis [TB] traces back to antiquity. Despite significant progress of various diagnostic methods and introduction of anti-tuberculosis drugs in past decades, TB is still a major worldwide health concern which leads annually to two million deaths, especially after the emergence of multidrug-resistant Mycobacterium TB and HIV co-infection. Presented here is a brief review of conventional and new TB diagnostic laboratory methods including their advantages and disadvantages as well as common challenges in diagnosis and management of TB

[Evaluating the rate and way of delivering radiotherapy services as one of cancer treatment methods in middle income and low income countries]

Radiotherapy plays a prominent role in cancer treatment. Researches indicate that radiotherapy has been used for curing most of registered malignant cancers. It has been the best choice and sedation for treatment and control of local cancers with the least side effects. Therefore, safe and effective provision of radiotherapy services is crucial and complex. This study aims to show radiotherapy role in controlling cancer in middle and low income countries. This is a descriptive and comparative study with a cross-sectional time frame. The data are searched and abstracted from related databases of East European, Latin America, Asian and African countries. They have been compared for achieving required results. Some of low and middle income countries have only a limited access to radiotherapy services, along with no access for 22 countries from Africa and Asia. Studies conducted in 72 low and middle income countries showed that there are no radiotherapy services within 24 countries among them with more than one million populations. Africa has the least average of radiotherapy facilities megavoltage per million populations compared to East Europe with the most one. The results also demonstrate that the countries with more population and low income are able to buy and provide radiotherapy, whereas those with less population are hardly amenable to invest in this service. Radiotherapy is a necessary part for an interdisciplinary treatment of cancer, which can be delivered safely and cost-effectively in low and middle income countries. Around half of cancer patients are subject to at least one course of radiotherapy during their treatment. This procedure will be the most useful cure if it is accompanied by other operations such as surgery and chemotherapy

Occupational exposure to blood and body fluids

Occupational exposure to blood and body fluids is an important hazard for health care workers, which places them at a high risk for blood-borne infections including hepatitis B virus, hepatitis C virus and human immunodeficiency virus and results in psychological and emotional stresses. Several preventive measures have been proposed including pre-exposure [e.g., education, use of standard precautions, use of needle protective devices, and vaccination] and post-exposure [e.g., post-exposure prophylaxis and early detection of disease] prevention. In this article, the Importance of occupational exposure to blood and body fluids and the basic concepts of exposure prevention and management are reviewed

[Effect of oral vanadyl sulphate on ultrastructure of pancreatic islets beta cells in streptozotocin-induced diabetic rats]

Considering insulin like effects of vanadium salts, these compounds have been evaluated as a therapeutic agent for treatment of diabetes mellitus in the experimental models of the disease in animals. This study was performed to study the ultrastructrure of islet beta cells in streptozotocin [STZ]- induced diabetes in rats after treatment with vanadyl sulfate [VS]. diabetes was induced in male Wistar rats by intravenous injection of 40 mg/kg STZ. Equal volume of normal saline was injected via lateral tail vein in sham animals. Seven days after injection animals in both groups were divided into treated and control groups. VS was added to the drinking water of the diabetic treated [DT] and Sham treated [NT] animals with a concentration of 0.5 mg/ml for one week and 1mg/ml up to three months. Untreated diabetic [DC] and sham rats [NC] received tap water during this period. Two months later all animals were killed. Langerhans islets were isolated from exocrine parts by use of collagen digestion, and were fixed in glutaraldehyde. Ultrastructure of islet beta cells were studied by means of transmission electron microscope. VS treatment led to amelioration of the symptoms of diabetes including hyperglycemia and polydepsia in DT rats. DC rats remained diabetic during the period of study. No significant changes were observed in plasma glucose and fluid intake of NT animals. Ultrastructural studies of islet beta cells of DT rats showed normal cells with normal chromatin distribution, well-developed rough endoplasmic reticulum, increased cytoplasmic granules and no clear sign of cell injury. Lymphocytic infiltration was not detected in langerhans islets of DT group. Nuclear pyknosis, cytoplasmic vacuolization, lymphocytic infiltration and signs of cell death such as cell necrosis were found in the islets of beta cells of DC rats. Cytoplasm of islets beta cells of NT rats were more granular in comparison to NC rats. Considering the results of this study we concluded that amelioration of diabetes signs in VS treated STZ induced diabetic rats are accompanied by preservation of islets beta cells ultrastructure

[Genetic predisposing of P53 codon 72 on developing of breast cancer in postmenopausal women in Isfahan]

Introduction: Breast cancer is one of the most common cancers among women in worldwide. 53P the suppression gene tumor has a principal role in genomic stability and its function is variated by the codon 72 polymorphism

