[Study the development level of provinces in Iran: a focus on health indicators]

Introduction: access to health care is one of the main goals in all societies. This study aimed to investigate the access level in provinces in Iran

Methods: this descriptive-applied and cross-sectional study was conducted in 2012. Statistical population consisted of all provinces in Iran. Data were collected through library and online research. The Ministry of Health and Medical Education and Statistics Center of Iran as authorities of Information, were referred to for collecting relevant data. Taxonomy techniques were used to assess the of development level of provinces, Shannon entropy techniques were used to determine the weights of indicators and TOPSIS techniques were employed to rank states in terms of access to health care

Results: based on Taxonomy technique from among 31 provinces, 12 provinces were considered to be developed, 9 semi-developed and 10 underdeveloped. Based on Shannon entropy, the ratio of the number of pharmacists to province population was the most important indicator. According to TOPSIS, in term of access to health services; Markazi and Ardabil provinces ranked the first and the last respectively

Conclusion: due to the large differences among provinces, planners and officials are recommended to allocate the funds according to the development level

[Antibiotic susceptibility and multi-drug resistance of escherichia coli isolates producing CTX-M and TEM type beta-lactamases in Mashhad, Iran, in 2010]

One of the most common causes of bacterial resistance to beta-lactam antibiotics is beta-lactamase producing. The aim of this study was to compare the antibiotic resistance of urinary Escherichia coli [E. coli] isolates producing CTX-M and TEM type beta-lactamases, and to determine the strains with co-resistance to multiple antibiotics in Mashhad, Iran. E. coli bacteria were isolated from urine samples of hospitalized patients referred to two selected hospitals in Mashhad, Iran, in 2010. The bacteria were identified by differential biochemical tests and confirmed using Microgene Kit tests. The antibiotic assay was performed by disk diffusion method. Double disk approximation and phenotypic confirmatory test were carried out for screening ESBLs. Plasmids of ESBL-producers were extracted. TEM and CTX-M type beta-lactamase-producing bacteria were identified using the polymerase chain reaction [PCR]. The percentage of bacteria with bla[CTX-M] gene was more than bla[TEM] [97.2% vs. 58.3%]. Of the 36 bacteria producing ESBL, 20 isolates had both genes. Resistance to cefotaxime was more than ceftazidime among the isolates. A greater percentage of isolates with bla[CTX-M] gene were resistant or intermediate to non-lactam antibiotics; nalidixic acid, ciprofloxacin, nitrofurantoin, and gentamicin [P<0.05] in comparison with the isolates encode bla[TEM,CTX] genes. 16 of 36 ESBL-producers [44.4%] were co-resistant to ciprofloxacin, nalidixic acid and co-trimoxazole [nine isolates encode bla[CTX-M] and eight encode both genes, bla[TEM,CTX]]. The results indicated that the prevalence of bla[CTX-M] gene was higher than bla[TEM] in the studied population and the bacteria encoding bla[CTX-M] gene had a great resistance to gentamicin and likely the gene of resistance to gentamicin could be transmitted with bla[CTX-M] gene

[Comparing the effects of IV and intranasal midazolam administration on pain, anxiety and fear of children undergoing painful invasive procedures]

Among children, there are several painful diagnostic or therapeutic procedures especially in malignant disease which may evoke fear and anxiety that may interfere with the treatment. Due to various reports on the efficacy of midazolam, we compared the effects of intranasal versus intravenous midazolam in reducing the pain, fear, and anxiety in children undergoing painful procedures at Loghman hospital between 2005-2006. This randomized clinical trial was conducted on two 30-participant groups of patients aged 4-15 years who were to underwent painful procedures [including bone marrow aspirations and lumbar punctures]. One group received intravenous Midazolam and the other one did intranasal Midazolam before the procedures. Pain was measured based on Bieri facial pain scale, whereas anxiety was determined based on Yale-Pas scale. Fear was measured and analyzed between the two groups by Chi-square and fisher's exact tests. Side affects were documented in both groups as well. 50% of patients in the IV group, and 53.3% in the intranasal group had the Yale-PAS anxiety score of above 37, which was yielding a significant difference [P<0.9]. 90% of the subjects in the intranasal group had mild pain while 10% had moderate one. In the IV group 74% experienced a mild pain and 25.9% suffered from moderate pain, whereas 10% experienced none at all. No significant difference was observed between the levels of pain amongst two groups [P<0.9]. In both groups fear bacame less during and after the procedure and it was significantly decreased in intranasal group. Since the effect of intranasal and IV Midazolam on reducing the pain, anxiety, and fear is not significantly different, regarding the simplicity of intranasal administration, this approach may be of further compliance and more practicality for analgesia of painful procedures

[In vitro anti-Helicobacter pylori activity of cumin [Cuminum cyminum L.] and tarragon [Artemisia dracunculus L.] extracts]

Helicobacter pylori [HP] infection is the most common gastrointestinal bacterial disease worldwide. It is known that HP could be eradicated by a combination of therapeutic agents, but sometimes the cure thus achieved is incomplete and undesirable side effects are certain to occur. On the other hand, the anti- Helicobacter pylori effect of traditional herbal medicines has not been extensively studied. Cumin and tarragon are plants that are native to Iran and it has been reported that they are beneficial in gastric problems. In this study their activity against HP was examined. Percolated methanol and aqueous extracts of plant leaves were tested against 45 clinical isolates of HP. Growth inhibition was determined by the filter paper disc diffusion method on modified egg yolk emulsion agar [EYE agar] compared with amoxicillin and metronidazole. The effect of both methanol extracts of cumin and tarragon were significantly better than their aqueous extracts [p<0.001]. Methanol extract of tarragon and aqueous extract of cumin exhibited the most and least anti-HP activity, respectively. The minimum inhibitory concentration [MIC] of methanol extract s of cumin and tarragon were 691 micro g/ml. Both of two methanol extracts preserved their anti-HP activity after autoclaving for 20 min. Preliminary phytochemical screening of the cumin methanol extract indicated the presence of saponins and in the tarragon methanol extract indicated presence of saponins and tannins. Screening among natural resources and plants, which are used in folk medicine for gastric problems could be beneficial. This study demonstrated that tarragon and cumin inhibited the growth of H. pylori strains in vitro