Demographic, clinical features and treatment outcomes in 700 achalasia patients in Iran

Achalasia is the most recognized motor disorder of the esophagus. Because it is an uncommon disease, most studies have reviewed small numbers of patients. Here, we report demographic, clinical features and treatment outcomes in 700 achalasia patients. In all patients, diagnosis was established based on clinical, radiological, endoscopic and manometric criteria. A questionnaire was completed for each patient and included the patient's age, gender, initial symptoms, frequency of different symptoms, presence of positive family history for achalasia, other accompanying diseases and treatment outcomes. In our study men were affected more than women [54.3% vs. 45.7%]. Patients' mean age was about 38 years. The most frequent symptoms noted were: dysphagia to solids and liquids, active regurgitation, passive regurgitation and weight loss, respectively. Women complained of chest pain more than men [59% vs. 47.1%, p=0.04]. The vast majority of our patients were treated by pneumatic dilation [PD] of the LES and in long-term follow-up, 67% were in the responder group. Females responded better than males to PD. Dysphagia to solids is the most common symptom in patients with achalasia. Chest pain was significantly higher among women. PD is an effective treatment for achalasia with long-term efficacy in the majority of patients

[ survey of concerns and psychological disorders in elderly sanatorium]

This study aims at knowing old age problems especially for those living at elderly sanatorium and extending counseling services to the vast and new field of geriatrics in Iran. In this study, 120 old people who lived at governmental and private elderly sanatorium in Tehran, Iran were randomly enrolled and studied using SCL90-R. The results showed that signs of depression and somatization disorders were the most common ones among the elderly in elderly sanatorium. In all studied clinical scales, the rate of psychological symptoms was more among women than men. The most important worries of the elderly were economic status, social relations, dissatisfaction with old age, lack of favorite activities and their family members' treatment. Since living at an elderly sanatorium means staying away from family support and that it is considered reproachable, attending to psychological and emotional needs of the elderly sanatorium is essential

Comparison of high resolution ultrasonography and nerve conduction study in the diagnosis of carpal tunnel syndrome: diagnostic value of median nerve cross-sectional area

Carpal tunnel syndrome [CTS] is a common peripheral entrapment neuropathy. This study was performed to evaluate whether high-resolution ultrasonography may be an alternative diagnostic method for nerve conduction study [NCS] in the diagnosis of carpal tunnel syndrome. 132 wrists of 82 patients and 152 wrists of controls were enrolled in the study. The cross sectional area of the median nerve was measured at the carpal tunnel inlet and outlet in all patients and controls. All patients had a nerve conduction study. Then comparison between ultrasonography and NCS was performed. Combination of clinical diagnosis and NCS was used as the gold standard. The mean cross-sectional area [CSA] of the median nerve at the tunnel inlet was 11.4 +/- 1.7 mm[2] for the patient group and 5.78 +/- 0.9 mm[2] for the control group [P<0.001]. The mean cross-sectional area at the tunnel outlet was 9.9 +/- 1.2 mm[2] for the patient group and 4.7 +/- 0.7 mm[2] for the control group [P<0.001]. The best cut-off value of CSA at the tunnel inlet and the outlet was 7.5 mm[2]. In patients with clinical diagnosis of CTS we confirmed that the diagnostic value of ultrasonography is similar to NCS and sonography may be used in primary evaluation of CTS

[Knowledge translation: a model for research utilization]

The present study was aimed to design a knowledge transfer model that would provide a conceptual framework for linking the different components of a knowledge translation cycle. Such a theoretical model will enable us to organize and evaluate the current situation and design further studies on the transfer of research generated knowledge. This research, performed in 2006-7 in Tehran University of Medical Sciences, utilized two district methodologies: the first part was a narrative review with the goal of identifying the existing knowledge transfer models; the second part included focus group discussions to find out the views and opinions of researchers and decision-makers concerning the factors that promote or hinder knowledge translation within the health system. The two studies have provided the input for designing a "Knowledge Translation Cycle" with five domains: Knowledge Creation, Knowledge Transfer, Research Utilization, Question Transfer, and the context of University. Within each domain, the model includes two components [with the exception of the university context]. This model offers a theoretical basis for identifying the basic requirements and the linking mechanisms for the translation of knowledge