Objective: Investigate the codon 72 polymorphism of P53 and the effect of menopause on the development of invasive breast ductal carcinoma

Materials and Methods: A case-control study was conducted on 96 patients with invasive breast ductal carcinoma and their 96 matched controls in Isfahan. The different genotypes of the codon 72 of P53 gene were identified by using allele-specific polymerase-chain reaction. Breast cancer patients were divided into two groups: postmenopausal and premenopausal. Statistical analysis was performed by using chi[2]-test

Results: In control group, the distribution of Arg/Arg, Arg/Pro and Pro/Pro genotypes were 36.5%, 45.8% and 17.7% respectively. The distributions of Arg/Arg, Arg/Pro and Pro/Pro in case group were 70.8%, 21.9% and 7.3% respectively. There is significant statistical difference in the distribution of P53 codon 72 polymorphism between case and control groups [P<0.001]. In addition, 76% of patients with Arg/Arg genotype were in post-menopause age group [P=0.05]

Conclusion: The findings of this study indicated that the polymorphism of codon 72 P53 is a genetic predisposing factor for the development of invasive breast ductal carcinoma in the studied sample in Isfahan and most of the patients were in postmenopausal age group

[ rare case report of musculocutaneous nerve]

Knowing the variations of the brachial plexus is of high importance during the surgery of axilla for surgeons. A rare case was observed in the left upper limb of a 55- year old female's cadaver, during the routine dissection in Gilan Medical University. In this case the musculocutaneous nerve that normally arises from the lateral cord of brachial plexus, originated from median nerve, without perforating coracobrachialis muscle, and was located between biceps brachii and brachialis muscles and innervated them. Then, it pierces the deep fascia just below the elbow and extends as lateral cutaneous nerve of forearm. The nerve of coracobrachialis muscle is a branch directly isolated from lateral cord and enters into the muscle

[Death of teaching autopsy [review article]]

At the middle of the 20th century, autopsy has a fundamental role in medical education in Iran, guided by the influential Oslerian philosophy 'as is your pathology so is your medical practice'. Students not only attended autopsies, but also had learnt to conduct them. In contrast, today the use of autopsy in medical education is falling down to death. Although this falling is worldwide, but the situation in Iran is much worse. Rarely Iranian medical schools deal with educational autopsy and some of them are quite unfamiliar with autopsy. There are several reasons for this declining including sophisticated medical education with autopsy, community attitudes,clinicians' and pathologist' reluctance, hospital concern about legal action, religious attitudes, consent from the family and funding priorities. Even with new diagnostic modalities, autopsy remains an important tool for quality and safety assurance. A systematic review of reports on autopsies from USA, European and Australian hospitals, revealed 9 to 40% [on average 23.5%] of clinically missed diagnoses and managements involving the principal or underlying cause of death.The key roles of hospital autopsies are Improving safety and quality in diagnosis and treatment, Providing benefits to families, Advancing understand-ing of disease, Allowing good programming for emerging disease and frequently seen disease, and Educating medical and allied health professionals.We have concluded that, reversing the decline of autopsies will require cooperative action at several levels of the healthcare system, particularly including clinicians and pathologists and also governmental and financial bodies and legal authorities

[A survey of detecting Chlamydia pneumoniae DNA with the aid of PCR in human coronary arteries and ascending aorta at postmortem and in alive patients]

Atherosclerosis is an important agent of mortality and morbidily among humans. Knowledge of the causative and precipitating factors of atherosclerosis is therefore highly important. Among the factors, infections have been cited among which Chlamydia pneumoniae. Accordingly we performed a systemic dissection of the 3 coronary arteries and ascending aorta in 49 postmortem subjects who underwent operation and 5 atherosclerotic plaques in alive subjects and studied the relationship in individual persons between the presence of Chlamydia pneumoniae DNA and the number of major risk factors. Other major risk factors comprising age, sex, blood pressure, diabetes mellitus, smoking, hypercholestrolemia and history of deaths due to heart ailment in families were also studied. From each vessels, two sections were obtained, one determining pathological grading of atherosclerosis [study classification], and other determining the prevalence of Chlamydia pneumonia DNA by polymerase chain Reaction [PCR] method. PCR was performed in Pasteur Institute. C.Pneumoniae was detected by PCR in 14 [25.9%] out of 54 subjects. 19 segments of vessels were positive for C. Pneumoniae out of which 16 segments [84.2%] had atherosclerosis and an equal or more than 3 in pathologic gradings. In the C. Pneumoniae positive patients, in comparison of the two groups comprising of patients with one or more risk factors, no statistically significant difference was seen [P>0.05]. This study opens up the path for management strategies in eradicating C. Pneumoniae, and decreasing morbidity, mortality secondary to atherosclerosis

Comparing transesophageal echocardiography and transthoracic echocardiography for diagnosis of infectious endocarditis

Infectious endocarditis [IE] is caused by a variety of microbial agents and poses severe complications such as embolic and septic events. This condition is aggravated among elderly patients and is associated with a high morbidity rate. Recent advances in diagnostic modalities, especially transesophageal echocardiography [TEE] have revolutionalized early diagnosis, prediction of emboli, treatment and evaluating the outcomes of interventions. In this article, we explain our experience with 4 cases of infectious endocarditis. Having had the clinical suspicions to IE, patient underwent routine diagnostic procedures including transthoracic echocadiography [TTE] and blood culture. Surprisingly, TTE was negative for all patients; however, the clinical symptoms and the presence of complications were favoring IE, therefore, all were subjected for TEE. TEE confirmed the diagnosis of IE in all 4 cases. There were mitral valve vegetations measured 0.5-3cm in three cases, whereas the other one presented with aortic valve vegetation measured 1cm. Three patients had blood culture positive for staphylococcus aureus and one patient with aortic valve vegetations had enterococcus positive blood culture. All patients had developed various complications and one had splinter hemorrhage. Two patients underwent surgical valvuloplasty, however, one of them was re-operated for splenectomy due to splenic abscess. All patients received an appropriate antibiotic regimen including vancomycine and cefteriaxon and were discharged in satisfactory state. Patients were routinely admitted for follow up TEE, while none developed symptoms or complications compatible with IE. Our results revealed that TEE is significantly superior to TTE for diagnosis and follow up of IE

Histological and immunohistochemical study of pancreatic islet beta cells of diabetic rats treated with oral vanadyl sulphate

Vanadium salts have been suggested as a possible therapeutic agent for the treatment of diabetes. The aim of the present study was to clarify histological and immunohistochemical changes that occur in the pancreatic [beta] cells of vanadyl sulphate [VS]-treated streptozotocin [STZ] induced diabetic rats. Male Wistar rats were made diabetic by injecting a single intravenous dose of STZ [40 mg/kg] and were divided into two groups seven days after STZ injection. In the first group VS was administered via drinking water at a concentration of 1 mg/mL and treatment was maintained until normoglycemia appeared [DT]. A second group of diabetic animals received distilled water for the same period and were considered as control diabetic [DC]. One group of animals [NC] was injected intravenously with the same amount of vehicle as the diabetic rats and was considered as non-diabetic control. VS treatment was accompanied by amelioration of the signs of diabetes in DT rats while DC animals remained diabetic during this period. Hemotoxylin - Eosin stained pancreatic sections of DC rats showed a decrease in the number and size of islets and a disruption in their architecture. In DT rats the histological appearance of the islets was normal, their shape and size being within normal limits. In horseradish peroxidase procedure [using guinea pig antiserum to insulin as primary antibody] performed on pancreatic islet paraffin sections of rats, insulin immunoreactivity was found in the majority of the islets in DT rats while in the islets of DC rats immunoreactivity was rare. The results of this study indicated that amelioration of diabetes in vanadyl sulphate treated diabetic rats was accompanied with well preservation of islet structure and insulin immunoreactivity

Histology of pulmonary lesions in victims of chemical warfare

Twenty six patients with chemical warfare exposure have been investigated for possible morphologic changes of the lung. A wide variety of pulmonary changes were seen including both obstructive type lung lesions and interstitial pneumonitis. The most common hazard was ARDS, which resulted in acute respiratory failure in some cases and chronic interstitial fibrosis and respiratory failure in others. Finally, the most dangerous hazard is the risk of lung cancer

Late complications of sulfur mustard in respiratory system

In the last few years many chemically injured patients have been visited throughout the country in order to investigate the late respiratory complications of sulfur mustard. 35 patients who were previously admitted for mustard poisoning underwent complete clinical examination as well as spirometry, fiberoptic bronchoscopy [FOB], Bronchoalveolar lavage [BAL], and transbronchial lung biopsy [TBLB]. The results of this study reveal a high incidence of air flow obstruction in these patients [50%]. BAL shows decreased numbers of macrophages and increased numbers of lymphocytes and neutrophils, and the presence of eosinophils [between 1 to 5%]. Certain pathologic features have been encountered. We conclude that late respiratory complications of sulfur mustard are major causes of morbidity and are quite resistant to therapy