Effect of IV dexamethasone on incidence of nausea and vomiting and beginning of oral intake in adenotonsillectomy

Tonsillectomy and adenotonsillectomy are two of the most common surgical procedures performed in children. Although new surgical technique has reduced immediate postoperative hemorrhage, other complications such as postoperative nausea and vomiting [PONV], pain, poor oral intake, dehydration and fever, however, continues to be a concern in children undergoing tonsillectomy. The purpose of the present study was to determine whether one single, large dose of IV dexamethasone administered before surgery could decrease PONV and improve oral intake after surgery, This study was performed on 50 children, 2-12 yr of age undergoing adenotonsillectomy. To specifically delineate the contribution of dexamethasone, all anesthetic and nonanesthetic factors that could influence the incidence of PONV were standardized. Each child received dexamethasone 1 mg/kg [maximal dose 25 mg] [steroid group] or an equal volume of saline [control group] before initiation of surgery. Twenty seven children were in steroid group and 23 children were in control group. There were no significant differences between two groups with respect to age, weight and sex but the incidence of PONV was lower in steroid group in both in the recovery [0.00 vs. 0.30 +/- 0.5 in control group] [p= 0.007] and in the ward [0.22 +/- 0.6 vs. 0.82 +/- 0.9 in control group] [p= 0.010]. Oral intake begins after 1.64 +/- 0.74 hr vs. 1.96 +/- 1.1 in control group. Compared with placebo, dexamethasone significantly decreased the incidence of PONV in the immediate and late post operative period [6 hr and 6-24 hr respectively] but it didn't influence oral intake

[A Study on noise- induced hearing loss in Agriculture and industry factory - Iran]

Noise-induced hearing loss is a prevalent work-related morbidity in the country. We determined the strength of association between hearing loss and occupational noise exposure as the first step in prevention programs. A historical cohort study involving 100 exposed and 31 non-exposed subjects was conducted. Noise exposure was estimated using sound level meter BSEN 60651, Type 2. Past noise exposure was estimated using the existing data on the place and type of work. Audiometry was used to assess hearing loss in each subject in 3- year intervals on an occupational cohort from 1993-2004. Noise-induced hearing loss was found in 49% [49 subjects] of the exposed group and 9.7% [3 subjects] of non-exposed group [p<.0001]. Nobody used any form of hearing protection routinely in either group. Relative risk for noise-induced hearing loss was 5.1[CI95%: 1.7- 15.1].Time at risk was estimated 24.9 years [22.7-27.1] in exposed and 22.2 years [20.7-23.7] in unexposed group by survival analysis. More legislation, hearing conservation programs, and surveillance and biological monitoring of work sites and workers are required to prevent occupational hearing loss. Planning strategies for noise assessment and control can help improve the work environment. Gross occupational exposure to noise has been demonstrated to cause hearing loss and the authors believe that occupational hearing loss in the country is a widespread problem

[High exposure to polycyclic aromatic hydrocarbons may contribute to high risk of esophageal cancer in northeastern Iran]

The northeastern region of Iran has some of the highest rates of esophageal squamous cell carcinoma [ESCC] in the world. To investigate the role of polycyclic aromatic hydrocarbons [PAHs] in the etiology of ESCC in northeastern Iran, we measured urine 1-hydroxypyrene glucuronide [1-OHPG], a stable PAH metabolite, in 99 inhabitants of this area. Results: The median urine 1-OHPG in participants of this study was 4.2 pmol/ml. Forty-two subjects [42%] had levels ranging from 1 to 5 pmol/ml, indicative of moderate PAH exposure, and 41 [41%] had levels above 5 pmol/ml, indicative of very high exposure. Further analysis showed that 1-OHPG levels were high in all subgroups of our study subjects, including both sexes; rural and urban dwellers; and smokers and non-smokers. Only 15% of the variance in 1-OHPG was explained by age, sex, residence, smoking, nass, or opium consumption. This pattern of PAH exposure parallels with the ESCC incidence pattern seen in this area. We conclude that people in northeastern Iran are exposed to widespread and very high levels of PAH, largely from unknown sources, and this may contribute to the high rates of ESCC observed in this area